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Testicular cancer

Key sources
The following summarized guidelines for the evaluation and management of testicular cancer are prepared by our editorial team based on guidelines from the American Urological Association (AUA 2023), the European Association of Urology (EAU 2023), the European Association of Urology (EAU/ESPU 2023; 2021), the European Reference Network on Rare Adult Solid Cancers (EURACAN/ESMO 2022), the U.S. Preventive Services Task Force (USPSTF 2011), and the American Society of Clinical Oncology (ASCO 2010).
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Guidelines

1.Screening and diagnosis

Indications for screening: as per USPSTF 2011 guidelines, do not screen for testicular cancer in asymptomatic adolescent or adult males.
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  • Self-examination

  • Diagnosis

2.Classification and risk stratification

Staging: use the TNM staging system to guide management decisions.
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  • Risk stratification

3.Diagnostic investigations

Physical examination: perform a physical examination of supraclavicular, cervical, axillary, and inguinal lymph nodes, breast, and testicles.
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  • Diagnostic imaging

  • Imaging for staging

  • Serum tumor markers

  • Evaluation of the contralateral testis

4.Medical management

General principles: manage a solid mass in the testis identified by physical examination or imaging as a malignant neoplasm until proven otherwise.
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  • Management of neoplasia in situ

  • Management of locoregional disease (seminoma)

  • Management of locoregional disease (nonseminoma)

  • Management of advanced/metastatic disease (seminoma)

  • Management of advanced/metastatic disease (nonseminoma)

  • Salvage treatment

  • Thromboprophylaxis

  • Fertility preservation

5.Surgical interventions

Radical orchiectomy: as per AUA 2023 guidelines, perform radical inguinal orchiectomy in patients with a testicular lesion suspicious for malignant neoplasm and normal contralateral testis. Avoid performing trans-scrotal orchiectomy.
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  • Testis-sparing surgery

6.Specific circumstances

Prepubertal patients: as per EAU 2023 guidelines, recognize that testicular tumors in prepubertal patients have a lower incidence and a different histologic distribution compared to adolescent and adult patients.
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7.Follow-up and surveillance

Follow-up: as per AUA 2023 guidelines, elicit history, perform a physical examination, and obtain cross-sectional imaging of the abdomen (with or without the pelvis) every 4-6 months for the first 2 years and then every 6-12 months in subsequent 3-5 years in patients with clinical stage I seminoma electing surveillance. Consider obtaining routine surveillance imaging of the chest and serum tumor markers assessment as clinically indicated.
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  • Management of relapse