What are the diagnostic and treatment options for testicular cancer?

From the Guidelines

Testicular cancer should be diagnosed and treated according to the most recent guidelines, which emphasize the importance of physical examination, ultrasound imaging, and blood tests for tumor markers, followed by surgical removal of the affected testicle and adjuvant therapy as needed, with a focus on minimizing morbidity, mortality, and optimizing quality of life. The diagnostic approach for testicular cancer typically involves a combination of physical examination, ultrasound imaging, and blood tests for tumor markers such as alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase 1. The treatment of testicular cancer depends on the type and stage of the cancer, with seminomas and non-seminomas requiring different approaches 1. For stage I seminomas, surgery alone or surgery followed by single-dose carboplatin or radiation therapy to the retroperitoneal lymph nodes may be recommended 1. For stage I non-seminomas, options include surveillance, retroperitoneal lymph node dissection, or adjuvant chemotherapy with BEP (bleomycin, etoposide, cisplatin) for 1-2 cycles 1. Advanced disease typically requires 3-4 cycles of BEP chemotherapy, with bleomycin 30 units IV weekly, etoposide 100 mg/m² IV days 1-5, and cisplatin 20 mg/m² IV days 1-5, repeated every 21 days 1. Regular follow-up with physical exams, tumor marker tests, and imaging studies is essential for at least 5 years after treatment, as testicular cancer has excellent cure rates exceeding 95% when properly treated, even in advanced stages, due to its high sensitivity to platinum-based chemotherapy 1. Key considerations in the management of testicular cancer include the potential for hypogonadism and infertility, and the importance of sperm banking prior to treatment, particularly in patients with a history of subfertility or those undergoing orchiectomy 1. The 2023 European Association of Urology guidelines on testicular cancer provide a comprehensive framework for the diagnosis, treatment, and follow-up of testicular cancer, emphasizing the importance of a multidisciplinary approach and the need for ongoing surveillance and monitoring to optimize outcomes 1. Overall, the goal of treatment for testicular cancer is to minimize morbidity, mortality, and optimize quality of life, while also achieving excellent cure rates through the use of evidence-based guidelines and a multidisciplinary approach to care.

From the FDA Drug Label

The usual cisplatin dose for the treatment of testicular cancer in combination with other approved chemotherapeutic agents is 20 mg/m 2IV daily for 5 days per cycle.

The diagnostic and treatment options for testicular cancer include chemotherapy with cisplatin, which is administered at a dose of 20 mg/m2IV daily for 5 days per cycle in combination with other approved chemotherapeutic agents.

• Key considerations for treatment include:
  • Dose and administration: Cisplatin should be administered by slow intravenous infusion, and the dose should not be given by rapid intravenous injection.
  • Combination therapy: Cisplatin is often used in combination with other chemotherapeutic agents.
  • Patient monitoring: Patients should be carefully monitored for possible anaphylactic-like reactions and supportive equipment and medication should be available to treat such a complication.
  • Renal function: The dose of cisplatin should be adjusted based on renal function, and patients with impaired renal function may require a reduced dose. 2

From the Research

Diagnostic Options for Testicular Cancer

• The U.S. Preventive Services Task Force recommends against routine screening in asymptomatic men 3, 4
• Men with symptoms should receive a complete history and physical examination 3
• Scrotal ultrasonography is the preferred initial imaging study 3, 4
• If a solid intratesticular mass is discovered, orchiectomy is both diagnostic and therapeutic 3

Treatment Options for Testicular Cancer

• Active surveillance, chemotherapy, retroperitoneal lymph node dissection, and radiation therapy are treatment options following orchiectomy 3
• Radiation treatment plays a role in adjuvant therapy after orchiectomy of stage I, IIA, and IIB seminomas 5
• The combination of surgery and cisplatin-based chemotherapy has resulted in a cure rate of >90% in patients with testicular cancer 6
• For patients desiring future fertility, sperm banking should be discussed early in the course of treatment 3, 4

Importance of Accurate Pathology Diagnosis

• Radical orchiectomy specimens present a unique set of challenges for pathology assessment owing to their rarity and complexity 7
• Central review for pathology diagnosis of orchiectomy specimens can reveal significant discrepancies involving multiple parameters between original and second opinion pathology reports 7
• Accurate pathology diagnosis is crucial for patient management and treatment planning 7

Role of Family Physicians in Testicular Cancer Care

• Family physicians often play a role in the care of cancer survivors and should be familiar with monitoring for recurrence and future complications, including secondary malignant neoplasms, cardiovascular risk, and infertility and subfertility 3, 4
• Family physicians should encourage patients to bank sperm because of possible infertility and evaluate for recurrence and future complications, especially cardiovascular disease 4