Posttreatment follow-up for men with testicular germ cell tumors
- William K Oh, MD
William K Oh, MD
- Section Editor — Testicular Cancer
- Professor of Medicine
- Mount Sinai School of Medicine
- Chief, Division of Hematology Oncology
- Tisch Cancer Institute
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Testicular germ cell tumors (GCTs) are one of the most curable solid neoplasms due to improved staging and surgical techniques, the use of platinum-based combination chemotherapy, and the availability of serum tumor markers (beta subunit of human chorionic gonadotropin [beta-hCG], alpha fetoprotein [AFP], and lactate dehydrogenase [LDH]) to monitor for the response to treatment and the presence of occult disease. For men with testicular GCTs, the five-year survival rate is over 95 percent. (See "Overview of the treatment of testicular germ cell tumors" and "Serum tumor markers in testicular germ cell tumors".)
The follow-up and surveillance for recurrence in men who have completed their initial definitive treatment for testicular cancer will be reviewed here. The use of serum tumor markers during the initial treatment of testicular GCTs is discussed separately.
At the conclusion of treatment, surveillance is appropriate for:
- Kollmannsberger C, Tandstad T, Bedard PL, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol 2015; 33:51.
- Oldenburg J, Alfsen GC, Waehre H, Fosså SD. Late recurrences of germ cell malignancies: a population-based experience over three decades. Br J Cancer 2006; 94:820.
- Geldart TR, Gale J, McKendrick J, et al. Late relapse of metastatic testicular nonseminomatous germ cell cancer: surgery is needed for cure. BJU Int 2006; 98:353.
- Shahidi M, Norman AR, Dearnaley DP, et al. Late recurrence in 1263 men with testicular germ cell tumors. Multivariate analysis of risk factors and implications for management. Cancer 2002; 95:520.
- George DW, Foster RS, Hromas RA, et al. Update on late relapse of germ cell tumor: a clinical and molecular analysis. J Clin Oncol 2003; 21:113.
- Salem M, Gilligan T. Serum tumor markers and their utilization in the management of germ-cell tumors in adult males. Expert Rev Anticancer Ther 2011; 11:1.
- Vesprini D, Chung P, Tolan S, et al. Utility of serum tumor markers during surveillance for stage I seminoma. Cancer 2012; 118:5245.
- Gilligan TD, Seidenfeld J, Basch EM, et al. American Society of Clinical Oncology Clinical Practice Guideline on uses of serum tumor markers in adult males with germ cell tumors. J Clin Oncol 2010; 28:3388.
- Gietema JA, Meinardi MT, Sleijfer DT, et al. Routine chest X-rays have no additional value in the detection of relapse during routine follow-up of patients treated with chemotherapy for disseminated non-seminomatous testicular cancer. Ann Oncol 2002; 13:1616.
- Sharir S, Jewett MA, Sturgeon JF, et al. Progression detection of stage I nonseminomatous testis cancer on surveillance: implications for the followup protocol. J Urol 1999; 161:472.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
- Schmoll HJ, Jordan K, Huddart R, et al. Testicular non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v147.
- Schmoll HJ, Jordan K, Huddart R, et al. Testicular seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v140.
- Wood L, Kollmannsberger C, Jewett M, et al. Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J 2010; 4:e19.
- Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 2008; 53:478.
- Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II. Eur Urol 2008; 53:497.
- Motzer RJ, Agarwal N, Beard C, et al. Testicular cancer. J Natl Compr Canc Netw 2012; 10:502.
- Bellamy EA, Husband JE, Blaquiere RM, Law MR. Bleomycin-related lung damage: CT evidence. Radiology 1985; 156:155.
- Spiess PE, Kassouf W, Brown GA, et al. Surgical management of growing teratoma syndrome: the M. D. Anderson cancer center experience. J Urol 2007; 177:1330.
- ONCOLOGIC FOLLOW-UP
- Duration of follow-up after treatment
- Monitoring approaches
- - History and physical examination
- - Serum tumor markers
- - Radiographic studies
- Guidelines for follow-up
- - NSGCT
- - Seminoma
- Detection of recurrent disease
- - Interpreting serum tumor markers
- - Pulmonary nodules
- - Growing teratoma syndrome
- - False-positive elevation of serum beta-hCG
- TREATMENT-RELATED COMPLICATIONS