The Germ Cell Subcommittee of the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP) have developed recommendations for the surveillance of patients who have been diagnosed with Stage 1 Testicular Cancer.
We previously conducted a survey of Medical Oncologists in Australia to determine the patterns of management and surveillance imaging for stage I testicular cancer during 2010 (1). There was considerable variation in the management of patients and the frequency of surveillance imaging amongst the medical oncologists surveyed. More than a third of clinicians recommended 10 or more computed tomography (CT) scans over a 5 year period. This frequency of CT imaging carries significant risk of radiation exposure, and is inconsistent with most modern international guidelines that recommend substantially less frequent scans.
The newly published recommendations from ANZUP are for use within Australia and New Zealand by Medical Oncologists who usually provide care and follow-up for testicular cancer patients. The recommendations provide an evidence based standardised protocol for follow-up of Stage I testicular cancer which are based on the expected frequency, timing and pattern of disease recurrence and aims to minimise unnecessary radiation exposure. It provides a suggested follow-up schedule for both stage 1 seminoma and non-seminoma testicular cancer, and takes into account the administration of adjuvant chemotherapy. The recommendations include guidance on the timing of clinic visits, physical examinations, imaging, and blood tests (for both tumour markers and testosterone levels).
Along with the recommendations, there is a handout available for patients which explains the purpose of surveillance and outlines the follow-up schedule. A customisable patient schedule is also available, which allows users to enter the patient’s name, histology, operation date and use of adjuvant chemotherapy. An individualised patient follow-up schedule is then created using this information based on the follow-up recommendations. This includes the timing and dates of follow up, as well as what investigations will occur at each time point. It can be further customised as appropriate to the clinical situation.
The use of a standardised protocol across Australia and New Zealand will provide a consistent level of high quality care in line with international guidelines. It will also provide a platform for potential future research. We plan to evaluate the use and acceptability of these recommendations in the future as well as repeat the survey to assess the change in management and surveillance patterns over time.
The surveillance recommendations can be found on the ANZUP website.
[hr] Reference: 1. Grimison P, Houghton B, Chatfield M, Toner GC, Davis ID, Martin J, et al. Patterns of management and surveillance imaging amongst medical oncologists in Australia for stage I testicular cancer. BJU Int. 2013;112(2):E35-43.
About the Authors:
Dr Nicky Lawrence (MBCHB, FRACP) is a Medical Oncologist and Clinical Research Fellow for ANZUP, NHMRC Clinical Trials Centre, University of Sydney.
Associate Professor Andrew Weickhardt (MBBS, FRACP, DMedSc) is a Medical Oncologist at the Olivia Newton-John Cancer and Wellness Centre, Victoria.