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German Specialists Treating Testicular Cancer Follow Different Guidelines with Resulting Inconsistency in Assessment of Retroperitoneal Lymph-Node Metastasis: Clinical Implications and Possible Corrective Measures - Beyond the Abstract

In the Federal Armed Forces Hospital in Koblenz, Germany, we are specialized in treating young soldiers and civilians with testicular cancer, frequently in metastatic clinical stage IIA/B. During interdisciplinary radio-/urooncological conferences, there are often discussions about the assessment of retroperitoneal lymph node metastasis in patients with testicular cancer especially concerning the diameter which is considered for staging (short or long axis and radiological plane).

Current guidelines lack specific and consistent recommendations concerning practice patterns. Assuming that not only our department is confronted with this problem, the idea was developed to perform a study evaluating the consistency of staging of patients in specialized testicular cancer centers in Germany.

After analyzing the answered questionnaire, we could show that the assessment of retroperitoneal lymph node metastases in testicular cancer patients is inconsistent in Germany. Due to inconsistent guideline recommendations, we assume that this is an important international problem, as well. However, despite the probable consequence of different therapy decisions which could result in over- or under-therapy of patients, the issue also concerns the interpretation of studies not usually defining their practice patterns in staging. This raises the question of if the study cohorts of different stages are really comparable. Further studies are already ongoing to identify the “best” diameter in order to give specific and consistent guideline recommendations to further improve a standardized, evidence-based treatment of testicular cancer with retroperitoneal lymph nodes metastases irrespective of the individual center.

Written by: Justine Schoch,1 Kathrin Haunschild,2 Angelina Strauch,1 Kai Nestler,3 Hans Schmelz,1 Pia Paffenholz,2 David Pfister,2 Thorsten Persigehl,4 Axel Heidenreich,2,5 Tim Nestler1,2

  1. Department of Urology, Federal Armed Forces Hospital Koblenz, Koblenz, Germany
  2. Department of Urology, University Hospital of Cologne, Cologne, Germany
  3. Institute of Diagnostic and Interventional Radiology, Federal Armed Forces Hospital Koblenz, Koblenz, Germany
  4. Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
  5. Department of Urology, Medical University Vienna, Vienna, Austria
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