Follow-up for patients with testicular cancer should ensure early detection of relapses. Optimal schedules and minimum requirements for cross-sectional imaging are not clearly defined, and guideline recommendations differ. Our aim was to analyse the clinical impact of different imaging modalities for detection of relapse in a large prospective cohort (Swiss Austrian German Testicular Cancer Cohort Study, SAG TCCS).
Patients with seminoma or nonseminoma were prospectively enrolled between January 2014 and February 2023 after initial treatment (n = 1175). Follow-up according to the study schedule was individualised for histology and disease stage. Only patients who had received primary treatment were considered. We analysed the total number of imaging modalities and scans identifying relapse and the timing of relapse.
We analysed data for 1006 patients (64% seminoma, 36% nonseminoma); 76% had stage I disease. Active surveillance was the most frequent management strategy (65%). Recurrence occurred in 82 patients, corresponding to a 5-yr relapse-free survival rate of 90.1% (95% confidence interval 87.7-92.1%). Median follow-up for patients without relapse was 38.4 mo (interquartile range 21.6-61.0). Cross-sectional imaging of the abdomen was the most important indicator of relapse 57%, abdominal CT accounting for 46% and MRI for 11%. Marker elevation indicated relapse in 24% of cases. Chest X-ray was the least useful modality, indicating relapse in just 2% of cases.
On the basis of findings from our prospective register, we have adapted a follow-up schedules with an emphasis on abdominal imaging and a reduction in chest X-rays. This schedule might provide additional guidance for clinicians and will be prospectively evaluated as SAG TCCS continues to enrol patients.
We analysed the value of different types of imaging scans for detection of relapse of testicular cancer. We used our findings to propose an optimum follow-up schedule for patients with testicular cancer.
European urology open science. 2024 Sep 11*** epublish ***
Stefanie Fischer, Silke Gillessen, Odile Stalder, Angelika Terbuch, Richard Cathomas, Florian A Schmid, Deborah Zihler, Beat Müller, Christian D Fankhauser, Anita Hirschi-Blickenstorfer, Luis Alex Kluth, Bettina Seifert, Arnoud J Templeton, Walter Mingrone, Mark-Peter Ufe, Natalie Fischer, Jörg Beyer, Regina Woelky, Aurelius Omlin, Ursula Vogl, Katharina Hoppe, Jörn Kamradt, Sacha I Rothschild, Christian Rothermundt
Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland., Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland., Department of Clinical Research, CTU Bern, University of Bern, Bern, Switzerland., Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Comprehensive Cancer Center Graz, Graz, Austria., Division of Medical Oncology/Haematology, Cantonal Hospital Graubünden, Chur, Switzerland., Department of Urology, University Hospital Zurich, Zurich, Switzerland., Department of Medical Oncology and Haematology, Cantonal Hospital Aarau, Aarau, Switzerland., Department of Medical Oncology, Cantonal Hospital Luzern, Luzern, Switzerland., Department of Urology, Cantonal Hospital Luzern, Luzern, Switzerland., Onkozentrum Hirslanden, Clinic Hirslanden, Zurich, Switzerland., Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany., Department of Medical Oncology, Cantonal Hospital Liestal, Basel, Switzerland., Department of Medical Oncology, St. Claraspital/St. Clara Research and Faculty of Medicine, University of Basel, Basel, Switzerland., Department of Medical Oncology, Cantonal Hospital Olten, Olten, Switzerland., Ammerland Klinik, Westerstede, Germany., Department of Medical Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland., Department of Medical Oncology, University Hospital Bern, Bern, Switzerland., Department of Medical Oncology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland., Onkozentrum Zurich und Uro-Onkologisches Zentrum, Hirslanden Klinik Zurich, Zurich, Switzerland., Stadtspital Triemli Zurich, Zurich, Switzerland., Urologie Zentrum Bern und Hirslanden Bern, Bern Switzerland., Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Basel, Basel, Switzerland.