Non-risk-adapted Surveillance for Stage I Testicular Cancer: Critical Review and Summary

Phillip Martin Pierorazio, Peter Albers, Peter C Black, Torgrim Tandstad, Axel Heidenreich, Nicola Nicolai, Craig Nichols

Research output: Contribution to journalReview article

Abstract

CONTEXT: Cancer-specific survival for men with clinical stage I testicular cancer (CSITC) is uniformly excellent. Non-risk-adapted active surveillance (NRAS) is a management strategy for CSITC to minimize overtreatment and avoid possible long-term side effects of adjuvant therapy.

OBJECTIVE: To review the evidence regarding oncologic outcomes for men with CSITC undergoing NRAS and discuss ongoing controversies in the management of CSITC.

EVIDENCE ACQUISITION: MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1987 through January 1, 2017.

EVIDENCE SYNTHESIS: A total of 68 studies were included in the critical review. The rationale for NRAS, oncologic outcomes, surveillance protocols, and comparative efficacy of risk-adjusted active surveillance (AS) were reported with strength of evidence and risk of bias evaluated. Cancer-specific survival approaches 100% for men with CSITC undergoing NRAS. Active treatment is limited to 20-30% of patients who will recur; these patients will require salvage chemotherapy and possible retroperitoneal lymph node dissection. Existing AS protocols include imaging and laboratory evaluations that are initially intensive but less frequent with increasing follow-up.

CONCLUSIONS: NRAS is an attractive management option for men with CSITC, which maintains outstanding long-term cancer cure while sparing most patients treatment by avoiding prophylactic chemotherapy, radiation, or surgery.

PATIENT SUMMARY: Men with clinically localized (stage I) testicular cancer have an excellent prognosis, regardless of management. Non-risk-adapted active surveillance is an attractive management option where only patients destined to relapse will receive any treatment following orchiectomy. However, individual patient preferences should be discussed in selecting a management strategy.

Original languageEnglish
Pages (from-to)899-907
Number of pages9
JournalEuropean Urology
Volume73
Issue number6
DOIs
Publication statusPublished - Jun 2018

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Testicular Neoplasms
Drug Therapy
Neoplasms
Survival
Orchiectomy
Patient Preference
Therapeutics
Lymph Node Excision
PubMed
MEDLINE
Radiation
Recurrence

Cite this

Pierorazio, P. M., Albers, P., Black, P. C., Tandstad, T., Heidenreich, A., Nicolai, N., & Nichols, C. (2018). Non-risk-adapted Surveillance for Stage I Testicular Cancer: Critical Review and Summary. European Urology, 73(6), 899-907. https://doi.org/10.1016/j.eururo.2017.12.030

Non-risk-adapted Surveillance for Stage I Testicular Cancer : Critical Review and Summary. / Pierorazio, Phillip Martin; Albers, Peter; Black, Peter C; Tandstad, Torgrim; Heidenreich, Axel; Nicolai, Nicola; Nichols, Craig.

In: European Urology, Vol. 73, No. 6, 06.2018, p. 899-907.

Research output: Contribution to journalReview article

Pierorazio, PM, Albers, P, Black, PC, Tandstad, T, Heidenreich, A, Nicolai, N & Nichols, C 2018, 'Non-risk-adapted Surveillance for Stage I Testicular Cancer: Critical Review and Summary', European Urology, vol. 73, no. 6, pp. 899-907. https://doi.org/10.1016/j.eururo.2017.12.030
Pierorazio, Phillip Martin ; Albers, Peter ; Black, Peter C ; Tandstad, Torgrim ; Heidenreich, Axel ; Nicolai, Nicola ; Nichols, Craig. / Non-risk-adapted Surveillance for Stage I Testicular Cancer : Critical Review and Summary. In: European Urology. 2018 ; Vol. 73, No. 6. pp. 899-907.
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abstract = "CONTEXT: Cancer-specific survival for men with clinical stage I testicular cancer (CSITC) is uniformly excellent. Non-risk-adapted active surveillance (NRAS) is a management strategy for CSITC to minimize overtreatment and avoid possible long-term side effects of adjuvant therapy.OBJECTIVE: To review the evidence regarding oncologic outcomes for men with CSITC undergoing NRAS and discuss ongoing controversies in the management of CSITC.EVIDENCE ACQUISITION: MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1987 through January 1, 2017.EVIDENCE SYNTHESIS: A total of 68 studies were included in the critical review. The rationale for NRAS, oncologic outcomes, surveillance protocols, and comparative efficacy of risk-adjusted active surveillance (AS) were reported with strength of evidence and risk of bias evaluated. Cancer-specific survival approaches 100{\%} for men with CSITC undergoing NRAS. Active treatment is limited to 20-30{\%} of patients who will recur; these patients will require salvage chemotherapy and possible retroperitoneal lymph node dissection. Existing AS protocols include imaging and laboratory evaluations that are initially intensive but less frequent with increasing follow-up.CONCLUSIONS: NRAS is an attractive management option for men with CSITC, which maintains outstanding long-term cancer cure while sparing most patients treatment by avoiding prophylactic chemotherapy, radiation, or surgery.PATIENT SUMMARY: Men with clinically localized (stage I) testicular cancer have an excellent prognosis, regardless of management. Non-risk-adapted active surveillance is an attractive management option where only patients destined to relapse will receive any treatment following orchiectomy. However, individual patient preferences should be discussed in selecting a management strategy.",
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T2 - Critical Review and Summary

AU - Pierorazio, Phillip Martin

AU - Albers, Peter

AU - Black, Peter C

AU - Tandstad, Torgrim

AU - Heidenreich, Axel

AU - Nicolai, Nicola

AU - Nichols, Craig

N1 - Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2018/6

Y1 - 2018/6

N2 - CONTEXT: Cancer-specific survival for men with clinical stage I testicular cancer (CSITC) is uniformly excellent. Non-risk-adapted active surveillance (NRAS) is a management strategy for CSITC to minimize overtreatment and avoid possible long-term side effects of adjuvant therapy.OBJECTIVE: To review the evidence regarding oncologic outcomes for men with CSITC undergoing NRAS and discuss ongoing controversies in the management of CSITC.EVIDENCE ACQUISITION: MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1987 through January 1, 2017.EVIDENCE SYNTHESIS: A total of 68 studies were included in the critical review. The rationale for NRAS, oncologic outcomes, surveillance protocols, and comparative efficacy of risk-adjusted active surveillance (AS) were reported with strength of evidence and risk of bias evaluated. Cancer-specific survival approaches 100% for men with CSITC undergoing NRAS. Active treatment is limited to 20-30% of patients who will recur; these patients will require salvage chemotherapy and possible retroperitoneal lymph node dissection. Existing AS protocols include imaging and laboratory evaluations that are initially intensive but less frequent with increasing follow-up.CONCLUSIONS: NRAS is an attractive management option for men with CSITC, which maintains outstanding long-term cancer cure while sparing most patients treatment by avoiding prophylactic chemotherapy, radiation, or surgery.PATIENT SUMMARY: Men with clinically localized (stage I) testicular cancer have an excellent prognosis, regardless of management. Non-risk-adapted active surveillance is an attractive management option where only patients destined to relapse will receive any treatment following orchiectomy. However, individual patient preferences should be discussed in selecting a management strategy.

AB - CONTEXT: Cancer-specific survival for men with clinical stage I testicular cancer (CSITC) is uniformly excellent. Non-risk-adapted active surveillance (NRAS) is a management strategy for CSITC to minimize overtreatment and avoid possible long-term side effects of adjuvant therapy.OBJECTIVE: To review the evidence regarding oncologic outcomes for men with CSITC undergoing NRAS and discuss ongoing controversies in the management of CSITC.EVIDENCE ACQUISITION: MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1987 through January 1, 2017.EVIDENCE SYNTHESIS: A total of 68 studies were included in the critical review. The rationale for NRAS, oncologic outcomes, surveillance protocols, and comparative efficacy of risk-adjusted active surveillance (AS) were reported with strength of evidence and risk of bias evaluated. Cancer-specific survival approaches 100% for men with CSITC undergoing NRAS. Active treatment is limited to 20-30% of patients who will recur; these patients will require salvage chemotherapy and possible retroperitoneal lymph node dissection. Existing AS protocols include imaging and laboratory evaluations that are initially intensive but less frequent with increasing follow-up.CONCLUSIONS: NRAS is an attractive management option for men with CSITC, which maintains outstanding long-term cancer cure while sparing most patients treatment by avoiding prophylactic chemotherapy, radiation, or surgery.PATIENT SUMMARY: Men with clinically localized (stage I) testicular cancer have an excellent prognosis, regardless of management. Non-risk-adapted active surveillance is an attractive management option where only patients destined to relapse will receive any treatment following orchiectomy. However, individual patient preferences should be discussed in selecting a management strategy.

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JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 6

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