Testicular%20cancer Management

Management

Follow Up

The primary goals of follow-up during the first 5-10 years are early detection and treatment of relapse
- Patients relapse within the first 1-2 years following initial treatment and as such, frequent and intensive surveillance should be done at this time; late relapses can occur after 5 years and thus, annual follow-up may be advised
- Cured patients have approximately 2% cumulative risk of having a cancer develop in the contralateral testis within 15 years following initial diagnosis with the risk higher in seminomas than nonseminomatous primary tumors

It should also prevent, detect and treat late toxicities of the disease, eg hypogonadism, infections, post-chemotherapy cardiovascular disease, metabolic syndrome, leukemia, second solid non-germ cell tumor, pulmonary, renal, neuro and ototoxicity
Optimal follow-up schedule is adapted according to national and institutional requirements and is determined by the histology of the original tumor and the stage and risk of recurrence at first presentation
- Individualize follow-up based on site and biology of the disease and the length of therapy course

Perform reassessment of disease activity in patients with new or worsening disease regardless of the time interval from prior studies
Interval clinical evaluation with a history and PE, serum tumor markers, a chest X-ray and an abdominal or pelvic CT scan are performed on follow-up
- Physical exam or imaging studies almost always detect relapse in patients with seminoma
- Increased levels of tumor markers are often the earliest sign of relapse when monitoring all stages of nonseminomas and metastatic seminomas and indicate treatment even in the absence of metastatic disease on imaging studies
- Consider a chest CT scan if thoracic symptoms are present or if supradiaphragmatic disease is seen at diagnosis
- Testicular ultrasound may be done for any equivocal exam

Listed below is the minimum follow-up schedule for testicular cancer:

Clinical Stage	Procedure	Year
Clinical Stage	Procedure	1	2	3	4	5
Stage I seminoma surveillance after orchiectomy	History and PE	2-4x	1-2x	1-2x	1x	1x
	Chest X-ray	As clinically indicated
	Abdominal ± pelvic CT scan	3x	1-2x	1-2x	1x	1x
Stage I seminoma surveillance after chemotherapy or radiation therapy	History and PE	1-2x	1-2x	1x	1x	1x
	Chest X-ray	As clinically indicated
	Abdominal ± pelvic CT scan	1x	1x	1x	-	-
Stage I NSGCT without risk factors active surveillance	History, PE, and tumor markers	6x	4x	2-3x	2x	1x
	Chest X-ray	4th, 12th month	1x	1x	1x	As clinically indicated
	Abdominal ± pelvic CT scan	2-3x	2x	1x	As clinically indicated
Stage I NSGCT with risk factors active surveillance	History, PE, and tumor markers	6x	4x	2-3x	2x	1x
	Chest X-ray	3x	2-3x	2x	1x	As clinically indicated
	Abdominal ± pelvic CT scan	3x	2-3x	2x	1x	As clinically indicated
Stage I NSGCT after adjuvant chemotherapy or RPLND	History, PE, and tumor markers	4x	4x	2x	2x	1x
	Chest X-ray	1-2x	1x	-	-	-
	Abdominal ± pelvic CT scan	1x	1x	-	-	-
Stage IIA, IIB nonbulky seminoma surveillance after radiation therapy or postchemotherapy	History and PE	4x	2x	2x	2x	2x
	Chest X-ray	2x	2x	-	-	-
	Abdominal ± pelvic CT scan	3x	1x	1x	As clinically indicated
Stage IIB bulky, IIC, III seminoma surveillance postchemotherapy	History and PE	6x	4x	2x	2x	1x
	Chest X-ray	6x	4x	1x	1x	1x
	Abdominal ± pelvic CT scan	3x	2x	1x	1x	As clinically indicated
Stage IA, IB NSGCT with 1 cycle chemotherapy or primary RPLND	History, PE, and tumor markers	4x	4x	2x	2x	1x
	Chest X-ray	1-2x	1x	-	-	-
	Abdominal ± pelvic CT scan	1x	1x	-	-	-
Stage II-III NSGCT surveillance after complete response to chemotherapy ± postchemotherapy RPLND	History, PE, and tumor markers	6x	4x	2x	2x	2x
	Chest X-ray	2x	2x	1x	1x	-
	Abdominal ± pelvic CT scan	2x	1-2x	1x	As clinically indicated
Pathologic Stage IIA, IIB NSGCT after primary RPLND and chemotherapy	History, PE, and tumor markers	2x	2x	1x	1x	1x
	Chest X-ray	2x	1x	1x	1x	1x
	Abdominal/pelvic CT scan	1x	As clinically indicated
Pathologic Stage IIA, IIB NSGCT after primary RPLND without chemotherapy	History, PE, and tumor markers	6x	4x	3x	2x	1x
	Chest X-ray	3-6x	2-4x	1x	1x	1x
	Abdominal/pelvic CT scan	3-4x	2-4x	1x	1x	1x

Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.