Canadian consensus guidelines for the management of testicular germ cell cancer.

Abstract

Testicular tumours are uncommon but constitute an important group of malignancies in young men. Worldwide, it is estimated that there were more than 48 500 new cases and 8900 deaths from the disease in 2002.1 The vast majority are primary germ cell tumours (GCTs) and the incidence has doubled in the past 30 years (with most of the increase in seminomas).2 While most patients present with early-stage and highly curable disease, the continued rise in the incidence of these tumours presents a major challenge. Germ cell testicular tumours are the most common solid malignancies in males between the ages of 20 and 35; it is estimated that in 2008 there will be 900 new cases and 30 deaths from testicular cancer in Canada.3 Germ cell cancer is a rare disease that requires expert treatment. Clear evidence has emerged that patients with germ cell cancer benefit from treatment in centres with special experience in the field.4 However, it is also of considerable importance that clear, comprehensive and up-to-date consensus guidelines are available which represent the current “state of the art” in diagnosis and management of germ cell cancer. The European Germ Cell Cancer Consensus Group published guidelines in 2004 (updated in 2008) and these reflect the “European” approach to management of patients with GCTs.5–7 In October 2007, the 1st Canadian Germ Cell Cancer Consensus Conference was held in Toronto with support from the Canadian Partnership against Cancer (CPAC), the Canadian Institute of Health Research, multiple provincial cancer agencies, the Dell’Elce Testicular Cancer Research Fund from the Princess Margaret Foundation and industry sponsors. The initiative was endorsed by the Canadian Urological Association, the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncologists. There were a total of 46 attendees from across Canada and international invitees (Dr. Peter Albers, Dr. Robert Huddart and Dr. Craig Nichols). The group reviewed and discussed the current literature and the Canadian experience with germ cell cancer. The group developed this Canadian Consensus Guideline to cover many aspects of the diagnosis and management of germ cell cancer.