Table 1.
Comparison of follow-up schedules including investigations and their intervals for patients with stage I testicular germ cell tumour stratified by histology and adjuvant treatment receiveda
| Histology and treatment | STM/CTAP/CXR/CTC interval (mo) |
|||||
|---|---|---|---|---|---|---|
| EAU/ESMO | NCCN | SWENOTECA | SAGTCCS | Toronto | AUA | |
| Seminoma | ||||||
| AS | ||||||
| Year 1 | 6/6/0/0 | (3–6)/4–6 & 12/b/b | 6/6c/0/0 | 3/6/12/0 | d/6/0/0 | d/4–6/0/0 |
| Year 2 | 6/6/0/0 | (6)/6/b/b | 6/6c/0/0 | 3/6/0/0 | d/6/0/0 | d/4–6/0/0 |
| Year 3 | 6/12/0/0 | (6–12)/6–12/b/b | 6/12c/0/0 | 6/12/0/0 | d/6/0/0 | d/6–12/0/0 |
| Year 4 | 12/0/0/0 | (12)/12–24/b/b | 6/12c/0/0 | 6/0/0/0 | d/12/0/0 | d/6–12/0/0 |
| Year 5 | 12/12/0/0 | (12)/12–24/b/b | 12/12c/0/0 | 6/12/0/0 | d/12/0/0 | d/6–12/0/0 |
| Year >5 | d/12/0 (until y9), no CT in y6 & y8, CXR at y9 | |||||
| Adjuvant CBP | ||||||
| Year 1 | Same as for AS | (6–12)/12/b/b | 6/6c/0/0 | Same as for AS | Same as for AS | Same as for AS |
| Year 2 | (6–12)/12/b/b | 6/6c/0/0 | ||||
| Year 3 | (12)/12/b/b | 6/12c/0/0 | ||||
| Year 4 | (12)/0/b/b | 6/12c/0/0 | ||||
| Year 5 | (12)/0/b/b | 12/12c/0/0 | ||||
| Year >5 | STM/MRI at 7/10 yr | |||||
| Adjuvant RT | ||||||
| Year 1 | Same as for AS | (6–12)/12/b/b | 6/0c/0/0 | Same as for AS | Same as for AS | Same as for AS |
| Year 2 | (6–12)/12/b/b | 6/12c/0/0 | ||||
| Year 3 | (12)/12/b/b | 6/0c/0/0 | ||||
| Year 4 | (12)/0/b/b | 6/0c/0/0 | ||||
| Year 5 | (12)/0/b/b | 12/12c/0/0 | ||||
| Year >5 | ||||||
| Nonseminoma | ||||||
| AS without LVI | ||||||
| Year 1 | 3/6/6/0 | 2/4–6/at 4 & 12/b | 3/6c/0/0 | 2/at 4 & 12/4/0 | 2 (+m1)/4/0/4 | 2–3/3–6/3–6/0 |
| Year 2 | 3/12/6/0 | 3/6/12/b | 3/6c/0/0 | 3/6/6/0 | 2/12/0/12 | 2–4/4–12/4–12/0 |
| Year 3 | 6/12/0/0 | 4–6/12/12/b | 6/12c/0/0 | 6/12/12/0 | 4/0/0/0 | 4–6/12/12/0 |
| Year 4 | 6–12/0/0/0 | 6/b/12/b | 6/12c/0/0 | 6/0/0/0 | 6/0/0/0 | 6–12/12–24/12–24/0 |
| Year 5 | (6–)12/12/0/0 | 12/b/b/b | 6/12c/0/0 | 6/12/12/0 | 12/12/0/12 | 6–12/12–24/12–24/0 |
| Year >5 | ||||||
| AS with LVI | ||||||
| Year 1 | Same as for AS | 2/4/4/b | 2/6c/0/0 | 2/4/4/0 | 2 (+ m1)/4/0/4 | Imaging at shorter intervals than without LVI (no specific schedule) |
| Year 2 | without LVI | 3/4–6/12/b | 3/6c/0/0 | 3/12/6/0 | 2/12/0/12 | |
| Year 3 | 4–6/6/6/b | 6/12c/0/0 | 6/12/12/0 | 4/0/0/0 | ||
| Year 4 | 6/12/12/b | 6/12c/0/0 | 6/0/0/0 | 6/0/0/0 | ||
| Year 5 | 12/b/b/b | 6/12c/0/0 | 6/12/12/0 | 12/12/0/12 | ||
| Year >5 | ||||||
| Adjuvant 1× BEP | ||||||
| Year 1 | 3/6/6–12/0 | 3/12/6–12/b | 3/12c/0/0 | 3/6/6/0 | Not available | Not available |
| Year 2 | 3/12/12/0 | 3/12/12/b | 3/12c/0/0 | 3/12/12/0 | ||
| Year 3 | 6/12/12/0 | 6/0/0/0 | 6/12c/0/0 | 6/12/12/0 | ||
| Year 4 | 6/0/0/0 | 6/0/0/0 | 6/0c/0/0 | 6/0/0/0 | ||
| Year 5 | 6/12/12/0 | 12/0/0/0 | 6/12c/0/0 | 6/12/12/0 | ||
| Year >5 | ||||||
STM = serum tumour markers; CTAP = abdominopelvic computed tomography; CXR = chest X-ray; CTC = chest CT; EAU = European Association of Urology; ESMO = European Society for Medical Oncology; NCCN = National Comprehensive Cancer Network; SWENOTECA = Swedish and Norwegian Testicular Cancer Group; SAGTCCS = Swiss Austrian German Testicular Cancer Cohort Study; AUA = American Urological Association; AS = active surveillance; RT = radiotherapy; LVI = lymphovascular invasion; CBP = carboplatin; BEP = bleomycin, etoposide, and cisplatin; y9 = year 9; m1 = month 1; MRI = magnetic resonance imaging (abdominopelvic).
Optional investigations are in parentheses.
As clinically indicated (CXR when CTAP is obtained; consider CTC instead of CXR in symptomatic patients).
SWENOTECA explicitly recommends MRI instead of CT.
No routine STM measurements recommended in the AUA and Toronto guidelines for seminoma (for the AUA, only to be considered if elevated bHCG before orchiectomy or when clinically indicated).