[Follow-up in patients with testicular germ cell tumors-an update].

Abstract

Systematic follow-up (FU) examinations in patients with testicular germ cell tumors (GCTs) came into practice in the 1980s. The goal is to detect recurrent disease as early as possible to facilitate successful treatment. Cross-sectional imaging and tumor marker measurements (AFP, bHCG) represent the mainstay of FU examinations. Due to the biological and clinical diversity of GCTs, there is no uniform general pattern of examinations that would suit all GCT patients. Therefore, FU should be performed in a risk-adapted way; the rationale of which is to tailor examinations to the extent needed, while keeping examinations as short as possible. In the entire population of testicular GCTs, there are around 20 different risk categories that are characterized by histology, clinical stage, and antecedent treatment and that differ from each other with respect to frequency of relapses (2-50%), time interval to relapse, and topography of recurrent disease. In terms of clinical practice, three risk groups should be employed: (1) seminoma all stages, (2) nonseminoma clinical stage 1, and (3) nonseminoma all other clinical stages. The FU examinations specifically required in these categories are listed in three roster tables, accordingly. The following items are at variance with the German S3 guidelines from 2019: (a) the number of risk groups is reduced to three (instead of 4) and the groups are newly defined, (b) cross-sectional imaging with computed tomography (CT) is replaced by magnetic resonance imaging (MRI) for reasons of radiation protection, (c) abdominal sonography is replaced by MRI for reasons of superior diagnostic accuracy, (d) no more chest X‑ray in FU of seminoma patients, and (e) lactate dehydrogenase (LDH) no longer a marker for testing in FU. Another goal of FU is the early detection of second diseases ensuing from treatment of GCT such as hypogonadism, metabolic syndrome, cardiovascular diseases, and second malignancies. Therefore, FU should be continued beyond the 5 year threshold with annual visits.