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Kurzbeschreibung/Zielsetzung

About 400 men are diagnosed with testicular cancer in Switzerland every year [1]. In the last three decades substantial progress has been made in the treatment of testicular cancer: The majority of patients with metastatic testicular cancer can be cured since the introduction of cisplatin-based chemotherapy [2]. Recommendations of a European panel for diagnosis and treatment of germ cell tumours have been published and recently updated [3, 4]. S. Gillessen is a member of the consensus panel. Relapse rates and mortality have been reduced even more within the last 15 years due to the stringent application of standard chemotherapy followed by resection of residual disease [5]. For patients with stage I seminomatous and non-seminomatous testicular cancer “active surveillance” programs have become an accepted and widely used strategy in the treatment, because the survival rates are comparable with those after adjuvant chemotherapy. Active surveillance incorporates close follow-ups and start of treatment as soon as recurrence is detected and adjuvant treatment is avoided. Hence “active surveillance” is more than just follow-up, but rather a strategy to avoid overtreatment and to use chemotherapy only when indispensable. Surveillance-based options require clear recommendations for follow-up schedules. These should be feasible and reflect the known risk of recurrence in frequency of the procedures. So far there is no international consensus regarding the follow-up of testicular cancer patients. Oncological and urological organisations/societies in different countries have published their guidelines: European Association of Urology (EAU) [6], German Cancer Study Group [7], American NCCN guidelines [8] and European ESMO guidelines [9, 10]. These guidelines differ considerably especially in regard to the frequencies and types of imaging procedures.
Evidence-based follow-up recommendations can be formulated with the knowledge of different risk and recurrence patterns as shown by a recent publication [11].
Accordingly, patients should be grouped into risk categories. An ideal follow-up schedule identifies recurrence early without causing harm by using unnecessary radiation in these young long-term survivors.
Apart from tumour recurrence, follow-up should include detection of long-term side effects from chemo- and radiotherapy: Hypogonadism, metabolic syndrome and cardiovascular disease as well as secondary malignancies are the most important long-term sequelae [12–16]. Patients who have undergone chemotherapy as well as radiotherapy for testicular cancer are known to have a particularly excessive risk for cardiovascular events and secondary tumours [14].
An interdisciplinary working group of Swiss medical oncologists, urologists and radiation oncologists developed evidence-based recommendations for the follow-up of testicular cancer patients in 2007 and 2008, which were presented and discussed by a multinational group with oncologists from both Germany and Austria in 2009 and published in 2010 [17].
We now plan a prospective observational study in testicular cancer patients. Eligible patients must have reached a complete remission after treatment or are followed within an active surveillance strategy, and must have had their home address at diagnosis in a canton participating in the Swiss cancer registries network. We will document patient age, histology, disease stage, treatment and follow-up data.