Open Access

ARTICLE

Appropriateness of testicular cancer management: a population-based cohort study

Winson Y. Cheung¹, Alain Demers², Deloar Hossain³, Tim Owen⁴, Shahida Ahmed⁴, Piotr M. Czaykowski⁵

1 Department of Medical Oncology, University of Toronto, Toronto, Ontario, Canada
2 Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
3 Bostwick Laboratories, Glen Allen, Virginia, USA
4 Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
5 Section of Hematology/Oncology and Department of Community Health Sciences, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
Address correspondence to Dr. Piotr M. Czaykowski, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9 Canada

Canadian Journal of Urology 2007, 14(3), 3542-3550.

Abstract

Objective: Testicular cancer is a highly curable malignancy of young men. Appropriate and timely management is critical to ensure optimal clinical outcomes. A 3-year population-based review of testicular cancer patients in Manitoba, Canada was undertaken to evaluate our management patterns.
Methods: Men diagnosed with testicular cancer from 1998 to 2000 were identified from the Provincial Cancer Registry. Chart review was utilized to collect information on demographic characteristics, timelines of diagnostic and staging investigations, completeness of pathology reports, management, and outcomes.
Results: Seventy-eight men were identified with 80 testicular cancers: 46 (59%) patients had 48 seminomas and 32 (41%) had non-seminomatous germ cell tumors (NSGCT). One or more pre-operative tumor markers were missing or unavailable in 41 (52%) cases. Median time from scrotal ultrasound to orchiectomy was 7 days, but was greater than 2 weeks in 13 (16%) patients. Pathology reports provided acceptable detail in only 21 (27%) cases. Eighteen subjects (23%) did not complete necessary staging investigations (chest and abdominal imaging, and post-orchiectomy markers) until at least 3 weeks after surgery. Post-orchiectomy management of both seminoma and NSGCT patients was largely within acceptable limits apart from some non-standard chemotherapy choices in advanced stage disease, and significant departures from standard recommendations regarding surveillance. The Kaplan-Meier estimate of overall survival at 5 years is 97% in seminoma and 84% in NSGCT.
Conclusions: Although clinical outcomes do not appear to have been compromised, deficiencies are evident in testicular cancer management in Manitoba from 1998 to 2000, indicating the need for well-defined management guidelines and improved education of caregivers.

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