Why find an expert
There are more urologists and medical oncologists in the country than testicular cancer patients. Which means many doctors may not see it very often and simply do not have the experience and expertise needed to deal with some of the complexities and nuances involved in testicular cancer treatments. Only a small percentage of doctors can be considered experienced, let alone expert.
Testicular cancer treatments are well established for successful outcomes. However, unfavorable outcomes can occur for many reasons: late diagnosis, misinterpretation of pathology, imaging studies or tumor markers, mis-assignment of risk category, misuse or over use of imaging modalities, inconsistent delivery of chemotherapy, suboptimal Retroperitoneal Lymph Node Dissections and even mortalities from unnecessary treatments.
We are certainly not saying that individual doctors are not capable of treating testicular cancer patients but treatment or oversight by more experienced physicians can help assure better outcomes. High volume centers see larger numbers of testicular cancer patients, have multi-disciplinary teams and have surgeons, pathologists and medical oncologists that have extensively focused their careers on testicular cancer. Their experience breeds familiarity with various guidelines, the ability to customize treatments for each patient and the case experience to confidently make the tough clinical decisions.
To give you some perspective, the National Cancer Database (NCDB) contains over 1500 medical centers that treat cancer and less than 20 of them see 20 or more new testicular cancer patients a year.
A look at stage III testicular cancer patients from 1998 – 2011 showed that patients treated at higher volume centers had better survival outcomes. Center volumes were classified by quartiles of 1-5, 6-10, 11-60 or > 60 testicular cancer patients diagnosed per hospital per year. Better survival outcomes were observed in relationship to hospital volume and were most evident in centers that saw 5 or less vs. > 60 testicular cancer patients per year. The media number of testicular cancer patients seen per hospital per year was 8 with a dramatic range of 1-115 patients seen per year.
A 2014 study indicated that for those applying for certification with the American Board of Urology from 2003 to 2013 only 3.4% of urologists documented doing a RPLND in their case logs. Of those that did log an RPLND, 75% logged the equivalent of 2 RPLNDs per year. Over 50% of all RPLNDs were done by surgeons that logged the equivalent of 4 or less RPLNDs per year. Three urologists logged 23% of all the RPLND cases showing a dramatic difference in individual surgeon volumes ranging from 2 to 118 RPLNDs per year.
All of this is why getting the right diagnosis and treatment protocol may involve getting a second opinion, and it may also mean consulting with an expert. We realize that asking your doctor for a second opinion or for them to reach out for advice from an expert isn't easy. But, a concise commentary, from testicular cancer experts around the world sums it up nicely. Give Practice Makes Perfect: The Rest of the Story in Testicular Cancer as a Model Curable Neoplasm a read and simply print it out and hand it to your physician. If your physician isn't receptive in you getting a second opinion or expert input, then let us know and we can help you get the information you need together and reach out directly to one of the experts.
Find an expert
The Testicular Cancer Resource Center maintains a list of of experts. These are not the only doctors who know how to treat testicular cancer, but most of them have chosen testicular cancer as their specialty / area of research. They see high volumes of patients and are familiar with the complexities and nuances in treating the most difficult of cases. You may not see an expert in your location or be able to travel to them. In this case, contact us as we may know a physician in your area, that while not on the TCRC list, that is more than capable to treating you.
Check out the list of Testicular Cancer Experts maintained by The Testicular Cancer Resource Center.
Testicular Cancer Treatment Guidelines
Testicular cancer guidelines have been developed by various organizations to serve as blueprints for best practices in the diagnosis and treatment of the disease. Medical knowledge and technology are constantly evolving, as do the guidelines. Variations in guidelines exist due to the organizations and committees involved in their development, the timing of the reviews and publications, geographical differences in local practices and on the basis of available data and expert consensus. Below are some of the more commonly referred to guidelines.
National Comprehensive Cancer Network
The National Comprehensive Cancer Network is an alliance of 28 leading cancer centers in the United States. The NCCN Testicular Cancer Guidelines are free but users must register for a free account to access them. The NCCN Guidelines are updated on an ongoing basis and the latest versions are listed on their site.
American Urological Association
In 2019, the American Urological Association (AUA) released their Diagnosis and Treatment of Early Stage Testicular Cancer Guidelines. In full disclosure, our founder served as a reviewer of the guidelines before their publication. Primarily addressing early stage disease, the AUA Guidelines address some issues that are not covered in the NCCN Guidelines.
Guidelines outside of the United States
European Society of Medical Oncology (ESMO)
The 2013 version of the Testicular Seminoma and Non-seminoma: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up have received and eUpdate in 2020 and an eUpdate in 2017.
In 2016, ESMO also held a consensus conference with 36 testicular cancer experts to discuss any controversial issues involving the diagnosis, treatment and follow-up for testicular cancer that have arisen since the 2013 Clinical Practice Guideline publication. The conference publication is available at ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up.