What are the key considerations for choosing between surveillance, surgery, and chemotherapy in testicular cancer? On this episode of BackTable Urology, host Dr. Rich Matulewicz is joined by Dr. Sean Kern and Dr. Sam Funt for an in-depth discussion on clinical approaches to testicular cancer. They start with a real-world case, reviewing initial evaluation, imaging, tumor markers, and counseling on fertility, body image, and hypogonadism. The conversation highlights how nuanced patient selection influences decisions between surveillance, surgical intervention, and adjuvant chemotherapy.
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Timestamps
00:00 - Introduction01:40 - Initial Case Workup and Counseling06:28 - Why Testicular Cancer Happens09:17 - Management Considerations with Post-Orchiectomy Pathology19:21 - RPLND Benefits and Drawbacks23:39 - Surveillance Schedule and Long Term Follow Up28:17 - Second Tumor Risk30:36 - Evolving Seminoma Treatment37:57 - RPLND Selection Factors40:10 - Adjuvant Chemo Debate and Pathology46:06 - Closing Takeaways
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More about this episode
The episode explores postoperative management, including long-term surveillance, risk of a second tumor, and strategies for lifelong follow-up. The doctors discuss evolving practice in the management of low-volume stage II seminoma, the increasing use of RPLND to reduce chemo and radiation exposure, and the importance of extended patient counseling over multiple visits. The discussion emphasizes individualized care, the role of new diagnostics, and the need for reassurance and support throughout the treatment journey.
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Resources
Society of Urologic Oncology https://suonet.org/home.aspx
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