Second opinion on testicular tumors: quality diagnosis and treatment

Marina Virko
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For over a decade, German patients with cancer of the testes have been entitled to a free online second opinion procedure. Primary physicians can obtain a second opinion from the expert of their choice within one or two days.

Berlin/Hamburg – A little more than ten years ago, the German Society of Urology (DGU) launched the Testicular Tumor Second Opinion project. In 2018, every third newly diagnosed testicular tumor case was submitted for review by the national expert network. An interim evaluation based on the analysis of more than 6000 cases proved that it had led to therapy improvement in about 20 percent of cases, the DGU reported.

The network’s experts describe it as “therapy improvement” when the initially planned therapy did not take into account all clinical features and therefore did not fully comply with the current guidelines. Most often it concerned testicular cancer stage IIA patients with small nodules in the abdominal cavity.

"Those could be both metastases and nonspecific lymph node enlargement", -explains Mark Schrader, project co-initiator and leader. In such cases, inexperienced doctors may often recommend chemotherapy. According to current standards, however, it would be advisable to wait six weeks to check whether we are indeed dealing with metastases, Schrader told the newspaper “Deutsches Ärzteblatt”.

Another mistake in therapy planning that the experts of the Second Opinion Testicular Tumor Project often have to correct is the adjuvant therapy of stage I testicular tumors, explains the chief physician of the Helios Klinikum Berlin-Buch urology department. Already for several years, valid guidelines have been recommending only one cycle with cisplatin, etoposide and bleomycin (BEP) instead of two ones.

"We knew that the treatment quality of testicular tumors, which are a rare cancer type, varies greatly from region to region", - Schrader says. He adds that often there is limited experience in dealing with advanced stage cases.

A centralized network facilitating second opinions and advice from experienced   physicians ensures effective therapy planning, regardless of where this relatively rare type of urologic cancer is primarily being treated.

Currently another project is being launched in Germany. It is dedicated to a second opinion on penile cancer, which is another rare urological condition. For this purpose, a German Penile Cancer Registry has been created and a pilot model of a national second opinion procedure on penile cancer has been developed.

© gie/aerzteblatt.de


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