European Association of Urology Guidelines on Testicular Cancer: 2023 Update
- Study type
- Clinical guideline
- Study name
- EAU TC 2023
- Design
- Clinical guideline; summary of the 2023 version of the annual EAU guideline, based on a structured literature search, with a strength rating for each recommendation
- Source
- Eur Urol · 2023
In plain words
This European Association of Urology guideline is the association’s official summary on the diagnosis and treatment of testicular cancer: ultrasound and blood tests before surgery, removal of the testicle through the groin, an offer of sperm banking, regular follow-up as the preferred option for most stage 1 patients, and, for spread disease, chemotherapy with a number of courses matched to the prognostic group.
Key points
Key guideline recommendations
- Strong
Stage I seminoma: fully inform the patient about all management options, including surveillance or adjuvant therapy after orchidectomy, and about the treatment-specific recurrence rates and acute and long-term side effects.
- Strong
Stage I seminoma: offer surveillance as the preferred management option if resources are available and the patient is compliant.
- Strong
Stage I seminoma: offer one dose of carboplatin at an AUC of 7 if adjuvant chemotherapy is considered.
- Strong
Stage I seminoma: do not give adjuvant treatment to patients at very low risk of recurrence (no risk factors).
- Strong
Stage I seminoma: do not give adjuvant radiotherapy routinely; reserve it for highly selected patients who are not suitable for surveillance and have a contraindication to chemotherapy.
- Strong
Stage I non-seminoma: inform patients about all management options after orchidectomy (surveillance, adjuvant chemotherapy and RPLND), the recurrence rates and the acute and long-term side effects of each.
- Strong
Stage I non-seminoma: offer surveillance or risk-adapted treatment based on lymphovascular invasion.
- Strong
Stage I non-seminoma: discuss one course of BEP as an adjuvant treatment alternative if the patient is not willing to undergo or comply with surveillance.
- Strong
Treat low-volume stage IIA/IIB non-seminoma with raised markers as IGCCCG good- or intermediate-prognosis metastatic disease, with 3 or 4 cycles of BEP.
- Weak
In clinical stage IIA non-seminoma without raised markers, nerve-sparing RPLND by an experienced surgeon in a specialised centre is the recommended initial treatment.
- Weak
In small-volume (stage IIA, less than 2 cm) marker-negative non-seminoma, consider repeat staging after 6 weeks before the final decision.
- Strong
Treat metastatic non-seminoma (above stage IIC) with intermediate prognosis with 4 cycles of standard BEP.
- Weak
Metastatic non-seminoma with poor prognosis: give one cycle of BEP (or VIP if lung function is impaired) and assess the markers after 3 weeks; with a favourable decline continue the same regimen up to 4 cycles, and with an unfavourable decline intensify chemotherapy.
- Strong
Surgically remove visible residual masses (more than 1 cm) after chemotherapy for non-seminoma when markers are normal or normalising.
- Weak
Stage IIA/IIB seminoma: initially offer cisplatin-based chemotherapy according to the IGCCCG prognostic group, or alternatively radiotherapy, and inform the patient about the possible late effects of both.
- Strong
Treat stage IIC seminoma with primary chemotherapy according to IGCCCG (BEP×3 in good prognosis and BEP×4 in intermediate prognosis).
- Weak
In men with metastatic germ cell tumours, weigh each patient’s potential benefits and risks of thromboprophylaxis during first-line chemotherapy.
- Weak
Avoid central venous-access devices during first-line chemotherapy whenever possible.
Study population
Men with testicular cancer (germ cell tumours) at all stages: diagnosis, treatment of stage I, metastatic disease, relapse and follow-up after treatment.
Endpoints
Recommendations are given as “strong” or “weak”.
Safety and side effects
Before treatment, patients should be informed about long-term toxicities: metabolic syndrome, cardiovascular events, second malignancies (35-year cumulative incidence 20%; 95% CI 18.9–21.5%) and psychological effects such as anxiety, depression and fatigue. Subnormal testosterone levels have been reported in survivors treated with chemotherapy.
Clinical significance and place in guidelines
This summary brings together the main EAU recommendations across all stages: active surveillance as the preferred option in stage I seminoma, and one dose of carboplatin AUC 7 if adjuvant treatment is considered; surveillance or risk-adapted treatment based on lymphovascular invasion (one cycle of BEP) in stage I non-seminoma; BEP×3 in good prognosis and BEP×4 in intermediate and poor prognosis; assessment of marker decline after one cycle of BEP in poor prognosis; and VIP, TIP or GIP for salvage. The full, current guideline is updated every year on the EAU website (the 2026 version with a summary published in the same journal).
Limitations
The abstract is general; the recommendations on this card are taken from the tables and text of the full 2023 paper. Much of the supporting evidence is retrospective or from older trials, and some recommendations (such as thromboprophylaxis) are weak. Later versions (2024 to 2026) may have changed some details.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.