Initial management of testicular cancer: practice survey among urologists and pathologists.
BACKGROUND
The objective of this study was to conduct a declarative professional practices survey among urologists of the French Association of Urology (AFU) and French pathologists concerning their management of testicular cancer.


METHODS
A questionnaire was sent to all urologists, members of the AFU, and another questionnaire was sent to French pathologists, members of the International Academy of Pathology, French Division, in June 2010. A total of 289 urologists (29%) and 84 pathologists (19%) returned the questionnaires.


RESULTS
Fifty-seven percent of urologists declared that they performed fewer than 5 orchidectomies per year. Pathologists declared that they examined less than 5 orchidectomy specimens per year in 24% of cases. The laboratory work-up (only alpha fetoprotein [AFP], lactate dehydrogenase [LDH], and total human chorionic gonadotropin [hCG]) and the radiological work-up (only testicular ultrasound and chest, abdomen, and pelvis computed tomography [CT] scan) were performed strictly according to guidelines in 15.9% and 65.7% of cases, respectively. A total of 31.8% of urologists declared that they performed the minimum assessment required by guidelines (AFP, LDH, total hCG, testicular ultrasound and chest, abdomen, and pelvis CT scan plus other examinations not recommended). Prognostic factors of stage I tumors, to define the indications for adjuvant therapy, were correctly declared in 7.3% of nonseminomatous germ cell tumors (vascular and/or lymphatic emboli) and in 13.8% of seminomas (tumor size >4 cm and rete testis invasion).


CONCLUSIONS
This survey demonstrated that clinical practice did not comply with guidelines, which raises the question of the measures that can be taken to ensure better application of guidelines or how to develop expert centers for the management of these rare tumors.
Service d'Urologie, Hôpital Hôtel Dieu, Nantes, France. Electronic address: jrigaud@chu-nantes.fr.
Jérôme
J
Rigaud
Service d'Urologie, Hôpital Val de Grâce, Paris, France.
Xavier
X
Durand
Service d'Anatomo-Pathologie, Amiens, France.
Philippe
P
Camparo
Service d'Urologie, Clinique Kennedy, Nîmes, France.
Christophe
C
Avances
Service d'Oncologie, Hôpital Saint Louis, Paris, France.
Stéphane
S
Culine
Service d'Urologie, Groupe Hospitalier Diaconesses, Croix Saint Simon, France.
Philippe
P
Sebe
Service d'Oncologie Médicale, centre Léon Bérard, Lyon, France.
Aude
A
Flechon
Service d'Urologie, Hôpital Lapeyronie, Montpellier, France.
Thibaut
T
Murez
Service d'Urologie, Hôpital de Rangueil, Toulouse, France.
Michel
M
Soulie
D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D008297:Male; D009919:Orchiectomy / Q000706:statistics & numerical data*; D010338:Pathology, Clinical; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011795:Surveys and Questionnaires; D013736:Testicular Neoplasms / Q000601:surgery*; D014572:Urology
Compliance; Guidelines; Orchidectomy; Seminoma; Testis