Use of imaging for active surveillance in testicular cancer: Is real-world practice concordant with guidelines?


  • Bishal Gyawali Queen's University
  • Rebecca Griffiths
  • Andrew G. Robinson
  • Matthew D.F. McInnes
  • Philippe L. Bedard
  • Christopher M. Booth



germ cell tumors, testicular cancer, stage I, seminoma, non-seminoma, active surveillance


Introduction: Imaging is an integral component of active surveillance (AS) following orchiectomy for stage 1 non-seminoma (NSGCT) and seminoma germ cell tumors. In this population-based study, we describe use of imaging among patients with early-stage testicular cancer and evaluate whether they are concordant with guideline recommendations.

Methods: This is a population-based, retrospective cohort study to describe use of imaging among all patients with early-stage testicular cancer treated with AS in the Canadian province of Ontario. The Ontario Cancer Registry was linked to electronic records of treatment to identify use of chest and abdomen/pelvis imaging. Data from 2000–2010 were included, with followup for up to five years for patients with non-seminoma and 10 years for patients with seminoma. The key outcome of interest was the frequency of imaging at temporal milestones following orchiectomy. Compared to the most contemporaneous guidelines in Ontario, any discordant frequency of imaging was defined as underuse or overuse. Substantial under- or overuse was defined as >1 imaging test less/ more than what was recommended during a 12-month period.

Results: The study population included 569 patients with NSGCT (median age 28) and 1107 with seminoma (median age 37). Among patients with NSGCT, adherence with body imaging was low in years 1–3 of surveillance (range 26–37%, predominantly underuse) and higher in years 4–5 (63–67%, predominantly overuse). Adherence with chest imaging was even lower (range 11–34% during years 1–5). Among patients with seminoma, adherence with abdominal and chest imaging was relatively stable and comparable throughout the 10-year followup period (range 23–47% abdomen and 28–47% chest). Multivariable analysis confirmed that underuse of imaging was more common in recent years. NSGCT histology was associated with underuse in years 1–2 but overuse in years 3–5.

Conclusions: In routine clinical practice, patients with testicular cancer commonly receive imaging discordant to the protocol for AS, with a substantial proportion receiving both under- and overuse at various times during surveillance followup.


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How to Cite

Gyawali, B., Griffiths, R. ., Robinson, A. G. ., McInnes, M. D. ., Bedard, P. L. ., & Booth, C. M. . (2021). Use of imaging for active surveillance in testicular cancer: Is real-world practice concordant with guidelines?. Canadian Urological Association Journal, 16(2), 26–33.



Original Research