UROLOGICAL ONCOLOGY

Impact of diagnostic delay in testis cancer: results of a large population-based study
Huyghe E, Muller A, Mieusset R, Bujan L, Bachaud JM, Chevreau C, Plante P, Thonneau P
Human Fertility Research Group, Paule de Viguier Hospital, Toulouse University III, France; Urology and Andrology Department, Paule de Viguier Hospital, Toulouse, France
Eur Urol. 2007; 52: 1710-6

• Objective: Testis cancer is the most common cancer in young men, and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. Diagnostic delay (DD), defined as the time elapsing from the onset of tumour symptoms to the day of diagnosis, is a way to evaluate the rapidity of diagnosis. We assessed the relationship between DD, disease stage, and survival rate.
• Methods: A series of 542 patients diagnosed with a germ cell tumour between 1983 and 2002 at health facilities in the Midi-Pyrenees region, southwest France, were asked about DD. We analysed DD together with data regarding the disease (histologic type, stage), its treatments, and prognosis (impact on survival).
• Results: Mean DD was longer in seminoma (4.9 +/- 6.1 mo) than in non-seminomatous germ cell tumour (NSGCT; 2.8 +/- 4.0 mo). DD was correlated with disease stage for the whole population (p = 0.014) and for NSGCT (p = 0.0009), but not for seminoma. DD had a significant impact on the 5-yr survival rate in the overall population (p = 0.001) and in the NSGCT group (p = 0.001), but not in the seminoma group. Global trends in mean DD did not change over the 20-yr study period, but we observed a slight decrease during the last decade.
• Conclusions: DD is highly correlated with stage and survival in NSGCT. Urologists should promote programmes to enhance awareness and knowledge of testis cancer, so the diagnosis can be made more rapidly.
  
  
• Editorial Comment
  The authors report on the impact of diagnostic delay on ultimate outcome on survival. They report on a large cohort of 542 patients over a time of 20 years. This paper shows quite impressively that testicular tumors are often neglected by the patients for longer periods. Differences between seminomas and non-seminomatous germ cell tumors (NSGCT) certainly relate to the different growth rates between these tumors and how fast the patient begins to feel uncomfortable with this unclear process in his scrotum. In fact, diagnostic delay in NSGCT resulted in a significantly impaired survival. The authors state correctly that consequently, testis cancer awareness programs should be promoted and young men should be educated in scrotal self-examination.
  One final question however was not addressed in this paper, that is the role of the physician. Was there any significant delay between first visit to a physician and diagnosis? Any differences between general practitioner and urologist?
  I recommend thorough reading of this article.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de