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    Testis Ca care deviates from guidelines in 30% of patients

    Inappropriate imaging studies most frequent departure from guidelines, study finds

    Badar M. Mian, MDBadar M. Mian, MD

    “Journal Article of the Month” is a new Urology Times section in which Badar M. Mian, MD, in which Badar M. Mian, MD (left), offers perspective on noteworthy research in the peer-reviewed literature.  Dr. Mian is associate professor of surgery in the division of urology at Albany Medical College, Albany, NY.


    Nearly one-third of men with testicular cancer undergo diagnostic or therapeutic interventions that are at odds with guidelines from the National Comprehensive Cancer Network (NCCN), according a study published in the Journal of Urology (2017; 197:684-9).

    Kevin Wymer, MD, and co-authors from the University of Chicago; Johns Hopkins University, Baltimore; and the University of Southern California, Los Angeles reported that non-guideline-directed care could be identified in 30% of men with testicular cancer.

    Also by Dr. Mian: Major decline in prostate Bx rates follows PSA publications

    The investigators retrospectively analyzed their pooled data to determine the extent to which testicular cancer care follows the NCCN guidelines. Of the 705 consecutive patients with testicular tumor, 80% had the diagnosis made elsewhere before referral to these centers. After excluding non-germ cell or secondary or benign tumors, 536 patients had detailed records available for analysis.

    A mismatch between the documented care and the 2015 NCCN guidelines was noted in 177 patients (30%). Higher likelihood of mismatched care was noted in Hispanic men or those who underwent an orchiectomy at a community site or had pain at presentation or had metastatic disease. The mismatched care was classified into four categories: overtreatment, under-treatment, misdiagnosis, and inappropriate treatment.

    Next: Inappropriate imaging noted in 44%


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