Management of Testicular Cancer at Milton Keynes University Hospital NHS Foundation Trust: A Five-Year Retrospective Analysis

Abstract

Intr oduction: According to the European Association of Urology (EAU) guidelines, testicular cancer accounts for 1% of adult malignancies and 5% of urological tumours, with an incidence of 3 - 10 per 100,000 males annually in Western countries. Germ cell tumours (GCTs) represent 90% - 95% of cases, with non-seminomatous and mixed GCTs typically presenting in the third decade of life, and seminomas in the fourth. Early diagnosis through physical examination, scrotal ultrasound, tumour markers, and staging imaging is essential. Methods: A retrospective audit was conducted at Milton Keynes University Hospital, reviewing cases of testicular cancer from September 2018 to May 2024. Patients were identified through electronic medical records and data were extracted on demographics, tumour markers, imaging, histopathology, and management. Results: Forty patients were included, aged 18 to 89 years. Pre-operative ultrasound identified features of testicular tumour in 90% (36/40), though 10% (4/40) had benign histology. Conversely, 5% (2/40) had normal ultrasound findings but malignant histology. Elevated AFP, β -HCG, and LDH were observed in 10% (4/40), 25% (10/40), and 47.5% (19/40) respectively. Histopathology confirmed seminoma in 45% (18/40), mixed GCT in 32.5% (13/40), and other rare tumours in the remaining cases. Staging CT scans were performed in 82.5% (33/40), and post-operative tumour markers were monitored. Sperm banking was offered to 60% (24/40) and prosthesis placement to 27.5% (11/40). Conclusion: The management of testicular cancer at our centre aligns with EAU guidelines, demonstrating adherence to recommended diagnostic pathways, surgical management, and supportive care.