OBJECTIVE: To evaluate the practice patterns of Canadian urologists in the management of stage I testicular seminoma.
METHODS: A survey was conducted with a three-page questionnaire among Canadian urologists between July and November 2002. Results: The overall response rate was 48%. The total number of completed and partially completed questionnaires was 198 and 212, respectively. Ninety-four responders described their practice as university-affiliated teaching centre, while 118 reported community-based or private practice. All ordered CT abdomen/pelvis with either chest x-ray or CT scan of chest for staging investigation. Only 1% would order a lymphangiogram. About one third would not offer surveillance as a management option for stage I testicular seminoma. When asked to rank, in order of preference, three management options (surveillance, adjuvant radiotherapy, and adjuvant chemotherapy) under four different clinical scenarios varying in perceived relapse risk and the presence/absence of fertility preservation concern, the majority selected adjuvant radiotherapy as the treatment of choice for a patient with high relapse risk or no fertility concern. When a patient had desire to preserve fertility as well as low relapse risk, surveillance was chosen as the preferred management strategy. There was no significant response difference between academic and community urologists.
CONCLUSION: There was some variation among Canadian urologists in the management of stage I testicular seminoma. The issue of fertility preservation and perceived relapse risk were important factors influencing management decisions. There was no significant difference between academic and community-based urologists with respect to patient volume and management approaches.