Redefining Good-prognosis Seminoma: Implications for Clinical Practice of the Updated International Germ Cell Cancer Collaborative Group Classification and Results from the SEMITrends Survey

The 2021 updated International Germ Cell Cancer Collaborative Group classification for seminomatous germ cell tumours confirmed and refined the original classification, introducing the notion that lactate dehydrogenase (LDH) elevation above 2.5 times the upper limit of normal separates the good-risk prognostic group into two distinct subgroups, with clearly inferior survival outcomes for the high-LDH subgroup. Validation of this prognostic factor has understandably opened the question of the optimal management for patients with high-LDH good-risk seminoma. In the absence of prospective evidence, guideline-recommended management options have not changed. However, there is evidence from the testicular cancer community that management trends might have been influenced by the poor prognosis associated with elevated LDH. The Testicular Cancer Guidelines Panel of the European Association of Urology has undertaken a global survey among oncologists and onco-urologists to document management trends and differences. PATIENT SUMMARY: Levels of an enzyme called LDH (lactate dehydrogenase) can differ among patients with testicular cancer that has good prognosis. Recent evidence shows worse outcomes for patients with higher LDH. This information should be used to update clinical guidelines and to tailor personalised treatment plans for these patients.