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Pelvic Scans May Not Be Needed During Surveillance for Early Testicular Cancer

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Safety of omitting pelvic imaging in patients with stage I germ cell tumor (GCT) on surveillance A multi-institutional study.DOI 10.1016j.urolonc.2025.12.002

Many men with stage I germ cell tumors, a common form of testicular cancer, are treated with active surveillance after surgery. This means doctors monitor patients closely with regular tests and scans instead of giving immediate additional treatment.

Surveillance usually includes several CT scans, which help detect cancer recurrence early. These scans are helpful but also expose young patients to radiation over many years, and they add to healthcare costs.A new study looked at whether routine pelvic CT scans are really necessary during surveillance.

Researchers analyzed 285 patients with stage I germ cell tumors who were followed at three major medical centers. During follow-up, about 15% of patients developed recurrence in pelvic or groin lymph nodes.However, most of these recurrences were also visible on standard abdominal CT scans or appeared together with other recurrence sites. Only 5 patients (1.7%) had recurrence that could be detected only on pelvic CT scans.

For patients without risk factors like undescended testicle or previous groin surgery, the chance of a recurrence detectable only in the pelvis was even lower, around 1.3%.

If pelvic scans were removed from routine surveillance, patients could receive less radiation exposure over time. The study estimated a reduction of about 2–3.5 millisieverts of radiation over five years. It could also save around 700 to 800 dollars per patient in healthcare costs.

These findings suggest that routine pelvic CT scans may not be necessary for many patients with early testicular cancer. Doctors may still use pelvic imaging in selected cases, but reducing unnecessary scans could make surveillance safer and more cost-effective.

DOI: 10.1016/j.urolonc.2025.12.002

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