Active surveillance following orchiectomy for stage I testicular germ cell tumors
- Graeme S Steele, MBBCh, FCS
Graeme S Steele, MBBCh, FCS
- Assistant Professor of Surgery
- Harvard Medical School
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Testicular germ cell tumors (GCTs) have become one of the most curable solid neoplasms due to remarkable treatment advances that began in the late 1970s. These include a better understanding of the natural history of testicular tumors, improved staging and surgical techniques, the availability of serum tumor markers, and the use of effective platinum-based combination chemotherapy . Prior to that time, testicular cancer accounted for 11 percent of all cancer deaths in men between the ages of 25 and 34, and the five-year survival rate was 64 percent . With modern treatment, the five-year survival rate for all men with testicular GCTs is over 95 percent .
Following orchiectomy, men with clinical stage I testicular GCTs (table 1A-B) can be managed with active surveillance or a short course of adjuvant chemotherapy. For men with seminoma, radiation therapy is also an option; for those with nonseminomatous GCTs, retroperitoneal lymph node dissection (RPLND) is an alternative. There have been no randomized trials comparing active surveillance with adjuvant therapy or RPLND.
Regardless of treatment strategy, the long-term cancer-specific survival for clinical stage I testicular GCTs approaches 100 percent . The approach to treatment in an individual patient is based upon a detailed consideration of patient-specific factors and the short-term and long-term toxicities associated with each approach.
This topic will review the role of active surveillance following orchiectomy in appropriately selected patients. Related topics include:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Motzer RJ, Agarwal N, Beard C, et al. Testicular cancer. J Natl Compr Canc Netw 2012; 10:502.
- Einhorn LH. Treatment of testicular cancer: a new and improved model. J Clin Oncol 1990; 8:1777.
- Ries LA, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1975-2001, National Cancer Institute, Bethesda, MD, 2004 http://seer.cancer.gov/csr/1975_2007/index.html (Accessed on April 11, 2011).
- Stephenson AJ, Aprikian AG, Gilligan TD, et al. Management of low-stage nonseminomatous germ cell tumors of testis: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology 2011; 78:S444.
- Richie JP, Garnick MB, Finberg H. Computerized tomography: how accurate for abdominal staging of testis tumors? J Urol 1982; 127:715.
- Gels ME, Hoekstra HJ, Sleijfer DT, et al. Detection of recurrence in patients with clinical stage I nonseminomatous testicular germ cell tumors and consequences for further follow-up: a single-center 10-year experience. J Clin Oncol 1995; 13:1188.
- Nicolai N, Pizzocaro G. A surveillance study of clinical stage I nonseminomatous germ cell tumors of the testis: 10-year followup. J Urol 1995; 154:1045.
- Vergouwe Y, Steyerberg EW, Eijkemans MJ, et al. Predictors of occult metastasis in clinical stage I nonseminoma: a systematic review. J Clin Oncol 2003; 21:4092.
- Alexandre J, Fizazi K, Mahé C, et al. Stage I non-seminomatous germ-cell tumours of the testis: identification of a subgroup of patients with a very low risk of relapse. Eur J Cancer 2001; 37:576.
- Albers P, Siener R, Kliesch S, et al. Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial. J Clin Oncol 2003; 21:1505.
- Schmoll HJ, Souchon R, Krege S, et al. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15:1377.
- Freedman LS, Parkinson MC, Jones WG, et al. Histopathology in the prediction of relapse of patients with stage I testicular teratoma treated by orchidectomy alone. Lancet 1987; 2:294.
- http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf (Accessed on January 13, 2016).
- Mortensen MS, Lauritsen J, Kier MG, et al. Late Relapses in Stage I Testicular Cancer Patients on Surveillance. Eur Urol 2016; 70:365.
- Nayan M, Jewett MA, Hosni A, et al. Conditional risk of relapse and surveillance for clinical stage I testicular cancer. Eur Urol 2016.
- Ernst DS, Brasher P, Venner PM, et al. Compliance and outcome of patients with stage 1 non-seminomatous germ cell tumors (NSGCT) managed with surveillance programs in seven Canadian centres. Can J Urol 2005; 12:2575.
- Yu HY, Madison RA, Setodji CM, Saigal CS. Quality of surveillance for stage I testis cancer in the community. J Clin Oncol 2009; 27:4327.
- Loehrer PJ Sr, Gonin R, Nichols CR, et al. Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor. J Clin Oncol 1998; 16:2500.
- Pico JL, Rosti G, Kramar A, et al. A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours. Ann Oncol 2005; 16:1152.
- Miller KD, Loehrer PJ, Gonin R, Einhorn LH. Salvage chemotherapy with vinblastine, ifosfamide, and cisplatin in recurrent seminoma. J Clin Oncol 1997; 15:1427.
- Vuky J, Tickoo SK, Sheinfeld J, et al. Salvage chemotherapy for patients with advanced pure seminoma. J Clin Oncol 2002; 20:297.
- Fosså A, Fosså SD. Serum lactate dehydrogenase and human choriogonadotrophin in seminoma. Br J Urol 1989; 63:408.