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 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:
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