Is a Policy of Surveillance Warranted in Early Stage Testicular Cancer Following Orchiectomy?
The progress in imaging modalities and in the available treatment options in recent decades has ren-dered, stage I testicular cancer, the most frequent malignancy in the young male population, highly curable. Seventy percent of seminomas and 50% of nonseminoma testicular tumors are diagnosed as stage 1 disease (Bosl and Motzer 1997; Fossa and Horwich 1989). High inguinal orchiectomy has been the standard initial diagnostic and treatment approach for a patient with a suspected testicular tumor. In the past, even patients with no clinical signs of cancer dissemination were additionally subjected to adjuvant retroperitoneal lymph node dissection (RPLND) or locoregional radiotherapy. There were certainly reasons justifying this cautious approach. Patients with stage I testicular cancer, a highly aggressive disease, had a good prognosis, but due to the insufficient accuracy of clinical staging and a low probability of curing patients with relapsed disease, survival rates were usually proportional to the incidence of relapse and ranged at that time from 70% to 90% (Carter 1983; Maier and Sulak 1973; Whitmose 1979; Peckham and McElwain 1974). Although not proven by randomized trials, some authors believed that a combined approach, which often included chemotherapy, gave a decrease in relapse rate and a higher overall survival.
KeywordsGerm Cell Tumor Testicular Cancer Testicular Tumor Nonseminomatous Germ Cell Tumor Testicular Seminoma
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