Management of stage I nonseminomatous germ-cell tumors

Following orchiectomy in patients with stage 1 nonseminomatous germ-cell tumors (NSGCT), there are three treatment options. Retroperitoneal lymph-node dissection (RPLND) is currently the treatment of choice in the United States and can be both diagnostic and therapeutic but is associated with surgical morbidities. Surveillance is the least invasive but carries the highest potential for relapse and can be timely and costly for both patient and physician. Primary chemotherapy avoids the morbidity of surgery while achieving similar survival rates, albeit with potentially significant side effects. The advantages and disadvantages of each treatment modality are discussed.