Stage I nonseminomatous germ cell tumors: the case for management by risk stratification

For patients with clinical stage I nonseminomatous germ cell tumor (NSGCT), the therapeutic options after orchiectomy are retroperitoneal lymphadenectomy, surveillance, and chemotherapy. Ideally the option selected will be based on an individualized assessment of the estimated risk of progression based on prognostic factors, so called risk-adapted treatment, to reduce overall burden of therapy while maintaining survival. It is possible to identify patients at low risk of progression who can be followed by active surveillance initially. Prognostic factors for high risk, while well defined, do not identify all patients at risk and those that are destined to progress, can usually be salvaged with delayed therapy. Most centres recommend either surgery or primary chemotherapy for those defined as being at high risk for progression. Prognostic factors for high risk however, while well defined, do not identify all patients at risk and those that are destined to progress, can usually be salvaged with delayed therapy.