Surveillance for clinical stage I nonseminomatous testis carcinoma: rationale and results

Surveillance protocols for clinical stage I nonseminomatous germ cell tumors of the testis have demonstrated that using current staging methods, approximately 75% of clinical stage I patients can be cured with orchiectomy alone. With treatment of patients who relapse, the overall outcome with surveillance is similar to that of standard therapy. Retrospective analysis of clinical and pathologic parameters appears to identify a subgroup of patients with a very low risk of relapse. If confirmed in prospective studies, this low-risk group will be well suited for orchiectomy with subsequent observation. The remainder of patients have an intermediate (40-60%) risk of relapse. How these remaining patients are best managed is a subject of controversy. The resolution of this controversy will likely require substantial improvement in the methods for predicting relapse, or substantial reductions in the patient burden of surgical and chemotherapeutic treatment.