[Is it necessary to begin therapy with orchiectomy in patients with advanced stage testicular tumors?]

Seven patients with germ cell tumours of the testis in advanced stages of the disease were treated by primary chemotherapy without previous orchidectomy. To achieve complete remission it was necessary to remove the residual tumour in five patients (in two from the lungs and in three from the retroperitoneal space). Two of the seven patients had a persisting vital tumour in the ectomized testis. Five patients survive in complete remission for an average period of 9.6 months (range 3-18 months) after termination of treatment. In patients with germ cell tumours of the testis in advanced stages of the disease primary chemotherapy should be preferred and treatment should not be started by orchidectomy. Contemporary methods of visualization and laboratory examinations provide adequate evidence of the presence of germ cell tumours and the asset of a rapid effect of chemotherapy on metastases is greater than the advantages of accurate histopathological classification of the tumour. After termination of chemotherapy orchidectomy is indicated because even in patients with complete remission of secondaries a vital malignant tumour may persist.