Diagnostics and therapy of germinal testicular tumors

Based on experience in the treatment of 627 patients with germinal testicular tumor and referring to recent literature, the age distribution (children, 3.6%, men over 50 years, 6.3%), importance and possibilities of early detection as well as sensitivity, specificity and accuracy of tumor markers, ultrasonography and X-ray examinations are described. In N0M0 stage seminomas, cure can be effected by radiotherapy in almost 100% of the cases. An alternative 'watch policy' is discussed. In N1-2M0 stage seminomas, cure can be achieved by irradiation in more than 90% of the cases. Primary polychemotherapy is needed in stage N3M0 or M1 as well as in stage N4M0 and N1-4M1 seminomas. Complete remission can be obtained in more than 90% of the patients if salvage operation, further chemotherapy or radiotherapy is performed in cases without complete remission after semicastration and primary chemotherapy. In N0M0 stage non-seminomas (excluding pT4 cases, choriocarcinoma, and patients with persistently elevated markers following semicastration), 'watch policy' has the disadvantage of requiring optimal monthly follow-ups and progression in 20% of the cases. While modified lymphadenectomy reduces the progression rate to 10% with low operative morbidity, it leads to an irreversible loss of ejaculation in 12% of the patients. With both modalities, if progression is detected, full recovery can be expected with immediate polychemotherapy. In stage N1-2M0 non-seminomas, a tumor-free condition can be obtained in close to 100% of the cases by lymphadenectomy and adjuvant chemotherapy. In stage N3,4 and/or M1, first primary polychemotherapy is carried out. In the case of a residual tumor this is followed by salvage operation and, if active tumor is found, by salvage chemotherapy. With this treatment, recovery can be achieved in 70-80% of the cases depending on the involvement of surrounding organs.