[Orchidectomy only for stage I testicular teratoma?]

In the past few years the therapeutic options for non-seminomatous germ-cell tumors of the testis have evolved rapidly. Until recently it was usual practice with patients in clinical stage I to perform lymphadenectomy or retroperitoneal radiotherapy after orchidectomy. However, for 60-80% of these patients this therapy was not necessary, since they were already cured by orchidectomy alone. With the improvement of clinical staging and the success of modern chemotherapy, it seems to be possible to follow up stage I patients clinically. The various aspects which justify this "wait-and-see" strategy are discussed. Further, the question is discussed whether all patients in clinical stage I may be treated in this way, or whether specific groups at severe risk of metastatic disease at the time of orchidectomy should be excluded.