How should we identify high risk testicular tumour patients? Round table discussion

Various prognostic models are used to predict the outcome of testicular tumour patients, and these are usually based on serum tumour marker levels (AFP and hCG), number and size of metastases to para aortic nodes, lungs and supraclavicular nodes. Greater predictive accuracy can be achieved if 'dynamic markers' are used in addition to these pretreatment variables. Dynamic markers are assessed during treatment by examining the rate of tumour marker decline. Prognostic models can subdivide patients into good risk, intermediate risk, and very poor risk groups. Cisplatin may be replaced by the less toxic carboplatin in good risk patients. High dose chemotherapy with autologous bone marrow transplantation should only be considered for very poor risk patients. Prognosis may be worse if the patient is a smoker, or if he has a first degree relative with testicular cancer. New markers such as chromosomal abnormalities or gene mutations should be examined.