Testicular germ cell tumors represent the most common malignancies in young males; 70% of patients with seminomas and 50% of those with nonseminomatous germ cell tumors (NSGCT) have clinical stage I at diagnosis. Lymphovascular invasion, embryonal-cell carcinoma component, absence of yolk sac histology and MIB1 proliferation rate represent predictors of micrometastatic diseasein stage I NSGCT. Therapeutic options following orchiectomy in patients with stage I NSGCT comprise nerve-sparing retroperitoneal lymph node dissection, surveillance or adjuvant cisplatin-based chemotherapy. All available treatment modalities produce excellent results, with a long-term survival of almost 100%. Consequently, therapy-induced toxicity is an important concern in the management of these patients. An individually tailored approach that takes into account the prognostic factor profile as well as the patient’s preferences and their ability to comply with each one of the modalities is the key to the management of stage I testicular cancer.

1.
Warde P, Jewett MA: Surveillance for stage I testicular seminoma: is it a good option? Urol Clin North Am 1998;25:425–433.
2.
Read G, Stenning SP, Cullen MH, et al: Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party. J Clin Oncol 1992;10:1762–1768.
3.
Sturgeon JF, Jewett MA, Alison RE, et al: Surveillance after orchidectomy for patients with clinical stage I nonseminomatous testis tumors. J Clin Oncol 1992;10:564–568.
4.
Donohue JP, Thornhill JA, Foster RS, et al: Retroperitoneal lymphadenectomy for clinical stage A testis cancer (1965–1989): modifications of technique and impact on ejaculation. J Urol 1993;149:237–243.
5.
Cullen MH, Stenning SP, Parkinson MC, et al: Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report. J Clin Oncol 1996;14:1106–1113.
6.
Pont J, Albrecht W, Postner G, et al: Adjuvant chemotherapy for high-risk clinical stage I nonseminomatous testicular germ cell cancer: long-term results of a prospective trial. J Clin Oncol 1996;14:441–448.
7.
Böhlen D, Borner M, Sonntag RW, et al: Long-term results following adjuvant chemotherapy in patients with clinical stage I testicular nonseminomatous malignant germ cell tumors with high risk factors. J Urol 1999;161:1148–1152.
8.
Dearnaley DP, Fossa SD, Kaye SB, et al: Adjuvant bleomycin, vincristine and cisplatin (BOP) for high risk clinical stage I (HRCSI) non-seminomatous germ cell tumours (NSGCT): a Medical Research Council (MRC) pilot study (abstract). Proc Am Soc Clin Oncol 1998;17:309a.
9.
Pectasides D, Skarlos D, Dimopoulos AM, et al: Two cycles of carboplatin-based adjuvant chemotherapy for high-risk clinical stage I and stage IM non-seminomatous germ cell tumours of the testis: a HECOG trial. Anticancer Res 2003;23:4239–4244.
10.
Sobin LH, Wittekind CH (eds): TNM Classification of Malignant Tumours. Union Internationale contre le Cancer, ed 5. New York, Wiley-Liss, 1997.
11.
Sogani PC, Perrotti M, Herr HW, et al: Clinical stage I testis cancer: long-term outcome of patients on surveillance. J Urol 1998;159:855–858.
12.
Spermon JR, Roeleveld TA, van der Poel HG, et al: Comparison of surveillance and retroperitoneal lymph node dissection in stage I nonseminomatous germ cell tumors. Urology 2002;59:923–929.
13.
Roeleveld TA, Horenblas S, Meinhardt W, et al: Surveillance can be the standard of care for stage I nonseminomatous testicular tumors and even high risk patients. J Urol 2001;166:2166–2170.
14.
Moul JW, McCarthy WF, Fernandez EB, et al: Percentage of embryonal carcinoma and of vascular invasion predicts pathological stage in clinical stage I nonseminomatous testicular cancer. Cancer Res 1994;54:362–364.
15.
Heidenreich A, Sesterhenn IA, Mostofi FK, et al: Prognostic risk factors that identify patients with clinical stage I nonseminomatous germ cell tumors at low risk and high risk for metastasis. Cancer 1998;83:1002–1011.
16.
Leibovitch I, Foster RS, Kopecky KK, et al: Identification of clinical stage A nonseminomatous testis cancer patients at extremely low risk for metastatic disease: a combined approach using quantitative immunohistochemical, histopathologic, and radiologic assessment. J Clin Oncol 1998;16:261–268.
17.
Heidenreich A, Albers P, Hartmann M, et al: Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. J Urol 2003;169:1710–1714.
18.
Lewis DJ, Sesterhenn IA, McCarthy WF, et al: Immunohistochemical expression of p53 tumor suppressor gene protein in adult germ cell testis tumors: clinical correlation in stage I disease. J Urol 1994;152:418–423.
19.
Albers P, Orazi A, Ulbright TM, et al: Prognostic significance of immunohistochemical proliferation markers (Ki-67/MIB-1 and proliferation-associated nuclear antigen), p53 protein accumulation, and neovascularization in clinical stage A nonseminomatous testicular germ cell tumors. Mod Pathol 1995;8:492–497.
20.
Foster RS, Roth BJ: Clinical stage I nonseminoma: surgery versus surveillance. Semin Oncol 1998;25:145–153.
21.
Sesterhenn IA, Weiss RB, Mostofi FK, et al: Prognosis and other clinical correlates of pathologic review in stage I and II testicular carcinoma: a report from the Testicular Cancer Intergroup Study. J Clin Oncol 1992;10:69–78.
22.
Donohue JP, Foster RS: Retroperitoneal lymphadenectomy in staging and treatment: the development of nerve-sparing techniques. Urol Clin North Am 1998;25:461–468.
23.
McLeod DG, Weiss RB, Stablein DM, et al: Staging relationships and outcome in early stage testicular cancer: a report from the Testicular Cancer Intergroup Study. J Urol 1991;145:1178–1183.
24.
Janetschek G, Hobisch A, Peschel R, et al: Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular carcinoma: long-term outcome. J Urol 2000;163:1793–1796.
25.
Nelson JB, Chen RN, Bishoff JT, et al: Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular tumors. Urology 1999;54:1064–1067.
26.
Horwich A, Peckham MJ: Surveillance after orchidectomy for clinical stage I germ-cell tumours of the testis. Prog Clin Biol Res 1988;269:471–479.
27.
Pizzocaro G, Pasi M, Zanoni F, et al: Relapse pattern of pathologic stage I nonseminomatous germ cell tumors of the testis following orchidectomy and lymphadenectomy. Eur Urol 1985;11:79–82.
28.
Freedman LS, Parkinson MC, Jones WG, et al: Histopathology in the prediction of relapse of patients with stage I testicular teratoma treated by orchidectomy alone. Lancet 1987;ii:294–298.
29.
Peckham MJ, Barrett A, Horwich A, et al: Orchiectomy alone for stage I testicular non-seminoma: a progress report on the Royal Marsden Hospital study. Br J Urol 1983;55:754–759.
30.
Raghavan D, Colls B, Levi J, et al: Surveillance for stage I non-seminomatous germ cell tumours of the testis: the optimal protocol has not yet been defined. Br J Urol 1988;61:522–526.
31.
Thompson PI, Nixon J, Harvey VJ: Disease relapse in patients with stage I nonseminomatous germ cell tumor of the testis on active surveillance. J Clin Oncol 1988;6:1597–1603.
32.
Hornak M, Zvara V, Ondrus D: ‘Surveillance’ of non-seminomatous testicular tumors: a prospective study of 100 patients in the first stage of illness. Ann Urol (Paris) 1992;26:306–310.
33.
Swanson DA: The case for observation of patients with clinical stage I nonseminomatous germ cell testicular tumors. Semin Urol 1993;11:92–98.
34.
Patel SR, Richardson RL, Kvols L, et al: Observation after orchiectomy in clinical stage I nonseminomatous germ cell tumor of testis: Mayo Clinic experience. Am J Clin Oncol 1990;13:379–381.
35.
Rorth M, Jacobsen GK, von der Maase H, et al: Surveillance alone versus radiotherapy after orchiectomy for clinical stage I nonseminomatous testicular cancer. Danish Testicular Cancer Study Group. J Clin Oncol 1991;9:1543–1548.
36.
Nicolai N, Pizzocaro G: A surveillance study of clinical stage I nonseminomatous germ cell tumors of the testis: 10-year follow-up. J Urol 1995;154:1045–1049.
37.
Gels ME, Hoekstra HJ, Sleijfer DT, et al: Detection of recurrence in patients with clinical stage I nonseminomatous testicular germ cell tumors and consequences for further follow-up: a single-center 10-year experience. J Clin Oncol 1995;13:1188–1194.
38.
Sandeman TF, Yang C: Results of adjuvant chemotherapy for low-stage nonseminomatous germ cell tumors of the testis with vascular invasion. Cancer 1988;62:1471–1475.
39.
Gimmi S, Sonntag R, Brunner K, et al: Adjuvant treatment of high risk (HR) clinical stage I testicular carcinoma (TC) with cisplatin (C), bleomycin (B) and vinblastine (V) or etoposide (E). Proc Am Soc Clin Oncol 1990;9:140.
40.
Madej G, Pawinski A: Risk-related adjuvant chemotherapy for stage I non-seminoma of the testis. New Trends of Diagnostics and Treatment of Testicular Tumours, 3rd International Symposium on Advances in Urologic Oncology, San Remo, 1991, vol 51.
41.
Bajorin DF, Sarosdy MF, Pfister DG, et al: Randomized trial of etoposide and cisplatin versus etoposide and carboplatin in patients with good-risk germ cell tumors: a multiinstitutional study. J Clin Oncol 1993;11:598–606.
42.
Horwich A, Sleijfer DT, Fossa SD, et al: Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide, and carboplatin in good-prognosis metastatic nonseminomatous germ cell cancer: a Multiinstitutional Medical Research Council/European Organization for Research and Treatment of Cancer Trial. J Clin Oncol 1997;15:1844–1852.
43.
Studer UE, Fey MF, Calderoni A, et al: Adjuvant chemotherapy after orchiectomy in high-risk patients with clinical stage I non-seminomatous testicular cancer. Eur Urol 1993;23:444–449.
44.
Oliver RT, Raja MA, Ong J, et al: Pilot study to evaluate impact of a policy of adjuvant chemotherapy for high risk stage 1 malignant teratoma on overall relapse rate of stage 1 cancer patients. J Urol 1992;148:1453–1455.
45.
Chevreau C, Soulie M, Rischmann P, et al: Adjuvant chemotherapy in high risk stage I non-seminomatous germ cell tumors. Proc Am Soc Clin Oncol 1997;16:320a.
46.
Abratt RP, Pontin AR, Barnes RD, et al: Adjuvant chemotherapy for stage I non-seminomatous testicular cancer. S Afr Med J 1994;84:605–607.
47.
Ondrus D, Goncalves F, Kausitz J, et al: The value of prognostic factors in the management of stage I nonseminomatous germ cell testicular tumors (NSGCTT). Neoplasma 1996;43:195–197.
48.
Kollmannsberger C, Beyer J, Droz JP, et al: Secondary leukemia following high cumulative doses of etoposide in patients treated for advanced germ cell tumors. J Clin Oncol 1998;16:3386–3391.
49.
Schmoll HJ, Souchon R, Krege S, et al: European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004;15:1377–1399.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.