Surveillance for Stage I Testicular Cancer: How Effective?

Summary and Comment |
October 8, 2014

Surveillance for Stage I Testicular Cancer: How Effective?

  1. Robert Dreicer, MD, MS, FACP

Disease-specific survival at 15 years was 99%.

  1. Robert Dreicer, MD, MS, FACP

After undergoing orchiectomy, men with stage I nonseminoma germ cell tumors (NSGCT) can be managed with retroperitoneal lymph node dissection (RPLND), adjuvant chemotherapy (cisplatin, etoposide, and bleomycin), or surveillance. Regardless of how patients are managed, the cure rates of these patients are in the range of 98% to 99%.

To examine outcomes associated with surveillance, investigators reviewed the records of 1226 men in the Danish National Patient Register who were observed after orchiectomy for stage I NSGCT between 1984 and 2007. Most patients had tumor markers drawn monthly during year 1, every 3 months during year 2, and every 6 months during years 3 to 5. Computed tomography (CT) imaging was performed at 4, 8, 12, 36, and 60 months. Median follow-up was 180 months.

Early relapses were mainly detected by an increase in tumor markers, and late relapses were detected by CT scans. Fifty-nine percent of relapses occurred within the first 6 months after orchiectomy, and 80% occurred within the first year (median time to relapse, 5 months). Of all relapses, 89% were detected at routine examinations, and 7% were detected by patient report. Six patients died of germ cell tumor, including one who refused systemic therapy. Testicular-cancer–specific survival at 15 years was 99%. At 5 years, six patients had relapsed, one had died, and five were without evidence of disease. Adherence to the surveillance program was good; only 48 patients (3.9%) dropped out before the final control at 5 years.

Comment

For the small subset of patients at high risk for systemic failure (with vascular or lymphatic invasion, embryonal carcinoma, and absence of yolk sac tumor), the potential utility of adjuvant chemotherapy should be discussed. However, for the bulk of patients with stage I NSGCT, this large, well-documented study with long follow-up provides a substantial level of comfort that patients can be managed safely without the adverse effects of chemotherapy or RPLND.

Editor Disclosures at Time of Publication

  • Disclosures for Robert Dreicer, MD, MS, FACP at time of publication Consultant / Advisory board Millenium; Dendreon; Medivation; Janssen; Roche Speaker's bureau Bayer Editorial boards Urology; Clinical Genitourinary Cancer; Current Urology Reports Leadership positions in professional societies National Cancer Institute (Co-Chair, GU Oncology Steering Committee)

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