Testicular Cancer: Screening, Diagnostic and Therapeutic Considerations

The treatment of germ-cell tumours of the testis can be considered as a model for cancer management, representing public education, diagnosis and cure with long term follow-up. Psychosocial distress, fertility and secondary tumour induction can also be studied. The aetiology of this disease is largely unknown; however, there is an increasing incidence in several regions such as Scandinavia, the UK and the US. Thus, the institution of preventive measures is needed. At present, large scale screening of at-risk age groups is not justified because of the very low incidence of the disorder and lack of adequate screening tools. Better education regarding the signs and symptoms of testicular cancer at schools and universities, perhaps including testicular self-examination and close follow-up of particular risk groups (those with maldescended testes or orchidopexy) may need more attention. The management of the disease following orchiectomy and staging, both in the adjuvant setting and of patients with metastatic disease, has proved successful with cure rates ranging from 85 to 98% for the majority of patients. The introduction of cisplatin-containing combination chemotherapy, careful surveillance and improved diagnostic tools have contributed to the successful treatment of testicular cancer. A small subgroup of patients with poor prognosis (50% cure rate) still need more intensive therapy. Treatment is successful for most patients and more time can be spent reducing acute and late toxicity in long term survivors and studying sociopsychological aspects in these men. Eventually, it may not be necessary for further randomised trials in patients with good prognosis because only minor improvements are being obtained from great efforts and costs.