Management of Nonseminomatous Germ Cell Tumor of the Testis

About 5-7/100,000 men are diagnosed with testis cancer annually. A large proportion of these are pathologically classified as non-seminomatous germ cell tumor (NSGCT). The majority of NSGCT patients present with clinical stage (CS) I disease, which is characterized by a germ cell tumor confined to the testis, a negative metastatic work-up which includes a chest X-ray (CXR), computed tomography scan of the abdomen and pelvis (CT A&P), and negative serum tumor markers (STM) post-orchiectomy. Patients who present with CS I testis cancer have a 30 percent chance of harboring occult metastatic disease postorchiectomy, and thus controversy exists as to what represents the best treatment strategy following radical orchiectomy. Currently, there are 3 treatment strategies available for patients with CS I testis cancer, each one associated with a 99% cure rate: surveillance, adjuvant chemotherapy, and primary retroperitoneal lymph node dissection (RPLND).