Changing concepts in the management of testis cancer

ABSTRACT

The emergence of extremely effective chemotherapy for testis cancer has changed many management concepts. Accurate clinical staging may eliminate the need for a node dissection in carefully selected stage I patients. Early detection of metastases is facilitated by using serum markers. Adjuvant chemotherapy after surgery may virtually eliminate recurrences. High-risk patients that respond poorly to standard treatment can be identified at the time of diagnosis; new protocols for this group are being developed. Chemotherapy is an effective treatment for seminoma and is the preferred initial treatment for a high-stage disease. Postchemotherapy surgery can aggravate the pulmonary fibrosis induced by bleomycin; consequently, appropriate precautions must be taken. All of these changes emphasize the importance of a continuing reappraisal by the practicing urologist of treatment philosophies for testis cancer.