Paternity in men with stage I testis tumors on surveillance.

PURPOSE We report long-term paternity in men with stage I testis tumors who were managed initially by surveillance. PATIENTS AND METHODS One hundred five patients with clinical stage I nonseminomatous germ cell tumors of the testis were entered on a surveillance protocol and followed up for more than 10 years. Actual fertility potential was assessed by pregnancy. RESULTS Of the 105 patients, 41 (39%) have fathered children, which includes 36 of 78 (46%) patients while on active surveillance and five of 27 (19%) patients after treatment for relapse. Of 63 couples who attempted a pregnancy on surveillance or were presumed capable of impregnation (whether they tried or not), 41 (65%) were successful. CONCLUSION These results show that the majority of men with stage I testis tumor who are on surveillance after orchiectomy, have a suitable partner, and attempt impregnation achieve a successful pregnancy. Pregnancy rates appear to be less than reported in men who have a nerve-sparing retroperitoneal lymph node dissection (RPLND) because more patients on surveillance require treatment for relapse, which reduces their chances for pregnancy.

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Surveillance after orchidectomy for patients with clinical stage I nonseminomatous testis tumors.

Journal of Clinical Oncology ◽

10.1200/jco.1992.10.4.564 ◽

1992 ◽

Vol 10 (4) ◽

pp. 564-568 ◽

Cited By ~ 91

Author(s):

J F Sturgeon ◽

M A Jewett ◽

R E Alison ◽

M K Gospodarowicz ◽

R Blend ◽

...

Keyword(s):

Clinical Stage ◽

Germ Cell Tumors ◽

Stage I ◽

Clinical Staging ◽

Retroperitoneal Lymph Node Dissection ◽

Increased Risk ◽

Close Supervision ◽

Risk Of Progression ◽

Testis Tumors ◽

Nonseminomatous Germ Cell Tumors

PURPOSE This study was designed to determine the proportion of patients with clinical stage I nonseminomatous germ cell tumors of the testis (NSGCTT) managed with surveillance after orchidectomy who have more advanced disease and, therefore, require further treatment, the time to progression, the sites of progression, and the efficacy of treatment delayed until progression was recognized. PATIENTS AND METHODS One hundred five patients were observed prospectively without further treatment after orchidectomy and full clinical staging. Treatment was given immediately upon detection of marker-positive, clinical, or radiologic evidence of disease. RESULTS Thirty-seven patients (35.2%) have required further therapy for disease progression, occurring from 2 to 21 months after diagnosis. Thirty-six patients have been successfully treated. Overall, 104 patients (99%) remain alive and free of disease at 12 to 121 months after orchidectomy. Progression occurred in the retroperitoneum in 25 of 37 patients who developed further disease on surveillance. The presence of vascular invasion in the primary tumor was predictive of an increased risk of progression. CONCLUSION Surveillance is a valid alternative to immediate retroperitoneal lymph node dissection in patients with clinical stage I NSGCTT but should be recommended only under the close supervision of physicians experienced in the diagnosis and treatment of testicular cancer.

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Long-term followup results of 1 cycle of adjuvant bleomycin, etoposide, and cisplatin chemotherapy for high risk clinical Stage I nonseminomatous germ cell tumors of the testis

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2008.07.020 ◽

2008 ◽

Vol 26 (5) ◽

pp. 563-564

Author(s):

Donald L. Trump

Keyword(s):

High Risk ◽

Germ Cell ◽

Clinical Stage ◽

Germ Cell Tumors ◽

Stage I ◽

Nonseminomatous Germ Cell Tumors

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Accuracy of clinical staging in stage I and IIa/b testicular nonseminomatous germ cell tumors (NSGCT) and implications on survival.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e17058 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e17058-e17058

Author(s):

Arnav Srivastava ◽

Hiren V. Patel ◽

Sinae Kim ◽

Isaac Kim ◽

Eric A. Singer ◽

...

Keyword(s):

Overall Survival ◽

Imaging Techniques ◽

Clinical Stage ◽

Germ Cell Tumors ◽

Stage I ◽

Clinical Staging ◽

Retroperitoneal Lymph Node Dissection ◽

Kaplan Meier ◽

Nonseminomatous Germ Cell Tumors

e17058 Background: Clinical stage (CS) dictates treatment in men with testicular cancer and its inaccuracy may affect clinical outcome. We evaluate the accuracy of clinical staging in men with CS I and CS IIA/B NSGCT and explore the implications of inaccurate staging on overall survival. Methods: Using the National Cancer Database (NCDB), we abstracted all patients with clinical Stage I-IIB NSGCT who received a primary retroperitoneal lymph node dissection (RPLND) from 2004 to 2014. Primary RPLND was defined as RPLND performed for CS I-IIB patients without prior chemotherapy. CS was cross-tabulated with pathologic nodal staging data. Survival for patients who were accurately staged (CS I patients with pN0 disease, CS IIA patients with pN1 disease) and for CS I patients found to have pN+ disease was determined using the Kaplan Meier method. Results: 1,639 CS I-IIB patients underwent primary RPLND. Among CS I patients, 23% had upstaging of disease (pN1-3), of which 13.9%, 8%, and 1.1% were pN1, pN2, and pN3, respectively (Table). Pathologic N1-3 disease was higher in CS IB vs. CS IA patients (35.1% vs 14.2%, respectively). Of CS IIA patients, 23.1% had pN0 disease, while 44.8%, 13.4%, and 1.3% had pN1, pN2, and pN3 disease, respectively. At a median follow-up of 56.3 months, mortality rates for CS I patients who had pN1, pN2, and pN3 disease were 2.8%, 4%, and 9.1%, respectively, and < 1% for men with pN0 disease. 10-year overall survival for CS1 patients was significantly less favorable if upstaged to pN2 or pN3 disease after RPLND vs. pN0 or pN1. Conclusions: Nearly a quarter of patients with CS I NSGCT are under-staged and are found to have pN1-3 after RPLND. Nodal disease burden is associated with survival. Novel imaging techniques and biomarkers are needed to improve the sensitivity of detecting NSGCT. [Table: see text]

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