title: Surveillance after orchidectomy for patients with clinical stage I nonseminomatous testis tumors.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: J F
authors.initials: JF
authors.lastname: Sturgeon
authors.forename: M A
authors.initials: MA
authors.lastname: Jewett
authors.forename: R E
authors.initials: RE
authors.lastname: Alison
authors.forename: M K
authors.initials: MK
authors.lastname: Gospodarowicz
authors.forename: R
authors.initials: R
authors.lastname: Blend
authors.forename: S
authors.initials: S
authors.lastname: Herman
authors.forename: H
authors.initials: H
authors.lastname: Richmond
authors.forename: G
authors.initials: G
authors.lastname: Thomas
authors.forename: W
authors.initials: W
authors.lastname: Duncan
authors.forename: A
authors.initials: A
authors.lastname: Munro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D009919:Orchiectomy; D011446:Prospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors