Non-risk-adapted Surveillance for Stage I Testicular Cancer: Critical Review and Summary

Cancer-specific survival for men with clinical stage I testicular cancer (CSITC) is uniformly excellent. Non-risk-adapted active surveillance (NRAS) is a management strategy for CSITC to minimize overtreatment and avoid possible long-term side effects of adjuvant therapy.

To review the evidence regarding oncologic outcomes for men with CSITC undergoing NRAS and discuss ongoing controversies in the management of CSITC.

MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1987 through January 1, 2017.

A total of 68 studies were included in the critical review. The rationale for NRAS, oncologic outcomes, surveillance protocols, and comparative efficacy of risk-adjusted active surveillance (AS) were reported with strength of evidence and risk of bias evaluated. Cancer-specific survival approaches 100% for men with CSITC undergoing NRAS. Active treatment is limited to 20-30% of patients who will recur; these patients will require salvage chemotherapy and possible retroperitoneal lymph node dissection. Existing AS protocols include imaging and laboratory evaluations that are initially intensive but less frequent with increasing follow-up.

NRAS is an attractive management option for men with CSITC, which maintains outstanding long-term cancer cure while sparing most patients treatment by avoiding prophylactic chemotherapy, radiation, or surgery.

Men with clinically localized (stage I) testicular cancer have an excellent prognosis, regardless of management. Non-risk-adapted active surveillance is an attractive management option where only patients destined to relapse will receive any treatment following orchiectomy. However, individual patient preferences should be discussed in selecting a management strategy.

European urology. 2018 Jan 12 [Epub ahead of print]

Phillip Martin Pierorazio, Peter Albers, Peter C Black, Torgrim Tandstad, Axel Heidenreich, Nicola Nicolai, Craig Nichols

Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: ., Department of Urology, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany., Department of Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada., St Olavs University Hospital, Trondheim, Norway., Department of Urology and Uro-Oncology, Universitätsklinikum Köln, Köln, Germany., Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Section of Urology, Virginia Mason Medical Center, Seattle, WA, USA.