Management of Low Stage Testicular Seminoma

Mischel Neill, MD, Padraig Warde, MD, Neil Fleshner, MD, MPH, FRCSC*

Division of Urology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Avenue, Toronto, Canada M5G 2M9

Seminoma of the testicle accounts for approximately 1% of all male cancers [1] and represents an ideal model for a curable human malignancy. It was predicted that approximately 3000 to 4000 American men would be diagnosed with seminoma in 2006 [2]. Incidence rates for seminoma have increased over the past 20 years [3]. Although Americans of African descent are at lower risk for seminoma, a 124.4% increased incidence of seminoma among Black American males has recently been reported [3]. Seminomas represent approximately 50% of germ cell tumors [4] and typically present as an asymptomatic mass among men in their fourth decade of life. Semi-noma is sensitive to radiotherapy and chemotherapy, thus cure is an expected outcome among men who have low-stage disease. Because cure rates are so high, current controversies revolve around minimizing treatment-related long-term morbidity and the amount and type of up-front therapy. For the purpose of this article, we focus on men who have clinical stage I (any primary T stage without clinically identifiable lymphatic or visceral metastasis) and stage II (any primary T stage with evidence of metastatic spread to regional lymph nodes, with five or fewer nodes involved and each 2 cm or less in greatest dimension) disease.

* Corresponding author.

E-mail address: [email protected] (N. Fleshner).

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