Diagnostics and therapy of germinal testicular tumors

Abstract

Based on experience in the treatment of 627 patients with germinal testicular tumor and referring to recent literature, the age distribution (children, 3.6%, men over 50 years, 6.3%), importance and possibilities of early detection as well as sensitivity, specificity and accuracy of tumor markers, ultrasonography and X-ray examinations are described. In N0M0 stage seminomas, cure can be effected by radiotherapy in almost 100% of the cases. An alternative 'watch policy' is discussed. In N1-2M0 stage seminomas, cure can be achieved by irradiation in more than 90% of the cases. Primary polychemotherapy is needed in stage N3M0 or M1 as well as in stage N4M0 and N1-4M1 seminomas. Complete remission can be obtained in more than 90% of the patients if salvage operation, further chemotherapy or radiotherapy is performed in cases without complete remission after semicastration and primary chemotherapy. In N0M0 stage non-seminomas (excluding pT4 cases, choriocarcinoma, and patients with persistently elevated markers following semicastration), 'watch policy' has the disadvantage of requiring optimal monthly follow-ups and progression in 20% of the cases. While modified lymphadenectomy reduces the progression rate to 10% with low operative morbidity, it leads to an irreversible loss of ejaculation in 12% of the patients. With both modalities, if progression is detected, full recovery can be expected with immediate polychemotherapy. In stage N1-2M0 non-seminomas, a tumor-free condition can be obtained in close to 100% of the cases by lymphadenectomy and adjuvant chemotherapy. In stage N3,4 and/or M1, first primary polychemotherapy is carried out. In the case of a residual tumor this is followed by salvage operation and, if active tumor is found, by salvage chemotherapy. With this treatment, recovery can be achieved in 70-80% of the cases depending on the involvement of surrounding organs.