Advances in the Treatment of Testicular Cancer

Yaron Ehrlich; David Margel; Marc Alan Lubin; Jack Baniel

Transl Androl Urol. 2015;4(3):381-390.

Abstract and Introduction

Abstract

Germ cell tumors (GCT) are relatively uncommon, accounting for only 1% of male malignancies in the United States. It has become an important oncological disease for several reasons. It is the most common malignancy in young men 15–35 years old. GCTs are among a unique numbers of neoplasms where biochemical markers play a critical role. Finally, it is a model of curable cancer. In this review we discuss cancer epidemiology, genetics, and therapeutic principles. Recent advances in the management of stage I GCT and controversies in the management of post chemotherapy residual mass are presented.

Introduction

Despite their infrequency, accounting for only 1% of male malignancies in the United States, germ cell tumors (GCTs) have become an important oncological disease for several reasons. GCT is the most common malignancy in young men, 15–35 years old, and thus, has the potential to greatly shorten a man's productive years. Second, GCT is amongst a unique group of neoplasms in whom biochemical markers play a critical role. In GCT's serum tumor markers are an integral part of patient management as part of diagnosis, staging, risk assessment, evaluation of response to therapy and detection of relapse. Finally, GCT is a model of curable cancer, and a triumph of modern oncology. Current chemotherapy protocols and surgery yield cure rates exceeding 95%.^[1]

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Table 1. International germ cell consensus classification prognostic groups in patients with metastatic disease treated with first line chemotherapy
Risk group	NSGCT	Seminoma	5-year survival*
Good prognosis	Primary site: testis or RP and metastases: nodal or pulmonary and marker level: S1	Primary site: all and metastases: nodal or pulmonary and marker level: any LDH, any hCG	Seminoma 86%; NSGCT 94%
Intermediate prognosis	Primary site: testis or RP and metastases: nodal or pulmonary and marker level: S2	Primary site: all and metastases: non-pulmonary visceral and marker level: any LDH, any hCG	Seminoma 72%; NSGCT 83%
Poor prognosis	Primary site: mediastinal or metastases: non-pulmonary visceral or marker level: S3	No patients classified as poor prognosis	NSGCT 71%

NSGCT, nonseminomatous germ cell tumor; S1, a-fetoprotein (AFP) <1,000 ng/mL, and human chorionic gonadotrophin (hCG) <5,000 mIU/mL, and lactic dehydrogenase (LDH) <1.5 upper limit of normal; S2, AFP =1,000–10,000 ng/mL, or hCG =5,000- 50,000 mIU/mL, or LDH =1.5–10 upper limit of normal; S3, AFP >10,000 ng/mL, or hCG >50,000 mIU/mL, or LDH >10 upper limit of normal; RP, retroperitoneum; *, survival data for seminoma patients based on IGCCCG study (57). Survival for NSGCT patients is based on a more recent meta-analysis (58).

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Advances in the Treatment of Testicular Cancer

Abstract and Introduction

Abstract

Introduction

Tables

References

Authors and Disclosures

Authors and Disclosures

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