A 31-year-old man was found to have a 6 cm left testicular mass and underwent a left radical orchiectomy. Pathology demonstrates pT1 mixed non-seminomatous germ cell tumor. A staging computed tomography scan of the abdomen/pelvis and the CXR are unremarkable. His post-orchiectomy tumor markers are within normal limits.
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Answer: Given pT1 pathology, patient is at low risk for tumor recurrence if he elects surveillance.
A large proportion of patients with non-seminomatous germ cell tumor is cured by orchiectomy alone. Vascular invasion (venous or lymphatic) has been shown to be most important predictor of tumor recurrence following orchiectomy.1
Furthermore, pT1 (Stage IA) staging indicates that vascular invasion is not present. As such, if a patient elects surveillance chances of tumor recurrence are on the order of 15%.2, 3
The case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.
- Vergouwe Y, Steyerberg EW, Eijkemans MJ, et al. Predictors of occult metastasis in clinical stage I nonseminoma: a systematic review. J Clin Oncol 2003;21:4092-4099.
- Nguyen CT, Fu AZ, Gilligan TD, et al. Defining the optimal treatment for clinical stage I nonseminomatous germ cell testicular cancer using decision analysis. J Clin Oncol. 2010;28:119-125.
- Sturgeon JF, Moore MJ, Kakiashvili DM, et al. Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital’s experience. Eur Urol 2011;59:556-562.