Klin Onkol 1991; 4(6): 181-185.
Summary: In a prospective study 90 patients in clinical stage I nonseminomatous testicular tumours were investigated by policy of surveillance, which consisted of a regular follow-up after orchiectomy alone until the disease progression was confirmed. Follow-up revealed that 59 of the 90 patients (65,6%) were free of disease at 25 to 83 months (mean 53) after orchiectomy. Progression of disease was detected in 31 patients (34,4%) at 3 to 27 months (mean 7) following orchiectomy. Patients with progression were treated by PVB chemotherapy. 86 of 90 patients (95,6%) alive free of disease at 3 to 83 months (mean 49,3) after completion of therapy. The authors evaluated risk factors of the disease progression: delay in the diagnosis of testicular tumour, T staging category, size and histopathology of primary tumour, preorchiectomy serum levels of AFP and beta-hCG, presence of intratubular neoplasia and vascular invasion and sperm count before orchiectomy. The results revealed a significant correlation only between the sperm count and progression of disease. While progression of disease was detected in 22 of 48 patients (45,8%) with a low sperm count < 10 x 10 mil/ml, it was observed in 8 of the 39 patients (20,9%) with sperm count > 10 x 10 mil/ml. The authors proposed the individualisation of optimal therapy according to supposed risk of progression. In accordance with that it may be select adequate therapeutic method: policy of surveillance, retroperitoneal lymdenectomy or chemotherapy.
