Stage I testicular cancer

It is the most common presentation of testicular cancer, and accounts for approximately 75% of all patients diagnosed at this stage.

Stage I testicular cancer is characterized by negative tumor markers and no evidence of metastases after orchiectomy for the primary tumor.

Associated with a survival rate of close to 100%.

Negative prognostic factors for seminoma include a tumor volume of 4 cm or more and invasion of the rete testis.

The five-year relapse rate for stage I seminoma is 31 1/2% in the presence of a tumor volume of greater than 4 cm or involvement of the rete testis, while a relapse rate of 4% is observed without either of these risk factors.

Despite a relapse rate of 10-20% in seminoma, survival in stage I disease approaches 100%, because nearly all relapsed patients are cured by chemotherapy, radiation therapy, or surgery.

Therefore active surveillance is the preferred choice for management of patients with stage I seminoma.

When relapse occurs the median time to relapse is 14 months in patients undergoing surveillance for stage I seminoma.

92% of recurrences are observed within the first three years.

CT scans or MRI imaging of the abdomen alone is sufficient to detect the vast majority of relapses.

Adjuvant chemo therapy for stage I seminoma with a single cycle of carboplatin at a dose of AUC 7 reduces the risk of relapse from 15 to 5%, a comparable result to that with radiation therapy.

Adjuvant, carboplatinum lowers the rate of relapse in high-risk patients than lower risk patients on surveillance 1.4% versus 9.8%, respectively.

Adjuvant chemo therapy represents overtreatment for 80 to 85% of patients who are cured by surgery alone for stage I seminoma.

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