Changing concepts in the management of testis cancer1
The emergence of extremely effective chemotherapy for testis cancer has changed many management concepts. Accurate clinical staging may eliminate the need for a node dissection in carefully selected stage I patients. Early detection of metastases is facilitated by using serum markers. Adjuvant chemotherapy after surgery may virtually eliminate recurrences. High-risk patients that respond poorly to standard treatment can be identified at the time of diagnosis; new protocols for this group are being developed. Chemotherapy is an effective treatment for seminoma and is the preferred initial treatment for a high-stage disease. Postchemotherapy surgery can aggravate the pulmonary fibrosis induced by bleomycin; consequently, appropriate precautions must be taken. All of these changes emphasize the importance of a continuing reappraisal by the practicing urologist of treatment philosophies for testis cancer.