Rajendra Nerli
Clinical stage I is the most frequent clinical presentation of non-seminoma testicular cancer. Despite a survival rate of close to 100%, the management of patients with this disease stage is controversial. The recurrence rate is 15% to 50% for those with stage I non-seminoma. A highly sensitive and specific biomarker that can predict or confirm relapse of disease, and help to drive a definitive risk-adapted management is still not available. Lymph vascular invasion (LVI) in the orchiectomy specimen has been used as a risk factor in patients with stage I non-seminoma, however, the discriminative power of LVI is modest at best. Presently there is no definitive biomarker that can predict a recurrence following a radical orchiectomy. In situations such as this, active surveillance of these patients helps avoid overtreatment in 50% to 85% of patients, with no risk of long-term side effects in non-relapsing patients and a preserved overall survival of almost 100% after specific treatment for recurrent disease. Although active surveillance has been accepted as the preferred option for stage I low-risk non-seminoma, its role in high-risk stage I non-seminoma remains controversial.
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