TESTIS CONSERVATION STUDIES IN GERM-CELL CANCER JUSTIFIED BY IMPROVEDPRIMARY CHEMOTHERAPY RESPONSE AND REDUCED DELAY, 1978-1994

Objective To investigate the need for the continued encouragement of e arly diagnosis of germ cell cancer of the testis, in view of the preva iling cure rate of 95%. Patients and methods The study comprised a ret rospective review of 453 unselected and previously untreated patients referred to one centre between 1978 and 1984, comparing the delay from first symptoms with the histological diagnosis.Results With a delay o f <30 days, 20% of patients had overt metastases at presentation and i f the delay was >4 months, 55% had metastases (chi-squared trend = 15. 9, P<0.001); 18% of Stage-1 patients under surveillance with a delay o f <30 days relapsed, compared with 38% of those with a delay of >4 mon ths. During the period 1978-1983, 16% of patients were seen after a de lay of <60 days, during the period 1984-1988 the proportion was 22% an d during 1989-1994, 31% (chi-squared trend = 8.2, P<0.004), There was a non-significant trend for a more prolonged delay in those aged <21 y ears and >40 years, Thirty-two patients had chemotherapy with the prim ary tumour in situ; at orchidectomy, 13 of 18 had no viable malignancy and four of five with viable malignancy also had drug-resistant metas tases. Fourteen did not undergo orchidectomy; within a median follow-u p of 9 years, one developed a second (histologically different) tumour after 12 years. The outcome of preliminary attempts to use neoadjuvan t chemotherapy with or without partial orchidectomy for patients with tumours in a solitary testis is discussed. Conclusion These findings c learly justify the continued encouragement of early diagnosis, possibl y best performed as part of an extended educational programme of genit al health at puberty, The long-term potential for testis conservation should be explored initially in tumours in a solitary testis.