HOW SAFE IS SURVEILLANCE IN PATIENTS WITH HISTOLOGICALLY LOW-RISK NONSEMINOMATOUS TESTICULAR CANCER IN A GEOGRAPHICALLY EXTENDED COUNTRY WITH LIMITED COMPUTERIZED TOMOGRAPHIC RESOURCES

In patients with clinical stage I non-seminomatous testicular cancer o nly limited information is available about the administrative problems with the surveillance programme, in particular if this policy is to b e implemented in a geographically extened country with limited compute rised tomography (CT) resources. One hundred and two patients with non -seminomatous testicular cancer clinical stage I and low-risk histolog y (MRC criteria, UK) were followed by the surveillance policy for at l east 1 year after orchiectomy (median 47 months, range 21-81 months). Twenty-two patients (22%) relapsed after a median time of 5 months (ra ne 2-18 months), 14 of them in the retroperitoneal space. Serum alpha- fetoprotein and/or human chorionic gonadotrophin were elevated in eigh t of the 22 relapsing patients. The progression-free and cancer correc ted survival rates were 78% and 99% respectively. Patient non-complian ce did not represent a major problem, whereas the regular and adequate performance of necessary CT examinations yielded some administrative difficulties. One and 3 years after orchiectomy about 50% of the relap se-free patients had no psychological problems and were satisfied with the surveillance programme, whereas 46% reported minor and 4% major p sychological distress. Despite non-negligible administrative difficult ies in geographically extended countries, surveillance is feasible and safe in compliant patients with low-risk non-seminomatous testicular cancer stage I. The responsible cancer centre and the local hospitals should establish a high degree of cooperation and enable adequate foll ow-up in these patients.