Progression detection of stage I nonseminomatous testis cancer on surveillance: Implications for the followup protocol

Purpose: To optimize followup in patients with stage I nonseminomatous test is cancer on surveillance we evaluated the contribution of each followup mo dality to the detection of progression as well as morbidity and mortality o utcomes. Materials and Methods: After orchiectomy 170 patients with clinical stage I nonseminoma were prospectively placed on a surveillance protocol. History, physical examination, serum tumor markers, abdominal and pelvic computeriz ed tomography (CT), and chest x-ray were used for followup. The number of f ailures, methods and timing of progression detection, treatments required, mortality rate and subsequent contralateral primary tumors were recorded. Results: The 170 surveillance patients were followed a median of 6.3 years, Within 2 years (median 6.9 months) postoperatively 48 patients (28.2%) had disease progression. History, physical examination, markers, CT and chest radiography provided the initial evidence of progression in 18 (37.5%), 34 (70.8%), 34 (70.8%), and 4 (8.3%) patients,respectively. Each modality was the only indicator of failure in 2 (4.2%),4 (8.3%), 10 (20.8%) and 0 cases, respectively. Of the 170 patients 122 (71.8%) required no additional treat ment beyond orchiectomy, 26 (15.3%) received 1 and 22 (12.9%) underwent mor e than 1 therapeutic modality. Only 1 patient (0.6%) died of disease. Contr alateral tumors developed in 5 cases (2.9%) therapeutic a mean of 8.1 years after orchiectomy. Conclusions: In stage I nonseminoma patients, surveillance history, physica l examination, tumor markers and abdominopelvic CT are necessary components of the followup protocol. Removal of routine chest x-ray from the protocol would not have changed progression detection. The initial surveillance vis it must occur by 2 months postoperatively. Patients should be followed beyo nd 5 years and likely for Life in addition to regular patient self-examinat ion.