cisplatin-based chemotherapy will cure almost all early relapses. At this time, surveillance must still be considered investigational; it is not offered to patients with seminoma.
In a recent study, the relapse rate varied from 20 to 40 percent. However, for good-risk patients or those with a true T1, N0, M0 tumor , the rate decreased to 15 to 25 percent.
In contrast, the relapse rate increased significantly to over 50 percent for poor-risk Stage I cases having tumor invasion of the epididymis, spermatic cord and lymphatic and/or blood vessels, particularly for the embryonal cell carcinoma variety. Surveillance should not be offered for such poor-risk cases.
If surveillance is the form of therapy chosen for good-risk cases, it should be realized that this demands very careful follow-up, every four to six weeks for at least one to two years. Although almost all relapses will be found within the first 10 to 12 months, tumors have recurred as late as three years after diagnosis. With careful follow-up and starting chemotherapy immediately after detection of a relapse, less than 1 to 2 percent of men will die. For men not willing to make this type of follow-up commitment, the correct choice is surgery.
Stage II
TNM Any T, N1-3, M0
The tumor involves the retroperitoneal lymph nodes either in a single node measuring 3/4 in. (2 cm) or less (N1), in a single node 3/4 to 2 in. (2 to 5 cm) or with multiple nodes all less than 2 in. (5 cm) (N2), or in any node larger than that (N3).
