Following radical orchiectomy, imaging and serum tumor markers give information about the testicular type (seminoma versus non-seminoma) and cancer stage.
For men with Stage I non-seminoma, surveillance may be an appropriate option and may provide a cure in approximately 70% of men without the risks of chemotherapy or surgery. A recent study by Sharir et al., looked closely at the best means of detecting tumor spread in a group of 170 patients being followed by surveillance. As expected, almost 30% had disease progression within 2 years after initial diagnosis and were treated. The most important tools for diagnosing these patients included history, physical examination, tumor markers, and CT scanning at regularly performed intervals, starting 2 months after initial orchiectomy. Even with this extremely close follow-up, one patient died of cancer.
Two cycles of chemotherapy is also an option for men with Stage I non-seminoma. The advantage of this approach is to treat the 30% of men who may have residual disease; however, the disadvantage are the side effects of chemotherapy, which include potential damage to hearing, and/or to the kidneys. Side effects can also include neuropathy, or hypersensitivity to cold and heat, and numbness or tingling sensations in the hands or feet.
Retroperitoneal lymph node dissection (RPLND) is surgical removal of the lymph nodes where testicular cancer may land. Advances in surgical approaches to RPLND have significantly decreased the complications from this procedure. The developments of nerve sparing surgery and modified template dissections have limited the previously encountered problems of retrograde ejaculation following this operation. Although this was traditionally performed using an open surgical approach, faculty at Weill Cornell offer a minimally invasive approach with robotic assistance. This shortens the length of hospitalization to an overnight stay and leads to shorter return to activities of daily living.
