Better Testicular Cancer Outcomes with Active Surveillance

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Late, advanced stage relapse rarely seen and are treatable with standard therapy.
Late, advanced stage relapse rarely seen and are treatable with standard therapy.

Active surveillance for clinical stage I (CSI) testicular cancer leads to excellent outcomes, according to a study published online in the Journal of Clinical Oncology.

Christian Kollmannsberger, M.D., from University of British Columbia in Vancouver, Canada, and colleagues retrospectively studied data from 2,483 CSI patients: 1,139 CSI nonseminoma and 1,344 CSI seminoma managed with active surveillance. Most were treated between 1998 and 2010.

The purpose of the study was to evaluate active surveillance as a management strategy and to acquire patient data regarding timing and type of relapse.

The researchers found that relapse occurred in 221 (19 percent) CSI-nonseminoma and 173 (13 percent) CSI-seminoma patients. For lymphovascular invasion-positive CSI nonseminoma, the median time to relapse was four months, but was eight months for lymphovascular invasion-negative CSI nonseminoma and 14 months for CSI seminoma.

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Relapses were detected by computed tomography scan in 87 percent of seminoma recurrences, in 48 percent of lymphovascular invasion-negative patients, and 41 percent of lymphovascular invasion-positive patients, while tumor markers detected recurrences in 3, 38, and 61 percent, respectively.

There were three disease-related deaths in patients with CSI nonseminoma, while one patient with CSI seminoma and two patients with CSI nonseminoma died because of treatment-related events. Both early- and late-relapse patients had advanced disease. Standard therapy cured all late recurrences. Five-year disease-specific survival was 99.7 percent.

"These data may inform further refinement of rationally designed surveillance schedules," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

  1. Kollmannsberger, Christian, et al. "Patterns of Relapse in Patients With Clinical Stage I Testicular Cancer Managed With Active Surveillance." Journal of Clinical Oncology. doi: 10.1200/JCO.2014.56.2116. August 18, 2014.

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