Testis conservation studies in germ cell cancer justified by improved primary chemotherapy response and reduced delay, 1978-1994

Br J Urol. 1996 Jul;78(1):119-24. doi: 10.1046/j.1464-410x.1996.04224.x.


Objective: To investigate the need for the continued encouragement of early diagnosis of germ cell cancer of the testis, in view of the prevailing cure rate of 95%.

Patients and methods: The study comprised a retrospective review of 453 unselected and previously untreated patients referred to one centre between 1978 and 1984, comparing the delay from first symptoms with the histological diagnosis.

Results: With a delay of < 30 days, 20% of patients had overt metastases at presentation and if the delay was > 4 months. 55% had metastases (chi-squared trend = 15.9, P < 0.001); 18% of Stage-1 patients under surveillance with a delay of < 30 days relapsed, compared with 38% of those with a delay of > 4 months. During the period 1978-1983, 16% of patients were seen after a delay of < 60 days, during the period 1984-1988 the proportion was 22% and during 1989-1994, 31% (chi-squared trend = 8.2, P < 0.004). There was a non-significant trend for a more prolonged delay in those aged < 21 years and > 40 years. Thirty-two patients had chemotherapy with the primary tumour in situ; at orchidectomy, 13 of 18 had no viable malignancy and four of five with viable malignancy also had drug-resistant metastases. Fourteen did not undergo orchidectomy; within a median follow-up of 9 years, one developed a second (histologically different) tumour after 12 years. The outcome of preliminary attempts to use neoadjuvant chemotherapy with or without partial orchidectomy for patients with tumours in a solitary testis is discussed.

Conclusion: These findings clearly justify the continued encouragement of early diagnosis, possibly best performed as part of an extended educational programme of genital health at puberty. The long-term potential for testis conservation should be explored initially in tumours in a solitary testis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bleomycin / therapeutic use
  • Cisplatin / therapeutic use
  • Cohort Studies
  • Drug Resistance, Neoplasm
  • Etoposide / therapeutic use
  • Germinoma / diagnosis
  • Germinoma / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Orchiectomy
  • Retrospective Studies
  • Seminoma / diagnosis
  • Seminoma / drug therapy
  • Testicular Neoplasms / diagnosis
  • Testicular Neoplasms / drug therapy*
  • Time Factors
  • Treatment Outcome


  • Bleomycin
  • Etoposide
  • Cisplatin

Supplementary concepts

  • BEP protocol