Non–Risk-Adapted Surveillance in Clinical Stage I Nonseminomatous Germ Cell Tumors: The Princess Margaret Hospital’s Experience

28-year late spermatic cord relapse of a testicular non-seminomatous germ cell tumour, managed robotically

“…1,2 This has proven an effective strategy to maintain high survival and minimize morbidity. As a result, this approach has been recommended by several guidelines and adopted by many other centres worldwide.…”

“…1,[3][4][5] The current active surveillance protocol for CSI NSGCT at Princess Margaret involves regular and structured monitoring of tumour markers (alpha-fetoprotein [AFP], human chorionic gonadotropin [hCG], lactate dehydrogenase [LDH]) and computed tomography (CT) scans of the chest, abdomen, and pelvis, and has been previously outlined in the literature. 1,6 After two years of active surveillance, the intensity is tapered. After five years, most patients with no evidence of disease are now discharged from further followup to their primary care provider.…”

“…After five years, most patients with no evidence of disease are now discharged from further followup to their primary care provider. 1,6 Good evidence exists to stop after five years because our subsequent relapse risk has been very low. In a pooled analysis of 938 men with CSI NSGCT managed with active surveillance, only 1% experienced relapse after three years of post-orchiectomy surveillance.…”

“…3 Overall, the relapse rate for CSI NSGCT is 26-35%. 1,3,[6][7][8] The most likely site of relapse is the retroperitoneum, followed less frequently by the lung.…”

“…1,3,4 Relapses beyond two years are considered late relapse and are much less common. A 2007 systematic review of testicular GCT surveillance found only seven reported recurrences after five years of surveillance, with a maximum time to relapse of 14.25 years.…”