Prompt Orchiectomy Reduces Morbidty and Mortal from Testicular Carcinoma

Abstract

The records of 154 patients with non-seminomatous germ cell testicular tumours were reviewed to determine the potential effect of prompt diagnosis and orchiectomy on morbidity and mortality from this disease. Orchiectomy was performed 30 days or less after the onset of testicular symptoms on 65 patients (Group 1) and more than 30 days after the onset of symptoms on 89 patients (Group 2). The initial clinical stages of Group 1 patients were: I, 40 (62%); II, 14 (22%); III, 5 (8%); marker only, 6 (9%). The initial clinical stages for Group 2 patients were: I, 25 (28%); II, 15 (17%); III, 35 (39%); marker only, 14 (16%). The difference between the percentages of Group 1 and Group 2 patients with stage I disease was statistically significant, as was the difference between the percentages of Group 1 and Group 2 patients with stage III disease. One of the Group 1 patients died, whereas 11 of the Group 2 patients died. In 5 of the Group 2 patients who died, orchiectomy had been performed more than 120 days after the onset of testicular symptoms. This study suggests that orchiectomy performed promptly after the onset of testicular symptoms not only helps to reduce mortality from testicular cancer but also has a major effect on its morbidity by reducing the need for systemic chemotherapy or major surgery.

Changing Incidence and Delay of Testicular Cancer in Southern Norway (1981-1992)

“…On the other hand, our series confirms the report of Chilvers et al [ 18] that a short delay period is correlated with a more beneficial prognosis, even if mod ern chemotherapy is applied. As also reported by Wishnow et al [19], a short delay is furthermore correlated with the incidence of stage I disease and thus favours the possibility to apply less intensive treatment. In other words, the reduction of delay means that more patients present with stage I testicular cancer and will thus benefit from the surveillance programme or low-dose radiothera py with a favourable toxicity profile of these therapeutic modalities.…”

Does delayed diagnosis or scrotal incision affect outcome for men with non‐seminomatous germ cell tumours?

“…However, when the West of Scotland data were analysed in this way, no association was apparent. In contrast, when analysis was based on grouped times to diagnosis, only one [9] of three studies [ 7 and the present study] demonstrated a consistent relationship between prognostic category and delay of more or less than 1 month [9] or 3 months/100 days, respectively [7] (Table 3).…”

“…Several studies have suggested that a longer mean time to diagnosis is associated with more advanced stage Accepted for publication 19 April 1994 [6-91, although there is conflicting evidence on the influence of diagnostic delay on relapse-free [7] and overall survival [8,9].…”

The changing distribution of stage in nonseminomatous testicular germ cell tumours, from 1977 to 1996

“…The earlier detection of testicular malignancies will lead to an increasing proportion of stage I patients who can benefit from the successful surveillance policy, i.e. orchidectomy alone with no additional treatment [ 18, 26]. Furthermore, earlier diagnosis of metastatic disease will probably increase the proportion of patients who can be treated with less toxic chemotherapeutic regimens.…”