Management of Stage I Testicular Cancer

Jerusha Padayachee; Roderick Clark; Padraig Warde; Robert J. Hamilton


Curr Opin Urol. 2022;32(1):17-23. 

In This Article

Abstract and Introduction


Purpose of Review: Testicular cancer is the most common solid malignancy amongst young men, and a large proportion present with stage I disease. The options for management following radical orchiectomy are multifold. We review here approaches to treatment in this setting, providing an update on recent publications.

Recent Findings: At Princess Margaret Cancer Centre, we maintain a nonrisk adapted active surveillance approach. With a dedicated surveillance program using low-dose computed tomography imaging, patients are appropriately identified early for treatment on relapse. There are ongoing investigations into minimizing toxicities of treatments for relapse, and in particular, retroperitoneal lymph node dissection (RPLND) presents an attractive alternative. This, though, remains investigational in the setting of seminoma.

Summary: Testicular cancer is a highly curable malignancy. In stage I disease, an active surveillance approach following radical orchiectomy is preferred, irrespective of risk-profile. This approach serves to limit the toxicity of adjuvant treatment in a significant proportion of patients, while maintaining excellent survival outcomes.


Testicular cancer, while relatively uncommon, represents the most common solid malignancy in men aged between 20 and 34 years.[1] Based on data from GLOBOCAN, an estimated 74 458 new cases of testicular cancer were diagnosed in 2020 across the world.[2] Testis cancers are highly curable malignancies, with survival rates estimated at greater than 95%.[3] Despite the rarity of this malignancy, given the younger age of presentation, it is important to note that the potential years of life lost due to death from testicular cancer is the largest among all cancer sites.[4] Equally so, given the high cure rate, it is important to be cognizant of the potential toxicities of treatment; which can include late effects of infertility, cardiovascular disease (CVD), peripheral neuropathy and second malignancies.[5]

Germ cell tumours (GCTs) represent 95% of testicular cancer; with the two main subgroups being seminomas and nonseminomatous germ cell tumours (NSGCT). Approximately 70–80% of patients with GCTs present with clinical stage I (CSI) disease, and patterns of practice in this setting are variable. There has been increasing interest in exploring means to preserve excellent clinical outcomes while minimizing toxicities of treatment in this young patient group. We present here an update on recent developments guiding treatment of CSI seminoma and NSGCT.