Advanced testicular cancer: update for urologists.

Abstract

Testicular cancer is a model for a curable neoplasm. We review past and present accomplishments in treating testis cancer and emphasize controversial surgical issues of interest to the urologist. We reviewed early and recent chemotherapy trials of germ cell tumors, stressing random prospective phase III studies. In addition, we address specific and complicated issues that are of particular relevance for the urologist, analyzing recently published articles. Cisplatin combination chemotherapy has dramatically improved the cure rate for patients with germ cell tumors. The indications for post-chemotherapy resection for residual masses are discussed. The major goal 25 years ago was to develop a successful chemotherapy regimen for disseminated disease, which has now been accomplished with cisplatin combination chemotherapy. Present issues include optimal treatment in patients with poor prognostic characteristics, salvage chemotherapy strategies and indications for post-chemotherapy surgical resection.