Stage I nonseminomatous germ cell tumor of the testis: more questions than answers?

The outcome of patients with stage I nonseminomatous germ cell tumors (NSGCTs) is excellent, with 99% overall 5-year survival. If treated with orchiectomy alone, approximately 30% of patients relapse with metastatic disease. Therefore adjuvant therapy with either chemotherapy or retroperitoneal lymph node dissection (RPLND) is often recommended, despite impressive results with active surveillance alone. This article addresses the risks and benefits of each approach.