Justification of the use of surveillance in the management of Stage I germ cell tumours of the testis.

Analysis of patients with germ cell tumours of the testis treated at the London Hospital during the last 30 years has shown that the incidence of pure seminoma has fallen from 69 to 39%. Coincident with this, the incidence of patients with metastases detectable at presentation in all other types of germ cell tumour has increased from 19 to 62%. These observations may explain why the relapse rate of the most recently treated patients with Stage 1 malignant teratoma was the same whether or not they received prophylactic radiotherapy and substantially less than that reported in the literature 30 years ago for orchiectomy alone. These changes justify the use of a surveillance policy for Stage 1 tumour in studies by specialist centres.