Stage I nonseminoma germ cell cancers are highly curable (98%. As with seminomas, the initial treatment is radical inguinal orchiectomy. Then there are 3 options per guidelines:
1.Retroperitoneal lymph node dissection (RPLND) – mostly for stage IA. This has the advantage of a high cure rate and the disadvantages of major surgery with its complications and the possibility of the loss of ejaculation.
2.Careful observation with frequent (usually monthly) doctor visits and tests for several years. This has the advantage of no surgery or chemotherapy side effects. Its disadvantage is that the cancer can return and without careful watching can grow so large that it may not be curable. So far, this has not happened in men who saw their doctor for follow-ups as scheduled. About 80% of relapses occur in the first 12 months, and most of the rest in the next 12 months.
3.For stage IB – 2 cycles of chemotherapy. Most guidelines recommend PEB (platinum, etoposide, bleomycin).
When the patient refuses bleomycin, I consider carboplatin/Etoposide in the appropriate doses for this protocol ( somewhat higher than when given with bleomycin)appropraite. THis si based on studies in good prognosis testicular cacner that showed equivalence of these two regimens. No such studies have been carried for adjuvant treatment of stage IB testicular cancer but they would be difficult to initiate and complete due to rarity of this cancer. There would be no other option if the patient refuses PEB.
Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Horwich A, Laguna MP. Guidelines on testicular cancer. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. 54 p. [35 references]