[Treatment of stage I non-seminomatous germ cell tumors of the testis].

The incidence of germ-cell tumours of the testicle is approximately 4/100,000 men. Approximately half of these have non-seminomatous tumours. Chemotherapy has made clinical cure possible in most patients with metastasis and good prognosis factors (small tumour volume and low or normal hormone markers). This observation has led to a modification of the treatment protocols for patients with stage I disease, i.e. normal imaging after orchidectomy and normal plasma levels of chorionic gonadotrophin and alpha fetoprotein. There are currently three acceptable ways of managing patients with stage I non-seminomatous germ-cell tumours of the testicle after orchidectomy: the wait and see approach generally adopted in Great Britain, retroperitoneal lymphadenectomy used in the United States, or as often proposed in France, adjuvant chemotherapy. The analysis of outcomes reveals that the risk of recurrence would be smallest with retroperitoneal lymphadenectomy or adjuvant chemotherapy while morbidity due to anejaculation would be greater with the former technique. In our opinion, a wait and see attitude combined with chemotherapy adapted for cases with a risk of extratesticular involvement would be justified both in terms of cost-effectiveness and in patient comfort and psychological well-being. This protocol has been adopted by the Cancerology Committee of the French Association of Urology and is strongly encouraged.