Testicular germ cell tumors

Optimal quality of cancer care is crucial for best outcomes.This is especially true for patients suffering from testicular germ cell tumors.These patients are very young,sometimes adolescent,usually healthy and cure rates independent of stage of the disease in industrialized countries approach 97%.With these figures,testicular germ cell tumors present a role model for a curable cancer.The life expectancy of patients in early stages with local treatment followed by active surveillance is not limited compared to the general population.In patients with metastatic disease tumor recurrences do not impact on the life expectancy either since most of the recurrences are curable as well.However,in metastatic patients,the long-term sequelae of the initial systemic treatment like secondary malignancies and life-threatening long-term toxicities due to cisplatin meanwhile represent the most frequent causes of death 30 and more years after end of treatment.Therefore,the initial decision whom and how to treat gets more and more important.This edition of the

Asian Journal of Urology

compiles three papers that highlight special important topics in the diagnosis and treatment of germ cell tumors.A more and more sophisticated understanding of the molecular pathogenesis of such tumors is presented by Daniel Nettersheim.Research regarding the pathophysiology of germ cell tumors is not only important for a better understanding of the malignant development of germ cell cancer cells from spermatogonia.It is of utmost importance for patients who suffer from chemoresistant tumors,usually of yolk sac origin.In recent years,mechanisms to potentially overcome chemoresistance have been detected(

e.g.

the differentiation factor FOXA2 and possible effects of histondeacetylase-inhibitors[HDAC-I]like belinostat and panobinostat)by this research group.Christian Winter summarizes the current state-of-the-art of treatment of stage I non-seminoma,one of the most frequent tumors at diagnosis.In stage I tumors,the exact histopathological diagnosis with all components of a mixed germ cell tumor is important to tailor treatment.Thorough investigations regarding vascular and lymphatic invasion of the primary tumor strongly influence the recommendation towards adjuvant chemotherapy after orchidectomy in patients with a high risk of recurrence.Andreas Hiester focuses on the important surgical treatment in patients with metastatic disease.In these patients who harbor residual disease after chemotherapy,we currently have no alternative to surgery due to a limited negative predictive value of imaging regarding residual teratoma and vital cancer in those lesions.Moreover,the surveillance of teratoma patients is not recommended due to the development of a malignant somatic transformation over time.Therefore,in most patients,a complete resection of the residual masses is indicated and contributes to this overall perfect oncological outcome of patients,with germ cell cancer if treated in experienced centers.All papers together will yield a perfect overview of state-of-the-art diagnostics and treatment of this rare tumor which is certainly a model for optimal cancer care.

Peter Albers

Düsseldorf University Hospital,Medical Faculty,Heinrich-Heine University Düsseldorf,Germany

E-mail address:

Peter.Albers@med.uni-duesseldorf.de