Surveillance for Stage I Seminoma: Part II

Dr. Bruce Roth, Professor of Oncology in the Division of Medicine at Siteman Cancer Center, Washington University at St. Louis, spoke with CancerNetwork at the 2013 ASCO meeting about topics in seminoma. Here he discusses the large Danish study by Mortenson et al (ASCO abstract 4502), which showed surveillance alone is sufficient after orchiectomy for men with stage I seminoma, focusing on its potential impact on use of radiation therapy after surgery in this setting.

Cancer Network: Have you encountered any physician misconceptions about the value of RT for men following orchiectomy for stage I seminoma?  How can they be addressed?

Dr. Roth: There are certainly people who will advocate for treatment based on either their perception either that the data was not strong enough to tell that patient reliably that, long-term this [surveillance alone] will not negatively impact your survival and guarantee you that you won’t have larger-volume disease, higher-risk disease, or a lower chance of cure. And clearly, this study negates that argument completely.

The other [consideration] is that people [physicians] will argue that patients will have angst about, you know, having a 20% chance of recurrence, and the reliability of patients showing up for follow-up.  I think that the “angst” issue is really overblown; I don’t see that in my practice, and every patient in my practice goes to surveillance. I think, in many cases, the patient develops angst because they physician explaining the different [management] options has angst about it, and there’s some transference. And if the patient picks up that maybe the doctor’s a little bit nervous about that [surveillance alone] as an option, then they’re [patients] are going to be nervous about that. But I think that what this [Mortenson study] data says, both for patients and physicians, is “this [surveillance alone] is a safe way to go.” And you won’t overtreat 85% of the patients like we’re doing now [by treating] all comers.

Cancer Network: Thank you very much for your time.

Dr. Roth: Okay, thank you.