Surveillance is preferred by many doctors and patients because the VAST majority of patients can be cured when they relapse. HOWEVER, successful surveillance requires strict compliance on behalf of both doctor and patient. RPLND is the most accurate way to stage patients, and cure rates in expert hands approach 100%, but it is associated with POTENTIALLY significant morbidity. Chemotherapy, usually with 2 cycles of bleomycin, etoposide, and cisplatin, is also associated with an excellent outcome, but there are concerns regarding longer-term toxicities, such as infertility and SECOND CANCERS. High-dose chemotherapy with autologous stem cell support is feasible and potentially cures a proportion of patients with resistant disease. However, data on this treatment as initial therapy for higher-risk patients are scarce.

Surveillance is preferred by many doctors and patients because the vast majority of patients can be cured when they relapse. However, successful surveillance requires strict compliance on behalf of both doctor and patient. RPLND is the most accurate way to stage patients, and cure rates in expert hands approach 100%, but it is associated with potentially significant morbidity. Chemotherapy, usually with 2 cycles of bleomycin, etoposide, and cisplatin, is also associated with an excellent outcome, but there are concerns regarding longer-term toxicities, such as infertility and second cancers. High-dose chemotherapy with autologous stem cell support is feasible and potentially cures a proportion of patients with resistant disease. However, data on this treatment as initial therapy for higher-risk patients are scarce.