Stromal invasion in the rete testis and tumor diameter >4 cm are risk factors for relapse in CSI seminoma. Patients without risk factors have a low RR and adjuvant therapy is not justified in these patients. The efficacy of adjuvant carboplatin is relatively low and there is need to explore more effective adjuvant treatment options in patients with high-risk seminoma. The data do not support the concept of a steep dose response for adjuvant carboplatin.

RP leads to significant increases in serum gonadotropins and significant DHT decrease in both serum and urine. These hormonal changes are independent of inhibin B.

We found no evidence of a beneficial effect of this specific screening procedure but strong evidence of a difference in overall survival in screening attendees and nonattendees. These findings should be considered when interpreting previous and upcoming studies of the effect of screening programs.

Background Reports on perioperative complications after Post-Chemotherapy Retroperitoneal lymph node dissection (PC-RPLND) for Non-Seminoma Germ Cell Tumour (NSGCT) are from experienced single centres, with a lack of population-based studies. Objective To assess the complications of bilateral and unilateral PC-RPLND. Design, Setting, Participants Prospective, population-based observational multicentre study that included all patients with NSGCT that underwent PC-RPLND in Norway and Sweden 2007 to 2014. In total 318 patients, 87 underwent bilateral PC-RPLND and 231 unilateral PC-RPLND. Median follow-up 6 years.Outcome measurements and statistical analysis Bilateral and unilateral PC-RPLND were compared for the outcome intra-and postoperative complications (graded by Clavien-Dindo) and retrograde ejaculation (with or without nerve-sparing surgery). Complications were reported as absolute counts and percentages. The x 2 -test was used for comparisons Results and LimitationsThe incidence of intraoperative complications was higher for bilateral PC-RPLND compared to unilateral PC-RPLND (14% vs. 4.3%, p=0.003), with ureteral injury as the most frequent reported complication (2% of the patients). Postoperative complications were more common after bilateral than unilateral PC-RPLND (45% vs 25%, p=0.001) with Clavien ≥3b reported in 8.3% and 2.2% respectively (p=0.009). Lymphatic leakage was the most common complication occurring in 11% of the patients. Retrograde ejaculation occurred more frequently after bilateral than unilateral surgery (59% vs 32%, (p<0.001). Limitation of the study include reporting of retrograde ejaculation, which was based on chart review. Conclusions Intraoperative complications and postoperative complications includingretrograde ejaculation are more frequent after bilateral PC-RPLND compared to unilateral PC-RPLND.