Editing Germ Cell Tumours (section)

==== Delayed orchiectomy ====

* In a small subset of patients with widespread and/or symptomatic GCT, the diagnosis is made based on biopsy of a metastatic lesion or empirically based on clinical and serologic features. In these unique settings, initiation of systemic chemotherapy supersedes diagnostic orchiectomy. '''Because of high discordance of pathologic response rates within the testicle, a delayed orchiectomy is recommended for all patients with NSGCT after induction chemotherapy, even in the setting of a complete response in the retroperitoneum'''
* The role of delayed orchiectomy is more controversial in patients with presumed primary retroperitoneal/extragonadal GCT.
** Radical orchiectomy has been advocated when the metastatic pattern of retroperitoneal disease lateralizes to the expected distribution of a testicular primary.