PURPOSE There is equipoise regarding the optimal treatment of clinical stage (CS) I nonseminomatous germ cell @entity5 (NSGCT). Formal mechanisms that enable @entity1 to consider @entity5 outcomes, treatment-related morbidity, and personal preferences are needed to facilitate decision making between retroperitoneal lymph node dissection (RPLND), primary chemotherapy, and surveillance. METHODS Decision analysis was performed using a Markov model that incorporated likelihoods of survival, treatment-related morbidity, and utilities for seven undesired post-treatment health states to estimate the quality-adjusted survival (QAS) for each treatment option. Utilities were obtained from 24 hypothetical NSGCT @entity1 using a visual analog (rating) scale and standard gamble. Results Overall, QAS associated with each treatment was high and differences in QAS were small. Surveillance was the preferred intervention for @entity1 with a risk of relapse less than 33% and 37% using the rating scale and standard-gamble method of utility assessment, respectively. Active treatment was favored over surveillance for @entity1 with relapse risk on surveillance greater than 33% and 37% by the rating scale (RPLND preferred) and standard-gamble methods (primary chemotherapy preferred), respectively. Substantial differences in average utilities were seen depending on the method used. By the rating scale, @entity1 substantially devalued life in six of seven undesired health states but they were surprisingly tolerant of treatment-related morbidity using standard gamble. CONCLUSION A decision model has been developed for CS I NSGCT that estimates QAS for RPLND, primary chemotherapy, and surveillance by considering @entity5 outcomes, morbidity, and @entity1 preferences. Surveillance was the preferred intervention for all except those @entity1 at high risk for relapse.

Defining the optimal treatment for clinical stage I nonseminomatous germ cell XXXX using decision analysis.

@entity5 :: ('MESH:D009369', 'Disease') :: ['cancer', 'testicular cancer'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient']
@entity5 :: (MESH:D009369,Disease) :: ['testicular cancer']
