An understanding of the elements that have contributed to the remarkable cure rate in patients with germ cell cancers is a useful exercise for clinicians. The prevailing view is that the introduction of chemotherapy was largely responsible for this remarkable success. Although chemotherapy is clearly the required ingredient, there are other important contributing factors that were essential for the high cure rate. These contributing elements include the understanding of the biology of the cancer and the availability markers. The understanding of the clinical biology and ability to assay persistent minimal cancer led to the appropriate integration of systemic and local therapies. The treatment of germ cell cancers is the paradigm of multidisciplinary therapy of cancer because it accommodates many variables into the clinical decision-making process.