Description

• Testicular cancer accounts for <1% of all cancers in men; it is the most common solid malignancy in men aged 20 to 34 years (1).
• An estimated 9,610 new cases were diagnosed, and an estimated 440 deaths occurred in the United States in 2020 (2).
• Rates for new cases have been rising 0.8% each year over the last 10 years, but death rates have been stable.
• The median age at diagnosis is 33 years. The median age at death is 41 years (2).
• Treatment produces an overall 5-year survival of 95%; for African American patients, this 5-year survival rate is alarmingly lower but has improved from 86% to 92.3% (2).

Epidemiology

Incidence
The number of new cases of testicular cancer was 5.9 per 100,000 men per year with the number of deaths at 0.3 per 100,000 men per year (2).

Prevalence
In 2017, there were an estimated 269,769 men living with testicular cancer in the United States (2).

Etiology and Pathophysiology

95% of all malignant tumors arising in the testes are germ cell tumors (GCTs), which are subclassified as follows:

• Seminomatous GCTs: most common type overall
• Nonseminomatous GCTs (NSGCTs): These include embryonal cell carcinoma, choriocarcinoma, yolk sac tumor, teratomas, or often multiple cell types; these are more clinically aggressive tumors.

Genetics
Approximately 48.9% of the risk of getting testicular cancer is explained by heritable factors (3).

Risk Factors

• Cryptorchidism is the most firmly established risk factor: Relative risk of testicular cancer in all patients with cryptorchidism is 3 to 8, with a lower relative risk of 2 to 3 in those undergoing orchiopexy by age 12 years; in patients with unilateral cryptorchidism, the relative risk of testicular cancer in the contralateral normally descended testis is negligible (4).
• Personal history of testicular cancer
• Use of muscle building supplements
• Positive family history for testicular cancer
• Testicular dysgenesis
• Klinefelter syndrome
• Caucasian race
• HIV infection

General Prevention

No evidence that screening for testicular cancer is effective (5).