Testicular Tumors

Germ-cell tumors of the testes are the most common type of malignant tumor in men aged 20 to 40. Their incidence in Germany is 10 per 100 000 men per year, with an estimated 4200 new cases annually.

This selective review is based on the recommendations of the German clinical practice guideline on the diagnosis, treatment and follow-up care of testicular germ-cell tumors, as well as on pertinent original articles and reviews.

The treatment of germ-cell tumors requires an interdisciplinary approach comprising resection of the affected testis followed by further steps that depend on the histological type and stage of the tumor, which may include active surveillance, chemotherapy, radiotherapy, further surgery, or some combination of these measures. Two-thirds of germ-cell tumors are diagnosed in clinical stage I, when they are still confined to the testis; one-third are already metastatic when diagnosed, with organ metastases in 10-15%. Stage-based multimodal treatment approaches are associated with cure rates of more than 99% for stage I tumors and 67-95% for advanced metastatic disease, depending on the degree of progression.

For patients with early-stage tumors, overtreatment should be avoided in order to minimize long-term sequelae. For those whose tumors are in advanced stages, it must be decided which patients should receive intensified treatment to optimize the outcome. Multimodal treatment approaches are associated with high cure rates even for patients with metastatic disease.