Insights From Testicular Cancer Deaths in the U.S. Military: Case Reports

Testicular cancer is the most common cause of cancer in the U.S. male active duty population. Advancements in surgical and chemotherapy approaches have led to a 95% 5-year survival rate across all stages. The United States Preventive Services Task Force recommends against non-symptomatic clinical screening or patient self-examination citing the high survival rate and overall low civilian incidence. We present 2 case reports of active duty individuals who died from complications of testicular cancer. Case 1 was found deceased. At autopsy, a pelvic mass was found disrupting the aorta along with hemoperitoneum. The mass was subsequently identified as a metastatic mixed germ cell tumor. Case 2 presented with orchalgia and a testicular mass, but did not attend to his ordered ultrasound before deployment. He returned to the United States with a >10 cm testis, widespread metastatic disease, and a serum beta-human chorionic gonadotropin (hCG) over 250,000. A non-seminomatous germ cell tumor was presumed, and an orchiectomy was delayed to initiate chemotherapy. He died shortly after therapy was initiated from a pulmonary hemorrhage. In this article, we discuss how unique features of the military population may impact testicular cancer care with evidence from these 2 cases along with suggestions where impactful change can be made.