Testicular Cancer: Diagnosis, Treatment, and Biomarker Advances

Recent advances in testicular cancer have led to a paradigm shift toward more precise, patient-centered care. Current challenges include the identification of accurate biomarkers, the management of incidentally detected small testicular masses (STM), the refinement of surgical techniques through robotic and modified-template approaches to minimize morbidity, and the prevention of overtreatment while maintaining oncological safety. Advanced molecular biomarkers, such as microRNA-371a-3p, currently demonstrate >90% sensitivity for detecting viable germ cell tumors, surpassing classical markers, yet remain limited by their inability to detect teratomatous components. Circulating tumor DNA have also emerged as a promising biomarker for minimal residual disease detection and personalized follow-up. The management of STMs is of growing interest, driven by the rising use of high-resolution scrotal ultrasonography and the consequent improvement in lesion detection. As most incidental findings are benign, this has prompted reconsideration of traditional radical orchiectomy as the standard intervention. STMs require careful evaluation that integrates imaging characteristics, clinical context, and intraoperative frozen section analysis to enable more tailored management. Given the high survival rates of testicular cancer, the avoidance of overtreatment and associated morbidity remains critical. Accordingly, contemporary strategies emphasize active surveillance for low-risk tumors, selective use of adjuvant therapy, and the adoption of minimally invasive surgical techniques. These advances, supported by improved imaging and biomarker profiling, facilitate more accurate patient stratification, balancing curative intent with preservation of quality-of-life.