Testicular Cancer Questions & Answers

1. Testicular Cancer Treatment. National Cancer Institute. Available at http://www.cancer.gov/cancertopics/pdq/treatment/testicular/HealthProfessional/page1. February 22, 2021; Accessed: August 12, 2021.

2. Surveillance, Epidemiology, and End Results Program. SEER Stat Fact Sheets: Testis Cancer. National Cancer Institute. Available at http://seer.cancer.gov/statfacts/html/testis.html. Accessed: August 12, 2021.

3. American Cancer Society. Cancer Facts & Figures 2021. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf. Accessed: August 12, 2021.

4. American Cancer Society. Key statistics for testicular cancer. American Cancer Society. Available at http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-key-statistics. January 12, 2021; Accessed: August 12, 2021.

5. McGlynn KA, Devesa SS, Sigurdson AJ, Brown LM, Tsao L, Tarone RE. Trends in the incidence of testicular germ cell tumors in the United States. Cancer. 2003 Jan 1. 97(1):63-70. [QxMD MEDLINE Link].

6. Trabert B, Chen J, Devesa SS, Bray F, McGlynn KA. International patterns and trends in testicular cancer incidence, overall and by histologic subtype, 1973-2007. Andrology. 2014 Oct 20. [QxMD MEDLINE Link].

7. Chia VM, Quraishi SM, Devesa SS, Purdue MP, Cook MB, McGlynn KA. International trends in the incidence of testicular cancer, 1973-2002. Cancer Epidemiol Biomarkers Prev. 2010 May. 19(5):1151-9. [QxMD MEDLINE Link]. [Full Text].

8. Kusler KA, Poynter JN. International testicular cancer incidence rates in children, adolescents and young adults. Cancer Epidemiol. 2018 Aug 18. 56:106-111. [QxMD MEDLINE Link].

9. McGlynn KA, Devesa SS, Graubard BI, Castle PE. Increasing incidence of testicular germ cell tumors among black men in the United States. J Clin Oncol. 2005 Aug 20. 23(24):5757-61. [QxMD MEDLINE Link].

10. Chien FL, Schwartz SM, Johnson RH. Increase in testicular germ cell tumor incidence among Hispanic adolescents and young adults in the United States. Cancer. 2014 Sep 1. 120(17):2728-34. [QxMD MEDLINE Link].

11. De Padova S, Urbini M, Schepisi G, Virga A, Meggiolaro E, Rossi L, et al. Immunosenescence in Testicular Cancer Survivors: Potential Implications of Cancer Therapies and Psychological Distress. Front Oncol. 2020. 10:564346. [QxMD MEDLINE Link]. [Full Text].

12. Lubberts S, Meijer C, Demaria M, Gietema JA. Early ageing after cytotoxic treatment for testicular cancer and cellular senescence: Time to act. Crit Rev Oncol Hematol. 2020 Jul. 151:102963. [QxMD MEDLINE Link]. [Full Text].

13. Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. 2007 May 3. 356(18):1835-41. [QxMD MEDLINE Link].

14. Travis LB, Fossa SD, Schonfeld SJ, McMaster ML, Lynch CF, Storm H. Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst. 2005 Sep 21. 97(18):1354-65. [QxMD MEDLINE Link].

15. van Leeuwen FE, Stiggelbout AM, van den Belt-Dusebout AW, et al. Second cancer risk following testicular cancer: a follow-up study of 1,909 patients. J Clin Oncol. 1993 Mar. 11(3):415-24. [QxMD MEDLINE Link].

16. Walsh TJ, Croughan MS, Schembri M, Chan JM, Turek PJ. Increased risk of testicular germ cell cancer among infertile men. Arch Intern Med. 2009 Feb 23. 169(4):351-6. [QxMD MEDLINE Link].

17. [Guideline] Testicular Cancer. National Comprehensive Cancer Network. Available at https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf. Version 2.2021 — April 13, 2021; Accessed: August 12, 2021.

18. Subik MK, Gordetsky J, Yao JL, di Sant'agnese PA, Miyamoto H. Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: its role in preventing unnecessary orchiectomy. Hum Pathol. 2012 Mar 8. [QxMD MEDLINE Link].

19. American Joint Committee on Cancer. Testis. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, et al, eds. AJCC Cancer Staging Manual. 8th edition. New York: Springer; 2017.

20. International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor- based staging system for metastatic germ cell cancers. J Clin Oncol. 1997 Feb. 15(2):594-603. [QxMD MEDLINE Link].

21. van Dijk MR, Steyerberg EW, Habbema JD. Survival of non-seminomatous germ cell cancer patients according to the IGCC classification: An update based on meta-analysis. Eur J Cancer. 2006 May. 42(7):820-6. [QxMD MEDLINE Link].

22. Kollmannsberger C, Tyldesley S, Moore C, et al. Evolution in management of testicular seminoma: population-based outcomes with selective utilization of active therapies. Ann Oncol. 2011 Apr. 22(4):808-14. [QxMD MEDLINE Link].

23. Mead GM, Fossa SD, Oliver RT, Joffe JK, Huddart RA, Roberts JT, et al. Randomized Trials in 2466 Patients With Stage I Seminoma: Patterns of Relapse and Follow-up. J Natl Cancer Inst. 2011 Feb 2. 103(3):241-249. [QxMD MEDLINE Link].

24. Oliver RT, Mead GM, Rustin GJ, Joffe JK, Aass N, Coleman R, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol. 2011 Mar 10. 29 (8):957-62. [QxMD MEDLINE Link].

25. Tandstad T, Dahl O, Cohn-Cedermark G, Cavallin-Stahl E, Stierner U, Solberg A. Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program. J Clin Oncol. 2009 May 1. 27(13):2122-8. [QxMD MEDLINE Link].

26. De Santis M, Becherer A, Bokemeyer C, Stoiber F, Oechsle K, Sellner F. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004 Mar 15. 22(6):1034-9. [QxMD MEDLINE Link].

27. Daugaard G, Gundgaard MG, Mortensen MS, Agerbæk M, Holm NV, et al. Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol. 2014 Dec 1. 32(34):3817-23. [QxMD MEDLINE Link].

28. Einhorn LH, Williams SD, Chamness A, Brames MJ, Perkins SM, Abonour R. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007 Jul 26. 357(4):340-8. [QxMD MEDLINE Link].

29. Pectasides D, Pectasides M, Farmakis D, Aravantinos G, Nikolaou M, Koumpou M. Gemcitabine and oxaliplatin (GEMOX) in patients with cisplatin-refractory germ cell tumors: a phase II study. Ann Oncol. 2004 Mar. 15(3):493-7. [QxMD MEDLINE Link].

30. Ge V, Banakh I, Tiruvoipati R, Haji K. Bleomycin-induced pulmonary toxicity and treatment with infliximab: A case report. Clin Case Rep. 2018 Oct. 6 (10):2011-2014. [QxMD MEDLINE Link]. [Full Text].

31. Haugnes HS, Aass N, Fosså SD, Dahl O, Brydøy M, Aasebø U, et al. Pulmonary function in long-term survivors of testicular cancer. J Clin Oncol. 2009 Jun 10. 27 (17):2779-86. [QxMD MEDLINE Link]. [Full Text].

32. Willemse PM, Hamdy NA, de Kam ML, Burggraaf J, Osanto S. Changes in Bone Mineral Density in Newly Diagnosed Testicular Cancer Patients After Anti-cancer treatment. J Clin Endocrinol Metab. 2014 Aug 13. jc20141722. [QxMD MEDLINE Link].

33. Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med. 2009 Feb 26. 360(9):902-11. [QxMD MEDLINE Link].

34. [Guideline] Laguna MP, Albers P, Albrecht W, et al. Testicular Cancer. European Association of Urology. Available at https://uroweb.org/guideline/testicular-cancer/. July 2019; Accessed: September 5, 2019.

35. [Guideline] Oldenburg J, Fosså SD, Nuver J, Heidenreich A, Schmoll HJ, Bokemeyer C, et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct. 24 Suppl 6:vi125-32. [QxMD MEDLINE Link]. [Full Text].

36. [Guideline] Oldenburg J and Horwich A, on behalf of the ESMO guidelines committee. eUpdate – Testicular Seminoma and Non-Seminoma Treatment Recommendations. ESMO.org. Available at https://www.esmo.org/Guidelines/Genitourinary-Cancers/Testicular-Seminoma-and-Non-Seminoma/eUpdate-Treatment-Recommendation. June 29, 2017; Accessed: August 13, 2021.

37. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005 Jul 23-29. 366(9482):293-300. [QxMD MEDLINE Link].

38. Albers P, Siener R, Krege S, Schmelz HU, Dieckmann KP, Heidenreich A. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. 2008 Jun 20. 26(18):2966-72. [QxMD MEDLINE Link].

39. Albqami N, Janetschek G. Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer. J Endourol. 2005 Jul-Aug. 19(6):683-92; discussion 692. [QxMD MEDLINE Link].

40. Aparicio J, Germa JR, Garcia del Muro X, Maroto P, Arranz JA, Saenz A. Risk-adapted management for patients with clinical stage I seminoma: the Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol. 2005 Dec 1. 23(34):8717-23. [QxMD MEDLINE Link].

41. Beck SD, Foster RS, Bihrle R, Cheng L, Ulbright TM, Donohue JP. Impact of the number of positive lymph nodes on disease-free survival in patients with pathological stage B1 nonseminomatous germ cell tumor. J Urol. 2005 Jul. 174(1):143-5. [QxMD MEDLINE Link].

42. Chung PW, Warde PR, Panzarella T, Bayley AJ, Catton CN, Milosevic MF. Appropriate radiation volume for stage IIA/B testicular seminoma. Int J Radiat Oncol Biol Phys. 2003 Jul 1. 56(3):746-8. [QxMD MEDLINE Link].

43. Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol. 2003 Mar 15. 21(6):1101-6. [QxMD MEDLINE Link].

44. Culine S, Kramar A, Théodore C, Geoffrois L, Chevreau C, Biron P. Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate- and poor-risk metastatic nonseminomatous germ cell tumors: Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol. 2008 Jan 20. 26(3):421-7. [QxMD MEDLINE Link].

45. de Wit R, Roberts JT, Wilkinson PM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5-day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. 2001 Mar 15. 19(6):1629-40. [QxMD MEDLINE Link].

46. Haugnes HS, Aass N, Fossa SD, et al. Pulmonary function in long-term survivors of testicular cancer. J Clin Oncol. 2009 Jun 10. 27(17):2779-86. [QxMD MEDLINE Link].

47. Hinton S, Catalano PJ, Einhorn LH, Nichols CR, David Crawford E, Vogelzang N. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Cancer. 2003 Apr 15. 97(8):1869-75. [QxMD MEDLINE Link].

48. Holm M, Hoei-Hansen CE, Rajpert-De Meyts E, Skakkebaek NE. Increased risk of carcinoma in situ in patients with testicular germ cell cancer with ultrasonic microlithiasis in the contralateral testicle. J Urol. 2003 Oct. 170(4 Pt 1):1163-7. [QxMD MEDLINE Link].

49. Horvath A, Korde L, Greene MH, Libe R, Osorio P, Faucz FR, et al. Functional phosphodiesterase 11A mutations may modify the risk of familial and bilateral testicular germ cell tumors. Cancer Res. 2009 Jul 1. 69(13):5301-6. [QxMD MEDLINE Link]. [Full Text].

50. Houck W, Abonour R, Vance G, Einhorn LH. Secondary leukemias in refractory germ cell tumor patients undergoing autologous stem-cell transplantation using high-dose etoposide. J Clin Oncol. 2004 Jun 1. 22(11):2155-8. [QxMD MEDLINE Link].

51. Jones WG, Fossa SD, Mead GM, Roberts JT, Sokal M, Horwich A. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol. 2005 Feb 20. 23(6):1200-8. [QxMD MEDLINE Link].

52. Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. 2004 Jan 1. 22(1):108-14. [QxMD MEDLINE Link].

53. Kondagunta GV, Bacik J, Bajorin D, Dobrzynski D, Sheinfeld J, Motzer RJ. Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors. J Clin Oncol. 2005 Dec 20. 23(36):9290-4. [QxMD MEDLINE Link].

54. Kondagunta GV, Bacik J, Donadio A, Bajorin D, Marion S, Sheinfeld J. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005 Sep 20. 23(27):6549-55. [QxMD MEDLINE Link].

55. Melchior D, Muller SC, Albers P. Extensive surgery in metastatic testicular cancer. Aktuelle Urol. 2003 Jul. 34(4):214-22. [QxMD MEDLINE Link].

56. R. T. Oliver, G. M. Mead, P. J. Fogarty, S. P. Stenning, MRC TE19 and EORTC 30982 trial collaborators. Radiotherapy versus carboplatin for stage I seminoma: Updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214). J Clin Oncol. 2008. 26:(May 20 suppl; abstr 1).

57. Rick O, Bokemeyer C, Weinknecht S, Schirren J, Pottek T, Hartmann JT. Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer. J Clin Oncol. 2004 Sep 15. 22(18):3713-9. [QxMD MEDLINE Link].

58. Chung P, Warde P. Stage I seminoma: adjuvant treatment is effective but is it necessary?. J Natl Cancer Inst. 2011 Feb 2. 103 (3):194-6. [QxMD MEDLINE Link].

59. Kollmannsberger C, Tandstad T, Bedard PL, Cohn-Cedermark G, Chung PW, Jewett MA, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015 Jan 1. 33 (1):51-7. [QxMD MEDLINE Link].

60. Daugaard G, Gundgaard MG, Mortensen MS, Agerbæk M, Holm NV, Rørth M, et al. Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol. 2014 Dec 1. 32 (34):3817-23. [QxMD MEDLINE Link].

61. Feldman DR, Hu J, Dorff TB, Lim K, Patil S, Woo KM, et al. Paclitaxel, Ifosfamide, and Cisplatin Efficacy for First-Line Treatment of Patients With Intermediate- or Poor-Risk Germ Cell Tumors. J Clin Oncol. 2016 Jul 20. 34 (21):2478-83. [QxMD MEDLINE Link].

62. Mulherin BP, Brames MJ, Einhorn LH. Long-term survival with paclitaxel and gemcitabine for germ cell tumors after progression following high-dose chemotherapy with tandem transplant. Am J Clin Oncol. 2015 Aug. 38 (4):373-6. [QxMD MEDLINE Link].

63. Seidel C, Oechsle K, Lorch A, Dieing A, Hentrich M, Hornig M, et al. Efficacy and safety of gemcitabine, oxaliplatin, and paclitaxel in cisplatin-refractory germ cell cancer in routine care--Registry data from an outcomes research project of the German Testicular Cancer Study Group. Urol Oncol. 2016 Apr. 34 (4):167.e21-8. [QxMD MEDLINE Link].

Kush Sachdeva, MD Southern Oncology and Hematology Associates, Inspira Health Network

Disclosure: Nothing to disclose.

Mansoor Javeed, MD, FACP Clinical Assistant Professor of Medicine, University of California, Davis, School of Medicine; Consultant, Sierra Hematology-Oncology Medical Center

Mansoor Javeed, MD, FACP is a member of the following medical societies: American College of Physicians, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Issam Makhoul, MD Laura F Hutchins, MD, Distinguished Chair of Hematology and Oncology, Professor of Medicine, Co-Chair, Breast Cancer Disease Oriented Committee, Director of Hematology/Oncology Division, Department of Internal Medicine, University of Arkansas for Medical Sciences College of Medicine

Issam Makhoul, MD is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Bagi RP Jana, MD, MBA, MHA, FACP Professor of Cancer Medicine, MD Anderson Cancer Center; Professor of Medicine, University of Texas Medical Branch at Galveston

Bagi RP Jana, MD, MBA, MHA, FACP is a member of the following medical societies: American Cancer Society, American Medical Association, American Society of Clinical Oncology, SWOG

Disclosure: Nothing to disclose.

Brendan Curti, MD Director, Genitourinary Oncology Research, Robert W Franz Cancer Research Center, Earle A Chiles Research Institute, Providence Cancer Center

Brendan Curti, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, Oregon Medical Association, Society for Immunotherapy of Cancer

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Prometheus Pharmaceuticals, BMS<br/>Received research grant from: Prometheus Pharmaceuticals, Viralytics, MedImmune, BMS, Galectin Therapeutics.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

E Jason Abel, MD Associate Professor of Urologic Oncology, Department of Urology, Associate Professor of Radiology (Affiliate Appointment), Department of Radiology, University of Wisconsin School of Medicine and Public Health; Attending Urologist, William S Middleton Memorial Veterans Hospital

E Jason Abel, MD is a member of the following medical societies: American Medical Association, American Society of Clinical Oncology, American Urological Association, Harris County Medical Society, Kidney Cancer Association, Society for Basic Urologic Research, Society of Urologic Oncology, Texas Medical Association

Disclosure: Nothing to disclose.

Philip Schulman, MD Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center

Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, Medical Society of the State of New York

Disclosure: Nothing to disclose.

The author and editors wish to thank Salah Almokadem, MD,  Assistant Professor of Medicine, Department of Medicine, Penn State Milton S Hershey Medical Center; and Charles J Ryan, MD, Assistant Clinical Professor, Department of Medicine, Division of Hematology and Oncology, University of California at San Francisco, for their contributions to previous versions of this article.

• Print this section
• Print the entire contents of
• Print the entire contents of article