Update on epidemiologic considerations and treatment trends in testicular cancer

Abstract

Purpose of review: We aim to give an overview of the epidemiology and treatment trends of testicular germ cell tumors (TGCTs), with an emphasis on recent trends.

Recent findings: The incidence of TGCT appears to be increasing, particularly in developed countries, although the reasons are not well understood. There is evidence of racial differences in predisposition to TGCT, with white men having highest risk and men of African or Asian descent having lower risk. In the United States, the incidence of TGCT among Hispanics appears to be rising most quickly. A recent genomic analysis indicates there is no highly penetrant major TGCT susceptibility gene. Incorporation of multidisciplinary care has led to excellent long-term cure rates; however, access to care and insurance remains barriers in young men. Recent treatment trends have centered on maximizing oncologic outcomes while minimizing long-term morbidity.

Summary: Emerging population-level data provide critical insight into the evolving demographics of TGCT, which may allow for elucidation of biologic and environmental determinants of TGCT. Further, identification of socioeconomic barriers to excellent clinical outcomes will allow for targeted interventions to patients with unique demographic and socioeconomic considerations. Treatment trend analyses suggest that the field is moving toward minimizing treatment-related morbidity.

Figure 1A. Estimated age-standardized rates of incident cases of testicular cancer, worldwide in 2012

Source: GLOBOCAN 2012, Graph production: Cancer Today, (http://gco.iarc.fr/today), World Health Organization

Figure 1B. Estimated age-standardized rates of deaths due to testicular cancer, worldwide in 2012 (Reprinted with Permission from the International Agency for Research on Cancer)

Source: GLOBOCAN 2012, Graph production: Cancer Today, (http://gco.iarc.fr/today), World Health Organization

Figure 2. Testicular cancer treatment patterns stratified by hospital volume. (A) Stage I seminoma, (B) stage I nonseminomatous germ cell tumor, (C) management of stage II to III nonseminomatous germ cell tumor following chemotherapy.

RPLND – retroperitoneal lymph node dissection, PC-RPLND – post-chemotherapy retroperitoneal lymph node dissection Source: Woldu SL, Matulay JT, Clinton TN, Singla N, Krabbe L-M, Hutchinson RC, et al. Impact of hospital case volume on testicular cancer outcomes and practice patterns. Urologic Oncology: Seminars and Original Investigations. 2018;36(1):14.e7-.e5.