Testicular tumors

Testicular tumors are rare and have significant differences in pathogenesis, histology, management, and outcomes based on age at presentation. Specifically, the relationship to puberty, often reflected by age 11y in the literature, is a critical consideration when approaching patients. While patients generally experience excellent outcomes, adolescent and young adult males experience worse survival than any other age group, making this a particular important population to focus future research efforts on. Diagnosis and initial management centers on histology. The patient's age and tumor marker levels are critical in guiding this management decision point. Prepubertal patients with normal tumor markers generally undergo partial orchiectomy and post-pubertal patients undergo radical orchiectomy, regardless of tumor marker levels. Both approaches utilize an inguinal incision to maintain predictable drainage patterns of the tumor. There are some nuances in tumor marker interpretation based on patient age that are important to consider. Staging with further cross-sectional imaging is generally reserved for after confirmation of pathology. Outcomes are generally excellent, with many patients not needing anything more than surveillance after initial partial/radical orchiectomy. Surveillance usually consists of tumor marker and imaging monitoring. It is imperative to involve a multi-disciplinary team approach if adjuvant therapy is needed. Discussion of following pediatric vs. adult protocols is necessary, with most experts advocating for adult protocols for post-pubertal patients due to the superior oncologic outcomes. It is imperative that the treating surgeon/urologist and oncologist are on the same page.