Testicular Cancer, An Issue of Urologic Clinics

Each year there are approximately 8000 new cases of testicular cancer diagnosed in the United States, resulting in almost 400 deaths. The incidence of testicular cancer, the most common solid tumor in men between the ages of 20 and 35 years, is rising in the United States and Europe. The management of patients with testicular cancer has evolved significantly over the past 25 years, representing a model in the successful multidisciplinary approach to a solid malignancy with the appropriate integration of surgery and cisplatin- based chemotherapy resulting in improvements in survival from 60% to 65% in the 1960s to over 95% at present.Given the high probability of achieving cure, considerable effort has been focused on individualizing therapy for specific patients in an attempt to minimize morbidity, preserve quality of life without adversely impacting survival. This has been possible because of refinements in histologic, serologic, and radiographic parameters which has resulted in improved risk assessment for patients of all stages. Surgical techniques and the development of less toxic and more effective chemotherapy regimens has also played a critical role. The apparent overtreatment of many patients, and the availability of multiple approaches that achieve cure, has resulted in a number of significant controversies in the management of testicular cancer. The long term survival of patients has identified significant issues that appear to have been underappreciated in the past, such as late relapse, reoperative surgery and the long-term sequelae of treatment, particularly chemotherapy. Some of these problems have prompted us to reexamine and challenge previously accepted treatment paradigms. This issue of the Urologic Clinics of North America describes the current state- of-the-art therapy for testicular cancer and specifically addresses some of the important controversies faced by clinicians today. This has been possible due to the insight and expertise of an exceptional group of distinguished urologists, medical and radiation oncologists, and pathologists.