Testicular germ cell tumors.

Testicular cancer is the most frequent solid tumor in young male adults and a disease with elusive pathogenesis. Germ cell tumors represent 95% of all testicular cancers. There was an increasing incidence of testicular germ cell tumors during the second half of the 20th century. Despite their increased incidence, mortality is lower than 10% and the cure rate has reached 95%. Epidemiology of the disease shows remarkable geographic and racial variation. Known risk factors and the increased incidence during the last 50 years have led to the development of the two prevalent theories for the pathogenesis of the disease, Henderson theory and Rajpertde Meyts and Skakkebaek theory. Appropriate diagnosis and staging of the disease are crucial for successful management. Testicular ultrasound, CT scans, histological examination and serum tumor markers should be utilized in order to stratify the patient correctly. Treatment strategy is chosen according to the patient stage and prognostic group stratification. "Fine tuning" is needed in order to find the balance between treatment, cure and toxicity. Despite progress in therapeutic management, cure rates for poor risk patients do not exceed 50%. These patients should be encouraged to participate in clinical trials. Long-term toxicity of testicular germ cell tumors' treatment is also another issue that should be kept in mind during follow-up of these patients. This disease became the model of "curable" cancer and gave hope for cure of metastatic malignant diseases in general, as only 400 patients die from this disease in USA annually. More progress will be made only through well-designed clinical trials.