Metachronous Testicular Germ-cell Tumors: The Importance of a Long-Term Follow-up

Testicular germ cell tumors (TGCT) are the most common malignancy in young male adults. They can be bilateral, and occur as a synchronous or metachronous tumor. The authors intend to characterize the prevalence and outcome of metachronous TGCT in the last 12 years of experience at our center. Cancer data base of our center was reviewed in order to find the patients that had TGCT in the period between 1996 and 2008 and, among those, the patients that had a second malignancy in the contralateral testicle after at least 6 months apart. Risk factors, clinical presentation, histological characteristics, staging, therapy and outcome were considered. Two out of 79 patients had metachronous TGCT, representing 2.5% of the group. Both cases had a low stage malignancy at the time of the diagnosis of the first tumor, and the diagnosis of the second TGCT happened 7 and 12 years later. Both patients are still alive without evidence of residual disease, under androgen replacement therapy and with testicular bilateral prostheses. Sperm cryopreservation was done in one of the patients. Long-term surveillance for TGCT is needed due to the probability of a second malignancy after the first 5 years of normal follow up. Special consideration must be given to patients submitted to bilateral orchiectomy concerning sperm cryopreservation, androgen replacement therapy and testicular prostheses.