What is the likely risk factor for testicular cancer in a 35-year-old male athlete?

Risk Factors for Testicular Cancer in a 35-Year-Old Male Athlete

The most likely risk factor for testicular cancer in a 35-year-old male athlete is previous cryptorchidism (undescended testis), not testicular torsion or testosterone supplement use. 1

Established Risk Factors for Testicular Cancer

Testicular cancer is the most common solid malignancy among males aged 15-40 years, with a mean age at diagnosis of 33 years 2. Understanding the risk factors is crucial for early identification and management.

Primary Risk Factors (In Order of Strength of Association)

• Cryptorchidism (undescended testis):

  • Strongest established risk factor with a relative risk of 3.18 compared to general population 1
  • Risk is particularly high for ipsilateral testicular cancer (RR 6.33) 1

• Family history of testicular cancer:

  • Especially in first-degree relatives (father/brothers) 3
  • The European Germ Cell Cancer Consensus Group identifies this as a significant risk factor 3

• Previous testicular cancer:

  • Increases risk of contralateral disease 1
  • 2-3% of testicular cancers present as bilateral tumors during lifetime 3

• Testicular dysgenesis/abnormal testicular development 1

• Infertility:

  • Associated with increased risk of developing testicular cancer 4
  • May share common etiological factors with testicular cancer 4

Other Considerations

• Age: Testicular cancer is most common in men aged 15-40 years 2
• Testicular atrophy: Volumes <12 ml are associated with higher risk 3

Addressing the Options in the Question

1. Previous testicular torsion: Not established as a significant risk factor in major guidelines. While trauma has been studied, a case-control study showed no significant association after accounting for recall bias 5.

2. Use of testosterone supplements: Not listed as a risk factor in ESMO or NCCN guidelines 1. There is no established causal relationship between testosterone supplementation and testicular cancer development.

3. Recurrent epididymorchitis: Not established as a significant risk factor in major guidelines. While inflammation might be associated with some cancers, there is insufficient evidence to support epididymorchitis as a risk factor for testicular cancer.

Clinical Implications

For a 35-year-old male athlete with testicular cancer:

• Evaluate for history of cryptorchidism
• Consider family history of testicular cancer
• Assess for testicular atrophy or signs of testicular dysgenesis
• Evaluate fertility status as it may be both a risk factor and affected by the disease

Early diagnosis and proper staging are critical, including tumor markers (AFP, β-HCG, LDH) and appropriate imaging studies 3.

Understanding these risk factors can help with risk stratification and appropriate follow-up, especially given the excellent survival rates (97% overall five-year survival) with proper treatment 6.