At what age is testicular cancer most commonly diagnosed?

Testicular Cancer Age of Diagnosis

Testicular cancer is most commonly diagnosed in males between the ages of 15 and 34 years. 1, 2

Epidemiology and Age Distribution

Testicular cancer represents a relatively rare malignancy overall but has significant importance in young adult males:

• It is the most common solid tumor in men between 15-34 years of age 1
• The mean age at diagnosis is 33 years 2
• Annual incidence is approximately 5.4-6.3 cases per 100,000 males 1, 3
• Approximately 8,590-10,000 new cases are diagnosed annually in the United States 1, 2
• Despite being only 1.1% of all male cancers, it is the predominant cancer in this young age group 1
• The incidence has more than doubled in the past 40 years worldwide 1

Risk Factors

Several established risk factors for testicular cancer development include:

• Prior history of testicular cancer
• Positive family history
• Cryptorchidism (undescended testicle)
• Testicular dysgenesis
• Infertility
• Caucasian ethnicity (higher risk)
• Cannabis use
• Genetic conditions such as Klinefelter syndrome 1, 2

Prognosis and Mortality

Despite being the most common cancer in young men, testicular cancer has excellent outcomes:

• Overall 5-year survival rate is approximately 95-97% 2, 4
• Mortality rate is low at 0.38 cases per 100,000 males per year 3
• Even with advanced disease, cure rates are high
• Stage-specific 5-year survival rates:
  • Stage I: 99%
  • Stage II: 92%
  • Stage III: 85% 2

Clinical Implications

Understanding the age distribution of testicular cancer has important implications:

• Awareness campaigns should target males in the 15-34 age group
• Although routine screening is not recommended by the USPSTF for asymptomatic males (Grade D recommendation) 1, awareness of symptoms is critical
• Young men with risk factors should be educated about the potential signs of testicular cancer
• The most common presenting symptom is a painless testicular mass 2
• Prompt diagnosis and treatment are essential for optimal outcomes

Common Pitfalls and Caveats

1. Despite being most common in young adults, testicular cancer can occur at any age
2. The USPSTF recommends against routine screening in asymptomatic males due to the low incidence and high cure rates even when detected at symptomatic stages 1
3. The recommendation against screening does not apply to males with a history of cryptorchidism or other high-risk factors 1
4. Fertility preservation should be discussed early in the course of treatment, as this age group is often in their reproductive years 3, 4
5. Long-term survivorship concerns are particularly important in this young population, including body image, fertility, hypogonadism, mental health, and late effects of therapy 2

Understanding that testicular cancer predominantly affects young men between 15-34 years is crucial for appropriate clinical suspicion, timely diagnosis, and optimal management of this highly curable malignancy.