Clinical characteristics of testicular germ cell tumors in patients aged 50 years and older: A large-scale study from the Cancer Registration Committee of the Japanese Urological Association

Objectives: To determine the characteristics of testicular germ cell tumors in older patients. Methods: A testicular cancer survey was carried out by the Japanese Urological Association in 2011 to register the testicular cancers diagnosed in 2005 and 2008. The survey included age, presenting symptoms, physical examination findings, tumor markers, histopathology, clinical stage, treatment and clinical outcomes. These factors were compared between patients aged ≥50 years and those aged <50 years at diagnosis. Results: Of the 1119 cases of primary testicular germ cell tumors, 123 (11.0%) were diagnosed at age ≥50 years. Compared with patients aged <50 years, germ cell tumors in older patients were more frequently seminomas (74.8% vs 61.4%, P = 0.004) and clinical stage I at diagnosis (79.5% vs 70.7%, P = 0.041). Metastatic germ cell tumors in patients aged ≥50 years were more frequently classified into the good prognosis group according to the International Germ Cell Consensus Classification compared with those in younger patients (84.0% vs 53.8%, P = 0.003). Nevertheless, cancer-specific survival of patients aged ≥50 years was not superior to that of younger patients (4-year survival rates; 93.7% vs 97.8%). Conclusions: Testicular germ cell tumors in patients aged ≥50 years are more commonly seminomas, and tend to be diagnosed at earlier stages compared with younger patients; however, the prognosis of older patients is not favorable compared with that of younger patients.