The Biology and Treatment of Metastatic Testicular Cancer

Despite remarkable advances in the past three decades, metastatic testicular cancer is still a leading cause of cancer death in young men. It is not clear why some patients are cured and others are not, and new treatments are still needed for this disease. Testicular cancer is not one disease but rather has multiple histologic subtypes. A better understanding of the biology of these different histologic subtypes of testicular cancer, and the use of a multidisciplinary approach, have significantly contributed to improving how we currently approach a young patient with testicular cancer. In addition, DNA microarray analysis has provided insight into the molecular pathobiology of the types of testicular cancer. Genetic and epigenetic alterations are two other important factors that could play a role in the behavior of the types of testicular cancer. Because of the multipotential nature of these tumors, patients with metastatic testicular cancer can present with different clinical scenarios, requiring different treatments. In this chapter, we discuss the biology and the treatment options for patients with metastatic testicular cancer based on tumor type and prognostic categories. Future directions and unmet needs for patients suffering from this disease are also discussed.EPIDEMIOLOGY OF TESTICULAR CANCERHuman testicular cancers result from malignant transformation of premeiotic or early meiotic testicular germ cells. These cancers can demonstrate differentiation of all three germinal layers. Testicular cancers are the most common malignant neoplasm of males 15 to 34 years of age and a major cause of death from cancer in this age group.