Cases Of Testicular Cancer Research Articles

Projection of the number of new testicular cancer cases in the world

Projection of the number of new testicular cancer cases in the world

Survivorship Issues in Testicular Cancer

Testicular cancer (TC) is the most prevalent tumor in young men aged 15–40 years, with an annual incidence of 3–11 new cases per 100,000 males in Western countries. In 2020, the International Agency for Research on Cancer reported 74,458 newly diagnosed cases of TC globally. The etiology of TC is complex and includes both genetic and environmental factors. The prognosis of TC is excellent with a >90% cure rate and a >95% 5-year survival rate with appropriate treatment. Treatments for TC include active surveillance, chemotherapy, radiotherapy, and retroperitoneal lymph node dissection, depending on the clinical stage and tumor subtype. It is crucial that patients receive information on the diagnosis, therapeutic management options, consequences of treatments, and surveillance protocols, which allows the patient to play an active role in the decision-making process. Fear of recurrence often affects TC survivors. Therefore, it is essential to fully involve the patient in the choice of the treatment to ensure an optimal compliance, especially when selecting the active surveillance strategy. In the modern era, in light of the excellent outcomes achieved in TC management, one of the high priorities is to deliver curative treatments while minimizing long-term toxicity. This focus can have a positive impact on quality of life and life expectancy of TC survivors.

Trends in the global, regional, and national burden of testicular cancer from 1990 to 2019: an observational study with 30-year global data.

Testicular cancer (TC) is currently the most common malignancy in young and middle-aged men. A comprehensive assessment of TC burden is in lack. Global incidence, deaths, and disability-adjusted life-years (DALYs) of TC from 1990 to 2019 were obtained. Estimated annual percentage change (EAPC) was calculated to quantify trends in TC changes during the period. Relationships between disease burden and age, socio-demographic index (SDI) levels, human development index (HDI) were further analyzed. Globally, incident cases of TC more than doubled from 1990 to 2019, together with an increasing of global age-standardized incidence rates (ASIR) of TC from 1.9 to 2.8. The age-standardized deaths rates (ASDR) remained stable from 0.31 to 0.28. The similar results were reflected in the DALYs. In 2019, the highest ASIR were found in Southern Latin America, Central Europe and Western Europe. Analogously, the highest ASDR were found in Southern Latin America followed by Central Latin America and Central Europe. The burden of incidence increased with SDI, appropriately reached a peak at about 0.78, and then declined. Similarly, the burden of deaths increased with SDI, met a maximum at about 0.7. From 1990 to 2019, the ASIR of TC has increased significantly, while the ASDR has been relatively stable and slightly decreased. The disease burden of TC is shifting to regions and countries with moderate to high levels of development. TC remains a rapidly growing global health problem, and new changes in TC burden should be considered when formulating new TC control policies.

Rising testicular cancer incidence in Spain despite declining mortality: an age-period-cohort analysis

BackgroundTesticular cancer, primarily affecting young men, has seen an alarming rise globally. This study delves into incidence and mortality trends in Spain from 1990 to 2019 using the Global Burden of Disease (GBD) database and the Age-Period-Cohort (A-P-C) model. MethodsWe analyzed GBD data on testicular cancer cases and deaths in Spain, calculating age-standardized rates (ASIR and ASMR) and employing Joinpoint regression to identify significant shifts. The A-P-C model further dissected the effects of age, period, and birth cohort on these trends. ResultsA striking doubling in testicular cancer incidence was observed, from 3.09 to 5.40 per 100,000 men (1.9% annual increase), while mortality rates remained stable and even decreased in younger age groups (0.34 to 0.26 per 100,000, 0.8% annual decrease). Joinpoint analysis revealed four distinct periods of increasing incidence, with a recent slowdown. The A-P-C model highlighted a consistent rise in incidence risk with each successive generation born after 1935, contrasting with a progressive decline in mortality risk across cohorts, particularly marked for those born since the 1960s. ConclusionWhile mortality rates are encouraging, Spain reflects the global trend of escalating testicular cancer incidence. The A-P-C analysis suggests a generational influence, but the underlying causes remain elusive. Further research is crucial to understand these trends and implement effective prevention strategies to combat this growing health concern.

Restricted access and advanced disease in post-pandemic testicular cancer.

Urologists observed reduced cancer consultations and surgeries during the SARS-CoV-2 pandemic, raising concern about treatment delays. Testicular cancer serves as a particularly sensitive marker of this phenomenon, as the clinical stage of testicular cancer at presentation is predictive of cancer-specific survival. We aimed to investigate whether COVID-related restrictions to primary care access resulted in increased incidence of metastatic germ cell testis cancer. A retrospective chart review was conducted on all cases of testicular cancer managed surgically at our center from March 1, 2018, to February 28, 2023. Patients were categorized into temporal cohorts, representing before, during, and following the implementation of COVID-19 public health restrictions in the province of Newfoundland and Labrador. Forty-one cases of testicular germ cell tumors were identified during the study period. The mean age at diagnosis was 40.8 years (standard deviation ±13.7). Demographics did not vary across the cohorts. Clinical stage 3 disease remained stable before and during the pandemic at 10.5% and 9.1% of cases, respectively. In the post-pandemic period, there was an increase to 27.3% (p=0.617). Surgical wait times remained stable across the pandemic (p=0.151). There was a 16.8% rise in clinical stage 3 disease from the pre-pandemic to post-pandemic period. Our study failed to identify a statistically significant increase in metastatic testis cancer incidence upon lifting of pandemic restrictions. Further study is necessary to confirm suspicions that pandemic restrictions contributed to increased incidence of metastatic testis cancer.

A case of testicular cancer in a long‐term hydranencephaly survivor with undescended testes

IntroductionThe development of malignant tumors in patients with hydranencephaly is extremely rare. We describe the first case of testicular cancer that developed in the undescended testes of a long‐term survivor of hydranencephaly.Case presentationA 32‐year‐old man with severe cerebral palsy due to hydranencephaly was referred to our department for the evaluation of a subcutaneous lump in the lower right abdomen. He was a long‐term survivor of hydranencephaly. After confirming the diagnosis of right testicular cancer originating in his undescended testes, surgical resection was performed. Pathological examination revealed a mixed‐type germ cell tumor.ConclusionThe decision‐making process for treating malignant tumors, like testicular cancer, in adults with severe cerebral palsy can be challenging. Clinical ethics consultation could be helpful in avoiding treatment delays.

Aumento de la incidencia del cáncer testicular en España a pesar del descenso de la mortalidad: un análisis edad-periodo-cohorte

BackgroundTesticular cancer, primarily affecting young men, has seen an alarming rise globally. This study delves into incidence and mortality trends in Spain from 1990 to 2019 using the Global Burden of Disease (GBD) database and the Age-Period-Cohort (A-P-C) model. MethodsWe analyzed GBD data on testicular cancer cases and deaths in Spain, calculating age-standardized rates (ASIR and ASMR) and employing Joinpoint regression to identify significant shifts. The A-P-C model further dissected the effects of age, period, and birth cohort on these trends. ResultsA striking doubling in testicular cancer incidence was observed, from 3.09 to 5.40 per 100,000 men (1.9% annual increase), while mortality rates remained stable and even decreased in younger age groups (0.34 to 0.26 per 100,000, 0.8% annual decrease). Joinpoint analysis revealed four distinct periods of increasing incidence, with a recent slowdown. The A-P-C model highlighted a consistent rise in incidence risk with each successive generation born after 1935, contrasting with a progressive decline in mortality risk across cohorts, particularly marked for those born since the 1960s. ConclusionWhile mortality rates are encouraging, Spain reflects the global trend of escalating testicular cancer incidence. The A-P-C analysis suggests a generational influence, but the underlying causes remain elusive. Further research is crucial to understand these trends and implement effective prevention strategies to combat this growing health concern.

A decade in focus: mixed germ cell tumors with choriocarcinoma components

Introduction: This 10-year registry review aimed to investigate the clinical behaviour and outcomes of mixed germ cell tumours with choriocarcinoma components, a rare and aggressive subtype of testicular cancer, in Saudi Arabia. The study explores the demographic characteristics of affected patients, tumour profiles, and the mortality rate associated with this malignancy. Methods: Utilizing data from the Saudi Cancer Registry, the authors identified 33 cases of mixed germ cell tumours with choriocarcinoma components among 1001 testicular cancer cases recorded between 2008 and 2017. Demographic information, including age, marital status, region of residency, year of diagnosis, and 10-year survival status, were collected. Tumour factors, such as the basis of diagnosis, origin site, behaviour, grade, extension, and laterality, were also analyzed. Results: The majority of cases (78.8%) occurred in the young age group (18–45 years), and most tumours (97%) originated in normally descended testes. Grade IV (undifferentiated anaplastic) tumours and distant metastasis were present in 45.5% of patients. All cases exhibited malignant tumour behaviour. The overall mortality rate was 15%, with a mean time from diagnosis to death of 7.72 months (range: 0.5–21.5 months). Conclusion: Mixed germ cell tumours with choriocarcinoma components are rare and tend to affect younger populations. These tumours demonstrate aggressive clinical behaviour, with a significant proportion presenting with high-grade lesions and metastasis at diagnosis. The observed mortality rate underscores the poor prognosis associated with this malignancy. Our study provides essential insights into the clinical characteristics of this rare tumour subtype in the Saudi Arabian population, emphasizing the need for further research to identify prognostic factors and optimize management strategies for affected patients.

SOME PATHOMORPHOLOGICAL FEATURES OF GERM CELL TUMORS OF TESTICLE

Objective: This study aims at identifying the main individual clinical and morphological features of germ cell testicular tumours through a detailed pathomorphological analysis of biopsy and postoperative material.
 Materials and Methods: The study involved the examination and analysis of archival biopsy and post- operative material of testicular cancer cases in Poltava and the Poltava region between 2018 and 2022. The samples were obtained from the Poltava Regional Pathology Bureau. Histological preparations were made using standard methods, stained with haematoxylin and eosin, and subjected to microscopic examination.
 Results: A total of 22 cases of testicular cancer were registered in the Poltava Regional Pathology Bureau between 2018 and 2022. The average age of men diagnosed with these tumours was 43.6±14.9 years. The study identified different types of germ cell testicular tumours, including typical seminoma, spermatocytic seminoma, embryonal cancer, and mixed germinative tumours (combinations of spermatocytic seminoma, embryonal cancer, and teratoma; combinations of typical seminoma and embryonal cancer; combinations of embryonal cancer and teratoma). Microscopic examination revealed histological features specific to each of these tumour types.
 Conclusions: Among germ cell tumours of the testicles in the Poltava region over the past 5 years, typical seminoma was the most frequently detected type, an average age of patients with the diagnosis is 50 years. The youngest patient diagnosed with testicular cancer was 21 years old, who had embryonal cancer. Germ cell testicular tumours have a heterogeneous structure, posing challenges in making pathomorphological di- agnoses. However, detailed microscopic examination enables the verification of the histological type of the tumour and identification of individual features of germinogenic neoplasias.

Saudi Nursing Students' Knowledge and Perception of Testicular Cancer Assessment and Management: A Cross-Sectional Study.

Testicular cancer (TC) incidence is increasing worldwide. This study aimed to investigate Saudi nursing students' knowledge and perception about TC. This cross-sectional study was done using convenience sampling method. In this study, 280 nursing students from different nursing schools in six cities of Saudi Arabia were recruited. A structured self-report questionnaire was used to collect data. About 49.2% of the participants received education about TC in their nursing schools. The findings showed lack of enough knowledge about TC among Saudi nursing students. Mostly, the participants reported that heredity factor and having family history of TC (48.9%) and age between 56 and 70 years (41.8%) were the most common risk factors of TC. According to the participants, physical examination was the most common diagnostic test usually used for early detection of TC (40.4%) and biopsy test was the most accurate test to confirm TC diagnosis (45.4%). Only one third of the participants (34.6%) knew that between 75% and 100% of TC cases can be cured in case of early detection. About half of the participants (51.8%) reported that surgical procedure was the most common treatment for TC. The nursing students who had high GPA (r=0.86, p<0.001), were unwilling to get more information on TC (r=0.24, p=0.04), had family history of TC (r= 0.53, p=0.02), medical problems with testicles (r= 0.69, p=0.01), received education about TC in their school of nursing (r=0.65, p=0.02), and were more self-confident in assessing and managing TC (r=0.38, p=0.03) had higher level knowledge about TC. Conclusion: Despite the importance of nurses' roles in assessing and managing TC, nursing students in Saudi Arabia still did not have enough knowledge about TC. Improving nursing programs' curricula and conducting health education programs are recommended.

Time to man up: Increased risk of testicular cancer among boys with cystic fibrosis

Epidemiologic studies have identified an increased risk of certain malignancies among people with cystic fibrosis. Testicular cancer is one of these malignancies. Potential explanations for this observation include primary effects of the cystic fibrosis transmembrane conductance regulator gene or protein on tissue versus secondary effects which are caused by abnormal anatomy and physiology. Two cases of testicular cancer among adolescent boys receiving care at the same cystic fibrosis care center are presented. Current U.S. Preventive Services Task Force guidelines recommend against routinely screening, medical or self-examination, for testicular cancer among adolescent or adult males. Given the increased risk of testicular cancer among boys and men with cystic fibrosis, this recommendation must be reassessed. As part of its recent focus on reproductive health, the cystic fibrosis care community should, at minimum, develop age-appropriate education resources for adolescent and adult males with cystic fibrosis.

Testicular Cancer - The Great Masquerader

Purpose: Testicular cancer is rare with increasing incidence worldwide. Testicular cancer can mimic many other diseases leading to delay in diagnosis. Delays in diagnosis and management of testicular cancer are associated with advanced stage, increased morbidity and poor prognosis. This case report aims to highlight a case of testicular cancer who presented with metastasis due to delays in testicular cancer diagnosis and ways to improve diagnosis.&#x0D; Methodology: The study focused on a 17-year-old boy presented with severe intermittent abdominal pain for a month. He was reviewed by the general physicians, internists, haematologists, radiologists, general surgeons and urologists. He was given several diagnoses before he was correctly diagnosed as advanced right testicular cancer. It took a total of 31 days in a tertiary institution to reach this diagnosis.&#x0D; Findings: The boy had a radical right inguinal orchidectomy. He had 4 courses of bleomycin, etoposide and cisplatin chemotherapy. He made remarkable recovery after treatment. A follow up was recommended closely with abdominal CT, and serum tumour markers (reverted to normal after treatment).&#x0D; Recommendations: Prompt diagnosis of testicular cancer can reduce treatment delays. Physician education, adequate patient evaluation, investigations, and a high index of suspicion would aid diagnosis. Health awareness campaign, testicular self-examination, and good health insurance schemes would reduce patient-related factors which result in delays. Reduction in diagnostic delay is expected to improve outcome and reduce cost of management of the disease.

Differences in incidence, staging, and survival of urologic cancers in patients under 65 living in the US-Mexico border region.

To describe and compare the incidence, stage at diagnosis, and survival for genitourinary cancers in the border regions and in Hispanic-Americans. A population-based search was performed using the Surveillance, Epidemiology, and End Results Program 18 database and the Texas Cancer Registry from 2000 to 2017. Cox regression models were performed with adjusted for age, gender, race, cancer type, cancer stage, insurance status, and cause of death were used to compare cancer-specific survival. A total of 63,236 kidney and renal pelvis, 38,398 bladder, 170,640 prostate, 24,313 testicular cancer cases were identified. Cancer-specific survival was found to be improved in Hispanic-Americans in kidney and renal pelvis (hazard ratio [HR], 0.903, 95% confidence interval [CI], 0.856-0.952, p = 0.0001), and bladder cancers (HR, 0.817, 95% CI, 0.743-0.898, p < 0.001), despite a more advanced stage at diagnosis in Hispanics with bladder cancer (p < 0.0074). Testicular cancer has a survival disadvantage for individuals living in the border region (HR, 1.315, 95% CI, 1.124-1.539, p = 0.0006). Disparities exist between Hispanic-Americans and Non-Hispanic White and also between individuals living in the border counties when compared to other regions. This is most significant in individuals with testicular cancer residing in the border region who demonstrate worse overall survival.

Unveiling the Taboo: Awareness of Testicular Cancer &amp; Testicular Self Examination

Male sexual and reproductive health is as important as the well-being of other organ-systems. The female breast cancer awareness mission acquired it's Renaissance in Pakistan, a decade back, but the male sexual and reproductive health is a topic almost untouched. The month of April is celebrated as the month of Testicular Cancer (TC) awareness worldwide, as declared by the American Association for Cancer Research. Among the males aged 20-40 years, TC is the most common malignancy encountered worldwide. It is the second most common malignant neoplasm of teenagers aged 15-19 years.1 Of all the malignancies in males, TC has a reported frequency of 0.5-1.5%.2 According to Globocan 2012, the incidence of new cases of TC worldwide was 0.4% which remained constantly the same in 2020, but the number of cases of TC increased significantly worldwide. The incidence of mortality related to TC was documented to increase from zero percent to 0.1% in Globocan 2020 fact sheets3,4.

MP46-10 ELUCIDATING THERAPEUTIC OPTIONS FOR TREATMENT-NAÏVE AND CISPLATIN-RESISTANT TESTICULAR CANCER

You have accessJournal of UrologyCME1 May 2022MP46-10 ELUCIDATING THERAPEUTIC OPTIONS FOR TREATMENT-NAÏVE AND CISPLATIN-RESISTANT TESTICULAR CANCER Julie-Ann Cavallo, Daniel Ranti, Elliot Merritt, Anna Tocheva, John P. Sfakianos, and Benjamin Hopkins Julie-Ann CavalloJulie-Ann Cavallo More articles by this author , Daniel RantiDaniel Ranti More articles by this author , Elliot MerrittElliot Merritt More articles by this author , Anna TochevaAnna Tocheva More articles by this author , John P. SfakianosJohn P. Sfakianos More articles by this author , and Benjamin HopkinsBenjamin Hopkins More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002612.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Platinum-based chemotherapy is the standard of care (SOC) for patients with advanced testicular cancer (TC). However, outcomes for platinum-refractory tumors remain poor. This project seeks to use functional diagnostic approach to both predict therapeutic response for patients with testicular cancer and evaluate the utility of alternate therapeutic strategies that may improve responses for patients with platinum-refractory disease. METHODS: Using an IRB-approved protocol, we obtained tissue from platinum-sensitive and -resistant TC patients. Tissue specimens were obtained from 13 tumors: 10 primary, 2 post-treatment, and 1 lymph node. To functionally model therapeutic responses for patients with TC, we used our RAPiDS (Rapid Assessment of Patient Drug Sensitivity) screens on primary patient-derived organoids (PDOs) to stratify patient response to SOC therapies and evaluate the relative sensitivity of the tumors to alternative therapeutic regimens. For these studies, we conducted screens with nine therapeutics in a clinically relevant range of concentrations to extract correlative drug response data within two weeks from dissociation. RESULTS: Using the RAPiDS protocol, we developed and evaluated drug sensitivities in five PDOs (Figure 1A). Normalized luminescence from Cell-TiterGlo cell viability assays were used to determine Area Under the Curve (AUC) as a function of drug concentration (Figure 1A and B). Heatmaps show the median centered z-score for these AUC values across the therapeutics screened in each patient to gauge relative sensitivity (Figure 1A). All of our screened TC cases showed sensitivity to one or more alternative therapies tested, regardless of PDO response to first- or second-line SOC (Figure 1B). CONCLUSIONS: This data suggests that RAPiDS could be used on TC PDOs to help guide the selection of treatment options within clinically relevant timelines, which has the potential to be useful, especially in metastatic and rare cancer settings where therapeutic options are limited. Additionally, we are currently investigating the utility of RAPiDS in refractory and metastatic TC. Source of Funding: Mount Sinai School of Medicine seed funds © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e776 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julie-Ann Cavallo More articles by this author Daniel Ranti More articles by this author Elliot Merritt More articles by this author Anna Tocheva More articles by this author John P. Sfakianos More articles by this author Benjamin Hopkins More articles by this author Expand All Advertisement PDF DownloadLoading ...

The role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the prognosis of patients with testicular cancer

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as systemic inflammatory response markers, have been shown to play a role in prognostic factors for patients with malignancies in recent years. However, their application as the prognostic factors of testicular cancer remains unknown. This study aims to evaluate the prognostic role of testicular malignancies using preoperative hematological parameters, NLR and PLR, and their pre-diagnostic role in the staging of testicular cancer. Methods: This was a cross-sectional retrospective study of thirty-nine patients who underwent radical orchiectomy due to testicular cancer at the Department of Urology Haji Adam Malik General Hospital between January 2014 and December 2018. For each patient, clinical features including age, sex, clinical stage, chemotherapy, radiology report, pre-treatment neutrophil count, lymphocyte count, platelet count, NLR, PLR, and postoperative histopathological report were collected. Then we analyzed the association between NLR, PLR and the testicular cancer metastasis incidence. Result: The mean age of the patients was 27.56 ± 17.47 years. Seventeen patients had seminoma (42.5%), 16 others were yolk sac type of cancer (40.0%), and the rest six patients were teratoma (3 patients), lymphoma (2 patients), and embryonal carcinoma (1 patient). More than half (66.48%) of the patients received chemotherapy after radical orchiectomy, with 48.70% in clinical stage III. PLR was associated with testicular cancer metastases (p=0.024), while NLR was not (p=0.729). Conclusion: High pre-treatment PLR levels are associated with the occurrence of metastasis in testicular cancer patients. Hematological parameters will become critical in the preoperative evaluation of such testicular cancer cases. The potential prognostic significance of NLR and PLR in testicular cancer should be tested with further studies.

Incidence of Testicular Cancer in Transfeminine Patients following Vaginoplasty with Orchidectomy.

Background:Little is known about the prevalence of testicular cancer in the transfeminine population. Only six cases have been reported in the literature. This case series reports six additional cases of various testicular cancers found in transfeminine patients who underwent vaginoplasty with orchidectomy in our institution.Methods:In our institution, all specimens are routinely sent to pathology following vaginoplasty with orchidectomy. This permitted the identification of all positive cases of testicular cancer. A chart review was conducted to retrieve patient demographics, duration of hormonotherapy, type of neoplasm, the context of its discovery, and cancer follow-up.Results:A total of 2555 patients underwent vaginoplasty with orchidectomy between January 2016 and January 2021. All specimens were sent to pathology for analysis. A total of six (0.23% of patients) specimens revealed malignant lesions.Conclusions:Increased societal awareness toward the transgender population encourages recourse to gender-affirming procedures. Little is known about the incidence of testicular cancer in the transfeminine population. In total, 0.23% of patients in our cohort presented with positive pathology findings indicative of testicular cancer. All cancers were found to be only locally invasive, and all patients were successfully treated. We therefore encourage routine pathology examination for all specimens following vaginoplasty with orchidectomy.

Long-term residential exposure to air pollution and risk of testicular cancer in Denmark: A population-based case-control study.

The incidence rate risk of testicular cancer has increased over the last four decades, and most significant increase has been among Caucasian men in Nordic countries. Second-generation immigrant studies indicate a significant role of environmental exposure in testicular cancer. We conducted a nationwide register-based case-control study, including 6,390 testicular cancer cases registered in the Danish Cancer Registry between 1989 and 2014. Up to four age-matched controls for each case (n=18,997) were randomly selected from Civil Registration System. Ambient air pollution levels were estimated at addresses of cases and controls with a state-of-the-art air pollution modeling system. We mostly found ORs close to 1.00 and with 95% confidence intervals (CI) spanning 1.00. Exposure during the year preceding birth was associated with ORs for NO2 of 0.87 (95%CI: 0.77-0.97) per 10 µg/m3 and for organic carbon of 0.84 (95%CI: 0.72-0.98) per 1 µg/m3. Exposure during the first 10 years of life was associated with ORs for organic carbon of 0.79 (95%CI: 0.67-0.93) per 1 µg/m3, for O3 of 1.20 (95%CI: 1.07-1.34) per 10 µg/m3 and for secondary inorganic aerosols of 1.07 (95%CI: 1.00-1.15) per 1 µg/m3. Early-life exposure to NO2 and OC was associated with lower risk for testicular cancer whereas early-life exposure to O3 and SIA was associated with higher risk. We report both positive and negative associations between ambient air pollutants and risk of testicular, dependent on pollutant, exposure time window and age at diagnosis. This is the first study to investigate such associations.

Incidence of testicular cancer in trans women using gender-affirming hormonal treatment: a nationwide cohort study.

ObjectiveTo assess the incidence of testicular cancer in trans women (male sex assigned at birth, female gender identity) using gender‐affirming hormonal treatment.Patients and MethodsData of trans women starting hormonal treatment at our gender identity clinic between 1972 and 2017 were linked to the national pathology database to obtain testicular cancer diagnoses. The standardised incidence ratio (SIR) was calculated using the number of observed testicular cancer cases in our cohort and the number of expected cases based on age‐specific Dutch incidence rates. Subgroup analyses were performed in testicular tissues sent for histopathological analysis at the time of bilateral orchidectomy, and when follow‐up exceeded 5 years.ResultsThe cohort consisted of 3026 trans women with a median follow‐up time of 2.3 interquartile range (IQR) (1.6–3.7) years. Two testicular cancer cases were identified whilst 2.4 cases were expected (SIR 0.8, 95% confidence interval 0.1–2.8). In addition, one testicular cancer case was encountered in an orchidectomy specimen (0.1%). In the 523 trans women with a follow‐up time of >5 years (median [IQR] 8.9 [6.4–13.9] years), no testicular cancer was observed.ConclusionTesticular cancer risk in trans women is similar to the risk in cis men. The testicular cancer cases occurred within the first 5 years after commencing hormonal treatment, and the percentage of cases encountered at the time of bilateral orchidectomy was low. As no testicular cancer was observed in trans women with a long follow‐up period, long‐term hormonal treatment does not seem to increase testicular cancer risk.

Testicular cancer survivors have shorter anogenital distance that is not increased by 1 year of testosterone replacement therapy.

Is anogenital distance (AGD) shorter in testicular cancer (TC) survivors than in men from the general population, and is AGD affected by testosterone replacement therapy in adulthood? AGD, measured as distance from anus to scrotum (AGDas), is shorter in TC survivors and does not change as a result of testosterone replacement therapy. Animal studies have shown that AGD is a postnatal 'read-out' of foetal androgen action, and short AGD in male offspring is considered a sign of feminization caused by in utero disruption of the reproductive system. Likewise, measurement of AGD in human studies has suggested AGD to be part of the testicular dysgenesis syndrome hypothesis, which proposes that male reproductive disorders, such as hypospadias, cryptorchidism, some cases of impaired semen quality and TC, all share a common foetal origin. The aim was to assess AGD in men with a history of TC and controls, and furthermore to examine AGD during testosterone replacement therapy in adulthood. Study participants were TC survivors with a mild Leydig cell insufficiency who participated in a randomized double-blind study of testosterone replacement therapy versus placebo for 52 weeks (N = 69). Men from the general population were prospectively included from a study on testicular function as controls (N = 67). We measured two variants of AGD; as our primary outcome the anoscrotal distance (AGDas) measured from the centre of the anus to the posterior base of the scrotum, and secondarily the anopenile distance (AGDap) measured from the anus to the cephalad insertion of the penis. Using multiple regression analysis, the mean difference in AGD between TC survivors and men from the general population was assessed, adjusted for height, BMI and examiner. Next, AGD was measured before and after 52 weeks of treatment with testosterone or placebo, and with covariance analysis differences between the two groups at follow-up was assessed after adjustment for baseline AGD, examiner, BMI and change in BMI during treatment. TC survivors had a shorter AGDas (-0.84 cm, 95% CI: -1.31; -0.37) compared to men from the general population, and AGDas did not differ between the testosterone and placebo treated group at follow-up (0.11 cm, 95% CI: -0.22; 0.44). In contrast, AGDap was not shorter in TC survivors after adjustment (0.05 cm, 95% CI: -0.30; 0.39), and was 0.48 cm longer (95% CI: 0.13; 0.82) at follow-up in the testosterone treated compared to the placebo-treated group. A limitation of the study is that the number of included men was limited, and results need confirmation in a larger study. Furthermore, TC survivors were significantly older than controls. For the comparison of AGD in TC survivors and controls, it was not possible to conduct the examinations with the examiner being blinded to which group he was examining, and it cannot be excluded that this can cause a bias. The shorter AGDas in TC survivors compared to controls, which did not change upon adult testosterone replacement therapy, supports the hypothesis that reduced AGD is part of the testicular dysgenesis syndrome and may be a marker of disrupted foetal testicular development. By contrast, AGDap was not shorter in TC survivors and might be modestly sensitive to adult testosterone treatment, and thus inferior to AGDas as a constant postnatal marker of the foetal androgen environment. Expenses were paid by the Department of Oncology, Copenhagen University Hospital, Rigshospitalet. Kiowa Kirin International covered expenses for Tostran and placebo. The Danish Cancer Society, The Danish Cancer Research Foundation, the Preben & Anna Simonsen Foundation, and Rigshospitalet have supported the study. L.P. was financed by the Research Fund of the Capital Region of Denmark. The authors have no competing interests. Part of the study is based on men participating in a randomized controlled trial registered at ClinicalTrials.gov, NCT02991209, 25 November 2016.