Testicular tumors in men aged 60 years or older undergoing orchiectomy.

Background: Testicular tumors are rare, particularly in aged men. Indeed, germ cell tumors occur mostly in the young population. Importantly, few studies have systematically characterized testicular tumors, other than lymphomas and spermatocytic tumor, diagnosed in the elderly. We herein aim to assess the clinicopathologic features of such tumors, particularly germ cell tumors, and their oncologic outcomes in old men.

Methods: We analyzed 46 consecutive patients undergoing orchiectomy for testicular tumors at the age of ≥60 years at the University of Rochester Medical Center, together with 343 control patients aged <60 years.

Results: The most common neoplasms identified in the elderly group were diffuse large B-cell lymphoma (n=15, 33%) and pure seminoma (n=15, 33%), followed by mixed germ cell tumor (n=4, 9%) or Leydig cell tumor (n=4, 9%), spermatocytic tumor (n=3, 7%), Sertoli cell tumor (n=2, 4%), and 1 case (2%) of epidermoid cyst, metastatic carcinoma, or plasmacytoma. Seminoma patients had pT1 (n=9) or pT2 (n=5) diseases subsequently treated with prophylactic radiotherapy (n=3) or chemotherapy (n=2), in addition to 1 pT3/cN2 case undergoing chemotherapy with clinically complete response. None of these cases with seminoma had disease recurrence during 10-174 months (median: 82) of follow-up. Mixed germ cell tumors (seminoma component: n=3; embryonal carcinoma: n=3; yolk sac tumor: n=3; choriocarcinoma: n=1; teratoma: n=3) included 3 pT1 and 1 pT2 diseases. Two of these patients with mixed germ cell tumor postoperatively developed lymph node metastasis, underwent lymph node dissection without or with chemotherapy, and were alive without disease after 52 or 157 months, respectively, while the other two, one with prophylactic chemotherapy, had no recurrence 28 and 75 months after orchiectomy. Interestingly, ≥60-year-old patients with mixed germ cell tumor, whose incidence was significantly lower than that in <60-year-old patients, had a significantly higher risk of postoperative recurrence, compared with the younger groups with either mixed germ cell tumor (n=98) or non-seminomatous germ cell tumor (n=31) or only the former in both univariate and multivariable settings.

Conclusions: Nineteen (41%) of ≥60-year-old men in our orchiectomy cohort were found to have germ cell tumor. Remarkably, none of these patients appeared to have aggressive disease with or without preventive radiotherapy or chemotherapy or adjuvant treatment, while the age was an independent predictor of recurrence in those with mixed germ cell tumor.