Mate infertility - More than a stastistical risk factor for Germ Cell Tumors?

The primary patient age group for malignant germ cell tumors is 20-35 years . In this group testicular cancer is the most common tumor. Germ cell cance r has long been a model for curable neoplasm, and multimodal therapy regime s lead to cure rates of approximately 100%. Testicular intraepithelial neop lasia (TIN) is recognized as a precursor of seminomatous and nonseminomatou s germ cell tumors and is found by testicular biopsy with a diagnostic sens itivity of 99.5%. After 57 years, patients with TIN, if left untreated, hav e invasive growth in 50-70% of cases. At the time of diagnosis, 60% of pati ents with germ cell cancer show severe impairment of fertility,as it is the case in 25% of cases after successful therapy. Current case control studie s and reports from andrological centers reveal an increased risk for testic ular cancer in patients with impaired fertility. We found TIN in 5.3% of ou r andrological patients (n = 114). Radiotherapy (18-20 Gy) was offered to p atients with bilateral TIN or TIN in a single testis, and orchiectomy was p erformed in cases of inconspicuous contralateral testis. Both forms of ther apy lead to cure rates of 100%. In selected patients with high risk for tes ticular cancer, TIN must be excluded by testicular biopsy when operative pr ocedures on infertility are performed.