WG1 – Epidemiology and Etiology

Coordinators:

The incidence of testicular tumors is globally increasing, with certain differences between various countries. This represents a significant morbidity and mortality burden that requires urgent addressing. Detailed and robust epidemiological data and their proper analysis and interpretation are necessary for meaningful actions.

Both genetic and external factors are involved in testicular tumor etiopathogenesis. Testicular tumors are malignancies with a strong hereditary background. An increasing number of susceptibility genes have been identified in genome-wide association studies. While polygenic inheritance has been proposed in the past, epigenetic mechanisms are at the focus of recent studies. Of external factors, the exposure to endocrine-disrupting agents at early life stages has been associated with an increased risk of testicular tumors; further environmental risks are explored in ongoing research.

WG2 – Molecular Biology and Pathology

Coordinators:

The molecular and biological features of testicular tumors have been uncovered step by step. They are unique and distinct from other cancers, related to their germinal and embryonal character with a typical low mutation burden, lack of targetable lesions, presence of large rearrangements, and epigenetic alterations. High-throughput technologies also reveal specific tumor signatures. The molecular basis of cisplatin resistance, as the major cause of treatment failure, has been intensively studied, and some of the potential events have already been identified. While these findings have considerably extended our understanding of testicular tumors, they have so far had little impact on disease management, and their implementation into novel therapy approaches has been eagerly awaited.

WG3 – Biomarkers

Coordinators:

The discovery of miR371a-3p as a highly specific and sensitive marker of germ cell tumors, except teratomas, has been a major achievement of recent testicular research. Its potential for the detection of an active tumor and disease monitoring has been demonstrated; however, its role in clinical settings has not yet been established, and the results of ongoing studies are warranted. The search for novel biomarkers has been facilitated by the developing techniques of liquid biopsy. These are bringing interesting novel findings that are currently under further exploration.

WG4 – Imaging and Surgery

Coordinators:

Surgery, as one of the main therapeutic modalities in testicular tumor management, has been permanently evolving in terms of both the role within the multimodal treatment approach, as well as the techniques of surgical interventions. Robotic surgery is establishing a novel standard of care; due to the rarity of the disease, and thus the limited number of these procedures worldwide, the evidence-based data are hard to obtain, and centralization and close collaboration are essential.

WG5 – Clinical Trials and Novel Therapies

Coordinators:

Since the 80s, cisplatin-based chemotherapy has been the mainstay of systemic therapy in testicular tumors. Contrary to other cancers, no targeted therapy or immunotherapy has proven effective and been approved for use in these tumors. The impact of high-dose chemotherapy has not yet been confirmed. The results of a few ongoing studies aimed at novel therapies in testicular tumors are awaited. There is a long-term need for further clinical trials based on the recent findings of the preclinical research. Tight collaboration and high numbers of participating centers are crucial for adequate patient enrollment and robust results.

WG6 – Long-term Sequelae and Quality of Life

Coordinators:

With the young men population affected and the high overall cure rates, the long-term sequelae of the oncologic treatment and the quality of life require the utmost attention and appropriate measures. Careful research into the problems, including hidden consequences, is a necessary prerequisite for a tailored follow-up. Early physical, psychological, and social rehabilitation may significantly alleviate the complications. Fertility problems often arise not only due to the administered therapy but also from a common cause leading to testicular dysgenesis and call for complex interventions.