Demographics, Clinical Characteristics, and Treatment Patterns in Patients with Testicular Tumor: A Single Hospital-Based Study

ORIGINAL ARTICLE
Badr Alharbi, Emad Alwashmi, Hatim Alnosayan, Faisal Awadh Al-Harbi, Ziyad Abdullah Alsweed, Turki Awadh Al-Mutairi, Meshal Abdullah Al-Ghannam, Adil Khalaf Altwairgi

 
For citation: Alharbi B, Alwashmi E, Alnosayan H, Al-Harbi FA, Alsweed ZA, Al-Mutairi TA, Al-Ghannam MA, Altwairgi AK. Demographics, Clinical Characteristics, and Treatment Patterns in Patients with Testicular Tumor: A Single Hospital-Based Study. International Journal of Biomedicine. 2025;15(1):135-140. doi:10.21103/Article15(1)_OA13
 
Originally published March 5, 2025

Abstract: 

Background: Testicular cancer (TC) is one of the most prevalent malignancies that develops in young adult males aged 15–40 years. This study aimed to assess and evaluate the prevalence, incidence, clinical symptoms, and management of TC in the Qassim region of Saudi Arabia.
Methods and Results: This retrospective study was conducted at King Fahad Specialist Hospital in Buraidah, Qasim Region, Saudi Arabia. The study population comprised 14 patients diagnosed with TC between October 2017 and July 2024, with complete medical records. Most patients (64.3%) were aged between 20 and 30 years. All patients exhibited symptoms, primarily testicular swelling (42.9%) or a combination of testicular swelling and pain (28.6%). Seminoma was the most prevalent histological type (64.3%), with lesions more frequently located in the right testicle (57.1%) and most tumors measuring ≤4 cm (85.7%). Concerning tumor markers, half of the patients exhibited elevated beta-human chorionic gonadotropin (ß-hCG) levels (50%). In contrast, alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) levels were elevated in fewer cases (21.4% and 35.7%, respectively). Most patients presented with early-stage tumors—T1a (28.6%), T1b (35.7%), and T2 (28.6%), the predominant stages observed. Lymph node involvement was minimal, with a significant portion classified as N0 (71.4%), while a smaller group exhibited N2 involvement (21.4%). Notably, none of the patients demonstrated distant metastasis (M0). A substantial proportion of patients received adjuvant treatment (92.9%), and the primary surgical approach employed was open radical inguinal orchiectomy (78.6%). Nearly all patients completed their therapy (92.9%), with follow-up durations predominantly within one year (57.1%) or extending to 1–3 years (35.7%). There were no recorded cases of recurrence. Sperm cryopreservation was done for 5(36.7%) patients.
Conclusion: The study findings highlighted testicular swelling as the most common presenting symptom, with seminoma being the predominant subtype. Notably, the right testicle was more frequently affected, and elevated ß-hCG levels were observed as a common biomarker for TC.

Keywords: 
testicular cancer • seminoma • ß-hCG
References: 
  1. Park JS, Kim J, Elghiaty A, Ham WS. Recent global trends in testicular cancer incidence and mortality. Medicine (Baltimore). 2018 Sep;97(37):e12390. doi: 10.1097/MD.0000000000012390. PMID: 30213007; PMCID: PMC6155960.
  2. Cassell A, Jalloh M, Ndoye M, Yunusa B, Mbodji M, Diallo A, Gaye O, Labou I, Niang L, Gueye S. Review of Testicular Tumor: Diagnostic Approach and Management Outcome in Africa. Res Rep Urol. 2020 Feb 18;12:35-42. doi: 10.2147/RRU.S242398. PMID: 32110551; PMCID: PMC7035899.
  3. Znaor A, Skakkebaek NE, Rajpert-De Meyts E, Kuliš T, Laversanne M, Gurney J, Sarfati D, McGlynn KA, Bray F. Global patterns in testicular cancer incidence and mortality in 2020. Int J Cancer. 2022 Sep 1;151(5):692-698. doi: 10.1002/ijc.33999. Epub 2022 Mar 26. PMID: 35277970.
  4. Safiri S, Hassanzadeh K, Janbaz Alamdary S, Mousavi SE, Nejadghaderi SA, Sullman MJM, Naghdi-Sedeh N, Kolahi AA. The burden of testicular cancer from 1990 to 2019 in the Middle East and North Africa region. Front Oncol. 2023 Dec 22;13:1276965. doi: 10.3389/fonc.2023.1276965. PMID: 38188291; PMCID: PMC10767553.
  5. Rajpert-De Meyts E, Aksglaede L, Bandak M, Toppari J, Jørgensen N. Testicular Cancer: Pathogenesis, Diagnosis and Management with Focus on Endocrine Aspects. 2023 Mar 29. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905224.
  6. Nauman M, Leslie SW. Nonseminomatous Testicular Tumors. 2023 Aug 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 33760513.
  7. Board PDQATE. Prostate Cancer Treatment (PDQ®). In: PDQ Cancer Information Summaries [Internet]. National Cancer Institute (US); 2023.
  8. Mangone L, Marinelli F, Bisceglia I, Masini C, Palicelli A, Morabito F, Di Girolamo S, Neri A, Pinto C. Incidence and Survival of Testicular Cancers in a Province in Northern Italy and Their Association with Second Tumors. Biology (Basel). 2023 Nov 9;12(11):1409. doi: 10.3390/biology12111409. PMID: 37998008; PMCID: PMC10669588.
  9. Wagner T, Toft BG, Lauritsen J, Bandak M, Christensen IJ, Engvad B, Kreiberg M, Agerbæk M, Dysager L, Carus A, Rosenvilde JJ, Berney D, Daugaard G. Prognostic factors for relapse in patients with clinical stage I testicular non-seminoma: A nationwide, population-based cohort study. Eur J Cancer. 2024 May;202:114025. doi: 10.1016/j.ejca.2024.114025. Epub 2024 Mar 17. PMID: 38531266.
  10. Giona S. The Epidemiology of Testicular Cancer. In: Barber N, Ali A, editors. Urologic Cancers [Internet]. Brisbane (AU): Exon Publications; 2022 Sep 12. Chapter 9. PMID: 36343137.
  11. Yazici S, Del Biondo D, Napodano G, Grillo M, Calace FP, Prezioso D, Crocetto F, Barone B. Risk Factors for Testicular Cancer: Environment, Genes and Infections-Is It All? Medicina (Kaunas). 2023 Apr 7;59(4):724. doi: 10.3390/medicina59040724. PMID: 37109682; PMCID: PMC10145700.
  12. Huang J, Chan SC, Tin MS, Liu X, Lok VT, Ngai CH, Zhang L, Lucero-Prisno DE 3rd, Xu W, Zheng ZJ, Chiu PK, Ng AC, Enikeev D, Nicol D, Spiess PE, Laguna P, Teoh JY, Wong MCS. Worldwide Distribution, Risk Factors, and Temporal Trends of Testicular Cancer Incidence and Mortality: A Global Analysis. Eur Urol Oncol. 2022 Oct;5(5):566-576. doi: 10.1016/j.euo.2022.06.009. Epub 2022 Jul 19. PMID: 35863988.
  13. Escobar D, Daneshmand S. Disparities in Testicular Cancer: A Review of the Literature. Cancers (Basel). 2024 Oct 10;16(20):3433. doi: 10.3390/cancers16203433. PMID: 39456529; PMCID: PMC11505726.
  14. Alghamdi IG. Testicular Cancer in Saudi Arabia Between 2004 and 2017. Res Rep Urol. 2023 Jan 24;15:37-45. doi: 10.2147/RRU.S393819. PMID: 36718376; PMCID: PMC9884001.
  15. Al-Muftah M, Al-Ejeh F. Cancer Incidence and Mortality Estimates in Arab Countries in 2018: A GLOBOCAN Data Analysis. Cancer Epidemiol Biomarkers Prev. 2023 Dec 1;32(12):1738-1746. doi: 10.1158/1055-9965.EPI-23-0520. PMID: 37733340; PMCID: PMC10690144.
  16. Noureldin YA, Alqirnas MQ, Aljarallah MF, Alfraidi OB, Alghafees MA, Ghazwani Y, Alkhayal A. Testicular cancer among Saudi adults: Hands on a nationwide Cancer Registry over 10 years. Arab J Urol. 2022 Jun 10;20(4):182-188. doi: 10.1080/2090598X.2022.2084902. PMID: 36353476; PMCID: PMC9639499.
  17. Altowaijri K, Aldehaim M, Alshammari O, Aldohan R, AlTabbaa F, Kazi A. A Survey on the Knowledge and Awareness of Testicular Cancer and Testicular Self-Examination Among Men in Saudi Arabia. Cureus. 2024 Mar 8;16(3):e55778. doi: 10.7759/cureus.55778. PMID: 38586720; PMCID: PMC10999108.
  18. Salati S, Aljabr I, Alharbi M, Almatroudi M. ASSESSMENT OF MEDICAL STUDENTS’ KNOWLEDGE, ATTITUDE AND THE IMPACT OF EDUCATIONAL INTERVENTION ON TESTICULAR CANCER AWARENESS AT QASSIM UNIVERSITY, SAUDI ARABIA. 2021;2.
  19. Alshamsan B. Trends of cancer incidence in Qassim Region, a descriptive analysis of data from the Saudi Cancer registry 2002-2016. Int J Health Sci (Qassim). 2022 Sep-Oct;16(5):21-31. PMID: 36101847; PMCID: PMC9441648.
  20. Albasri AM, Hussainy AS. Histopathological pattern of testicular diseases in western Saudi Arabia. Saudi Med J. 2018 May;39(5):476-480. doi: 10.15537/smj.2018.5.22142. PMID: 29738007; PMCID: PMC6118176.
  21. Shephard EA, Hamilton WT. Selection of men for investigation of possible testicular cancer in primary care: a large case-control study using electronic patient records. Br J Gen Pract. 2018 Aug;68(673):e559-e565. doi: 10.3399/bjgp18X697949. Epub 2018 Jul 2. Erratum in: Br J Gen Pract. 2018 Sep;68(674):416. doi: 10.3399/bjgp18X698513. PMID: 29970393; PMCID: PMC6058651.
  22. Li B, Cai H, Kang ZC, Wu H, Hou JG, Ma LY. Testicular metastasis from gastric carcinoma: A case report. World J Gastroenterol. 2015 Jun 7;21(21):6764-8. doi: 10.3748/wjg.v21.i21.6764. PMID: 26074716; PMCID: PMC4458788.
  23. Alder L, Al-Juhaishi T, Smith SC, Paul AK. Testicular Swelling as an Initial Presentation of a Patient With Metastatic Gastric Cancer. Fed Pract. 2019 May;36(Suppl 3):S26-S28. PMID: 31138980; PMCID: PMC6533893.
  24. Baird DC, Meyers GJ, Hu JS. Testicular Cancer: Diagnosis and Treatment. Am Fam Physician. 2018 Feb 15;97(4):261-268. PMID: 29671528.
  25. Abomelha M. Adult testicular cancer: Two decades of Saudi national data. Urol Ann. 2017 Oct-Dec;9(4):305-309. doi: 10.4103/UA.UA_11_17. PMID: 29118528; PMCID: PMC5656951.
  26. Alotaibi M, Saadeddin A, Bazarbashi S, Alkhateeb S, Alghamdi A, Alghamdi K, Murshid E, Abusamra A, Rabah D, Ahmad I, Al-Mansour M, Alsharm A. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for testicular germ cell tumors. Urol Ann. 2016 Apr-Jun;8(2):141-5. doi: 10.4103/0974-7796.179240. PMID: 27141181; PMCID: PMC4839228.
  27. Stephenson A, Bass EB, Bixler BR, Daneshmand S, Kirkby E, Marianes A, Pierorazio PM, Sharma R, Spiess PE. Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023. J Urol. 2024 Jan;211(1):20-25. doi: 10.1097/JU.0000000000003694. Epub 2023 Sep 14. PMID: 37707243.
  28. Aydin AM, Zemp L, Cheriyan SK, Sexton WJ, Johnstone PAS. Contemporary management of early stage testicular seminoma. Transl Androl Urol. 2020 Jan;9(Suppl 1):S36-S44. doi: 10.21037/tau.2019.09.32. PMID: 32055484; PMCID: PMC6995845.
  29. Koschel SG, Wong LM. Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer. Transl Androl Urol. 2020 Dec;9(6):3094-3102. doi: 10.21037/tau.2019.12.20. PMID: 33457282; PMCID: PMC7807348.
  30. Goldberg H, Klaassen Z, Chandrasekar T, Fleshner N, Hamilton RJ, Jewett MAS. Germ Cell Testicular Tumors-Contemporary Diagnosis, Staging and Management of Localized and Advanced disease. Urology. 2019 Mar;125:8-19. doi: 10.1016/j.urology.2018.12.025. Epub 2018 Dec 28. PMID: 30597167.
  31. Tverye A, Nangia A, Fantus RJ. Testicular Cancer Survivorship and Fertility Preservation. Urol Clin North Am. 2024 Aug;51(3):429-438. doi: 10.1016/j.ucl.2024.03.011. Epub 2024 Apr 16. PMID: 38925745.
  32. Parekh NV, Lundy SD, Vij SC. Fertility considerations in men with testicular cancer. Transl Androl Urol. 2020 Jan;9(Suppl 1):S14-S23. doi: 10.21037/tau.2019.08.08. PMID: 32055481; PMCID: PMC6995852.
  33. Hamano I, Hatakeyama S, Ohyama C. Fertility preservation of patients with testicular cancer. Reprod Med Biol. 2017 May 18;16(3):240-251. doi: 10.1002/rmb2.12037. PMID: 29259474; PMCID: PMC5715882.

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Received November 11, 2024.
Accepted December 22, 2024.
©2025 International Medical Research and Development Corporation.