Epidemiological and clinical aspects of carcinoma in situ of the testis.

Despite the high cure rate in men with testicular cancer, efforts should be made to diagnose the disease at the preinvasive stage. The disease, which affects young males, is potentially lethal. Furthermore, testicular neoplasia diagnosed at the stage of CIS can be cured without the negative impact on the life-quality of the survivors, as chemotherapy and other systemic treatment can be avoided. The treatment of choice is orchidectomy if the neoplasia is unilateral, or localized irradiation in bilateral cases. Testicular biopsy performed after puberty is at present the only reliable diagnostic method. Screening for CIS in the contralateral testis should be offered to men with unilateral testicular cancer. Patients with assumed extragonadal germ cell tumour and intersex individuals are also recommended to have a biopsy for CIS. Biopsies should also be considered in adults with maldescended testes and in selected cases of infertility. In the future the techniques of detecting of CIS cells in semen may become refined. In such circumstances, the general male population may be targeted for screening and more cases of testicular cancer could then be prevented.