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Although testicular germ cell tumors (TGCTs) most commonly affect younger men, there has been an increase in their incidence among men older than 45 years in the past 2 decades. We sought to characterize differences in clinicopathologic features, management patterns, and survival outcomes for TGCTs by age at diagnosis.

The Surveillance, Epidemiology, and End Results database was used to identify all patients aged 15 to 70 years who were diagnosed with TGCTs by orchiectomy between 2004 and 2021. Comparative statistics assessed differences in clinicopathologic characteristics and management patterns between younger (15-44) and older (45-70) patients. The Kaplan-Meier method and log-rank test were used to evaluate cancer-specific survival (CSS) by age group.

A total of 34,738 patients were included in the analysis, of whom 5719 (16.5%) were in the older age group. Older patients were more likely to present with seminoma (78.7% vs. 49.9%, P < 0.001) and clinical stage I disease (72.9% vs. 70.0%, P < 0.001) compared to younger patients. Among stage I patients, there were no significant differences in histology-specific management patterns by age. Overall, 1,052 (3.0%) deaths were attributable to testicular cancer over a median follow-up of 7.4 years. Five-year CSS surpassed 96% for patients with clinical stage I and stage II disease, irrespective of histology or age group; however, for patients with stage III disease, older age was associated with statistically significant worse CSS compared to younger age, both for seminoma (86.0% vs. 92.2%, P < 0.001) and non-seminoma (65.7% vs. 81.6%, P < 0.001).

Older men with TGCTs present with higher rates of seminoma and stage I disease compared to younger men. Among patients with stage III disease, CSS is worse in those who are older at diagnosis. Understanding how age influences TGCT phenotype and outcomes can help inform age-specific management strategies.