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inally, a discrepancy in the reporting of testicularancer may have been present in the 10 to 14-year-ld age group. Although we attempted to choose aoung age cutoff, to segregate the childhood tumorsrom the adult, it is quite possible that teratomas inhis age group are actually mixed nonseminomatouserm cell tumors of the adult variety that have a tera-omatous component.

CONCLUSIONS

Testicular tumors in children are rare overall.oung boys most often get yolk sac tumors and

eratomas very early in life; choriocarcinomas andeminomas are exceedingly uncommon. The great-st incidence of testicular tumors occurred inother” races, substantially different from the adultxperience in which whites have the greatest inci-ence. Unlike adult testicular tumors, no clear in-rease has occurred in childhood testicular tumorver time.

REFERENCES1. Huyghe E, Matsuda T, and Thonneau P: Increasing in-

idence of testicular cancer worldwide: a review. J Urol 170:–11, 2003.

2. Bergstrom R, Adami HO, Mohner M, et al: Increase inesticular cancer incidence in six European countries: a birthohort phenomenon. J Natl Cancer Inst 88: 727–733, 1996.

3. Richiardi L, Bellocco R, Adami HO, et al: Testicularancer incidence in eight northern European countries: secu-ar and recent trends. Cancer Epidemiol Biomarkers Prev 13:157–2166, 2004.

4. McGlynn KA, Devesa SS, Sigurdson AJ, et al: Trends inhe incidence of testicular germ cell tumors in the Unitedtates. Cancer 97: 63–70, 2003.

5. McKiernan JM, Goluboff ET, Liberson GL, et al: Risingisk of testicular cancer by birth cohort in the United Statesrom 1973 to 1995. J Urol 162: 361–363, 1999.

6. Pharris-Ciurej ND, Cook LS, and Weiss NS: Incidencef testicular cancer in the United States: has the epidemicegun to abate? Am J Epidemiol 150: 45–46, 1999.

7. Li FP, and Fraumeni JF: Testicular cancers in children:pidemiologic characteristics. J Natl Cancer Inst 48: 1575–581, 1972.

8. Surveillance, Epidemiology, and End Results (SEER)rogram Public-Use CD-ROM (1973–2000). Washington,C, National Cancer Institute, Surveillance Program, Cancertatistics Branch, 2000.

9. World Health Organization: International Classificationf Diseases for Oncology. Geneva, World Health Organization,000.10. Ross JH, Rybicki L, and Kay R: Clinical behavior and a

ontemporary management algorithm for prepubertal testisumors: a summary of the Prepubertal Testis Tumor Registry.

Urol 168: 1675–1679, 2002.

ROLOGY 68 (2), 2006

11. dos Santos Silva I, Swerdlow AJ, Stiller CA, et al: Inci-ence of testicular germ-cell malignancies in England andales: trends in children compared with adults. Int J Cancer

3: 630–634, 1999.12. Van Den Eeden SK, and Weiss NS: Is testicular cancer

ncidence in blacks increasing? Am J Pub Health 79: 1553–554, 1989.13. Petersen GR, and Lee JA: Secular trends of malignant

umors of the testis in white men. J Natl Cancer Inst 49: 339–54, 1972.

EDITORIAL COMMENTWalsh et al. have come to the reassuring conclusion that the

ncidence of testicular tumors in the prepubertal populationas been relatively stable during the past 30 years. This is inirect contrast to the findings from multiple studies suggest-ng that the incidence of testicular cancer in the adult popula-ion has increased during the same period. These differencesn incidence trends suggest that different etiologies may un-erlie the childhood and adult testicular cancer, as suggestedy the differences in natural history.The SEER database is a powerful tool for performing popu-

ation-based assessments of epidemiologic, pathologic, andealth-services trends over time. Even with a large databaseuch as SEER, however, we are limited in our ability to detectrends with respect to very rare events. At an incidence ofoughly 2 per 1 million person-years, prepubertal testicularancer represents such a rare event. Thus, even if a true bio-ogic phenomenon were driving increases in testicular cancer,t is possible that no database would have the power to detecthanges affecting only a handful of the tens of millions ofusceptible prepubertal boys. It would be interesting to knowhat the authors’ power calculations showed with respect toow small a change they would have been able to detect usingheir data.

Although testicular cancer rates in children appear to betable (and very low), other studies have suggested that thencidence of other male-specific conditions is increasing,ncluding subfertility and penile anomalies.1,2 Hopefully,dditional research will elucidate the factors underlyinghese trends.

REFERENCES1. Sharpe RM: Hormones and testis development and pos-

ible adverse effects of environmental chemicals. Toxicol Lett20: 221–232, 2001.2. Nelson CP, Park JM, Wan J, et al: The increasing inci-

ence of congenital penile anomalies in the United States.Urol 174: 1573–1576, 2005.

Caleb Nelson, M.D., M.P.H.Brady Urological Institute

Baltimore, Maryland

doi:10.1016/j.urology.2006.05.035© 2006 ELSEVIER INC.

ALL RIGHTS RESERVED

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