Introduction: Primary testicular non-Hodgkin’s lymphoma (PTL) is a very rare disease, comprising 1% of all non-Hodgkin’s lymphoma and <5% of all cases of testicular tumors. With a median age at diagnosis of 67 years, PTL is the most common testicular malignancy in men aged >60 years. However, scare data has been published on PTL in younger patients and their overall outcomes. Our goal was to compare clinical parameters and survival outcomes between patients older and younger than 60.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for all patients diagnosed with PTL diagnosis from 1980–2013. Data collected consisted of demographic and clinical parameters, including staging, pathological, and survival data. Patients were stratified according to their age and compared.

Results: The cohort included 1679 patients comprising 3.45% of all testicular tumors detected during a period of 33 years. The fraction of PTL out of all testicular tumors had remained stable at 3.24% in the 1980–1984 and 3.73% in 2010–2013 periods, although the absolute number of cases has increased from 85 per year in 1980 to 378 in 2013. Overall 433 patients (25.8%) were older than 60 years of age, with 208 (12.4%) being <50 and 91 (5.4%) <40. Older and younger patients exhibited similar racial diversity, geographical origin, and T stage. Almost all patients in both groups had mature B cell lymphoma. A larger percentage of younger patients received radiation to the contralateral testicle (43.4% vs. 31.9% of older patients, p<0.001) and chemotherapy (82.2% vs. 66%, p<0.001). More older patients had insurance (97.8% vs. 88.2%, p<0.001). On average, younger patients were less likely to die of their disease (28.2% vs. 38.8%, p<0.001), with a median survival time of 283 months vs. 98 months (p<0.001) (Figure 1). Fine and Grey competing risk multivariable analysis demonstrated that increasing age, worse T stage, and mature T cell histopathology conferred a worse cancer-specific outcome while receiving radiotherapy, chemotherapy, and being insured had a protective role.

Conclusions: PTL is the most common testicular malignancy in men older than 60 years of age, but more than a quarter of the patients are younger than 60 and more than 12% are <50. Younger patients are more likely to receive chemotherapy and radiation and overall do better in terms of disease-specific survival. Being younger, insured, having a lower T stage, and being treated with chemotherapy and radiotherapy increase the chances of survival.