Testicular cancer is the role model of a curable cancer. About 10%of patients initially present with advanced disease and tumor spread to the lungs. However, even with adverse prognostic parameters these patients experience an impressive survival if treated by a multimodality management of chemotherapy and surgery. The combination of cisplatin, bleomycin, and etoposide has become the gold standard in this disease. Patients can be divided into good, intermediate, and poor prognosis groups. Patients with poor prognosis disease are much more likely to fail conventional chemotherapy and are candidates for dose-intensive protocols or transplants as first-line treatment. Surgery in advanced testicular tumors is an integral part of the multimodality treatment. However, the indications for surgery in testis cancer have changed over the last 10 years. Surgery in metastatic disease may even be beneficial for patients with recurrent tumors, patients with persisting marker elevations during chemotherapy, or patients with late relapse of the disease. Treatment paradigms and follow-up strategies for the different stages of testicular germ cell tumors continue to be defined and refined, as research in these areas continues.