Purpose <p>Recent studies have suggested a change in the epidemiologic pattern of testicular germ-cell tumors (TGCTs) and advances in therapeutic strategies have led to significant changes in their treatment over the last decades. Treatment guidelines for early-stage testicular cancer recommend de-escalation of therapy by the adoption of surveillance strategies. This study aimed to describe trends in TGCTs diagnosed over the last 30&#xa0;years at our center and evaluate the impact of evolving treatment strategies.</p> Methods <p>We retrospectively analyzed 277 TGCT patients treated from 1994 to 2023. Clinical characteristics, treatment patterns, and outcomes were assessed across three 10-year periods. Survival and relapse rates were estimated using Kaplan–Meier methods; significance was set at p &lt; 0.05.</p> Results <p>A significant increase in incidence was observed (p &lt; 0.05), along more stage I diagnoses (p &lt; 0.05) and older age at diagnosis, including a higher proportion aged ≥ 40&#xa0;years (p &lt; 0.001). Seminoma incidence doubled, while non-seminoma remained stable. In stage I disease, the use of active surveillance increased significantly, while adjuvant chemotherapy declined (p &lt; 0.0005). Recurrence rates slightly decreased but were not statistically significant. Cause-specific 10-year survival improved from 95% to 97.2%, with overall survival stable at ~ 94%. The risk of second primary malignancies was notable, including contralateral testicular cancer (2.9%) and second malignant neoplasms (SMNs) (5.0%). A substantial burden of non-cancer-related causes of death were also observed.</p> Conclusions <p>A real increase in the incidence of TGCTs and age at diagnosis was confirmed. These trends highlight a shift toward less aggressive treatment while maintaining excellent outcomes. However, the notable occurrence of SMNs and non-cancer mortality underscores the need for long-term follow-up that includes survivorship care beyond oncological monitoring.</p>