Establishment of gold-standard chemotherapy and the subsequent development of salvage therapy have much improved the prognosis of patients with testicular germ cell cancer. However, not all patients with this disease get the best possible outcome in Osaka, Japan. A population-based study of testicular cancer cases diagnosed during 1993-1999 was performed using the Osaka Cancer Registry database to verify changes in prognosis and to examine their relationship with hospital procedure volume. Patients' referrals to hospitals during 1990-2001 were also examined to evaluate the degree of centralization. The 5-year relative survival rate of testicular cancer as well as testicular germ cell cancer in Osaka during 1993-1999 was markedly improved compared with that of previous periods (1975-1992); but remained lower than those reported in the EUROCARE-4 and Surveillance Epidemiology and End Results program. There appeared to be a significant association between survival and hospital procedure volume, even with adjustment made for clinical stage, age and histology. Centralization of referrals had not progressed during the past 12 years. In conclusion, the prognosis of testicular cancer in Osaka has improved remarkably, but nevertheless has remained lower than in the EU and/or the USA. Little progress has been made in centralization of hospital referrals.