ObjectivesTo perform a retrospective cohort analysis for metastatic tumors in the testes to explore the timing, presentation and prognosis of this particular type of metastases and the factors that influence outcome.Patients and methodsA nationwide retrospective review of pathology reports of patients with pathologically confirmed metastases to the testis between 1991 and 2021 was performed. Data was collected from the Dutch nationwide pathology databank (PALGA) and the Dutch Cancer Registry (NCR). Log‐rank testing and Kaplan‐Meier analyses were used to assess overall survival, and Cox proportional hazard models were used for multivariate survival analysis.ResultsA total of 175 patients with a testicular metastasis were included. The median age at diagnosis of testicular metastasis was 67 years (range 3‐88). Testicular metastases originated from a variety of primary tumors, though most frequently from the prostate (40.6%), kidney (13.7%), colon (10.3%), bladder (7.4%), and skin (5.7%). Synchronous testicular metastasis was detected in 53 cases, while 114 metachronous lesions were found after a median interval of 22 months (IQR 1‐53) after the original cancer diagnosis. Overall survival after the diagnosis of a testicular metastasis was poor with a median survival of 14.2 months (95% CI 10.2 – 18.3). The primary tumor origin was an independent factor for survival, with worst survival for patients with primary skin, bladder and colon cancer.ConclusionTesticular metastases are very uncommon and arise mainly from primary tumors anatomically close to the testes. Most patients develop metachronous testicular metastasis in an oligometastatic disease stage. These metastases have invariably poor survival.