Oncologists increasingly exploit differences in testicular germ cell tumors to deliver more personalized treatment. Imaging is essential in this process, aiding in the selection of risk-stratified management strategies. Consideration of relevant prognostic factors strengthens image interpretation, allowing for a more nuanced radiographic evaluation. This paper uses a clinically focused, stage-by-stage approach to delineate the risk factors for relapse and metastasis that radiologists should consider during staging, response assessment, and surveillance.