Purpose To evaluate the association between grade II and III testicular Microlithiasis (TM) and Testicular Germ Cell Tumor (TGCT), reporting disease-free survival over 7 years. Materials and Methods: The association between TM and TGCT was studied in 7,320 male patients referred to the radiology department of an Italian hospital for several scrotal disease. TM associated with TCGT was diagnosed in all men by ultrasound (US) and by testicular histology specimens. All patients with TM were followed-up annually with US. Chi-square, Kaplan-Meyer and Fisher’s exact test were used for statistical analysis. Results: The incidence of TM was 1.4% (98 of 7320). Twenty eight patients with TGCT (28 of 58, 48.2%) had associated TM. During the follow-up, testicular cancer was detected in six patients (incidence 6.12%, 95% confidence interval from 2.8 to 12.7); four of these were recurrences of TGCT, while the other two patients were ex novo TGCT. There was a significant difference (p < 0.001) between the rate of TGCT in men with TM (28 of 98, 28.5%) and that in men without TM (30 of 7222, 0.4%) with an odds ratio of 95.89 [95% CI 42.7 - 110.5]. Conclusion: The association found between TGCT and TM addresses microlithiasis as a prospective marker for testicular tumor. Yearly follow-up with US should be taken into consideration, encouraging self-examination in the meantime.