Testicular Cancer Treatment for Young Men: What You Need to Know

July 6, 2020

Testicular cancer is cancer that originates in one or both testicles — the two egg-shaped glands (enclosed in the scrotum) that produce testosterone (a male hormone) and sperm. Part of what makes testicular cancer unique is that it occurs overwhelmingly more often in young men: The average age of diagnosis is 33 years old.

The good news is that testicular cancer is a relatively rare form of cancer. It is also one of the most treatable and curable forms.

“Testicular cancer is very treatable and unique in the sense that even if it is diagnosed at an advanced stage, patients can be cured, and the majority of patients can still have a high quality of life for a very long time,” says Alok Tewari, MD PhD, a physician at the Lank Center for Genitourinary Oncology at Dana-Farber/Brigham and Women’s Cancer Center.

What are the symptoms of testicular cancer?

The most common symptom of testicular cancer is a painless swelling of a testicle or the entire scrotum. Oftentimes, men will ignore this symptom because there is no accompanying pain; however, only 10% of testicular cancer patients report acute pain at the time of diagnosis.

Other symptoms of testicular cancer include:

  • Painless lump or swelling of either testicle
  • Dull ache in the lower abdomen or groin
  • Sudden build-up of swelling in the scrotum
  • Pain, discomfort, or numbness without swelling
  • Any other noticeable change in the testicles or scrotum (i.e., one becomes firmer or larger than the other)

If you notice swelling, or any of these other symptoms, it is important to seek medical attention. While these symptoms may not be due to cancer, it is still critical to notify your primary care doctor.

Risk factors for testicular cancer

Although the exact cause of testicular cancer is unknown, there are a number of risk factors associated with a higher chance of developing the disease, including::

  • Cryptorchidism, a condition also referred to as an undescended testicle. In this case, one or both of the testicles do not move down into the scrotum before birth. This condition is often surgically fixed during infancy, and the risk is believed to be lower if the operation is performed before puberty.
  • Family history, or having a first-degree relative with the disease. 
  • Race: White males are four times more likely than black men to have testicular cancer.
  • Personal history: If you have previously had testicular cancer in one testicle, you are at a slightly higher risk of developing it in the other.

Remember, testicular cancer can occur in any man, at any age. If you are experiencing one or multiple symptoms associated with testicular cancer, it is important you speak with your primary care physician.

How is testicular cancer diagnosed?

If you are experiencing symptoms associated with testicular cancer, your primary care physician will conduct a physical examination which may be followed by a scrotal ultrasound. This accurate, non-invasive procedure (the probe is put on the skin) will show if there are any tumors or other abnormalities. If something is detected, you will likely be referred to a urologist for further care.

If there is suspicion for testicular cancer, a blood test will look for elevated levels of tumor markers (alpha-fetoprotein or AFP, beta-human choriogonadotropin or b-HCG, and lactate dehydrogenase or LDH) — substances sometimes created by cancer cells and released into the blood stream. In testicular cancer, serum tumor markers can help assess for the specific subtype of cancer and monitor response to therapy. They are also used in advanced cases to help determine prognosis and treatment.

Serum tumor markers are not a perfect test: A patient can have testicular cancer even with normal tumor marker levels, and elevated levels of these proteins are not always due to testicular cancer.

If testicular cancer is suspected after a physical exam, ultrasound, and blood tests, the affected testicle will be surgically removed (in a process known as radical inguinal orchiectomy) and studied under a microscope.  

What are the types of testicular cancer?

The most common type of testicular cancer is a germ cell tumor. There are two main types of malignant germ cell tumors: seminoma and non-seminoma. The distinction is made based on how the tissue looks under the microscope. About half of testicular cancer cases are seminoma, with the other half being non-seminoma. 

What are the stages of testicular cancer?

There are three stages of testicular cancer (stage I, II, III), and more than half of all testicular cancers are detected in stage I. Here is what the stages mean:

  • Stage I: No evidence the cancer has spread to another lymph node or organ
  • Stage II: The cancer has spread to regional lymph nodes, but not to distant lymph nodes or organs.
  • Stage III: Cancer has spread to a distant lymph node or organ.

All types of testicular cancer can be very curable and treatable, regardless of which stage of testicular cancer that you are diagnosed with.

What is treatment for testicular cancer like?

Your diagnosis will determine which form of therapy is best for you. Surgical removal of the testicle is a highly effective treatment for testicular cancer and may be the only necessary action. Surgical removal of the testicle will not affect your ability to have children or maintain an erection. A “fake” testicle, or prosthesis, can also be placed into the scrotum if you and your doctor determine that is a safe step for you.

Treatment also differs by stage:

  • Stage I: Surgical removal of the cancerous testicle may be all that is needed. However, your doctor may also recommend a short course of chemotherapy or radiation therapy.
  • Stage II: It is likely chemotherapy or radiation will be needed following surgery. In some instances, lymph-node removal may also be advised.
  • Stage III: Treatments need to be the most aggressive and will include chemotherapy. However, it’s important to remember that stage III testicular cancer is still very curable.

What should I know about fertility?

A majority of testicular cancer patients will have normal fertility. Make sure to speak to your doctor as there are precautions you can take if you would like, including sperm banking.

What’s next in testicular cancer treatment?

Testicular cancer is very treatable, and usually curable. Many researchers, including those at Dana-Farber, are working to better understand the reasons that testicular cancers develop and spread. Ongoing research is also focused on how to make the life-saving therapeutic regimens used today more precise. This is being done in order to potentially reduce any risk of short or long-term side effects of therapy while still preserving their efficacy.