Often, a team of doctors (urologist, oncologist, radiation oncologist) will work together to find the best treatment plan for each patient. Choices will be based on the exact diagnosis and health of the patient. Treatment options include:
Before any treatment starts, men should talk with their urologist about if they want to have a child. Infertility and changes in male hormones are common after certain treatments. Sperm banking may be useful before treatment, mostly if you hope to have children in the future.
Men can also ask about a testicular prosthesis (fake body part) before surgery. This is a way to make the testicles look more “normal” after a testis is removed.
Surveillance is a way to look for changes with normal check-ups. These include a physical exam, tumor marker tests, and imaging tests. Imaging tests start with an ultrasound of the scrotum. They can also involve chest x-rays or CT scans. No matter what treatment, most men should be checked for signs of low-testosterone as well.
Surveillance is recommended for Stage 0 and some Stage 1 cancers.
- Patients with stage I seminoma. It should involve a physical exam, tumor marker test and imaging:
- Every 4-6 months for the first 2 years; every 6-12 months in years 3-5
- Patients with stage 1 non-seminoma germ cell tumors (NSGCT), after surgery. It should include a physical exam and tumor marker test:
- Every 2-3 months in year 1; every 2-4 months in year 2; every 4-6 months in year 3; every 6-12 months in years 4-5
- Patients with stage I NSGCT, after surgery. It should involve a chest x-ray and other imaging:
- Every 4-6 months in year 1; every 4-12 months in year 2; one time in years 3-5
If the cancer shows signs of growth, or if hormone levels change, then more treatment may be offered. If not, only surveillance is needed.
Surgery is the main treatment for testicular cancer. Most often, an orchiectomy is done to remove the entire testis. Depending on the diagnosis, other options may be offered. Changes in fertility should be discussed first.
- Orchiectomy is used to diagnose and treat both early-stage and later-stage testicular cancer. This surgery removes the entire testicle and mass through a small cut in the groin. The spermatic cord is also removed. The cell type will be confirmed and staged with this surgery.
- After surgery, regular surveillance is done to make sure the cancer doesn’t return.
- If one testicle is removed and the other is normal, testosterone levels should be fine. The remaining, healthy testicle should make enough testosterone. (10-15% of testicular cancer survivors will have low testosterone levels and can get treatment.)
- If a man is concerned about the way he looks, a testicular prosthesis is an option.
- Testis-sparing surgery (TSS) is only recommended in select cases. This surgery removes just the tumor tissue, not the entire testis. For this, the mass must be very small and tumor markers must be negative. This is best for men with benign tumors, rather than cancer.
- When TSS is done, regular surveillance is important because the cancer can return. Other side effects, like infertility, are possible.
- If the tumor is malignant, and the man has a normal testicle on the other side, then TSS is not recommended.
- Retroperitoneal lymph node dissection (RPLND) is a complex surgery used to limit the side effects of removing the lymph nodes in the back of the abdomen. A skilled surgeon is used and it can be helpful for some men. This surgery is an option for patients with stage I cancer and a high risk for recurrence. It is typically for men with non-seminomatous germ cell tumors. It can be used rather than chemotherapy for patients with stage IIA or IIB non-seminoma tumors.
- After RPLND surgery, chemotherapy or surveillance is offered depending on the cancer location, type and risk of recurrence.
- It is important to work with a highly experienced surgeon.
Radiation is used to kill cancer cells on the testis or in nearby lymph nodes. It is used for seminoma-cell cancers, because some forms of non-seminoma are resistant to radiation. It may be an option if testicular cancer (either type) has spread to distant organs like the brain. There are a few radiation therapy types used.
Chemotherapy is used for cancers that spread beyond the testicles, or if tumor markers rise after surgery. Serum tumor markers and imaging tests help guide how much chemotherapy to use, and if it can help.
These drugs travel through the body in the bloodstream and cause side effects. They can wipe out cancer cells that may have traveled to lymph nodes. It's also used to help lower the risk of cancer coming back after surgery.
Sometimes, more than one chemotherapy drug may be combined for testicular cancer treatment. These drugs are given in three or four, three-week cycles. Sometimes more surgery will be done to remove tumors after chemo.
Beyond basic surgery, care depends on the type of cancer cell and results. Even if cancer was found early and treated, follow-up tests are recommended.
If, after time, cancer returns, then more treatment will be needed.