A Complete Guide to Testicular Cancer Treatments

Surveillance means that a doctor or oncologist recommends that you monitor your symptoms and cancer growth rather than get immediate treatment.

Doctors often recommend surveillance for stage 0 testicular cancer. That’s when the cancer has not yet reached your nearby blood vessels. This means there’s no urgent need for treatment.

In later stages, a doctor might recommend surveillance after surgery to avoid having to go through more invasive treatments.

A doctor may suggest one or both of the following surveillance methods:

• Computed tomography (CT): A CT scan uses rotating X-ray devices to take several cross-sectional images of your testicles and the area around them.
• Magnetic resonance imaging (MRI): An MRI scan uses huge magnets to take detailed images of your body. A doctor may prefer an MRI over a CT scan since it does not expose you to any radiation. It can also produce more detailed images.

Some of the benefits of surveillance include that:

• It lowers your exposure to side effects of treatments such as surgery and radiation.
• It lowers the chance that you’ll need more invasive treatments when you find testicular cancer early.
• It allows you to closely monitor the growth of your cancer cells to identify the right time for further treatment.

Risks

Some of the risks of surveillance include that:

• It may cause you to put off future treatment.
• It may expose you to radiation from X-rays and CT scans.
• It won’t help relieve any symptoms you may experience in the early stages of testicular cancer.

An orchiectomy is a surgery to remove one or both of your testicles. It helps prevent the cancer from spreading to your surrounding tissues or organs.

An orchiectomy takes about 30 to 60 minutes. During the procedure:

1. A surgeon will make a small cut on your scrotum or the area above your pubic bone.
2. They’ll then cut out the testicle from your scrotum and lift it out through the incision.
3. The surgeon will tie off or clamp your spermatic cords to keep blood from gushing into the area.
4. They’ll insert a prosthetic testicle in place of the removed one.
5. They’ll rinse the area with saline solution and close the incision with stitches or sutures.

The benefits of an orchiectomy include that:

• It removes the source of testicular cancer before it spreads.
• It presents an option for a quick outpatient procedure with minimal complications.
• It increases your survival rate significantly.

Side effects

Side effects after an orchiectomy can include:

• pain or redness in the area around the incision
• discharge or bleeding from the incision
• having a high fever (above 100°F, or 37.8°C)
• having trouble urinating
• blood pooling in your scrotum (hematoma)
• numbness or tingling in your scrotum

Long-term complications sometimes associated with an orchiectomy include:

• osteoporosis
• becoming infertile
• hot flashes
• experiencing depression
• not being able to get or keep an erection (erectile dysfunction)

Retroperitoneal lymph node dissection (RPLND) is a surgery to remove the lymph nodes in your abdomen near your kidneys and several major blood vessels.

The goal of RPLND is to stop the cancer from spreading to your kidneys and surrounding tissues. There are two options for this procedure:

• Open surgery: The surgeon makes an incision across your abdomen to remove your lymph nodes and cancerous tissue. This can pose high risks due to the dense network of nerves and blood vessels in the area.
• Laparoscopic surgery: The surgeon makes several small incisions instead of one large one. They’ll use small tools and a thin, lighted tube to remove your lymph nodes and cancerous tissue. This method shortens your recovery time and lowers your risk of complications.

Some possible benefits of RPLND include that:

• It lowers or removes your need for chemotherapy.
• It takes only 1 day and allows you to go home the next day (if done by laparoscopic surgery).
• It lowers your risk of complications from other treatments such as chemotherapy and radiation.
• It lowers your risk of erectile dysfunction, which is associated with orchiectomy and other surgeries.

Side effects

Some side effects and complications of RPLND can include:

• pain or tenderness in the area of the surgery
• having trouble pooping or passing gas
• discharge or blood from the incision site
• semen not coming out when you ejaculate (retrograde ejaculation)
• having trouble getting your partner pregnant
• swelling or bulging from an incisional hernia

Radiation therapy uses concentrated doses of radiation aimed at specific areas that cancer cells affect. It helps stop the cancer cells from growing or destroys them by damaging their DNA.

A doctor may use radiation along with surgery to stop any remaining cancer cells from spreading. The procedure is as follows:

1. You’ll lie on a treatment table. Medical staff will give you coverings to wear to protect you from radiation.
2. A linear accelerator machine directs a focused beam of radiation at the affected area.
3. The machine may move around and aim the beam at multiple areas.

You may need several sessions to fully treat and remove cancerous tissue. Radiation therapy can also help stop cancer from spreading to nearby bones and relieve pain from inflammation around the cancerous tissue.

Side effects

Possible side effects of radiation therapy include:

• fatigue
• skin irritation
• hair loss
• lowered blood cell counts
• pain
• nausea
• vomiting

Chemotherapy (or chemo) delivers chemical drugs into your body to help destroy cancerous cells. Chemotherapy can also help stop testicular cancer from coming back.

There are several options for receiving chemotherapy treatment:

• Intravenous (IV): You receive treatment through an IV line directly into a vein. This allows the chemotherapy to treat the cancer through your body, including your testicle and surrounding areas.
• Oral: You take a series of pills containing the chemotherapy drug.
• Injection: A healthcare professional injects a liquid into your skin. They may first implant a port or catheter into your skin for easy access if you have a long series of injection treatments.

According to the National Cancer Institute, 10 different chemotherapy drugs are approved to treat testicular cancer. Doctors often use these drugs in specific combinations, such as:

• BEP: bleomycin, etoposide phosphate, and cisplatin (Platinol)
• JEB: carboplatin (JM8), etoposide phosphate, and bleomycin
• VeIP: vinblastine sulfate (Velban), ifosfamide, and cisplatin

Side effects

Chemotherapy can have a wide range of side effects, including:

• nerve pain
• bruising or bleeding
• constipation and diarrhea
• hair loss
• fatigue
• fever
• appetite and weight loss
• nausea and vomiting
• fluid buildup and swelling (lymphedema)
• having trouble focusing or remembering things
• changes in your skin or nails
• having trouble sleeping
• loss of fertility

This treatment couples chemotherapy with a transplant of stem cells into your bones to help you regrow bone marrow that you lose or damage due to chemo.

Chemotherapy can cause significant damage to your bone marrow. But a stem cell transplant allows you to undergo aggressive treatments while also minimizing chemo side effects and lowering your risk of recurrence.

This treatment is expensive and complex. Doctors do not usually recommend it unless you have advanced or metastasized testicular cancer that they have not been able to successfully treat with other therapies.

Side effects

This treatment shares many of the same side effects as traditional chemotherapy. Bone marrow stem cell transplants can also cause side effects, such as:

• anemia
• low platelet count
• graft-versus-host disease
• Gram-positive infection
• herpes virus infection
• yeast infection
• cytomegalovirus
• varicella-zoster viral infection

For stage 0 testicular cancer (aka carcinoma in situ), a doctor may recommend any of the following:

• surveillance
• radiation
• orchiectomy

If testicular cancer has progressed to stage 1 or further, you will likely need an orchiectomy. What treatment you have beyond surgery will depend on the type of tumor you have.

There are two common types of testicular cancer tumors: seminomas and nonseminomas.

Seminomas grow slowly but can spread to your lymph nodes. Nonseminomas grow more quickly and may be made up of multiple cell types.

Seminomas

Nonseminomas

The cost of treatment can vary greatly depending on the type of treatment and where you receive the treatment. Even active surveillance can be costly, depending on the imaging costs and how often you have appointments.

According to 2014 research, the total treatment cost for testicular cancer in the early stages was $17,283 to $26,190. For advanced testicular cancer, it was $48,877 to $51,592. These figures include identifying the cancer, treatment, and follow-up costs.

High dose chemotherapy with stem cell transplant is much costlier than other treatment options. According to 2017 research, total healthcare costs for stem cell transplants can be upward of $500,000.

These estimates do not necessarily include what your health insurance provider might pay before you owe any out-of-pocket costs. According to a 2017 study, radiation is the most reimbursed treatment plan, followed by chemotherapy, then RPLND. But the study authors note that testicular cancer is more likely than other cancers to affect young people who may be uninsured.

If you receive successful treatment for cancer in one testicle, it likely won’t affect your fertility so long as the other testicle remains healthy. But permanent damage to your testicular tissues from cancerous cells can lower your fertility over time.

Some treatments for testicular cancer, such as chemotherapy, can also lower your fertility during treatment. Lowered testosterone production due to a removed testicle can also affect your fertility.

You may want to consider freezing and storing sperm before testicular cancer treatment to help increase your chances of being able to have children later in life after treatment. This could cost about $1,500 to $2,500 for 3 years. Your insurance might cover this expense.

Here are answers to some other frequently asked questions about testicular cancer treatments and their results.

What is the chance of recurrence after treating testicular cancer?

After treatment, doctors will continue to monitor your condition for several years. According to 2021 research, between 30% and 32% of people on surveillance after surgery experience a relapse. More than 90% of relapses occur within 2 to 3 years.

There’s also a risk of other cancers developing after treatments such as chemo or radiation. These are known as second cancers. Your risk of a second cancer can increase over time, doubling after 10 years, even after your testicular cancer is successfully treated.

What can I do if treatments for testicular cancer do not work?

Work closely with a doctor, oncologist, or other specialist to monitor your progress as you receive testicular cancer treatments. Most treatments are successful, and treatments for recurrence are also important to help keep returning cancer cells from spreading.

If treatment does not work, you and a doctor will want to weigh the benefits and risks of further treatment. The doctor may shift their focus to treatments to relieve symptoms and help you keep up a good quality of life.

Are there alternative treatments for testicular cancer?

Some people advocate for the use of alternative therapies to treat various cancers. Such therapies include vitamins, herbs, acupuncture, massage, or special diets. But conventional treatments are so effective in treating testicular cancer, most people do not look into alternative therapies.

Still, some people may choose to use these therapies in addition to regular treatment to help relieve symptoms. But the American Cancer Society (ACS) warns that there’s little evidence to support these treatments. Some may even cause harm.

Be sure to consult a doctor if you plan to use any alternative or complementary treatments.

Testicular cancer treatments are usually successful, especially with an early diagnosis and treatment in the early stages.

If you receive a diagnosis, talk with a doctor about the possible benefits, side effects, and costs associated with different treatments. When deciding, you and a doctor will consider the stage of your cancer, your overall health, and your outlook.