Every year, around 2,300 men in the UK are diagnosed with testicular cancer, with most aged between 15 and 49 years old. Fortunately, testicular cancer is highly treatable with a good outlook for those diagnosed. We spoke to Mr Jas Kalsi, Consultant Urologist and Male Fertility Expert, to learn more about the types of treatment available for testicular cancer in our blog.
What type of testicular cancer treatment will I have?
If you’ve been diagnosed with testicular cancer, the treatment you receive will depend on the type of cancer you have and what stage it is at.
The most common type of testicular cancer is called germ cell tumours; these can be further categorised into seminomas and non-seminomas.
There are also different stages of testicular cancer:
- Early-stage, or stage 1, testicular cancer is contained within the testicle.
- Stage 2 testicular cancer is when the cancer has spread to nearby lymph nodes located in your pelvis or abdomen.
- Stage 3 testicular cancer is when the cancer has spread to distant areas of the body.
Surgery to remove the testicle
An orchidectomy is a surgical procedure to remove the testicle.
It is usually always the first recommended line of treatment for testicular cancer and may be the only treatment needed if your cancer has not spread or is unlikely to re-occur.
The procedure is performed under general anaesthetic, meaning you’ll be asleep. Your surgeon will make an incision in the groin and push the testicle upwards from the scrotum to remove it, before closing the site with stitches. In total, an orchidectomy takes around 30 minutes to complete.
Sometimes, an orchidectomy is combined with the insertion of a prosthetic testicle. However, this procedure can also be carried out at a later stage if you are unsure about having a prosthetic.
In many cases, you will be able to go home the same day as your procedure.
Provided your other testicle is healthy, removing one testicle should not cause issues with your sex life or fertility. However, some men do choose to freeze sperm (sperm banking), especially if their orchidectomy is being combined with other treatments like chemotherapy or radiotherapy.
Occasionally, the remaining testicle does not produce enough testosterone, which can cause symptoms like reduced sex drive, tiredness, and low mood. If this occurs – or in rare instance that both testicles are removed (called a bilateral orchidectomy) – you will need to have testosterone replacement therapy.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to eliminate cancer cells. There are several reasons you may be recommended chemotherapy:
- to reduce the risk of cancer returning after surgery (adjuvant chemotherapy)
- to treat cancer that has spread (metastasised)
- to treat cancer that has returned after surgery
The type of chemotherapy you have depends on what stage your cancer is at. Patients with stage 2 or 3 testicular cancer will often require several cycles of chemotherapy. If you have stage 2 seminoma, you may be treated with radiotherapy and a shorter course of chemotherapy instead.
Chemotherapy usually takes place on an outpatient basis, in a day unit. The drugs are delivered intravenously (via injection or a drip), typically in three-weekly cycles.
Depending on the type of chemotherapy you have, your fertility may be reduced temporarily or permanently. Your consultant may advise you to consider freezing your sperm (sperm banking). It is also important to avoid conceiving a child both while treatment is ongoing and for up to one year following its conclusion, as chemotherapy can be harmful to the developing foetus.
Radiotherapy involves the use of radiation to destroy cancer cells. Testicular cancer is usually treated using external radiotherapy, which is when high-energy beams (X-rays) are delivered from outside of the body.
There are various instances in which radiotherapy may be used:
- for a type of testicular cancer called seminoma, which has spread to your lymph nodes at the back of your stomach (the retroperitoneal lymph nodes)
- if you are unable to have chemotherapy
- if your seminoma reoccurs
Seminoma cancer is very sensitive to X-rays, which is why it usually responds well to radiotherapy.
Delivered in partnership with GenesisCare, Cromwell Hospital is home to Europe’s most advanced radiotherapy centre which provides the latest, leading-edge equipment including the Varian Edge and MRIdian MR Linac.
One of the side effects of radiotherapy is that it can damage healthy cells in addition to cancer cells. However, our radiotherapy centre utilises state-of-the-art equipment and techniques that allow radiation beams to be pinpointed very precisely at the tumour, minimising damage to surrounding healthy cells.
Fertility and testicular cancer treatment
Many men with testicular cancer are concerned as to how treatment may affect their ability to have children in the future. You will usually be advised by your consultant to consider freezing your sperm (sperm banking), particularly if you are having chemotherapy or radiotherapy.
Your sperm will typically be stored at a specialist fertility clinic for up to 10 years – although this may be extended if required – and you will need to pay a yearly fee for storage. Most clinics will recommend collecting between two to three samples for freezing.
If you are worried about your fertility and finding it difficult to cope, you may wish to seek professional support. At Cromwell Hospital, all cancer patients receive eight counselling sessions free of charge with our Macmillan accredited cancer counsellor.
About the consultant
Mr Jas Kalsi is a Consultant Urological Surgeon and Male Fertility Expert at Cromwell Hospital. He is an expert in the investigation and treatment of male health problems such as lumps in scrotum, infertility, Peyronie’s disease, erectile dysfunction and lower urinary tract symptoms. He provides a range of minimally invasive procedures including injection therapy for Peyronie’s, sound wave treatment for ED and Rezum and Urolift for urinary symptoms.