Testicular Cancer: Symptoms Men Should Know

When caught early, testicular cancer is among the most curable types of cancer.

“It’s one of our major success stories in cancer,” says Preston C. Sprenkle, MD, a Yale Medicine urologist who specializes in treating testicular, prostate, bladder, and other urologic cancers. “We have very, very high cure rates and long-term survival rates of more than 95% overall.”

The key is knowing the symptoms to watch for and getting treated early.

Below, Dr. Sprenkle describes the symptoms of testicular cancer, how to perform a self-exam, and what men can expect if they’re diagnosed with the disease and need treatment.

For many men, the first symptom is a painless lump or swelling in one testicle. Other symptoms may include an accumulation of fluid in the scrotum (the sac of skin that covers the testicle) or a dull ache in the groin. In the disease’s early stages, symptoms can sometimes be subtle. That’s why self-exams and an examination by your doctor during regular check-ups are important.

Also, early detection most often means less intensive treatment. Advanced-stage disease requires more aggressive therapy, which is associated with more significant side effects from treatments that can include chemotherapy, radiation, and more.

Many doctors recommend that all men—particularly between ages 15 to 35, the approximate age range when risk for the disease is highest—should perform a testicular self-exam.

A self-exam performed once a month in the shower is an easy way to check for symptoms.

“Men just need to feel their scrotum and their testicles for any new lump or bump,” says Dr. Sprenkle. “They should also see if a testicle seems to be a lot larger or harder than it was before. If so, then it needs to be evaluated. These cancers typically grow very quickly. From month to month, there would be a difference that you would notice.”

Pain is not typically a symptom of testicular cancer, he adds.

Doctors, including pediatricians, should also conduct testicular exams during annual checkups. Having an undescended testicle or a family history of testicular cancer are among the factors that increase risk for the disease.

Diagnosis occurs most often when a young man is in his teens to his early to mid 30s. In men in or near their 70s, there also can be a spike in diagnoses of a different type of testicular cancer most often found in older men, known as primary testicular lymphoma (PTL). Symptoms of PTL are similar to those of testicular cancer in younger men and can include a painless lump or bump in the testicle and a heavy feeling in the scrotum.

If a man has symptoms based on a self-exam or his physician suspects testicular cancer after performing an examination, the next step is an evaluation by a urologist. The doctor usually recommends an ultrasound, which is typically followed by a CT scan. Caught early, testicular cancer usually is found in one testicle only and has not spread.

For men who want to ensure that they can father children following treatment, the most effective method is semen preservation—giving a semen sample and cryopreserving it in cold storage. This is an option for anyone who is diagnosed with a testicular mass and is considering treatment.

“We say, ‘Since you’re going through this, you should consider banking sperm,’” explains Dr. Sprenkle. “’We will figure out later if you need it. You may not, but if you end up needing chemotherapy or even radiation, it could have a significant negative impact on your fertility in the future.’”

Some studies show that more than half of men with testicular cancer also have low sperm counts prior to any treatment. “Sperm preservation is a precaution, so we can get the greatest volume of live sperm before any treatments, including surgery,” says Dr. Sprenkle.

Orchiectomy, the removal of a testicle or both, is the standard treatment for testicular cancer. Typically, it is necessary to remove only one testicle.

“Usually, the remaining testicle is adequate for fertility,” says Dr. Sprenkle. “Even though there is research that shows an association with testicular cancer and decreased fertility, this reduced sperm count seems to exist whether the testicle is removed or not. Usually, we don’t know if that decreased fertility pre-existed the orchiectomy. Some men worry about their fertility changing significantly, or their testosterone levels dropping, but there’s generally no appreciable change in those areas with the loss of one testicle.”

During diagnosis, the CT scan that is typically performed includes the abdomen to determine if any lymph nodes are enlarged due to the spread of cancer.

If enlarged lymph nodes are detected, the diagnosis is changed to stage II testicular cancer, and the treatment plan is adjusted. However, the prognosis for long-term survival remains very high, at about 95%.

“When the cancer is small and isolated to the testicle, those patients have the best survival and have a much-reduced need for additional surgery, chemotherapy, or radiation,” Dr. Sprenkle says. “If the cancer has already spread, especially if there is a large volume in the abdomen, chest, or throughout the body, the cancers tend to be more aggressive. In those cases, treatment usually involves chemotherapy and radiation, both of which have more side effects, and there is a higher likelihood of future metastasis.”

Some patients need no further treatment beyond the removal of a testicle, which is followed by surveillance that becomes less frequent over time.

“We watch men very closely with blood tests, often with at least five years of imaging, which can range from X-rays to CT scans and MRIs,” Dr. Sprenkle says. “The intensity of that imaging depends on their risk.”

The duration of imaging also varies, he adds. “Doing tumor marker evaluations [with blood tests] is often enough,” Dr. Sprenkle says. Tumor marker blood tests assess the presence of specific genes, proteins, hormones, and enzymes in the blood of people with cancer. Those markers are produced by cancerous cells or by normal cells in response to cancer.

Unfortunately, some men who’ve been treated for testicular cancer may be too casual about booking their recommended follow-up visits.

“Because young men, in particular, don't like to go to the doctor, the biggest struggle is trying to get them to come in consistently,” he says. Although cancer recurrence is not common following treatment for testicular cancer, “we don’t want to miss something, so we talk to men about the importance of these doctor visits and create a schedule that is appropriate for each person who’s been treated for the cancer,” Dr. Sprenkle adds.