Most testicular cancer can be cured with surgery, radiation therapy, or chemotherapy. Because seminomas and nonseminomas grow in different ways, the two types may need different treatments. Treatment also depends on the stage of the cancer, the patient’s age and general health, and other factors.
Men who have testicular cancer should discuss their concerns about sexual function and fertility with a doctor. If both testicles are removed, the man becomes infertile. However, male hormones can be administered to ensure that sexual function remains essentially normal. Testosterone can be replaced by intramuscular injection usually given every two weeks, by patches, applied to the skin daily, or by testosterone gel rubbed into the skin daily.
If a specific treatment might cause infertility, sperm can be frozen for future use. This procedure can allow some men to produce children after loss of fertility.
Surgery to remove the testicle through an incision in the groin is called a radical inguinal orchiectomy; as long as a man has one remaining healthy testicle, he can still have a normal erection and produce sperm. This means that an operation to remove one testicle does not make a man impotent and seldom interferes with fertility. An artificial testicle can be placed into the scrotum, providing the weight and feel of a normal testicle, if a man wishes.
Some of the lymph nodes located deep in the abdomen also may be removed. This type of surgery does not change a man’s ability to have an erection or an orgasm, but it can cause sterility because it interferes with ejaculation. If this is a concern, the doctor may be able to remove the lymph nodes by using a special nerve-sparing surgical technique that may protect the ability to ejaculate normally.
Surgery may be combined with radiation therapy or chemotherapy or both.
Radiation therapy for testicular cancer is external and is usually aimed at lymph nodes in the abdomen. Seminomas are highly sensitive to radiation; however, because nonseminomas are less sensitive to radiation, men who have this type of cancer usually do not have radiation treatment. Radiation therapy interferes with sperm production, but most patients regain fertility within a few months after treatment ends. In the event that fertility might not be recovered, before treatment, many men store sperm at a special facility or bank, where it can be preserved for later use.
Chemotherapy may be the first treatment if the cancer has spread outside the testicle. Some anticancer drugs interfere with sperm production, permanently in some patients and temporarily in others. Chemotherapy has made the biggest difference in reducing deaths of testicular cancer.
Bone marrow transplant
In a bone marrow transplant procedure, bone marrow is removed from the patient, treated with drugs to kill the cancer cells, and then frozen. The patient then is given chemotherapy, with or without radiation, to destroy the remaining cancer cells (the chemotherapy also destroys the remaining bone marrow). The frozen marrow is then thawed and injected back into the patient. This relatively new treatment for testicular cancer has shown some promising initial results, but it is not routinely recommended by doctors since traditional chemotherapy is typically very successful.