Testicular Cancer: What Men Should Know About Detection and Treatment

Testicular Anatomy

Testicular cancer is “one of the great success stories we have in cancer treatment,” said David Sharp, MD, Assistant Professor of Urology at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James).

Advances in “imaging, our understanding of the disease and advances in chemotherapy, surgery and when to apply surgery” have combined to add up to a survival rate of well over 90 percent, he said.

April is Testicular Cancer Awareness Month and an opportunity to further educate men. Knowledge leads to more self-exams, earlier diagnosis and treatment, and higher success rates.

“If you feel something, say something,” said Dr. Sharp, who recommends men do a monthly self-exam of their scrotum and testicles and visit their doctor if they feel anything unusual. The first symptoms are usually a lump on the testicle, swelling and discomfort.

“Certainly a delay in diagnosis is a huge factor in bad outcomes,” Dr. Sharp said. “Some men are in denial and delay seeking care.”

Another key to the improved survival rates is the advanced, multi-disciplinary care patients receive at a comprehensive cancer center such as The James, which sees many cases of this rare type of cancer. There will be about 8,700 new cases of testicular cancer diagnosed this year in the United States, according to the National Cancer Institute (NCI).

“Our multidisciplinary approach is critical in the optimization of treatment,” Sharp said, adding specialists at The James involved with testicular cancer treatment include surgeons (such as Dr. Sharp), medical oncologists, radiation oncologists, radiologists and pathologists.

“We all work together and that’s a big difference compared to other (cancer hospitals),” he said.

The testicles are the glands that produce testosterone and sperm. Testicular cancer is most common among males who are between the ages of 15 and 35.

Men diagnosed with testicular cancer usually have it in one testicle and, after treatment, the vast majority is able to lead a normal sex life and father children. Risk factors include: Having an undescended testicle or abnormal development of the testicles; a family history of testicular cancer, especially a father or brother; and having already had cancer in the other testicle.

Most testicular tumors are removed surgically to prevent the cancerous cells from spreading to other parts of the body. This procedure is called an inguinal orchiectomy.

“My partners and I probably do six to 10 orchiectomies a month,” Dr. Sharp, adding they treat patients from across Ohio and from several other states.

They also perform one or two retroperitoneal lymph node dissections (RPLND) a month. This procedure removes nearby abdominal lymph nodes, necessary only when the cancer has spread to them.

“Not a lot of these surgeries are done,” Dr. Sharp said. “That’s why it should be done at a comprehensive cancer center where the patient will receive optimal care from surgeons who are experts in this type of surgery.”

As Dr. Sharp said, testicular cancer is very treatable. When it is in the early stages, and has not spread beyond the testicles, it is considered “localized” testicular cancer. The 5-year survival rate for “localized” testicular cancer is about 99 percent, according to the NCI. When a patient’s testicular cancer is “regional” and has spread to the abdominal lymph nodes, the 5-year survival rate is 96 percent. When a patient’s testicular cancer becomes “distant” and has spread further, the 5-year survival rate drops to about 74 percent.

“When the cancer has spread widely, even to the brain, we still have several treatment options.” Dr. Sharp said.

Dr. Sharp specializes in testicular, prostate and kidney cancers. The ability to cure patients and save lives is one of the reasons he was drawn in this direction.

“The surgeries are interesting and challenging and you can make a difference in people’s lives,” Dr. Sharp said. “So many patients are curable and I get a lot of satisfaction from that.”