Surgery for Testicular Cancer

After having a radical inguinal orchiectomy, an option for people with clinical stage I testicular cancer (seminoma or non-seminoma) may be surveillance. The advantage of surveillance is that patients may avoid additional treatment that may not be needed. With surveillance, the patient is monitored closely, and active treatment begins only if the cancer recurs. This option involves regular doctor appointments for physical examinations, blood tests for tumor markers, computed tomography (CT) scans, and chest x-rays. This approach requires dedication by the doctor and patient to stick to the surveillance schedule so that any recurrence can be detected at an early stage. It is only considered as an option if AFP and beta-hCG levels are normal or return to normal after the testicle with cancer is removed.

The main advantage of surveillance is that it avoids any further treatment after orchiectomy for those who do not have the disease return. About 82% of patients with seminoma and 75% of patients with non-seminoma will not have the disease return after orchiectomy. For an individual patient, the risk of recurrence may be higher or lower based on risk factors determined by the pathologist’s examination of the tumor after the testicle has been removed.

• It can preserve testosterone production, thereby reducing the need for hormone replacement therapy.
• It can maintain fertility.
• It can maintain quality of life by avoiding low testosterone-related issues like low energy, mood changes, osteoporosis, and sexual dysfunction.

• It is associated with a higher risk of the testicular cancer returning.
• After surgery, close lifelong monitoring is necessary.
• After surgery, radiation is usually recommended, which can affect sperm and testosterone.

In some cases, the surgeon can remove lymph nodes through very small skin incisions in the abdomen by using a laparoscope and other long, thin surgical tools. A laparoscope is a narrow, lighted tube with a small camera on the end that lets doctors see inside the abdomen. The surgeon’s hands are not inside the patient’s body during this type of surgery.

In laparoscopic surgery, after being put to sleep, you’re turned onto your side. Several small incisions are made on your abdomen. The laparoscope and surgical tools are put in through the incisions to remove the lymph nodes. The incisions are then closed.

Patients recover much more quickly from this operation than the standard open procedure and are walking soon after surgery. There’s usually less pain and patients are eating sooner.

Laparoscopic surgery seems to be a lot easier for the patient, but doctors aren’t sure if it’s as safe and effective as the standard “open” surgery in removing all the lymph nodes that may contain cancer. Because of this uncertainty, doctors are more likely to recommend chemotherapy after laparoscopic surgery if cancer is found in the lymph nodes.

This procedure is most often used for patients with early-stage non-seminomas to see if the lymph nodes contain cancer. As with the standard open procedure, this is a complex operation that should only be done if the surgeon is very experienced.

Losing one testicle usually has no effect on a man’s ability to get an erection and have sex. But if both testicles are removed, sperm cannot be made, and a man becomes infertile. Also, without testicles, a man cannot make enough testosterone, which can decrease sex drive and affect his ability to have erections. Other effects could include fatigue, hot flashes, and loss of muscle mass. These side effects can be avoided by taking testosterone supplements, either in a gel, a patch, or a shot. Pills are generally not reliable sources of testosterone.

Testicular prosthesis

Usually, men with testicular cancer are young and may be concerned about changes in how they look. They may be dating and worry about a partner’s reaction, or they may feel embarrassed by the missing testicle when in locker rooms.

To restore a more natural look, a man can have a testicular prosthesis surgically implanted in his scrotum. The prosthesis approved for use in the United States is filled with saline (salt water) and comes in different sizes to match the remaining testicle. When in place, it can look like a normal testicle. There can be a scar after the operation, but it’s often partly hidden by pubic hair. Some men might want a prosthesis, while others might not. You should discuss your wishes with your surgeon before surgery. It could also help to talk with someone who has a testicular prosthesis to hear what it has been like for them.

An RPLND, a surgery to remove retroperitoneal lymph nodes, is a major operation. Serious complications are not common, but they can happen. About 5-10% of patients have short-term problems after surgery, such as infection or bowel obstruction (blockage). The standard approach for an RPLND requires a large incision in the abdomen, which will leave a scar and can take some time to heal. Your ability to get up and move around after the operation will be limited for some time. This is less likely to be an issue if you have laparoscopic surgery, which uses smaller incisions.

Retrograde ejaculation

An RPLND usually does not cause impotence – a man can still have erections and sex. However, this surgery may cause problems with ejaculation. If certain nerves are damaged during the RPLND, when a man ejaculates, the semen may go backward into the bladder and not come out through the urethra to exit the body. This is called retrograde ejaculation, which can make it hard to father children.

To avoid this ejaculation dysfunction, surgeons have developed a type of retroperitoneal lymph node surgery called nerve-sparing surgery. It can be a good option for certain patients, when done by experienced doctors. Testicular cancer often affects men at an age when they might be trying to have children. These men may wish to discuss nerve-sparing surgery with their doctors, as well as sperm banking (freezing and storing sperm cells obtained before treatment). Men with testicular cancer often have lower-than-normal sperm counts, which can sometimes make it harder to collect a good sperm sample. See How Cancer and Cancer Treatment Affect Fertility in Men for more about this.