Testicular Cancer: What Young Men Need to Know About Symptoms, Self-Exams and Early Detection

Testicular cancer is not common — about 1 of every 250 males will develop the disease at some point during their lifetime. But the incidence rate of testicular cancer is rising about 10 percent every five years.

And it’s primarily a cancer that strikes young men between the ages of 15 and 40, with the average age at the time of diagnosis at 33, says the American Cancer Society. Testicular cancer can also go undetected in early stages because a painless lump or mass may go unnoticed. April is Testicular Cancer Awareness Month. 

Ahmed Eldefrawy, M.D., urologic oncologist at Baptist Health Miami Cancer Institute.

Testicular cancer primarily strikes young men between the ages of 15 and 40, with the average age at the time of diagnosis at 33, says the American Cancer Society. Many of these men may be starting families. If the cancer is caught early, orchiectomy — or the removable of the cancerous testicle — is a very viable option with a very good outcome. If cancer is localized, chemotherapy or radiation may not be needed, says Dr. Eldefrawy.

“After removing the testicle, obviously the sperm count will be low,” said Dr. Eldefrawy. “These patients have just one testicle removed, they have not gotten chemotherapy or any additional radiation or removing of the lymph nodes. So, the vast majority of these patients will see their sperm count improve significantly. And after one year, 50 percent of these patient will have normal sperm account.”

Trying to conceive naturally may take a while following successful testicular cancer treatment.

“It could take a year or even longer to be able to conceive,” said Dr. Eldefrawy. “So, if you have the time to try naturally, then that would be the answer, especially if the couple is young. And again, if you wait longer after treatment for testicular cancer, the sperm quality tends to improve.”

Factors That Affect Fertility

There are many factors that can influence sperm count or the ability to ejaculate, including the severity of the cancer, the surgery required, and the substantial follow-up treatments, primarily chemotherapy and radiation.

“The sperm count immediately declines after chemotherapy or radiation,” explains Dr. Eldefrawy. “In the case of radiation, it can take up to two years for patients to recover and go back to their normal sperm count. And, obviously, the dose of radiation is different. So, if the patient received a higher dose of radiation, it might take even longer to recover to the baseline sperm count.

The recovery from chemotherapy also depends on the doses and duration of treatment, and the chemotherapy agent that is used.

“But with chemotherapy, patients also tend to recover from it and have basically their regular baseline sperm count after several months or up to a year after getting the chemotherapy,” says Dr. Eldefrawy.

Prostate Cancer and Sperm Banking

Prostate cancer is the most common cancer among men in the U.S., and the second leading cause of cancer death in men after lung cancer. But the U.S. prostate cancer rate is on the decline, mostly because of the growing treatment options and targeted therapies. Despite the high rate of success in treating prostate cancer, most men cannot father biologic children naturally afterward.

One very common solution is sperm banking before treatment, in which semen containing sperm is frozen in liquid nitrogen. After thawing, sperm will regenerate and can be used for artificial insemination. Another option is to retrieve sperms from the testicle by a minor surgery and this can be done after treatment as the sperm production in the testicles will not be affected.

“It’s very curable and very treatable cancer, but unfortunately this cancer and any form of treatment will definitely affect fertility,” said Dr. Eldefrawy. “The two treatment options that has been around for many years and the gold standard until now is prostatectomy (removal of the prostate) and radiation therapy, and they can result in erectile dysfunction and loss of ejaculation completely.”

“These two approaches (sperm banking or surgical sperm retrieval) are the only possible methods to attain fertility,” he adds. “But, to have normal conception, such as ejaculation and normal fertility, is not possible after prostate cancer treatment, either after removing the prostate or following radiation.”

Bladder and Kidney Cancers

Two other cancers that may affect male fertility are bladder and kidney cancers. In bladder cancer, non-aggressive tumors do not pose a threat to male fertility. However, aggressive bladder cancers “which invade the muscle of the bladder requires the gold standard treatment — which is to remove the bladder,” said Dr. Eldefrawy.

When the bladder is removed, “we remove the prostate at the same time. And this usually results in erectile dysfunction and loss of ejaculation. So, fertility in this case will be only available by again extracting sperm from the testicle by minor surgery or sperm banking before surgery,” he adds.

Kidney cancer occasionally can affect very young patients and some who have genetic predisposition to develop kidney cancer, Dr. Eldefrawy said.

“Luckily, this is one of the cancers that does not affect fertility whatsoever,” adds Dr. Eldefrawy. “It’s a surgical disease where we remove the tumor if it’s localized and small, and we repair the kidney. We’re able to save the kidney for the most part, and these patients recover pretty well. And very, very rarely we would use chemotherapy for it.

A man’s lifetime risk of dying from this cancer is very low, even if it is detected after it has spread to other organs, said Ahmed Eldefrawy, M.D., a urologic oncologist at Baptist Health Miami Cancer Institute.

“Wefind that the incidence of testicular cancer is increasing … if we compare the incidence rate now to about 10 or 20 years ago,” explains Dr.Eldefrawy. “We find that every five years, the incidence increases about10 percent. What is the cause of this increase? It’s unknown. It’s most likely environmental changes that cause genetic mutations that could be resulting in higher rates of testicular cancer. That’s most likely what it is. Still, at the end of the day, testicular cancer is rare. It’s just that the incidence is increasing over time.”

The primarysymptom of testicular cancer is a lump or mass in either testicle and a feeling of heaviness in the scrotum.

“Men should be aware that testicular cancer can be completely painless,” emphasizes Dr. Eldefrawy. “I’ve seen so many patients who have had it fora year or two. And I ask them why they didn’t come in earlier when they noticed they had it. And they say it was painless, so it didn’t bother them. But if men feel a lump or mass, they should go see their doctor, whether it’s their primary care physician or a urologist if they have access to one.”

Here’s more from Dr. Eldefrawy on testicular cancer:

Question: What is the No. 1 symptom of testicular cancer?

Dr. Eldefrawy: “Seeing or feeling a mass that comes off the testicle, and it’s usually a lot harder in consistency than the normal feeling of a testicle. It’s worth saying that testicular cancer is painless. And if people complain of pain, it’s not really pain — it’s more of a discomfort or heaviness if the mass gets bigger. And they can grow bigger really fast over weeks and months. So, the heaviness from the size of the mass is what creates a discomfort. But, generally, it’s painless.”

Question: Any other symptoms besides a lump or mass?

Dr. Eldefrawy: “Usually, we catch it early …  and we find a small mass. But if men ignore it mainly because it’s painless, then it can spread. And this cancer is highly metastatic and spreads very quickly. So that’s when the rare symptoms can happen. Some patients may have a lung mass. Their lungs will be affected by the testicular cancer. So, they would get shortness of breath because the normal lung tissues are significantly reduced to — sometimes more than half of the lung tissues are replaced by cancer. They will get short of breath with minimal effort. Sometimes they can even cough blood. I’ve also seen a patient with a brain mass and these patients can develop seizures. And, occasionally, they have very large lymph nodes in the retroperitoneum (the area in the back of the abdomen behind the tissue that lines the abdominal wall and covers most of the organs in the abdomen) and they can develop back pain.”

Question: Are there any preventative measures that men can take against testicular cancer?

Dr. Eldefrawy: “There are preventive measures in terms of early detection, but not in terms of not getting testicular cancer. Men who are going to develop testicular cancer will develop it no matter what. What they can do is to detect it very early before it metastasizes so it can be treated early. Prevention can take the form of self-examination once a month in the shower. And that’s recommended for men between the ages of 15 and 40. That’s peak time for testicular cancer. So once a month, every man should examine their testicles. The self-exam is done with one hand over each testicle, usually with the thumb and the middle and index finger against the skin. Stretch the skin over the testicle. With the other hand, feel the testicle to see if a lump or mass or different consistency. Perform the same self-exam over the other testicle.”

Question: What is the probability of testicular cancer on both sides?

Dr. Eldefrawy: “Roughly, one out of 100 testicular cancer patients will develop cancer on both sides. The vast majority is only on one side. I only saw one patient that had on both sides at the same time. It’s rare.”

Question: What are the top risk factors for testicular cancer?

Dr. Eldefrawy: “White men tend to have more testicular cancer (than men of color). The other risk factor, in addition to a family history of testicular cancer, is being born with undescended testicles. When a boy is born with undescended testicles, we wait up to a year for the testicles to descend on their own. After one year, if it doesn’t descend, we perform a surgical procedure known as orchiopexy to move the testicle down into the scrotum. So, males born with an undescended testicle are at a higher risk of having testicular cancer in the future, even if the orchiopexy was successful.”