For most men faced with testicular cancer, surgery to remove the testicle is the first treatment. After that surgery, you and your doctor must decide what to do next. For stage I seminoma testicular cancer, these are your choices:
This decision aid is about stage I seminoma testicular cancer. The treatment decision for stage I nonseminoma testicular cancer is different.
There are two main types of testicular cancer: seminoma and nonseminoma. Seminomas tend to respond well to radiation treatment, while nonseminomas most often require chemotherapy or other treatment. Seminomas are also less likely to spread to the lungs, liver, and brain.
"Stage I" means that the cancer doesn't seem to have spread. Some stage I cancers actually have spread to the lymph nodes of the lower back but can't be seen.
Both types of cancer are very often cured, especially if they are found and treated early. Compared to other forms of cancer, testicular cancer—even when it has spread to other parts of the body—has a very high cure rate.
The first treatment is surgery to remove the testicle. After that, most men have three choices: surveillance, radiation, and chemotherapy. About 15 to 20 out of 100 men who choose surveillance will need more treatment. But any of the three choices will cure seminoma cancer in more than 95 out of 100 men.1
Surveillance means that you are being watched closely by your doctor but are not having further treatment.
You have exams, chest X-rays, and blood tests regularly during the first few years, as well as CT scans. It can be hard to go to the doctor's office that often. Unless your cancer comes back, the number of checkups and tests will gradually decrease over the next 10 years.
With surveillance, you may be able to avoid the risks and side effects of radiation or chemotherapy. About 80 to 85 out of 100 men who choose surveillance find that surgery cured the seminoma cancer and they don't need more treatment.1
Even when cancer is found after a period of surveillance, it is usually possible to cure the cancer if it's found early. Because of this, many doctors consider it reasonable for some men to choose surveillance.
Radiation most often is focused on the lymph nodes in the pelvis and lower back, because that is where the cancer usually spreads.
When this cancer is found very early, it can be very hard to tell if these lymph nodes are cancerous. That's why radiation may be used even when no cancer can be seen.
Chemotherapy is the use of very strong drugs to kill cancer cells. For men with stage I seminoma, chemotherapy may be used instead of radiation therapy. It is less toxic than radiation therapy and may work just as well to keep cancer from coming back.1
Your doctor can talk to you about which chemotherapy drugs have the least harmful side effects.
Perhaps the greatest risk of choosing surveillance has to do with missing your follow-up tests and exams. Without regular testing and checkups, you can miss cancer that has returned until it spreads beyond the lymph nodes and is harder to cure. If you choose surveillance, it's very important to strictly follow your doctor's schedule of tests and exams.
When cancer does come back during surveillance, it usually hasn't spread any farther than the lymph nodes in the lower back and pelvis. It can usually be treated successfully when the testing schedule has been followed closely.
Radiation treatment has side effects. Most (such as fatigue, nausea, vomiting, and diarrhea) are short-term. That means they go away when treatment is done. Other side effects can permanently affect your lifestyle and future health, but they aren't common. The most serious long-term risks from radiation include:
Chemotherapy, often called chemo, for testicular cancer has caused permanent infertility in some men. Because most men diagnosed with this cancer are younger than 35, this is important to think about when you choose which treatment to use.
Men who are going to have this treatment should bank their sperm ahead of time if they want to father children in the future. Talk to your doctor about any fertility concerns you may have.
Side effects of chemo
Many men do not have problems with side effects from chemo. Other men have a great deal of trouble with them. If you have problems, your doctor can use other medicines to help you feel better.
Common side effects include:
|Try surveillance||Have radiation|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"When I was a senior in high school, my doctor found a lump on my testicle during a physical. After doing some tests, he told me I had testicular cancer. I guess the good news was that we had found it early enough that it might not have spread yet. After surgery, my doctor looked at my test results and said that there was a good chance that orchiectomy by itself might cure me. I decided that I didn't want to go through with radiation or chemotherapy unless I absolutely had to, no matter how many checkups I had to go to. It's been about 3 years now, and so far the cancer has not come back. I still go in pretty often for exams and blood tests, but to me it's worth it. I think I made the right choice."
— Stephen, age 20
"About 6 months after our wedding, I discovered a lump on my testicles when I was in the shower. Needless to say, I was very concerned, and I scheduled an appointment with my doctor the next day. Within 3 weeks, I was having an orchiectomy. After that, my doctor said that my cancer was at an early stage and that I was very lucky to have found it because the lump wasn't very big. He told me that I could either have radiation therapy, chemotherapy, or wait and see if I was cured. I decided to wait and see. That was 2 years ago. Last week, my doctor found something on my CT scan that didn't look right. As it turns out, my cancer has come back. So now I'm going to have to have radiation therapy anyway. I wish I had just gotten it over with 2 years ago rather than going through all the checkups and tests, and worrying about it all this time."
— Randall, age 29
"Around 4 years ago, I found a lump on my testicles. After being diagnosed with early-stage seminoma testicular cancer, I decided to do chemo right away rather than surveillance or radiation therapy. My doctor told me that chemo doesn't carry the same risk as of my getting another kind of cancer later in life. I know that there is still a small chance of being infertile from the chemotherapy. But to me it's an acceptable risk. My testicular cancer has been cured, and I feel great."
— Adolfo, age 32
"When I was 29, I was diagnosed with stage I seminoma testicular cancer. At the time, I was told that my cancer was found at a very early stage and that I could either choose radiation or surveillance after orchiectomy. I decided to go with radiation therapy, because I wanted my cancer to be cured as soon as possible. At the age of 46, I was diagnosed with leukemia, which my doctor says could be a result of the radiation therapy I received during treatment for testicular cancer. There's no way to be sure that it's what caused my leukemia. But now I wish I had thought about a surveillance program a little more seriously."
— Jeff, age 49
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
I'm worried that if I have treatment, I may not be able to have children.
I'm willing to put up with the possibility of not having children if it means my cancer will be cured for good.
A long schedule of regular checkups and tests during surveillance will be worth it if it means I won't need to have other treatment.
I don't like the idea of chemotherapy.
I don't like the idea of radiation treatment.
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT using surveillance
NOT having radiation treatment
NOT having chemotherapy
1. Which treatment means having checkups and tests often during the first few years?
2. If you're worried that chemotherapy or surgery will leave you infertile, can you bank your sperm ahead of time?
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Christopher G. Wood, MD, FACS - Urology, Oncology|