New and classic treatments for testicular cancer

New and classic treatments for testicular cancer: clinical trials and surgical procedures

Testicular cancer is the most common form of cancer in men under the age of 35. Approximately 7,500 cases are diagnosed annually in the United States, with 400 cases proving fatal each year. Despite an increase in the number of testicular cancer cases over the last decade, new treatments are improving survival rates. Even many patients with late-stage testicular cancer can be cured; the overall cure rate for testicular cancer is an encouraging 90 percent.

Urological Illustrations by Fairman Studios for American Urological Association patient education materials

Surgery, chemotherapy, and radiation for testicular cancer: the classic options

If testicle tumors are diagnosed in their early stages, current treatments are very effective.

– The most effective way to remove testicle tumors is to remove the entire testicle, a procedure known as an orchiectomy. Often, an orchiectomy is performed during the diagnostic biopsy. Although surgery removes an entire testicle, if the surviving testicle is healthy, sexual function is unimpaired.

– During an orchiectomy, the surgeon may also remove regional lymph nodes. Local lymph nodes may have been affected by testicular cancer. This extensive lymph node removal surgery does have certain risks. Nerve damage caused by the surgical removal of lymph nodes may affect ejaculation. Surgeons are constantly looking for new ways to preserve nerves around the lymph nodes so sexual performance is not affected by surgery.

– Chemotherapy is a systemic treatment, meaning the drugs affect the entire body, which can cause many side effects. Sperm production may be affected during chemotherapy. While this is usually temporary, chemotherapy’s affect on sperm can be permanent, and men should consider sperm banking before treatment.

Genetic screening and testicle transplants: hope for the future

A man’s genetic code may increase his risk of testicular cancer, according to Dr. Haifin Lin at North Carolina’s Duke University. Dr. Lin and his research team believe they have isolated a gene that increases the risk of seminoma, a variety of testicular cancer that develops in sperm-producing germ cells.

The gene in question is an overactive variety of the HIWI gene. In a small clinical trial examining nineteen men with seminoma-type testicular cancer, twelve of the participants displayed signs of overactive HIWI genes. The HIWI genes present in the seminoma cells of the twelve men were sixteen times more active than normal. The overactive gene may account for the rapid cell reproduction that characterizes seminoma tumors.

If accurate, the study suggests a significant 63 percent of men with seminoma testicular tumors present with overactive HIWI genes. Dr. Lin is also careful to point out that the results of such a small clinical trial will need to be verified by larger studies.

If future studies confirm the Duke University research team’s findings, the knowledge could eventually yield a screening test for seminoma tumors. As testicular cancer is the most common cancer diagnosed in men under forty, an effective screening test could detect seminoma tumors at early stages of development, increasing treatment options, and survival rates.

Testicular transplants: reversing chemotherapy-caused infertility?

Chemotherapy treatments for testicular cancer can result in infertility. For this reason, men planning to have families after treatment are advised to use sperm banking in case of complications. If young boys with testicular cancer are left infertile by chemotherapy, little can be done: sperm banking is not an option prior to pubescence.

A new surgical treatment may offer a solution to this problem. The Christie Hospital, in Manchester, England, performed the first human testicle transplant in 2001, apparently curing a man of chemotherapy-induced infertility.

The case involved a man who received chemotherapy as a treatment for Hodgkin’s disease, blood-borne cancer. Prior to chemotherapy, doctors collected testicle tissue from the patient. The tissue was then frozen in liquid nitrogen. After treatment, which caused his infertility, the tissue was surgically returned to the testicles. The patient was able to father a child after the procedure.

Testicular transplants had proven successful when performed on animals, so the results were not entirely surprising. However, some doctors question whether the procedure did indeed restore fertility, or if fertility returned spontaneously (while rare, some men do recover from chemotherapy-induced infertility years after treatment).

If the surgery was a success, the procedure offers hope to testicular cancer patients who are too young to bank sperm, or men to ill to produce sperm. Seven men underwent the treatment; only one recovered from his infertility, so the treatment requires more study and clinical investigation.

The value of research: clinical trials and surgical procedures

Treatments are most effective when testicular cancer is caught in its earliest stages. Unfortunately, some forms of testicular cancer have no obvious symptoms until the disease is advanced. Clinical trials have discovered that certain testicular tumors produce characteristic markers that can be detected by blood tests, increasing the chances of detecting early testicular tumors.

Research into testicular cancer markers has revealed that high levels of AFP (alpha-fetoprotein) can be found in the blood of 85 percent of men with non-seminoma testicular cancer. As a result, the chance that such cancer will be detected by routine blood work has increased.


The article is written by licensed urologists: Dr. David M. Kaufman and David M. Weiner, MD. If you have any questions after reading the article, you can contact us by asking a question in the feedback form

Was this article helpful?
YesNo