Testicular Cancer Surveillance & Scanxiety

Testicular cancer is among the most treatable cancers there is. Five-year relative survival in the United States is around 97%. Roughly 9,700 men are diagnosed each year and about 600 die — a ratio unlike almost any other solid tumour. The median age at diagnosis is 33.

That context belongs at the front, because surveillance can make a situation feel more precarious than it is. Surveillance exists precisely because the odds are good. For many men with stage I disease, removing the testicle is enough; giving chemotherapy or radiotherapy to everyone "just in case" would mean treating many people to benefit few. Surveillance is not a decision to do nothing. It is a decision to hold treatment in reserve and check carefully.

Three strands, repeated on a schedule.

Blood markers. Alpha-fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG) and lactate dehydrogenase (LDH). These are made by some germ cell tumours, and a rise can flag relapse before anything is visible on imaging. Two limitations are worth knowing. Pure seminoma does not produce AFP, so a normal AFP proves nothing there. And LDH is non-specific, rising with all kinds of tissue turnover. Markers can also drift up for benign reasons, so a single mildly abnormal value is usually repeated before anything else changes.

Examination and history. Feeling the remaining testicle, the abdomen and the neck, and asking about back pain, cough or breathlessness.

Imaging. CT of the abdomen and pelvis is the main tool, because the first place these tumours spread is the retroperitoneal lymph nodes, alongside chest imaging.

Schedules differ by tumour type. European guidance for stage I seminoma on surveillance sets markers and clinic visits about twice a year for the first three years, then annually, with abdominopelvic CT or MRI at defined points out to five years. Stage I non-seminoma is watched more intensively at the start — markers and visits around four times a year in the first two years — because relapses cluster early. Ask for your own schedule in writing; the intervals are meant to loosen over time.

The dread that builds before a scan and while waiting for results has a name in the research literature — scanxiety — and it has been studied. A scoping review of 36 studies found it affects people during treatment and years into survivorship. Two patterns recur: anxiety climbs as the appointment approaches, and the gap between the scan and hearing the result is the worst part, often worse than the scan itself. Anxiety frequently drops immediately after the scan is done, before any result is known, which says a great deal about how much of it is anticipation rather than intuition.

Naming it matters, because it is easy to read your own dread as a signal that something is wrong. It usually is not. It is a predictable response to a scheduled reminder of uncertainty.

• Ask for the scan and the results appointment to be booked close together, and ask before you leave how long the wait will be.
• Decide in advance how you want results delivered. Some people want portal access the moment it posts; others want to hear it from a person first. Tell your team which you are.
• Book the scan at a time that limits empty waiting, and put something concrete in the diary for the day results are due.
• Tell one person your dates so you are not carrying it silently.
• Keep your own copy of the schedule and your marker values. Watching your own numbers stay flat is often steadying.

Relapse detected on surveillance is usually found early and remains highly treatable — that is the entire design of the strategy. Very late relapse beyond five years is rare, in the region of 0.5%. Follow-up eventually transitions into a survivorship plan focused on long-term health: hormone levels, fertility, and cardiovascular risk.

• NCI SEER: Cancer Stat Facts — Testicular Cancer
• EAU Guidelines: Testicular Cancer — Follow-up After Curative Therapy
• AUA Guideline: Diagnosis and Treatment of Early-Stage Testicular Cancer
• Surveillance-associated anxiety after curative-intent cancer surgery: a systematic review (Annals of Surgical Oncology, 2024)