Newly Diagnosed With Testicular Cancer: First Steps

Testicular cancer is one of the most curable cancers there is. NCI states that the cure rate exceeds 90 percent for seminomas at all stages, and approaches 100 percent for low-stage seminomas and nonseminomas.

For 2026, the American Cancer Society projects 9,810 new cases and 630 deaths in the United States. That is 0.5 percent of new cancer diagnoses and 0.1 percent of cancer deaths. NCI's own SEER measurements, from men diagnosed between 2016 and 2022, put five-year relative survival at 94.6 percent. Just over half of cases, 51.0 percent, are diagnosed in men aged 20 to 34.

None of that makes the next few weeks easier. It does mean the planning conversation is mostly about how to cure this with the fewest long-term costs.

If you asked why they operated instead of doing a biopsy first, here is the answer.

NCI states that radical inguinal orchiectomy, with high ligation of the spermatic cord done first, is the procedure of choice for both diagnosing and treating a malignant testicular mass. The incision goes in the groin, not the scrotum.

Going through the scrotum risks spreading tumor into scrotal tissue or to the inguinal lymph nodes. The difference shows up in the numbers: local recurrence was 2.9 percent with a transscrotal approach against 0.4 percent with the inguinal approach. Distant recurrence and survival were equivalent, but the local problem is avoidable.

Most cancers are staged by anatomy. Testicular cancer adds a fourth letter, S, for serum tumor markers. The numbers themselves change your stage.

AFP, alpha-fetoprotein. Elevated in 40 to 60 percent of nonseminomas. It is never elevated in a pure seminoma. NCI is explicit: a raised AFP means the tumor is a nonseminoma, even if the pathology report says seminoma. That single rule can redirect an entire treatment plan.

Beta-hCG. Elevated in about 14 percent of stage I pure seminomas and about 50 percent of metastatic seminomas, and in 40 to 60 percent of nonseminomas. False positives happen, including from marijuana use and from cross-reaction with luteinizing hormone.

LDH, lactate dehydrogenase. Nonspecific, and it rises in many conditions unrelated to cancer. NCI notes limited value for catching relapse during surveillance, but it is a significant prognostic factor in metastatic disease.

The S categories work like this:

• S0. All markers normal.
• S1. LDH under 1.5 times normal, and beta-hCG under 5,000 mIU/mL, and AFP under 1,000 ng/mL.
• S2. LDH 1.5 to 10 times normal, or beta-hCG 5,000 to 50,000, or AFP 1,000 to 10,000.
• S3. LDH above 10 times normal, or beta-hCG above 50,000, or AFP above 10,000.

Ask for your marker values in writing, with the date of each draw. Markers fall in a predictable way after surgery, so the trend matters as much as any single number.

This is the decision with a deadline, and it is easy to miss in the first week.

NCI states that men can be offered the opportunity to bank sperm before any treatment except orchiectomy. That means before chemotherapy, before retroperitoneal lymph node dissection, and before radiation.

The outlook afterward is reasonably good. Two large studies found roughly 70 percent of patients fathered children after treatment. NCI recommends waiting at least 3 months after finishing chemotherapy before trying to conceive. Radiation scatter can depress counts for 1 to 2 years, and counts often recover.

Bank anyway. It is cheap insurance against the 30 percent.

Stage I seminoma. Three options: surveillance with imaging and markers, a single dose of carboplatin, or radiation to the retroperitoneal lymph nodes.

Stage I nonseminoma. Three approaches, none shown to give longer survival than the others: surveillance after orchiectomy, one or two cycles of chemotherapy, or retroperitoneal lymph node dissection followed by observation.

Stage II seminoma. For non-bulky disease, radiation below the diaphragm at 30 to 36 Gy, or chemotherapy; for bulky disease, chemotherapy. Which one depends on how large the involved nodes are.

Stage II nonseminoma. If markers are normal after orchiectomy, lymph node dissection with close follow-up is one route. Larger or marker-positive disease is usually treated with chemotherapy first, with surgery afterward if disease remains.

Stage III. Cisplatin-based chemotherapy. BEP is standard, and EP is used when bleomycin is contraindicated. Three or 4 cycles, set by the international risk classification into good, intermediate, or poor prognosis groups.

BEP is bleomycin, etoposide, and cisplatin given together in cycles. EP is the same combination without the bleomycin. Ask your team for the exact doses and cycle length written down.

Retroperitoneal lymph node dissection, or RPLND, is often described as surgery. NCI frames it primarily as a staging tool.

The reason is accuracy. About 25 percent of men with clinical stage I nonseminoma get restaged as pathological stage II once the nodes are examined. Imaging missed the disease.

It is not perfect either. About 10 percent relapse despite normal imaging, normal markers, and benign pathology from the dissection.

Because most men here are cured and young, decades of follow-up follow. NCI quantifies several of the costs, and they are worth weighing when two options have similar cure rates.

• Second leukemia. Etoposide raises relative risk 15 to 25 fold, though cumulative incidence stays under 0.5 percent at 5 years at standard doses below 2 g per square meter.
• Heart disease. Radiation to the mediastinum carries a 2.5-fold increase in coronary heart disease. Mediastinal radiation plus chemotherapy raises it almost threefold. BEP was linked to a borderline 1.5-fold increase in cardiovascular disease. Cardiac events overall ran about 2.5-fold higher than with surveillance.
• Lungs. A cisplatin dose above 850 mg confers a threefold increased risk of restrictive lung disease, and bleomycin adds risk as the cumulative dose climbs.
• Hearing. Bilateral loss at 4 to 8 kHz frequencies, though hearing aids are rarely needed.
• Kidneys. About a 15 percent drop in creatinine clearance, which then stays stable.
• The other testicle. About a 2 percent cumulative risk of cancer there over 15 years, which is why the remaining testicle stays under watch.

• Get the pathology report, including whether it is pure seminoma or nonseminoma.
• Get every marker value with dates, and ask when the next draw is.
• Ask whether an AFP result conflicts with the stated histology.
• Schedule sperm banking before any further treatment.
• Ask whether surveillance is an option for you, and what it would require.
• Ask what the follow-up schedule looks like at 5, 10, and 15 years.

• Call 911 or go to an emergency department if you suddenly cannot catch your breath, start wheezing, or get chest pain during or after chemotherapy. Bleomycin, used in several testicular regimens, can injure the lungs.
• Call your cancer team the moment it happens, day or night, if you run a temperature of 100.4°F (38°C) or higher, or get shaking chills, while your blood counts are low from chemotherapy. CDC classes that combination as a medical emergency. If you cannot reach the team quickly, go to an emergency department and tell them at once that you are on chemotherapy.
• Call your care team the same day if the groin or scrotal wound after your orchiectomy turns red and swollen, leaks fluid, or the pain climbs instead of settling.
• Call your care team within a day or two if you notice a new lump, ache, or change in the remaining testicle. You are asked to check it regularly and to report anything unusual.

• https://www.cancer.gov/types/testicular/hp/testicular-treatment-pdq
• https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://medlineplus.gov/druginfo/meds/a682125.html
• https://seer.cancer.gov/statfacts/html/testis.html
• https://www.cdc.gov/cancer-preventing-infections/patients/fever.html