Questions to Ask About Testicular Cancer Treatment

This page is for men with testicular cancer and the people helping them. It explains what drives the treatment plan and lists questions for each step.

Three things set the direction, and all three are usually settled in the first two weeks.

The first is histology, the cell type seen under the microscope: seminoma or nonseminoma. Any tumor that is 100% seminoma is a seminoma. Everything else, including any mixture, is managed as a nonseminoma.

The second is the tumor markers, drawn before and after the testicle comes out.

The third is what the abdominal CT shows in the retroperitoneal lymph nodes, the nodes at the back of the belly.

The context is worth stating plainly. NCI calls testicular cancer highly treatable and usually curable. For seminomas across all stages, the cure rate is over 90%. For low-stage seminomas or nonseminomas, it nears 100%. NCI lists an estimate of 9,720 new US cases and 600 deaths for 2025, a figure that comes from the American Cancer Society.

AFP, beta-hCG, and LDH should be measured before the testicle is removed. That is a clear instruction in NCI's clinical summary. It is easy to miss in a fast-moving week.

Here is what each one does:

• AFP is raised in 40% to 60% of men with nonseminomas. Seminomas do not make it. So a raised AFP means a mixed germ cell tumor, even when the pathology reads pure seminoma. The exception is a better explanation, such as liver disease.
• Beta-hCG is raised in about 14% of stage I pure seminomas before surgery, in about half of metastatic seminomas, and in 40% to 60% of nonseminomas.
• LDH rises in both types. NCI is candid that it is weak on its own. One study covered 499 patients. A raised LDH was unrelated to cancer in 7.7%, and cancer-related in only 1.4%. The positive predictive value was 12.8%. That is the share of raised LDH results that actually pointed to cancer.

Two false-positive traps are worth naming. Beta-hCG assays can cross-react with luteinizing hormone, which is one reason a mildly raised result on its own does not settle anything. There are also clinical reports of marijuana use raising beta-hCG. Either way, a marker that does not fit the rest of the picture should be checked by the treating team before it changes the plan. They may repeat the test or use another one.

• Will this be a radical inguinal orchiectomy, through the groin, with high tying of the spermatic cord?
• Why is a cut through the scrotum avoided?

That second question has a number attached. A review of published series compared the two routes. Local recurrence was 2.9% through the scrotum and 0.4% through the groin. Distant recurrence and survival were the same. The local gap was statistically significant. The worry is spilling tumor into scrotal tissue or groin nodes.

• Can sperm banking happen before the operation, or is between surgery and chemotherapy soon enough?
• Is a testicular implant an option, and can it go in during the same operation?

This is where the choice is genuinely open, and where a clear conversation pays off most.

Surveillance after surgery means no radiation and no chemotherapy. Scans take their place. NCI describes the schedule used in the reported series, which ran scans and chest imaging frequently in the first years and then tapered over roughly a decade. Do not treat that as your timetable. Ask your center for its own written, dated surveillance schedule and what each appointment involves.

More than 1,200 patients have been managed this way. The 10-year recurrence rate was 15% to 20%. Nearly all recurrences were cured with later radiation or chemotherapy. Relapse after 5 years is unusual, but it can happen in up to 4%.

Two features change the odds:

• Tumor larger than 4 cm.
• Invasion of the rete testis, a network of small tubes inside the testicle.

The 5-year relapse risk in the series NCI reports was about 10% with neither, 16% with one, and 32% with both. They shift the odds. They do not by themselves decide between surveillance and treatment, and not every guideline weighs them the same way. Ask for the numbers by name, then ask what your team recommends and why.

If surveillance does not appeal, a short course of carboplatin is the main alternative. The MRC-TE19 trial randomized 1,477 men to carboplatin or to radiation. Five-year relapse-free survival was 94.7% and 96.0%, a gap of 1.3%. The single seminoma death was in the radiation arm.

Radiation is no longer favored. The reason is second cancers. A SEER analysis of men treated with radiation for stage I seminoma found a raised risk of death from second cancers, with a standardized mortality ratio of 1.89. That compares the deaths seen with the deaths expected in the general population. An international study followed survivors for 20 to 29 years. Radiation doubled the risk of a second cancer.

Ask what the pathology says about lymphovascular invasion (cancer in small blood or lymph vessels) and the proportion of embryonal carcinoma, a fast-growing cell type. Both push toward treatment rather than surveillance.

Ask about the CT too. Some patients have normal scans and normal markers after surgery. NCI reports that nearly 20% with seminoma and 30% with nonseminoma still relapse if nothing more is done. A clean scan is not the same as no disease.

If retroperitoneal lymph node dissection comes up, ask whether a nerve-sparing technique is planned, because the nerves involved control ejaculation.

A second opinion at a center that treats many germ cell tumors can be worth the trip. Ask whether a tumor board will review the case. Ask how often the center treats germ cell tumors.

One more question is worth asking. Does trial eligibility depend on a start date? Some options close once first-line therapy begins.

Bring the pathology report, the marker values with their dates, and the CT report. Ask for the numbers, not a summary word. Tumor size in centimeters and the exact marker values are what the decision rests on.

Our page on testicular cancer covers the basics, and our page on metastatic testicular cancer covers the questions that come up if disease has spread.

• National Cancer Institute, Testicular Cancer Treatment (PDQ) - Health Professional Version, updated May 16, 2025, accessed August 6, 2026
• National Cancer Institute, Testicular Cancer Treatment (PDQ) - Patient Version, accessed August 6, 2026
• American Cancer Society — Cancer Facts & Figures