Testicular Cancer: Symptoms, Diagnosis, Treatment, and Prognosis

Testicular cancer is a malignant tumor that develops in one or both testicles. In most cases, the disease affects young men between the ages of 15 and 45. Although testicular cancer accounts for only about 1.6% of all cancers in men, it is the most common type of cancer in this age group.
Testicular cancer usually begins with uncontrolled cell proliferation in the testicular tissue. These cells can develop into a tumor that—if left untreated—can spread to neighboring structures or even beyond the abdominal cavity to other organs, forming metastases.
When detected and treated early, testicular cancer is almost always curable.

The exact causes of testicular cancer are not yet fully understood. However, specialists believe that a combination of genetic and developmental factors plays a role. One clearly established risk factor for testicular cancer is undescended testicles (maldescensus testis). Men in whom one or both testicles did not fully descend into the scrotum during childhood have a significantly increased risk of testicular cancer—even if the undescended testicle was surgically corrected.

Other risk factors for testicular cancer include:

• Family history: If a father or brother has already been diagnosed with testicular cancer.
• Previous history of testicular cancer: The risk of developing the disease again increases slightly.
• Certain genetic conditions (e.g., Klinefelter syndrome).
• Infertility or hormonal imbalances that can affect testicular health.

Lifestyle factors or diet, on the other hand, do not appear to have a direct influence on the development of this malignant tumor.

Image showing a testicle with tumor growth © Crystal light | AdobeStock

The symptoms of testicular cancer can vary widely. Often, those affected notice palpable lumps or an increase in the size of the affected testicle. Some men experience a feeling of heaviness in the scrotum or a pulling pain in the lower abdomen.

Typical signs of testicular cancer include:

• A lump or irregular hardening in the testicle
• Swelling or a feeling of tightness in the scrotum
• Pain on pressure, rarely stabbing pain
• A pulling sensation extending into the abdomen
• In rare cases: Enlargement of the breasts (gynecomastia)

Testicular tumors do not always cause immediate symptoms. Therefore, it is important to see a urologist immediately if testicular cancer is suspected.

The process of diagnosing testicular cancer usually begins with a physical examination by a urologist. This is followed by an ultrasound examination of both testicles to visualize their structure and detect any lumps.

In addition, tumor markers are measured in the blood. These so-called tumor markers (AFP, β-HCG, and LDH) provide information about the type of tumor, the stage, and the progression of the disease. Elevated levels can also be used after surgery to monitor treatment and during follow-up care for testicular cancer.

To confirm the diagnosis with certainty, a tissue sample is usually taken. The procedure involves making an incision in the groin to remove the affected testicle and analyze the tissue histologically. In cases of advanced-stage cancer, CT or MRI scans are also performed to detect possible metastases in other organs.

Staging is based on the international TNM classification (tumor size, lymph node involvement, metastases):

The earlier testicular cancer is detected, the better the chances of a cure.

Treatment for testicular cancer depends on the type and stage of the tumor.
It almost always begins with surgery (radical orchiectomy), in which the affected testicle is completely removed through an incision in the groin. The goal is to remove all malignant tissue.

In early stages, surgery alone is often sufficient.
Patients are then closely monitored (a strategy known as “active surveillance” for testicular cancer) to detect any recurrence in a timely manner.

If the tumor has already spread to lymph nodes or other organs, the following treatments are usually administered:

• Chemotherapy to destroy any remaining cancer cells
• Radiation therapy for certain seminomas
• For non-seminomas, additional surgical removal of metastases if necessary

Treatment should begin immediately after diagnosis.
In experienced centers, patients can receive treatment at a specialized testicular cancer center to benefit from interdisciplinary expertise.

The prognosis for testicular cancer is very good.
More than 95% of men with testicular cancer are permanently cured if the disease is detected early.
Even in advanced stages with metastases, modern combination chemotherapy offers high chances of cure.

Factors important for prognosis include:

• the stage at the time of diagnosis,
• tumor marker levels,
• and the type of tumor (seminoma or non-seminoma).

Young men who get regular checkups therefore have particularly good prospects for a full recovery.

Once treatment is complete, a structured follow-up program is crucial for detecting recurrences in a timely manner.

Recommended intervals:

1. Year 1: every 3 months
2. Years 2–3: every 6 months
3. From the 4th year onward: annually for up to 10 years after the end of treatment

Follow-up care for testicular cancer includes physical examinations, ultrasound, imaging (CT/MRI), and regular monitoring of tumor markers in the blood. The risk of a relapse is highest in the first few years following treatment.

Since there is no specific screening test, self-examination of the testicles is particularly important. Men should check their testicles once a month, ideally after showering, when the skin is relaxed.

Here’s how to perform a testicular self-exam:

1. Gently cup the testicle between your thumb and fingers.

2. Gently roll it between your fingers and check for lumps, hardening, or changes in size.

3. Compare both testicles with each other—minor differences are normal.

4. If you suspect testicular cancer, seek medical evaluation immediately.

Men with a family history of testicular cancer or undescended testicles should be especially vigilant, as they have an increased risk of testicular cancer.

After successful treatment, most patients lead normal lives.
Surgery to remove a testicle generally has no effect on sexual function or hormone levels.
Chemotherapy or radiation therapy may temporarily reduce sperm production.

To preserve fertility, semen can be frozen before treatment begins.
If the loss of a testicle causes psychological distress, a testicular prosthesis is available as an aesthetic option.

Anyone seeking medical care due to suspected testicular cancer or for the treatment of testicular cancer should be treated at a specialized center for testicular cancer.
Here, urologists, oncologists, and surgeons work together in an interdisciplinary team to achieve optimal results.
There, patients with testicular cancer are treated according to current guidelines and with state-of-the-art diagnostic methods.

Early symptoms of testicular cancer are usually palpable lumps or hard areas in the scrotum. Those affected often report a feeling of heaviness, an increase in size, or a pulling, pressing sensation in the lower abdomen. Pain is rare in testicular cancer. Since testicular cancer often begins without symptoms, it is important to recognize changes early and have them evaluated by a doctor promptly.

German Cancer Aid, Information Sheet “Testicular Cancer – Detection and Treatment”

Testicular cancer develops as a result of uncontrolled cell division in the testicular tissue. The exact mechanism is not yet fully understood, but there is a link between testicular cancer and undescended testicles, as well as genetic factors. Testicular cancer mostly affects young men between the ages of 15 and 45—an age group that otherwise rarely develops malignant tumors. In Germany, testicular cancer is considered a rare form of cancer, but it is the most common type of cancer among young men.

Treatment for testicular cancer depends on the stage of the disease. First, the affected testicle is removed through an incision in the groin. In early stages, surgery is often sufficient; in advanced stages, it is followed by chemotherapy or radiation therapy. If necessary, further treatment for testicular cancer may be required, such as the surgical removal of metastases. Thanks to modern therapies, the chances of recovery are good—for testicular cancer detected early, the cure rate is over 95%.

Onkopedia Guideline “Testicular Tumors,” DGHO 2024.

Even after successful treatment of cancer, there is a small risk that testicular cancer will return. That is why regular follow-up examinations—including blood tests for tumor markers, ultrasound, and, if necessary, CT scans—are crucial. The risk of recurrence is highest in the first few years after treatment ends. Consistent follow-up care makes it possible to detect new tumors early and treat them immediately.

DKG 2024.

In most men, sexual function remains intact after testicular cancer surgery. The remaining testicle continues to produce sufficient testosterone. Chemotherapy can temporarily reduce sperm production. To preserve the ability to have children, doctors recommend freezing sperm before treatment begins. Many men report that they are fully healthy again after completing therapy and that their quality of life is hardly affected.

German Cancer Aid – “Life After Testicular Cancer,” 2023.

Yes. A monthly self-examination of the testicles helps detect testicular cancer early. Men should regularly check their testicles to detect any lumps or changes in size early on. The best time to do this is after a shower, when the skin is relaxed. If testicular cancer is detected early, the chances of recovery are very good, even if metastases are already present.