TESTICULAR CANCER • TESTIS PRESERVATION • MALE FERTILITY • BRISBANE
Testicular Cancer
Specialist assessment of testicular masses and testicular cancer, with particular attention to testis-sparing surgery in selected cases and fertility preservation before cancer treatment.
A new testicular lump or ultrasound-detected mass needs timely assessment, but not every intratesticular lesion is malignant and not every patient has the same fertility priorities. The initial plan should establish what the lesion is likely to be, whether the testis can safely be preserved in a selected situation, and whether fertility preservation should occur before treatment.
Educational information only. A website cannot determine whether a testicular mass is cancer, whether testis-sparing surgery is appropriate or whether sperm can be retrieved.
UNDERSTANDING TESTICULAR MASSES
Not every testicular mass follows the same pathway
Testicular cancer most commonly presents as a mass within the testis, but ultrasound can also identify small incidental lesions that may be benign. Clinical examination, high-quality scrotal ultrasound and serum tumour markers help determine how suspicious a lesion appears.
When a germ-cell tumour is suspected, radical inguinal orchidectomy remains the standard initial operation. However, there are selected situations where preserving testicular tissue may be reasonable, particularly with a small or indeterminate mass, a solitary testis, bilateral lesions or a lesion with a substantial likelihood of benign pathology.
Fertility should be considered before treatment rather than after it. Testicular cancer itself is associated with impaired semen quality in some men, and cancer treatment can further affect sperm production.
WHEN TO SEEK ASSESSMENT
Symptoms and signs that can occur with testicular cancer
Many testicular cancers are found because of a painless lump or change in the testis. Pain does not exclude cancer, and not every painful or swollen testis is malignant.
A new lump or firmness
A new intratesticular lump, focal firmness or a testis that feels different from the other side deserves examination.
Change in size or shape
Enlargement, asymmetry, heaviness or a change in the contour of one testis can prompt assessment.
Discomfort or ache
Some tumours are associated with pain, heaviness or a dull scrotal ache rather than a painless mass.
Incidental ultrasound lesion
Small non-palpable lesions are increasingly discovered during ultrasound for pain, infertility or another scrotal problem.
Fertility assessment finding
A mass may occasionally be detected during investigation of impaired fertility or abnormal semen parameters.
Symptoms outside the testis
Less commonly, advanced disease can present with symptoms related to lymph nodes or other sites and requires prompt staging.
RISK CONTEXT
Who has a higher risk of testicular germ-cell tumour?
Most men with a testicular lump do not have a known risk factor, but several clinical features are relevant.
Previous undescended testis
Cryptorchidism is associated with increased lifetime testicular cancer risk even after previous orchidopexy.
Previous testicular cancer
A personal history of germ-cell tumour increases concern about future disease in the contralateral testis.
Family history
Testicular cancer in a first-degree male relative is a recognised risk factor.
Testicular atrophy or impaired spermatogenesis
Reduced testicular volume and impaired sperm production can occur within the broader testicular dysgenesis spectrum.
INITIAL ASSESSMENT
How a suspicious testicular mass is assessed
The initial objective is to define the lesion, obtain baseline tumour markers, assess fertility where relevant and identify whether immediate surgery or additional characterisation is appropriate.
History & examination
The onset of the mass, pain, fertility history, previous undescended testis, prior testicular cancer and family history are considered alongside examination of both testes.
High-frequency scrotal ultrasound
Ultrasound assesses both testes and helps distinguish intratesticular from paratesticular pathology and characterise lesion size, vascularity and surrounding tissue.
Serum tumour markers
Standard tumour markers are checked before surgery and repeated afterward because they contribute to diagnosis, staging and follow-up.
Fertility assessment
Semen analysis and sperm cryopreservation should be discussed early, particularly in men who have not completed their family or who already have impaired sperm production.
Additional imaging when useful
MRI may occasionally help characterise an indeterminate lesion or assist planning for potential testis-sparing surgery when ultrasound is inconclusive.
Staging imaging when cancer is diagnosed or strongly suspected
Cross-sectional imaging of the chest, abdomen and pelvis is used according to the clinical situation to assess for metastatic disease.
STANDARD SURGICAL PATHWAY
Radical inguinal orchidectomy
When a testicular germ-cell tumour is suspected, the standard operation is removal of the affected testis and spermatic cord through an inguinal incision. This provides definitive tissue diagnosis and local tumour staging.
The operation is performed through the groin rather than through the scrotum when testicular cancer is suspected. The removed specimen is examined by pathology to determine tumour type and local stage.
A testicular prosthesis can be discussed before surgery and may be inserted at the same operation or later according to patient preference. This page does not promote any particular prosthesis product or manufacturer.
TESTIS-PRESERVING SURGERY
When can testis-sparing surgery be considered?
Testis-sparing surgery removes a focal lesion while preserving the remaining testicular tissue. It is a selected strategy that is most relevant when avoiding unnecessary loss of testicular function is particularly important and the lesion is suitable for local excision.
Small or indeterminate mass likely to be benign
Selected small lesions with negative tumour markers and imaging features that do not clearly establish malignancy may be suitable for surgical exploration with the aim of avoiding unnecessary orchidectomy.
Solitary testis
When the affected testis is the only remaining testis, preservation of endocrine and reproductive function can be particularly important if oncologically reasonable.
Bilateral testicular tumours
Bilateral disease can create a strong reason to consider preservation of functioning testicular tissue where tumour characteristics and residual tissue permit it.
Selected non-germ-cell tumours
Some interstitial or stromal tumours have a different biological profile from conventional germ-cell cancer and may be suitable for local excision in selected circumstances.
INTRA-OPERATIVE DECISION SUPPORT
Frozen section examination
During testis-sparing exploration, the removed lesion can be assessed immediately by an experienced pathologist. This helps determine whether preservation of the remaining testis is reasonable or whether completion orchidectomy is required. Final pathology can occasionally differ from the intra-operative assessment, so delayed completion surgery can still become necessary.
BALANCED DECISION-MAKING
Potential advantages and limitations of testis-sparing surgery
POTENTIAL ADVANTAGES
Why preserving testicular tissue can matter
- May preserve endogenous hormone-producing tissue.
- May preserve some reproductive potential.
- Avoids removal of an entire testis when pathology is ultimately benign.
- Can be especially relevant with a solitary testis or bilateral lesions.
LIMITATIONS & TRADE-OFFS
Why preservation is not always appropriate
- Malignancy may still be present in a small or indeterminate lesion.
- Microscopic germ-cell abnormality may remain in the preserved testis.
- Additional treatment or completion orchidectomy can become necessary.
- Preserved tissue does not guarantee normal testosterone or fertility.
- Long-term surveillance can be more intensive.
FERTILITY PRESERVATION
Fertility should be discussed before testicular cancer treatment
Testicular cancer is often diagnosed in men during reproductive years. Semen quality may already be reduced at diagnosis, and subsequent surgery or oncological treatment can further affect fertility.
Semen analysis
A pre-treatment semen analysis can identify normal sperm production, reduced sperm numbers or azoospermia and can change the fertility-preservation plan.
Sperm cryopreservation
Ejaculated sperm banking should be discussed before planned orchidectomy or additional cancer treatment where feasible, particularly for men who may wish to have children in the future.
Assess the other testis
Contralateral testicular size, ultrasound findings, prior undescended testis and baseline fertility may influence both cancer and reproductive planning.
Plan for azoospermia or severe sperm impairment
If ejaculated sperm banking is not possible because sperm are absent or extremely limited, surgical sperm retrieval at the time of cancer surgery may be considered.
ONCOLOGICAL FERTILITY PRESERVATION
What is onco-TESE?
Onco-TESE refers to surgical sperm retrieval performed in conjunction with testicular cancer surgery. It is most relevant when a man has testicular cancer but ejaculated sperm banking is not possible because semen analysis shows azoospermia or severe impairment.
At radical orchidectomy, sperm-containing seminiferous tubules may remain in areas of testicular tissue away from the tumour. Selected non-tumour tissue can be examined for sperm by an experienced fertility laboratory, with suitable sperm cryopreserved for possible future use in assisted reproduction.
The opportunity is time-sensitive because removal of the affected testis permanently removes that tissue. For this reason, men with severe semen abnormalities should ideally be identified before surgery so that the cancer and fertility teams can plan together.
ONCO-TESE PATHWAY
How fertility preservation can be integrated with cancer surgery
This is a general pathway. Timing and laboratory arrangements vary and must not delay urgent cancer care.
Identify fertility priorities early
Ask about current family plans, future fertility goals and previous infertility before definitive treatment.
Perform semen assessment where feasible
Semen analysis identifies whether ejaculated sperm cryopreservation is possible and whether severe sperm impairment or azoospermia is present.
Cryopreserve ejaculated sperm when available
If sperm are present, banking before surgery or further cancer treatment is generally the simplest fertility-preservation approach.
Coordinate onco-TESE when indicated
If sperm banking is not possible because of azoospermia or severe semen impairment, surgical retrieval can be planned at the time of radical orchidectomy in selected patients.
Long-term reproductive planning
Cryopreserved sperm can later be discussed with a fertility specialist according to relationship status, partner factors and future family plans.
AFTER ORCHIDECTOMY
What determines the next step?
Further treatment is not based on the ultrasound appearance alone. Final pathology, tumour markers, staging imaging and individual recurrence risk determine whether surveillance or additional oncological treatment is appropriate.
Final pathology
Pathology establishes tumour type, local tumour features and whether germ-cell neoplasia in situ or another tumour category is present.
Repeat tumour markers
Markers are repeated after surgery and interpreted according to their expected fall over time.
Staging
Imaging determines whether disease is confined to the testis or there is evidence of nodal or distant spread.
Multidisciplinary treatment planning
Depending on tumour type and stage, the next step may be surveillance, additional surgery, radiation-based treatment or systemic oncological treatment. Specific medicines are not promoted on this public page.
THE OTHER TESTIS
When is contralateral testicular biopsy discussed?
Routine biopsy of the opposite testis is not necessary for every man with testicular cancer. It may be discussed when the risk of germ-cell neoplasia in situ is higher.
Relevant factors include a small or atrophic contralateral testis, impaired spermatogenesis and a previous history of undescended testis.
The decision should balance the possibility of detecting microscopic precursor disease against the morbidity and treatment implications of finding it.
SURVIVORSHIP
Fertility, testosterone and sexual health after testicular cancer
Cancer treatment can have long-term reproductive and hormonal consequences, and these issues should form part of survivorship rather than being addressed only if symptoms become severe.
Fertility
Future sperm production can be affected by baseline testicular function and the treatment required. Cryopreserved sperm can provide a reproductive option when natural conception is not possible later.
Testosterone
The remaining testis often provides ongoing hormone production after unilateral orchidectomy, but symptoms and hormone levels should be reviewed when hypogonadism is suspected.
Sexual function
Body image, libido, ejaculation and sexual confidence can be affected by diagnosis and treatment. These are appropriate topics for routine follow-up.
Prosthesis choice
A testicular prosthesis can be discussed for cosmetic symmetry after orchidectomy. Product-specific selection belongs in individual informed consent rather than public advertising.
AFTER CURATIVE TREATMENT
Testicular cancer follow-up and survivorship
Follow-up depends on tumour type, stage and treatment received. It is designed to identify recurrence when relevant and address longer-term treatment effects.
Tumour surveillance
Clinical review, tumour markers and imaging are scheduled according to the individual cancer pathway.
Contralateral testis awareness
Men should remain aware of new changes in the remaining testis and seek assessment if a new lump develops.
Hormonal health
Symptoms suggesting reduced testosterone production can be assessed with appropriate clinical and biochemical evaluation.
Fertility & late effects
Fertility goals, sexual function and other long-term consequences of treatment should remain part of survivorship care.
INTERSTATE & INTERNATIONAL PATIENTS
Seeking an opinion about a testicular mass or testis-preserving surgery?
Patients can provide scrotal ultrasound reports and images, tumour-marker results, semen-analysis results and previous operative or pathology information for review. The likely need for urgent surgery, additional imaging, fertility preservation or in-person assessment can then be discussed before major travel arrangements.
TESTICULAR CANCER FAQ
Common questions
Does every testicular lump mean cancer?
No. Benign and non-germ-cell lesions can occur, particularly among small ultrasound-detected masses. However, an intratesticular mass should be assessed promptly because imaging cannot reliably classify every lesion.
Can testicular cancer be diagnosed with ultrasound alone?
Ultrasound is central to assessment, but definitive diagnosis usually depends on surgical pathology. Tumour markers and staging imaging provide additional information but do not replace histology.
If my tumour markers are normal, can I still have testicular cancer?
Yes. Normal serum tumour markers do not exclude testicular cancer, so a suspicious mass still requires appropriate assessment.
Why is testicular cancer surgery performed through the groin?
When germ-cell cancer is suspected, the standard operation removes the testis and spermatic cord through an inguinal approach. A scrotal approach is avoided because it can alter local lymphatic and surgical considerations.
Can you remove the tumour and leave the testis?
Sometimes, but only in selected situations. Testis-sparing surgery may be discussed for a small or indeterminate lesion with a meaningful likelihood of benign pathology, or when preserving tissue is particularly important because of a solitary testis or bilateral disease. It is not the routine operation for a typical suspected germ-cell tumour.
What is frozen section examination?
Frozen section is rapid pathological assessment of tissue during surgery. During selected testis-sparing procedures, it can help determine whether the remaining testis can reasonably be preserved or whether completion orchidectomy is required.
Could I still need the whole testis removed after testis-sparing surgery?
Yes. Completion orchidectomy may become necessary if intra-operative or final pathology shows a tumour for which preservation is not considered appropriate, or if final pathology differs from the initial frozen section assessment.
Does preserving part of the testis guarantee fertility?
No. Remaining testicular tissue does not guarantee normal sperm production or hormone function. Baseline fertility, tumour biology, additional treatment and the amount of functioning tissue all matter.
Should I bank sperm before testicular cancer surgery?
Sperm cryopreservation should be discussed before planned orchidectomy or additional cancer treatment where feasible, particularly if future fertility is important.
What if there are no sperm in my semen before orchidectomy?
Men with testicular cancer and azoospermia may be considered for surgical sperm retrieval at the time of orchidectomy. This is called onco-TESE. Retrieval is not guaranteed and requires appropriate laboratory coordination.
What is onco-TESE?
Onco-TESE is testicular sperm extraction performed in conjunction with testicular cancer surgery. Non-tumour testicular tissue is assessed for viable sperm that may be cryopreserved for potential future assisted reproduction.
Who should be offered onco-TESE?
Current European reproductive guidance recommends offering it at radical orchidectomy to men with testicular cancer who have azoospermia or severe abnormalities in semen parameters. Individual planning is still required.
Does onco-TESE delay cancer treatment?
Fertility planning should be coordinated promptly so that it does not create an inappropriate delay in definitive cancer care. Feasibility depends on urgency, fertility-laboratory access and the individual clinical situation.
Will sperm found with onco-TESE allow natural conception?
Surgically retrieved sperm are cryopreserved for possible use with assisted reproductive techniques. Finding sperm does not guarantee fertilisation, pregnancy or live birth.
Do I need a testicular prosthesis?
No. A prosthesis is optional. It can be discussed before orchidectomy and may be inserted at the same operation or later, according to preference and individual circumstances.
Does one testis usually make enough testosterone?
Many men maintain adequate hormone production with one healthy testis, but some develop biochemical or symptomatic testosterone deficiency and should be assessed if relevant symptoms occur.
Does having had an undescended testis matter?
Yes. A history of cryptorchidism is associated with increased testicular cancer risk and can also be relevant to fertility and contralateral testicular assessment. Adult undescended-testis management deserves separate individual assessment.
Will I always need chemotherapy after orchidectomy?
No. Further treatment depends on tumour type, stage, pathology, tumour markers and individual risk. Some men are managed with surveillance after orchidectomy, while others require additional oncological treatment.
TESTICULAR ONCOLOGY & MALE FERTILITY
Planning cancer treatment without overlooking testicular function
Dr Jack Crozier is a Brisbane urologist whose practice includes testicular cancer, male fertility and testicular surgery. Assessment of a testicular mass considers oncological safety alongside the possibility of testicular preservation and fertility preservation where clinically appropriate.
Particular attention can be useful in men with small indeterminate masses, a solitary testis, bilateral lesions, impaired semen parameters, azoospermia or previous undescended testis.
INDIVIDUAL ASSESSMENT
Have you been found to have a testicular mass?
If a lump or ultrasound lesion has been identified, individual assessment can clarify the level of concern, the appropriate surgical pathway and whether testis preservation or fertility preservation should be considered before treatment.