Testicular Masses & Testis-Sparing Surgery
A lump or abnormality within the testicle deserves careful assessment. While some testicular masses are cancerous, others are benign and, in selected situations, it may be possible to remove the abnormal area while preserving the remaining testicle.
Not every testicular mass is the same
A testicular mass may be discovered because you notice a lump, heaviness or change in the testicle, or it may be found incidentally during an ultrasound performed for another reason.
Solid masses arising within the testicle require appropriate assessment because testicular cancer is one possible cause. However, benign tumours and other non-cancerous abnormalities can also occur.
The aim of assessment is therefore not simply to determine whether surgery is needed, but to clarify the likely diagnosis and whether preserving part of the testicle is safe and appropriate.
- Is the abnormality truly within the testicle?
- Does the ultrasound appearance raise concern for malignancy?
- Are tumour markers elevated?
- How large is the lesion relative to the remaining testicle?
- Is there a normal testicle on the other side?
- Are fertility or testosterone production important considerations?
How is a testicular mass investigated?
The appropriate pathway depends on your examination, ultrasound findings, blood tests, age, fertility priorities and the characteristics of the lesion.
Clinical assessment
Assessment includes your symptoms, previous testicular conditions or surgery, fertility history and examination of both testes.
Scrotal ultrasound
Ultrasound helps determine whether a lesion is intratesticular or outside the testicle and assesses its size, appearance and blood flow.
Tumour markers
Blood tests may include AFP, beta-hCG and LDH when testicular malignancy is suspected. Results are interpreted alongside the imaging and clinical findings.
Fertility assessment
Semen analysis and discussion about sperm banking may be appropriate when fertility could be affected by the underlying condition or its treatment.
Hormone assessment
Testosterone and related hormone tests may be relevant in men with a solitary testicle, bilateral abnormalities or concern about testicular function.
Individualised surgical planning
If surgery is required, the safest approach depends on the likelihood of malignancy and whether testicular preservation is oncologically appropriate.
What is testis-sparing surgery?
Testis-sparing surgery, also called a partial orchidectomy, involves removing a testicular lesion while leaving as much healthy testicular tissue as possible.
It differs from a radical orchidectomy, in which the entire affected testicle is removed through an incision in the groin.
Testis-sparing surgery is not appropriate for every testicular tumour. When a testicular lesion has features strongly suspicious for a typical germ-cell cancer, radical inguinal orchidectomy remains the usual surgical approach.
Testis preservation may be discussed in selected situations such as:
- A small lesion with features suggesting a benign tumour
- Selected incidentally discovered small testicular masses
- A tumour affecting a solitary testicle
- Carefully selected bilateral testicular tumours
- Situations where preserving functioning testicular tissue has particular importance
- Cases in which the lesion is technically suitable for local excision
The decision depends on the individual circumstances and should include discussion of both the potential benefits of preservation and the possibility that further treatment may still be required.
Partial orchidectomy or radical orchidectomy?
The aim is not to preserve the testicle at any cost. The appropriate operation depends first on cancer safety and then on the potential value of preserving functioning testicular tissue.
Radical inguinal orchidectomy
The entire affected testicle is removed through an incision in the groin.
- Usual approach for a mass suspicious for testicular germ-cell cancer
- Provides definitive tissue for pathological examination
- May be both diagnostic and therapeutic
- The other healthy testicle usually provides ongoing testosterone production
- Fertility implications should still be considered before treatment
Testis-sparing surgery
The lesion is removed while attempting to preserve uninvolved testicular tissue.
- Reserved for appropriately selected cases
- Can preserve functioning testicular tissue
- May involve intra-operative frozen-section examination
- Further surgery may be required depending on pathology
- Follow-up depends on the final diagnosis and remaining testicular tissue
How can testis-sparing surgery work?
In selected cases, surgery can be planned so that the mass is removed and examined while the operation is still underway.
Locate the lesion
The abnormal area is identified, sometimes with intra-operative ultrasound depending on its size and position.
Remove the mass
The lesion is carefully excised while attempting to preserve uninvolved testicular tissue.
Frozen-section assessment
In appropriate cases, a pathologist examines tissue during the operation to help guide the surgical decision.
Complete the safest operation
If the findings are concerning for malignancy or preservation is not considered appropriate, removal of the entire testicle may be required.
Frozen-section examination can assist decision-making but does not replace the final laboratory assessment. The final pathology result determines whether any additional treatment or surveillance is required.
Fertility and testosterone matter too
Many patients diagnosed with a testicular tumour are young and may still be planning a family. Testicular conditions themselves can sometimes be associated with impaired sperm production even before treatment.
When future fertility is important, it may be appropriate to discuss semen analysis and sperm cryopreservation before surgery or subsequent cancer treatment.
Most men with one healthy remaining testicle maintain adequate testosterone production. However, hormone assessment may be important when both testes are affected, the remaining testicle is abnormal or there are symptoms suggesting reduced testosterone production.
Explore testicular conditions and treatment
Testicular mass FAQs
Does a testicular lump always mean cancer?
No. Testicular lumps and ultrasound abnormalities can have benign or malignant causes. However, a new solid mass within the testicle should be assessed because testicular cancer is an important diagnosis to exclude.
Can an ultrasound tell whether a testicular mass is cancer?
Ultrasound provides important information about the location and characteristics of a testicular lesion, but imaging does not always provide a definitive diagnosis. The complete assessment may also involve examination, tumour-marker blood tests and, in selected cases, surgery and pathological examination.
Can a testicular tumour be removed without removing the whole testicle?
Sometimes. Testis-sparing surgery can be considered in selected situations, particularly where a lesion has a significant likelihood of being benign or preservation of testicular tissue has particular importance. It is not the standard approach for every suspected testicular cancer.
What is a partial orchidectomy?
Partial orchidectomy is another term for testis-sparing surgery. The abnormal area is removed while attempting to leave healthy functioning testicular tissue in place.
What is a frozen section?
Frozen section is an examination of tissue by a pathologist while an operation is still taking place. In appropriately selected testis-sparing procedures it may help determine whether the remaining testicular tissue can be preserved. Final pathology remains necessary.
Could the whole testicle still need to be removed?
Yes. When testis-sparing surgery is planned, there should be a clear discussion beforehand about circumstances in which radical orchidectomy may become necessary, including concerning intra-operative or pathological findings.
Should I freeze sperm before testicular surgery?
Not everyone requires sperm banking. It may be particularly relevant when future fertility is important, sperm production is already impaired, both testes are affected or additional cancer treatment may be required. This can be discussed before treatment.
Will removing one testicle lower my testosterone?
A healthy remaining testicle can often produce sufficient testosterone. Individual circumstances vary, and blood testing may be appropriate when there is concern about the function of the remaining testicle or symptoms of low testosterone.
Testicular & Reproductive Urology
Assessment focused on both the underlying diagnosis and the longer-term implications for testicular function.
Testicular and paratesticular tumour care
Dr Jack Crozier is a FRACS-qualified urologist and fellowship-trained andrologist. His fellowship experience includes uro-oncology, testicular and paratesticular tumours, male fertility and reconstructive andrology.
Patients with testicular masses can be assessed with consideration of cancer risk, surgical options, fertility and hormonal function. Where testis-sparing surgery is being considered, suitability depends on the individual clinical and imaging findings.
Have you been diagnosed with a testicular mass?
A specialist assessment can help clarify the significance of the finding, whether further investigation is required and which surgical options may be appropriate.