If you have testicular cancer, the typical path starts with surgery to remove the affected testicle, followed by monitoring and sometimes additional treatment like chemotherapy or radiation. The outlook is overwhelmingly positive: 99% of men whose cancer hasn’t spread beyond the testicle are alive five years later, and even when the cancer has reached distant parts of the body, the five-year survival rate is 72%. It’s one of the most treatable cancers, especially when caught early.
But knowing you’ll “probably be fine” doesn’t answer the questions actually running through your head. Here’s what the process looks like from start to finish.
What You’ll Notice First
The first sign is usually a lump or swelling on one testicle. It’s almost always just one side. You might also notice a feeling of heaviness in the scrotum, a dull ache in your lower belly or groin, or sudden swelling. Some men experience back pain or tenderness in their breast tissue, though these signs are less common and often show up later.
Not every lump is cancer. Fluid-filled cysts, swollen veins, and infections can all cause similar symptoms. But a painless, hard lump that wasn’t there before is the classic red flag that leads to the next step.
How It Gets Diagnosed
An ultrasound is usually the first test. It uses sound waves to create an image of the inside of the testicle and can distinguish between a solid mass (more likely cancer) and a fluid-filled one (usually benign). Blood tests check for proteins called tumor markers that many testicular cancers produce at elevated levels. Two of these markers also help identify which type of cancer is present, which matters for treatment decisions.
Unlike most other cancers, testicular cancer usually isn’t biopsied with a needle before surgery. Instead, the testicle itself is removed through an incision in the groin and sent to a pathologist. This surgery is both the primary diagnostic tool and the first line of treatment.
The Two Main Types
Testicular cancers fall into two broad categories: seminomas and nonseminomas. Seminomas grow slowly and are most common in men in their 40s and 50s. They respond especially well to radiation therapy. Nonseminomas tend to grow faster and are actually more common overall. They’re often made up of several different cell types and are typically treated with chemotherapy if additional treatment is needed after surgery.
Your type determines what happens next, how aggressively your team monitors you, and which treatments are on the table.
Surgery: What to Expect
The standard surgery removes the entire testicle through a cut in the groin area, not the scrotum. Full recovery takes several weeks. For the first few days, you’ll want loose clothing and minimal activity. For roughly two weeks, you’ll need to avoid heavy lifting, running, and sex.
Losing one testicle doesn’t automatically mean you’ll need hormone replacement. The remaining testicle can often produce enough testosterone on its own. However, some men do develop low testosterone afterward, so your hormone levels will be tested periodically. If your levels drop, replacement therapy is an option. A prosthetic testicle can also be placed during or after surgery if you want one for cosmetic reasons.
What Happens After Surgery
Once the testicle is removed and analyzed, doctors stage the cancer based on how far it has spread and whether your blood markers have returned to normal. The possible next steps range from simple monitoring to chemotherapy or radiation, depending on the stage and type.
Surveillance Only
If the cancer was caught early and appears confined to the testicle, you may not need any further treatment. Instead, you’ll enter a surveillance program with regular blood tests and imaging scans. For seminomas in the first two years, this typically means blood work and an abdominal scan twice a year. For nonseminomas, blood work happens about four times a year in the first two years, with scans twice in year one. The schedule gradually loosens over five years as the risk of recurrence drops.
Chemotherapy
When cancer has spread to lymph nodes or beyond, chemotherapy is the standard approach. The most common regimen uses three drugs given in 21-day cycles. Treatment days involve IV infusions at a clinic, with some days off in between each cycle.
Side effects can include mouth sores, nausea, allergic reactions (flushing, rash, shortness of breath), and hearing changes like ringing in the ears. Most side effects improve after treatment ends, though some hearing changes can persist long-term. Hair loss and fatigue are also common during treatment but temporary.
Radiation
Radiation is primarily used for seminomas, particularly when cancer has reached nearby lymph nodes. It’s highly effective against this type. Nonseminomas are generally not treated with radiation.
Survival Rates by Stage
Testicular cancer has some of the best survival statistics of any cancer. Based on data from 2015 to 2021:
- Localized (confined to the testicle): 99% five-year survival
- Regional (spread to nearby lymph nodes): 96% five-year survival
- Distant (spread to lungs, liver, or other organs): 72% five-year survival
Even the distant stage number is remarkably high compared to most other cancers. Chemotherapy has been a game-changer for testicular cancer outcomes, turning what was once a deadly diagnosis into a highly curable one at nearly every stage.
Fertility and Family Planning
This is one of the most important practical concerns, and it needs to be addressed before treatment starts. Surgery, chemotherapy, and radiation can all affect your ability to have children. Some treatments damage sperm directly, others lower hormone levels, and others affect the organs involved in producing or releasing sperm.
If there’s any chance you want biological children in the future, sperm banking should happen before your first treatment. Even a single stored sample can make fatherhood possible later. Some men with fast-growing cancers may not have time to bank multiple samples before treatment needs to begin, but the conversation should happen as early as possible. Having one testicle removed doesn’t necessarily make you infertile on its own, since the remaining testicle can still produce sperm. But if chemotherapy or radiation follows, the picture changes.
Long-Term Monitoring
After treatment ends and you’re in remission, follow-up continues for at least five years. The schedule depends on your cancer type and stage, but it generally involves blood tests for tumor markers and periodic CT or MRI scans of your abdomen and pelvis. In the first two years, visits are more frequent because that’s when recurrence is most likely. By years four and five, you’re typically down to annual or biannual check-ins.
For men who had advanced disease with lung involvement, chest CT scans are added to the schedule. Hormone levels are also monitored over time, since low testosterone can develop months or years after treatment and cause fatigue, mood changes, reduced sex drive, and loss of bone density. These effects are treatable once identified, which is why ongoing follow-up matters even when you feel completely fine.