Does testicular cancer cause infertility

​​​​​​A testicular cancer diagnosis can be a shock for any man, especially when considering it impact on fertility and the ability to have children. Feelings of anxiety and fear in such situations are completely natural, as anyone would be concerned about whether the treatment might affect their future fertility. In this Dalili Medical article, we will discuss the relationship between testicular cancer and infertility, how different treatments may impact fertility, and the available options to preserve it before and during the treatment journey.

• ​​​​​​Can testicular cancer cause infertility?

• If only one testicle is removed, your ability to have children is usually not affected, and you won’t be infertile. However, fertility may decrease slightly.

• Can a testicle be transplanted?
  Yes, a patient can request a doctor to implant a prosthetic testicle made of silicone. This helps fill the empty space after testicle removal and maintains a natural appearance.

• What is testicular cancer?
  Testicular cancer occurs in the testicles, which are located inside the scrotum—a loose sac of skin beneath the penis. The testicles are responsible for producing male sex hormones and sperm, which play a crucial role in reproduction.

Testicular Cancer Incidence Rates
Around 4,000 men in Germany are diagnosed with testicular cancer every year, making up about 1–2% of all malignant cancers in men. This type of cancer is the most common among men aged 20 to 35 and is rarely seen in men over 60. In recent years, the number of new cases has increased, and geographical distribution has a clear impact on the prevalence of the disease.

Can Testicular Cancer Cause Infertility?
Simply put, yes, testicular cancer can cause infertility. This is because most treatment methods, such as chemotherapy, radiation therapy, or surgery, can affect fertility. However, if the cancer is only in one testicle, the remaining healthy testicle may compensate by producing enough testosterone to maintain reproductive health.

If both testicles need to be removed or if the cancer spreads to the healthy testicle, the risk of infertility is much higher. In such cases, the patient may need lifelong testosterone replacement therapy, which can lead to infertility in the future. Therefore, doctors should inform patients about the potential effects of treatment on fertility before starting therapy, allowing them to plan and take appropriate measures to preserve fertility.

What Are the Symptoms of Testicular Cancer?
In many cases, testicular cancer may not cause noticeable symptoms, or the symptoms may resemble those of an infection or injury. About 75% of men who notice a lump or swelling in the testicle are diagnosed with cancer.

Sometimes, the disease remains asymptomatic and is discovered incidentally during medical examinations for other conditions, such as infertility tests, where a small tumor in the testicle may be detected.

Early symptoms of testicular cancer can be subtle but may include:

• A lump or swelling in the testicle: The first noticeable sign is often a lump or enlargement of the testicle. There may be pain, but in most cases, the lump is painless. Some patients also experience a feeling of heaviness or discomfort in the lower abdomen or scrotum.
• Unusual breast growth or tenderness: In rare cases, testicular tumors may produce female hormones (such as estrogen), leading to breast enlargement or even loss of libido.
• Precocious puberty in children: In young boys, if the tumor produces androgens, it may cause early signs of puberty, such as deepening of the voice or excessive hair growth on the face and body.

Other Possible Symptoms

• Orchitis and Epididymitis

  • Orchitis: Inflammation of the testicles, usually caused by a viral or bacterial infection.
  • Epididymitis: Swelling of the epididymis (the tube that carries sperm), which is typically treated with antibiotics.

• Other Conditions That Can Cause Testicular Pain

  • Testicular Torsion: Occurs when the testicle twists around the spermatic cord, cutting off its blood supply. This requires emergency surgery to save the testicle.
  • Inguinal Hernia: Happens when part of the intestine pushes into the scrotum, often requiring surgical treatment.
  • Hydrocele: A fluid buildup around the testicle, usually painless, but if bothersome, it can be treated surgically.

Advanced Testicular Cancer Symptoms

In later stages, testicular cancer may cause additional symptoms beyond a lump in the testicle, such as:

• Pain in the lower back or abdomen
• Headaches or confusion
• Coughing (sometimes with blood), shortness of breath, and chest pain

Causes of Testicular Cancer

The exact cause of testicular cancer is still unknown, but several factors may increase the risk:

• Age: Most common in men aged 20–35.
• Genetic Factors: A family history of testicular cancer may increase the risk.
• Undescended Testicle (Cryptorchidism): If a testicle does not descend into the scrotum after birth, the risk is higher.
• Abnormal Testicular Development: Certain developmental issues in the testicles may increase the likelihood of cancer.
• Repeated Testicular Infections: Frequent inflammations may be a risk factor.
• HIV Infection: Some studies suggest that HIV may increase the risk of testicular cancer.
• Infertility: Research indicates a possible link between fertility problems and a higher risk of developing testicular cancer.

How Is Testicular Cancer Diagnosed?

Sometimes, men discover testicular cancer on their own by chance or during a self-exam. In other cases, a doctor may detect it during a medical check-up. If there is suspicion of a tumor, the doctor may request the following tests:

• Ultrasound Imaging:

  • Used to examine the scrotum and testicles to determine the nature of the mass—whether it is solid or fluid-filled—and whether it is inside or outside the testicle.
  • The procedure involves applying gel to the scrotum while the doctor moves a handheld probe to create images.

• Blood Tests:

  • A blood test is performed to check for tumor markers, which are substances that may increase in some cases of testicular cancer.
  • Elevated tumor markers are not definitive proof of cancer, but they help in diagnosis.

• Surgery for Testicle Removal (Radical Inguinal Orchiectomy):

  • If cancer is suspected, the doctor may recommend removing the affected testicle.
  • The testicle is then analyzed in a laboratory to confirm whether the tumor is cancerous and to determine its type.

Types of Testicular Cancer

After removing the affected testicle, it is examined to determine the type of cancer, which helps in selecting the best treatment and assessing the severity of the disease. Testicular cancer is generally classified into two main types:

• Seminoma:

  • This type can occur at any age but is more common in older men.
  • Seminomas tend to grow more slowly and are less aggressive compared to non-seminomas.

• Non-Seminoma:

  • This type usually develops at a younger age and grows more rapidly, with a higher potential for spreading.
  • There are different subtypes of non-seminoma tumors, including:
    • Choriocarcinoma
    • Embryonal carcinoma
    • Teratoma
    • Yolk sac tumor

Stages of Testicular Cancer

After confirming the diagnosis, the next step is determining the cancer stage, which helps in choosing the best treatment plan. To identify the stage, the doctor may request:

• Computed Tomography (CT) Scan:

  • Provides detailed images of the abdomen, chest, and pelvis to check if the cancer has spread beyond the testicle.

• Blood Tests:

  • Helps detect tumor markers in the blood, which assist in determining if cancer remains in the body after the testicle is removed.

Stages of Testicular Cancer:

• Stage I: The cancer is confined to the testicle and has not spread anywhere else.
• Stage II: The cancer has spread to the lymph nodes in the abdomen.
• Stage III: The cancer has reached other parts of the body, typically spreading to the lungs or liver.

When Should You See a Doctor?

You should consult a urologist if you experience:

• Pain in the testicles or groin area
• Lumps or swelling in the testicle
• Any other concerning symptoms

Oncologists and urology specialists can help with proper diagnosis and treatment of testicular cancer.

Is There a Link Between Testicular Cancer and Testicular Injury?

No, testicular cancer is not caused by direct injuries to the testicle, but it can develop due to other risk factors.

What Are the Risk Factors for Testicular Cancer?

Most men diagnosed with testicular cancer do not have known risk factors, but some factors may increase the likelihood of developing the disease, including:

Undescended Testicle (Cryptorchidism):

• A testicle that does not descend into the scrotum naturally increases the risk of testicular cancer.

Family History:

• If close relatives have had testicular cancer, the risk may be higher.

Infertility:

• Some studies suggest a link between fertility issues and an increased risk of testicular cancer.

Previous Testicular Cancer:

• If a person has had testicular cancer before, the chances of developing it again are higher.

HIV Infection:

• HIV may be a risk factor for testicular cancer.

Ethnicity:

• Studies indicate that some ethnic groups may be more susceptible to testicular cancer than others.

Treatment Options for Testicular Cancer

Treatment varies based on cancer type, stage, overall health, and patient preference. The main treatment options include:

1. Surgery

Radical Inguinal Orchiectomy (Testicle Removal):

• The primary treatment at all stages of testicular cancer.
• The affected testicle is completely removed through an incision in the groin.
• A saline-filled artificial testicle can be implanted for cosmetic purposes.
• In early stages, surgery alone may be sufficient without additional treatments.

Retroperitoneal Lymph Node Dissection (RPLND):

• Removal of nearby lymph nodes through an abdominal incision.
• Surgeons try to avoid damaging surrounding nerves, but in some cases, nerve damage may affect ejaculation (though it does not impact erections).
• Regular follow-ups are required to detect any recurrence.

2. Radiation Therapy

• Uses high-energy radiation (such as X-rays) to destroy cancer cells.
• Primarily used for seminomas, especially after testicle removal.

Side Effects:

✔ Nausea and fatigue
✔ Skin redness and irritation in the abdominal and groin area
✔ Temporary reduction in sperm count, which may affect fertility

 Tip: If you plan to have children in the future, discuss sperm freezing options with your doctor before starting treatment.

3. Chemotherapy

• Uses drugs to destroy cancer cells throughout the body.
• Can be the primary treatment or used before/after surgery to remove lymph nodes.

Side Effects:

✔ Fatigue and nausea
✔ Hair loss
✔ Weakened immune system and increased risk of infection

 Tip: Certain medications can help reduce side effects—consult your doctor for available options.

Undescended Testicle (Cryptorchidism):

• A testicle that does not descend into its natural position in the scrotum increases the risk of testicular cancer.

Family History:

• If close relatives have had testicular cancer, the risk may be higher.

Infertility:

• Some studies suggest a link between fertility issues and an increased risk of testicular cancer.

Previous Testicular Cancer:

• If a person has had testicular cancer before, the chances of developing it again are higher.

HIV Infection:

• HIV may be a risk factor for testicular cancer.

Ethnicity:

• Studies indicate that some ethnic groups may be more susceptible to testicular cancer than others.

Treatment Options for Testicular Cancer

Treatment varies based on cancer type, stage, overall health, and patient preference. The main treatment options include:

1. Surgery

Radical Inguinal Orchiectomy (Testicle Removal):

• The primary treatment at all stages of testicular cancer.
• The affected testicle is completely removed through an incision in the groin.
• A saline-filled artificial testicle can be implanted for cosmetic purposes.
• In early stages, surgery alone may be sufficient without additional treatments.

Retroperitoneal Lymph Node Dissection (RPLND):

• Removal of nearby lymph nodes through an abdominal incision.
• Surgeons try to avoid damaging surrounding nerves, but in some cases, nerve damage may affect ejaculation (though it does not impact erections).
• Regular follow-ups are required to detect any recurrence.

2. Radiation Therapy

• Uses high-energy radiation (such as X-rays) to destroy cancer cells.
• Primarily used for seminomas, especially after testicle removal.

Side Effects:

✔ Nausea and fatigue
✔ Skin redness and irritation in the abdominal and groin area
✔ Temporary reduction in sperm count, which may affect fertility

???? Tip: If you plan to have children in the future, discuss sperm freezing options with your doctor before starting treatment.

3. Chemotherapy

• Uses drugs to destroy cancer cells throughout the body.
• Can be the primary treatment or used before/after surgery to remove lymph nodes.

Side Effects:

✔ Fatigue and nausea
✔ Hair loss
✔ Weakened immune system and increased risk of infection

???? Tip: Certain medications can help reduce side effects—consult your doctor for available options.

How Do Testicular Cancer Treatments Affect Fertility?

The impact of testicular cancer treatment on fertility depends on the type of treatment received. Here’s a breakdown of how each type of treatment affects the ability to have children:

1. Surgical Treatment

• Removal of One Testicle:

  • Usually does not affect fertility, as the remaining testicle can produce enough sperm and testosterone to maintain reproductive ability.
  • Some men may experience a slight decrease in sperm count, but this does not always lead to infertility.

• Removal of Both Testicles:

  • Causes permanent infertility, as no sperm is produced after both testicles are removed.
  • Requires lifelong testosterone replacement therapy to compensate for the hormone deficiency.

• Retroperitoneal Lymph Node Dissection (RPLND):

  • Surgery may lead to retrograde ejaculation, where sperm enters the bladder instead of being expelled through the penis, potentially causing infertility.
  • Retrograde ejaculation can sometimes be treated with medication, but in some cases, infertility may be permanent.

2. Chemotherapy

• Temporarily affects sperm production, and it may take about a year or longer for fertility to return after treatment.
• High-dose chemotherapy with stem cell support may result in permanent infertility.
• Usually does not affect sexual function or libido.
• Patients planning to have children in the future are advised to freeze their sperm before starting treatment.

3. Radiation Therapy

• Does not typically affect sexual function or the ability to have intercourse.
• In most cases, it does not cause permanent infertility, but it may temporarily reduce sperm count.
• Patients are advised to wait at least one year after treatment before trying to conceive.

What Can You Do to Preserve Fertility?

✔ Freeze sperm before starting treatment as a precaution.
✔ Consult a urologist about treatment options for retrograde ejaculation if it occurs.
✔ Follow a healthy lifestyle after treatment to improve the chances of fertility recovery.

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The specialist responsible for treating testicular cancer depends on the stage of the disease and the treatment plan.

• Urologist: A specialist in diseases of the urinary system and male reproductive organs. They are responsible for diagnosing the condition and performing surgical procedures such as testicle removal.

• Oncologist: A specialist in cancer treatment, responsible for administering chemotherapy and radiation therapy and monitoring the patient in cases where the cancer has spread.

In some cases, both specialists collaborate to develop the best treatment plan for the patient.