Most common treatment options

There are various treatment options based on initial staging and prognosis of advanced disease. In more advanced stages and in patients needing a Retroperitoneal Lymph Node Dissection (RPLND) please see our Experts and Guidelines page for information on the importance of selecting the proper treatment team and getting second opinions.

 

• Active Surveillance: If a patient has early stage testicular cancer and their tumor markers are normal or return to normal after surgery then an active surveillance program may be a treatment option. This option involves regular doctor visits with CT-scans, x-rays and blood work to closely monitor for the cancer returning. This option requires great dedication by the patient and the doctor to follow the surveillance schedule so that any recurrence can be detected early. Many men (70-80%) may be able to avoid additional chemotherapy/radiation after the orchiectomy and active surveillance allows for this option but the follow up schedule does require a lot of dedication and needs to be discussed with your doctor. Some schedules may require check-ups every few months.

• Radiation Therapy: Radiation therapy uses high-energy beams of radiation to help destroy any cancer cells that were left behind after the orchiectomy. These left over cancerous cells can spread through the lymph system to other areas of the body. The external radiation is aimed at the lymph nodes in the abdominal and/or groin area to kill any cancer cells. Radiation therapy is usually done daily for five days a week for 3-4 weeks. Normal cells are also killed by the radiation and can lead to side effects.

  Side effects of radiation therapy include: fatigue, skin changes/burns, loss of appetite, nausea, diarrhea, stiff joints/muscles. These side effects are usually only temporary and should improve once treatments are over. Radiation therapy can also interfere with sperm production despite the use of shields to reduce the amount of radiation that the remaining testicle receives. The long-term risk of secondary cancers from the radiation is something you may want to discuss with your doctor.

• Chemotherapy: Chemotherapy are drugs that are given intravenously to kill any remaining cancer cells and to keep the cancer from returning. Chemotherapy is usually used more for non-seminomas that seminomas. Chemotherapy is usually given in cycles meaning that it is given daily for 5 days and then none, or only a single dose per week, is given for the next two weeks and then the cycle is repeated.
  
  Full dose chemotherapy, usually 3-4 rounds over 9-12 weeks, is given for testicular cancer that has spread. If in early stages Adjuvant Chemotherapy is used, in a single cycle or single dose, to prevent the odds of the cancer returning. 
  
  Sometimes patients are borderline between stage I, where there is no spread, and stage II disease, where there has been spread. Sometimes it can take up to 6 weeks or more to properly do the initial staging depending on tumor marker levels and need for repeat imaging tests. If needed, be patient, as we believe making the right decision is better than making a fast decision.

  Chemotherapy also kills healthy cells and can lead to side effects. Side effects of chemotherapy include: nausea, vomiting, hair loss, loss of appetite, fatigue, mouth sores, fever, chills, numbness. Chemotherapy can also interfere with sperm production which can be permanent.

   

• Retroperitoneal Lymph Node Dissection (RPLND): This is a surgery to remove the retroperitoneal lymph nodes that are located at the back of the abdomen. The surgery involves an incision down the middle of the abdomen to remove the lymph nodes. A RPLND is a complex operation that requires substantial experience and technical skill in order to remove the lymph nodes and reduce the likelihood of side effects. A RPLND should really only be done by a surgeon who is highly experienced with this operation.

Complementary and alternative methods

Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

Only the cancer care team can advise if a complementary or alternative method might be helpful. They can give more information about what is known (or not known) about the method, which can help patients make an informed decision.