It is better to remove testicles

Hirslanden blog

Every year around 440 men develop testicular cancer in Switzerland. In fact, testicular cancer is the most common type of cancer in men under 40. If the disease is discovered, there is usually a good chance of recovery. Urologist PD Dr. med. Jörn Kamradt, attending physician at the Salem Hospital in Bern.

Dr. Kamradt, who should I turn to if I have the feeling that I have felt testicular cancer?

PD Dr. med. Jörn Kamradt: The first point of contact if testicular cancer is suspected is a urologist. As a specialist in the male genital organs, he is a specialist who is very familiar with the subject.

What happens if I go to the urologist with a suspicion of testicular cancer?

PD Dr. med. Jörn Kamradt: The urologist will first palpate the testicles himself. The motto here is: no diagnosis through the pants. The testicles are then examined with the ultrasound. With these two examinations, the diagnosis of testicular cancer can be made or excluded in most cases.

If the urologist suspects testicular cancer, he will take a blood sample to determine what are known as testicular tumor markers. In addition, an X-ray examination (CT) of the chest and abdominal area is arranged to see whether there are already metastases of the testicular cancer in the lymph nodes or organs.

What is the treatment for testicular cancer?

PD Dr. med. Jörn Kamradt: In the vast majority of cases, the first thing to do is to surgically remove the testicle affected by the tumor. This procedure is performed through a small incision in the groin and can be performed under spinal or general anesthesia. Even if settlements have already been found in the body in the computed tomography, the removal of the tumor-bearing testicle is necessary because the pathologist can then determine the type and local extent of the testicular cancer under the microscope, which is important for further therapy. If there is evidence of settlements in the body, chemotherapy follows; radiation therapy or surgical removal of lymph node settlements in the abdominal cavity may rarely be necessary.

Does testicular cancer always have to have the entire testicle removed?

PD Dr. med. Jörn Kamradt: If the opposing testicle is healthy and inconspicuous, the entire tumor-bearing testicle is always removed. If there is still uncertainty as to whether testicular cancer is present, a sample will be taken from the tumor during the operation and sent for a quick section examination. If the testicular cancer is confirmed under the microscope, the tumor-bearing testicle is completely removed. A testicle-preserving operation can only be attempted in the case of a single testicle or a testicular tumor on the opposite side.

Will I have an empty scrotum after a testicular cancer operation?

PD Dr. med. Jörn Kamradt: That is basically correct. After a testicle has been removed, the scrotum is only filled with the testicle on the opposite side. If this disturbs your body feeling, you can insert a testicular prosthesis during the operation yourself or later. This testicular prosthesis is made of plastic, feels like a real testicle and is available in different sizes (to match the opposite side). These prostheses are purely cosmetic and have no biological function.

Am I still a man with just one testicle?

PD Dr. med. Jörn Kamradt: Yes! In addition to the production of sperm for reproduction, the testes are the most important production site for the male sex hormone testosterone. If a testicle has to be removed, the healthy opposing testicle is usually able to produce enough testosterone so that the "masculinity" does not experience any change. The sperm from a single testicle are also sufficient for fertility.

In the very rare situation that both testicles have to be removed at the same time or only one testicle is present, for example because the other testicle was removed in childhood due to a twisted testicle, sperm can be frozen away before the last testicle is removed (so-called cryopreservation) . In this way, a later desire for children can still be made possible through artificial insemination with one's own sperm. In these cases, the testes' lack of testosterone production must be replaced by three monthly injections of synthetically produced testosterone. The effect of synthetic testosterone is identical to that of the body, so that you do not feel any change.

How will my sex life change after testicular cancer treatment?

PD Dr. med. Jörn Kamradt: As long as there is still a healthy anti-testicle that produces sufficient testosterone, no changes in sexual desire, erectile function (limb stiffness) or the ability to orgasm are to be expected or feared. It must still be prevented during sexual intercourse, as the sperm of the opposing testicle can lead to pregnancy. In patients who require surgical removal of lymph node deposits, a permanent dry ejaculation can occur as a side effect of the procedure. The ejaculation empties into the bladder instead of the urethra during orgasm. The desire and erectile function are not changed by this.

A testicular cancer was discovered in me, which should be treated. I still want to have children, is that still possible after the treatment?

PD Dr. med. Jörn Kamradt: Patients with testicular cancer are more likely to have poor sperm quality, and the removal of the testicles and possible chemotherapy further limit fertility. For this reason, patients with testicular cancer are offered sperm freezing before starting treatment in order to maintain fertility later. If chemotherapy is necessary to treat testicular cancer, contraception should be used during and for a few months after chemotherapy to prevent birth defects when conceiving children.

I have testicular cancer that has already been treated. How big is the risk that the other testicle will also become ill?

PD Dr. med. Jörn Kamradt: About 5 percent of all men with testicular cancer develop a second tumor in the other testicle, usually within the first 5 years of the initial diagnosis. Disease is very rarely possible up to 10 years later. In 1 to 2 percent of all testicular cancers, it occurs in both testicles at the same time.

Is Testicular Cancer a Malignant Cancer?

PD Dr. med. Jörn Kamradt: Most testicular tumors are malignant, which means that they have the ability to settle down (metastases) in the body. Even with evacuation, the chance of a cure from cancer is very high. Around 95 percent of all men with testicular cancer can be cured from it. As with almost all malignant tumors, the same applies to testicular cancer: the earlier it is detected, the better the chances of recovery.

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Filed in category: medicine

Keywords: testicles / testicular cancer / men's health / Salem hospital