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Testicular Cancer – What you Need to know

July 20, 2021 (updated July 20, 2021) Published by

What is testicular cancer?

Testicular cancer is a cancer that originates in one or both testicles, or testes. Your testes are the male reproductive glands located inside your scrotum, which is the pouch of skin located underneath your penis. Your testes are responsible for producing sperm and the hormone testosterone.

Testicular cancer most often begins with changes in the germ cells. These are the cells in your testicles that produce sperm. These germ cell tumors account for more than 90 percent of testicular cancers.

There are two main types of germ cell tumors:

  • Seminomas are testicular cancers that grow slowly. They’re usually confined to your testes, but your lymph nodes may also be involved.
  • Nonseminomas are the more common form of testicular cancer. This type is faster growing and may spread to other parts of your body.

Testicular cancer can also occur in the tissues that produce hormones. These tumors are called gonadal stromal tumors.

Testicular cancer is the most commonly diagnosed cancer in men ages 15 to 35, but it can occur at any age. It’s also one of the most treatable cancers, even if it’s spread to other areas.

According to the American Cancer Society, for those with testicular cancer in early stages, the five-year survival rate is greater than 95 percent.

Risk factors for testicular cancer

Risk factors that can increase your risk of developing testicular cancer include:

  • having a family history of the disease
  • having abnormal testicular development
  • being of Caucasian descent
  • having an undescended testicle, which is called cryptorchidism

Symptoms of testicular cancer

Some men show no symptoms when diagnosed with testicular cancer. When symptoms do appear, they can include:

  • testicular pain or discomfort
  • testicular swelling
  • lower abdominal or back pain
  • enlargement of breast tissue

Make an appointment with your doctor if you have any of these symptoms.

How is testicular cancer diagnosed?

The tests your doctor may use to diagnose testicular cancer may include:

  • a physical exam, which can reveal any testicular abnormalities, such as lumps or swelling
  • an ultrasound to examine the internal structure of the testicles
  • blood tests called tumor marker tests, which may show elevated levels of substances related to testicular cancer, like alpha-fetoprotein or beta-human chorionic gonadotropin

If your doctor suspects cancer, your entire testicle may need to be removed to obtain a tissue sample. This can’t be done when your testicle is still in the scrotum because doing so can cause cancer to spread through the scrotum.

Once the diagnosis has been made, tests such as pelvic and abdominal CT scans will be done to see if the cancer has spread anywhere else. This is called staging.

The stages of testicular cancer are as follows:

  • Stage 1 is limited to the testicle.
  • Stage 2 has spread to lymph nodes in the abdomen.
  • Stage 3 has spread to other parts of the body. This type of cancer commonly spreads to the lungs, liver, brains, and bone.

The cancer is also categorized based on the expected response to treatment. The outlook can be good, intermediate, or poor.

Treating testicular cancer

There are three general categories of treatments used for testicular cancer. Depending on the stage of your cancer, you may be treated with one or more options.

Surgery

Surgery is used to remove one or both of your testicles and some surrounding lymph nodes to both stage and treat cancer.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It may be administered externally or internally.

External radiation uses a machine that aims the radiation at the cancerous area. Internal radiation involves the use of radioactive seeds or wires placed into the affected area. This form is often successful in treating seminomas.

Chemotherapy

Chemotherapy uses medication to kill cancer cells. It’s a systemic treatment, which means it can kill cancer cells that have traveled to other parts of your body. When it’s taken orally or through the veins, it can travel through your bloodstream to kill cancer cells.

In very advanced cases of testicular cancer, high-dose chemotherapy may be followed by a stem cell transplant. Once the chemotherapy has destroyed the cancer cells, the stem cells are administered and develop into healthy blood cells.

Complications of testicular cancer

Though testicular cancer is a highly treatable cancer, it can still spread to other parts of your body. If one or both testicles are removed, your fertility may also be affected. Before treatment begins, ask your doctor about your options for preserving your fertility.

References

Testicular Cancer Understanding the Different Types

Testicular Cancer – Understanding the Different Types

July 20, 2021 (updated July 20, 2021) Published by

Testicular cancer can affect men of every age, across the world. But testicular cancer is not just one type of cancer. In fact, there are two main types of testicular cancer: germ cell tumors and stromal cell tumors. Each of these types also have subtypes. In addition, some of those subtypes have their own subtypes, leading to many different types of testicular cancer.

What is testicular cancer?

Testicular cancer is a type of cancer that happens in the testicles, or testes. These make male sex hormones and sperm. Testicles are located inside the scrotum, which is underneath the penis.

Testicular cancer is rare. However, it’s the most common cancer in males between ages 15 and 35. It’s a very treatable type of cancer and may be treated with surgery, chemotherapy, radiation therapy, or a combination of these treatments.

What are the types of testicular cancer? 

There are two main types of testicular cancer: germ cell tumors and stromal tumors. In addition, both types have subtypes.

Germ cell tumors

Overall, germ cell tumors are the most common type of testicular cancer, accounting for over 90 percent of testicular cancer. There are two main types of germ cell tumors, and you can have one type or a mixed type. Both types occur at about the same rate.

Seminoma germ cell tumors

One type is seminoma germ cell tumors, which grow and spread slowly in most cases. There are two types of seminoma germ cell tumors:

  • Classic seminoma, which account for 95 percent of seminoma germ cell tumors
  • Spermatocytic seminoma, which are more common in older men

Both types of seminoma cell tumors make a type of tumor marker called human chorionic gonadotropin, but no other types of tumor marker. Chemotherapy and/or radiation are usually the best treatments, especially if the cancer has spread, but surgery may also be possible.

Nonseminomatous germ cell tumors

The second type of germ cell tumor is nonseminomatous germ cell tumors. There are four main types, but most people will have more than one type:

  1. Embryonal carcinoma. A rapidly growing and aggressive tumor, which occurs in about 40 percent of nonseminomatous germ cell tumors.
  2. Yolk sac carcinoma. The most common type of testicular tumor in children, but it’s rare in adults. It responds well to chemotherapy.
  3. Choriocarcinoma. A very rare and aggressive type of tumor.
  4. Teratoma. Usually occurs in the mixed type of tumor. It’s usually local, but may spread to nearby lymph nodes. Teratomas are resistant to chemotherapy and radiation, and are best treated with surgery. There are three types of teratoma, including mature teratomas, immature teratomas, and teratomas with somatic type malignancy. This third type is very rare.

Stromal tumors

Stromal tumors make up less than 5 percent of testicular cancers. They develop in tissues around the germ (reproductive) cells in testicles. Most stromal tumors have a good prognosis after surgery.

There are two types of stromal tumors:

  • Leydig cell tumors, which make testosterone
  • Sertoli cell tumors, which are usually benign

What are the symptoms of testicular cancer?

Many symptoms of testicular cancer can also be caused by other conditions, such as an injury or certain infections. Therefore, if you have symptoms, it’s important to talk to your doctor to see if you can rule out any conditions.

Some men may not have symptoms of testicular cancer, even if the cancer starts to spread.

If you do have symptoms, they may include:

  • a lump in your testicle (usually the first symptom)
  • testicle swelling
  • a heavy feeling in your scrotum or lower abdomen
  • aching in your scrotum or lower abdomen
  • pain in your scrotum (not a common symptom)

There are also symptoms that may be a sign of certain types of testicular cancer. These symptoms are all rare and include:

  • Breast swelling or soreness, which can be because of germ cell or leydig cell tumors
  • Early puberty, which can happen with leydig cell tumors

Symptoms of advanced testicular cancer are dependent on where the cancer has spread:

  • lymph nodes: low back pain or stomach pain
  • lungs: shortness of breath, cough, or chest pain
  • brain: headaches or confusion
  • liver: stomach pain

How is testicular cancer diagnosed?

A lump in your testicle is usually the first sign of testicular cancer. Some men discover the lump on their own, while others learn about it during a physical exam at their doctor’s office.

If you have a lump in your testicle, your doctor will do tests to figure out if the lump is cancer. First, they’ll do an ultrasound of your scrotum. This tells them whether the lump is solid or filled with fluid and whether it’s inside or outside the testicle itself.

Then they’ll likely do a blood test to look for tumor markers. These are substances in your blood that may increase if you have cancer.

If these tests indicate that you have cancer, your doctor may recommend surgery to remove your testicle. The testicle will be analyzed to see if it’s cancerous, and if so, what type of cancer you have.

If a cancer diagnosis is confirmed, you might need tests to figure out if the cancer has spread. These include:

  • CT scan in areas testicular cancer often spreads to, such as your pelvis, chest, or abdomen
  • blood tests to see if you still have elevated tumor markers after your testicle was removed

How is testicular cancer treated?

Treatment for testicular cancer depends on several factors, including what stage the cancer is in and your personal preferences, as some treatments can impact fertility.

The first line of treatment for all types of testicular cancer, regardless of type or stage, is removing the affected testicle. If your cancer hasn’t spread, this may be the only treatment you need. Your doctor may also remove nearby lymph nodes if the cancer has spread there.

Radiation is sometimes used for seminoma-type tumors. It uses high-powered beams of energy to kill cancer cells. These beams are targeted at specific areas of your body where there’s cancer. If used on your testicle, radiation therapy may impact fertility.

You may also have chemotherapy as your only treatment or after surgery if your cancer has spread. This type of treatment uses drugs to kill cancer cells throughout your body. Chemotherapy may also lead to infertility.

What is the outlook if you have testicular cancer?

Testicular cancer is considered very treatable in most cases. For all men with testicular cancer, the cure rate is greater than 95 percent.

Even if the cancer has spread, there is an 80 percent overall cure rate. However, different metastase locations have different outlooks, especially in stromal tumors. In patients with stromal tumors, spread to the lung, liver, or bone leads to worse outcomes than spread to distant lymph nodes.

In patients with seminoma, only liver metastases lead to worse outcomes. For all types, the outlook is better if the cancer has only spread to one other area of the body.

The outlook may also depend on the type of testicular cancer. In stage one tumors, germ cell tumors have a better five-year survival rate than stromal tumors. The average cure rates are:

  • all germ cell tumors: 99.7 percent
  • leydig cell tumors: 91 percent
  • sertoli cell tumors: 77 percent

References

Living With One Testicle FAQs

Living With One Testicle – FAQs

July 18, 2021 (updated July 18, 2021) Published by

Most people with a penis have two testicles in their scrotum — but some only have one. This is known as monorchism.

Monorchism can be the result of several things. Some people are simply born with just one testicle, while others have one removed for medical reasons.

Read on to learn how having one testicle can impact your fertility, sex drive, and more.

Why does it happen?

Having one testicle is usually the result of an issue during fetal development or surgery.

Undescended testicle

During late fetal development or shortly after birth, testicles descend from the abdomen into the scrotum. But sometimes, one testicle doesn’t drop into the scrotum. This is called an undescended testicle or cryptorchidism.

If the undescended testicle isn’t found or doesn’t descend, it will gradually shrink.

Surgical removal

The procedure to remove a testicle is called orchidectomy.

It’s done for a range of reasons, including:

  • Cancer. If you’re diagnosed with testicular cancer, prostate cancer, or breast cancer, removing a testicle may be part of treatment.
  • Undescended testicle. If you have an undescended testicle that wasn’t found when you were younger, you may need to have it surgically removed.
  • Injury. Injuries to your scrotum can damage one or both of your testicles. If one or both become nonfunctional, you may need surgery.
  • Infection. If you have a serious viral or bacterial infection affecting one or both of your testicles, you may need and orchiectomy if antibiotics don’t do the trick.

Testicular regression syndrome

In some cases, an undescended testicle may be the result of testicular regression syndrome. This condition is also known as vanishing testes syndrome.

It involves the “disappearance” of one or both testicles shortly before or after birth. Before birth, the fetus might appear to have two testicles, but they eventually wither away.

Will it affect my sex life?

Usually not. Many people with one testicle have a healthy and active sex life.

A single testicle can produce enough testosterone to fuel your sex drive. This amount of testosterone is also enough for you to get an erection and ejaculate during an orgasm.

However, if you recently lost a testicle, your healthcare provider can give you a some more detailed guidance on what to expect. It may take a bit of time for things to get back to normal.

Can I still have children?

Yes, in most cases, people with one testicle can get someone pregnant. Remember, one testicle can provide enough testosterone for you to get an erection and ejaculate. This is also enough to produce adequate sperm for fertilization.

As long as you’re in good health and don’t have any underlying conditions that could impact your fertility, you should be able to have children.

If you have one testicle and seem to be having fertility issues, consider following up with a healthcare professional. They can do some quick tests using a sperm sample to check for any issues.

Is it linked to any health risks?

Having just one testicle is rarely a risk factor for other health conditions. However, it can lead to some health complications.

These include:

  • Testicular cancer. People with an undescended testicle have an increased risk of this type of cancer. The cancer can occur on the undescended testicle or the descended one.
  • Subfertility. In rare cases, having one testicle can reduce your fertility. Still, this doesn’t mean you can’t have children. You may just have to be a bit more strategic about your approach.
  • Hernias. If you have an undescended testicle that hasn’t been removed, it may lead to a hernia in the tissue around your groin that requires surgical treatment.

The bottom line

Several human organs come in pairs — think about your kidneys and lungs. Usually, people can live with just one of these organs while maintaining a healthy, normal life. Testicles are no different.

But it’s still important to regularly follow up with a doctor, especially if you have an undescended testicle. This will help to catch any complications, such as testicular cancer, early on, when they’re easier to treat.

While having one testicle is unlikely to have an impact on your health, it can affect your self-esteem, especially in sexual relationships.

If you feel self-conscious about it, consider a few sessions with a therapist. They can help you work through these feelings and give you tools to help you navigate sexual relationships.

References

Testicular Cancer - Can a Pregnancy Test Detect It

Testicular Cancer – Can a Home Pregnancy Test Detect It?

July 18, 2021 (updated July 18, 2021) Published by

Testicular cancer is when cancerous cells develop in the testicles. According to the American Cancer Society, it’s a relatively uncommon cancer. Only about 1 in 250 men (0.4 percent) will develop it at some point during their life.

You may have seen social media posts about using a home pregnancy test to detect testicular cancer. While this is technically possible, it’s not a medically sound way to test for cancer — and there are even some ways it can cause harm.

Keep reading to learn more about why people are using pregnancy tests for testicular cancer if there’s any truth to this method, and what to do if you suspect you may have testicular cancer.

Why are people using pregnancy tests for testicular cancer?

The use of a home pregnancy test to detect testicular cancer goes back to a social media post from several years ago. In it, the poster described his male friend’s positive pregnancy test.

Various comments urged the poster to tell his friend to see a doctor, as a positive pregnancy test in a male could be a sign of testicular cancer. After visiting a doctor, it did turn out that the test-taker had a small testicular tumor.

The rationale behind this is that testicular tumors can lead to an increase in a hormone called human chorionic gonadotrophin (hCG). This is the same hormone that’s detected by home pregnancy tests.

Therefore, if a male uses a home pregnancy test and receives a positive result, it means extra hCG has been detected in the urine.

However, this is in no way a diagnosis. It should prompt a doctor’s visit for further testing.

Can pregnancy tests actually detect testicular cancer?

Testicular cancer is associated with elevated levels of certain markers, including hCG. The common diagnostic tests for testicular cancer work to detect these markers in a person’s blood.

Cancer markers can also be present in urine. Because of this, it’s technically possible for a home pregnancy test to detect testicular cancer.

The idea of using a home pregnancy test to detect testicular cancer isn’t new. In fact, the use of a urine pregnancy test for testicular cancer screening has been reported as early as the mid-1980s.

Since then, various publications have mentioned using urine pregnancy tests as a screening method. This is particularly true when the materials and equipment aren’t on hand to do blood tests for hCG and other testicular cancer markers.

But it never became a widespread practice and for good reason (more on that below).

What are the potential downsides of using a pregnancy test to detect testicular cancer?

While it’s possible for a home pregnancy test to detect hCG levels related to testicular cancer, there are some very important drawbacks to know about using this testing method.

Let’s explore these in the context of both a negative and a positive test result.

Negative result

A negative result on a home pregnancy test doesn’t mean you don’t have testicular cancer. This is because not all testicular cancers will produce elevated levels of hCG or other cancer markers.

It’s possible to have a testicular tumor and receive a negative result on a home pregnancy test. A negative home pregnancy test can provide a false sense of security, delaying diagnosis and treatment.

If you’re concerned about testicular cancer, it’s very important to see a doctor for screening, and not rely on the results of a home pregnancy test.

Positive result

There are several things that can interfere with home pregnancy tests and lead to a false-positive result. Some examples include:

  • protein in the urine (proteinuria)
  • blood in the urine (hematuria)
  • certain types of medications, such as:
    • antiseizure medications
    • anxiety medications
    • methadone

Getting a positive result on a home pregnancy test may cause unnecessary levels of stress, as well as unnecessary visits to your doctor.

It’s also important to point out that other types of cancer, such as those of the stomach and lung, have been documented to produce hCG. In this rare scenario, a positive result could indicate a type of cancer other than testicular cancer.

When to seek medical care

The outlook for testicular cancer improves with early diagnosis and treatment. Because of this, it’s very important to seek medical evaluation if you have any signs or symptoms of testicular cancer.

Some things to look out for include:

  • a lump or swelling in your testicle, which is usually painless
  • dull pain that’s localized to the lower abdomen or scrotum
  • a feeling of heaviness in the scrotum

Performing a testicular self-exam once a month can help you know what’s normal for your testicles. As such, it can help you identify any noticeable changes that may be associated with testicular cancer.

The takeaway

Home pregnancy tests are not a reliable way to detect testicular cancer. The idea came about because hCG — the hormone that’s detected on a pregnancy test — can be at elevated levels in testicular cancer.

However, not all testicular cancers produce increased levels of hCG, making a negative result misleading. On the other hand, the presence of blood or protein in the urine as well as the use of certain medications can lead to a false-positive result.

Overall, a home pregnancy test may not be useful for detecting testicular cancer. If you have symptoms of testicular cancer, it’s important to see a doctor for further testing rather than relying on a home pregnancy test.

References

Testicular Ultrasound - What You Need to Know

Testicular Ultrasound – What You Need to Know

July 18, 2021 (updated July 18, 2021) Published by

What is a testicular ultrasound?

A testicular ultrasound is a diagnostic test that obtains images of the testicles and the surrounding tissues in your scrotum. Ultrasound is also called sonography or ultrasound scanning. Your doctor may refer to a testicular ultrasound as a testicular sonogram or scrotal ultrasound.

The two testicles are the primary male reproductive organs. They produce sperm and the male sex hormone testosterone. Your testicles are in your scrotum, which is the fleshy pouch of tissue that hangs under your penis.

An ultrasound is a safe, painless, and noninvasive procedure. The procedure uses high-frequency sound waves to produce images of organs inside your body.

An ultrasound uses a probe or transducer. This handheld device converts energy from one form to another. It’s moved against the targeted part of your body in sweeping motions. The transducer emits sound waves as it moves across your body. The transducer then receives the sound waves as they bounce off your organs in a series of echoes. A computer processes the echoes into images on a video monitor. Normal and abnormal tissue transmit different types of echoes. A radiologist can interpret the echoes to distinguish between benign condition like a collection of fluid around your testicle and a solid mass that could be a malignant tumor.

Why do I need a testicular ultrasound?

A testicular ultrasound is the primary imaging method used to observe and diagnose abnormalities in the testicles. Your doctor may recommend a testicular ultrasound to:

  • verify whether a lump in your scrotum or testicles is solid, which indicates a tumor, or filled with fluid, which indicates a cyst
  • determine the outcome of trauma to your scrotum
  • evaluate for possible testicular torsion, which is a twisted testicle
  • identify sources of pain or swelling in your testicles
  • detect for and evaluate varicoceles, which are varicose spermatic veins
  • assess the causes of infertility
  • find the location of an undescended testicle

Ultrasound echoes can provide real-time still or moving images. Data from moving images is useful in examining blood flow to and from your testicles.

Each testicle connects to the rest of your body by a spermatic cord. This tube contains an artery and a vein. The tube also includes the vas deferens, which carry sperm from the testicles to the urethra. Your doctor can study blood flow in your testicles to find narrowing or blockages interfering with the flow of semen and hindering fertility.

What are the risks involved with a testicular ultrasound?

A testicular ultrasound won’t put you at risk for any health problems. There’s no radiation exposure during the procedure. However, you may have increased pain or discomfort during the procedure if you have certain testicular issues, such as testicular torsion or an infection.

How do I prepare for a testicular ultrasound?

Typically, there’s no special preparation necessary for a testicular ultrasound. There’s no need for dietary restrictions, fasting, or a full bladder before the exam.

Speak with your doctor about any prescription or over-the-counter medications you take. There rarely is a need to interrupt or discontinue medication before a testicular ultrasound.

How is a testicular ultrasound performed?

A testicular ultrasound is usually an outpatient procedure performed in the radiology department of a hospital or at your doctor’s office.

Typically, a testicular ultrasound takes about 20 to 30 minutes. It involves the following steps.

Preparation

You may need to change into a hospital gown. You won’t typically receive sedatives, anesthesia, or topical numbing agents.

Positioning

You’ll lie on your back with your legs spread. The ultrasound technician may place a towel underneath your scrotum to keep it elevated. They may place wide strips of tape across your thighs and under your scrotum to elevate your scrotum.

You’ll need to lie completely still during the procedure.

Imaging technique

The technician will apply a warm, water-based gel to your testicles. This gel will allow the transducer to glide over your body. It also facilitates the conduction of the sound waves.

The technician will glide the transducer around your scrotum, moving back and forth. You may feel pressure as the technician pushes it firmly against your body. You may feel discomfort if there’s pressure on an area where you have tenderness due to an abnormality.

The technician will position the transducer against your body from different angles.

After the procedure

The technician will wipe the gel off your body after the procedure.

After your testicular ultrasound, you can resume your normal activities and diet. No recovery time is necessary.

What do the results mean?

A radiologist will analyze the images obtained during your testicular ultrasound. They’ll then send a report detailing the results of the test to your doctor.

If there are abnormal findings on your testicular ultrasound, they may indicate:

  • an infection in your testicle
  • a benign cyst
  • a testicular torsion, which is a twisted spermatic cord restricting blood flow to your testicle
  • a testicular tumor
  • a hydrocele, which is a benign collection of fluid around your testicle
  • a spermatocele, which is a fluid-filled cyst on the ducts of your testicle
  • a varicocele, which is an enlarged vein in the spermatic cord of your testicle

Your doctor will probably recommend further investigation if the testicular ultrasound identifies a tumor.

References

Testicle Biopsy - What You Need to Know

Testicle Biopsy – What you Need to Know

July 18, 2021 (updated July 18, 2021) Published by

What is a Testicular Biopsy?

A testicular biopsy takes a tissue sample from your testicle for laboratory analysis.

The two testicles are the male reproductive organs. They produce sperm and the male sex hormone testosterone. Your testicles are located in your scrotum, which is the fleshy pouch of tissue that hangs under your penis.

A testicular biopsy can be used to:

  • diagnose the location and condition of a lump in the testes
  • diagnose causes of male infertility
  • obtain sperm for in vitro fertilization (IVF)

There are two different procedures for a testicular biopsy.

Percutaneous Biopsy

With a percutaneous biopsy, a thin biopsy needle is inserted through the skin. The needle has a syringe on the end to collect the testicular tissue. This procedure does not require an incision or stitches. It also is called a fine needle biopsy.

A core needle biopsy is a variation on this technique. It uses a hollow, spring-loaded needle to extract a cylinder of cells. This is called a core sample. A core sample is a larger specimen than one from a fine needle biopsy.

Open Biopsy

An open biopsy is also called a surgical biopsy. Your doctor starts by making a cut in the skin. A cut also is made in the testicle. Then a small tissue sample is taken from the opening and stitches are used to close the cuts.

Diagnostic Uses of a Testicular Biopsy

A testicular biopsy is an important tool in diagnosing male infertility. However, it is not the first step. For the initial phase in a fertility evaluation, your doctor will take a health history and order blood tests and a semen analysis.

Semen analysis looks at the quantity and quality of your sperm. The initial semen sample is usually obtained by masturbation.

Semen analysis can identify the following problems:

  • abnormally low levels of sperm
  • poor quality of sperm
  • azoospermia (absence of sperm)

Blood and hormone tests often can identify the causes of low sperm levels. However, when these tests are not conclusive, you may need a testicular biopsy.

A testicular biopsy may be used to:

  • determine whether sperm production problems are caused by a blockage
  • retrieve sperm for use in IVF. This is done if sperm are being made in the testicles but are not present in the semen.
  • diagnose testicular cancer
  • determine the cause of a lump in the testicles

Preparation for a Testicular Biopsy

The preparations required for this test are minimal.

Tell your physician about any prescription or over-the-counter medications you are taking. Discuss whether these medications should be used before and during the test.

Certain drugs may pose a special risk during the procedure. These include:

  • anticoagulants (blood thinners)
  • nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen
  • any medications that affect blood clotting

If you are receiving general anesthesia, you will need to fast from food and drink for at least eight hours before your test. If you are given a sedative to take at home before the biopsy, you will not be able to drive yourself to the procedure.

Administration of a Testicular Biopsy

A testicular biopsy is usually an outpatient procedure. It may be performed at your doctor’s office or a hospital.

The biopsy typically takes about 15 to 20 minutes. It is performed by a doctor or another trained health professional.

You may be offered a sedative to help you relax for the test. Since you have to stay completely still, some doctors prefer to use general anesthesia instead. With either medication, the biopsy technique remains the same.

You will be asked to lie on your back and the scrotum will be cleaned to remove bacteria. An injection of local anesthesia will numb the skin of the scrotum. You may feel a slight sting.

Open Biopsy

If you are having an open biopsy, the following procedure is typical:

  1. Your physician will make a small incision through the skin.
  2. A tiny, pea-sized amount of testicular tissue is removed.
  3. When the biopsy is taken, you will feel pressure or minor discomfort. You should not feel pain.
  4. Typically, one absorbable stitch closes the cut in the testicle. Another stitch closes your skin. Stitch removal is not necessary.
  5. The same technique is done on the second testicle.

Percutaneous Biopsy

The procedure for a percutaneous biopsy will depend on the type of needle used — a core needle or a fine needle.

  • In both cases, a needle is inserted through the skin of the testicle.
  • If you are having a core needle biopsy, you will hear a loud clicking or popping sound when the tissue sample is being extracted.
  • If you are having a fine needle biopsy, the tissue sample will be drawn out with a syringe.
  • The same technique is done on the second testicle.

Diagnosing Testicular Cancer

Testicular biopsy is rarely used to diagnose testicular cancer. Typically, it is performed when the diagnosis is uncertain. This is because a biopsy, unfortunately, increases the likelihood the cancer will spread.

Your physician is more likely to use ultrasound for cancer diagnosis. Your testicle can also be examined and removed through open surgery. This is called a radical inguinal orchiectomy.

A radical inguinal orchiectomy to diagnose cancer includes the following steps:

  1. Your physician will make a cut in your groin.
  2. The testicles will be removed from the scrotum and examined.
  3. If abnormal tissue is found, a small portion will be taken for analysis.
  4. A pathologist will examine the tissue. This will be done immediately, while you wait.
  5. If the tissue sample is benign (noncancerous), the testicle will be returned to the scrotum.
  6. If the tissue sample is malignant (cancerous), the testicle will be removed. The spermatic cord will be removed as well. This prevents the spread of cancer cells to the rest of the body.

Recovery from a Testicular Biopsy

After your testicular biopsy, you will receive special instructions to help you heal and remain comfortable. Instructions will vary depending on the type of biopsy.

You may be advised to:

  • refrain from sexual activity for one to two weeks
  • wear an athletic supporter for several days
  • keep the site of the biopsy dry, and avoid washing it for several days
  • avoid aspirin for one week
  • use acetaminophen for soreness

It is normal to have swelling, discoloration, and discomfort for a few days. A small amount of bleeding is also common. Your doctor may also warn you about other routine side effects that are procedure-dependent.

Risks of a Testicular Biopsy

A testicular biopsy can help your doctor resolve your infertility problems. It does not carry a risk of erection or fertility problems after the procedure.

Prolonged bleeding and post-procedure infection are two potentially serious risks. However, they are rare. Contact your physician if you experience:

  • bleeding that soaks the bandage at the biopsy site
  • hematoma (a collection of blood under the skin)
  • severe pain or swelling of the scrotum
  • fever or chills

Another possible risk is internal damage to the testicles or nearby areas. This is rare.

Interpreting the Results of a Testicular Biopsy

Your tissue sample will be analyzed under a microscope. The pathologist will identify any defects in sperm production or development.

Your results may show normal sperm development. If you previously had a low or zero sperm count, an obstruction may be the cause of your infertility.

Blockages in the vas deferens have been shown to cause this type of infertility. The vas deferens is the tube that carries sperm from the testicles to the urethra. Surgery may be able to correct the problem.

Additional causes of abnormal results include:

  • spermatocele: a fluid-filled cyst on the ducts of the testicles
  • orchitis: a swelling of the testicles caused by an infection
  • testicular cancer

References

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