Testicular cancer: Which treatment should I have for stage I seminoma testicular cancer after my surgery?

1. Get the facts

Your options

For most men faced with testicular cancer, surgery to remove the testicle is the first treatment. After that surgery, you must decide what to do next. For stage 1 seminoma testicular cancer, these are your choices:

Try watchful waiting. This means following a schedule of frequent checkups and tests.
Have radiation treatment to kill any stray cancer cells.
Have chemotherapy to kill any stray cancer cells.

This decision aid is about stage I seminoma testicular cancer. For information about treatment options for stage I nonseminoma testicular cancer, see:

Testicular cancer: Which treatment should I have for stage I nonseminoma testicular cancer after my surgery?

Key points to remember

If your biggest concern is that the cancer might come back, think about choosing treatment over watchful waiting. Treatment with radiation or chemotherapy is the best choice for completely getting rid of the cancer. In North America, radiation is much more widely used than chemotherapy
Radiation and chemotherapy have risks and side effects. Watchful waiting lets you avoid these risks and side effects, or at least put them off for a while.
About 80 to 85 out of 100 men who choose watchful waiting are cured. They don't have to worry about future treatment. This means that about 15 to 20 of those 100 men do need treatment later.¹
For watchful waiting, you must be willing to have frequent checkups and tests. Without this close follow-up, if the cancer comes back it might not be found until it has spread and is harder to treat.
If your cancer comes back and is found early, you will have the same chances for survival as men who had treatment right after their surgery.
If you don't want to do watchful waiting but are worried that other treatment might harm your fertility, ask your doctor about banking your sperm before treatment.

FAQs

What is stage I seminoma testicular cancer?

There are two main types of testicular cancer: seminoma and nonseminoma germ-cell tumors. Seminomas tend to respond well to radiation treatment, while nonseminomas most often require chemotherapy or other treatment. Seminomas are also less likely to spread to the lungs, liver, and brain.

"Stage I" means that the cancer doesn't seem to have spread. Some stage I cancers actually have spread to the lymph nodes of the lower back but can't be seen.

Both types of cancer are very often cured, especially if they are found and treated early. Compared to other forms of cancer, testicular cancer—even when it has spread to other parts of the body—has a very high cure rate.

What are the treatment choices for stage I seminoma testicular cancer?

The first treatment is surgeryto remove the testicle. After that, most men have three choices: watchful waiting, radiation, and chemotherapy. Chemotherapy for stage I seminoma is used mainly in Europe. But it is also available in the United States.

Watchful waiting

Watchful waiting means that you are being watched closely by your doctor but are not having further treatment.

You have exams, chest X-rays, and blood tests regularly during the first few years, as well as CT scans. It can be hard to go to the doctor's office that often. Unless your cancer comes back, the number of checkups and tests will gradually decrease over the next 10 years.²

With watchful waiting, you may be able to avoid the risks and side effects of radiation or chemotherapy. About 80 to 85 out of 100 men who choose watchful waiting are cured. They don't have to worry about future treatment. This means that about 15 to 20 of those 100 men do need treatment later.¹

Even when cancer is found after a period of watchful waiting, it is often easy to cure if it's found early. Because of this, many doctors consider it reasonable for some men to choose watchful waiting.

Radiation treatment

Radiation is a common treatment for seminomas. It most often focuses on the lymph nodes in the pelvis and lower back, because that is where the cancer usually spreads.

When this cancer is found very early, it can be very hard to tell if these lymph nodes are cancerous. That's why radiation is used even when no cancer can be seen.

Radiation cures this cancer in 98 out of 100 men who have this treatment after their surgery.^2, ³ This means that it doesn't cure the cancer in 2 out of 100 men.

Chemotherapy

Chemotherapy is the use of very strong drugs to kill cancer cells.

Your doctor can talk to you about which chemotherapy drugs have the least harmful side effects.

What are the risks of watchful waiting?

Perhaps the greatest risk of choosing watchful waiting has to do with missing your follow-up tests and exams. Without regular testing and checkups, you can miss cancer that has returned until it spreads beyond the lymph nodes and is harder to cure. If you choose watchful waiting, it's very important to strictly follow your doctor's schedule of tests and exams.

When cancer does come back during watchful waiting, it usually hasn't spread any farther than the lymph nodes in the lower back and pelvis. It can usually be treated successfully when the testing schedule has been followed closely.

What are the risks of radiation treatment?

Radiation treatment has side effects. Most (such as fatigue, nausea, vomiting, and diarrhea) are short-term. That means they go away when treatment is done. Other side effects can permanently affect your lifestyle and future health, but they aren't common. The most serious long-term risks from radiation include:

Infertility. Radiation may cause permanent infertility in some men. Because many men diagnosed with testicular cancer are younger than 35, this can be an important issue. Men should bank their sperm before they have radiation treatment if they want to father children in the future. Talk to your doctor about any concerns you may have.
Secondary cancer. Although radiation treatment is focused on cancer cells, it can also harm healthy cells. This sometimes leads to other cancers, such as leukemia, that show up many years later.
Heart disease, such as heart attack.

What are the risks of chemotherapy?

Chemotherapy, often called "chemo," for testicular cancer has caused permanent infertility in some men. Because most men diagnosed with this cancer are younger than 35, this is important to think about when you choose which treatment to use.

Men who are going to have this treatment should bank their sperm ahead of time if they want to father children in the future. Talk to your doctor about any fertility concerns you may have.

Side effects of chemo

Many men do not have problems with side effects from chemo. Other men have a great deal of trouble with them. If you have problems, your doctor can use other medicines to help you feel better.

Common short-term side effects include:

Nausea and vomiting.
Hair thinning or hair loss.
Mouth sores.
Diarrhea.
An increased chance of bleeding and infection.

Other side effects depend on the type of drug used. These other side effects can include:

Not having enough white blood cells. Chemo may also lower the amount of red blood cells and platelets in the blood.
Numbness and tingling in the hands or feet.
Hearing loss.
Mild rash.
Problems with the kidneys and liver. These problems usually go away after you stop treatment. But in rare cases they are permanent.
Birth defects. Don't use this medicine if you want to father a child while you are taking it.

The chemo used for testicular cancer has also been linked with serious long-term side effects, but this isn't common. The side effects may include:

High blood pressure.
Increased cholesterol levels.
Kidney, heart, and lung damage.
Increased risk of other cancers, such as leukemia and melanoma.¹

2. Compare your options

	Try watchful waiting	Have radiation
What is usually involved?	You have frequent checkups, X-rays, blood tests, and CT scans during the first few years.	You have treatments at a hospital radiation department every weekday for a few weeks. Treatments take 10 to 15 minutes and are painless
What are the benefits?	Watchful waiting works for many men. Out of every 100 men who try watchful waiting, about 85 remain free of cancer.¹	Radiation cures 98 out of 100 cases of stage I seminoma cancer.^2,³
What are the risks and side effects?	It can be hard to follow the long and intense schedule of checkups and tests that are required with watchful waiting. Cancer may come back.	Short-term side effects of radiation may include fatigue, nausea, vomiting, and diarrhea. Radiation can cause serious long-term health problems, including secondary cancers, but this isn't common. Radiation can cause infertility, but this isn't common.
	Have chemotherapy
What is usually involved?	The chemotherapy drug is usually injected into a vein in your hand or arm. This method is called an IV. Treatment is most often done in a hospital. You have treatments for about 3 months.
What are the benefits?	Chemotherapy works as well as radiation for stage I seminoma cancer.⁴
What are the risks and side effects?	Side effects of chemotherapy can include nausea and vomiting, hair loss, mouth sores, and diarrhea. Chemotherapy can cause infertility, but this isn't common.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Testicular Cancer.

Personal stories about choosing radiation therapy, chemotherapy, or watchful waiting for stage I seminoma

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" When I was a senior in high school, my doctor found a lump on my testicle during a physical. After doing some tests, he told me I had testicular cancer. I guess the good news was that we had found it early enough that it might not have spread yet. After surgery, my doctor looked at my test results and said that there was a good chance that orchiectomy by itself might cure me. I decided that I didn't want to go through with radiation or chemotherapy unless I absolutely had to, no matter how many checkups I had to go to. It's been about 3 years now, and so far the cancer has not come back. I still go in pretty often for exams and blood tests, but to me it's worth it. I think I made the right choice. "

— Stephen, age 20

" About 6 months after our wedding, I discovered a lump on my testicles when I was in the shower. Needless to say, I was very concerned, and I scheduled an appointment with my doctor the next day. Within 3 weeks, I was having an orchiectomy. After that, my doctor said that my cancer was at an early stage and that I was very lucky to have found it because the lump wasn't very big. He told me that I could either have radiation therapy, chemotherapy, or wait and see if I was cured. I decided to wait and see. That was 2 years ago. Last week, my doctor found something on my CT scan that didn't look right. As it turns out, my cancer has come back. So now I'm going to have to have radiation therapy anyway. I wish I had just gotten it over with 2 years ago rather than go through all the checkups and tests, and worrying about it all this time. "

— Randall, age 29

" Around 4 years ago, I found a lump on my testicles. After being diagnosed with early-stage seminoma testicular cancer, I decided to do chemo right away rather than radiation therapy or watchful waiting. My doctor told me that chemo doesn't carry the same risk of my getting another kind of cancer later in life. I know that there is still a small chance of being infertile from the chemotherapy. But to me it's an acceptable risk. My testicular cancer has been cured, and I feel great. "

— Adolfo, age 32

"When I was 29, I was diagnosed with stage I seminoma testicular cancer. At the time, I was told that my cancer was found at a very early stage and that I could either choose radiation or surveillance (watchful waiting) after orchiectomy. I decided to go with radiation therapy because I wanted my cancer to be cured as soon as possible. At the age of 46, I was diagnosed with leukemia, which my doctor says could be a result of the radiation therapy I received during treatment for testicular cancer. There's no way to be sure that that's what caused my leukemia. But now I wish I had thought about a surveillance program a little more seriously. "

— Jeff, age 49

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

I’m worried that if I have treatment, I may not be able to have children.

Not important

Somewhat important

Very important

I’m willing to put up with the possibility of not having children if it means my cancer will be cured for good.

Not important

Somewhat important

Very important

A long schedule of regular checkups and tests during watchful waiting will be worth it if it means I won’t need to have other treatment.

Not important

Somewhat important

Very important

I don’t like the idea of chemotherapy.

Not important

Somewhat important

Very important

I don’t like the idea of radiation treatment.

Not important

Somewhat important

Very important

My other important reasons:

Not important

Somewhat important

Very important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Watchful waiting

NOT using watchful waiting

Leaning toward

Undecided

Leaning toward

Radiation treatment

NOT having radiation treatment

Leaning toward

Undecided

Leaning toward

Chemotherapy

NOT having chemotherapy

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Which treatment means having checkups and tests often during the first few years?

Watchful waiting
Radiation
Chemotherapy
I'm not sure

You’re right. Watchful waiting requires an intense schedule of frequent checkups and tests.

2. Which treatment choice has the highest cure rate?

Watchful waiting
Radiation
Chemotherapy
I'm not sure

Yes, you’re right. Radiation has a very high cure rate and is the best option for completely getting rid of the cancer.

Decide what's next

1. Do you understand the options available to you?

Yes
No

2. Are you clear about which benefits and side effects matter most to you?

Yes
No

3. Do you have enough support and advice from others to make a choice?

Yes
No

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.