Testicular Cancer Awareness Month: Early Detection and Risk Assessment Pave the Way Toward Optimal Outcomes

Adam Calaway, MD, MPH

Raising awareness about testicular cancer and reinforcing the importance of early detection remain central to improving outcomes in the young male population, according to Adam Calaway, MD, MPH.

“[Although] testicular cancer is not common overall, it is the most common cancer in young males. Nobody wants to hear the word ‘cancer,’ especially younger patients who have their whole lives ahead of them,” Calaway explained. “However, it’s crucial for patients to understand that testicular cancer is highly curable, and the risk of dying from it is low—regardless of the stage at diagnosis.”

In an interview with OncLive^®, Calaway discussed the current state of testicular cancer in 2025, including the importance of public awareness, the role of monthly self-examinations, and practical strategies for early diagnosis in primary care settings. He also provided an overview of treatment approaches across early and advanced disease, as well as emerging clinical research focused on minimizing treatment-related complications.

Calaway is an assistant professor of urology at University Hospitals and Case Western Reserve University School of Medicine in Cleveland, Ohio

OncLive: What should clinicians understand about the current state of testicular cancer diagnosis and treatment in 2025?"

Calaway: First and foremost, it's important to understand that for young men in particular, testicular cancer is the most common solid malignancy diagnosed. That is for men approximately 18 to 44 [years of age]. It is not common; approximately 10,000 cases are diagnosed in the United States each year, and rates are slowly rising. One way that we can make for earlier diagnoses is [to raise] awareness and [share the] knowledge that self-examinations are the best mode of surveillance and screening.

What advice would you give to primary care physicians regarding the importance of early detection of testicular cancer?

In general, it's always better to detect a cancer earlier rather than later, and that's for many different reasons. Earlier detection tends [means less chance of] metastatic disease outside of the area where it started, and it also tends [to associate with] less risk of needing further therapies that potentially have lifelong toxicities.

The best way to diagnose [testicular cancer] early is a monthly self-examination. In the world of 2025, when apps and social media are ever present, there are [ways] young men can get [reminders] on their phones [for an exam]. There are clear instructions on how to do [a self-examination]

One of the most important things [about testicular cancer] is knowledge of the disease and knowledge that it is commonly [diagnosed] in younger men. There is always a stigma when it comes to genital-based concerns—whether it's male or females—in wanting to seek out help and care at the doctor. Sometimes even as physicians, there's a little bit of awkwardness to some degree in the primary care [setting] about doing examinations in those sensitive areas. [Knowing what to look] for and how they detect [testicular cancer] is incredibly important for patients and providers to know.

If a primary care physician detects a mass on a patient's testes, what are the subsequent steps for a potential diagnosis?

[Testicular cancer typically presents with] a mass within the testicle, not around the testicle. And normally it feels firm and hard. If that is a concern, it is essential that patients get an urgent urologic visit.

It's important if they can get a few things for us prior to that visit. A scrotal ultrasound is the best imaging modality to look at a testicular mass, and it is important to get some blood work on serum tumor markers. Testicular cancers are most likely testicular germ cell tumors, which may secrete serum tumor markers called AFP and hCG that can be detected in the blood. [These levels] can be completely normal, even in a setting of testicular cancer, but their elevation helps us manage things and gives us some degree of assurance of what we're dealing with.

What options are available to physicians for treating testicular cancer, and how do should these considerations be presented to patients?

The first line of treatment is surgical treatment. When a solid mass [is found] within the testicle, that normally requires a radical orchiectomy. That's normally a brief outpatient surgery it takes roughly 30 to 60 minutes, depending upon the situation, and patients get to go home the same day. There are some risks, namely to the local area, like bruising and swelling that we counsel patients on, and we try to prevent that with some scrotal rest and support.

Prior to surgery, it's important, to [consider other factors]. The testicle has 2 main roles: it makes sperm, and it makes testosterone. Prior to [performing] an orchiectomy, it is essential—especially because [most] patients are likely to [have testicular cancer] during procreating years or [as they are] interested in having families—to offer sperm banking, and that's often done in our institution with our fertility clinics. Because cosmesis is important, we should also recognize that testicular prosthesis can be offered either to be inserted at the same time of removal or down the road.

The other thing that we sometimes think of is the testosterone, and sometimes getting a baseline testosterone [reading], prior to removal will help us going forward whether testosterone replacement is necessarily as a starting point.

When considering more advanced stages of disease, how might the treatment approach evolve?

Most testicular cancers are germ cell tumors, and germ cell tumors can be of two types; seminomas and non-seminomas. [Testicular cancer treatment] is regimented, and we treat seminomas a little differently than we treat non-seminomas.

After the testicle is removed, there are 2 important things that I tell all patients that we have to do. First, we have to stage them, [to see] if there are areas of spread, and that's normally done through CT scans of the chest, abdomen, and pelvis. Then we have to assign them a risk group based on data from those CT scans and data from serum tumor markers.

Despite the high rates of cure with testicular cancer, is there any ongoing research that could help address treatment challenges in this space?

We've been blessed in in such a small incidence-based cancer to have a long-standing history of wonderful clinical trials that have informed us of how to treat these patients appropriately and [ultimately] cure the large majority of them, however far [their disease has progressed] at the time of diagnosis. However, there are a few interesting areas that have either been reported or [that are currently] being investigated.

First and foremost, [we have seen an evolution in] the role of more advanced surgeries in patients with seminomas. [We know that] the most common place for testicular cancer to spread, especially in a seminoma, is into the retroperitoneal lymph nodes, [which is] an area of the body that sits behind the intestines by the big blood vessels of the body. We [also] know that seminomas tend to spread in a very predictable way.

Historically, chemotherapy and radiation therapy have been used to treat and to cure those patients with large degree of certainty, but these are also patients who are young and are destined to live decades and decades. Then we've looked at those patients over time, and those treatments have costs. Survivors are [at a higher] risk of [developing] cardiovascular issues down the road, or, most importantly, secondary malignancies.

We're trying to investigate other ways to treat retroperitoneal lymph nodes when patients have seminomas and minimize those [adverse effects]. There are multiple studies, both here in the United States and abroad, [looking at retroperitoneal lymph nodes dissection] and the role of doing surgery in those situations.

Looking at recurrence-free survival rates after surgery without chemotherapy and without radiation, [they could] be around 80 %, and sometimes even higher, which offers a high degree of cure without having to be exposed to life-altering toxicity [from chemotherapy or radiation]. That's quite excitin, because it's changing the dogma of how to [approach treatment] and potentially cementing what we've all known in this disease for a long period of time: we can cure a high degree of patients. Now, we're focusing on what the effects of those cures are and how we can minimize them.