What happens when the testes are removed due to testicular cancer?

The removal of a testis is a significant medical procedure often necessary in cases like testicular cancer.

However, concerns about fertility, especially for younger individuals aspiring to start families, are common.

What happens if a patient is required to have his testes removed?

Speaking to Sinar Daily, University Malaya Urologist Dr Ahmad Nazran Fadzli explains the implications and the steps patients can take to safeguard their reproductive health.

"If you remove one testis, most of the time, the chances of having children remain the same," he said.

According to Dr Nazran, the key factor that might impact fertility is not the removal of a testis but the chemotherapy that often follows.

He said chemotherapy can significantly affect sperm production, which is why patients are advised to consider sperm banking before undergoing treatment.

Sperm banking is a medical procedure that allows individuals to preserve their fertility by freezing and storing sperm for future use.

Dr Nazran said facilities at University Malaya are able to provide this service, enabling patients to conceive later through assisted fertilisation techniques if natural fertility is compromised.

"At University Malaya, we have a sperm banking facility. Here, sperm is stored in liquid nitrogen at temperatures as low as minus 198 degrees Celsius.

"This allows the sperm to remain viable for up to 40 years, enabling patients to conceive through assisted fertilisation techniques if chemotherapy affects their sperm production," he said.

"If you remove one testis, most of the time, the chances of having children remain the same, said Dr Ahmad Nazran Fadzli - Photo by Sinar Daily

HOW IS TESTICULAR CANCER DIAGNOSED?

Dr Nazran highlights that the most common symptom of testicular cancer is a painless lump in the scrotum. However, he said this can be misleading.

"About 20 per cent of cases present with pain, which is often mistaken for an infection. If antibiotics don't resolve the issue, it’s crucial to consult a doctor again because it could still be cancer," he said.

When asked about the treatment and surgery, Dr Nazran said the first line of treatment is typically surgery to remove the affected testis, which also allows doctors to determine the type of cancer.

In advanced cases where the disease has spread, he said chemotherapy may precede surgery.

"In some instances, patients come in with severe symptoms like acute shortness of breath due to multiple lesions in the lungs.

“These cases require immediate chemotherapy before surgical intervention," he explained.

The key factor that might impact fertility is not the removal of a testis but the chemotherapy that often follows. Photo source: 123rf

SELF EXAMINATION

With no specific screening test available, Dr Nazran emphasise the importance of monthly self-examinations as an easy and effective early detection method.

He said testicular cancer predominantly affects younger men, particularly those aged 15 to 35, further revealing that while routine prostate cancer screening is typically recommended for men above 50, cases among younger individuals are becoming increasingly common.

"We’ve seen some patients in their 30s diagnosed with prostate cancer. That’s worrying because, like other cancers in Malaysia, we are seeing patients getting younger,” he explained.

He added that boys as young as 15 should begin self-examinations, which should be done once a month.

"It’s not that difficult. The best time is while you’re having your bath in a standing position. Use your thumb and your finger to examine whether the surface of the testis is smooth or not. The good thing is, we have two sides, so you can compare," he said.

Commenting further, Dr Nazran said testicular cancer can present itself in various ways, with some cases being particularly challenging.

He shared a unique case from his practice involving a patient diagnosed with testicular cancer in both testes.

"One side had to be completely removed, but for the other, I performed a partial removal to try to preserve it.

"The testes not only support fertility but also produce testosterone, the main male hormone. Without it, a man may experience symptoms similar to menopause in women, such as hormonal imbalances," he said.

In cases where testosterone levels cannot be preserved, patients may require lifelong hormone supplementation to maintain normal physiological functions.