How Is Testicular Cancer Treated?

Testicular Cancer Treatment: Surgery, BEP Chemotherapy, and Surveillance

Last updated and reviewed on June 28, 2026.

Testicular cancer treatment is one of the success stories of modern medicine. The combination of surgery, platinum-based chemotherapy, and radiation therapy, used in carefully tailored combinations depending on the tumor type and stage, cures the vast majority of men with this disease. Even men with widely metastatic testicular cancer are frequently cured, which sets this cancer apart from most others. Treatment decisions are made based on the type of tumor (seminoma versus nonseminoma), the stage of the disease, the tumor marker levels, and the patient's overall health.

Testicular cancer treatment is best coordinated by a multidisciplinary team that includes a urologic oncologist (who handles surgery), a medical oncologist (who manages chemotherapy), and a radiation oncologist. At high-volume cancer centers, these specialists work together and have deep experience with testicular cancer, which translates into better outcomes for patients.

Surgery

Surgery is the first step in treating virtually all testicular cancers, regardless of stage.

• Radical inguinal orchiectomy: The removal of the affected testicle through an incision in the groin is the foundational treatment for testicular cancer. It is done through the groin (not through the scrotum) to preserve the natural lymphatic drainage of the testicle and avoid spreading cancer cells to the wrong set of lymph nodes. The surgery takes about an hour, is usually done under general anesthesia, and most men go home the same day or the next morning. Recovery is generally straightforward, and most men return to normal activities within two to four weeks.

Removing one testicle does not affect a man's ability to have sex or achieve an orgasm, and most men with a healthy remaining testicle maintain normal testosterone levels and fertility. For men whose other testicle may also be at risk, or in rare cases of bilateral cancer or cancer in a single remaining testicle, the treatment becomes more complex, and preserving some testicular tissue when possible is an important goal.

A testicular prosthesis (an artificial implant that looks and feels like a natural testicle) can be placed in the scrotum during or after the orchiectomy. This is a personal choice, but many men find it beneficial for body image and psychological well-being. Ask your urologist if this option is something you want to discuss.

• Retroperitoneal lymph node dissection (RPLND): RPLND is a surgery to remove the lymph nodes at the back of the abdomen where testicular cancer most commonly spreads first. It is used in specific situations: as a primary treatment option for certain nonseminoma Stage I patients with high-risk features, for management of residual masses after chemotherapy in nonseminoma patients, and sometimes for small-volume Stage II nonseminoma. RPLND is a major abdominal surgery that requires significant expertise to perform well, and it is strongly recommended that it be done at a high-volume center with surgeons who perform this operation regularly.

A potential side effect of RPLND is retrograde ejaculation, in which semen goes backward into the bladder during orgasm rather than out of the penis, because the surgery can disrupt the nerves that control ejaculation. Nerve-sparing RPLND, performed by skilled surgeons, preserves ejaculation in the majority of men.

Radiation Therapy

Radiation therapy plays a specific and limited role in testicular cancer treatment today.

• For Stage I and Stage IIA/IIB seminoma, radiation to the retroperitoneal lymph nodes was the historical standard of care after orchiectomy. Because seminoma is exquisitely sensitive to radiation, even low doses can sterilize microscopic spread in the lymph nodes very effectively. However, in recent years, active surveillance and single-agent carboplatin chemotherapy have emerged as alternative approaches for Stage I seminoma, and the use of radiation for Stage I seminoma has declined significantly because of concerns about long-term side effects, including a small increase in the risk of secondary cancers in the radiation field over many years.
• For Stage IIA and IIB seminoma, radiation to the retroperitoneal and sometimes the pelvic lymph nodes remains a treatment option alongside chemotherapy, and the choice between them depends on the pattern of lymph node involvement, the patient's preferences, and the expertise of the treating center.

Radiation is not a standard treatment for nonseminoma because nonseminomas are less radiosensitive than seminomas.

Chemotherapy

Chemotherapy is the cornerstone of treatment for metastatic testicular cancer and also plays an important role in Stage I disease management.

• BEP chemotherapy (bleomycin, etoposide, cisplatin): The BEP regimen is the most important treatment in the history of testicular cancer. It is given in cycles over three to four weeks, with the number of cycles depending on the stage and risk category. Three cycles of BEP are the standard for good-prognosis metastatic disease. Four cycles are used for intermediate and poor-prognosis disease. BEP has been refined over decades and cures the large majority of men with metastatic testicular cancer, including many with widely spread disease.

Common side effects of BEP include nausea and vomiting (managed effectively with modern anti-nausea medications), fatigue, hair loss, low blood counts increasing the risk of infection, numbness or tingling in the fingers and toes (neuropathy from cisplatin), and hearing changes. Bleomycin can cause lung toxicity, particularly in patients who smoke or who have certain other risk factors, and pulmonary function is monitored during treatment.

• EP chemotherapy (etoposide and cisplatin): For Stage I nonseminoma patients who choose adjuvant chemotherapy rather than surveillance or RPLND, one or two cycles of EP are used instead of BEP, with fewer cycles and omitting bleomycin to reduce the risk of lung toxicity.
• Carboplatin: Single-agent carboplatin is an option for Stage I seminoma patients who choose adjuvant treatment rather than surveillance or radiation. It is given as one or two cycles and is well tolerated compared to full BEP.
• Salvage chemotherapy: For the small percentage of patients whose cancer does not respond adequately to first-line BEP or who relapse after achieving a complete response, salvage chemotherapy regimens are used. The most common are TIP (paclitaxel, ifosfamide, cisplatin) and VeIP (vinblastine, ifosfamide, cisplatin). For patients who relapse after standard-dose salvage chemotherapy, high-dose chemotherapy with autologous stem cell transplant (in which a patient's own stem cells are collected, stored, and then reinfused after very high doses of chemotherapy) is an option and cures a significant proportion of this very difficult-to-treat group.

Active Surveillance

Active surveillance is a management strategy in which a man with Stage I testicular cancer (either seminoma or nonseminoma) is closely monitored after orchiectomy without receiving any immediate additional treatment. The rationale is that the majority of Stage I patients are already cured by the orchiectomy alone, and the goal of surveillance is to detect the small minority who do relapse and treat them at that point, when treatment is still highly effective.

For Stage I nonseminoma, approximately 20 to 30 percent of patients relapse on surveillance, and almost all of these relapses are caught early and cured with chemotherapy. For Stage I seminoma, approximately 15 to 20 percent of patients relapse on surveillance, and these relapses are typically caught at an early and highly curable stage.

Active surveillance requires commitment to a rigorous schedule of clinic visits, blood tests for tumor markers, and imaging (CT scans), particularly in the first two to three years after treatment. Men who cannot reliably attend frequent follow-up appointments may not be ideal candidates for pure surveillance.

The significant advantage of surveillance is that it spares the roughly 70 to 85 percent of patients who are already cured from the potential short- and long-term side effects of additional treatment.

Supportive and Palliative Care

Supportive care is an important part of testicular cancer treatment and is not just for men with advanced disease. It includes the management of chemotherapy side effects (nausea, fatigue, infection risk, neuropathy), attention to fertility preservation, management of anxiety and psychological distress, and guidance on returning to normal life after treatment.

Testosterone production may also be affected, particularly in men who have had treatment to both testicles or who have had extensive lymph node surgery. Testosterone levels should be monitored after treatment, and hormone replacement therapy is available for men whose levels are significantly low.

Follow-Up Care After Treatment Ends

Long-term follow-up after testicular cancer treatment is essential for two reasons. First, it monitors for disease recurrence, which most commonly occurs in the first two years after treatment. Second, it watches for the late effects of treatment, because some of the therapies used, particularly cisplatin, bleomycin, and radiation, can have effects on the cardiovascular system, kidneys, hearing, nerves, and lungs that emerge years or decades after treatment ends.

Follow-up for Stage I patients on surveillance involves regular physical exams, tumor marker measurements, and CT scans on a schedule that is intensive in the first year and gradually decreases over time. For patients who received chemotherapy or radiation, follow-up also includes monitoring for treatment-related late effects, including cardiovascular risk factors, kidney function, pulmonary function (for those who received bleomycin), and surveillance for secondary cancers.

Testicular cancer survivors who were treated in their twenties and thirties may carry elevated cardiovascular risk for decades afterward, related primarily to platinum-based chemotherapy. Addressing cardiovascular risk factors like blood pressure, cholesterol, and smoking in this population is an important part of long-term survivorship care.

Sources:

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