Orchiectomy

Orchiectomy is surgery to remove testicular tissue. The purpose and extent of surgery differ between testicular cancer and advanced prostate cancer. For cancer confined to a testicle, radical orchiectomy removes the affected testicle. In advanced prostate cancer, orchiectomy is used to lower testosterone as a form of hormone treatment. Bilateral surgery involves both testicles; total removal and a subcapsular approach are different options. The subcapsular approach is designed to retain the feeling of testicles within the scrotum. This hormone-treatment operation is different from testis-sparing surgery, which removes a small testicular mass while preserving healthy tissue.

For a small testicular mass, partial removal may be an option in carefully selected cases at an experienced centre. A 2019 review identified masses measuring 2 cm or less as potential candidates, but did not establish an approved size threshold. Ultrasound during surgery helps locate the mass, and rapid examination of tissue helps distinguish benign growths from cancer. There were no randomized trials comparing this approach with radical orchiectomy.

For advanced prostate cancer, medicines that lower testosterone are an alternative to surgery. The choice concerns hormone treatment, not removal of a testicular tumour. In some patients with testicular cancer that has spread extensively or threatens a critical site, chemotherapy is given before orchiectomy. Evidence about this delayed surgery concerns that specific situation, rather than routine treatment of cancer confined to a testicle.

In a randomized trial of men with prostate cancer who chose hormone-lowering surgery, 35 received total removal of both testicles and 35 received the subcapsular operation. At three months, satisfaction scores and control of prostate-specific antigen, a blood marker used in prostate cancer care, did not differ significantly. On self-examination, 84% of the subcapsular group felt that their testicles had not been removed, compared with 28% of the total-removal group. These results describe short-term perception and blood-marker control, not a cancer cure rate.

A separate randomized trial followed 58 men with advanced prostate cancer for 48 weeks, comparing subcapsular surgery with triptorelin injections. Testosterone levels were 29% lower with the injections across the follow-up measurements. This was a hormone measurement, not a demonstration of longer survival. These findings should not be transferred to surgery for testicular cancer.

Fertility is an important consideration in testicular cancer treatment. In a 2026 study of 25 patients with testicular germ cell cancer, sperm was tested before surgery and again within eight weeks, before further treatments that could harm fertility. Total sperm count fell in 18 patients and rose in seven. Sperm concentration and movement declined significantly, although the change in total sperm count was not statistically significant. The researchers supported freezing sperm before surgery, with additional storage after surgery considered individually.

For men having hormone-lowering treatment for advanced prostate cancer, changes in weight and metabolism also matter. In a randomized study of 58 men, the subcapsular surgery group had a greater increase in weight than the triptorelin group at 48 weeks: the between-group difference was 3.30 kg. Across both groups, body fat, cholesterol and insulin resistance increased, while lean body mass fell. Insulin resistance means the body responds less effectively to the hormone that controls blood sugar. A broader 2023 review found conflicting evidence about which treatment had the better metabolic profile, so surgery cannot simply be described as safer than medication in this respect.

After surgery for testicular cancer, examination of the removed tissue helps guide the next stage of care. Review by a pathologist specialising in urinary and genital cancers can support individual treatment planning. For testicular germ cell tumours, the tissue report describes the tumour type and stage and helps the care team decide about additional treatment. These decisions are part of cancer care after surgery, rather than a measure of how quickly the surgical wound heals.