Condition & Treatments
Testicular cancer and other findings on a scrotal scan
Testicular cancer and other findings on a scrotal scan: what they mean for men with fertility problems
Prof Raheem performs a scrotal ultrasound for every man he sees in clinic with a fertility problem. As well as explaining poor sperm production, the scan can find conditions that matter for your general health, including, rarely, testicular cancer. Men with fertility problems have a higher risk of testicular cancer than other men [1], so a careful scan is part of good fertility care.
I N S H O R T
Most findings are harmless, but some need treatment or follow-up.
Testicular cancer is more common in men with fertility problems.
Found early, it is very treatable. If anything needs treatment, sperm can be frozen first to protect your fertility.
What the scan can find
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Varicocele: swollen veins above the testis, the most common treatable cause of male infertility.
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Small or soft testes, or an uneven pattern inside the testis, which can explain low sperm production.
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Testicular microlithiasis: tiny specks of calcium in the testis. On its own it is usually harmless, but in men with other risk factors it needs follow-up [2, 3].
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Lumps in the testis. Most small lumps found in men with fertility problems are benign, but every lump needs careful assessment, as testicular cancer must be ruled out [4].
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Cysts and fluid: cysts of the epididymis (spermatoceles) and fluid around the testis (hydrocele). These are usually harmless.
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An undescended or missing testis, or a missing or blocked vas deferens, which can explain a very low or zero sperm count.
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Signs of past infection or inflammation in the epididymis.
Testicular cancer and your fertility
Testicular cancer is the most common cancer in men aged 15 to 44 in Europe [1], and men with fertility problems are more likely to develop it [1]. It is also one of the most treatable cancers, especially when found early.
Signs to look out for. A painless lump or swelling in a testis, a feeling of heaviness in the scrotum, or a change in the size or feel of a testis. Any of these should be checked promptly.
How it is diagnosed. A scrotal ultrasound, blood tests for tumour markers, and, if cancer is confirmed, a CT scan to check whether it has spread.
How it is treated. Usually by removing the affected testis (orchidectomy), sometimes followed by chemotherapy or radiotherapy. In selected men with a small lump, particularly if only one testis remains or sperm production is poor, removing only the lump may be considered.
The effect on fertility. Testicular cancer often affects sperm before any treatment begins: around half of men have a low sperm count at diagnosis [1]. Chemotherapy and radiotherapy can reduce sperm production further.
Protecting fertility. Sperm should be frozen before surgery or any other treatment. If there is no sperm in the semen, sperm can often be taken directly from the testis at the time of the orchidectomy (onco-TESE). Prof Raheem works alongside your cancer team to arrange this quickly, so your treatment is not delayed.
Testicular microlithiasis: when follow-up is needed
In infertile men, testicular microlithiasis is linked to a much higher rate of testicular cancer [2]. European guidelines advise extra care when it comes with other risk factors: both testes affected, small testes, a history of an undescended testis, or a previous testicular cancer. In these men, follow-up with regular examination and ultrasound, or sometimes a testicular biopsy, may be advised [3]. Without risk factors, routine follow-up is not usually needed, but checking your testes yourself each month is sensible.
If something is found
Prof Raheem explains the finding and what it means for you, in plain English.
Further tests, where needed: blood tumour markers, or an MRI scan
Sperm freezing, before any surgery or treatment that could affect your fertility.
Treatment or referral: from simple reassurance and follow-up, to surgery or specialist cancer care, arranged quickly.
Why this matters to your care
A scan by a specialist who sees men with fertility problems every day means findings are recognised, explained and acted on, and that your fertility is protected while your general health is looked after.
Common questions
Does a lump always mean cancer?
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No. Most small lumps found in men with fertility problems are benign. But every lump needs proper assessment.
I've been told I have microlithiasis. Should I worry?
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Usually not. It matters mainly when there are other risk factors, and Prof Raheem will tell you if you need follow-up.
Will treatment affect my fertility?
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It can, which is why sperm is frozen first whenever treatment could affect it.
References
1. Maiolino G, et al. Male infertility and the risk of developing testicular cancer: a critical contemporary literature review. Medicina, 2023;59(7):1305. Link
2. Barbonetti A, et al. Testicular cancer in infertile men with and without testicular microlithiasis: a systematic review and meta-analysis of case-control studies. Frontiers in Endocrinology, 2019. Link
3. Diagnostic and prognostic implications of testicular microlithiasis (review including the EAU Sexual and Reproductive Health Guideline 2024). Link
4. ESUR Scrotal and Penile Imaging Working Group. Scrotal ultrasound in male infertility: recommendations. European Radiology, 2024. Link