Questions for your Doctor: Before the Orchiectomy
This list of questions is intended to help you make the most of your visit to
the urologist in preparation for an orchiectomy. It is not an exhaustive list of
questions, so be sure to look it over before you see the doctor and add any others
that might apply to your specific situation.
This particular list is intended to be used after you have been diagnosed with testicular
cancer, but before you have received any treatment. The scope of the questions
is pretty narrow since there are few choices at this point. The orchiectomy is
almost always done before any other treatment is started. If your tumor is
very advanced and you already know that from CT Scans, Tumor Markers, or other
symptoms, then it might make sense to begin chemotherapy right away and skip
the orchiectomy. However, this is pretty unusual, and I would not recommend doing
it without having your doctor consult with an
If you have any comments, questions, or suggestions about this list, please
feel free to send me an email!
These are general questions that most people have when they learn that
they have testicular cancer, and they are going to need to have it removed.
- Why do you think I have cancer? How sure are you?
- Why do you have to remove the whole testicle?
- What happens if they discover that it is not cancer?
- Can you do anything before actually removing the testicle to make sure
that it is necessary to remove it?
(There is a surgical procedure called a frozen-section biopsy that allows
a pathologist to take a quick look at the inside of the testicle before actually
removing it. It is pretty crude, and there would need to be clear evidence of
no cancer before they would forgo the orchiectomy. But you can still ask about
- Do I have any other choice of treatment(s)?
- How will this surgery affect my sex life and fertility?
- What is my prognosis for fertility following treatment?
(Note: If your remaining testicle is not completely normal in size and
function, you may want to mention that to the doctor and emphasize the next
four questions. It is unusual, but it is possible to come out of the orchiectomy
either sterile or requiring supplemental testosterone.)
- Should I bank sperm before the operation, just in case?
- How can I find out more about the sperm banking service?
- Will losing this testicle stop me from producing testosterone and "being a man"?
- Can you get a measurement of my testosterone and LH levels before
the surgery, just in case?
(There is no strictly medical reason to do these tests, and the doctor
will probably say it is not needed. However, it is our experience that 10-30%
of guys will have a testosterone problem after this surgery. If this type of
testing is done before the surgery, it is much easier to diagnose and treat the
problem later on. LH is another hormone related to testosterone production)
- What are your qualifications to treat testicular cancer?
(In truth, the inguinal orchiectomy is a simple operation, and any
urologist should be able to do it. More experience is needed later on, for
any further surgery or other treatment.)
- Have you treated someone for this kind of cancer before? If so, how many?
These questions are specifically aimed at the details surrounding the surgical
procedure and recovery.
- How soon should the operation be done?
(The operation should not be delayed too long. If they try to delay it
more than a week or so, don't just accept it. Ask if that won't just let
the cancer spread, and try to get the surgery done sooner. If you hear the
famous "I'm going to be on vacation" or "I have to go to a conference" excuse,
then consider finding a different surgeon. It is your body. You do not need to
wait for a time convenient for your doctor!
- What kind of tests need to be done before the surgery?
(At a minimum, your tumor markers must be measured right before the
surgery. As I already mentioned, we also recommend testosterone and LH testing.)
- Where will I have to go for the operation?
- Will you do a frozen section biopsy before removing the testicle?
- Can you explain the surgical procedure?
(You need an inguinal orchiectomy.
In other words, they remove the testicle
through an incision on your belt line. If the doctor describes an incision in
the scrotum, then find a different doctor. That is NOT the correct procedure
if testicular cancer is even a remote possibility.)
- How long will the operation take?
- What kind of anesthesia will be used?
- Will you use sutures or staples? Why?
- Will residents be participating in the operation?
- What kind of pain medicine will be available after the operation?
- What will it feel like afterward?
- How long will I have to stay in the hospital after the operation?
- How do I know I'm getting the best treatment?
- What sort of hospital room will I be in?
- Whom would you recommend for a second opinion?
- What type of costs am I looking at?
After the Surgery is Over
- What happens after surgery?
- Will I need any more treatment after this is done?
- What are the possible side effects of this type of surgery? Are they permanent?
- Should I expect any nerve damage or numbness around the incision?
- How long will the side effects last?
- Are there any side effects that I should I report immediately?
- What are the long-term risks?
- Can I do anything to help the incision heal nicely? Should I rub
vitamin E on the scar?
- Are there any activities I should or should not do following surgery?
- Will the surgery affect my work/education?
- How soon after surgery can I go back to school/work?
- How long will it take before I can get back to my normal routine?
- How soon after surgery will I be able to drive?
- After the surgery is over, which specialist will manage my care?
(This is an important question. The answer probably depends on what is
found by the pathologist, but it is likely that the urologist is not going to
be taking care of you forever, and it is good to get that out on the table.)
Obviously, removing a cancerous testicle will leave you with one less
testicle. Most men are OK with this, but a lot of younger, single guys are
really bothered by this. In the past, due to silicone implant issues in the
United States, it has been very difficult to do anything about this. Times
have changed, and if you are interested in an implant, it is possible to get
one. You may have to do some work and/or have two surgeries, though, so
investigate this issue up front. For more information, check out the TCRC's
- Is it possible for me to have an implant inserted at the same time as
- If so, where would I need to go to find one?
- What hospital could I have this procedure done in?
- How can I get an implant manufacturer to provide me with one?
- Who must I contact to see this through?
- Is getting an implant dangerous to my health?
Your urologist is not a psychologist, and bedside manners vary a lot. You
may or may not want to ask about this sort of stuff, and even if you ask, you
may not get a good response. Obviously, if you are reading this list, you know
that the TCRC exists. We have many support options available if you are interested.
- Can I get help for dealing with my feelings?
- Does the hospital offer counseling? Is there a social worker I
can talk to about this?
- How should I talk about the disease with my family and children?
- Are you willing to speak with my wife (or other family members)
about my cancer and my treatment?
- I'm worried of what my friends will say. How should I deal with that?
- Are there support groups for testicular cancer?
- Are there support groups available for my family?
Here are some random questions that you might want to ask. Some talk about
the far future, and others may give you more insight into the nature and opinions
of your doctor.
- Can changing what I eat help me recover from my surgery or cancer?
- How do I access a dietician if I have nutritional concerns or difficulties?
- Will I still be able to look after my family, or will I need help?
- Will I be able to live a normal life when I get older?
- What kind of supplies, equipment, or any other help will I need when I go home?
- When can I start regular exercise after the surgery?
- Would you be willing to consult with a Testicular Cancer expert if a
- What telephone numbers I should have in order to reach you?
the nurse? the hospital?
- When will I next see you?