Testicular Cancer Surveillance & Scanxiety

Testicular cancer is among the most treatable cancers there is. SEER puts five-year relative survival in the United States at 94.6% for cases diagnosed between 2016 and 2022. The American Cancer Society projects about 9,810 new diagnoses and 630 deaths in 2026. That ratio is unlike almost any other solid tumor. The median age at diagnosis is 33.

That context belongs at the front. Surveillance can make a situation feel more precarious than it is. In fact surveillance exists precisely because the odds are good. For many men with stage I disease, removing the testicle is enough. Giving chemotherapy or radiotherapy to everyone "just in case" would mean treating many people to benefit few. Surveillance is not a decision to do nothing. It is a decision to hold treatment in reserve and check carefully.

Three strands, repeated on a schedule.

Blood markers. Alpha-fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG) and lactate dehydrogenase (LDH). Some germ cell tumors make these. A rise can flag relapse before anything shows on imaging. Two limits are worth knowing. Pure seminoma does not produce AFP, so a normal AFP proves nothing there. And LDH is non-specific. It rises with all kinds of tissue turnover. Markers can also drift up for harmless reasons. So a single mildly abnormal value is usually repeated before anything else changes.

Examination and history. Feeling the remaining testicle, the abdomen and the neck. Asking about back pain, cough or breathlessness.

Imaging. CT of the abdomen and pelvis is the main tool, alongside chest imaging. The abdomen matters most because the first place these tumors spread is the retroperitoneal lymph nodes.

Schedules differ by tumor type. Take European guidance for stage I seminoma on surveillance. It sets markers and clinic visits about twice a year for the first three years, then annually. Abdominopelvic CT or MRI comes at defined points out to five years. Stage I non-seminoma is watched more intensively at the start. That means markers and visits around four times a year in the first two years, because relapses cluster early. Ask for your own schedule in writing. The intervals are meant to loosen over time.

The dread that builds before a scan, and while waiting for results, has a name in the research literature. It is called scanxiety, and it has been studied. A scoping review of 36 studies found it affects people during treatment and years into survivorship. Two patterns recur. Anxiety climbs as the appointment approaches. And the gap between the scan and hearing the result is the worst part, often worse than the scan itself. Anxiety often drops immediately after the scan is done, before any result is known. That says a great deal. Most of it is anticipation, not intuition.

Naming it matters. It is easy to read your own dread as a signal that something is wrong. It usually is not. It is a predictable response to a scheduled reminder of uncertainty.

• Ask for the scan and the results appointment to be booked close together, and ask before you leave how long the wait will be.
• Decide in advance how you want results delivered. Some people want portal access the moment it posts. Others want to hear it from a person first. Tell your team which you are.
• Book the scan at a time that limits empty waiting, and put something concrete in the diary for the day results are due.
• Tell one person your dates, so you are not carrying it silently.
• Keep your own copy of the schedule and your marker values. Watching your own numbers stay flat is often steadying.

Relapse found on surveillance is usually caught early, and it stays highly treatable. That is the entire design of the strategy. Very late relapse beyond five years is rare, in the region of 0.5%. Follow-up eventually turns into a survivorship plan, focused on long-term health: hormone levels, fertility, and cardiovascular risk.

• NCI SEER: Cancer Stat Facts — Testicular Cancer
• EAU Guidelines: Testicular Cancer — Follow-up After Curative Therapy
• AUA Guideline: Diagnosis and Treatment of Early-Stage Testicular Cancer
• Derry-Vick et al., Scanxiety among Adults with Cancer: A Scoping Review to Guide Research and Interventions (Cancers, 2023)