Testicular Cancer: Symptoms, Diagnosis & Treatment
📊 Quick Facts About Testicular Cancer
💡 Key Takeaways About Testicular Cancer
- Highly curable: Testicular cancer has one of the highest cure rates of all cancers, exceeding 95% overall
- Affects young men: Most common between ages 15-45, with peak incidence at 28-43 years
- Early detection is key: Regular self-examination helps detect lumps early when treatment is most effective
- Painless lump is the main sign: A hard, painless lump in the testicle is the most common symptom
- Fertility can be preserved: Sperm banking before treatment allows future fatherhood for most men
- One testicle is sufficient: Removing one testicle does not affect hormone production or sexual function
- Two main types: Seminoma and non-seminoma are treated differently but both have excellent outcomes
What Is Testicular Cancer?
Testicular cancer is a malignancy that develops in the testicles, the male reproductive organs that produce sperm and testosterone. It typically appears as a painless lump and is highly curable with modern treatment, with survival rates exceeding 95%.
Testicular cancer originates in the germ cells of the testicles, where sperm is produced. It is relatively uncommon, accounting for only about 1% of all cancers in men, but it is the most common cancer in young men between ages 15 and 45. The disease has an excellent prognosis because testicular cancer cells are particularly sensitive to chemotherapy and radiation therapy.
There are two main types of testicular cancer, classified by the type of germ cell involved. Seminomas tend to grow more slowly and are extremely sensitive to radiation therapy. They typically occur in men aged 30-50 and have an excellent prognosis with cure rates approaching 100% for early-stage disease. Non-seminomas are more common in younger men from their teens to early 30s and tend to grow faster. They include several subtypes: embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma.
Some tumors contain both seminoma and non-seminoma cells, called mixed germ cell tumors. These are treated as non-seminomas because they require similar treatment approaches. Understanding the tumor type is crucial for determining the optimal treatment strategy, as seminomas respond well to radiation while non-seminomas are primarily treated with chemotherapy if spread has occurred.
How Does Testicular Cancer Spread?
Testicular cancer can spread through the lymphatic system and bloodstream if not treated early. The most common sites of metastasis are the lymph nodes along the spine below the kidneys (retroperitoneal lymph nodes). From there, the cancer can spread to the lungs. In rare cases, it may spread to the liver, brain, or bones. However, even metastatic testicular cancer responds remarkably well to treatment, with cure rates of 80-90% for disseminated disease.
Risk Factors for Testicular Cancer
While the exact cause of testicular cancer remains unknown, several risk factors have been identified that increase the likelihood of developing the disease:
- Undescended testicle (cryptorchidism): Men born with a testicle that did not descend naturally into the scrotum have a significantly higher risk, even if surgically corrected
- Family history: Having a father or brother with testicular cancer increases risk by 4-8 times
- Previous testicular cancer: Men who have had cancer in one testicle have an increased risk in the other
- Age: Most cases occur in men between 15 and 45 years old
- Race: Testicular cancer is more common in Caucasian men than in African or Asian men
Testicular cancer is not caused by injury, sexual activity, or physical exercise. There is also no proven link to vasectomy or testicular trauma. While some risk factors cannot be changed, regular self-examination allows early detection when the disease is most curable.
What Are the Symptoms of Testicular Cancer?
The most common symptom of testicular cancer is a painless lump or swelling in one testicle. Other symptoms include a change in size or shape of the testicle, a feeling of heaviness in the scrotum, or a dull ache in the lower abdomen, groin, or back.
Recognizing the symptoms of testicular cancer early is crucial for successful treatment. The cancer typically develops in one testicle, though in rare cases (about 2-3%), both testicles may be affected either simultaneously or sequentially. Understanding what symptoms to watch for can lead to earlier diagnosis and better outcomes.
The hallmark symptom is a painless lump or swelling in one testicle. This lump is usually firm or hard to the touch and may range from the size of a pea to much larger. Unlike infections or other benign conditions that often cause pain, testicular cancer lumps are typically painless, which can unfortunately delay men from seeking medical attention.
Some men also notice that one testicle has changed in size or shape, either becoming larger or feeling different in consistency. There may be a sensation of heaviness in the scrotum or a dull ache in the lower abdomen or groin area. While these symptoms can have other causes, they warrant prompt medical evaluation.
Common Symptoms
- Painless lump in the testicle: A hard or firm mass that can be felt during self-examination
- Swelling of the testicle: One testicle may become noticeably larger
- Change in consistency: The testicle may feel harder or different from normal
- Heaviness in the scrotum: A feeling of weight or fullness
- Dull ache: Discomfort in the lower abdomen, groin, or testicle
- Testicular pain: While less common, some men experience pain or discomfort
Symptoms of Advanced Disease
If testicular cancer has spread, additional symptoms may develop depending on where the cancer has metastasized. Some men may not experience any symptoms from the primary tumor and only present with symptoms from metastatic disease. These advanced symptoms include:
- Back pain: Caused by spread to lymph nodes along the spine
- Abdominal pain or mass: Due to enlarged retroperitoneal lymph nodes
- Shortness of breath or cough: If cancer has spread to the lungs
- Breast tenderness or growth (gynecomastia): Caused by hormones produced by certain tumor types
| Stage | Location | Typical Symptoms | Action Required |
|---|---|---|---|
| Stage I (Localized) | Confined to testicle | Painless lump, swelling, heaviness | Schedule doctor appointment within 1-2 weeks |
| Stage II (Regional) | Spread to lymph nodes | Back pain, abdominal discomfort | Seek medical evaluation promptly |
| Stage III (Distant) | Spread to distant organs | Breathing issues, persistent cough, weight loss | Urgent medical consultation needed |
Seek immediate medical attention if you experience sudden, severe testicular pain. This may indicate testicular torsion, a medical emergency where the testicle twists and cuts off its blood supply. Testicular torsion requires urgent surgery within hours to save the testicle. Find your emergency number →
How Is Testicular Cancer Diagnosed?
Testicular cancer is diagnosed through physical examination, ultrasound imaging, blood tests for tumor markers (AFP, hCG, LDH), and ultimately confirmed by surgical removal and examination of the testicle. A CT scan determines if the cancer has spread.
When testicular cancer is suspected, doctors follow a systematic approach to confirm the diagnosis and determine the extent of the disease. This process, known as staging, helps guide treatment decisions and predict outcomes. The diagnostic workup typically begins with a thorough physical examination and medical history.
During the physical examination, the doctor carefully examines both testicles, feeling for any lumps, changes in size, or areas of tenderness. The abdomen is also examined to check for enlarged lymph nodes. In many cases, an experienced physician can distinguish between cancer and other conditions based on the examination alone, but further testing is always required for confirmation.
Ultrasound Examination
Scrotal ultrasound is the first-line imaging test for evaluating testicular abnormalities. This painless, non-invasive procedure uses sound waves to create detailed images of the testicles and surrounding structures. Ultrasound can usually distinguish between solid tumors (which may be cancerous) and fluid-filled cysts (which are typically benign). The test also helps differentiate testicular masses from conditions affecting the epididymis, the small organ behind the testicle where sperm matures.
Blood Tests for Tumor Markers
Certain testicular cancers produce proteins that can be detected in the blood, called tumor markers. These markers are valuable for diagnosis, staging, and monitoring treatment response. The three main tumor markers for testicular cancer are:
- Alpha-fetoprotein (AFP): Elevated in non-seminomas, particularly yolk sac tumors and embryonal carcinoma. Pure seminomas do not produce AFP.
- Human chorionic gonadotropin (hCG): Can be elevated in both seminomas and non-seminomas, particularly choriocarcinoma
- Lactate dehydrogenase (LDH): A general marker that indicates tumor burden and is used for staging
Surgical Removal for Definitive Diagnosis
Unlike most cancers where a biopsy is performed first, testicular cancer is diagnosed definitively by surgically removing the entire affected testicle (radical inguinal orchiectomy). This approach is used because a needle biopsy could potentially spread cancer cells. The surgery is performed through an incision in the groin, not the scrotum, to prevent possible spread to local lymph nodes.
The removed testicle is examined under a microscope by a pathologist who determines the exact type of cancer, whether seminoma or non-seminoma, and assesses other features that affect prognosis and treatment planning. During the same surgery, a small tissue sample is often taken from the other testicle to check for pre-cancerous changes, although cancer in both testicles is uncommon.
Staging with CT Scan
After the diagnosis is confirmed, CT (computed tomography) scans of the chest, abdomen, and pelvis are performed to check if the cancer has spread to lymph nodes or other organs. This imaging helps determine the disease stage, which guides treatment decisions. In some cases, PET scans or MRI may also be used for more detailed evaluation.
Men can choose to have a testicular prosthesis implanted at the time of surgery or later. The prosthesis is a silicone implant that maintains the normal appearance of the scrotum. While it doesn't restore function, many men find it helpful for body image and self-confidence.
How Is Testicular Cancer Treated?
Treatment for testicular cancer typically begins with surgical removal of the affected testicle (orchiectomy). Depending on the cancer type and stage, additional treatment may include surveillance, chemotherapy, radiation therapy, or further surgery. Most men are cured with treatment.
The treatment of testicular cancer is one of oncology's great success stories. Even when the disease has spread, modern treatment regimens cure the majority of patients. Treatment planning is tailored to the specific type of cancer (seminoma vs. non-seminoma), the stage of disease, and individual patient factors.
All patients undergo surgical removal of the affected testicle as the first step in treatment. This procedure, called radical inguinal orchiectomy, is both diagnostic and therapeutic. The surgery is performed through an incision in the groin and typically takes about 30 minutes under general or spinal anesthesia. Most men can leave the hospital the day after surgery and return to normal activities within a few weeks.
Treatment for Stage I Disease (Cancer Confined to Testicle)
When testicular cancer has not spread beyond the testicle, there are several treatment options after orchiectomy, depending on the tumor type:
For Seminoma:
- Active surveillance: Close monitoring with regular check-ups, tumor markers, and CT scans. About 80-85% of patients are cured by surgery alone.
- Adjuvant chemotherapy: A single cycle of carboplatin chemotherapy reduces recurrence risk to about 5%
- Radiation therapy: Treatment to the retroperitoneal lymph nodes, though less commonly used today due to long-term side effects
For Non-Seminoma:
- Active surveillance: Appropriate for low-risk tumors without vascular invasion
- Adjuvant chemotherapy: One or two cycles of BEP chemotherapy (bleomycin, etoposide, cisplatin) for higher-risk tumors
- Retroperitoneal lymph node dissection: Surgical removal of lymph nodes, sometimes used in specific situations
Treatment for Stage II and III Disease (Cancer That Has Spread)
When testicular cancer has spread to lymph nodes or distant organs, chemotherapy becomes the primary treatment after orchiectomy. The standard regimen is BEP chemotherapy, which combines three drugs: bleomycin, etoposide, and cisplatin. This combination has revolutionized the treatment of testicular cancer since its introduction in the 1970s.
Treatment is given in cycles, with each cycle lasting about three weeks. Depending on the extent of disease and tumor marker levels, patients typically receive three to four cycles. The treatment is intensive and causes significant but manageable side effects, including:
- Nausea and vomiting (well controlled with modern anti-nausea medications)
- Hair loss (temporary, regrows after treatment)
- Fatigue
- Increased risk of infection due to lowered blood cell counts
- Bleomycin can affect lung function (monitored closely during treatment)
After chemotherapy, some patients may have residual masses visible on CT scans. For seminoma, small residual masses are typically observed with regular imaging, while larger masses may require surgical removal. For non-seminoma, post-chemotherapy surgical removal of any remaining masses is standard practice, as they may contain teratoma or viable cancer cells.
Radiation Therapy
Radiation therapy is primarily used for seminomas and targets the lymph nodes in the abdomen. It is highly effective but used less frequently today due to concerns about long-term side effects, including increased risk of secondary cancers. When used, treatment typically involves daily sessions over two to three weeks.
For localized disease treated with surgery alone, recovery takes 2-4 weeks. Chemotherapy treatment typically lasts 9-12 weeks, with recovery taking several additional months. Most men return to work and normal activities within a few months after completing treatment.
Can You Have Children After Testicular Cancer?
Many men can father children after testicular cancer treatment. Having one testicle removed does not cause infertility. However, chemotherapy and radiation can temporarily or permanently affect sperm production. Sperm banking before treatment is strongly recommended.
Fertility is an important concern for men diagnosed with testicular cancer, as the disease primarily affects young men of reproductive age. The good news is that most men maintain or regain fertility after treatment, though the impact depends on the type and extent of treatment received.
Removing one testicle does not cause infertility. The remaining testicle typically produces enough sperm for natural conception and continues to produce adequate testosterone to maintain sexual function and overall health. Studies show that men with one testicle have similar fertility rates to men with two testicles when no additional treatment is needed.
However, chemotherapy and radiation therapy can significantly impact sperm production. The effects may be temporary, with sperm counts recovering within one to two years after treatment, or they may be permanent, particularly with higher doses of chemotherapy or radiation directed at the retroperitoneal area.
Sperm Banking
All men diagnosed with testicular cancer should be offered the opportunity to bank sperm before starting treatment. Sperm banking involves collecting and freezing sperm samples, which can be stored indefinitely and used later for assisted reproduction. This is done before orchiectomy when possible, as even before treatment, some men with testicular cancer have lower sperm counts than normal.
The sperm banking process is straightforward, typically requiring one to three samples collected over a few days. While there may be pressure to start treatment quickly, most centers can accommodate sperm banking without significantly delaying cancer treatment.
Fertility After Treatment
For men who choose surveillance after orchiectomy, fertility is generally not affected beyond any pre-existing issues. After chemotherapy, sperm production typically recovers, though it may take 1-2 years. It is recommended to wait at least 6 months after completing chemotherapy before attempting to conceive naturally, to ensure any damaged sperm have been cleared from the system.
Some men experience retrograde ejaculation after retroperitoneal lymph node dissection, where semen goes backward into the bladder instead of out through the penis. While this does not affect sexual pleasure or orgasm, it can impact natural conception. However, sperm can often be retrieved from the urine for assisted reproduction.
While testosterone production usually remains adequate with one testicle, some men may develop testosterone deficiency after treatment, especially if they receive intensive chemotherapy or radiation. Symptoms include fatigue, decreased libido, and mood changes. Testosterone replacement therapy is available and effective for men who need it.
How Do I Perform a Testicular Self-Examination?
Perform a testicular self-exam monthly, during or after a warm shower when the scrotum is relaxed. Hold each testicle between your thumbs and fingers, rolling gently to feel for lumps or changes. Know what is normal for you so you can detect any changes early.
Regular testicular self-examination is the most effective way to detect testicular cancer early, when it is most treatable. While there are no routine screening tests for testicular cancer, self-examination allows men to become familiar with their normal anatomy and quickly notice any changes that warrant medical attention.
Self-examination should be performed monthly, ideally during or immediately after a warm bath or shower. The warmth relaxes the scrotal skin, making it easier to feel the testicles and detect any abnormalities. The entire examination takes only a few minutes.
Step-by-Step Self-Examination
- Stand in front of a mirror: Look for any swelling or changes in the skin of the scrotum
- Examine one testicle at a time: Hold the testicle between your thumbs and fingers with both hands and roll it gently but firmly
- Feel the entire surface: Check for any lumps, bumps, or areas of unusual hardness
- Identify the epididymis: This soft, tube-like structure behind each testicle is normal and should not be confused with a lump
- Compare both testicles: It is normal for one to be slightly larger or hang lower than the other
- Note any changes: If you find anything unusual, contact a healthcare provider promptly
What to look for during self-examination:
- Hard lumps or nodules on the surface or within the testicle
- Change in size or shape of either testicle
- A feeling of heaviness in the scrotum
- Dull ache in the lower abdomen or groin
- Swelling or fluid collection in the scrotum
Most lumps found during self-examination are not cancer. Common benign conditions include epididymal cysts, spermatoceles, and varicoceles. However, any new lump or change should be evaluated by a doctor to rule out cancer. An ultrasound can usually quickly determine if a lump is concerning.
What Is the Prognosis for Testicular Cancer?
Testicular cancer has an excellent prognosis with more than 95% of men being cured. Even when the cancer has spread, modern chemotherapy achieves cure rates of 80-90%. Early detection improves outcomes, with nearly 99% survival for localized disease.
Testicular cancer is one of the most curable cancers, with overall survival rates that far exceed most other malignancies. This success is due to the cancer's remarkable sensitivity to chemotherapy, particularly cisplatin-based regimens developed in the 1970s that transformed the disease from often fatal to highly curable.
The prognosis depends primarily on the stage at diagnosis and the type of tumor. For localized disease (stage I), the five-year survival rate approaches 99%. Even for metastatic disease, survival rates remain impressive: 96% for regional spread and 73% for distant metastases. These figures continue to improve as treatment protocols are refined.
Prognosis by Stage and Type
Stage I (Localized to testicle): Nearly all patients are cured. With active surveillance, about 80-85% of seminomas and 70-75% of non-seminomas will not recur after orchiectomy alone. Those who do recur are usually cured with additional treatment.
Stage II (Spread to regional lymph nodes): Cure rates remain above 95% for most patients. Treatment typically involves chemotherapy followed by surgery to remove any residual masses.
Stage III (Distant metastases): While more challenging, the majority of patients are still cured. Prognosis depends on the specific sites of spread and tumor marker levels. "Good prognosis" patients have cure rates exceeding 90%, while even "poor prognosis" patients have cure rates of 50-60%.
Follow-Up After Treatment
Regular follow-up is essential after treatment for testicular cancer, both to detect any recurrence early (when it is most treatable) and to monitor for long-term side effects of treatment. The follow-up schedule is most intensive in the first two years, when the risk of recurrence is highest.
Typical follow-up includes:
- Physical examination
- Blood tests for tumor markers (AFP, hCG, LDH)
- CT scans of the abdomen and pelvis
- Chest X-ray or CT
After five to ten years without recurrence, most men are considered cured and can discontinue regular cancer surveillance, though they should remain vigilant about any new symptoms and continue regular health check-ups.
What Happens If Testicular Cancer Comes Back?
If testicular cancer recurs, most men can still be cured with additional treatment. Second-line chemotherapy and sometimes high-dose chemotherapy with stem cell transplant are effective for recurrent disease, achieving long-term cure in the majority of patients.
Recurrence of testicular cancer, while concerning, is usually still curable with appropriate treatment. Most recurrences occur within the first two years after initial treatment, which is why follow-up during this period is particularly important. The approach to treating recurrent disease depends on the initial treatment received and the extent of recurrence.
For men who were initially managed with surveillance and experience recurrence, standard chemotherapy with BEP typically achieves cure. For those who have already received chemotherapy, second-line regimens using different drug combinations (such as TIP: paclitaxel, ifosfamide, and cisplatin) can be effective.
For more resistant cases, high-dose chemotherapy with autologous stem cell transplant offers another chance for cure. In this approach, very high doses of chemotherapy are given, followed by infusion of the patient's own previously collected stem cells to restore bone marrow function. Cure rates of 50-60% have been reported even for heavily pre-treated patients.
How Does Testicular Cancer Affect Daily Life?
Most men return to normal life after testicular cancer treatment. Having one testicle does not affect sexual function or hormone levels in most cases. Some long-term effects from treatment may include fatigue, hearing changes, or fertility issues, but overall quality of life is typically excellent.
The diagnosis and treatment of testicular cancer can be physically and emotionally challenging, but most men make a full recovery and return to their normal activities, relationships, and careers. Understanding what to expect can help men cope better during and after treatment.
Physical Recovery
Recovery from orchiectomy is relatively quick, with most men returning to normal activities within two to four weeks. Chemotherapy is more demanding, causing fatigue and other side effects during treatment, but these typically resolve within a few months after completion. Regular physical activity, as tolerated, helps maintain fitness and improve mood during treatment.
Sexual Health
Most men maintain normal sexual function after testicular cancer treatment. Having one testicle does not affect the ability to achieve erection, reach orgasm, or experience sexual pleasure. Testosterone production usually remains adequate, though some men may need supplementation if levels become low.
Psychological factors, including anxiety, depression, and body image concerns, can affect libido and sexual confidence. These feelings are normal and often improve with time. Counseling and support groups can help men and their partners navigate these challenges.
Potential Long-Term Effects
Chemotherapy can cause some lasting effects that men should be aware of:
- Hearing changes: Cisplatin can cause hearing loss or tinnitus (ringing in the ears), usually mild but sometimes permanent
- Peripheral neuropathy: Numbness or tingling in the hands and feet that usually improves but may persist
- Fatigue: Some men experience persistent fatigue that can take months to years to fully resolve
- Cardiovascular health: Increased long-term risk of cardiovascular disease, making healthy lifestyle choices important
- Secondary cancers: Small increased risk of developing other cancers later in life
Emotional Well-being
Being diagnosed with cancer at a young age can be emotionally difficult. Many men experience anxiety about recurrence, concerns about fertility and relationships, and difficulty returning to "normal" life after treatment. These feelings are common and valid. Support resources include:
- Professional counseling or therapy
- Support groups for testicular cancer survivors
- Online communities and resources
- Discussions with the healthcare team
Studies consistently show that most testicular cancer survivors report good to excellent quality of life after treatment. While some challenges may persist, the overwhelming majority of men return to full, active lives and report satisfaction with their physical, emotional, and social well-being.
Frequently Asked Questions About Testicular Cancer
The most common early sign of testicular cancer is a painless lump or swelling in one testicle. Other early signs include a change in size or shape of the testicle, a feeling of heaviness in the scrotum, or a dull ache in the lower abdomen or groin. Some men also experience testicular pain or discomfort. It's important to perform regular self-examinations to detect any changes early. If you notice any of these symptoms, see a doctor promptly for evaluation.
Testicular cancer has one of the highest cure rates of all cancers. The overall 5-year survival rate exceeds 95%. Even when the cancer has spread, modern treatment with chemotherapy achieves cure rates of 80-90%. When detected early and localized to the testicle, the survival rate approaches 99%. This excellent prognosis is due to the effectiveness of cisplatin-based chemotherapy and the cancer's high sensitivity to treatment.
Many men can still father children after testicular cancer treatment. Having one testicle removed does not cause infertility, as the remaining testicle usually produces enough sperm. However, chemotherapy and radiation therapy can temporarily or permanently affect sperm production. Men are offered sperm banking before treatment to preserve fertility options. Sperm production often recovers within 1-2 years after treatment, but it's recommended to wait at least 6 months after chemotherapy before trying to conceive.
Testicular cancer is diagnosed through several steps: First, a physical examination of the scrotum. Then an ultrasound scan, which can distinguish between tumors and other conditions like inflammation. Blood tests for tumor markers (AFP, hCG, LDH) provide additional diagnostic information. The definitive diagnosis is made by surgically removing the affected testicle (radical orchiectomy) and examining the tissue under a microscope. A CT scan is performed to check if the cancer has spread.
The exact cause of testicular cancer is not fully understood, but several risk factors have been identified. The main risk factors include: having an undescended testicle (cryptorchidism), family history of testicular cancer, previous testicular cancer in the other testicle, and certain genetic conditions like Klinefelter syndrome. Testicular cancer is not linked to injury, physical activity, or sexual activity. It is most common in young men aged 15-45, with peak incidence between ages 28-43.
Seminoma and non-seminoma are the two main types of testicular cancer, both arising from germ cells. Seminomas tend to grow more slowly and are very sensitive to radiation therapy. They typically occur in men aged 30-50 and have an excellent prognosis. Non-seminomas grow faster and are more common in younger men (teens to early 30s). They include several subtypes: embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. Non-seminomas are treated primarily with chemotherapy if spread has occurred. Both types have high cure rates with appropriate treatment.
References and Sources
This article is based on peer-reviewed research and international clinical guidelines. Key sources include:
- European Association of Urology (EAU). EAU Guidelines on Testicular Cancer. 2024. uroweb.org/guidelines/testicular-cancer
- National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Testicular Cancer. Version 1.2024.
- Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249.
- Cheng L, Albers P, Berney DM, et al. Testicular cancer. Nat Rev Dis Primers. 2018;4(1):29.
- World Health Organization (WHO). WHO Classification of Tumours of the Urinary System and Male Genital Organs. 5th ed. 2022.
- Einhorn LH. Treatment of testicular cancer: a new and improved model. J Clin Oncol. 1990;8(11):1777-1781.
- Fizazi K, Pagliaro L, Laplanche A, et al. Personalised chemotherapy based on tumour marker decline in poor prognosis germ-cell tumours (GETUG 13): a phase 3, multicentre, randomised trial. Lancet Oncol. 2014;15(13):1442-1450.
About the Medical Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising board-certified physicians specializing in oncology, urology, and evidence-based medicine.
Medical Writing
Content developed by medical writers with expertise in oncology, following GRADE evidence framework and international clinical guidelines.
Medical Review
Reviewed by board-certified urologic oncologists ensuring accuracy and adherence to current best practices and guidelines.
Evidence Level: This article is based on Level 1A evidence from systematic reviews, meta-analyses, and international clinical practice guidelines (EAU, NCCN, WHO).