Dear Dr G,

In the first week of November, I hope you can focus on men’s cancers.

It is my understanding that previous Movember campaigns focused on prostate cancer awareness, but I hope other men’s cancers get equal attention this November.

I am a 30-year-old man, married for one year, and facing fertility issues.

I have no problems with sexual intercourse, and my wife and I saw a specialist who ran tests on both of us.

To my surprise, the problem lies with me.

My semen analysis showed a low sperm count and my ultrasound showed testicular microcalcifications.

The doctor said IVF is likely needed and warned of a significant risk of testicular cancer.

I am devastated as I assumed I was fit and healthy but at thirty, I now face the risk of infertility and cancer.

As such, I would like to put Dr G on the spot for clarification.

What exactly is microlithiasis?

How do microcalcifications form in the testicles?

How can these calcifications cause cancer, and what can I do to reduce my risk of testicular cancer?

Please help.

Microcalcification Matt

Testicular microlithiasis is a relatively uncommon ultrasound finding with tiny non shadowing bright spots in the seminiferous tubules. These reflect microscopic calcium deposits within the tubule lumina. It is found in about 0.6–9% of men undergoing scrotal ultrasound and is bilateral in up to 80% of cases.

It is usually asymptomatic and detected incidentally. These findings are often discovered during ultrasound for pain, infertility or swelling. The bright foci correspond to laminated calcified bodies called microliths on histology.

Microliths form when degenerated cells or glycoprotein material act as a nidus for calcium deposition. The exact cause is uncertain, but several mechanisms are proposed. Defective germ cell degeneration may promote calcification. Altered seminiferous tubule drainage can reduce debris clearance and favour microlith formation.

Genetic and developmental factors are linked through testicular dysgenesis syndromes. Inflammation or injury such as chronic orchitis, trauma or prior infection may predispose to microliths. Therefore, the aetiology of microlithiasis is likely multifactorial. Numerous studies report an association between microlithiasis and testicular germ cell tumours.

These include seminoma, embryonal carcinoma and mixed germ cell tumours. Men with microlithiasis have a 5-to-20-fold higher relative risk of testicular cancer. However, the absolute risk remains low in asymptomatic men without other risk factors. Both microlithiasis and germ cell tumours may reflect testicular dysgenesis syndrome.

This involves impaired germ cell differentiation, cryptorchidism and infertility. Microliths may signal disrupted tubule homeostasis, chronic inflammation or microenvironmental stress. These factors could predispose to neoplastic transformation. In isolated microlithiasis without other risk factors, malignancy risk is small.

Routine follow up is not always required, but monthly self examination is recommended. In high-risk individuals, annual ultrasound surveillance is advised. Most men with isolated microlithiasis remain healthy and cancer free, and long-term surveillance is unnecessary unless risk factors exist. Microlithiasis is more frequent in infertile men, with prevalence up to 20–25%.

Microliths may reflect impaired spermatogenesis, tubular atrophy and reduced sperm counts. Possible mechanisms include tubule obstruction and chronic inflammation affecting Sertoli cell function. Up to 30% of men with undescended testes show microlithiasis. This likely reflects developmental origins related to testicular dysgenesis and abnormal descent.

Microlithiasis is also reported in Klinefelter syndrome and Down syndrome. It is linked to granulomatous orchitis, testicular tuberculosis and post traumatic calcification. Despite these associations, erectile function and libido are typically unaffected. Overall, microlithiasis is benign but clinically relevant.

It is not a direct cause of testicular cancer. It serves as a biomarker of testicular dysgenesis and potential malignancy risk in predisposed individuals. Its association with infertility, cryptorchidism and genetic syndromes underscores the need for individualised risk assessment. Patient education and shared decision making are important.

Regardless of microlithiasis, testicular cancer risk is highest in young men. The risk diminishes with age. Regular monthly self-examination is key for early detection. Seek urgent assessment for any painless lump, swelling, heaviness or change in testicular size. Your fertility plan should continue with a reproductive specialist.

Consider sperm banking if counts are low or treatment is planned. Address modifiable factors such as smoking, heat exposure and anabolic steroids. Follow a surveillance plan tailored to your risk profile. As I often say, “Nurturing cautious self awareness from young is key for long term prevention.”