Who is generally at risk for testicular cancer?
We usually see it in men between ages 20 and 40. You can see it outside those ages, but it becomes considerably less common. If you’re looking at older ages past 60, that’s really rare. There are some people who are at higher risk, including those with any history of an undescended testicle, a family history of testicular cancer, or a history of cancer in the other testicle.
Does testicular cancer tend to be caught early?
Most of the time, but about 15% to 30% of testicular cancer patients present with metastatic disease, which means the cancer has spread to other parts of the body. It's most curable without chemotherapy in early stages.
What are some of the early symptoms that men can be looking for?
Often the first symptom is a lump on the testicle – that’s generally the most common symptom, and it’s why I recommend my patients perform a self-check once a week in the shower. They should get to know what’s normal for them, and be able to tell when something feels out of the ordinary.
A person might notice one testicle feels swollen or larger, or in cases when the cancer has metastasized a person might have pain in their back, chest, or abdomen. The problem is, you’re generally not going to feel that kind of pain at an earlier stage of the disease. So, if you’re a younger man and you’ve had gradually worsening back pain over several months, don’t ignore it, get it checked out.
What are the most common treatments for testicular cancer?
Often the first step is surgery to remove the affected testicle. Given that we have two testicles, the other will pick up the slack, so a man is going to be able to make adequate testosterone and still be able to father children. We do have the option to implant a prosthetic testicle if it will help him feel better about his body image.
In cases where the cancer has metastasized, chemotherapy is a very common tool we use and one of the reasons why testicular cancer is so curable. There aren’t a lot of targeted therapies or immunotherapies being used because it would be hard to improve on the extremely high cure rates with types of chemotherapy that we’ve had for 50 years. Sometimes we do need to do major surgery after chemotherapy, which is why we prefer to catch these cancers as early as possible.
What advice do you give young men who may feel hesitant or even embarrassed to mention concerns to their health care provider?
I would say that any provider is going to want to know about anything out of the ordinary, and the best-case scenario is that it turns out to be benign. It can be hard to say something because this is a sensitive part of the body and a man may feel self-conscious, but as a provider I want him to speak up. If a man has a mass on his testicle that he’s concerned about, we can get an ultrasound. If it looks benign, we will figure it out very quickly. If it looks cancerous, we should move quickly toward treatment since some of these cancers can grow and spread quickly.
I don’t think there needs to be panic out there, just an awareness. It’s important for men to know their bodies and to know when something doesn’t feel right or seem right, and then to ask their doctor. Thankfully, testicular cancer is very treatable, but we can’t treat it if we’re not catching it.