Men don’t like to talk about testicular and prostate cancer. We don’t like to think about the places we’re afflicted or the side effects we’re experiencing. Most of us would rather pretend nothing is wrong than visit the sterile environment of a medical facility and talk to a stranger about our most intimate areas.
M Physician’s Christopher Weight, MD, has spent almost 20 years studying and treating urology and urologic cancer. His father was diagnosed with prostate cancer during his residency so he knows the trickiness of the topic firsthand. He got into the field because urologic cancers—testicular, prostate, kidney, and bladder—are treatable and very often curable. But, ignoring the issue, he says, is when real problems occur.
“A lot of the challenges come when men ignore or don't seek help or don't get treated,” Dr. Weight says. “But if men are proactive with [testicular and prostate] cancer, in particular, it’s very rare to die from them."
The Prevalence of Testicular & Prostate Cancer
An estimated 1.7 million people were diagnosed with cancer in 2018 and more than 609,000 cancer-related deaths occurred. It goes without saying that cancer is a prevalent and pervasive killer that impacts vast numbers of Americans every year.
“Not all cancer is the same,” Dr. Weight says. “The good news is most men, probably 95 percent or higher, will survive these cancers if they get treated and their conditions are followed.”
In 2019, there were an estimated 9,560 new cases of testicular cancer diagnosed, and 410 sufferers were expected to die from it. Testicular cancer comprises just 0.5 percent of all new cancer diagnoses and just 0.1 percent of cancer-related deaths.
Prostate cancer diagnoses are far more common—174,650 estimated new cases in 2019—and more sufferers die from it—31,620 in 2019—but it comprises 10 percent of new diagnoses and just 5 percent of all deaths.
Proactively Preventing Testicular & Prostate Cancer
Time and again, Dr. Weight says the key to avoiding becoming one of the tragic statistics of urologic cancer is being proactive. Consistent self-exams, periodic screenings, exploring family history, and eating well can all contribute to reducing the likelihood of testicular and prostate cancer among men.
Testicular cancer recommendations
Most types of cancer develop in men as they age, but testicular cancer is somewhat rare in that it usually shows up in men in their 20s and early 30s.
“When I say ‘be proactive’ with testicular cancer, I mean doing periodic self-exams and if you feel any abnormalities, get a medical opinion about it,” he says.
Dr. Weight explains that men should be looking for a hard mass in the testicle itself. Not everything inside the scrotum is considered the testicle—blood vessels, muscles, tubes, etc. reside there as well—but men should be on the lookout for a discernable hard mass.
“I'm not talking about a grain of salt,” Dr. Weight cautions. “Sometimes you can get a little calcification or something that's not concerning but really it's a mass at the size of a pea or bigger that should alert you that there might be something abnormal there.”
Prostate cancer recommendations
Prostate cancer, on the other hand, doesn’t generally show up in patients until the late 60s or
early 70s. Being proactive with this type of cancer is threefold: Getting a prostate-
specific antigen (PSA) screening test, which is simply a blood draw, exploring your family
history, and watching what you eat.
Dr. Weight recommends getting a PSA in your 50s to establish a baseline from which deviations can be identified and treated. PSAs can be problematic if the results are interpreted incorrectly or too much stock is given to any one value but they’re a useful first step in prostate cancer prevention. In addition, he says, it is valuable to look to your family for signs of increased cancer activity.
“If multiple men in your family have prostate cancer that should encourage you to think about getting screened at a young age,” he says. “And, if women in your family have breast cancer, that increases your risk for prostate cancer.”
Dietary recommendations
The research is not 100 percent conclusive on the link between diet and prostate cancer, but causal relationships are being explored. “Obesity is connected to prostate cancer risk, but we’re unsure about the details,” Dr. Weight explains. “We don’t know if it’s the state of being obese or if it’s something about the lifestyle that leads to obesity.”
Either way, there is a specific food-related relationship most men won’t want to hear. Dr. Weight says red meat and grilled processed meat have both been implicated in increasing one’s risk for prostate cancer.
“It’s a real downer,” Dr. Weight laughs. “There is pretty solid evidence that when you cook brats, bacon, or grill burgers, you create these compounds called heterocyclic amines. When they come in contact with DNA, they can bind and mutate the DNA.”
Moreover, they have found heterocyclic amines in men with prostate cancer and in those who undergo prostate surgery. But, he’s quick to point out that while the data aren’t conclusive that red and processed meats cause prostate cancer, they are conclusive that heterocyclic amines damage DNA.
“What I often say is that anything that you’ve heard is good for your heart like exercising and eating well, is probably good for your prostate … and good for your erections, by the way,” Dr. Weight says.
Dealing with a Testicular or Prostate Cancer Diagnosis
Cancer comprises more than 120 different diseases, which means the prognosis, quality of life, and expectations for each diagnosis differ drastically. But, testicular and prostate cancer are unique forms of the disease that provide a relatively encouraging outlook.
Testicular cancer
A diagnosis of testicular cancer almost always means the testicle that is affected will need to be removed. But, the reality of removing a testicle is not as intimidating as it sounds.
“It’s usually an outpatient surgical procedure where you go home the same day,” Dr. Weight says. “About 60 to 65 percent of those testicular cancer cases are early stage and localized, meaning they're found early enough that the surgery may be all that is needed to treat it.”
This type of testicular cancer is considered Stage One and there are usually no long-term sequelae and it does not usually affect sexual performance or fertility. There is even a prosthesis available that can be inserted if men are concerned about the appearance of a missing testicle.
For the 35-40 percent of cases in which the cancer has spread to the retroperitoneal—i.e., the origin of the testicles, located behind the kidneys—there can be some long-term challenges.
Dr. Weight explains: “We're finding more and more there are long-term consequences of chemotherapy that can manifest in some numbness and tingling in hands, fingers and toes, which seems to be exacerbated by cold weather. So that makes it a little more frustrating for Minnesotans.”
Another long-term risk of chemotherapy is late cardiac toxicity, which means testicular cancer survivors who have chemo generally have a higher rate of heart attacks later in life. Also, cancerous cells that aren’t destroyed by chemotherapy may have to be removed surgically, which can create additional risk factors for fathering children.
“The long-term effects do present challenges so that underscores the importance of the timeliness of the treatment because, if you catch it at Stage One, it can often be cured by a pretty straightforward surgical procedure,” Dr. Weight says.
Prostate cancer
Given its prevalence and the timing in which diagnoses usually occur, prostate cancer can certainly present some quality-of-life challenges but the short-term risk of death is very low.
Around 40 percent of prostate cancer cases require surgery or radiation, which can impact sexual and urinary function. But, as long as the cancer is localized—i.e., within the prostate or immediate vicinity—when it is diagnosed, the survival rate for your next five years is 100 percent. Extrapolate that out to 15 years, and the cancer specific survival rate is still around 80-90 percent.
In other words, if you’re diagnosed with prostate cancer at an early stage, your chances of living five years are virtually guaranteed and you’re more than likely to live at least another 15 years.
“We now watch [rather than treat] about 50 to 60 percent of prostate cancer cases because we know the short-term risk of death from low-stage, low-grade prostate cancer is quite low,” Dr. Weight says. In fact, the slow progression of most prostate cancer has caused some to suggest that it shouldn’t be called “cancer” anymore.
“If you can leave it alone and nothing happens to over half the people diagnosed, that doesn’t fit into the cancer category in most people’s minds,” he says. “But Prostate Cancer is a mixed bag.
Some prostate cancer remains quite aggressive and even with all of our best treatments, we still lose thirty thousand men every year to prostate cancer in the U.S.”
The Bottom Line
If you’re diagnosed with prostate or testicular cancer, don’t panic. It’s a serious diagnosis but taking the right steps can mean the difference between dealing with it or letting the disease win.
First, seek a second opinion. Testicular cancer is very rare and prostate cancer moves so slowly that a second opinion from a specialist who sees a lot of these cancers is wise.
Next, keep perspective. “Just because you have cancer or a concern in this place it isn’t the entirety of you.” Dr. Weight says. “Sometimes men wonder if it has to do with sexual behavior or number of partners or something. Some people are worried about what it might mean. It just occurs. It happens to men and it's usually treatable and often curable.”
Finally, seek out a support network. “I think [finding a support network] is super helpful,” Dr. Weight says. “To connect with other men who are going through the same thing and hearing how they have dealt with it is really valuable. It’s also really helpful for your spouse to have other spouses to connect with.”
If you’ve been diagnosed with any form of cancer and you or your spouse is looking for some support, check out this list of groups in the Minneapolis-St. Paul area.