How to Avoid Testicular Cancer

Sean Kimerling was a successful New York TV sportscaster and a lifelong athlete.  When he started to experience unexplained back pain, it was chalked up to an old sports injury. But the pain got worse. It was testicular cancer, discovered too late. We lost Sean in 2003, at age 37.

The death of any young man in his prime is a tragedy. But Sean’s was particularly heartbreaking. If he had been diagnosed early, he likely would have lived a normal life.

If you’re like most guys, you don’t even want to think about testicular cancer, let alone talk about it. But talking about it and getting educated could save your life.

Early Detection is the Game Changer

Testicular cancer is treatable. Survival rates for stage I diagnosis are as high as 99 percent. But the odds drop as the disease progresses, so early detection is absolutely critical.

Understand the Risk

Cancer begins when cell production goes out of control. In healthy tissue, new cells surface as needed to replace older or damaged ones. With cancer, some cells mutate and replicate unchecked. Left untreated, these rogue cells can spread to other parts of the body, leading to cancer that is more difficult to treat or even death.

Unlike other cancers, testicular cancer strikes young, healthy men. For men aged 30 to 39, it is one of the most frequently diagnosed types of cancer. All the causes are not well understood, but here’s what we do know:

• White men aged 15 to 44 are at risk, but it is rare among African Americans
• Men with a family history are at higher risk, as are those born with undescended testicles, even after surgical correction
• Men previously diagnosed have a slightly higher risk of cancer in the other testicle
• Research has uncovered no strong association with diet, exercise or occupational radiation exposure
• There’s no link between testicular and prostate cancer
• Past injury doesn’t seem to increase risk, but it’s not unusual for it to be discovered after trauma

Know What to Check For

In its early, most treatable phase, it produces no pain and shows no outward signs. So, self-examination is our best defense. It’s simple, painless and could save your life. We recommend a self-exam every other month to check for signs. It’s easy to do, and it can be done in the shower or bath.

Once you know the lumps and bumps of your anatomy—how your “normal” feels—you will be on guard for something firm and less compressible, almost like a small marble in the midst of normal tissue. You should also report any significant change in size, shape, or consistency.

What If I Do Feel Something Unusual?

Your primary care provider can perform a more thorough exam. Most of the time, there is nothing to worry about. But if something is suspect, an ultrasound will be scheduled. If it turns up anything of concern, the next step is referral to a urologist.

Urologists know what to look for, and we can also order special blood tests for tumor markers to better plan treatment strategy.

Staging and Treatment

Treatment almost always includes surgery. Other forms of therapy may be in order, depending on the stage.

• Stage I is when the mass is confined to the testicle, the most treatable form. Most men present this way, with treatment at a 99% success rate
• Stage II involves nearby lymph nodes as well, but the treatment odds are still good—at 96%
• Stage III has spread to other parts of the body, like the lung, heart or brain. Treatment success rate is 73%, but it’s rare for the disease to get this far before detection
• Unlike other cancers, this one has no stage IV.

We don’t recommend biopsy—taking a sample of tissue for lab testing—as it can spread the cancer cells. The best course of action is removal of the affected testicle, a procedure known as radical orchiectomy.

The tissue is tested and additional tests are administered on the pelvis, to identify the type and extent of cancer and determine if chemotherapy or other post-surgical treatment is needed.

Planning a Family

The testicles perform two major functions: producing sperm for reproduction and testosterone, which affects facial hair, musculature, and other hallmarks of the male sex. For most men, one testicle can do the work of two. The surgical procedure alone doesn’t generally affect testosterone production, semen quality, fertility or sexual function.

Many men diagnosed with testicular cancer are at the age for starting or growing a family. We recommend a discussion about sperm banking to protect the reproductive legacy, in case future treatment puts sperm production at risk. A urologist specializing in fertility can complete a full evaluation.

Sperm banking may not be covered by insurance, but it is inexpensive, and grants or other forms of financial aid may be available.

Life after Surgery

Since most men present early, they don’t need chemotherapy or radiation, and their prognosis is very good. The procedure is generally very well tolerated, with a short recovery time. During the removal, the surgeon can implant a prosthesis, or artificial testicle, that looks and feels natural.

Sexual function is rarely affected long term. Chemotherapy or radiotherapy can affect sperm quality and can cause fatigue that affects the mood for sex. After chemotherapy or radiotherapy, men should wait one year before trying to conceive to allow damaged sperm to clear from the body, and some men may not recover fertility after chemotherapy or radiotherapy. If surgery involved lymph nodes in the back, there is a small chance of complication that will prevent ejaculation. Although very rare, it’s another good reason to bank sperm.

Most men treated early live normal, healthy lives. But since the risk of recurrence and other cancers is never zero, we recommend healthy lifestyle choices for the future, including maintaining good nutrition and a healthy weight; staying active and exercising; and limiting alcohol intake. Smokers are encouraged to quit, since tobacco use increases the risk of many other cancers and can complicate chemotherapy.

It may seem a daunting prospect, but with early detection, testicular cancer is among the most treatable forms of cancer. The more you learn about it, the better prepared you will be. Ask your doctor for more information and keep doing self-exams. With vigilance and education, there’s no reason for this disease to keep you out of the game.