By Deborah Jeanne Sergeant
Estimates for testicular cancer are approximately 9,310 new cases diagnosed and 400 deaths, according to the American Cancer Society. About one out of every 250 men will develop testicular cancer at some point during their lifetime.
Unlike many cancers, it strikes mostly young and middle-aged men at an average of age 33. Only 6 percent of cases are in children and teenagers and men over age 55 comprise only 8 percent. Also uncommon is its high likelihood of successful treatment. As with most cancers, early detection and treatment improves the chances of good outcome.
“Sometimes a low sperm count can be a first sign of testicular cancer,” said Jeanne O’Brien, professor of urology and male infertility for URMC Urology. “Men with testicular cancer have lower sperm count. They often come to a fertility expert who finds a mass.”
Some men may notice a painful lump in the testicle or a lump in the abdomen while showering or dressing.
“Most know it’s been there for moths before they come in,” said physician Edward M. Messing, professor of urology, as well as oncology and pathology at University of Rochester School of Medicine and Dentistry. “Most related it to unrelated scrotal trauma, like getting hit during athletics.”
Rarely, pain in the scrotum could indicate testicular cancer.
Messing estimated that one third of cancers are caught once metastatic. But despite its spreading, “it’s one of the few cancers where there’s a very high probability of cure, even when far advanced,” Messing said. “It can be in the 90 percent level.”
The reason is that testicular cancer is very sensitive to chemotherapy, even in the advanced stage; however, the severity and cost of treatment increases if the disease has advanced.
Messing said most doctors recommend removal of the diseased testicle, as European doctors have attempted testicle-sparing approaches with little success. Sparing the testicle increases the chances of the cancer spreading to the lymph nodes.
“Usually, it’s so big by the time you’ve found it, it has replaced the testicle,” Messing said.
Although men can still father children with one testicle, the chemotherapy may cause infertility, and it can affect the nerves that cause semen to ejaculate (although erections still occur).
Risk factors include a non-descended testicle at birth, a factor for one out of 1,000 boys. Messing said that the testicle that had not descended is at exceptionally higher risk than in other patients and even the normal testicle has an elevated risk.
Caucasian ancestry is also a risk factor.
A man with a previous testicular cancer has a higher risk in developing cancer in the remaining testicle, which is why banking sperm is a good idea for men who still hope to father children after treatment for testicular cancer.
“Before starting treatment, we can have them bank their sperm so when they’re done with treatment, they won’t regret not banking the sperm,” O’Brien said. “For the two to three newly diagnosed patients I see a year, I will always offer the option to bank their sperm. We have a reproductive endocrinologist who runs the lab.”
Both Messing and O’Brien recommend monthly self exams.
“It’s similar to women and breast exams,” O’Brien said. “In the shower, use a warm, soapy hand once a month to feel any lumps, bumps or things that don’t belong. You can find anything abnormal.”
But more exams isn’t necessarily better. O’Brien said it can lower the threshold for what feels abnormal.