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Posted April 08, 2022 by Joseph Dankoff, MD
Listen to this episode of the Healthy Vitals Podcast.
Dr. Dankoff provides an overview of testicular cancer. Learn about symptoms, prevention, and treatment options.
Scott Webb: According to the Testicular Cancer Society, one guy every hour is diagnosed with testicular cancer. But if diagnosed early, the survival rate is 95% or higher. And joining me today for a frank conversation about testicular cancer, including the importance of self checks, is Dr. Joseph Dankoff. He's a physician and urologist with Summa Health.
This is Healthy Vitals, a podcasts from Summa Health. I'm Scott Webb. Doctor, it's so great to have you back on. We've spoken before. And I was just mentioning, we tend to talk about, you know, guy stuff and that's kind of in my wheelhouse, being a 53-year-old guy. And great to have you on. This topic, you know, is one that I'm sure folks have a lot of questions, guys have a lot of questions about, and maybe their family members too. So let's start here with a basic one. What is testicular cancer?
Dr. Joseph Dankoff: Testicular cancer, of course, as the name implies is a cancer originating in the testicle. It is something that does tend to affect our younger men. So as opposed to the conversation we had previously, where we were talking about things that can affect older men, we're talking about something that happens to younger men now. This is the most common cancer in men ages 20 to 40. And for men ages 15 to 19, it's only second to leukemia as the most common tumor in that age group. So we're talking about a much younger population. We're talking about the high school age, the college age, young men that we really need to have checking themselves. Not that it can't happen to older men, but it's much more common in the younger men.
Scott Webb: We'll see now, this is why we have the experts on like yourself, because I didn't know that. I've never done a podcast on this, so I'm so glad to have you on. So let's dig into this just a little bit then. Do we know why it affects younger males more so than guys my age?
Dr. Joseph Dankoff: Not really. We don't know. That we do know one of the risk factors is if a young man is born with an undescended testicle, which can be something that young men can be born with, that the testicle doesn't make its way in the mother's womb whole way down from the abdomen into the scrotum. That malpositioning of the testicle makes it at higher risk of forming a tumor. So one of the risk factors is if a man, when he was a baby or when he was a child had an undescended testicle, that's either never been brought into the scrotum or surgically been brought down into the scrotum, we need to keep an eye on that for the rest of the man's life.
If there's a family history of testicular cancer, or if a man is having troubles fathering a child for unknown reasons. And you know, he and his spouse are trying to have a child, they just don't seem to be able to get a pregnancy going, that's something where in the back of our mind we have to be sure that we're not dealing with some type of malignancy.
Scott Webb: What are some of the other signs and symptoms of testicular cancer?
Dr. Joseph Dankoff: Something that wasn't there a month ago. The women are taught very carefully from a very early age to check their breasts monthly, to make certain that any new lumps get evaluated. And we are advocating that for our young men too, that they check themselves monthly. Anything that wasn't there a month ago needs to be evaluated. Many times, it doesn't turn out to be anything serious, but it could be. And the problem with guys is that guys don't want to talk about that kind of stuff. And guys don't want to mention to their parents or to their significant other that there's something new there because you're supposed to be a guy and you're Superman, and that's a problem.
Scott Webb: You know, maybe this is obvious, but as you and I are sort of acknowledging here that guys don't always want to talk about things. And we're two guys, and we're going to talk about this today. So is there a right and wrong way for a guy to check himself?
Dr. Joseph Dankoff: A lot of times we recommend they do it in the shower when the water's nice and warm, the scrotum tends to relax a little bit. And you know, I think we're past the era where men feel awkward talking about this. So interesting when Tom Green from MTV caught testicular cancer in 2000 and he got on and told his story to the world that was revolutionary in the conversation for testicular cancer, because if you're old enough to remember the movie Brian's Song...
Scott Webb: I am. Yeah.
Dr. Joseph Dankoff: Yeah. Brian Piccolo had testicular cancer in 1969. And then the movie was made for TV in 1971 and they portrayed cancer treatment. "Oh, well, you have the stiff upper lip, you know, and he toughed it out and he had a full head of hair at the beginning of the movie and a full head of hair at the end of the movie. That's not reality. That's a very wrong way of portraying at least the cancer care at that time. So then you come along and Lance Armstrong is diagnosed in 1996 and Scott Hamilton in 1997. But when Tom Green went on MTV and told his story point blank and very vivid description, that was great, because young men saw that and could relate to that. And the conversation could happen because people didn't feel weird talking about something like that. And that's really the important thing is that guys, if they have a new lump in there, you don't got to be feeling weird about it. You got to go to a doctor and get it checked out.
Scott Webb: Right. Well, let's talk about that then. You know, here in 2022, it's weird to hear hear myself say that out loud, but 2022, right? Let's talk about from, you know, Brian's Song and Brian Piccolo in 1971. How far have we come? What are the treatment options? What's the prognosis, the outlook for patients?
Dr. Joseph Dankoff: In 1971, in the era before the chemotherapy, that's revolutionary chemotherapy that came around in the 1980s, if a man presents at that era with advanced testicular cancer, there's about a five or 10% chance of him surviving it. Today, even for massively advanced disease, we're talking survival, the curability in the 80 to 90% range. And fortunately, probably 70% of the time, the tumor is completely confined to the testicle. So when we identify that there's a lump there, we're going to have to remove the man's testicle. That in 70% of the cases cures the man and he won't need any additional therapy. So early detection is really important here.
Now, having said that, 30% of the time it isn't confined to the testicle and there may be need for additional therapy down the road, radiation therapy, chemotherapy. Chemotherapy advances have been dramatic, especially with this disease, the blood markers that can be obtained to assess the status of disease. Testicular cancer blood markers were the very first blood markers ever to be linked to the status of a specific cancer. So we use those blood tests to be able to identify status of disease and, down the road, if there's any recurrence of the disease. So we have lots of tools in our toolbox to help identify it and treat it early and get it taken care of .
Scott Webb: You know, we talked a little bit about family history, genetics. Is there anything else that we can do? Because we cannot outrun those things, of course, but acknowledging them and knowing our family history obviously would be really helpful. But is there anything else that we can do, the young men can do, adolescents can do to prevent testicular cancer?
Dr. Joseph Dankoff: Oh, there's not anything that we know of that will prevent testicular cancer. But the early identification of it is the really important thing. God in his wisdom gave us two of just about everything in case one had to be sacrificed or damaged or something like that. And testicles are in that category. So a young man, if he develops a tumor in a testicle and it has to be removed, has the other one on the other side, and there is plenty of male hormone manufactured by a single testicle. There's more than plenty of sperm manufactured from a single testicle to adequately maintain both of those functions, the hormonal and the fertility aspect. So men don't have to worry that by losing one that they throw in the towel completely, not the case. And there are ways that if a man has to go through chemotherapy, we can do sperm banking. We can do hormone replacement therapy if necessary. So there's lots of other things that can be done to help as an adjuvant way if a man has to go through therapy and doesn't have sufficient hormone manufacturing from a single testicle.
Scott Webb: And doctor, we're having this frank conversation today and it's a good one. Kind of wondering if some guys opt for a testicular prosthetic or prosthesis, I'm not sure how to say that. But are those a thing? And do some guys choose to go that route?
Dr. Joseph Dankoff: They do exist. Absolutely. And what is interesting is that if say a pre-pubertal child, or even an adolescent has to have one placed because he wants to look the same as the other guys, you know, and maybe may have a partner someday that he doesn't want to look lopsided for. And then as he gets older, the other one may grow, he can even have it replaced for a next larger size. So it matches the other one. And even to the discerning eye, they'll look the same. We've even had experienced healthcare providers that couldn't tell the difference between the one that was the fake one and the one that was the real one. So, they're very realistic. They'll definitely make the man have the appearance that he has two.
Scott Webb: Whether it's confidence, self-esteem, just sort of the balance of things down there, I can kind of understand why somebody might want that.
Dr. Joseph Dankoff: True. There are other men that, you know, they're in a stable relationship that have told me, "I just want to be alive. I just want to have the cancer behind me. I've been married for a few years. She doesn't care what I look like down there and I don't care what I look like down there. And I'm perfectly fine only having one," and we're very supportive of that too. But. You're right, I mean, everybody's different from those standpoints.
Scott Webb: Yeah. There's definitely no wrong way. It's whatever works for the patient, but good to know that there are options. Of course, we always like that as patients. And always educational and informative having you on, especially today. This has been really sort of eyeopening for me and really helpful. I'm sure it is for listeners as well. So as we wrap up here, what would be your final takeaways? I'm sure it's early diagnosis and things like that, but let's hear it from you, doctor.
Dr. Joseph Dankoff: Yeah. I mean, 9,000 men are going to be diagnosed with testicular cancer in this country each year. And 400 of them might die of testicular cancer. So we want those numbers, especially the number that die of testicular cancer, we want that to decrease. So the best way is for early detection, early identification, getting men hooked in with providers that are at facilities that are familiar with the treatment of testicular cancer, getting them hooked in with proper oncology support, proper surgical support, proper radiation-oncology support, a multidisciplinary treatment plan. Most cases, when that happens, the men have excellent long-term survival and long-term results.
Scott Webb: That's great to hear. You know, with Colorectal Cancer Screening Month here, we've been doing a bunch of those and so many forms of cancer, you know, people just don't have to die from them. People don't have to die from colorectal cancer, but you have to be screened. Men don't have to necessarily die and most won't from testicular cancer if they're diagnosed early and treated early,
Dr. Joseph Dankoff: And this is very definitely a disease that the chemotherapy explosion in the 1980s and 1990s, this is one of the diseases that there's no question about, that made a huge difference to the advent of lifesaving chemotherapy regimens that are standard things now that were just coming into play when I was coming through my training in the 1980s, that was just being newly developed at that time. And now, it's standard care 30 years later.
Scott Webb: Yeah, for sure. And I always get excited when I see your name on my schedule, because I know you're going to have all the answers, I'm going to get a great education and then hopefully it will be a great conversation for the listeners. So as always, thanks so much. You stay well.
Dr. Joseph Dankoff: My pleasure. You take care.
Scott Webb: To schedule an appointment, call 330-374-1255 or visit summahealth.org/urology for more information.
And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.