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Men’s health questions

The danger of prostate cancer lies in the fact that a patient might be asymptomatic and still have aggressive cancer. That is why there is value in screening for prostate cancer in an appropriate male with risk factors for the disease. Usually, screening starts at age 50 years, unless very high risk (like a first-degree relative) then we might start screening from as early as 40 years.

Male patients above the age of 50 years sometimes have a poor urinary flow, which in most cases refers to an enlarged prostate. This doesn’t necessarily mean that the patient has cancer, but sometimes acts as a trigger to screen for prostate cancer.

One of the most common symptoms that indicates advanced prostate cancer, include lower backache with or without weakness of the lower limbs. The first most common site for metastases from prostate cancer, is the lumbar spine.

As for testicular cancer, the most common sign to look out for include a painless lump in the testis. Up to 10 percent of patients with testicular cancer present with testicular pain. Although testicular cancer represents only about 1 percent of all cancers in men, it is the most common solid malignancy affecting males between ages 15 and 35 years.

Signs and symptoms suggesting advanced disease include shortness of breath (from lung metastases), loss of weight, abdominal pain and gynaecomastia (a condition where men develop female-like breasts).

1. How can men mitigate their risk relating to the following health issues?

Prostate cancer

Unfortunately, most of the important risk factors for developing prostate cancer cannot be mitigated. Keep in mind that all men are at risk for prostate cancer.

This risk increases significantly with older age. It is very rare to find prostate cancer in men younger than 50 years. Up to 80 percent of men aged 80 years, will have prostate cancer. Luckily, the majority of these cancers are slow growing and thus rarely cause morbidity or death.

Ethnic background plays a significant role in the incidence and aggressiveness of prostate cancer. African American men develop prostate cancer more often and are more likely to die of prostate cancer compared to Caucasian and Hispanic men. Unfortunately, data from South African ethnicities and the relation to prostate cancer is scarce. Available local data suggests that men from black ethnicity are at higher risk for prostate cancer.

Men who have a first-degree relative (father or brother) with prostate cancer are more likely to develop prostate cancer. Men with female relatives with breast cancer related to the breast cancer gene (BRCA) are also a higher risk for developing prostate cancer.

Some research suggests that a diet high in animal fat and low in vegetables may increase your risk for prostate cancer.

Testicular cancer

Again, most risk factors for developing testicular cancer cannot be mitigated. The most important risk factors include a history of undescended testis (cryptorchidism), previous cancer in the other testis, family history, HIV, Caucasian ethnicity and hypospadias.

The risk for testicular cancer becomes less if an undescended testis is brought down with a surgical procedure earlier in life, however these patients still have an increased risk for developing testicular cancer in both his testicles. In adults with a testis that is still inside the abdomen, the surgical removal is sometimes indicated, purely because of the high risk of developing cancer in that testis and the inability to do self-examination on that testis. Approximately 10 percent of all testicular germ cell tumours have a history of previous cryptorchidism.

Patients with previous testicular cancer should do careful follow-up and self-examination of the remaining testis, as this testis has the same genetic make-up and thus the same risk for developing cancer.

Approximately 1 to 3 percent of men with a testicular germ cell tumour have a family member with the disease, which is a significantly higher incidence compared to the general public. This risk is 6 to 10-fold higher in patients with first degree relatives.

Patients with HIV and previous hypospadias (abnormal opening of the urethra on the penis or scrotum) both are associated with a slightly higher incidence of testicular cancer.

Traditionally the incidence of testicular cancer is higher in Caucasians compared to African Americans, however this demographic seems to be changing.

2. To encourage men to take action and manage their health risks, it’s important to debunk myths that stop them from doing just that. What have you found to be 2 of the most common myths relating to each of the following issues, and what is the truth?

Prostate cancer

Myth 1: All patients diagnosed with prostate cancer needs active treatment

Active management options to cure prostate cancer includes surgery, radiotherapy, hormonal treat or a combination of the mentioned modalities. These options are associated with significant morbidity, including erectile dysfunction and voiding problems. Newer technologies like robotic assisted surgery seems to minimise the morbidity, but ultimately cannot guarantee that the treatment will be free of complications and morbidity.

For this reason, we DO NOT offer active curative treatment to all patients diagnosed with prostate cancer. Your urologist will discuss treatment options in full after being diagnosed with prostate cancer. Patients at extremes of age and also patients with significant and multiple medical comorbidities will usually be offered “watchful waiting” as a management option. The rationale behind this decision is that the treating urologist/oncologist is of the opinion that in this specific scenario, the cancer will probably progress very slow and that the patient is unlikely to die because of the cancer. You will still be followed up closely, with the view of lesser morbid treatment once the cancer progresses. Another management option is called “active surveillance”. This approach is reserved for fit and healthy patients with a good life expectancy and a low risk prostate cancer. These patients get followed up regularly to determine when the cancer is becoming more aggressive, at which stage the patient will require active curative treatment. This can save a patient the morbidity of the treatment for a couple of years, without compromising the patient’s chance at cure.

Myth 2: The dreaded finger test can be replaced by a blood test.

Unfortunately (for both doctor and patient), the digital rectal examination still has an important role in the diagnosis and management of prostate cancer. It is well known that this test is not accurate to determine the presence of prostate cancer, but valuable information can be obtained with regards to the size and stage of the prostate cancer.

The fear of the digital rectal examination is not a reason to stay away from the doctor. By far the majority of patients report only mild discomfort during the examination. It is a quick test and with enough lubrication, should hardly be troublesome.

Testicular cancer

Myth 1: You can’t have children after treatment of testicular cancer

Up to 50 percent of men with testicular cancer have a low number of sperm even before treatment. Treatment with surgery, radiation, or chemotherapy can reduce or eliminate sperm production, causing infertility. For this reason, it is recommended that a patient should store sperms prior to the start of treatment for testicular cancer. This is done by a process called semen cryopreservation.

Men who weren’t able to store sperm before treatment may still be able to father a child after treatment, depending upon the type and amount of treatment used.

Myth 2: Testicular cancer has a very poor prognosis

As far as solid organ cancers go, testicular cancer probably has one of the best prognoses. More than 95 percent of ALL patients diagnosed with testicular cancer survive their disease. Even patients with stage 3 disease (already spread to other organs) have a decent chance of survival with a combination of surgery, chemotherapy with or without radiotherapy.

3. Is it possible to do a self-examination for prostate and/or testicular cancer? If so, what is the basic guide to this / are there any tips for doing this correctly?

Patients with prostate cancer may have no symptoms at all. Unfortunately, no self-examination tool is available to screen for prostate cancer. The most commonly used screening test for prostate cancer is a blood test (serum-prostate specific antigen or PSA), combined with a digital rectal examination. The diagnosis of cancer can only be made by doing a formal biopsy of the prostate.

Testicular cancer is probably the cancer where self-examination has the most value.  This is of upmost importance in patients with high risk for developing testicular cancer. Monthly self-examination, or even assisted by one’s partner or spouse, can pick up many small lumps early and prompt further investigation. It can be useful to compare the testicles with one another and pay attention to any discrepancy in size, contour or consistency of the testes. The testis should be palpated between the thumb and two other fingers. If you have any concern, you have to see your GP or urologist as soon as possible. The doctor will request some blood tests looking at tumour markers and a formal ultrasound scan of the testes. The only way to confirm the diagnosis of testicular cancer as well as the type of cancer is by means of surgical removal of the testis, via an inguinal incision.

4. What are symptoms or warning signs a man can observe in himself for prostate or testicular cancer? When is it time to seek medical intervention?

The danger of prostate cancer lies in the fact that a patient might be asymptomatic and still have aggressive cancer. That is why there is value in screening for prostate cancer in an appropriate male with risk factors for the disease. Usually screening starts at age 50 years, unless very high risk (like a first degree relative) then we might start screening from as early as 40 years.

Male patients above the age of 50 years sometimes have poor urinary flow, which in most cases refers to an enlarged prostate. This doesn’t necessarily mean that the patient has cancer, but sometimes acts as a trigger to screen for prostate cancer.

One of the most common symptoms that indicates advanced prostate cancer, include lower backache with or without weakness of the lower limbs. The first most common site for metastases from prostate cancer, is the lumbar spine.

As for testicular cancer, the most common sign to look out for include a painless lump in the testis. Up to 10 percent of patients with testicular cancer present with testicular pain. Although testicular cancer represents only about 1 percent of all cancers in men, it is the most common solid malignancy affecting males between ages 15 and 35 years.

Signs and symptoms suggesting advanced disease include shortness of breath (from lung metastases), loss of weight, abdominal pain and gynaecomastia (a condition where men develop female-like breasts).

By Dr Ernst De Wet, Urologist
Mediclinic Louis Leipoldt
021 948 9025

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