Education

Testicular Cancer

Facts & Figures

Doctors do not know the exact cause of testicular cancer

Testicular cancer is highly curable when detected early

Most testicular cancers are found by men themselves

95% of patients with testicular cancer are alive after a five-years

50% of men seek treatment after cancer has spread beyond the testicles to other locations in the body

Risk Factors

Young men between the ages of 15 and 39

White men are affected more than men of other races

Men who have an undescended testicle (cryptorchidism)

Genetic condition known as Klinefelter’s Syndrome

Relatives with testicular cancer

Signs & Symptoms

Pain or swelling in testicle and/or scrotum

Lumps or nodules in testicle, painful or not

Enlargement of the testicle

Change in the way a testicle feels

Pain in the lower abdomen, back, or groin

Collection of fluid within the scrotum

Shrinking of a testicle

Enlargement or tenderness of the breasts

How is Testicular Cancer Diagnosed?

To help find the cause of symptoms, the doctor evaluates a man’s general health.
The doctor also performs a physical exam and may order laboratory and diagnostic tests.

• Blood tests that measure the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers such as alpha-fetoprotein (AFP, Beta-human chorionic gonadotropin (HCG), and lactate dehydrogenase ( LDH may suggest the presence of a testicular tumor, even if it is too small to be detected by physical exams or imaging tests.
• Ultrasound, a test in which high-frequency sound waves are bounced off internal organs and tissues. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection or a collection of fluid unrelated to cancer.
• Chest X-rays: Simple chest x-rays are often used to determine if the cancer has spread to the lungs
• Computed Tomography (CT) scanning: This machine uses a rotating X-ray beam to create a series of pictures of the body from many different angles. A computer processes the information and produces a detailed cross-sectional image of selected parts of the body. Sometimes, a dye is injected into a vein to highlight details on the scan. A CT scan is especially valuable for identifying the spread of tumors to lymph nodes. If the tumor markers are high enough, a CT scan may also be done of the brain. Keep in mind, however, that it is hard to see into areas like the abdomen, and just because a CT scan says everything is normal does not mean that the cancer has not spread at all.
• Biopsy to determine whether cancer is present. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called radical inguinal orchiectomy. In rare cases (for example, when a man has only one testicle), the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding with orchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue. If the problem is cancer, this procedure could cause the disease to spread.
  

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  Standard Treatment Options

• Surgery to remove the testicle through an incision in the groin is called a radical inguinal orchiectomy. Men may be concerned that losing a testicle will affect their ability to have sexual intercourse or make them sterile. However, a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove one testicle does not make a man impotent (unable to have an erection) and seldom interferes with fertility (the ability to produce children). For cosmetic purposes, men can have a prosthesis (an artificial testicle) placed in the scrotum at the time of their orchiectomy or at any time afterward. Some of the lymph nodes located deep in the abdomen may also be removed (lymph node dissection). This type of surgery does not usually change a man’s ability to have an erection or an orgasm, but it can cause problems with fertility if it interferes with ejaculation. Patients may wish to talk with their doctor about the possibility of removing the lymph nodes using a special nerve-sparing surgical technique that may preserve the ability to ejaculate normally.
• Radiation Therapy uses high-energy rays to kill cancer cells and shrink tumors. It is a local therapy, meaning that it affects cancer cells only in the treated areas. External radiation (from a machine outside the body), aimed at the lymph nodes in the abdomen, is used to treat seminomas. It is usually given after surgery. Because nonseminomas are less sensitive to radiation, men with this type of cancer usually do not undergo radiation therapy. Radiation therapy affects normal as well as cancerous cells. The side effects of radiation therapy depend mainly on the treatment dose. Common side effects include fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhea. Radiation therapy interferes with sperm production, but many patients regain their fertility over a period of 1 to 2 years.
• Chemotherapy is the use of anticancer drugs to kill cancer cells. When chemotherapy is given to testicular cancer patients, it is usually given as adjuvant therapy (after surgery) to destroy cancerous cells that may remain in the body. Chemotherapy may also be the initial treatment if the cancer is advanced; that is, if it has spread outside the testicle at the time of the diagnosis. Most anticancer drugs are given by injection into a vein. Chemotherapy is a systemic therapy, meaning drugs travel through the bloodstream and affect normal as well as cancerous cells throughout the body. The side effects depend largely on the specific drugs and the doses. Common side effects include nausea, hair loss, fatigue, diarrhea, vomiting, fever, chills, coughing/shortness of breath, mouth sores, or skin rash. Other side effects include dizziness, numbness, loss of reflexes, or difficulty hearing. Some anticancer drugs also interfere with sperm production. Although the reduction in sperm count is permanent for some patients, many others recover their fertility.
  

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 Testicular Cancer Staging

Stage I: Cancer is found only in the testicle. Removing the testicle alone should cure the patient, though many will choose some form of additional treatment just to be sure…

Stage II: Cancer has spread to the lymph nodes in the abdomen. Removing the testicle alone will not cure the patient, and more treatment is necessary.

Stage III: Cancer has spread to areas above the diaphragm such as the lungs, neck or brain. There may be also be cancer in parts of the body such as the bones or liver. In this situation, chemotherapy is absolutely required. Surgery may also be needed.

Stage IV: To the best of my knowledge, there is no such thing as Stage IV testicular cancer. However, it is possible that Stage IV may still be used in some places in Europe. Suffice to say that Stage IV is probably very similar to Stage III.

Recurrent: Recurrent disease means that the cancer has come back after it has been treated. It may recur in the same place or in another part of the body.

 Follow-Up Treatment

• Regular follow-up exams are extremely important for men who have been treated for testicular cancer. Like all cancers, testicular cancer can recur.
• Men who have had testicular cancer should see their doctor regularly and should report any unusual symptoms right away.
• Follow-up varies for different types and stages of testicular cancer. Generally, patients are checked frequently by their doctor and have regular blood tests to measure tumor marker levels. They also have regular x-rays and computed tomography, also called CT scans or CAT scans.
• Men who have had testicular cancer have an increased likelihood of developing cancer in the remaining testicle.
• Patients treated with chemotherapy may have an increased risk of certain types of leukemia, as well as other types of cancer. Regular follow-up care ensures that changes in health are discussed and that problems are treated as soon as possible.
  

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Men’s Health Issues

Low Testosterone

Testosterone levels decline steadily after age 40. The decline is relatively small, at an average rate of about 1% to 2% percent per year. By middle age and older, virtually all men experience some decline in testosterone — but only a small percentage of aging men have levels far below those considered normal for their age.

Low testosterone is associated with heart disease, depression, Metabolic Syndrome, diabetes, cognitive disorders and even osteoporosis. A 2007 study found that low testosterone was associated with increased risk of death from heart disease, cancer and all causes. One of the reasons that low testosterone is so deadly is that it somehow effects all the major cardiovascular markers. One recent large scale epidemiological study found that low testosterone men, < 250, were 1) fatter, 2) had lower HDL, 3) higher triglycerides, 4) higher blood pressure and 5) higher blood glucose. The low testosterone men were tracked over 18 years and it was found that they had a 40% higher death rate from all causes!

The symptoms of low testosterone usually creep up upon you slowly and quitely. Because of this, many guys ignore their low testosterone symptoms for months or even years: they literally get used to to feeling lousy and functioning poorly.

Signs & Symptoms

Fatigue
Depression
Mental fogginess/fuzziness
Difficulty concentrating
Anxiety
Loss of muscle
Increased weight gain
Decreased facial hair
Mood Swings
Irritability
Reduced strength
Osteoporosis
High cholesterol (high LDL/low HDL)
Impotence
Low libido
Low sperm count
Enlarged breasts

Health Status

• Percent of men 18 years and over in fair or poor health: 11.9%

Health Risk Factors

• Percent of men 18 years and over who met the 2008 federal physical activity guidelines for aerobic activity through leisure-time aerobic activity: 52.3%
• Percent of men 18 years and over who currently smoke: 21.5%
• Percent of men 18 years and over who had 5 or more drinks in 1 day at least once in the past year: 31.2%
• Percent 20 years and over who are obese: 33.9% (2007-2010)
• Percent 20 years and over with hypertension: 31.7% (2007-2010)

Health Insurance Coverage

• Percent of males under 65 years without health insurance coverage: 18.9%

Mortality

• Number of deaths (all ages): 1,217,379
• Deaths per 100,000 population: 803.8
• Leading causes of death
  • Heart disease
  • Cancer
  • Accidents)
    

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Compared to women, men…

Facts and Figures

• 24% of men are less likely to go to the doctor compared to women. The average life expectancy for men is five years fewer than women (presently 77 years old compared to 82).
• 1 in 2 men, and 1 in 3 women, will be diagnosed with cancer in their lifetime.
• Evidence suggests that about a third of the 571,950 cancer deaths expected to occur will be related to obesity, physical inactivity and poor nutrition, and thus could be prevented.
• 1 in 6 men will be diagnosed with prostate cancer in his lifetime.
  In 2012, 242,000 new cases of the disease will be diagnosed and more than 28,000 men will die of prostate cancer.
• Testicular cancer is the most common cancer in American males between the ages of 15 and 35.
  8,590 men will be diagnosed with the disease and 360 will die.
• 1 in every 13 men will develop lung cancer.
• While not as common, men can get breast cancer.
  About 2,140 new cases of breast cancer will be diagnosed among men and about 450 men will die from the disease.
  More than 3.5 million cases of skin cancer are diagnosed each year in the US.
• An estimated 13 million or 11.8% of all adult men over the age of 20 in the US have diabetes.
• Approximately 76.4 million men and women in the US have high blood pressure- 1 in 5 do not know it.
• About 1 in 3 adults has high blood pressure, and blood pressure tends to rise with age.
• Researchers estimate that at least 6 million men in the United States suffer from a depressive disorder every year.
• Four times as many men commit suicide compared with women.
• 6 million people die every year from tobacco use and exposure to tobacco smoke. One person dies every six seconds.
  

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  Wellness Checks

Maintaining healthy lifestyle choices, a good diet and getting regular medical check-ups and screening tests can dramatically influence your health. Regardless of age, keep your health in check by doing the following:

HAVE AN ANNUAL PHYSICAL
Find a doctor and make a yearly appointment each Movember for a general health check. Getting annual checkups, preventative screening tests and immunizations are among the most important things you can do to stay healthy.

KNOW YOUR FAMILY HEALTH HISTORY

Family history is one of the most powerful tools to understanding your health. Family history affects your level of risk for cancer, diabetes, heart disease and stroke, among other illnesses. It all starts with a conversation; talk to your family and take note of illnesses that a direct relative has experienced. Be sure to learn about relatives that are deceased as well.

DONT SMOKE!
If you do smoke, stop! Compared to non-smokers, men who smoke are about 23 times more likely to develop lung cancer. Smoking causes about 90% of lung cancer deaths and doubles your risk of heart disease.

BE PHYSICALLY ACTIVE
If you are not already doing some form of exercise, start small and work up to a minimum of 30 minutes of moderate physical activity most days of the week. Stay on the move throughout the day; long periods of sitting increases your risk for disease. Every little bit counts take the stairs instead of the elevator or take a walk during your lunch break.

KEEP IT REGULAR
As best you can, try to keep a schedule and eat, sleep and exercise at the same time each day.

SLEEP WELL
The quality of your sleep can dictate how much you eat, how fast your metabolism runs, how fat or thin you are, how well you can fight off infections and how well you can cope with stress. Keep a regular pattern of sleep, going to bed and waking up at roughly the same time is key.

KNOW YOUR BODY
You should record every sign and symptom you experience and discuss this with your doctor.

EAT A HEALTHY DIET

Fill up with fruits, vegetables, whole grains and choose healthy proteins like lean meats, poultry, fish, beans and nuts. Eat foods low in saturated fats, trans fats, cholesterol, salt and added sugars. Moderation is key, as is eating a wide range of foods to ensure you get a variety of nutrients. The best source of vitamins is from food.

STAY AT A HEALTHY WEIGHT
Balance calories from foods and beverages with calories you burn off by physical activities. Only 33% of adults are at a healthy weight for their height. Obesity and being overweight pose a major risk for chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension, stroke and certain cancers.

MANAGE YOUR STRESS
Stress, particularly long-term stress, can be the factor in the onset or worsening of ill health. Managing your stress is essential to your health and well-being. Take time out each day and go for a walk or do something you find relaxing.

DRINK ALCOHOL ONLY IN MODERATION
Alcohol can be part of a healthy balanced diet, but only if consumed in moderation. This means no more than two drinks a day for men, and one drink a day for women (a standard drink is one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine or 1.5 ounces of 80-proof distilled spirits).

Prostate Cancer

THE STATS

• 1 in 6 men will be diagnosed with prostate cancer in their lifetime a new case is diagnosed every 2.1 minutes.A man dies from prostate cancer every 18 minutes.
• In 2012, 242,000 new cases of the disease will be diagnosed and 28,000 men will die of prostate cancer.
• Prostate cancer is the most frequently diagnosed cancer in men after skin cancer.
• A man is 35% more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.
• The incidence rates are nearly double for African American men.
• If detected and treated early, prostate cancer has a 95 percent success rate.
• While there are cases of prostate cancer showing up in younger men, it is recommended that men begin an annual screening at age 50 and at age 40 if there is a family history.
  

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WHAT IS PROSTATE CANCER?

The normal prostate is a small, squishy gland about the size of a walnut. It sits under the bladder and in front of the rectum. The urethrathe narrow tube that runs the length of the penis and carries both urine and semen out of the bodyruns directly through the prostate. The rectum, or lower end of the bowel, sits just behind the prostate and the bladder.

Sitting just above the prostate are the seminal vesiclestwo little glands that secrete about 60% of the substances that make up semen. Running alongside and attached to the sides of the prostate are the nerves that control erectile function.

The prostate is not essential for life, but its important for reproduction. The prostate typically grows during adolescence under the control of the male hormone testosterone and its byproduct DHT, or dihydrotestosterone. Prostate cancer occurs when cells within the prostate grow uncontrollably, creating small tumors. The term cancer refers to a condition in which the regulation of cell growth is lost and cells grow uncontrollably. Most cells in the body are constantly dividing, maturing and then dying in a tightly controlled process. Unlike normal cells, instead of dying, as they should, cancer cells outlive normal cells and continue to form new, abnormal cells.

Prostate cancer typically is comprised of multiple very small, primary tumors within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard interventions such as surgery or radiation that aim to remove or kill all cancerous cells in the prostate. Unfortunately, at this stage the cancer produces few or no symptoms and can be difficult to detect.

WHAT IS METASTATIC PROSTATE CANCER?

Metastatic cancer is cancer that has spread from the place where it first started to another place in the body. If untreated and allowed to grow, the cells from these tumors can spread in a process called metastasis. In this process, prostate cancer cells are transported through the lymphatic system and the bloodstream to other parts of the body, where they lodge and grow secondary tumors. The most common sites of cancer metastasis are the lungs, bones and liver. Once the cancer has spread beyond the prostate, cure rates drop dramatically.

In most cases, prostate cancer is a relatively slow-growing cancer, which means that it typically takes a number of years for the disease to become large enough to be detectable, and even longer to spread beyond the prostate. This is good news. However, a small percentage of patients experience more rapidly growing, aggressive forms of prostate cancer. Unfortunately, it is difficult to know for sure which prostate cancers will grow slowly and which will grow aggressively complicating treatment decisions.

The spread of cancer outside the prostate can be detected by the presence of prostate cancer cells in areas surrounding the prostate such as the seminal vesicle (glands near the bladder), lymph nodes in the groin area, the rectum and bones. When prostate cancer spreads to another site, such as bone, the new tumor is still considered to be prostate cancer, not bone cancer.

HOW CURABLE IS PROSTATE CANCER?

As with all cancers, “cure” rates for prostate cancer describe the percentage of patients likely remaining disease-free for a specific time. In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free.

Because approximately 90% of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very highnearly 100% of men diagnosed and treated at this stage will be disease-free after five years. By contrast, in the 1970s, only 67% of men diagnosed with local or regional prostate cancer were disease-free after five years. However, being diagnosed with prostate cancer can still be a life-altering experience. It requires making some very difficult decisions about treatments that can affect not only the life of the man diagnosed, but also the lives of his family members in significant ways for many years to come. Prostate cancer can be slow to grow following initial therapy, and it has been estimated that about 20-30% of men will relapse after the five-year mark and begin to show signs of disease recurrence.

RISK FACTORS

Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men. The older you are, the more likely you are to be diagnosed with prostate cancer. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69. In fact, about 97% of all prostate cancers are diagnosed in men 50 and older.

The roles of race and family history are important as well. African American men are 60% more likely to develop prostate cancer compared with Caucasian men and are nearly 2.5 times as likely to die from the disease.
Genetic studies suggest that strong familial predisposition may be responsible for 5%-10% of prostate cancers.
Men with a first-degree relativefather, brother or sonwith a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is even higher if the affected family members were diagnosed at a young age, with the highest risk seen in men whose family members were diagnosed before age 60.

Although genetics might play a role in deciding why one man might be at higher risk than another, social and environmental factors, particularly  diet and lifestyle  are likely to have an effect as well.

In recent years, research has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease.

When weighing risk factors for prostate cancer, its also important to recognize that there are  non-risk factors , or factors that have not been linked to an increase in risk.

SCREENING

The purpose of screening is to detect prostate cancer at its earliest stages, before any symptoms have developed.
Typically, prostate cancer thats detected by screening is in the very early-stages and can be treated most effectively. Physicians can screen for prostate cancer quickly and easily in their office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam.

The PSA Blood Test

PSA is a protein produced by the prostate and released in very small amounts into the bloodstream. When theres a problem with the prostatelike the development and growth of prostate cancermore and more PSA is released. It eventually reaches a level where it can be easily detected in the blood. During a PSA test, a small amount of blood is drawn from the arm, and the level of PSA is measured.

The Digital Rectal Exam

During a DRE, the physician inserts a gloved, lubricated finger into the rectum and examines the prostate for any irregularities in size, shape, and texture. Often, the DRE can be used by urologists to help distinguish between prostate cancer and non-cancerous conditions.

The question of screening is a personal and complex one. Its important for every man to talk with his doctor about whether prostate cancer screening is right for him.

There is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects.

Ultimately, decisions about screening should be individualized based on a mans level of risk, overall health, and life expectancy, as well as his desire for eventual treatment if he is diagnosed with prostate cancer. When to start screening is generally based on individual risk, with age 40 being a reasonable time to start screening for those at highest risk (genetic predispositions or strong family histories of prostate cancer at a young age). For otherwise healthy men at high risk (positive family history or African American men), starting at age 40-45 is reasonable.

Its important for men to create a proactive prostate health plan based on your lifestyle and family history, as well as to discuss these tests with your doctor to make the screening decisions that are best for you.

Depression in Men

THE STATS

• An estimated 26.2% of Americans ages 18 and older about one in four adults suffer from a diagnosable mental disorder in a given year.
• One of the most common manifestations of mental illness is depression.
• Depression affects more than 19 million Americans every year, regardless of age, race, or gender.
• Over 6 million men (7% of the population) are diagnosed with depression each year

WHAT IS DEPRESSION?

Depression is more than just a low mood it is a whole-body illness that affects your energy, thoughts, body and behavior. Depression is a serious, yet treatable mental health disorder that can affect any man, no matter how burly his moustache. You may lack energy, have difficulty sleeping or sleep more than usual. Some people feel anxious or irritable and find it difficult to concentrate. Major depression or bipolar (manic-depressive) disorder is responsible for 30% to 70% of suicide attempts. Suicide is the eighth leading cause of death in the United States, accounting for more than 1% of all deaths with four times as many men committing suicide as women.

The good news is, just like a physical illness, depression is treatable and effective treatments are available. The key is to remove the stigma around men opening up and talking about their feelings. Once men are comfortable discussing their issues, they will be aware of the signs and symptoms for mental illness and can seek help.

WHAT MAKES A PERSON MORE AT RISK OF DEPRESSION?

Different types of depression often have slightly different symptoms and may require different treatments. Some events or situations that have been linked with depression include:

• Having a serious medical illness
• Family conflict
• Isolation or loneliness
• Unemployment
• Drug and alcohol use
• Changes in the brain
• Having a family member with depression
• Its important to remember that each person is different and it is often a combination of factors that puts a person at risk of depression

TIPS TO STAY MENTALLY HEALTHY

Talk to your doctor. There are many underlying causes of depression and a doctor can guide you to the proper course of treatment whether that is therapy, medication or lifestyle change.

• Eat a nutritious and balanced diet
• Manage stress
• Keep a regular sleep cycle
• Stay active and exercise regularly
• Participate in your favorite activities
• Spend time with friends and loved ones

THINGS TO REMEMBER

• Depression and anxiety are common and treatable
• Help is available and its important to seek help early the sooner the better
• Depression and anxiety disorders are illnesses, not weaknesses, and people shouldnt feel ashamed to seek help
• By talking about depression and anxiety, we can help raise awareness and reduce the stigma