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Welcome to the Why Urology podcast with Dr. Todd Brandt.

This podcast is my personal attempt to teach you about your genito-urinary tract, what can go wrong, and how your urologist may just become your superhero.

The name of the podcast comes from my ongoing need to answer the question that I get so often from patients, friends, and family, “Why Urology? Why did you choose to become a urologist?”

Mar 4, 2018

If you have been listening to this podcast you know that I have incorporated stories I like about people I find inspiring.  During the Olympics last month, I was only emotionally invested in one story, only one athlete, competing in Pyeongyang, South Korea. Cross-country skier Jessie Diggings is from a small town, Afton, MN, near where I live. Jessie Diggins was a medal contender at these Olympic games, hoping for the first medal for any female cross county skier from the United States. She and teammate Kikkan Randall became the first ever Olympic gold medalists for the United States in cross-country skiing, and the first women to win any medal in cross-country skiing.

 I know you are all wondering what Jessie Diggings and testicle cancer may possibly have in common. Listen in, and find out.

About 9,000 young men will be diagnosed with testicle cancer this year in the United States. Men at greatest risk are between the ages of 20-34. White males will be affected four times the rate of African-American men and three times the rate of Asian-Americans. Risk factors for testicle cancer include a history of an undescended testicle, a family history of testicular cancer and a previous history of testicle cancer in the other testicle. Marijuana smoking has also been implicated.

Diagnosis is usually made by the patient after he feels a mass in his testicle on self-examination.  The mass is confirmed by a physician’s exam and a scrotal ultrasound. Blood tests called tumor markers (AFP, HCG, LDH) are taken to help determine if that mass is cancerous and of what cell type and to help stage the cancer. Some men are diagnosed when they have other symptoms of advanced disease, such as abdominal pain from an abdominal cancer spread or shortness of breath from metastasis to the lungs.

A urologist will schedule a surgery for removal of the testicle. A radical inguinal orchiectomy removes the cancerous testicle and the spermatic cord during an outpatient surgery.  The testicle and cord is sent to a pathologist to determine the tumor’s cell type, whether it is a pure seminoma or a mixed germ cell tumor.

CT scans and other x-rays are taken to further stage the disease. 

Sperm banking should be discussed in case the patient is still wanting to have children.

Once a final stage and cell type can be determined a decision will be made as to whether the patient will need radiation, chemotherapy, surgery, a long-term surveillance protocol, or all of the above.  We don’t have time in this podcast to go over all of the options. Your physician team who will help you navigate these decisions will most likely include a urologist, a medical oncologist, and a radiation oncologist.

The good news is that you are a favorite to win the race if you have testicle cancer. Overall patient’s five-year survival greater than 95 %, with early stage disease having survival rates approaching 99%. Awesome!

Most men are oblivious to the easiest thing they can do to detect a problem early, regular self-examination. And many guys who feel something may NOT come in to the doctor for a long time. Many patients, because they are a little embarrassed, allow a tumor to grow before coming in for an appointment.

Don’t be that guy. Anything that is tender needs evaluation. Anything that is growing needs evaluation.  Any firm area or lump in the testicle needs evaluation.

What happens if that lump you feel is not cancer? No big deal. I would rather see many nervous guys and reassure them than miss a tumor. I try to let guys know they did the right thing if they are feeling something they are uncomfortable with, a lump or something tender, and come in to have it checked.  

Upon reaching puberty, all men should conduct a regular (most medical societies suggest monthly) testicular self-exam and ask your doctor during any physical to perform one as well. Self-examination of the testes is critical for early detection of testicular cancer. Your focus should be on trying to detect any changes from month to month.

The best time to self-exam is after a warm bath or shower when the scrotal skin is relaxed.

Examine each testicle separately. Gently roll the testicle between the thumb and forefingers with both hands. The testicle itself should feel round and smooth. Feels for any lumps or irregularities. Most cancerous lumps or bumps are painless. It's normal if one testicle is slightly larger or hangs lower than the other. 

The epididymis is a soft tube-like structure behind the testicle that collects and carries sperm to the spermatic cord. Become familiar with this structure. Some guys initially mistake it for an abnormal mass. Most firm areas you feel in the epididymis are noncancerous but should be examined by a physician anyway if you feel something.

Remember you are feeling for any changes in size, shape, or texture. After a couple of months of doing the exam monthly you will easily be able to tell when or if something has changed.

That’s it. It takes just few minutes to do. If you notice a lump or any changes as mentioned above, you should seek medical advice and schedule an appointment immediately.

Remember testicular cancer if detected early is one of the most curable cancers.

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