Episode 12. Testis Cancer: The Young Male’s Cancer

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Episode Summary:

Take-home messages from this heart-rending episode: First, we need to normalize talking about testicles, with frank talk and humor. Second, Carpe Testes! — guys should start regularly checking the health of the family jewels at puberty. Testis cancer has a very high cure rate if caught early.

Episode Guests:

Christopher Porter, M.D., Director of Clinical Research at Virginia Mason Medical Center, Co-Director Urologic Oncology, Fellowship Director, Urologic Oncology, Virginia Mason Medical Center

Nancy Balin J.D., Founder, The Family Jewels Foundation 

During This Episode We Discuss:

  • Testis Cancer, the importance of self-exam, early diagnosis, evaluation and treatment.
  • Testis Cancer is not a uniform disease, variations in cell types make some types more concerning and difficult to cure.
  • Following Testis Cancer, limiting or eliminating radiation or chemo therapy for localized Stage 1 with appropriate cell type.
  • Stigma and how to destigmatize talking about testicular concerns with young men.
  • Teaching young men about testis, testicular exam and testis cancer awareness.
  • Teaching parents about testicular awareness.
  • Advances and cures in Testis Cancer.
  • Guidelines for follow up, how long until you’re considered cured?
  • New potential genetic markers.
  • The importance of an opinion on Testis Cancer from a high-volume center.

Quotes (Tweetables):

“I became a testicular cancer educator because I lost a child to the disease. Jameson Jones was 14 when he was diagnosed with late-stage testicular cancer, he had symptoms for about a year, which is why he was diagnosed so late and why he eventually died of a disease that was cured 15 years before he was born”.

Nancy Balin, J.D.

“In terms of diagnosing and self-awareness, we believe that young men should perform a self-exam beginning at puberty and if they have questions should ask their general doctors about the exam or whether it’s abnormal or not.”

“Testicular Cancer is the most common tumor for young men and is extremely curable if found early”.

Christopher Porter, M.D.

Recommended Resources:

Episode Transcript: 

Speaker 1 (00:06):

A baseball game, a day in a park with friends and family, fishing in a remote stream, work, travels, providing for loved ones, or heading out for adventures. Whatever you do, whatever you enjoy, you need your health. The Original Guide to Men’s Health is presented by the Washington State Urology Society to help take you through the steps necessary to get the most out of life. If you have invested in a retirement plan for your future, why not invest in your body. After all, it makes better sense to retire healthy and enjoy your future. These podcasts are a guide for how to take care of yourself. If you take care of your car and maintain it, why not do the same for your personal machine, your body. If you know you should, but haven’t yet, the information in these podcasts contains some easy recommendations for where, when, and how to get started. Follow the podcast as we explore men’s health with renowned experts and embark on a journey towards better health.

Speaker 2 (01:31):

On today’s episode of the Original Guide to Men’s Health, we’ll be speaking about testes cancer. We’ll be speaking with Dr. Christopher Porter, director of clinical research at Virginia Mason Medical Center. He is co-director of urologic oncology and director of the fellowship program for urologic oncology. We’ll also be speaking with Nancy Baylin. JD. Nancy is the founder of the Family Jewels Foundation. Testes cancer, it’s a significant issue for young men. We need to know more about it. Stay tuned. As we start today’s episode on testes cancer, I think it’s probably reasonable to have Nancy tell a story. Nancy, go ahead.

Speaker 3 (02:17):

I will. Thank you, Dr. Pellman. I became a testicular cancer educator because I lost a child to the disease. Jamison Jones was 14 when he was diagnosed with late stage testicular cancer. At that time, they called it stage four. Now it’s 3C. He had had symptoms for about a year, which is why he was diagnosed so late, and why he eventually died of a disease that was cured 15 years before he was born. He went through four cycles of BEP. We got him into remission the first time and he went to high school. We were told after two years of remission that, “oh, he’s not going to get it again, he’s not going to get it again.” And we continued with his surveillance. Jameson relapsed at the end of his freshman year at Washington State University. And I knew because it was such a late relapse that we were probably going to lose him that time.

Speaker 3 (03:05):

He still fought the good fight for a year and a half: four courses of chemo, four courses of high-dose chemo, a stem cell rescue, and nothing was enough, and he died on October 7th, 2010, when he was 20. He left behind two younger sisters who were then 12 and 18. So the first mission that we accomplished was to endow a scholarship in his memory for siblings of kids who have cancer. As the years passed, and I saw more and more at times, young men who would ask online or elsewhere that I’d seen them, how come I didn’t know that my testicles weren’t supposed to hurt? How come I didn’t know the symptoms of testicular cancer, as they themselves would be diagnosed late stage, and then they would die. And I became more and more passionate, which is the word people most often use about me, about educating about this cured cancer. One of my repetitive things I say about Jameson is that its ridiculous and angering and painful that my child died of a cancer that was cured before he was born, but not so curable when you wait a year with your symptoms. My entry into the testicular cancer world came because I was a caregiver twice for a boy and then a young man with cancer, and then we lost him to it.

Speaker 2 (04:16):

And you have been an advocate in many senses since then. You have taken upon the legislation to try to promote education about testes cancer awareness and testicular exams. You have taken on advocacy at events to spread information. So I want to look at Dr. Porter for a moment. And as you had referenced, we generally think of testes cancers as a curable disease in this day and age. But Dr. Porter, it still is a significant disease, and let’s start with detection. What do young men need to be aware of?

Speaker 4 (04:53):

Thanks Dr. Pellman. Thanks so much. That’s a tragic story and sort of grips your heart when you hear that story. We do hear it here. We’re one of the centers for testicular cancer, and we do a lot of it. The disease, although very curable for the vast majority of men and young men and boys, can be fatal if it’s of a certain type or if it’s delayed in the diagnosis. So in terms of diagnosing and self-awareness, we believe that young men should perform self exams at the beginning of puberty, and if they have questions, should ask the general doctors about the exam and whether it’s abnormal or not. That should be then moved up a ladder preferably to a urologist at a time when that self exam is abnormal. I can tell you that we teach self-exam to all men who come to me after they’ve had testis cancer, because there’s a risk, a five percent risk of harboring contralateral disease at a later day. And so we teach them, and they all tell me that they’re going to teach their siblings or their children at the right time. But that’s the main stay, it’s really self-exam.

Speaker 2 (06:12):

It’s not that difficult. I think if they can achieve instruction from a physician, it could be their primary care doctor, their practitioner, their nurse practitioner, or their PA, but learning to do an exam and realizing that, as I tell patients, your testes ought to be isomers in chemistry, we learned about the left and right, they should be equal. And I get them familiar with the exam. And I say, if anything changes, don’t wait.

Speaker 4 (06:37):

That’s right. I usually tell them this is normal today. Check it in the shower tonight. And then you’ll know if something changes, right. And then come in.

Speaker 2 (06:47):

In then frequency, I tell patients once a month and I say, just pick the first day of every month in the shower. It’s easy to remember. It’s the first day of the month. Check yourself. In this day and age, there’s certainly a lot of instruction on YouTube. And there is a great British piece of Rihanna teaches a testicular exam.

Speaker 4 (07:06):

I’ve seen it. 

Speaker 3

Oh I haven’t seen that one. I have a few others.

Speaker 2 (07:09):

And as only the British could do, it’s wonderful. But it is available. So even if someone doesn’t have access to their practitioner to learn, they can get the idea of what they should be doing by going to YouTube. Besides the self-testicular exam, what else should we be aware of? Who’s at risk?

Speaker 4 (07:28):

Well, clearly a family history. Men who’ve had an undescended testis. Evidence may be that some men who have had “a hernia repair,” cause that may have been an undescended testis they didn’t know about. That’s probably about it in terms of risk factors.

Speaker 2 (07:45):

I see occasionally a patient who had a testicular ultrasound, maybe because they had an inflammation, infection, or benign swelling. There are some swellings that are benign, but you should go to your practitioner and find out. But they see microscopic calcifications. The radiologists always point that out and practitioners are generally concerned about the risk for testes cancer. This is more rare, but if somebody has an abnormal testes ultrasound with calcification, are they at a slight increased risk?

Speaker 4 (08:17):

So the literature is actually sort of divided on this. If you look at the urological literature, we don’t think they are. If you look at the radiologic literature, they suggest that there is. In essence, I tend to follow them for about usually a year, and then if it hasn’t changed, I teach them self exam after that.

Speaker 2 (08:37):

I remember a lecture from one of the army physicians who said, “you know, we have troops that have this issue, microscopic calcification with testes.” And he said, “we can’t be ultrasounding them all the time. They’re on the move. So we teach them the self-testicular exam.” So I think that’s a good solution for this. Let’s look at a young man who finds something abnormal and comes in. And your first step is of course, a physical exam, and you agree that there is something abnormal. What else happens?

Speaker 4 (09:08):

You know, the first step is a history. We take a fertility history as well. The next step is whether there’s a family history of cryptorchidism, a hidden testicle, etc., undescended. Then we confirm it with a physical exam. They very often have already got an ultrasound showing something. We go through that with the patient. And then we explain that the vast majority of solid tumors that have flow within the testes are malignant in young men. And we recommend at least one sperm bank because there is some evidence that they may be infertile afterwards if that testicle is their only good one for making sperm. So we would perform the radical orchiectomy within 24 hours of them sperm banking. And we scan their abdomen and pelvis and chest and draw their markers of course, their tumor markers.

Speaker 2 (10:10):

These are blood tests that certain testes tumors make substances that we would assay for in the blood. Certain types of tumors don’t make anything but certain types do.

Speaker 4 (10:21):

So, they’re called beta-HCG and alpha fetoprotein, and there is a new test that’s going to be coming out very soon that’s going into a phase three trial out of Vancouver called, it’s a micro-RNA test, which is positive for just about every germ cell tumor. So that’s coming out on the next phase of our ability to diagnose germ cell tumors.

Speaker 2 (10:47):

Now, people hear radical. That’s just a term that we as surgeons use when we’re removing an entire organ. And it’s important to take the entire testicle. It’s done through an inguinal incision, like a hernia incision. It’s generally a same-day surgery. And that allows us to remove the tumor in a very specific way so things aren’t contaminated and other body parts, and to have the ability to then have the pathologist tell us what cell type. So testes tumor is a variety of cell types.

Speaker 4 (11:17):

There’s generally two main categories. One category is seminoma, that’s one cell type, and the other one is non seminoma, which is everything else. Both of those germ cell tumors are exquisitely sensitive to chemotherapy and both of them carry an excellent prognosis in general.

Speaker 2 (11:37):

So part of that after removal is in the staging, the scanning, CT scan or MRI. Is pet scanning used?

Speaker 4 (11:45):

Very rarely. So a CT scan is the mainstay of scanning the chest, abdomen, and pelvis. We tend to do it prior to the orchiectomy. We then follow it. We then expect them if they are stage one, the preferred approach is surveillance. And in that regard, we obtain between five and six scans in the next five years, the majority in the first two years, because that’s the highest relapse rate. They’ll get mockers periodically through that time.

Speaker 2 (12:15):

So if somebody has a scan that shows fairly massive lymph node involvement, they’re going to get more chemo than somebody who shows no lymph node involved.

Speaker 4 (12:26):

Correct. So patients who have no lymph node involvement, the preferred approach is not to treat them, but to follow them conservatively with scans and markers. There are some small instances where we do treat them, but it’s rare. For patients who have disease in the retroperitoneum around the kidneys and the great vessels, those patients are almost certainly treated with upfront chemotherapy. The bulkier the disease and disease not in the lymph nodes, but in other solid organs, would raise their stage and require more chemotherapy.

Speaker 2 (13:04):

So the utility of the markers is not only looking at a scan to see if there’s improvement, but to see the markers decline and go away.

Speaker 4 (13:12):

That’s right. So the markers are very good if they are high to begin, with a very good prediction of control of the disease.

Speaker 2 (13:20):

And then you continue to follow those through the time period, that’s the intense follow up. When can you tell somebody that you’ve treated that they’re “cured,” at what point?

Speaker 4 (13:31):

So if you’re in stage one disease, that’s disease that hasn’t spread, and you’re followed, the vast majority of people will not relapse after two years. There is a small, but finite relapse rate between two years and five years. But when you get to five years the relapse rate is very low. It’s not zero, but it’s very, very low. So you generally, at five years, we can tell them if you’re stage one and you haven’t had a relapse, you’re probably out of the woods. If you’re stage two or three, and you’ve been treated with chemotherapy and then have needed or not needed consolidative surgery to remove any residual lymph nodes, which is important, we follow them after that. And usually by two years, if they have not relapsed, we consider them to be close to being out of the woods, but we’d like to get them to the five-year mark.

Speaker 2 (14:22):

When we look at young men, obviously it’s a group that, at the height of vitality, they do well. This, you know, people think chemo is extremely toxic, but they do return to normal function afterwards. They shouldn’t shy away from treatment because of the concern about, oh I’m going to be debilitated for the rest of my life.

Speaker 4 (14:44):

Yeah, that’s right. I think young men are obviously very resilient and they do well on the whole from chemotherapy. So it’s not nothing to be terrified of but something that’s important to use.

Speaker 2 (14:59):

And then, you know, we refer to testicular function, we have two main functions. One is fertility, we talked about sperm banking before chemo or surgery. The other is male hormone production, generally male hormone production survives this.

Speaker 4 (15:16):

It does. There’s obviously two testicles. Before taking the testicle out for cancer, we always draw a testosterone level because we like to know where they’re starting. And then we monitor them closely after removal of that testicle for symptoms of what we call hypogonadism for low testosterone because that one testicle that we took out could have been the main producer of testosterone. So we like to keep an eye on it and it can always be replaced appropriately if we need to.

Speaker 2 (15:46):

Yeah. Removing a testicle is of a concern cosmetically to a young man who, as peers, is potentially an athlete be showering or will potentially be dating. Parents are concerned. We do have prosthetics. Very good prosthetics. So for an appearance across the shower room, you wouldn’t know any difference.

Speaker 4 (16:09):

Correct. Yeah. And so you bring up a good point. We offer all the men who undergo orchiectomy removal and at the same time placement of the prosthesis. They don’t all take it and it can be done later. So they have time to think about it. In our experience here, we have a lot of men that do think about it and then if they want it, we’d do it at a later date. The experience down in California has been more people take it up earlier on.

Speaker 2 (16:39):

So Nancy, at gatherings where you’re trying to educate the public about testes cancer, what sort of things do you bring up? Do you go to the parents, the young men, or both?

Speaker 3 (16:48):

Both. I was provoked into a lot of memories by Dr. Porter’s answers to your questions. One is where you were talking about the fact that this is a young man or even a young male’s cancer. Jamison was a boy when he was diagnosed, and 13 when he started having symptoms. So when I’m talking to, I have two demographics that I approach. One is the target demographic, I think of it as young males ages 15 to 44. And the other demographic is their parents because those are my peers. So when I approach young males, say a scouting troop, what I like to say is I’ll go anywhere where young males gather. So in fact, I’m going to a high school tomorrow to teach health classes all day long. So say it’s a high school group. I have a PowerPoint, of course.

Speaker 3 (17:29):

And I have pictures up there. And I say to these, I ask these students, so what is it about you guys that makes this a young males cancer? Makes a perfect storm of bad facts. What is it about you guys, about young males? And I have a little cartoon of Superman. And usually a hand flies up and somebody says, well, we’re invincible. And I say, that’s right. And then I have a cartoon of an evil doctor with a big syringe in his hand. And they say, well, we don’t like to go to the doctor. Yes, that’s right. And then I have a photo of a polar bear with his paw over his eyes. And the caption is OMG, this is so embarrassing. And I tell them, the combination of you’re feeling invincible, you’re not wanting to go to the doctor, and the fact that this is embarrassing.

Speaker 3 (18:09):

It’s about your, your genitals, your testicles. It’s a very bad list of factors. And it is the reason that Jameson waited a year before he told us that he had symptoms. In my tri-fold, my pamphlet that encloses a shower card, there’s a quote on the front, and that is Jameson talking. He was in high school for the first three years of his remission. And I found out years after he died from a female friend that, when they were in high school, and she was a female friend he was chatting with, he said to her, it just kept getting bigger and bigger but I was too embarrassed to tell my mom. So I feel that I can legitimately say that Jamison died of embarrassment. So I talked to the young guys about that, and because of my demographic, what I know, I grew up with sisters.

Speaker 3 (18:55):

I didn’t grow up with boys. So when I acquired a stepson, I did not know how to talk to him, I didn’t know what to do with him. And I quickly learned from Jameson that young male humor is the Hangover movies, Stephen Colbert’s The Daily Show, it is talking about farting at the dinner table, I mean, it’s just a whole different genre of humor. And what I knew instinctively is I could not approach a group of young males and say, be sure you don’t get cancer. You know, what I do is I approach them with humor, which is why my foundation is called the Family Jewels Foundation, which is why my 5k is called the Family Jewels 5k, which is why when I have a wine walk, because being in the Woodinville area, you have to have a wine walk, it’s going to be called, and they won’t be there, but the parents will be there.

Speaker 3 (19:36):

It’s going to be called Checkout Our Low-Hanging Fruit. And why my pub crawl in Kenmore every year is called A Ball Crawl. I have a slide in my PowerPoint, which has at least a couple of dozen euphemisms for testicles. If you Google “euphemism for testicles,” you find them all. And I am happy to say that I am not too embarrassed to use any one of them as a pawn. If I see a tree that has two bulges in it, and it looks enough like a penis and testicles to me, I’m going to take that picture and I’m going to use it somewhere because I reach them through humor. They start listening to me because it’s funny. I mean, testicles are funny. They’re funny looking, they’re weird, some of them are hairy. I mean, they’re just, they’re weird. And guys don’t want to talk about it.

Speaker 3 (20:20):

When I talk to their parents, Dr. Porter was talking about puberty being a good time to start self exams, and I, of course, I agree that the major youngest age is 15 of the demographic. So right, when parents ask me, so I have a three-year-old son, when should I talk to him? I say, today. You start today. You talk to your kids in an age appropriate way, such as when you’re bathing your child and you’re cleaning him and you talk about, okay, so you clean the testicles and you check them. You check everything and make sure it’s okay. When you teach junior that when he falls down and smashes his elbow and it really hurts, he should come tell mama that his elbow hurts. Well, if other parts of his body hurt, they’re all body parts. So you come tell mama or daddy or your coach or somebody, your health teacher, if your testicle hurts. I use a lot of hashtags because, look at my demographic, they’re all over the internet and social media, and my favorite hashtag is, one of my favorite hashtags is, there’s nothing embarrassing about cancer.

Speaker 3 (21:11):

I have a series of signs I call nut notes that I bring. In fact, I have them in my car because I’m going to the high school tomorrow. And they are little sayings, some of which I’ve stolen from the Brits. The Brits have a great sense of humor about testicle cancer. There’s multiple groups and they are funny. They have testicle costumes they wear at their parades. I don’t think we could get away with that in Woodinville and Bothell. But they have some funny sayings and I’ve copied a few and I’ve made up a lot of others. The one I stole from them is, check your nads lads. My personal favorite is [inaudible].

Speaker 2 (21:48):

So we want to desensitize the people really concerned and the embarrassment about sharing that something is different. And the word here is, if something is different, tell somebody.

Speaker 3 (21:59):

And I’d like to say, I also liked that Dr. Porter just parroted exactly what I said. When I finish telling a guy my 30 second lecture about testicles, which is, and you’ll correct me if I need to change this of course, they shouldn’t hurt. They shouldn’t have lumps or bumps, unlike breast tissue, which can be lumpy and bumpy. And they shouldn’t be radically different sizes or growing or shrinking. But I say to them, so when you go home and tell your best buddy about this embarrassing conversation you had with a middle-aged woman, what I want you to convey to him is this, and this is the message I want you to take away. I know you’re down there, because babies start going down there when they’re like nine months old. I know you’re down there. And then they always laugh and they look embarrassed.

Speaker 3 (22:38):

While you’re down there, because you’re down there, give them a check. And here’s the takeaway. You know what they’re like on a normal basis. If there’s ever a change, don’t wait. That’s the message I tell them. If you forget the rest of this embarrassing conversation, what I want you to remember is, don’t wait. And the way I try to drive through the embarrassment of a young man listening to this lecture from me is I tell them so look, we’ve already talked about the middle-aged female part. So I know it’s not going to happen to you because, you know, I know he feels invincible. But when you go to your soccer practice and you tell your buddy about this incredibly weird conversation you had with the middle-aged woman and you tell them my 30 second lecture about testicles, and he looks at you and says, “crap, I got to go to the doctor because I have one of those.,” then you may have just saved your best buddy’s life.

Speaker 3 (23:22):

How awesome is that? And I do that to try to drive around the invincibility and instead have a little part of the back of their brain that remembers this because Jameson had symptoms for a year. He was a cross country runner. Could nobody in the locker room have seen that one of his testicles was getting to be the size of a baseball? On the other half of my side of who I educate are the parents. So I already told you about, you know, age appropriate start today. You use one of those embarrassing car conversations when you both look through the windshield and don’t have to look at each other. But there’s a part of the story that involves the grownups in the family and that is that we knew that Jamison was having pain in his testicle.

Speaker 3 (24:01):

We were all good parents. We went to his cross country meets. He was a cross country runner starting in junior high. And we all saw him double over the finish line. We had no idea that we should be considering that he might have cancer. Well, we thought that he wasn’t wearing tight enough running short support. So every time somebody saw him double over, we would bug him. “Jameson, you’ve got to buy better training shorts.” So when I was on the way to the emergency room, when he was writhing around the living room floor complaining about testicle pain, I thought, oh buddy, you finally bought yourself a torsion. It never occurred to me that it could be cancer.

Speaker 2 (24:34):

So that’s a torsion twisted testicle, which is painful. And while he did have pain, many of the lumps are painless. In fact, I’d say the majority of the testes cancers that I have seen have presented because somebody felt something that’s different, not because it necessarily hurt.

Speaker 4 (24:49):

Yeah. They are. They can either be painful or tender or as you know, painless. And anything abnormal really is key.

Speaker 2 (25:01):

So besides a potential new genetic marker, what else have we potentially evolved to in our ability to look at this disease?

Speaker 4 (25:13):

The disease is constantly being examined. So it’s one of the great champions of chemotherapy, right? So it is platinum sensitive. And so we’re trying to work out better and better ways to limit toxicity. We know we can cure just about everyone if we get it early enough, and we know that we don’t have to cure folks that don’t have disease that spread. So really the disease, the point is we’re trying to limit toxicity and limit the early treatment. So for example, for patients with seminoma in stage one disease, we’re recommending against any form of radiation because radiation can come back and harm them with secondary cancers later in their life. And similarly, we’re trying to limit the use of chemotherapy in men who don’t have the disease that spread because we don’t know what chemotherapy does to them 10, 15, 20 years down the line. They don’t need it. From a surgical standpoint, we’re trying to do the appropriate surgery on the right patient and spare the nerves where appropriate, and that’s for a large disease in the retroperitonium that is left after chemotherapy. And similarly, there are some cases where there’s extensive disease that spreads that we have to go off to surgically at all different sites, and so those need very aggressive care. So it is really, do the right thing for the right patient at the right time. And you really need a place that does a lot of it. I think that’s a real take home.

Speaker 2 (26:54):

Yeah. I think the Centers of Excellence for testes cancer is an absolute. The level to which we have achieved the sophistication of who should be watched and who should get what combination of chemo for how long is not the occasional practitioner.

Speaker 4 (27:14):

Right. And we run a testicular cancer tumor board here every two weeks and we’re happy to see any cases that want to be reviewed. So we don’t keep them here, but if they need to be reviewed and advice given, we’re happy to do that. I think that’s really a good resource for the practitioners in the field.

Speaker 2 (27:36):

Well, any last comments? 

Speaker 3:

Well, depending on the audience of this podcast, what I would urge is that parents, grownups, anybody who’s listening to this podcast, normalize the conversation about body parts, about testicles. Testicular cancer does not have a national champion that turns the month of October pink. In fact, right now April is testicular cancer awareness month. One thing that the foundation did was we sought a governor’s proclamation that in fact, April is testicular cancer awareness month in Washington, because it is all over the country. And we got that, which we’re going to try and do a health event in Olympia. It’s one group of people at a time. And the pushback that I get is, oh, you know, at schools, “I don’t know if parents are going to be comfortable with you talking about that.” And my reaction to that, I can’t get angry because I know why Jamison waited, but what I do is I tell Jameson’s story and I tell them that that sort of embarrassment is what took him from us.

Speaker 3 (28:37):

And an example I use even more often is if you look at our logo, it’s supposed to be a little stylistic, but it’s a scrotum with two jewels in it. Jameson’s favorite color was green so they’re emeralds. And it’s a shape of a scrotum with jewels in it, hence family jewels. So I show my logo and I test people and I say, so can you tell what that is? So women look at it and they say, “yeah, I can see that right away.” They say “yeah I see.” And I test them and I say “yeah, it’s a scrotum with testicles.” Men, almost a hundred percent do this: they look at it, and then they look up and they look at me and they back up because then they realize what it is and they’ve gotten embarrassed, and I say to them “you know that backing up thing you just did, that embarrassment? That’s why my stepson died.”

Speaker 3 (29:20):

And I watched that. I watched the realization flow over them like, oh, this is embarrassing. That man, that poor kid died because of his embarrassment. So I watched them surmount the wall of, okay, I need to talk about this even though it’s hard. So my takeaway message is, talk about it, talk about it, talk about it. People complain about their hypochondriac kids. That’s the kind of kid you want to get testicular cancer, God forbid, if any kids should get it. The strong, silent types, they’re the ones who wait. So teach your kids, teach your students, your athletes, your patients, your everything. If something is off or different about your body. Don’t wait. Tell somebody. 

Speaker 2 (30:10):

Dr. Porter, last comment.

Speaker 4 (30:11):

So first, thanks Nancy for being such a great advocate for this. I think the main point is testicular cancer is the most common tumor of young men and is extremely curable if found early. So if you feel something wrong, talk about it, number one. Number two, I would urge after you’ve been seen to at least get an opinion from a high volume center who do a lot of it so that your best possible outcome with the minimum side effects can be afforded to you.

Speaker 2 (30:49):

Well, I appreciate both of your expertise and your time. 

Speaker 3 (30:54):

Thank you Dr. Pelman, this is great. 

Speaker 4 (30:56):

Thank you, Dr. Pelman.

Speaker 1 (30:57):

This completes another podcast chapter of the Washington State Urology Society’s, Original Guide to Men’s Health. This is Dr. Richard Pelman reminding you to take care of yourself. Washington State Urologist Society wishes to thank all contributors who volunteered their time and knowledge. The information presented is the opinion of the speakers. The society also wishes to thank Sean Fox for his invaluable technical assistance The music theme, San Juan Bells, was written and performed by Dr. Dave Whiting. The podcasts are the property of the Washington State Urology Society. Reproduction and use without the express consent of the society is strictly prohibited. For more information about men’s health, visit wsus.org or visit your physician or care provider.

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