Prostate and testicular cancer care

Prostate cancer and testicular cancer are both cancers of the male reproductive system. Of the two, prostate cancer is the most common. In fact, prostate cancer is the most common cancer and second-leading cause of cancer deaths in men, the most common being skin cancer. About 1 in 9 men will be diagnosed with prostate cancer in their lifetime.

Whether you have prostate cancer or testicular cancer, at Allina Health, you will have a team of specialists working with you throughout your diagnosis, treatment and recovery. This team may include oncologists, urologists, radiologists and other specialists and will be coordinated by a nurse navigator, who will be your primary point of contact.

The core value of the care we offer at Allina Health is our focus on your overall health.  It is important to us that you take charge of your care every step of the way. To help you stay as involved as possible, you’ll have tools and support including the Allina Health account, an online resource to help you schedule appointments, communicate with your health care providers, review test results and more.

Most cases of prostate cancer are diagnosed through annual screening that is recommended for men over the age of 50. The main tests used are:

• Blood tests: The prostate-specific antigen (PSA) test looks for PSA in the bloodstream. PSA is a protein made by the prostate.
• Digital rectal exam (DRE): This is a physical exam of the prostate during which your doctor uses their finger inserted into the rectum to feel the prostate and check for abnormalities.
• Imaging tests: A transrectal ultrasound (a probe inserted into the rectum) and transrectal magnetic resonance imaging (MRI) are used.
• Biopsy: A transrectal biopsy is done during a transrectal ultrasound, during which a needle is inserted into the prostate to remove a tissue sample for testing.

Testicular cancer is extremely rare. However, it is the most common cancer in men between the ages of 15 and 34. There is no routine screening test for testicular cancer. In most cases, men detect the cancer themselves during a self-exam or by chance. A doctor may also find it through a routine physical.

Tests to detect and diagnose testicular cancer include:

• Blood test: This is known as a serum marker test. It is done to check the levels of tumor markers, such as the alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG). Elevated levels of these proteins in the blood suggest the presence of a tumor.
• Imaging tests: An ultrasound is often the first test done for testicular cancer to determine whether the lump on the testicle is a tumor or is caused by another issue.
• Biopsy: A biopsy is rarely ordered for testicular cancer before the testicle is removed, as this can increase the risk of the cancer spreading. The blood and imaging tests typically provide enough information to make a diagnosis, and the testicle is sent to the lab for biopsy after removal.

According to the American Cancer Society, other imaging tests that may be done for either one or both of prostate and testicular cancer are:

• computed tomography (CT) scan (to check whether the cancer has spread to other areas of the body)
• magnetic resonance imaging (MRI) (to check whether the cancer has spread to the brain or spinal cord)
• positron emission tomography (PET) scan (to check for small concentrations of cancer cells in the body and check whether lymph nodes contain cancer cells or scar tissue once chemotherapy is finished)
• bone scan (to check if the cancer has spread to the bones)
• chest X-ray (to see if the cancer has spread to the lungs)

When you receive a cancer diagnosis, your doctors will work to determine how far the cancer has spread. This will be expressed as a stage, with Stage 0 being the least advanced and Stage IV being the most advanced for prostate cancer. For testicular cancer, there is no stage IV, so the most advanced stage is stage III.

At Allina Health, your cancer care team will work closely with you to determine the best course of treatment.

Prostate cancer is unique in that it grows slowly. For this reason, older men in particular may not need treatment at all. Instead, you may decide that no treatment is the best option, with regular checkups to monitor your situation. When treatment is needed, the most common treatment is surgery to remove the entire prostate, along with some surrounding healthy tissue and nearby lymph nodes. Additional treatment options include radiation, cryotherapy, hormone, immunotherapy and chemotherapy that need to be tailored to your needs

Certain treatments for testicular cancer can cause infertility that may be permanent. Patients who may wish to have children should consider sperm banking before having treatment. Sperm banking is the process of freezing sperm and storing it for later use.

Testicular cancer is most commonly confirmed after the affected testicle is removed and the tissue examined by a pathologist. Depending on test results, your care team may recommend additional treatment such as chemotherapy or radiation.

Most people start by seeing their primary care provider. If your provider suspects prostate cancer or testicular cancer, they will refer you to a urologist, who may recommend that you have imaging tests, a biopsy or surgery to confirm a cancer diagnosis. 

If you are diagnosed with prostate or testicular cancer, you may have the following questions

• How treatable is my prostate/testicular cancer?
• How advanced is my prostate/testicular cancer?
• What is the most common/recommended treatment for my prostate/testicular cancer?
• How will treatment affect my daily life?
• Will treatment impact my fertility?
• Does prostate/testicular cancer spread?
• Can my prostate/testicular cancer be cured?
• What support resources are available to help me?
• Whom should I call if I have questions after I leave the office?

It is important to make sure that your insurance plan covers the diagnosis and treatment of your prostate or testicular cancer. Contact your health insurance provider before testing and treatment, so you know what is covered and what you will need to pay for on your own.

You can also use the number on your membership card to call your insurance provider whenever you have questions about your coverage.

How to prevent prostate cancer

The cause of prostate cancer is not known for certain, so there is no proven way to prevent the condition. However, there are risk factors associated with prostate cancer, including obesity and poor diet.

The best thing you can do to protect yourself against prostate cancer is to eat a diet low in fat and high in fruits and vegetables, don’t smoke and exercise regularly. It’s also important to get regular physicals and regular prostate cancer screenings once you are over the age of 50—if you have a family history of prostate cancer, screenings should start at age 40.  

Learn more about prostate cancer risk factors, symptoms and prevention.

How to prevent testicular cancer

Currently we don’t have data on what you can do to prevent testicular cancer. What we do know is there are some risk factors associated with an increased risk of developing testicular cancer.

These risk factors are:

• having had an undescended testicle
• testicles that developed abnormally
• a personal history of testicular cancer
• a family history of testicular cancer (particularly in a father or brother)
• being white.

The cause of both prostate cancer and testicular cancer is unknown. However, it is suspected that genetic factors play a role.

When it comes to prostate cancer, it can be caused by gene mutations acquired throughout a man’s lifetime, possibly due to high levels of androgens (male hormones) or insulin-like growth factor-1 (IGF-1) or due to prostate inflammation. There are also several inherited gene mutations that may cause the disease. 

In its early stages, prostate cancer does not have any symptoms. As it progresses, symptoms can include:

• trouble urinating (difficulty starting the flow of urine, a weak urine stream, difficulty emptying the bladder completely or an urge to urinate frequently)
• pain or burning during urination
• blood in the urine or semen
• trouble getting an erection
• pain in areas to which the cancer has spread, such as the hips, back and chest
• numbness or weakness in the feet and legs
• loss of bowel or bladder control
• shortness of breath
• fatigue
• rapid heartbeat
• dizziness
• anemia

Testicular cancer is typically first detected when a lump on the testicle is found, or the testicle becomes swollen. This lump or swelling may be painful. As the cancer progresses, there may also be pain in areas of the body to which the cancer has spread, such as the lower back, abdomen or lungs.

Since the symptoms of testicular cancer can also be signs of other issues, it is important to see your doctor if you have any of the following:

• a lump or swelling in one or both testicles that is painless
• a change in how the testicle feels
• a dull aching pain in the groin or the lower abdomen
• a rapid build-up of fluid in the scrotum
• pain or discomfort in a testicle or in the scrotum