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Dr. David Hill: This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today we're talking with Michelle Dellorso, advanced practice nurse and certified family nurse practitioner with Carle Health Urology about testicular and prostate cancer. Michelle, welcome.

Michelle Dellorso, NP: Thank you for having me.

Dr. David Hill: So testicular cancer, prostate cancer, definitely both in the urology zone.

Michelle Dellorso, NP: Correct.

Dr. David Hill: They're rather different in terms of who's susceptible, how we screen, how we treat. Can you talk to us a little bit about some of the differences, and maybe let's just start with testicular cancer.

Michelle Dellorso, NP: Sure. So testicular cancer is most common in the ages of 20 to 40 years old. it is pretty rare. The best screening is monthly testicular exams. Unfortunately, there's no hard and fast rule, no strict guidelines, for recommendation on. Screening for testicular cancer. It is generally recommended by urology to do a self exam monthly, which is literally just trying to feel to see if there's any bumps or masses. If something is felt, then we would recommend that you'd be referred to urology for workup. Now, workup for testicular cancer typically starts out with an ultrasound done of the scrotum.

This is the best imaging for testicular cancer, and it will evaluate whether that mass is on the testicle or is it somewhere within the scro. From that, then we can determine whether blood work is needed to look at different cancer markers. And then if that is positive, then we start talking about treatment for testicular cancer. Treatment for testicular cancer typically includes removal of the testicle. We typically will have discussion with the patient on whether sperm banking for fertility issues is necessary.

We also have the discussion on whether a testicular prosthesis is indicated or recommended for that patient. It is very individualized care. And there is some screening that is long term typically with evaluations and blood work.

Dr. David Hill: So it sounds like testicular cancer is really a concern for younger men. You said age 20 to 40, and then that seems like a good transition to the prostate. Who needs to be concerned about that?

Michelle Dellorso, NP: Prostate cancer screening typically starts at age 55, the American Urological Association recommend screening to start at age 55. They do not recommend screening below 55. Screening typically includes not only a PSA level, which is a blood test, that's for prostate specific antigen. That is a protein that is produced by the prostate that floats through the blood. We use that value in conjunction with a digital rectal exam.

The digital rectal exam helps us feel size of the prostate and whether we feel any abnormalities in the prostate because the exam can be subjective. We use that in conjunction with the blood work and risk factors of prostate cancer to determine an overall risk of prostate cancer.

Dr. David Hill: And what are some of those risk factors?

Michelle Dellorso, NP: The risk factors include age, ethnicity, family history and genetic. And any significant or chronic inflammation of the prostate.

Dr. David Hill: So what would cause chronic inflammation of the prostate then?

Michelle Dellorso, NP: So the prostate does grow throughout a person's entire lifetime, and we call this benign prosthetic hyperplasia. The prostate just grows forever, and so eventually you can get some inflammation because of infections, like urinary tract infections, congestion of the prostate from. conditions such as like decreased blood flow, things like that.

Dr. David Hill: All right, so those are all things we should report if we're having this screening. And now you mentioned benign prosthetic hypertrophy. That's not cancer, but say middle-aged gentleman who starts getting up in the middle of the night to pee, do you need to be worried?

Michelle Dellorso, NP: So you should be evaluated, but I would typically say, don't worry unless we tell you to worry. Oftentimes this is again, very benign and we can treat those symptoms to give you better quality of life.

Dr. David Hill: Great. So say I show up in your office, I've been referred, maybe I had a high PSA or I have a complaint, in that area. What's gonna happen when I get there? What should I be looking forward to?

Michelle Dellorso, NP: First things first is we're gonna do a lot of asking about symptoms, how long they've lasted. We will go over some family history of different urologic conditions. We typically will check a PSA level if you've not had one done within the last year. We are looking to see if that number is elevated from previous years or is it elevated if you've never had one done. We kind of work from most serious to less serious conditions, so we always wanna rule out cancer first, and we do that with the PSA and we also, I would expect a digital rectal exam that day.

After that, we will go over the symptoms and discuss whether they seem to be symptoms related to obstruction from the prostate, or do they appear to be symptoms that are more irritative, such as urinary frequency, urgency. And the getting up in the middle of the night, we treat obstructive symptoms a little bit differently than irritative symptoms. Depending on which way we think the direction is going, we can treat with medications.

Dr. David Hill: Well, that sounds really helpful. Do you have any less takeaways or messages that you wanna leave listeners about your services?

Michelle Dellorso, NP: Just know that if you're having symptoms, we are here. Don't be embarrassed to discuss them, you don't have to live with symptoms just due to age. There are things that we can do to help, and if we can give you some better quality of life and better sleep, then that's what we're here for. And obviously cancer screening. The earlier it's caught, the better our options are for treatment.

Dr. David Hill: Well, that is fantastic news. Michelle Dellorso, thank you so much for speaking with us today.

Michelle Dellorso, NP: Thank you very much, Dr. Hill.

Dr. David Hill: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill.