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Prevention, Diagnosis and Treatment of Testicular Cancer
Dr. Praneeth Vemulapalli discusses signs and symptoms of testicular cancer, preventive tips, and treatment options available.
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Learn more about Praneeth Vemulapalli, MD
Praneeth Vemulapalli, MD
Dr. Praneeth Vemulapalli is a board-certified urologist. He received his medical degree at Tufts University School of Medicine, graduating with Research Honors. He completed his surgical and urological training at SUNY Stony Brook University Medical Center. He joined Premier Medical Group and the Montefiore St. Luke's Cornwall medical staff directly from Ohio State University Medical Center where he was awarded the prestigious Clinical Fellowship in Robotic Urologic Surgery for 2011-2012. Dr. Vemulapalli treats all areas of urology, with a keen interest in minimally invasive and endoscopic surgery of the kidney, bladder, and prostate. He has contributed to abstracts, papers, and textbook chapters in the field of urology and minimally invasive surgery. He joined the practice in 2012.Learn more about Praneeth Vemulapalli, MD
Transcription:
Prevention, Diagnosis and Treatment of Testicular Cancer
Melanie Cole, MS (Host): Hello, welcome. Today we’re talking about testicular cancer. My guest is Dr. Praneeth Vemulapalli. He’s a board certified urologist with Monte Fiore St. Luke’s Cornwall. Dr. V, I'm gonna call you Dr. V for the purposes of this segment. Tell us a little bit about the prevalence of testicular cancer, and are there many types?
Praneeth Vemulapalli, MD (Guest): So there are a few different types of testes cancer. Testes cancer occurs approximately about 9,600 cases a year in the United States. It’s actually about 410 deaths, at least in the last calendar year, from testes cancer here in the United States. Typically effects younger males, typically between the ages of 15 to 38, but it can effect older males at times.
Host: Is there a screening tool?
Dr. Vemulapalli: There’s no discreet screening tool per se, but we do recommend that males, particularly younger males, perform serial self-exams in the shower examining their own testicles. If they feel any lumps or bumps that are not common. We usually ask them to bring that to the attention of their local doctor, their primary care doctor. That can help them to notice if there’s anything beyond the rate of normal growth and things of that nature. But usually if they feel a lump or enlargement in either testicle, sometimes they might notice the feeling of heaviness in the scrotum. Other times they can notice a dull ache in the lower abdomen or in the groin. Pain and discomfort can sometimes occur, but not all that common typically.
Host: Dr. V, this may seem a weird question, but as women we’re taught to do these self-breast exams and we’re also told that sometimes it’s pretty cystic. You might feel a lot of lumps and bumps. Is that the same for men? Do they have to get to know what their normal testes feel like so that they could recognize a bump? Or is it not like that?
Dr. Vemulapalli: That’s exactly Mel. You hit the nail on the head, and I couldn’t have said it any better myself. I think just getting to know what your normal anatomy is like. That’s why just checking yourself periodically in the shower. Then if you can notice that there’s anything atypical or anything that’s not common, you would be the first one to know and you could bring that to somebody’s attention. Sometimes you might not exactly know what a mass feels like. But if there’s a lump that you don’t normally notice, I'd bring that to somebody’s attention.
Host: That’s great information. So then how is it diagnosed? Is it something where a biopsy can be done or not really?
Dr. Vemulapalli: Well here’s the thing where testicular cancer’s a little bit different. So typically once someone notices a lump, they might bring it to the attention of their primary care doctor or pediatrician if it’s a younger male. They might examine them and notice hey, this is arising from the testicle. If that occurs, they typically would make a referral to a urologist. A urologist would examine that patient to notice is this something that’s arising from the testicle as opposed to arising from a different portion of the testes or scrotum, such as the epididymis.
If it is arising from the testes, our first primary modality of diagnosis is doing an ultrasound. It has no radiation exposure and really gives good detailed pictures of solid lesions that can be arising from the testes. If that occurs, our next method of action is that we would examine them with what we call testes cancer tumor markers. Those are blood tests that can sometimes be elevated if there is an actual testes cancer present. It’s coupled with the radiologic information form the ultrasound as well as the tumor markers, we might recommend removing the testicle. There’s a special way that we handle testes cancer in the sense that we don’t go through the scrotal space because that could effect treatment later on. If there is something concerning, we would surgically remove that testicle and pass it off to the pathologist to know what exactly is going on.
Host: So you remove the testicle to then find out the pathology. So it’s not where a little simple biopsy can be done. Tell us, Dr. V, about fertility because I think that that is going to be one of men’s biggest fears besides impotence.
Dr. Vemulapalli: Sure. That’s exactly right. So usually if we have a sonographic evidence that there is a solid mass here and if those tumor markers are elevated, it’s a pretty good indication that there could be a testes cancer there. If we remove that testicle, it could obviously impact fertility. So typically we might recommend sperm banking before a procedure like that. Normally if a person has a contralateral normal testis, they function normally, and fertility is not much of an issue.
Host: What about erectile dysfunction?
Dr. Vemulapalli: It has really no impact as long as you have a normal contralateral testicle.
Host: That’s great. I'm glad that you let us know that in this segment. Does this cancer commonly spread? Is it sometimes fatal or not really?
Dr. Vemulapalli: It could spread. Certainly I think if you talk to most urologists, they’ll reassure you that the rate of cure for this is extremely high, greater than 90/95%. I’ll let you know that the majority of patients that have testes cancer are found at stage I, which means that it’s limited to the testicle. That’s roughly approximately 70% of patients. Then those patients for stage I disease, it’s over a 95% cure. Even still when it’s moved out of the testicle, it can sometimes go into the lymph nodes and the lower back and move to other places, but it’s extremely responsive to chemotherapy and radiation therapy. So even those patients that have had spread of testes cancer still have cure rates well over 90%.
Host: Wow. That’s really an incredible statistic. So what other treatments might be tried if you’ve discovered whether it’s just limited to one of the testes or if it has spread. What other treatment? Are we looking at radiation or chemotherapy? Do those modalities come into play?
Dr. Vemulapalli: Yeah. So within the large umbrella of testes cancer, there can be different varieties. Those different varieties necessitate what the treatment options could be. A lot of times sometimes patients might get radiation therapy. They might get one single dose of chemotherapy, or they could get surgical therapy. That really depends on what specific type of testes cancer you have. So back when I said that if we have a cancer, we remove the testes, we pass it off to the pathologist, and the pathologist will look at under the microscope. They might have to do special stains to identify what particular variant of testes cancer the patient might have. Then that would impact what their final recommendation is for additional therapy. Once you’ve narrowed it down and you’ve treated it appropriately, the cure rate is really, really very. It’s something that we can really afford our patients a good deal of satisfaction to know that this is something that they have in their rearview mirror.
Host: One of the bigger things, I think, when people hear the words testicular cancer, men specifically, is the psychosocial and emotional aspect of this type of cancer. What do you see, Dr. V, as men deal with this and how they cope with whether they have to have a teste removed? What do you tell them?
Dr. Vemulapalli: That’s another great question Mel. So something like that, we really have to focus on the age demographic of the patients. As I said, most of these patients that get testes cancer are between say 15 and 35 years of age roughly. So in those patients, if they're younger, they remove a testicle, they might have certain body image issues concerned with that. So a lot of times if we’re removing a testicle, we can sometimes place a testicular prosthesis at that time or later on to offset the body image concerns that younger males might have.
Host: Isn’t technology amazing? As we wrap up, Dr. V, what would you like men and their partners that love them to know about testicular cancer? And the fact that you’ve given us such great statics on outcomes. Give us your best advice for whether it can be prevented or how important early diagnosis and self-exams are.
Dr. Vemulapalli: Well, that’s another great question. Unfortunately, there’s no way to prevent testes cancer, but there are a few what we call risk factors for developing testes cancer. One of the most common is ever having history of an undescended testicle. So testes normally form in the abdominal cavity during fetal development, and they usually descend into the scrotum before birth. Certain times babies when they're born, if they don’t have any appropriate testicles in the scrotum, they might get evaluated by their pediatrician. If they are noted to be in the abdomen, they need to be brought down. Those testes normally have a higher rate of developing testes cancer. So I would specifically encourage those patients to perform serial self-exams if they have a history of that.
Testes cancer can occur also in normal patients that have normal testicular maturation development. The one thing I would really, really stress is that just like you said before that women are really encouraged to do self-breast exams. Men should also be encouraged to do serial scrotal exams and testicular exams. They can do that with normal showering. And get to know their own bodies so if there is a change, they’ll know right away and they can alert somebody right away because this is a very, very treatable disease.
Host: What a great segment, Dr. V. Thank you so much for sharing your incredible expertise because I definitely think it’s something that not many people want to talk about, but you’ve really made it sound like something that is so treatable if it’s caught early. So thank you, again, for that great information. This is Doc Talk presented by Monte Fiore St. Luke’s Cornwall. For more information, please visit montefioreslc.org. This is Melanie Cole.
Prevention, Diagnosis and Treatment of Testicular Cancer
Melanie Cole, MS (Host): Hello, welcome. Today we’re talking about testicular cancer. My guest is Dr. Praneeth Vemulapalli. He’s a board certified urologist with Monte Fiore St. Luke’s Cornwall. Dr. V, I'm gonna call you Dr. V for the purposes of this segment. Tell us a little bit about the prevalence of testicular cancer, and are there many types?
Praneeth Vemulapalli, MD (Guest): So there are a few different types of testes cancer. Testes cancer occurs approximately about 9,600 cases a year in the United States. It’s actually about 410 deaths, at least in the last calendar year, from testes cancer here in the United States. Typically effects younger males, typically between the ages of 15 to 38, but it can effect older males at times.
Host: Is there a screening tool?
Dr. Vemulapalli: There’s no discreet screening tool per se, but we do recommend that males, particularly younger males, perform serial self-exams in the shower examining their own testicles. If they feel any lumps or bumps that are not common. We usually ask them to bring that to the attention of their local doctor, their primary care doctor. That can help them to notice if there’s anything beyond the rate of normal growth and things of that nature. But usually if they feel a lump or enlargement in either testicle, sometimes they might notice the feeling of heaviness in the scrotum. Other times they can notice a dull ache in the lower abdomen or in the groin. Pain and discomfort can sometimes occur, but not all that common typically.
Host: Dr. V, this may seem a weird question, but as women we’re taught to do these self-breast exams and we’re also told that sometimes it’s pretty cystic. You might feel a lot of lumps and bumps. Is that the same for men? Do they have to get to know what their normal testes feel like so that they could recognize a bump? Or is it not like that?
Dr. Vemulapalli: That’s exactly Mel. You hit the nail on the head, and I couldn’t have said it any better myself. I think just getting to know what your normal anatomy is like. That’s why just checking yourself periodically in the shower. Then if you can notice that there’s anything atypical or anything that’s not common, you would be the first one to know and you could bring that to somebody’s attention. Sometimes you might not exactly know what a mass feels like. But if there’s a lump that you don’t normally notice, I'd bring that to somebody’s attention.
Host: That’s great information. So then how is it diagnosed? Is it something where a biopsy can be done or not really?
Dr. Vemulapalli: Well here’s the thing where testicular cancer’s a little bit different. So typically once someone notices a lump, they might bring it to the attention of their primary care doctor or pediatrician if it’s a younger male. They might examine them and notice hey, this is arising from the testicle. If that occurs, they typically would make a referral to a urologist. A urologist would examine that patient to notice is this something that’s arising from the testicle as opposed to arising from a different portion of the testes or scrotum, such as the epididymis.
If it is arising from the testes, our first primary modality of diagnosis is doing an ultrasound. It has no radiation exposure and really gives good detailed pictures of solid lesions that can be arising from the testes. If that occurs, our next method of action is that we would examine them with what we call testes cancer tumor markers. Those are blood tests that can sometimes be elevated if there is an actual testes cancer present. It’s coupled with the radiologic information form the ultrasound as well as the tumor markers, we might recommend removing the testicle. There’s a special way that we handle testes cancer in the sense that we don’t go through the scrotal space because that could effect treatment later on. If there is something concerning, we would surgically remove that testicle and pass it off to the pathologist to know what exactly is going on.
Host: So you remove the testicle to then find out the pathology. So it’s not where a little simple biopsy can be done. Tell us, Dr. V, about fertility because I think that that is going to be one of men’s biggest fears besides impotence.
Dr. Vemulapalli: Sure. That’s exactly right. So usually if we have a sonographic evidence that there is a solid mass here and if those tumor markers are elevated, it’s a pretty good indication that there could be a testes cancer there. If we remove that testicle, it could obviously impact fertility. So typically we might recommend sperm banking before a procedure like that. Normally if a person has a contralateral normal testis, they function normally, and fertility is not much of an issue.
Host: What about erectile dysfunction?
Dr. Vemulapalli: It has really no impact as long as you have a normal contralateral testicle.
Host: That’s great. I'm glad that you let us know that in this segment. Does this cancer commonly spread? Is it sometimes fatal or not really?
Dr. Vemulapalli: It could spread. Certainly I think if you talk to most urologists, they’ll reassure you that the rate of cure for this is extremely high, greater than 90/95%. I’ll let you know that the majority of patients that have testes cancer are found at stage I, which means that it’s limited to the testicle. That’s roughly approximately 70% of patients. Then those patients for stage I disease, it’s over a 95% cure. Even still when it’s moved out of the testicle, it can sometimes go into the lymph nodes and the lower back and move to other places, but it’s extremely responsive to chemotherapy and radiation therapy. So even those patients that have had spread of testes cancer still have cure rates well over 90%.
Host: Wow. That’s really an incredible statistic. So what other treatments might be tried if you’ve discovered whether it’s just limited to one of the testes or if it has spread. What other treatment? Are we looking at radiation or chemotherapy? Do those modalities come into play?
Dr. Vemulapalli: Yeah. So within the large umbrella of testes cancer, there can be different varieties. Those different varieties necessitate what the treatment options could be. A lot of times sometimes patients might get radiation therapy. They might get one single dose of chemotherapy, or they could get surgical therapy. That really depends on what specific type of testes cancer you have. So back when I said that if we have a cancer, we remove the testes, we pass it off to the pathologist, and the pathologist will look at under the microscope. They might have to do special stains to identify what particular variant of testes cancer the patient might have. Then that would impact what their final recommendation is for additional therapy. Once you’ve narrowed it down and you’ve treated it appropriately, the cure rate is really, really very. It’s something that we can really afford our patients a good deal of satisfaction to know that this is something that they have in their rearview mirror.
Host: One of the bigger things, I think, when people hear the words testicular cancer, men specifically, is the psychosocial and emotional aspect of this type of cancer. What do you see, Dr. V, as men deal with this and how they cope with whether they have to have a teste removed? What do you tell them?
Dr. Vemulapalli: That’s another great question Mel. So something like that, we really have to focus on the age demographic of the patients. As I said, most of these patients that get testes cancer are between say 15 and 35 years of age roughly. So in those patients, if they're younger, they remove a testicle, they might have certain body image issues concerned with that. So a lot of times if we’re removing a testicle, we can sometimes place a testicular prosthesis at that time or later on to offset the body image concerns that younger males might have.
Host: Isn’t technology amazing? As we wrap up, Dr. V, what would you like men and their partners that love them to know about testicular cancer? And the fact that you’ve given us such great statics on outcomes. Give us your best advice for whether it can be prevented or how important early diagnosis and self-exams are.
Dr. Vemulapalli: Well, that’s another great question. Unfortunately, there’s no way to prevent testes cancer, but there are a few what we call risk factors for developing testes cancer. One of the most common is ever having history of an undescended testicle. So testes normally form in the abdominal cavity during fetal development, and they usually descend into the scrotum before birth. Certain times babies when they're born, if they don’t have any appropriate testicles in the scrotum, they might get evaluated by their pediatrician. If they are noted to be in the abdomen, they need to be brought down. Those testes normally have a higher rate of developing testes cancer. So I would specifically encourage those patients to perform serial self-exams if they have a history of that.
Testes cancer can occur also in normal patients that have normal testicular maturation development. The one thing I would really, really stress is that just like you said before that women are really encouraged to do self-breast exams. Men should also be encouraged to do serial scrotal exams and testicular exams. They can do that with normal showering. And get to know their own bodies so if there is a change, they’ll know right away and they can alert somebody right away because this is a very, very treatable disease.
Host: What a great segment, Dr. V. Thank you so much for sharing your incredible expertise because I definitely think it’s something that not many people want to talk about, but you’ve really made it sound like something that is so treatable if it’s caught early. So thank you, again, for that great information. This is Doc Talk presented by Monte Fiore St. Luke’s Cornwall. For more information, please visit montefioreslc.org. This is Melanie Cole.