Checking for testicular cancer

Your husband probably spends more time and money on his car than his health. "We're far more likely to get our car's oil changed and tires rotated at appropriate intervals than we are to take ourselves to lifesaving cancer screenings," says Moshe Shike, M.D., director of the Cancer Prevention and Wellness Program at Memorial Sloan-Kettering Cancer Center in New York City.

Looking under the hood of a car is an easier, and certainly less intimate, chore than checking for prostate, testicular, or bladder cancer. People tend to put off screenings because of busy schedules, embarrassment, or dread of discomfort--though professionals are trained to make these procedures as comfortable and unimposing as possible. A few minutes at the doctor's office pays off. "Discovered early, most cancers have a cure rate of up to 90 percent," says Shike.

"A lot of people walk around with symptoms and don't pay attention to them, delaying diagnosis," Shike adds. Share these facts about cancer screenings with your husband, son, or brother. They might save his life.

Prostate Cancer

Every year more than 180,000 new cases of prostate cancer are diagnosed in the United States. After lung cancer, it ranks as the second leading cause of cancer death in men.

The risk of developing prostate cancer increases with age. More than 75 percent of all prostate cancers occur in men older than 65, although these cancers can develop in those as young as 40. Men who have a family history of early prostate cancer (before age 55) or a personal or family history of enlarged prostate have a greater chance of developing prostate cancer. African American men are twice as likely to die from it. A diet low in fiber and high in fat and red meat also may be associated with increased risk.

Symptoms include a weak or interrupted urine flow; inability to urinate; difficulty starting or stopping urine flow; the need to urinate frequently, particularly at night; a burning sensation during urination; blood in the urine; painful ejaculation; and chronic pain in the lower back, hips, thighs.

Screening. The two most widely-used tests, specific antigen (PSA) blood test and rectal exam (DRE) help detect prostate cancer in early stages--when treatment can be most effective. Given together, both tests supply the doctor with the most accurate information. "Well over 90 percent of men who undergo annual screening with a PSA and DRE and who are found to have prostate cancer have localized disease," says Ian Thompson, M.D., professor and chief of urology at the University of Texas Health Science Center in San Antonio.

The American Urological Association says all men of appropriate age should receive counseling about early detection. The group advocates offering routine prostate cancer tests to men who expect to live 10 years or longer and who are over 50, over 40 and have a family history of the disease, or over 40 and African American.

The PSA has made a tremendous impact. "Since the inception of the PSA blood test, prostate cancer deaths in the United States have fallen for the first time after having climbed since record keeping began," says Thompson.

In general, PSA levels lower than 4.0 ng/ml are deemed normal. Doctors consider further evaluation when levels are higher.

Though slightly uncomfortable, the DRE is quick. The doctor inserts a gloved, lubricated finger into the rectum to check for any irregular or abnormally firm area.

"A man with an elevated PSA or a suspicious DRE should seek out the care of a urologist," says Thompson. "These specialists are skilled in diagnosing and treating prostate cancer. If a PSA is elevated, a prostate biopsy is the only method to determine if prostate cancer is the cause." This outpatient procedure takes 10 to 15 minutes.

A word of caution: Before the biopsy, anyone taking aspirin, medicine for arthritis, or any medicine that thins the blood needs to inform his doctor. The physician also needs to know whether the patient has a heart murmur or any artificial or transplanted material in his body. "During the biopsy, the urologist uses a narrow probe that is placed through the rectum and next to the prostate where it takes sound-wave images of the gland," explains Thompson. "After the gland is carefully inspected, biopsies are taken from several separate parts of the gland, using the ultrasound probe for guidance. The biopsies are usually taken with a special instrument that instantaneously removes the tissue." An antibiotic, given around the time of the biopsy, minimizes risk of infection.

Afterward, patients sometimes see a small amount of blood in the urine or stool. The ejaculate can be discolored for several weeks.

If the result of the biopsy is negative, the patient generally undergoes another PSA and DRE six to 12 months later.

Testicular Cancer

Testicular cancer is one of the few cancers that can be detected through men performing self-examination, says Robert Smith, M.D., director of cancer screening for the American Cancer Society. "Historically we know that men who are diagnosed late have been living with the symptoms and have been unaware of what they meant for some time. Testicular cancer is highly treatable but gets less treatable the longer you wait. Self-examination means finding this cancer at a more easily treatable stage." Most men diagnosed early go on to live normal reproductive lives.

The disease most commonly occurs in men 20- to 35-years-old and is four times more prevalent in whites than African Americans. Men who have a testicle that didn't descend into the scrotum at birth may be at increased risk. Each year 7,500 cases are diagnosed, with 300 men dying.

The National Cancer Institute (NCI) reports that those diagnosed with testicular cancer have an increased risk of developing other cancers and a fivefold greater chance of developing leukemia.

Symptoms include enlargement of either testicle or a lump; a feeling of heaviness in the scrotum; dull ache in the abdomen or groin; sudden collection of fluid in the scrotum; pain or discomfort in the scrotum area; or an enlargement or tenderness of the breasts. A dull ache associated with activity (and even at rest) may occur as the tumor grows, adds Smith. The tumor, however, should not cause pain during intercourse.

Screening. "Testicular cancer has a very simple screening test: self-examination," says Thompson. "Many testicular tumors, in fact, are discovered by men feeling an abnormality in the testis during a bath or shower." Warm water relaxes the scrotum, making it easier to examine. It's recommended that men examine the testes at least once a month by gently rolling each testicle between the thumb (on top) and the middle and index fingers (underneath). One testicle may seem slightly larger than the other, but that's not unusual. Cancerous lumps usually are found on the sides of the testicle but can appear on the front. Men need to report changes immediately to their doctor.

Bladder Cancer

More than 55,000 cases of bladder cancer are diagnosed yearly in the United States. Men are three times more likely to develop the disease than women. Bladder cancer occurs in whites at twice the rate of African Americans. Smokers also are at an increased risk for bladder cancer. People living in urban areas and those working in dye, rubber, and leather industries also are considered at higher risk. Individuals under 40 usually do not develop the disease.

Symptoms include experiencing the need to urinate but not being able to go. Any amount of blood in the urine may be a sign. Depending on the amount of blood, the urine may range from a pale yellow-red to a darker red. A routine urine test performed as part of a general medical checkup can uncover small amounts of blood otherwise not detectable. Although blood in the urine may be an early warning of bladder cancer, it may indicate kidney stones, urinary tract infections, or enlargement of the prostate gland.

Detection. The sooner most bladder cancers are found, the more treatable they are. Most doctors refer at-risk patients to a urologist for outpatient tests, such as urine cytology, an examination of urine under a microscope to find precancerous or cancerous cells.

An intravenous pylegram (IVP) is an X-ray exam that lasts about one hour. The doctor injects a dye into a vein. The solution travels to the kidneys, ureters, and bladder and outlines them on an X ray.

To view the inside of the bladder, the urologist performs a 15-minute cystoscopy by inserting a slender tube with a light and magnifying lens through the urethra and into the bladder. A suspicious growth or an abnormal area prompts a biopsy.

The best way to beat cancer is through early detection. So when one of the guys in your life is fiddling under the hood of the car, remind him to take time for his own preventive maintenance.

KNOWLEDGE IS POWER