Prostate Cancer
In males, prostate cancer ranks second among the most common cancers to be diagnosed. Understanding risk factors, signs/symptoms, and screening for prostate cancer is key to getting diagnosed early, which improves patient outcomes.
Risk Factors: The age of the patient is the highest risk factor. The most common age range for prostate cancer to be diagnosed is from 65 through 74. The race of the patient is also an important factor to consider, as African American’s have the highest incidence of prostate cancer. Diet is another key factor in assessing prostate health. Diets high in animal fat and low in fruits/vegetables appear to lead to higher incidence of prostate cancer. Interestingly, coffee appears to have a protective effect on the prostate.
Signs and symptoms: The primary concern with prostate cancer is that symptoms are usually nonexistent. However, patients may present with urological complaints that are not very specific, such as blood in the urine and/or blood in the semen. If the cancer has spread, the most common complaint may be bone pain due to the metastasis to the bone.1
Screening: The recommended age for average risk individuals to start screening is 50 years old. High risk individuals, such as African Americans or those with a strong family history of prostate cancer may consider screening at ages 40 to 45. The recommended screening test is done through a blood test called the PSA (prostate-specific antigen). The DRE (digital rectal exam) is not recommended as part of the screening process for prostate cancer. Experts recommend a screening PSA to be completed every one to two years until the age of 75 if the patient has a 10-year life expectancy.2
Testicular Cancer
In males ages 15 through 35, testicular cancer is the most common cancer to be diagnosed. However, for all cancers diagnosed in males, testicular cancer only counts for one percent. Understanding the signs and symptoms of testicular cancer, along with the diagnosis process is essential to having a positive outcome. No screening recommendation for testicular cancer exists at this time.
Signs and Symptoms: Initially, the presenting symptom may be a new hard nodule or mass located on a testicle. The nodule/mass does not usually cause any pain. The patient may present with signs of metastatic disease: cough, enlarged lymph nodes, or pain in the bones.
Diagnosis: The primary test of choice to diagnose a testicular cancer is done with a scrotal ultrasound. A CT scan of the abdomen/pelvis and/or chest x-ray may be preformed to assess for metastasis. Serum tumor markers may also be checked due to association with testicular cancers: beta-HCG (beta subunit of HCG), LDH (lactate deyhydrogenase), and AFP (alpha-fetoprotein). It is important to consider cryopreservation of sperm for fertility purposes.
Treatment: Surgical removal of the testicle with the tumor is the method to remove testicular cancer. Further treatment with chemotherapy and/or radiation is dependent on metastasis to other sites.3
Low Testosterone (Hypogonadism)
Low testosterone is a common and fairly easily diagnosed concern of many men. Understanding the risk factors, symptoms, diagnosis and treatment can help improve the patient’s quality of life.
Risk Factors: Certain congenital and chromosomal abnormalities (Klinefelter’s syndrome) are associated with low testosterone. Certain infections, such as mumps, have been linked to testosterone deficiency. Chronic disease such as cirrhosis, AIDs, and renal failure may cause low testosterone. In addition, the use of certain medications, such as steroids, may decrease a person’s testosterone. No specific reason may be identified to cause a person’s deficiency in testosterone as well.
Symptoms: In younger males, the symptoms may present with a lack of pubertal changes, such as difficulty gaining muscle, absent facial hair, and lack of a deeper voice. In older males who are past the age of puberty, symptoms may include low libido, a depressed state, and decreased energy.
Diagnosis: Low testosterone can usually be diagnosed with a blood test for total testosterone levels. The specimen should be collected between 8 am-10 am and the patient should be in a fasted state.⁴
Treatment: Testosterone supplementation should only occur if a patient is clinically diagnosed appropriately with three separate serum testosterone levels done between 8 am-10 am along with signs/symptoms consistent with low testosterone. Supplementation for low testosterone can be done through various routes. The most popular methods of administration include topical gels, intramuscular injections, and subcutaneous pellets.⁵
©2022HealthSpot References: (1) Kantoff, P. W., Smith, J. A., & Taplin, M. E. (2019). Clinical presentation and diagnosis of prostate cancer. Uptodate. Retrieved from https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-prostate-cancer (2) Hoffman, R. M. (2019). Screening for prostate cancer. Uptodate. Retrieved from https://www.uptodate.com/contents/screening-for-prostate-cancer (3) Michaelson, M. D., Oh, W. K., Richie, J. P., & Steele, G. S. (2019). Clinical manifestations, diagnosis, and staging of testicular germ cell tumors. Uptodate. Retrieved from https://www.uptodate.com/contents/clinical-manifestation-diagnosis-and-staging-of-testicular-germ-cell-tumor (4) Snyder, P. J. (2019a). Clinical features and diagnosis of male hypogonadism. Uptodate. Retrieved from https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-male-hypogonadism (5) Snyder, P. J. (2019b). Testosterone treatment of male hypogonadism. Uptodate. Retrieved from https://www.uptodate.com/contents/testosterone-treatment-of-male-hypogonadism