♂️ Prostate & Testicular Cancer
One is old and slow, one is young and fast. Opposite ages, opposite tempos.
⚖️ Opposite in almost every way
Pairing these two makes both stick, because nearly every feature is a mirror image.
| Prostate | Testicular | |
|---|---|---|
| Typical age | Over 65 | 15–35 — young men |
| Tempo | Usually slow-growing | Fast-growing |
| First sign | Often none; urinary changes later | Painless firm lump or heaviness |
| Detected by | PSA and digital rectal exam | Self-examination |
| Spreads to | Bone — pelvis, spine, ribs | Lymph nodes, lungs |
| Outlook | Good when confined | Very high cure rate, even when spread |
Old and slow versus young and fast. If a stem gives you a 25-year-old with a scrotal lump, it is not prostate. If it gives you a 70-year-old with back pain and trouble starting his stream, think prostate with bone metastasis.
👨 Prostate cancer
Early prostate cancer causes no symptoms at all. When urinary symptoms do appear they are the same ones benign enlargement causes, which is exactly why they get dismissed.
Symptoms, when they come
- Hesitancy — difficulty starting the stream
- Weak or interrupted stream; dribbling at the end
- Frequency and nocturia; urgency
- Feeling the bladder has not emptied
- New, persistent back, hip or pelvic pain in an older man is bone metastasis until ruled out.
| BPH — benign | Prostate cancer | |
|---|---|---|
| On rectal exam | Smooth, rubbery, symmetrically enlarged | Hard, irregular, nodular, asymmetric |
| Course | Gradual urinary symptoms | Silent, then urinary or bone symptoms |
| PSA | Can be mildly raised | Often higher, and rising over time |
- PSA is not a cancer test. It rises with BPH, prostatitis, urinary infection, recent ejaculation, catheterisation and even a rectal exam. The trend matters more than one value.
- Draw the PSA before the digital rectal exam, not after.
- Diagnosis is by transrectal ultrasound-guided biopsy; the Gleason score grades aggressiveness.
- Risk: age, Black race, family history, BRCA mutations.
Treatment and its costs
- Active surveillance for low-risk disease — monitoring, not neglect. Explain that, or the patient hears "they are doing nothing".
- Radical prostatectomy — expect urinary incontinence and erectile dysfunction; teach Kegel exercises, catheter care, and no heavy lifting or straining.
- Radiation, external or brachytherapy seeds. With seeds, follow the safety instructions on distance from pregnant women and young children for the stated period.
- Androgen deprivation — hot flushes, loss of libido, bone loss, mood change, gynaecomastia. Bone density is monitored.
👦 Testicular cancer
The most common solid cancer in men aged 15–35, and one of the most curable cancers there is — if it is found. Finding it depends almost entirely on the man noticing it himself.
Signs
- A painless, firm lump on the testis, or the whole testis enlarged or hardened
- A heavy, dragging feeling in the scrotum
- Dull ache in the lower abdomen or groin
- Sudden fluid collection; breast tenderness or enlargement from hormone secretion
- Back pain if it has reached the lymph nodes
Painless again. Young men expect cancer to hurt and wait, and this one does not wait with them.
Risk factors
- Cryptorchidism — an undescended testis, even after surgical correction. The strongest risk factor.
- Family or personal history; testicular atrophy
- Age 15–35; higher in white men
✋ Testicular self-examination — teach it properly
Normal anatomy that gets mistaken for a lump: the epididymis is a soft, comma-shaped structure along the back of each testis, and one testis normally hangs slightly lower than the other. Say both out loud when teaching, or the man finds his own epididymis and panics — or worse, assumes every lump is normal.
- Tumor markers — AFP, beta-hCG and LDH — help diagnose, stage, and track response.
- Scrotal ultrasound first; then orchiectomy, with chemotherapy or radiation as needed.
- Discuss sperm banking before treatment starts, not after. Chemotherapy and radiation can cause infertility, and once treatment has begun the option is gone.
- Reassure that one remaining testis usually maintains normal hormones and fertility, and that a prosthesis is available.
Say the awkward part. These are young men who will not raise body image, sexual function or fertility on their own. Raise it first, matter-of-factly, and the conversation becomes possible.