The Malta Independent on Sunday
Have a date with your testicles once a month to check for abnormalities – Movember
Despite living in the age of having access to technology at the tip of our fingers, some men still do not know about the importance of self-checking for testicular cancer. “I recommend that men, especially younger men, find the time, ideally once a month after a warm shower, to have a date with their testicles and to check for any lumps or abnormalities,” Simon Bugeja, consultant urologist told The Malta Independent on Sunday.
Movember is all about raising awareness of men’s mental health, testicular cancer and prostate cancer and whilst the discussion has improved, there is still much more to be done.
Bugeja is a consultant urologist who specialises in all conditions affecting the urinary tract, and he deals with all types of urological malignancies, namely prostate, kidney, bladder and testicular cancer. His subspecialisation is in reconstruction of the urinary tract and treatment of erectile dysfunction.
Bugeja spoke to The Malta Independent on Sunaday about why men should not feel ashamed or embarrassed to talk about testicular or prostate cancer and how checking and getting tested can save lives.
Testicular cancer most common in males aged 20-40 years
Whilst testicular cancer constitutes around 1% of cancers in men, it is still the most common cancer in males aged 20-40 years. “On average we would have around 15-20 cases of testicular cancer a year,” explained Bugeja. “Even though the numbers are small, it is very important to catch it early, as when done so testicular cancer is highly treatable.”
Bugeja stressed the importance that men check themselves often for any changes or abnormalities in the testis.
Best way to do self-examination
Bugeja recommended that once a month, ideally after a shower so the skin of the scrotum is relaxed, a man should check and look out for any lumps. “It is important to know what you need to look out for and also what is normal. When you do a self-examination test you want to see that the testicles are smooth, soft and move around in the scrotum sack.”
He said that it is also normal for one testicle to be bigger than the other or that one is higher placed than the other. “Men need to look out for lumps or any change in size or shape. The vast majority of cases in testicular cancer are when a lump is present, and you will only notice that if you check.”
He said that many men put up an act of being ‘macho’, who would rather ignore the pain or lump and wait till it goes away. “There is absolutely nothing wrong with speaking up about pain, and I have had many patients come in to see me because of certain testicular discomfort, but they would not be aware about testicular cancer or self-examination, and my role then is to make this information more widespread.”
He said that it becomes a problem when the lump is left for too long, which could result in the tumour growing larger and the cancer spreading. “Whilst in this day in age information is so widespread, we still have men coming in when the tumour is large, leaving it too late. That is why we continue to stress the importance of checking yourself regularly.”
Prostate cancer more common in older men
With regard to prostate cancer, Bugeja said that it is much more common in older men and that around one in seven men at some stage develop a form of prostate cancer. “We usually see men over the age of 60 being diagnosed with prostate cancer, but if a family member also had it, the cancer could also appear at a younger age, even in a man’s early 50s.”
Bugeja explained that the function of the prostate – a small gland which sits underneath the bladder – is to produce the fluid contained in semen. Unlike testicular cancer, a man cannot examine the prostate himself, but can get a PSA (prostate specific antigen) blood test done.
“The test recognises the substance which is produced by normal prostatic tissue and is detected in the blood stream. The substance is produced in a higher amount when there is prostate cancer; when this happens, we usually do more checks and tests.” He also explained that a physical test can be done, like when an urologist does a rectal exam to feel for any bumps or hard areas on the prostate, which is just in front of the rectum.
When should you start checking?
“It is recommended that the first time you should check for prostate cancer is around 50 years old and if there has been a family history, and then you start checking around 45. Based on your results and your risk factor, then it will be decided how frequently you have your blood checked.”
Bugeja said that like testicular cancer, once screened early, the cancer can be treated and cured. A man can either have surgery to remove the prostate or receive a form of radio therapy directly to the prostate. “Once again I stress the importance of getting checked and catching the cancer at an early stage, that way one can be given treatment which can control the cancer or the after effects of treatment.”
He also mentioned that penile cancer, although very rare, has high mortality rates and must be caught early to be treated. “It is important that men keep themselves clean and do regular checks not just for their testicles but also their penis for any lumps, ulcers or lesions.”
Life after cancer
Whilst treatment and cure are extremely important factors, Bugeja also highlighted that patients should be aware of the side effects that treatment can bring.
After prostate cancer a man can face side effects of urinary incontinence (unable to control urine) or erectile dysfunction. When it comes to treating testicular cancer, one can face fertility issues or the removal of a testicle.
“There are a number of side effects, but we talk to these men about all the complications and the treatment provided to them to help them live with these side effects. At the hospital we have a multidisciplinary team who works together when it comes to the treatment of the patient.”
Talk to one another
Bugeja recounts how many patients have told him that they have delayed coming in for a check-up because they were shy or embarrassed. Some patients waited until the pain was too much to bear.
“We need to talk to each other and there is absolutely nothing to be ashamed or embarrassed about when we talk to our friends about any problems we might have. We need to continue raising awareness about these cancers, especially if we want to catch them early and save lives.”