It's 'Movember,' time for men to talk about uncomfortable topics - like prostate and testicular cancer

Dr. Paul Gellhaus
Dr. Paul Gellhaus

With November right around the corner, you may hear talk of “Movember,” a global initiative to raise awareness of men’s health issues.

And you may see men sprouting facial hair during the initiative’s “No Shave November” to raise funds for and awareness of prostate and testicular cancer. Part of the reason prostate cancer, in particular, is misunderstood is that people don’t know much about the prostate itself, said Dr. Nathaly François, a urologist at Mercy Medical Center in Cedar Rapids.

“The prostate is a very small gland that sits just underneath the bladder, right in front of the rectum,” François said. “It is part of the male reproductive system that produces one of the substances found in semen.”

Cancer of the prostate is relatively common — one in seven men will be diagnosed with it during their lifetimes. Doctors typically begin screening men for the cancer at age 55.


The screening involves a blood test — called PSA, for prostate specific antigen — and a rectal examination.

“To simplify it, the PSA is a protein that is produced in the prostate gland that we expect to stay in the prostate and not show up in the bloodstream,” Francois said.

“If there’s any sort of change to the architecture of the prostate gland — whether from prostate infection, prostate inflammation, urinary infection, prostate enlargement, or prostate cancer, to name a few — that protein can escape from the gland and show up in higher levels in the bloodstream,” she said.

An elevated PSA suggests prostate cancer but does not automatically mean a cancer diagnosis, Francois said.


The chance of getting prostate cancer is higher if someone in your immediate family — father, grandfather, brother or uncle — has been diagnosed, or if you are African American.

“Those would be reasons for an earlier screening, anywhere between age 40 and 54,” said Dr. Paul Gellhaus, a urologist and clinical assistant professor at University of Iowa Health Care in Iowa City.

As men age, they may notice changes to their urination, but that alone is not a reliable factor in helping detect prostate cancer.

“We try to allow patients the appropriate education so their mind can be at peace as they notice changes,” François said.

“Prostate cancer is not typically symptomatic until it is advanced,” Gellhaus agreed. “Men could feel great, but be harboring a potentially lethal cancer without early screening. Even with a diagnosis, prostate cancer can be either be observed or treatable in the majority of cases.”


If a man’s PSA is elevated, a urologist would perform a rectal exam and an ultrasound biopsy. Recent advancements at the University of Iowa allow doctors to perform prostate MRIs to look at the entire prostate for areas of concern.

“That especially can help us perform a more efficient biopsy procedure,” Gellhaus said, adding it also can help avoid multiple biopsies.

If the cancer is low-risk, doctors may watch it through regular biopsy and “active surveillance.” But if it is clinically significant, surgery or radiation may be required.

At the University of Iowa, Gellhaus said, the surgery is done robotically to help with a faster recovery.


“Quality of life is especially important,” François said. “Some patients are over-treated, and their quality of life can therefore be diminished by the consequences of some of the treatment options.”

Infertility, incontinence and impotence are all potential side effects of prostate cancer treatment. “Ultimately, the risk category into which a patient’s prostate cancer falls helps to guide the kind of treatment the patient will undergo.” Francois said.


Another male cancer, testicular cancer, tends to occur in men during their 20s and 30s and is commonly diagnosed after a painless testicular mass or swelling is noticed.

“Many men are embarrassed by this and simply hope it goes away but that delays the process of diagnosis and treatment,” said Gellhaus.

Conversely, a lot of testicular “lumps” turn out to be benign conditions that don’t require surgery.

François agreed that speaking up is important as there are no general screening guidelines for testicular cancer.

“As soon as there is a suspicion, you’ll want to make sure it’s addressed quickly,” she said.

If a tumor is found to be cancerous, it is more “fast track in terms of management,” which often means removing the testicle surgically.

“Most men,” Gellhaus said, “remain at their baseline sexual and fertility standpoint after surgery. Plus, there are prosthesis available if men are worried about their scrotum not looking ‘normal.’ ”

François said a onetime chemotherapy treatment could be in order.


The encouraging news is that testicular cancer tends to be localized, Gellhaus said. “The cure rate is typically high, especially if it is caught early. “I encourage men to check their testicles once a month, using the date of your birthday as a good

way to remember when to do it. Note any changes or differences and talk to a doctor if you are concerned.”


Both François and Gellhaus noted that with both types of cancer, patients don’t typically experience pain. So it’s important to self-examine for testicular lumps, to have PSA screenings for prostate cancer and to be an advocate for yourself. Gellhaus also noted he and other physicians are always supportive of men seeking a second opinion so patients feel comfortable with their decisions.

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