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Home , Prostate, Prostate cancer, Testicular cancer

Every year in the UK over 50,000 men will be diagnosed with a male-specific : , testicular or penile.

This leaflet offers information on the three – from , risk factors and causes through to tests to determine a diagnosis and treatment options. A quick, simple visit to the GP to discuss worrying signs and symptoms can make a huge difference. The earlier the diagnosis and the sooner treatment can begin, the better the chance of survival.

www.orchid-cancer.org.uk

Introduction 3

Although rare, testicular cancer most commonly affects men between the ages of 15-45 with around 2,400 men being diagnosed each year in the UK. Fortunately, testicular cancer is highly treatable and the majority of men will be cured. Research shows that 98% of men diagnosed with testicular cancer will be alive 10 years after treatment. For more information on testicular cancer please see our website yourprivates.org.uk i Spine Bladder Pubic Seminal Prostate Vesicle

The are located inside the What is testicular cancer? scrotum; the loose bag of skin that hangs below the penis. From the start of Testicular cancer occurs when normal, puberty, each testicle produces . healthy cells, which are carefully The testicles also produce 90% of the regulated in the body, begin to male . reproduce uncontrollably in the testicles. It usually occurs in one testicle but can occur in both.

4 What are the different types of testicular cancer? lumps attached directly to the testicle(s) (usually painless) Around 95% of testicular tumours arise from the cells which line the swelling or enlargement of a testicle testicles, and are called germ cell an increase in firmness tumours. The most common of these is called and is made up of a pain or discomfort in the testicle single type of cell which is slow or scrotum growing and less likely to spread to a sudden collection of fluid in other parts of the body. It is more the scrotum common in men over the age of 30. The remaining types are often grouped a feeling of heaviness in the together and known as non-seminoma. scrotum a dull ache in the lower part of the Self-examination and possible , the scrotum or groin signs of testicular cancer rarely; pain in the back, not relieved It is important for men to be familiar by painkillers due to enlarged with the general structure of the testicle glands (see next page) (see diagram on page 6) and what is rarely; breast and nipple tenderness normal for them. One testicle may be (gynaecomastia) associated with slightly bigger than the other and one hormonal changes caused by some may hang down slightly lower but they types of testicular cancer should both be roughly the same size and shape and the surface free of any lumps. A simple, quick testicular self- If a man finds something that doesn’t examination can be performed on a feel normal it is vital that he sees his GP regular basis, ideally after a warm bath to rule out testicular cancer. Around 96% or shower when the scrotum and the of abnormalities found in the scrotum testicles are relaxed. will not be testicular cancer and non-cancerous conditions can usually Men should be aware of any changes be easily identified. A pain in the testicle and in particular the following: doesn’t necessarily mean cancer; there can be many causes.

For more information on non-cancerous yourprivates.org.uk conditions please see

Testicular Cancer 5 Testicular Self-Examination (TSE) This is the easiest way to identify any potential testicular problems. It only takes a few minutes to perform and gives men a good excuse for feeling their balls. It’s best performed monthly after a bath or shower when the scrotum will be warm, relaxed and easy to touch. Figure 1. Men should: 1. Check each testicle separately using one or both hands (Figure 1) 2. Roll each testicle between the thumb and fingers to check that the surface is free of lumps or bumps 3. Get to know their balls; their size, texture and . Identify the epididymis or sperm collecting tube, often mistaken for an abnormal lump that runs behind each testicle (Figure 2) Figure 2.

What are the likely causes of testicular cancer?

There is no single known cause of testicular cancer. However, research Intratubular germ cell neoplasia studies have shown the following are (IGCN) are abnormal cells in the risk factors: testicle. If left untreated, they may develop into cancer in about 50% An undescended testicle of men (). Around 10% Taller than average men of men diagnosed with testicular cancer will have had a history of this Men whose testicles are not functioning normally (causing A brother or father who has had , poor sperm production) testicular cancer Men with HIV are more likely to A previous history of testicular develop testicular cancer cancer

6 Having a , experiencing a Treatment options: single injury to the testicles or being what are they? sexually active does not cause testicular cancer. Removing the affected testicle by (orchidectomy) is the standard How is testicular cancer treatment for testicular cancer. It will diagnosed? not adversely affect someone’s sexual performance or fertility providing An scan of the testicles that the other testicle is healthy and a is extremely accurate at identifying prosthetic - or false testicle - can be testicular abnormalities and if testicular inserted in place of the removed one. cancer is suspected men will be referred After surgery no further treatment to a hospital specialist called a urologist may be needed, providing the cancer for assessment. Further investigations has not spread. However, to reduce any such as a CT scan and blood tests will possibility of the cancer returning in the be performed to check to see if other future it may be recommended that a areas of the body have been affected. short course of should Treatment will depend on whether be given. testicular cancer is localised to the testicle If there is obvious evidence that the or has spread to lymph nodes (see cancer has spread then a longer course below) in the abdomen or chest. of chemotherapy will be recommended. What are lymph nodes? Once treatment has stopped, men will be monitored on a regular basis for at The has a natural drainage least five years. system; the which is responsible for getting rid of unwanted Sex and treatment substances such as bacteria or old blood cells. Whether someone decides to remain sexually active during cancer treatment Lymph nodes are filters situated along or not is entirely a personal choice and this system. Their job is to filter out and the type of treatment will affect men in trap these unwanted substances, and different ways. Men will be able to talk to make sure they are safely eliminated to their healthcare team if they have any from the body in a fluid called lymph. concerns. Sometimes cancer cells can travel along the lymphatic system and reach other areas of the body.

Testicular Cancer 7

Every year over 47,000 men in the UK will be diagnosed with prostate cancer. It is the most common cancer in men and an estimated 1 in 8 men will develop the condition in the UK. i Spine Bladder Pubic bone Seminal Vesicle Prostate Rectum Urethra Vas deferens Epididymis Penis Testicle Scrotum

The prostate gland is located just below What is prostate cancer? the bladder. It is only found in men and is responsible for helping to produce the Prostate cancer occurs when normal, fluid found in . The gland is tiny healthy cells, which are carefully at birth but grows in size after puberty regulated in the body, begin to due to rising levels of the male hormone reproduce uncontrollably in the prostate testosterone. gland. In most cases, the growth is slow and the cancer can go undetected for many years because it causes very few symptoms. In rarer cases, however, prostate cancer grows quickly and may spread to other parts of the body, such as the lymph nodes or .

8 What are the symptoms? Less common symptoms There is no single symptom to indicate include the following: the presence of prostate cancer. In fact, many men with early prostate cancer Blood in the or semen have no symptoms at all. Problems with the prostate are common. Because the prostate gland What are the likely causes of surrounds the tube known as the prostate cancer? urethra, which passes urine from the There are a number of risk factors: bladder to the outside of the body, any prostate or growth (benign or Age. Prostate cancer mainly affects malignant) may cause problems with men over the age of 50. It is rare in . men under this age Ethnicity. Men of African Caribbean Symptoms of prostate cancer may descent are more likely to develop include the following: prostate cancer Slow or weak flow of urine Family history of prostate cancer. Urinating more frequently or Having a brother or father with urgently than usual prostate cancer increases the risk Difficulty starting to urinate compared to men with no family history of the disease. If a first Pain or burning sensation when degree relative was diagnosed with urinating prostate cancer under the age of 60 Unexplained urinary the risk is higher These symptoms can also be caused Family history of . by the prostate gland obstructing The risk increases slightly in men the bladder due to non-cancerous who have a strong family history prostate enlargement which can in of female breast cancer and vice turn affect the and muscles versa (National Cancer Institute). which control urination. This is thought to be because two carried by both men and Difficulty getting or maintaining an or pain during women (called BRCA1 and BRCA2) increase the risk of breast cancer in Impotence women and prostate cancer in men These symptoms can also be caused . A poor diet high in saturated by age, diabetes, heart or and may increase the cardiovascular disease. risk of developing several types of Constipation, altered bowel habit cancer including prostate cancer This symptom can also be caused by age, low intake of fibre and lack of exercise.

Prostate Cancer 9 Diet A good all round diet such as the Mediterranean diet (illustrated below) combined with exercise appears to be generally beneficial to health.

RED A few times a month MEAT Salt in moderation DESSERTS In addition - EGGS the following POULTRY substances appear FISH to offer some Snacks: Nuts in protection against A few times a week DAIRY, CHEESE ETC moderation prostate cancer; OLIVES AND OLIVE OIL pomegranate juice, Daily 6 glasses of water green tea (6 cups Red wine in a day), processed FRUIT BEANS, VEGETABLES Regular moderation tomatoes (found exercise in pasta and other sauces) and oily fish. BREAD - PASTA - RICE - BULGAR WHEAT AND OTHER CEREALS AS WELL AS POTATOES

How is prostate cancer diagnostic test for prostate cancer as diagnosed? levels can be high in people who do not have the condition. Having a PSA test Two tests are commonly used for the can be very reassuring if it is normal and, initial investigation of prostate symptoms: importantly, can help find some cancers A digital (DRE) at an early stage. Unfortunately, the PSA is quick and simple to perform, and test does miss some prostate cancers involves a GP inserting a gloved, and it can lead to unnecessary worry lubricated finger into the rectum (back and further tests in people who do not passage) to feel the prostate gland. have cancer. All men over the age of 50 are entitled to have a PSA blood test A PSA (Prostate Specific Antigen) blood performed and a DRE of their prostate. test measures the level of a substance If there is a strong family history or men produced by the prostate which can are of direct African-Caribbean descent be elevated in the presence of prostate then they should think about consulting cancer. The PSA test is not a specific their GP around the age of 45.

10 Prostate cancer is diagnosed from samples of tissue removed from the prostate ? gland during a . It is now common Q. What is meant by the “grade” and to perform a special type of Magnetic “stage” of prostate cancer? Resonance Imaging scan (MRI) before A. If a man is diagnosed with prostate taking biopsy samples from the prostate cancer, a specialist healthcare team gland to identify and target potentially will need to identify the “grade” cancerous areas. or aggressiveness of the cancer If a man is diagnosed with prostate in order to determine the best cancer the specialist healthcare team may course of treatment. The “grade” carry out additional investigations such as of cancer is determined by taking a bone scan. of the prostate gland The results of all these investigations and the system used to measure and the biopsies will be used to give the the grade is called the Gleason cancer a stage (how far it has spread; see system. If the cancer is slow diagram below). This can be summarised growing it will have a low “Gleason as T stage where T stands for tumour. score”. Other terms such as involvement (see page 7), and spread of cancer to bones may be discussed and are referred to in letter form as N and M respectively.

Bladder Spine Prostate T 1 Bladder T2 Rectum

T3 Prostate

T4 Tumour invading other structures

Prostate Cancer 11 Treatment options: Treatment will depend on a number what are they? of factors, and every individual will be assessed carefully before any treatment There are a number of treatment options decisions are made. A team of urologists, for prostate cancer: oncologists and other health professionals called a Multi Disciplinary Team (MDT) will discuss all of the available results and Active surveillance and “watchful make a recommendation for a particular waiting” treatment(s) based on their knowledge Surgery (open, keyhole or robotic and experience. This recommendation will surgery) then be discussed with the patient. The following tables contain a list of treatment Radiotherapy options; when they are used and some potential side effcts. Chemotherapy

Treatment option When it’s used Drawbacks

Active Often used for men with low-risk or slow- Can lead to surveillance growing cancers. It involves close monitoring while with regular check-ups; PSA tests, DREs and waiting to see usually further biopsies after a year or eighteen if cancer will months. Curative treatment can be commenced progress. if there is any sign of the cancer progressing or a patient were to change their mind and opt for treatment. Active surveillance prevents men rushing into treatment for their cancer which may cause unwanted side effects when the cancer may not progress or cause any problems for some time.

“Watchful This is used for older men or men who may waiting” not be fit enough for a particular treatment and have no obvious symptoms. Surgery Can be used when cancer remains localised. Can cause It will involve the removal of the whole prostate erection and and occasionally lymph problems nodes (see page 7). There are several types of or urinary surgery including “open”, keyhole (laparoscopic) incontinence. and robotic. No type of surgery has been proved to be better than the others with regard to possible side effects although recovery time will be quicker with laparoscopic or robotic surgery.

12 Treatment option When it’s used Drawbacks

Radiotherapy Used as an alternative to surgery. Can be Can cause either external (where an external beam is erection and directed at the cancer) or internal (where urinary problems radioactive seeds are placed into or near the and occasionally cancer – this is known as “”). minor bowel Brachytherapy is usually used if the cancer damage. is confined to the prostate gland whereas external beam and a newer type of radiotherapy treatment Intensity Modulated Radiotherapy (IMRT) can be used to treat early spread of cancer beyond the prostate.

Hormone therapy Used to slow cancer growth and reduce Can cause hot tumour size. Usually used when cancer flushes, loss of has spread beyond the prostate to other sex drive and organs or the bones. It works by removing osteoporosis or blocking the male hormone, testosterone, (thinning of the which encourages growth of prostate cancer. bones). Eventually, It is usually very effective at regressing and cells become controlling prostate cancer but does not cure immune and other the disease. treatments may be needed. Also used before external beam radiotherapy for localised disease and sometimes for several years after radiotherapy if cancer has spread onto the surface of the prostate or into the seminal vesicles.

Chemotherapy Combinations of , chemotherapy or Treatment will new treatments new types of hormone therapy can be used have side effects and combination when initial hormone therapy has failed. that may affect a treatment. man’s quality of life.

Prostate Cancer 13 New treatments Treatment options: longer term There are many new treatments for The treatment offered to each person will prostate cancer under development be regularly reviewed and may change and these include: over time. The specialist healthcare team will support people through this process. New types of blood tests to identify specific substances in the body which may help identify men who are at greater Sex and treatment risk of prostate cancer or may develop Whether someone decides to remain significant disease. sexually active during cancer treatment New types of hormone therapy and or not is entirely a personal choice and chemotherapy to treat men with more the type of treatment will affect men in advanced prostate cancer. different ways. Men may wish to talk to their specialist healthcare team if they and have any concerns. This treatment uses the individual’s own to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defences against cancer. ?

Q. What are clinical trials? A. Some people with cancer may be asked to take part in a clinical trial. These trials are an important part of the cancer research process. Individuals who take part in a clinical trial may receive the standard treatment for their cancer or be among the first to receive a new treatment. Many newer treatments are being developed to treat prostate cancer and men with more advanced disease may be asked to take part in trials to evaluate their effectiveness.

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Penile cancer is a rare cancer affecting around 630 men each year. It is more common in men over the age of 50 years although younger men can be affected too. i Spine Bladder Pubic bone Seminal Vesicle Prostate Rectum Urethra Vas deferens Epididymis Penis Testicle Scrotum

The penis is the external male sexual What is penile cancer? . The main part of the penis is known as the shaft and the head of Penile cancer occurs when normal, the penis is called the glans. At birth healthy cells, which are carefully the glans is covered by a loose piece of regulated in the body, begin to skin, known as the which may reproduce uncontrollably. In most cases, be removed in infancy - this is known this growth is slow. as . Inside the penis is the urethra, the tube through which urine and semen exit the body.

Penile Cancer 15 Possible signs of penile cancer How is penile cancer Common signs include: diagnosed? It can be very difficult to recognise the White or red scaly patches signs and symptoms of penile cancer. GPs may never see someone with the disease Red moist patches of skin because of its rarity. Many symptoms can Change in the colour of the skin be mistaken for common, non-cancerous conditions. Skin thickening Growth, bump or sore If an initial course of treatment does not “clear up” or resolve symptoms or there is any doubt about a condition it is important that men are referred to a What are the likely causes of hospital specialist called a urologist who penile cancer? may request further investigations. This There is no single known cause of penile may include a sample of tissue (a biopsy) cancer. However, research studies have being taken from the penis. If penile shown that the following may play a role cancer is found, men will be referred to a in penile cancer: specialist centre or Supra-Network.

The human papilloma virus (HPV). HPV is a very common type of ? virus spread by skin to skin contact Q. What is a Supra-Network? and around 80% of the worlds A. Supra-Network centres are population will be exposed to it in designed to treat certain types of their lifetime. Rarer types of HPV, cancer. These centres have surgeons types 16 and 18, (spread by intimate and nurses who are very skilled at sexual contact) are linked with treating penile cancer. penile cancer, anal cancer, cervical cancer and some throat cancers. Like all viruses the body’s immune The specialist team will carry out various system usually destroys HPV but tests and investigations to determine the sometimes it can lay dormant for most effective treatment. many years before causing problems Penile cancer is less common in men who have had their foreskin removed (been circumcised) soon after birth

16 Treatment options: what are they? ? There are three possible types of Q. Why might you be recommended treatment available to men: surgery, or refused a specific treatment? radiotherapy and chemotherapy. A. No two cases of cancer are the Surgery is the most common treatment same. The type and extent of the option for penile cancer. Removing small, cancer will vary, as will the medical surface cancers that have not spread history and general health of the can be performed using minor surgery. person being treated. The specialist Removal of part or all of the penis may healthcare team (MDT) will be recommended if the cancer has consider all these factors before spread to a wider area. Today it is much recommending a specific course more common for specialist surgeons to of treatment. This treatment will preserve as much as the penis as possible then be discussed carefully with the and reconstructive surgery which may individual concerned. involve skin grafts can sometimes be used Specialist nurses at supra-networks to restore the appearance of the penis. can also provide support and Radiotherapy and chemotherapy can information for patients. be used to treat more advanced penile cancer. However, chemotherapy cream may sometimes be used to treat very small, early cancers that are confined to Sex and treatment the foreskin or end of the penis. The type of treatment will affect men Photodynamic therapy (PDT) is a new in different ways. Access to specialist type of treatment which is being tested support from counsellors or therapists for treating penile cancer. It uses laser, can be very helpful. or other light sources combined with a light sensitive drug (sometimes called a photosensitising agent), to destroy abnormal cells. PDT is only available at specialist centres.

Penile Cancer 17 Resources Low-down, Orchid’s newsletter, features the latest news and developments For further information and support in male cancer including research, on male cancer, please visit the Orchid treatments, new services and events. website at www.orchid-cancer.org.uk or call 020 3745 7310 or contact the Other helpful websites include: nurse helpline below. www.cancerhelp.org – which offers a broad Orchid has produced a series of leaflets range of information and support from and Factsheets on specific issues Cancer Research UK for everyone affected relating to male cancer. You may find the by cancer. www.macmillan.org.uk – offers information following helpful: and support for everyone affected by cancer. Testicular Cancer - all you need to www.prostatecanceruk.org – Prostate know booklet Cancer UK provides support and information to people affected by prostate Ball Basics - a quick guide to testicular health and testicular cancer. cancer Prostate Cancer and You - a quick guide to prostate cancer Penile Cancer Booklet and Information Leaflets Resources i Orchid has a Male Cancer Helpline staffed by specialist nurses on 0808 802 0010 or email [email protected]

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