14. Breaking Down Testicular and Prostate Cancer

[00:00] Hello, everyone. Welcome to our podcast. My name is Nivet. I'm joined with Shannon. Hi, Nivet. Hi, Shannon. How are you doing? I'm good today. Thank you.

[00:20] for today's topic because today's topic is around men's health. We're going to be talking about prostate and testicular cancer particularly. I think men in general are not the best in taking care of their own health. So I think it's a good topic to talk about and we have Dr. Matt Mood here who is a specialist in these topics. Shana, do you want to introduce?

[00:40] Yes. We have with us today Dr. Syed Mahmoud. He is an oncology and hematology physician. He's the medical director at the Aquilino Cancer Center and he's also based with Maryland Oncology Hematology. So thank you for joining us today Dr. Mahmoud. We really appreciate it. Oh thank you. Thank you. It's a pleasure to be here. Yes.

[01:00] You said it, men don't always take care of themselves. Absolutely. I think men's health in general, I feel like they don't go to the doctors as much or they don't, you know, proceed for their yearly physicals. I know my family is similar in some of those places as well and doing the yearly checkups. How important is it to get their yearly physical and what are some of the questions?

[01:20] they should be asking when they do go to their providers. You know, it's a pleasure to be here in the month of September and for prostate cancer awareness month. And I mean, this is a common issue. I mean, I can speak for myself and for my own family, men in general, it's a common generalization, but no one likes to go to the doctor. Just taking

[01:40] the time. I think that the key things for men's health is trying to think about, well, what can I do to prevent issues from coming up? Preventative health is a key thing here. Absolutely. There's a lot that we can do to live a good lifestyle, healthy lifestyle, and prevent issues from coming. Oh, great. Is there a particular screening for prostate cancer?

[02:00] men should be looking for and what are some of the guidelines in today's world. Yeah, so prostate cancer screening, a little bit of a controversial topic. When we talk about screening, it's, you have to understand that the goal of screening at a population level is to do a measure that's cheap, that can identify cancer early and the goal is to prevent

[02:20] And unfortunately for prostate cancer screening, the data is somewhat mixed. And that is why from the United States Perminative Services Task Force, they do not have a strong recommendation on one way or the other regarding prostate cancer screening. And they actually say they leave it up to the patient and the doctor to talk about the risk and benefits of this.

[02:40] And that's because there's two large trials showing that the data is mixed. Yes, screening we know can identify cancer sooner. The key thing is by identifying cancer sooner, are we really making a difference in preventing death? What comes with that is sometimes over diagnosis and over treatment. The American Cancer Society actually comes down a bit stronger on this. They generally

[03:00] do for cancer screening. And their general recommendations for prostate cancer screening is for the average risk men starting at the age of 50 to have a conversation with their doctor. And to consider screening. And screening for prostate cancer is either with the PSA test and or the prostate exam, digital rectal exam. And you consider doing that every

[03:20] two years, average age, I'm sorry, age of 50. Now when you think about risk factors, there are people who are at higher risk that you may want to consider starting sooner. And that is anyone with the first degree relative, that means for most men, their brother or father that if they had a diagnosis of prostate cancer before

[03:40] age of 65, that's considered a high risk. Unfortunately, African American men are also considered at high risk. So for those high risk individuals, we consider screening starting at the age of 45. And in particular, the screening recommendations from the American Cancer Society go down earlier to the age of 40 if you had basically two or a grade

[04:00] first-to-be relatives with a history of prostate cancer, or you have one of these what we call hereditary cancer syndromes, or have a mutation you were born with that puts you at higher risk for getting prostate cancer. Absolutely. And I think there's so many different scenarios of where your health could be and what are the risk factors that you're involved with. I think to our earlier conversation,

[04:20] That's why it's so important to have that conversation with your physician and provider and talk to them about am I in one of those risk factors or am I okay? Do I need to get these testing or screening? Am I one of those people that I need to look for these symptoms and what risk factors are associated with it? So I think it's very important. Now are these similar for testicular cancer as well?

[04:40] So I would say testicular cancer is very different. There are rare genetic, let's say, syndromes that are associated with high risk of testicular cancer. It's very rare. One for example is something called Klinefelter syndrome. But as is the case with even prostate cancer, the vast majority of people who develop testicular cancer or prostate cancer

[05:00] is someone who doesn't have a family history. So for testicular cancer, there is no effective screening study or screening modality for testicular cancer. It's all about identifying signs and symptoms, getting checked out early. You know, the key thing about testicular cancer is this generally happens in young men, whereas it's a rare cancer in general, less than

[05:20] 1% of solid tumors are testicular cancers. However, it's the most common solid tumor diagnosis in men between the ages of 20 and 34. Wow, that's very odd. I was going to say, I didn't know that, but it happens younger. That's right, this is the age where men don't expect to get anything, and the key thing is that it presents generally as either a painless lump

[05:40] painful lump in the testes and most people chock it up at that age or like you don't expect any issue you think you got injured you think oh it's some infection it's gonna go away but that is where something if something is present just get it checked out by the doctor it is one of the most curable cancers out there risk of death is actually quite low if you get it checked out and

[06:00] treated effectively and treatment is very effective, but the key thing is identification. That's where we lose out and where we may delay in diagnosis and delay getting things checked out is when you just ignore it or decide that it's something else on your own accord and don't get it checked out by the doctor. Yeah, I think it's really good to know that, you know, when people hear cancer, they're related to not curable or, you know, fatal.

[06:20] in some cases, but it's good to know that this is not fatal and very curable in early stages and identification is the key. What are some of the myths around testicular cancer?

[06:40] trauma was thought to be associated with increased risk for testicular cancer. And that's just not the case. That hasn't been proven. The data has not borne that out. The main risk factors for testicular cancer is really undescended testes. It's also called cryptorchetism. That's usually identified at birth, and by the age of 1, most testes should descend down into the

[07:00] discrotum and if that's usually picked up by the pediatrician, it gets surgically corrected. That's the highest risk for testicular cancer outside of the genetic cancer syndrome that we talked about. The only other main risk factor is if you've had one before, then you're at high risk for getting another one. And in general, if you look at race, Caucasian white individuals

[07:20] men are at four to five times higher risk just by pure rates alone compared to other ethnic groups. So that's just something to know. So you mentioned, to stick to ulcer cancer being pretty rare, what about prostate cancer for men? Prostate cancer is actually one of the most common cancers in men. It's actually the leading most common cancer outside of skin cancer for men and it's the second leading

[07:40] cancer cause of death in men in the United States. So it's quite common whereas you know you have about 10,000 new cases of testicular cancer a year in the United States. When I say cancer you're talking about 270,000 cases per year. And so it's quite common one in eight men are going to be diagnosed in their lifetime.

[08:00] breast cancer for women. Exactly. So for women, breast cancer is most common, and for men it's prostate cancer. Whereas one in 41 men will actually die from prostate cancer. So it's not that high risk of death, but it is very common. And the key thing that we're learning about nowadays is that there is a strong genetic

[08:20] link to prostate cancer. If you think about your own family history, think about how many people in your family have a cancer history and it's quite common. And we now know we're doing much better at testing for gene mutations, identifying mutations that people are born with that are associated with cancer, not only prostate cancer but other cancers. And the cost of testing has gone.

[08:40] down quite a bit. At most, if you have enough family history, your insurance will cover testing. The availability of genetic counselors to do this for you to kind of go through your family history and identify things, it's much more prevalent and available. I'm part of a practice that we have several people that can do genetic counseling for you and the out-of-pocket costs even

[09:00] even if you're in insurance for whatever reason does it pay for it, the out-of-pot cost for broad testing is somewhere around $200 or so. So it's quite affordable compared to even just like 10, 15 years ago. So just identifying that, not only could it help you, it could help other people in your family and prevention is the key thing here. And maybe there are things you

[09:20] you can do to even prevent cancer from developing, especially in breast cancer and ovarian cancer and things like that. We've talked about that on this podcast. It seems to be a recurring theme is prevention and just knowing your body, knowing what's going on, and developing a relationship with your physician to talk about that. And you said prostate cancer, it's a little, it's kind of mixed up.

[09:40] on what to do, what's not mixed is just knowing your doctor and finding one and having those conversations. Same thing for women. That's a recurring theme here. And we've talked a little bit too about having that conversation with your family and knowing your history that it's not the most pleasant thing to talk about, but it's important to just be aware of what's in your background.

[10:00] What's going on with your family? I think the tide will shift. I came from a culture and a background where people didn't talk about other family members' health. They kept it all hush-hush or secret or personal. And that's fair, but knowing your family history can make a big difference to your own health. Absolutely. What are some myths around prostate cancer? You talked about prostate cancer.

[10:20] about a little for testicular cancer, what about for prostate?

[10:40] cancer, the data has not been proven out. The only thought around that was that if there was some chronic inflammation of the prostate, we do think that chronic inflammation can be an increased risk for cancer in general and that those vasectomies and SCDs can cause inflammation around the area. But again, specifically for those, the data is very

[11:00] very inconclusive and I would say those are myths in terms of prostate cancer. Other things, generally, yes, living or eating a good diet, having good weight control, exercise, smoking. These for prostate cancer are not clearly linked, but these are general good health, right? You want to do that? You want to eat healthy. You want to have

[11:20] have a good weight goals and you want to not smoke. So all those things are good in general. So I strongly recommend those for anybody, but specifically linked to prostate cancer, it's really not that strong yet. As I've reached 40 and gone over 40, my husband too, and I just find myself thinking about these things. Didn't think about them.

[11:40] five years ago, probably, but as I've gotten older, I just tend to think about my health more, and I try to push myself and push my husband too, to kind of be like, okay, we've been sitting on the couch for too long. Or just eating healthier. That's good advice. Yeah, I think that's one of the other common themes we're seeing over the past few podcasts as well.

[12:00] normal health in general, preventative measures, is highly beneficial in those long ways, regardless of which disease processes or issues we're talking about. Even though, as you said, it's not directly linked overall in general, health for both men and women, it's highly beneficial. Absolutely. Absolutely. In terms of treatment for both of

[12:20] them. You've mentioned a little bit that there's testicular cancer is curable. Is prostate, I know they've made a lot of advances in treatment in general just for cancer. Is it still earlier you catch it the better your options are and survival rates? I would say in general you want to catch it early, right? No one wants to catch it cancer-late.

[12:40] Again, in terms of the screening and identifying, the data is mixed on if it will actually make you live longer. So the vast majority of men, if you look at autopsy series, there's prostate cancer in men. Most men live and die with prostate cancer and they don't even know it. It's something that's slow growing, it may be there, it's part of the human existence. The question is, we don't know which one.

[13:00] ones are going to be the bad players and actually shorten people's lives. We don't know that. So yes, we can identify cancer early, but then that causes sometimes over diagnosis and over treatment. So it's really a discussion with your doctor for how I view it personally, because it's easy to say talk to your doctor, where's the nuances here? Right? I personally feel that if you have a family history.

[13:20] it's kind of a no-brainer to have that discussion. So then because that family history proves that whether it's biologic, whether it's environmental, someone in your family, there is some predisposition or there's some genetic predisposition, whatever you want to call it. And that's where I get concerned when I look at, I see people in clinic all the time and they're having this diagnosis and then.

[13:40] Then you see, oh, there's multiple family members. And that's the person you think, could there have been an intervention to catch it early? I would say advancements in treatments are vast. Before there was a kind of very intensive surgery that most people do. Now it's all robotic. Recovery time is excellent. Surgery is one of the mainstays, but you don't need surgery. Many prostate cancer patients

[14:00] cancer is found early, you can watch prostate cancer. Like I said, I've heard that term watch full weighting. Exactly, exactly. Because again, this is generally a slow growing that's usually we use that for the lower grade prostate cancers that prove that they're slow growing cancers. But radiation therapy with what we call brachytherapy, which is in planting these radiation seeds into the prostate that doesn't require.

[14:20] surgery. And then later on down the line of the cancer journey, you may be talking about hormone therapy and chemotherapy. And there's big pushes now in terms of diagnosis and imaging monologies for prostate cancer that are really advancing. That's wonderful. That's good to hear that things are moving forward at becoming more advanced. And so maybe that'll encourage people

[14:40] to continue to keep up with their health and catch it early so that they have a lot of options. As a final say, what do you think we should have? Like what do you, one take away for men to keep up with their health? Go to the doctor. You know, I- We haven't said that enough today. No, I know, because it is a, honestly it is a recurring theme. If you talk to any doctor that treats a lot of people-

[15:00] people. It's a recurring theme. There's usually a couple that comes in and someone's dragging the other person in on both sides. Okay. It happens on both sides. But yes, it's commonly the men being dragged in and the people who ignore things are usually in the worst shape. And yes, if you catch, if there's a problem that's, can't be explained.

[15:20] something with your health, do not put your head in the sand. Go see the doctor. I tell some of my patients, you know, I give them permission to poke you, poke them with a sharp stick to get them to the doctor. Okay, because, you know, if there is an issue, they need to get checked out, especially with the last couple of years with COVID. A lot of people, rightfully so, concern about going into the doctor.

[15:40] doctor, concerned about being around other sick people. And that has led to delays in diagnosis and later presentations. And we've seen that just in the last couple years in our own clinic, let alone nationally. So that I think is the big deal. And just to take another point, especially for colon cancer, I'm just putting aside, you know, cancer

[16:00] rates are becoming higher for younger people. And just because you're young, don't expect medical issues can't come up. And that's just something that we need to all be aware of. Yeah, we've heard that actually in some past episodes, even around heart disease in women, it's occurring in younger colorectal cancer. We heard today testicular cancer is more common in younger men.

[16:20] So no matter your age, pay attention to your health, know your body, find a doctor that you can connect with and have a relationship with. Absolutely. Well, thank you, thank you for coming. Thank you for all this great information. Nim it, any final thoughts? Thank you, Dr. MacMood, to come here and help us with elaborate on prostate cancer and testavirus cancer for our listeners. You're welcome, my pleasure. And thank you to our listeners.

[16:40] nurse. Don't forget to like or subscribe for new episodes at either Apple Podcast or Spotify. We really appreciate you tuning in. If you do want to learn more about Dr. Mahmoud and his practice, you can go to Marylandoncology.com for more about Adventist healthcare. You can go to Adventist healthcare.com. Thanks.

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