Things You're Too Embarrassed to Ask a Doctor Season 1, Episode 2: Testicular and Prostate Health with Dr. Scott Eggener

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You're listening to Things You're Too Embarrassed to Ask a Doctor, a production of UChicago Medicine. Each week, we'll feature one physician and ask them your most searched questions in their areas of expertise. For more information on our episodes, visit us at www.UChicagoMedicine.org/podcast. Have something you're too afraid to ask your doctor? Tweet us at tytepodcast. I'm your host Kat Carlton.

Hello, and welcome to an especially cringe worthy episode of our show. Today, we're going to focus on a couple male sex organs, namely the testicles and prostate, and some both scary and painful things that can happen to both. Here's a little preview.

People are going to start cringing in their cars or while they're exercising right now, but testicles can twist on themselves.

That was urologist Scott Eggener, our guest on today's show. I'll let Dr. Eggener talk about what exactly it means to be a urologist.

So I'm a urologist, which takes care of men and women but in the genitourinary system. So all of the sexual organs in a man and then kidneys, tubes that drain the kidneys, bladder in everybody.

And you do surgeries as well, correct?

We do. When needed, we do surgery.

While Dr. Eggener can treat both biological men and women, today we'll be focusing on people with male sex organs. Our first topic today is testicles.

Nearly everyone is born with two testicles. And there's two main functions to it. Number one is to provide testosterone throughout the body for a variety of purposes. And the second one is to generate sperm, which can travel up that spermatic cord, and obviously during an ejaculation, goes into partner. And if it's meant for fertility, I think everyone can take it from there.

Next, can you talk about what happens when there's pain in the testicles?

So the testicles start as infants and neonates in the back of the abdomen. And when we're in the uterus, they drift downwards and ultimately attach to cords, and end up obviously in the scrotum. They're easily accessible. There are things that can go wrong with them. And we encourage most guys at the time of puberty at least once a month to examine their testicles. And if there's anything wrong, let one of their physicians know.

So when they're experiencing pain, what could that be a sign of?

Yeah, the great news is pain in the testicle rarely means something serious is going on, but it warrants an evaluation, particularly it's not going away. But there's a whole range of things, infections, hernias, inflammation. Very rarely it's caused by cancer.

Another question that's searched a lot. Which testicle is more important?

So if you have two testicles, and not all guys do, and if they're the same size, they're contributing equally. There are occasions where one is larger than the other and might be contributing more.

But mainly, it doesn't matter. Most the time neither is more important.

I'm left handed. So I'll say the left testicle is slightly more important.

So another one is how or why does testicle size increase?

So during puberty when there's a surge of testosterone, the testicles grow in size because they have more to do. They have to produce more testosterone themselves, and they also are obviously important for sperm production. But after puberty, they stay the same size until late in age when testosterone levels start drifting lower. And sometimes they can start shrinking a little bit.

With a crushed testicle heel?

That sounds really painful.

It really does.

It often does. If there's an injury to the testicle, obviously, get it checked out. Sometimes it requires some fixing by a urologist. Sometimes it needs a whole lot of nothing and just some TLC.

Will a swollen testicle go away?

Depends on the source of the swollen testicle. But if a testicle swollen, obviously, mention it to a parent, a friend, and hopefully a physician for an evaluation. But there's a lot of things that can cause that.

What is a testicular cysts and are they painful?

So testicular cysts are surprisingly common, but they're usually next to the testicle rather than arising from the testicle. There's this little tiny structure next to the testicle called the epididymis. It's kind of shaped like a worm attached to the side of the egg shaped testicle. Really, really common to get cysts there. Really, really, really uncommon that it causes problems. But on occasion, they can get really large and get in the way of things or cause pain. And bring it to someone's attention if it's bothering you.

By someone's attention, do you mean a physician?

Ideally.

What is testicular torsion and what does that feel like?

So people are going to start cringing in their cars or while they're exercising right now, but testicles can twist on themselves. Basically that cord that attaches can twist and the blood supply can cut off. And it gets extremely painful really quickly and shout out loud kind of pain. And if that occurs to you where it happens quickly, you get into an emergency room. It's most common in teenagers, 20s, people in their 20s and 30s. And if it's caught in time, we can and twist them and save the testicle. If people wait too long, the blood supply gets compromised. And oftentimes the testicle is dead and needs to be removed.

Is there a time frame you usually look at?

Earlier is better. Sort of each hour matters. We can usually save the testicle if people show up within six or eight hours, but our success rate is lower the longer they wait.

But the pain is going to be so bad, people are probably going to head to the emergency room right away.

This isn't subtle. You know that something is going on. And the mind is amazing and sometimes explains things away. But if you do experience that pain, get in to see somebody.

During the research phase of this episode, I consulted with a few friends who expressed concerns about testicular cancer in specific. One of them mentioned to me.

We're told all the time to check for testicular lumps, but I have absolutely no idea what they feel like. What do they feel like?

So I don't think it'll be a surprise to anyone that boys and men can often be knuckleheads when it comes to their health. And the bottom line is if you feel your testicle-- and I encourage doing it at least once a month, preferably in the shower elsewhere-- use the first three fingers on each hand. If there's ever a lump or a bump that wasn't there before, get it checked out. The good news is it's usually not cancer. But if it is testicular cancer, it usually feels like a firm bump. Or on occasion, the entire testicle has gotten very firm and a nodular.

Testicular cancer is incredibly uncommon. There's only about 8,000 people a year in the US that are diagnosed with it. But the sweet spot where most guys are diagnosed are between the ages of 18 and 35. If it's diagnosed, it's one of the most curable cancers that we have. So sometimes there's very minimal treatment. Sometimes it's more extensive. Don't let your mind take you and convince you that it's something else. Go get checked out. Make sure it's not testicular cancer. Even if it is testicular cancer, incredibly high likelihood of curing it.

Moving on to the prostate. Let's talk about what is the prostate and what does the prostate do.

I really, really wish I knew why we have a prostate. All it does is cause problems. The only known function of it is it helps to liquefy the ejaculation. So it's not as much of a coagulate. It's sort of smoother and easier and probably travels better to where it needs to go, which is the cervix and uterus in a woman. Now after that, all it does is causes problems. It gets big and causes urinary symptoms. It gets infected and causes pain and urinary symptoms. And it causes cancer very regularly.

Do people need a prostate?

So if you're done having children, your prostate is completely and utterly useless. And in fact, one holy grail dream of mine would be once people are done having kids, if they could take a magic pill that makes their prostate evaporate, it would be so many fewer problems for so many fewer men.

We talked a little bit about this, but where exactly is the prostate located?

So unfortunately the prostate is in ground zero of so many other structures. So it is basically deep in the pelvis, sort of near the bladder, your urinary tube called the urethra, near the penis, near the rectum, near the nerves that are important for erections. So there's a lot going on down in that space.

How is prostate cancer diagnosed?

So there's a variety of ways. In the United States, the most common is people have a blood test called the PSA, which leads to a biopsy of the prostate, and cancer is identified. There are other men who have urinary symptoms, or people feel their prostate and there is a firmness or a nodule, and that leads to the diagnosis. And then unfortunately, there are men who are going about their normal business and have symptoms throughout their body and have pain or other discomfort, go to the doctor, and the prostate cancer has spread elsewhere and is causing issues.

How dangerous is prostate cancer? How early is it usually detected?

It's really crazy in that there are many, many men who are diagnosed with prostate cancer, that it's never going to cause them any problems and they don't need any treatment done. And we monitor it and they live out their days, hopefully decades, and the prostate cancer never causes an issue. The other end of the spectrum is prostate cancer that is really aggressive and is destined to kill somebody. And it's still the second leading cause of cancer related death amongst men in the United States. So it has a lethal component to it. And then literally everywhere in between, that really wimpy or that really aggressive form.

Who gets prostate cancer?

So only men, and only people with prostates, which is sometimes confusing for people. And there are risk factors for people to get prostate cancer. The most common ones are people that have a family history of prostate cancer, people with African ancestry, people with genetic abnormalities within their family that lead to a higher risk of prostate cancer. But in general, anyone over the age of 40 or 50 is at slightly increased risk of having prostate cancer.

And so besides that blood test, are there any signs men should be looking out for that they may or may not have this cancer?

So whether to get that blood test is highly controversial and probably can't dive into all the details now. But it's worth at least discussing with your primary care doctor, hey, should I consider getting this PSA blood test and talk it through? If you have a family history, or African ancestry, or that some of these genetic abnormalities, I personally think you should get the blood test. There are times that urinary symptoms can be the first symptom. Thankfully, most guys who have urinary symptoms do not have prostate cancer, but that would be something to bring up to your doc as well.

So in order to diagnose the cancer, is there a biopsy that has to happen?

For virtually everyone diagnosed with prostate cancer, we need to make sure via obtaining some tissue from the prostate. It sounds awful on how we do that. We put a needle either through the skin or through the rectum into the prostate. Most guys who go through it say that wasn't as bad as I was told it would be. It's usually about a 5 to 10 minute procedure. There's some local anesthesia. You take some antibiotics before and after, but you walk out of the office the same day. And you get an answer on whether there's cancer there or not.

So that was one of our big questions, which was our prostate biopsy is painful? So you say most people think it's less painful than they've been told once they actually have it done.

No one after a prostate biopsy would say, hey, thank you can I have another one? There's always some level of discomfort. The majority of men say, OK, I can deal with that pretty easily. But there are a subset of men where it's particularly painful. And there are rare occasions where we do it in an operating room with some anesthesia if the guy is particularly uncomfortable.

Can prostate cancer spread?

It can in a subset of men. And there are certain features that make a prostate cancer more or less likely to spread.

And what are those features?

Depending on what your PSA level is, which is that blood test, what the cancer looks like under the microscope, how the prostate feels, how much cancer is in the prostate. And if we're concerned about the potential of it spreading, we get pictures and scans to make sure it hasn't spread.

So you treat a lot of these. What are the treatment options when people are diagnosed with this?

So I tell guys the good news and the bad news is there's a lot of options. A lot of times it would be so much easier, quicker, and simpler if I said, here's what you have, here's what you need to do, and we go forward with it. But I think having options is a good idea. And there's a whole range. For a big chunk of men, we literally just observe it. They need no treatment, and they need reassurance on the really low likelihood of it causing problems.

If it's in the area of the prostate, the most common treatments are some form of surgery or some form of radiation therapy. Although there's a bunch of newer exciting ways of treating it that are being evaluated. And then if the cancer has spread elsewhere in the body, the most common form of treatment is hormone therapy. And there's been a lot of exciting advances over the last couple of years. And there's all sorts of other newer non-hormonal types of medications that have extended life for guys with metastatic disease.

This has been Things You're Too Embarrassed to Ask a Doctor. Dr. Eggener, thanks so much for being on our show today.

Great to be here. It was fun to talk.

Once again, I'm Kat Carlton, and you've been listening to Things You're Too Embarrassed to Ask a Doctor. Music from today's episode is by Blue Dot Sessions. For more information on our show or to submit your own question, visit you www.UChicagoMedicine.org/podcast or tweet us at tytepodcast.

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