Advancing Urologic Cancer Treatment with Cutting-Edge Technology

Name: Advancing Urologic Cancer Treatment with Cutting-Edge Technology
Uploaded: 2025-05-19T12:46:55.7966667Z
Duration: 29 min

May 19, 2025

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00:00Funding for Yale Cancer Answers
00:02is provided by Smilow Cancer
00:04Hospital.
00:06Welcome to Yale Cancer Answers
00:08with the director of the
00:09Yale Cancer Center, Doctor Eric
00:11Winer.
00:12Yale Cancer Answers features conversations
00:15with oncologists
00:16and specialists who are on
00:17the forefront of the battle
00:18to fight cancer.
00:20This week, it's a conversation
00:21about the care of patients
00:23with urologic cancers with doctor
00:25Preston Sprenkle.
00:26Doctor Sprenkle is an associate
00:28professor of urology at the
00:29Yale School of Medicine.
00:31Here's doctor Winer.
00:35Why don't we start off
00:37just hearing a little bit
00:39about you
00:41and how you got interested
00:42in urologic cancers.
00:45So I trained in urology
00:48residency in New York and
00:51was really impressed with the
00:53complexity
00:54of urologic
00:56cancers and
00:58the challenges that we face
01:00when treating them.
01:02I think it was
01:04a lot of basic science,
01:06the integration of science
01:07in clinical medicine,
01:09and,
01:11really
01:13how we were able to
01:14try to integrate all these
01:17complex technical issues with
01:20patient care and
01:21helping patients
01:23and especially men with prostate
01:25cancer
01:26understand their diagnosis and make
01:28good treatment decisions.
01:30Since being at Yale,
01:32this has grown from starting
01:34an MRI
01:36ultrasound fusion prostate biopsy program
01:38to really be more accurate
01:40in the way that we
01:40diagnose prostate cancer,
01:42limit
01:43the number of men who
01:45have to have a prostate
01:46biopsy by using that
01:48imaging.
01:49And now
01:51we've transitioned that
01:53into
01:54more precise treatments with prostate
01:56cancer ablation therapies.
01:58And we'll drill down
01:59on some of those.
02:02As a breast cancer doctor,
02:03I often think of prostate
02:05cancer as
02:08the men's equivalent
02:09of postmenopausal
02:11breast cancer.
02:12And I think it is
02:14in a number of ways,
02:15and one of those ways
02:17is that prostate cancer isn't
02:18just one disease.
02:20It's really a range of
02:22different diseases that
02:24can vary from those that are
02:27remarkably
02:28slow growing
02:30to those that are more
02:31aggressive.
02:32Can you just
02:33talk a little bit about,
02:35first, maybe the very slow
02:37growing prostate cancers and
02:40what does and doesn't have
02:41to be done in terms
02:42of treatment for some men?
02:44Yeah. Thank you for
02:45that question.
02:47There's a tremendous
02:50almost rainbow
02:51of ways that we
02:53interpret and manage prostate cancers,
02:56a tremendous breadth. So low
02:58grade prostate cancer, there is
03:00an ongoing international discussion about
03:03whether or not we should
03:04be calling it prostate cancer
03:05because it seems to have
03:07such a low
03:10likelihood of ever causing a
03:12man's death that we follow
03:14those routinely with something called
03:16active surveillance.
03:18It does not require treatment.
03:21We monitor it closely so
03:22that we can pick up
03:23early if
03:25it is one of those
03:26very rare cases that
03:27has the potential or will
03:29behave more aggressively in the
03:30future.
03:32So that used to
03:33be about half or more
03:35than half of the prostate
03:36cancers that we would diagnose
03:38with now usage of better
03:40screening techniques, including this MRI
03:42imaging for the prostate.
03:45At most academic centers, it's
03:47now closer to about a
03:48third. So we've been able
03:49to avoid doing prostate biopsies
03:52and diagnosing
03:53these low grade cancers in
03:54about a quarter of the
03:55men that we used
03:56to diagnose it in.
03:58And I'm sure that
04:00even when someone's told that
04:01they have
04:03low grade prostate cancer and
04:04it's unlikely to cause their
04:06death, it still causes some
04:08amount of distress.
04:10Definitely.
04:11And that's one of
04:13the largest challenges that we
04:14have is how to
04:17reassure these men
04:18who have all of a
04:19sudden gotten this cancer diagnosis
04:21that this is not something
04:23that is dangerous to them
04:25and that in many cases,
04:28the management or a treatment
04:30for this prostate cancer
04:32is probably worse than the
04:34disease itself. And that is
04:35one of the major challenges
04:36that we have in
04:37managing
04:39prostate cancer.
04:40Yeah. Well, here again is
04:41the parallel with breast
04:43cancer where
04:46we recognize that for some
04:47patients, we need new and
04:49better therapies, and there are
04:50still people who die of
04:52breast cancer in much the
04:53same way there are people
04:55who die from prostate cancer.
04:57But then there's a large
04:58population where we need to
05:00figure out
05:01how we can do less
05:03and achieve the same outcomes.
05:05So when you're identifying
05:07these patients who have
05:10low grade prostate cancer, you
05:12still use
05:14a Gleason score?
05:16And you wanna talk about
05:17that a little bit?
05:18We do. So the Gleason
05:21scoring system has evolved somewhat.
05:24We're now using
05:25a Gleason grade grouping
05:27system because
05:29the historical Gleason score sort
05:31of went from two to
05:32ten, but
05:34we only considered things of
05:36a six or higher to
05:37be cancer.
05:38But intuitively, a six out
05:40of ten seems bad. And
05:41so even though that's the
05:43lowest
05:44grade.
05:47So a concerted effort by
05:49the International Society of Urologic
05:50Pathology,
05:51they regraded it or rebranded
05:53it as a grade group
05:54one through five. So now
05:55we're on a five point
05:56scale. A one out of
05:58five is much more intuitively
05:59kind of low risk and
06:00low
06:01grade. But there still is,
06:03and there is actually an
06:04effort
06:06underway to reevaluate
06:08Gleason, especially now that we
06:09have a lot more genomic
06:11information about prostate cancer.
06:13There are efforts underway
06:15to reevaluate that.
06:17And is a Gleason six
06:18the equivalent now of a one?
06:20That is correct. Yep.
06:21So grade group one is
06:22a Gleason six. Grade group
06:24two is a Gleason three
06:26plus four equals seven. And
06:27that was the other confusing
06:28thing is you had a
06:29three plus four equals seven
06:30and a four plus three
06:31equals seven. Those are now
06:32grades one, two, and three.
06:34So it's a little bit
06:35more clear
06:37for us to be able
06:38to communicate.
06:44Gleason six, or the new one, is
06:48where you're very often
06:50talking about active surveillance?
06:53Correct.
06:54All of the guidelines internationally
06:56at this point for grade
06:57group one or Gleason six
06:59recommend active surveillance. They recommend
07:01against treatment. And that is
07:03because
07:04the data suggests a greater
07:06than ninety nine percent fifteen
07:08year survival without any intervention
07:11for men with the
07:13grade group one prostate cancer.
07:15So some of us are
07:17very
07:18adamant about not treating anyone
07:20with Gleason six or grade
07:21group one disease.
07:23And as we've gained more
07:24experience, we've actually expanded that
07:25to a large percentage of
07:26men with grade group two
07:28prostate cancer
07:29where we monitor them closely
07:31but do not require initial
07:32treatment.
07:33And, of course, the reason
07:35that you wanna try to
07:36avoid treatment is there are
07:38consequences.
07:39And maybe this is a
07:40good time for you to
07:41just touch on
07:43some of the problems that
07:45arise after either
07:47surgery
07:47or radiation for prostate cancer.
07:52You're
07:52absolutely right. There are kind
07:53of two main reasons not
07:55to treat men with these
07:56low and intermediate risk cancers.
07:57One is we know that
07:58it's not dangerous as we
08:00are talking about. There now
08:01are randomized clinical trials that
08:03show really minimal or no
08:05survival benefit to treating men
08:06with low and intermediate risk
08:08prostate cancer with fifteen and
08:10even twenty years of follow-up.
08:11In addition to the survival
08:13safety,
08:14any treatments that we perform
08:16have significant or can have
08:19significant quality of life impact.
08:21So typically because of the
08:22location of the prostate being
08:24in the middle of the
08:25pelvis, it's near the rectum,
08:27it's near the bladder. The
08:28urethra passes through the prostate.
08:31So this is gonna impact
08:32potentially a man's urinary function,
08:34so their ability to hold
08:35their urine, their sexual function,
08:37their ability to get an
08:38erection or ejaculate,
08:40and also bowel function potentially
08:42in like diarrhea or other
08:44problems.
08:46Surgery is most commonly associated
08:48with urinary incontinence.
08:50Radiation therapy
08:52has significant concern for sort
08:54of bowel dysfunction or
08:57bowel function disruption.
08:59And in terms of erectile
09:02dysfunction, that's with both surgery
09:04and radiation or
09:06more surgery?
09:09We're starting to get into
09:10the details, which is great,
09:11but it in large
09:12part depends on
09:13where the cancer is located.
09:15So surgery
09:16can be done where we
09:17try to preserve the nerves
09:18that are related to sexual
09:20function,
09:21but that depends largely on
09:22if the cancer is near
09:23those nerves. A primary goal
09:26of treatment is to get
09:27the cancer out.
09:28And this is so called nerve sparing
09:30prostatectomy?
09:31Exactly. So with a
09:33nerve sparing prostatectomy,
09:36that is pretty equivalent in
09:38terms of impact on sexual
09:39function to radiation when we
09:41look out to five years
09:42and beyond. Before five years,
09:44there's less impact with radiation,
09:46but probably more impact with
09:47surgery.
09:48The issue is if you
09:49start to have cancer where
09:50we have to remove the
09:51nerve bundles with surgery,
09:53that has a much greater
09:54negative impact on erectile function.
09:56And that in part
09:58is why there's a
09:59growing interest in therapies like
10:01ablation therapies for prostate cancer,
10:04where now that we
10:05have this great imaging and
10:07ability to do targeted biopsy
10:09of the prostate, we can
10:10actually localize the cancers within
10:11the prostate,
10:13and we can now, with
10:14some of these ablation technologies,
10:16localize and treat the area
10:18with the prostate cancer
10:19and leave the rest of
10:20the prostate alone.
10:21Is that, on average, a much
10:22lower rate of sexual dysfunction,
10:25much lower rate of urinary
10:27incontinence and bowel dysfunction
10:29compared to surgery and radiation?
10:31So this now opens up
10:33the area of better tools
10:36we have for both diagnosing
10:38and treating.
10:41And what's changed in terms of
10:43diagnosis?
10:44The biggest
10:46change was
10:47the more widespread adoption of
10:50prostate MRI. So around two
10:52thousand ten, two thousand twelve,
10:54we began to really see
10:56an uptick
10:57globally in the utilization of
10:59prostate MRI.
11:00At that point, it was
11:01largely done in very specialized
11:03centers. We are very fortunate
11:04at Yale to have very
11:06experienced
11:07radiologists who are focused on
11:08prostate MRI.
11:09It is now more widely
11:11accepted and is
11:13done broadly.
11:14There still is dramatic variation
11:17in the quality of prostate
11:18MRI that's completed, but that
11:19has really shifted the playing
11:20field for us over the
11:22last decade because it allows
11:23us, like you mentioned earlier,
11:24to be able to see
11:25inside the prostate,
11:27see where lesions are, and
11:28more accurately diagnose
11:31the cancer. So by putting
11:32needles into the lesion, we're
11:34much more accurate with our
11:36biopsies,
11:37and we know
11:38what is there with more
11:39confidence.
11:40And does MRI and I
11:42think you were mentioning this
11:43before, does MRI help you
11:45decide not to do biopsies
11:47at times?
11:48It does. Correct. So the
11:50the major screening tool remains
11:53a PSA blood test. So
11:54that is our primary screening
11:56tool
11:56that is recommended but
11:58the guidelines vary. It's a
12:00shared decision making, so deciding
12:02whether or not a man
12:03wants to be screened.
12:04But in general, that conversation
12:06should happen starting around age
12:08fifty to fifty five,
12:10and that usually is a
12:11PSA blood test. For people
12:13with a first degree relative,
12:14we would
12:16suggest considering earlier prostate cancer
12:18screening.
12:19And in terms of
12:22more accurately diagnosing the cancer,
12:25these MRIs help that as
12:26well so that if you're
12:28planning to do a biopsy,
12:30you can do it more
12:31accurately with the use of
12:32MRI.
12:34Correct, the MRI allows us to look
12:35inside the prostate. We can
12:37see where a lesion is.
12:38We can then
12:39typically, have a 3D
12:40modeling where we combine
12:42the MRI with our real
12:44time ultrasound. It allows us
12:45to guide the needles for
12:46a more accurate
12:48biopsy.
12:49And finally, before we take
12:50just a a brief break,
12:53I mentioned earlier that there
12:55are more than two hundred
12:56and fifty thousand cases,
12:57but,
12:59many of those are, of
13:00course,
13:01cases where
13:02a man's life is not
13:04threatened.
13:06How many cases of prostate
13:08cancer are there where you're
13:09more worried
13:11about
13:12the potential impact on survival?
13:15For that matter, how many
13:16deaths a year?
13:18Yes. So that is
13:19a very good question. I
13:20mean, I don't know the
13:22exact number of deaths off
13:23the top of my head.
13:24It is pretty significant, though.
13:25The last number I recall
13:26was around probably twenty seven
13:28thousand.
13:30It is a percentage of
13:31of the men who were
13:32diagnosed.
13:33It's really those with metastatic
13:35prostate cancer that
13:37we really worry about.
13:38And that's why screening and
13:40early detection is really, really
13:42important. Finding this cancer before
13:44its metastatic
13:45allows us to intervene.
13:48And in
13:50many, many, of those
13:51men, we can prevent the
13:52development of metastatic disease. So,
13:54again, a disease where sometimes
13:57it's just very slow growing
13:59and sometimes
14:00more aggressive and still
14:02a disease that
14:04threatens quite a number of
14:05people's lives. Well, we're gonna
14:07take just a brief
14:08break and we'll be back
14:10and continue our discussion about
14:12prostate cancer with doctor Preston
14:14Sprenkle.
14:15Funding for Yale Cancer Answers
14:17comes from Smilow Cancer Hospital,
14:19where they will be hosting
14:20an in person Cancer Survivors
14:22Day celebration on June fifth.
14:25For details and to register,
14:26please reach out to canceranswers
14:28at yale dot edu.
14:32Breast cancer is one of
14:33the most common cancers in
14:35women. In Connecticut alone, approximately
14:37three thousand five hundred women
14:38will be diagnosed with breast
14:40cancer this year, but there
14:42is hope thanks to earlier
14:43detection, non invasive treatments, and
14:45the development of novel therapies
14:45to fight breast cancer. Women
14:45should schedule
14:50a baseline mammogram
14:52beginning at age forty or
14:53earlier if they have risk
14:54factors associated with the disease.
14:57With screening, early detection, and
14:59a healthy
14:59lifestyle, breast cancer can be
15:01defeated.
15:02Clinical trials are currently underway
15:04at federally designated comprehensive cancer
15:06centers, such as Yale Cancer
15:08Center and Smilow Cancer
15:10Hospital,
15:11to make innovative new treatments
15:13available to patients.
15:14Digital breast tomosynthesis
15:16or three d mammography is
15:18also transforming breast cancer screening
15:21by significantly reducing unnecessary procedures
15:24while picking up more cancers.
15:26More information is available at
15:27yale cancer center dot org.
15:29You're listening to Connecticut Public
15:31Radio.
15:32Good evening again. This is
15:34Eric Winer with Yale Cancer
15:35Answers. I'm joined tonight by
15:37doctor Preston Sprenkle, a urologic
15:40oncologist
15:42and an associate professor in
15:43urology here at Yale School
15:45of Medicine.
15:47We've been talking about prostate
15:48cancer. We're gonna move on
15:49and talk a little bit
15:50about testicular cancer in just
15:52a few minutes.
15:53But, before we leave the
15:55area of prostate cancer, I
15:57wanna talk about
15:58this
16:00new approach,
16:02that involves focal therapy
16:04or doing something less than
16:06treating the entire prostate,
16:09when a man has cancer.
16:11And,
16:12maybe you can just touch
16:13on this and how long
16:14it's been going on and
16:17how focal therapy is done.
16:20Sure. Thank you.
16:21So
16:22focal therapy is an
16:25exciting new intervention. It's actually
16:27not that new. There have
16:28been ablation
16:30therapies
16:31for prostate cancer for decades.
16:33So one of the early
16:34ones was cryoablation
16:35or using cold energy to
16:38destroy prostate tissue.
16:40Initially,
16:41we were doing whole prostate
16:43treatments with this approach. And
16:45at that time, it did
16:46have less of the impact on
16:50urinary continents than prostatectomy, and
16:52so it was used not
16:54infrequently.
16:55As we gained more information
16:58using MRI to
16:59be able to localize prostate
17:01cancer within the prostate,
17:03the idea of focal therapy
17:05or treating just part of
17:06the prostate where the cancer
17:07is located
17:11became of more interest. And
17:12this is something you mentioned in
17:14breast cancer. You do lumpectomy.
17:15In kidney cancer, we remove
17:17just the tumor. We don't
17:18remove the whole organ necessarily,
17:20anymore now that we
17:22can localize where the cancer
17:24is in
17:25the gland or in the organ.
17:28So focal therapy for prostate
17:29cancer has evolved. I've personally
17:31been doing that for almost
17:32ten years, with a combination
17:34of cryoablation
17:35and irreversible
17:37electroporation.
17:37These are both needle based
17:39technologies
17:40where
17:41we can see the prostate
17:43with the MRI. We localize
17:45it with a targeted biopsy.
17:46We localize the cancer within
17:48the prostate,
17:49and then we can use
17:50those images and information to
17:51place needles into the prostate
17:53in the area where the
17:54cancer is located and really
17:56destroy that prostate tissue.
17:58By leaving the urethra,
18:00leaving the other side of
18:02the prostate alone,
18:03even potentially leaving both nerve
18:06bundles alone, we see much
18:08better preservation of quality of
18:10life in terms of sexual
18:11function, urinary function.
18:13Now
18:13while I've been doing these
18:15technologies for ten years, they
18:16are not widely accepted or
18:18widely done around the country.
18:20The technologies are still considered
18:22investigational in many areas, and
18:25so we do this as
18:26part of an IRB approved
18:28research registry. We're still tracking
18:31the outcomes.
18:32We're making sure that it
18:33is safe. We're making sure
18:34that the cancer control
18:36is adequate and appropriate.
18:38So I think it is
18:39very exciting, but it's
18:40not something that I think
18:42at this point, is appropriate
18:44for just anyone to be doing.
18:45And reading the tea
18:47leaves, do you think that
18:49this is something that will be
18:52done more widely in another
18:53five to ten years?
18:55I believe it will. We
18:56just had our
18:58International American Urological
18:59Association meeting.
19:01It was presented as one
19:03of the plenary
19:04lectures, and there is definitely
19:06growing interest.
19:08Those of us who've been
19:09doing it for a while
19:10do think it is approaching
19:11sort of what we call
19:12primetime.
19:13It is almost ready for
19:15wider
19:16distribution and dissemination
19:17as the quality controls
19:20are being better put into
19:21place.
19:22But just
19:25an educated guess, this is
19:27not something that is for
19:28a patient who has
19:30more locally advanced prostate cancer
19:32or
19:33maybe somebody who has a
19:35more aggressive subtype of prostate
19:37cancer?
19:38You're absolutely right. I mean,
19:39at this point,
19:42this is not for everyone.
19:43So an ablation therapy is
19:44not for when there are
19:45a lot of anatomic considerations
19:47in addition to cancer aggressiveness
19:49considerations.
19:50We currently only recommend this
19:52really for men with intermediate
19:54risk prostate cancer. There is
19:55not a role at this
19:57time for
19:58treating high risk disease, although
20:00there are some clinical trials
20:03evolving in those areas.
20:05So even as part of
20:06the research,
20:07one has to be quite
20:08selective.
20:09That is correct.
20:11Good.
20:12And then finally,
20:15there are still many men
20:16who need to have their
20:17prostate removed when diagnosed with
20:20prostate cancer.
20:22And sometimes an alternative is
20:24radiation. How do you make
20:25those decisions?
20:27So radiation and surgery very
20:29often are considered
20:31to have pretty equivalent cancer
20:33control.
20:34So it largely is a
20:35very personal decision of the
20:37patient
20:38and comparing the quality of
20:39life impact of the different
20:42treatment approaches.
20:44It's a long discussion,
20:46but in brief, we sort
20:47of compare the impact on
20:49urinary function, impact on sexual
20:50function, the duration of treatment,
20:52the recovery from treatment,
20:55what are some of the
20:55long term consequences that you
20:57can expect from the treatment.
20:58But it often is
20:59focused on quality of life
21:00factors,
21:01since the cancer control is
21:03relatively similar.
21:06Well, we're gonna move
21:08on and talk a little
21:09bit about testicular cancer.
21:12Testicular cancer,
21:14unlike prostate cancer, which predominantly
21:17is a disease in
21:20middle aged or older men,
21:21though it can occasionally happen
21:23in people in their forties
21:24and younger, but quite rarely.
21:27Testicular cancer is quite different.
21:30There
21:31are under ten thousand cases
21:33a year in the US,
21:35and the average age is
21:36thirty three.
21:37So this is a cancer
21:39of young men.
21:41And,
21:42maybe you can just
21:44talk a little bit about
21:47what often brings someone in
21:49with a new diagnosis of
21:51testicular cancer.
21:52In general, there isn't a
21:54lot of screening that goes on.
21:56Correct. So there
21:58is not a
22:00systematic screening that is done
22:02by a health care provider
22:03typically, although
22:05and that's largely because testicular
22:07cancers,
22:08when they do occur,
22:09tend to be very
22:11fast growing and present rather
22:13quickly.
22:14There is screening that can
22:16be done. So young men
22:17starting in their late teens
22:19should do testicular
22:20self exams probably on a
22:22monthly basis.
22:24And that is honestly how
22:26men present. So it is
22:27a new mass that they
22:29feel in the testicle or
22:31in their scrotum.
22:32That is the most common
22:34presentation.
22:36And it can be picked
22:37up early if someone is
22:38doing a routine testicular self
22:40exam. But I'm gonna guess
22:42that most young men don't
22:44do that routinely and that
22:46when they find this, it's
22:47just
22:48almost an accident.
22:51That is often the case.
22:53Yes. And that's why we
22:54attempt to
22:57engage young men and pediatricians
22:59to educate young men. And
23:01there is
23:02outreach on college campuses to
23:04sort of tell guys
23:06or instruct guys on how
23:07to do a testicular self
23:09exam. But you're correct. Most
23:10often it is
23:12something that it's hard to
23:13miss and you note a
23:15change in the testicle or on it.
23:19And there are
23:21a few different types of
23:22prostate cancer,
23:24some of which are
23:26potentially more aggressive than others,
23:29typically
23:30divided as seminomas and non
23:33seminomonas cancers.
23:36Correct. Yeah. So testicular cancer
23:38has two large subgroups and
23:39there are other small subgroups.
23:42Seminoma
23:45is the most prevalent or
23:47most common type of testicular
23:48cancer, and then we cluster
23:50a bunch of the others,
23:52embryonal,
23:54and others into yolk sac
23:56into nonseminoma.
23:58And that's because the prognosis
23:59with seminoma is quite good.
24:01The way that we treat
24:02them are a little bit
24:03different, but pure seminoma
24:05is often cured just by
24:07removal of the tumor alone.
24:09Whereas non seminoma can
24:12also often be cured by
24:13that alone, but has a
24:14slightly higher rate of
24:15recurrence and needing additional treatment.
24:19Testicular cancer, in truth, was
24:21the
24:22original
24:23huge success in medical oncology.
24:26It's the one tumor type,
24:28albeit rare,
24:30that
24:31early studies with chemotherapy
24:33demonstrated
24:34that you could dramatically
24:36increase the cure rate
24:38with the use of chemotherapy
24:40in these
24:42germ cell tumors, the non
24:44seminomonas cancers.
24:46Correct. Yes.
24:48Chemotherapy
24:49use, especially in non seminoma,
24:51because initially we use radiation
24:53therapy for seminoma. That has
24:56changed now. We now will
24:57often use chemotherapy for seminoma
24:59as well.
25:01But, yes, it absolutely was
25:02one of our great success
25:05stories in in oncology, especially
25:07because patients are young,
25:09and we're able to have
25:10very, very high treatment success
25:13rates. I think the caveat
25:15to that, I mean, it's
25:16excellent that we're able to,
25:18you know, save
25:19many people and keep them
25:20alive.
25:22But
25:23I still need to make
25:23a plug for early detection
25:25because when we find these ealry
25:28and we can treat them
25:29with surgery alone, we don't
25:31have to give chemotherapy.
25:32And the longer that we
25:33wait, the worse the cancer
25:35is, the more chemotherapy is
25:36needed and the more chemotherapy,
25:38again, the more side effects.
25:40And especially in young men
25:42who have a long time
25:43to live after treatment,
25:44we do unfortunately see that
25:46secondary cancers and other problems
25:48can develop when we have
25:49to give more chemotherapy. So,
25:52still is very important to
25:53kind of if you hear
25:55this, if you're a young
25:56man, you know, testicular self
25:58exam is something you could
25:59do in the shower once
25:59a month. It's not difficult.
26:01Doesn't take much time.
26:03And, it can definitely
26:06you know, if God
26:07forbid, something happened,
26:09by detecting it
26:10early, it can help prevent
26:12a lot of
26:13difficulty down the road. I
26:15think it's a really important
26:16message because the chemotherapy,
26:19while
26:19relatively
26:20brief, meaning a few months,
26:24is not for the faint
26:25of heart.
26:26And it's tough chemotherapy
26:28and no one wants to
26:30get it if they can
26:31manage to avoid it.
26:33And I think, you know,
26:34the other message is
26:36because
26:37young people tend to sometimes
26:39put things off is if
26:40someone finds something, they need
26:42to take action
26:44and see their doctor
26:46and not just wait until
26:48it gets bigger and bigger.
26:50Correct. And it's very easy
26:51for us to do an
26:52evaluation. So it's a quick
26:53physical exam to see if
26:54we feel something in the
26:55testicle and then an ultrasound.
26:57So it's a really noninvasive
26:59initial diagnostic evaluation.
27:02Yes.
27:02Well, that's important.
27:05And what are some of
27:06the things that
27:08can masquerade as testicular cancer?
27:10So what other kinds of
27:12lumps arise in the testis?
27:14There can be a lot
27:15of lumps and bumps in
27:16the testis. So, you know,
27:17very commonly there can be
27:18a cyst, in the epididymis,
27:20which is something that sits
27:22right behind the testicle. You
27:23can even have a cyst
27:24in the testicle,
27:27varicocele
27:28sort of this bag of
27:29worms feeling that people describe
27:31as just a vein that's
27:32in the scrotum.
27:34So there are other things
27:35that can definitely masquerade as
27:37a testicular cancer,
27:39but, again, all of those
27:40can pretty easily be differentiated
27:42with a scrotal ultrasound. So
27:44if you feel something that's
27:45abnormal,
27:46just get it checked out.
27:48And this is a situation
27:49where you're not doing things
27:51like focal ablative therapy. You're
27:54doing surgery.
27:55If someone has testicular cancer,
27:57what does the surgery
27:59involve?
28:01So
28:02the surgery for testicular cancer
28:04is often
28:06removal
28:06of the involved testicle. So
28:08a surgical removal of the
28:09involved testicle.
28:12Men have two
28:14testicles typically,
28:16and
28:16so removing one does not
28:18appear to change the
28:21fertility risk or change
28:23testosterone
28:24levels.
28:25So
28:26if there is someone who
28:27has only one testicle, we
28:28will consider
28:29doing a partial
28:31orchiectomy, removing just the tumor,
28:33but that's a very rare
28:34occurrence.
28:35Doctor Preston Sprenkle is an
28:37associate professor of urology at
28:39the Yale School of Medicine.
28:41If you have questions, the
28:42address is canceranswers
28:43at yale dot edu,
28:45and past editions of the
28:46program are available in audio
28:48and written form at yale
28:49cancer center dot org.
28:51We hope you'll join us
28:52next time to learn more
28:53about the fight against cancer.
28:55Funding for Yale Cancer Answers
28:57is provided by Smilow Cancer
28:59Hospital.