“It is a relatively rare tumor in the population: it affects more or less 3% of male tumors but it is important because it concerns a segment of the population between 15 and 35-40 years old. Self-examination is the first and most effective form of prevention. But an enormous socio-cultural taboo persists. For a male, the sense of shame in having his genitals examined is still great”
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ghisagazzetta
Listening to Andrea Salonia is a pleasure. He combines his profound knowledge as a man of science (he is professor of urology at the Vita-Salute San Raffaele University of Milan; director of the Urological Research Institute of the San Raffaele Hospital and advisor to the Italian Society of Urology) with the ability to tell stories (he is also writer). He has the ability to make difficult and perhaps – because socio-cultural taboos still exist – difficult to deal with topics understandable. In this case, taking inspiration from the case of Achille Polonara, an Italian basketball player, we are talking about testicular cancer.
Professor, let’s start from the fact that today the Virtus Bologna player underwent surgery to remove this tumor
”Surgical intervention, not only in your case, serves to explore the testicle and check what type of disease the patient has. Testicular disease is, obviously, an oncological disease. It is a relatively rare tumor in the male population because it concerns more or less 3% of male tumors but it is particularly important because it concerns a segment of the population between the ages of 15 and 35-40. We are therefore talking about a young population, in the midst of professional activities but to life also from the point of view of affection, parenting, sexuality and, if we can even say, body image. These are all elements very closely linked to each other and which from a practical point of view have an impact in an extremely delicate moment also from an emotional point of view”.
It is a pathology that is generally talked about little
“There is very little talk about this type of disease except when great sports champions suffer from it. The most striking case, years ago, was that of Lance Armstrong, but there are also the cases of Francesco Acerbi and Ivan Basso.”
When it comes to tumors the first question is always the same: can it be cured?
”The first important element to underline is that all these people we have mentioned have survived, they are, in quotation marks, cured of testicular cancer. We in the ‘medicose’ find it a little difficult to talk about recovery from a tumor unless they have passed several years from what are the manifestations, symptoms, signs or recurrences of the disease itself. Time is a fundamental aspect. But for a 20-year-old, time is a totally different dimension compared to a 70-year-old person. From a practical point of view, it is the time horizon that changes and also the way in which the tumor is treated. Testicular cancer, among other things, is one of those tumors which, fortunately, is cured in more than 90 years. % of cases. It is a tumor that responds very well to surgical choices, which is sometimes the only necessary therapy, then it responds very well to chemotherapy, radiotherapy is now very rarely applied. Let’s go back to saying that it heals rather well from a rare tumor which however affects young boys”.
Can those who have suffered from testicular cancer have children?
”Testicular diseases are mostly those that are called germ cell diseases, so on average, 95% of these diseases reside in those cells that belong to the world of sperm production. They therefore concern more intimately the ability to become fathers. In fact, among the main risk factors for testicular cancer we recognize the anomaly of the characteristics of the spermiogram. It is therefore quite easy for an infertile man to have testicular cancer. The second factor is family history, the third risk factor is a condition anatomical which is called cryptorchidism (at birth one or both testicles are not where they should be, i.e. inside the scrotum). Then there is another problem which is anatomical because up to 2% of patients who suffer from this pathology unfortunately they develop a contralateral diseased testicle even after many years.The real problem is that this pathology impacts very young people and can cause a problem for parenting. This is why it is always very important, when faced with a person suffering from testicular cancer, to suggest what is called ‘freezing of seminal fluid’ because perhaps in the future the sperm can be used for medically assisted procreation.”
The testes also serve to produce testosterone
“The testes functionally have two roles: exocrine function (producing sperm) and endocrine function (producing testosterone). For males it is the main hormone and is fundamental for sexuality, reproduction, well-being of the muscles, bones, brain, the function of sleep, cognition, memory…”
How is testicular cancer “discovered”?
”This disease is discovered mainly on two bases. First: because the testicular tumor causes a change in size, or consistency (hardness) of the testicle. This is what usually occurs. The first real criterion is that the diagnosis is made directly by those who suffer from it. It is very different from other tumors. It is a bit similar, we could say, to breast cancer because self-examination often allows us to identify nodules or harder areas of different consistency. Testicular cancer, however, is of an age group, and of a sex, which however is not really accustomed to paying attention to the self, meaning this as I regularly palpate my testicles which should be two smooth olives – not small like leccine , but let’s say in the Ascoli style – with a tensile elastic consistency, that is, as if it were a water balloon not completely filled with water. The consistency must be palpable but modifiable with pressure. When a modification of the profile occurs, or a sort of pebble and hard nut, they must attract attention. Testicular cancer rarely causes pain and rarely leads to the presence of traces of blood in the semen which is another difficult topic to deal with because it is difficult for a young man – unless he has already consolidated a certain robustness of personality – to face this fear and report or complain about this symptom”.
The second method?
”The diagnosis is often made incidentally via ultrasound. This was the case of my friend Ivan Basso who had an ultrasound of his testicles after a bicycle fall. This type of diagnosis is therefore made by self-examination or by means of ultrasound.”
A topic that we know is very close to your heart: little prevention is done
“No, unfortunately it isn’t done at all. The 96th congress of the Italian Society of Urology concluded on Sunday in Rome. With Minister Schillaci we talked about prevention even if it was about prostate cancer which is another of the major urological problems. On a numerical level, it is the first male cancer. Obviously it concerns an enormously larger population. For this reason, strategies have been developed regarding the possibility of population screening for years and years. However, in the case of testicular cancer, as we were saying, the first diagnosis is self-examination. Do you know what the key point is? Until a few decades ago there was the military visit where, like it or not, during the “three days” the boys received the first and perhaps only evaluation of the external genitalia at a time following the pediatric one”.
Women have now understood the concept of prevention. For men the situation is still very vague
“It’s very different to think that a mother takes her daughter to the gynecologist, which happens regularly, and a father takes his son to an andrologist or urologist. Totally different, it almost doesn’t exist. It will happen to me ten times a year and I see thousands of patients. An enormous socio-cultural taboo persists. For a male, the sense of shame in having his genitals examined is still great. This is why information is fundamental.”
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