Having the balls to face the truth about cancer

With November being Movember and men’s health awareness month, I have been reading about the various cancers that affect men.

While prostate cancer often receives the most attention, I recently came across information regarding testicular cancer.

I am 32 years old, married, and hoping to start a family soon. A friend of mine was recently diagnosed with testicular cancer at 29.

He was otherwise healthy, exercised regularly, and had no symptoms apart from a small, painless lump.

His diagnosis frightened me, as I always assumed cancer was a disease of old age.

I have also heard that men who had undescended testicles in childhood face a higher risk.

I am eager to take charge of my health, so I would like to put Dr G on the spot:

How common is testicular cancer, especially among Malaysian men?

What are the key risk factors, and is there anything we can do to prevent it?

Should men perform regular self-examinations, and does early detection make a critical difference?

Finally, if a man is diagnosed, does it inevitably mean losing his fertility, testosterone, or sexual function?

I hope you can shed some light on this often-overlooked disease during Movember.

Testicular cancer is relatively uncommon, yet it stands out as one of the most significant solid malignancies affecting younger men. It predominantly strikes adolescents and young adults, most frequently between the ages of 15 and 40, with about half of all cases diagnosed in men aged 20 to 45.

Globally, roughly 72,000 new cases are diagnosed each year, representing a small fraction of all cancer diagnoses. Rates are highest in Northern and Western Europe, North America, and Australia, while Asian populations generally report lower incidence rates.

More than 90% of testicular cancers originate from germ cells, the specialised cells responsible for producing sperm. These malignancies are broadly divided into seminomas and non-seminomas, each behaving differently and requiring distinct treatment considerations.

While the exact causes remain incompletely understood, a history of cryptorchidism (undescended testicles) is one of the strongest recognized risk factors. Men born with this condition face approximately five to eight times the risk of developing testicular cancer compared to those whose testicles descended normally.

Myth-busting is equally important when discussing risk. Questions often arise regarding whether tight underwear, keeping a mobile phone in a trouser pocket, frequent cycling, masturbation, or vigorous sexual activity increase risk. Fortunately, there is no convincing evidence linking any of these activities to testicular cancer.

Furthermore, while maintaining a healthy weight, exercising, avoiding tobacco, and limiting alcohol are essential for overall health, lifestyle changes have not been shown to specifically lower testicular cancer risk. In fact, the majority of men who develop the disease have no identifiable risk factors, meaning even someone who exercises daily, eats well, and has no family history can still be affected.

Because prevention is not always possible, early detection is crucial. The hallmark symptom is a painless lump or swelling in one testicle, and men should never assume a lump is harmless simply because it does not hurt.

A practical routine is to perform regular self-examinations during or after a warm shower when the scrotal skin is relaxed. Any new persistent lump, firm area, or unexplained enlargement warrants a prompt medical evaluation. A simple, painless testicular ultrasound can quickly distinguish solid abnormalities from benign conditions like epididymal cysts or fluid accumulation.

The prognosis for testicular cancer is exceptionally strong. According to American cancer survival statistics, approximately 99% of men diagnosed with cancer confined to the testicle survive at least five years relative to the general population. Even when the disease has spread to nearby lymph nodes, the five-year relative survival rate remains around 96%.

Crucially, removing one testicle rarely compromises long-term sexual function or fertility. In most cases, the remaining healthy testicle produces adequate testosterone to maintain libido, erections, muscle mass, and overall hormonal balance.

As we observe Movember, the message for younger men is straightforward: health awareness should not wait for your first grey hair. While we cannot reliably prevent every case of testicular cancer, we can recognize developmental risks, ensure early treatment for undescended testicles, stay familiar with normal anatomy, and seek timely medical advice when something changes.

Perhaps the greatest danger is not the disease itself, but the false sense of security that youth, physical fitness, and an absence of pain can create. True strength includes acknowledging vulnerability and taking action when something feels off.

Looking after your health is not a challenge to your masculinity—it is the ultimate act of preserving your future, your fertility, and your life. As testicular cancer survivor Lance Armstrong once noted, "It’s all about awareness."

Dr G is often put on the spot by fearful young men about the prevention of testicular cancer. His view is: When it comes to testicular cancer, prevention may not always be in our control, but awareness and early action make all the difference.

On that note, have a preventive Movember November!

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Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. This column is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at askdrg@thestar.com.my

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11月是Movember（胡须月）和男性健康意识宣传月，我一直在阅读有关影响男性的各种癌症的资料。

虽然前列腺癌通常最受关注，但我最近偶然发现了一些关于睾丸癌的信息。

我今年32岁，已婚，希望不久后能组建家庭。我的一位朋友最近被诊断出患有睾丸癌，年仅29岁。

他身体其他方面都很健康，经常锻炼，除了一个不痛的小肿块外，没有任何其他症状。

他的诊断结果让我感到害怕，因为我一直认为癌症是老年人才会得的病。

我还听说，童年时期患有隐睾的男性面临更高的风险。

我非常重视自己的健康，所以我想向G医生提出一个问题：

睾丸癌有多常见，尤其是在马来西亚男性中？

主要风险因素有哪些？我们可以采取哪些措施来预防？

男性是否应该定期进行自我检查？早期发现是否至关重要？

最后，如果一名男性被诊断出患有这种疾病，是否就必然意味着他会失去生育能力、睾酮水平或性功能？

我希望您能在“胡须月”（Movember）期间，让更多人了解这种经常被忽视的疾病。

睾丸癌虽然相对少见，但却是影响年轻男性的最常见的实体恶性肿瘤之一。它主要侵袭青少年和青年，最常发生于15至40岁之间，约一半的病例发生在20至45岁的男性中。

全球每年约有72,000例新发病例，仅占所有癌症诊断病例的一小部分。北欧和西欧、北美和澳大利亚的发病率最高，而亚洲人群的发病率普遍较低。

超过90%的睾丸癌起源于生殖细胞，即负责产生精子的特殊细胞。这些恶性肿瘤大致分为精原细胞瘤和非精原细胞瘤，二者的生物学行为各不相同，需要采取不同的治疗方法。

虽然确切病因尚未完全明确，但隐睾症（睾丸未下降）病史是目前公认的最强风险因素之一。患有此病的男性罹患睾丸癌的风险约为睾丸正常下降男性的五到八倍。

在讨论风险时，破除迷思同样重要。人们常常会问，紧身内裤、把手机放在裤兜里、频繁骑自行车、手淫或剧烈的性生活是否会增加患睾丸癌的风险。幸运的是，目前尚无确凿证据表明这些行为与睾丸癌有任何关联。

此外，虽然保持健康体重、锻炼身体、避免吸烟和限制饮酒对整体健康至关重要，但生活方式的改变并不能降低睾丸癌的风险。事实上，大多数患上这种疾病的男性并没有可识别的风险因素，这意味着即使是每天锻炼、饮食健康且没有家族史的人也可能患病。

由于预防并非总是可行，早期发现至关重要。其典型症状是单侧睾丸出现无痛肿块或肿胀，男性切勿因为肿块不痛就认为它无害。

一个实用的方法是定期进行自我检查，最好在温水淋浴期间或之后，此时阴囊皮肤放松。任何新出现的持续性肿块、硬块或不明原因的增大都应立即就医。简单、无痛的睾丸超声检查可以快速区分实质性异常与良性病变，例如附睾囊肿或积液。

睾丸癌的预后非常好。根据美国癌症生存统计数据，约99%被诊断为局限于睾丸的睾丸癌患者，其五年生存率至少高于普通人群。即使癌细胞已扩散至附近的淋巴结，五年相对生存率仍保持在96%左右。

至关重要的是，切除一侧睾丸很少会损害长期的性功能或生育能力。在大多数情况下，剩余的健康睾丸会产生足够的睾酮来维持性欲、勃起、肌肉量和整体激素平衡。

值此“胡须月”（Movember）之际，我们向年轻男性传递的信息很简单：健康意识不应等到你长出第一根白发才出现。虽然我们无法完全预防每一例睾丸癌，但我们可以识别发育风险，确保隐睾症早期治疗，熟悉正常的解剖结构，并在出现任何变化时及时就医。

或许最大的危险并非疾病本身，而是年轻、体魄强健和无痛感所带来的虚假安全感。真正的强大在于正视自身的脆弱，并在感觉不对劲时采取行动。

照顾好自己的健康并非是对男性气概的挑战——而是守护未来、生育能力和生命的终极之举。正如睾丸癌幸存者兰斯·阿姆斯特朗曾经说过的那样，“关键在于意识。”

G医生经常被一些害怕患睾丸癌的年轻男性问及如何预防睾丸癌。他的观点是：就睾丸癌而言，预防或许并非总能尽在掌握，但提高意识和及早采取行动至关重要。

鉴于此，祝大家在十一月做好预防性胡须护理！

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乔治·李医生是一位泌尿科顾问医师和临床副教授，他的专业领域是男性健康。本专栏旨在帮助男性打破关于男性健康问题的种种迷思和禁忌，这些问题可能难以启齿。您可以通过 askdrg@thestar.com.my 向他提问。

感谢您的报告！

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