Having the balls to face the truth about cancer

Dear Dr G,

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.

Yours sincerely,

Fearful Freddy

 

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!