November Men’s Health Month (Movember): What to Know About Prostate and Testicular Health

In many parts of the world, men’s health awareness in November is associated with the “Movember” movement, known by its moustache symbol. The Movember Foundation is an international charity that funds research and programmes in prostate cancer, testicular cancer, mental health and suicide prevention.

This article summarises the campaign’s two urological topics, prostate and testicular health, based on scientific guidelines. The campaign is an awareness initiative; medical recommendations do not come from the campaign but from guidelines such as those of the European Association of Urology (EAU). Mental health is a separate field of expertise and is not covered here.

PSA (prostate-specific antigen) is not a cancer test. It is a protein produced by prostate tissue and can also rise with benign prostate enlargement or inflammation of the prostate. A PSA decision is therefore not a screening applied to everyone but a personal decision made together with your doctor.

According to the EAU guideline, early PSA testing can be considered from the age of 50 in men without additional risk factors. For men with a relative diagnosed with prostate cancer before the age of 60, and for men of African descent, the age given is 45; for carriers of a BRCA2 mutation it is 40.

The guideline recommends this approach for well-informed men whose life expectancy is at least 15 years. It also states plainly that men without symptoms and with a life expectancy of less than 10 to 15 years should not be tested with PSA. The reason is the risk of overdiagnosis, meaning the detection of a cancer that would never have caused a problem, together with the risk of unnecessary tests and biopsies.

A raised PSA does not mean “there is cancer”. In a man without symptoms and with a normal examination whose PSA is moderately raised (3-10 ng/mL), the first step is usually to repeat the test; and for the decision on biopsy, an MRI of the prostate is now often used first.

For more detail, see our article “Prostate Cancer: Symptoms and Treatment Options”.

A weakening urinary stream, frequent urination and waking at night are mostly due to benign prostate enlargement and are not specific to cancer. By contrast, blood in the urine or semen, new bone pain that does not settle, or unexplained weight loss should be assessed by a doctor without delay. Blood in the urine can be painless; the absence of pain does not make the finding unimportant.

According to the EAU guideline, testicular cancer accounts for about 1% of all cancers in adult men and about 5% of urological tumours; in Western societies three to ten new cases occur per 100,000 men each year. Most patients are between 18 and 40 years old at diagnosis.

The disease often appears as a painless lump or swelling. Pain can also occur and may delay the diagnosis. A high-resolution scrotal ultrasound is used for assessment; when testicular cancer is suspected, ultrasound of both testicles is recommended.

In the great majority of patients the disease can be treated: the EAU guideline reports a five-year relative survival of about 95% in Western Europe. This figure is a group average; it varies from person to person with the type and stage of the disease. Because treatment can affect fertility, the option of sperm banking is discussed with all men before treatment begins.

Early findings can be confused with other testicular conditions such as inflammation of the epididymis or a fluid collection. For that reason, a man who notices swelling or hardness in a testicle should not try to diagnose himself but have it assessed by examination and ultrasound.

Scientific opinion on this differs, and that should be said openly. The US Preventive Services Task Force (USPSTF) recommends against screening for testicular cancer in adolescent and adult men without symptoms, whether by a doctor’s examination or by self-examination (grade D, 2011). Its reasons are that the disease is rare, that treatment results are quite good even in advanced stages, and that a benefit of screening has not been shown.

The same document notes that most testicular cancers are found by chance by the patient himself or his partner. These two points do not contradict each other: regular screening is not a practice with a demonstrated benefit, but a man who notices a new lump, hardness or enlargement in a testicle should not put off showing it to a doctor.

There is one exception: men who were treated in childhood for an undescended testicle have a higher risk of testicular cancer, and the EAU paediatric urology guideline recommends follow-up and self-examination for them during and after puberty.

Testicular torsion (the testicle twisting on its own axis) is not cancer, but it is an emergency in which time is critical. Severe pain that starts suddenly, especially with nausea and vomiting, suggests it. The EAU paediatric urology guideline states that the chance of saving the testicle depends on time and that the critical window is about four to six hours; tests such as ultrasound must not delay surgery.

In such a situation do not wait for an appointment; go to the nearest emergency department.

Note whether anyone in your family has had prostate, breast or ovarian cancer, which medicines you take, and whether you have had testicular or prostate problems before. Some prostate medicines affect the PSA value, so always tell your doctor which medicines you take.

This article is for general information and does not replace medical advice. The decision on screening and examination is individual and requires assessment by a doctor.

If you are struggling with your mental health, please contact a health professional. If you have thoughts of harming yourself, call your local emergency number (112 in Turkey and across the EU) or go to the nearest emergency department.