Testicular Cancer, Prostate Cancer and PSA: Working Up Common Urologic Presentations

Immunotherapy is highly effective and carries far fewer side effects than standard chemotherapy. In cancers with a large initial tumour burden, such as lung cancer, it is usually combined with chemotherapy at first, since immunotherapy alone takes time to bring a heavy disease burden under control. Once the disease responds, treatment continues on immunotherapy alone to maintain that response.

Any scrotal swelling should first be evaluated with ultrasound, which will show a testicular mass or enlargement, but there is no test that gives a confirmed diagnosis before surgery, that only comes after radical orchiectomy. Of 100 patients presenting with a testicular swelling, roughly 80 to 90 percent will have cancer and about 10 percent tuberculosis, so for the large majority a biopsy is avoided, since it risks spreading the cancer, in favour of going directly to orchiectomy. Tumour markers such as AFP and beta-hCG, elevated in seminoma and yolk-sac tumours, can support the ultrasound finding, but the standard recommendation regardless of marker levels is orchiectomy rather than biopsy.

PSA is not specific for prostate cancer at all, no tumour marker is specific for any single cancer. An elevated PSA in a patient with a prostatic mass could reflect BPH or cancer, and can rise even after a digital rectal exam or ejaculation. Very high values, such as over 100, are more suggestive of cancer, so if PSA is extremely elevated yet the biopsy shows only BPH, the biopsy may simply have missed the cancerous core, which does happen. In such suspicious cases, a gallium-68 PSMA PET scan, highly specific for prostate cancer, can help confirm or rule out malignancy before treating for BPH alone.

Core needle biopsy is sufficient for breast cancer, and there is no need for excisional biopsy in most cases. For a small tumour such as a fibroadenoma, excisional biopsy is an option, but core needle biopsy is equally effective, and if the mass proves benign, surgery can be avoided altogether.

Unfortunately there is no specific genetic mutation identified for uterine fibroids and no targeted drug role for them, since fibroids are benign tumours, not cancers. Treatment options remain limited to hormonal therapy or surgery.

Ultrasound identifies a testicular mass, but the confirmed diagnosis only comes after radical orchiectomy; a pre-operative biopsy is avoided because it risks spreading the cancer.

Roughly 80 to 90 percent will have cancer and about 10 percent tuberculosis.

A gallium-68 PSMA PET scan, which is specific to prostate cancer tissue, can help determine whether the biopsy simply missed the cancerous area rather than assuming the high PSA was a false alarm.