Any thoughts, symptom or test similarities?

[Gilly]

Hello,

Thanks for taking the time to read my post. I have some concerns and I am wondering if anyone has any thoughts, similar symptoms or ultrasound and blood test results, either to help put my mind at ease or brace me for a reality.

I noticed a hard painless lump on my right testicle after 2-3 days of a dull ache in April 2018. I went to the doctor and was referred to ultrasound in May 2018 which confirmed a 3mm x 6mm mass; tech report is unsure of exactly what they see or exactly where mass is located, "possibly adjacent" to testicle.. One month ultrasound recheck is scheduled on June 21 and urologist appointment is scheduled on June 15. Blood test was 243 LDH (110-230), 5.5 AFP (<8.4), <1 HCG (<3).

I have had very bad on/off lower back for many years (sciatica / piriformis syndrome), occasionally feeling some of that pain radiate from my back to my testicle if it was a really bad day, or if I just tweaked it the wrong way. I have some lower back pain now, nothing compared to my worst days, however the dull ache has also returned to my testicle over the past 4-5 days which is adding more concern to this issue for me.

I am a father of 3 girls with number 4 on the way. I want to be as proactive as possible to deal with this in the event that something is wrong, not only for myself but also for my wife and kids. Any feedback is appreciated, or even suggestions or questions for the urologist that I should ask at my appointment on June 15.

Thanks!

[Davepet]

With a history of back pain, the odds are good that it has nothing to do with your testicle. Pain transference is a pretty common thing. Youir markers are normal, LDH isn't really a marker and inflammation in many parts of the body can cause a rise. It's pretty unusual for an U/S to be that inconclusive.I think I would schedule with a different tech or even facility, and I would want it to happen before the next doc appointment, not after.

If you have the report, please post the exact wording of it. We have a few members that are good at deciphering med speak,

Dave

[Gilly]

Thanks for the quick reply. I will take your advice and schedule at a different facility for the next ultrasound and prior to the urologist appointment, and also hope to obtain a copy of the first ultrasound report on Friday when I'm back at the doctor for a long ago scheduled physical.

I suppose my concern about the blood test results stem from information that I have read online regarding LDH being the only elevated marker in some seminomas - Seminoma - Wikipedia https://en.m.wikipedia.org/wiki/Seminoma

Thanks again!

[mcintoda]

Hi Gilly,

Your blood tests are normal range. LDH is a non-specific inflammatory marker that can be affected by exercise, injury etc. Only elevations from baseline (like 1.5 to 2x) are clinically significant for TC ; and probably only in combination with other symptoms or markers. Unfortunately, negative markers does not rule out TC; approximately 50% of stage I patients have no elevated tumor markers.

Can you feel this mass on your own? What does "possibly adjacent" mean? Is this in the report? Can you get the ultrasound report and give it to another party for 2nd opinion?

Sharing my own experience: mine was only 11 mm, but rock hard. Mine was located on the surface of the testicle, like a split pea glued on.

In general, a hypoechoic mass on ultrasound (when mass is in or on the testicle, I believe) is treated like TC until proven otherwise. My doc said there is a saying something like "Never let the sun set on a testicular mass"; meaning its urgent matter. Guessing your doc is waiting to see if it changes to try and rule in/out some other things like epididymitis, infection, hydrocele, benign cyst etc.

I have heard many stories of people getting misdiagnosed with one of those conditions and a month or two later get diagnosed with TC. Also heard of folks who had a TC scare and even orchiectomy but then found it was benign.

Since your appointments are in a few weeks, it seems like a reasonable timeline to intervene even if it were to be TC, however. I would definitely advocate for you to try and accelerate the timeline if you feel something serious is occurring; be your own advocate -- trust your self-awareness. The most common situation for early stage TC is a painless lump in testicle with nothing else.

To hopefully give you some comfort: even if it is TC in the worst case, it's likely at an early stage (likely given small mass size, no tumor markers) which is very curable (95%+).
"In large population-based patient series, 75-80% of seminoma patients, and about 55% of patients with NSGCT cancer have stage I disease at diagnosis"

If they do recommend orchiectomy then I'd say you should ask about:
1. Sperm banking (in case you want more kids)
2. Hormonal tests (testosterone, LH, FSH etc)

[Gilly]

Thanks for sharing.

Yes, I have become very familiar with my testicles in recent weeks and I can definitely feel a palpable mass on the middle exterior side of my right testicle; it's very hard and feels about the size of a lentil. It has become a bit more noticeable over recent weeks, I don't know if that's just in my head or because it's getting larger; tough to judge the size with just my finger tip and during a shower is the best time, although even when I'm not relaxed it's still palpable.

The ultrasound was essentially inconclusive and the report was broadly dictated to me by my doctor. I pressed him for more answers and theories, such as a possible cyst on the tunica albuguinea considering his saying that it's "possibly adjacent" to the testicle. He was reluctant to hypothesize and assured me that the urologist should be able to provide me with more answers and that a 1 month follow up ultrasound should also reveal more. I will get a copy of the first ultrasound report on Friday and post the findings on here, hopefully someone can help to decipher it.

I do not take pharmaceuticals and I am typically not very trusting of doctors, concerned that they are often not knowledgable and incorrectly under or over diagnose people so frequently. My experience with this issue has only supported my concerns thus far. I made an appointment within a week of finding the lump and was sent for an ultrasound, which I was essentially told is inconclusive despite a 3mm x 6mm mass being present. I had to push for blood work and my doctor reluctantly agreed, but he filled out the requistion form initially for CEA. I couldn't recall the TC markers that I had read about in that moment, but questioned him about CEA and was told that ovarian and testicular tumor markers are more or less the same. He called me at 9:00pm on the same day to advise that he requested the wrong markers and to come back into his office next day for the correct requisition form (AFP, HCG, LDH). Upon going for the blood work they only took samples for AFP and LDH. I only noticed upon checking my results online the following day and went back into the lab, at which point they realized having missed taking the sample for HCG.

Approaching 6 weeks with inconclusive answers and complications at every step is becoming very frustrating, particularly when I can sense within myself that something is wrong and reading everywhere online that hard painless lumps on the testicle should be treated very seriously until proven otherwise. I am ready to face this head on in the event it is TC and will feel much better if it's not. Not knowing is causing me more stress than anything and I am extremely disappointed in the health care services of Ontario at this point.

Thanks and will update when I learn more.

[HouTex]

Your second opinion ultra sound will likely be the ticket for one party or another. Good that you are getting a second!

The the mass is very hard is troubling.

I had a mass of masses (cysts) around my remaining testicle till the sack was large orange size. A month ago I had them all removed in a surgery that is much like vasectomy but with a larger opening.

I would describe the differences between my cancer and the many cysts as a fist tightly held. Push on an area around the palm is cyst like. Push on a knuckle its cancer like. Layman diagnosis here...

Good luck and prayers!

[Gilly]

Thanks for the reply and mentioning vasectomy. Hopefully the second ultrasound that I have now rescheduled to June 13 in a different city will provide more clarity.

Does anyone know if a vasectomy can be done at the same time as an orchiectomy. I may be thinking too far ahead at this point, but in the event that I do have an orchiectomy recommended in the coming days or weeks, could an already planned vasectomy also be done too, 2 birds - 1 stone? I already have 3 girls with number 4 due in August and my wife and I will not be trying for a boy, so a vasectomy is already scheduled in September.

Thanks.

[mcintoda]

Gilly,

At least in USA and my experience, this kind of thing is managed by urologists and medical oncologists (if TC is confirmed with pathology).

My reading of your first post was that your doc was a urologist. The family docs here (GP) generally refer these cases and don't do the blood work, CT scans etc. TC is relatively rare, so don't expect non-specialists to be up to date with the details! If you're in a small regional center they may see only a handful of cases per year! Also I would request to have a written copy of the ultrasound report.

When I had a hypoechoic mass (determined by ultrasound report), they issued a stat (rapid) referral to a urologist. Within 1-2 days they called me in as an urgent, fit-me-in appointment. Urologist scheduled me for orchiectomy within a week.

If I were you I'd try to get into a urologist ASAP, if only for peace of mind.
​
One other thing: don't palpate the testicle too much (once a month is enough), it will only lead to irritation and could mislead you.

Also, I remembered another question to ask in case they recommend orchiectomy: consider whether you would want a testicular implant (silicone). It can be done all at once.

[Gilly]

I have just received a copy of the first ultrasound report from May 24, it reads as follows:

"There is a 6 x 3 x 6 mm hypoechoic nodule along the anterior surface of the right mid testis. This appears to be arising adjacent to rather than within the testis. Both testes and epididymides otherwise appear unremarkable. The etiology of the above-mentioned nodule is uncertain. A follow-up ultrasound is recommended in one month."

My appointment with a urologist is scheduled on June 15, so I have scheduled the follow-up ultrasound a bit earlier than one month, on June 13 and also in a different city than the first ultrasound; hoping for more clarity to be provided this time.

Any thoughts or opinions on the first ultrasound report is very much appreciated.

Thanks!

[Davepet]

I think its good that you have a new U/S in a few days. I would not mention the previous results to the technician, you don't want to chance introducing any bias.

Dave