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Testicular biopsy and trouble diagnosing - any experiences?

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  • Testicular biopsy and trouble diagnosing - any experiences?

    Hi everyone! A new user here. Looking for an advice on diagnosing testicular cancer.

    So I recently discovered a rather large, painless lump in one of my testicles. Got an appointment with a urologist who sent me to do tests. My blood results came back good (no increase in any TC markers). My ultrasound results are somewhat unclear, though - the doctor who was doing the ultrasound said he's almost sure the lump is benign. However, the urologist had a look and thinks that it's still quite possible that it might be cancer and recommends orchiectomy.

    Obviously, I'd want to be as sure of diagnosis as possible before a surgery. The urologist mentioned that biopsy might be an option, but warned that there are risks - apparently, if something goes wrong, hematoma can happen and then they'd need to remove the testicle regardless? Also, as I understand, biopsy can increase the risk of the cancer (if it's there) spreading to the rest of the body?

    If anyone has had testicular biopsy, I'd be very thankful for any advice - experiences, risks etc. Is it a dangerous test to make?

    Also, if anyone has any experience with difficulty in properly diagnosing testicular cancer, all advice is also super welcome. Like, is it a usual thing to do orchiectomy, even if the blood results are negative? To be honest, I'm quite confused and scared at the moment. I'm also from a very small country and apparently we very few cases per year, so information is hard to come by. Sorry if something comes off as ignorant, I'm still very uninformed about the topic.

  • JoeTheAstronaut
    replied
    Good luck, xiphias, the urologist should know best, and getting second opinion gives you the comfort in making the right decision. Hope it all goes well!

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  • Davepet
    replied
    Please keep us updated as you learn more.
    Last edited by Davepet; 06-03-20, 03:35 PM.

    Leave a comment:


  • xiphias
    replied
    Hi everyone! So, an update - I'll have a surgery in the upcoming weeks. I consulted another urologist with more experience with TC and she said it absolutely needs to be taken off and that biopsy is too dangerous. I'll do another ultrasound and a CT scan just to get a better picture, but it's decided. Feel very stressed, but also relieved.

    Many thanks to everyone who answered, I really appreciate it. Guess I might be coming to this forum in the future Take care everyone!

    Leave a comment:


  • Mike
    replied
    A needle biopsy through the scrotum is an old procedure and to my knowledge has been condemned as if it is cancer it can lead to unusual patters of spread. To my knowledge MRI doesn't add a lot of information on the evaluation of scrotal masses but I would ask my doctor if the MRI would be anticipated to add additional information that would be better than just repeating the scrotal US in 4-6 weeks. However, I agree that the results as you describe seem a little more concerning than one of the people are saying.

    Mike

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  • Harxxony
    replied
    Hi again. You are right, it is confusing. You wrote ultrasound technician, so not the US radiologist? If it was just a technician, his opinion is irrelevant. If it was US radiologist, his opinion is much more relevant than urologists, but US "slightly heterogeneous(?) formation with marked vascularity, and some microcalcinates"
    doesn't sound as something benign. Vascularity (blod flow through mass) is usually euphemism for cancer. I was is similar situation; US doc recommended biopsy, but urologists discarded idea as obsolete. All of them sounded that they are far from experts, just like yours. MRI scan for testicles is also strange idea; maybe he ment that MRI is for abdomen/pelvis region?

    Leave a comment:


  • xiphias
    replied
    Hi everyone, thanks for sharing and the info! It's so good to have a forum like this.

    The main reason why I'm confused is because the ultrasound technician and urologist have different opinions about the ultrasound report. The ultrasound technician said that to him the lump almost definitely looks benign. But the urologist looked at the ultrasound pictures and says that to him it looks malignant. The ultrasound guy also told me that urologists can sometimes be too heavily in favour of a surgery and advised me to get more scans to make sure. He suggests an MRI scan in the ultrasound report. The urologist looked at the report, but says the MRI scan would be of no real use. On top of that, the ultrasound guy is around 55-60 and has (I assume) seen a lot of cases while the urologist is rather young. I know that a urologist's opinion is more important and I don't want to be paranoid, they both seem very professional. I also don't mean to get my hopes up just because the ultrasound doctor has a different option. But obviously I'm very confused by all this and want to make as sure as possible.

    Translating the words of the ultrasound doc is a bit complicated cause I'm not sure of the right English terms. But basically he writes that there's a slightly heterogeneous(?) formation (that'd be the lump) with marked vascularity, and some microcalcinates. He recommends an MRI scan.

    As for biopsy - the urologist told me that it's done with a needle. He also mentioned that it is done very rarely in TC cases and can potentially be dangerous. He said he will consult another specialist and will get back to me soon. I still don't understand that much about this procedure, but I will definitely find out more before making any decisions. That is one of the reasons why I also wrote on this forum.

    I will see two other urologists in the upcoming days for second (and third) opinion, both with more experience with TC. Will bring the ultrasound results with me. Like I said, I'm from a small country - we only get about 30 cases per year. So not every urologist has a lot of experience with this.

    Leave a comment:


  • Mike
    replied
    By biopsy, I am assuming that this would not be done through the scrotum, as that is an old procedure that has basically been condemned nowadays. Basically, they take the testicle out via the groin, do a frozen section and then determine to remove it or replace it in the scrotum. But one would need to have pathologists in the OR capable of doing it. Not sure what the actual ultrasound says but if it is indeterminate, then perhaps asking the doctor if a repeat ultrasound in 4-6 weeks may provide additional information?

    Mike

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  • Harxxony
    replied
    Hi xiphias, sorry to welcome you here. I'll try to be exact as much as I can. First, TC markers are irrelevant for diagnosis. If they are increased then it's most likely TC, but if they are normal, it still can be TC. Basically, 95% (more or less) of intratesticular growths are TC. Golden standard in situation with testicular mass is orchidectomy. However, if ultrasound doc said he's almost sure it's benign, it is important information, my guess is that he wouldn't say that if he isn't very convinced. Can you provide exact US results in docs words?

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  • Webzfactory
    replied
    I had stage 3B with 5cm mass in the lung and no markers what so ever, and it was a mixed non seminoma with ec and seminoma so you can't go by the markers. If the lump is part of the testicle, in doubt I would want it to come out. Life with 1 testicle and no cancer is a perfectly normal life without any impact...

    Leave a comment:


  • xiphias
    replied
    Thanks, Dave! I was under the impression that if the blood markers are negative, it gives reasonable hope it could be something else, but this puts it in some perspective. I'll still try to get biopsy if I can get it quickly and if they tell me it's safe, I found they do one in a hospital nearby. But it's good to know.

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  • Davepet
    replied
    Blood markers are only useful when positive, proving there IS TC. It is entirely possible to have tc with negative markers. Biopsy is usually reserved for guys with only one nut, because of the risks & in the hope to preserve some function, but from the reports here (including me on #2), seems it's almost always TC & needs to come out

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