Reason to celebrate gains in treating testicular cancer

The debate over health care has been divisive and rancorous, with legitimate issues of access, cost and quality sometimes overshadowed by agendas on both sides of the political aisle. Unfortunately, this divide has spilled over into medical arena, with battles over turf breaking out among different interest groups over market share.

Amid this discussion is an appropriate time to reflect on one of the most unheralded accomplishments in medicine, the interdisciplinary efforts that have revolutionized the treatment of testicular cancer.

April is Testicular Cancer Awareness Month. Testicular cancer is the most common solid tumor in men under 40; nearly 1 in 250 men will be diagnosed with testicular cancer during their lifetime.

Historically, the treatment of testicular cancer was largely based on luck: if the tumor was detected when still organ confined, there was a high chance of cure, if not, the prognosis was very grim.

In fact, in the not too distant past, the discovery of a suspicious testicular mass was a virtual surgical emergency; urologists would often operate the same day as seeing the patient the first time to not allow any time for even a single cell to escape.

The heart-breaking course this disease all too often took was depicted in the movie "Brian’s Song," memorializing the friendship between Gale Sayers and testicular cancer victim Brian Piccolo (who succumbed to his illness in 1970 at the age of 26).

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Although urologists are the typical physicians of first contact, and generally “quarterback” the treatment of the disease, the advances made in testicular cancer therapy cannot be credited to a single specialty.

From the pathologists who worked to improve and standardize classification of the disease, to radiation oncologists who developed improved methods to target and treat tumors while simultaneously substantially reducing radiation dose and side effects, to medical oncologists who refined chemotherapeutic protocols that substantially improved survival and minimized toxicity, and finally to urological surgeons who integrated these approaches with state-of-the-art minimally invasive surgical techniques, research in this field was truly multi-disciplinary.

Critically, these efforts could not have happened without funding from both government agencies and pharmaceutical companies as well. Although not every cancer survivor can enjoy the success of Lance Armstrong, who won an astonishing seven Tour de France races after his 1996 battle with his disease, today, more than 95 percent of those diagnosed with testicular cancer will not only survive, but go on to live full, healthy and productive lives.

Although we have made great strides, no physician who has ever witnessed the untimely death of a victim of this disease can be satisfied until all those stricken can be cured.

Early detection still is critical, and young men and boys should be encouraged to perform testicular self-examination in the same way women are taught breast self-exams. Any change in the character of the testicle, any nodules or masses within the scrotum (whether painful or not), or even a feeling of achiness or fullness in the genital area may be important warning signs, and indicate that an evaluation by a physician is necessary.

While most of the time these issues are completely benign, only a trained health care professional, after performing a careful history and physical examination, can determine if further lab or diagnostic tests are necessary.

The cooperative effort to improve treatment of testicular cancer is but one example of how committed professionals who put aside issues irrelevant to the care of patients can produce near miraculous results. Collaboration between physicians, industry, the government and patient groups were all essential to this success. While we celebrate our accomplishments with testicular cancer this month, and work to further improve education on early diagnosis and treatment, it would be wise for all of us to remember these lessons as we seek to shape how health care is to be delivered in the future.

Deepak A. Kapoor, M.D. is president of the Large Urology Group Practice Association, representing more than 1,800 urologists nationwide, as well as Chairman and CEO of Integrated Medical Professionals, PLLC, the largest independent urology group practice in the United States.