Dear Dr G,

I am a 30-year-old man devastated after a recent diagnosis of testicular cancer, following me noticing a lump in my right testicle while showering.

The lump was not tender and I recalled your advice about painless testicular lumps in younger men.

The lump grew and I became more worried, so I went to the doctors.

My nightmare came true when they said the lump was likely to be cancer.

After an ultrasound and CT scan, more bad news followed about spread to my lungs and even my brain.

I was advised to have my testicle removed as soon as possible and I began to accept an inevitable end of life due to cancer.

However, I was taken aback when doctors said bad news can become a turning point.

They mentioned the journey of Lance Armstrong, and I was told to start treatment with a positive mindset.

They said this adversity can be turned into a health opportunity.

I am putting Dr G on the spot for clarity on testicular cancer treatment.

Is it true testicular cancer is the most curative cancer, even at late stages.

Who is Lance Armstrong and what was his cancer journey.

Is late-stage cancer a death sentence and how can devastation become opportunity.

Yours truly,

Devastated Dave

Lance Armstrong’s journey through testicular cancer is a well known story of survival and reinvention. In 1996, at twenty-five, he was diagnosed with advanced testicular cancer. The disease had spread to his lungs, abdomen and brain. He had ignored warning signs such as testicular discomfort, coughing blood and abdominal pain.

His diagnosis showed that cancer does not discriminate, even in elite athletes. He underwent an orchiectomy to remove the diseased testis and then had aggressive chemotherapy and urgent brain surgery. The platinum based BEP regimen was chosen to preserve lung capacity. He also banked sperm to protect future fertility.

The physical toll was severe with weight loss, fatigue and nausea and the mental burden was heavier with fear, uncertainty and loss of identity. Against the odds, he survived and rebuilt himself through disciplined rehabilitation.

Each step of recovery marked victory over a life threatening disease. He returned to cycling and won the 1999 Tour de France. That achievement symbolised the possibility of reclaiming health and purpose. Later doping controversies do not erase the resilience of his cancer comeback.

In 1997, he founded the Livestrong Foundation to support those with cancer. The yellow wristbands became symbols of solidarity and open conversation. Livestrong normalised topics like self-examination and fertility preservation for men. It also advanced survivorship planning and emotional openness in men’s health.

The message is that cancer can transform rather than end a life. Men are encouraged to take symptoms seriously and advocate for themselves. Masculinity includes vulnerability and emotional courage alongside physical toughness. Life after cancer can be rich with purpose and meaning. Survival is often about battles won quietly within oneself.

As Armstrong said, “Pain is temporary, quitting lasts forever.”

For testicular cancer, adversity can be temporary and opportunity long lasting. Testicular cancer is among the most curable solid cancers. Many patients are cured even after the cancer has spread to lymph nodes or lungs. Cure rates remain high with modern chemotherapy and expert care. Early diagnosis and guideline-based treatment are critical to outcomes.

Your questions are valid and your concerns are understandable. Seek prompt surgery and oncology input without delay. Keep hope, stay informed and accept support at every step.

The post Turning cancer adversity into health opportunity appeared first on George Lee.my.

Dear Dr G,

I am a 30-year-old man at the peak of my career and relationship.

My girlfriend and I met at work about two years ago. We are engaged and planning to get married next year.

My girlfriend noticed a lump in my right testicle while we were being intimate.

The lump was tender at first but eventually became painless, which initially reassured me, so I left it without further worries.

Over the last two months, the lump has grown bigger, and I am increasingly worried.

I was horrified when the doctors told me the painless lump was likely cancer.

Contrary to common beliefs, the doctors said testicular cancer is more common in younger men.

In fact, I was advised to have my testicle removed as soon as possible.

With a heavy heart, I am putting Dr G on the spot to face the challenges of dealing with testicular cancer.

Why is testicular cancer more common in younger men? Am I wrong in assuming cancer risk tends to increase with age?

Can you tell me how testicular cancer is diagnosed? Is a biopsy required?

I understand the treatment of testicular cancer involves the removal of testicles and chemotherapy and radiotherapy. Does that spell the end of my sex life and dreams of parenthood? I am so worried. Can you help?

Yours truly,

Terrified Tom

TESTICULAR cancer involves malignant changes that develop in the testes and is the most common malignancy occurring almost exclusively in younger men. The two peak incidences for such cancer are at the ages of 25 and 35.

The risk tends to be highest among Caucasians in Northern European countries and the USA, and relatively uncommon in Asian and African populations. Two common types of testicular cancers are Seminoma and Non-Seminomatous Germ Cell Tumor (NSGCT). Although it is largely unknown why such cancers occur in younger men, malignant changes during the active phase of spermatogenesis are likely the reason.

The exact etiology of testicular cancer is unclear. However, it is associated with men with a history of undescended testicles and infertility. About 10% of testicular cancers occur in men with a history of an undescended testicle. The testicles develop inside the abdomen of the fetus during gestation and descend to the scrotum before birth.

In some men, the failure of the descent leaves the testicles in the abdomen or groin. The higher scrotal temperature is thought to impair spermatogenesis and induce malignant transformation of the germ cells. Genetic defects are also believed to play a role, as it is associated with men with a history of infertility and family history of testicular cancer.

Most men with testicular cancer present with a painless lump in the testicle. Although some may have a dull ache in their scrotum, most describe growing lumps without any pain or discomfort, leading to false assurance and delayed diagnosis and treatment.

Diagnosing testicular cancer is straightforward using ultrasound scans and blood investigations. Tumor markers such as Alpha Feto Protein (AFP) and Beta HCG are usually elevated during late stages of cancer. A biopsy of the testicle is not advisable as it can cause unnecessary spread of the cancer. Surgical removal of the affected testicle is mandatory to determine the type of cancer and assist further adjuvant chemo or radiotherapy.

Before surgical interventions, men are usually asked to perform semen analysis to assess the necessity for freezing. The removal of the affected testicle is described as orchidectomy. The surgery is performed through an incision in the groin instead of a scrotal approach to ensure the cancer is confined and not spread to other lymphatic systems.

Recovery from radical orchidectomy takes up to one month. The removal of one cancerous testicle tends to have no adverse impact on sexual and reproductive functions for most men, as demonstrated by athletes like Lance Armstrong.

Despite presenting with late-stage testicular cancer metastasized to the brain, Armstrong underwent surgical and adjuvant interventions, became cancer-free, and won numerous cycling tournaments. He is also reported to have fathered children without difficulties. In the spirit of Movember November, the spotlight is on men’s health and cancers affecting men.

Testicular cancer deserves attention as it affects young, sexually active men. On a positive note, this malignancy is one of the most curable cancers, with five-year survival rates of more than 95%. The survival rate for early-stage cancer is near 100%.

Lance Armstrong famously said: “Pain is temporary, quitting lasts forever!”

This inspires many facing the challenges of testicular cancer at a young age.

Dr G’s view is: “The pain of initial diagnosis is temporary, the prospect of testicular cancer cure is forever!”

The post Understanding testicular cancer and its impact on young men appeared first on George Lee.my.

Dear Dr G,

As Dr G is featuring a testicular cancer awareness campaign for the month of Movember, I hope to use this opportunity to raise concerns about testicular swellings that have been bothering me.

I am in my late twenties and have experienced painless swelling of my left testicle over the last few months.

My parents told me I was born prematurely with an undescended testicle, so I am paranoid about any abnormalities in the scrotum.

I was reassured the swelling was painless, so I observed for a few more weeks before seeing the doctors.

As the swelling continued to worsen, I eventually went to the doctors.

To my horror, the doctor said it is likely to be cancer and requires surgical removal to confirm the diagnosis.

I underwent two ultrasound scans and sought another medical opinion, all of which came to the same conclusion of cancer.

I am now convinced the operation is inevitable, but I would like to put Dr G on the spot for last-ditch clarifications.

Why is testicular cancer more common in young men?

Am I wrong in assuming cancer risk tends to increase with age?

Can you tell me how testicular cancer is diagnosed?

Shouldn’t a cancerous testicle be painful, rather than painless?

Is testicular cancer genetic in origin, and will it affect my younger son too?

Finally, do you think I have harmed myself by delaying the diagnosis by a few weeks?

Yours truly,

Painless Pete

Testicular cancer is a malignant growth that develops in the testes. It is well recognised to occur predominantly in younger men, with peaks around ages 25 and 35. The risk is highest among Caucasians in Northern Europe and the United States. It is relatively uncommon among Asian and African men.

Although the exact causes in younger men are unclear, genetic changes during active spermatogenesis likely play a role. The exact aetiology remains uncertain, but key risk factors include undescended testicles and male infertility. Men born with an undescended testicle expose the gland to a warmer body temperature. This temperature difference increases malignancy risk by up to fifty fold.

Around ten percent of testicular cancers occur in men with a history of undescended testicle. The testes form in the abdomen of the foetus and normally descend into the scrotum before birth. Failure of descent may leave a testis in the abdomen or groin. Higher temperature is thought to impair spermatogenesis and trigger malignant transformation of germ cells.

Genetic defects also appear to contribute, especially with a family history of testicular cancer or infertility. Early testicular cancer often presents as a painless lump in the testicle. Some men report a dull ache due to a heavier scrotum that aches with movement. Because most lumps are painless, men can be falsely reassured, delaying diagnosis and treatment.

Late disease may cause systemic symptoms such as malaise, weakness, headaches or body aches as metastases develop. Diagnosis is usually straightforward with an ultrasound scan and blood tests. Scrotal ultrasound is typically definitive for identifying a testicular tumour.

Tumour markers help assess type and burden of disease. These include alpha fetoprotein, beta hCG and lactate dehydrogenase. A positive urine pregnancy test in a man can sometimes indicate elevated beta hCG from a germ cell tumour. Staging scans may follow to guide treatment and prognosis.

Testicular cancer deserves attention because it affects adolescents and young adult men. On a positive note, it is among the most curable cancers, with five-year survival rates approaching 100% in early stages. Early detection relies on regular self examination and prompt medical review of any new lump.

The key lesson is that a painless lump can still be serious and must not be ignored. Self awareness, tenderness for your own health and timely action save lives.

The post Painless testicle lumps and cancer fears appeared first on George Lee.my.

Dear Dr G,

In the first week of November, I hope you can focus on men’s cancers.

It is my understanding that previous Movember campaigns focused on prostate cancer awareness, but I hope other men’s cancers get equal attention this November.

I am a 30-year-old man, married for one year, and facing fertility issues.

I have no problems with sexual intercourse, and my wife and I saw a specialist who ran tests on both of us.

To my surprise, the problem lies with me.

My semen analysis showed a low sperm count and my ultrasound showed testicular microcalcifications.

The doctor said IVF is likely needed and warned of a significant risk of testicular cancer.

I am devastated as I assumed I was fit and healthy but at thirty, I now face the risk of infertility and cancer.

As such, I would like to put Dr G on the spot for clarification.

What exactly is microlithiasis?

How do microcalcifications form in the testicles?

How can these calcifications cause cancer, and what can I do to reduce my risk of testicular cancer?

Please help.

Microcalcification Matt

Testicular microlithiasis is a relatively uncommon ultrasound finding with tiny non shadowing bright spots in the seminiferous tubules. These reflect microscopic calcium deposits within the tubule lumina. It is found in about 0.6–9% of men undergoing scrotal ultrasound and is bilateral in up to 80% of cases.

It is usually asymptomatic and detected incidentally. These findings are often discovered during ultrasound for pain, infertility or swelling. The bright foci correspond to laminated calcified bodies called microliths on histology.

Microliths form when degenerated cells or glycoprotein material act as a nidus for calcium deposition. The exact cause is uncertain, but several mechanisms are proposed. Defective germ cell degeneration may promote calcification. Altered seminiferous tubule drainage can reduce debris clearance and favour microlith formation.

Genetic and developmental factors are linked through testicular dysgenesis syndromes. Inflammation or injury such as chronic orchitis, trauma or prior infection may predispose to microliths. Therefore, the aetiology of microlithiasis is likely multifactorial. Numerous studies report an association between microlithiasis and testicular germ cell tumours.

These include seminoma, embryonal carcinoma and mixed germ cell tumours. Men with microlithiasis have a 5-to-20-fold higher relative risk of testicular cancer. However, the absolute risk remains low in asymptomatic men without other risk factors. Both microlithiasis and germ cell tumours may reflect testicular dysgenesis syndrome.

This involves impaired germ cell differentiation, cryptorchidism and infertility. Microliths may signal disrupted tubule homeostasis, chronic inflammation or microenvironmental stress. These factors could predispose to neoplastic transformation. In isolated microlithiasis without other risk factors, malignancy risk is small.

Routine follow up is not always required, but monthly self examination is recommended. In high-risk individuals, annual ultrasound surveillance is advised. Most men with isolated microlithiasis remain healthy and cancer free, and long-term surveillance is unnecessary unless risk factors exist. Microlithiasis is more frequent in infertile men, with prevalence up to 20–25%.

Microliths may reflect impaired spermatogenesis, tubular atrophy and reduced sperm counts. Possible mechanisms include tubule obstruction and chronic inflammation affecting Sertoli cell function. Up to 30% of men with undescended testes show microlithiasis. This likely reflects developmental origins related to testicular dysgenesis and abnormal descent.

Microlithiasis is also reported in Klinefelter syndrome and Down syndrome. It is linked to granulomatous orchitis, testicular tuberculosis and post traumatic calcification. Despite these associations, erectile function and libido are typically unaffected. Overall, microlithiasis is benign but clinically relevant.

It is not a direct cause of testicular cancer. It serves as a biomarker of testicular dysgenesis and potential malignancy risk in predisposed individuals. Its association with infertility, cryptorchidism and genetic syndromes underscores the need for individualised risk assessment. Patient education and shared decision making are important.

Regardless of microlithiasis, testicular cancer risk is highest in young men. The risk diminishes with age. Regular monthly self-examination is key for early detection. Seek urgent assessment for any painless lump, swelling, heaviness or change in testicular size. Your fertility plan should continue with a reproductive specialist.

Consider sperm banking if counts are low or treatment is planned. Address modifiable factors such as smoking, heat exposure and anabolic steroids. Follow a surveillance plan tailored to your risk profile. As I often say, “Nurturing cautious self awareness from young is key for long term prevention.”

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Dear Dr G,

October is generally dedicated to Breast Cancer Awareness and as such, it is called Pink October

I would like to take this opportunity to ask about a mystery in my breasts.

I am a man in my late forties with strange sensations in my chest recently.

It started as tingling in both nipples, followed by constant nagging discomfort in both breasts.

I understand from your last article that breast cancer can occur in 1% of men.

Thankfully, there is no lump that I can feel in my breasts.

My wife thinks it is all in my mind, but I was bothered enough to seek specialist help.

I was referred to a breast specialist for the pain, and attending such a clinic felt awkward.

The specialist said I have mastalgia, possibly due to hormonal changes.

She assured me it is nothing serious, but if the pain persists, I may need tests and treatment.

In the spirit of Pink October, I would like to put Dr G on the spot about mastalgia.

Can you tell me the meaning of mastalgia?

What can cause breast pain in men, what should I look out for and what treatment is available for me.

Please help.

Regards.

Mastalgia Matthew.

Mastalgia derives from “mast‑”, meaning breast, and “‑algia”, meaning pain. Mastalgia can range from mild tenderness and burning discomfort to severe throbbing or stabbing chest pain. In women, such non-serious pain can affect one or both breasts and often recurs before menstruation.

Apart from menstruation, causes of breast pain in women include oral contraceptive pills, early pregnancy and the onset of menopause. Only about 2% of breast pain is related to breast cancer. Breast tissue in adolescent boys does not progress despite hormonal surges.

Although breast tissue in men is functionless, men still face risks of breast conditions. Common causes of breast pain in men include trauma, fat necrosis, gynaecomastia and, rarely, breast cancer. When breast tissue is badly damaged, especially after sport or road traffic accidents, cells can die and regenerate.

This process can cause single or multiple lumps of fat necrosis in the chest. The skin over a lump may appear red, bruised or dimpled, mimicking cancerous changes. Ultrasound and biopsy may be necessary to confirm the diagnosis. Fat necrosis is generally self limiting as dead tissue dissolves over time.

In severe cases, surgical removal of dead tissue may be necessary. Muscular strain after heavy lifting or press-ups is another common cause of breast pain in men. Strain to the pectoralis major and minor can induce nagging chest pain.

Although pain may not originate in breast tissue, it can be felt in the breast area. Such musculoskeletal injury usually requires rest and stretching to aid healing and pain relief. Gynaecomastia and breast cancer can also concern men with mastalgia, and it is the benign overgrowth of male breast tissue caused by an imbalance of male and female hormones.

The condition is usually painless, but many men feel self-conscious and experience discomfort. In some cases, overgrown tissue may harbour a lump that could represent early breast cancer. Although gynaecomastia is benign, persistent discomfort may lead to treatment with tamoxifen, radiation or surgery.

Options include liposuction or mastectomy for symptom relief. Other breast conditions linked to mastalgia include breast cysts and fibroadenoma. Breast cysts are common in women but rare in men, and one type is a fibroadenoma; this is a non-cancerous lump in the fibro‑glandular breast tissue.

These lumps may or may not be palpable, but breast discomfort is a common symptom. Breast cancer in men is rare, but it usually presents as a lump with skin puckering or dimpling. Such features require urgent surgical assessment, and non-breast causes of chest pain can also present as mastalgia. Pain location and cause may be vague and difficult to pinpoint.

Chest discomfort is commonly associated with heartburn, respiratory conditions and heart disease. Persistent breast pain of unknown origin may warrant endoscopy, imaging or an ECG. These help to identify non breast conditions that can mimic mastalgia. Breast pain is common in women across their lives.

Monthly hormonal changes and pregnancy can present as mastalgia. In the spirit of Pink October, it is important to be breast cancer aware and to show empathy. When men with mysterious breast discomfort put Dr G on the spot, he usually reassures them.

He explains the condition is usually benign and self-limiting and also reminds men to be more “breast aware” of the issues women face, with empathy.

The post Mastalgia in Men appeared first on George Lee.my.

Dear Dr G,

I understand that October is dedicated to Breast Cancer Awareness, commonly known as Pink October. However, I’m curious if the general public is aware that breast cancer can also affect men.

I’m a 37-year-old man who discovered a lump in my breast about six months ago. Initially, I wasn’t too concerned, as I’ve always had a bit of gynecomastia (enlargement of breasts in males). But when the lump started to hurt, I was shocked to learn that doctors wanted to perform tests to rule out breast cancer. After undergoing several uncomfortable tests and a biopsy, I was diagnosed with breast cancer.

I felt embarrassed and scared, but I proceeded with a modified mastectomy. Thankfully, all the cancer was removed, and I am now recovering well. I hope my story can serve as a platform to highlight the issue of male breast cancer.

Could you provide information on how common breast cancer is in men? What are the risk factors? Is it true that men tend to be diagnosed at a later stage?

Thank you, and Happy Pink October to you and your readers.

Sincerely,

Pinky Paul

October is widely recognised as Breast Cancer Awareness Month, symbolised by the pink ribbon. This movement began with Charlotte Haley, whose family members were diagnosed with breast cancer. She initially distributed peach-coloured ribbons to raise funds for research. In 1991, the Susan G. Komen Foundation began using pink ribbons at a charity race in New York City for breast cancer survivors. This practice evolved into an international campaign, uniting various charities to raise awareness and funding for breast cancer research, diagnosis, treatment, and cure.

Male breast cancer is rare, accounting for about 1% of all breast cancer cases. In the US, approximately 2,140 men are diagnosed annually, resulting in about 450 deaths. The incidence is increasing, typically affecting men in their sixties and seventies. Globally, male breast cancer results in around 20,000 deaths each year. Due to its rarity, large-scale studies often exclude males, leaving our understanding based on smaller studies.

The most well-known risk factor for male breast cancer is a genetic mutation in the BRCA gene. Other factors include alcohol abuse, ionizing radiation, and exposure to female hormones. High estrogen levels can occur due to medications, obesity, and liver diseases. Klinefelter Syndrome, a genetic condition where a man inherits an extra X chromosome, significantly increases the risk of developing breast cancer.

Treatment for breast cancer in men is similar to that in women, primarily involving mastectomy. Due to the smaller amount of breast tissue in men, a modified mastectomy is often performed. Post-surgery treatments may include radiotherapy and hormonal therapies, depending on factors such as genetic mutations and HER-receptor status.

Historically, male breast cancer was thought to have worse outcomes than female breast cancer. This belief was due to a lack of awareness leading to late diagnoses and increased metastasis risks. However, a National Institutes of Health study found that 63.1% of male cases present with localised disease, compared to 45.4% in females. The rates of local lymph node spread were 29.1% in males and 43.6% in females, with distant metastases at 5.7% in males and 8.1% in females.

Despite its rarity, male breast cancer advocacy has grown. The Brandon Greening Foundation for Breast Cancer in Men, established in 2009, encourages both men and women to wear pink, celebrating survivors and remembering those lost. The campaign supports those affected by breast cancer and advocates for advanced research.

The post Breaking the silence: Understanding male breast cancer risks appeared first on George Lee.my.

Dear Dr G,

I AM emailing in desperation, as a middle-aged man recently diagnosed with prostate cancer.

In view of my age, the specialist persuaded me to undergo the robotic operation.

The surgeon counselled me on the potential complications of the operation.

Since the cancer was stage one, the doctor also mentioned various other options including external beam radiation and active monitoring.

He also mentioned that as the tumour is low grade in nature, I have some time to consider my options.

The most obvious consideration I am taking into account is my erection, as I have a young wife.

Although my wife assured me cancer elimination is a priority, whatever decision I make has to take into account our sexual activities.

I would like to put Dr G on the spot for some opinion.

First of all, why are prostate cancer cases on the rise these days?

Can you tell me what is the correlation between prostate cancer and erectile dysfunction?

What are the impacts of prostate cancer treatment on erectile functions?

What is the best way to preserve erectile functions before interventions?

I also heard about penile rehabilitation. What exactly is that and how do I do it?

Please help.

Yours truly,

Rehabilitate Romeo

The prostate is a gland located just below the bladder, closely surrounded by nerves and blood vessels vital for erectile function. Public awareness of prostate cancer and the utilisation of the Prostate Specific Antigen (PSA) for screening have become more prevalent in the last two decades.

Media coverage of prominent figures affected by prostate cancer, such as the Singapore Prime Minister, has also encouraged men to present younger with early disease that is suitable for radical intervention. Treatments for prostate cancer, though lifesaving, can disrupt these delicate structures.

Radical prostatectomy can potentially cause nerve damage during surgery, which is a major cause of post-operative erectile dysfunction (ED). External beam radiotherapy or brachytherapy can also damage the blood vessels and nerves involved in erection. Lastly, Androgen Deprivation Therapy (ADT), which lowers testosterone, reduces libido and erectile capacity, leading to sexual dysfunction even in the absence of structural nerve damage.

Between 30–80% of men after radical prostatectomy experience ED, depending on surgical technique, patient age, and baseline function. Radiotherapy can also result in up to 50% of men developing ED within 5 years post-treatment. Nearly all men experience reduced libido and erectile function within months of hormonal therapy.

The improvement of medical technology and surgical techniques in recent years has evolved to give clinicians an advantage in identifying and protecting the neurovascular bundle responsible for the erectile and sexual functions of men. Despite the introduction of such “nerve-sparing” radical prostatectomy, the rate of erectile dysfunction can still be at best 14% and in some series as high as 100% in men after the operation.

Of course, the post-operative erectile function recovery is quite variable. Factors that may influence the return of sexual function include age, baseline sexual ability before the operation, and preoperative state of health.

Clearly, men who had problems such as diabetes, smoking, hypertension, and dyslipidemia would expect poorer outcomes in sexual performance after the operation. Although the terminology of “rehabilitating” the penis from “wrongdoing” is somewhat misleading, the notion of penile rehabilitation is essentially to prevent irreversible structural and functional damage.

This is achieved by forcefully enhancing the circulation and hence oxygenation of the tissues to facilitate recovery from the surgical insults. It is generally agreed that the first four weeks following the operation are non-beneficial for rehabilitating the penis. It is also well recognised that the window of responsiveness ranges from one to twenty-four months.

Apart from the recovery of erectile rigidity, some studies have even demonstrated benefits of sensory recovery and penile length that had been compromised after cancer operations. The regime utilised to rehabilitate the penis is very variable. This can range from daily doses of medications such as the blue pills to daily use of penile vacuum pumps and the injections of medications.

Besides, data is also emerging on the use of shock waves aiming to generate new vasculature of the penis to restore functions. Although many trials have demonstrated success, the exact dosage, interval of rehabilitation, and the long-term benefits of penile rehabilitation are generally unknown.

The detection of prostate cancer at early stages often ensures higher chances of oncological outcomes with radical surgery, especially in younger men with aggressive disease.

Undoubtedly, the trauma of surgery itself often leaves men with adversities such as erectile dysfunction and incontinence. Although the concept of penile rehabilitation may be in its early stages of research, it offers potential hope for men to regain functioning manhood after a hard time dealing with surgery.

The post Understanding prostate cancer treatment and preserving erectile function appeared first on George Lee.my.

Dear Dr G,

I understand you are dedicating the whole month of September to prostate cancer and sexual health.

I also would like to take this opportunity to discuss my dilemma with testosterone replacement therapy and prostate cancer.

I am a man in my mid-sixties and was diagnosed with Late Onset Hypogonadism, also commonly known as male menopause, ten years ago.

As my testosterone levels were so low, I was put on testosterone replacement therapy so that I could maintain my libido.

Sadly, over the last few months, I was diagnosed with prostate cancer, and the doctors suspected it is related to the testosterone drive.

My oncologists have suggested for me to stop testosterone replacement therapy.

In fact, the doctors even suggested I may need to go on medical castration to control the malignancy.

Clearly, I am horrified at how testosterone has landed me in a cancerous mess.

On the other hand, I am also fearful of how the testosterone deprivation will affect my sexual relationship with my wife in the future.

I hope to put Dr G on the spot for some clarification between testosterone drive and prostate cancer risks.

Firstly, can testosterone cause prostate cancer?

Will all men with higher levels of testosterone be at risk of prostate cancer?

On the other hand, will prostate cancer itself affect the levels of testosterone?

How can the treatment of prostate cancer alter my sex drive and erection?

And finally, will my sex life be completely doomed without my testosterone drive.

Yours truly,

Risky Rick

Prostate cancer is the most common solid tumor among men, and its relationship with testosterone has intrigued doctors and researchers for over 80 years. Testosterone, the main male sex hormone, drives male vitality, muscle mass, and, importantly, is responsible for sexual desire.

Because the prostate is a hormone-sensitive gland, both cancer and its treatments are closely tied to testosterone.

In the 1940s, researchers Charles Huggins and Clarence Hodges already discovered the curious link between testosterone and prostate cancer. The study revealed when men’s testosterone production dropped, their prostate cancer stopped growing.

The researchers also found that giving testosterone to men with prostate cancer made their cancer grow. The finding of this link was so significantly important that Charles Huggins was awarded the Nobel Prize in Physiology or Medicine in 1966. This discovery led to the long-standing belief that “testosterone fuels prostate cancer”.

Modern understanding and current evidence paint a more nuanced picture. In a Saturation model, once androgen receptors in prostate tissue are saturated at relatively low testosterone levels, additional testosterone does not significantly stimulate further cancer growth.

On the one hand, some studies suggest men with very low testosterone may present with more aggressive cancers, possibly because the disease adapts to thrive in a low-androgen environment. On the other hand, most men with normal testosterone never develop prostate cancer, indicating multiple genetic, environmental, and lifestyle factors play roles.

Although prostate cancer itself will not affect testosterone levels directly, treatments such as Androgen Deprivation Therapy (ADT), lowers testosterone to castration levels. Almost all men on ADT experience reduced or absent sexual desire, resulting in erections become rare or impossible. Patients also experience fatigue, mood swings, hot flashes, and loss of confidence further reduce sexual well-being.

Strategies to overcome libido loss have also been studied extensively. Medical interventions such as Phosphodiesterase-5 inhibitors can help with erections if nerves are intact. For men cured of prostate cancer and with low testosterone, carefully monitored testosterone replacement therapy (TRT) may restore libido, though this is still controversial and must be supervised by specialists.

Penile rehabilitation with the use of vacuum devices or injections after surgery helps preserve erectile tissue health.

Lifestyle measures such as regular exercise can boost testosterone naturally, improve mood, and enhance body image. On the other hand, a healthy diet that is rich in fruits, vegetables, lean protein can support vascular health and indirectly benefits erectile function and testosterone production.

Sleep and stress reduction also play vital roles as poor sleep and high stress lower testosterone and libido.

Psychological and relationship support can also be important for couples, as sex therapy and counseling can help couples adapt to changes in intimacy. Open communication and honest discussions with partners reduce frustration and maintain closeness.

Alternative intimacy approaches such as exploring non-penetrative sexual activity, sensual touch, and emotional intimacy can maintain connection when erections are difficult.

Australian-born academic and influential feminist Germaine Greer once warned: “Testosterone is a rare poison”.

When it comes to the poisonous effect of testosterone and prostate cancer, the relationship between testosterone and prostate cancer is complex and far from the simple “testosterone causes cancer” view of the past.

Treatments, particularly androgen deprivation therapy, can significantly reduce libido and sexual function, often impacting quality of life as much as the disease itself.

Men facing the threat of prostate cancer and challenges of testosterone deprivation treatments often put Dr G on the spot for his opinion on the utilisation of this “poison”.

His view is: “With medical therapies, lifestyle adjustments, and psychological support, many men can regain intimacy and sustain fulfilling relationships without risking cancer growth without reigniting the hormone.”

The post Testosterone drive and prostate cancer risk appeared first on George Lee.my.

Dear Dr G,

I understand you usually address sexual health issues. My concerns, however, are not strictly sexual, though I worry that the consequences of this disease may affect my sexual health.

I am in my early 40s and have been sexually active throughout my life. A decade ago, my father was diagnosed with prostate cancer, and his treatment has left me fearful, especially regarding my own sexual health.

I accompanied my father to most of his treatments. He was catheterised and later underwent radiotherapy. Although he is now in remission, I learned from consultations with the urologist that he has sacrificed much in terms of sexual function and continence.

I am unsure whether there is a prostate cancer awareness month, but I hope to put Dr G on the spot regarding hereditary prostate cancer.

Can prostate cancer be inherited? Which genes are usually involved? What proportion of men have hereditary prostate cancer? Are there lifestyle changes that can help reduce the risk? Can medication or supplements prevent prostate cancer, and are there any side effects? Finally, should I inform my teenage sons that prostate cancer may run in the family?

Yours sincerely,

Hereditary Harry

September is prostate cancer awareness month, following the success of Pink Oct for breast cancer. Prostate cancer is among the most common malignancies affecting men worldwide. While most cases are sporadic, about 10–15% are hereditary, meaning they are linked to inherited gene mutations.

Understanding risk factors, recognising the genetic basis, and adopting preventive strategies are crucial for men with a family history of prostate cancer.

The genetic risk factors for hereditary prostate cancer are not yet fully understood. Key inherited mutations, such as BRCA1 and BRCA2, increase the risk of developing prostate cancer by 2–5 times, often leading to earlier onset and more aggressive disease. Other mutations, such as HOXB13, are also strongly linked to early-onset hereditary prostate cancer. Defects in DNA repair mechanisms allow mutations to accumulate, increasing susceptibility.

Having a first-degree relative (father, brother, or son) with prostate cancer doubles a man’s risk. The risk rises further with multiple affected relatives or early-onset cases in the family. Genetic counselling and testing are therefore recommended for men with several family members affected by prostate, breast, ovarian, or pancreatic cancer, or with early-onset cases (diagnosed before age 55). Known family mutations, such as BRCA1/2, or aggressive or metastatic prostate cancer are also important reasons for screening.

Genetic testing not only clarifies risk but also guides screening strategies and informs relatives about their own health. While genetic risk cannot be eliminated, lifestyle and medical strategies can help reduce the chance of developing aggressive disease.

Screening and early detection are widely recognised to save lives. PSA testing and digital rectal examination (DRE) should start as early as 40–45 years in high-risk men. More frequent monitoring helps detect cancer at an early stage, increasing the chance of successful treatment.

Dietary approaches are important for prevention. Plant-rich diets—especially those high in fruits, vegetables, whole grains and legumes—are key. Lycopene-rich foods, such as tomatoes, and cruciferous vegetables like broccoli and cauliflower, are protective. Healthy fats, especially omega-3 fatty acids from fish, nuts, and seeds, as well as green tea and soy, contain bioactive compounds with potential benefits. Conversely, red and processed meats are linked to an increased risk of many cancers.

Lifestyle measures are also vital. Maintaining a healthy weight is important, as obesity is linked to more aggressive prostate cancer. Regular physical activity reduces inflammation and supports hormone balance. Smoking and excessive alcohol use are associated with higher cancer risk and mortality. Chronic stress and poor sleep can disrupt hormone regulation and weaken immune protection, significantly raising cancer risk.

Chemoprevention—using medicine to prevent cancer—has been widely studied in prostate cancer. Medicines such as 5-alpha-reductase inhibitors (finasteride and dutasteride) may help reduce risk, but studies show they mainly protect against lower- and intermediate-risk cancers and may actually increase the risk of aggressive cancers. These medicines can also reduce sexual libido. The role of chemoprevention remains debated, but future trials may help men with hereditary risk qualify for targeted preventive strategies.

Hereditary cancer risk affects the whole family. Genetic testing can reveal risks for siblings, sons, and daughters. Family communication is essential, empowering relatives to make informed health decisions. Psychological support and counselling are often necessary to help cope with anxiety and lifestyle changes.

Hereditary prostate cancer highlights the intersection of genetics and lifestyle. While genes such as BRCA2 and HOXB13 significantly increase risk, proactive strategies—genetic testing, vigilant screening, healthy lifestyle choices, and preventive interventions—can reduce the burden of disease.

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Dear Dr G,

I am a thirty-five-year-old man who has had a healthy sexual relationship with my wife for the last five years.

In reality, I am faced with a dark secret of my past that torments me regularly.

In my late twenties, I was curious about my sexuality and perhaps experimented a bit with my sexual orientation.

After confirming my true heterosexuality, I left that past dark secret behind me.

Unfortunately, I noticed a small flower-like growth arising from my anus recently and went to the doctors.

The doctor told me the growth was an anal wart, and I was shocked to find out it is related to the Human Papillomavirus (HPV), which is essentially a sexually transmitted infection (STI).

The doctor performed some cryotherapy treatment for the warts, which was successful for a while, but they recur regularly.

On the last occasion, the doctor decided to biopsy the wart.

Indeed, he found some precancerous cells he called AIN.

I am terrified and would like to put Dr G on the spot for the issues of my anal warts and the risk of cancer.

I thought HPV was a virus that only affects women. Why is it affecting my anus?

Is it true anal warts only affect men having sex with men? Can they be transmitted any other way?

Are the viruses oncogenic and always cause anal cancers?

What exactly is AIN and anal cancer?

Finally, I have heard about the vaccine. Do you think it is too late for me to have it?

Regards,

Aston

Almost 80 million Americans are infected with HPV, and about 14 million new cases are added each year. Around 1% of sexually active adults live with recurrent genital warts. Genital warts are an infection caused by the transmission of Human Papilloma Virus (HPV) during sexual contact.

Out of the 170 subtypes of HPV, more than 40 are spread through genital and anal contact, and HPV 6 and 11 are commonly linked to anal warts. HPV transmission occurs in both men and women, and the risk factors for cancer include an early age of sexual intercourse, multiple sexual partners, poor hygiene, and smoking.

Nearly all sexually active persons are infected by HPV at some point in their lives, making it the most common sexually transmitted infection globally. Ninety percent of affected individuals demonstrate no symptoms despite the infections, and the virus is thought to resolve spontaneously within two years.

HPV can persist, resulting in either warts or precancerous lesions. Low-risk HPV subtypes like HPV 6 and 11 can result in regular genital warts with low risks of cancer. On the other hand, oncogenic subtypes of the virus such as HPV 16 and 18 can typically affect the cervix, vulva, and vagina in women. The virus is also known to infect the oropharyngeal cavity and anus, risking oropharyngeal and anal cancers in both genders.

Anal warts appear as visible “flower-like” lesions in the anus. In many cases, normal skin tags can be mistakenly diagnosed as anal warts. Scraping the lesion for DNA analysis of the subtype of the virus is the most accurate way of diagnosis. Precancerous detection of AIN (Anal Intraepithelial Neoplasia) is typically associated with high-risk HPV subtypes.

Such precancerous lesions can be treated with minimally invasive modalities such as infrared photocoagulation and laser therapy. Regular follow-up and biopsies are required, as the progression of the lesions to anal cancer makes future treatments complicated.

About 8,300 people are diagnosed with anal cancers every year in the United States, representing about 0.5% of new cancers. Contrary to common belief, anal cancers do not just affect MSM (Men having Sex with Men). In fact, women are affected more often than men, with women above sixty having double the risk of such cancer.

The standard treatment of anal cancer may include radical surgery therapy and chemoradiation. The five-year survival rate of anal cancer in the United States is only 68%, due to late presentations. The most effective way to get protection against HPV is to get vaccinated.

Although the vaccine is supposed to be for both sexually naive boys and girls at the age of 13, protection is also demonstrable up to the age of 45. Other ways to diminish the transmission of HPV include reducing the number of sexual partners and avoiding sexual contact with a partner when the warts are present. HPV vaccines are also advocated for individuals diagnosed with anal warts to enhance immunity against HPV.

The French philosopher Albert Camus, who was the second youngest recipient of the Nobel Prize in Literature, once said: “Autumn is a second spring when every leaf is a flower.”

The existence of genital warts has been documented since ancient Greece, while causation by a virus was only determined in 1907. The curious nature of the transmission of HPV is that it is highly contagious with each sexual contact, but the manifestations may vary from being harmlessly dormant to precariously insidious.

When nearly all sexually active adults are infected with the HPV virus at some point in their sexual lives, it is indeed fair to assume “every visible leaf is a potential flower in the bum!”

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