Primary care of urologist?

[jnickerson]

Hello all –

Several years ago, after watching a biography detailing Lance Armstrong’s battle with testicular cancer I undertook my first self exam. I immediately felt several lumps, and, as you can probably imagine, was pretty much convinced that I had testicular cancer. I immediately jumped on the internet, which, in hind site, was maybe not such a great idea – I diagnosed myself in about 10 minutes. I contacted my primary care physician to set up an appointment.

Well, it turned out I had several cysts, all of which were benign, harmless. I kept up the self-exams for several years, but, on a less frequent basis. I’ve recently noticed a largish lump protruding from my right testicle – it is somewhat painful to squeeze, but nothing extreme – I’m not quite sure how long it’s been there.

My question – I certainly trust my primary care physician, he is an excellent doctor, however, several years ago I developed a suspicious mole that turned out to be melanoma in situ – before finally having a biopsy performed, a different doctor assured me, on several occasions, that it was nothing. Well, I received a second opinion, had it removed, a biopsy was performed and, as mentioned it was melanoma.

So, my question, would you recommend that I contact a urologist, or, my primary care physician? Does a visit to the urologist typically require a referral?

The lump is rather hard, and is located on the downward facing end of the testicle. We just had a child ten months ago and I’m sort of freaking out.

Any help would be much appreciated.

[Margaret]

I strongly recommend that you contact a urologist. Primary docs are great and some have experience with this but some don't. I read an interesting article that in some areas a urologist can practice for 20 years and never see a case of TC...let alone a family doctor. It really is a rare form of cancer. Some basic facts...about 7,000 case of TC will be found this year...but 330,000 new cases of prostate cancer will be found this year and 180,000 new cases of breast cancer this year. When you compare the numbers, you can see how rare this cancer is.

I am sure they mean well, but when it somes to your health, I would not take any chances. In your case since you have had issues with cysts, it is a good idea to be fully checked by a urologist so they can do a yearly exam. I am not sure what your insurance says about a visit to the urologist and if it will require a referral? I would call them and ask. If you need a referral, call your family doctor and tell them you would like to get in to see someone.

Chances are what you have is a cyst, but nothing feels better than actually going to the doctor and having them give you a clean bill of health. I hope you will come back and let us know what they say. I will be thinking of you and hoping this is not causing you too much stress and anxiety. Also, happy news about your new baby!

Margaret

[jnickerson]

Thank you so much for the extremely quick response and the reassuring information. My primary care physician will be receiving a call from me this afternoon : )

And I agree, primary care physicians are great, but I would much rather see a specialist.

Thanks again for the quick response, and I wish your husband and yourself way more than luck!!!

I will certainly post back with the results. [SIZE=3]

[Margaret]

I will be saying prayers for you and your family for a quick "all clear" from the doctor.

[dadmo]

J:
Any mass protruding from the testicle must be examined and your best bet would be to have a urologist do the exam. Does the mass feel as if it part of the testicle? Can it be moved?

[fuse929]

I agree with Margaret that a urologist is always the way to go with issues down there. Family doctors may be able to make a diagnosis, but in the time it takes them to make a referral to a urologist something bad can possible happen. I'm not comfortable waiting around with I have symptoms of anything.

Bobby

[jnickerson]

J:
Any mass protruding from the testicle must be examined and your best bet would be to have a urologist do the exam. Does the mass feel as if it part of the testicle? Can it be moved?

It’s more of a somewhat hard mass – I’m familiar with cysts – they’re typically round, unattached and movable – some of them are very close to the testicle, but they can still be moved.

The lump is definitely attached, I cannot “pinch” it away from the testicle – it feels more like the testicle is elongated, the longer part being very firm – it moves a little, but it is firmly attached.

I should add that the left testicle does not have a similiar protrusion.

[dadmo]

J:
These are not good signs. It may be a benign tumor but I would get to a doctor yesterday. Don't let your primary put off an ultrasound by telling you it's just an infection. This thing needs to be examined now.

[jnickerson]

J:
These are not good signs. It may be a benign tumor but I would get to a doctor yesterday. Don't let your primary put off an ultrasound by telling you it's just an infection. This thing needs to be examined now.

Thank you, I appreciate the frank and prompt advice. I just called and made an appointment for next Thursday, the soonest they could get me into the office. Does anyone have any tips for getting an “emergency” visit? Is a week too long to wait?

I just checked it again, and at times, it feels as though it is moving – but of course, I am not taking any chances.

[dadmo]

You wouldn't be the first person to go to the emergency room complaining of testicular pain. It may not be anything but the sooner it's looked at the better.

[jnickerson]

Ah – I didn’t think of that – good advice. Now, what is the likelihood that I would see a urologist vs. an emergency room nurse or doctor? (That’s probably not a fair question, there’s really no way for you to know.)

[dadmo]

You will probably see the emergency room doctor who will schedule you for an ultrasound. That should get the ball rolling.

[Fed]

I'm joining the thread late, but at the right time. I was diagnosed in the ER after having spoken with my GP. It was the day before Thanksgiving, and all of the docs had already skipped town, hence the ER was my only choice (otherwise, I would have had to wait at least 5 days before anyone could see me). When I checked in and said that I was there because of testicular pain, they pretty much put me at the front of the line, and I was having an ultrasound done within two hours. Be very detailed on your symptoms when you get triaged. You will likely be seen first by a PA, who will do the first exam (you will be manhandled a lot) and likely order the ultrasound. If the mass is indeed solid and cancer is suspected, then a urology consult will be requested. In the event they do suspect cancer, request that they do a blood draw for tumor markers and possibly a pelvic/abdominal CT and chest X-ray on site, just so you have all that out of the way.

One thing, how does the rest of the affected testis feel like? Hard, soft, painful, larger, smaller?

[jnickerson]

Before I continue I want to thank you all for the quick, thoughtful responses –you provide such a great service – it’s really quite heartwarming.

Aside from the lump, which is somewhat tender when squeezed, nothing more than the usual pain associated with a testicle exam, there is no pain –the testicle feels normal, no more or less dense or soft than the other. There is a largish, what I imagine to be, cyst, right up against it, and the lump feels somewhat smaller when it is moved aside.

[dadmo]

It's quite possible that you also have a cyst which may be making the lump appear larger then it is. It still needs to be checked ASAP.