Pathophysiology
- Prostate cancer: Malignant cells in the prostate gland. Tumors require testosterone to grow. Commonly spreads to bladder, rectum, and pelvic/inguinal lymph nodes. Bony metastasis to vertebral column, ribs, and pelvis is frequent
- Testicular cancer: Germ cell tumors account for 90% — seminomas (slow-growing, radiation-sensitive) and nonseminomas (aggressive). Cryptorchidism is the only consistent risk factor
- Penile cancer: Typically squamous cell carcinoma. Associated with HPV and uncircumcised status
- Scrotal cancer: High rate of metastasis to lymph nodes. Linked to occupational tar/soot exposure
- Prostate cancer symptoms mimic BPH (frequency, urgency, nocturia), delaying detection
Signs and Symptoms
Hallmark Indicators
- Prostate: Early stages often asymptomatic. Later: restricted urinary flow, hematuria, blood in ejaculate, persistent bone pain in pelvis/spine
- Testicular: Painless lump or enlargement of one testicle (most common presenting sign). Heaviness or dull ache in lower abdomen/groin. Occasional gynecomastia from hCG-secreting tumors
- Constitutional: Unexplained weight loss, persistent fatigue, drenching night sweats
- Deep, aching bone pain in pelvis or spine worse at night (indicates metastasis)
Red Flags and Rule-Outs
- Painless testicular lump in a young male: Immediate medical referral — do not delay
- Hematuria (blood in urine) or difficulty starting urinary flow: Common to both BPH and prostate cancer — requires medical evaluation
- Deep bone pain in pelvis or spine, worse at night: Indicates metastatic spread. High fracture risk
- Any unexplained lump >5 cm: Immediate referral
- Gynecomastia in a young male: May indicate hCG-secreting testicular tumor
MT Considerations
- Goal: Palliative support to manage pain, anxiety, insomnia, and depression
- Brachytherapy: Clients undergoing brachytherapy (radioactive pellets for prostate cancer) should delay massage until pellets are removed
- Bone fragility: Prostate cancer frequently metastasizes to vertebral column, ribs, and pelvis. Extreme caution with pressure
- Lymphedema risk: Inguinal lymph node removal creates lifelong risk of lower extremity lymphedema
- Psychosocial impact: Treatment often involves side effects (erectile dysfunction, sterility, orchiectomy). Massage provides nurturing touch for altered body image and emotional distress
- Self-examination counseling: Encourage regular monthly testicular self-examination for early detection
- Treatment side effects: See chemotherapy and radiation-therapy
CMTO Exam Relevance
- Prostate cancer symptoms mimic BPH. Hematuria or difficulty starting urinary flow requires medical evaluation
- Testicular cancer is the most common cancer in males aged 15-35. Cryptorchidism is the primary risk factor
- Inguinal lymph nodes are the sentinel nodes for male genital cancers
- PSA and DRE are primary prostate cancer screening tools
- Seminomas are slow-growing and radiation-sensitive. Nonseminomas are more aggressive
- A painless testicular lump requires immediate referral
Key Takeaways
- Prostate cancer is the leading cause of cancer death in men. Its symptoms mimic BPH, delaying detection
- Testicular cancer is the most common cancer in males aged 15-35 with a high cure rate if caught early
- Prostate cancer frequently metastasizes to bone (vertebral column, ribs, pelvis). Extreme caution with pressure
- Brachytherapy patients must delay massage until radioactive pellets are removed
- Inguinal lymph node removal creates lifelong lymphedema risk in the legs