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The Forgotten Cancer

Under-discussed and often unnoticed, testicular cancer affects thousands of young men every year

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Testicular cancer survivor Jason Lacoste with his wife Lori and daughters Allie and Leah. - PHOTO BY LINDA SMITH
  • Photo by Linda Smith
  • Testicular cancer survivor Jason Lacoste with his wife Lori and daughters Allie and Leah.

In October 2011, Jason Lacoste was 30 years old, married, raising two young daughters and totally unprepared for what was to come. While driving to work one day, he felt a sudden pain in his groin. "I was surprised, but I didn't really think too much of it," Lacoste says. "Then it happened again when I was driving on the interstate, and I thought, 'OK, something is not right here.'" Two weeks later, he received a cancer diagnosis.

  Most men diagnosed with testicular cancer don't feel any pain at all. A painless lump in the testes is usually the only sign. In that respect, Lacoste was lucky. Had it not been for the brief pain he'd felt, he may never have noticed the hard lump in his right testicle. Like most testicular cancer patients, he had no other symptoms. "The pain was so slight it would be as if someone pinched you," he says. "That was it."

  Lacoste's wife Lori encouraged him to schedule an appointment with East Jefferson General Hospital (EJGH) urologist Dr. Sean Collins, the physician who had treated her for kidney stones during her most recent pregnancy. Still relatively unconcerned, Lacoste thought he'd see Collins and be back at work within a couple of hours. But Collins found the lump right away, and Lacoste instead embarked on what would be a yearlong battle with testicular cancer.

  "I sent [Lacoste] directly down to imaging so he could get an ultrasound," Collins says. "The ultrasound revealed a mass, about 1.6 centimeters, and three smaller ones. At that point, I had to tell him he had cancer and he would need to have surgery as soon as possible. It all happened very fast." That was a Thursday. On the following Monday, Collins removed Lacoste's entire right testicle.

  Testicular cancer is separated into two groups: seminoma and non-seminoma. Seminomas tend to be less aggressive and easier to treat than non-seminomas, but doctors can't determine the type until after the testicle is removed. Typically, any hard lump found in the testicles indicates cancer. Because there are no medical screenings for testicular cancer (like mammography for breast cancer or PSA testing for prostate cancer), tumors often are found by self-examination or by the patient's spouse or partner.

  When an ultrasound confirms a mass, surgical removal of the entire testicle is almost always recommended. While surgery does not always have long-term fertility consequences, it can cause semen to be expelled into the bladder instead of through the penis. In addition, radiation, chemotherapy, and the cancer itself potentially can affect sperm quality. According to the American Cancer Society, approximately 8,600 new cases of testicular cancer will be diagnosed in 2012, affecting mostly young men ages 20-34. Because so many testicular cancer patients are young men, a wait-and-see approach is sometimes an alternative, depending on the type of cancer and the patient's desire for children.

  Before surgery, Lacoste received a CAT scan, chest X-ray and blood work to determine whether the cancer had spread to his lymph nodes. Following the test, Collins called Lacoste to tell him the prognosis looked good. It appeared that Lacoste's cancer was localized in the testicle and had not spread to other parts of his body. The surgery was successful, and they scheduled a follow-up visit to go over the pathology report and see how Lacoste was healing.

  "I felt confident that they got it and everything was gone," Lacoste says.   

  Unfortunately, the pathology report showed that he had high-risk, stage IB embryonal carcinoma of the testes with cancer cells outside the tumor. The cancer could have entered his blood stream and not yet accumulated enough to show up in his blood work. "Of the non-seminomas, embryonal testicular cancer tends to be more likely to recur," Collins says. "If someone has a large amount of embryonal, they need treatment with surgery to remove the lymph nodes or chemotherapy because of the high risk of recurrence."

  In the past, the next step would be a retroperitoneal lymph node dissection (RPLND) — another major surgery. But before scheduling anything, Collins suggested they consult the latest guidelines of the MD Anderson Cancer Center, a resource available only to MD Anderson Affiliate hospitals. Because there are many forms of testicular cancer, the differences in treatments can be great. For Lacoste, the most up-to-date recommendation was chemotherapy. Surveillance was another option.

  "I asked Dr. Collins, 'What are my chances of this coming back if I don't go through chemotherapy?' He said, 'Fifty percent,'" Lacoste says. "I asked, 'What if I do [undergo chermotherapy]?' He said, 'Approximately 2 percent.' So I said, 'Sign me up for the chemotherapy.'"

  Lacoste was treated by EJGH oncologist Dr. Laura Brinz and received a strong round of chemotherapy infusions. In the following months, he had good days and bad days. He lost his energy and his hair and often was confined to his home. But he got better.

  "I guess I've always been a fighter," Lacoste says. "I was born almost three months premature. The doctors told my parents, 'You'd better spend as much time with him as you can.' I wasn't supposed to make it."

  Lacoste is cancer-free now and grateful for any opportunity to educate young men about a dangerously under-discussed disease. "It's not the kind of thing a young guy or even a lot of men want to talk about," he says. "I hope that by talking about what happened to me, I can help to make more people aware of the disease."

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