Men’s reproductive cancers include prostate cancer, testicular cancer and penile cancer. Cancer is the abnormal growth of malignant cells.

Prostate cancer is by far the most common cancer of the male reproductive system. It is the second leading cause of cancer death in men. Whereas prostate cancer usually affects men in middle and older age, testicular cancer is more likely to strike young men. Both types of cancer can be detected early and have a high survival rate. Penile cancer is rare in developed nations and consists almost entirely of skin cancer. It, too, is curable when detected and treated early.

The cause of male reproductive cancers is unknown, but there are many risk factors. These include family history, genetic mutations, viral infections, fatty diet and smoking.

Symptoms may be absent in men’s reproductive cancers, or they can be caused by or mistakenly attributed to other conditions. Men should consult a physician for problems with urination, a lump in the testicles, warts on the penis and other genital irregularities. 

Physicians have many ways of diagnosing men’s reproductive cancers, including physical examination, blood tests, x-rays, ultrasound and biopsy.

Possible treatments for these cancers include surgery, radiation therapy and chemotherapy. Prevention of male reproductive cancers may be possible by getting regular medical checkups and avoiding risk factors such as exposure to viral infections.

Men’s reproductive cancers are abnormal growths of malignant cells in the organs of the male reproductive system. The main types of men’s reproductive cancers include prostate cancer, testicular cancer and penile cancer.

The organs of the male reproductive system are located in and around the lower part of the pelvis. The penis, located between the legs, contains a shaft of spongy tissue and the tip, or glans. At birth, a fold of skin called the foreskin covers the glans. For cultural, religious or hygienic reasons, the foreskin may be removed in a procedure called a circumcision. The inside of the penis consists of spongy tissue that swells with blood during an erection.

The urethra is a tube that runs the length of the penis. It then passes through the prostate to the urinary bladder. The urethra carries urine and semen at different times. The prostate gland is located in front of the rectum and below the bladder and surrounds the urethra. As men age, the prostate often enlarges and constricts the urethra, making urination more difficult.

The testicles (also called testes) are two oval glands, about 2 inches (5 centimeters) long and 1 inch (3 cm) in diameter when mature. The testicles produce sperm cells and hormones such as testosterone. They are located inside the scrotum, a pouch outside the pelvis behind the penis.

Ducts throughout the area transport fluids such as semen, the fluid that contains sperm cells. Sperm cells produced in the testes move through the epididymis and the vas deferens through the prostate. Sperm then passes into the seminal vesicles and then into the urethra during ejaculation. Other fluids produced in the prostate and seminal vesicles mix with the sperm cells in the semen to protect them. Semen in the seminal vesicles leaves the body through the penile part of the urethra during ejaculation. The urethra is also the pathway used to move urine out of the body from the bladder through the penis.

Men’s reproductive cancers begin when cells in the prostate, testicles or penis grow out of control because of damage to DNA. DNA is genetic material present in every cell in the body. Normally the body can repair damage to DNA. When it cannot, cells reproduce abnormally and become malignant. Of the cancers that affect the male reproductive organs, prostate cancer is by far the most common.

Male reproductive cancers vary according to the kinds of cells affected. These cancers include:

• Adenocarcinoma. Cancer in glandular cells. These cells account for most prostate cancers.
  
  
• Germ cell tumors. Cancer in germ cells, normally found in the gonads (sex organs). While these cells can travel and cause tumors in other body areas, they are most frequently associated with testicular cancer in men and ovarian cancer in women.
  
  
• Squamous cell carcinoma. Develops from flat, scaly epithelial cells in the skin and the inner linings of the body. This accounts for most penile cancer and some prostate cancer.
  
  
• Sarcoma. Develops in the blood vessels, smooth muscle and other connective tissues. Sarcomas are rare in men’s reproductive cancers.
  
  
• Small cell carcinoma. Small round cancer cells that develop from nerve-like cells. Small cell carcinoma occurs infrequently in the prostate. It is more common in the lungs and can also affect the ovaries, cervix and other organs.
  
  
• Melanoma and basal cell carcinoma. Skin cancers that occasionally affect the penis.

In addition to these primary men’s reproductive cancers, there are secondary cancers that have spread from somewhere else. These are considered to be a metastasizing cancer of the organ where they started. For example, lymphoma or prostate cancer can spread to the testicles.

Staging men’s reproductive cancers takes into account the extent of the primary tumor, whether the cancer has spread to nearby lymph nodes, and whether there is metastasis to distant structures.

In 2007, the American Cancer Society estimates that there will be more than 228,000 new cases of men’s reproductive cancer diagnosed. Nearly 219,000 of these cases will be prostate cancer – the most common of the men’s reproductive cancers. When detected and treated early, this type of cancer has a good prognosis for survival.

Cancer can occur in almost any area of the male reproductive system. These cancers include:

• Prostate cancer.  Usually a slow-growing cancer, but one that can spread rapidly and invade bone and other structures. It accounts for 9 percent, or about 27,000, of male cancer deaths a year, according to the American Cancer Society (ACS). About one man in six will be diagnosed with prostate cancer, but only one man in 35 will die of the disease. Ninety-nine percent of men diagnosed with prostate cancer survive it at least five years, often far longer. Most prostate cancer is diagnosed after age 65.
  
  In the United States, black men have a 60 percent higher risk of prostate cancer than white men, according to the ACS. Prostate cancer is more common in North America and Europe than in Africa and other parts of the world. Scientists do not know the reasons for this difference.
  
  
• Testicular cancer. One of the most curable kinds of cancer, with more than 90 percent of patients surviving the disease. It is diagnosed in almost 8,000 American men a year. In the United States, white men face five to 10 times the risk of testicular cancer as black men and twice the risk of Asian men, according to the ACS. The worldwide risk is highest in the United States and Europe, lowest in Africa and Asia.
  
  
• Penile cancer. This cancer, which consists mostly of types of skin cancer, is rare in developed nations. It affects about one American man in 100,000, according to the ACS. In the United States, it accounts for about 0.2 percent of cancer in men and 0.1 percent of cancer deaths in men. In parts of Africa and South America, however, it accounts for up to 10 percent of cancer deaths in men.
  
  
• Urethral cancer. A condition even more rare than penile cancer. The urethra is about 8 inches long (20 centimeters [cm]) in men and 1.5 inches (3.8 cm) in women. It carries urine from the urinary bladder outside the body, and in men it also carries semen out of the penis during ejaculation. Urethral cancer affects women more than men.

Scientists do not know what causes the growth of malignant cells in the male reproductive system. There are several factors that increase a man’s risk of developing reproductive cancers. However, many men with reproductive cancers do not have any of the risk factors. These risk factors include:

• Family history. Having a brother or father who has prostate or testicular cancer raises a man’s risk of developing that type of cancer.
  
  
• Genetic mutations. Alterations in DNA that develop during a man’s life or are inherited from a parent. Gene mutations may account for 5 to 10 percent of prostate cancers, according to the National Cancer Institute, and appear to play a smaller role in testicular cancers.
  
  
• Age. As with most cancers, the risk of prostate and penile cancers increases with age. Testicular cancer usually affects young men.
  
  
• Race. Black Americans have a higher risk of prostate cancer than white Americans but lower risk of testicular cancer. Penile cancer is more common in Africa than in Europe and the United States.
  
  
• Diet. A diet high in animal fats and low in vegetables and fruits appears to increase the risk of prostate cancer and has been linked to increased risk of many other types of cancer.
  
  
• Smoking. Experts link smoking to increased risk of penile and many other types of cancer.
  
  
• Viral infections. Men with human immunodeficiency virus (HIV) and AIDS (acquired immune deficiency syndrome) appear to have a greater risk of testicular and penile cancers.  Infection with human papillomavirus (HPV) is a major factor in penile cancer.
  
  
• History of other cancers.
  
  
• Prostatic intraepithelial neoplasia (PIN). Changes in the structure of prostate gland cells. Many scientists think this is a risk factor for prostate cancer.
  
  
• Certain congenital conditions. Disorders that reduce male hormones, such as Klinefelter’s syndrome, increase the odds of developing testicular cancer.
  
  
• Skin disorders. A condition producing multiple moles has been associated with testicular cancer. Use of ultraviolet light and certain drugs has been associated with penile cancer.

The relationship of circumcision to risk for penile cancer is a matter of dispute. In some areas where there are high rates of penile cancer, circumcision is uncommon. However, experts belive that other factors, such as poor hygiene or viral exposure may be more closely associated with the cancer risk, not circumcision.

Male reproductive cancers may have no indicators. Also, symptoms of these conditions may suggest a number of other disorders as well. Possible signs and symptoms include:

• Difficulties with urination, including a burning sensation or blood in the urine. It may involve weak urine flow or increased urination, especially at night. These difficulties may suggest prostate cancer or other prostate problems.
  
  
• Impotence or loss of sex drive. Possible signs of prostate or testicular cancer.
  
  
• A lump in the testicle. Present in 90 percent of testicular cancer.
  
  
• Abnormal growths on the penis. The most common sign of penile cancer.
  
  
• Pain in the hips or lower back. May be present if a men’s reproductive cancer has metastasized to bone.
  
  
• Difficulty breathing, chest pain and coughing. May be present if a men’s reproductive cancer has spread to the lungs.

There are many ways of screening and diagnosing male reproductive cancers. A physician will take a medical history and perform a physical examination that may include:

• A digital rectal exam (DRE) to screen for prostate cancer. The physician carefully inserts a gloved, lubricated finger into the rectum to feel for abnormalities in the prostate.
  
  
• Feeling the testicles for lumps, swelling or tenderness.
  
  
• Inspecting and feeling the penis for any abnormalities.
  
  
• Feeling the abdomen for signs of enlarged lymph nodes.

Other diagnostic methods involve:

• Blood tests. A sample of blood is typically drawn from a vein in the arm. Many cancers produce tumor markers, which are proteins that may indicate the extent of cancer that is present, how well a treatment is working or whether a tumor has recurred. Types of tumor markers include:
  
  
• • Prostate-specific antigen (PSA). Prostate cancer usually raises the PSA level in blood above the normal 4 nanograms per milliliter (ng/mL). PSA may be slightly elevated without cancer being present. However, men with undifferentiated (very malignant) prostate cancers can have normal or low levels of PSA.
    
    
  • Alpha-fetoprotein and beta-human chorionic gonadotropin. Elevated levels suggest testicular cancer.
    
    
• Ultrasound. A machine that uses harmless sound waves to create images of the prostate, testicles, penis or other body parts on a video monitor.
  
  
• Biopsy. A sample of tissue is taken from the prostate or penis for examination under a microscope. In rare cases, a physician may surgically open the scrotum to take a biopsy of a testicle.
  
  
• CAT scan (computed axial tomography). This type of x-ray test takes several pictures to create cross-sectional images of the body. This can help reveal the location of the cancer and if a cancer has spread to other organs in the body.
  
  
• MRI (magnetic resonance imaging). This procedure uses radio waves and magnetism instead of x-rays to create images that are similar to but more detailed than CAT scans.
  
  
• PET scan (positron emission tomography). Sugar containing a radioactive substance is injected into the vein and collects in cancerous tissue. It can detect the location of cancer and help reveal whether the cancer has invaded the lymph nodes.
  
  
• Bone scan. Images are taken after a radioactive tracer is injected into the patient’s arm to highlight bone structures. This is most commonly used to determine if prostate cancer has spread to the bone.

There are several standard approaches for treating male reproductive cancers. For many of these cancers, some form of surgery is the first line of treatment. They may involve removal of cancerous tissue and lymph nodes. Types of surgery include:

• Prostatectomy. Surgical removal of the prostate gland. This is one possible treatment for prostate cancer. The procedure typically involves general anesthesia and a hospital stay of several days. If the surgery removes all the cancer (i.e., there are no deposits of cancer cells, even microscopic ones, outside the prostate), it usually cures prostate cancer.
  
  
• Orchiectomy. Surgical removal of a testicle. This is one possible treatment for testicular or prostate cancer. It is usually an outpatient procedure or can involve brief hospitalization. It involves local, spinal or general anesthesia. If both testicles are removed, the patient will become infertile. Bilateral orchiectomy is occasionally used as a palliative treatment for prostate cancer, working by removing the male hormone (testosterone) on which the prostate cancer feeds.
  
  
• Cryotherapy. Freezing and destruction of cancer cells with liquid nitrogen. This is a treatment for prostate cancer and small skin cancers of the penis. It is not as well established yet as surgery or radiation therapy.
  
  
• Excision. Use of a surgical knife to cut out early-stage penile skin cancer and some surrounding nearby skin. The remaining skin is sewn back together.
  
  
• Laser surgery. Use of a laser beam to kill early-stage penile skin cancer.
  
  
• Penectomy. Surgical removal of some or the entire penis. This is the most common and effective treatment for advanced penile cancer.

Other non-surgical treatments for these cancers include:

• Radiation therapy. Use of high-energy x-rays or other types of radiation to destroy prostate, testicular or penile cancer cells. It is often used along with other treatments, such as surgery or chemotherapy.
  
  
• Chemotherapy. Use of one or more powerful medications to destroy cancer cells. Testicular cancers are highly sensitive to chemotherapy. Small skin cancers on the penis may be treated with a topical drug called fluorouracil cream. Chemotherapy has seldom been used with prostate cancer unless it has spread to other areas and is not responding to hormone therapy. However, new and more effective drugs are being developed for clinical treatment.
  
  
• Hormonal drug therapy. Control of metastatic prostate cancer cells with oral medications or injections that reduce male hormone levels.
  
  
• Watchful waiting. Regular monitoring of prostate cancer that appears not to pose a threat. The physician uses tests such as the digital rectal exam and prostate-specific antigen (PSA) test to monitor a patient's status. Watchful waiting is used if the risks of surgery or other treatments are judged to outweigh the benefits. More aggressive treatment can be started if necessary.
  
  Since many men, particularly older men, have small prostate cancers that may never represent a threat to them, watchful waiting has become an accepted course of action for certain patients. Its use has been carefully studied and confirmed in these patients but it is not appropriate for all patients, especially younger men. This is a course of action that can only be undertaken after careful consultation between patient and his physician.

Researchers are developing new treatments for men’s reproductive cancers, including biological therapy, which uses the body’s immune system to fight cancer. Some studies are researching the use of therapeutic vaccines to treat advanced prostate cancer.

There is no single way to prevent men’s reproductive cancers. However, there are several ways for men to reduce their risk of developing these cancers or for increasing the odds of preventing the disease from being advanced at the time of diagnosis. These methods include:

• Regular physical examination. Men are less likely than women to see a physician for an annual physical or symptoms of a medical problem. A physician can screen for prostate cancer with the digital rectal exam and prostate-specific antigen (PSA) test.
  
  
• Regular self examination. For men at risk of developing testicular cancer, monthly self-examinations are recommended. Patients should promptly report any irregularities to a physician. Physicians differ regarding whether self-examinations are advised for men without risk factors but since it is simple, rapid and without side effects, men (including teenagers) should discuss this with their primary care physicians.
  
  
• Avoiding unsafe sexual practices. This reduces the risk of penile cancer and possibly testicular cancer.
  
  
• Eating a healthy diet. A diet low in animal fats, high in vegetables, fruits and whole grains is recommended to reduce general cancer risk.
  
  
• Dietary substances. Some dietary substances have been found to have an effect on risk for prostate cancer. For example, selenium, a mineral found in whole grains, seafood and nuts may reduce the risk of prostate cancer. Research about the role of the antioxidant lycopene is conflicting. It was previously thought to reduce the risk for prostate cancer, but a recent study shows no benefit. Another study showed that excess amounts of the antioxidant beta-carotene were associated with an increased risk of an aggressive prostate cancer.
  
  
• Regular exercise. Being physically active at least 30 minutes a day five days a week is recommended to reduce general cancer risk.
  
  
• Avoiding sun exposure. This is recommended to reduce skin cancer risk, including some penile cancers.
  
  
• Not smoking. Recommended to reduce general cancer risk.

Recently developed vaccines have been approved to protect girls and young women from strains of human papillomavirus (HPV), which is associated with most cases of cervical cancer in women and with some cases of penile cancer. Research continues into the potential use of these vaccines for boys and men.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about men's reproductive cancers:

1. Am I at greater risk for men's reproductive cancers?
   
   
2. If so, which type is of most concern to me?
   
   
3. Do the symptoms vary with the type of cancer?
   
   
4. What are the primary risk factors?
   
   
5. What tests will be used to diagnose these cancers in me?
   
   
6. What are the treatment options for each cancer?
   
   
7. What are the risks associated with these treatments?
   
   
8. What is the general prognosis for these cancers?
   
   
9. What are the chances that these cancers spread to other parts of the body?
   
   
10. How will I know if the cancer has progressed?
    
    
11. If I have cancer, are my sons at a greater risk for the cancer?
    
    
12. What preventive steps can I take to lower my risk of developing these cancers?