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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17669
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Very anxious need advice. , I recently noticed a very

Customer Question

Very anxious need advice. Hello, I recently noticed a very small spot/bump on my left testicle. It is about the size of a grain of sand and seems to be on the top left side of the testicle. I cant tell if its part of the tesicle itself or on the outside although it feels like a spot on the surface. I am very worried about testicular cancer. I dont have a history of cancer in my family but this has made me really really anxious. It feels not so soft and not so hard but its very very small so its hard to tell. It does feel like the top of it is very pointy the same way a zit would feel with a pointy head. Can you advise on what this sounds like, I am seeing a urologist next week.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello again.

You have had several experts tell you that this does not sound like a cancer, but you are still anxious about it being cancer.

What further information would be able to allay your anxiety about this being cancer?
Customer: replied 1 year ago.

How can they be so sure that based on a description I have given that it is not something cancerous. let me explain why I am worried. Firstly it just appeared all of a sudden and was not there. Secondly the top of it feels very pointy almost like a zit would be, I have read cysts are usually soft, and not on the testicle itself, in my case this seems to be like a spot on the side of the testicle not part of it the same way you would have a bump on the skin. My question is how can I be sure I mean what would imply that this could be cancer?

Expert:  Dr. D. Love replied 1 year ago.
The primary reason is the size. Something the size of a grain of sand that can be felt anywhere on your body typically is not a concern. Similarly, if we see something as small as a grain of sand on a chest x-ray or chest CT, it is not going to be biopsied - even in a smoker - and lung cancer is far more common and deadly than any other type of cancer.

You say you are concerned because it appeared all of a sudden, but it would be impossible for you to have been able to feel something smaller that was gradually developing into something the size of a grain of sand. You can just barely feel it now. You certainly could not have felt it when it was even smaller, even if it gradually developed into this size over years.

As I said before, it is fine to monitor this grain of sand, and if it progressively enlarges, it would be appropriate to consider further evaluation, but we typically do not perform any evaluation of something the size of a grain of sand.
Customer: replied 1 year ago.

Okay you say the primary thing that does not bring up concern is the size. However what about the fact that it feels a little hard to touch, by hard I mean the top part seems like the top of a spot would be. If it is a cyst for example, I have heard that cysts are usually round and soft is that true? I was seen by my GP last week and she said it is most lilkely to be an epididymal cyst because of the size and location. But I was under the immpression that cysts are a lot softer and dont feel point on the top is this correct? Also it feels like a spot on the surface of the testicle rather than feeling like it is part of the testicle again I dont know what this means.

Expert:  Dr. D. Love replied 1 year ago.
From your description, it sounds more like a small collection of fibrous tissue, rather than a cyst. But the reality is that we typically do not evaluate something the size of a grain of sand, because it does not really matter whether it is fibrous tissue or a cyst or a concretion mentioned by the third expert.
Customer: replied 1 year ago.

I don't understand what you mean by you do not evaluate something the size of a grain of sand? I thought that any new lump or spot on the testicle needs to be evaluated? What would be a case where I should be concerned I mean what am saying is what type of lump would be cause for concern because even something so small could be the start of testicular cancer. I just need to understand in what case one would be concerned as to the chance of it being testicular cancer.

Expert:  Dr. D. Love replied 1 year ago.
We do not biopsy something the size of a grain of sand because it is not fruitful and small benign lesions are extremely common, and then there will be so many scars from the biopsy procedures that it would be difficult to feel a significant lump if it were to develop. An early testicular cancer is typically about the size of a pea.

In addition, while the risk of infection of a wound from a biopsy is quite low, if we start biopsying every grain of sand that develops, there will still be many infections that will develop, some of which will become severe infections. Ultimately, we will be causing more complications and disease than any benefit from the biopsy. As for any procedure, we only consider doing a procedure if the likelihood of benefit outweighs the likelihood of risk.
Customer: replied 1 year ago.

But my understanding is that for the testicles something can not be biopsied without removing the entire testicle? Also I have read that fibrous tissue often shares some similarities to malignant lumps and that in some cases the testicle has to be removed. When you say fibrous tissue what do you mean? What does the fact that it has a pointy head mean like a spot? I am very anxious about this and part of me is almost convinced that this could be testicular cancer.

Expert:  Dr. D. Love replied 1 year ago.
Something on the surface of the testicle can easily be biopsied. Even deeper structures may be able to be biopsied. A needle biopsy frequently cannot be done, but an open biopsy can be done in many circumstances.

Fibrous tissue is a particular type of tissue that is composed of fibers and is everywhere in your body, but can accumulate in certain areas. It is nothing like malignant tissue, although they may feel firm on exam.

The pointy head does not mean anything other than the shape of the grain of sand.
Customer: replied 1 year ago.

My final question, is it that you dont think that this is the start of testicular cancer because of what I describe? Or what makes you say it is not.

Expert:  Dr. D. Love replied 1 year ago.
I do not think that it is the start of cancer for the reason noted above.
Customer: replied 1 year ago.

I dont see the reason can you please ellaboraate

Expert:  Dr. D. Love replied 1 year ago.
As I said above - The primary reason is the size. Something the size of a grain of sand that can be felt anywhere on your body typically is not a concern. Similarly, if we see something as small as a grain of sand on a chest x-ray or chest CT, it is not going to be biopsied - even in a smoker - and lung cancer is far more common and deadly than any other type of cancer.
Customer: replied 1 year ago.

Okay thank you. One final question, is it true that if the lump or spot is on the testicle itself 95% of the time it is cancerous and if it is on the surface of the testicle then it it not a cause for concern? How can I distinguish if something is on the surface of the testicle or within the testicle itself? When I roll the testicle between my fingers it feels like a spot on the testicle.

Expert:  Dr. D. Love replied 1 year ago.
It would not be true for a lump that is the size of a grain of sand.

If you cannot distinguish the location on exam, then the only option would be to see your doctor.
Customer: replied 1 year ago.

when i exam it myself the testicle feels smooth its just that it feels like there is a spot on the top left side of the testicle thats how it feels

Expert:  Dr. D. Love replied 1 year ago.
It sounds like it is more in the epididymis, but this is also based on the fact that the only doctor that has examined this thought that it was in the epididymis. It cannot be truly determined without doing an exam, which obviously cannot be done over the internet.
Customer: replied 1 year ago.

Doctor can you say with a lot of certainty that this is not the begining of testicular cancer, mainly because of the size? I mean all lumps would have started small at some point.
Are you still available?

Customer: replied 1 year ago.

Are you still available?

Expert:  Dr. D. Love replied 1 year ago.
I have already commented upon this in our previous discussion. Obviously, any tumor must have been the size of a grain of sand at some point, but realistically, exceedingly few lumps that are a grain of sand are ultimately found to be cancer.
Customer: replied 1 year ago.

Hi Doctor,

I have a follow up question. I saw the urologist and had a scan and as you said it was infact fibrous tissue, which was very tiny. It has since gone on to start disappearing completely.
I mentioned before I have a history of prostititis which sometimes flares up and goes. Recently I noticed that after ejaculation I have a little discomfort in my testicles just afterwards its not really pain but rather a sensation as if someone is squeezing my testicles, I had not noticed this before, it started a couple of days ago and as my ultrasound from 3 weeks ago is fine, what does this indicate? In your view? I have no other symptoms.

Expert:  Dr. D. Love replied 1 year ago.
This is a separate question and you have not yet provided a positive rating for my first answer.
Customer: replied 1 year ago.

Apologies. I will give you an excellent rating for this.. Can you address the question?

Expert:  Dr. D. Love replied 1 year ago.
I would be glad to address this additional question after you give a positive rating for the answer to the original question.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17669
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Dr. D. Love and other Medical Specialists are ready to help you
Customer: replied 1 year ago.

Are you able to follow up on the additional quesiton above?

Expert:  Dr. D. Love replied 1 year ago.
Although any condition that can cause testicular pain may occur after ejaculation, the most common cause of testicular pain or discomfort after ejaculation would be an infection of the tube that drains the testicles, called epididymitis. This tube connects to the prostate, and men that have recurrent prostate infections also can develop an infection into this tube.

Another common cause of scrotal pain or discomfort after ejaculation is a muscle strain or spasm, which.can be related to irritation of the nerve that serves the scrotum.
Customer: replied 1 year ago.

But I dont have any symptoms of epididymitis, the testicle does not hurt on its own and I dont have any flank pain or any other symptoms, what woudld this suggest?

Expert:  Dr. D. Love replied 1 year ago.
It would suggest what I said above.
Customer: replied 1 year ago.

Yes I understand but I dont think its epididimityis as I dont seem to have any of the symptoms associated with it. Also the prostatitis I had in the past was non bacterial prostatitis. I dont seem to have any other pain symptoms and after ejaculation its not pain as such but rather a discomfort or small squeezing sensation.

Expert:  Dr. D. Love replied 1 year ago.
These are the most common causes. If you want a more definitive diagnosis, thn you need to see your doctor.
Customer: replied 1 year ago.

By the most common causes do you mean common causes of this type of discomfort? Could it also not be due to a flare up of prostatitis symptoms?

Expert:  Dr. D. Love replied 1 year ago.
Yes, these are the most common cause of this symptoms. That was your question and that was what I answered.

Bacterial prostatitis would typically not cause this symptom unless it has spread into an epididymitis. Non-bacterial prostatitis can be due to nerve irritation, and nerve irritation is one of the possible causes of this symptom, as noted above. However, the nerve to the prostate is different than the nerve to the scrotum, so it would involve irritation of different nerves.
Customer: replied 1 year ago.

From what I describe you think it could be one of the things above. Should I take any medication or give it some time and see how it is?

Expert:  Dr. D. Love replied 1 year ago.
They are certainly the most common causes. If it is bothering you, then you should be seen for a defintive diagnosis.

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