Olympic swimmer Eric Shanteau postpones testis cancer treatment: One Urologist’s Opinion

Despite being a urologist, when I learned in the news that 24- year old US swimmer Eric Shanteau was delaying treatment for newly diagnosed testis cancer until after the Olympic Games in Beijing, my initial response was probably similar to what many other readers thought: “What the heck is he doing that for? Why doesn’t he do the ‘right thing’ and realize his health comes first!” But after a moment, reason kicked in. I get it, and I suspect if faced with the same situation, I might just do the same thing. It all comes down to the difficulty in assessing risk, and substituting our own value judgments on others. We all seem to have it down when it comes to knowing the right thing for other people to do.

Testis cancer is the most common cancer among young men aged 18-35, after which time this form of cancer becomes considerably less common. The most common symptom is a painless lump involving the testis itself. In nearly all cases treatment includes removing the entire testicle, and possibly undergoing additional treatment with surgery, chemotherapy or radiation depending on the kind of tumor and whether or not it has spread. Despite this mortifying tableau, the treatment of testis cancer is one of the great success stories in medicine over the last 50 years. Cure rates- real cure rates, meaning the disease won’t come back even after the “traditional” 5 year waiting period- are well over 90%, and approach this figure even when the cancer has spread to lymph nodes or the lungs. By report, Lance Armstrong is one example of cure after widespread metastases from testis cancer.

What does this mean for Eric Shanteau? We tend to think of testis cancer as a rapidly growing cancer, which should mean that the best chance for cure- as well as the need for less aggressive or extensive treatment- is early treatment. Realistically, though, a delay of several weeks or a month is unlikely to make a big difference in the spread of cancer. About 7 years ago I saw a man in the office for infertility, and on examination the right testicle was so large and irregular that it was twice the size of the left one. When I asked him to feel the testis he told me it had felt abnormal and had been growing for over one year! Fear that he might have cancer had prevented him from seeing a doctor until his wife made him see me for the fertility problem. Despite the delay in diagnosis, he underwent successful treatment, and is cured. He and his wife adopted two baby girls. 

Infertility doesn’t always accompany treatment for testis cancer. In many men, sperm numbers and testosterone production are normal. Not long ago I performed a vasectomy on a man who had undergone successful treatment for testis cancer and fathered two children afterwards. Some men choose to have a testicular implant placed in the scrotum after the testicle is removed, to make them look like they “still have two,” but many men just don’t care about this, or simply feel proud of beating cancer.

So, after a moment’s reflection, I’m not as worried about Eric Shanteau’s decision to defer his treatment for testis cancer as I had been initially. After all, the additional risk is small, and he’s been working towards his Olympic goal for many years. Who are we to say the dream isn’t worth the small additional health risk? It seems to me that the biggest issue for Eric may be the psychological burden of walking around with the knowledge that he has a cancer growing inside him. Yet denial is not just a river in Egypt, but can also be a successful coping strategy in the short-term. In this case it may just turn out to be the ticket to fulfillment of a life’s goal.

Olympic Issues:

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Gold Medal Mindset--The Mind of An Olympian

Update on Jul 29, 2008 by At Basil & Spice

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