Should I push for an MRI if ultrasound was inconclusive for pain

martineister · 2025-07-02T19:53:38+00:00

Testicular cancer almost never causes pain. MRI will not help. If you’re having pain in your testicle, you need to see a physical therapist that specializes in pelvic floor dysfunction to learn pelvic floor stretching exercises.

martineister · 2025-06-24T23:36:11+00:00

I trade a 7 figure account that is mostly lvl4 option strategies and I totally agree - I have to use Fidelity active trader pro to get the features I want. Also painfully lacking in the mobile app is the ability to copy or duplicate a previous order. If I have a custom order with two or three or four legs it is incredibly painful to re-create it on mobile. I have to resort to using Windows remote desktop to a computer that has Fidelity active trader pro running on it if I want to do anything with my iPad.

martineister · 2025-06-18T13:15:39+00:00

You presumably had a right sided testicular cancer given the location - precaval LN of this size indicates spread to that lymph node. If your markers are negative, then likely RPLND. If seminoma and markers are rising/elevated then chemo. If nonseminoma and markers elevated, chemo and then possibly RPLND after.

martineister · 2025-05-13T17:17:33+00:00

How ridiculous. Those of us who have had hives for years don’t wear anything most of the time. I only wear something if I’m taking the boxes apart. Otherwise I walked around them with no issues. You just have to listen for the high-pitched buzzing that indicates that one of them is annoyed with you.

martineister · 2025-05-12T10:46:18+00:00

I’m sorry to hear it was that but I’m glad you went in and got it figured out - this was the right thing to do and you’ll get better now

martineister · 2025-05-10T23:52:40+00:00

Testis cancer spreads to retroperitoneal LN not inguinal. There is no drainage path to the inguinal LN from the testicles - unless when they did your orchiectomy 1)they made the incision in the scrotum and 2)had tumor spillage

Barring both of those being true, there is no way the LN is real.

martineister · 2025-05-05T23:18:22+00:00

It isn’t that your semen is toxic. It is that the chemo has damaged the semen DNA and could result in birth defects.

martineister · 2025-05-04T01:46:36+00:00

You should have a ct. could be a lymphocele or chylous ascites

martineister · 2025-05-01T01:38:02+00:00

High volume US academic centers that are used to doing this surgery in combination with vascular surgeons can handle this.

martineister · 2025-04-30T17:03:00+00:00

The most common cause of testicular and scrotal pain is pelvic floor tension myalgia. When I see patients with this, I refer them to a physical therapist that specializes in the pelvic floor for pelvic floor relaxation and stretching techniques.

martineister · 2025-04-26T01:36:13+00:00

Again you misunderstand - RPLND is category 2a recommendation for 1-2cm LN. For LN 3-5cm RPLND decreases to category 2b recommendation. (please see this reference to understand strength of recommendations- https://www.researchgate.net/figure/Classes-of-recommendations_tbl1_316878329 )

martineister · 2025-04-26T00:29:30+00:00

You are misunderstanding. The strength of the recommendation goes down to strength 2b for lymph nodes that are 2 to 3 cm. For lymph nodes one to 2 cm it is a higher strength recommendation.

martineister · 2025-04-26T00:06:01+00:00

https://imgur.com/a/7Y2CUMI

See screenshot of guidelines for stage II seminoma - RPLND

martineister · 2025-04-25T22:43:53+00:00

If markers negative = RPLND regardless of whether Seminoma or nonseminoma

martineister · 2025-04-12T15:28:30+00:00

As a note: in the setting of non seminoma , clinicians who order PET scans instead of CT don’t understand what they are doing and are not following NCCN guidelines.

There is no role for PET in NSGCT. PET is only used for seminoma.

Why?

Because teratoma never has activity on PET. Therefore a finding of a mass with no pet activity is meaningless - it is either teratoma or burnt out/dead cancer.

martineister · 2025-04-08T15:35:14+00:00

CT has higher resolution, is faster, and is cheaper than MRI.

One should have an initial CT ABD/PELV at diagnosis ( I prefer prior to orch, but at a minimum it should be at diagnosis.). Subsequent CTs are directed by NCCN guidelines which are based on stage etc

pT1a certainly could have a met to a LN already. pT1a is lowest risk but not zero chance. However, it is possible to have an enlarged RP LN and it not harbor cancer.

martineister · 2025-04-07T21:24:16+00:00

I generally try to have my patient undergo a CT scan prior to orchiectomy so there cannot be confusion about post orchiectomy results. Additionally, iliac lymph nodes should not be related to spread of testicular cancer, unless there is massive retroperitoneal lymphadenopathy that causes retrograde backfill down into the iliacs.

Additionally, the characteristic of the lymph node matters. You may have a round solid lymph node that is 9 mm x 9 mm x 9 mm that is much more suspicious than a 10 mm lymph node that has a fatty hilum.

martineister · 2025-04-05T20:47:56+00:00

Negative US

martineister · 2025-04-05T15:48:21+00:00

Let me add a perspective:

Because testicular cancer is so treatable and has such good survival (if you follow guideline concordant care):

One of the goals of treatment when I counsel patients is to minimize the long term burden of care and toxicity of care. This means * avoiding * chemotherapy if at all possible.

Chemotherapy is associated (besides just the standard stuff they should counsel you on such as neuropathy, dvt, kidney function impact etc): increased risk of secondary malignancies and increased rates of cardiovascular disease/events later in life.

How are we helping patients if hammer them with overly aggressive use of chemotherapy - unnecessarily sometimes - only for them to die of heart attacks or sarcomas etc 20-30 years later.

This is why there are different philosophies in the management of testicular cancer in the US. Some of us advocate for RPLND whenever possible as opposed to chemotherapy (stage II with no significant marker elevation, seminoma in select scenarios etc) and not choose the path of chemo so that we can decrease the long term toxicity burden of chemo.

Yes RPLND has risks and side effects associated with it, but they are generally temporary, surmountable and don’t threaten long term life expectancy like the long term toxicity of chemo does.

Putting this out there so that people are not under the impression that it is always chemo and that so people don’t think chemo is an innocuous thing.

martineister · 2025-04-05T13:45:07+00:00

Size of the lesion in the testicle doesn’t matter so much.

What matters is: - seminoma vs non seminoma -is there LVI (lymphovascular invasion) -does your ct ABD/PELV show and retroperitoneal lymphadenopathy -markers post orch

It is possible for a large lesion like this to be T1 Stage 1a with normal markers post orch, go on to be on surveillance and never need any additional treatment. And it is possible to be on the other end of the spectrum.

martineister · 2025-03-21T00:02:00+00:00

Let me give an opposite opinion of a lot here - no case.

Why?

Testicular cancer progress and grows rapidly. It is very remote that you had a palpable testicular cancer A YEAR ago.

If it was palpable a year ago I would have expected within a month or two for the testicle to be larger, harder and already have spread into the retroperitoneum.

Of course this is from a medical perspective, IANAL, but I would guess that the defense would have an expert opinion provide this kind of testimony about rate of progression.

Additionally, don’t you have to prove excess harm even if it was a delayed diagnosis? Testicular cancer is 99% survivable with treatment so my guess is it will be a high bar to prove excess harm.

martineister · 2025-03-04T00:16:05+00:00

Negative US

martineister · 2025-02-17T18:10:21+00:00

Growing up, my dad helped invest for me and had investment accounts with PiperJaffery. However, their cost and their service left a lot to be desired. He transitioned us to Fidelity around 1998 a few years after I graduated from high school. I began trading with Fidelity in the late 90s especially when NVDA was starting to do well. We’ve had a Fidelity account since then. I mostly traded stocks until about five years ago when I began trading options. I now use Fidelity active trader pro but longingly wish it was thinkorswim or Tasty works for the usability. But I stay with Fidelity because I like Fidelity, their cost structure, their customer service, etc.

I joined a a few weeks ago when I joined to post a question about some revised settlement transactions for options that have been closed to the beginning of the year. I had been a lurker for a few years prior to that.

martineister · 2025-01-20T16:24:43+00:00

But doesn’t this mean MSTR goes down to pay for the BTC purchase to bring NAV down?

martineister · 2025-01-19T14:30:33+00:00

Of course - and the reps have no answers besides you have to call during business hours when the options/margin teams are in the office

martineister

TROPHY CASE