Dr. Scott Eggener - Second Opinions & Overtreatment in Testicular Cancer

Episode 135

When should you seek a second opinion? Are you at risk of being over-treated? And why do so many survivors feel unexpectedly low after beating cancer? In this wide-ranging episode of It Takes Balls, Dr. Scott Eggener — professor and chair of the Department of Urology at UCLA Health, and one of the leading experts in testicular cancer care — shares an honest, information-packed outlook every patient and survivor should hear.

Dr. Eggener makes a strong case for second opinions, explaining that because testicular cancer is rare, it's sometimes managed unconventionally even by well-trained, well-intentioned doctors — with real consequences for cure rates, financial burden, and treatment toxicity. He shares what a thorough second opinion actually involves (records, imaging, exam, and sometimes a repeat pathology review), why pathology reads can differ between a general and a GU-specialized pathologist, and why patients should never feel it's rude to ask a doctor how many testicular cancer cases they treat each year. He also dispels the old "don't let the sun set on a testicular cancer" urgency, noting there's rarely a true rush — and describes how tight-knit and collaborative the expert community is, with specialists regularly helping guide care from afar.

The conversation moves into overtreatment and de-escalation — the heart of Dr. Eggener's research philosophy: curing patients with the least amount of therapy and the least exposure to short- and long-term toxicity. He addresses "Reddit bias" (why the sickest cases dominate online while most patients do well with orchiectomy alone), what over-treatment tends to look like, why prevention through the right team matters most, and the exciting frontier of biomarkers like microRNA-371 and ctDNA that may one day individualize treatment and spare men unnecessary surgery or chemo.

Fielding a series of thoughtful listener questions, Dr. Eggener covers adjuvant therapy after RPLND for seminoma, the limited role of LDH in monitoring, residual masses after chemo, and how multidisciplinary tumor boards handle complex cases like lung nodules. On scans and "scanxiety," he shares how he works to minimize cumulative radiation, the proven links between chemo and radiation and secondary malignancies, and why a calm conversation with your physician is often the best antidote to fear.

Finally, he talks about the survival paradox — the very real experience of feeling like you should be grateful and great, yet not always feeling that way after cancer. It's a candid, humane close to a conversation grounded in a simple principle: there are no stupid questions, and the whole point of an appointment is to get all of yours answered.

Whether you're newly diagnosed, weighing treatment options, or years into survivorship, this episode is an essential guide to advocating for yourself and getting the right care from the right people.

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