394. Testicular Pain and Stage 4 Breast Cancer

Episode 394 – Dr. Susan MacDonald on Testicular Pain, Pelvic Floor Dysfunction, and Rebuilding Life After Stage 4 Breast Cancer
Normal scan. Normal labs. Still in pain. Now what?
Dr. Casperson is joined by fellow urologist Dr. Susan MacDonald for a conversation that starts with male pelvic pain and ends somewhere much more personal. They discuss why men with testicular pain are so often dismissed, how chronic pain gets mislabeled, and why pelvic floor dysfunction and referred pain get missed again and again.
Then Dr. MacDonald shares her own story. She was diagnosed with de novo stage 4 bilateral breast cancer after missing her own early symptoms, and she describes what it's like to go from surgeon to patient. She talks openly about fatigue, grief, hormonal changes, and the career pivot she never chose. She also explains why she now wants to help patients move beyond survival mode toward resilience and joy.
In this episode:
How Dr. MacDonald found urology by accident (Grand Rounds, free pizza, and the realization that it's a surgical specialty)
Why male reconstruction and urethroplasty won her over
What urethral strictures are, and why tissue from inside the cheek is used to repair them
How common testicular and pelvic pain is. She estimates about 5% of urology consults.
Why chronic pain is harder to treat than a kidney stone, and why normal imaging doesn't mean the pain isn't real
The harm of forcing a diagnosis, and patients carrying "heavy bricks in a backpack" of labels
Thinking through a differential diagnosis out loud, with the patient as a partner
Placebo effects, and why antibiotics can seem to help even when infection isn't the cause
Pelvic floor dysfunction as the missing center of the Venn diagram, and the value of working with pelvic floor physical therapists
Her stage 4 breast cancer diagnosis, and how surgeons are trained to ignore their own bodies
Living through treatment: fatigue, insomnia, arthritis, hormonal changes, and grief
Why leaving full-time academic surgery was forced, not voluntary, and her pivot into video education and speaking
Sex after cancer, and why the messaging for men and women is so different
Tart cherry juice and hot flashes
Dr. MacDonald Linked In
As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.
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