“Off-Label” Usage Of Testicular Self-Examination (Tse): Benefits Beyond Cancer Detection

Testicular cancer (TCa) is the most common cancer among 15- to 34-year-old males. Treatments are highly effective, which help foster approximately 98% 5-year survival rate. There are very few known causal factors of the disease (e.g., cryptorchidism and family history), thus possibly limiting primary prevention methods. Secondary preventative measures, on the other hand, most notably testicular self-examination (TSE), are well-known and are promoted to help prevent late-stage diagnosis of TCa. However, debate ensues as to whether or not TSE provides any benefit. In light of a recent systematic review conducted by these authors assessing the effectiveness of TSE promotion interventions, we propose that the behavior can serve as a tool not just for detection of TCa, but other male-specific urogenital health concerns, including varicoceles, hydroceles, among others. Furthermore, we suggest that TSE can also help foster informed decision-making skills among males with regard to health concerns and treatment options. However, our advocacy is in direct conflict with U.S. Preventive Services Task Force’s influential “D” rating of TSE and others who recommend against performing TSE. This article offers an overview of the dispute over TSE’s purpose and net benefit. We conclude that TSE is a behavior that is beneficial beyond detecting cancer. These proposed “off-label” uses of the procedure make for an effectual means to promote testicular health, self-awareness, and wellness among males. Recommendations for future research and advocacy are presented to the academy

Off-Label Usage of Testicular Self-Examination (TSE): Benefits Beyond Cancer Detection

Testicular cancer (TCa) is the most common cancer among 15- to 34-year-old males. Treatments are highly effective, which help foster approximately 98% 5-year survival rate. There are very few known causal factors of the disease (e.g., cryptorchidism and family history), thus possibly limiting primary prevention methods. Secondary preventative measures, on the other hand, most notably testicular self-examination (TSE), are well-known and are promoted to help prevent late-stage diagnosis of TCa. However, debate ensues as to whether or not TSE provides any benefit. In light of a recent systematic review conducted by these authors assessing the effectiveness of TSE promotion interventions, we propose that the behavior can serve as a tool not just for detection of TCa, but other male-specific urogenital health concerns, including varicoceles, hydroceles, among others. Furthermore, we suggest that TSE can also help foster informed decision-making skills among males with regard to health concerns and treatment options. However, our advocacy is in direct conflict with U.S. Preventive Services Task Force’s influential “D” rating of TSE and others who recommend against performing TSE. This article offers an overview of the dispute over TSE’s purpose and net benefit. We conclude that TSE is a behavior that is beneficial beyond detecting cancer. These proposed “off-label” uses of the procedure make for an effectual means to promote testicular health, self-awareness, and wellness among males. Recommendations for future research and advocacy are presented to the academy

Recommendations For Treating Males: An Ethical Rationale For The Inclusion Of Testicular Self-Examination (Tse) In A Standard Of Care

The phrase “standard of care” is primarily a legal term representing what procedure a reasonable person (i.e., health practitioner) would administer to patients across similar circumstances. One major concern for health practitioners is delivering and advocating for treatments not defined as a standard of care. While providing such treatments may meet certain ethical imperatives, doing so may unwittingly trigger medical malpractice litigation fears from practitioners. Apprehension to deviate, even slightly, from the standard of care may (seem to) put the practitioner at significant risk for litigation, which, in turn, may limit options for treatment and preventive measures recommended by the practitioner. Specific to testicular treatment, certain guidelines exist for cancer, torsion, vasectomy, and scrotal masses, among others. As it relates to screening, practitioner examination is expected for patients presenting with testicular abnormalities. Testicular self-examination (TSE) advocacy, however, is discouraged by the U.S. Preventive Services Task Force, which may prompt a general unwillingness among health practitioners to promote the behavior. Considering the benefits TSE has beyond cancer detection, and the historical support it has received among health practitioners, it is paramount to consider the ethical implications of its official “exclusion” from preventive health and clinical care recommendations (i.e., standard of care). Since good ethics should lead practitioner patient care guidelines, not fear of increased malpractice risks, we recommend the development of a standard of care for counseling males to perform TSE

Recommendations for Treating Males: An Ethical Rationale for the Inclusion of Testicular Self-Examination (TSE) in a Standard of Care

The phrase standard of care is primarily a legal term representing what procedure a reasonable person (i.e., health practitioner) would administer to patients across similar circumstances. One major concern for health practitioners is delivering and advocating for treatments not defined as a standard of care. While providing such treatments may meet certain ethical imperatives, doing so may unwittingly trigger medical malpractice litigation fears from practitioners. Apprehension to deviate, even slightly, from the standard of care may (seem to) put the practitioner at significant risk for litigation, which, in turn, may limit options for treatment and preventive measures recommended by the practitioner. Specific to testicular treatment, certain guidelines exist for cancer, torsion, vasectomy, and scrotal masses, among others. As it relates to screening, practitioner examination is expected for patients presenting with testicular abnormalities. Testicular self-examination (TSE) advocacy, however, is discouraged by the U.S. Preventive Services Task Force, which may prompt a general unwillingness among health practitioners to promote the behavior. Considering the benefits TSE has beyond cancer detection, and the historical support it has received among health practitioners, it is paramount to consider the ethical implications of its official exclusion from preventive health and clinical care recommendations (i.e., standard of care). Since good ethics should lead practitioner patient care guidelines, not fear of increased malpractice risks, we recommend the development of a standard of care for counseling males to perform TSE