Monday, December 1, 2014

The Importance of Testicular Self-Examination

Testicular Cancer is the most common malignancy in men aged 15-34 years old. While there are less than 10k cases of testicular cancer diagnosed every year, the cure rate is greater than 95% for all new cases – leaving hundreds of thousands of survivors in the US at any given moment.[1]  Men with cancer confined to the testicle are almost guaranteed a cure – the long-term survival is approximately 99%. While the cure rate for men with metastatic disease (or cancer spread from the testicle) is still 75%, these men are often subjected to chemotherapy and/or surgery. Read our prior blog on the life-saving additional of Platinum-based Chemotherapy to the Treatment of Metastatic Testicular Cancer.

While most men present with a painless testicular mass, upwards of 15-60% of men will still present with testicular cancer that has spread.[2]  One of the challenges in treating this disease is therefore trying to get more men to present with early-stage, confined testicular cancer before they develop metastatic disease. In the US, on average, men wait 4-6 months prior to seeking a professional opinion for an abnormality in their scrotum and this can lead to higher rates of chemotherapy and worse survival rates.[3,4]

The best means for early-diagnosis and treatment is Testicular Self-Examination (TSE). It is recommended that men examine themselves in a shower once per month for any lumps, bumps, firmness or abnormalities in their testicles. TSE is advocated for by a number of Testicular Cancer advocacy groups including the Testicular Cancer Awareness Foundation (TCAF, The TCAF describes how to perform TSE:
  • The best time to self-exam is after a warm bath or shower when the scrotal skin is relaxed.
  • Examine each testicle gently with both hands by rolling the testicle between the thumb a forefingers.
  • Find the epididymis, the soft tube-like structure behind the testicle that collects and carries sperm. If you are familiar with this structure, you won't mistake it for an abnormal mass.

  • Look for any lumps or irregularities. Remember that lumps or bumps may also present themselves as painless.
  • Look for any changes in size, shape, or texture. Remember it's normal for one testicle to be slightly larger.
The most important step in TSE is to seek a medical opinion if something abnormal is felt.


Testicular cancer can grow and spread incredibly quickly and seeking a timely opinion from a testicular cancer expert is of utmost importance – a timely diagnosis can help diagnose the disease early and prevent the need for chemotherapy or extensive surgery. 
For any man with a testicular abnormality - especially those 15-35 - the first thought should be testicular cancer. 
These men should be evaluated immediately with a scrotal ultrasound; if an abnormality, tumor markers (see our prior blog on Testicular Tumor Markers); and should be referred to an urologist or testicular cancer expert. Men should not be treated with antibiotics or anti-inflammatories without an ultrasound or evaluation by an expert.

Of note, the US Preventive Services Task Force (USPSTF) recommends against TSE, citing "moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits". A future blog will address the shortcomings of the USPSTF recommendation and the evidence supporting TSE.


This blog was written by Phillip M. Pierorazio, MD; Assistant Professor of Urology and Oncology and Director of the Division of Testicular Cancer at the Brady Urological Institute at Johns Hopkins.

[1] SEER Stat Fact Sheets: Testis Cancer,
[2] Stephenson, A. J., and T. D. Gilligan. 2012. Neoplasms of the testis. Pp. 837–870 in A. J. Wein, L. R. Kavoussi, A. C. Novick, A. W. Partin and C. A. Peters, eds. Campbell-Walsh urology. Chapter 31, vol. 1, 10 ed. Elsevier Saunders, Philadelphia, PA.
[3] Moul JW, Paulson DF, Dodge RK, et al: Delay in diagnosis and survival in testicular cancer: impact of effective therapy and changes during 18 years. J Urol 1990; 143: pp. 520-523
[4] Stephenson AJ, Russo P, Kaplinsky R, et al: Impact of unnecessary exploratory laparotomy on the treatment of patients with metastatic germ cell tumor. J Urol 2004; 171: pp. 1474-1477