In a recent study, investigators sought to understand the current viewpoints of the general population on testicular cancer and testicular self-examination.
Every year, guidelines are updated to reflect the advancements in research and technology that pertain to specific areas in urology. But do these guidelines reflect the knowledge and education that men receive in the real world?
A recent Urology Practice study,1 led by Shawn Dason, MD, seeks to understand the current viewpoints of the general population on testicular cancer and testicular self-examination. A cross-sectional survey was conducted to learn more about what knowledge American men actually have on this topic. Dason is a urologic oncologist and an assistant professor of urology at The Ohio State University, Columbus, Ohio.
I'm a urologist that focuses as a uro-oncologist, partially on testicular cancer, and I've noticed that a lot of the patients that we're seeing with testicular cancer who, when they're diagnosed, have metastatic disease, really didn't have any discussion with their primary care physician at any point about the topic and had very little insight into how they might have known that they had cancer, or how they might have come in earlier. That led me to look into what the official recommendations were for screening and really what the literature was on this topic.
I found that, realistically, the screening bodies are fairly against self-examination and don't really discuss education about testicular cancer very much as part of something the primary care physician should do. Additionally, there was some suggestion in older studies, usually conducted in other geographic locations, where the baseline knowledge of men surrounding testicular cancer and the best practices surrounding self-exam were very limited. So, this led me to think, "Hey, in a more modern era where everybody is on the internet, and maybe educational practices and understanding has changed, what does this look like now? What's the landscape now?" And then, how do men feel about this recommendation against looking for testicular cancer? Against teaching them about it, or teaching them to self-exam? And realistically, I think that motivation to understand, to go backwards from these patients diagnosed with testicular cancer already, was what led to the study.
To be honest, I think a lot of the findings mirrored the hypotheses we had going into this. And so, they weren't per se very surprising. Maybe it was surprising to find very similar data to what we had hoped or expected to find, but not surprising in a sense. I think the big findings are that men know about testicular cancer, but they may not know a lot and they feel like they could know more. Their primary care physician or provider generally did not necessarily discuss testicular cancer as a dedicated topic, even though this is an important health concern in younger men. And men are very motivated to learn about that. They're very interested in that topic, especially because it is a health concern that affects them and it's very common. They are very motivated to perform, or at least to discuss, testicular self-examination for screening for testicular cancer. Now, that's a separate topic as to the data surrounding that and how that should be employed as a public health practice, but at least maybe it leads to some impetus to think about this as something worthy of active investigation and to be reconsidered. American men are very interested in this practice.
The 1 challenge as a urologist, specifically a uro-oncologist, is that I see patients on a referral basis, generally after they've been diagnosed with cancer. I think the findings of the study are more applicable to the earlier aspects of that disease when that patient that's ultimately diagnosed is much younger and needs to be educated about self-exam and discussion of testicular cancer. So, the findings are difficult for me to personally incorporate, but what I think is also part of my role is serving as an advocate for this disease and discussing a lot of these situations with primary care providers and discussing it when they are asking for a recommendation of how they should approach this topic. Then I would definitely advocate that men do want to know about testicular cancer, and whether or not you believe in teaching them self-exam, it would be at least reasonable to discuss testicular cancer as a whole, just so that they're aware of it. Then, maybe if they are not frequently doing self-exams, they know to present early.
The other side of things is that in my younger patient population that may be diagnosed with testicular cancer, patients that are at an elevated risk for cancer in the other testicle, we generally already teach them self-exam. I think that this just endorses that practice in a sense, although they are at elevated risk compared to just screening. And sometimes these patients ask, "Hey, what should my children do? What should my family members do? What should my parents do?" That's a similar situation where you discuss if it is an option to consider self-exam when you're counseling the patient diagnosed with testicular cancer directly or family recommendations.
The take-home message is that testicular cancer should definitely not be a taboo subject. We should widely discuss it with men that are in the age range that could develop it. We should definitely advocate to our primary care colleagues often that urologists are a pinnacle in their community for advocating and discussing recommendations surrounding men's health issues. And we should definitely advocate that men do want to know about this. Whether one routinely teaches men self-exam is a matter of debate, but I think that it at least provides an opportunity to discuss the concept if testicular cancer as a broad topic is broached with patients. Then, the motivated patient can be educated further based on that conversation. It also sets research priorities. It's an important topic affecting a lot of men and has a lot of implications being a screening study. And so, we should be thinking about prioritizing this since the data is very limited. Certainly, from a patient and population perspective, there's a lot of interest in this topic.
I think that it's just a recognition of the possible regret that these men feel when they're diagnosed at an advanced stage and often ignore their symptoms. Delayed presentation is a fairly common issue in testicular cancer, and it's always a question as to whether there could have been some more education earlier on, on a general level, to prevent these men from going down that rabbit hole and ultimately requiring more intense treatment, maybe impacting their quality of life, and in some settings, their survival. Although it's a very treatable cancer, there are still some significant challenges with burden of treatment. The more treatment you get, your quality of life in the long term is impacted, and you're at risk for many other health conditions. And we know that the earlier you present, the less treatment you ultimately need. That means the less chemotherapy you need, the less surgery you need, the less radiation. So, the earlier one could get diagnosed, it could prevent a lot of these things. There's a big opportunity to impact patient quality of life and reduce the regret and challenges that many patients feel when ignoring their symptoms. I think that's an important message here.
1. Beebe S, Scimeca A, Diab D, Wong NC, et al. Testicular cancer knowledge and viewpoints of American men. Urol Pract. Published online September 29, 2021. doi:10.1097/UPJ.0000000000000267