Screening Programs for Seminoma
Screening for testicular cancers in general was not recommended by Buetow in 1996 due to the following considerations:
- Not a major health problem
- Testicular cancer is uncommon and screening would not be cost effective
- Screening by self-examination is sensitive but not specific
- Screening has not shown to improve outcomes of disease
Testicular Self Examination
Testicular self examination, and particularly education regarding it, is a controversial topic:
- On one side, there is evidence that earlier discovery of testicular malignancy improves outcomes, including survival
- On the other side, there is no evidence that teaching of testicular examination improves disease outcome, and only serves to increase anxiety levels in patients
Testicular malignancies are increasing in frequency but most are curable with a combination of surgery, radiotherapy and chemotherapy.
- Teaching of testicular self examination is recommended in the United Kingdom
- Testicular self examination is not endorsed in the United States, although individuals are not discouraged.
Surveillance of Contralateral Testis
Patients with a testicular malignancy have a 12-fold higher risk of developing a malignancy in the contralateral testis compared with the normal population, with a lifetime incidence of about 2%. Recommendations for patients after they have undergone orchidectomy and adjuvant therapy are not universal:
- The most basic advice is for the patient to self-examine the remaining testis for any changes
- Ultrasound is a sensitive and specific test for malignancy, and some authors advocate the use of regular ultrasound of the remaining testis. The goal is to perform a partial orchidectomy in these men to preserve their hormonal function.
- European authors often recommend a testicular biopsy of the remaining testis to look for carcinoma in situ (intraductal germ cell neoplasia).