Is routine screening for testicular cancer recommended in asymptomatic men, and what are the guidelines for self‑examination, high‑risk individuals, and follow‑up imaging?

Testicular Cancer Screening

Routine screening for testicular cancer is NOT recommended in asymptomatic men, including both clinician examination and testicular self-examination (TSE), as the harms of screening outweigh any potential benefits. 1

Primary Recommendation for the General Population

The U.S. Preventive Services Task Force gives a Grade D recommendation against routine testicular cancer screening, meaning clinicians should actively discourage this practice in asymptomatic adult males. 2 This applies to:

• Testicular self-examination (TSE) by patients 1, 2
• Clinical examination by physicians as a screening tool 1, 2
• All asymptomatic adolescent and adult males regardless of age 1

Rationale Against Screening

The evidence supporting this recommendation is compelling:

• Excellent survival regardless of detection method: Over 90% of all newly diagnosed testicular cancer cases are cured, even when detected at symptomatic stages, with 5-year survival rates of 99% for stage I, 92% for stage II, and 85% for stage III disease. 2, 3

• Extremely low incidence: Annual incidence is only 5.4 cases per 100,000 males, making the absolute risk minimal despite being the most common cancer in men aged 15-34 years. 2, 3

• No evidence of improved outcomes: There is inadequate evidence that systematic TSE detects cancer at earlier or more curable stages compared to incidental discovery by patients or partners. 2, 4

• Unknown test characteristics: The sensitivity and specificity of TSE are unknown, with no data demonstrating that TSE improves detection accuracy. 2

• Harms outweigh benefits: False-positive results lead to unnecessary anxiety, additional testing, and diagnostic procedures with their own risks. 2

High-Risk Individuals: Important Exceptions

Men with testicular microlithiasis (TM) AND associated risk factors should perform TSE, as this may result in early detection of testicular germ cell tumors. 2 The European Association of Urology specifically recommends TSE for men with TM plus any of the following:

• Infertility 2
• History of cryptorchidism (undescended testis) 2
• Personal history of testicular cancer 2
• Atrophic testes 2

Men with isolated TM without additional risk factors should NOT undergo extensive screening, including TSE, ultrasound follow-up, or tumor marker monitoring. 2

Other Risk Factors (No Screening Recommended)

While the following increase testicular cancer risk, they do NOT warrant routine screening in asymptomatic men:

• Family history of testicular cancer 5, 3
• Gonadal dysgenesis 3
• Klinefelter syndrome 3
• Cannabis use 3
• White race 4
• Tobacco use 4

Consensus Among Major Organizations

All major medical organizations align with the recommendation against routine screening:

• American Academy of Family Physicians: Recommends against routine screening 1, 2
• American Cancer Society: Does not recommend TSE 1, 2
• American Academy of Pediatrics: Does not include TSE in preventive health recommendations 1, 2

Critical Clinical Caveat

Any man who notices testicular symptoms must immediately seek medical evaluation. 2 The recommendation against screening applies ONLY to asymptomatic men. Symptoms requiring urgent evaluation include:

• Painless testicular mass 4, 5, 3
• Scrotal heaviness 4
• Dull ache in the testicle or scrotum 4
• Acute testicular pain 4
• Changes in testicular size or consistency 2

Diagnostic Workup for Symptomatic Patients

When testicular cancer is suspected based on symptoms:

• Scrotal ultrasonography is the preferred initial imaging study 4, 5
• If ultrasound shows a solid intratesticular mass, immediate referral to a urologist is indicated 4, 5
• Laboratory assessment should include GCT-associated serum tumor markers: α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase 5, 3
• Radical inguinal orchiectomy is both diagnostic and therapeutic 5, 3

Follow-Up for Testicular Cancer Survivors

Testicular cancer survivors should follow standard age-appropriate cancer screening guidelines with NO additional cancer screening protocols required. 6 The American Urological Association explicitly states that additional cancer screening beyond what is recommended for the general population is not recommended, regardless of treatment received (radiation, chemotherapy, or both). 6

Critical Survivorship Monitoring

While cancer screening remains standard, survivors require specific monitoring:

• Cardiovascular disease surveillance: Patients treated with radiation and/or chemotherapy face elevated cardiovascular risk and need regular monitoring of diet, exercise, smoking status, lipid levels, blood pressure, and glucose control. 6

• Hypogonadism monitoring: All testicular cancer survivors should be monitored for signs and symptoms of hypogonadism. 6

• Secondary malignancy counseling: Survivors should be counseled about elevated risk of secondary malignancies and maintain appropriate health care with their primary care physician. 6

Common Pitfalls to Avoid

• Do not teach or encourage routine TSE in asymptomatic men without specific high-risk features (TM plus additional risk factors), as this contradicts evidence-based guidelines. 1, 2

• Do not confuse the recommendation against screening with discouraging symptomatic evaluation—any testicular symptoms warrant immediate medical assessment. 2

• Do not order additional cancer screening for testicular cancer survivors beyond age-appropriate guidelines for the general population. 6

• Do not neglect cardiovascular risk management in testicular cancer survivors treated with chemotherapy or radiation, as this is a major source of morbidity and mortality in this population. 6