From the Guidelines
A testicular exam is a crucial procedure that should be performed by healthcare providers to check for abnormalities in the testicles, including prior scars, location, size, consistency, and contours, as it can reveal masses consistent with testicular cancer. According to the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) guideline part I, published in The Journal of Urology in 2021 1, a thorough examination of the scrotum and testes is essential for diagnosing and treating infertility in men. The exam should include checking for prior scars suggesting prior scrotal surgery or trauma, as well as assessing the location, size, consistency, and contours of the testes.
Key components of a testicular exam include:
- Checking for prior scars suggesting prior scrotal surgery or trauma
- Evaluating the location of the testes, as scrotal position is important for normal function
- Assessing the size, consistency, and contours of the testes, as a majority of the testis is devoted to spermatogenesis
- Identifying any masses consistent with testicular cancer, which can be detected through a thorough exam 1.
Healthcare providers should perform testicular exams during routine physical examinations, typically asking the patient to stand while they examine each testicle for abnormalities. Regular exams are important because testicular cancer is most common in men between 15-35 years old and is highly treatable when caught early. By prioritizing testicular exams, healthcare providers can improve morbidity, mortality, and quality of life outcomes for patients.
From the Research
Testicular Exam Overview
- Testicular cancer is the most common solid tumor among males 15 to 34 years of age, with an estimated 8,850 new cases and 410 deaths during 2017 in the United States 2
- The overall five-year survival rate is 97% with effective treatment 2
- Risk factors for testicular cancer include undescended testis (cryptorchidism), personal or family history of testicular cancer, age, ethnicity, and infertility 3, 2, 4
Diagnosis and Staging
- Scrotal ultrasonography is the preferred initial imaging study for testicular cancer diagnosis 2
- If a solid intratesticular mass is discovered, orchiectomy is both diagnostic and therapeutic 2
- Staging through chest radiography, chemistry panel, liver function tests, and tumor markers guides treatment 2
- Testicular tumors are usually diagnosed at ultrasonography (US) and are staged at computed tomography (CT) or magnetic resonance (MR) imaging 3
Treatment Options
- Active surveillance, chemotherapy, retroperitoneal lymph node dissection, and radiation therapy are treatment options following orchiectomy 3, 2
- Radical inguinal orchiectomy is the primary treatment for most patients with testicular germ cell tumors (GCTs) 4
- Postorchiectomy management is dictated by stage, histology, and risk classification 4
- For patients desiring future fertility, sperm banking should be discussed early in the course of treatment 2