‘OFF-LABEL’ USE OF
TESTICULAR-SELF EXAMINATION (TSE)
Michael J. Rovito, Ph.D., CHES, FMHI
James E. Leone, Ph.D., MPH, MS, LAT, ATC, CSCS, *D, CHES, FMHI
Chase T. Cavayero, OSMII
GOALS FOR THIS DISCUSSION
1. Discuss testicular cancer (TCa) and groups
particularly at risk
2. Discuss ways to prevent late-stage TCa diagnosis
3. Discuss the controversy surrounding TCa prevention,
specifically, testicular self-examination (TSE)
4. Offer evidence and commentary contrary to USPSTF
recommendations
TESTICULAR CANCER: A PROBLEM?
?
TESTICULAR CANCER: A PROBLEM?
Yes
Why?
TESTICULAR CANCER: A PROBLEM?
Facts
 Number one cancer among certain groups of men
 Primarily affects younger males….
TESTICULAR CANCER: A PROBLEM?
Facts
 Many diagnoses post-diaspora from the testicles
 “Hurricane” cancer  Fast growth
 Many diagnoses post-diaspora from the testicles
……Implications for lifelong disability and/or early death
……Quality of life issues?
Source: http://www.cancernetwork.com/cancer-management/testicular
TESTICULAR CANCER: A PROBLEM?
Source: http://www.cancer.org/acs/groups/content/@nho/documents/document/testicularcancerpdf.pdf
PREVENTION
Tertiary
Primordial
Wellness
Secondary
Primary
PREVENTION
Orchiectomy
Smoking
prevention
Wellness
TSE
Smoking
cessation
OVERVIEW AGAINST TSE
•
The debate over TSE demarcates along the harm/benefit
meridian
•
USPSTF gives TSE a 'D' rating…b/c…
1. TCa's rarity
2. Lack of evidence demonstrating accuracy with
clinical/self-examination
3. Treatment has highly favorable outcomes
4. Mortality not significantly lowered from TSE performance
•
Lin & Sharangpani's (2010) evidence review confirmed the 2004
‘D rating’
•
False positive anxiety  causes stress and unnecessary worry
IN RESPONSE
1. TCa’s relative rarity
 RESPONSE
 TC among the top killers among young adult males
2. Lack of evidence demonstrating accuracy with
exams (clinical and self)
 RESPONSE
 Ambiguous assessment of execution efficacy
 Lack of robust evidence to make such a conclusion
IN RESPONSE
3. Treatment has highly favorable outcomes
 RESPONSE
 Favorable if outcomes are solely defined as survivorship
 QoL and costs must be factored into this equation
4. Mortality not significantly lowered from TSE
performance
 RESPONSE
 Lack of robust evidence to make this conclusion
IN RESPONSE
Lin and Sharangpani (2010)
 Did not find studies screening asymptomatic men
 Symptomatic men appeared to vary in the 3 studies
 Small sample size and lack of ‘screening benefit’ outcome
The ‘D rating’ was upheld with virtually absent evidence
IN RESPONSE
False Positive Anxiety
 Would you rather be safe than sorry?
 What’s the tradeoff?
 Some anxiety for your life?
 Begs the question, what’s your life worth?
 ALARMIST? Maybe…..
 EFFECTIVE? Hopefully….
How about
costs?
OUR RECOMMENDATIONS
REASSESS THE EVIDENCE…
 Reassess the criteria/evidence for TSE rating

Need to offer TSE recommendations with other
factors besides TCa cancer prevention in
asymptomatic men


Limited in scope
Evidence just isn’t there to make such a conclusion
for a D rating
PROMOTE ‘OFF LABEL’ USE
 TSE is beneficial for ‘off-label’ use

Identify other urogenital issues that TSE can be useful
for detecting

Conduit for increasing informed decision-making
(IDM) skills

Can increase comfort in speaking about sensitive
health topics

Can increase knowledge on said issues

Can lead to healthier discussions, and thus, healthier
outcomes
WHERE DO WE GO FROM HERE?
 Advocate for lifespan wellness
 TSE is a tool that can assist in lifelong healthiness
 Clinical counseling of TSE
 Reassess USPSTF PSA recommendations
CONTACT
Men’s Health Initiative
www.MHInitiative.org
@MHInitiative
Michael J. Rovito
[email protected]
@RovitoMJ
James E. Leone
[email protected]
@DrJimsHealth