Recommendations for Treating Males: An Ethical Rationale for the Inclusion of Testicular Self-Examination (TSE) in a Standard of Care

Abstract

The phrase "standard of care" is primarily a legal term representing what procedure a reasonable person (i.e., health practitioner) would administer to patients across similar circumstances. One major concern for health practitioners is delivering and advocating for treatments not defined as a standard of care. While providing such treatments may meet certain ethical imperatives, doing so may unwittingly trigger medical malpractice litigation fears from practitioners. Apprehension to deviate, even slightly, from the standard of care may (seem to) put the practitioner at significant risk for litigation, which, in turn, may limit options for treatment and preventive measures recommended by the practitioner. Specific to testicular treatment, certain guidelines exist for cancer, torsion, vasectomy, and scrotal masses, among others. As it relates to screening, practitioner examination is expected for patients presenting with testicular abnormalities. Testicular self-examination (TSE) advocacy, however, is discouraged by the U.S. Preventive Services Task Force, which may prompt a general unwillingness among health practitioners to promote the behavior. Considering the benefits TSE has beyond cancer detection, and the historical support it has received among health practitioners, it is paramount to consider the ethical implications of its official "exclusion" from preventive health and clinical care recommendations (i.e., standard of care). Since good ethics should lead practitioner patient care guidelines, not fear of increased malpractice risks, we recommend the development of a standard of care for counseling males to perform TSE.

Assessing Health-Related Quality of Life Among Survivors of Testicular Cancer: A Systematic Review

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Eclipsed by the Prostate: Expanding Testicular Cancer Scholarship Through Years of Potential Life Lost and Economic Productivity

“…Although mortality from the disease is decreasing, overall incidence has increased rapidly over the past few decades ( Kennett, Shaw, & Woolley, 2014 ). Attention offered to this disease, still, pales in comparison with not just PCa-related scholarship but also other outcomes dominant in this specific age category, including human papillomavirus (HPV)-related cancers (including anal, penile, oropharyngeal, and rectal together), despite those cancers, in the aggregate, affecting ~15,800/year ( Viens et al, 2016 ) versus ~8,800 for just TCa (see Rovito et al, 2015 , for an expanded discussion).…”

A Cross-Sectional Analysis of Testicular Cancer Symptom Recognition and Stage of Diagnosis

“…Another issue of concern that could affect disease symptom registration among males includes the United States Preventive Services Task Force’s (USPSTF) recommendation against testicular examinations to screen for cancer (see Fadich et al, 2018 ; Rovito et al, 2016 ). Although the USPSTF states that their recommendations are just that (i.e., recommendations), others report that they have much more influence pertaining to if clinicians decide to advocate for TSE in their clinic or not, which affects if males perform the behavior ( Rovito et al, 2018 ).…”