1. ‘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

2. 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

3. TESTICULAR CANCER: A PROBLEM? ?

4. Yes Why?

5. TESTICULAR CANCER: A PROBLEM? Facts Number one cancer among certain groups of men Primarily affects younger males….

6. 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

7. Source: http://www.cancer.org/acs/groups/content/@nho/documents/document/testicularcancerpdf.pdf TESTICULAR CANCER: A PROBLEM?

8. PREVENTION Wellness PrimordialPrimarySecondaryTertiary

9. PREVENTION Wellness Smoking prevention Smoking cessation TSE Orchiectomy

10. 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

11. 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

12. 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

13. 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

14. 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….

15. How about costs?

16. OUR RECOMMENDATIONS

17. REASSESS THE EVIDENCE…

18.  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

19. PROMOTE ‘ OFF LABEL ’ USE

20.  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

21. WHERE DO WE GO FROM HERE ?

22.  Advocate for lifespan wellness  TSE is a tool that can assist in lifelong healthiness  Clinical counseling of TSE  Reassess USPSTF PSA recommendations

23. CONTACT Men’s Health Initiative www.MHInitiative.org @MHInitiative Michael J. Rovito michael.rovito@ucf.edu @RovitoMJ James E. Leone James.Leone@bridgew.edu @DrJimsHealth