Contrary to traditional medical teaching, painful testicular enlargement is a strong predictor of testicular cancer in men above 50 years of age, according to a study published in the British Journal of General Practice.
There is a dearth of studies on the clinical features and presentation of testicular cancer in general practice, which is why the current recommendations of The National Institute for Health and Care Excellence (NICE) for the management of possible testicular cancer in primary care are based solely on clinical consensus.
This new matched case-controlled study used primary care electronic patient records from the Clinical Practice Research Datalink to compare symptoms in 1398 men with testicular cancer and 4956 control patients in the year before diagnosis.
Analysis of the data showed that the positive predictive values for testicular lump and swelling were both greater than 2%. Risk assessment found that certain combinations of symptoms - some of which are not included in the guidelines - have risks greater than 3%, which reach the NICE threshold for urgent referral. Several symptom combinations have risks of 1%-3%, for which an ultrasound is appropriate.
Other non-lump combinations also had risk estimates above the NICE 3% threshold for urgent referral, including testicular pain with raised inflammatory markers or with groin pain (both 3.7%).
These results largely support NICE recommendations, but they also provide additional information as to which symptoms or symptom combinations warrant ultrasound, the authors said.
