Not every mass or lump in the testicle is testicular cancer. Many other lesions or processes in the testicle can be present that are not cancerous. For example, bruises or healing after some type of trauma can be associated with a hard area that is not cancer of the testicle. Only careful ultrasound physical exam and sometimes biopsy can differentiate whether something worrisome is happening or if it's just a benign or non-cancerous process. I would encourage a man to let their doctor know about any persistent lump or swelling or hard area in the testicle that doesn't go away with time. Of course, any pain in the testicle or surrounding structures would be another reason to let your doctor know so that they can evaluate. Almost always, ultrasound is considered an extension of the physical exam. We get an incredible amount of detailed information from a simple ultrasound of the scrotum, which, combined with the physical exam, usually gives us a good indication of whether something worrisome is going on.
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