From the Guidelines
The appropriate workup for a 23-year-old male with a left testicular mass should begin with a thorough history and physical examination, followed by scrotal ultrasound as the initial imaging study of choice, as recommended by the most recent guidelines 1.
Initial Evaluation
The initial evaluation should include:
- Scrotal ultrasound with Doppler to confirm the presence of an intratesticular mass and evaluate the contralateral testis 1
- Serum tumor markers, including alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH), to aid in diagnosis, prognosis, and monitoring treatment response 1
- Complete blood count, comprehensive metabolic panel, and urinalysis to assess overall health and detect any potential abnormalities
Further Management
If testicular cancer is suspected based on ultrasound findings, further management may include:
- CT scans of the abdomen and pelvis with contrast to stage the disease and evaluate for metastatic spread 1
- Chest imaging (X-ray or CT) to assess for pulmonary metastases
- Discussion of fertility preservation through sperm banking before any surgical intervention, as treatment may affect fertility 1
- Radical inguinal orchiectomy (surgical removal of the affected testicle) as the definitive diagnostic and therapeutic procedure, given the high risk of malignancy in young men with testicular masses 1
Key Considerations
- Testicular masses in young men carry a high risk of malignancy, particularly germ cell tumors, and prompt evaluation is essential for early diagnosis and treatment, which significantly improves prognosis 1
- Serum tumor markers have a low sensitivity, especially in seminoma, and normal marker levels do not exclude germ cell tumors (GCTs) 1
- Fertility preservation through sperm banking should be discussed before any therapeutic intervention that may compromise fertility, including surgery, radiation therapy, and chemotherapy 1
From the Research
Appropriate Workup for a 23-year-old Male with a Left Testicular Mass
The appropriate workup for a 23-year-old male with a left testicular mass includes:
- History and physical examination to identify any risk factors or symptoms suggestive of testicular cancer, such as cryptorchidism, family history of testicular cancer, or a painless testicular mass 2
- Scrotal ultrasound to evaluate the testicular mass and determine if it is solid or cystic 2, 3
- Laboratory assessment of germ cell tumor-associated serum tumor markers, including α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase 2, 4
- Prompt referral to a urologist for further evaluation and management, as testicular cancer is a potential diagnosis 2, 3
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of testicular cancer are crucial to optimize outcomes, with 5-year survival rates of 99%, 92%, and 85% for stages I, II, and III, respectively 2 Treatment decisions should consider long-term survivorship concerns, including body image, fertility, hypogonadism, mental health, financial cost, adherence to follow-up, and late adverse effects of therapy 2
Diagnostic Considerations
Other potential causes of a testicular mass, such as hydrocele, varicocele, and spermatocele, should be considered in the differential diagnosis 3 Benign causes of scrotal masses may be diagnosed and managed in the primary care office, while malignant causes require prompt referral to a urologist 3 Imaging studies, such as MRI, may be useful in evaluating testicular masses, particularly in cases where the diagnosis is uncertain 5