What's the next step for a 23-year-old male with a left testicular mass suspicious for cancer on ultrasound?

From the Guidelines

The next step for a 23-year-old male with a suspicious left testicular mass on ultrasound should be prompt referral to a urologist for further evaluation and management, with the most recent guidelines from 1 supporting radical inguinal orchiectomy as the primary initial treatment for most patients with a suspicious testicular mass. The urologist will likely order serum tumor markers including alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH), which help in diagnosis and staging, as recommended by 1 and 1. A chest, abdomen, and pelvis CT scan would also be recommended to evaluate for potential metastatic disease. The definitive treatment typically involves a radical inguinal orchiectomy (surgical removal of the affected testicle through an inguinal incision), which serves both diagnostic and therapeutic purposes, as stated in 1 and 1. This surgery should be performed as soon as possible, usually within days of diagnosis. Sperm banking should be offered before any treatment begins, as both the cancer and treatments can affect fertility, as noted in 1 and 1. Testicular cancer is highly treatable with excellent survival rates, especially when caught early, with the urgency for evaluation stemming from testicular cancer's typically rapid growth rate and potential for metastasis, though it remains one of the most curable solid tumors even when advanced. Key considerations in management include:

• Prompt referral to a urologist for further evaluation and management
• Serum tumor markers for diagnosis and staging
• Chest, abdomen, and pelvis CT scan for metastatic disease evaluation
• Radical inguinal orchiectomy as the primary treatment
• Sperm banking before treatment begins
• Testicular cancer's high treatability and excellent survival rates with early detection.

From the FDA Drug Label

INDICATIONS Cisplatin Injection is indicated as therapy to be employed as follows: Metastatic Testicular Tumors In established combination therapy with other approved chemotherapeutic agents in patients with metastatic testicular tumors who have already received appropriate surgical and/or radiotherapeutic procedures The next appropriate step for a 23-year-old male with a left testicular mass suspicious for cancer on ultrasound is not directly addressed in the provided drug label. Key points:

• The drug label discusses treatment options for metastatic testicular tumors, but does not provide guidance on the initial diagnosis or staging.
• It mentions that cisplatin is used in combination therapy with other approved chemotherapeutic agents in patients who have already received appropriate surgical and/or radiotherapeutic procedures. The FDA drug label does not answer the question.

From the Research

Next Steps for a 23-Year-Old Male with a Left Testicular Mass

The next appropriate step for a 23-year-old male with a left testicular mass suspicious for cancer on ultrasound involves several considerations based on current medical evidence.

• Radical Orchiectomy: This is typically the first step in managing testicular cancer, as it allows for the removal of the tumor and provides tissue for histopathological examination to determine the type and stage of cancer 2, 3.
• Staging: After orchiectomy, staging tests such as computed tomography (CT) scans are performed to determine if the cancer has spread to other parts of the body 2, 4.
• Treatment Options: Depending on the stage and type of testicular cancer, treatment options may include active surveillance, radiotherapy, or chemotherapy for stage I testicular cancer 2, 4, 5.
• Importance of Approach: The approach to surgery, whether through a high inguinal orchiectomy or other methods, is crucial to prevent tumor spillage and ensure complete removal of the tumor 3, 6.
• Consideration of Testis-Sparing Surgery: While radical orchiectomy is standard, testis-sparing surgery may be considered in certain cases, though it carries a risk of local recurrence 6.
• Follow-Up: Regular follow-up is essential, especially for patients on active surveillance, to monitor for recurrence or metastasis 5.

Key Considerations

• The choice between different treatment modalities depends on the specific characteristics of the tumor, patient preferences, and the stage of the disease.
• Each treatment option has its benefits and risks, which should be discussed thoroughly with a healthcare provider.
• The role of surveillance versus immediate treatment after orchiectomy is an area of ongoing research and depends on various factors including tumor size and patient risk factors 5.