Diagnosis and Treatment of Early Stage Testicular Cancer

1. A solid mass in the testis identified by physical exam or imaging should be managed as a malignant neoplasm until proven otherwise. (Clinical Principle, )

2. In a man with a solid mass in the testis suspicious for malignant neoplasm, serum tumor markers (AFP, hCG, and LDH) should be drawn and measured prior to any treatment, including orchiectomy. (Moderate, C)

3. Prior to definitive management, patients should be counseled about the risks of hypogonadism and infertility. (Moderate, C)

4. Scrotal ultrasound with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm. (Strong, B)

5. Testicular microlithiasis in the absence of solid mass and risk factors for developing a GCT does not confer an increased risk of malignant neoplasm and does not require further evaluation. (Moderate, C)

6. Patients with normal serum tumor markers (hCG and AFP) and indeterminate findings on physical exam or testicular ultrasound for testicular neoplasm should undergo repeat imaging in six to eight weeks. (Clinical Principle, )

7. MRI should not be used in the initial evaluation and diagnosis of a testicular lesion suspicious for neoplasm. (Moderate, C)