Investigations for Testicular Cancer

Mandatory Initial Investigations

The European Association of Urology recommends scrotal ultrasound with Doppler and serum tumor markers (AFP, β-HCG, LDH) before any intervention, including orchiectomy, for suspected testicular cancer 1, 2
Alpha-fetoprotein (AFP) is essential for all suspected testicular malignancies, as recommended by the European Society for Medical Oncology 1, 3, 4
Beta-human chorionic gonadotropin (β-HCG) is required for diagnosis and staging, according to the European Association of Urology 1, 3, 4
Lactate dehydrogenase (LDH) is an important prognostic factor, particularly in advanced disease, as stated by the European Society for Medical Oncology 2, 3, 4
High-frequency scrotal ultrasound with Doppler (>10 MHz transducer) is the mandatory first-line imaging to confirm intratesticular mass, assess size, detect multifocal disease, and evaluate the contralateral testis, as recommended by the American Urological Association 1, 2, 3, 4

A CT scan of chest, abdomen, and pelvis is required for staging after diagnosis, according to the National Comprehensive Cancer Network 3, 4, 5
Chest X-ray is part of the standard staging workup, as recommended by the European Society for Medical Oncology 3, 5

Complete blood count, renal function (urea, creatinine, electrolytes), and liver function tests are recommended by the European Association of Urology 5

Repeat serum markers 7 days post-surgery to assess half-life kinetics, as recommended by the American Urological Association 7
AFP half-life should be <7 days, and β-HCG half-life should be <3 days, according to the European Society for Medical Oncology 3, 4
Delayed decline or rising levels indicate residual disease and affect staging, as stated by the European Association of Urology 2

Risk factors for testicular cancer include cryptorchidism (RR 3.18), family history of testicular cancer, testicular atrophy (<12-16 ml volume), hypospadias, inguinal hernia, and infertility, as reported by the European Society for Medical Oncology 2, 3
Presentation of testicular cancer can include painless testicular mass, scrotal pain, back/flank pain, and gynecomastia, according to the American Urological Association 8

Never delay obtaining tumor markers before orchiectomy, as baseline values are essential for staging and monitoring, as recommended by the European Association of Urology 1, 2
Never use scrotal approach for suspected malignancy, as inguinal orchiectomy is mandatory, according to the European Association of Urology 2
Do not rely on normal tumor markers to exclude cancer, as markers have low sensitivity and normal levels do not exclude disease, as stated by the European Society for Medical Oncology 2