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Testicular Cancer — RACP Adult Medicine MCQ

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ModerateMedical OncologyTesticular CancerRACP Adult Medicine

A 30-year-old man presents with a painless scrotal mass. Ultrasound confirms a solid 3 cm testicular mass. Serum AFP is elevated and beta-hCG is mildly elevated. CT staging shows no distant metastases. What is the most appropriate initial management?

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Correct answer: C — Radical inguinal orchidectomy

A solid testicular mass in a young man should be managed with radical inguinal orchidectomy for diagnosis and local control – NOT transscrotal biopsy (risk of tumour seeding along the scrotal skin). Tumour markers (AFP, beta-hCG, LDH) and histopathology guide subsequent management. Elevated AFP indicates non-seminomatous germ cell tumour components. Staging determines the need for adjuvant chemotherapy, surveillance, or RPLND.

Reference: Cancer Council Australia – 2019 – Testicular Cancer Optimal Care Pathway