Primum Non Nocere: Active Surveillance For Clinical Stage I Testicular Cancer

An 18-year-old man developed acute right testicular pain. He saw his primary care physician who noted an enlarged tender firm right testicle. An ultrasound demonstrated a 6-cm solid mass in the right testicle. He was referred to urology for further evaluation. Laboratory studies showed serum alpha-fetoprotein (AFP) 1.4 ng/mL (normal < 6.1 ng/mL) and human chorionic gonadotropin (HCG) 10 mIU/mL (normal < 5 mIU/mL). A computed tomography (CT) scan of the abdomen and pelvis demonstrated no evidence of retroperitoneal lymphadenopathy, and chest x-ray showed no pulmonary nodules. The patient underwent a right inguinal orchiectomy for a 6-cm seminoma, classic type, confined to the testicle. The tumor involved the rete testis but not the epididymis or tunica vaginalis. Lymphovascular invasion was noted. After orchiectomy, his serum HCG was less than 5 mIU/mL. He is referred to medical oncology to discuss ongoing management.