A 20-year-old man presents with a hard testicular mass. What is the initial diagnostic evaluation?

• A. Serum Alpha Fetoprotein Levels
• B. Serum Human Chorionic Gonadotropin Hormone
• C. CT Scan of the Pelvis
• D. Ultrasound of the Testicles

Answer: (D)

Begin with scrotal ultrasound because it quickly confirms that a mass is arising from the testicle, characterizes whether it is solid or cystic, and uses Doppler to assess blood flow. This information is crucial in a young man presenting with a hard testicular mass, since intratesticular solid lesions are highly suspicious for malignancy and ultrasound is the most sensitive, noninvasive way to evaluate it and guide next steps.

Serum tumor markers like alpha-fetoprotein and hCG are helpful after a mass is identified to help subtype and stage germ cell tumors, but they do not localize or characterize the mass itself. CT imaging of the pelvis or body is used for staging once cancer is confirmed, not as the initial test.