Diagnosis and management of indeterminate testicular lesions

Modern imaging techniques frequently detect small or uncertain testicular lesions. Traditionally, such cases would lead to radical orchidectomy, but there is increasing awareness that many lesions may be benign, leading to potential overtreatment. Radical orchidectomy can significantly impact fertility, endocrine function, and psychosexual well-being, especially in cases involving abnormal contralateral testis or bilateral lesions. Organ-preserving approaches should be considered for uncertain lesions. Image-based surveillance is effective for indeterminate lesions ≤15 mm, but concerns about undiagnosed germ cell tumors remain. Optimal surveillance methods are still debated, but histological sampling, such as excisional biopsy, shows promise. Most marker-negative indeterminate solitary lesions ≤25 mm are benign.