When will you consider doing a biopsy of a potential metastatic site (lymph node, lung/visceral) for testicular cancer after orchiectomy?   

I will biopsy a potential metastatic deposit seen on the scan after the orchiectomy if tumor markers are negative, have reduced to normal with appropriate half-lives, or are equivocal. A raised LDH, in isolation, is not enough to support the diagnosis of metastasis, and I will usually biopsy if that...