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Serum Tumor Markers with ambiguous ultrasound?

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  • Serum Tumor Markers with ambiguous ultrasound?

    Hello, a colleague of mine reports that he has had an ambiguous ultrasound for TC, and despite treating him with a series of different antibiotics, he continues to have some pain "down there". While the most likely explanation is that it is NOT testicular cancer, he has asked his doc to do the tumor marker series (bHCG, AFP, LDH) to see if those help shift the balance on thinking about whether it is testicular cancer, an infection, or some other process. The doc has refused, saying that "we don't need to go there yet", but I don't see the downside to giving them a check - they are routine, inexpensive tests, and the bHCG and AFP are pretty specific.

    Does anyone know why the docs won't just run the serum tumor marker tests? What's to lose?

    Thanks!
    Painless lump 5/18/2017
    Orchidectomy June 2017 (4.5cm, rete testis involvement)
    Chemo Summer 2017 (2x7AUC carboplatin)
    No evidence of relapse since, but plenty of anxiety about it.

    I'm also an epidemiologist, and a professor at a medical school (with NO training in oncology), oh, and gay, too.

  • #2
    Hi Bill. My guess is that most GP doctors never encounter TC in their whole career so they are mostly unaware of the importance of catching and treating it early. Heck even urologists may only see it once a year or less. My urologist wanted to wait 3 weeks to do my I/O after i had my US and blood tests.

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    • #3
      Could be an insurance thing. Markers are not really a primary diagnostic tool, more of a confirmation of other clinical evidence, which seems to not be present here. TC is almost always painless, are there any lumps felt? Exactly what is meant by "ambiguous U/S"? Was something unusual found but could not be identified as TC?
      Jan, 1975: Right I/O, followed by RPLND
      Dec, 2009: Left I/O, followed by 3xBEP

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      • #4
        I got pain in testis, went to primary care doc, she checked inguinal nodes (?), didn't find anything, but nevertheless sent me to private urological 'expert'. He perfomed physical screening and concluded that it's prostate inflammation. I asked him to do testicular US, but he said that there is no point for that (and he is a private practicioner, cash only). I asked him again, and than he said something like 'ok, its your money'. Off course, it was TC, he then ordered markers immediately. On next examination 6 months later he didn't remember me, but said something like 'I'm the doc that saved your life'. So, basically, i think it's just arogancy. Don't argue with them, just go to another doc.
        45yo, left I/O 07/30/2018, T1 pure seminoma, surveillance...
        Waiting...

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        • #5
          Thanks DB, Dave & Harxxony!
          I suspect you're right, it's just unfamiliarity with the subject. I've encouraged my colleague to go to my urologist, who was on top of things and very helpful for me. I'm sure she will be for him as well.

          Thanks again!
          Painless lump 5/18/2017
          Orchidectomy June 2017 (4.5cm, rete testis involvement)
          Chemo Summer 2017 (2x7AUC carboplatin)
          No evidence of relapse since, but plenty of anxiety about it.

          I'm also an epidemiologist, and a professor at a medical school (with NO training in oncology), oh, and gay, too.

          Comment


          • #6
            I would certainly look at getting a second opinion. Even having a different radiologist read or re-do the US may be helpful. Running the blood tests seems reasonable to me and they are cheap, and while they would not rule out TC they could rule it in I suppose.

            Mike
            Oct. 2005 felt lump but waited over 7 months.
            06.15.06 "You have Cancer"
            06.26.06 Left I/O
            06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
            06.30.06 It's Official - Stage I Seminoma
            Surveillance...
            Founded the Testicular Cancer Society
            6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

            For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

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