Announcement

Announcement Module
Collapse
No announcement yet.

Pur seminoma - surveillance or adjuvant chemo/radiotherapy?

Page Title Module
Move Remove Collapse
X
Conversation Detail Module
Collapse
  • Filter
  • Time
  • Show
Clear All
new posts

  • Pur seminoma - surveillance or adjuvant chemo/radiotherapy?

    I have been reading threads on this forum for some time and now got histological results. I found a lump on my left testicule in the beginning of May, had a radical inguinal orchiectomy on 12th June.

    (translated form French, so I hope it is clear)

    Germinal tumour, pure seminome, intratesticular. Tumour in the lower pole.

    pTNM: pT1NxMxR0
    Size: 2.5 cm (grand axis), homogenous, beige colour, intrapulpular
    Tumour limited to the testicle
    Vascular invasion: none
    Cordonal invasion: none
    Perineural invasion: none
    Tumoral necrosis: none
    Associated lesions: none

    positive PLAP, C-Kit and AE1-AE3
    negative BetaHCG and AFP

    I am having a meeting with an oncologist next week, my urologist thinks surveillance is likely to be suggested. What is the chance of relapse in this case? On a positive note, he said the result is the best possible (compared to other possible ones). Would some adjuvant make sense?

    Has anyone had a similar case?






  • #2
    You need CT scans to complete the staging. But if they are negative for metastasis then surveillance is the route to go for seminoma with no LVI, normal tumor markers, and clear CT scans.
    6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
    6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
    7/7/15: bHCG 56, AFP 42, LDH 322
    7/13/15 - 9/18/15: 4xEP
    10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
    10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
    4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
    4/20/16: RPLND @ IU - teratoma only!
    9/18/2017 all clears up to this date!

    Comment


    • #3
      I had the almost same pathology report and same size. It was also 100% seminoma. I was also debating between surveillance and adjuvant chemo, and finally chose surveillance. That was already 5 years ago. I finished the last fifth year CT scan a few months ago and still found clean. If I were you, I would choose surveillance.

      Comment


      • #4
        I'm pretty much in the same boat. My oncologist has me on surveillance as well. I was stages at 1A in which he said there would be a 20% chance of relapse. He said if I was staged at 1B he would have suggested radiation or a small dose of chemo. He said risk of relapse for 1B was 50% which is why they opt to hit it early just in case. I hope this helps.
        April 2017 - Scheduled physical with DR for testicular pain / ultrasound scheduled
        May 2017 - US shows 3 solid masses 1.2 x 0.7 x 0.7 cm/0.8 x 0.5 x 0.8 cm/ 0.4 x 0.3 x 0.4 cm
        June 2017 - Left orchiectomy & diagnosed with Seminoma
        As of October 2017 - All clear!

        Comment


        • #5
          Thanks for your inputs! I had my first follow up on surveillance now in October after the orchidectomy in June.

          The good news is that CT is all clear, the markers (LDH, HCG) are also ok, except AFP which was 7.0 before orchidectomy (June) and went to 7.8. on 10/10/2017 and again down to 7.3 on 10/19/2017 (today). My oncologist is a bit worried and wants to repear the blood test and do a PET scan to be sure. She said she d prefer it to be around 5. I understand PET scan is even more detailed than a CT scan (which was negative), but should I do chemo based just on a PET scan (in case there should be anything on PET scan)?

          I had a pure seminoma and orchidectomy should not have influenced the AFP levels anyway. I read some topics here that fluctuating AFP levels are no reason for concern until they reach 25, does a PET scan actually make sense then?

          Comment


          • #6
            AFP is not secreted by seminoma. And my lab's normal level was 0 - 9 ng/ml. I would keep watching the bloodwork but some people just have normal AFP in the higher normal range. I think I would continue with regular surveillance, perhaps monitoring bloodwork more closely. I wouldn't think a PET is necessary at this point and most certainly not chemo.
            6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
            6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
            7/7/15: bHCG 56, AFP 42, LDH 322
            7/13/15 - 9/18/15: 4xEP
            10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
            10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
            4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
            4/20/16: RPLND @ IU - teratoma only!
            9/18/2017 all clears up to this date!

            Comment


            • #7
              (I had posted this already in an other post, I think it might be useful for you too) Quoting from the EAU Guidelines on TC (2011 update) :

              "There is no evidence for using a fluorodeoxyglucose-positron emission tomography (FDG-PET) scan in staging.However, FDG-PET is recommended in patients with seminoma who have any residual mass at least 6wk after chemotherapy, to help decide between watchful waiting and active treatment.FDG-PET is not recommended in the restaging of patients with NSGCTs after chemotherapy."

              Comment

              Working...
              X