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Pur seminoma - surveillance or adjuvant chemo/radiotherapy?

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  • 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!

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    • #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.

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      • #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 inguinal exploration and left radical orchiectomy. Pathology - Seminoma, classic type and intratubular germ no neoplasia - seminomatous. CT scan shows 2 long nodules (most likely granulomas) and Borderline prominent but non specific mesenteric nodes within the right lower quadrant.
        July 2017 - 2nd CT scan all clear! Lung nodules stable. Active surveillance 5 years.

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