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Recurrance??? Next course after BEP?

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  • Recurrance??? Next course after BEP?

    Hi all, thinking I was in the clear, it's been awhile since I was last active on here. However, it seems like it is back, but i have no treatment plan, and feel like I'm in limbo...i would welcome your thoughts

    to go back in time a bit, i was diagnosed about this time last year, pure seminoma. My hcg did not normalize, and began to rise after the I/O. My second post I/O CT indicated spread to the lymph nodes, and the doctor recommended 3xBEP. I wondered about doing RPLND, but the thought of surgery scared me more than the chemo, and he felt the BEP would do the trick, so I followed the recommendation. I finished the BEP at the beginning of this year. Post BEP CT was good, tumor markers were normal, and the doctor told me it was successful.

    The first quarterly surveillance was done at the end of April and I had a slightly elevated HCG (14). The doctor ordered a CT, which showed no changes. A second blood test about 2 weeks later showed a slight increase in the HCG (to 18) and a third, about 3 weeks after that was at 16. A forth, yesterday, went up to 20. We had figured the HCG would've increased significantly over this time period (about 1.5 months) so when I saw my oncologist today he seemed a bit perplexed. He wasn't ready to order a new CT or a PET yet and he said he wants to discuss my case with others (tumor board st MD Anderson), and said he may need to call Dr. Einhorn as well.

    as many of you have probably experienced, the unknowns and waiting are harder on me than the treatment has been. I feel like I'm in limbo, and don't know what to expect. I've been trying to prepare myself mentally for the RPLND, but not sure how I'll go about that if it is indeed the course of action. I will have to travel to get it done (I'm in New Mexico) and because my doctor is affiliated with MD Anderson, he would send me to Houston. Does anyone have experience with the surgeons at MD Anderson? The Mayo clinic in Phoenix, or University of Colorado (a TC center of excellence) might be easier for me do to because of proximity, and where I have friends, any experience here with them?


  • #2
    With a clear CT, I'd be surprised if a rplnd was recommended. If they have not done so, I would want an U/S on the remaining testicle to rule that out as the source.

    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP


    • #3
      I’m not going to have a huge amount to add. I know the waiting is torture.
      If you have a clear CT RPLND doesn’t seem to make sense, to me at least. It’s an invasive procedure but with knowledge of the procedure the worst part for mine was the first day or two after. And that was mostly because I didn’t know beforehand morphine and I do not get along.

      As far as MD Anderson goes, I can’t speak to surgeons but the facility itself is wonderful. I’m, most likely, going to be spending 4-5 months there for stem cell transplant/ high dose chemo. Everyone there was extremely helpful, they take the time to make sure your comfortable with everything. For what I’ll need they have been fantastic so far.


      • #4
        Thanks for the responses.
        I did ask about doing an ultrasound, but after the exam he wasn't ready to order it, possibly after the 'tumor board' meets to discuss my case.
        My doctor had previously suggested that the RPLND could be in my future with an explanation alone the lines of 'the surgeons would argue that that is where the disease was last observed, so is the most likely place for anything to remain'. That makes sense to me, but isn't a real convincing argument either.