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Adjuvant Chemo vs. RPLND vs. Surveillance and late relapse(?) - any advice welcome!

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  • Adjuvant Chemo vs. RPLND vs. Surveillance and late relapse(?) - any advice welcome!

    Hi everyone,

    Firstly, thank you for setting up this great forum, and to everyone who is sharing their experiences! This has helped me a lot already. Now I feel I need some advice before deciding on the next step for my treatment. My problem is that opinions here in the UK are slightly biased, so I would welcome any independent advice.

    My I/O was three weeks ago, and the pathology came back 100% yolk sac tumor with vascular invasion. Therefore, I was recommended to do 1xBEP or 2xBEP. I live in the UK, and RPLND is uncommon here, so it has not yet been discussed in detail. However, I am wondering if anyone has thoughts about the decision between adjuvant chemo and RPLND given the chance of late relapse? I know that first-line chemo will cure with 98% probability, but for argument's sake, say there is a late relapse 5 years down the line, and I had chemo before, is there not a good chance that the tumor will then be chemo-resistant? Can this potential problem be avoided with RPLND instead of having chemo now, or would the tumor be likely chemo-resistant anyway...? I am aware that RPLND has risks, but I am willing to take them.

    If anyone has thoughts or even better experience with this concern through discussing with doctors, then, please reply. All help is greatly appreciated.

    Jul 5 2013:
    • Ultrasound Suspicious
    • AFP = 33, bHCG = 66
    • --> Diagnosed with testicular tumor (left)
    • --> Same Day I/O
    Jul 8 2013: CT (Abdomen/Thoras/Pelvis) ALL CLEAR
    Jul 12 2013:
    • AFP 11, bHCG 4
    • Histology: 100% yolk sac tumor (confined to testis only) with vascular invasion
    Jul 19 2013: AFP 5, bHCG <2
    Jul 26 2013: AFP 0, bHCG <2
    Aug 5-26 2013: 1xBEP
    Monthly markers = 0, CXR (Nov 2013) CLEAR