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RPLND as Primary Treatment for my 2A EC?

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  • SchoolOnHold
    started a topic RPLND as Primary Treatment for my 2A EC?

    RPLND as Primary Treatment for my 2A EC?

    Backstory:

    23 years old. Two tumors in my right testicle. Primary tumor was 2.1cm, secondary .8cm. Tunica Albuginea and vascular invasion. Pathology found 100% Embryonal Carcinoma. Serum on July 21, 2017 read

    AFP 6.0
    HCG 1 cm. 1 was 2.0cm and 1 was 1.8cm. Others existed around 1cm. Chest CT was clear

    Met with the oncologist who took more serum on 8/23. New readings were

    AFP 5.9
    HCG 1.4
    LDH 187

    Oncologist gave a clinical staging of 2A (T1(should this be T2? I know it doesn't change the final staging once in 2) N1 S0) and reccomends RPLND as a primary course of treatment.

    I understand the preference for surgery and lower or possibly no chemo given the long term implications of chemotherapy, but I'm a little concerned about treating EC with lymph surgery given the possibility of jumps and it's aggression.

    ​Does this course sound reasonable to you all?
    Last edited by SchoolOnHold; 08-25-17, 03:09 PM.

  • Joe.shupe22
    replied
    Make it happen yourself. Find a surgeon and get a
    an appointment. If rplnd is what you want to choose then go for it. Screw the oncologist 🤣. I didnt ask mine, I went and made it happen myself.

    Leave a comment:


  • Trekga
    replied
    The waiting part is difficult for a lot of men especially before treatment path is decided.

    Leave a comment:


  • SchoolOnHold
    replied
    I get that, but oncology seemed happy enough with clean serums. I just wish I could have gotten the CT before waiting two weeks to meet with urology. Now it's another week for a CT and then who knows how long before whichever treatment begins

    Leave a comment:


  • Trekga
    replied
    It is good to see what CT Scan shows and blood work shows a few weeks post orchietcomy.

    Leave a comment:


  • SchoolOnHold
    replied
    Ugh, so I met with the urologist today and he has reservations about rplnd as primary treatment given the speed of embryonal. I have another CT scan and blood work before we make a final decision but it really does not feel great to have the two people on my "team" seemingly playing hot potato with my treatment

    Leave a comment:


  • biwi
    replied
    The long term health effects of RPLND are less severe than chemo (assuming you don't have any surgery complications). I Think it would be worth primary RPLND here if you fit the criteria that the experts say. full open bilateral though I'd say though if you want the best chance at avoiding chemo.

    Leave a comment:


  • SchoolOnHold
    replied
    Not yet, what is the half life on serum? My second markers were taken on 8/23 and thought they took a while to change?

    Leave a comment:


  • Trekga
    replied
    Glad you chimed in Joe, hope you are doing well.
    Schoolonhold~ Have you had your markers done again?

    Leave a comment:


  • Joe.shupe22
    replied
    I had a robotic rplnd for stage 2A 100% embryona. Ended up having 2 nodes positive for EC, everything else clear. I relapsed in 4 months and needed 3x bep. If I could do it all oover I would have done an open procedure. I have no side effects from the surgery. My reccomendation would be to do the rplnd first. It can be a very curative procedure and has way less chance of long term complications than chemo does. If you relapse, you get the chemo and are cured. If not, you've avoided chemo which is awesome! Just make sure you get the surgery at a center of excellence.

    3x bep is a much more difficult treatment than RPLND in my opinion.

    Leave a comment:


  • Daniel_Eye
    replied
    Tough call for sure. I was staged at IIA, however, my markers were a lot higher than yours and I ended up at IIB. If I had the choice I think I'd do RPLND because chemo sucks. Obviously, retrograde ejaculation is a big concern so get your sperm tested and bank if you want to have kids in the future.

    Leave a comment:


  • RJKD
    replied
    Einhorn tends to favor RPLND in these cases. I've seen this with many of his patients. If you can achieve an 80% chance of cure (20% relapse rate) with an RPLND, and have chemo on the back-burner, then do it. 3 x BEP should be a last resort until all other options have been exhausted.

    Leave a comment:


  • dcalandrelli
    replied
    I was in the same position and went the chemo route. There's no real wrong choice I feel. I can see both sides of the argument and they both make sense. Personal choice. I wanted to go the chemo route because I had read of some relapses for pure embryonal post surgery and wanted to avoid both. Einhorn told me if I went chemo that the cure rate was almost 100%. That was enough for me to decide on it.
    Last edited by dcalandrelli; 08-25-17, 08:03 PM.

    Leave a comment:


  • SchoolOnHold
    replied
    Yeah I have 2 retro nodes that are enlarged, nothing else on the ct. It's good to know have the consensus, I was trusting of the oncologist and urologic oncologist, but was just freaking out about it

    Leave a comment:


  • RJKD
    replied
    If I'm reading your post correctly, you have 2 enlarged lymph nodes. Is that in the retroperitoneum? If you indeed have clinical stage 2A disease, then RPLND is generally the preferred treatment as long as your tumor markers are normal. A second choice is 3 x BEP.

    This is a no-brainer. You do the RPLND, preferably open and bilateral. Even though you have 100% EC, this is still the recommended choice by most advanced centers.

    Leave a comment:

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