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Elevated AFP Levels after Orchiectomy

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  • Elevated AFP Levels after Orchiectomy

    Hey everyone. I'm new to posting to the forum, but have been checking out posts since I first found the lump back at the end of June 2017.

    A little background history on me. 29, newly married, 2 boys (2 1/2 & 4 months) So, I accidentally found the lump on my left testicle in June. After seeing my physician and getting an ultrasound, they thought it was nothing, just maybe a blood clot because that testicle already had a varicocele according to the ultrasound. I was referred to a urologist which checked it out and said that it was definitely not a clot. Had it removed about 2 weeks later once it was known that my AFP levels were about 100. Another 2 weeks after the orchiectomy, I was told that I had a Stage 1A, mixed germ cell, non-seminoma (48% yolk sac / 48% embryonal carcinoma, and 2% benign teratoma) tumor. They did not see any cancer cells in the spermatic cord. CT Scans and blood work were done to find that it was recommended that I was put under surveillance. August 11 was my appointment to give the treatment options, and thats when we both agreed that surveillance was the best option at the moment. Then my AFP levels were about 10 which I was told was more than most, but thats not an issue. Septemeber 26 was my first surveillance appointment, and everything seemed good. Got my blood test results back yesterday to find that my AFP levels were elevated to 20.7. Now, I have a scheduled CT Scan.

    ​My question is, should I be concerned that they rose that quickly as long as they don't go over 25? My wife and I want more children which sucks because I'm afraid it might be recommended to sperm bank and start chemo treatment.
    Last edited by philuck; 09-29-17, 02:38 PM.

  • #2
    hi philuck,

    i am sorry to welcome you here but hey, you are still in a pretty good position.

    If you did not have too much alcohol before the AFP test (2-3 days in advance) or you don't have liver problems , it is likely (but not sure) that you will need either RPLN or chemo. BUT we have seen cases on this forum where the AFP went back from this level... .. i would re- test AFP in 1-2 weeks. Maybe you are one of the guys who have a relatively high AFP level by default.

    Re chemo: in case you have cancer you might receive less than 3 rounds... but even if you get 3 your fertility might easily return appr 1 yr after the chemo. Of course bank anyway..

    Lets hope its just a false alarm.

    Comment


    • #3
      First and foremost, thanks for the response. Any little bit helps.

      The doc thought that my AFP levels were higher than most because they stopped at 10. The problem is, we don't have a baseline to really go off of, or exactly how high my levels were immediately prior to orchiectomy. After my CT Scan and getting the results, I was figuring another blood test was going to be done to see if they leveled off again. I haven't had a drink in weeks because I saw that it could give false positives. I was figuring that chemo would be the next option if something is found or the levels do not decrease. Plus, I have some nodules on my lungs that need to be monitored it seems. I was told that if I was to do chemo, then I would do one full round and I would have to bank.

      Comment


      • #4
        Einhorn says don't worry until 25. My AFP was 5 or so before chemo, 12 halfway through chemo, and 19 at 2 and a half weeks after chemo. I was freaking out, but we tested again a month later and it had dropped to 10, lowest it has been since pre chemo. We attributed the rise to the death of cells releasing and their proteins being excreted as a result. Now obviously you haven't had chemo so my story wouldn't be the same, but I've seen others who had rises up to around 20 and go back down. You may need chemo if it goes up again, but it is extremely effective and will cure you.
        3/29/17 Diagnosed 100% Embryonal 4/10/17 Left I/O CT scan shows a few suspicious lymph (biggest 1.9 cm) 5/8/17 - 7/3/17 3xBEP 7/20/17 CT Scan Clear, AFP has uptick to 19 8/16/17 AFP Drops in half to 10, ALL CLEAR! 11/16/17 All Clear! AFP continues to drop! 3/19/18 All clear!

        Comment


        • #5
          I have to make a correction that my AFP levels rose to 21.7, not 20.7, sorry. I've seen a chunk of guys on this site that said that their levels slowly rose over the span of months and they had seminoma tumors. Being that mine was non-seminoma and my levels rose more quickly than I've seen, thats why I had to ask. My doc said the same thing about it rising to 25. Wanted to see if anyone was in the same boat as I, and what was recommended to them.

          Comment


          • #6
            The waiting game- it is TOUGH!!!
            My son's tumor markers rose after Orchietcomy a few weeks later, ?However, it was both his AFP and HCG. But his AFP was still over 25 before rising, his markers never normalized as expected post orchietcomy, and than started rising 4/5 weeks post r/o.
            Son Grant
            dx 12/21/16 at age 17

            BEP x3
            Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
            2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
            Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.
            Grant is enjoying his senior year in High School Cancer Free!

            Comment


            • #7
              The waiting game is tough. Definitely right there Trekga. Mine did lower under the mark and still are under to the best of our knowledge since Tuesday. Just hope it ends up being nothing. Will keep everyone posted once I have the CT Scan and get the results this upcoming Thursday.

              Comment


              • #8
                Finally got my CT Scan results back and they said it looks good. Just waiting on the doc to call me and hopefully see about another blood test. It’s been 2 weeks since my last one so, we’íre hoping that they lowered from the 21.7.

                Comment


                • #9
                  The day after getting my CT Scan results, I requested another blood test because my oncologist wasnít worried and said that he would me at the end of November for my next surveillance appointment. I asked to do it for peace of mind. A week later I had it done and the results went from 21.7 to 46.5. So in an eight week period, my levels went from 10.7 to 46.5. Next week, I have to sperm bank, one more blood test in two weeks, then start to plan 4 cycles of chemo.

                  Currently, Iím looking into a second opinion as well. Are there any thoughts as to why the CT Scan came up clean, but my levels are showing otherwise?

                  Comment


                  • #10
                    Is that four cycles of EP or BEP?
                    3/29/17 Diagnosed 100% Embryonal 4/10/17 Left I/O CT scan shows a few suspicious lymph (biggest 1.9 cm) 5/8/17 - 7/3/17 3xBEP 7/20/17 CT Scan Clear, AFP has uptick to 19 8/16/17 AFP Drops in half to 10, ALL CLEAR! 11/16/17 All Clear! AFP continues to drop! 3/19/18 All clear!

                    Comment


                    • #11
                      I would only do 4 cycles of EP, not BEP. Glad you were proactive, if you had waited until November your markers would probably have jumped up more. The wait and see approach is common after Orchiectomy in regard to markers unless they extremely high to start. You might even want another CT scan if your next blood work shows further increase. My son had normal initial CT Scan.
                      The waiting is tough.
                      Son Grant
                      dx 12/21/16 at age 17

                      BEP x3
                      Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
                      2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
                      Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.
                      Grant is enjoying his senior year in High School Cancer Free!

                      Comment


                      • #12
                        The dr suggested EP I believe. He did mention BEP, but said about the lung function side effects. I going to try and schedule an appointment this week for another opinion at Fox Chase in Philly because asking for another blood test and lack of concern hasnít been sitting well with me. After my next blood test, I will see what my dr says about additional scans especially because I will have my other opinion hopefully by that point.

                        Comment


                        • #13
                          Second opinion is always good. But everyone will recommend chemo. The CT scans will eventually show something with markers that high over normal and rising. But more successful to nab it now. Cancer can secrete tumor markers before it is large enough to be visible in CT's.
                          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!
                          3/29/2018 all clears up to this date!

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                          • #14
                            My son sees Dr. Geynisman at Fox Chase. Highly recommend

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                            • #15
                              MamaAng, thatís going to be the doc that I will be seeing on Friday.
                              Biwi, I know that everyone will recommend chemo, itís just how itíll be administered is my concern. Where Iím from, they do it differently than at Philly or NY.

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