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  • LDH Isoenzymes

    My first time posting here. My husband was diagnosed back in June 2012 with Stage 1b non-seminoma. Pathology was 100% EC w/ a single foci of LVI. Markers were all normal. He opted for 1xBEP since he had a 50% chance of relapse on surveillance. His oncologist recommended 2xBEP but I consulted with Dr. Einhorn who said that only 1 cycle was recommended. All markers and CT scans have been normal and he was discharged from oncology in June 2017. His follow up protocol aligned with NCCN mostly but he did have CT scans in the 3rd and 4th year that NCCN doesn't call for. His oncologist recommended that he have his PCP check tumor markers once a year and he had them done with his physical a few weeks ago. All levels came back normal except our PCP ordered LDH isoenzymes in addition to total LDH and those came back completely out of range. I think the test was ordered accidently but the results are still making me nervous. He was elevated on LD5. He spoke to his oncologist today who told him that LDH is very non specific but he wouldn't completely ignore the results and suggested retesting in 3-4 months. Does anyone have any experience with LDH isoenzymes results and connections to TC? Thanks!

  • #2
    At my last checkup I asked my urologist to check ldh levels, he said he would if I wanted, but that if my afp and hcg weren't elevated it wouldnt mean much. However, I have 100% seminoma and maybe that's the difference in reason for testing the levels, Im not sure to be honest.

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    • #3
      I've written to Dr Craig Nichols (big time TC expert) about testing for LDH for patient's with stage 1 disease and he advises against this. There have been a few studies showing that it adds zero utility and there are many false positives (meaning LDH is elevated for reasons other than cancer). I can say for sure that LDH is very non-specific, and even hemolysis in the test tube can increase the number.

      I also know that Dr Einhorn recommends against testing for LDH in stage 1 disease for the above mentioned reasons.
      Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

      7/1/2015: felt tiny lump on side of R testicle
      7/30/2015: Ultrasound shows 2 intra-testicular masses.
      7/31/2015: tumor markers normal, CXR clear
      8/5/2015: R orchiectomy
      8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
      8/14/2015: CT abdomen/pelvis clear, Stage 1b
      8/24/2015: started 1 x BEP

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      • #4
        I've had elevated LDH in three occasions:

        1. active cancer
        2. post rplnd healing
        3. after a very strenuous snowmobile trip where i was very sore every night.
        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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        • #5
          I should clarify my post because I wasn't clear. His LDH value is fine (164), always has been in the normal range. Our PCP ordered LDH isoenzymes which are the 5 components that make up total LDH. The results are given as percentages of total LDH and those results are completely off of what is considered normal. He is very elevated in the 5th enzyme. I know that this isn't a test that is used for TC surveillance but didn't know if anyone had any knowledge of it. Thanks!

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          • #6
            LDH-V elevations can indicate liver disease or simply muscle damage from working out. https://www.mayomedicallaboratories....erpretive/8679 but I would assume that it is nothing but a red herring. As others have said, it is not very specific and odds are that unless the lab test was ordered in error you never would have known it was even an issue nor would it have become an issue.

            I had a similar lab error when they ordered a liver panel instead of a potassium level when I was battling Dengue Fever. In that case the liver panel indicated that I had a viral hepatitis with critical liver enzyme elevations (which completely resolved) due to acute illness with the Dengue Fever. Now I obviously avoided alcohol for a few months but otherwise, I never would have known nor was it of any real concern as it was just a temporary thing that would have resolved on its own once the virus died off. In fact, it would have ben better perhaps not to know of the levels as it just raised concern that wasn't really needed (although it did help in me avoiding the alcohol intake)

            Mike
            Oct. 2005 felt lump but waited over 7 months.
            06.15.06 "You have Cancer"
            06.26.06 Left I/O
            06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
            06.30.06 It's Official - Stage I Seminoma
            Surveillance...
            Founded the Testicular Cancer Society
            6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

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            • #7
              Here's a couple of links on LDH Isoenzymes:

              https://www.urmc.rochester.edu/encyc...ase_isoenzymes

              https://www.mayomedicallaboratories....erpretive/8679

              What, exactly, were his numbers?
              Jan, 1975: Right I/O, followed by RPLND
              Dec, 2009: Left I/O, followed by 3xBEP

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              • #8
                His numbers were 16, 27, 21, 13, 23. The normal ranges for the lab used differ from those in the article but L1 and L2 are low, L4 and L5 are high based on our Lab. I cannot find anything associating these values with TC other than L1 generally being produced by germ cell malignancies. I will add that he had liver function tests run as part of his physical and all those values were normal.

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                • #9
                  Well, without knowing the lab reference numbers, all I can say is the article says L5 should be lower than L4. Based on the article, it does not seem to indicate anything about TC, but might be something that his doc will want to look into.

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

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