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Best treatment for seminoma pT1, chance of recurrence

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  • Best treatment for seminoma pT1, chance of recurrence

    Hello folks!
    I am confused by the different opinions that I get. I had left orchiectomy, left side in May 2016, pathology showed seminoma stage 1, pT1. Doctor advised active surveillance and I followed (no R/T, no chemo). PET scan in January showed 3 para-aortic lymph nodes with SUV 3, but within normal size (10mm). Another PET in the end of May showed 2 (?!) lymph nodes with SUV 2.7 and still in normal size. Oncologists suggest R/T although I read articles, studies, forums, watched videos that the best thing is RPLND or chemo (RT has a chance of second tumor in 15-20 years). But my doctors say that I don't need such an advanced surgery and that chemo has worse side effects. Also they tell me that R/T can pinpoint the lymph nodes and technology is so advanced in the last years that it has almost no side effects, compared to 10-15-20 years ago.

    Any advice would be much appreciated.

    EDIT: Tumor markers were always normal (pre, post surgery)



    March 2016 - mass in left testicle, tumor markers normal
    May 11, 2016 - performed left orchiectomy
    May 2016 - pathology seminoma stage 1, pT1
    June 2016 - PET/CT all clear, tumor markers normal
    Oct 2017 - CT scan showed 3 enlarged para-aortic LN, but within 1cm
    Jan 2018 - PET/CT shows persistent 3 para-aortic LN, SUV 3, within 1cm
    May 2018 - PET/CT shows 2 para-aortic LN, SUV 2.7, within 1cm
    Last edited by Miroslav; 07-11-18, 03:14 AM.

  • #2
    Well what your doctor isnt saying is that both chemo and RT run the risk of maybe developing something 15/20 yrs down the road. Does that mean something like a second cancer from treatment mayne happen? It may or may not?
    So it comes down to what you can live with RT or chemo which to you feel more comfortable doing. There are alot of resources and information out there that you can read through and make a decision on what is the best course of you.
    RPLND may or may not be a cure for cancer, i had all 3xBEP and relapsed, RPLND and relapsed. So does that happen to everyone? Ot course not, i just dont do anything easy or normal. So dont take your doctor advice and not research info your self. Its best to be your own biggest advocate so you cam decide which course of treatment is best for you within the guidelines of the options given to you.
    Jan 2012- U/S mass in Left testicle
    Feb 2012- I/O performed to remove cancer
    Mar 1,2012- pathology pure seminoma
    Mar 7, 2012 PET SCAN stage IIa
    April 2012 Mayo clinic carbolite.
    May 2012 carbolite failed, started BEP x3
    August 7th 2012- BEP complete
    April 2013 CT/PET show relapse
    May 2013 RPLND
    Aug 2013 Relapse again Started VIeP x2
    Dec 2013 HDC completed CT/PETSCAN 1.1 cm x .8 cm right lower lung lobe
    Feb 2014 confirmed false positive all clear FINALLY !
    Jan 2015 1 year cancer free Pet/CT scan
    Jan 2016 2 years cancer free "Pet/CT scan
    Jan 2017 3 years cancer free "Pet/CT scan
    Jab 2018 4 years cancer free "Pet/CT scan, labs, xrays


    • #3
      Before you do anything; I am wondering why are they mentioning treatments anyways ?

      I ask because:
      1: The Nodes shrank (one of three wasn't mentioned in the second reading)
      2: the SUV value (3) is not high
      3: the nodes are less than 1 cm

      Have you had any blood work recently....specifically tumor markers ?

      Yes, those nodes bear watching, but until it's pretty much proven to be cancer, I would hold on treatments.

      However; like eodtech says, non of these decisions are easy and only you can be your best advocate for your health/treatments. Non of the treatments mentioned are easy. However; they all lead to cure...each with it's downside which only you can decide which one is best for you.

      Do what you are comfortable with and with whatever resources you have and the experience of the doctors that you can have. If you cannot get an RPLND done by the best surgeon then opting for chemo or R/T are the better options.

      - Matt
      March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
      March 13th: Left IO 100% Classic Seminoma
      6.3 x 5.1 x 3.8 cm, no invasion of anything
      LDH never fully normalized
      Stage: IS
      Watchful Waiting
      May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
      May 12th: started 3xBEP
      Neupogen during Cycle 2 and 3
      July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
      August 4th: Post Chemo CT/PET scan
      September 4th: Port removed
      Jan 9th 2019: 4.5 YEARS ALL CLEAR !


      • #4
        You did not mention what type of TC was discovered in the pathology report?
        Jan, 1975: Right I/O, followed by RPLND
        Dec, 2009: Left I/O, followed by 3xBEP


        • #5
          With seminoma a primary RPLND for stage II disease is rarely done. I suppose you may find a surgeon but most consider it still to be investigational. In the US, there is a clinical trial with several locations that are doing RPLND for seminoma:

          I am wondering if the PET is just confusing things? While the nodes could be something, if it were just CT, I don't think there would be much alarm if they under 1 cm, except to keep monitoring them. I personally would want to be certain that I had a relapse before I underwent chemotherapy or radiation therapy. I am not sure of your age and with stage IIa, there does tend to be a preference for RT over chemotherapy given recent reviews that I have seen and the NCCN Guidelines recommend either. It certainly is a difficult choice to make but both have excellent outcomes.

          Some of the more recent things I have seen are (and there is more out there):

          The one thing I would take into consideration and discuss with my doctor as well as the risk of relapse with chemotherapy vs. RT. For example, if you get RT and relapse, needing chemotherapy then the combination may increase your risk for secondary malignancies and cardiovascular disease later. Full disclosure, I am a pharmacist so I would rather prefer chemotherapy but in stage IIa disease it would be a difficult decision for me to not choose radiation therapy. Actually, RPLND in the clinical trial would interest me as well.

          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
          Founded the Testicular Cancer Society
          6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

          For some reason I do not get notices of private messages on here so please feel free to email me directly at if you would like to chat privately so as to avoid any delays.