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1x BEP or Survillence - My first post

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  • 1x BEP or Survillence - My first post

    I visited my Oncologist for the first time today. I was staged at non seminoma
    1B after my orchiectomy and my tumor markers normalized. My pathology was a mixed germ tell tumor 75% Yolk Sac, 25% embryonal carcinoma, and 5% teratoma with LVI.

    Ive been given the tough decision to choose between Surveillance or 1x BEP. Im not entirely sure what to choose at this point. Given that the LVI is present the chance of relapse is 50% but I've also read that the percentage of EC has a defining factor. Im not sure that the low EC percentage would lower the chance of relapse at all.

    If i did choose surveillance, and relapsed the normal protocol of 3x BEP would be next.

    Obviously I'm trying to avoid chemo at all costs, but with the high chance of relapse I'm having trouble deciding.

    Oncologist says that if i were to choose Chemo, the latest i could start treatment is Nov. So i guess i have time to decide.

    Anyone have any opinions?

    Best,

  • #2
    Doing chemo the first time gave me a solid 4 yrs before recurrence, i truly believe if i didnt do the treatment i would have only made it a year or so before it came back. BEP is tough! But you need to fight fire with fire sometimes and look at long term goals of a cancer free life! I can think of 100 reason not to do chemo, but all i need is 1 reason to do it, i dont want the cancer to come back! Good luck and stay strong man!

    Comment


    • #3
      Originally posted by Keavier View Post
      I visited my Oncologist for the first time today. I was staged at non seminoma
      1B after my orchiectomy and my tumor markers normalized. My pathology was a mixed germ tell tumor 75% Yolk Sac, 25% embryonal carcinoma, and 5% teratoma with LVI.

      Ive been given the tough decision to choose between Surveillance or 1x BEP. Im not entirely sure what to choose at this point. Given that the LVI is present the chance of relapse is 50% but I've also read that the percentage of EC has a defining factor. Im not sure that the low EC percentage would lower the chance of relapse at all.

      If i did choose surveillance, and relapsed the normal protocol of 3x BEP would be next.

      Obviously I'm trying to avoid chemo at all costs, but with the high chance of relapse I'm having trouble deciding.

      Oncologist says that if i were to choose Chemo, the latest i could start treatment is Nov. So i guess i have time to decide.

      Anyone have any opinions?

      Best,
      Sorry to hear it. It's your decision and a family member can make you feel more secure about it, but take a look around and maybe ask another doctor. If all suggest the BEP than do it. I finished my 5 days in a row of my first cycle of EP, today is day 7 and I feel just fine. I'm working on ladders and ceiling. If you push yourself you can do anything Most important is to feel safe in yourself.

      Take care
      Dec 2017 - felt lump and never checked it out.
      07.17.18 - Diagnosed with TC
      07.20.18 - Left I/O
      08.04.18 - Pathology - Seminoma
      08.24.18 - CT Scan shows 3 enlarged lymph nodes (3.3x3.1cm & 3.3x3.2cm & 5.1x3.9cm) no other organs met
      09.04.18 - OFFICIAL STAGE 3A Seminoma
      09.06.18 - Started 4xEP @ MD Anderson
      11.12.18 - Finished 4xEP
      12.20.18 - Waiting for my PET SCAN...

      Comment


      • #4
        Originally posted by Keavier View Post
        Obviously I'm trying to avoid chemo at all costs, but with the high chance of relapse I'm having trouble deciding.
        A 50% chance of relapse is also a 50% chance you are already cured, so it is not correct to say you have a high chance of relapse. Yoi have an equally high chance of not needing more treatment.

        What this boils down to is how adverse are you to taking chances? Personally, I would flip the coin & hope to avoid chemo, knowing I will still survive if I lose the coin toss, even though it means a lot more chemo. Some folks aren't comfortable with that & prefer to take treatment they may not need in the hopes it will make 3xBEP unlikely. It is a personal decision you need to make based on how you will feel about the end results with both possibilities.

        Dave

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

        Comment


        • #5
          There are two schools of thought here by the docs:
          1. Non-risk adapted: All stage 1 patients should get surveillance. We don't want to overtreat patients since at most they have 50% chance of relapse.
          2. Risk-adapted. Stage 1B patients (high risk) should get 1xBEP while stage 1A patients should get surveillance.

          The long-term data about the risks of secondary cancer, cardiovascular disease etc are not robust for 1xBEP. It may be better than 3xBEP but its not evident in data yet.

          While it may not reduce the relapse risk as much as 1xBEP, adjuvant RPLND surgery should still be discussed as an option. The issue is that RPLND should be done by an expert. RPLND is one way to reduce relapse risk without the long-term effects of 1xBEP. RPLND doesn't preclude you from getting chemo later, should you need it.


          Age 31 - Portland, OR
          01NOV16- Pain in right testicle, palpable mass
          13NOV16- R I/O. Markers normal
          27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
          06DEC16 - CT scan clear
          09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
          03JAN17- Ended 1xBEP; start surveillance
          18MAR17-2nd pathology report shows 90% EC , 10% seminoma

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