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I'm dealing with my 2nd round of TC and am having a hard time with landing on the best treatment option. I was just diagnosed with a 2nd primary TC after having BEP for stage 1S nonseminoma 9 years ago.
This time I have a stage 1A seminoma. HCG was slightly elevated pre I/O and then normalized at my first followup. CT scan was unremarkable and was compared with the last one I had 4 years ago. Pathology showed seminoma with tumor size 3cm, no rete testis invasion, no LVI, no sperm cord involvement.
As I think most doctors do in this scenario, both my treating Urologist and Oncologist are strongly recommending surveillance and have quoted a relapse risk of 10-15% given the tumor size and absence of rete testis invasion. I think if this was my first time around I would be a little more quick to accept the surveillance route, but because I have already had 3xBEP I'm a little more concerned. After having a rather long talk with my oncologist he did say that treatment in the event of relapse would not be BEP, but rather EP or VIP. I have a lot of anxiety about going through chemo again given all of the studies about long term risks afterwards and going through it again would likely only make those risks greater.
Part of me is leaning toward 1xCarboplatin to reduce the recurrence risk down to single digits, knowing that I likely don't need it. I don't qualify for the study IU is participating in for stage I/IIA RPLND for seminoma patients, which if offered would be an option that doesn't carry the long term risks.
I know my situation is pretty unique given the past history, but am just looking for thoughts from the general group. I love the idea of surveillance, but really struggle with scan anxiety.
Thanks
This time I have a stage 1A seminoma. HCG was slightly elevated pre I/O and then normalized at my first followup. CT scan was unremarkable and was compared with the last one I had 4 years ago. Pathology showed seminoma with tumor size 3cm, no rete testis invasion, no LVI, no sperm cord involvement.
As I think most doctors do in this scenario, both my treating Urologist and Oncologist are strongly recommending surveillance and have quoted a relapse risk of 10-15% given the tumor size and absence of rete testis invasion. I think if this was my first time around I would be a little more quick to accept the surveillance route, but because I have already had 3xBEP I'm a little more concerned. After having a rather long talk with my oncologist he did say that treatment in the event of relapse would not be BEP, but rather EP or VIP. I have a lot of anxiety about going through chemo again given all of the studies about long term risks afterwards and going through it again would likely only make those risks greater.
Part of me is leaning toward 1xCarboplatin to reduce the recurrence risk down to single digits, knowing that I likely don't need it. I don't qualify for the study IU is participating in for stage I/IIA RPLND for seminoma patients, which if offered would be an option that doesn't carry the long term risks.
I know my situation is pretty unique given the past history, but am just looking for thoughts from the general group. I love the idea of surveillance, but really struggle with scan anxiety.
Thanks
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