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Stage 1a non-seminoma, considering adjuvant BEP

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  • Stage 1a non-seminoma, considering adjuvant BEP

    Here's my situation. Exactly a month ago, on January 10th I had orchidectomy, left testicle removed. AFP slightly elevated prior surgery (93), it went back to normal after 4 weeks, dropping exactly by half each week. Pathology results came with all kinds of germ tumors, with embryonal carcinoma as dominant one (but not pure), don't know exact percentage. No LVI, or spermatic cord invasion. All of that puts me on stage 1a.

    I've been put on quite aggressive surveillance - blood tests and CT scan every 3 months for 2 years.

    My doctor didn't mention adjuvant chemo, put me on surveillance by default and said if I relapse (low chance) he will still cure me. That was pretty much my last follow-up visit. I'm in Japan btw. but he speaks English and is a reputable doctor, so far doing everything according to protocols.

    I'm considering 1 cycle of BEP. There's few reasons for that:

    - peace of mind. Even though my current reoccurrence rate sits somewhere between 15 to 25%, knocking it down to just 2-3% would make me feel much better mentally and I could just move on mostly. Right now, all I think about is whether this crap is still in my body or not

    - good timing. If I ever need treatment, the time is now. My current job contract is ending this month and I could begin chemo in March. Also, I got some note from city hall that combined with my health insurance here makes it that I wouldn't pay more than 800$ for one month of hospitalization and treatment

    - I might move from Japan in September, and honestly following surveillance appointments this often could be complicated (it's more about CT scans, blood work is not so much of a problem). And eventual treatment would most likely totally disrupt my life later (I've been living abroad for last 6 years and moving countries quite often)

    - I feel like I could manage one cycle just fine compared to full three. I know it will still suck no matter what, but the thought of 3xBEP scares me

    What's your opinion?

  • #2
    BEPx1 is certainly an option and from your three points it seems like it makes sense for you given the life interruptions that would occur if you relapsed and the added need for more rigorous imaging on active surveillance. You would still probably need the blood work every 3 months for the first two years but that is easier than the CT scans and would probably only need that annually for the first two years. If I were in your situation, it seems like I'd make the choice to do the BEPx1 and I am usually more pro active surveillance.

    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

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

    Comment


    • #3
      I have always and will always think adjuvant therapy in the case of chemo is a poor choice. That is my opinion obviously, and I've only been in this world for 6 weeks. To me though, we are young in the spectrum of cancer, so the detrimental effects of chemo will have time to compound. It's only one round so it wouldn't be that bad for sure, but it could also cause you to have cancer later in life, especially leukemia. You do what works best for you, it may very well be that adjuvant therapy saves you from a recurrence; you will never know.

      Do what makes you comfortable, for me that was not having to do chemo at all. (yet anyway, fingers crossed. Adjuvant therapy was also not recommended to me either, but I wouldn't take the option if it was.)

      Comment


      • #4
        The long-term effects of BEPx1 are certainly not without risk but they are thought to be less than BEPx3. The 111 Trial was just published and may offer some insight as far as the immediate effects of the BEPx1 https://www.europeanurology.com/arti...895-4/fulltext

        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

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

        Comment


        • #5
          Surveillance, RPLND, 1 x BEP are all options. Surveillance is usually recommended for most patients, but personal circumstances must be taken into account.

          The difference between 1 x BEP and 3 x BEP in terms of recovery and side effects is very significant. I can speak from spending quite a bit of time in this community.
          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

          Comment


          • #6
            I really want to go for it, my mind won't stop spinning. I'm yet to talk with my doctor about it (my visit is on 25th), he never mentioned adjuvant bep, so I'm not sure what his reaction will be. There is another thing that I'm a bit worried - am I running out of time for this? What is the best timing between orchiectomy, normalized markers and start of adjuvant treatment? I had my surgery on January 10th, markers normalized on February 4th when I was diagnosed with stage 1a. I'd like to start 1xbep in the beginning of March.

            Comment


            • #7
              I guess I can follow-up on this. I emailed Dr. Einhorn and he replied within minutes, even though he's not working at the office at the moment. What an amazing, dedicated man. He understands my concerns and while his personal preference would be surveillance, he said no problem getting BEP x1 in my situation. I just need to do blood markers within a week and CT scan within 4 weeks of starting adjuvant chemo to ensure I'm still stage 1. Hope it'll go well...

              Comment


              • #8
                Originally posted by 1821979 View Post
                I guess I can follow-up on this. I emailed Dr. Einhorn and he replied within minutes, even though he's not working at the office at the moment. What an amazing, dedicated man. He understands my concerns and while his personal preference would be surveillance, he said no problem getting BEP x1 in my situation. I just need to do blood markers within a week and CT scan within 4 weeks of starting adjuvant chemo to ensure I'm still stage 1. Hope it'll go well...

                Glad that you heard from Dr. Einhorn and the decision is very much a "what is best for you" decision. Glad he mentioned the 4 weeks from last CT, I usually see recommendations of 6 weeks as well by the way, if that helps.

                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

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

                Comment

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