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Big Time Confusion !

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  • Big Time Confusion !

    Hello Everyone !
    New to the group - and of course new to this TC mess too.

    A short summary -
    Surgery(Orchiectomy) on 8th Sep 2020
    Pre Surgery AFP - 68
    Pre Surgery HCG - 47
    PET Scan - Clear - no nodes
    Chest XRAY - Clear

    Pathology - Embroyal Carcinoma 70% + Immature Teratoma 30% + LVI positive

    AFP after 21 days of surgery - 5.70
    HCG after 21 days of surgery - 9.50 > after 1 week > 7.50 > after 1 week > 10.20

    Now comes the confusion part -
    Oncologist 1 = suggests 3xBEP keeping
    Oncologist 2 = suggests 1xBEP , plus optional 1xBEP more OR 1xEP - because the HCG values are marginally above normal. He states that ideally 3x or 4x normal values are normal as there are at least 10 factors that can raise HCG marginally. ( Hetrophile antibodies / fatty liver / thyroid etc ) Infact my Lab always states in their footnote - Hetrophil Antibodies can cause elevation.
    Surgeon 1 = suggests 1xBEP and not RPNLD. He says robotic RPNLD if required can be done after chemo too.

    I really don't know which option to choose from. I know everything has positives and negatives, but please if someone was in the same confusion and numbers , can suggest something ?

  • #2
    I personally would want to make sure that there were no other causes for the slightly elevated beta-hCG or that the levels were consistently and significantly increasing before jumping into chemotherapy, minus any other imaging signs of metastasis. Without normal levels, I would avoid BEPx1 or x2 as it seem like under treatment, where if they are truly elevated BEPx3 or EPx4 would seem more appropriate. Also, I would ask if RPLND is even an option with markers that are not normal and if the relapse rate with elevated markers is higher than if the markers were normal.

    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.

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    • #3
      I agree with Mike, that is a minimal blip on the hcg at this point, I'd want to wait for something more of a trend up, after all, even marijuana use can give it a bump up.

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

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