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Should I be Worried ? (Elevated LDH)

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  • Should I be Worried ? (Elevated LDH)

    I just had my Yearly checkup this week. It wasn't a bad checkup. Mostly just chit chat about this past year, how our families are doing, COVID, etc.
    My oncologist. asked if I was having any of the symptoms that she always wants me to be on the look out for, such as: unexplained fevers, fatigue, weight loss, night sweats, back pain etc.
    I've not been symptomatic of anything other than the fact that my overall fitness level has gone down since working from home most of the past year.

    However she then pointed out that my LDH level was 310 U/L; which is above the ULN for that test which is 228 U/L.

    Since I am asymptomatic of TC she feels that it's nothing to be concerned about. However she wants to retest it in 6 weeks.

    When I started Chemo, 6.5 years ago my LDH was around 280 ... even lower than it is now. Though I had clear evidence of mets. on my PET scan then, which is how I ended up doing 3xBEP.
    So naturally this gets me worrying because for me LDH was part of my initial dealing with TC all those years ago.

    Anyways, I reached out to Dr. Einhorn about this and his reply was:

    "
    I have zero concern. LDH is very non- specific, unlike serum hCG and AFP. Thus we do not routinely check LDH levels during follow- up visits.
    "

    So Einhorn does not check LDH on his patients during follow up. He has no concern. Interesting, as I have seen other journal articles in other cancers indicating that LDH has little utility in follow ups, etc.

    I had an appt. with my GP today regarding a knee/muscle inflammation injury and I mentioned this to him also. He wasn't concerned as LDH can be up a bit for many reasons other than cancer.

    I know that LDH can be up for many reasons including muscle/skeletal injuries and I have been dealing with this knee, and my hip for the last several weeks ... so here's to hoping it's related t that, or anything other than TC for that matter.

    In the the last 6.5 years since completing chemo I have had all three tumor markers go above normal at least once ... these false alarms are getting annoying. Based on Dr. Einhorn's response I am half tempted to have my onco. discontinue checking LDH on my checkups. But then part of me would rather know that something "may" be up.

    Any thoughts from the team are always welcome.

    - 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
    July 2021: 7 YEARS ALL CLEAR !

  • #2
    Personally, I would only discontinue LDH checks if I would be overly worried about very minor elevations like yours. I would hate to miss an elevation that *was* significant but with your history of inflammation, your slightly elevated levels are almost certainly due to that, since LDH actually isn't a tumor marker, it is a measure of inflammation that is only sometimes useful in tracking TC,
    Last edited by Davepet; 01-29-21, 08:39 PM.
    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP

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    • #3
      Jeski I had the same problem last November.
      I hadn't had a blood test for more than a year (neither LDH, AFP nor Bhcg).
      The result fell and my level was 467 U/L (the norm is between 135 and 225 U/L).
      My levels have always been within the norm.
      I saw my doctor who told me that he thought it was a laboratory error and that a bad blood test could cause the result. He asked me to test again 5 days later.
      5 days later, my level went back down to 160 U/L.
      After a while I remembered that the nurse had had a hard time taking my blood: she had pricked me in my left arm and nothing was flowing, then in my right arm and it was the same thing, so she moved the syringe around in my arm to get some blood. I think that's what caused the increase in LDH.
      I think it will be necessary to redo a blood test within 5 days.

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