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Stage 3a non-seminoma, PC-RPLND or not?

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  • Stage 3a non-seminoma, PC-RPLND or not?

    Hi All,

    This is Nan from Beijing. first of all, i'd like to give my great thanks to this forum, i learnt so much from you guys about the treatment and experience.

    My husband was diagnosed with non-seminoma stage 3a, 100% pure embryonal carcinoma. he has finished 3 cycles BEP on Feb 12th 2021, and took a PET/CT scan on Feb 19th. after Chemo his tumor markers are all normalized, but PETCT shows he still had few retroperitoneum lymph nodes up to 9mm, paraaortic. and PET shows FDG uptake with SUV max 1.4...this uptake really scares us.. .

    Now, we are not sure should we take RPLND at this moment? or go with surveillance? our urologist recommends surveillance and check another CT after 3 months, but another doc said we should take 2 more rounds chemo....I also emailed Dr. Einhorn, and he recommends close surveillance.

    Is there anyone here has similar case like my husband? this PET result is terrifying me how to make next step decision. I'm just afraid if we dont take PC-RPLND now, it would make future treatment more difficult if there's still cancer in the residual mass.. and would it then lower down the cure rate?? hope some one can give me some your experience.

    Thanks all!


    10/30/2020, CT scan: 2*2.2cm on left testis, multiple lymph nodes<1.2cm, multiple nodules on left lungs <0.5cm
    11/16/2020, AFP 65.3; bHCG 3.18; LDH 353;
    11/17/2020 - left I/O, pure embryonal carcinoma
    12/11/2020 - 2/12/2021, start 3 cycles BEP
    12/19/2021, AFP 5.7, bHCG<0.1, LDH 170; PETCT: still mutiple lymph nodes greatest 0.9cm, FDG uptake SUV max 1.4; lungs are clear luckily.

  • #2
    It is not unheard of to have nodes still show up a week after chemo is finished, have they decreased in size? My node was decreased but still enlarged at my first PET scan post chemo, it was not visible in the next one.
    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP

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    • #3
      I am glad that you reached out to Dr Einhorn. I am not sure, given the node response and the negative markers, why one would recommend more chemotherapy at this point as there seems to be a response and not disease progression. Post chemo, there is debate on if doing a RPLND with a highly skilled surgeon for nodes <1 cm should be done or monitoring. Both are commonly used options at major testicular cancer centers. I am not sure why they are doing PET vs just CT either as there can be false positives with PET, especially right after chemotherapy (although the SUV max of 1.4 is not all that worrisome to me). It seems reasonable to monitor the nodes via CT, until there is a more clear picture on disease progression showing further intervention is more definitively needed.

      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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      • #4
        hi Mike, i also searched some paper about using PET for non-seminoma, like you said sometimes it gives false positive or false negative result..i'm also not sure why most of doctors here now prefer to do a PET instead of just CT. My husband's doctor said the necrosis can also cause FDG uptake, so he also didnt worry too much about it .

        I read an article which was quoted in NCCN guidelines that <1cm node and negative marker is also treated as complete response and the recurrence rate is very low in such group of patients. So me and my husband has decided to go with surveillance and have another CT check after 3 months, hope the nodes will continue to shrink!! thanks for your previous sharing of Dr. Einhorn's email and also the suggestions. this forum is really really helpful.

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