Reply to monitoring of seminoma patients with serum markers

Abstract

The use of tumor marker determinations for monitoring patients with cancer is common, but this practice is not always evidence-based. Guidelines for monitoring of testicular cancer invariably recommend the use of serum marker determinations, but the recommendations are not based on randomized studies.1 Vesprini et al 2 have evaluated the validity of this practice in a retrospective study based on chart review of serum tumor marker results during surveillance of stage I seminoma. Lactate dehydrogenase (LDH), human chorionic gonadotropin (hCG), and alpha-fetoprotein (AFP) together with clinical and imaging data were registered. Elevated serum markers were found in 11 of 65 (17%) patients at relapse, but in only 1 did the marker elevation precede detection of relapse by imaging or clinical examination. Thus, the authors conclude that routine measurement of serum markers can be discontinued during surveillance of seminoma.In a study on 42 patients with seminoma, we found elevated concentrations of the hCG heterodimer in 17% of the patients preoperatively, but of the free beta-subunit (hCGb) in 52%. It is noteworthy that in 17 cases (40%), hCGb was the only elevated marker. Of 4 patients with seminoma who had a relapse, 2 had an elevated hCGb level; in 1 patient, this was the first sign of relapse. Of 51 patients with nonseminomatous cancers, hCG was elevated in 37 patients (73%) and hCGb in 40 patients (78%) preoperatively, and at relapse, 5 of 18 (28%) patients had an isolated increase in hCGb level. 3Thanks to rapid improvement of imaging methods, the need for markers in monitoring of seminoma patients has decreased. However, the radiation burden of repeated imaging is not negligible. As Vesprini et al suggest, gathering additional data on the utility of serum marker determinations is certainly recommended. The results from our study suggest that serum markers, and especially hCGb, still may have a role in the monitoring of patients with seminoma. These results need to be confirmed in larger studies. CONFLICT OF INTEREST DISCLOSUREThe work was funded by grants from Finska L€ akares€ allskapet (all authors, one grant each) and a grant from the Finnish Cancer Organizations (Ulf-Håkan Stenman