From the Guidelines
Testicular tumor markers, including alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH), should be monitored regularly after diagnosis and treatment of testicular cancer to detect recurrence early, with the most recent guidelines recommending monitoring schedules based on tumor type, stage, and treatment received 1.
Key Markers
- Alpha-fetoprotein (AFP)
- Human chorionic gonadotropin (hCG)
- Lactate dehydrogenase (LDH) These markers are crucial for diagnosing germ cell tumors, determining prognosis, and assessing treatment outcome, as emphasized in recent clinical practice guidelines 1.
Monitoring Schedule
The specific monitoring schedule depends on the tumor type, stage, and treatment received.
- Non-seminomatous germ cell tumors typically require more frequent monitoring of AFP and hCG.
- Pure seminomas may only need hCG and LDH monitoring as they rarely produce AFP. The most recent guidelines provide a framework for serum tumor marker levels in non-seminoma testicular cancer, including LDH, b-hCG, and AFP 1.
Importance of Monitoring
Monitoring testicular tumor markers is essential because they can detect recurrence before it becomes clinically apparent on imaging studies.
- Rising marker levels, even with normal imaging, should prompt further evaluation as they may indicate recurrent disease.
- The half-life of AFP is 5-7 days and hCG is 24-36 hours; failure of these markers to decline appropriately after treatment suggests residual disease, as noted in previous studies 1. Monitoring should be combined with appropriate imaging studies and physical examinations as part of comprehensive surveillance, in line with established clinical practice guidelines 1.
From the Research
Testicular Tumor Markers
The primary testicular tumor markers used for monitoring include:
- Alpha-fetoprotein (AFP) 2, 3, 4, 5, 6
- Human chorionic gonadotropin (hCG) 2, 3, 4, 5, 6
- Lactate dehydrogenase (LDH) 3, 5, 6
Clinical Applications
These markers play a crucial role in:
- Diagnosis of testicular cancer 3, 6
- Staging of the disease 3, 5, 6
- Monitoring treatment response 2, 3, 5, 6
- Surveillance of patients after treatment 2, 3, 5, 6