Surveillance Guidelines for Testicular Tumor 2 Years Post-Excision
At 2 years post-orchiectomy, you should continue surveillance with history and physical examination plus serum tumor markers (AFP, β-HCG, LDH) every 6 months for years 3-5, with abdominal/pelvic CT imaging once in year 3 and once in year 4 or 5. 1
Year 3-5 Surveillance Protocol
The specific monitoring schedule depends on the histology and initial treatment approach:
For Seminoma (Stage I)
Clinical Assessment:
- History and physical examination every 6-12 months during years 3-5 1
- Serum tumor markers (AFP, β-HCG, LDH) every 6-12 months for years 3-4, then annually thereafter 1
Imaging:
- Abdominal/pelvic CT scan every 6-12 months in year 3, then annually for years 4-5 if on surveillance 1
- If treated with adjuvant radiotherapy or carboplatin: abdominal/pelvic CT annually for first 3 years only (you are now past this window) 1
- Chest imaging only as clinically indicated 1
For Non-Seminomatous Germ Cell Tumor (NSGCT)
Clinical Assessment:
- Physical examination every 4-6 months in year 3, then every 6-12 months for years 4-5 1
- Serum tumor markers (AFP, β-HCG, LDH) every 4-6 months in year 3, then every 6-12 months for years 4-5 1
Imaging:
- Chest x-ray and abdominal/pelvic imaging once in year 3, and once in year 4 or 5 1
- Higher-risk patients (with lymphovascular invasion) may warrant more frequent imaging 1
Critical Timing Considerations
The highest recurrence risk has already passed. The vast majority of recurrences (90%) occur within the first year, and nearly all occur within the first 2 years post-orchiectomy 2. At your current 2-year timepoint, the annual risk of recurrence after adjuvant treatment is less than 0.3% 1.
Beyond 5 Years
After 5 years, the risk of late relapse is ≤1%. 1 Annual serologic and radiographic assessment may be performed thereafter only as clinically indicated based on specific concerns 1. Routine surveillance imaging can be discontinued after 5 years in most patients 1.
Detection Methods
Tumor markers and CT imaging detect 97.6% of recurrences. 2 For seminoma, abdominal-pelvic CT is the primary detection method, as the retroperitoneal nodes are the most common relapse site 1. For NSGCT, both tumor markers and imaging are essential, though markers may only precede radiographic findings in 35% of cases 3.
Important Caveats
- Chest radiographs have limited utility and should only be obtained when clinically indicated, not routinely 1
- If relapse occurs, full restaging is required and treatment should be based on the TNM-s status at relapse 1
- Retroperitoneal relapses are typically detected later (median 10 months) compared to lung metastases (median 3 months) 3
- Survivorship monitoring should include assessment for hypogonadism, cardiovascular disease risk (especially if treated with chemotherapy or radiation), and secondary malignancies 1, 4