What are the tumor markers for testicular cancer?

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Last updated: April 16, 2025 • View editorial policy

From the Guidelines

Alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) are the primary tumor markers used to diagnose and monitor testicular cancer, with serum tumour markers determined before and after orchiectomy and throughout follow-up for accurate staging and risk stratification 1. These markers are elevated in approximately 85% of testicular cancer cases, though levels vary by cancer type.

  • Seminomas typically elevate hCG in 15-20% of cases,
  • while non-seminomas often show elevations in both AFP and hCG. LDH serves as a less specific marker but indicates tumor burden and can help with prognosis. These markers are essential not only for initial diagnosis but also for monitoring treatment response and detecting recurrence. Blood tests for these markers should be performed before surgery and then regularly during follow-up care. A rising marker level after treatment may indicate recurrence, while declining levels suggest effective treatment. However, normal marker levels don't rule out testicular cancer, as some tumors don't produce these substances. Therefore, these markers should always be interpreted alongside imaging studies and physical examination findings for comprehensive patient management, as recommended by the ESMO-EURACAN clinical practice guideline for diagnosis, treatment, and follow-up of testicular seminoma and non-seminoma 2, 1, 3. The use of serum tumour markers is crucial for accurate staging and risk stratification, and for monitoring treatment and detecting relapse, with approximately 5% of GCT patients harbouring GCNIS in the contralateral testis, requiring physical and/or US examinations during follow-up 3.

From the Research

Testicular Cancer Markers

  • The most commonly used testicular cancer markers are alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) 4, 5, 6, 7, 8
  • These markers play a crucial role in the diagnosis, staging, and surveillance of testicular cancer, particularly for seminomatous and nonseminomatous germ cell tumors 4, 7
  • AFP and HCG are specifically associated with non-seminomatous germ cell testicular tumors, while LDH is also elevated in some cases 5, 8

Clinical Applications

  • The markers are used to monitor treatment response and detect relapse, with a rise in marker levels indicating potential relapse 6
  • However, the markers can also produce false-positive results, highlighting the need for careful interpretation and correlation with imaging findings 6, 7
  • The positive predictive value (PPV) of the markers varies, with beta-HCG having the highest PPV and LDH having the lowest 6

Additional Markers

  • Other markers, such as PLAP, OCT3/4, NANOG, SOX2, REX1, AP-2γ, and LIN28, have been identified as potential novel markers for testicular cancer, particularly for germ cell tumors 5
  • These markers may offer improved sensitivity and specificity for diagnosis and surveillance, but further research is needed to fully evaluate their clinical utility 5

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.