title: Utility of serum tumor markers during surveillance for stage I seminoma.
abstract: BACKGROUND
  The serum tumor markers α-fetoprotein (AFP), β-human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) are often measured as part of surveillance protocols in patients with stage I seminoma. In this study, the authors evaluated the utility of routine measurement of these markers in the detection of disease relapse.
  
  
  METHODS
  Data were gathered from a prospectively maintained database of patients who underwent surveillance for stage I testicular seminoma diagnosed between 1982 and 2005 at Princess Margaret Hospital. Patients were followed on a predefined schedule with physical examination (PE), serum tumor markers, abdominopelvic computed tomography, and chest x-rays. The records of patients who relapsed were examined for details of imaging and serum tumor markers throughout the period of follow-up until the time of relapse.
  
  
  RESULTS
  Of the 527 patients who were managed by surveillance, 75 patients (14%) relapsed at a median follow-up of 72 months. Of these, 65 patients relapsed within the first 3 years and had routine serum tumor markers measured. In total, 11 patients had abnormal tumor markers at the time of relapse (AFP, 0 patients; HCG, 6 patients; LDH, 4 patients; and HCG and LDH, 1 patient). Only 1 patient had an elevated tumor marker (LDH) before relapse, as defined by an abnormal imaging study (n = 64) or physical examination (n = 1), for which the treatment and outcome were not affected.
  
  
  CONCLUSIONS
  Serum tumor marker levels did not aid in the early diagnosis of disease relapse in patients with stage I seminoma who were managed with surveillance. The current results indicated that routine measurement of serum tumor markers can be discontinued safely in seminoma surveillance schedules.
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Vesprini
authors.forename: Peter
authors.initials: P
authors.lastname: Chung
authors.forename: Shaun
authors.initials: S
authors.lastname: Tolan
authors.forename: Mary
authors.initials: M
authors.lastname: Gospodarowicz
authors.forename: Michael
authors.initials: M
authors.lastname: Jewett
authors.forename: Martin
authors.initials: M
authors.lastname: O'Malley
authors.forename: Joan
authors.initials: J
authors.lastname: Sweet
authors.forename: Malcolm
authors.initials: M
authors.lastname: Moore
authors.forename: Tony
authors.initials: T
authors.lastname: Panzarella
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sturgeon
authors.forename: Linda
authors.initials: L
authors.lastname: Sugar
authors.forename: Lynn
authors.initials: L
authors.lastname: Anson-Cartwright
authors.forename: Padraig
authors.initials: P
authors.lastname: Warde
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D006063:Chorionic Gonadotropin / Q000097:blood*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D012008:Recurrence; D018239:Seminoma / Q000175:diagnosis*; D013736:Testicular Neoplasms / Q000175:diagnosis*; D057832:Watchful Waiting; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D007770:L-Lactate Dehydrogenase