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Is round four really necessary?

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  • Is round four really necessary?

    My 24 year old son was diagnosed with stage 3 TC. We go inhouse Monday for round four. On May 15th, his AFP was at 975. On June 19th, before he started round three, it was at 14. If the magic number is under 25, then why give a 4th round? Why not do test now, like PET and MRI, to see if it's all gone? I have asked this question and didn't get a real answer. Just we don't test again until after treatment. I don't get it. Why give more meds than needed?

  • #2
    I believe the normal range for AFP is 0-6 so 14 would not be normalized yet.


    • #3
      At stage 3 four rounds have been proven to be needed to insure they get it all & there is little chance for recurrence. This chemo has a very high success rate, it's best not to take chances.

      Jan, 1975: Right I/O, followed by RPLND
      Dec, 2009: Left I/O, followed by 3xBEP


      • #4
        I don;t know the details about your son but the decision to do BEPx4 vs. BEPx3, for example, is based on the patient's prognosis of advanced disease. The prognosis is basically Good, Intermediate or Poor (there is no Poor prognosis for seminoma though). This is based on the patients origin of the germ cell tumor, the extent of metastasis and the tumor markers. The decision to add or subtract rounds really isn't made once treatments are started because it is due to that initial data.

        Oct. 2005 felt lump but waited over 7 months.
        06.15.06 "You have Cancer"
        06.26.06 Left I/O
        06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
        06.30.06 It's Official - Stage I Seminoma
        Founded the Testicular Cancer Society
        6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

        For some reason I do not get notices of private messages on here so please feel free to email me directly at [email protected] if you would like to chat privately so as to avoid any delays.


        • #5
          Just because markers have (nearly) normalized after three rounds, and even if CT scans are clear at this point, it doesn't mean that all of the cancer has been killed just yet. The last round is meant to finish off whatever might be left, that might not be detectable on scans or blood tests. Going with only three rounds if the initial diagnosis and staging (and risk assessment) pointed to four is asking for trouble and increases the odds of a relapse. You would want a very well known TC expert like Dr Einhorn or others to weigh in, and sign off on skipping a round. I don't think it would happen unless the patient was facing life-threatening side effects from the treatment (rare), or if they didn't agree with the initial staging or risk classification, and felt like BEPx4 was over-treatment.
          Young Adult Cancer Survivorship by Steve Pake
          April is Testicular Cancer Awareness Month!

          Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
          My Survivorship Thread | All of my Blogs


          • #6
            Everyone has explained it. You can always email Dr. Einhorn for another opinion. Almost done with chemo.Hang in there mom!
            Son Grant
            dx 12/21/16 at age 17

            BEP x3
            Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
            2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
            Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.


            • #7
              Thank you for your answers. The meds are messing with him some. The bleo causes side effects like shaking and fever, and is messing with his oxygen intake. He had his last one this week, they are stopping it for round four. Last week they said protein is leaking into kidneys. Probably from cisplatin. I read that should be temporary, would just rather not do five more days, if it isn't needed. I know I don't have much choice, other than to trust them.


              • #8
                Shake & bake is a common side effect of Bleo. I had it in one of my earlier rounds & they gave me a single tylenol before each additional round & I never had another bout of it. Others have reported that an antihistamine helps.

                With stage 3 TC, I would not be comfortable eliminating Bleo in round 4. To the best of my knowledge, the shaking & fever are not dangerous, just [email protected] uncomfortable.Shortness of breath is pretty common during BEP, mine took a couple of months to improve after I was done, but I ended up being able to hike further & faster than pre-chemo (it did take some effort to get there).

                My advice is to do everything possible to get rid of his TC now. While there are treatments for recurrences, my understanding is that they are more difficult to get through, & somewhat less likely to succeed.

                Jan, 1975: Right I/O, followed by RPLND
                Dec, 2009: Left I/O, followed by 3xBEP