Surveillance or Radiation Treatment??

[frjw]

I recently was diagnosed with a tumor in my left testicle. I had a left side orchiectomy on June 15. The pathology report indicated it was stage one seminoma. (Prior to surgery I had an ultrasound, CT Scan and blood work....the CT Scan indicated only the tumor in the testicle, the blood work indicated that my LDH level was abnormally high (around 700).

The urologist/surgeon stated that all indications (serum markers??) indicated that all the cancerous cells/tumor was removed.

In meeting with the oncologist, she stated I had 3 options: surveillance, radiation of about 15 treatments of low dosage, or a couple treatments of chemo.

As I understand, the treatment with radiation is only being recommended in case some microscopic cells happen to remain and the cells are sensitive to it. She stated I can opt for surveillance only but I will have to have more check ups (CT scan, chest xrays ect, blood work--3 times per year ect).

I am struggling with which option (ruled out chemo)...radiation or surveillance. I am a strong proponent of gylconutrients and have increased my amounts prior to surgery and afterwards. I read where 85 % of the people who had a left orchiectomy and took radiation did not really need to do the radiation.


I would appreciate advice on benefits/concerns with surveillance or radiation treatment. I would really like to hear from someone that chose surveillance and the procedures they followed. I want to be confident in my decison.

An additional question is, how come I did not have a follow up CT scan, blood work after the surgery? (The initial CT scan indicated no signs of cells outside the tumor in the left testicle). Should I request post op CT scan or blood work? How do you know your body is responding to the radiation treatment anyhow?

Thanks.

[Fed]

Hey man,
Welcome to the Forum. You will find here plenty of people that have faced the same dilemma you are dealing with at the time.

I myself was diagnosed with stage I seminoma. In fact, my diagnosis was pretty much identical to yours, except that my LDH was only on the high end of normal. I was originally dead-set on getting adjuvant radiation, but a large group of docs (my first med onc, the rad onc, my second opinion from Sloan, my current med onc, and my urologist) said that, in my case, RT would be overkill. This is for two reasons: 1) no LV invasion and 2) no rete testis invasion. Without those two factors, they said that it would be better to be monitored very closely. My current regimen is abdominal/pelvic CT scan, chest X-ray, and blood markers every 4 months. I also get an ultrasound every 6 months on lefty (the remaining guy) because there is a tiny "thing" (3 mm) that no one can explain what it is, so this is just to be cautious. Other than the anxiety surrounding lab time, surveillance has suited me well. If I were to relapse, I know that I still have a huge arsenal at my disposal to beat this. Under surveillance, there's an 80-85% chance that I'm already cured with the I/O alone. Had I gotten RT, the chances of cure would have sky-rocketed to 98%; however, there is evidence in the literature of a higher incidence of secondary cancers due to radiation. I should note that this is a long term effect (i.e. if that would happen, it would be about 20 years from now).

You basically have to do what makes you feel most comfortable. I'm sure you will hear plenty of opinions from people here. Just do what you consider best for your situation. Are you getting your LDH drawn again to make sure it has gone down?

Keep us posted. We're pulling for you!

[rjs]

I had a very similar diagnosis to you and was presented with the same options. It can be a little overwhelming since everything involves percentages. Ultimately, you have to go with what you know you can handle and what feels right for your unique situation (every situation is unique). I approached the decision by wanting to do everything I know I could do NOW and that meant taking radiation route. I have no regrets. In the end, the chances of a secondary cancer from exposure to radiation is so low that it is almost not worth thinking about. In my mind, the percentage of a recurrence from following surveillance was higher than any issues in the long term from radiation. But that was the way I rationalized my decision and you will need to come to your own decision through your own process. The great news is that with seminoma, as long as you are consistent with check-ups (either with surveillance or post-adjuvant treatment) then if anything were to come back then it can readily be taken care of. There really is no wrong decision here. Only what you are most comfortable doing and are willing to commit to following. Hang in there. The hard part (finding out you have cancer) is over. Now keep educating yourself, pick the right path for you and keep living your life!

-rs

[fuse929]

Not sure if you got them, but I responded to your PM's about this topic.

[frjw]

Thanks

Thanks for the various angles and views.

I talked with my oncologist today and she explained (or re-explained) that my blood work (prior to surgery) for the first two markers were normal, it was only the LDH that was elevated indicating a tumor was growing at the time.

She described the seminoma at stage 1a. Thus I find it challenging to go through radiation.

Once again thanks for your advice and input it is helpful. Yes Fuse929 I rec'd your messages...thanks.