Another one...

[fabryx]

Dear All,

I've found this forum surfing the internet and it's really very interesting
for someone that just discovered the TC hell!

ok.. let's start from the beginning..
I'm a little bit hypocondriac and the 29th july while surfing the internet
I've found a page that was describing the TC.
While I was checking my testicles I've noticed that my left one was smaller
then the right one.. and it was strange.. (different from the other one)
So the next monday I went to the doctor .. that told me that it was normal...
Since I was not convinced I decided to go to a urologist the day after (31th)
and he found me the TC!
Everything was very fast..
I was on surgery the day after (1st Aug) and now... after that I've all the
results of the exams, I've to take a difficult decision:

Radiotherapy or Surveillance?

I was diagnosed with:
SEMINOMA on left Testis
Dimensions are 9mm
It's confined in the testis (no invasion)
The CT Scan is negative
The markers are negative
I'm 36 year old

My urologist is suggesting RT.. while the oncologist is suggesting
surveillance with CT scan/ Markers / and chest Xray every 2 months for the
first 6 months then every 6 months for 3 years.

Does someone here have a similar experience?

Sorry for my poor english.. but I'm Italian :-)

thanks.

[Mom]

Hi and welcome to the forum. I am responding to you as a caregiver. Both my husband and son had TC and for all intents and purposes are cured. The moderators are away right now attending the Lance Armstrong Foundation Challenge in Philadelphia or on vacation or attending a conference so you are stuck with me for the moment but believe me you will be hearing from them shortly. If you can find the posts by Fed, one of our moderators, you will find that he had a similar diagnosis faced with a similar decision and chose surveillance, but you will see others who chose radiation. There really is no wrong choice, it has to be one you are comfortable with. I can understand the difference in opinion regarding your treatment because your tumor was very small and you have no invasion. I applaud your doctors for their quick diagnosis and response. Ciao! Dianne

[Karen]

Welcome to the forum. It really is amazing how you ended up going to the doc and being diagnosed! 9mm is quite small and chances are you caught it early enough that the I/O cured you. The decision to go the surveilance or RT route is a personal choice. Both are acceptable. RT is more aggressive in case there is any micrometastesis. You will still have regular follow-ups after RT, although they are not as frequent as surveillance.

You mentioned that you are a bit of a hypochondriac. Consider what your emotional/mental tolerance will be for a "watch and wait" approach with surveillance. Waiting for results from follow ups, thinking every ache and pain is a recurrance can really mess with your emotions. As I said, either choice is acceptable from a TC perspective, but you may need to consider the emotional choice as well as the physical.

Please keep us posted!!! We have a number of members in Italy.

[fabryx]

thanks for the quick answers!

Yes it's true.. my doctors was very quick and the surgery was also not too painful..

I'm considering the surveillance since my oncologist told me that even with the RT there's not 100% possibility that I'm cured!

[Margaret]

thanks for the quick answers!

Yes it's true.. my doctors was very quick and the surgery was also not too painful..

I'm considering the surveillance since my oncologist told me that even with the RT there's not 100% possibility that I'm cured!

I am very happy to hear this news. Cured is a wonderful thing!!! Stay here and support others if you can, you will find this family to be a blessing in your life.

[Scott]

...my oncologist told me that even with the RT there's not 100% possibility that I'm cured!

While that's true, there's not much in life that is 100% guaranteed.

As other members have said, either surveillance or radiation therapy is appropriate, and you can work with your doctors and learn from the experience of other survivors to make the right choice for you.

[dadmo]

fabryx:
Both surveillance and RT are reasonable choices. My opinion on what I would do has changed as I have gained more knowledge about this disease. A few years ago I would have wanted treatment right away, just to make sure the cancer was dead. Now that I understand how effective close surveillance can be I would hold of on RT/chemo until I was sure it was needed.
You have no bad choice here. My only other comment is that surveillance can be very stressfull and not everyone is comfortable with "watchful waiting".

[fuse929]

I had a similar diagnosis and chose surveillance. It is stressful near check-up time, but I would rather that than unnecessary radiation.

[Fed]

Buon Giorno!

I really don't have much to add, since everyone else that has responded to your post has covered everything. If it adds anything, I, like you, had seminoma stage I-A. I originally was set on getting radiation, but all my doctors were against it because it could potentially result in "overtreatment". With surveillance and a case like yours, your chances of a relapse in the next five years are 15-20%. The important thing is that if you choose this route, you should never miss a follow-up. My usual schedule is CT scan, chest X-ray and tumor markers every 4 months for the first 3 years (every 6 months in years 4-6, and yearly thereafter).

You really have no bad choices, so whatever you choose, rest assured you will be fine. In bocca al lupo!

[fabryx]

Thanks to everyone for the answers!

On Monday I've an appointment with another Urologist just to have a third opinion.
I've read many articles.. and I think that I will go for surveillance... the oncologist told me that the first 6 months I've to do CT Scan and Xray every 2 months.
It seems that there's a new algorithm to decide if surveillance is the right approach:

"
Approximately 80% of patients with clinical stage I seminoma are cured with orchiectomy. In spite of this, treatment recommendations in many countries favor the use of adjuvant treatment, such as para-aortic radiotherapy, in all patients. Such a strategy accepts the possibility that 80% of patients could be overtreated. Canadian and British investigators retrospectively evaluated risk factors to predict those 20% of patients at risk of relapse, and identified rete-testis invasion and a tumor size of >4 cm as significant factors in multivariate analyses.1 The Spanish group that conducted the present study should be congratulated for being the first to use these risk factors prospectively in clinical decision-making.
"


I will keep you posted!..

On another topic... is the LAF present in Italy?.. I would like to help in some way..

thanks.
Fabrizio.

[Fish]

Hi Fabrizio:

My second TC was seminoma and I chose surveillence. Although checkups are stressful, I am happy with my decision.

I had all factors suggesting low chance of recurrence:
age > 35
No angiolymohatic or rete invasion
tumor < 4 cm

The oncologist estimated chance of recurrence at 6%.

I decided that I only wanted radiation if I knew I needed it.

4 years out - so far, so good.

Best of luck.

[fabryx]

Acne...

Dear Experts,

I'm writing in this thread because there are all the informations about me.. maybe this is the wrong area.

After the testis removal, I've noticed that I had an increase of ACNE..(on the face) is this related?..
Also I feel a strange energy... I'm going to gym 2 time a week.. but I don't get tired as before.
This is not a problem... but it's different from just 1 month ago.

Did you had a similar experience?

[petep]

it's tough to know if the change is in the head or real...

but I do know the docs told me post IO and also post chemo, my hormone levels would be fluctuating...I never had benchmarks to see how they fluctuated...but I could tell just from facial hair that they must have been moving around...

pete

[Mom]

When my husband started on his testosterone replacement therapy he got acne on his back and it was pretty bad. As soon as the dose was adjusted he was fine. When my son went through chemo he had something similar to acne, almost like chicken pox, and his doctor gave him something and it went away. It is a good guess that your hormones are in flux. Give it some time and if you don't get back to normal you might have your doctor refer you to an endochronologist.