Seminoma: Surveillance or radiation?

[tc2006]

Thanks to you all, it is so good to hear from people that have been in a similar situation. Sometimes, I find it just overwhelming listening to the doctors - not that they are not competent, but they all have their opinion, and at the end of the day, you are alone making the decision.

IowaBrian, thanks for the link. I will definitively check it out.
Eric, your comments are very interesting. I actually thought a lot about the long term chances of getting a second tumor, but then again some people are telling me not to worry about tomorrow .. just get the seminoma treated today. Did you have any cancer in the family when you decided to do radiation, or was that not an issue?
Krokar, I have been thinking about the psychological stress of doing surveillance (somewhere I read that with surveillance, you can't be sure for up to 10 years or more if the cancer returns) - and also about the chemo that may be needed if I do relapse. My doctors said that b/c of the large size tumor, I am probably at 'high risk' to relapse, so I guess I am trying to rationalize whether the radiation really reduces my risk to relapse or not. The enlarged nodes make me nervous too - the doctors tend to think they are not metastasis, but maybe merely enlarged due to the orchiectomy. But then again, they are only on the right side which is where the tumor was ... the problem seems to be that with nodes under 1cm, the CT can't really tell what it is. I've been thinking about getting another CT before deciding what to do next ... do you guys think that would make sense, 4 weeks after surgery?
Kurt Hansen, how big was your first tumor? And why did the doctors put you on radiation back then, was surveillance not an option in 1984? Was chemo discussed when your cancer came back? How are you coping with the psychological stress of surveillance?

How real do any of you think the long term risk of radiation to develop a second cancer really is? My doctors talk about a less than 1% chance, but I read a post from somebody in this forum (TSX?) who said the chances are really more like 10% !?!

Anyhow, I'd like to thank all of you (and the rest of this great forum) for sharing your experience and taking the time to comment on mine. I hope things will work out ok for every one of you.

[IowaBrian]

Here is a good article or guidelines that is linked in the library section

http://www.nccn.org/professionals/physician_gls/PDF/testicular.pdf

It is in PDF format so it might take a little while to download but it is very good reading.
Brian

[Eric]

I think you should choose surveillance.
Radiation does not garantee a 100% cure(maybe 97%).
You should wait and if cancer spread i suggest chemo that give you less chance of getting another cancer. In 2001 i had radiation and i thought it was gone but 4 years later i had to go on chemo. Now i am fine but i had both treatment that raise my chances to get a second cancer. I think that a lot of doctors have change their opinion about radiation because some reduced chemo protocol do the same results with less long term effect.
I think radiation should be used only if you know that cancer is localized at just one place in your body, but not in adjuvant treatment because the chances are high that you receive unnecessary radiation.

[Krokar]

Hi,
it depends from country to country what they recomend but surveillance is for someone with good nerves I think. You can find many many discussions also on this forum and research articles comparing all treatement methods. In practice you can choose between surveillance, radiation or chemo with Carboplatin, even it is not still very popular in USA. Result is always cure rate near 100% and this is the best to know.

I don't know why they said to you that those enlarged nodes are probably not cancer ? Did they made a biopsy or they are not enlarged anymore ?

[kurt Hansen]

Hi
Here is my storie I have lost both my testicles and both times seminoma stage 1 first time in 1984 and second time 2 years ago.
In 1984 I had radiation and this time I am on surveillance.
My tumor was 4 cm and the hospital told me that when the tumor is less than 6 cm they put you on surveillance, in Denmark you don`t get to choose
yourselves,they tell you what to do.
I have no problems with surveillance I wish that I had been on that in 1984 too, I know the risk but altso know that I can be cured if I get cancer again.
But ofcourse you must listen to your doctor they know best what to doo.

[tc2006]

Hi,

I am a brandnew member in this forum, but have read several threads and found them very helpful. I've been recently diagnosed stage I seminoma (despite a couple of nodes <1cm on my CT which I was told were probably not cancer), have orchiectomy behind me, and am now looking for information that could help me decide whether to choose surveillance over radiation, or vice versa, after orchiectomy. I have been told surveillance is becoming more popular especially in Europe these days, but have yet to find somebody with seminoma who has done it; most urologists in the U.S. seem to recommend radiation. My tumor markers were negative pre-OP, and my pathology is fairly clean (tumor confined to capsule). However, the tumor was pretty large (>5cm), and so I wonder whether I shouldn't almost 'count on' a relapse and hence rather do radiation. Can anybody in this forum provide any guidance? Thanks.