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Seminoma surveillance- elevated b-HCG

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  • Seminoma surveillance- elevated b-HCG

    I was diagnosed Pure Seminoma w/ no invasion in May 2006. I am 27, had tumor crossectionally >4 cm removed and have elected to follow surveillance for now. Pre-surgery b-HCG was 914 and AFP was normal.

    Initially my indicators were good. Near normal b-HCG and negative CTscan. Since then my b-HCG has remained elevated (2-4) but CT and PET scans have remained negative. My oncologist and radiation oncologist have both recommended treatment (RT and Chemo). Both have suggested that there is a 30-70% chance nothing is wrong with me but treatment would ultimately resolve any doubt about either a naturally high level of b-HCG or remaining TC.

    I have continued blood tests (b-HCG and AFP) on a weekly to bi-weekly basis and I have had two CT-scans and one PET scan since May 2006. The b-HCG plot peaked in Sept at 5.5. It has since falling back to an average of 3.4. AFP has registered one elevated reading at 6.2.

    A few questions:
    1) How common is a naturally elevated b-HCG?
    2) Is it proper to treat on elevated b-HCG alone? Is more evidence necessary?
    3) Is there harm in waiting for the b-HCG to hit a milestone (say 10) before initiating treatment?
    4) Are there threads I am missing that discuss a similar situation?

    Thank you for any help.

  • #2
    Your not even elevated, normal range is 0-5.



    1) How common is a naturally elevated b-HCG?
    they said 30-70%, and from my experience I would say it was more like 70% chance nothing is wrong with you, they will try encourage you to get treatment for whatever reason, so personally I would ignore this elevation until it goes over 5, provided your morning total testosterone level is above 650ng/dl
    2) Is it proper to treat on elevated b-HCG alone? Is more evidence necessary?
    Elevated hCG can be caused by low testosterone, or marijuana use. So I would get yours checked.
    3) Is there harm in waiting for the b-HCG to hit a milestone (say 10) before initiating treatment?
    I doubt it, you were at 900, so whats 5 or 10?
    4) lots http://www.google.com.au/search?hs=4...G=Search&meta=
    Last edited by Michael112; 11-24-06, 02:43 PM.
    Aged 23 ;; 09/06 left I/O ;; Markers normal ;; 100% Seminoma Stage 1. ;; 10x8x16mm & 7x7x8mm ;; rete testis invasion. ;; no vascular invasion. ;; surveillance. ;; HRT.

    Comment


    • #3
      I also don't think your hcg is elevated, and I'm not sure why your doctors are referring to it as elevated. I'm not sure any of the TC experts would recommend treatment at your hcg level with no evidence of metastatic disease based on your normal CT and PET scans. Now if you had a continuously rising HCG level that would be a different case. Plus as Michael indicated there can be other causes of increased hcg levels (but yours really aren't elevated. Don, one of our moderators, had a rising hcg a few months back, then it returned to normal, check out this link http://www.tc-cancer.com/forum/showthread.php?t=3285

      I suspect you're fine for the time being, you could always contact Dr. Einhorn at Indiana University for a second opinion.

      Dr Lawrence Einhorn
      Dept of Medicine
      Phone: (317) 274-0920
      Fax: (317) 274-3646

      Best wishes.
      Fish
      TC1
      Right I/O 4/22/1988
      RPLND 6/20/1988
      TC2
      Left I/O 9/17/2003
      Surveillance

      Tho' much is taken, much abides; and though we are not now that strength which in old days moved earth and heaven; that which we are, we are; one equal temper of heroic hearts, made weak by time and fate, but strong in will; to strive, to seek, to find, and not to yield.

      Comment


      • #4
        there are several things that can cause elevated b-hcg -

        I rec'd an email from einhorn once stating he would never start a patient on chemo if the only indicator was bhcg < 10.

        As it happened I did have a mass in my lymph nodes but the bhcg showed up before that...I peaked at 4.6...but it was 0 pre and just post surgery..

        one protocol calls for an injection of testosterone...if the only sympton is elevated bhcg...somee studies have shown and einhorn confirmed this for me...that some males with no cancer at all have bhcg levels greater than 0...interesting because many sites out there say males never, ever, ever have any bhcg...

        they key is to keep having the markers checked, look for changes and your docs will continue the chest xrays and ct scan if they suspect something.
        - lump first noticed 11/20/2005
        - I/O right Dec 8, 2005
        - 95% embryonal / 5% seminoma
        - normal markers PRE surgery
        - no vascular invasion, tunica free of cancer, epididymis free of cancer, lungs free, lymph free
        - Stage I diagnosis
        - surveillance
        - mid feb '06, beta hcg slightly elevated = 4.6...small enlarged lower node seen on CT scan...
        - 3BEP began feb 20, 2006
        - finished 3 BEP, last bleo, april 17, 2006
        - CT scan, blood markers, chest..all clear
        - back on surveillance

        Comment


        • #5
          Thanks to you all for the educational responses. This is wonderful resource for anyone associated with TC. I am in line for a 2nd opinion at IU. I will keep you all posted on the outcome.

          -Ben

          Comment


          • #6
            Originally posted by Michael112
            Your not even elevated, normal range is 0-5
            The "normal" range depends on the lab. The one we use has a reference range of 0 - 2.0. Ray was 5.6 pre I/O. Don's thread that Fish pointed you too was a steady rise until he started testosterone supplements. Glad you're getting a second opinion....good luck!!!
            Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

            Comment


            • #7
              Elevated B-hcg

              Hello all,

              My husband had pure seminoma 7 months ago, his left testicle was removed, it was self confided, no spread or anything. After that we chose surveillance as opposed to our doctor who suggested one dose of chemo but my husband decided on surveillance ever since every 2 months he is having his blood tests, cancer markers, CT scan, the results were all fine until our last check, his AFP, LDH was perfectly fine but B-HCG was 43.5 now, which was 1 to 1.5 on the previous checks, we have been reading about all you were writing, our doc suggested he will have his bcg test every month if it is still same levels, he will have pet scan, his ct scan was perfectly clear this time and last time. we are worried he might have the recurrance, is 43.5 level of bcg so high you think

              thank you all, very happy to find this forum as it is so informative and helping
              ebru
              Aug 2006 - Markers normal, mass found on ultrsound
              One day later - left I/O
              pure seminoma stage 1A no vascular invasion or lymphatic envolvement
              Surveillance every three months = CT & blood clear
              April 2007 CT clear but Bhcg 43, other markers normal.
              re tested every 10 days stayed around 46
              May 2007 Pet/CT scan all clear, bhcg 90 other markers normal, PLAP normal
              monitoring Bhcg every 10 days

              Comment


              • #8
                ebru,
                Welcome to the forum. Go back a few posts and read the thread fish pointed folks to (Don's posts). The b-HCG should be checked again but he needs his testosterone levels checked as well. My husbands doc also checks FSH and LH if there is a spike in b-HCG. Keep us posted and good luck!
                Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

                Comment


                • #9
                  elevated bhcg

                  hello all,
                  I wanted to let you know that after our blood test my husbands bhcg level decreased from 43 to 23, so this shows it is going to a positive direction, we asked our doc if we should check his testostorone level he said even if it is low or high it does not give us the real answer so he suggests we keep checking on bhcg every 10 day, we are going tomorrow again hopefully it will go down more
                  I will keep you posted

                  many thanks for sharing
                  ebru
                  Aug 2006 - Markers normal, mass found on ultrsound
                  One day later - left I/O
                  pure seminoma stage 1A no vascular invasion or lymphatic envolvement
                  Surveillance every three months = CT & blood clear
                  April 2007 CT clear but Bhcg 43, other markers normal.
                  re tested every 10 days stayed around 46
                  May 2007 Pet/CT scan all clear, bhcg 90 other markers normal, PLAP normal
                  monitoring Bhcg every 10 days

                  Comment

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