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partial orchiectomy, path report shows tumor in biopsies... now what?

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  • partial orchiectomy, path report shows tumor in biopsies... now what?

    greetings and strength to all. it sucks to even be here, but makes me feel stronger if you can all deal with this too.

    i had a skin infection, the doc felt my testicle and said it felt small and i should have it examined. i got an ultrasound and it turned out to be small or atrophic - but meanwhile, the other testicle had a mass in it.

    we watched it for 3 mos., negative tumor markers, and when it grew, did a partial orchiectomy (testis sparing surgery) on feb 7 2007. it was classic seminoma. no l/v invasion. maybe some rete teste invasion. tumor size around 3.5 cm.

    the problem is, the bed biopsies had frank tumor in them. although the surgeon burnt the area, therefore, there is probably still tumor inside me. ct scan was clear and chest x ray normal.

    so here we go, what to do next.

    most all the docs i have consulted say orchiectomy, then surveillance. no one seems to ever have radiated just one testicle before. i am asking them why not do two courses of carboplatin and not do the orchiectomy, and do surveillance, monthly ultrasounds the first year, etc. - then do the orch. if anything grows.

    my main doctor, who is very conservative, thinks we can "get away with that" but would be most comfortable with the orchiectomy.

    no one seems to know or want to bet if carboplatin can kill frank tumor in the testis. it seems to do so in the retroperitoneum, and may work on CIS in the testes. but the safest thing to do seems to be orchiectomy.

    again, my "good" testicle is atrophic. i banked sperm already. my testosterone was 630 pre op (normal scale 245 to 1000) and is now 362 post op. i guess i can assume i would be on testosterone replacement therapy postop.

    what would you guys do?? i think i would be as scared of recurrence having just done the carboplatin and no orch. as i would be with the orchiectomy and just surveillance after.

    i am stumped, all these doctors are brilliant, but they don't have a lot to add.

    my best, roberto

  • #2
    I can see the logic behind either an orchiectomy or strict surveillance now. I don't follow the reasoning for carboplatin at this time in your situation. Have you consulted with a testicular cancer center of expertise?
    Scott, [email protected]
    right inguinal orchiectomy 6/5/2003 > nonseminoma, stage I > surveillance > L-RPLND 6/24/2005 for recurrence, suspected teratoma but found seminoma, stage II > chylous ascites until 9/2005 > surveillance and "all clear" since


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    • #3
      thanks scott

      the docs handling me are from ucsf and they are top notch. no one is suggesting just surveillance because it seems to all that frank tumor was left inside. it's either orch and surveillance, orch and carboplatin, or, as i am suggesting, carboplatin and surveillance...

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      • #4
        Originally posted by roberto
        the docs handling me are from ucsf and they are top notch. no one is suggesting just surveillance because it seems to all that frank tumor was left inside. it's either orch and surveillance, orch and carboplatin, or, as i am suggesting, carboplatin and surveillance...
        Carboplatin would have little, if any, effect in a tumor behind the blood/testis barrier. And it is not true that it can kill frank tumors in the retroperitoneum. In fact, it is fairly ineffective in that setting. It seems to work well for adjuvant therapy, but remember, that is for micromets.


        And the jury is still out on whether it can kill CIS. In fact, it's not even a treatment for CIS, while radiation is. Perhaps you should explore radiation as an option... There have been a couple of papers using it to kill frank tumors. You get to keep the testosterone producing capacity of your testicles, but you will absolutely lose fertility. Maybe worth a shot. I can forward you a link to the papers if you are interested.

        Best,

        DJM
        Detected mass 10-6-06, Radical left I/O 10-10-06, Stage I seminoma, 1.5 cm primary, No LV invasion, No Rete Testis Invasion... Currently on Surveillance.

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        • #5
          thanks djm,

          i am very interested, but was told that radiation would fry my testicle, leaving no sperm production as you noted (not an issue, i have sperm banked) but also frying leydig cell/testosterone production. also was told there was some concern about scatter to the other testicle.

          i just talked to a friend of the family who is a radiation oncologist and am backing away from carboplatin - like scott suggested, chemo is only indicated when it is indicated. i just don't want to have another surgery if i can avoid it, and dont want to use tesosterone replacement if i can avoid it...

          thanks again

          roberto

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          • #6
            Well your current T level warrants TRT but that is a personal choice and totally up to you.

            If you were to have radiation on your testicle it would kill sperm production in both, but you would still have some leydig cells although your T level would drop furthur than what it is now, but if you had an orchiectomy it would obviously also drop. I cant say which one would drop it more.

            Sertoli cells are way more radiosensitive than leydig cells, but I havent read much about it.
            If you really dont care about sperm production then I cant think of a reason why you shouldnt have radiation therapy unless there are undocumented effects from it such as prostate and penile damage.
            Also keep in mind radiation sickness may be less convenient than surgery.


            If you do a search you will find I brang up the subject on carboplatin instead of I/O and I posted some pubmed articles on it, I cant remember if it does kill CIS or not.
            Aged 23 ;; 09/06 left I/O ;; Markers normal ;; 100% Seminoma Stage 1. ;; 10x8x16mm & 7x7x8mm ;; rete testis invasion. ;; no vascular invasion. ;; surveillance. ;; HRT.

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            • #7
              thanks all. i feel ok, my libido is down i think. i think i am moving towards the orchiectomy, have it scheduled for next monday. then surveillance and TRT. all your comments were on point. thanks a lot chris.
              roberto

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              • #8
                Fyi

                BBC, News, BBC News, news online, world, uk, international, foreign, british, online, service
                Detected mass 10-6-06, Radical left I/O 10-10-06, Stage I seminoma, 1.5 cm primary, No LV invasion, No Rete Testis Invasion... Currently on Surveillance.

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                • #9
                  Sounds like good news, but note the quote, "We will need to follow patients for several more years before we can be certain that tumour recurrence has been prevented rather than just delayed..."
                  Scott, [email protected]
                  right inguinal orchiectomy 6/5/2003 > nonseminoma, stage I > surveillance > L-RPLND 6/24/2005 for recurrence, suspected teratoma but found seminoma, stage II > chylous ascites until 9/2005 > surveillance and "all clear" since


                  Your donation funds Livestrong services for people facing cancer now. Please sponsor my ride!

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