The Testicular Cancer Resource Center

Testicular Cancer Treatments: After Treatment


One of the most common questions we hear on TC-NET is "My treatment is done. Now what?" Well, while the active part of the treatment process is behind you, you still need to have a regular check-up regimen (called a surveillance protocol) to make sure that the cancer is really gone for good - and guys unfortunately have a well-earned reputation for not following all the way through with surveillance protocols. Remember, just like initial diagnosis, the earlier a recurrence is detected, the easier it will be to treat it successfully.

With that in mind, here are our generic surveillance recommendations. They should be thought of as suggested follow-up procedures for standard situations, and they should not be thought of as the ONLY possible surveillance protocol. Individual circumstances may force a change in the protocol - but at least you will have a basis to work from. In general these protocols are pretty conservative (read: frequent) - but this IS cancer we're talking about, so being conservative is not necessarily a bad thing to shoot for. Our thanks to Dr. Craig Nichols of Providence Cancer Center and Dr. Mary Gospodarowicz of Princess Margaret Hospital in Toronto for their assistance in providing the data and reviewing the content of this page.

Before we start, there are a couple of things you should know:

While not specifically mentioned in the surveillance protocols listed below, a physical examination by your oncologist should coincide with all of your testing. A physical exam is necessary because you cannot always rely on the blood tests and CT scans. The idea that the CT "sees" everything is simply not true. Dr Nichols describes the physical exam as follows:

"The primary goals of physical exam are to assess areas not well evaluated by CTs, to evaluate any new symptoms, to assess potential toxicities of treatment and to evaluate the remaining testis for second primary tumors. Accordingly, I recommend that, at a minimum, vital signs be taken (especially blood pressure), an exam of the neck be done to assess for lymph nodes (especially supraclavicular nodes), palpation of the male breasts be performed to rule out gynecomastia, examination of the orchiectomy and other surgical scars should be done and, especially, a thorough examination of the remaining testis should be performed. This also gives the opportunity to query the patient regarding symptoms like sexual function, back pain, shortness of breath, fatigue, social function and other issues that may impact on survivorship. The exam obviously would be expanded if new symptoms are reported."

Our recommendations are divided by type of testicular cancer, stage, and treatment given.

Clinical Stage I Nonseminoma - Treated with Surveillance only
Note: "Clinical" refers to the diagnosis being based on clinical data (pathology, markers, xrays)

Pathological Stage I Nonseminoma - Treated with RPLND only
Note: "Pathological" refers to the diagnosis being based on physical evidence (in TC usually via RPLND surgery)

Pathological Stage II Nonseminoma - Treated with RPLND only

(Please note that this protocol is appropriate if you had a good RPLND where all the lymph nodes in the template were removed as a single package. If your RPLND was not done in this manner, you might want to discuss a protocol that uses an occasional CT scan in addition to the tests listed here.)

Pathological Stage II Nonseminoma - Treated with RPLND and 2xBEP

(This is a difficult protocol to specify: On the one hand, 2 cycles of BEP chemo will not make up for a bad RPLND. If you feel that you fall into this category, you might want to discuss a more frequent protocol that uses an occasional CT scan in addition to the tests listed here. On the other hand, patients in this category treated at IU essentially never relapse, so this protocol may be overkill.)

Stage II or Stage III nonseminoma - Treated with Chemotherapy, cancer in remission:

For Good Risk cancer (seminoma; nonseminoma with AFP < 1000 ng/ml, hCG < 5000 mIu/ml, or LDH < 1.5 times the upper limit of normal; no liver, bone, or brain metastases; gonadal or retroperitoneal primary tumor)

For Poor Risk cancer (nonseminoma with AFP > 10,000 ng/ml, hCG > 50,000 mIu/ml, LDH > 10 times upper limit of normal; mediastinal primary site; bone. liver, or brain metastases; advanced lung metastases)

*** An abdominal CT should be done twice a year for those patients who had large volume teratoma.

Clinical Stage I Seminoma - Treated with Surveillance only

Princess Margaret Hospital Protocol

Nichols protocol

Clinical Stage I Seminoma - Treated with Adjuvant Radiation

Princess Margaret Hospital Protocol

Nichols protocol

Stage II Seminoma - treated with Radiation

Princess Margaret Hospital protocol

Nichols protocol

Stage III or IIb Seminoma - treated with Chemotherapy

Nichols protocol


More questions? Ask away!

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This page was last updated on Dec 05, 2012
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