Improved staging for testicular cancer using biologic tumor markers: a prospective study

The effective use of surgery, chemotherapy and radiation therapy for patients with testicular cancer requires accurate staging for therapy and/or interpretaton of end results. The conventional staging parameters, including the lymphangiogram, inferior venacavogram and excretory urogram, often yield a considerable staging error. With sensitive and specific radioimmunoassays of serum alpha-fetoprotein and human chorionic gonadotropin in 118 patients with embryonal carcinoma with or without teratoma undergoing clinical and surgical staging the staging errors have decreased to 9 to 14 per cent in stage I and 5 to 10 per cent in stage II cases. Various clinical observations have been made in this group of patients: 1) persistently elevated serum markers after orchiectomy for testicular cancer invariably indicate stage II or III disease, 2) persistently elevated serum markers after positive lymphadenectomy usually suggest stage III disease and 3) persistently elevated serum markers after lymphadenectomy negative for tumor invariably indicate stage III disease. Therefore, such determinations are important guides to further therapy and must be an essential feature of adjuvant trials.