Role of human chorionic gonadotropin in patients with pure seminoma

Human chorionic gonadotropin (beta-hCG) and alpha-fetoprotein (AFP) are widely established specific and sensitive tumor markers for nonseminomatous testicular cancer. In 106 patients with pure seminoma, a highly sensitive method detected beta-hCG both before and repeatedly during therapy. The low detection limit of the test (0.3 IU/l) coincided with the 95 percentile of a group of 60 healthy blood donors. Its 100 percentile of < 1.0 IU/l was applied as the upper limit of the normal range. In 30.2% of our patients with pure seminoma, elevated beta-hCG levels were noted prior to orchiectomy. The levels returned to normal in 76% of these patients thereafter, and in 34% after additional irradiation or chemotherapy. During an observation period of 2-84 months, all beta-hCG-positive patients were in complete remission. Prior to semicastration, 1 patient showed extremely high beta-hCG levels, while in another patient, beta-hCG and AFP were elevated simultaneously. In both cases, tumor marker levels did not seem to agree with the histology of 'pure seminoma' and rather suggested the presence of nonseminomatous tumor cells. Increased AFP levels contradict the presence of a pure seminoma and indicate a nonseminomatous testicular tumor. The same holds true for strongly elevated beta-hCG levels, whereas levels of up to 200 IU/l correlate with the diagnosis of pure seminoma.