Testicular cancers germ cell tumors (GCTs) have become one of the most curable solid neoplasms, due to remarkable treatment advances that began in the late 1970s. Prior to that time, testicular cancer accounted for 11 percent of cancer deaths in men between the ages of 25 to 34, and the five-year survival rate was 64 percent . Currently, the five-year survival rate is over 95 percent, largely due to better understanding of the natural history of testicular tumors, improved staging and surgical techniques, the use of effective platinum-based combination chemotherapy, and the availability of highly sensitive serum tumor markers to detect minimal residual disease. (See "Overview of the treatment of testicular germ cell tumors".)
Three serum tumor markers have established roles in the management of men with testicular germ cell tumors:
- The beta subunit of human chorionic gonadotropin (beta-hCG)
- Alpha fetoprotein (AFP)
- Lactate dehydrogenase (LDH)
Serum concentrations of AFP and/or beta-hCG are elevated in 80 to 85 percent of men with nonseminomatous germ cell tumors (NSGCTs). In contrast, serum beta-hCG is elevated in fewer than 25 percent of seminomas, and AFP is not elevated in pure seminomas (table 1).
Although these markers can provide supportive evidence for the initial diagnosis of a testicular cancer and are useful for prognosis and risk stratification, their main utility is for monitoring response to treatment and detecting recurrence. The role of these serum tumor markers in the management of men with testicular germ cell tumors (GCTs) will be reviewed here. The integration of serum tumor markers into the overall follow-up plan for patients who have completed their initial treatment for a germ cell tumor is discussed separately. (See "Posttreatment follow-up for men with testicular germ cell tumors".)