Recommendations

To help doctors determine when to use AFP, hCG, and LDH test results to monitor treatment and follow-up care, ASCO recommends the following:

• AFP and hCG should not be used to screen for germ cell tumors, to decide whether orchiectomy (surgery to remove one or both testicles) is needed, or to make treatment decisions for patients with cancer of unknown primary, which means that the site where the cancer began cannot be identified.
• For all patients undergoing removal of a testicle (orchiectomy) for suspected testicular cancer, AFP, hCG and LDH should be measured. If levels are high before orchiectomy, they should be checked after orchiectomy to find out if they are returning to normal.
• To determine the stage and prognosis (chance of recovery) of a non-seminoma, AFP and hCG should be measured before orchiectomy. Also, AFP, hCG, and LDH should be measured after orchiectomy and before other treatment begins for testicular cancer, and before chemotherapy for patients with non-seminoma that began outside of the testicles.
• AFP and hCG should be measured before retroperitoneal lymph node dissection (RPLND; removal of the lymph nodes in the back of the abdomen), before each cycle of chemotherapy begins for non-seminoma, after all chemotherapy is finished, and periodically after treatment ends to watch for a recurrence (return of cancer after treatment). Read below to learn when these tests are recommended.
• For patients with testicular pure seminoma that has spread to other parts of the body (stage II or III disease) and for seminomas that began somewhere other than the testicle, hCG and AFP should be measured periodically after treatment ends to help monitor for a return of the cancer. Read below to learn when these tests are recommended.
• Tumor markers should not be used to make or change treatment decisions for seminoma, or to watch for a recurrence of stage I seminoma.