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Serum tumor markers in the evaluation of male germ cell tumors

Nature Reviews Urology volume 7, pages 610–617 (2010)Cite this article

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Abstract

Serum tumor markers play a critical role in the diagnosis, staging, risk stratification, and surveillance of patients with testicular germ cell tumors (GCTs). Production of the oncofetal substances α fetoprotein and human chorionic gonadotropin can aid the diagnosis of testicular GCTs, and specific patterns of marker elevation can be used to determine the type of tumor, particularly as it pertains to nonseminoma. These markers, in addition to lactate dehydrogenase, have been incorporated in the standard TNM staging system for testicular tumors; the S stage category corresponds to serum elevation of these proteins. Furthermore, the degree of serum tumor marker elevation has been incorporated into standardized patient risk groupings, which are used to guide therapeutic management. The rate of tumor marker decay after radical orchiectomy is an important index to monitor, as a slow decline might be indicative of metastatic disease and should prompt a thorough systemic survey. The rate of tumor marker decline is already being utilized in the setting of metastatic GCTs to determine response to chemotherapy, and has been used in some scenarios to individualize the type of chemotherapy patients received. Compared to any other solid organ malignancy, the role of serum tumor markers in GCT is unprecedented; these markers are instrumental in the diagnosis and management of testicular GCT.

Key Points

  • The prognostic utility of serum tumor markers is reflected in the inclusion of a category in the standard TNM staging system to account for elevation of three such markers: α fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase

  • At least one serum tumor marker is elevated in 85% of nonseminomatous germ cell tumors, and a significant number of seminomas and nonseminomas are associated with elevated markers before radiographic or clinical manifestations of disease

  • The differential diagnosis for elevated serum tumor markers includes neoplastic, infectious, metabolic, toxic and genetic etiologies

  • Initial evaluation of patients with elevated serum tumor markers should include a complete history and physical examination, scrotal ultrasonography, chest radiography, and blood tests including liver function tests, complete blood count, and a metabolic panel

  • The rate of serum tumor marker decline after orchiectomy or after treatment for metastatic nonseminoma has prognostic significance and should be considered in management algorithms

  • In general, the schedule for surveillance after radical orchiectomy includes monthly measurements of serum tumor markers for the first year after treatment with gradually widening surveillance intervals until the sixth year of recurrence-free status when annual measurement can commence

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Acknowledgements

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 11th Floor 161 Fort Washington Avenue, New York, 10032, NY, USA

    LaMont J. Barlow, Gina M. Badalato & James M. McKiernan

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L. J. Barlow, G. M. Badalato and J. M. McKiernan contributed equally to the researching, discussion, writing and reviewing of the manuscript.

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Correspondence to James M. McKiernan.

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Barlow, L., Badalato, G. & McKiernan, J. Serum tumor markers in the evaluation of male germ cell tumors. Nat Rev Urol 7, 610–617 (2010). https://doi.org/10.1038/nrurol.2010.166

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