Surveillance after seminoma

After an operation to remove a testicle for cancer it is important that men are seen regularly for blood tests (every couple of months for a seminoma), x-rays and other checks (see ‘Follow-up’), at least for the first few years.

If a man has a seminoma, and if there is no spread of the disease, a single dose of chemotherapy (carboplatin) may be used after surgery to treat the cancer.

Until fairly recently surveillance after surgery (regular monitoring with frequent blood tests and x-rays), without chemotherapy, radiotherapy or other adjuvant therapy, has not been considered a suitable option for men with stage 1 (early stage) seminoma, because with a seminoma the blood tests are not very reliable in detecting recurrence. However, because there are some concerns about the long-term effects of some treatments, such as chemotherapy and radiotherapy, some doctors now offer men, with a stage 1 seminoma, surveillance as another option after surgery, as long as they understand the pros and cons, and as long as they agree to attend outpatient clinics regularly for checks and CT scans.

Many doctors consider that surveillance alone for men with seminoma is still ‘experimental’ or ‘unproven’. This is partly because there is uncertainty about the number of CT scans that are needed for men with early stage 1 seminoma, who have chosen surveillance.

Not all patients are happy with the idea of surveillance. One man, who had a seminoma, was told that there were three possible treatment options, radiotherapy, chemotherapy or surveillance, but he was told he would have radiotherapy. He trusted his doctors to make the right decision, and was glad to be given radiotherapy. He found the idea of surveillance rather worrying, and in stark contrast to the earlier pattern of his diagnosis and treatment, which focused on prompt treatment.

Explains why he was glad that he was told he would have radiotherapy to prevent any recurrence.

Age at interview 46

Gender Male

Age at diagnosis 44

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Was there any choice of treatment after that, did you have to have more treatment or did you have a choice of what you might do?

I was told theres 3 paths they could take; to have chemotherapy, radiotherapy or none and it would be decided for me which way they would go.

You couldn’t help to make that decision?

No, not as I, no, no, no. There were trials apparently of various things at the time but I wasn’t offered an option. I was told I’d have 17 sessions of radiotherapy over a month.

Did you ask how they made that decision or why they made that decision?

No I trusted them to make the right decision (laughs). The most worrying thing, I was most worried about them saying, “You won’t have any treatment at all,”

You wanted to have some treatment?

I felt some treatment, yes that’s right.

Can you explain why you felt that?

There was something said about this course where you don’t have any treatment at all, to see how the body naturally recovers or whatever, and I found that quite worrying because I thought you know everybody said to me this is a matter of timing, you know get diagnosed early, you need to get into hospital quickly, you know and all the rest of it. And now we need to, I had to cancel the family holiday because you know I needed to get on with this radiotherapy and all this sort of thing, it was all about time and speed, “So we can catch anything if theres anything there.” So the thought of, without them knowing anything, any more about me or the state I was in, to say were going to try giving you no treatment, was quite worrying, because if there was something there then it would give it time to spread, that was my reasoning.

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Two men with seminoma were discouraged from choosing surveillance as an option, even though they wanted to follow that route. One man was upset because he wanted surveillance, but his doctor told him that the health authority wouldn’t allow it because the frequent CT scans that he would need would cost more than a short course of radiotherapy.

Explains why he wasn’t able to have surveillance even though that’s what he wanted.

Age at interview 33

Gender Male

Age at diagnosis 32

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We discussed what the next steps were in my treatment after the surgery with the knowledge that they’d been able to gather from the histology. At that point the urologist said she could offer me two alternatives for treatment. One would be a short course of prophylactic radiotherapy which would be over a short number of weeks of daily treatments, and that would be a sort of preventative course of radiotherapy to try and eradicate any likelihood of further disease developing. Or at that point she said she could offer, I could just go on a very intensive surveillance regime, where they would just keep a very close eye on me and there would be, you know very regular testing of you know x-rays and blood tests and I would imagine CT scans, she didn’t really go into that much detail of, of that option. And she said you know that was something for me to think about and, and take a decision on. It further developed that the protocols of the Health Authority where I was receiving my treatment were such that they wouldn’t offer a pure surveillance approach to, to you know further treatment and that my only options were to have radiotherapy. The urologist when she was making me aware of that in the phone call, I’m not sure whether she regretted saying it, but suggested that the reasons for that were economic, and that it was easier just to send you in for a short course of radiotherapy and then have a reduced surveillance regime instead of just this very intensive sort of you know, what would appear to be monthly tests.

So at the point, at that point I was actually considering that my preference probably would be for surveillance, I was rather irritated to discover that that wouldn’t be an option for me so, and I would actually have to go for the radiotherapy.

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Another man chose surveillance, but his oncologist wasn’t keen on the idea because he was worried about the level of radiation that would be delivered with frequent CT scans. In the end the man ‘reluctantly’ agreed to have a single dose of Carboplatin (chemotherapy).

Explains why he agreed to have chemotherapy even though he would have preferred surveillance.

Age at interview 42

Gender Male

Age at diagnosis 42

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The prospect of radiation or chemotherapy drugs didn’t enthuse me, shall I say so I was more interested in the surveillance option. He [the doctor] didn’t seem at all keen on that, wouldn’t, didn’t recommend it. He seemed, I think he shared my concerns about the radiotherapy and I’d read the information about radiotherapy which suggested that there were er long term problems associated with that and so he was sort of directing me I guess down the chemotherapy option, but not forcing me down that route, but he wasn’t recommending do nothing as such.

A lot of conflicting information. Most of the information is, seems to be study based, controlled studies and different conclusions being drawn. Probably more er suggested that whilst surveillance appeared to be an equivalent method of treatment to radiotherapy or chemotherapy they didn’t recommend that it would be appropriate outside of a controlled study and that the studies all seemed to be conducted with very regular CT scans every 3 months. When I talked to the oncologist he didn’t think that was a good idea at all because of the xray dosage that you get through a CT scan. If we went for surveillance he would only be talking about an annual CT, he wasn’t at all keen on doing any more regular than that and the sites that had been suggested surveillance were all sort of saying if you can’t follow this sort of protocol then it’s not a very good idea. And they were all talking CT scans every 3, 4 months for the first 2 or 3 years and then gradually increasing the intervals between the scans.

In the end I guess you sort of, well bowed to pressure may be isn’t the right way of putting it, but as I said before I’d already crossed out radiotherapy, didn’t want anything to do with that so that left me with making a choice between the new chemotherapy that they were trialing and surveillance. The surveillance protocol, programme that I would be offered in this country didn’t seem to meet the suggested standard required by the information on the American site that had first awakened me to surveillance as an option for this so

You mean you wouldn’t be able to have enough CT scans?

Wouldn’t be able to have enough CT scans or regular enough CT scans, regular enough xrays er not that I want lots of radiation but it seems to you know suggest that you know it suggested that it needed to be followed closely, that closely to catch any recurrence early so that it could be treated. So I ended up agreeing reluctantly I guess to the Carboplatin treatment.

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Surveillance after teratoma

After an operation to remove a testicle for cancer it is important that men are seen regularly for blood tests, x-rays and other checks (see...