The value of tumor markers in testicular seminomas. Results of a prospective multicenter study.

OBJECTIVES: In the course of a prospective multicenter trial, the value of tumor markers in seminomas was assessed.

METHODS: Human chorionic gonadotropin (HCG), lactate dehydrogenase (LDH) and placental alkaline phosphatase (PlAP) were determined before and after orchidectomy and in the follow-up. Patients with elevated alpha-fetoprotein were considered to have nonseminomas. The half-lives were 24-36 h for HCG and 1 day for LDH and PlAP.

RESULTS: The incidence of HCG, LDH and PlAP was 35, 34 and 56%, respectively. In 84% of the patients at least one of the three markers was elevated. PlAP had the highest sensitivity to detect metastatic disease (51%), with a specificity of 91%. HCG and LDH were elevated in 42 and 46% of patients in stage II-III with specificities of 95 and 96%. PlAP was the best method to indicate a relapse, but the specificity was low, especially in smokers. For nonsmokers it was in the same range as HCG and LDH.

CONCLUSIONS: Eighty-four percent of seminomas are marker-positive. PlAP has the highest incidence and sensitivity. Specificity is impaired in smokers. All three markers should be determined in seminomas.