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Testicular Tumour Markers

Created: 7/12/2008


Testicular Tumour Markers


  • Substances detected in the blood, urine or tissues that are associated with the presence of cancer

  • Produced either by the tumour, by the body in response to the cancer but also in some benign conditions

  • Useful in screening, diagnosis, staging, prognosis and monitoring response to treatment

Testicular Tumour Markers

  • Oncofetal proteins:
    • Alpha-fetoprotein (AFP)
    • Human chorionic gonadotrophin (ß-hCG)

  • Cellular enzymes:
    • Lactate dehydrogenase (LDH)
    • Placental alkaline phosphatase (PLAP)


  • Normal fetal serum protein – fetal yolk sac, liver and GI tract. Trace amounts after age 1 year.
  • Expressed by trophoblastic elements in 50-70% of terotomas and yolk sac tumours.
  • Raised AFP is NEVER found in pure seminoma or pure choriocarcinoma.
  • In seminomas, suggests the presence of non-seminomatous element.
  • Serum half-life: 5-7 days.
  • [<10 ng/ml].


  • Glycoprotein with alpha and beta subunits.
  • Produced by syncytiotrophoblastic cells of placenta.
  • Expressed by syncytiotrophoblastic elements of:
    • choriocarcinomas (100%).
    • terotomas (40%).
    • seminomas (10-15%).
    • pure seminomas (0-5%).
  • Serum half-life: 24-36 hours.
  • [ß-subunit <5 mIU/ml, <1 ng/ml]


  • Ubiquitous cellular enzyme (muscle, liver, kidney and brain).
  • Marker of all germinal cell tumours (less specific than AFP or ß-hCG).
  • Seminomas: Elevated in 10-20% (metastatic disease 80%).
  • NSGCTs: Elevated (metastatic disease 50-60%).
  • Degree of elevation correlates with tumour burden.
  • Useful in monitoring treatment response in advanced seminoma.
  • Prognostic value in patients with metastatic disease and is therefore included in staging.


  • Fetal isoenzyme - different from adult alkaline phosphatase.
  • Advanced GCTs: Elevated in up to 40%.
  • Non-specific and not widely used.
  • May be elevated in smokers.

Clinical uses

  • Measured at presentation:
  • Normal markers do not exclude metastatic disease.
  • Measured 1-2 weeks post-radical orchidectomy:
    • Normalisation of markers does not indicate absence of disease. Persistent elevation usually indicates residual or metastatic disease (but also elevated in liver dysfunction and hypogonadotrophism).
  • Measured during follow-up:
    • To assess response to treatment and residual disease.


  • 80-85% of testicular tumours have positive markers.
  • 85-90% of NSGCTs have raised markers.
  • 10-15% of NSGCTs have normal markers.
  • Terotomas: 75% have elevated ß-hCG and/or AFP.
  • Pure seminomas: do not produce AFP, 0-5% ß-hCG.
  • Seminomas: 10-15% produce ß-hCG.
  • LDH elevated in metastatic seminomas and teratomas

  • Degree of marker elevation directly proportional to tumour burden.
  • Markers indicate tumour histology: If AFP elevated in seminoma, tumour has non-seminomatous elements.
  • Negative tumour markers becoming positive on follow up usually indicates tumour recurrence.
  • Markers become positive earlier than on imaging studies.


   Tumour Type              AFP(%)     BHCG(%) 
 Seminoma  0  7
 Teratoma  38  25
 Teratocarcinoma  64  57
 Embryonal  70  60
 Choriocarcinoma  0  100

S Staging

The S classification is based on the nadir value after orchidectomy.

Sx: markers not available or not performed.

S0: markers within normal limits.

S1: AFP <1000 ng/ml and hCG <5000 mIU/ml and

LDH 1-1.5 x normal upper limit

S2: AFP 1000-10,000 or hCG 5000-50,000 or

LDH 1.5-10 x normal

S3: AFP >10,000 or hCG >50,000 or

LDH >10 x normal

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