Beta-HCG Levels and Their Implications After Testicular Cancer Surgery

Q: Beta-HCG Levels and Their Implications After Testicular Cancer Surgery

Hello： Your situation may still require discussion with your attending physician regarding the possibility of recurrence or subsequent treatment that may necessitate imaging studies. <br>Please refer to http：//www.tand.org.tw/publications/into.asp?/365.html for normal values in m

The mechanism of beta-HCG (beta-human chorionic gonadotropin) involves its role as

In response to Dr.
Du's question: What is the unit of beta-HCG for determining the stage post-surgery? How long has it been since the surgery? Stage IA, with all indices normal.
The unit for beta-HCG is mIU/mL.
It has been approximately 8 months post-surgery.
Below is the previous inquiry:
Hello, I am a testicular cancer patient with embryonal carcinoma who has undergone surgical resection.
Recently, there has been a rising trend in beta-HCG levels, fluctuating from initially undetectable to 3.3 mIU/mL -> 2.6 -> 2.5 -> 6.7 -> 3.2.
Blood tests are conducted approximately every two to four weeks.
The hospital has also scheduled a series of imaging examinations.
I have seen in some literature that hypogonadism may cause false positives, as the pituitary gland can produce hormones that stimulate the testes to produce testosterone.
HCG is an intermediate product; assuming the testicular function was already suboptimal and now only one testis remains, the ability to produce testosterone may have deteriorated, leading to insufficient suppression of the pituitary gland, etc.
(I apologize for this section being completely unclear; it’s a patchwork of information...) Could you please explain the entire mechanism? Is there indeed a possibility of beta-HCG false positives from a physiological standpoint? Thank you.

xingfu de ri zi, 30~39 year old female. Ask Date: 2022/08/15

Dr. Du Shixi reply Urology

Hello: Your situation may still require discussion with your attending physician regarding the possibility of recurrence or subsequent treatment that may necessitate imaging studies.
Please refer to http://www.tand.org.tw/publications/into.asp?/365.html for normal values in males, and you can check http://www2.cch.org.tw/labsearch/Lab_Detail.aspx?CODE=FENHCG%E3%80%81FREHCG for additional information.
As for any hormonal changes in the pituitary-gonadal axis after surgery, generally, testosterone levels do not decrease significantly in a short period.
It may be necessary to consider LH, FSH, testosterone, and estradiol levels as well.
Wishing you good health.

Reply Date: 2022/08/15

More Info

Understanding beta-HCG levels after surgery for testicular cancer, particularly in the context of embryonal carcinoma, is crucial for monitoring potential recurrence and assessing the patient's hormonal status. Beta-human chorionic gonadotropin (beta-HCG) is a hormone that can be elevated in certain types of testicular cancer, and its levels are often used as a tumor marker in follow-up care.

In your case, you mentioned that you underwent surgery for stage IA embryonal carcinoma and that your beta-HCG levels have fluctuated over the past eight months post-surgery. The values you provided (3.3 mIU/mL, 2.6, 2.5, 6.7, and 3.2) indicate variability, which can be concerning. Typically, after the surgical removal of a testicular tumor, beta-HCG levels should trend downward towards zero if there is no residual disease. An increase or fluctuation in these levels may suggest the possibility of residual or recurrent disease, but it can also be influenced by other factors, including hormonal changes.

Regarding the hormonal dynamics you mentioned, hypogonadism can indeed play a role in the interpretation of beta-HCG levels. In men, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which stimulate the testes to produce testosterone and sperm. If testosterone levels are low due to the loss of one testicle or other factors, the pituitary may increase LH and FSH production in an attempt to stimulate the remaining testicle. This hormonal imbalance can lead to elevated beta-HCG levels, as the hormone can be produced in small amounts by the testes and may also be influenced by other hormonal pathways.

The phenomenon of false-positive beta-HCG results is indeed documented in the literature. Conditions such as hypogonadism, liver disease, and even certain medications can lead to elevated beta-HCG levels without the presence of malignancy. Therefore, while your fluctuating beta-HCG levels are concerning, they do not definitively indicate cancer recurrence without further investigation.

In your case, it is essential to continue regular follow-ups with your healthcare provider, including imaging studies and possibly additional blood tests to monitor other tumor markers such as alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH). These markers, in conjunction with beta-HCG, can provide a more comprehensive picture of your health status post-surgery.

In summary, while fluctuating beta-HCG levels after surgery for testicular cancer can raise concerns about recurrence, they can also be influenced by hormonal changes and other benign factors. Continuous monitoring and a thorough discussion with your healthcare team are vital to determine the best course of action and to ensure that any potential issues are addressed promptly.

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