Role of Lactate Dehydrogenase (LDH) in Identifying Relapse for Patients with Stage I Testicular Cancer on Surveillance.

Tumor markers alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH) assume a key role in the management of testicular germ cell tumors (GCT). While AFP and hCG have modest sensitivity and specificity for GCT, LDH has weak sensitivity and specificity. We explored the utility of LDH in identifying relapse among stage I seminomatous and nonseminomatous GCT (NSGCT) on surveillance.

Patients with a history of stage I testicular GCT were identified from a prospectively maintained database at Princess Margaret Cancer Centre from December 1980 to May 2021 and surveyed according to established institutional algorithms guidelines. The utility of LDH elevation to independently detect GCT relapse was examined.

Among 1014 seminoma and 676 NSGCT patients, 176 and 176 patients relapsed with a median time to relapse of 13.6 and 8.9 months, respectively. Imaging alone was the most common mode of relapse detection in 144 and 74 of seminoma and NSGCT patients, respectively. LDH was elevated in 49 cases of seminoma and 38 of NSGCT at relapse but was never the sole relapse indicator. Among 350 seminoma and 311 NSGCT patients who never relapsed, 210 and 233 had at least one elevated LDH value.

LDH alone did not independently contribute to early relapse detection in stage I seminoma or NSGCT. Elevated LDH values were documented in a high proportion of non-relapsing seminoma and NSGCT cases.

The Journal of urology. 2022 Aug 23 [Epub ahead of print]

Adam Bobrowski, Lynn Anson-Cartwright, Kopika Kuhathaas, Di Maria Jiang, Peter Chung, Philippe Bedard, Padraig Warde, Martin O'Malley, Joan Sweet, Robert J Hamilton

Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Division of Urology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.