To help doctors determine when to use AFP, hCG, and LDH test results to monitor treatment and follow-up care, ASCO recommends the following:

• AFP and hCG should not be used to screen for germ cell tumors, to decide whether orchiectomy (surgery to remove one or both testicles) is needed, or to make treatment decisions for patients with cancer of unknown primary, which means that the site where the cancer began cannot be identified.
• For all patients undergoing removal of a testicle (orchiectomy) for suspected testicular cancer, AFP, hCG and LDH should be measured. If levels are high before orchiectomy, they should be checked after orchiectomy to find out if they are returning to normal.
• To determine the stage and prognosis (chance of recovery) of a non-seminoma, AFP and hCG should be measured before orchiectomy. Also, AFP, hCG, and LDH should be measured after orchiectomy and before other treatment begins for testicular cancer, and before chemotherapy for patients with non-seminoma that began outside of the testicles.
• AFP and hCG should be measured before retroperitoneal lymph node dissection (RPLND; removal of the lymph nodes in the back of the abdomen), before each cycle of chemotherapy begins for non-seminoma, after all chemotherapy is finished, and periodically after treatment ends to watch for a recurrence (return of cancer after treatment). Read below to learn when these tests are recommended.
• For patients with testicular pure seminoma that has spread to other parts of the body (stage II or III disease) and for seminomas that began somewhere other than the testicle, hCG and AFP should be measured periodically after treatment ends to help monitor for a return of the cancer. Read below to learn when these tests are recommended.
• Tumor markers should not be used to make or change treatment decisions for seminoma, or to watch for a recurrence of stage I seminoma.

Patients diagnosed with a germ cell tumor may need special blood tests to test for tumor markers at different times before, during, and after treatment in addition to standard imaging tests. Talk with your doctor about what tests are needed for your type and stage of cancer, what the test results mean, and how often you'll need to be tested. For men with non-seminoma and advanced seminoma, it's important to continue with follow-up testing of tumor marker levels after treatment for a germ cell tumor ends, particularly because increases in the tumor markers levels are often the first sign that the cancer has returned. ASCO recommends the following schedule for testing tumor marker levels:

• For non-seminoma, AFP and hCG should be measured every one to two months in the first year after treatment ends, every two to four months in the second year, every three to six months in the third and fourth years, every six months in the fifth year, and annually thereafter, continuing for at least 10 years.
• For advanced seminoma, tumor marker levels should be tested every two to four months in the first year after treatment ends, every three to four months in the second year, every four to six months in the third and fourth years, and annually thereafter, continuing for at least 10 years.

In addition to testing tumor marker levels, additional tests, such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and lung function, may be needed as part of your follow-up care for a germ cell tumor. Talk with your doctor about these tests and when they should be done because the schedule will likely be different from the tumor marker testing schedules listed above.

Questions to Ask the Doctor

To help doctors give their patients the best possible care, ASCO asks its medical experts to develop evidence-based recommendations for specific areas of cancer care, called clinical practice guidelines. Due to the rapid flow of scientific information in oncology, new evidence may have emerged since the time a guideline or assessment was submitted for publication. As a result, guidelines and guideline summaries, like this one, may not reflect the most recent evidence. Because the treatment options for every patient are different, guidelines are voluntary and are not meant to replace your physician's independent judgment. The decisions you and your doctor make will be based on your individual circumstances. These recommendations may not apply in the context of clinical trials.