Testicular tumor markers: Corner-stones in the management of malignant germ cell tumors / Hoden-Tumor-marker: Eckpfeiler in der Behandlung maligner Keimzelltumoren

Management of testicular tumor patients without marker assessment is unacceptable in these days. Markers are included in the TNM scheme since 1997 in form of the S classification. The combination of AFP, hCG, LDH and PLAP shows high specificity and sensitivity, in contrast to most tumor markers in other malignancies. While preoperative markers are usually available, it is less common to monitor the immediate postoperative course. Still there are patients with the first control of tumor markers four weeks after surgery. In patients showing normal markers after four weeks, one may have missed a prolonged marker decline, such overlooking remaining tumor tissue which could have been treated more easily if detected in time, and not as late as metas- tases can be identified by imaging alone. If markers have not normalized after four weeks, there is a substantial delay in starting adjuvant treatment with a probable decreased chance for cure of the disease. Furthermore, tumor markers are important for classi- fying the risk of primary metastatic disease as well as for evaluation of response to chemotherapy. Marker nor- malization is a prerequisite for successful post-chemo- therapy surgery. During follow-up, rising markers are able to identify relapsing tumors at an earlier stage than imag- ing techniques alone.