Gilbert SM et al. (2007) The use of tumor markers in testis cancer in the United States: a potential quality issue. Urol Oncol [doi:10.1016/j.urolonc.2006.12.018]

The use of tumor markers is an important component of diagnosis and management of testicular cancers, and failure to measure these markers might be deemed suboptimum care. In a recent paper, Gilbert et al. have reported the possible underuse of these markers in the US, which represents an important quality-of-care concern.

The authors identified 4,742 cases of testicular cancer from the US population-based SEER database and evaluated the use of the tumor markers α-fetoprotein (AFP), human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH). For each marker, data were collapsed into two categories: measured, and not measured or unknown. Measurement of all three markers was documented in only 16.8% of patients; 44.7% of patients had records of at least AFP and hCG measurements. Documented use of tumor markers varied significantly by geographic region, with a trend towards less-frequent measurement in metropolitan areas as compared with whole states (range 6.7–83.0% for at least AFP and hCG measured). In multivariate analysis, geographic location and year of diagnosis independently predicted tumor marker use, although the majority of sites did not show increased frequency of measurement with time. By contrast, in prostate cancer cases, documented PSA measurement was common (frequency 70–90%), suggesting that the observed low frequency of AFP, hCG and LDH measurement was not attributable to inadequate reporting.

Without measurement of tumor markers, patients with testicular cancer are at risk for inappropriate staging and inaccurate assessment of treatment response.