Patient context
Pre-operative markers
Draw before orchiectomy. AFP normal < 10 ng/mL · β-hCG normal < 5 IU/L · LDH expressed as multiples of the upper limit of normal.
Tumour pathology
pT1 limited to testis/epididymis, no LVI (may invade tunica albuginea, not tunica vaginalis) · pT2 LVI, hilar soft tissue, epididymis or tunica vaginalis · pT3 spermatic cord · pT4 scrotum (UICC 2025).
Strongest predictor of relapse in stage I NSGCT (up to 50% vs 15%). LVI makes the tumour pT2.
Changes the plan: primary RPLND is supported in clinical stage I.
Post-orchiectomy markers
Half-lives: AFP 5–7 days · β-hCG 1–3 days.
Staging & imaging
If not yet imaged: contrast CT chest/abdomen/pelvis after the post-operative marker draw.
Clinical modifiers
Impaired renal function, advanced age, significant lung disease, active smoking, or impaired PFTs (DLCO/Va < 60%).
Testicular volume < 12 mL and/or history of cryptorchidism.