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Licensed Unlicensed Requires Authentication Published by De Gruyter April 21, 2023

Comparison between free β subunit of human chorionic gonadotropin (hCG) and total hCG assays in adults with testicular cancer

  • Carel J. Pretorius ORCID logo EMAIL logo , Urs Wilgen , Sandra Klingberg , Anna Zournazi , Linda Sanders and Jacobus P.J. Ungerer



We tested the hypothesis that the free-β subunit (βhCG) is diagnostically more sensitive with total hCG assays (hCGt) not detecting all tumours secreting βhCG. The effects of sex, age, and renal failure were investigated as secondary objectives.


We compared βhCG with hCGt in 204 testicular cancer patients (99 seminomas, 105 non-seminonatous germ cell tumours). The effects of sex and age were determined in 125 male and 138 female controls and that of renal failure was investigated in 119 haemodialysis patients. Biochemical assessment of gonadal status was performed with LH, FSH, oestradiol and testosterone.


Discordant results were common with isolated increases of hCGt observed in 32 (15.7 %) and βhCG in 14 (6.9 %) patients. Primary hypogonadism was the most common cause of isolated hCGt increases. After therapeutic interventions βhCG decreased below its upper reference more rapidly than hCGt. We observed unequivocal false negative results in two patients with non-seminomatous germ cell tumours. Both occurred in patients with clinical tumour recurrences; in one instance we observed a false negative hCGt while in the second false negative βhCG’s were documented in serial samples.


The similar false negative rates did not support the hypothesis that βhCG will detect more patients with testicular cancer than hCGt. In contrast to hCGt, βhCG was unaffected by primary hypogonadism which is a predictably frequent complication in testicular cancer patients. We therefore recommend βhCG as the preferred biomarker in testicular cancer.

Corresponding author: Carel J. Pretorius, Chemical Pathology, Pathology Queensland, Level 3 Block 7 Royal Brisbane and Women’s Hospital Campus, Herston 4029, QLD, Australia; and Faculty of Medicine, The University of Queensland, Brisbane, Australia, Phone: +617 36460083, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: The local Institutional Review Board deemed the study as low risk and exempt from formal review ((LNR/2019/QRBW/60401).


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Supplementary Material

This article contains supplementary material (

Received: 2022-09-18
Accepted: 2023-04-11
Published Online: 2023-04-21
Published in Print: 2023-09-26

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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