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The search for distant metastases should be more careful when tumour markers are elevated (especially after initial surgery):

• Ca 19-9 or CEA for colo-rectal tumours,

• Ca 15-3 for mammary carcinoma,

• PSA for prostate cancer,

• βHCG et αFP for testis tumours.

Some classifications use tumour marker levels thus modifying the therapeutic indications (noticeably for testicular, ovarian and extra-gonadal germinal tumours).

For testis cancer, the serum value of tumour markers (the S criteria) will classify the tumour from SX to S3.

In prostate cancer, although not yet integrated in the TNM classification system, a high PSA value(above 20 ng/ml) suggests involvement beyond the prostate and should modify the therapeutic decision (for instance, no radical prostatectomy). See the Partin tables.