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Raffo M, Di Naro A, Napolitano L, Aveta A, Cilio S, Pandolfo SD, Manfredi C, Lonati C, Suardi NR. Testicular Cancer Treatments and Sexuality: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:586. [PMID: 38674232 PMCID: PMC11051825 DOI: 10.3390/medicina60040586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
The incidence of testicular cancer (TC) has been rapidly increasing over the past years. Diagnosis and early treatment have shown good oncological control, guaranteeing the patient different treatment approaches according to histology and tumor stage. Currently, physicians usually prioritize oncological outcomes over sexual outcomes and quality of life, considering as a first aim the overall survival of the patients; however, differently from other neoplasms, quality of life is still strongly affected among TC patients, and sexual outcomes are frequently compromised after each TC treatment. Several studies have suggested that each treatment approach may be associated with sexual dysfunctions, including erectile dysfunction, ejaculatory disorders, fertility issues, and hormonal changes. Since testicular cancer patients are more frequently young men, the subject of this work is substantial and should be analyzed in detail to help specialists in the management of this disease. The aim of the current narrative review is to generally describe every treatment for TC, including surgery, chemotherapy, radiotherapy, and retroperitoneal lymph node dissection, and to establish which sexual dysfunction may be specifically associated with each therapy.
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Affiliation(s)
- Massimiliano Raffo
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Angelo Di Naro
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Achille Aveta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, 80138 Naples, Italy;
| | - Chiara Lonati
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
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Conduit C, Lewin J, Weickhardt A, Lynam J, Wong S, Grimison P, Sengupta S, Pranavan G, Parnis F, Bastick P, Campbell D, Hansen AR, Leonard M, McJannett M, Stockler MR, Gibbs P, Toner G, Davis ID, Tran B, Kuchel A. Patterns of Relapse in Australian Patients With Clinical Stage 1 Testicular Cancer: Utility of the Australian and New Zealand Urogenital and Prostate Cancer Trials Group Surveillance Recommendations. JCO Oncol Pract 2023; 19:973-980. [PMID: 37327464 DOI: 10.1200/op.23.00191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 06/18/2023] Open
Abstract
PURPOSE International guidelines advocate for active surveillance as the preferred treatment strategy for patients with stage 1 testicular cancer after orchidectomy although a personalized discussion is required. MATERIALS AND METHODS We conducted an analysis of individuals registered in iTestis, Australia's testicular cancer registry, to describe the patterns of relapse and outcomes of patients treated in Australia where the Australian and New Zealand Urogenital and Prostate Cancer Trials Group Surveillance Recommendations are widely adopted. RESULTS A total of 650 individuals diagnosed between 2000 and 2020 were included, 63% (411 of 650) seminoma and 37% (239 of 650) nonseminoma. The median age was 34 years (range 14-74). 26% (106 of 411) with seminoma and 15% (36 of 239) nonseminoma received adjuvant chemotherapy. After a median follow-up of 43 months (range 0-267) postorchidectomy, relapse occurred in 10% (43 of 411) of seminoma and 18% (43 of 239) of nonseminoma. The two-year relapse-free survival was 92% (95% CI, 89 to 95) and 82% (95% CI, 78 to 87) in seminoma and nonseminoma, respectively. All relapses (86 of 86) were detected at a routine surveillance visit; 98% (85 of 86) were asymptomatic and detected solely through imaging (62 of 86, 72%), tumor markers (6 of 86, 7%), or a combination (17 of 86, 20%). The most common relapse site was isolated retroperitoneal lymphadenopathy (53 of 86, 62%). No nonpulmonary visceral metastases occurred. At relapse, 98% (84 of 86) had International Germ Cell Cancer Collaborative Group (IGCCCG) good prognosis; 2 of 86 intermediate prognosis (both nonseminoma). No deaths occurred. CONCLUSION In our cohort of stage 1 testicular cancer, where national surveillance recommendations have been widely adopted, recurrences were detected at routine surveillance visits and, almost exclusively, asymptomatic with IGCCCG good-prognosis disease. This provides reassurance that active surveillance is safe.
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Affiliation(s)
- Ciara Conduit
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Jeremy Lewin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Melbourne, VIC, Australia
| | - Andrew Weickhardt
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
- La Trobe University, Melbourne, VIC, Australia
- Department of Medical Oncology, Austin Health, Heidelberg, VIC, Australia
| | - James Lynam
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia
- University of Newcastle, Callaghan, NSW, Australia
| | - Shirley Wong
- Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Peter Grimison
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
| | - Shomik Sengupta
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Urology, Eastern Health, Box Hill, VIC, Australia
| | - Ganes Pranavan
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia
| | - Francis Parnis
- Department of Medical Oncology, Icon Cancer Centre, Adelaide, SA, Australia
| | - Patricia Bastick
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Southside Cancer Care Centre, Kogarah, NSW, Australia
- Department of Medical Oncology, St George/Sutherland Hospital, Caringbah, NSW, Australia
| | - David Campbell
- Department of Medical Oncology, Barwon Health, Geelong, VIC, Australia
| | - Aaron R Hansen
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Matt Leonard
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Margaret McJannett
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Martin R Stockler
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
- Department of Medical Oncology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Guy Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Ian D Davis
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Monash University Eastern Health Clinical School, Box Hill, VIC, Australia
- Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Ben Tran
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Anna Kuchel
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- University of Queensland, Brisbane, QLD, Australia
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Koyama J, Yamashita S, Kakimoto K, Uemura M, Kishida T, Kawai K, Nakamura T, Goto T, Osawa T, Nishimura K, Nonomura N, Nishiyama H, Shiraishi T, Ukimura O, Ogawa O, Shinohara N, Suzukamo Y, Ito A, Arai Y. Sexual function using the EORTC QLQ-TC26 in testicular cancer survivors: A multi-institutional, cross-sectional study. Int J Urol 2023; 30:1044-1050. [PMID: 37522577 DOI: 10.1111/iju.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To evaluate sexual function after treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Testicular Cancer 26 (EORTC QLQ-TC26) questionnaire in Japanese testicular cancer (TC) survivors in a multi-institutional, cross-sectional study. METHODS This study enrolled TC survivors who visited any of eight high-volume institutions in Japan from 2018 to 2019. After obtaining informed consent, participants completed the EORTC QLQ-TC26 questionnaires. We evaluated sexual function after treatment for TC using the EORTC QLQ-TC26 and analyzed the impact of treatment on sexual function in TC survivors. RESULTS A total of 567 TC survivors responded to the EORTC QLQ-TC26. Median age at the time of response was 43 years (interquartile range [IQR] 35-51 years), and median follow-up period after treatment was 5.2 years (IQR 2.2-10.0 years). Sexual function, particularly ejaculatory function, was significantly lower after post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) than after Surveillance or Chemotherapy groups (p < 0.05). In the PC-RPLND group, nerve-sparing procedure preserved postoperative ejaculatory function after RPLND compared with the non-nerve-sparing and offered improved ejaculatory function with time. On multivariate analysis, RPLND was a significant predictor of post-treatment ejaculatory dysfunction, particularly without nerve-sparing (odds ratio 3.0, 95% CI 1.2-7.7, p < 0.05). In addition, TC survivors with nerve-sparing RPLND had higher sexual activity than those without. CONCLUSION This survey of the EORTC QLQ-TC26 showed that sexual function and activity in TC survivors after RPLND was reduced in the absence of nerve-sparing techniques.
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Affiliation(s)
- Juntaro Koyama
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Koji Kawai
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Terukazu Nakamura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
- Department of Urology, Saiseikai Imperial Gift Foundation Inc. Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Takayuki Goto
- Department of Urology, Graduate School of Medicine and Faculty of Medicine Kyoto University, Kyoto, Kyoto, Japan
| | - Takahiro Osawa
- Department of Urology, Graduate School of Medicine Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | | | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine and Faculty of Medicine Kyoto University, Kyoto, Kyoto, Japan
| | - Nobuo Shinohara
- Department of Urology, Graduate School of Medicine Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Urology, Miyagi Cancer Center, Natori, Miyagi, Japan
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Lockhart CM, McDermott CL, Mendelsohn AB, Marshall J, McBride A, Yee G, Li MS, Jamal-Allial A, Djibo DA, Vazquez Benitez G, DeFor TA, Pawloski PA. Identification of cancer chemotherapy regimens and patient cohorts in administrative claims: challenges, opportunities, and a proposed algorithm. J Med Econ 2023; 26:403-410. [PMID: 36883996 DOI: 10.1080/13696998.2023.2187196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Real-world evidence is a valuable source of information in healthcare. This study describes the challenges and successes during algorithm development to identify cancer cohorts and multi-agent chemotherapy regimens from claims data to perform a comparative effectiveness analysis of granulocyte colony stimulating factor (G-CSF) use. METHODS Using the Biologics and Biosimilars Collective Intelligence Consortium's Distributed Research Network, we iteratively developed and tested a de novo algorithm to accurately identify patients by cancer diagnosis, then extract chemotherapy and G-CSF administrations for a retrospective study of prophylactic G-CSF. RESULTS After identifying patients with cancer and subsequent chemotherapy exposures, we observed only 12% of patients with cancer received chemotherapy, which is fewer than expected based on prior analyses. Therefore, we reversed the initial inclusion criteria to identify chemotherapy receipt, then prior cancer diagnosis, which increased the number of patients from 2,814 to 3,645, or 68% of patients receiving chemotherapy had diagnoses of interest. Additionally, we excluded patients with cancer diagnoses that differed from those of interest in the 183 days before the index date of G-CSF receipt, including early-stage cancers without G-CSF or chemotherapy exposure. By removing this criterion, we retained 77 patients who were previously excluded. Finally, we incorporated a 5-day window to identify all chemotherapy drugs administered (excluding oral prednisone and methotrexate, as these medications may be used for other non-malignant conditions) as patients may fill oral prescriptions days to weeks prior to infusion. This increased the number of patients with chemotherapy exposures of interest to 6,010. The final cohort of included patients, based on G-CSF exposure, increased from 420 from the initial algorithm to 886 using the final algorithm. CONCLUSIONS Medications used for multiple indications, sensitivity and specificity of administrative codes, and relative timing of medication exposure must all be evaluated to identify patient cohorts receiving chemotherapy from claims data.
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Affiliation(s)
- Catherine M Lockhart
- Biologics and Biosimilars Collective Intelligence Consortium, Alexandria, VA, USA
| | - Cara L McDermott
- Biologics and Biosimilars Collective Intelligence Consortium, Alexandria, VA, USA
| | - Aaron B Mendelsohn
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - James Marshall
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Ali McBride
- University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Gary Yee
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Minghui Sam Li
- University of Tennessee Health Science Center, Memphis, TN, USA
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Uldbjerg CS, Lim YH, Glazer CH, Hauser R, Juul A, Bräuner EV. Maternal Serum α-Fetoprotein Levels during Pregnancy and Testicular Cancer in Male Offspring: A Cohort Study within a Danish Pregnancy Screening Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114112. [PMID: 36360990 PMCID: PMC9655085 DOI: 10.3390/ijerph192114112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 05/12/2023]
Abstract
Testicular cancer is believed to originate from disruptions of normal androgen-estrogen balance in-utero. α-fetoprotein (AFP) may modify fetal response to estrogens via estrogen interaction. In a cohort study, we investigated the association between circulating maternal pregnancy AFP and testicular cancer risk in offspring. Of the 56,709 live-born males from a pregnancy screening registry in 1980-1995, our study included 50,519 singleton males with available second trimester blood samples from their mothers and complete covariate ascertainment. Testicular cancer diagnoses and covariate data were obtained from nationwide Danish health registries. Cox regression and Kaplan-Meier analyses estimated the prospective risk of testicular cancer (all, seminoma, nonseminoma) by AFP multiples of the median. During follow-up, 163 (0.3%) of the included males developed testicular cancer, of which 89 (54.6%) were nonseminomas. Maternal serum AFP levels greater than/equal to the median were associated with a relative risk of testicular cancer close to unity (RR 1.04, 95% CI 0.76; 1.41) compared to AFP below the median. Associations differed by type of testicular cancer (RRseminoma 0.81, 95% CI 0.51; 1.29, RRnonseminoma 1.31, 95% CI 0.85; 2.02). On balance, our findings do not support that serum AFP in pregnancy can be used as a predictor of testicular cancer in offspring.
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Affiliation(s)
- Cecilie S. Uldbjerg
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Clara H. Glazer
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Urology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Russ Hauser
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02115, USA
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Elvira V. Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-3545-0820
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Spinelli C, Cito G, Morelli G, Ghionzoli M, Bertocchini A, Sanna B, Galli L, Antonuzzo A, Morganti R, Strambi S. Testicular germ cells tumors in adolescents and young adults: Management and outcomes from a single-center experience. Arch Ital Urol Androl 2021; 93:301-306. [PMID: 34839629 DOI: 10.4081/aiua.2021.3.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate and compare the effectiveness of active surveillance versus post-surgical active treatment, in patients with testicular germ cells tumor (TGCT). MATERIALS AND METHODS We retrospectively analyzed 52 patients who underwent surgery for TGCT from January 2009 to December 2014. All the patients were divided into two age groups: the Group A included children-adolescents from 18 months to 21 years old, while the Group B comprised young adults from 22 to 39 years old. Clinical, histopathological, therapeutic and follow-up data were collected. RESULTS Overall, 22 patients (42,3%) were enrolled in the Group A and 30 patients (57.7%) were categorized in the Group B. Inguinal orchiectomy was performed in all patients. Retroperitoneal lymphadenectomy was performed in 4 patients (7.7%). Post-surgical management differed based on clinical stage, resulting in active surveillance or adjuvant therapy. After an average 7 years follow-up period (range: 3.5-9.0 years), the overall survival rate is 100%. The relapse risk is significantly higher for the patients in the Group B, displaying a recurrence free-survival rate of 72% versus 95% (Group A); 11 relapses (21.1%) were recorded 2 years after surgery. Of these, 3 recurrences (12.0%) occurred in patients undergoing an active surveillance approach, while 8 (29.6%) in patients subjected to an active treatment. CONCLUSIONS The excellent prognosis in both age groups confirms the high curability of this neoplasia. The active surveillance could represent an optimal option for low recurrence risk tumors. However, post-surgical treatments should be taken into consideration for TGCT with high risk factors, including tumor size, lymphovascular and rete testis invasion.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Gianmartin Cito
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence.
| | - Girolamo Morelli
- Department of Urology and Andrology Surgery, University of Pisa.
| | - Marco Ghionzoli
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Alessia Bertocchini
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Beatrice Sanna
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Luca Galli
- Medical Oncology II, University of Pisa, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa.
| | - Andrea Antonuzzo
- Medical Oncology I, National Health Service Department of Translational Medicine Research and New Technologies in Medicine and Surgery, University of Pisa.
| | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa.
| | - Silvia Strambi
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
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Abstract
Background Late relapse (LR) of nonseminomatous germ cell tumour (NSGCT) is uncommon, with limited data published. LR is defined as relapse occurring after a disease-free interval of 2 yr. Objective To review features of NSGCT LR in a UK tertiary centre. Design setting and participants A total of 3064 patients were referred from January 2005 to December 2017. We identified patients who experienced LR after initial pathology demonstrated NSGCT and reviewed data for their original and LR presentation and management. Outcome measurements and statistical analysis Outcomes included time to LR measured from the date of diagnosis, and overall survival. This was assessed using Cox proportional Hazards modelling, with stratification or adjustment for potential confounders. Results and limitations We identified 101 patients with LR; the median time to LR was 96 mo. Forty-three patients (42.6%) experienced relapse after 10 yr. Univariable log-rank testing revealed that the median time to LR was significantly shorter for patients who had not received induction chemotherapy (iCTx; 54 mo, 95% confidence interval [CI] 48-108) than for those who did (112 mo, 95% CI 84-186; p = 0.04). Patients who had received iCTx were less likely to have elevated tumour markers (36% vs 46%) and more likely to undergo initial surgical resection at LR compared to CTx-naïve patients. Postpubertal teratoma (PPT), yolk sac, and dedifferentiated elements predominated for patients with iCTx exposure, whereas active GCT or fibrosis predominated in postchemotherapy resections for CTx-naïve patients at LR. Forty-one men underwent postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) as part of their initial treatment for metastatic disease. Of these, 20 experienced LR in the retroperitoneum, with 18 undergoing repeat RPLND as part of their LR management. Fifteen of the repeat RPLND histopathology specimens had a PPT component. There have been 23 deaths overall; survival was worse for patients presenting with symptoms (13/36, 33%) and those receiving CTx and no surgery (10/17, 59%) at LR. Conclusions When LR of NSGCT occurs, it is frequently after an extended interval and is later among patients with prior iCTx, with PPT predominating. The high frequency of LR within the retroperitoneum following PC-RPLND reinforces the need for good-quality PC-RPLND. Patient summary We reviewed data for patients who had a late relapse of testicular cancer. We found that patients who did not receive chemotherapy as the first treatment for their initial diagnosis had a shorter time to relapse. Our results highlight the importance of long-term follow-up for testicular cancer.
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Health-Related Quality of Life in Testicular Cancer Survivors in Japan: A Multi-Institutional, Cross-Sectional Study Using the EORTC QLQ-TC26. Urology 2021; 156:173-180. [PMID: 33785401 DOI: 10.1016/j.urology.2021.02.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the health-related quality of life (QOL) of testicular cancer (TC) survivors using the Japanese version of the EORTC QLQ-TC26 questionnaire in a multi-institutional, cross-sectional study. METHODS This study recruited TC survivors who were followed after treatment for TC at eight high-volume institutions between January, 2018 and March, 2019. The participants completed the EORTC QLQ-TC26 questionnaire and mailed the completed questionnaires to a central institution. The QOL scores were assessed according to therapeutic modality (watchful waiting, WW; chemotherapy, CT; and CT followed by retroperitoneal lymph node dissection, CT+RPLND) and follow-up period and compared using analysis of variance and Student's t-test. RESULTS A total of 567 TC survivors responded to the questionnaire. The median age at response was 43 years (IQR 35-51 years), and the median follow-up was 5.2 years (IQR 2.2-10.0 years). As for treatment side effects and physical limitations, the scores of the CT+RPLND group were significantly higher than those of the WW group, especially within one year after treatment. In addition, TC survivors in the CT+RPLND group reported high impairment related to job and education problems and future perspective less than 5 years after treatment. Even TC survivors in the WW group were anxious about job and education issues within one year after treatment. CONCLUSION TC survivors were anxious about not only cancer recurrence, but also their jobs and education. TC patients should be given appropriate information on QOL after treatment for TC to attenuate post-treatment anxiety and improve their health-related QOL.
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Contemporary trends in management of stage 1 seminoma. Urol Oncol 2021; 39:240.e1-240.e8. [PMID: 33602622 DOI: 10.1016/j.urolonc.2020.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/29/2020] [Accepted: 08/14/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Surveillance is now the preferred treatment strategy for patients with stage 1A/1B seminoma as reflected by the National Comprehensive Cancer Network guidelines. In this study, we aimed to describe trends in adjuvant management strategy for stage 1A/B seminoma from 2004 to 2016 using the National Cancer Database. MATERIALS AND METHODS The database was queried for patients diagnosed with stage 1A/1B seminoma between 2004 and 2016. Staging was determined using the American Joint Committee on Cancer guidelines. Surveillance was defined as no treatment with chemotherapy or radiation within 60 days of diagnosis. Proportions of cancer patients utilizing surveillance, radiation, and single-agent chemotherapy were summarized annually. Kaplan-Meier survival analysis was used to compare overall survival between groups. RESULTS 8,686 patients with stage 1A/1B seminoma met inclusion criteria over the course of the study period. Overall, 3,004 (34.6%) patients began adjuvant chemotherapy or radiation within 60 days. Utilization of surveillance increased from 39.8% in 2004 to 86.8% in 2016 while utilization of radiation decreased from 59.7% to 4.6%. High-volume centers adopted surveillance earlier than low-volume centers. CONCLUSION This study describes trends in utilization of surveillance, chemotherapy, and radiotherapy for stage 1A/1B seminoma over 12 years. A major shift from utilization of adjuvant treatment to surveillance in patients with stage 1A/B seminoma is observed in this large national cancer database; a minority of patients now receive adjuvant treatment and risk-related toxicities. Survival analysis reveals similar survival at a median 5-year follow-up. The results provide insight into the time needed for clinical practice to adopt the preferred approach of surveillance over the time period studied.
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Yamashita S, Suzukamo Y, Kakimoto K, Uemura M, Kishida T, Kawai K, Nakamura T, Goto T, Osawa T, Yamada S, Nishimura K, Nonomura N, Nishiyama H, Shiraishi T, Ukimura O, Ogawa O, Shinohara N, Ito A, Arai Y. Validation study of the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Testicular Cancer 26 for patients with testicular cancer. Int J Urol 2020; 28:176-182. [DOI: 10.1111/iju.14422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Shinichi Yamashita
- Department of Departments of Urology Tohoku University Graduate School of Medicine Sendai Miyagi Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation Tohoku University Graduate School of Medicine Sendai Miyagi Japan
| | - Kenichi Kakimoto
- Department of Urology Osaka International Cancer Institute Osaka Osaka Japan
| | - Motohide Uemura
- Department of Urology Osaka University Graduate School of Medicine Suita Osaka Japan
| | - Takeshi Kishida
- Department of Urology Kanagawa Cancer Center Yokohama Kanagawa Japan
| | - Koji Kawai
- Department of Urology University of Tsukuba Tsukuba Ibaraki Japan
| | - Terukazu Nakamura
- Department of Urology Kyoto Prefectural University of Medicine Kyoto Kyoto Japan
- Department of Urology Saiseikai Imperial Gift Foundation Inc. Saiseikai Suita Hospital Suita Osaka Japan
| | - Takayuki Goto
- Department of Urology Graduate School of Medicine and Faculty of Medicine Kyoto University Kyoto Kyoto Japan
| | - Takahiro Osawa
- Department of Urology Graduate School of Medicine Hokkaido University Sapporo Hokkaido Japan
| | - Shigeyuki Yamada
- Department of Departments of Urology Tohoku University Graduate School of Medicine Sendai Miyagi Japan
| | - Kazuo Nishimura
- Department of Urology Osaka International Cancer Institute Osaka Osaka Japan
| | - Norio Nonomura
- Department of Urology Osaka University Graduate School of Medicine Suita Osaka Japan
| | | | - Takumi Shiraishi
- Department of Urology Kyoto Prefectural University of Medicine Kyoto Kyoto Japan
| | - Osamu Ukimura
- Department of Urology Kyoto Prefectural University of Medicine Kyoto Kyoto Japan
| | - Osamu Ogawa
- Department of Urology Graduate School of Medicine and Faculty of Medicine Kyoto University Kyoto Kyoto Japan
| | - Nobuo Shinohara
- Department of Urology Graduate School of Medicine Hokkaido University Sapporo Hokkaido Japan
| | - Akihiro Ito
- Department of Departments of Urology Tohoku University Graduate School of Medicine Sendai Miyagi Japan
| | - Yoichi Arai
- Department of Departments of Urology Tohoku University Graduate School of Medicine Sendai Miyagi Japan
- Department of Urology Miyagi Cancer Center Natori Miyagi Japan
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11
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Koyama J, Yamashita S, Yamada S, Fujii S, Goto T, Katayama H, Satake Y, Sato T, Shimada S, Kawasaki Y, Kawamorita N, Mitsuzuka K, Arai Y, Ito A. Impact of cancer therapy on post-treatment ejaculation disorder and sexual life in testicular cancer survivors. Int J Urol 2020; 28:69-74. [PMID: 33131119 DOI: 10.1111/iju.14403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the impact of cancer therapy on post-treatment ejaculation in patients with testicular cancer. METHODS A total of 74 testicular cancer survivors provided completed International Index of Erectile Function-15 questionnaires before and after treatment between 2010 and 2017. Sexual function, particularly ejaculatory function, was evaluated before and after treatment. In this study, patients who answered "1 = almost never/never" or "2 = a few times" for questionnaire number 9 (ejaculation frequency) were defined as having "ejaculation disorder." RESULTS Of 74 testicular cancer survivors, 50 (68%) had no ejaculation disorders before treatment. Four (44%) of nine survivors, who received chemotherapy and retroperitoneal lymph node dissection, developed ejaculation disorders after treatment. On multivariate analysis, retroperitoneal lymph node dissection was a significant predictor of post-treatment ejaculation disorder (P = 0.042). Of 60 survivors with evaluable ejaculation function after treatment, 24 (40%) did not attempt sexual intercourse, and multivariate analysis showed ejaculation disorder had a significant negative impact on having sexual intercourse (P = 0.035). Furthermore, the mean International Index of Erectile Function-15 scores in the groups with and without ejaculation disorders after treatment were 24.0 and 51.9, respectively (P < 0.001). CONCLUSION Ejaculation disorders occur at high rate after retroperitoneal lymph node dissection. Many testicular cancer survivors reporting no sexual intercourse have ejaculation disorders, suggesting an adverse impact on sexual life. Urologists should provide proper counselling regarding the risk of ejaculation disorder and its possible impact on sexual life.
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Affiliation(s)
- Juntaro Koyama
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shigeyuki Yamada
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Urology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
| | - Shinji Fujii
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takuro Goto
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiromichi Katayama
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yohei Satake
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takuma Sato
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shuichi Shimada
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshihide Kawasaki
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Naoki Kawamorita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Urology, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Yao Y, Zhang C, Han B, Tang Y, Xiong Y, Wang S. [Shikonin induces cell death by inhibiting glycolysis in human testicular cancer I-10 and seminoma TCAM-2 cells]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1288-1294. [PMID: 32990238 DOI: 10.12122/j.issn.1673-4254.2020.09.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the pattern of shikonin-induced cell death in testicular cancer cell I-10 and seminoma TCAM-2 cells and explore the possible mechanism in light of mitochondrial function and glycolysis. METHODS I-10 cells treated with 0, 1.2, 1.4 and 1.6 μmol/L shikonin and TCAM-2 cells treated with 0, 0.5, 1 and 1.5 μmol/L shikonin were examined for mitochondrial membrane potential and production of reactive oxygen species (ROS) using JC-1 kit and ROS kit, respectively. The levels of intracellular lactic acid in the cells were detected using a lactic acid kit. The inhibitory effect of shikonin on the proliferation of the cells was assessed with MTT assay. The death patterns of the cells were observed by transmission electron microscopy, and annexin V-FITC/PI double staining was used to detect cell apoptosis. Western blotting was used to detect the relative expression levels of the apoptotic proteins Bax, Bcl-2, and cleaved caspase-3, the autophagy- related protein LC3B and glycolysis- related proteins PKM2, GLUT1 and HK2. RESULTS MTT assay showed that shikonin significantly inhibited the proliferation of I-10 and TCAM-2 cells in a time- and dose-dependent manner (P < 0.05). The IC50 values of shikonin in I-10 cells at 24, 48, and 72 h were 1.8, 1.36 and 1.16 μmol/L, as compared with 2.37, 0.8 and 0.41 μmol/L in TCAM-2 cells, respectively. Shikonin treatment significantly reduced mitochondrial membrane potential, increased ROS levels and lower the level of lactic acid in both I-10 and TCAM-2 cells (P < 0.05). Transmission electron microscopy and annexin V-FITC/PI double staining demonstrated that shikonin induced apoptosis and excessive autophagy in I-10 and TCAM-2 cells (P < 0.05). In both I-10 and TCAM cells, shikonin treatment significantly down- regulated the expressions of Bax, Bcl-2, cleaved caspase-3, PKM2, GLUT1 and HK2, and up-regulated the expression of autophagy-related protein LC3B (P < 0.05). CONCLUSIONS Shikonin can inhibit the proliferation, induce apoptosis and increase autophagy in both I-10 and TCAM-2 cells probably by affecting energy metabolism of the cells.
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Affiliation(s)
- Yue Yao
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Chong Zhang
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Bing Han
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Yurui Tang
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Yanjun Xiong
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Sheng Wang
- Department of Urology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
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Pasalic D, Prajapati S, Ludmir EB, Tang C, Choi S, Kudchadker R, Frank SJ. Outcomes and Toxicities of Proton and Photon Radiation Therapy for Testicular Seminoma. Int J Part Ther 2020; 7:11-20. [PMID: 33274253 PMCID: PMC7707326 DOI: 10.14338/ijpt-20-00018.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/30/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To determine the clinical outcomes and toxicities of proton beam therapy (PBT) versus 3D-conformal photon radiation therapy (XRT) in patients with testicular seminoma. Materials and Methods This observational study evaluated consecutive patients with testicular seminoma who were treated with inguinal orchiectomy and radiation therapy at a single, tertiary, high-volume center in 2008-19. Acute toxicity was scored with the Common Terminology Criteria for Adverse Events V 4.0. Organs at risk were contoured retrospectively by 2 investigators. Recurrences and secondary malignancies were based on routine follow-up imaging, either computed tomography or magnetic resonance imaging. Results Fifty-five patients were treated with radiation therapy, 11 in the PBT-arm and 44 in the XRT-arm, with a median follow-up interval of 61 months (interquartile range [IQR]: 32-79 months). Acute treatment-related diarrhea, grade 1 to 2, was more common among XRT-treated patients (0% vs 29.5%, P = .039), and dermatitis, grade 1, was more likely among PBT-treated patients (27.3% vs 2.3%, P = .004). Dosimetrically, PBT-treated patients, relative to XRT-treated patients, had lower dose to organs at risk including the kidney, bladder, femoral head, spinal cord, bowel, pancreas, and stomach. The 5-year overall survival rate was 100% and disease-free survival rate was 96.4% for all patients. Two patients, all in the XRT-arm, had disease recurrence: 1 in the pelvis and 1 in the lung. Three patients, all in the XRT-arm, were diagnosed with a secondary malignancy: 1 in-field pancreaticoblastoma, 1 in-field colon adenocarcinoma, and a stage IV T-cell lymphoma. Conclusion Proton beam therapy for testicular seminoma resulted in excellent clinical outcomes and was associated with lower rates of acute diarrhea but higher rates of acute dermatitis. Proton beam therapy resulted in no in-field secondary malignancies and a more favorable dosimetric profile for organs at risk relative to XRT. Reduced dose to organs at risk, such as the kidneys, may result in long-term improvement in function.
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Affiliation(s)
- Dario Pasalic
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Surendra Prajapati
- Department of Radiation Physics, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan B Ludmir
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chad Tang
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seungtaek Choi
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajat Kudchadker
- Department of Radiation Physics, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Nason GJ, Chung P, Warde P, Huddart R, Albers P, Kollmannsberger C, Booth CM, Hansen AR, Bedard PL, Einhorn L, Nichols C, Rendon RA, Wood LA, Jewett MAS, Hamilton RJ. Controversies in the management of clinical stage 1 testis cancer. Can Urol Assoc J 2020; 14:E537-E542. [PMID: 32569575 DOI: 10.5489/cuaj.6722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In November 2018, The Canadian Testis Cancer Workshop was convened. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, nurses, patients and patient advocacy groups. One of the goals of the workshop was to discuss the challenging areas of testis cancer care where guidelines may not be specific. The objective was to distill through discussion around cases, expert approach to working through these challenges. Herein we present a summary of discussion from the workshop around controversies in the management of clinical stage 1 (CS1) disease. CS1 represents organ confined non-metastatic testis cancer that represents approximately 70-80% of men at presentation. Regardless of management, CS1 has an excellent prognosis. However, without adjuvant treatment, approximately 30% of CS1 nonseminomatous germ cell tumors (NSGCT) and 15% of CS1 seminoma relapse. The workshop reviewed that while surveillance has become the standard for the majority of patients with CS1 disease there remains debate in the management of patients at high-risk of relapse. The controversy in the management of CS1 testis cancer surrounds the optimal balance between the morbidity of overtreatment and the identification of patients who may derive most benefit from adjuvant treatment. The challenge lies in a shared decision process where discussion of options extends beyond the simple risk of relapse but to include the long-term toxicities of adjuvant treatments and the favorable cancer-specific survival.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Christopher M Booth
- Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lawrence Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori A Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Yamashita S, Koyama J, Goto T, Fujii S, Yamada S, Kawasaki Y, Kawamorita N, Mitsuzuka K, Arai Y, Ito A. Trends in Age and Histology of Testicular Cancer from 1980-2019: A Single-Center Study. TOHOKU J EXP MED 2020; 252:219-224. [DOI: 10.1620/tjem.252.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Juntaro Koyama
- Department of Urology, Tohoku University Graduate School of Medicine
| | - Takuro Goto
- Department of Urology, Tohoku University Graduate School of Medicine
| | - Shinji Fujii
- Department of Urology, Tohoku University Graduate School of Medicine
| | | | | | - Naoki Kawamorita
- Department of Urology, Tohoku University Graduate School of Medicine
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine
- Department of Urology, Miyagi Cancer Center
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine
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Contemporary Assessment of Survival Rates in Stage I Testicular Seminoma: A Population-Based Comparison Between Surveillance and Active Treatment After Orchiectomy. Clin Genitourin Cancer 2019; 17:e793-e801. [DOI: 10.1016/j.clgc.2019.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/08/2019] [Accepted: 04/19/2019] [Indexed: 11/17/2022]
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17
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Karim S, Wei X, Leveridge MJ, Siemens DR, Robinson AG, Bedard PL, Booth CM. Delivery of chemotherapy for testicular cancer in routine practice: A population-based study. Urol Oncol 2019; 37:183.e17-183.e24. [DOI: 10.1016/j.urolonc.2018.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 11/27/2022]
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