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Abstract
PURPOSE OF REVIEW Testicular cancer is the most common solid malignancy amongst young men, and a large proportion present with stage I disease. The options for management following radical orchiectomy are multifold. We review here approaches to treatment in this setting, providing an update on recent publications. RECENT FINDINGS At Princess Margaret Cancer Centre, we maintain a nonrisk adapted active surveillance approach. With a dedicated surveillance program using low-dose computed tomography imaging, patients are appropriately identified early for treatment on relapse. There are ongoing investigations into minimizing toxicities of treatments for relapse, and in particular, retroperitoneal lymph node dissection (RPLND) presents an attractive alternative. This, though, remains investigational in the setting of seminoma. SUMMARY Testicular cancer is a highly curable malignancy. In stage I disease, an active surveillance approach following radical orchiectomy is preferred, irrespective of risk-profile. This approach serves to limit the toxicity of adjuvant treatment in a significant proportion of patients, while maintaining excellent survival outcomes.
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Affiliation(s)
- Jerusha Padayachee
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto
| | - Roderick Clark
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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2
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Rubero J, Lee J, Solomon M, Wu JC, Ganti L. Testicular Germ Cell Tumor Presenting to the Emergency Department. Cureus 2021; 13:e12618. [PMID: 33585107 PMCID: PMC7872484 DOI: 10.7759/cureus.12618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors report on a case of a patient who presented to the emergency department (ED) and was ultimately diagnosed with stage IV testicular non-seminomatous germ cell tumor. The patient was cachectic with a tumor on the neck, abdomen, and scrotum. Germ cell tumors (GCTs) exhibit characteristic symptoms at different points in development. Appropriate treatment can cure most GCTs. While cancer may not be thought of as an ED diagnosis, it can often be the place where patients first present, even when advanced. Recognizing it is important for prompt treatment.
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Affiliation(s)
- Jose Rubero
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Jenny Lee
- Emergency Medicine, Brown University, Providence, USA
| | | | - Jesse C Wu
- Emergency Medicine, University of Central Florida College of Medicine/HCA Healthcare Graduate Medical Education Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Plantation, USA.,Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium Emergency Medicine Residency Program of Greater Orlando, Orlando, USA
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3
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Guner E, Seker K. The role of preoperative albumin to globulin ratio in predicting prognosis in testicular cancer patients. Actas Urol Esp 2020; 44:469-476. [PMID: 32600877 DOI: 10.1016/j.acuro.2020.03.011] [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: 01/13/2020] [Revised: 03/09/2020] [Accepted: 03/22/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES In recent years, the incidence of testicular cancer has increased, but mortality rates have decreased thanks to the improvements in treatment. Although primary tumor characteristics and serum tumor markers are associated with metastasis and relapse, their predictive value is not reliable. Therefore, there is a need for new biomarkers that predict prognosis. In this study, we aimed to investigate the role of preoperative albumin to globulin ratio (AGR) in predicting retroperitoneal lymph node (RPLN) involvement, distant metastasis and prognosis in testicular cancer. MATERIAL AND METHODS We retrospectively analyzed the medical records of all patients that underwent radical inguinal orchiectomy at our hospital between 2007 and 2018. AGR was calculated using the equation: AGR=serum albumin/(serum total protein-serum albumin). The predictive value of AGR for RPLN involvement and distant metastasis was evaluated using receiver operating characteristic analysis and its prognostic value was evaluated using Kaplan-Meier survival analysis. RESULTS A total of 115 patients with a mean age of 33.4±7.7years were included in the study. In multivariate analysis, AGR less than 1.47 and the presence of lymphovascular invasion were detected as the factors predicting RPLN involvement and distant metastasis. The AGR of patients who had died was significantly lower than AGR of those who were alive, 1±0.2 versus 1.6±0.3 (P=.001). In Kaplan-Meier survival analysis, the mean survival of patients with higher AGR (>1.47) was found longer than patients with lower AGR (<1.47). CONCLUSIONS Preoperative AGR is a biomarker that may be used in predicting RPLN involvement, distant metastasis and prognosis in testicular cancer.
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Koši Kunac A, Gnjidić M, Antunac Golubić Z, Gamulin M. Treatment of germ cell testicular cancer. Acta Clin Croat 2020; 59:496-504. [PMID: 34177060 PMCID: PMC8212650 DOI: 10.20471/acc.2020.59.03.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Germ-cell testicular cancer (GCTC) is a malignant neoplasm derived from the primordial germ cell. Although it accounts for approximately 1% of all malignancies in men, it is the most common cancer of younger male population, with the highest incidence between ages 15 and 35. Testicular cancer incidence rate has risen globally over the past several decades, with the average increase in the incidence of testicular cancer in Croatia of 7% per annum from the year 1983 to 2007. Two main groups are seminomas and non-seminomas, each accounting for 50% of cases, and they differ in treatment modalities and response to therapy. Despite increase in the incidence rate, a promising circumstance is that GCTC has become a model of curable cancer. Because of advances in diagnostic procedures, sophisticated radiation techniques and especially the introduction of cisplatin based chemotherapy protocols together with advanced postchemotherapy surgical techniques, curability is expected in about 95% of all patients diagnosed with testicular cancer and over 70% of patients with advanced disease. In this review, we will focus on treatment strategies of primary GCTC.
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Affiliation(s)
| | - Milena Gnjidić
- Zagreb University Hospital Centre, Department of Oncology, Division of Medical Oncology, Unit of Uro-oncology, Referral Center for Treatment of Germ Cell Tumors and Extragonadal Germ Cell Tumors of the Ministry of Health of the Republic of Croatia, Zagreb, Croatia
| | - Zrna Antunac Golubić
- Zagreb University Hospital Centre, Department of Oncology, Division of Medical Oncology, Unit of Uro-oncology, Referral Center for Treatment of Germ Cell Tumors and Extragonadal Germ Cell Tumors of the Ministry of Health of the Republic of Croatia, Zagreb, Croatia
| | - Marija Gamulin
- Zagreb University Hospital Centre, Department of Oncology, Division of Medical Oncology, Unit of Uro-oncology, Referral Center for Treatment of Germ Cell Tumors and Extragonadal Germ Cell Tumors of the Ministry of Health of the Republic of Croatia, Zagreb, Croatia
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Abstract
PURPOSE OF REVIEW Testicular germ cell tumour (TGCT) is a common malignancy among young men. There is controversy regarding the best approach for patients with clinical stage I disease due to rates of relapse with active surveillance in contrast to overtreatment with adjuvant therapy. The aim of this review is to describe the role of prognostic factors in this setting. RECENT FINDINGS Molecular prognostic factors have been described as a possible future aid to clinical and histologic features in the approach of patients with clinical stage I germ cell tumours. SUMMARY Prognostic factors currently available are not accurate enough and may lead to overtreatment. However, though active surveillance has shown long-term survival near to 100% in the management of clinical stage I germ cell tumours, there is a significant percentage of patients with occult metastatic disease, who benefit from adjuvant therapy. In light of these data, future research is needed to better define high-risk patients for relapse, taking into account molecular markers recently reported.
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Conditional risk of relapse in patients with germ cell testicular tumors: personalizing surveillance in clinical stage 1 disease. Curr Opin Urol 2019; 28:454-460. [PMID: 29916845 DOI: 10.1097/mou.0000000000000526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Germ cell testicular tumors (GCTTs) are the most common malignancy in young men, and the incidence is increasing worldwide. Most patients present with clinical stage I (CS1) disease, and active surveillance is being increasingly adopted as the preferred initial treatment modality. In this review, we describe the concept of conditional risk of relapse (CRR), an evolving risk estimate for CS1 GCTT patients on active surveillance who have not relapsed. RECENT FINDINGS At diagnosis, patients are often counseled about their initial risk of relapse based on known risk factors present at diagnosis. However, the risk estimate becomes less informative in patients who have survived a period of time without experiencing relapse. CRR, on the other contrary, provides specific information on a patient's evolving risk of relapse over time. This dynamic estimate can be used to tailor surveillance protocols based on future risk of relapse within risk subgroups. SUMMARY Implementation of CRR in patients on active surveillance can reduce the burden of follow-up, the number of physician visits and tests, and lower costs for the healthcare system. Finally, CRR estimates provide patients with a meaningful, evolving risk estimate, and may help reassure patients and reduce potential anxiety while continuing active surveillance.
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Douglass L, Kovac E, Campbell S, Stephenson A, Meade P, Maizels M. Computer-enhanced visual learning: open primary, nerve-sparing retroperitoneal lymph node dissection. J Pediatr Urol 2019; 15:270-272. [PMID: 31221396 DOI: 10.1016/j.jpurol.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/19/2022]
Affiliation(s)
- L Douglass
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
| | - E Kovac
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
| | - S Campbell
- Department of Urology, Cleveland Clinic Foundation, OH, USA
| | - A Stephenson
- Department of Urology, Cleveland Clinic Foundation, OH, USA
| | - P Meade
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - M Maizels
- Division of Pediatric Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Goldberg H, Klaassen Z, Chandrasekar T, Fleshner N, Hamilton RJ, Jewett MAS. Germ Cell Testicular Tumors-Contemporary Diagnosis, Staging and Management of Localized and Advanced disease. Urology 2018; 125:8-19. [PMID: 30597167 DOI: 10.1016/j.urology.2018.12.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 01/15/2023]
Abstract
Germ cell testicular tumors are the most commonly diagnosed cancer in young men, with cure rates exceeding 95%. Clinical stage 1 disease is the most common manifestation, with radical orchiectomy curing the majority of Clinical stage 1 patients, making active surveillance the treatment of choice, with a cancer specific survival nearing 100% and low relapse rates. However, in metastatic disease, chemotherapy, radiotherapy, and surgery are curative options. Chemotherapy remains the mainstay of therapy for advanced disease with surgical management of residual disease. Patients with advanced disease should be treated in high volume experienced academic centers with multidisciplinary teams. Research exploring refinement of diagnosis and treatment, and lowering treatment burden is underway.
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Affiliation(s)
- Hanan Goldberg
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada.
| | - Zachary Klaassen
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Thenappan Chandrasekar
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Neil Fleshner
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Robert J Hamilton
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
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Robotic Primary RPLND for Stage I Testicular Cancer: a Review of Indications and Outcomes. Curr Urol Rep 2016; 17:41. [DOI: 10.1007/s11934-016-0597-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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