Recommandations en Onco-Urologie 2010 : Tumeurs germinales du testicule

[Primary urological cancers in a context of limited resources: Epidemiology and treatment]

OBJECTIVES

To describe the epidemiological, clinical and therapeutic aspects of primary urological cancers in semi-urban areas in Burkina Faso.

PATIENTS AND METHOD

A descriptive study was conducted over the period from 1 January 2008 to 31 December 2017 in the General Surgery Department of the Tenkodogo Regional Hospital, located in the east of Burkina Faso. All patients over 15 years of age who were diagnosed with primary urological cancer were included.

RESULTS

A total of 160 patients were included. One hundred and thirty-one patients were male (81.9%). The sex ratio was 4.5. The average age of the patients was 58.9 years (standard deviation: 18 years). We found 73 cases of prostate cancers (45.6%), 53 bladder cancers (33.1%), 17 kidney cancers (10.6%), 11 testicular cancers (6.9%) and 6 cancers of the male external genitalia (3.7%). The histological types of prostate cancer were adenocarcinoma (88%) and neuroendocrine carcinoma (12%). Thirty-seven prostate cancers (50.7%) were diagnosed at the T3 stage and 12 others (16.4%) at the T4 stage. Prostate cancer treatment was only medical in 23 patients; surgical treatment was indicated in 50 other patients. The 5-year survival was 85%. Sixteen patients (30.2%) had metastatic bladder cancer at the time of diagnosis. The treatment of vesical cancers has been palliative in 50 cases.

[Non palpable testicular tumors. Retrospective series]

OBJECTIVE

To report our experience in 13 cases with nonpalpable testicular tumors and review the literature.

MATERIAL AND METHODS

From 1998 to 2012, 13 patients were diagnosed with nonpalpable testicular tumors. The data base was performed prospectively, and analyzed retrospectively. We evaluated demographic data, clinical presentation, ultrasound tumor features, tumor markers, frozen and final histopathological findings. All patients were also evaluated with serum tumor markers and the surgical approach was inguinal.

RESULTS

The mean age was 46.4 years and the most frequent clinical presentation were orchialgia in six patients (46.1%) and infertility in three (23%). All masses were hypoechoic with an average tumor size of 8.9 mm. The serum tumor markers were negative in all patients and the final histopathological findings were six seminomas, two embryonal carcinomas, one seminiferous tubules atrophy, a segmental testicular infarction, a Sertoli cell tumor and a Leydig cell tumor.

CONCLUSIONS

Nonpalpable testicular masses were benign in almost half of the cases; therefore, we recommend using the frozen section pathology as a tool to perform conservative surgery in selective cases.

[Growing teratoma syndrome]

Growing teratoma syndrome (GTS) is a rare entity, characterized by enlarging masses of the retroperitoneum or other location occurring during or after systemic chemotherapy for the treatment of non-seminomatous germ cell of the testis (NSGCT). Three criteria define this syndrome: enlarging metastatic masses, normalized serum markers and no component of viable germ cell tumor in this mature teratoma. Prognostic is excellent after the resection of these masses, but this surgery has to be as much complete as possible. Surgical excision of large GTS lesions is technically challenging, a serious intraoperative complications may occur, that's why the treatment must not be delayed.

[Urological cancers: ECCO/ESMO congress 2011]

In the Congress of European Cancer Organisation (ECCO)/European Society for Medical Oncology (ESMO), which took place in Stockholm between 23 and 27 September 2011, urological cancers were the subject of various oral presentations and posters. A selection of the more innovative researches, likely to change the patients' management was performed. In prostate cancer, abiraterone acetate should be indicated in patients previously treated with docetaxel and sipuleucel-T in patients with asymptomatic or minimally symptomatic castrate-resistant prostate cancer. Alpharadine should be indicated in patients with symptomatic bone metastases and denosumab in non-metastatic prostate cancer patients with a high risk of developing bone metastases. In metastatic renal clear cell carcinoma, the genetic polymorphisms are predictive for efficacy of anti-angiogenic agents. Targeting both vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) pathways is a very promising strategy. In urothelial cancer, two molecules are promising, the belinostat and the bortezomib. Other news on penile cancer and testicular seminoma are discussed.

[Postchemotherapy retroperitoneal lymphadenectomy for testicular cancer. Literature review by the Oncology Committee of the French Association of Urology, External Genitalia Group]

INTRODUCTION

Postchemotherapy retroperitoneal lymphadenectomy (PC RPLDN) leads to an overall survival rate for testicular cancer exceeding 75%. Several questions still persist concerning: preoperative assessment of residual masses, reducing templates of dissection, choosing surgical approaches or including RPLND in high-risk patients' management.

METHOD

The main series in the literature of the past 20 years were analyzed and selected to address these issues and reach a consensual diagnostic and therapeutic approach.

RESULTS

Forty-eight original articles (1992 to 2011) were selected. They confirm that no preoperative tool can predict the histological nature of residual masses. The unilateral modified template is a valid option for selected patients but the full bilateral dissection remains the standard but more morbid. The laparoscopic approach is being evaluated. The LDNRP PC is indicated in "high risk" situations especially after salvage chemotherapy.

CONCLUSION

The bilateral lymphadenectomy by laparotomy of any supracentimeter residual mass, 6 weeks after chemotherapy, for germ cell tumors of the testicle is a standard of care.

The role of imaging in staging and monitoring testicular cancer

The prognosis for testicular cancer is excellent, with a 5-year survival rate greater than 95%. Patients affected can therefore expect to be cured after treatment. Successful treatment requires assessment of the condition at the various stages of its management. Imaging plays a major role in initial analysis of the lymphatic extension and in looking for metastases. It is essential for evaluating the response to treatment and during follow-up after treatment. CT is the most commonly used imaging method in this context, but the role of PET is currently developing. The purpose of this paper is to review the role of the imaging methods commonly used in the management of testicular cancer.

[Stage I seminoma: therapeutic strategy: surveillance, radiotherapy, chemotherapy. A case-report]

The management guide-lines about stage I seminoma (pT1 à pT4, No, Mo) recommend to perform a surveillance, an adjuvant chemotherapy based on carboplatine, or a radiotherapy. However, these options are not equivalent for side effects and relapse risk. Debates are in progress in order to simplify the surveillance protocols which remain essential because of the tumoral relapses for 15% of the patients. The occurrence of a tumoral relapse during the follow-up does not decrease the specific survival. The para-aortic 20 Gy radiotherapy is efficient on the seminoma and decreases the relapse risk. Its main side-effect is a long-term risk of secondary cancer. Carboplatine chemotherapy is also an efficient option which provides good results on the specific survival and the survival without progression. Very few studies assess the long-term side effects of chemotherapy. In the end, the therapeutic decision must be taken with the patient after informing him about all the therapeutic options.