Analysis of active surveillance uptake for localized prostate cancer in Quebec in 2016: A Canadian bicentric study and comparison with 2010 data

INTRODUCTION

Active surveillance (AS) has emerged as a primary management strategy for low-risk prostate cancer (PC) patients. We aimed to assess AS uptake over a 1-year snapshot throughout Quebec and to compare it to 2010 multicentric Canadian data.

METHODS

A retrospective chart review and data collection was performed in 1 academic and 2 non-academic community centres from Quebec, among men identified in 2016 with localized T1c-T2c PC on biopsy, fulfilling NCCN criteria of low-risk (LR)-PC, including very-low-risk (VLR) and non-VLR-PC, and favourable-intermediate risk (FIR)-PC. AS adherence was defined when chosen as initial strategy, without any radical treatment within 6 months.

RESULTS

Overall, 259 patients fulfilled the inclusion criteria with 50.2% of VLR-PC patients. At 6 months, 81% patients in the LR group and 65% in the FIR group were considered as adherent to AS, in both centres, but with an increased use of AS in the community centres compared to 2010 data. The rates of AS maintenance decreased at 12 months to respectively 69% and 58%. Among the VLR group, the rate of initiation was 98% and decreased to 85% at 12 months.

CONCLUSION

Our data suggest that the majority of low-risk PC patients indeed initiated an AS in 2016, with even a greater proportion of VLR-PC patients compared to 2010. This ideal strategy should be encouraged and improved at 12 months, and assessed with recent data and longer follow-up.

LEVEL OF EVIDENCE: 4

Secondary cancer prevention among the youth: research status and policy recommendations for the EU

Background

In early 2021, Europe's Beating Cancer Plan was announced on World Cancer Day. While the European Commission's plan does not include a focus on secondary cancers prevention, the secondary cancers are the sixth most common group of malignanciesThe review aims to 1) synthesize the existing approaches and interventions for cancer prevention in young cancer patients and survivors, 2) deliver evidence-based recommendations for how to best adapt the existing cancer prevention guidelines for young cancer survivors including children, adolescents or young adults (AYA).

Methods

Four major databases (PubMed, Web of Science and PsycINFO, PsycNET) were screened for relevant literature on cancer prevention in childhood and AYA cancer patients and survivors using a combination of terms.

Results

The search yielded 2,712 unique articles from which 32 met the inclusion criteria. Few existing studies focus on AYA or directly address cancer prevention in young survivors. More emphasis is needed on other preventative measures beyond healthy diet and physical exercise.

Conclusions

This review revealed a gap in the translational research in cancer prevention for young people with cancer. The findings emphasize that childhood and AYA cancer patients and survivors need not be overlooked. A pan-European research framework for prevention of second primary cancer among young people is recommended to gain knowledge on how to best adapt the measures against second primary cancers in youth.

Key messages

Developing targeted cancer prevention measures in young cancer survivors may lower the burden of second primary cancers as well as attenuate the fear of recurrence, one of the most prevalent worries. A pan-European research framework for prevention of second primary cancer among young people is recommended to gain knowledge on how to best adapt the measures against second primary cancers in youth.

Testicular pain as an atypical presentation of sarcoidosis

Sarcoidosis is a systemic granulomatous disease, with genitourinary tract involvement being very rare (0.2% of all sarcoidosis cases). Genitourinary sarcoidosis may present with a scrotal mass with or without testicular pain, often mimicking epididymo-orchitis or malignancy. Only 8 cases of genitourinary sarcoidosis have been reported in the literature in the last 14 years. We describe the case of a 25-year-old man who was referred with testicular pain. Scrotal ultrasonography demonstrated multiple bilateral hypoechoic testicular lesions that were of similar size and distributed unusually throughout the testicular parenchyma. Computed tomography detected a nodule in the middle lobe of the right lung, multiple small volume nodes in the retrocaval and left para-aortic regions, and enlarged bilateral external iliac and inguinal nodes, similar to those found in metastatic testicular cancer. Following ultrasound guided excision of one of the lesions, histopathological examination confirmed granulomatous inflammation consistent with sarcoidosis.