Management Of Testicular Cancer Research Articles

Surgical management of testicular cancer with limited retroperitoneal disease.

Chemotherapy offers excellent long-term survival rates for men with clinical stage II germ cell tumours. However, in this predominantly younger population, chemotherapy is associated with long-term adverse effects. Primary retroperitoneal lymph node dissection (RPLND) may serve as an alternative treatment option, preserving oncological safety while potentially reducing adverse effects in men with limited retroperitoneal disease. The rate of negative surgical specimens (pN0) in primary RPLND series varies between 4% and 16% in seminoma and 12-29% in nonseminoma, respectively. This suggests that early restaging, novel biomarkers, and/or percutaneous biopsies should be considered to minimize overtreatment. In stage II seminoma, three prospective RPLND series with follow-up periods ranging from 22 to 51 months report recurrence rates between 6% and 30%. In contrast, only retrospective data are available for stage II nonseminoma, with follow-up periods and recurrence rates yet to be fully defined. Following primary RPLND with confirmed viable cancer, adjuvant chemotherapy reduces recurrence risk. In cases of recurrence after primary RPLND, first-line chemotherapy remains a highly effective salvage option. Ongoing research is needed to identify risk factors for contralateral retroperitoneal disease to refine surgical templates and to determine predictors of recurrence, allowing for more personalized decisions regarding the use of adjuvant chemotherapy and follow-up strategies. Men with clinical stage II germ cell tumours may benefit from RPLND due to its lower risk of long-term side effects. Chemotherapy is an effective salvage treatment if needed. Although RPLND is a safe and promising option, further studies are required to better understand relapse risks and to tailor treatment plans based on individual patient factors.

Testicular cancer malpractice trends

ObjectiveMedical and surgical advancements have been made in testicular cancer management over the past 50 years. The evolution of practice standards is expected to provide patients benefits in quality of life and oncologic outcomes, but changes in care standards can introduce potential opportunities for increased malpractice claims against providers. We seek to evaluate if modifications in testicular cancer management have translated to a rise in malpractice lawsuits. MethodsA retrospective review of testicular cancer malpractice cases within the Google Scholar Case Law database was performed from January 1, 1975, to January 1, 2024. ResultsOf 102 cases initially screened, 24 were identified after duplicates were excluded and cases irrelevant to malpractice litigation in testicular cancer patients. Most cases were related to delays in diagnosis or treatment (n = 21, 87.5%). Two cases (8.3%) were in response to complications from radiation treatment, and 1 case (4.2%) was a suit in response to the loss of semen specimen for fertility preservation after testicular cancer diagnosis. No malpractice claims were filed in response to surveillance practices or surgical techniques utilized for retroperitoneal lymph node dissection. ConclusionsDespite the adoption of changes in testicular cancer management and ongoing controversies in care, an increase in malpractice lawsuits in response to changing paradigms in testicular cancer was not seen.

Conventional versus high-dose salvage chemotherapy for relapsed testicular germ cell tumours

Since the introduction of cisplatin-based combination chemotherapy, patients with metastatic germ cell tumours achieve very high cure rates of >80%. Nevertheless, about 30% of patients relapse despite guideline-endorsed first-line treatment. Of these, again about 50% of patients can still achieve cure with platinum-based salvage chemotherapy and eventually post-chemotherapy residual mass resection.Salvage chemotherapy generally involves platinum-based combination chemotherapy, either as conventional dose cisplatin-based combinations again or as high-dose chemotherapy with subsequent autologous stem cell transplantation.To date, high level evidence from randomised trials supporting the use of salvage high-dose chemotherapy for all patients relapsing after first-line treatment remains lacking, but a large international retrospective registry study had shown a 15% overall survival benefit for patients undergoing salvage high-dose chemotherapy.In this article, we summarise the available literature on the different salvage treatment approaches and discuss these in the light of current treatment guideline recommendations for the management of testicular cancer.

The clinical value of complete blood count-based immun parameter in predicting testicular cancer pathology and prognosis

Aim: The management of testicular cancer (TC) requires more specific and applicable biomarkers. We aimed to determine the ability of complete blood count (CBC) based inflammatory markers to predict tumor pathology and prognosis in TC. Methods: Patients who underwent inguinal orchiectomy for testicular germ cell tumors (TGCTs) at our hospital between January 2011 and December 2022 were included in the study. The medical records of patients with pathologically confirmed TC, including demographics, preoperative tumor markers, preoperative CBC, tumor characteristics, pathological outcomes, postoperative follow-up, and survival outcomes, were retrospectively collected. CBC-based inflammatory markers were compared between seminomatous and non-seminomatous TGCTs. To determine the independent prognostic significance of survival, the data were analyzed and fitted to the multivariate Cox proportional risk regression model. Results: The median follow-up was 48 (1-140) months. In our chord, 69 patients had seminomatous TGCTs (Group 1), and 66 had non-seminomatous TGCTs (Group 2). The median ages of Groups 1 and 2 were 35 (22-74) years and 31 (21-72) years(p

Evaluation of antioxidant enzyme levels, oxidative stress markers and serum prolidase activity in testicular cancer.

Testicular cancer is a significant malignancy affecting males, and understanding the underlying biochemical changes associated with the disease is essential for improved management and treatment strategies. Prolidase enzyme, has been implicated in various disease processes. The assessment of serum prolidase activity and its relationship with testicular cancer can provide valuable insights into the pathophysiology of the disease. The objective of this study was to investigate serum prolidase activity, oxidative stress markers, and antioxidant enzyme levels in patients with testicular cancer and evaluate their potential associations, aiming to enhance our understanding of the biochemical alterations and potential implications for testicular cancer management. A total of 33 male patients diagnosed with testicular cancer were included, along with 35 age-matched male volunteers as the control group. Serum samples were collected and stored at -20°C until analysis. The measurement of superoxide dismutase (SOD), glutathione peroxidase (GSHPx), glutathione-S-transferase (GST), malondialdehyde (MDA), glutathione (GSH), and prolidase levels was performed. The findings demonstrated significantly elevated serum prolidase activity and malondialdehyde (MDA) levels in testicular cancer patients compared to the control group (all, p < 0.05). Conversely, superoxide dismutase (SOD), glutathione peroxidase (GSHPx), and glutathione-S-transferase (GST) levels were significantly lower in testicular cancer patients (p < 0.05). In this study, serum prolidase activity and biochemical markers associated with oxidative stress were investigated in testicular cancer patients. Oxidative stress markers and serum prolidase activity were found to be elevated in testicular cancer. Long-term prospective studies are needed to determine the effectiveness of antioxidant use in cancer treatment.

Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives.

This narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer (TC). It explores the significance of RPLND as both a diagnostic and therapeutic tool, highlighting its contribution to accurate staging, its impact on oncological outcomes, and its influence on subsequent treatment decisions. RPLND serves as an essential diagnostic procedure, aiding in the precise assessment of lymph node involvement and guiding personalized treatment strategies. It has demonstrated therapeutic value, particularly in patients with specific risk factors and disease stages, contributing to improved oncological outcomes and survival rates. Recent studies have emphasized the importance of meticulous patient selection and nerve-sparing techniques to mitigate complications while optimizing outcomes. Additionally, modern imaging and surgical approaches have expanded the potential applications of RPLND. In the context of TC management, RPLND remains a valuable and evolving tool. Its dual role in staging and therapy underscores its relevance in contemporary urological practice. This review highlights the critical role of RPLND in enhancing patient care and shaping treatment strategies, emphasizing the need for further research to refine patient selection and surgical techniques.

Management of Testicular Cancers in Brazzaville

Management of Testicular Cancers in Brazzaville

Surgical Management of Testicular Cancer

Surgical Management of Testicular Cancer

Management of testicular cancer: Practice survey in localized stage.

Management of testicular cancer requires a complete evaluation to confirm the localized stage and effective treatment according to guidelines to ensure the best outcome. The primary objective of this study was to evaluate practices at each stage of care in patients with a localized testicular tumor. The secondary objective was to evaluate the oncological prognosis of these patients according to the modalities of care. We conducted a multicenter practice evaluation study with retrospective collection and evaluation of patient records. The study was conducted in two French departments (population pool of 2 million inhabitants) between January 1, 2010, and January 31, 2015, enabling a five-year followup of patients. Patients presenting with stage I testicular tumor according to the American Joint Committee on Cancer classification were included in the analysis. A total of 226 records were analyzed; 93% of patients underwent bilateral scrotal ultrasound and 93.25% had a chest-abdomen-pelvis computed tomography scan. A total of 29.65% of patients had a preoperative tumor marker assay in accordance with guidelines; 94% of patients had a total orchiectomy, with a median time of 15 days. At the end of the followup period, 17 patients had suffered a recurrence of their disease. Providing adjuvant care in accordance with guidelines reduced the risk of recurrence in patients with a seminomatous tumor. Our study showed heterogeneity in compliance with guidelines for evaluation and effective treatment of patients with a localized testicular tumor. Some essential practices, such as assays of tumor markers and fertility preservation for patients over 40 years, were not well carried out. Adjuvant management of localized tumors appears to be an important predictor of recurrence.

EARLY-STAGE TESTICULAR CANCER MANAGEMENT REFERRING TO EUROPEAN ASSOCIATION OF UROLOGY (EAU) GUIDELINES: A SURVEY IN INDONESIA

Objective: This study aimed to determine the management of early-stage testicular cancer among urologists in Indonesia by using a survey. Material &amp; Methods: This research was a descriptive-analytic study using a survey method through a Google-forms questionnaire distributed to urologists throughout Indonesia who were willing to participate. Data were collected from September 1 to 30, 2021. Results: Of the total respondents, 15 (14.2%) respondents were consultant urologic oncologists, and 90 (85.71%) respondents were non-consultant urologists or consultant urologists non-oncology. There was no difference in the treatment given by consultant uro-oncologists and non-consultant urologists/consultant urologists non-oncology in the management of surveillance of stage IA-IB seminoma (66.7% vs. 55.6%, p-value = 0.207), chemotherapy of stage IIA-IIB seminoma (100.0% vs. 90.0%, p-value = 0.080), surveillance of stage I non-seminoma cancers (46.7% vs. 41.1%, p-value = 0.304), and chemotherapy of stage IIA and IIB non-seminoma cancers (80% vs. 91.1%, p-value = 0.193). Conclusion: In general, as many as 84.4% of oncology consultant urologists and 83.7% of non-consultant urologists/consultant urologists non-oncology have performed initial diagnostic examinations, treatment, and follow-up following testicular cancer management guidelines according to the European Association of Urology 2021.

Nerve-sparing technique in RPLND for testicular cancer.

The management of testicular cancer has evolved over time with multimodal therapy. Retroperitoneal lymph node dissection (RPLND), which is a complex and potentially morbid treatment option, remains the mainstay in surgical treatment. This article reviews the surgical template, approach and anatomical considerations with regards to nerve spare in RPLND. The standard full bilateral RPLND template has evolved over time to include the area between the renal hilum, bifurcation of the common iliac vessels, and the ureters. Morbidity with regards to ejaculatory dysfunction has led to further refinements in this procedure. Advancements in anatomical understanding of the retroperitoneal structures and their relationship to the sympathetic chain and hypogastric plexus has allowed for modification of surgical templates. Further refinements in surgical nerve sparing techniques have improved functional outcomes without sacrificing oncological outcomes. Finally, extraperitoneal access to the retroperitoneum and minimally invasive platforms have been implemented to further reduce morbidity. RPLND requires strict adherence to oncological surgical principles regardless of template, approach and technique. Contemporary evidence shows that outcomes are best for advanced testis cancer patients when managed at high volume tertiary care facilities with surgical expertise and access to multidisciplinary care.

German specialists treating testicular cancer follow different guidelines with resulting inconsistency in assessment of retroperitoneal lymph-node metastasis: clinical implications and possible corrective measures

BackgroundTesticular germ cell tumors (GCTs) are aggressive but highly curable tumors. To avoid over/undertreatment, reliable clinical staging of retroperitoneal lymph-node metastasis is necessary. Current clinical guidelines, in their different versions, lack specific recommendations on how to measure lymph-node metastasis.ObjectiveWe aimed to assess the practice patterns of German institutions frequently treating testicular cancer for measuring retroperitoneal lymph-node size.MethodsAn 8‐item survey was distributed among German university hospitals and members of the German Testicular Cancer Study Group.ResultsIn the group of urologists, 54.7% assessed retroperitoneal lymph nodes depending on their short-axis diameter (SAD) (33.3% in any plane, 21.4% in the axial plane), while 45.3% used long-axis diameter (LAD) for the assessment (42.9% in any plane, 2.4% in the axial plane). Moreover, the oncologists mainly assessed lymph-node size based on the SAD (71.4%). Specifically, 42.9% of oncologists assessed the SAD in any plane, while 28.5% measured this dimension in the axial plane. Only 28.6% of oncologists considered the LAD (14.3% in any plane, 14.3% in the axial plane). None of the oncologists and 11.9% of the urologists (n = 5) always performed an MRI for the initial assessment, while for follow-up imaging, the use increased to 36.5% of oncologists and 31% of urologists. Furthermore, only 17% of the urologists, and no oncologists, calculated lymph-node volume in their assessment (p = 0.224).ConclusionClear and consistent measurement instructions are urgently needed to be present in all guidelines across different specialistic fields involved in testicular cancer management.

Imaging Recommendations for Diagnosis, Staging, and Management of Testicular Cancer

AbstractThe common testicular tumors affect young males in the third and fourth decades and germ cell tumors especially have excellent post-treatment outcomes. Hence, guidelines for clinical, radiological, and tumor marker assessment for diagnosis, response assessment, and surveillance of these tumors have critical impact on the management of these tumors. This article aims to discuss the current recommendations and guidelines regarding the clinical and radiological assessment and treatment pathways of testicular tumors.

HF01-17 MOBILIZE THE TROOPS! MILITARY INVOLVEMENT IN THE HISTORY OF TESTICULAR CANCER

You have accessJournal of UrologyCME1 Apr 2023HF01-17 MOBILIZE THE TROOPS! MILITARY INVOLVEMENT IN THE HISTORY OF TESTICULAR CANCER Kit Yuen, Alexis Steinmetz, Phillip Rappold, and Ronald Rabinowitz Kit YuenKit Yuen More articles by this author , Alexis SteinmetzAlexis Steinmetz More articles by this author , Phillip RappoldPhillip Rappold More articles by this author , and Ronald RabinowitzRonald Rabinowitz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testicular cancer is a rare malignancy that has become a manageable disease, assisted by the study of the large number of such tumors found in World War II (WWII) soldiers. METHODS: A literature review of textbook chapters, manuscripts, online texts, and peer-reviewed articles was performed for historical descriptions of testis tumors and its treatments. RESULTS: Saint Donat in 1696 described a testis teratoid tumor as a “fetal monstrosity”. Testicular tumor pathology was first documented by British physicians Percival Pott and Astley Cooper in the mid to late 1700s. In 1794, Scottish surgeon Benjamin Bell described the presentation of a testis tumor as a firm painless fleshy enlargement. If treatment with mercury failed, orchiectomy was done. It wasn’t until 1910 that French urologist Maurice Chevassu reported radical orchiectomy. Diagnosis, staging, and evaluation of response to therapy was propelled forward with the discovery of tumor marker human chorionic gonadotropin in 1927. Radiation was introduced to treat testicular cancer in the 1940s. Testis cancer, a tumor of young men, was found in high frequency in the military. Prior to WWII, case series of more than 50 subjects were rare. From examining more than 900 soldiers with testis tumors, the histopathology was established in 1946. In 1950, two large military studies reported that RPLND improved survival compared to orchiectomy alone. In 1952, a modified classification system was published by Frank Dixon and Robert Moore in the first Armed Forces Institute of Pathology (AFIP) tumor atlas. Fathollah Mostofi, along with other military pathologists, contributed greatly to the field; in 1972 he led a group to devise a standardized World Health Organization (WHO) classification system. Until the advent of platinum combination chemotherapy, metastatic disease was bleak and uniformly fatal, with a 90% mortality rate within 1 year. Chemosensitivity was first demonstrated in the 1950s with actinomycin combined with methotrexate. In 1974, a regimen of cisplatin, vinblastine with bleomycin was introduced by Lawrence Einhorn and John Donahue at Indiana University for advanced testicular cancer with greatly improved survival. RPLND templates were further refined with lymph node mapping studies, which decreased morbidity significantly. CONCLUSIONS: World War II brought together young men with testis cancer, a rare disease that ignited fifty years of basic and clinical research resulting in one of the greatest oncological success stories. The military contributed greatly to the diagnosis, histopathology and management of testicular cancer. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e261 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kit Yuen More articles by this author Alexis Steinmetz More articles by this author Phillip Rappold More articles by this author Ronald Rabinowitz More articles by this author Expand All Advertisement PDF downloadLoading ...

Testicular Cancer - The Great Masquerader

Purpose: Testicular cancer is rare with increasing incidence worldwide. Testicular cancer can mimic many other diseases leading to delay in diagnosis. Delays in diagnosis and management of testicular cancer are associated with advanced stage, increased morbidity and poor prognosis. This case report aims to highlight a case of testicular cancer who presented with metastasis due to delays in testicular cancer diagnosis and ways to improve diagnosis.&#x0D; Methodology: The study focused on a 17-year-old boy presented with severe intermittent abdominal pain for a month. He was reviewed by the general physicians, internists, haematologists, radiologists, general surgeons and urologists. He was given several diagnoses before he was correctly diagnosed as advanced right testicular cancer. It took a total of 31 days in a tertiary institution to reach this diagnosis.&#x0D; Findings: The boy had a radical right inguinal orchidectomy. He had 4 courses of bleomycin, etoposide and cisplatin chemotherapy. He made remarkable recovery after treatment. A follow up was recommended closely with abdominal CT, and serum tumour markers (reverted to normal after treatment).&#x0D; Recommendations: Prompt diagnosis of testicular cancer can reduce treatment delays. Physician education, adequate patient evaluation, investigations, and a high index of suspicion would aid diagnosis. Health awareness campaign, testicular self-examination, and good health insurance schemes would reduce patient-related factors which result in delays. Reduction in diagnostic delay is expected to improve outcome and reduce cost of management of the disease.

Factors impacting the delay in diagnosis and treatment of testicular cancer: A review

Early diagnosis and management of testicular cancer can improve mortality and prognosis. This systematic review found extensive patient-, physician-, and system-related factors that increased the length of time to diagnosis. Future preventative strategies should target the modifiable factors such as lack of awareness, embarrassment, accessibility, general practitioner education, and clinical training and streamlined imaging processes.

Follow-up of testicular germ cell tumors-historical aspects and current recommendations

Systematic follow-up examinations of patients cured of testicular cancer first gained attention by caregivers in the 1980s only after the management of the disease had significantly been improved by the introduction of cisplatin-based chemotherapy and almost synchronously, by the implementation of computerized tomography (CT) and serum tumor markers. Follow-up involves three aims: early diagnosis of recurrence, detection of treatment-related toxicity, and detection of secondary diseases. As the clinical presentation of testicular cancer is very heterogeneous, there is no uniform follow-up for the disease. Instead, risk-adapted follow-up schedules are required. Since the release of the German AWMF S3guideline for the management of testicular cancer in 2019, high level evidence has accumulated for the noninferiority of magnetic resonance imaging (MRI) to CT with regard to abdominal imaging. Therefore, it is appropriate to modify the recommendations for follow-up given in the 2019 issue of the S3guidelines. The modifications recommended herein relate to three issues: (1)Only three risk groups (instead of formerly four) are identified, i.e., seminoma (all stages); nonseminoma clinical stage1b (i.e., pT2, with lymphovascular invasion) on surveillance; nonseminoma all other stages. All patients cured from poor risk disease or from relapses require individual follow-up schedules not included in the recommendations tabulated herein. (2)CT and abdominal sonography are replaced by MRI. (3)Chest X‑ray imaging during follow-up of seminoma patients is no longer recommended.

Testicular Cancer in Trans People Using Feminising Hormone Therapy– A Brief Review

The number of transgender (or trans) individuals, including those who have a binary and/or non-binary gender identity, seeking gender-affirming hormone therapy is increasing.1 In this brief review, we aim to provide an overview of gender affirmation and synthesise current literature describing case reports and management of testicular cancer in trans people using feminising hormone therapy.

Specialist management of testicular cancer: Report of the last 10 years at a Portuguese tertiary referral academic centre.

To describe our experience on testicular cancer (TC) management, underlining the clinical/pathological scope, administered treatments, outcomes, and challenges. TC incidence is rising globally. The predominant histology is germ cell tumour (GCT). In most patients, orchiectomy is curative. Still, a significant proportion of patients will need further tailored treatment. Specialist Reference Centres have proven themselves successful in this setting. Published data regarding TC in Northern Portugal is lacking. Retrospective review of consecutive TC patients at a specialist tertiary referral academic centre between January 2010 and December 2020. Statistical analysis was performed using the STATA® version 13.1 software. Multivariate logistic and survival analyses were performed. 125 patients met the inclusion criteria. The median age is 35 (28-40) years; 19% of patients had risk factors for TC - infertility being the most common (11%); 50% of patients wanted sperm cryopreservation prior to treatment; 68% of patients had stage I GCT, 16% stage II, and 17% stage III. Compared to seminoma, non-seminomatous GCT were associated with younger age (p < .001) and higher stages at diagnosis (p = .02); 24% of stage IA/B GCT underwent adjuvant chemotherapy; 47% of patients with metastatic GCT at presentation had refractory disease, requiring tailored treatment. The median follow-up time is 33 (13-65) months. There was no late relapse. The 5-year OS rate is 98.0%. The 5-year survival of metastatic disease is 95.8%. Despite contemporary excellent cure rates, the challenges of testicular cancer management still endure, especially in advanced stages. Therefore, public awareness is recommended, in order to avoid late presentations - special attention should be given to those who have known risk factors. The existence of Reference Centres is of paramount importance in order to achieve the best outcomes possible.

The diagnosis and management of testicular cancer

Health visitors can offer advice to men on the signs and symptoms of testicular cancer, in addition to encouraging them to seek help as required