Pub Date : 2024-05-14DOI: 10.1016/j.euf.2024.05.003
Stamatios Katsimperis, Lazaros Tzelves, Zafer Tandogdu, Anthony Ta, Robert Geraghty, Themistoklis Bellos, Ioannis Manolitsis, Nikolaos Pyrgidis, Gerald Bastian Schulz, Ashwin Sridhar, Gregory Shaw, John Kelly, Andreas Skolarikos
{"title":"Reply to Marco Moschini, Francesco Montorsi, Giuseppe Rosiello, Andrea Salonia, and Alberto Briganti's Letter to the Editor re: Stamatios Katsimperis, Lazaros Tzelves, Zafer Tandogdu, et al. Complications After Radical Cystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials with a Meta-regression Analysis. Eur Urol Focus 2023;9:920-9.","authors":"Stamatios Katsimperis, Lazaros Tzelves, Zafer Tandogdu, Anthony Ta, Robert Geraghty, Themistoklis Bellos, Ioannis Manolitsis, Nikolaos Pyrgidis, Gerald Bastian Schulz, Ashwin Sridhar, Gregory Shaw, John Kelly, Andreas Skolarikos","doi":"10.1016/j.euf.2024.05.003","DOIUrl":"https://doi.org/10.1016/j.euf.2024.05.003","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140944445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1016/j.euf.2024.05.002
Klaus-Peter Dieckmann, Francesca Grobelny, Armin Soave, Yue Che, Tim Nestler, Cord Matthies, Julia Heinzelbecker, Alexander Winter, Axel Heidenreich, Tabea Niemzok, Cansu Dumlupinar, Markus Angerer, Christian Wülfing, Pia Paffenholz, Gazanfer Belge
Background and objective: Serum levels of microRNA-371a-3p (M371) represent a novel and sensitive biomarker of germ cell tumours (GCTs). This study analysed the utility of M371 to identify viable cancer (VC) in postchemotherapy (pc) residual masses with the underlying goal of avoiding overtreatment.
Methods: A multicentric, prospective diagnostic study was conducted in 180 GCT patients undergoing pc resection of residual masses. A correlation of M371 measurement results with the histological presence of VC in masses was found. A receiver operating characteristic analysis was performed for exploring the performance characteristics of the test.
Key findings and limitations: The sensitivity was found to be 68.9%, specificity 99.3%, area under the curve 0.813, positive predictive value 0.969, and negative predictive value 0.905; sensitivity is significantly associated with the percentage of VC in the mass. In specimens with ≤10% VC, there were 33.3% elevated M371 levels as opposed to 85.7% in specimens with >50% VC. Teratoma and somatic-type malignancy do not express M371. A lack of a central pathological review is a limitation.
Conclusions and clinical implications: The M371 test can identify 68.9% of patients with VC in pc masses. However, cases with <10% VC in the mass may escape detection. Teratoma does not express M371. The test alone cannot correctly identify patients requiring pc surgery, but it may be a tool for scheduling the extent of surgery.
Patient summary: The microRNA-371a-3p (M371) test can identify about two-thirds of patients with viable cancer in residual metastatic masses following chemotherapy for germ cell tumours. Only masses with high percentages of viable cancer cells can be identified, and the histological subtype teratoma remains undetected with the test.
{"title":"Serum Levels of MicroRNA-371a-3p for Predicting the Histology of Postchemotherapy Residual Masses of Germ Cell Tumours.","authors":"Klaus-Peter Dieckmann, Francesca Grobelny, Armin Soave, Yue Che, Tim Nestler, Cord Matthies, Julia Heinzelbecker, Alexander Winter, Axel Heidenreich, Tabea Niemzok, Cansu Dumlupinar, Markus Angerer, Christian Wülfing, Pia Paffenholz, Gazanfer Belge","doi":"10.1016/j.euf.2024.05.002","DOIUrl":"https://doi.org/10.1016/j.euf.2024.05.002","url":null,"abstract":"<p><strong>Background and objective: </strong>Serum levels of microRNA-371a-3p (M371) represent a novel and sensitive biomarker of germ cell tumours (GCTs). This study analysed the utility of M371 to identify viable cancer (VC) in postchemotherapy (pc) residual masses with the underlying goal of avoiding overtreatment.</p><p><strong>Methods: </strong>A multicentric, prospective diagnostic study was conducted in 180 GCT patients undergoing pc resection of residual masses. A correlation of M371 measurement results with the histological presence of VC in masses was found. A receiver operating characteristic analysis was performed for exploring the performance characteristics of the test.</p><p><strong>Key findings and limitations: </strong>The sensitivity was found to be 68.9%, specificity 99.3%, area under the curve 0.813, positive predictive value 0.969, and negative predictive value 0.905; sensitivity is significantly associated with the percentage of VC in the mass. In specimens with ≤10% VC, there were 33.3% elevated M371 levels as opposed to 85.7% in specimens with >50% VC. Teratoma and somatic-type malignancy do not express M371. A lack of a central pathological review is a limitation.</p><p><strong>Conclusions and clinical implications: </strong>The M371 test can identify 68.9% of patients with VC in pc masses. However, cases with <10% VC in the mass may escape detection. Teratoma does not express M371. The test alone cannot correctly identify patients requiring pc surgery, but it may be a tool for scheduling the extent of surgery.</p><p><strong>Patient summary: </strong>The microRNA-371a-3p (M371) test can identify about two-thirds of patients with viable cancer in residual metastatic masses following chemotherapy for germ cell tumours. Only masses with high percentages of viable cancer cells can be identified, and the histological subtype teratoma remains undetected with the test.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":5.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.euf.2023.07.009
{"title":"Reply to Kun-Peng Li, Shun Wan, Chen-Yang Wang, and Li Yang’s Letter to the Editor re: Tatsushi Kawada, Ekaterina Laukhtina, Fahad Quhal, et al. Oncologic and Safety Outcomes for Endoscopic Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An Updated Systematic Review and Meta-analysis. Eur Urol Focus 2023;9:236–40","authors":"","doi":"10.1016/j.euf.2023.07.009","DOIUrl":"10.1016/j.euf.2023.07.009","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9976796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.euf.2023.08.007
Background
Salvage radical prostatectomy (sRP) yields poor functional outcomes and relatively high complication rates. Gleason score (GS) 6 prostate cancer (PCa) has genetic and clinical features showing little, if not absent, metastatic potential. However, the behavior of GS 6 PCa recurring after previous PCa treatment including radiotherapy and/or ablation has not been investigated.
Objective
To evaluate the oncological outcomes of sRP for radio- and/or ablation-recurrent GS 6 PCa.
Design, setting, and participants
Retrospective data of sRP for recurrent PCa after local nonsurgical treatment were collected from 14 tertiary referral centers from 2000 to 2021.
Intervention
Prostate biopsy before sRP and sRP.
Outcome measurements and statistical analysis
A survival analysis was performed for pre-sRP biopsy and sRP-proven GS 6. Concordance between PCa at pre-sRP biopsy and sRP histology was assessed.
Results and limitations
We included GS 6 recurrent PCa at pre-sRP biopsy (n = 142) and at sRP (n = 50), as two cohorts. The majority had primary radiotherapy and/or brachytherapy (83.8% of GS 6 patients at pre-sRP biopsy; 78% of GS 6 patients at sRP) and whole-gland treatments (91% biopsy; 85.1% sRP). Biopsy GS 6 10-yr metastasis, cancer-specific survival (CSS), and overall survival (OS) were 79% (95% confidence interval [CI] 61–89%), 98% (95–99%), and 89% (78–95%), respectively. Upgrading at sRP was 69%, 35.5% had a pT3 stage, and 13.4% had positive nodes. The sRP GS 6 10-yr metastasis-free survival, CSS, and OS were 100%, 100%, and 90% (95% CI 58–98%) respectively; pT3 and pN1 disease were found in 12% and 0%, respectively. Overall complications, high-grade complications, and severe incontinence were experienced by >50%, >10%, and >15% of men, respectively (in both the biopsy and the sRP cohorts). Limitations include the retrospective nature of the study and absence of a centralized pathological review.
Conclusions
GS 6 sRP–proven PCa recurring after nonsurgical primary treatment has almost no metastatic potential, while patients experience relevant morbidity of the procedure. However, a significant proportion of GS 6 cases at pre-sRP biopsy are upgraded at sRP. In the idea not to overtreat, efforts should be made to improve the diagnostic accuracy of pre-sRP biopsy.
Patient summary
We investigated the oncological results of salvage radical prostatectomy for recurrent prostate cancer of Gleason score (GS) 6 category. We found a very low malignant potential of GS 6 confirmed at salvage radical prostatectomy despite surgical complications being relatively high. Nonetheless, biopsy GS 6 was frequently upgraded and had less optimal oncological control. Overtreatment for recurrent GS 6 after nonsurgical first-line treatment should be avoided
{"title":"Recurrent Gleason Score 6 Prostate Cancer After Radiotherapy or Ablation: Should We Observe Them All? Results from a Large Multicenter Salvage Radical Prostatectomy Consortium","authors":"","doi":"10.1016/j.euf.2023.08.007","DOIUrl":"10.1016/j.euf.2023.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Salvage radical prostatectomy (sRP) yields poor functional outcomes and relatively high complication rates. Gleason score (GS) 6 prostate cancer (PCa) has genetic and clinical features showing little, if not absent, metastatic potential. However, the behavior of GS 6 PCa recurring after previous PCa treatment including radiotherapy and/or ablation has not been investigated.</p></div><div><h3>Objective</h3><p>To evaluate the oncological outcomes of sRP for radio- and/or ablation-recurrent GS 6 PCa.</p></div><div><h3>Design, setting, and participants</h3><p>Retrospective data of sRP for recurrent PCa after local nonsurgical treatment were collected from 14 tertiary referral centers from 2000 to 2021.</p></div><div><h3>Intervention</h3><p>Prostate biopsy before sRP and sRP.</p></div><div><h3>Outcome measurements and statistical analysis</h3><p>A survival analysis was performed for pre-sRP biopsy and sRP-proven GS 6. Concordance between PCa at pre-sRP biopsy and sRP histology was assessed.</p></div><div><h3>Results and limitations</h3><p>We included GS 6 recurrent PCa at pre-sRP biopsy (<em>n</em> = 142) and at sRP (<em>n</em> = 50), as two cohorts. The majority had primary radiotherapy and/or brachytherapy (83.8% of GS 6 patients at pre-sRP biopsy; 78% of GS 6 patients at sRP) and whole-gland treatments (91% biopsy; 85.1% sRP). Biopsy GS 6 10-yr metastasis, cancer-specific survival (CSS), and overall survival (OS) were 79% (95% confidence interval [CI] 61–89%), 98% (95–99%), and 89% (78–95%), respectively. Upgrading at sRP was 69%, 35.5% had a pT3 stage, and 13.4% had positive nodes. The sRP GS 6 10-yr metastasis-free survival, CSS, and OS were 100%, 100%, and 90% (95% CI 58–98%) respectively; pT3 and pN1 disease were found in 12% and 0%, respectively. Overall complications, high-grade complications, and severe incontinence were experienced by >50%, >10%, and >15% of men, respectively (in both the biopsy and the sRP cohorts). Limitations include the retrospective nature of the study and absence of a centralized pathological review.</p></div><div><h3>Conclusions</h3><p>GS 6 sRP–proven PCa recurring after nonsurgical primary treatment has almost no metastatic potential, while patients experience relevant morbidity of the procedure. However, a significant proportion of GS 6 cases at pre-sRP biopsy are upgraded at sRP. In the idea not to overtreat, efforts should be made to improve the diagnostic accuracy of pre-sRP biopsy.</p></div><div><h3>Patient summary</h3><p>We investigated the oncological results of salvage radical prostatectomy for recurrent prostate cancer of Gleason score (GS) 6 category. We found a very low malignant potential of GS 6 confirmed at salvage radical prostatectomy despite surgical complications being relatively high. Nonetheless, biopsy GS 6 was frequently upgraded and had less optimal oncological control. Overtreatment for recurrent GS 6 after nonsurgical first-line treatment should be avoided","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405456923001943/pdfft?md5=8b40df7c606a5dbbb844f46ce29cd8a6&pid=1-s2.0-S2405456923001943-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10234926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.euf.2023.09.003
Context
Surgical management of lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) aims at ablating prostate adenoma by resection, enucleation, or vaporisation. Apart from established ablation modes according to the European Association of Urology guidelines, various technologies have emerged as safe/effective alternatives but remain under investigation.
Objective
To explore short-term benefits/harms of emerging technologies for surgical management of LUTS/BPO.
Evidence acquisition
A systematic literature search was conducted using MEDLINE, EMBASE, and CENTRAL via Ovid up to June 18, 2022. We included randomised controlled trials (RCTs) exploring aquablation, prostatic arterial embolisation (PAE), Rezum, prostatic urethral lift (PUL), and temporary implantable nitinol device (iTIND) versus sham/transurethral resection of the prostate (TURP).
Evidence synthesis
We included ten RCTs (1108 men). Aquablation versus TURP: insignificant change in International Prostate Symptoms Score (IPSS; mean difference [MD] 0.0, 95% confidence interval [CI] –2.44 to 2.44), quality of life (QoL; MD 0.30, 95% CI –0.81 to 0.21), maximum urinary flow rate (Qmax; MD –0.30, 95% CI –3.71 to 3.11), retreatment (risk ratio [RR] 0.18, 95% CI 0.02–1.66), and urinary incontinence (UI; RR 0.71, 95% CI 0.26–1.95). PAE versus monopolar TURP (M-TURP): insignificant change in IPSS (MD 3.33, 95% CI –28.39 to 35.05), QoL (MD 0.12, 95% CI –0.30 to 0.54), International Index of Erectile Function (IIEF-5; MD 3.07, 95% CI –1.78 to 7.92), and UI (RR 0.15, 95% CI 0.01–2.86), and significant change in Qmax (MD –9.52, 95% CI –14.04 to –5.0), favouring M-TURP. PAE versus bipolar TURP: insignificant change in IPSS (MD –2.80, 95% CI –6.61 to 1.01), QoL (MD –0.69, 95% CI –1.46 to 0.08), Qmax (MD –3.51, 95% CI –8.08 to 1.06), UI (RR 0.14, 95% CI 0.01–2.51), and retreatment (RR 1.91, 95% CI 0.19–19.63). PUL versus TURP: insignificant change in QoL (MD 0.40, 95% CI –0.29 to 1.09), UI (RR 0.13, 95% CI 0.02–1.05), and retreatment (RR 0.48, 95% CI 0.12–1.86), and significant change in IPSS (MD 3.40, 95% CI 0.22–6.58), and IIEF-5 (MD 3.00, 95% CI 0.41–5.59) and Qmax (MD –9.60, 95% CI –13.44 to –5.76), favouring PUL and TURP, respectively. Rezum and iTIND have not been evaluated in RCTs against TURP to date.
Conclusions
Supporting evidence for clinical use of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits/harms should be investigated further in high-quality RCTs.
Patient summary
This review summarises the evidence for the clinical use of aquablation, prostatic arterial embolisation (PAE), prostatic urethral lift (PUL), Rezum, and temporary implantable nitinol device (iTIND) to manage lower urinary tract symptoms secondary to benign prostatic obstruction. The supporting evidence for the clinical usage of aquablation, PAE, PUL, R
{"title":"Emerging Technologies for the Surgical Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Obstruction. A Systematic Review","authors":"","doi":"10.1016/j.euf.2023.09.003","DOIUrl":"10.1016/j.euf.2023.09.003","url":null,"abstract":"<div><h3>Context</h3><p>Surgical management of lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) aims at ablating prostate adenoma by resection, enucleation, or vaporisation. Apart from established ablation modes according to the European Association of Urology guidelines, various technologies have emerged as safe/effective alternatives but remain under investigation.</p></div><div><h3>Objective</h3><p>To explore short-term benefits/harms of emerging technologies for surgical management of LUTS/BPO.</p></div><div><h3>Evidence acquisition</h3><p>A systematic literature search was conducted using MEDLINE, EMBASE, and CENTRAL via Ovid up to June 18, 2022. We included randomised controlled trials (RCTs) exploring aquablation, prostatic arterial embolisation (PAE), Rezum, prostatic urethral lift (PUL), and temporary implantable nitinol device (iTIND) versus sham/transurethral resection of the prostate (TURP).</p></div><div><h3>Evidence synthesis</h3><p>We included ten RCTs (1108 men). Aquablation versus TURP: insignificant change in International Prostate Symptoms Score (IPSS; mean difference [MD] 0.0, 95% confidence interval [CI] –2.44 to 2.44), quality of life (QoL; MD 0.30, 95% CI –0.81 to 0.21), maximum urinary flow rate (Qmax; MD –0.30, 95% CI –3.71 to 3.11), retreatment (risk ratio [RR] 0.18, 95% CI 0.02–1.66), and urinary incontinence (UI; RR 0.71, 95% CI 0.26–1.95). PAE versus monopolar TURP (M-TURP): insignificant change in IPSS (MD 3.33, 95% CI –28.39 to 35.05), QoL (MD 0.12, 95% CI –0.30 to 0.54), International Index of Erectile Function (IIEF-5; MD 3.07, 95% CI –1.78 to 7.92), and UI (RR 0.15, 95% CI 0.01–2.86), and significant change in Qmax (MD –9.52, 95% CI –14.04 to –5.0), favouring M-TURP. PAE versus bipolar TURP: insignificant change in IPSS (MD –2.80, 95% CI –6.61 to 1.01), QoL (MD –0.69, 95% CI –1.46 to 0.08), Qmax (MD –3.51, 95% CI –8.08 to 1.06), UI (RR 0.14, 95% CI 0.01–2.51), and retreatment (RR 1.91, 95% CI 0.19–19.63). PUL versus TURP: insignificant change in QoL (MD 0.40, 95% CI –0.29 to 1.09), UI (RR 0.13, 95% CI 0.02–1.05), and retreatment (RR 0.48, 95% CI 0.12–1.86), and significant change in IPSS (MD 3.40, 95% CI 0.22–6.58), and IIEF-5 (MD 3.00, 95% CI 0.41–5.59) and Qmax (MD –9.60, 95% CI –13.44 to –5.76), favouring PUL and TURP, respectively. Rezum and iTIND have not been evaluated in RCTs against TURP to date.</p></div><div><h3>Conclusions</h3><p>Supporting evidence for clinical use of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits/harms should be investigated further in high-quality RCTs.</p></div><div><h3>Patient summary</h3><p>This review summarises the evidence for the clinical use of aquablation, prostatic arterial embolisation (PAE), prostatic urethral lift (PUL), Rezum, and temporary implantable nitinol device (iTIND) to manage lower urinary tract symptoms secondary to benign prostatic obstruction. The supporting evidence for the clinical usage of aquablation, PAE, PUL, R","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405456923002018/pdfft?md5=377e596d4ca941da02ee53f5873ec3c3&pid=1-s2.0-S2405456923002018-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41108694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.euf.2024.05.016
We compared the American Urological Association and the European Association of Urology guidelines on testicular cancer. We identified a few differences, in particular for management of low-volume metastatic serum tumor marker–negative stage IIA/B seminoma and nonseminoma, and of advanced and relapsing disease. Overall the rate of concordance between the guidelines is high.
Patient summary
We compared guidelines on testicular cancer published by the American Urological Association and the European Association of Urology. We found a high rate of agreement between the two guidelines, with some differences.
{"title":"Review of Discordance Between American Urological Association and European Association of Urology Guideline Recommendations for Testicular Cancer","authors":"","doi":"10.1016/j.euf.2024.05.016","DOIUrl":"10.1016/j.euf.2024.05.016","url":null,"abstract":"<div><p>We compared the American Urological Association and the European Association of Urology guidelines on testicular cancer. We identified a few differences, in particular for management of low-volume metastatic serum tumor marker–negative stage IIA/B seminoma and nonseminoma, and of advanced and relapsing disease. Overall the rate of concordance between the guidelines is high.</p></div><div><h3>Patient summary</h3><p>We compared guidelines on testicular cancer published by the American Urological Association and the European Association of Urology. We found a high rate of agreement between the two guidelines, with some differences.</p></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141287969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.euf.2024.05.006
Testicular germ cell tumours (GCTs) account for the majority of testicular malignancies. Seminomas and nonseminomas differ in prognosis and management strategies. While cisplatin-based chemotherapy has significantly improved survival rates, identification of residual masses after chemotherapy is crucial for determining further treatment and survival. For seminomas, spontaneous resolution of residual masses occurs in a significant percentage of cases. Fluorodeoxyglucose positron emission tomography (FDG PET) is recommended for evaluation of residual masses after chemotherapy. Retroperitoneal lymph node dissection (RPLND) offers therapeutic benefits but is challenging because of an increase in desmoplasia after chemotherapy. For nonseminomas, residual masses are common after chemotherapy, with surgical resection necessary for masses larger than 1 cm. FDG PET has limited utility, and timely surgical intervention is crucial for favourable outcomes. Teratoma, if left unresected, can lead to serious complications, including growing teratoma syndrome, malignant transformation, and late relapse. Extraretroperitoneal residual masses, particularly those containing teratoma, are associated with poorer prognosis. Surgical resection remains the mainstay treatment, with significantly higher progression-free and recurrence-free survival rates for fibrosis/necrosis in comparison to teratoma or viable cancer. Understanding the characteristics and management of residual masses after chemotherapy is paramount for optimising treatment strategies and improving patient outcomes in testicular GCT.
Patient summary
We reviewed treatment options for patients with testicular cancer who still have tumour tissue in the lower abdomen after chemotherapy. Surgical removal of the tumour is the main option; removal of lymph nodes can also help, but may be difficult because of tissue reactions to chemotherapy. Survival rates differ according to the tumour type and are lower for tumours beyond the lower abdomen.
睾丸生殖细胞瘤（GCT）占睾丸恶性肿瘤的大多数。精原细胞瘤和非精原细胞瘤在预后和治疗策略上有所不同。以顺铂为基础的化疗大大提高了患者的生存率，但化疗后残留肿块的鉴别对于决定进一步的治疗和生存率至关重要。就精原细胞瘤而言，残留肿块自发消退的病例占很大比例。建议使用氟脱氧葡萄糖正电子发射断层扫描（FDG PET）评估化疗后的残留肿块。腹膜后淋巴结清扫术（RPLND）具有治疗效果，但由于化疗后脱落细胞增多，因此具有挑战性。对于非小细胞瘤，化疗后残留肿块很常见，大于 1 厘米的肿块必须进行手术切除。FDG PET 的作用有限，及时的手术干预是取得良好疗效的关键。畸胎瘤如不切除，可导致严重的并发症，包括生长畸胎瘤综合征、恶性转化和晚期复发。腹膜外残留肿块，尤其是含有畸胎瘤的肿块，预后较差。手术切除仍是主要的治疗方法，与畸胎瘤或存活的癌症相比，纤维化/坏死的无进展生存率和无复发生存率明显更高。了解化疗后残留肿块的特征和处理方法对于优化治疗策略和改善睾丸 GCT 患者的预后至关重要。患者摘要：我们回顾了化疗后下腹部仍有肿瘤组织的睾丸癌患者的治疗方案。手术切除肿瘤是主要选择；切除淋巴结也有帮助，但由于组织对化疗的反应，可能会比较困难。肿瘤类型不同，存活率也不同，下腹部以外的肿瘤存活率较低。
{"title":"Mini-review: Evaluation and Management of Retroperitoneal Masses in Patients with Testicular Cancer","authors":"","doi":"10.1016/j.euf.2024.05.006","DOIUrl":"10.1016/j.euf.2024.05.006","url":null,"abstract":"<div><p>Testicular germ cell tumours (GCTs) account for the majority of testicular malignancies. Seminomas and nonseminomas differ in prognosis and management strategies. While cisplatin-based chemotherapy has significantly improved survival rates, identification of residual masses after chemotherapy is crucial for determining further treatment and survival. For seminomas, spontaneous resolution of residual masses occurs in a significant percentage of cases. Fluorodeoxyglucose positron emission tomography (FDG PET) is recommended for evaluation of residual masses after chemotherapy. Retroperitoneal lymph node dissection (RPLND) offers therapeutic benefits but is challenging because of an increase in desmoplasia after chemotherapy. For nonseminomas, residual masses are common after chemotherapy, with surgical resection necessary for masses larger than 1 cm. FDG PET has limited utility, and timely surgical intervention is crucial for favourable outcomes. Teratoma, if left unresected, can lead to serious complications, including growing teratoma syndrome, malignant transformation, and late relapse. Extraretroperitoneal residual masses, particularly those containing teratoma, are associated with poorer prognosis. Surgical resection remains the mainstay treatment, with significantly higher progression-free and recurrence-free survival rates for fibrosis/necrosis in comparison to teratoma or viable cancer. Understanding the characteristics and management of residual masses after chemotherapy is paramount for optimising treatment strategies and improving patient outcomes in testicular GCT.</p></div><div><h3>Patient summary</h3><p>We reviewed treatment options for patients with testicular cancer who still have tumour tissue in the lower abdomen after chemotherapy. Surgical removal of the tumour is the main option; removal of lymph nodes can also help, but may be difficult because of tissue reactions to chemotherapy. Survival rates differ according to the tumour type and are lower for tumours beyond the lower abdomen.</p></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.euf.2024.06.006
Testicular germ cell tumors (TGCTs) are an uncommon disease accounting for roughly 1% of newly diagnosed cancers in men worldwide. Incidence rates vary from 7 to 10 per 100 000 males in Europe and North America. Approximately 2–5% of patients with unilateral TGCT will also harbor germ cell neoplasia in situ (GCNIS) in the contralateral testicle, which may progress to cancer in at least 50% of individuals. The question of whether routine contralateral testicular biopsy should be performed in patients with testicular cancer to detect the presence of GCNIS remains controversial. Screening and treatment of GCNIS are warranted only if the patient’s outcome will be improved and there will be little impact on testicular function. In this review, we evaluate current guideline recommendations and the issues concerning contralateral testicular biopsy.
Patient summary
Among men with cancer in one testicle, about 2–5% will also have cells with cancerous potential, called germ cell neoplasia in situ (GCNIS), in the other testicle. This mini-review discusses issues related to routine biopsy of the other testicle and the risk factors and treatment options for GCNIS in men with testicular cancer.
{"title":"Contralateral Testicular Biopsy in Men with Testicular Cancer","authors":"","doi":"10.1016/j.euf.2024.06.006","DOIUrl":"10.1016/j.euf.2024.06.006","url":null,"abstract":"<div><p>Testicular germ cell tumors (TGCTs) are an uncommon disease accounting for roughly 1% of newly diagnosed cancers in men worldwide. Incidence rates vary from 7 to 10 per 100<!--> <!-->000 males in Europe and North America. Approximately 2–5% of patients with unilateral TGCT will also harbor germ cell neoplasia in situ (GCNIS) in the contralateral testicle, which may progress to cancer in at least 50% of individuals. The question of whether routine contralateral testicular biopsy should be performed in patients with testicular cancer to detect the presence of GCNIS remains controversial. Screening and treatment of GCNIS are warranted only if the patient’s outcome will be improved and there will be little impact on testicular function. In this review, we evaluate current guideline recommendations and the issues concerning contralateral testicular biopsy.</p></div><div><h3>Patient summary</h3><p>Among men with cancer in one testicle, about 2–5% will also have cells with cancerous potential, called germ cell neoplasia in situ (GCNIS), in the other testicle. This mini-review discusses issues related to routine biopsy of the other testicle and the risk factors and treatment options for GCNIS in men with testicular cancer.</p></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405456924000956/pdfft?md5=1fadf413978b0536ac0722ade0973ed7&pid=1-s2.0-S2405456924000956-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.euf.2023.08.014
{"title":"Re: Jordan M. Rich, Kennedy E. Okhawere, Charles Nguyen, et al. Transperitoneal Versus Retroperitoneal Single-port Robotic-assisted Partial Nephrectomy: An Analysis from the Single Port Advanced Research Consortium. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2023.06.004","authors":"","doi":"10.1016/j.euf.2023.08.014","DOIUrl":"10.1016/j.euf.2023.08.014","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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