EAU Guidelines on Testicular Cancer

Objectives: Testicular germ-cell cancer (TGCC) patients are at risk of developing hypogonadism but no risk factors have yet been defined. Methods: Blood was collected from 143 TGCC patients (after orchidectomy, prior to further therapy (T0) and 6, 12, 24, 36 and 60 months (T6, T12, T24, T36 and T60) after therapy). Biological hypogonadism (BH) was defined as: serum testosterone below 10 nmol/l and/or LH O10 IU/l; odds ratios (ORs) for BH with BH at T0, age, stage of disease, testicular characteristics, and androgen receptor polymorphism as predictors were calculated as well as the OR for developing BH post-treatment (one to two cycles of adjuvant chemotherapy (ACT) versus three to four cycles of higher dose chemotherapy (HCT) versus adjuvant radiotherapy (RT)). Results: HCT increased the OR for BH at T6 (OR 22, 95% confidence interval (CI) 4.4-118) and T12 (OR 5.8, 95% CI 1.5-22). RT increased the OR at T6 (OR 10, 95% CI 2.1-47) and at T12 (OR 3.9, 95% CI 1.1-14). Microlithiasis predicted BH at T0 (OR 11, 95% CI 1.2-112), T12 (OR 3.9, 95% CI 1.1-13), T24 (OR 3.0, 95% CI 1.0-8.8), T36 (OR 5.4, 95% CI 1.7-17) and T60 (OR 4.4, 95% CI 1.2-16). BH at T0 was a risk for BH at T6 (OR 53,, T12 (OR 125, 95% CI 37-430), T24 (OR 88, 95% CI 26-300) and T36 (OR 121, 95% CI 32-460). Conclusions: It is clinically relevant that BH at T0 and testicular microlithiasis were predictive factors for post-treatment BH. HCT and RT gave temporary BH.

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“…Treatment was given according to the Swedish Norwegian Testicular Cancer Group (Swenoteca) protocols (16,17).…”

Section: Cancer Treatmentmentioning

confidence: 99%

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Eberhard

Ståhl

Cwikiel

et al. 2008

European Journal of Endocrinology

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“…Warde et al 26 consideran que el riesgo de recidivas retroperitoneales es sólo del 6% a los 5 años de seguimiento en pacientes mayores de 34 años, con tumor menor de 6 cm y sin invasión tumoral. En estos casos estaría indicada únicamente la vigilancia 27 . La quimioprofilaxis en este tipo de tumores con carboplatino también ha sido utilizada por algunos autores 28 .…”

Section: R Diz Rodríguez Et Al/actas Urol Esp 2005; 29 (5): 457-464unclassified

“…La quimioprofilaxis en este tipo de tumores con carboplatino también ha sido utilizada por algunos autores 28 . Sin embargo, todavía no existen estudios a largo plazo sobre la eficacia de este tratamiento 27 .…”

Section: R Diz Rodríguez Et Al/actas Urol Esp 2005; 29 (5): 457-464unclassified

“…En este caso es preciso realizar quimioterapia complementaria con bleomicina, etopóxido y cisplatino (BEP). En el caso de que los nódulos sean negativos, la probabilidad de recidivas continúa siendo del 10% 27 . Se considera que los factores de riesgo de progre-sión tumoral son: la presencia de invasión vascular, y la positividad del anticuerpo monoclonal MIB-1 (signo de actividad proliferativa), y en menor medida la edad y el tamaño del tumor.…”

Section: R Diz Rodríguez Et Al/actas Urol Esp 2005; 29 (5): 457-464unclassified

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Tumores testiculares: Evaluación de la experiencia durante 25 años en un hospital militar

et al. 2005

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RESUMEN TUMORES TESTICULARES. EVALUACIÓN DE LA EXPERIENCIA DURANTE 25 AÑOS EN UN HOSPITAL MILITARObjetivos: Las neoplasias testiculares son frecuentes en el adulto joven, coincidiendo con la incorporación al Servicio Militar. El objetivo de nuestro trabajo es evaluar las características tumores, su evolución con el tiempo y el resultado de los tratamientos empleados en nuestro centro para este tipo de tumores.Material y métodos: Se realizó un estudio longitudinal retrospectivo en una cohorte de 98 pacientes de edad media 28,6 años, sometidos a orquiectomía por neoplasia testicular en nuestro centro entre los años 1979 a 2004. En el estudio se recogieron los datos referentes a la edad de los pacientes, las características tumorales, el tratamiento realizado y la evolución de la neoplasia.Resultados: En un 61% de los casos, el testículo afectado fue el derecho (diferencias significativas). El tipo histológico más común fueron los tumores germinales no seminomatosos (TGNS) (65,3%) de los casos seguidos de los seminomas puros (27,6%), y de tumores no germinales (TNG) (7,1%). Los TGNS se diagnosticaron a una edad media (23,2 años) significativamente menor que los otros dos tipos. El estadio I fue el más frecuente (58%). Los seminomas presentaron un estadio I con una mayor frecuencia significativamente mayor (80%) que el resto de los tumores. Los datos recogidos durante los 25 años no mostraron una variación significativa respecto a las características tumorales. El análisis de supervivencia indicó que las características tumorales con mejor pronóstico respecto a la probabilidad de recurrencias tumorales fueron los seminomas y los estadios tumorales I y II.Conclusiones: Los tumores germinales no seminomatosos (TGNS) son los más frecuentes en adultos jóvenes. La mayoría de los tumores se diagnostican en estadios iniciales, y su pronóstico es más favorable en el caso de los seminomas y los estadios I y II.Palabras clave: Neoplasia testicular. Factores pronósticos. Tratamiento. Análisis de supervivencia. ABSTRACT TESTICULAR NEOPLASMS. EVALUATION OF THE EXPERIENCE DURING 25 YEARS IN A MILITARY HOSPITALObjetives: The testicular tumors are frequent in the young adult, coinciding with the incorporation to the Military Service. The objective of our work is to evaluate the tumoral characteristic, its evolution with the time and the result of the treatments used in our center for this type of tumors.Material and methods: We carried out a retrospective longitudinal study in a cohort of 98 patients with an average age of 28,6 years, subjected to orchiectomy for testicular tumor in our center between 1979 to 2004. In the study, we collected data referred to the age of the patients, the tumoral characteristic, the outcome of the treatment and the evolution of the tumor.Results: In 61% of the cases, the affected testicle was the right (significant differences). The most common histologyc type was the non seminomatous germ cell tumors (NSGCT) (65,3%). Followed by the pure seminomas (27,6%), and non germinal cell tumors (NGC) (7,1%). ...

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“…4 For certain stages of some cancers including genitourinary cancers, cure is becoming a reality. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Although general opinion is that patients with poor-prognosis nonmetastatic prostate cancer cannot be cured, results from recent studies have prompted re-evaluation of this belief. The aim of this review is to examine the concept of cure in genitourinary cancers and focus on the role of adjuvant hormonal therapy in prostate cancer, with reference to re-examining the historical treatment paradigm, which considers androgen deprivation a palliative option.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant androgen deprivation therapy augments cure and long-term cancer control in men with poor prognosis, nonmetastatic prostate cancer

Fleshner

Keane

Lawton

et al. 2007

Prostate Cancer Prostatic Dis

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Historically, adjuvant androgen deprivation therapy has been viewed as a palliative treatment option for patients with poor-prognosis non-metastatic prostate cancer. In addition, guidelines from bodies such as the European Association of Urology and American Society for Clinical Oncology do not specifically categorize adjuvant hormonal therapy as being curative in intent. We propose that adjuvant androgen deprivation therapy should now be classified as a treatment of curative intent in patients with poor-prognosis, non-metastatic prostate cancer. By applying a carefully considered definition of cure (based on long-term (10-to 15-year) disease-free survival curves) to the findings from randomized controlled clinical trials that have studied adjuvant hormonal treatments in nonmetastatic prostate cancer, we challenged whether this viewpoint should now be considered redundant. According to our review of relevant studies and our definition of cure, goserelin appears to augment cure in a sizeable proportion of men with poor-prognosis non-metastatic prostate cancer when given adjuvant to radical prostatectomy or radiotherapy. Across several trials, the relevant survival curves for the goserelin-treated population became indefinitely flat after long-term followup. This indicates that these patients have a mortality risk comparable to the general population without prostate cancer. On the basis of the evidence presented within this review, we believe that, given it can control disease for a long period of time, adjuvant goserelin should be reclassified as a treatment of curative intent for patients with poor-prognosis non-metastatic prostate cancer.

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EAU Guidelines on Testicular Cancer

Cited by 127 publications

References 44 publications

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Tumores testiculares: Evaluación de la experiencia durante 25 años en un hospital militar

Adjuvant androgen deprivation therapy augments cure and long-term cancer control in men with poor prognosis, nonmetastatic prostate cancer

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