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Best of AUA 2013: Penile, Testis, and Urethral Cancer


Harcharan Singh Gill, MD, presents the take home messages on penile, testis, and urethral cancer from the AUA annual meeting in San Diego.

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Presented by Harcharan Singh Gill, MD

Stanford University School of Medicine, Stanford, CA


• A study of genetic expression in formalin-fixed specimens showed higher expression of ARID1A, a chromatin-remodeling expressor gene, in poorly differentiated tumors for penile squamous cell carcinoma.

• Strong expression of Glut1 was found in nearly half of penile tumors in one study.

• Expression of insulin-like growth factor 1 is associated with histologic grade in penile squamous cell carcinoma.

• In penile squamous cell carcinoma patients, genomic alterations were higher in patients with HPV infection.

• Fluorodeoxyglucose positron emission tomography/computed tomography may have a role in monitoring penile cancer patients during chemotherapy, but its role in staging is unclear.

• Patients with node-positive penile cancer had better case-specific survival when more than eight nodes were removed.

• Lymph node density of 0.22 was a predictor of cancer-specific survival in 81 patients with node-positive penile cancer.

• Volume (>4 cm) and number of inguinal nodes (>3) correlate with pelvic nodal metastasis in penile cancer patients.

• Rates of morbidity in inguinal node dissection for penile cancer (lymphedema, infection, lymphoceles, deep vein thrombosis, and wound necrosis) are independent of primary or lymph node stage.

• Endoscopic inguinofemoral node dissection is safe and effective but technically more challenging than the open approach.

• Glans-sparing surgery for Ta and T1G1 penile tumors has excellent functional and oncologic outcomes.

• Minimally invasive sentinel node dissection in patients with >T1G2 penile cancer proved reliable for identifying patients who required extended node dissection.

• Chemotherapy with docetaxel (Taxotere), fluorouracil (Efudex), and cisplatinum proved effective for treatment of locally advanced and metastatic penile cancer in a phase II study.

• The anti-epidermal growth factor receptor monoclonal antibody panitumumab (Vectibix) demonstrated significant activity in heavily pretreated penile squamous cell carcinoma patients.

• A review of 1,000 penile squamous cell carcinoma patients treated between 1956 and 2012 showed improved outcomes after 1994 in node-negative patients, possibly due to dynamic sentinel node biopsy. However, survival in node-positive patients did not improve.

• Of nearly 200 penile squamous cell carcinoma patients treated in a tertiary center, 86% had 5-year cancer-specific survival, with a trend toward greater organ preservation. Node-positive patients fared poorly.

• A longitudinal analysis of men with node-positive penile cancer showed improvement in surgical morbidity and staging but no change in survival.

• The incidence of testicular germ cell tumors continues to increase in the United States, most notably in Hispanic men.

• Circulating tumor cells were present in the testicular vein in 58% of men and in peripheral blood in 18%. They were also detected in both seminoma and non-seminoma and clinically localized and non-metastatic disease, but their role in diagnosis, staging, prognosis, and treatment remains unknown.

• Evaluation of 100 orchiectomy specimens showed unifocality in only 16.4% of seminomas and 16% of nonseminomatous germ cell tumors.

• Use of external beam radiation therapy for stage I testicular seminoma declined from 74% to 37% from 2000 to 2009.

• A modified post-chemotherapy retroperitoneal lymph node dissection technique for residual masses of testicular cancer yielded one recurrence in the RPLND field and none in the untouched contralateral side. The procedure reduces morbidity, but the follow-up is short term and larger studies are needed to confirm the technique’s safety.

• Patients undergoing redo post-chemotherapy RPLND had a higher complication rate, higher incidence of active cancer, and lower survival rate compared to standard post-chemotherapy RPLND.

• In 103 patients who underwent redo RPLND, nearly half had a teratoma, 30% had fibrosis, and 15% had a viable germ cell tumor.

• Malignant transformation is rare in germ cell tumors but is curable with surgery when found at orchiectomy with clinical stage I or RPLND in low-volume stage II.

• In a cohort of 2,186 patients who underwent RPLND, only 2% underwent pelvic lymph node dissection. Researchers observed a 4-year cure rate of 91%.

• Persistent CD30 expression in embryonal carcinoma during treatment is associated with poorer prognosis and shorter survival.

• An analysis of 126 patients diagnosed with primary urethral cancer found that half of the patients had urothelial cell carcinoma. No significant associations were found for age, gender, history of bladder cancer, or underlying histology. Node-positive disease and extent of surgery remain independent predictors of inferior progression-free survival.UT

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