Clinical Conversations by Experts
Physician-Scientist Review Articles
State of the Evidence Review Articles
Written by Mirko Preto, Federica Peretti, Marco Falcone
May 17, 2021
Penile cancer (PC) is  a rare malignancy with an incidence estimated less than 1/100 000 per year in the Western World1-3
Historically, demolitive surgical approaches, such as total or partial penile amputation, were the most commonly used. Indeed, demolitive options were deemed to be necessary in order to respect a macroscopic surgical margin of at least 2 cm.3-4 If the oncological outcomes of these approaches demonstrated to be satisfactory, they significantly affected aesthetic outcomes, as well as sexual and urinary functions.5-12 

Written by Zachary Klaassen, MD MSc
April 21, 2021
In 2021, there will be an estimated 9,470 new cases of testicular cancer in the United States with an estimated 440 testis cancer-related deaths.1 Importantly, the vast majority of men with testis cancer, even in advanced stages, are cured as a result of the success of high dose chemotherapy regimens that are tolerated by this typically young and healthy patient population. Given both the relatively young age at diagnosis and overall high survival rates, there has been a much needed and welcome focus on survivorship for testicular cancer patients.
March 1, 2021
It’s now been 3.5 years since I last wrote anything about testicular germ cell tumors and ongoing clinical trials.1  Although we still cure most men afflicted with this disease, we have not made any major new therapeutic advancements since I wrote that last article.  Approximately, 15-20% of patients with metastatic germ cell tumors will relapse following initial chemotherapy.  Even in this situation, approximately 50% can still be cured with salvage treatments, either with more conventional cisplatin-based chemotherapy or with high-dose chemotherapy and autologous stem cell rescue.2-4
Physician-Scientist Commentaries
State of the Evidence Review Articles
January 12, 2022
Background: The majority of men with testicular germ-cell tumours (GCTs) present with localised disease. After removal of the testis, a strict surveillance programmes with repeated measurements of the serum tumour markers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) is required. However, those serum markers only detect around half of all non-seminoma and the minority of seminoma relapses.1
Conference Coverage
Conference Highlights Written by Physician-Scientist
Presented by Alfredo Berruti, MD
The 2022 GU ASCO Annual meeting included a rare tumors oral abstract session featuring work from Dr. Alfredo Berruti and colleagues presenting results of the ADIUVO study, the first randomized trial on adjuvant mitotane in adrenocortical carcinoma patients.
Presented by Sia Daneshmand, MD
The SIU 2021 annual meeting included a plenary session with a State-of-the-Art lecture by Dr. Sia Daneshmand discussing new markers and the changing face of testicular cancer. Dr. Daneshmand started by highlighting that there are several challenges in testicular cancer, with several potential solutions.
Presented by Ben Tran, MBBS, FRACP
In the clinical trials session of the 2021 ANZUP annual scientific meeting, Dr. Ben Tran presented an update in germ cell tumors. This talk included an update on 5 ongoing trials/projects that ANZUP is involved with in this disease space. The P3BEP trial, phase 3 trial of accelerated versus standard BEP chemotherapy for intermediate and poor risk metastatic germ cell tumors, the TIGER trial, the PRESTIGE trial assessing primary RPLND for clinical stage II testicular germ cell tumors and its impact on HRQoL compared to chemo or radiotherapy, and lastly, iTestis, a testicular cancer registry platform for registry-based trials.
Presented by Alexandros Papachristofilou, MD
The ESMO 2021 annual meeting’s non-prostate cancer proffered paper session included a presentation by Dr. Alexandros Papchristofilou discussing results from the SAKK 01/10 phase II trial testing a single dose of carboplatin followed by involved-node radiotherapy as curative treatment for seminoma stage IIA/B. 
Presented by Alejandro R. Rodriguez, MD
At the plenary session of the AUA 2021 virtual annual meeting, Dr. Alejandro Rodriguez provided the Confederacion Americana de Urologia (CAU) lecture discussing controversies and challenges of penile cancer management.
Presented by Pilar Laguna, MD, PhD
The ASCO GU 2021 Genitourinary Cancers Symposium annual meeting included an invited discussant presentation by Dr. Pilar Laguna from The Netherlands to discuss “Imaging modality and frequency in surveillance of stage I seminoma testicular cancer: Results from a randomized, phase III, factorial trial (TRISST)” and “SEMS trial: Result of a prospective, multi-institutional phase II clinical trial of surgery in early metastatic seminoma.
Presented by Robert Huddart, MB BS MRCP FRCR PhD
Stage 1 testicular seminoma, which is defined as pure seminoma confined to the testis with no elevated tumor markers, has an excellent prognosis. Current management has shifted towards surveillance rather than adjuvant radiotherapy or chemotherapy for most patients.
Presented by Siamak (Sia) Daneshmand, MD
The management of stage 2A seminoma has been consistent over the past several years, consisting of either radiotherapy of 30 Gy to the para-aortic and ipsilateral iliac lymph nodes or primary chemotherapy with either three cycles of BEP or four cycles of EP. Cure rates with these approaches are excellent but are also associated with many life years of potential cumulative toxicities.
Presented by Guru Sonpavde, MD
Advanced urothelial carcinoma has among the worst prognosis for tumors treated by genitourinary oncologists. Standard of care dictates that patients receive platinum-based induction chemotherapy. However, even with this treatment, rates of recurrence and disease progression are high and overall survival is quite short due to the development of chemotherapy resistance.
Presented by Julien Van Damme, MD
It is estimated that radical orchiectomy results in sperm impairment, but with the recovery of fertility after 2-3 years and a successful conception rate of 80%. For those undergoing retroperitoneal lymph node dissection (RPLND), the summarized data suggests that retrograde or anejaculation occurs in 0-14% of patients, with a successful subsequent conception rate of 59-78%. Among patients undergoing radiotherapy, 24% are azoospermic at 6 months, but with recovery at 24 months and a successful conception rate of 66%.
Presented by Peter Albers, MD
Renowned testis cancer expert Dr. Peter Albers discussed personalized therapy to reduce treatment morbidity in testicular cancer at the rare tumors session of the European Association of Urology (EAU) Section of Oncological Urology (ESOU) 2021 Virtual meeting. Dr. Albers highlights that testicular cancer survivorship is heterogeneous across Europe ranging from 80% in Eastern Europe to 92% in Central Europe. 
Presented by Darren Feldman, MD
The newly formed Global Society of Rare Genitourinary Tumors (GSRGT) held its inaugural meeting, focusing on penile and testicular cancer. The session held Saturday, December 12th focused on testis cancer. In this session, the organizers convened a “Clinical Trials Corner” in which Dr. Darren Feldman presented an update on the TIGER trial (Alliance A021102 and EORTC E1407), a randomized phase III trial of TIP vs TI-CE as initial salvage chemotherapy for patients with germ cell tumors (GCT).
Presented by Lucia Nappi
To provide a context to the keynote lecture by Dr. Andrea Necchi discussing the management of chemotherapy-resistant germ cell tumors at the inaugural Global Society of Rare Genitourinary Tumors virtual summit, Dr. Lucia Nappi provided a commentary discussion of this topic. By way of background, Dr. Nappi notes that 20-30% of patients will relapse after first-line therapy, and the prognosis after second-line therapy is less favorable, with only 15-30% of patients maintaining a continued disease-free rate. 
Presented by Silke Gillessen, MD
The newly formed Global Society of Rare Genitourinary Tumors (GSRGT) held its inaugural meeting, focusing on penile and testicular cancer. The session held Saturday, December 12th focused on testis cancer. In this session, the organizers convened a “Clinical Trials Corner” in which Dr. Silke Gillessen presented an update from the International Germ Cell Cancer Collaborative Group (IGCCCG).
Presented by Philippe E. Spiess, MD
The first Global Society of Rare Genitourinary Tumors (GSRGT) virtual summit on penile cancer featured a keynote lecture by Dr. Philippe Spiess from the Moffitt Cancer Center discussing updates in the molecular basis of penile cancer. It is important to note that in 2018, there were an estimated 2,080 new cases of penile cancer diagnosed in the United States, with a suspected 410 patients dying of the disease. However, penile cancer makes up only 0.4-0.6% of all malignancies in the U.S. and Europe and is thus an ‘orphan malignancy.’ Dr. Spiess notes that over the time period of 1990-2007, there have been disappointing temporal trends in survival with no appreciable improvement.
Presented by James Lynam
The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP) 2020 mini Annual Scientific Meeting (ASM) virtual meeting featured a roundtable, multidisciplinary discussion of germ cell tumors chaired by medical oncologist Dr. James Lynam. Dr. Lynam’s panelists included medical oncologist Dr. Patricia Bastick, clinical nurse consultant Mrs. Lyndal Moore, and cardiothoracic surgeon Dr. Allen James.
Presented by Andreas Hiester, MD, and Peter Albers, MD
In an oral presentation in the session examining Organ Preservation in Challenging Cases at the 12th European Multidisciplinary Congress on Urological Cancers (EMUC), Dr. Andreas Hiester and Dr. Peter Albers led a discussion regarding organ sparing surgery in testicular cancer.
Presented by Sia Daneshmand, MD
At the Société Internationale d'Urologie (SIU) 2020 Virtual Annual Congress, Dr. Sia Daneshmand discussed the indications and challenges for retroperitoneal lymphadenectomy among patients with testicular cancer as part of the lymphadenectomy in urologic cancer instructional course.
Presented by Andreas Hiester
A randomized Phase III trial published in 20081 demonstrated that one cycle of bleomycin, etoposide, and platinum (BEP) therapy was associated with a lower risk of tumor recurrence relative to retroperitoneal lymph node dissection for an unselected population of clinical-stage 1 nonseminomatous germ cell tumors. 
Presented by Andreas Hiester
One cycle of adjuvant BEP chemotherapy has shown superiority and a clear benefit in recurrence-free survival over retroperitoneal lymph node dissection (RPLND) in patients with clinical stage 1 non-seminoma germ cell tumors, according to a German randomized phase 3 trial published in the Journal of Clinical oncology back in 2008.