CUA 2018: Does Prior Inguinoscrotal Surgery Alter Recurrence Patterns and Survival Outcome for Patients with Testicular Cancer? The Princess Margaret Cancer Centre Experience

Halifax, Nova Scotia ( Surgical dogma has long engrained in practicing urologists that prior scrotal or inguinal surgery violates the traditional lymphatic drainage patterns of testicular cancer, yet little evidence exists in the modern literature to support these concerns. This was primarily based on small historical single-institution series from the 1980’s and early 1990’s. While the management of the disease has not changed drastically in that time, systemic therapy has improved, radiographic technology has improved, and there is an increasing utilization of active surveillance for clinical stage 1 testicular cancer (CS1 TCa). As such, the authors of this study decided to utilize their large TCa database (as a major tertiary referral center for TCa in Canada) to help answer this question – an added benefit is that, as a major proponent of AS, the natural history of these patients can be better ascertained. 

CUA 2018: Do Men with Prior Military Service have an Increased Risk for Genitourinary Cancers? Results from the HINTS National Database 

Halifax, Nova Scotia ( Data published suggests that the incidence of select malignancies is higher among military personnel than the non-military population [1]. In this interesting study the authors used the Health Information National Trends Survey (HINTS national survey database 4th edition), to assess whether any history of military service predicts an increased incidence of cancers in general, and genitourinary (GU) cancers specifically. 

CUA 2018: Management of the Low Volume (1cm) Post-chemotherapy NSGCT Retroperitoneal Mass

Halifax, Nova Scotia ( 37 year old man, healthy, married with 2 kids, found to have a left testicular mass. Orchiectomy: pT3, +LVI, Rete+, Spermatic cord + (90% embryonal, 10% chorio). Post-orchiectomy his tumor markers remained elevated. Staging scans with 4.5 cm solitary left para-aortic LN. As he is good risk, he undergoes BEP x 3. Post-chemotherapy, his staging studies demonstrate a 0.9 cm left para-aortic node.

CUA 2018: Late Relapse of Testicular Cancer

Halifax, Nova Scotia ( Joel Sheinfeld, MD, a recognized expert in the management of testicular cancer (TCa), focused his talk on a niche topic within TCa management – the late relapse. Late relapse in TCa is defined as relapse >2 years after initial orchiectomy and definitive primary treatment. 

They recently completed an institutional study of patients with late relapse (LR) at MSKCC using their prospectively maintained database (1990-2017). They identified 157 patients with LR; 143 NSGCT and 14 seminomas. Of these patients, 30 were chemo-naïve. Patient demographics are below:

CUA 2018: Importance of Retroperitoneal Control in Germ Cell Tumor

Halifax, Nova Scotia ( Joel Sheinfeld, MD gave a talk on the importance of retroperitoneal control in germ cell tumors (GCTs). He began by stating that GCTs have a consistent pattern of metastatic spread, it is a disease of differentiation, and mainly affects young patients. Approximately 90% of the primary tumors of GCTs spread to the retroperitoneal lymph nodes, before spreading to other distant sites. Only 10% of tumors spread initially to distant sites. The retroperitoneal lymph nodes are first and often the only site of metastasis.

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