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Re: Peter Albers. Management of Stage I Testis Cancer. Eur Urol 2007;51:34–44
european urology 52 (2007) 286–296
References [1] Descazeaud A, Zerbib M, Flam T, Vieillefond A, Debre´ B, Peyromaure M. Can pT0 stage of prostate cancer be predicted before radical prostatectomy? Eur Urol 2006;50: 1248–53. [2] Bostwick DG, Bostwick KC. ‘Vanishing’ prostate cancer in radical prostatectomy specimens: incidence and long-term follow-up in 38 cases. BJU Int 2004;94:57–8. [3] Cao D, Hafez M, Berg K, Murphy K, Epstein JI. Little or no residual prostate cancer at RP: vanishing cancer or switched specimen? A microsatellite analysis of specimen identity. Am J Surg Pathol 2005;29:467–73. [4] Goldstein NS, Be´gin LR, Grody WW, Novak JM, Qian J, Bostwick DG. Minimal or no cancer in RP specimens: report of 13 cases of the ‘‘vanishing cancer phenomenon’’. Am J Surg Pathol 1995;19:1002–9. [5] Hammerer P. pT0 after radical prostatectomy: overtreatment for insignificant prostate cancer? Eur Urol 2004;45: 35. [6] Herkommer K, Kuefer R, Gschwend JE, Hautmann RE, Volkmer BG. Pathological T0 prostate cancer without neoadjuvant therapy: clinical presentation and followup. Eur Urol 2004;45:36–41. [7] Kollermann J, Feek U, Muller H, et al. Nondetected tumor (pT0) after prolonged, neoadjuvant treatment of localized prostatic carcinoma. Eur Urol 2000;38:714–20. [8] Ko¨llermann J, Hopfenmu¨ller W, Caprano J, et al. Prognosis of stage pT0 after prolonged neoadjuvant endocrine therapy of prostate cancer: a matched-pair analysis. Eur Urol 2004;45:42–5. [9] Mazzucchelli R, Barbisan F, Tagliabracci A, et al. Search for residual prostate cancer on pT0 radical prostatec-
295
tomy after positive biopsy. Virchows Arch 2007;450:371– 8. [10] Prayer-Galetti T, Gardiman M, Sacco E, Fracalanza S, Betto G, Pinto F. The finding of no tumor (pT0) in patients submitted to radical retropubic prostatectomy for clinically localized prostate cancer. Anal Quant Cytol Histol 2007;29:79–86. [11] Trpkov K, Gao Y, Hay R, Yimaz A. No residual cancer on radical prostatectomy after positive 10-core biopsy: incidence, biopsy findings, and DNA specimen identity analysis. Arch Pathol Lab Med 2006;130:811–6. Rodolfo Montironi* Marina Scarpelli Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region (Ancona), Ancona, Italy Antonio Lopez-Beltran Unit of Anatomic Pathology, Cordoba University Medical School, Cordoba, Spain Liang Cheng Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA *Corresponding author E-mail address: [email protected] (R. Montironi) March 5, 2007 Published online ahead of print on March 12, 2007 doi:10.1016/j.eururo.2007.03.012
DOI of original article: 10.1016/j.eururo.2006.06.004
Re: Peter Albers. Management of Stage I Testis Cancer. Eur Urol 2007;51:34–44 We read the review concerning management of stage I testis cancer from Peter Albers. All issues have been discussed with great ease of writing and outstanding competence. Both qualities rendered topics and arguments easy to comprehend, but not necessarily to share, unfortunately. Retroperitoneal lymphadenectomy (RPLND) was mentioned only three times in this paper. We do not believe that RPLND deserves this limited consideration in the 2000s. In experience in the United States as well as in Italy, RPLND remains a milestone in the treatment of clinical stage I nonseminoma disease. Historical [1] as well as recent [2–4] clinical experience supports RPLND because it is: (1) the most accurate procedure for retroperitoneal staging, (2) an effective treatment, being able to cure about two thirds of patients with nodal metastases without any further therapy, (3) an effective proce-
dure in the subset of high-risk patients (eg, vascular invasion), because about 70% of undetected metastases in these patients are just retroperitoneal and can be cured with surgery alone as mentioned above, (4) an effective therapy in overcoming possible presence of chemo-refractory disease (eg, teratoma), (5) an approach that does not alter the natural history of the disease and makes the follow-up programs easier (very low rate of abdominal and late recurrences), (6) a technique with a low morbidity (no mortality, no more than 1–2% of loss of antegrade ejaculation) when performed in high-volume institutions with a long experience in this disease, (7) able to avoid in nearly 90% of patients with clinical stage I non-seminoma some type of chemotherapy, which is currently receiving great attention due to the risks of long-term morbidities (eg, second cancers, cardiovascular diseases, and metabolic syndromes) as perfectly outlined by the author. Moreover RPLND is a continuously evolving technique. Larger and
296
european urology 52 (2007) 286–296
larger experiences with laparoscopic RPLND are available [5]. We cannot exclude the fact that in the near future laparoscopic RPLND could represent an additional choice in the management of the disease, having an even lower morbidity as a goal. References [1] Donohue JP, Thornhill JA, Foster RS, Rowland RG, Bihrle R. Retroperitoneal lymphadenectomy for clinical stage A testis cancer (1965 to 1989): modifications of technique and impact on ejaculation. J Urol 1993;149:237–43. [2] de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006;24:5482–92. [3] Stephenson AJ, Sheinfeld J. Management of patients with low stage nonseminomatous germ cell testicular cancer. Curr Treat Options Oncol 2005;6:367–77. [4] Nicolai N, Miceli R, Artusi R, Piva L, Pizzocaro G, Salvioni R. A simple model for predicting nodal metastasis in patients with clinical stage I nonseminomatous germ cell testicular DOI of original article: 10.1016/j.eururo.2006.08.022
tumors undergoing retroperitoneal lymph node dissection. J Urol 2004;171:172–6. [5] Albqami N, Janetschek G. Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer. J Endourol 2005;19:683–92. Nicola Nicolai* Luigi Piva Giorgio Pizzocaro Roberto Salvioni Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy *Corresponding author E-mail address: [email protected] (N. Nicolai) February 7, 2007 Published online ahead of print on February 14, 2007 doi:10.1016/j.eururo.2007.02.015
References [1] Descazeaud A, Zerbib M, Flam T, Vieillefond A, Debre´ B, Peyromaure M. Can pT0 stage of prostate cancer be predicted before radical prostatectomy? Eur Urol 2006;50: 1248–53. [2] Bostwick DG, Bostwick KC. ‘Vanishing’ prostate cancer in radical prostatectomy specimens: incidence and long-term follow-up in 38 cases. BJU Int 2004;94:57–8. [3] Cao D, Hafez M, Berg K, Murphy K, Epstein JI. Little or no residual prostate cancer at RP: vanishing cancer or switched specimen? A microsatellite analysis of specimen identity. Am J Surg Pathol 2005;29:467–73. [4] Goldstein NS, Be´gin LR, Grody WW, Novak JM, Qian J, Bostwick DG. Minimal or no cancer in RP specimens: report of 13 cases of the ‘‘vanishing cancer phenomenon’’. Am J Surg Pathol 1995;19:1002–9. [5] Hammerer P. pT0 after radical prostatectomy: overtreatment for insignificant prostate cancer? Eur Urol 2004;45: 35. [6] Herkommer K, Kuefer R, Gschwend JE, Hautmann RE, Volkmer BG. Pathological T0 prostate cancer without neoadjuvant therapy: clinical presentation and followup. Eur Urol 2004;45:36–41. [7] Kollermann J, Feek U, Muller H, et al. Nondetected tumor (pT0) after prolonged, neoadjuvant treatment of localized prostatic carcinoma. Eur Urol 2000;38:714–20. [8] Ko¨llermann J, Hopfenmu¨ller W, Caprano J, et al. Prognosis of stage pT0 after prolonged neoadjuvant endocrine therapy of prostate cancer: a matched-pair analysis. Eur Urol 2004;45:42–5. [9] Mazzucchelli R, Barbisan F, Tagliabracci A, et al. Search for residual prostate cancer on pT0 radical prostatec-
295
tomy after positive biopsy. Virchows Arch 2007;450:371– 8. [10] Prayer-Galetti T, Gardiman M, Sacco E, Fracalanza S, Betto G, Pinto F. The finding of no tumor (pT0) in patients submitted to radical retropubic prostatectomy for clinically localized prostate cancer. Anal Quant Cytol Histol 2007;29:79–86. [11] Trpkov K, Gao Y, Hay R, Yimaz A. No residual cancer on radical prostatectomy after positive 10-core biopsy: incidence, biopsy findings, and DNA specimen identity analysis. Arch Pathol Lab Med 2006;130:811–6. Rodolfo Montironi* Marina Scarpelli Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region (Ancona), Ancona, Italy Antonio Lopez-Beltran Unit of Anatomic Pathology, Cordoba University Medical School, Cordoba, Spain Liang Cheng Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA *Corresponding author E-mail address: [email protected] (R. Montironi) March 5, 2007 Published online ahead of print on March 12, 2007 doi:10.1016/j.eururo.2007.03.012
DOI of original article: 10.1016/j.eururo.2006.06.004
Re: Peter Albers. Management of Stage I Testis Cancer. Eur Urol 2007;51:34–44 We read the review concerning management of stage I testis cancer from Peter Albers. All issues have been discussed with great ease of writing and outstanding competence. Both qualities rendered topics and arguments easy to comprehend, but not necessarily to share, unfortunately. Retroperitoneal lymphadenectomy (RPLND) was mentioned only three times in this paper. We do not believe that RPLND deserves this limited consideration in the 2000s. In experience in the United States as well as in Italy, RPLND remains a milestone in the treatment of clinical stage I nonseminoma disease. Historical [1] as well as recent [2–4] clinical experience supports RPLND because it is: (1) the most accurate procedure for retroperitoneal staging, (2) an effective treatment, being able to cure about two thirds of patients with nodal metastases without any further therapy, (3) an effective proce-
dure in the subset of high-risk patients (eg, vascular invasion), because about 70% of undetected metastases in these patients are just retroperitoneal and can be cured with surgery alone as mentioned above, (4) an effective therapy in overcoming possible presence of chemo-refractory disease (eg, teratoma), (5) an approach that does not alter the natural history of the disease and makes the follow-up programs easier (very low rate of abdominal and late recurrences), (6) a technique with a low morbidity (no mortality, no more than 1–2% of loss of antegrade ejaculation) when performed in high-volume institutions with a long experience in this disease, (7) able to avoid in nearly 90% of patients with clinical stage I non-seminoma some type of chemotherapy, which is currently receiving great attention due to the risks of long-term morbidities (eg, second cancers, cardiovascular diseases, and metabolic syndromes) as perfectly outlined by the author. Moreover RPLND is a continuously evolving technique. Larger and
296
european urology 52 (2007) 286–296
larger experiences with laparoscopic RPLND are available [5]. We cannot exclude the fact that in the near future laparoscopic RPLND could represent an additional choice in the management of the disease, having an even lower morbidity as a goal. References [1] Donohue JP, Thornhill JA, Foster RS, Rowland RG, Bihrle R. Retroperitoneal lymphadenectomy for clinical stage A testis cancer (1965 to 1989): modifications of technique and impact on ejaculation. J Urol 1993;149:237–43. [2] de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006;24:5482–92. [3] Stephenson AJ, Sheinfeld J. Management of patients with low stage nonseminomatous germ cell testicular cancer. Curr Treat Options Oncol 2005;6:367–77. [4] Nicolai N, Miceli R, Artusi R, Piva L, Pizzocaro G, Salvioni R. A simple model for predicting nodal metastasis in patients with clinical stage I nonseminomatous germ cell testicular DOI of original article: 10.1016/j.eururo.2006.08.022
tumors undergoing retroperitoneal lymph node dissection. J Urol 2004;171:172–6. [5] Albqami N, Janetschek G. Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer. J Endourol 2005;19:683–92. Nicola Nicolai* Luigi Piva Giorgio Pizzocaro Roberto Salvioni Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy *Corresponding author E-mail address: [email protected] (N. Nicolai) February 7, 2007 Published online ahead of print on February 14, 2007 doi:10.1016/j.eururo.2007.02.015