- Email: [email protected]
MP80-02 INCREASING AGE OF PATIENTS WITH TESTICULAR CANCER: 1980-2016 SINGLE-CENTER EXPERIENCE
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
Sexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease III Moderated Poster 80 Monday, May 15, 2017
1:00 PM-3:00 PM
MP80-01 THE USE OF INTRA-OPERATIVE FROZEN SECTION DURING ORGAN SPARING SURGERY FOR PENILE CANCER GREATLY REDUCES THE LOCAL RECURRENCE RATE. LONG TERM FOLLOW UP DATA Ayman Younis, Dawn Cave, John Dormer, Timothy Terry, Jonathan Goddard, Duncan Summerton*, Leicester, United Kingdom INTRODUCTION AND OBJECTIVES: Local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and-29%. Intra-operative Frozen Section (FS) is a useful tool to ensure safe microscopic margins in organ sparing procedures in penile cancer. In this series, we evaluated the impact of intra-operative surgical margin assessment by FS examination during penile-cancer preserving surgery on the local recurrence rate. METHODS: We analysed all those patients in which intraoperative FS was employed during penile preserving surgery in a single tertiary referral centre (catchment of 6.5 million) from 2007-2014. The tissue analysed for margins was the Urethral “donut”, corporal and/or glandular tissue proximal to the resection margin. We looked to see if this technique altered the surgical technique and what affect it had on recurrence rates. Median follow-up was 28 (1-114) months. RESULTS: Of the total number of 93 patients, 39 (41.9%) had a total glansectomy, 44 (47.3%) a partial penectomy, 7 (7.5%) a wide local excision, 2 (2.2%) a total penectomy and one (1%) a circumcision. Intra-operative histological FS examination of the surgical margin was positive in 16 (17.2%) cases mandating further resection under the same anaesthetic. Final paraffin histological examination confirmed cancer-free margins in 100%. At follow-up, none of the 16 patients with initial positive FS had local recurrence. Only 1 (1%) patient with negative intra-operative FS developed local recurrence at 23 months. This patient’s histology was initially G3pT4. CONCLUSIONS: The use of intra-operative frozen section analysis during organ preserving surgery for penile cancer facilitates conservative surgery, reduces the need, distress and expense of further surgery and in this series contributed to a very low rate (1%) of local recurrence. Source of Funding: none
MP80-02 INCREASING AGE OF PATIENTS WITH TESTICULAR CANCER: 1980-2016 SINGLE-CENTER EXPERIENCE Shinichi Yamashita*, Shinji Fujii, Shigeyuki Yamada, Yoshihide Kawasaki, Hideaki Izumi, Naoki Kawamorita, Koji Mitsuzuka, Hisanobu Adachi, Yasuhiro Kaiho, Akihiro Ito, Yoichi Arai, Sendai, Japan INTRODUCTION AND OBJECTIVES: Testicular germ cell tumor is the most common cancer in young men, and its incidence has been increasing. The standard therapy for advanced testicular cancer is multi-agent chemotherapy comprising bleomycin, etoposide, and cisplatin. However, opportunities for a regimen consisting of etoposide, ifosfamide, and cisplatin increase in consideration of the risk of pulmonary toxicity from bleomycin, particularly among older men. This study therefore retrospectively examined trends over time in the age at diagnosis of testicular cancer.
e1081
METHODS: A total of 478 patients were diagnosed with and underwent treatment for testicular cancer at our institution between January 1980 and May 2016. Patients were divided into 4 groups according to the year of diagnosis: 1980 to 1989; 1990 to 1999; 2000 to 2009; and 2010 to 2016. RESULTS: Median age at diagnosis continuously increased, from 27 years (n¼53) to 31 years (n¼135), 34 years (n¼179) and 38 years (n¼111) in each period, respectively. Next, patients were divided by pathological type into 2 groups: a seminoma group with pure seminoma (n¼227; 47.5%); and a non-seminoma group with non-seminoma or mixed germ cell tumor (n¼251; 52.5%). In the seminoma group, median age increased constantly from 31 years (n¼20) to 34 years (n¼54), 36 years (n¼93) and 41 years (n¼60) in each period, respectively. Median age in the non-seminoma group also increased constantly from 26 years (n¼33) to 28 years (n¼81), 29 years (n¼86) and 35 years (n¼51) in each period, respectively. Interestingly, a continuous increase was also seen in the relative proportion of seminomas, from 37.7% to 40.0%, 52.0%, and 54.0% in each period, respectively. CONCLUSIONS: The age at diagnosis is rising for patients with testicular cancer, and the age of patients with testicular cancer may increase in future. This should be kept in mind for the decision-making process leading to chemotherapy for testicular cancer. Source of Funding: none
MP80-03 DISTRESS SCREENING IN PATIENTS WITH UROGENITAL MALIGNANCIES Pia Paffenholz*, Cologne, Germany; Maria Angerer-Shpilenya, Aachen, Germany; Johannes Salem, David Pfister, Axel Heidenreich, Cologne, Germany INTRODUCTION AND OBJECTIVES: Malignant tumors do not only have a somatic but also a psychological impact on patients. To date, only a few studies are available which evaluated the potential psychological burden of patients suffering from urogenital cancers. In this prospective, longitudinal study we examine the baseline psychological distress of patients treated for urogenital malignancies focussing on testicular cancer (TC) and prostate cancer (PCA). METHODS: Psychological distress of 192 inpatients treated for urogenital malignancies was evaluated using the distress thermometer (DT), a well-established clinical tool for the detection of distress, at admission to the hospital prior to any surgical or systemic therapy. The DT consists of a visual analogue scale ranging from 0 to 10 resulting in a low (0-3), moderate (4-6) or high (7-10) stress level. Furthermore, it contains a 36-item list of problems subdivided into 5 categories (practical, family, emotional, spiritual/religious, physical). RESULTS: Of the eligible 192 patients, 103 (54%) patients were diagnosed with PCA, 40 (21%) with TC, 22 (11%) with urothelial cancer, 21 (11%) with renal cell cancer and 6 (3%) with penile cancer. The mean DT score was 5 (interquartile range (IQR) 3-7) with the most common stressors being of emotional origin, namely fear (95/192, 50%), worry (85/192, 44%), nervousness (80/192, 42%), sleep disorders (75/192, 39%) and fatigue (61/192, 32%). DT analysis did not reveal any difference between the tumor entities but 64% of all patients displayed a moderate to high stress level requiring psycho-oncological support. The comparison of PCA and TC demonstrated a higher distress level in PCA patients in the subgroups of metastatic disease (median 5.5, IQR 4-8 vs. median 4, IQR 2-6; p ¼ 0.018), secondary therapy (median 6, IQR 5-8 vs. median 4.5, IQR 2.75-6; p ¼ 0.023) and salvage treatment (median 7, IQR 4.5-9 vs. 5, IQR 2.75-6; p ¼ 0.021). Furthermore, PCA patients receiving salvage treatment displayed significantly higher distress levels compared to non-salvage treated patients (median 7, IQR 4.5-9 vs. median 5, IQR 2-7; p 0.028). CONCLUSIONS: Our study shows that 64% of urological tumor patients should be offered psycho-oncological support. Especially patients suffering from advanced stage PCA seem to have a high stress level. Thus, physicians in the field of urologic oncology should be aware
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
Sexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease III Moderated Poster 80 Monday, May 15, 2017
1:00 PM-3:00 PM
MP80-01 THE USE OF INTRA-OPERATIVE FROZEN SECTION DURING ORGAN SPARING SURGERY FOR PENILE CANCER GREATLY REDUCES THE LOCAL RECURRENCE RATE. LONG TERM FOLLOW UP DATA Ayman Younis, Dawn Cave, John Dormer, Timothy Terry, Jonathan Goddard, Duncan Summerton*, Leicester, United Kingdom INTRODUCTION AND OBJECTIVES: Local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and-29%. Intra-operative Frozen Section (FS) is a useful tool to ensure safe microscopic margins in organ sparing procedures in penile cancer. In this series, we evaluated the impact of intra-operative surgical margin assessment by FS examination during penile-cancer preserving surgery on the local recurrence rate. METHODS: We analysed all those patients in which intraoperative FS was employed during penile preserving surgery in a single tertiary referral centre (catchment of 6.5 million) from 2007-2014. The tissue analysed for margins was the Urethral “donut”, corporal and/or glandular tissue proximal to the resection margin. We looked to see if this technique altered the surgical technique and what affect it had on recurrence rates. Median follow-up was 28 (1-114) months. RESULTS: Of the total number of 93 patients, 39 (41.9%) had a total glansectomy, 44 (47.3%) a partial penectomy, 7 (7.5%) a wide local excision, 2 (2.2%) a total penectomy and one (1%) a circumcision. Intra-operative histological FS examination of the surgical margin was positive in 16 (17.2%) cases mandating further resection under the same anaesthetic. Final paraffin histological examination confirmed cancer-free margins in 100%. At follow-up, none of the 16 patients with initial positive FS had local recurrence. Only 1 (1%) patient with negative intra-operative FS developed local recurrence at 23 months. This patient’s histology was initially G3pT4. CONCLUSIONS: The use of intra-operative frozen section analysis during organ preserving surgery for penile cancer facilitates conservative surgery, reduces the need, distress and expense of further surgery and in this series contributed to a very low rate (1%) of local recurrence. Source of Funding: none
MP80-02 INCREASING AGE OF PATIENTS WITH TESTICULAR CANCER: 1980-2016 SINGLE-CENTER EXPERIENCE Shinichi Yamashita*, Shinji Fujii, Shigeyuki Yamada, Yoshihide Kawasaki, Hideaki Izumi, Naoki Kawamorita, Koji Mitsuzuka, Hisanobu Adachi, Yasuhiro Kaiho, Akihiro Ito, Yoichi Arai, Sendai, Japan INTRODUCTION AND OBJECTIVES: Testicular germ cell tumor is the most common cancer in young men, and its incidence has been increasing. The standard therapy for advanced testicular cancer is multi-agent chemotherapy comprising bleomycin, etoposide, and cisplatin. However, opportunities for a regimen consisting of etoposide, ifosfamide, and cisplatin increase in consideration of the risk of pulmonary toxicity from bleomycin, particularly among older men. This study therefore retrospectively examined trends over time in the age at diagnosis of testicular cancer.
e1081
METHODS: A total of 478 patients were diagnosed with and underwent treatment for testicular cancer at our institution between January 1980 and May 2016. Patients were divided into 4 groups according to the year of diagnosis: 1980 to 1989; 1990 to 1999; 2000 to 2009; and 2010 to 2016. RESULTS: Median age at diagnosis continuously increased, from 27 years (n¼53) to 31 years (n¼135), 34 years (n¼179) and 38 years (n¼111) in each period, respectively. Next, patients were divided by pathological type into 2 groups: a seminoma group with pure seminoma (n¼227; 47.5%); and a non-seminoma group with non-seminoma or mixed germ cell tumor (n¼251; 52.5%). In the seminoma group, median age increased constantly from 31 years (n¼20) to 34 years (n¼54), 36 years (n¼93) and 41 years (n¼60) in each period, respectively. Median age in the non-seminoma group also increased constantly from 26 years (n¼33) to 28 years (n¼81), 29 years (n¼86) and 35 years (n¼51) in each period, respectively. Interestingly, a continuous increase was also seen in the relative proportion of seminomas, from 37.7% to 40.0%, 52.0%, and 54.0% in each period, respectively. CONCLUSIONS: The age at diagnosis is rising for patients with testicular cancer, and the age of patients with testicular cancer may increase in future. This should be kept in mind for the decision-making process leading to chemotherapy for testicular cancer. Source of Funding: none
MP80-03 DISTRESS SCREENING IN PATIENTS WITH UROGENITAL MALIGNANCIES Pia Paffenholz*, Cologne, Germany; Maria Angerer-Shpilenya, Aachen, Germany; Johannes Salem, David Pfister, Axel Heidenreich, Cologne, Germany INTRODUCTION AND OBJECTIVES: Malignant tumors do not only have a somatic but also a psychological impact on patients. To date, only a few studies are available which evaluated the potential psychological burden of patients suffering from urogenital cancers. In this prospective, longitudinal study we examine the baseline psychological distress of patients treated for urogenital malignancies focussing on testicular cancer (TC) and prostate cancer (PCA). METHODS: Psychological distress of 192 inpatients treated for urogenital malignancies was evaluated using the distress thermometer (DT), a well-established clinical tool for the detection of distress, at admission to the hospital prior to any surgical or systemic therapy. The DT consists of a visual analogue scale ranging from 0 to 10 resulting in a low (0-3), moderate (4-6) or high (7-10) stress level. Furthermore, it contains a 36-item list of problems subdivided into 5 categories (practical, family, emotional, spiritual/religious, physical). RESULTS: Of the eligible 192 patients, 103 (54%) patients were diagnosed with PCA, 40 (21%) with TC, 22 (11%) with urothelial cancer, 21 (11%) with renal cell cancer and 6 (3%) with penile cancer. The mean DT score was 5 (interquartile range (IQR) 3-7) with the most common stressors being of emotional origin, namely fear (95/192, 50%), worry (85/192, 44%), nervousness (80/192, 42%), sleep disorders (75/192, 39%) and fatigue (61/192, 32%). DT analysis did not reveal any difference between the tumor entities but 64% of all patients displayed a moderate to high stress level requiring psycho-oncological support. The comparison of PCA and TC demonstrated a higher distress level in PCA patients in the subgroups of metastatic disease (median 5.5, IQR 4-8 vs. median 4, IQR 2-6; p ¼ 0.018), secondary therapy (median 6, IQR 5-8 vs. median 4.5, IQR 2.75-6; p ¼ 0.023) and salvage treatment (median 7, IQR 4.5-9 vs. 5, IQR 2.75-6; p ¼ 0.021). Furthermore, PCA patients receiving salvage treatment displayed significantly higher distress levels compared to non-salvage treated patients (median 7, IQR 4.5-9 vs. median 5, IQR 2-7; p 0.028). CONCLUSIONS: Our study shows that 64% of urological tumor patients should be offered psycho-oncological support. Especially patients suffering from advanced stage PCA seem to have a high stress level. Thus, physicians in the field of urologic oncology should be aware