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CT Impact on Testicular Tumours Clinical Management
TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY
991
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.07.029 available at http://jurology.com/ Editorial Comment: This large secondary analysis of the prostate component of PLCO (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial) generated a lot of media attention when it was released earlier in this year. This focus, in turn, led balding male patients to come into my office (and I suspect into yours), worrying about their risk of prostate cancer. When I see large secondary epidemiology studies of this type, I always approach them with a healthy degree of skepticism. In this case it is probably justified. This study classifies men into 5 groups in worsening degree of baldness “severity,” ie no baldness, frontal baldness only, frontal and mild vertex baldness, frontal and moderate vertex baldness, and frontal and severe vertex baldness. The study failed to show any association between baldness (regardless of type) and overall risk of incident prostate cancer in PLCO. However, it revealed a relationship between risk of aggressive prostate cancer and frontal plus moderate vertex baldness only. This relationship was not noted in the more severe form of baldness, where the presumed etiology of the association (changes in endogenous hormone levels) would be more pronounced. This outcome is a red flag to me. If this finding were real, I would expect to see some sort of trend. However, none is there. The authors attribute this lack of trend to limitations in study design but I am inclined to blame a statistically spurious positive finding in the moderate vertex baldness group. Therefore, you can tell your balding patients to rest easy when it comes to their hairline and prostate cancer (although you may want to remind them to use sunscreen or wear a hat if they are going to be out in the sun). David F. Penson, MD, MPH
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: 18F-FDG PET/CT Impact on Testicular Tumours Clinical Management V. Ambrosini, G. Zucchini, S. Nicolini, A. Berselli, C. Nanni, V. Allegri, A. Martoni, D. Rubello, A. Cricca and S. Fanti Nuclear Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy Eur J Nucl Med Mol Imaging 2014; 41: 668e673.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.07.003 available at http://jurology.com/ Editorial Comment: Diagnostic imaging in patients with testicular tumors is based mainly on morphological change (size criteria). Use of positron emission tomography (PET) with computerized tomography (CT) enhanced with 18F-fluorodeoxyglucose (FDG) may give functional results. The authors studied 121 PET CTs in 56 patients with testicular tumor. PET CT showed good sensitivity (92%) and specificity (84%) for seminoma lesion detection. However, 18F-FDG PET characteristics were lower for nonseminomatous tumors, with a sensitivity of 77% and a specificity of 99%. The preliminary data from this study indicate the potential usefulness of 18F-FDG PET CT for patients with testicular tumor, particularly seminoma. Jerome P. Richie, MD
991
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.07.029 available at http://jurology.com/ Editorial Comment: This large secondary analysis of the prostate component of PLCO (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial) generated a lot of media attention when it was released earlier in this year. This focus, in turn, led balding male patients to come into my office (and I suspect into yours), worrying about their risk of prostate cancer. When I see large secondary epidemiology studies of this type, I always approach them with a healthy degree of skepticism. In this case it is probably justified. This study classifies men into 5 groups in worsening degree of baldness “severity,” ie no baldness, frontal baldness only, frontal and mild vertex baldness, frontal and moderate vertex baldness, and frontal and severe vertex baldness. The study failed to show any association between baldness (regardless of type) and overall risk of incident prostate cancer in PLCO. However, it revealed a relationship between risk of aggressive prostate cancer and frontal plus moderate vertex baldness only. This relationship was not noted in the more severe form of baldness, where the presumed etiology of the association (changes in endogenous hormone levels) would be more pronounced. This outcome is a red flag to me. If this finding were real, I would expect to see some sort of trend. However, none is there. The authors attribute this lack of trend to limitations in study design but I am inclined to blame a statistically spurious positive finding in the moderate vertex baldness group. Therefore, you can tell your balding patients to rest easy when it comes to their hairline and prostate cancer (although you may want to remind them to use sunscreen or wear a hat if they are going to be out in the sun). David F. Penson, MD, MPH
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: 18F-FDG PET/CT Impact on Testicular Tumours Clinical Management V. Ambrosini, G. Zucchini, S. Nicolini, A. Berselli, C. Nanni, V. Allegri, A. Martoni, D. Rubello, A. Cricca and S. Fanti Nuclear Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy Eur J Nucl Med Mol Imaging 2014; 41: 668e673.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.07.003 available at http://jurology.com/ Editorial Comment: Diagnostic imaging in patients with testicular tumors is based mainly on morphological change (size criteria). Use of positron emission tomography (PET) with computerized tomography (CT) enhanced with 18F-fluorodeoxyglucose (FDG) may give functional results. The authors studied 121 PET CTs in 56 patients with testicular tumor. PET CT showed good sensitivity (92%) and specificity (84%) for seminoma lesion detection. However, 18F-FDG PET characteristics were lower for nonseminomatous tumors, with a sensitivity of 77% and a specificity of 99%. The preliminary data from this study indicate the potential usefulness of 18F-FDG PET CT for patients with testicular tumor, particularly seminoma. Jerome P. Richie, MD