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Re: Management Trends in Stage I Testicular Seminoma: Impact of Race, Insurance Status, and Treatment Facility
TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY
355
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24825396 Editorial Comment: Urinary incontinence following radical prostatectomy for prostate cancer has been associated with substantial negative outcomes, including reduced general and health specific quality of life. Radical surgery for curative treatment of localized prostate cancer tends to be performed less often in elderly men compared to younger men for a variety of reasons. The most common is due to competing comorbidities, which can decrease estimated remaining life expectancy and tip the risk balance ratio away from surgery in this population. However, a desire to avoid complications such as urinary incontinence is also a reason to potentially avoid surgery in elderly men. These authors examined continence outcomes after robot-assisted radical prostatectomy in a cohort of 262 men at 3 hospitals in Melbourne, Australia who were treated by 2 consultant urological surgeons. Outcomes were analyzed by stratifying the group into those 70 years or older and younger patients. Early continence rates were slightly better for the younger men but by 3 months and at all subsequent points there was no statistical difference between the groups. These findings suggest that continence outcomes following this type of surgery are comparable based on age, and decisions regarding surgery should be individually based on other clinical parameters, such as estimated life expectancy and overall health status, rather than chronological age alone. Tomas L. Griebling, MD, MPH
Suggested Reading Giedelman C, Muhsin HA, Schatloff O et al: Perioperative, functional and oncological outcomes after robot-assisted radical prostatectomy in men 70 years of age and over with localized prostate cancer. J Urol, suppl., 2013; 189: e612, abstract 1494. Kundu SD, Roehl KA, Eggener SE et al: Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 2004; 172: 2227.
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Management Trends in Stage I Testicular Seminoma: Impact of Race, Insurance Status, and Treatment Facility P. J. Gray, C. C. Lin, H. Sineshaw, J. J. Paly, A. Jemal and J. A. Efstathiou Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Cancer 2015; 121: 681e687. doi: 10.1002/cncr.29094
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25345675 Editorial Comment: Representing less than 1% of male cancers, testicular seminoma is the most common solid tumor seen in patients 15 to 35 years old. Approximately 50% of patients will present with stage I disease, with excellent disease specific survival. The authors studied modern trends in the treatment of patients with stage I testicular seminoma using the National Cancer Data Base, with more than 34,000 patients with stage I testicular seminoma treated between 1998 and 2011. During this period observation for stage Ia/b testicular seminoma doubled, from 23% to 53%. Radiation therapy decreased from 70% to 29%. For patients with stage Ia/b seminoma observation after orchiectomy was more common in racial minorities, Hispanics and the uninsured. The authors conclude that active surveillance has increased significantly in recent years, whereas radiation therapy use has declined, particularly at academic centers. Race, insurance status and facility type were strongly associated with choice of adjuvant management. Jerome P. Richie, MD
355
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24825396 Editorial Comment: Urinary incontinence following radical prostatectomy for prostate cancer has been associated with substantial negative outcomes, including reduced general and health specific quality of life. Radical surgery for curative treatment of localized prostate cancer tends to be performed less often in elderly men compared to younger men for a variety of reasons. The most common is due to competing comorbidities, which can decrease estimated remaining life expectancy and tip the risk balance ratio away from surgery in this population. However, a desire to avoid complications such as urinary incontinence is also a reason to potentially avoid surgery in elderly men. These authors examined continence outcomes after robot-assisted radical prostatectomy in a cohort of 262 men at 3 hospitals in Melbourne, Australia who were treated by 2 consultant urological surgeons. Outcomes were analyzed by stratifying the group into those 70 years or older and younger patients. Early continence rates were slightly better for the younger men but by 3 months and at all subsequent points there was no statistical difference between the groups. These findings suggest that continence outcomes following this type of surgery are comparable based on age, and decisions regarding surgery should be individually based on other clinical parameters, such as estimated life expectancy and overall health status, rather than chronological age alone. Tomas L. Griebling, MD, MPH
Suggested Reading Giedelman C, Muhsin HA, Schatloff O et al: Perioperative, functional and oncological outcomes after robot-assisted radical prostatectomy in men 70 years of age and over with localized prostate cancer. J Urol, suppl., 2013; 189: e612, abstract 1494. Kundu SD, Roehl KA, Eggener SE et al: Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 2004; 172: 2227.
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Management Trends in Stage I Testicular Seminoma: Impact of Race, Insurance Status, and Treatment Facility P. J. Gray, C. C. Lin, H. Sineshaw, J. J. Paly, A. Jemal and J. A. Efstathiou Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Cancer 2015; 121: 681e687. doi: 10.1002/cncr.29094
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25345675 Editorial Comment: Representing less than 1% of male cancers, testicular seminoma is the most common solid tumor seen in patients 15 to 35 years old. Approximately 50% of patients will present with stage I disease, with excellent disease specific survival. The authors studied modern trends in the treatment of patients with stage I testicular seminoma using the National Cancer Data Base, with more than 34,000 patients with stage I testicular seminoma treated between 1998 and 2011. During this period observation for stage Ia/b testicular seminoma doubled, from 23% to 53%. Radiation therapy decreased from 70% to 29%. For patients with stage Ia/b seminoma observation after orchiectomy was more common in racial minorities, Hispanics and the uninsured. The authors conclude that active surveillance has increased significantly in recent years, whereas radiation therapy use has declined, particularly at academic centers. Race, insurance status and facility type were strongly associated with choice of adjuvant management. Jerome P. Richie, MD