Best of AUA 2014: Penile, Testis, and Urethral Cancer

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• Overtreatment of penile cancer persists, as radical surgery remains the predominant treatment for stage I disease.

• 18F-FDG positron emission tomography/computed tomography demonstrated 100% sensitivity and 78% specificity for preoperative determination of inguinal node status in patients with advanced penile cancer.

• A study of 316 patients with advanced penile cancer treated at four international referral centers showed a postoperative complication rate of 56.3%, a third of which were major. Number of lymph nodes removed and length of hospital stay were independent predictors of the risk of complications.

• Salvage inguinal lymph node dissection for metastatic recurrence of penile cancer showed that 12 of 20 patients remained alive at last follow-up, nine of whom were without evidence of disease.

• An analysis of 314 patients with recurrent penile cancer over a 53-year period showed that independent predictors of cancer-specific mortality were lymph node metastasis at initial treatment, regional versus local disease recurrence, and distant versus local recurrence.

• Lack of insurance almost doubled the likelihood of testicular cancer-specific mortality and increased the likelihood of metastatic disease at diagnosis by 60%.

• A query of the National Cancer Database for 1998 to 2011 showed that active surveillance for early-stage seminoma increased from 25.2% to 55.8% and use of adjuvant chemotherapy increased from 1.9% to 16.7% of cases. Use of adjuvant radiation therapy decreased from 72.9% to 27.5%. For nonseminomas, active surveillance increased its dominant position to a range between 58.8% and 66.2%, whereas use of adjuvant chemotherapy increased and the rate of retroperitoneal lymph node dissection decreased.

• A British study of retroperitoneal lymph node dissection identified 162 men who underwent the procedure at 18 specialist centers in 2012. Resection was successful in 97% of cases, with no perioperative deaths and a mean length of stay of 5.5 days. Results showed that 86% of the men required two or more units of packed red blood cells and 10% of patients had postoperative complications. Histology was necrosis in 22% of cases, teratoma in 42%, and visible cancer in 36%.

• A study of 13 patients with complex post-chemotherapy residual masses showed that all had intermediate- or poor-risk characteristics, and all had received four cycles of chemotherapy. Concomitant organ resection consisted of five patients with one to two metastatic vertebral bodies, six with infrahilar aorta or inferior vena cava involvement, two with common iliac artery or vein involvement, five with retrocrural nodes, and three with ipsilateral kidney.

• An analysis of 211 retrocrural dissection procedures in patients with advanced testicular cancer showed that surgery was limited to transabdominal incision in 67 patients and more extensive surgery in 144. Use of the transabdominal/transdiaphragmatic approach has increased in recent years. The transabdominal/transdiaphragmatic approach is associated with fewer complications and surgeries.

• An analysis of 107 patients with primary urethral cancer and synchronous bladder cancer showed that relapse-free survival (RFS) was associated with advanced pathologic tumor stage, clinically node-positive disease, and synchronous bladder cancer. The 5-year RFS was 67.8% for low-risk patients, 43.1% for intermediate-risk patients, and 0% for high-risk patients.UT

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