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BMJ Clinical Evidence Jan 2016More than half of painless solid swellings of the body of the testis are malignant, with a peak incidence in men aged 30 to 34 years. Most testicular cancers are germ... (Review)
Review
INTRODUCTION
More than half of painless solid swellings of the body of the testis are malignant, with a peak incidence in men aged 30 to 34 years. Most testicular cancers are germ cell tumours and half of these are seminomas, which tend to affect older men and have a good prognosis.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments following orchidectomy in men diagnosed with stage 1 germ cell tumours (confined to testis)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
At this update, 76 records were screened for inclusion. Appraisal of titles and abstracts led to the exclusion of 47 studies and the further review of 29 full publications. Of the 29 full articles evaluated, two systematic reviews and one RCT, were added at this update. Data from long-term follow-up of an already reported study were also added. We performed a GRADE evaluation for seven PICO combinations.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for seven interventions based on information about the effectiveness and safety of adjuvant chemotherapy (including different drugs and the number of cycles), adjuvant radiotherapy (including different regimens), adjuvant surgery, and surveillance/observation.
Topics: Chemotherapy, Adjuvant; Humans; Male; Neoplasms, Germ Cell and Embryonal; Radiotherapy, Adjuvant; Testicular Neoplasms
PubMed: 26741128
DOI: No ID Found -
Nature Reviews. Urology Jun 2012Cancer/testis antigens (CTAs) are a group of tumour-associated antigens (TAAs) that display normal expression in the adult testis--an immune-privileged organ--but... (Review)
Review
Cancer/testis antigens (CTAs) are a group of tumour-associated antigens (TAAs) that display normal expression in the adult testis--an immune-privileged organ--but aberrant expression in several types of cancers, particularly in advanced cancers with stem cell-like characteristics. There has been an explosion in CTA-based research since CTAs were first identified in 1991 and MAGE-1 was shown to elicit an autologous cytotoxic T-lymphocyte (CTL) response in a patient with melanoma. The resulting data have not only highlighted a role for CTAs in tumorigenesis, but have also underscored the translational potential of these antigens for detecting and treating many types of cancers. Studies that have investigated the use of CTAs for the clinical management of urological malignancies indicate that these TAAs have potential roles as novel biomarkers, with increased specificity and sensitivity compared to those currently used in the clinic, and therapeutic targets for cancer immunotherapy. Increasing evidence supports the utilization of these promising tools for urological indications.
Topics: Animals; Antigens, Neoplasm; Biomarkers, Tumor; Cancer Vaccines; Humans; Male; Testicular Neoplasms; Urologic Neoplasms
PubMed: 22710665
DOI: 10.1038/nrurol.2012.117 -
Nihon Hinyokika Gakkai Zasshi. the... Dec 1989A dramatic improvement in the survival of patients with testicular cancer has been witnessed in the 1970s. These advances are in the areas of diagnosis, staging, and... (Review)
Review
A dramatic improvement in the survival of patients with testicular cancer has been witnessed in the 1970s. These advances are in the areas of diagnosis, staging, and monitoring of patients with this disease. The thrust of improvement includes the finding of sensitive and specific markers, the introduction of CDDP, and utilization of CT. Also, the finding of the efficacy of multidisciplinary treatment consisting of intensive chemotherapy and surgery has played a decisive role in the management of patients. This paper is devoted of a discussion of the basic sciences related to testicular cancer and the diagnosis and management of this tumor.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Biomarkers, Tumor; Child; Child, Preschool; Combined Modality Therapy; Humans; Infant; Male; Middle Aged; Neoplasm Staging; Risk Factors; Testicular Neoplasms
PubMed: 2696804
DOI: 10.5980/jpnjurol1989.80.1695 -
International Journal of Cancer Dec 1999Carcinoma in situ of the testis (CIS) is the uniform precursor of testicular germ-cell tumours. Morphologically, CIS consists of large, intratubular, gonocyte-like cells... (Review)
Review
Carcinoma in situ of the testis (CIS) is the uniform precursor of testicular germ-cell tumours. Morphologically, CIS consists of large, intratubular, gonocyte-like cells with large nuclei and abundant glycogen. CIS cells are probably derived from primordial germ cells and are supposed to be present in the testis of a future testis cancer patient at the time of birth. CIS cells appear to spread inside the seminiferous tubules until CIS progresses to invasive cancer. Diagnosis is best achieved by surgical biopsy of the testis and subsequent immunohistological staining of placental alkaline phosphatase (PlAP). This enzyme is present in embryonal germ cells, CIS and seminoma as well as several other types of germ-cell tumour but usually not in normal germ cells. CIS is found in testicular tissue adjacent to testicular germ-cell tumours in about 90% of cases, and it is observed in all clinical groups known to be at risk for testicular cancer: cryptorchidism (2% to 4%), infertility (0% to 1%), ambiguous genitalia (25%) and contralateral testis of patients with testicular cancer (5%). Conversely, CIS is found in less than 1% of the normal male population, and this prevalence corresponds well to the life-time risk of testicular cancer in males. If CIS is left untreated, there is a 50% probability of progressing to frank germ-cell neoplasm within 5 years. Localised low-dose radiotherapy to the testis eradicates CIS and germ cells, while Leydig cells are preserved. The patient can thus be spared orchiectomy and hormone supplementation. Currently, dose-reduction studies are looking for the optimal radiation dose, which is expected to be around 14 to 16 Gy. After chemotherapy, there is a cumulative risk of 42% for recurrence of CIS within 10 years. The concept of CIS offers the chance of very early detection of testicular cancer and organ-preserving early treatment.
Topics: Carcinoma in Situ; Humans; Male; Prevalence; Risk Factors; Testicular Neoplasms; Testis
PubMed: 10597201
DOI: 10.1002/(sici)1097-0215(19991210)83:6<815::aid-ijc21>3.0.co;2-z -
The Journal of Clinical Endocrinology... Nov 2022The purpose of this study is to report development of a malignant testicular germ cell tumor (GCT) in 2 young adult males with familial male-limited precocious puberty... (Review)
Review
OBJECTIVE
The purpose of this study is to report development of a malignant testicular germ cell tumor (GCT) in 2 young adult males with familial male-limited precocious puberty (FMPP) because of LHCGR pathogenic variants in 2 families. Secondarily, to study the possible relation between FMPP and testicular tumors and to investigate whether FMPP might predispose to development of malignant testicular tumors in adulthood a literature review is conducted.
METHODS
Data on 6 cases in 2 families are obtained from the available medical records. In addition, a database search is performed in Cochrane, PubMed, and Embase for studies that report on a possible link between FMPP and testicular tumors.
RESULTS
The characteristics of 6 males with FMPP based on activating LH receptor (LHCGR) germline pathogenic variants are described, as are details of the testicular GCTs. Furthermore, a literature review identified 4 more patients with signs of FMPP and a (precursor of) testicular GCT in adolescence or adulthood (age 15-35 years). Additionally, 12 patients with signs of precocious puberty and, simultaneously, occurrence of a Leydig cell adenoma or Leydig cell hyperplasia are reported.
CONCLUSION
There is a strong suggestion that FMPP might increase the risk of development of testicular GCTs in early adulthood compared with the risk in the general population. Therefore, prolonged patient monitoring from mid-pubertal age onward including instruction for self-examination and periodic testicular ultrasound investigation in patients with a germline LHCGR pathogenic variant might contribute to early detection and thus early treatment of testicular GCT.
Topics: Adolescent; Adult; Humans; Male; Young Adult; Puberty, Precocious; Testicular Neoplasms
PubMed: 36071555
DOI: 10.1210/clinem/dgac516 -
Korean Journal of Urology Dec 2014Prepubertal testicular tumors are rare compared with postpubertal testicular tumors. The incidence of prepubertal testicular tumors peaks at 2 years of age, tapers off... (Review)
Review
Prepubertal testicular tumors are rare compared with postpubertal testicular tumors. The incidence of prepubertal testicular tumors peaks at 2 years of age, tapers off after 4 years of age, and then begins to rise again at puberty. Prepubertal and postpubertal testicular tumors show many differences, including the typical tumor histology, molecular biological differences, and the malignant potential of tumors at different ages. Pediatric testicular tumors are classified as benign or malignant on the basis of their clinical behavior and histologically are divided into germ cell and gonadal stromal (nongerm cell) tumors. Many histological and biological studies have further confirmed the distinct nature of prepubertal and postpubertal testicular tumors. These differences have led to various management strategies for prepubertal and postpubertal tumors. Because overall about 75% of prepubertal testicular tumors are benign, a testis-sparing approach is becoming more common in children. Orchiectomy and observation with very selective use of chemotherapy has become the standard approach when a malignant tumor is identified. Retroperitoneal lymph node dissection and radiation therapy play very limited roles.
Topics: Age Distribution; Child; Humans; Incidence; Male; Prognosis; Republic of Korea; Testicular Neoplasms
PubMed: 25512812
DOI: 10.4111/kju.2014.55.12.789 -
International Journal of Surgery... Dec 2023Testis-sparing surgery (TSS) is a safe treatment for patients with benign testicular tumors. Presently, assessments for evaluating the suitability of TSS are poorly...
BACKGROUND
Testis-sparing surgery (TSS) is a safe treatment for patients with benign testicular tumors. Presently, assessments for evaluating the suitability of TSS are poorly standardized, partially because testicular anatomical elements cannot be quantitatively described.
MATERIALS AND METHODS
The authors developed a scoring method known as the SAVE testis-sparing score based on four critical and accessible anatomical features of a testicular tumor. The SAVE score ranges from 0 to 8 and is divided into four risk classes ( low , medium , high , and extremely high ) to evaluate the feasibility of TSS, wherein low-risk indicates high feasibility and vice versa. This study included 444 testicular tumor patients from eight centers. Among them, 216 patients (model group: 151 patients, validation group: 65 patients) were included in the modeling analysis, and the other 228 patients from children's centers were included in the proportion analysis. Using retrospective data, patient characteristics associated with surgical methods were identified. Furthermore, a multivariate logistic regression model was built quantify the associations between these characteristics and the surgery method. The receiver operator characteristic curve was used to evaluate the classification efficiency of SAVE.
RESULTS
The SAVE testis-sparing score includes size (tumor size as maximal diameter), available testicular tissue volume, volume ratio of the tumor to the testis, and the exophytic / endophytic properties of the tumor. The SAVE scoring system accurately classified the suitability of TSS based on the complexity of benign testicular tumors.
CONCLUSION
The SAVE score is a reproducible and robust tool for quantitatively describing the anatomical characteristics of benign testicular tumors and guide the preoperative evaluation of TSS.
Topics: Male; Child; Humans; Retrospective Studies; Orchiectomy; Organ Sparing Treatments; Testicular Neoplasms
PubMed: 37738014
DOI: 10.1097/JS9.0000000000000752 -
Andrology Jul 2019Determining stage and anticipating prognosis are the two crucial steps after the diagnosis of a germ-cell cancer that both guide subsequent treatment decisions. This... (Review)
Review
Determining stage and anticipating prognosis are the two crucial steps after the diagnosis of a germ-cell cancer that both guide subsequent treatment decisions. This review focuses on metastatic disease, which means germ-cell cancers beyond stage I limited to the testis. In the past, major centers developed separate staging and prognostic classifications for metastatic germ-cell cancer, which heavily impaired communication and comparisons across clinical trials. More recently, the classification system of the International Germ-Cell Cancer Collaborative Group (IGCCCG) has found acceptance worldwide and is currently being updated.
Topics: Humans; Male; Neoplasm Staging; Neoplasms, Germ Cell and Embryonal; Prognosis; Testicular Neoplasms
PubMed: 30969027
DOI: 10.1111/andr.12615 -
American Family Physician May 1999Although testicular cancer accounts for only 1 percent of all tumors in males, it is the most common malignancy in males between 15 and 34 years of age. Cryptorchidism... (Review)
Review
Although testicular cancer accounts for only 1 percent of all tumors in males, it is the most common malignancy in males between 15 and 34 years of age. Cryptorchidism is the most significant risk factor for testicular cancer, increasing the risk up to 11-fold. A painless testicular mass is the classic presentation for testicular cancer, although a number of patients present with diffuse pain or swelling. Ultrasonography may be helpful in confirming the presence of a scrotal mass within the testicle. Intratesticular masses are considered malignant until proved otherwise. Radical orchiectomy is the treatment for the primary tumor. Staging of disease is based on tumor histology, serum tumor markers and presence of lymph-node or other metastatic disease. Depending on the stage of disease, further treatment may include observation, radiotherapy, chemotherapy or surgery. Survival rates in patients with testicular cancer have improved dramatically in the past 20 years and now exceed 90 percent overall.
Topics: Biomarkers, Tumor; Humans; Incidence; Male; Mass Screening; Neoplasm Staging; Patient Education as Topic; Prognosis; Survival Rate; Teaching Materials; Testicular Neoplasms; United States
PubMed: 10323360
DOI: No ID Found -
Andrology Jul 2019Testicular germ cell tumour (TGCT) is a malignancy with a high heritable component. The inherited risk is polygenic, and around 50 susceptibility genes are identified.... (Review)
Review
OBJECTIVE
Testicular germ cell tumour (TGCT) is a malignancy with a high heritable component. The inherited risk is polygenic, and around 50 susceptibility genes are identified. The functional role of the gene products for TGCT development is not well understood. The focus of this review is functional studies of genetic risk factors for TGCT derived from GCNIS and the signalling pathways involved in the pathogenesis.
RECENT DEVELOPMENTS
Genome-wide association studies have identified new risk loci for TGCT and confirmed previously identified susceptibility genes. Many of these risk genes are related to male germ cell development, sex determination and genomic integrity. Gain- and loss-of-function studies in animal models and TGCT cell lines, as well as gene and protein expression studies in TGCT patient samples, have contributed to the understanding of TGCT development. KITLG-KIT signalling is of crucial importance, but several other signal transduction pathways may also play a role. Many of the risk loci are in non-coding regions, and studies have revealed that non-coding RNAs may act as oncogenes or tumour suppressors in TGCT development.
CONCLUSIONS
The risk of TGCT is polygenic, and the underlying molecular mechanisms are complex. Several signalling pathways are related to TGCT development, and both proteins and non-coding RNAs may act as oncogenes or tumour suppressors. Epigenetic studies are of importance to get further knowledge about how the signalling pathways are regulated.
Topics: Animals; DNA, Neoplasm; Genes; Genetic Predisposition to Disease; Humans; Male; Neoplasms, Germ Cell and Embryonal; RNA, Neoplasm; Risk Factors; Signal Transduction; Testicular Neoplasms; Testis
PubMed: 31310060
DOI: 10.1111/andr.12663