Feasibility of active surveillance in small testicular mass: a mini review

Introduction

Widespread use of scrotal ultrasonography has led to the detection of incidental, non-palpable small testicular masses (STMs). Historically, all intratesticular masses were treated radically, however more conservative strategies are now being applied with growing evidence that up to 80% of STMs are benign lesions. Testis-sparing surgery is deemed a gold standard in STMs. However, the high probability of the benign nature of STMs and the excellent cure rate of localized testicular cancer has led to emerging attempts to use an active surveillance (AS) strategy for selected groups of patients.

Material and methods

We conducted a non-systematic review of the literature in the PubMed and Embase databases for articles associated with AS strategy in STMs.

Results

The main inclusion criteria for AS in patients with STMs were lack of risk factors of testicular cancer, no features of disseminated disease, negative tumor markers, non-palpable lesion that did not exceed 10 mm. Mean follow-up time of AS across the studies ranged from 9.6 to 29.6 months. Surveillance protocols were based on regular physical examination, scrotal ultrasonography and measurement of tumor markers. The change rate to active treatment ranged from 0% to 8% without reported deterioration of oncological outcomes. Patients have proceeded to surgical treatment based on their preference, lesion growth, change in echogenicity, tumor marker growth and the need for testicular exploration for other reasons.

Conclusions

Active surveillance is a reasonable conservative strategy in the management of STMs in selected groups of patients with minimal risk of deteriorating impact on oncological outcomes.

Diagnostic and treatment delays among patients with primary bladder cancer in Poland: a survey study

Introduction

The aim of this study was to determine and quantify the mechanisms responsible for the delays in bladder cancer diagnosis and initial treatment.

Material and methods

Patients referred to two academic hospitals in Poland with a primary bladder tumor were prospectively identified and structurally interviewed. For all patients, time intervals between symptom onset, diagnostic and therapeutic interventions were assessed.

Results

A total of 144 patients diagnosed with bladder cancer were included in the analysis. The median time from symptom onset to treatment was 112 days. This comprised of the following median waiting times: 1) patient waiting time of 13 days, 2) assessment waiting time of 14 days and 3) treatment waiting time of 42 days. In the multivariate analysis, large city residence (OR 0.2, 95% CI 0.1-0.6) and comorbidity (OR 0.3, 95% CI 0.1-0.8) reduced the risk of delay, whereas medium-sized city residence (OR 1.4, 95% CI 0.4-5.1) and general practitioner as the first medical professional contact (OR 5.3, 95% CI 0.6-50.0) increased the risk of delay.

Conclusions

Diagnostic and treatment waiting times for bladder cancer in Poland are unsatisfactory. Potential solutions for shortening these delays include healthcare policy changes such as utilization of the oncological priority programs, primary care education and public health campaigns.

Inosine monophosphate dehydrogenase 2 as a marker of aggressive and advanced prostate cancer

Introduction

There is a need for a new biochemical marker of aggressive prostate cancer (PCa). Inosine monophosphate dehydrogenase 2 (IMPDH2) is a candidate for such a marker – its activity is increased in certain tumors and neoplastic cell lines, including PCa, and may correlate with cancer aggressiveness.

Material and methods

IMPDH2 levels were measured in blood samples from 34 PCa patients. The results were analyzed and correlated with prostate-specific antigen (PSA), digital rectal examination (DRE), Gleason score, risk groups according to d'Amico and metastatic disease. Twenty healthy (non-PCa) patients served as the control group.

Results

There was no significant difference in IMPDH2 level between the PCa and control group, and no significant correlation between PSA and IMPDH2. IMPDH2 levels were significantly higher in the DRE (+) patients (148.5 ±174.8 vs. 33.4 ±46.4, p <0.05), in patients with metastatic disease (100.1 ±139.0 vs. 25.3 ±25.9, p <0.05) and in the high-risk group according to d'Amico (93.4 ±129.2 vs. 18.8 ±10.4, p <0.05). There was a significant correlation between the Gleason score and IMPDH2.

Conclusions

These results suggest that IMPDH2 is a promising candidate as a biomarker for those with advanced PCa and those at high risk of progression towards advanced PCa.

[Diagnostic value of the morphological ultrasound score system and the serum concentration of CA 125 in the diagnosis of malignant ovarian cancer]

OBJECTIVES

The aim of this study was to estimate the diagnostic value of the morphological ultrasound score system and the serum concentration of CA 125 in the diagnosis of malignant ovarian masses. The aim was realized by the evaluation of the statistical coefficients like sensitivity, specificity, positive predictive value and negative predictive value in three groups tested by different methods (A--ultrasonography, B--serum concentration of CA 125, C--both methods).

MATERIALS AND METHODS

We have analyzed 59 patients (17-77 years old)--mean 46.5 +/- 14.8 with ovarian malignant masses diagnosed in years 1999-2001.

RESULTS

Merz morphological ultrasound score system revealed its sensitivity of 92.3%, specificity--87.9%, positive predictive value--85.7% and negative predictive value--93.7%. Statistical coefficients for serum Ca 125 marker concentration was not so attractive: sensitivity--57.7%, specificity--90.9%, positive predictive value--83.4% and negative predictive value--73.2%. Using both methods at the same time we obtained significantly different coefficients: sensitivity--96.2%, specificity--80.0%, positive predictive value--78.1% and negative predictive value--96.6%.

CONCLUSIONS

Ultrasound assessment of ovarian morphology is very useful element in early detection of ovarian neoplasm. Serum CA 125 concentration assay is not a test verifying malignancy. Using both methods at the same time we increase its sensitivity and negative predictive value.

[Diagnostic value of transvaginal ultrasound in the detection of ovarian endometriosis]

The aim of the study was to estimate of efficiency of endovaginal ultrasonography in diagnosis of ovarian endometriosis. The study was performed in 59 women with ovarian tumors. Ultrasound examinations were performed with Aloka 2000 using 5.0 MHz transducers. The endovaginal ultrasonography is very useful in diagnosis of ovarian endometriosis, showing sensitivity--90%, specificity--68%, positive predictive value--75%, negative predictive value--86%. Ultrasound examination is an important tool in noninvasive diagnostic procedure of adnexal pathology.