Study Type – Therapy (prospective cohort) Level of Evidence 2a What’s known on the subject? and What does the study add? The debate concerning standard treatment following unilateral inguinal orchiectomy for patients with clinical stage I seminoma is ongoing. The MRC TE19/EORTC 30982 trial has proven the non‐inferiority of carboplatin to radiotherapy, representing a strong argument for the potential use of carboplatin especially with respect to a good long‐term side‐effect profile. More data and a longer follow‐up for carboplatin are required. Different guidelines state that ‘two courses of adjuvant carboplatin seem to further reduce the relapse rate. . . . but further experience and long‐term observations are needed’. The present study retrospectively evaluated the long‐term oncological efficacy and morbidity of this approach in a multicentre setting to add further long‐term data to this topic. OBJECTIVE • To evaluate, in a retrospective multicentre study, the long‐term oncological efficacy and morbidity of using carboplatin as an alternative treatment for patients with clinical stage I seminoma. PATIENTS AND METHODS • Patients with clinical stage I seminoma treated with two cycles of adjuvant single‐agent carboplatin (400 mg/m 2 body surface) from February 1990 until September 2008 were retrospectively identified. • A database was created (including information on patient characteristics, initial tumour staging, tumour marker levels, follow‐up, oncological outcome, treatment side effects and long‐term side effects), descriptive analyses were performed and the data were compared with those available in the literature. RESULTS • Of 282 stage I seminomas identified in 276 patients, risk factors for progression (pT2/3, vessel invasion or tumour diameter ≥4 cm) were detected in 48.2% of tumours. • Chemotherapy was well tolerated, with patients experiencing only mild nausea. Bone marrow suppression was common (leucopaenia in 36.7% and thrombocytopaenia in 50.5% of patients, mainly grade 1/2). Neither neutropenic fever, nor any bleeding complication occurred. • During a mean follow‐up of 75 months, three patients (1.06%) developed a retroperitoneal recurrence within the first 2 years after receiving adjuvant treatment and were salvaged by cisplatin‐based chemotherapy. A contralateral second testicular germ cell tumour was diagnosed in five patients. CONCLUSIONS • Two cycles of carboplatin monotherapy are highly effective and very well tolerated by all patients. The frequency of contralateral tumours appears to be reduced. • Despite the lack of a randomized trial, the available data in the literature suggest that the administration of two cycles instead of one cycle could lead to a reduction in recurrence rates of ≈50%.
Hydrocele testis is a common disease with a prevalence of 1% in adults. Although it can be diagnosed by physical examination, scrotal ultrasound represents a standard diagnostic tool, to exclude underlying pathologies among them testicular or scrotal malignancies.We conducted a retrospective analysis of 156 patients aged between 20 and 60 years who underwent surgical hydrocelectomy between 2003 and 2018. Pre-surgical ultrasound, histological results, complications and patients' characteristics were analysed.Malignancies were found in 0% of patients in the pre-surgical ultrasound. Interestingly, we found a higher incidence of hydrocele testis in patients with increasing age and 27% presented with symptoms other than painless enlargement of the scrotum. Among them recurrent pain was the most common. Surgical complications occurred in only 3.2%.Testicular cancer is an important differential diagnosis of hydrocele testis. However, in our study no case of incidental testicular cancer or scrotal malignancy was found in the pre-surgical ultrasound.
Die Ultraschalluntersuchung der Prostata kann suprapubisch mit einem gecurvten Schallkopf durchgeführt werden, sollte aber idealerweise mit einer Transrektalsonde erfolgen. Die sonographische Exploration des äußeren Genitales gelingt am besten mit hochauflösenden Linearschallköpfen, wobei endoluminale Sonden gelegentlich bei speziellen Fragestellungen (z. B. Inkontinenz) Anwendung finden können. Alle kommerziell erhältlichen Ultraschallgeräte verfügen über B-Bild-und Dopplertechniken, mit denen sich die meisten Fragestellungen beantworten lassen. Die Ultraschall-Elastographie, der kontrastmittelunterstützte Ultraschall und der 3D/4D-Ultraschall können in Einzelfällen hilfreiche Zusatzinformationen bieten.
OBJECTIVE To assess the use of real‐time elastography (RTE) for detecting prostate cancer in patients scheduled for radical prostatectomy (RP), as most solid tumours differ in their consistency from the deriving tissue, and RTE might offer a new tool for cancer detection. PATIENTS AND METHODS We examined 15 patients (mean age 56 years, sd 6.2, range 46–71) with RTE, using an ultrasonography (US) system with a 7.5‐MHz transrectal probe as a transducer. RTE is capable of visualizing displacements between pairs of US images of tissues when placed under axial compression. The stiffness of the lesion was displayed from blue (soft) to black (hard). Hard lesions with a diameter of ≥ 5 mm were considered as malignant. All patients had the diagnosis of prostate cancer confirmed by biopsy and had a mean (range) prostate specific antigen (PSA) level of 4.6 (1.4–16.1) ng/mL; all were scheduled for RP. US was performed by two investigators and interpreted by consensus. Cancer location and size was determined in the RTE mode only. One pathologist classified tumour location, grade and stage. The RTE findings were compared with the pathological findings. RESULTS There were no major complications during RP in any patient; all had a pT2 tumour on histopathological examination, the Gleason score was 5–9 and the mean (range) tumour size 1.1 (0.6–2.5) cm. Thirty‐five foci of prostate cancer were present at the pathological evaluation; multiple foci were found in 11 of the 15 glands. RTE detected 28 of 35 cancer foci (sensitivity 80%). The per‐patient analysis showed that RTE detected at least one cancer area in each of the 15 patients. Only four sites with false‐positive findings on RTE and no histopathological correlation were detected; these findings were obtained in the first five patients (period of learning). CONCLUSIONS RTE can be used to visualize differences in tissue elasticity. Our results show that RTE allows the detection of prostate cancer and estimation of tumour location and size. RTE of the prostate is a new imaging method with great potential for detecting prostate cancer.
