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  • Contralateral biopsies

    Some have discussed this in a post, so I report here.

    Some European countries do a contralateral biopsy in the other testis to search for carcinoma in situ, a precursor of TC.

    One member, Denise, have posted this article, which depicts practice in Germany :

    http://onlinelibrary.wiley.com/doi/1...14.00260.x/pdf

    I found a pretty interesting article in Annals of Oncology (April 2015), a major scientific journal in oncology.

    https://www.ncbi.nlm.nih.gov/pubmed/25542924

    Here are some of the key points in this article :

    Screening for contralateral CIS is controversial. The European Association of Urology recommends biopsy in patients with
    small testicular volume (<12 ml), a history of cryptorchidism, or
    poor spermatogenesis. The National Comprehensive Cancer Network recommends biopsy in cases of cryptorchidism, suspect
    ultrasound with intratesticular abnormalities, or marked atrophy
    of the testicle . In the present study, we found no significant difference in the
    risk of metachronous GCC between a screened and an un-
    screened cohort. Based on our results, single-site biopsy screening
    and treatment for CIS does not reduce the risk for metachronous
    GCC, and there is no evidence to support screening in its present
    form in unselected patients.

    Jean-Philippe
    December 15, 2015 : Right I/O. Markers normal.
    December 24, 2015 : Merry Christmas ! 100 % pure EC, no LVI.
    January 7, 2016 : CT scan : 2 RPLN of 8 and 9 mm
    February 2016 : Markers normal.
    March 2016 : Markers normal.
    April 2016 : Abnormal B-HCG (43). 14 mm (from 8) and 10 mm (from 9) lymph nodes.
    April 25, 2016 : Happy birthday ! Relapsed confirmed.
    May 2, 2016 : BEP x 3 begins.
    July 3, 2016 : BEP x 3 ends.
    July 2016 : Serum tumor markers normal. 10 mm (from 14) and 6 mm (from 10) lymph nodes. Back on surveillance !
    December 23, 2016 : Merry Christmas ! Serum tumor markers normal. 6.8 mm (from 10) and no more visible (from 6) lymph nodes. Surveillance continues.
    June 2017 : Serum tumor markers normal. 4 mm (from 7 mm) lymph node. Surveillance continues.

  • #2
    As always JP, you've posted some interesting articles. I have looked into this as well. One of my questions has been, does the biopsy itself lead to injury to the testicle and then increase the chances of testis cancer from forming? I know almost every expert will deny this. However, I cannot help but notice many people with TC noticing their TC after they were hit in the scrotum or kicked there. It makes me wonder if external injury can at least be a precipitant of TC in some cases.
    Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

    7/1/2015: felt tiny lump on side of R testicle
    7/30/2015: Ultrasound shows 2 intra-testicular masses.
    7/31/2015: tumor markers normal, CXR clear
    8/5/2015: R orchiectomy
    8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
    8/14/2015: CT abdomen/pelvis clear, Stage 1b
    8/24/2015: started 1 x BEP

    Comment


    • #3
      It's very interesting that a only few countries conduct a contralateral biopsy in the other testis. We know now that Sweden and Germany are among these.

      I went through my old emails, and I wrote Dr. Nichols (TC specialist) on 11.11 2015 regarding this:

      Me: My son (28) was diagnosed with TC in July, classic seminoma stage 1a, tumor markers were in the normal range, 1.7cm retained in the teste, no invasion. CT scan clean. both testicles show(ed) Microlithiasis (TM), The left teste (seminoma) was 11.8x12 mm and the right is 12 ML. The doctors recommend surveillance with a CT every 6 months and blood work every three months. The doctors did a biopsy (apparently procotrol in Europe) on the remaining teste and CIS (IGCNU) was negative with samples done from the upper and bottom side. If there was no CIS found, can this develop at a later time?

      Dr. Nichols: Unlikely, but it can be patchy and the testicle still needs to be watched.


      @RJKD Interesting thought. Since the first research was conducted in 1972, one should have noticed a correlation of TC in the tested patients in the last 40 years.
      Mother of Son (Son's date of birth: August 1987. Age at diagnosis 27, now 28)

      1 July 2015: Son discovered small knot in left testicle, no pain. Waited and observed.
      10 July 2015: Appointment with urologist. ultrasound: 1.7 cm tumor, blood work: AFP - 1.62 (5.50), bHCG- <0.1 (<2.0), LDH159 U/l (135-225), 2.65 umol/s/l (2.25-3.75) .
      14 July 2015: Hospital, same diagnosis.
      15 July: 2015 l/O, Pathology: Stage 1A 100% Seminoma.
      16 July 2015: CT - Clear
      October 2015: Blood work - Normal range
      January 2016: Bloodwork - Normal Range
      Febuary 2016: CT - Clear

      July 2016 - One year clear!!

      Active Surveillance recommended by hospital Doctors, His Urologist .
      Via email by Dr. Nichols and Dr. Einhorn

      Comment


      • #4
        I guess a biopsy would give an added piece of mind to the patient though. As long as there are no negative effects to it.
        07/14 : Sonogram found 3 masses on right testicle measuring 2.3x1.8x1.9cm, 1.3x0.7x0.7cm, and 0.6x0.6x0.8cm. Blood markers all fine
        07/20: Right Inguinal Orchiectomy
        07/29 : Pathology report : 4 100% Seminoma tumors, no evidence of Spermatic Cord or Lymphatic Invasion.
        08/11/2015: CT scans all clear, surveillance

        Comment


        • #5
          Pretty interesting thought, RJKD.

          Here's another view in a statistical way :

          - The number needed to treat (NNT) is 34. That means that about one in every 34 patients will benefit this procedure. The 33 others don't.
          - Number needed to harm (NNH): ? Risk of radiotherapy ? Not so well defined to my knowledge in this area.

          An intervention is beneficial if the number needed to treat don't exceed the number needed to harm. The more gap between NNT and NNH, the more beneficial is the intervention.

          Guiding principle in medicine : primum non nocere.

          Jean-Philippe
          December 15, 2015 : Right I/O. Markers normal.
          December 24, 2015 : Merry Christmas ! 100 % pure EC, no LVI.
          January 7, 2016 : CT scan : 2 RPLN of 8 and 9 mm
          February 2016 : Markers normal.
          March 2016 : Markers normal.
          April 2016 : Abnormal B-HCG (43). 14 mm (from 8) and 10 mm (from 9) lymph nodes.
          April 25, 2016 : Happy birthday ! Relapsed confirmed.
          May 2, 2016 : BEP x 3 begins.
          July 3, 2016 : BEP x 3 ends.
          July 2016 : Serum tumor markers normal. 10 mm (from 14) and 6 mm (from 10) lymph nodes. Back on surveillance !
          December 23, 2016 : Merry Christmas ! Serum tumor markers normal. 6.8 mm (from 10) and no more visible (from 6) lymph nodes. Surveillance continues.
          June 2017 : Serum tumor markers normal. 4 mm (from 7 mm) lymph node. Surveillance continues.

          Comment

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