FOIU 2018: Should the Primary Be Treated in Patients with Metastatic Disease?

Tel-Aviv, Israel (UroToday.com) Joel Sheinfeld, MD gave a short briefing discussing whether the primary tumor should be treated in metastatic testicular cancer patients. In short, the answer is Yes. Dr. Sheinfeld gave some data on delayed orchiectomy following chemotherapy. Teratoma is evident in 19-31% of cases, and a viable tumor is present in 13-30% of cases. Chemotherapy does not reliably treat germ cell tumors (GCT) in the testicle, nor does it treat germ cell neoplasia in situ (GCNIS), common in more than 90% of GCT patients. The morbidity in treating the primary tumor in testicular cancer is minimal and there is no contraindication to it.

According to Sheinfeld, in most cases, the more important question is not: should the primary tumor be treated in patients with metastatic disease, but rather why is the primary tumor still in place?

Testicular cancer usually presents as a local hard firm painless mass. Sometimes there is painful swelling or a dull ache. Metastatic sites include :

The retroperitoneum (causing back pain, gastrointestinal symptoms)
Supraclavicular nodes (causing neck mass)
Gynecomastia (5-10% of cases)
Thrombus in iliac or IVC (causing lower extremity swelling)
Brain metastases (causing CNS symptoms).

Sheinfeld concluded his talk and reiterated the importance of removing the primary tumor in metastatic testicular patients, and the earlier the better.

Presented by: Joel Sheinfeld, MD, MMSKCC, New York, New York, US

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 FOIU 4th Friends of Israel Urological Symposium, July 3-5. 2018, Tel-Aviv, Israel

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