The spectrum of testicular-epididymal fusion anomalies in children with cryptorchidism: Personal experience, systematic review and meta-analysis.

BACKGROUND: Testicular-epididymal fusion anomalies (TEFA) have been documented in the literature. The pathological significance of TEFA and their relationship to testicular maldescent is unclear. We aimed to clarify the real incidence of TEFA in children with undescended testes and their impact on testicular development after surgery. METHODS: We conducted a retrospective review (2010-2018) of all patients who underwent orchidopexy. Cases with TEFA confirmed intra-operatively were matched against controls with normal fusion for age at the time of surgery. Records from follow-up visits were assessed to compare testicular size at six-months. A systematic review and meta-analysis of the literature (1980-2019) was also performed. RESULTS: In our retrospective review, 54 (21.4%) of 252 cryptorchid testes were found to have TEFA (Table). Intra-abdominal testes were more likely to exhibit TEFA than inguinal testes (20.4% vs. 9.6%, RR 1.8 [1.0-3.1], P = 0.03). There were no differences in testicular size at the time of surgery (P = 0.29) or the six-month followup (P = 0.18). The systematic review identified eight studies with 4871 children (5240 orchidopexies). The overall rate of TEFA was 25.8% [95% CI 15.2-38.0]. Tail nonfusion (NF) (10.7% [95% CI 5.4-17.4]) was the most common followed by head NF (7.2% [95% CI 3.2-12.5]) and complete NF (6.3% [95% CI 3.7-9.5]). Intra-abdominal testes were more likely to exhibit TEFA than inguinal testes RR 2.6 [95% CI 1.9-3.5]; P < 0.001. CONCLUSIONS: Data from our retrospective review and the literature indicate that TEFA are present in approximately one-quarter of cryptorchid testes and are more commonly associated with intra-abdominal cryptorchidism. There appears to be no impact on testicular size at short-term followup. The clinical significance of TEFA remains unclear; long-term followup studies are necessary to better understand their impact on testicular development and function.

Early Post-treatment Prostate-specific Antigen at 4 Weeks and Abiraterone and Enzalutamide Treatment for Advanced Prostate Cancer: An International Collaborative Analysis.

BACKGROUND: Declines in prostate-specific antigen (PSA) levels at 12wk are used to evaluate treatment response in metastatic castration-resistant prostate cancer (mCRPC). PSA fall by ≥30% at 4wk (PSA4w30) has been reported to be associated with better outcome in a single-centre cohort study. OBJECTIVE: To evaluate clinical relevance of early PSA decline in mCRPC patients treated with next-generation hormonal treatments (NGHTs) such as abiraterone and enzalutamide. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective multicentre analysis. Eligible patients received NGHT for mCRPC between 6 January 2006 and 31 December 2017 in 13 cancer centres worldwide, and had PSA levels assessed at baseline and at 4 and/or 12wk after treatment. PSA response was defined as a ≥30% decline (progression as a ≥25% increase) from baseline. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Association with overall survival (OS) was analysed using landmark multivariable Cox regression adjusting for previous chemotherapy, including cancer centre as a shared frailty term. RESULTS AND LIMITATIONS: We identified 1358 mCRPC patients treated with first-line NGHT (1133 had PSA available at 4wk, and 948 at both 4 and 12wk). Overall, 583 (52%) had a PSA4w30; it was associated with longer OS (median: 23; 95% confidence interval [CI]: 21-25) compared with no change (median: 17; 95% CI: 15-18) and progression (median: 13; 95% CI: 10-15). A PSA12w30 was associated with lower mortality (median OS 22 vs 14; hazard ratio=0.57; 95% CI=0.48-0.67; p<0.001). PSA4w30 strongly correlated with PSA12w30 (ρ=0.91; 95% CI=0.90-0.92; p<0.001). In total, 432/494 (87%) with a PSA4w30 achieved a PSA12w30. Overall, 11/152 (7%) patients progressing at 4wk had a PSA12w30 (1% of the overall population). CONCLUSIONS: PSA changes in the first 4wk of NGHT therapies are strongly associated with clinical outcome from mCRPC and can help guide early treatment switch decisions. PATIENT SUMMARY: Prostate-specific antigen changes at 4wk after abiraterone/enzalutamide treatment are important to determine patients' outcome and should be taken into consideration in clinical practice.