Chemotherapy management for unfit patients with metastatic castration-resistant prostate cancer.

Administration of chemotherapy in prostate cancer depends on patient fitness. In unfit patients, physiological impairment determines the optimum treatment. Although no consensus on assessing patient fitness currently exists, this article proposes an algorithm combining the available information for administering chemotherapy, and in particular docetaxel, in unfit patients. It was constructed by reviewing factors that can influence treatment, such as performance status, taxane-related comorbidities and nutritional status. Geriatric scales for prostate cancer patients and alternative treatment regimens for this population are also reviewed. In summary, patients require overall assessment to optimise treatment. Use of docetaxel should be restricted in unfit patients, and other options must be evaluated, because of high toxicity and low efficacy.

[Treatment of stage I germ cell tumors of the testis]. / Tratamiento de los tumores de células germinales testiculares estadio I.

OBJECTIVE: To review the advantages, disadvantages and efficacy of the different therapeutic options for stage I seminoma and nonseminomatous germ cell testicular tumors. METHODS: The literature on the treatment of stage I germ cell testicular tumors was reviewed. RESULTS/CONCLUSIONS: Germ cell tumors of the testis constitute 1-1.5% of neoplasms in the male, accounting for 95% of testicular neoplasms, and is the most common solid tumor in men aged 20-35 years. Currently, 70% of the patients with seminoma and 50% of the patients with nonseminomatous germ cell testicular tumors are diagnosed in stage I. Radiotherapy following orchidectomy has classically been utilized in the treatment of stage I germ cell testicular tumors. Postoperative radiation therapy is currently being replaced by close patient follow-up in many centers. Retroperitoneal lymphadenectomy post-orchidectomy is the standard treatment for stage I nonseminomatous germ cell testicular tumors. Today, however, the foregoing approach is also being replaced by close postoperative follow-up.

[Diagnosis and management of carcinoma in situ of the testis]. / Diagnóstico y manejo del carcinoma "in situ" testicular.

OBJECTIVE: To review the diagnostic and therapeutic aspects of carcinoma in situ of the testis, the preinvasive stage of testicular germ cell tumors. METHODS: The indications for performing testicular biopsy in patients with a higher incidence of testicular carcinoma in situ (patients with infertility, cryptorchidism and/or testicular atrophy, gonadal dysgenesis and a previous diagnosis of testicular or extragonadal germ cell tumor) are discussed, with special reference to the controversy of whether biopsy of the contralateral testis is necessary in patients with primary testicular tumor. The advantages and disadvantages of the noninvasive diagnostic techniques as an alternative to biopsy are also discussed. RESULTS/CONCLUSIONS: Testicular biopsy is the main diagnostic procedure. Testicular ultrasonography is the most useful noninvasive diagnostic technique and can be considered in areas with a low incidence of tumor of the contralateral testis. Orchidectomy and radiotherapy are the two main therapeutic options for testicular carcinoma in situ. The choice between one or the other approach depends basically on whether the testicular involvement is unilateral or bilateral.