Genitourinary Tract Tumors in Children: An Update.

BACKGROUND: Genitourinary tract tumors in children are less common than in adults. Most of these tumors have different genetic backgrounds, clinical presentation, and oncologic behavior than their adult counterpart. As a result of low prevalence in children, some of the treatment approaches and recommendations are based on treatment experience in adult patients. However, thanks to scientific and technological development, survival rates have risen considerably. OBJECTIVE: This paper presents a review of the principal features of the tumors involving the genitourinary tract in children and an update in genetic background, diagnosis, and treatment. METHODS: A narrative review was performed on published literature about genitourinary tract tumors in pediatric patients. Papers presented in English and Spanish literature were reviewed. PubMed, Science Direct, and SciELO databases were used to collect information and present this article. RESULTS: Kidney tumors are the most common type of genitourinary tumors in children. Among those, Wilms tumor represents the majority of cases and shows the successful work of clinical trial groups studying this tumor type. Other tumors involving the genitourinary tract in children include Rhabdomyosarcoma, Transitional cell carcinoma, Testicular, and Adrenal tumors. CONCLUSION: Genitourinary tract tumors in children represent significant morbidity and economic burden, so awareness in early diagnosis represents improvement in treatment, clinical, and oncological outcomes.

Associations of Medicaid Expansion With Insurance Coverage, Stage at Diagnosis, and Treatment Among Patients With Genitourinary Malignant Neoplasms.

Importance: Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer. Objective: To assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer. Design, Setting, and Participants: This case-control study included adults aged 18 to 64 years with a new primary diagnosis of kidney, bladder, or prostate cancer, selected from the National Cancer Database from January 1, 2011, to December 31, 2016. Patients in states that expanded Medicaid were the case group, and patients in nonexpansion states were the control group. Data were analyzed from January 2020 to March 2021. Exposures: State Medicaid expansion status. Main Outcomes and Measures: Insurance status, stage at diagnosis, and receipt of cancer and stage-specific treatments. Cases and controls were compared with difference-in-difference analyses. Results: Among a total of 340 552 patients with newly diagnosed genitourinary cancers, 94 033 (27.6%) had kidney cancer, 25 770 (7.6%) had bladder cancer, and 220 749 (64.8%) had prostate cancer. Medicaid expansion was associated with a net decrease in uninsured rate of 1.1 (95% CI, -1.4 to -0.8) percentage points across all incomes and a net decrease in the low-income population of 4.4 (95% CI, -5.7 to -3.0) percentage points compared with nonexpansion states. Expansion was also associated with a significant shift toward early-stage diagnosis in kidney cancer across all income levels (difference-in-difference, 1.4 [95% CI, 0.1 to 2.6] percentage points) and among individuals with low income (difference-in-difference, 4.6 [95% CI, 0.3 to 9.0] percentage points) and in prostate cancer among individuals with low income (difference-in-difference, 3.0 [95% CI, 0.3 to 5.7] percentage points). Additionally, there was a net increase associated with expansion compared with nonexpansion in receipt of active surveillance for low-risk prostate cancer of 4.1 (95% CI, 2.9 to 5.3) percentage points across incomes and 4.5 (95% CI, 0 to 9.0) percentage points among patients in low-income areas. Conclusions and Relevance: These findings suggest that Medicaid expansion was associated with decreases in uninsured status, increases in the proportion of kidney and prostate cancer diagnosed in an early stage, and higher rates of active surveillance in the appropriate, low-risk prostate cancer population. Associations were concentrated in population residing in low-income areas and reinforce the importance of improving access to care to all patients with cancer.

Male infertility as a proxy of the overall male health status.

INTRODUCTION: Male infertility (MI) has been widely associated with different comorbid conditions. The aim of this review is to summarize the available evidences investigating the link between MI cancer, chronic non-malignant conditions and overall health. EVIDENCE ACQUISITION: A literature search has been conducted using the MEDLINE/PubMed and Scopus databases for English-language original and review articles and selecting publications from January 2007 to June 2017, although highly regarded older publications were also considered. The following key words and MeSH terms were combined: "male infertility," "semen analysis," "health," "comorbidities," "cancer," "metabolic syndrome," "diabetes," "hypertension," "cardiovascular diseases," and "mortality." EVIDENCE SYNTHESIS: Several studies supported a higher risk of testis cancer for patients with MI; conversely, controversial findings have been reported on the association between prostate cancer and MI. Beside urogenital malignancies, melanoma, bladder, thyroid and hematological malignancies have been also more frequently reported among infertile men. Large cohort studies supported a significant association between diabetes mellitus, metabolic disorders and MI. Similarly, the risk of developing cardiovascular diseases appears to be higher among infertile men. Of note, a significant association between semen alterations and the overall burden of comorbidities, as well as the overall mortality, has been reported. A common genetic background appears as the main pathophysiological link between infertility and other comorbidities. CONCLUSIONS: Male infertility is a proxy of the overall male health status. Physicians should comprehensively assess men presenting for couple infertility and properly followed-up these patients given their higher risk of developing cancer.

Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria.

Importance: Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignant abnormality. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignant abnormality among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. Objective: To estimate the effectiveness, costs, and incremental cost per cancer detected (ICCD) for 4 common diagnostic approaches evaluating AMH. Design, Setting, and Participants: A decision-analytic model-based cost-effectiveness analysis using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included adult patients with AMH on routine urinalysis with subgroups of high-risk patients (males, smokers, age ≥50 years) seen in the primary care or urologic referral setting. Interventions: Four diagnostic approaches were evaluated relative to the reference case of no evaluation: (1) computed tomography (CT) alone; (2) cystoscopy alone; (3) CT and cystoscopy combined; and (4) renal ultrasound and cystoscopy combined. Main Outcomes and Measures: At termination of the diagnostic period, cancers detected, costs (payer perspective), and ICCD per 10 000 patients evaluated for AMH. Results: Of the 4 diagnostic approaches analyzed, CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9 300 000. Ultrasound and cystoscopy detected 245 cancers and was most cost-effective with an ICCD of $53 810. Replacing ultrasound with CT detected just 1 additional cancer at an ICCD of $6 480 484. Ultrasound and cystoscopy remained the most cost-effective approach in subgroup analysis. The model was not sensitive to any inputs within the proposed ranges. Using probabilistic sensitivity analysis, ultrasound and cystoscopy was the dominant strategy in 100% of simulations. Conclusions and Relevance: The combination of renal ultrasound and cystoscopy is the most cost-effective among 4 diagnostic approaches for the initial evaluation of AMH. The use of ultrasound in lieu of CT as the first-line diagnostic strategy will optimize cancer detection and reduce costs associated with evaluation of AMH. Given our findings, we need to critically evaluate the appropriateness of our current clinical practices, and potentially alter our guidelines to reflect the most effective screening strategies for patients with AMH.

Physician-pharmacist collaboration for oral chemotherapy monitoring: Insights from an academic genitourinary oncology practice.

BACKGROUND: Oral chemotherapy is being routinely used in metastatic castrate-resistant prostate and renal cell cancer. Although convenient, these drugs require monitoring for adherence, toxicity, and drug interactions to maximize outcomes. Oncology pharmacists have the training and expertise that place them in an optimal position to collaboratively provide medication therapy management. METHODS: A board-certified oncology pharmacist, working in collaboration with a medical oncologist, initiated an oral chemotherapy-monitoring program. The pharmacist provided education, completed medication therapy management; monitored for adherence and toxicity; and recommended treatment of toxicity and supportive care issues. Patient encounters included one of the following: collaboration with medical oncologist visit, pharmacist visit, or telephone or email follow-up between visits. RESULTS: From December 2012 to May 2014, the pharmacist had 123 encounters with 20 patients with either metastatic prostate (n = 17) or renal cell cancer (n = 3). All patients were males (median age 80 years). Most encounters were clinic visits, in collaboration with physician visit or alone (52%); 36% were telephone encounters, and 11.3% were email follow-ups. Medication-related problems were identified in 25% of the 315 assessments made. Problems included: adverse drug reactions, 40%; inappropriate therapy, 20%; and noncompliance, 18%. Recommendations included: modification of laboratory monitoring, 25%; cancer or non-cancer therapy modification, 12%; drug discontinuation, 6.9%. Non-cancer therapy-related drug information and coordination of care accounted for 30% of recommendations. CONCLUSION: Our program led to identification of a number of potentially clinically significant issues for patients on oral chemotherapy and demonstrated the benefit of the pharmacist in the multidisciplinary team to assist in addressing them.

Advanced assessment of the endogenous hormone level as a potential biomarker of the urogenital tract cancer.

The evaluation of the relationships between the hormones involved in the urogenital tract cancer, including bladder, kidney, prostate, and testis, could prove important from diagnostic point of view. The determination of the steroid hormone profiles may likely provide a biomarker for discrimination of hormone-related diseases, as well as for differentiation of healthy volunteers from patients with cancer. The aim of the study was to demonstrate the changes in the steroid hormone profile (comprising corticosteroids, androgens and progesterone) in the urine of patients with the urogenital tract cancer versus urine from healthy subjects. A reliable analytical method based on liquid chromatography coupled with mass spectrometry was successfully applied to determine the urinary profiles of 6 endogenous steroids: cortisol, cortisone, corticosterone, testosterone, epitestosterone and progesterone for 92 urogenital tract cancer patients and 100 healthy controls. The obtained data was further evaluated by in-depth chemometric analysis, including the applied standardized Kennard-Stone's algorithm to pre-process the data. Mann-Whitney U test revealed statistically significant (p <0.05) differences in concentration of androgens and progesterone in the case of bladder cancer for male and female population, for male also cortisol and cortisone levels were significantly increased. PCA analysis proved a reasonable trend for differentiating healthy and cancer patients, and finally, applying PLS-DA model we were able to correctly classify 80.56%of cancer patients. Our results indicate that steroid hormone profile determination could be a promising approach for early diagnosis of urogenital tract cancer. However our preliminary results require an extension both in patient number and steroid profile.

Major urologic problems in geriatrics: assessment and management.

Elderly urologic patients require the same cautions as used in development of treatment programs for them in other disciplines. Because of potential interference with poor renal function or crossover effects with central or peripheral nervous system, however, many urologic drugs must be titrated appropriately. In treating cancer, erectile dysfunction, incontinence or urinary infection, patient quality of life and life span become dominant factors in making therapeutic decisions, by behavioral change, medication, or surgical intervention.

Single nucleotide polymorphisms: early diagnosis and risk assessment in genitourinary malignancy.

Genetic screening for malignancy has been limited to high-risk individuals with a strong hereditary predisposition to cancer. With the cloning of the human genome, it has become apparent that genetic anomalies are not limited to high-risk individuals; more than 10 million genetic variants exist. Because the vast majority of these genetic variants have no functional significance, current efforts are focused on identification of which impact cancer development and/or progression. Here, we review the rationale for studying polymorphic variants in urologic malignancies, prior studies in the field, and future avenues of research.

[Oncology and urology: relations between specialities].

The article presents the analysis of present-day medical care for patients with urogenital cancer (UGC) in the Russian Federation (RF). In 2004 cancer treatment service in the RF has 8 Research Cancer and Radiological Institutes, 110 inpatient and 7 outpatient cancer clinics. According to the statistics for 1998, UGC patients are treated in 32 specialized departments in 24 regions. The rest regions provide such care in urological departments and clinics. In view of the importance of oncourology nowadays, we propose to set up an oncourological section at All-Russia Urology Society as a center of integration of efforts of specialists in oncourology.

Follow-up surveillance strategies for genitourinary malignancies.

BACKGROUND: Genitourinary cancers account for more than 20% of all malignancies in the United States. These cancers do not usually yield rapid mortality, thereby necessitating longer-term surveillance strategies. METHODS: A review and analysis of relevant studies were performed. Follow-up strategies are proposed to reflect effective methods to detect recurrent prostate, bladder, renal, and testicular cancers. Cost analysis was performed using Medicare reimbursement rates. RESULTS: For genitourinary tumors, follow-up tests can be planned rationally based on detection rates and patterns. Tumor grade and stage drive follow-up strategies, along with therapeutic implications of detecting a recurrence. Symptomatic recurrences often obviate the need for radiographic tests and can minimize costs. Stage- specific plans for these four urologic malignancies are outlined specifically. CONCLUSIONS: Not all surveillance approaches have been critically tested for follow-up of genitourinary tumors, but ample data are available to propose sound medical and economic strategies.

Cancer risk and early detection assessment.

Nurses and physicians form an ideal corps for implementing cancer prevention and early detection efforts: providing health education, promoting health enrichment, defining high-risk groups and identifying patients who belong to them, and providing screening to ensure early diagnosis and prompt treatment. A personal medical history, a history of exposures in life-style, and a family history form the foundation for cancer risk assessment. The physical examination that follows takes into account the incidence and indications of cancer at various sites and the patient's risk profile. Health professionals can incorporate screening techniques into everyday practice by gathering information in the medical history, incorporating cancer detection in the physical examination, following up with more frequent screenings or referrals for those needing them, and becoming cancer detection advocates among patients and professional peers.

Assessment of radioimmunoassay of serum creatine kinase BB (CK-BB) as a tumor marker: studies in patients with various cancers and a comparison of CK-BB concentrations to prostate acid phosphatase concentrations.

The association between cancer and the BB isoenzyme of creatine kinase (CK-BB) was investigated, and the possibility of the role of CK-BB as a tumor marker was assessed. With the use of a specific radioimmunoassay, the concentration of CK-BB was measured in 524 sera (obtained from the National Cancer Institute-Mayo Clinic Serum Diagnostic Bank) from patients with a variety of benign and malignant disorders. In 79 of these sera, the results of radioimmunoassay for CK-BB were compared to those of three radioimmunoassays for prostate acid phosphatase. Abnormal CK-BB concentrations occurred in only about 11% of the 366 cancer patients. Some groups of cancer patients had higher rates; e.g., the CK-BB concentration was elevated in 29% of the prostate cancer patients. However, prostate acid phosphatase was abnormal in 65% of the patients with prostate carcinoma--a considerable higher fraction than that found with CK-BB. Findings in patients with benign and malignant gastrointestinal diseases indicate that CK-BB complements carcinoembryonic antigen data and might be useful as part of a tumor marker panel.