[Recent Therapy of Organ-confined Testis Cancer]. / Aktuelle Therapie organbegrenzter Hodentumoren.

BACKGROUND: In Germany, testicular cancer accounts for about 1-2% of all malignant tumours. Although, therefore, this is a rare tumour, it assumes an exceptional position among malignant tumours in several respects. In male patients aged 20-35 years it is the most common tumour, which directly affects the family and life planning of young men, a matter of prime importance at this age. Another aspect of testicular cancer is its excellent prognosis since the introduction of platinum-based chemotherapy into the armamentarium of testicular cancer therapy. Therefore, therapeutic innovations increasingly focus on reducing the radicality of treatment, even more so since this therapy, in addition to acute toxicity, can cause severe long-term consequences up to and including secondary malignancies. OBJECTIVES: This article gives an overview of the present therapeutic standard of stage I testicular cancer treatment. MATERIAL AND METHODS: Selective PubMed research Results and Discussion: Besides potential implications for organ-sparing surgery, the article elucidates the benefits of a risk-adapted therapeutic approach and indications for a surveillance strategy for patients with localised testicular cancer.

[Secondary prevention in patients with superficial urothelial carcinoma]. / Sekundäre Prävention bei Patienten mit oberflächlichem Urothelkarzinom.

BACKGROUND: Urothelial cancer is the 4th most common cancer in men and the 7th most common malignancy in women in Germany. 95 % of all tumors of the urinary bladder are urothelial carcinomas. At the time of diagnosis approximately 80 % of these carcinomas are not invasive. The affection is often multicentric. Approximately 10-15 % of the tumors develop into muscle-invasive growth. In this prospective study, we analyzed measures patients independently took to reduce their risk of bladder cancer recurrence. MATERIALS AND METHODS: During the period January 2012 to December 2013, we surveyed a total of 97 patients with superficial transitional cell carcinoma (pTa). The question was how far the diagnosis of urothelial cancer has changed their lives, eating and drinking habits or whether follow-up consultations had been carried out regularly. Furthermore, we recorded whether they accepted psychological care or had autonomously adopted prophylactic measures, as well as changed their smoking habits, if they had smoked. RESULTS: Of the 97 patients questioned, there were 79 men and 18 women (56 smokers and 41 nonsmokers). The median age was 71 years (range 36-96 years). For 22 patients (22.7 %), the diagnosis resulted in no changes. In 33 patients the changes were small (44 %), moderate in 20 (26.7 %), in 14 (18.6 %) strong and very strong in 8 (10.7 %). A total of 25 patients (25.8 %) changed their eating habits. In all, 49 patients changed their drinking habits; 48 patients claimed to drink more (> 2.0 L/day). One patient reduced his drinking amount. Regarding smoking, 40 patients (71.4 %) had stopped and 7 (12.5 %) reduced consumption, while 6 patients (10.7 %) had not changed their smoking habits. Overall, 44 patients (45.4 %) changed their physical activity: 11 (25 %) exercised more, 8 (18.1 %) less. Only 3 patients (3.1 %) used psycho-oncological care and 39 (40.2 %) patients used supportive/complementary medicine measures of favorablly influence their disease (mistletoe therapy, vitamin supplements). In addition, 22 patients (22.7 %) sought advice from their physician. However, 45.4 % of all patients did not believe in the success of their measures taken. CONCLUSION: Of all patients diagnosed with urothelial carcinoma, 77.3 % reported a change in their living habits and they were willing to take specific steps, such as giving up smoking, being more physically active, changing drinking and eating habits in order to positively influence their disease. However, almost half of the patients (45.4 %) did not believe in a resounding success of their measures taken.

[Histopathology reports of findings of prostate needle biopsies. Individual treatment]. / Histopathologische Befundberichte von Prostatastanzbiopsien. Individuelle Behandlungskonzepte.

OBJECTIVES: This survey-based study examined which information urologists extract from prostate needle biopsy reports and what is needed for clinical management of prostate cancer patients. MATERIAL AND METHODS: A questionnaire was developed to investigate several topics related to prostate cancer biopsies and four different clinical situations were explored separately, depending on whether the urologist intended a curative or palliative treatment. RESULTS: A total of 95 out of 282 (33 %) urologists responded to the questionnaire and returned anonymous responses. On average the participants had a professional career of 13 years (range 6 months to 38 years), 22 (23 %) urologists performed radical prostatectomy, 73 (77 %) were not surgically active, 55 (58 %) took 10-12 scores within the framework of the proposed first biopsy setting, 32 (34 %) took 6-8 scores and 6 (6 %) > 12 scores. Urologists with a professional career <15 years took significantly more biopsies. The primary and secondary Gleason patterns were required for only 36 (38 %) respondents to make treatment decisions. In prostate needle biopsies containing only a single focus of prostate cancer only 44 (48 %) of the respondents would request a Gleason score if not provided in the initial report. In addition to the Gleason score other information used by urologists to make treatment decisions included perineural invasion (60 %), periprostatic infiltration (57 %), extraprostatic spread (57 %) and the percentage of core involvement by cancer (13 %). Interestingly, in biopsies with multiple positive cores from separate locations 84 out of 95 urologists (88 %) used the highest Gleason grade to determine the treatment plan. The term atypical small acinar proliferation (ASAP) was uniformly considered sufficient to retake biopsies by 44 % (42/92) of urologists and only 53 % (49/92) of urologists performed rebiopsies in the case of high grade prostatic intraepithelial neoplasia (PIN). CONCLUSION: In this sample of 95 urologists there was high variability in the way clinicians used prostate needle biopsy pathology reports. The results of this survey underline that improved communication between urologists and pathologists is necessary.

[Renal masses in pregnancy. Diagnostics and therapeutic management]. / Nierentumore in der Schwangerschaft. Diagnostik und therapeutisches Management.

Cancer is the second most common cause of death in women of childbearing age. However, renal cell carcinoma (RCC) is a rare tumor in this collective with an incidence far below 5/100,000 cases per year. Therefore, medical experience with respect to diagnostics and therapeutic management of newly diagnosed RCC in pregnant women is scarce and the number of published cases low. However, recent studies indicated that higher estrogen levels and multigravidity could be associated with a higher risk of RCC. The aim of this article is to summarize the clinical experience in treating pregnant women with renal cancer against the background of those cases published in the literature.

[Intravesical therapy in non-muscle-invasive bladder cancer: indications and practical considerations]. / Intravesikale Therapie beim nicht muskelinvasiven Urothelkarzinom der Harnblase : Indikation und praktisches Management.

Intravesical treatment with various agents is an accepted standard for treating patients with non-muscle-invasive bladder cancer; all guidelines recommend its use. Depending on the agent and the instillation schedule, a reduction in recurrence and a decrease in the progression rate can be achieved.However, many of the recommendations in the various guidelines are currently under debate. Early instillation with a chemotherapeutic agent is probably overtreatment in patients requiring further induction or maintenance therapy because it adds no further benefit. The economic aspects of early instillations are also being discussed. Recent studies question the ability of bacillus Calmette-Guérin (BCG) instillations to reduce the progression of non-muscle-invasive bladder cancer. Furthermore, the superiority of maintenance therapies compared with induction schedules is under debate.There is a great body of evidence that the effectiveness of intravesical chemotherapy can be increased by simple measures. Reduction of BCG side effects without compromising the oncological outcome is possible.

[Complementary medicine in oncology]. / Komplementärmedizin in der Onkologie.

In cancer therapy vastly different kinds of treatment regimens, but as a rule scientifically validated and reviewed, play a central role dependent on the tumor entity. Besides the options of schoolbook medicine complementary, alternative and supportive treatment options are becoming more frequently used in routine clinical practice. Numerous concepts and agents, partly verified in studies and partly based on empirical experiences are being applied. It is our intention to give a survey of the most common agents and concepts and to point out the risks and capabilities.

Clinical value of transrectal ultrasound in the diagnosis of suspected neoplasia in the small pelvis.

PURPOSE: In daily clinical practice, it is challenging to accurately diagnose suspected neoplasias in the small pelvis by minimal invasive means, and CT-guided biopsy is often limited in its feasibility. The aim of our study was to evaluate whether transrectal ultrasound (TRUS)-guided biopsy can verify suspected neoplasias in the small pelvis histologically. MATERIAL AND METHODS: The study population consisted of 12 patients who underwent biopsy of suspected malignancy in the pelvis by TRUS. All patients had clinical signs of an advanced tumour stage and in all cases, biopsy utilising computerised tomography (CT scan) had been unsuccessful despite of a documented lesion on CT scan or magnetic resonance imaging. For the TRUS guided biopsy, a commercially available 3-dimensional 7.5-MHz-probe was used (Combison 530 D, GENERAL ELECTRIC, Milwaukee, USA). The probe was armed with an 18 G biopsy gun. RESULTS: In all patients, the suspected lesion was easily detectable by TRUS, and tissue for verification of the malignant origin of the lesions could be collected under real-time TRUS with only 2 patients needing anaesthesia. The biopsy cores were of excellent quality and adequate for conclusive pathological diagnosis. 6 cases of lymph node metastases of a transitional cell carcinoma were detected. 1 case of extended node metastasis in prostate cancer, 1 paravesical manifestation of recurrent cervical cancer, 1 metastasis of a paravesically infiltrating colon cancer and 2 cases of paravesical metastases of a gastric cancer were also diagnosed. In one case, extragenital endometriosis could be diagnosed. CONCLUSION: Based on our experience it can be stated that TRUS-guided biopsy is a reliable diagnostic tool for verification of the neoplastic origin of suspected masses in the small pelvis. In all cases with a history of unsuccessful CT guided biopsy, sufficient tissue cores for conclusive histology could be collected with our technique, and surgical exploration could be avoided. This technique is minimally invasive, without radiation exposure, well tolerated under analgesia, time efficient and cheap.