Page 69 - CUA Absracts 2022_Fulldraft

Poster 6: Oncology – Penis/Testis/Urethra, Prostate

cases of penile cancer subject to pandemic-induced delays in diagnosis MP-6.5
and treatment. Diagnostic delays were defined on a timeframe of delay Age-related differences in primary testicular lymphoma: A large,
greater than three months. Charts were examined for delays in diagnostic population-based cohort study
measures and treatments. Outcomes of interest aimed to identify areas Mohamad Baker Berjaoui , Jaime O. Herrera-Caceres , Yazan Qaoud ,
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of improvement for care, including virtual care and timeliness/urgency Raj Tiwari , Danny Ma , Mughda Khondker , Sumana Naidu , Katherine
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of reported urogenital concerns. Lajkosz , Miran Kenk , Khaled Ajib , Thenappan Chandraseka , Hanan
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Results: Secondary to virtual care appointments, three patients were Goldberg , Neil E. Fleshner 1
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unable to receive an initial physical exam, which delayed primary care 1 Division of Urology, Department of Surgery, University of Toronto,
referral and subsequent diagnosis. One patient had a physical exam Toronto, ON, Canada
delayed six months while receiving virtual care. A further 12 patients Introduction: Primary testicular non-Hodgkin’s lymphoma (PTL) is a very
underwent partial or total penectomy for late-stage presentation at our rare disease, comprising 1% of all non-Hodgkin’s lymphoma and <5% of
institution, 10 of which occurred in 2020. all cases of testicular tumors. With a median age at diagnosis of 67 years,
Conclusions: In cases of concern for penile malignancy, virtual care can- PTL is the most common testicular malignancy in men aged >60 years.
not replace the necessity of physical exams in preventing diagnostic and However, scare data has been published on PTL in younger patients and
treatment delays. In response, urologists at our center have altered prac- their overall outcomes. Our goal was to compare clinical parameters and
tices for urgent examination of referred males with genital abnormalities survival outcomes between patients older and younger than 60.
to prevent further exacerbation of delays. Methods: The Surveillance, Epidemiology, and End Results (SEER) data-
base was queried for all patients diagnosed with PTL diagnosis from
MP-6.4 1980–2013. Data collected consisted of demographic and clinical par-
Comparing and contrasting primary testicular lymphoma and ameters, including staging, pathological, and survival data. Patients were
germ cell tumors stratified according to their age and compared.
Mohamad Baker Berjaoui , Jaime O. Herrera-Caceres , Yazan Qaoud , Results: The cohort included 1679 patients comprising 3.45% of all tes-
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Raj Tiwari , Mughda Khondker , Sumana Naidu , Danny Ma , Katherine ticular tumors detected during a period of 33 years. The fraction of PTL out
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Lajkosz , Miran Kenk , Khaled Ajib , Thenappan Chandraseka , Hanan of all testicular tumors had remained stable at 3.24% in the 1980–1984
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Goldberg , Neil E. Fleshner 1 and 3.73% in 2010–2013 periods, although the absolute number of cases
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1 Division of Urology, Department of Surgery, University of Toronto, has increased from 85 per year in 1980 to 378 in 2013. Overall 433
Toronto, ON, Canada patients (25.8%) were older than 60 years of age, with 208 (12.4%) being
Introduction: Testicular cancer represents 1% of adult neoplasms, with the <50 and 91 (5.4%) <40. Older and younger patients exhibited similar
vast majority being primary germ cell tumors (GCT). On the other hand, racial diversity, geographical origin, and T stage. Almost all patients in
while primary testicular non-Hodgkin’s lymphoma (PTL) is a very rare both groups had mature B cell lymphoma. A larger percentage of younger
disease, comprising <5% of all cases of testicular tumors, it is considered patients received radiation to the contralateral testicle (43.4% vs. 31.9%
the most common testicular malignancy in men older than 60 years. To of older patients, p<0.001) and chemotherapy (82.2% vs. 66%, p<0.001).
our knowledge, no data have been published comparing survival rates More older patients had insurance (97.8% vs. 88.2%, p<0.001). On aver-
between PTL and GCT. Our aim was to analyze the differences in clinical age, younger patients were less likely to die of their disease (28.2% vs.
parameters and survival outcomes between patients with PTL and GCT. 38.8%, p<0.001), with a median survival time of 283 months vs. 98
Methods: The Surveillance, Epidemiology, and End Results (SEER) data- months (p<0.001). Fine and Grey competing risk multivariable analysis
base was queried for all patients with testicular tumors from 1980–2013. demonstrated that increasing age, worse T stage, and mature T cell histo-
Data collected consisted of demographic and clinical parameters, includ- pathology conferred a worse cancer-specific outcome while receiving
ing staging, pathological, and survival data. Patients were stratified accord- radiotherapy, chemotherapy, and being insured had a protective role.
ing to their tumor type and compared. Conclusions: PTL is the most common testicular malignancy in men older
Results: The cohort included 51 269 patients comprising all testicular than 60 years of age, but more than a quarter of the patients are younger
tumors managed during a period of 33 years. PTL patients (n=1745) than 60 and more than 12% are <50. Younger patients are more likely
accounted for 3.45% of all testicular tumors, compared to 96.6% (n=49 to receive chemotherapy and radiation and overall do better in terms
524) patients with GCT. The median age at GCT was 33 years (interquartile of disease-specific survival. Being younger, insured, having a lower T
rage [IQR] 26–41), compared to 70 (IQR 59–77) with PTL (p<0.001). In stage, and being treated with chemotherapy and radiotherapy increase
terms of treatment, similar rates of radical orchiectomy and radiation were the chances of survival.
noted between the two cohorts, while a major difference was noted in
chemotherapy rates. Among the GCT patients, 47 632 (96.2%) under- MP-6.6
went radical orchiectomy, compared to 1632 (93.5%) patients in the PTL Holmium laser enucleation of the prostate to patients with
cohort. Furthermore, in terms of radiation, 33 032 (66.7%) of the GCT bladder outlet obstruction, high prostate-specific antigen, and
patients underwent radiation therapy compared to 1106 (63.4%) patients negative prostatic biopsy is a reliable tool for missed prostate
in the PTL cohort (p=0.012). There was a considerable difference with cancer diagnosis
chemotherapy, with 34 905 of the GCT patients (70.5%) receiving chemo- Loay Abbas , Ahmed Kotb , Ahmed S. Zakaria , Walid Shahrour , Hazem
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therapy compared to 546 patients (31.3%) in the PTL cohort (p<0.001). Elmansy 1
Twenty-year survival probabilities were 82.3% (95% confidence interval 1 Division of Urology, Northern Ontario School of Medicine, Thunder
[CI] 81.8–82.9%) for GCT patients and 9.83% (95% CI 7.25–13.3%) for Bay, ON, Canada
PTL patients (p<0.001), with the adjusted hazard ratio of 2.57 (95% CI Introduction: The aim of this study was to report our experience doing
2.16–3.05, p<0.001). holmium laser enucleation of the prostate (HoLEP) to patients with high
Conclusions: Lower survival rates are noted among PTL patients when prostate-specific antigen (PSA) and negative prostatic biopsy.
compared to GCT patients. Younger patients are more likely to receive Methods: We conducted a retrospective study of all patients that had
chemotherapy and radiation and have better disease-specific survival HoLEP because of refractory bladder outlet obstruction. The study
outcomes. Reduced rates of chemotherapy in PTL patients may also be included all patients with high PSA and negative prostatic biopsy.
attributable to the blood-testis barrier creating sanctuaries for these tumors Results: Thirty-one patients were identified. The mean age was 74 years.
from systemic chemotherapy. The mean preoperative PSA and PSA density were 8 ng/ml and 0.08 ng/
ml/g, respectively. The mean prostate volume and resected weight were
106 cc and 72 g, respectively. The mean three-month postoperative PSA
and the mean PSA reduction were 4.6 ng/ml and 79%, respectively.
Prostate cancer was diagnosed in 27 patients (87%) with HoLEP; of these,
CUAJ • June 2022 • Volume 16, Issue 6(Suppl1) S67