AMERICAN UROLOGICAL ASSOCIATION
1998 NATIONAL SCIENTIFIC MEETING
SAN DIEGO CONVENTION CENTER
SAN DIEGO, CALIFORNIA
TITLES/DESCRIPTIONS OF SELECTED NEWSWORTHY SCIENTIFIC ABSTRACTS
Contact: Bill Glitz (703) 532-3797 or by e-mail at [email protected]
From May 30 through 12 noon on June 4, please call the Press Room
at (619) 525-6246.
Embargoed until Sunday, May 31
Fertility Update on Nerve Sparing RPLND in Clinical Stage 1
Nonseminoma--Abstract #174
(Richard S. Foster; 1:00 p.m. - 3:00 p.m. on Sunday, May 31;
podium presentation; Room 5A and 5B, San Diego Convention Center)
Testicular cancer occurs most commonly in young and middle-aged men. After surgical removal of the testis, patients often undergo retroperitoneal lymph node dissection (RLND), particularly if they have a stage 1 nonseminomatous germ cell testicular cancer which has high potential for relapse. These investigators performed nerve-sparing RLND on 483 stage 1 nonseminomatous germ cell testicular cancer patients between 1984 and 1996. The objective of this study was to review the long- term fertility preserving potential of the procedure. They found that of the 401 patients available for followup, 100% were able to achieve ejaculation. They also found that of 50 patients who had attempted pregnancy out of the 124 right-sided procedure males who reported fertility status, 40 (80%) had been successful. Of the 185 left-sided procedure patients who reported fertility status, 48 had attempted pregnancy with 42 (88%) being successful. The researchers conclude that nerve- sparing RLND effectively preserves emission, ejaculation, and long-term fertility. According to them, patients can be advised, that the procedure has no impact on long-term fertility in stage 1 disease, and should there be an effect it is probably due to any chemotherapy administered.
Is Retroperitoneal Lymph Node Dissection (RLND) Alone Optimal or
Sufficient Therapy for Clinical Stage 1 Nonseminomatous Germ Cell
Testicular Tumors (NSGCTT) at High Risk for Relapse?--Abstract
#179
(David A. Swanson; 1:00 p.m. - 3:00 p.m. on Sunday, May 31;
podium presentation; Room 5A and 5B, San Diego Convention Center)
Patients with clinical stage 1 nonseminomatous germ cell testicular cancer often are at risk for disease relapse. In 1989, this group of researchers began to perform retroperitoneal lymph node dissection (RLND) as therapy on these high risk patients. Out of 25 men, the procedure revealed metastases in the nodes of only 7. Yet 11 patients relapsed. Among this group were 4 of the 7 who had positive lymph nodes and 7 of 19 with negative lymph nodes. All those who relapsed received chemotherapy. According to the investigators, only 3 patients with positive lymph nodes did not relapse (at approximately 5 years followup). These individuals were considered potentially cured by RLND. The researchers said that the 12 patients with negative lymph nodes who had not relapsed to date (average of 55 months followup) were apparently cured by surgical removal of one or both testes. The investigators' data showed that RLND alone is not the answer. Close followup for this type of cancer is mandatory since 42% of these patients did relapse. These researchers are currently investigating whether 2 courses of preemptive chemotherapy instead of RLND might successfully kill hidden cancer cells in the lymph nodes and elsewhere in the body.
Age, PSA and the Chance of Curable Prostate Cancer Among Men with
Non-Palpable Disease--Abstract # 279
(H. Balletine Carter; 3:30 a.m. - 5:30 p.m. on Sunday, May 31;
podium presentation; Room 7A and 7B; San Diego Convention Center)
The objective of this research was to evaluate whether older men
had more extensive prostate cancer than younger males at the same
PSA level. A series of 492 men who had radical prostatectomies
was divided into three age categories: 69 men into the 40 - 50-
year-old bracket; 227 men into the 51 - 60 age group; and 196 men
into the 61 to 73-year-old category. Then the groups were
further divided into five PSA levels: 2.5 - 4.0 ng/ml; 4.1 - 6.0
ng/ml; 6.1 - 8.0 ng/ml; 8.1 - 10.0 ng/ml; and over 10 ng/ml. The
researchers defined curable prostate cancer as either an organ-
confined tumor, or a low grade penetration with negative margins
and no involvement of seminal vesicles or lymph nodes. After
running an analysis of their data, they concluded that, at the
same PSA level, older men are more likely to have extensive
prostate cancer than younger men. Furthermore, they do not
advocate setting higher PSA thresholds for older men because such
a change might compromise the cure rate.
Effect of "High-Dose" SWL (8000 Shocks at 24kV) to One Renal Pole
on Bilateral Hemodynamics and Tubular Function--Abstract # 267
(Lynn R. Willis; 3:30 p.m. - 5:30 p.m. on Sunday, May 31; podium
presentation; Room 1A and 1B, San Diego Convention Center)
Lithotripsy is used to break up kidney stones and upper urethral stones into tiny fragments so they can be secreted in the urine. However, a clinical dose of shock wave lithotripsy (SWL) to one kidney can damage tissue, impair renal blood flow, and temporarily reduce the tubular function of the kidney. These investigators wanted to test the hypothesis that a high "dose" of shock waves (8000 shocks at 24 kilovolts) to one kidney would cause great, sustained impairment of hemodynamics in both kidneys. Consequently, they used sham lithotripsy, 2000 shocks, or 8000 shocks to the right kidney of six-week-old anesthetized pigs. The found that a large number of shocks applied to one pole of a kidney caused similar, large, and sustained impairment of renal hemodynamics and large transient reduction of tubular function in both kidneys. They believe that their data suggests SWL-induced injury releases a substance that causes bilateral renal vasoconstriction and impairs renal tubular secretion.
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