380 Background: Testicular malignancy is the most common cancer affecting men aged between 15 and 44 years. In our centre, almost all low-risk seminoma (LRS) stage-I and non-seminomatous germ cell tumours (NSGCT) stage I (high and low-risk) tumours are followed-up on a surveillance program (SP) for a minimum of 5 years. LRS patients are scanned at 4, 6, and 12 monthly intervals during years 1, 2, and 3 to 5 years respectively. NSGCT undergo computer tomography (CT) scan at 3 monthly intervals in years 1 and 2, 4 monthly in year 3 and 6 monthly thereafter. Clinical examination, Chest X-ray (CXR) and tumour markers (TM) are performed at each visit. This retrospective audit examined if relapses were first detected by raised TM or radiologically, and if there was any difference in detection rate between these investigations to recommend reducing the frequency of CT scans, especially in lower risk groups, and therefore cumulative radiation exposure. Methods: The patient population was obtained from hospital electronic database. Metastatic patients, clinical trials patients and those who received adjuvant treatment upfront were excluded. Results: 396 patients were enrolled from 1999 to September 2013. 153 patients were followed-up in SP. 33 relapses (mean age 37 years, range 17-56) detected in SP. The mean relapse free survival period was 55.3 months (range 9.6-43.3) from date of diagnosis. No relapses were first detected on CXR. 4 patients had only TM elevated and 6 had CT abnormality found post TM elevation. 11 had simultaneous CT and TM abnormalities. For 12 patients, CT abnormality was detected with no TM raise. Of these, 8 were high risk (7 NSGCT and 1 pure seminoma) and 4 were low risk NSGCT. Patients were treated with standard BEP/EP chemotherapy regimen on relapse. All patients are alive to date and continue to be followed-up regularly. Conclusions: 12 patients in our study had relapses detected radiologically with no TM rise. 25% of these patients had low risk NSGCT. Without the CT scan, these patients would have faced potential delay in diagnosis and treatment. Results of prospective randomised trials are awaited to produce evidence to place confidence in less number of CT-scans for these patients during follow- up. Until then we recommend the current standard protocol be followed.
has been recently investigated. Hence, we explored the predictive value of ARV7, ARFL and PSMA combined expression on circulating tumor cells (CTCs) detected in mCRPC pts undergoing I line ARTA therapy (PRIMERA trial).Methods: Pts with mCRPC eligible for ARTA were prospectively enrolled. Twelve statuses were defined according to the combined expression of biomarkers (ARV7 and ARFL variants and PSMA) detection on CTCs at baseline. Multiple regression was performed to explore the correlation between status and treatment response features (overall PSA drop, 8 weeks PSA drop, PSA determined at 8 weeks, PSA nadir in CRPC status and time to CRPC).Results: Overall, cohort was composed of 28 pts. CTCs were detected in 15 (53.6 %) pts. PSMA, ARV7 and ARFL were expressed in 11, 2 and 9 pts, respectively. ARFL was significantly associated with increased PSA drop and overall PSA drop (P 0.02 and 0.04, respectively). ARFL-/PSMA+ status was significantly predictive for higher PSA at 8 weeks (P 0.01) and higher PSA nadir in CRPC status (P 0.01). Moreover, ARFL+/ PSMA-status was shown to be predictive for reduced time to CRPC development (P 0.02). ARV7-/ARFL+ status was shown to predict an increased PSA drop (P 0.01 and R2 0.2) and overall PSA drop (P 0.02).
Conclusions:The combined expression of ARFL, PSMA and ARV7 may affect biochemical treatment response and may be related to biological aggressiveness of disease. Our data prompt further prospective evidence to confirm biological rationale and implication of these biomarkers on treatment sequencing for mCRPC.
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