Clinically Relevant Insights on Testicular and Penile Cancer

Oncology

BOOK REVIEW Oncology Clinically Relevant Insights on Testicular and Penile Cancer A review of Testicular and Penile Cancer Edited by Marc S. Ernstoff, MD, John A. Heaney, MB, BCh, FRCSI, FACS, and Richard E. Peschel, MD, PhD Fitchburg, Mass: Blackwell Science, Inc; 173 pages, 1999 [Rev Urol. 2000;1(1):37-38] T his book is designed to provide the urologic oncologist with information on the epidemiology of testicular and penile cancer and on the diagnostic and therapeutic approach to patients with this disease. As such, the content is appropriate not only for urologic oncologists but also for those in training. The editors have assembled a national, multidisciplinary group of authors who are recognized experts in the field. The book is organized into two parts. The first part consists of 11 chapters that address the epidemiology, pathology, and molecular biology of testicular cancer; diagnostic and therapeutic approaches reviewed include surgery, radiation therapy, and chemotherapy. In this section, fertility is discussed, as is the management of extragonadal germ cell tumors. By nature of the rarity of penile cancer in North America, the discussion on it is condensed into two chapters. The material presented is clinically relevant, in keeping with the objective to serve as a guide for the practicing urologic oncologist. While the chapters are reasonably well organized, there is some redundancy: the chapter “Chemotherapy for Testicular Cancer” includes two pages on clinical presentation, diagnosis, and staging that duplicate the discussion in the chapter “Diagnostic Approaches to Testicular Cancer.” The depth of coverage is variable, with some chapters including a comprehensive review of the literature, while others provide mainly the experience of their author’s institution. Furthermore, there is little discussion of nuances that would be of importance during retroperitoneal lymphadenectomy, such as a review of preoperative CT scans for vascular anomalies that may increase the likelihood of complications. Despite the large number of authors, the writing style is reasonably consistent, with few exceptions. Generally, the book is well written, well indexed, and easy to read with large type. There is good use of tables to summarize outcomes data and provide a review of the literature. While the pathology chapters are well illustrated, those on management could be enhanced with CT scans of actual cases. The major shortcoming is that the latest references are from 1994 and 1995 in most chapters; a few references from 1996 appear in one or two chapters. As such, important recent advances, such as the International Germ Cell Consensus Classification (published in February 1997), are not discussed. Another book with a similar objective is the second edition of Testicular Cancer: Investigation and Management, edited by Alan Horwich, PhD, MRCP, FRCR. This book, published in 1996 by Chapman and Hall Medical, includes references from 1994 and 1995, which are more recent relative to the date of publication. The book, written by an international group of leaders in the field, is well organized, with chapters on chemotherapy and surgery divided according to stage and risk profile, respectively. Given that this book WINTER 2000 REVIEWS IN UROLOGY 37 Testicular and Penile Cancer continued contains 427 pages (compared with 173 pages for the book under review), there is more breadth and depth to the discussion, especially with respect to chemotherapy and its toxicity, salvage therapy, autologous bone marrow transplantation, and thoracotomy postchemotherapy. However, given the lack of significant change in the diagnosis and management of testicular and penile cancer in the past few years, the information presented in either book is not outdated. The overall strength of Testicular and Penile Cancer is that it outlines the multidisciplinary approach to the management of testicular and penile cancer in a concise fashion that is easy to read and understand. The primary weaknesses are the use of dated references relative to the date of publication and the inconsistent depth of coverage of various topics. However, these problems should not detract from the usefulness of the book as a valuable addition to the library of any urologic oncologist, especially in light of a price almost half that of similar books on testicular cancer. ■ Reviewed by Farhang Rabbani, MD, FRCSC Department of Urology Memorial Sloan-Kettering Cancer Center New York Nonprostate Urologic Oncology continued from page 33 day 63, the patient’s metastatic disease lesions started to diminish in size and number. By post-transplant day 110, he had achieved complete response. No residual metastatic disease was identifiable. The onset of the patient’s tumor response coincided with donor T cell chimerization in the patient. The patient is currently 15 months posttransplant and continues to be free of metastatic disease. Side effects of the allogeneic peripheral-blood transplant have included skin graft-versus-host disease (which was treated successfully with prednisolone) and cytomegalovirus (CMV) esophagitis as well as CMV gastritis (both managed successfully with ganciclovir). This exciting case report spawns further interest in the role of peripheral-blood allogeneic nonmyeloablative stem COMING cell transplantation for the management of metastatic refractory RCC. Thus far, patients undergoing allogeneic peripheral-blood stem cell transplants have demonstrated significant GVT effect in a number of tumor models, such as certain leukemias, lymphomas, and multiple myelomas. RCC is an interesting solid tumor model in which to evaluate this GVT phenomenon. RCC cells are commonly infiltrated by T cells, demonstrating HLA-restricted cytotoxicity specific to RCC cells. Furthermore, renal tissue-specific minor histocompatibility antigens have been described for RCC. Therefore, the theoretical potential exists that successful engrafting of donor T cells may allow renal tumorselective GVT response. This case report provides more substantial basis to such theoretical considerations. ■ IN Relationship Between Testosterone and Erectile Dysfunction JACOB RAJFER, MD 38 REVIEWS IN UROLOGY WINTER 2000