BackTable / Urology / Podcast / Episode #3
Management of Testicular Cancer
with Dr. Aditya Bagrodia and Dr. Jose Silva
Dr. Jose Silva talks with Urologist Dr. Aditya Bagrodia from UT Southwestern Medical Center about the medical and surgical management of testicular cancer.
BackTable, LLC (Producer). (2021, April 17). Ep. 3 – Management of Testicular Cancer [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Aditya Bagrodia
Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.
Dr. Jose Silva
Dr. Jose Silva is a board certified urologist practicing in Central Florida.
In this episode of BackTable Urology, urologic oncologist Dr. Aditya Bagrodia joins our host Dr. Jose Silva to discuss the diagnosis, treatment, and long-term management of testicular cancer.
The episode begins with an algorithm for initial work up of a testicular mass – scrotal ultrasound and tumor markers – and reviews the pre-orchiectomy timing of additional imaging and when more advanced imaging modalities like MRI or contrast-enhanced CT might be clinically useful. Dr. Bagrodia then walks through his surgical technique, highlighting practical tips to avoid common frustrations and complications. The pair also discuss operative technique and optimal timing for placement of testicular prostheses, as well as the role for partial orchiectomy in patients prioritizing fertility preservation and androgen production.
Dr. Bagrodia discusses indications for adjuvant chemotherapy and radiation, with a focus on avoiding over-treatment in these young patients and opting for observation when appropriate. He reviews surveillance protocols based on pathological stage, then walks through the management of recurrent and metastatic disease with an emphasis on the importance of multidisciplinary care.
The episode ends with an overview of Dr. Bagrodia’s current research, microRNAs. He reviews the sensitivity and specificity of these unique microRNAs in testicular cancer, explaining their potential to truly individualize care by correctly diagnosing equivocal tumors and identifying residual or recurrent disease.
AUA Guidelines: https://www.auanet.org/guidelines/guidelines/testicular-cancer-guideline
EAU Guidelines: https://uroweb.org/guideline/testicular-cancer/
NCCN Guidelines: https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf
Okay. Sounds good. So in terms of the procedure, are you counseling them on testicular implants prior to the procedure? Do you offer them? I use Coloplast. I usually do it at the time of the surgery. Do you do it afterwards? What is a good timing to offer it, and if we're going to offer it, then do it?
Excellent point. As someone who sees patients that largely have had their orchiectomy, one of the things that we run across most frequently is that they were never offered a prosthesis. So, placement of a prosthesis is associated with better self-image, body image, profiles. There have been multiple studies to show that, and many of the feelings of loss, of uneasiness, and of shame can be mitigated by placing a prosthesis. And, unequivocally, it's going to be easier to place it at the time of orchiectomy. This myth of placing it at a different time is really just that...it's an old wives' tale.
So I also use a Coloplast. The majority of patients are going to use a large. It is something that oftentimes needs to be pre-arranged. Generally the prosthesis are not kept on the shelf at many hospitals, so you do want to know who your rep is and have them come in. Practically, that may not always be possible, but if you're not thinking about it at that initial consultation, you're going to miss the window. You're going to miss the opportunity.
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