Specialist management of testicular cancer: Report of the last 10 years at a Portuguese tertiary referral academic centre.

OBJECTIVES: To describe our experience on testicular cancer (TC) management, underlining the clinical/pathological scope, administered treatments, outcomes, and challenges. TC incidence is rising globally. The predominant histology is germ cell tumour (GCT). In most patients, orchiectomy is curative. Still, a significant proportion of patients will need further tailored treatment. Specialist Reference Centres have proven themselves successful in this setting. Published data regarding TC in Northern Portugal is lacking. METHODS: Retrospective review of consecutive TC patients at a specialist tertiary referral academic centre between January 2010 and December 2020. Statistical analysis was performed using the STATA® version 13.1 software. Multivariate logistic and survival analyses were performed. RESULTS: 125 patients met the inclusion criteria. The median age is 35 (28-40) years; 19% of patients had risk factors for TC - infertility being the most common (11%); 50% of patients wanted sperm cryopreservation prior to treatment; 68% of patients had stage I GCT, 16% stage II, and 17% stage III. Compared to seminoma, non-seminomatous GCT were associated with younger age (p < .001) and higher stages at diagnosis (p = .02); 24% of stage IA/B GCT underwent adjuvant chemotherapy; 47% of patients with metastatic GCT at presentation had refractory disease, requiring tailored treatment. The median follow-up time is 33 (13-65) months. There was no late relapse. The 5-year OS rate is 98.0%. The 5-year survival of metastatic disease is 95.8%. CONCLUSIONS: Despite contemporary excellent cure rates, the challenges of testicular cancer management still endure, especially in advanced stages. Therefore, public awareness is recommended, in order to avoid late presentations - special attention should be given to those who have known risk factors. The existence of Reference Centres is of paramount importance in order to achieve the best outcomes possible.

[Preservation of fertility in transgender people]. / Preservação da fertilidade em indivíduos transgénero.

Young transgender people increasingly seek medical help to assist them in their gender transition with hormone therapy and/or sex reassignment surgery. However, these treatments limit fertility and may make them irreversibly infertile. Studies show that the transgender population wishes to have biological children and, to help them achieve this desire for parenthood, there are techniques for preserving fertility, such as cryopreservation of gametes, embryos and ovarian or testicular tissue. However, alongside these techniques, there are ethical issues and several challenges before, during and after these procedures, that may lead young transgender people to reject these methods of preserving fertility. In conclusion, health professionals should be informed about all these dynamics between gender transition therapies and their impact on fertility, in order to better guide these individuals in their decision.