Objective: We performed a population-based analysis focusing on primary extranodal lymphoma of either testis, kidney, bladder or prostate (PGUL). Methods: We identified all cases of localized testis, renal, bladder and prostate primary lymphomas (PL) versus primary testis, kidney, bladder and prostate cancers within the Surveillance, Epidemiology, and End Results database (1998-2015). Estimated annual proportion change methodology (EAPC), multivariable logistic regression models, cumulative incidence plots and multivariable competing risks regression models were used. Results: The rates of testis-PL, renal-PL, bladder-PL and prostate-PL were 3.04%, 0.22%, 0.18% and 0.01%, respectively. Patients with PGUL were older and more frequently Caucasian. Annual rates significantly decreased for renal-PL (EAPC: -5.6%; p=0.004) and prostate-PL (EAPC: -3.6%; p=0.03). In multivariable logistic regression models, older ager independently predicted testis-PL (odds ratio [OR]: 16.4; p<0.001) and renal-PL (OR: 3.5; p<0.001), while female gender independently predicted bladder-PL (OR: 5.5; p<0.001). In surgically treated patients, cumulative incidence plots showed significantly higher 10-year cancer-specific mortality (CSM) rates for testis-PL, renal-PL and prostate-PL versus their primary genitourinary tumors. In multivariable competing risks regression models, only testis-PL (hazard ratio [HR]: 16.7; p<0.001) and renal-PL (HR: 2.52; p<0.001) independently predicted higher CSM rates. Conclusion: PGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder. Relative to primary genitourinary tumors, PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL, even after adjustment for other-cause mortality.

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada Department of Urology European Institute of Oncology Milan Italy

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy Vita Salute San Raffaele University Milan Italy

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada Division of Urology University of Montreal Hospital Center Montreal Quebec Canada

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada Martini Klinik University Medical Center Hamburg Eppendorf Hamburg Germany

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Center Montreal Quebec Canada Urology Unit ASST Spedali Civili of Brescia Department of Medical and Surgical Specialties Radiological Science and Public Health University of Brescia Brescia Italy

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria Department of Urology Weill Cornell Medical College New York NY USA Department of Urology University of Texas Southwestern Dallas TX USA Department of Urology 2nd Faculty of Medicine Charles University Prag Czech Republic Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy Vita Salute San Raffaele University Milan Italy

Division of Urology University of Montreal Hospital Center Montreal Quebec Canada

Urology Unit ASST Spedali Civili of Brescia Department of Medical and Surgical Specialties Radiological Science and Public Health University of Brescia Brescia Italy

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