Search

HALLMARK gene set

ADT reduces tumor proliferation measured by Ki67

Purpose: WST11 vascular targeted photodynamic therapy (VTP) is a local ablation approach relying upon rapid, free radical-mediated destruction of tumor vasculature. A phase III trial showed that VTP significantly reduced disease progression when compared with active surveillance in patients with low-risk prostate cancer. The aim of this study was to identify a druggable pathway that could be combined with VTP to improve its efficacy and applicability to higher risk prostate cancer tumors.Experimental Design: Transcriptome analysis of VTP-treated tumors (LNCaP-AR xenografts) was used to identify a candidate pathway for combination therapy. The efficacy of the combination therapy was assessed in mice bearing LNCaP-AR or VCaP tumors.Results: Gene set enrichment analysis identifies the enrichment of androgen-responsive gene sets within hours after VTP treatment, suggesting that the androgen receptor (AR) may be a viable target in combination with VTP. We tested this hypothesis in mice bearing LNCaP-AR xenograft tumors by using androgen deprivation therapy (ADT), degarelix, in combination with VTP. Compared with either ADT or VTP alone, a single dose of degarelix in concert with VTP significantly inhibited tumor growth. A sharp decline in serum prostate-specific antigen (PSA) confirmed AR inhibition in this group. Tumors treated by VTP and degarelix displayed intense terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling staining 7 days after treatment, supporting an increased apoptotic frequency underlying the effect on tumor inhibition.Conclusions: Improvement of local tumor control following androgen deprivation combined with VTP provides the rationale and preliminary protocol parameters for clinical trials in patients presented with locally advanced prostate cancer. Clin Cancer Res; 24(10); 2408–16. ©2018 AACR.

International audience; Although several studies have examined the relationship between organochlorine pesticides (OCPs) and prostate cancer (PCa) risk, no data are available concerning the association between OCPs concentrations in periprostatic adipose tissue (PPAT), which reflects cumulative exposure, and PCa aggressiveness. Moreover, no previous study has compared OCPs exposure in two distinct ethno-geographical populations. The objectives were to analyze OCPs in PPAT of PCa patients from either Mainland France or French West Indies in correlation with features of tumor aggressiveness, after adjusting for potential confounders such age, BMI, and polyunsaturated fatty acid (PUFA) content of PPAT. PPAT was analyzed in 160 patients (110 Caucasians and 50 African-Caribbeans), 80 with an indolent tumor (ISUP group 1 + pT2), and 80 with an aggressive tumor (ISUP group more than 3 + pT3). The concentrations of 29 OCPs were measured in PPAT concomitantly with the characterization of PUFA content. Exposure patterns of OCPs differed according to the ethno-geographical origin. Most OCPs were found at higher concentration in Caucasian patients, whereas pp’-DDE content was twice as high in African-Caribbeans. Chlordecone was only detected in PPAT from African-Caribbean patients. Most OCP concentrations were positively correlated with age, and some with BMI. After adjusting for age, BMI, and PUFA composition of PPAT, no significant association was found between OCPs content and risk of aggressive disease, except of mirex which appeared inversely associated with aggressive features of PCa in Caucasian patients. These results highlight a significant ethno-geographic variation in internal exposure to OCPs, which likely reflects differences in consumption patterns. The inverse relationship observed between mirex concentration and markers of PCa aggressiveness need to be further investigated.

Background and objective To assess the medium-term tumor control in patients with localized prostate cancer (PCa) treated with vascular-targeted photodynamic (VTP) therapy with TOOKAD Soluble WST11 (VTP) and to assess the medium-term tolerability of the treatment. Design, setting, participants, and intervention During the clinical phase II studies, 68 patients were treated with VTP under optimal treatment conditions (WST11 at 4 mg/kg, light energy at 200 J/cm, and a light density index ≥1) and have been included in a 3.5-yr follow-up. Outcome measurements and statistical analysis Post-interventional visits were scheduled every 6 mo and conducted as per local standard practice in each study center. Cancer-free status was assessed by means of prostate-specific antigen kinetics, multiparametric magnetic resonance imaging and/or prostate biopsies. Results and limitations At the end of the 3.5-yr follow-up, overall successful focal ablation was achieved for 51 patients (75%). Cancer was identified in the untreated lobe in 17 patients (25%). In total, 34 patients (50%) were cancer-free in both the prostate lobes. In case of recurrent/persistent malignancy, the Gleason score remained consistent or changed at the maximum by one point (upgrading by 1 Gleason point to 3 + 4 for eight patients and 4 + 3 for two patients). There were 64 related adverse events (AEs): 48% were Clavien grade I, 47% were grade II, and 5% were grade III. There were no Clavien grade IV and V AEs. Limitations included small sample size and heterogeneity in the follow-up for some centers. Conclusions VTP is a safe and efficient treatment and represents an alternative option for localized low-risk PCa management over the medium term. Precise diagnostic methods and imaging tools are thereby essential requirements to ensure safe and complete targeted therapy. Patient summary In this report, we looked at the medium-term outcomes of focal photodynamic therapy for early-stage prostate cancer. We found that this form of treatment is efficient and might have the potential to become a therapeutic option for low-risk cancer. Effectiveness depends on precise diagnostic methods, such as magnetic resonance imaging and accurate biopsy.

Hypothesis: Partial Nephrectomy is oncological safe in patients with pT3a RCC. Purpose: To compare the oncological and functional outcomes of patients with pT3a RCC scheduled for PN and RN. Materials and Methods: We retrospectively reviewed patients with pT3a N0 M0 RCC who underwent partial or radical nephrectomy from 2005 to 2016. Perioperative characteristics, including estimated glomerular filtration rate, tumor size, pathological histology, and RENAL nephrometry score, were compared between patients scheduled for partial or radical nephrectomy. We used multivariable Cox proportional hazards regression models to compare overall survival, cancer-specific survival, and recurrence-free survival between planned procedure type. Results: Of the 589 patients, 369 (63%) and 220 (37%) were scheduled for radical and partial nephrectomy, respectively; 26 (12%) of the scheduled partial nephrectomy cases were intraoperatively converted to radical nephrectomy. After adjusting for tumor size and histology, there were no statistically significant differences in overall survival (hazard ratio 0.66; 95% CI, 0.38–1.13), cancer-specific survival (hazard ratio 0.53; 95% CI, 0.16–1.75), or recurrence-free survival (hazard ratio 0.66; 95% CI, 0.34–1.28) between patients scheduled for partial or radical nephrectomy. Fewer patients scheduled for partial nephrectomy had estimated glomerular filtration rate reductions 3 to 9 months after surgery than patients scheduled for radical nephrectomy. Conclusion: We found no evidence that patients scheduled to undergo partial nephrectomy had poorer oncologic outcomes than patients scheduled to undergo radical nephrectomy. In select patients with pT3a renal cell carcinoma in whom partial nephrectomy is deemed feasible by the surgeon, partial nephrectomy should not be discouraged.

Purpose: Almost half of the patients have had recurrent nephrolithiasis despite undergoing effective treatment. Our objective is to determine the recurrence rate of lithiasis after endourological management of nephrolithiasis and identify the risk factors for these recurrences.Methods: Data were gathered retrospectively from all patients who were treated for nephrolithiasis by endourological management from May 2014 to January 2017 in our university hospital. All patients who had postoperative renal colic and/or stone upon an imaging study were considered to have recurrent disease. The patients were devised into two groups: with and without recurrence. Many variables were also compared between these two groups.Results: A total of 190 patients were included in our study. At the end of a median follow-up of 32 months (range, 13–61 months), 25.8% of patients had a recurrent stone. In the multivariate analysis, the risk factors for recurrence were diabetes (HR: 7.9; p ) and smoking (HR: 3.5; p ). While the body mass index greater than 25 kg/m2 (HR: 2; p p p Conclusion: Stone recurrence is common after the management of urinary stones. In this study 25.8% of patients had recurred stone disease after endourological management with a median follow-up of 32 months. Our study findings showed that diabetes and smoking are risk factors for recurrence, while age and blood hypertension are protective factors that decreased the risk of recurrence.

Script Concordance Testing (SCT) is a method for clinical reasoning assessment in the field of health-care training. Our aim was to assess SCT acceptability and utility with a survey and an institutional prospective evaluation of students’ scores.With a user’s online survey, we collected the opinions and satisfaction data of all graduate students and teachers involved in the SCT setting. We performed a prospective analysis comparing the scores obtained with SCT to those obtained with the national standard evaluation modality.General opinions about SCT were mostly negative. Students tended to express more negative opinions and perceptions. There was a lower proportion of negative responses in the teachers’ satisfaction survey. The proportion of neutral responses was higher for teachers. There was a higher proportion of positive positions towards all questions among teachers. PCC scores significantly increased each year, but SCT scores increased only between the first and second tests. PCC scores were found significantly higher than SCT scores for the second and third tests. Medical students’ and teachers’ global opinion on SCT was negative. At the beginning SCT scores were found quite similar to PCC scores. There was a higher progression for PCC scores through time.

International audience; Objectifs : rapporter les résultats à 1 an du traitement mini-invasif de l’hyperplasie bénigne de prostate (HBP) par thermothérapie convective à la vapeur d’eau (système REZUM).Méthodes : cette technique a été proposée dans 2 centres français aux patients ayant une HBP symptomatique ou compliquée, en alternative à un traitement chirurgical ablatif classique ou à un traitement médicamenteux refusé. L’évaluation pré- et postopératoire de la symptomatologie urinaire a été basée sur le questionnaire IPSS, le débit urinaire maximal (Qmax) et le résidu post-mictionnel (RPM). L’évaluation des fonctions érectile et éjaculatoire a été basée sur les questionnaires IIEF5 et MSHQejd. Les taux de retraitement et les complications ont été rapportés. L’analyse statistique a été réalisée par un test t de Student ou par le test des rangs signés de Wilcoxon selon que les variables suivaient une loi de distribution normale ou non. Une valeur seuil de p < 0,01 a été considérée comme significative.Résultats : soixante-neuf patients ont été traités, en ambulatoire, d’octobre 2018 à novembre 2019. Huit patients étaient porteurs d’une sonde vésicale à demeure. Le volume prostatique médian préopératoire était de 47 (27–200) mL. À 6 mois postopératoire, le score IPSS était significativement diminué de 13,9 points (68,1 %, p < 0,001) et à 12 mois de 12 points (61,5 %, p < 0,001). À un an, le score de Qualité de vie a diminué de 3,2 points (p < 0,001) et le Qmax a été amélioré de 6 mL/s (p < 0,001). Tous les patients en rétention urinaire ont été sevrés de leurs sondes vésicales. Aucun effet indésirable grave (> Clavien II) n’a été observé. Aucune dysfonction érectile de novo et 10 % d’anéjaculation rétrograde ont été rapporté. Le taux de retraitement chirurgical à un an a été de 2,1 % (Tableau 1).Conclusion : les résultats à court terme de notre étude objectivent une amélioration significative de la symptomatologie urinaire et un respect de la fonction sexuelle. Cette étude suggère ainsi la reproductibilité, sur la population française en pratique courante, des résultats obtenus dans les études contrôlées randomisées nord américaines. Nous faisons toutefois état d’un taux de complications et notamment d’anéjaculation supérieurs à ceux rapportés dans ces mêmes études. La poursuite du suivi de notre cohorte est nécessaire afin d’évaluer l’évolution à moyen et long terme.

International audience; Purpose: To report the results of convective radiofrequency (RF) water vapor thermal therapy in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) with one-year follow-up evaluation.Material and method: The study was conducted in 2 French hospitals, for men with moderate to severe LUTS secondary to BPH, as an alternative to classical surgery treatment. The pre- and postoperative evaluation of urinary symptomatology was based on the International Prostate Symptom Score (IPSS) questionnaire, measures of peak urinary flow rate (Qmax) and post-void residual volume (PVR). Erectile and ejaculatory functions were evaluated via the IIEF5 and MSHQ-ejd questionnaires. Rates of retreatment and complications were also reported.Results: Sixty-two outpatients including 8 with urinary retention were treated. The median preoperative prostate volume was 47 (27-200) mL. At 6months postoperative, the IPSS had decreased significantly by 13.9 points (68.1%, PClavien II) were observed. No cases of de novo erectile dysfunction and an anejaculation rate of 10.8% was reported. The surgical retreatment rate at one year was 2.1%.Conclusion: The short-term results are encouraging, with significant efficacy on urinary symptoms and respect of sexual function. Nevertheless, it will be necessary to pursue the follow-up of this cohort to evaluate the mid-term and long-term evolution.

To determine whether immersive virtual patient simulation (IVPS) on the MedicActiv platform is influential in improving student academic performance in module validation tests.In this prospective randomized controlled study a comparison was made between IVPS training combined with regular faculty courses versus courses alone. The primary endpoint was module validation grades. Secondary endpoints were satisfaction scores (overall interest, ergonomics, realism, immersion, and training efficiency).Angers School of Medicine, France.2018 to 2019 class of fourth-year students, included on a voluntary basis. In the first semester 51 students were included, of whom 13 were excluded for lack of compliance (6 and 7 from the IVPS and control groups, respectively). In the second semester we included 57 students, of whom 10 were excluded for lack of compliance (2 and 8 from the IVPS and control groups, respectively).Mean age was 21 years (±0.8). There were 85 female and 23 male students. In the first semester mean grades were 13.4 ± 1.6 versus 11/.9 ± 2.4 in the IVPS and control groups, respectively (p = 0.038). In the second semester mean grades were 15.3 ± 2.5 versus 11.9 ± 3.6 in the IVPS and control groups, respectively p0.001. The entire study population was pooled (n = 85): mean grades were 14.5 ± 2.4 versus 11.9 ± 3 in the IVPS group and the control group, respectively, p0.001. The satisfaction questionnaire response rate was 54% (46/85). Score percentages ≥4 regarding overall interest, ergonomics, realism, immersion and training efficiency were 89%, 85%, 100%, 93%, and 93% respectively.Complementing conventional university education with simulation of virtual consultation cases on the MedicActiv platform improved student academic performance as compared with students studying regular courses. Students reported high levels of satisfaction with overall interest, ergonomics, realism, immersion and training efficiency on the MedicActiv platform.

INTRODUCTION AND OBJECTIVE:In a recent Phase III randomized controlled trial, TOOKAD-VTP has showed great efficacy in low risk (GG1) prostate cancer patients. However, about 28% of these patients p...

Resume Introduction Actuellement, environ 50 % des cancers de la prostate nouvellement diagnostiques sont localises a la glande prostatique et de faible risque selon la classification de d’Amico. Les therapies focales, dont l’objectif est le traitement de la seule lesion index du cancer, apparaissent comme une nouvelle alternative en cours d’evaluation dans la prise en charge de ces cancers. Outre l’interet dans le controle de la maladie, ces therapies focales presentent un tres faible risque de morbidite. La phototherapie dynamique a visee vasculaire (VTP) est l’une de ces nouvelles therapies emergentes. Methode Une revue exhaustive de la litterature concernant la VTP en cancerologie prostatique a ete realisee. Une recherche par les mots cles suivant « low-risk prostate cancer », « focal treatment », « vascular targeted photodynamic therapy » « TOOKAD » a ete realisee dans Pubmed et Embase. Resultats Dans les differentes etudes de phase II, la VTP a montre un taux de 80 % de biopsies negatives a 6 mois, avec une bonne tolerance clinique. L’etude europeenne de phase III, prospective randomisee comparant le VTP a la surveillance active, a montre une plus faible proportion de progression, ainsi qu’une duree avant progression plus importante pour la VTP. Les evenements indesirables sont majoritairement moderes et transitoires. La qualite de vie des patients est preservee, avec un impact modere sur les fonctions erectiles et urinaires. Conclusion La VTP semblent etre une nouvelle approche prometteuse dans le cancer de la prostate localise de faible risque.

Vascular-targeted photodynamic therapy (VTP) induces rapid destruction of targeted tissues and is a promising therapy for prostate cancer. However, the resulting immune response, which may play an important role in either potentiating or blunting the effects of VTP, is still incompletely understood. Myeloid cells such as myeloid-derived suppressor cells (MDSCs) and macrophages are often found in tumors and are widely reported to be associated with cancer angiogenesis, tissue remodeling, and immunosuppression. These cells are also known to play a critical role in wound-healing, which is induced by rapid tissue destruction. In this study, we investigated the effects of VTP on the recruitment of tumor-infiltrating myeloid cells, specifically MDSCs and tumor-associated macrophages (TAMs), in the Myc-Cap and TRAMP C2 murine prostate cancer models. We report that VTP increased the infiltration of myeloid cells into the tumors, as well as their expression of CSF1R, a receptor required for myeloid differentiation, proliferation, and tumor migration. As anti-CSF1R treatment has previously been used to deplete these cells types in other murine models of prostate cancer, we hypothesized that combining anti-CSF1R with VTP therapy would lead to decreased tumor regrowth and improved survival. Importantly, we found that targeting myeloid cells using anti-CSF1R in combination with VTP therapy decreased the number of tumor MDSCs and TAMs, especially M2 macrophages, as well as increased CD8(+) T cell infiltration, decreased tumor growth and improved overall survival. These results suggest that targeting myeloid cells via CSF1R targeting is a promising strategy to potentiate the anti-tumor effects of VTP.

Lower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. The GreenLight PVP is usually considered as an interesting surgical option for patients treated via oral anticoagulants (OACs) with regard to its haemostatic properties. The aim of this study was to assess the impact of maintaining OAC treatment in patients undergoing PVP. This study is a multicentre, open-label, randomized controlled trial (RCT) designed to show the non-inferiority of PVP surgery in patients with BPO treated with OACs. This study is designed to enrol 386 OAC-treated patients (treated with vitamin K antagonists and direct oral anticoagulants) who are undergoing PVP for BPO. Patients will be randomized (1:1) to either maintain or stop OAC treatment during the perioperative course. The intervention group will maintain OAC treatment until the day before surgery and resume OAC treatment the day after surgery, whereas the control group will stop OAC treatment (with or without low-molecular-weight heparin bridging therapy) according to the anaesthesia guidelines. The primary outcome of interest to be assessed is the 30-day complications rate according to the Clavien-Dindo classification. The secondary endpoint will examine the 30-day rate of haemorrhagic and thrombotic events. This study will provide 80% power to show non-inferiority, defined as not worse than a 10% (non-inferiority margin) inferior change in the proportion of patients with good outcomes (Clavien-Dindo score

We report the case of a 23-year-old woman treated by mesalazine for ulcerative colitis and who subsequently presented recurrent renal colic due to mesalazine urinary stones. This is the second case described in the literature.Mesalazine stones are soft, friable and have an orange-beige color. They are not visible on non-contrast computed tomography (CT). Their diagnosis is based on morpho-constitutional analysis and CT-urography. Patients treatedby mesalazine who present renal colic should undergo CT-urography in order to make the diagnosis.

Resume But Evaluer l’accessibilite previsible au post-internat pour les internes d’urologie terminant leur internat entre novembre 2013 et 2016. Materiel De septembre a novembre 2013, les representants des internes d’urologie inscrits en DESC dans chaque region ont ete contactes pour participer a l’etude. Un questionnaire leur a ete soumis afin de recenser localement le nombre d’internes prevoyant de terminer leur internat entre novembre 2013 et 2016, ainsi que le nombre de postes de chef de clinique-assistant (CCA) et d’assistant specialiste (AS) d’urologie permanents et provisoires dans la region, et leur occupation prevue durant la meme periode. Resultats En novembre 2013, notre etude a recense 334 urologues en formation (197 internes inscrits en DESC, 81 CCA, 56 AS). Cinquante-cinq internes ont termine leur internat en novembre 2013, alors que 67, 50, 77 internes ont prevu de terminer leur formation respectivement de novembre 2014 a 2016. L’accessibilite previsible au post-internat d’urologie a ete evaluee a 96,4 %, 82,1 %, 90,0 %, 74,0 % respectivement pour les internes terminant leur formation de novembre 2013 a 2016. Le deficit previsible de postes de post-internat a ete calcule a –2, –12, –5, –20 postes respectivement de novembre 2013 a 2016. Conclusion Le nombre previsible de postes de post-internat d’urologie reste insuffisant en France pour la periode 2013–2016. En raison d’un flux non stabilise d’internes prevoyant de terminer leur internat de novembre 2014 a 2016, leur accessibilite immediate a un post-internat a ete mesuree a 82,1 %, 90,0 %, 74,0 % respectivement sur la meme periode. Niveau de preuve 5.

Resume Introduction L’objectif de ce travail de l’AFUF etait d’etablir un etat des lieux des remunerations des gardes et astreintes des internes, assistants et chefs de clinique d’urologie en France. Materiel et methodes Les donnees ont ete recueillies de fevrier a mai 2013 par l’intermediaire d’un questionnaire envoye a tous les membres de l’AFUF (327 membres). Les remunerations etaient donnees en valeurs brutes. Resultats Quarante-trois internes ont participe a l’etude, 16 assistants et 16 chefs de clinique, permettant d’obtenir une representativite nationale de 62 % (54 hopitaux sur les 92 centres pratiquant l’urologie en France). La majorite des repondants etait d’astreinte operationnelle ou de securite. Vingt hopitaux (38 %) avaient une activite de prelevements multi-organes (PMO). Les remunerations medianes des internes etaient de 59,51 € par astreinte deplacee (demi-garde) et de 119,02 € par garde. Les assistants et chefs de clinique etaient remuneres de maniere forfaitisee pour 37,5 % d’entre eux (140 € pour les assistants [avec des variabilites de 40 a 195 €] et 130 € pour les chefs de clinique [42,5–180]) ou selon un tarif qui dependait du nombre ou du temps de deplacement pour les autres (62,5 %) : les deux premiers deplacements ou un deplacement e ou au-dela de 3 h et 365 et 473 € respectivement au-dela de 8 h. Les PMO etaient egalement remuneres de maniere forfaitisee (60 %) ou au tarif horaire (40 %). Au-dela d’un seuil de 2–3 heures, la remuneration horaire etait plus interessante que la remuneration forfaitisee. Conclusion Des disparites de remuneration des astreintes et gardes d’urologie ont ete mises en evidence. Les plus grandes variabilites concernaient la remuneration des astreintes forfaitisees au-dela d’un certain seuil d’heures deplacees et les astreintes de PMO des assistants et chefs de clinique. Ces differences meritent d’etre reconsiderees en vue d’une harmonisation nationale. Niveau de preuve 3.

Resume Objectif Evaluer les motivations, l’organisation pratique et le financement du Master 2 chez les jeunes urologues francais. Materiels et methodes Un questionnaire electronique a ete diffuse aux membres de l’AFUF ainsi qu’aux participants du seminaire de formation a la recherche « Graines et Sol » de l’AFU, entre juillet et septembre 2013. Les resultats sont presentes sous forme de mediane (ecart interquartile). Resultats Soixante reponses sur 115 etudiants ayant fait un Master 2 (52 %) ont ete analysees. L’âge median etait de 29 ans (28–30) lors de la realisation du Master 2 et la proportion masculine de 75 %. La bourse de l’AFU etait obtenue par 57,4 % des postulants, 56,4 % pour les diverses bourses et 47,6 % pour la bourse annee recherche. Le montant median brut annuel etait de 29 870 € (22 710–30 195) sans difference significative entre les subdivisions. Les complements financiers provenaient essentiellement de gardes (26,2 %), d’astreintes (28,6 %) et de remplacements (25 %). L’annee de Master 2 etait le plus souvent realisee entre la quatrieme et la cinquieme annee d’internat (53 %), pour une duree d’un an (96,7 %) et en France (86,6 %). La cancerologie urologique (60 %) etait la thematique la plus etudiee. Le Master 2 etait realise dans un projet de carriere hospitalo-universitaire (31,7 %) ou dans l’attente d’un post-internat (20,8 %). Environ un quart se voyait proposer un poste de CCA avant le Master 2. Cette annee etait source de publication pour 76,7 %. La these de Sciences interessait 63,3 % des repondants. Conclusion Cette etude confirmait l’interet des jeunes urologues francais pour une annee de Master 2. Le financement grâce aux bourses facilitait le deroulement de cette annee dans l’optique d’une carriere universitaire pour nombre d’entre eux. Niveau de preuve Niveau 3.

Resume Objectifs Les objectifs de cette etude etaient d’evaluer la place de la simulation dans la formation initiale des jeunes urologues francais. Materiels et methodes Un questionnaire electronique a ete diffuse a l’ensemble des internes et chefs de clinique, membres de l’AFUF entre fevrier et mai 2013. Les resultats sont presentes sous forme de mediane (ecart interquartile). Resultats Les reponses de 125 urologues en formation ont ete analysees (taux de reponse 38 %). Il s’agissait d’internes dans 90 cas (72 %), et de chefs de clinique ou assistants dans 35 cas (28 %). L’âge median etait de 29 ans (27–30), la proportion masculine de 77 %. Tous les CHU etaient representes. Quatre-vingt-dix (72 %) d’entre eux avaient acces a un pelvi-trainer et 66 (53 %) a des modeles animaux ou cadaveriques, mais ne l’utilisaient jamais ou moins d’une fois par mois dans 83 et 97 % des cas, respectivement. Soixante-douze (58 %) avaient utilise au moins une fois un simulateur utilisant la realite virtuelle et 38 (30 %) y avaient acces regulierement, mais sans encadrement dans 64 % des cas. Les facteurs limitant l’entrainement sur simulateur etaient l’absence de simulateur a disposition (70 %), le manque de temps (58 %), d’incitation (34 %) et d’encadrement (20 %). Si ces conditions etaient reunies, 86 % des jeunes urologues seraient prets a consacrer plus d’une heure par semaine a l’entrainement sur simulateur. Conclusion Cette etude a revele parmi l’echantillon interroge une sous-utilisation de la simulation dans la formation pratique. Cela etait explique par un manque d’accessibilite, mais surtout d’utilisation des moyens a disposition. Niveau preuve 3

Resume Introduction Plusieurs nouvelles molecules ont ete recemment developpees grâce a une meilleure comprehension des mecanismes impliques dans la progression du cancer de la prostate, notamment au stade de resistance a la castration (CRPC). Cet article a pour but de decrire les mecanismes d’action de ces nouveaux traitements hormonaux ainsi que les principaux resultats cliniques et leurs programmes de developpement. Materiels et methodes Une recherche bibliographique en langues francaise et anglaise par Medline ® et Embase ® en utilisant les mots-cles castration-resistant prostate cancer , abiraterone acetate , orteronel , enzalutamide et clinical trials a ete effectuee. Resultats La voie de signalisation aux androgenes reste la pierre angulaire de la prise en charge des cancers avances. Ainsi, quelques molecules ont pour cible la synthese androgenique comme l’acetate d’abiraterone et l’orteronel qui sont des inhibiteurs selectifs de l’enzyme CYP17. D’autres agissent en tant qu’antagonistes des recepteurs aux androgenes : l’enzalutamide, l’ARN-509 et l’ODM201. Enfin, le galeterone combine les deux effets. Conclusion Les progres conferes par ces molecules en terme de survie globale et qualite de vie, chez des patients avec CRPC metastatique, suggerent que l’utilisation de ces dernieres a des stades plus precoces de la maladie pourrait permettre de diminuer la morbidite et la mortalite du cancer de la prostate. La determination de la meilleure strategie de sequence ou d’association therapeutique pour optimiser l’utilisation de ces nouvelles molecules doit etre investiguee.

Objective: The aim of the study was to evaluate renal function and to identify factors associated with renal function deterioration after retrograde intrarenal surgery (RIRS) for kidney stones. Materials and Methods: We retrospectively analyzed patients with renal stones treated by RIRS between January 2010 and June 2013 at a single institute. We used the National Kidney Foundation classification of chronic kidney disease (CKD) to classify Glomerular Filtration Rate (GFR) in 5 groups. The baseline creatinine level was systematically pre-operatively and post-operatively evaluated. All patients had a creatinine blood measurement in June 2013. A change toward a less or a more favorable GFR group following RIRS was considered significant. Results: We included 163 patients. There were 86 males (52.8%) and 77 females (47.3%) with a mean age of 52.8±17 years. After a mean follow-up of 15.5±11.5 months, median GFR was not significantly changed from 84.3±26.2 to 84.9±24.5 mL/min (p=0.675). Significant renal function deterioration occurred in 8 cases (4.9%) and significant renal function amelioration occurred in 23 cases (14.1%). In univariate analysis, multiple procedures (p=0.023; HR: 5.4) and preoperative CKD (p=0.011; HR: 6.8) were associated with decreased renal function. In multivariate analysis these factors did not remain as predictive factors. Conclusion: Stone management with RIRS seems to have favorable outcomes on kidney function; however, special attention should be given to patients with multiple procedures and preoperative chronic kidney disease.

Introduction Vascular-targeted photodynamic therapy with TOOKAD® Soluble is an innovative focal therapy procedure assessed in localized prostate cancer treatment. Materials and methods This mini-invasive technique destroys targeted tissues using a photosensitizer [TOOKAD® Soluble (WST11), STEBA Biotech] activated by laser light in the presence of oxygen. Its application for prostate cancer requires intravenous infusion of TOOKAD® Soluble and the illumination of the targeted area by transperineal optical fibers inserted under trans-rectal ultrasound guidance under general anesthesia. Conclusion Based on the experience gained through hundreds of procedures, we describe here the standardized technique of vascular-targeted photodynamic therapy with TOOKAD® Soluble defined during the phase II and III trials.

International audience; Diethylstilbestrol (DES) has a direct cellular mechanism inhibition on prostate cancer. Its action is independent from the oestrogen receptors and is preserved after a first-line hormonal therapy. We aimed to identify proteins involved in the direct cellular inhibition effects of DES on prostate cancer. We used a clonogenic assay to establish the median lethal concentration of DES on 22RV1 cells. 22RV1 cells were exposed to standard and DES-enriched medium. After extraction, protein expression levels were obtained by two-dimensional differential in-gel electrophoresis (2D-DIGE) and isotope labelling tags for relative and absolute quantification (iTRAQ). Proteins of interest were analysed by quantitative RT-PCR and western blotting. The differentially regulated proteins (P$$1.3 fold; P$

International audience; Prostate adenocarcinomas present a high risk of metastasis. We report a case of an atypical prostate cancer metastasis. A male patient presented a prostatic adenocarcinoma treated by surgery. A biological recurrence was discovered during the follow-up by an increased rate of Prostate Specific Antigen (PSA) and was treated by hormonotherapy. Several months later, there was a re-increase of the PSA rate. The CT scan showed a radiation proctitis aspect. An intermittent hormonotherapy was decided. Six months later, he presented abdominal pain. Examinations were performed and showed a rectal carcinosarcoma with prostate origins. A surgical management was realised. The outcomes were an early recurrence. A symptomatic treatment was decided. There are not any rectal localisations reported in the literature. Only loco-regional invasions of the rectum are described and no histological modification of metastasis compared to the primitive tumor has been reported. So, we report a metastasis of a prostate adenocarcinoma which transformed into a carcinosarcoma.KEYWORDS: Adenocarcinoma; Carcinosarcoma; Metastasis; Prostate; Rectal neoplasm.

Objectifs L’objectif de l’etude a ete d’evaluer l’accessibilite au post-internat d’urologie en France pour les internes inscrits en DESC prevoyant de terminer leur internat de novembre 2013 a 2016. Methodes De septembre a novembre 2013, les representants des internes d’urologie inscrits en DESC dans chaque region ont ete contactes pour participer a l’etude. Un questionnaire leur a ete soumis afin de recenser localement le nombre d’internes prevoyant de terminer leur internat entre novembre 2013 et 2016, ainsi que le nombre de postes de chef de clinique-assistant (CCA) et d’assistants specialistes (AS) d’urologie permanents et provisoires dans la region, et leur occupation prevue durant la meme periode. Resultats Notre etude a recense 334 urologues en formation (197 internes inscrits en DESC, 81 CCA, 56 AS). Cinquante-cinq internes ont termine leur internat en novembre 2013, alors que 67, 50, 77 internes ont prevu de terminer leur formation respectivement de novembre 2014 a 2016. L’accessibilite previsible au post-internat d’urologie a ete evaluee a 96,4 %, 82,1 %, 90,0 %, 74,0 % respectivement pour les internes terminant leur formation de novembre 2013 a 2016. Le deficit previsible de postes de post-internat a ete calcule a –2, –12, –5, –20 postes respectivement de novembre 2013 a 2016. Conclusion Le nombre previsible de postes de post-internat d’urologie reste insuffisant en France pour la periode 2013–2016. En raison d’un flux non stabilise d’internes prevoyant de terminer leur internat de novembre 2014 a 2016, leur accessibilite immediate a un post-internat a ete mesuree a 82,1 %, 90,0 %, 74,0 % respectivement sur la meme periode.

International audience; OBJECTIVES: Photodynamic therapy is a new focal therapy for prostate cancer.METHODS: In this technique, a photosensitising agent is introduced intravenously, then activated by local laser illumination to induce tumour necrosis. Treatment efficacy is assessed by magnetic resonance imaging (MRI).RESULTS AND CONCLUSIONS: We illustrate specific post-treatment MRI aspects at early and late follow-up with pathological correlations.TEACHING POINTS:Dynamic phototherapy is a new and promising focal therapy for prostate cancer.One-week MRI shows increased volume of the treated lobe and large, homogeneous necrosis area.Six-month MRI shows significant changes of the prostate shape and signal.Six-month MRI becomes "base line" appearance for further follow-up or monitoring.