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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.

Objectives. To explore the proportion of patients with higher risk localized prostate cancer (PCa) that would become safely biopsy negative 12 months after non-thermal focal therapy with padeliporfin vascular-targeted photodynamic therapy (VTP). Methods. Multicenter study in a scenario of prostate-specific antigen (PSA) ≤ 20 ng/ml and variable PCa target volumes Gleason pattern 3 or low-volume secondary Gleason pattern 4, all patients received VTP, consisting of intravenous 4 mg/kg padeliporfin activated by light-diffusing fibers in the prostate. The prostate was biopsied at baseline, months 6 and 12, PSA, patient-reported functional outcomes and quality of life (QoL) questionnaires were recorded at baseline, months 3, 6, and 12 and adverse events (AE) throughout the study. Results. In the intention-to-treat population (n = 81), the proportion of patients with negative biopsies at month 12 was 74% (60/81 patients; 95% CI: 63.1%, 83.2%). In the per-protocol population, the proportion was 79% (58/73 patients; 95% CI: 68.4%, 88.0%). Questionnaire results indicated a slight improvement in urinary function and limited deterioration in sexual function. No difference in QoL was observed over time. A total of 42/81 (52%) patients reported mild or moderate and 4 of 81 (4.9%) experienced serious AE, all resolved without sequelae. No phototoxicity, cardiovascular event, fistula or prolonged urinary incontinence, secondary cancer or death was reported. Conclusions. Results support the efficacy, safety, and QoL associated with padeliporfin focal treatment for low/intermediate risk localized PCa. Objetivos: Explorar la proporción de pacientes con cáncer de próstata localizado (CaP) de mayor riesgo que se convertiría en una biopsia negativa con seguridad 12 meses después de la terapia focal no térmica con terapia fotodinámica dirigida vascular de padeliporfina (TFV). Métodos: Estudio multicéntrico en un escenario de antígeno prostático específico (PSA) ≤ 20 ng/ml y patrón 3 de Gleason de volúmenes objetivo de CaP variable o patrón 4 de Gleason secundario de volumen bajo. Todos los pacientes recibieron TFV, que consistió en 4 mg/kg de padeliporfina intravenosa activada por fibras difusoras de luz en la próstata. La próstata se biopsió al inicio del estudio y a los meses 6 y 12. El PSA, los resultados funcionales informados por los pacientes y los cuestionarios de calidad de vida (CdV) se registraron al inicio y a los meses 3, 6 y 12; los eventos adversos (EA) se registraron a lo largo del estudio. Resultados: En la población con intención de tratar (n = 81), la proporción de pacientes con biopsias negativas al mes 12 fue del 74% (60/81 pacientes, IC 95%: 63,1, 83,2%). En la población por protocolo, la proporción fue del 79% (58/73 pacientes, IC 95%: 68,4, 88,0%). Los resultados del cuestionario indicaron una ligera mejoría en la función urinaria y un deterioro limitado en la función sexual. No se observó diferencia en la CdV con el tiempo. Un total de 42/81 (52%) pacientes comunicaron EA leves o moderados y 4 de 81 (4,9%) experimentaron EA graves, todos resueltos sin secuelas. No se informó fototoxicidad, evento cardiovascular, fístula o incontinencia urinaria prolongada, cáncer secundario o muerte. Conclusiones: Los resultados respaldan la eficacia, la seguridad y la CdV asociadas con el tratamiento focal de padeliporfina para el CaP localizado de riesgo bajo/intermedio.

Objectives To explore the proportion of patients with higher risk localized prostate cancer (PCa) that would become safely biopsy negative 12 months after non-thermal focal therapy with padeliporfin vascular-targeted photodynamic therapy (VTP). Methods Multicenter study in a scenario of prostate-specific antigen (PSA) ≤ 20 ng/ml and variable PCa target volumes Gleason pattern 3 or low-volume secondary Gleason pattern 4, all patients received VTP, consisting of intravenous 4 mg/kg padeliporfin activated by light-diffusing fibers in the prostate. The prostate was biopsied at baseline, months 6 and 12, PSA, patient-reported functional outcomes and quality of life (QoL) questionnaires were recorded at baseline, months 3, 6, and 12 and adverse events (AE) throughout the study. Results In the intention-to-treat population (n = 81), the proportion of patients with negative biopsies at month 12 was 74% (60/81 patients; 95% CI: 63.1%, 83.2%). In the per-protocol population, the proportion was 79% (58/73 patients; 95% CI: 68.4%, 88.0%). Questionnaire results indicated a slight improvement in urinary function and limited deterioration in sexual function. No difference in QoL was observed over time. A total of 42/81 (52%) patients reported mild or moderate and 4 of 81 (4.9%) experienced serious AE, all resolved without sequelae. No phototoxicity, cardiovascular event, fistula or prolonged urinary incontinence, secondary cancer or death was reported. Conclusions Results support the efficacy, safety, and QoL associated with padeliporfin focal treatment for low/intermediate risk localized PCa.

Purpose In order to limit ischemia and operative bleeding during and after partial nephrectomy we developed a clampless laparoscopic technique, in a hybrid operating room, immediately after super-selective arterial embolization of the renal tumor. We evaluated feasibility and morbidity of this new approach of zero ischemia in partial nephrectomy. Methods We included prospectively 50 consecutive patients treated in a hybrid operating room by this new technique for a localized renal tumor in a university hospital between May 2015 and January 2017. We evaluated perioperative data, postoperative complications, surgical margin and modification of renal function one month after surgery. Renal tumor complexity was evaluated by the R.E.N.A.L. score. Results We included 30 (60%) men and 20 (40%) women with a median age of 61 years (32–84) and a median BMI of 26.85 kg/m2 (20.1–46.4). Tumors were at low, median and high complexity in respectively 11 (22%), 32 (64%) and 7 (14%) cases. Median endovascular and surgical procedures durations were 43 min (16–120) and 80 min (32–150). Median blood loss was 100 mL (10–850). Two Clavien II complications occurred. Median length of hospital stay was 3 days (2–7). Renal function was not modified one month after partial nephrectomy. Median tumor size was 3 cm (1.2–8). Forty tumors (80%) were malignant and surgical margins were positive in one (2%). Conclusions Clampless laparoscopic partial nephrectomy in a hybrid operating room without pedicular dissection after previous tumoral embolization is a technically safe and carcinologically efficient mini-invasive alternative for the management of localized renal tumors.

We assessed the midterm oncologic outcomes of vascular targeted photodynamic therapy with padeliporfin for low risk prostate cancer treatment.We prospectively assessed all patients treated with vascular targeted photodynamic therapy for low risk prostate cancer at our center. Patients were followed every 6 months. All patients underwent prostate biopsies 6 months after treatment or when there was biological or clinical progression. The primary end point was progression-free survival. Secondary end points were absent clinically significant cancer in the treated lobes, radical therapy and the prostate specific antigen rate. Variables were compared with the chi-square, Mann-Whitney or Wilcoxon test. Progression-free survival is reported with Kaplan-Meier curves.A total of 82 men were treated with vascular targeted photodynamic therapy. Median followup was 68 months (range 6 to 89). Median progression-free survival was 86 months (95% CI 82-90). Median prostate specific antigen decreased significantly by 41% 6 months after treatment and it remained stable during followup (p0.001). A total of 115 lobes were treated and absent clinically significant cancer was achieved in 94 (82%). Of the 82 patients 20 (24%) underwent radical therapy, including radical prostatectomy in 18 and brachytherapy in 2, at a median of 22 months (range 6 to 86). Study limitations include a single arm design, small population size and midterm followup.Padeliporfin vascular targeted photodynamic therapy for low risk prostate cancer achieved an 82% rate of absent clinically significant cancer in treated lobes and 76% of patients avoided radical therapy at a median followup of 68 months. However, longer followup is required to determine long-term outcomes.

INTRODUCTION: The prospective trial PCM301 randomized 413 men with low-risk prostate cancer to partial gland ablation with vascular-targeted photodynamic therapy (n=207) or active surveillance (n=206). Two-year outcomes were reported previously. Here we report four-year rates of intervention with radical therapy and further assess efficacy with biopsy results. MATERIALS & METHODS: Prostate biopsies were mandated at 12 and 24 months. Thereafter, patients were monitored for radical therapy, with periodic biopsies performed according to standard-of-care in each institution. Efficacy of ablation was assessed by biopsy results overall and ‘in-field’ (treated lobe, or lobe with index cancer). RESULTS: Conversion to radical therapy was less likely in the ablation cohort than the surveillance cohort: 7% versus 32% at two years, 15% versus 44% at three years, and 24% versus 53% at four years (HR 0.31, 95% CI=0.21–0.46). Triggers for radical therapy were similar in the two arms. Cancer progression rates overall and by grade were significantly lower in the ablation cohort (HR 0.42, CI = 0.29–0.59). End-of-study biopsy results were negative throughout the prostate in 50% after ablation versus 14% after surveillance (risk difference 36%, CI 28%, 44%) and Gleason 7 or higher cancer was less likely (ablation, 16%; surveillance, 41%). In-field biopsies contained Gleason 7 cancer in 10% after ablation versus 34% after surveillance. CONCLUSIONS: In this randomized trial of partial ablation for low-risk prostate cancer, photodynamic therapy significantly reduced the subsequent finding of higher-grade cancer on biopsy. Consequently, fewer patients converted to radical therapy, a clinically meaningful benefit that lowers treatment-related morbidity.

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

OBJECTIVE: To explore efficacy and safety of Botulinum Neurotoxin Type A (BoNT-A) prostatic injection in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperperplasia. MATERIALS AND METHODS: A phase 3 multicenter open-labeled study randomised patients to receive BoNT-A prostatic injection or optimized medical therapy. BoNT-A injection consisted in trans-rectal injections of 200 UI in the transitional zone of the prostate. Optimal medical therapy consisted in oral medication with any drug patented for LUTS. One month (M1) after randomisation patients in the BoNT-A group were asked to stop any medical therapy related to LUTS. The main judgment criterion was the IPSS score at M4. Per-protocol analysis was performed with a non-inferiority hypothesis (DeltaIPSS < 3). RESULTS: 127 patients were randomised to BoNT-A (n = 64) or medical therapy (n = 63). At randomisation mean IPSS was 16.9 +/- 7.2 in the BoNT-A group vs 15.7 +/- 7.3 in control. In the BoNT-A group, 44 patients (73.3%) could interrupt medical therapy for LUTS from M1 to M4. At M4, mean IPSS score was 12.0 +/- 6.7 in the BoNT-A group vs 11.8 +/- 6.9 in control. After adjustment for baseline IPSS, delta IPSS between groups was 0.01; 95% CI [- 2.14; 2.11] leading to accept the non-inferiority hypothesis. CONCLUSIONS: Four months after BoNT-A injection, most of the patients could interrupt LUTS-related medical treatments. In these patients, IPSS improvement was not inferior to optimized medical treatment, but the study design did not allow to conclude that this improvement was related with study drug rather than with sustained placebo effect. TRIAL REGISTRATION: NCT01275521.

Background In a cadaveric model with healthy kidneys, it has recently been highlighted that a single renal segment could be supplied by one or more arterial branches originating from an artery supplying another segment. Objective To demonstrate occurrences of anatomical variations of renal vascularization and to analyze vascularization of renal tumors. Design, setting, and participants This prospective monocentric study included all patients treated for a renal tumor between May 2015 and June 2017 by laparoscopic partial nephrectomy after superselective tumor embolization in a hybrid operating room. Intervention Three-dimensional renal and tumoral arteriography with cone-beam computed tomography scan was performed, coupled with preoperative cross-sectional imaging. This procedure provided an accurate vascular anatomical mapping of the kidney and allowed further analysis of tumor vascularization. Outcome measurements and statistical analysis Relation between anatomical variations of the vascularization and perioperative data was assessed. A χ2 test or Fisher’s test was used for qualitative variables, and a Student t test was used for quantitative variables. Results and limitations Out of the 60 patients included, only 25 (42%) presented a standard vascular subdivision. In 26 patients (43%), tumors were supplied by more than one branch and in 20 patients (33%), there was a branch supplying the tumor from another segment. In these cases of multiple or multi-segmental tumor vascularization, tumor size, operative duration, and duration of embolization were significantly higher than in the case of standard vascularization. These complex tumors were more often located at the upper pole of the kidney or at the junction of the anterior and posterior vascular territories of the kidney. Limitations of this study include the low number of patients and its monocentricity. Conclusions This study confirms that renal vascularization frequently differs from Graves’ reference model and that tumor vascularization can depend on several segmental branches. This vascular complexity explains surgical difficulties and must be taken into consideration when segmental arterial clamping is considered during partial nephrectomy. Patient summary We studied renal and tumor vascularization using three-dimensional preoperative arteriography data on tumor kidneys. We have shown that there is great variability in renal vascularization and that tumors can be vascularized branches that originate from an artery leading to another segment. This vascular complexity explains surgical difficulties and must be taken into consideration when segmental arterial clamping is considered during partial nephrectomy.

International audience; Background - Genetic and nutritional factors have been linked to the risk of aggressive prostate cancer (PCa). The fatty acid (FA) composition of peri-prostatic adipose tissue (PPAT), which reflects the past FA intake, is potentially involved in PCa progression. We analysed the FA composition of PPAT, in correlation with the ethno-geographical origin of the patients and markers of tumour aggressiveness. Methods - From a cohort of 1000 men treated for PCa by radical prostatectomy, FA composition of PPAT was analysed in 156 patients (106 Caucasians and 50 African-Caribbeans), 78 with an indolent tumour (ISUP group 1 + pT2 + PSA

International audience; PURPOSE: To evaluate long-term use, efficacy and tolerability of transcutaneous tibial nerve stimulation (TTNS) in the treatment of refractory overactive bladder (OAB).METHODS: We performed a prospective observational study and included all patients treated in a single center for OAB persisting after first-line anticholinergic treatment, with ≥ 24months follow-up. The protocol consisted of daily stimulation at home. The primary outcome was treatment persistence. Amelioration was defined as an improvement in urinary symptom profile (USP) score.RESULTS: We assessed 84 consecutive patients. After a mean follow-up of 39.3months and a mean treatment use of 8.3months, almost two-thirds of patients (71.8%) had discontinued TTNS. Treatment continuation was > 12months for 28 patients (33.3%) and > 18months for 16 patients (19%). TTNS was successful following 3months of treatment in 60 (71%) patients. Mean USP score stayed significantly lower than baseline until 12months of treatment, but was not significant anymore after 18months. Discontinuation therapy reasons were a lack of sufficient symptom relief for 59 (70%) patients, compliance difficulty for 5 (6%) patients and becoming asymptomatic for 6 (8%) patients. No serious adverse events occurred.CONCLUSIONS: The present study confirms the utility of TTNS as a treatment option for patients with resistant OAB. In the long-term use, few patients continued with therapy, mostly because of a decreased effectiveness with time.

International audience; INTRODUCTION: We evaluated the benefits of a specialized consultation created in 2014 for cutaneous penile lesions.MATERIALS AND METHODS: We performed a descriptive prospective study evaluating all patients sent for a monthly urologic-dermatologic consultation at a French university hospital from September 2014 to September 2015 for cutaneous penile lesions. All patients evaluated were included. We collected the demographic data, clinical examination findings, and the proposed diagnosis and treatment for every patient.RESULTS: A total of 27 patients were included; 4 (14.8%) had been referred by a general physician and 23 (85.2%) by a specialist. Cutaneous penile lesions had evolved within12 months in 15 patients (55.6%). Penile cancer was diagnosed in 5 patients (18.5%), of which 3 were squamous cell carcinoma (11.1%), 1 was metastasis of melanoma (3.7%), and 1 was extramammary Paget disease (3.7%). In addition, 1 patient (3.7%) had a premalignant lesion on a condyloma, 12 (44.4%) had balanitis, 2 (7.4%) had psoriasis lesions, 3 (11.1%) had condylomas, 1 (3.7%) had genital melanosis, and 3 (11.2%) had normal findings. Four patients (16.6%) underwent biopsy, 8 (33.3%) underwent surgery, and 12 (50%) received local treatment.CONCLUSION: The use of urologic-dermatology specialized consultations resulted in encouraging findings. Patients can benefit from multidisciplinary expertise and rapid treatment of various disorders. Thus, it seems important to develop reference centers created specifically for cancerous disease.

International audience; Prostate-specific antigen (PSA) is still the cornerstone of prostate cancer (PCa) screening and diagnosis in both research and current clinical practice. Inaccuracy of PSA is partly due to the influence of a number of genetic, clinical, and biological factors modifying PSA blood levels. In the present study, we detailed the respective influence of each factor among age, body mass index (BMI), prostate volume, and five single-nucleotide polymorphisms-rs10788160 (10q26), rs10993994 (10q11), rs11067228 (12q24), rs17632542 (19q13.33), and rs2928679 (8p21)-on PSA values in a cohort of 1374 men without PCa. Our results show that genetic factors, when risk variants are combined, influence PSA levels with an effect size similar to that of BMI. Taken together, the respective correlations of clinical parameters and genetic parameters would make it possible to correct and adjust PSA values more effectively in each individual. These results establish the basis to understand and implement a more personalised approach for the interpretation of PSA blood levels in the context of PCa screening and diagnosis. PATIENT SUMMARY: Prostate-specific antigen (PSA) values in an individual may vary according to genetic predisposition. The effect size of this variation can be significant, comparable with those resulting from clinical characteristics. Personalised PSA testing should take this into account

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.

Objectives To evaluate the optimal treatment conditions and effects of TOOKAD® Soluble vascular-targeted photodynamic (VTP) therapy in patients with localised prostate cancer. To evaluate the safety and quality of life after TOOKAD® Soluble VTP treatment in patients with localised prostate cancer. Patients and Methods Men (aged >18 years) diagnosed with localised prostate cancer, who were suitable for active surveillance, were invited to take part in the study. Patients who had received prior or current treatment for their cancer were excluded. There were two parts to the study: in part one, patients were assigned to one of two treatment groups based on the size of their prostates (patients with prostate size 80% of patients treated with this regimen having a negative biopsy at 6 months. Overall, the treatment was well tolerated and exhibited early signs of efficacy for minimally invasive focal treatment of localised prostate cancer.

Purpose To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). Methods A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. Results Consensus was attained on 23 of 27 topics; TargetedFT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. Conclusion Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1782-x) contains supplementary material, which is available to authorized users.

Proteomics is the branch of science concerned with understanding the expression, interactions and functions of proteins. Recent technical advances in the separation, analysis and identification of proteins combined with sophisticated bioinformatics, have allowed the technique to be applied to a multitude of diseases, including urological malignancies. Although two-dimensional gel electrophoresis combined with peptide mass fingerprinting has been the 'workhorse' of proteomics, other techniques such as Surface Enhanced Laser Desorption Ionisation Time-Of-Flight Mass Spectrometry (SELDI-TOF-MS), Isotope Coded Affinity Tag (ICAT) and Stable Isotope Labelling by Amino-acids in Culture (SILAC), are amongst the emerging technologies showing great promise. Much of the previous studies into urological malignancies have been fuelled by the urgent need to identify accurate biomarkers for the diagnosis, prognosis and monitoring of disease. The purpose of this review is to firstly give an overview of the basic concepts of commonly used proteomic techniques and to highlight their advantages and limitations. Secondly, the applications of these techniques to the study of urological malignancies (prostate, bladder and kidney) are reviewed. Finally, the future challenges faced by proteomics are discussed. © 2005 Elsevier B.V. All rights reserved.

Three-dimensional ultrasound (3-D US) is a non-invasive method of producing whole volume images of solid structures. Early work on prostate imaging identified several advantages over 2-D imaging with a good ability to detect intraprostatic lesions. Several 3-D transrectal ultrasound (3-D TRUS) systems are now available for prostate imaging. Initial work using gray scale ultrasound appears promising with reported overall staging accuracies of up to 94%. These results were favourable when compared to other modalities for local staging of prostate cancer. Several adjuncts to 3-D gray scale TRUS have been investigated. A greater sensitivity for cancer detection has been achieved with the addition of power colour Doppler and contrast agents. Further clinical applications for 3-D TRUS include assessing placement of brachytherapy seeds and for cyroablation techniques. Computer enhancement with image registration has shown that 3-D US images can be manipulated to derive more information. Although the results of gray scale imaging alone or with adjuncts and post processing appear promising, these techniques remain largely experimental.

BACKGROUND S100A6 and S100A2 are members of the S100 family of calcium binding proteins, which are down regulated in prostate cancer, however the molecular mechanism(s) underlying their loss of expression is unknown. METHODS The promoter and exon 1 region of the S100A6 and S100A2 genes was sequenced in bisulfite modified DNA from non-malignant, benign prostatic hyperplasia (BPH), malignant and metastatic prostate tissues and in cell lines. Immunohistochemistry was performed to correlate S100A2 expression with methylation status. RESULTS S100A6 methylation was absent or occurred at isolated sites in 14/14 cases of non-malignant epithelium and 5/5 cases of BPH tissues, whereas methylation was seen in 14/27 (52%) cases of prostatic cancer (P

Resume La suppression androgenique augmente clairement la survenue de facteurs de risque cardiovasculaire : augmentation de la masse grasse, diminution de la masse maigre, dyslipidemie et diabete de type II. De ce fait, plusieurs etudes (mais pas la totalite), ont rapporte une augmentation des pathologies coronariennes mais aussi de la mort subite et des arythmies ventriculaires letales en rapport avec une suppression androgenique, meme de courte duree. Ce risque est particulierement important chez les patients ayant deja des facteurs de risques cardiovasculaires ou des antecedents de pathologie cardiaque. Cet exces de risque cardiovasculaire est a mettre en balance par rapport au benefice de l’hormonotherapie en particulier sur la survie globale quand celle- ci est proposee en situation adjuvante a la radiotherapie, pour les tumeurs localement avancees de la prostate. En pratique, il est recommande que les patients soient adresses a leur medecin traitant pour une evaluation avant le debut du traitement, puis 3 a 6 mois apres le debut du traitement, puis une fois par an. L’evaluation initiale doit comprendre : un examen clinique (avec mesure de la tension arterielle et de l’indice corporel) et un examen biologique avec un bilan lipidique complet (Cholesterol total, HDL et LDL cholesterol, triglycerides) et glycemique. Il est egalement recommande que les patients avec une pathologie cardiovasculaire beneficient de conseils hygieno- dietetiques et de faibles doses d’aspirine (80 mg/j).

Study Type – Therapy (multi-centre cohort) Level of Evidence 2b OBJECTIVE To evaluate the early functional outcomes of transurethral plasma vaporization of the prostate (TUVis) in a multicentre study. PATIENTS AND METHODS A prospective multicentre observational study was conducted in eight urology departments. The inclusion criterion was benign prostatic hyperplasia (BPH) requiring surgical treatment. Patients on anti-coagulant therapy were not excluded. The TUVis procedure was performed according to a classic transurethral resection of the prostate (TURP) scheme following the manufacturer’s recommendations. We evaluated subjective functional outcome using self-questionnaires (International Prostate Symptom Score [IPSS] and five-item International Index of Erectile Function [IIEF-5]) and objective criteria (prostate volume, prostate-specific antigen [PSA], uroflowmetry, post residual volume) at baseline and at 1- and 3-month follow-ups. All types of complications were systematically recorded. RESULTS Despite 52% of patients receiving anticoagulant therapy before surgery, we reported only 3% with haemorrhagic complications, no blood transfusion, a mean catheterization time of 44 h and a mean postoperative stay of 2.9 nights. No significant change in irrigation time, catheter time or hospital stay was observed in patients with or without anticoagulant therapy. The IPSS and bother scores significantly decreased after the 3-month follow-up (57% and 59%, respectively), but the average remaining prostate volume was 29 cc and the tissue ablation rate was only 0.5 cc/min. Three major complications occurred, consisting of two urinary fistulas and one partial bladder coagulation. CONCLUSIONS The TUVis procedure has a proven fast postoperative recovery time, good short-term functional outcome and good haemostatic efficiency. However, the tissue ablation rate was lower than expected and we encountered three major complications, the mechanisms of which remain unclear. Considering the high energy level required to create the plasma effect, the generator, cable and resectoscope must be carefully checked before each procedure.

OBJECTIVES: Polyamines: Spermine (Spm) and Spermidine (Spmd), are essential for cell proliferation and differentiation. A measurement of erythocytes polyamines (EPA) was developed in our institution. Our objective was to evaluate this marker as a new prognostic factor in renal cell carcinoma. PATIENTS AND METHODS: A blood sample was prospectively taken before surgery, among 418 patients who had an enlarged nephrectomy (n=318) or a partial nephrectomy (n=100) to quantify EPA rates by using the HPLC technique. The qualitative and quantitative variables have been compared using chi(2) and Student statistical analyses. The survivals have been normalized by the Kaplan Meier and Cox methods. RESULTS: The average age of our population was 64 years (21-88). The average decline was 41 months (1-214). The median size of tumors was 6.5cm (1-24). The median rate of Spm and Spmd were respectively 4.7 (1-83) and 9 (2-86)nmol/8.10(9) erythrocytes. Spm and Spmd were linked to the T stage (p=0.001), and the ECOG (p=0.001 and 0,008). Spm was not linked at N and M stages but at the Fuhrman grade (p=0.001). Spmd was linked to the N, M stages (p=0.04). With univariate analysis, the tumor diameter, the TNM stage, the Fuhrman grade as well as Spm and Spmd (p

Resume Apres avoir expose les principes theoriques du laser dans l’HBP, cette seconde partie adopte une approche beaucoup plus pragmatique qui vise a familiariser l’utilisation des principaux lasers disponibles sur le marche francais. Le fonctionnement des differents dispositifs medicaux est presente dans le detail en insistant sur les fiches techniques et sans oublier les accessoires parfois indispensables. Seront decrits successivement le Greenlight d’AMS, le Revolix™ de Lisa, le Versapulse de Lumenis.

Purpose: Recently, two independent loci located at 8q24 that contribute to prostate cancer risk in men of European origin were identified. Experimental Design: Using Bayesian probability network and logistic regression model, we searched for associations between 34 single-nucleotide polymorphisms (SNP) located at 8q24 and the aggressiveness patterns of prostate adenocarcinoma or familial history of cancers in 823 White Caucasian French men. Results: Probability network according to the Markov chain algorithm separated the SNPs into two main groups: The first one was linked to the locus marked by rs6983267 and the second one was linked to the locus marked by rs1447295. When the patients were stratified according to tumor stage and prostate-specific antigen value, the association between the variant genotypes from six SNPs located in the second network and prostate cancer risk was strongest or confined to the patients from the more aggressive classes. However, the association between prostate cancer risk and the CC genotype of rs7841264, which marked the recombination hotspot at 8q24, was confined to patients with the highest Gleason score (odds ratio, 2.15; 95% confidence interval, 1.27-3.64; P = 0.004). Interestingly, the G allele of rs6983267 was associated with familial prostate cancer risk. Conclusions: Our data further support that variability at 8q24 is associated with a high risk of aggressive prostate cancer at diagnosis and is linked with familial history of prostate cancer. These results corroborate that 8q24 SNPs must be evaluated in terms of prostate cancer aggressiveness markers to optimize early diagnosis procedures and management of the disease.

Resume Introduction Les facteurs determinant les variations anatomiques macroscopiques et microscopiques de la prostate au cours du vieillissement sont peu connus. Nous avons evalue la correlation entre des polymorphismes specifiques de genes impliques dans la synthese des androgenes et des œstrogenes et l’anatomie macroscopique (poids prostatique) et microscopique (rapport stroma/epithelium) de la prostate au cours de la senescence. Methodes Le poids et la surface stromale prostatique d’une serie autopsique de 85 hommes âges de plus de 50 ans ont ete mesures, puis compares en fonction des polymorphismes de genes impliques dans la regulation des androgenes ou des œstrogenes. Les polymorphismes etudies etaient le nombre de repetition CAG du recepteur aux androgenes (AR), le nombre de repetition TA et les variants V89L du gene de la 5-alpha reductase ( SRD5A2) pour les androgenes, et les variants A1A2 de la 17-alpha hydroxylase ( CYP17 ) et nombre de repetitions TTTA de l’aromatase ( CYP19 ) pour les œstrogenes. Resultats Aucune association entre le nombre de repetitions TA de SRD5A2 ou TTTA de CYP19 et les parametres anatomiques de la prostate n’a ete observee. Il existait une correlation positive statistiquement significative entre l’âge et le poids de la prostate ( r = 0,21, p = 0,05), une correlation negative statistiquement significative entre le poids prostatique et le nombre de repetitions CAG ( r = −0,32, p = 0,003). Le groupe avec moins de 20 repetitions CAG etait associe a un poids prostatique plus important que les autres groupes. La surface du stroma etait plus importante dans le groupe (20–23) repetitions CAG ( p = 0,02) et dans le groupe A2A2 de CYP17 ( p = 0,016) que dans les autres groupes. Conclusion Un petit nombre de repetitions CAG est associe avec un poids prostatique plus eleve. Le nombre moyen de repetitions CAG du recepteur aux androgenes et le variant A2A2 du gene CYP17 sont associes avec une surface stromale plus importante.

Resume Recemment, de nouvelles voies therapeutiques ont ete explorees afin d’ameliorer les troubles mictionnels des patients presentant des troubles urinaires du bas appareil lies a une hyperplasie benigne de la prostate. L’objectif de cet article est de realiser une mise au point sur ces traitements : anti-inflammatoire, antidiuretique, anticholinergique et toxine botulinique. Les anticholinergiques, associes au risque de retention urinaire se revelent efficaces pour les troubles irritatifs en association a un alpha-bloquant. Les antidiuretiques peuvent etre proposes chez les patients de moins de 65 ans presentant une polyurie confirmee par un calendrier mictionnel, invalidante, liee a une HBP et refractaire au traitement classique de I’HBP. L’interaction entre l’inflammation et HBP n’est pas encore clarifiee. Les anti-inflammatoires semblant ameliorer les symptomes trouveraient peut etre une place dans un traitement ponctuel de 1’HBP car leur utilisation au long cours n’est pas recommandee. Les inhibiteurs de cox-2 ont ete retires du marche. Enfm, la toxine botulinique pourrait avoir une place dans le traitement des troubles lies a I’HBP si les etudes cliniques confirment les resultats prometteurs recemment publies. Ces nouvelles approches seront probablement a integrer dans les recommandations et les arbres decisionnels du traitement des troubles mictionnels lies a I’HBP.

It is established that partial nephrectomy is the standard of care for tumors confined to the kidney. Achieving a partial nephrectomy without renal ischemia and limiting operative bleeding is the subject of numerous researches. Since 2010, hybrid operating rooms have been used to perform both interventional radiology and surgical procedures at the same place and time. We used this latest technology to treat 3 patients with localized kidney tumors. The tumors were of moderate complexity and all were treated after immediate hyperselective embolization by laparoscopic surgery without dissection and clamping of the renal pedicle. The embolization of tumor vessels could be performed using image-stitching software. After embolization, operative time was 50, 70 and 80 minutes and blood loss was less than 100 ml for each case. Postoperative control 3D arteriography confirmed the respect of the vascularization of the healthy renal parenchyma. No postoperative complications occurred. Combined approach including hyperselective embolization and partial nephrectomy in the same time in a dedicated operating room is a new approach of zero ischemia during partial nephrectomy which reduces the difficulty of the surgery, limits injury to the kidney and increases patient safety.

The aim of this study was to identify predictive factors of urolithiasis etiology for acute renal colic (ARC) during pregnancy.We performed a retrospective review of all pregnant women hospitalized for an ARC between January 2007 and October 2012 in the department of Obstetrics and Gynecology of a University Hospital. Univariate and multivariate regression models were used to assess potential predictive factors of urolithiasis etiology.We included 82 patients. A urolithiasis was identified in 24 (29.3%) patients. In univariate analysis, we identified the following predictive factors for a urolithiasis etiology: primiparity (p = 0.017), leukocyturia (p = 0.021), left hydronephrosis10 mm and15 mm (p = 0.009; p = 0.02) and right hydronephrosis15 mm (p = 0.019). In multivariate analysis, only left hydronephrosis10 mm remained predictive for a urolithiasis etiology (p = 0.036; HR 7.45). A ureteral stenting was necessary for 23 patients (28.0%). Three patients (3.7%) had a premature membrane rupture and two patients (2.4%) delivered prematurely. After delivery, 10 patients (12.2%) required surgical treatment.Left hydronephrosis was related to urolithiasic etiology for ARC. Obstetrical consequences of ARC were minor.

Objectives To describe the step-by-step learning curve of the holmium laser enucleation of the prostate (HoLEP) surgical technique. Subjects/patients and methods A prospective, multicentre observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy but never having performed HoLEP. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation within 90 min (n = 51), followed by conversion to TURP (n = 14), incomplete morcellation (n = 8), significant stress (n = 9), or difficulty (n = 14) during HoLEP. Ignoring operating time, 64% of procedures were successful and four out of five centres did four consecutive successful cases. Of the five centres that completed the study, four chose to continue HoLEP. Conclusion Even in a prospective training structure, HoLEP has a steep learning curve exceeding 20 cases, with almost half of our centres choosing to abandon or not to continue with the technique. Operating time and difficulty of the enucleation seem the most important problems for a beginner. A more intensely mentored and structured mentorship programme might allow safer adoption of the procedure.

Nowadays the management of benign prostatic hypertrophia (BPH) is undergoing striking changes. The standard medical treatments are represented by three families which are the phytotherapy, the alpha-blockers and the 5-alpha-reductase inhibitors. These treatments were deemed as symptomatic and used only as monotherapy. Recent numerous studies bring new assessments on BPH: the medical treatment is able to modify the natural history of BPH especially by reducing the risk of acute urinary retention. Furthermore the association of two different therapeutic classes seems to be more efficient than the use of a monotherapy in some cases. Similarly the place of two instrumental techniques, the thermotherapy by microwaves or by radiofrequencies, previously proposed as alternatives to the surgical treatment seems to find their way rather as alternatives to the medical treatment. These different elements allow building a renewed decision tree which decisions are shared with the patient at each stage. This decision tree of the management of patients having non-complicated BPH symptoms must include initial clinical characteristics of the patient and its disease and the evolution under treatment which has not been yet considered in the international recommendations. It also considers the possibilities of associations with other therapeutic classes.

We investigated whether genetic lesions such as loss of heterozygosity (LOH) are detected in prostatic cells obtained by prostatic massage during early diagnosis of prostate cancer (CaP) and discussed their clinical relevance. Blood and first urine voided after prostatic massage were collected in 99 patients with total prostate-specific antigen (PSA) between 4 and 10 ng ml−1, prior to prostate biopsies. Presence of prostatic cells was confirmed by quantitative RT–PCR analysis of PSA mRNA. Genomic DNA was analysed for LOH on six chromosomal regions. One or more allelic deletions were found in prostatic fluid from 57 patients analysed, of whom 33 (58%) had CaP. Sensitivity and specificity of LOH detection and PSA free to total ratio

OBJECTIVE: Benign prostatic hyperplasia (BPH) is the most common benign tumour in ageing men. While the etiopathology remains unsolved, a disruption in the endocrine/autocrine-paracrine prostatic homeostasis, involving steroid hormones, contributes to the pathogenesis of BPH. DNA polymorphisms in genes involved in hormone synthesis, signalling and metabolism may, therefore, be responsible for these changes. We have evaluated the correlation between specific genotypes in androgen- and oestrogen-regulating genes (AR, SRD5A2, CYP17 and CYP19), and age-related prostatic changes. METHODS: We have tested genetic susceptibility to morphological and pathological criteria in 195 French Caucasians, using allelic variants for candidate genes involved in androgen/oestrogen prostatic activity: androgen receptor (CAG repeats), 5alpha-reductase type 2 (TA repeats, V89L and A49T mutations), A2 variant of the 17alpha-hydroxylase (CYP17) and the simple tandem repeat polymorphism (STRP) aromatase (CYP19) polymorphisms. RESULTS: The A2 variant of 17alpha-hydroxylase (CYP17) and allele 191 of STRP aromatase (CYP19) showed an opposite effect on age-related prostate hyperplasia: CYP17 being associated with increased risk of prostate enlargement and CYP19 with reduced risk. The 5alpha-reductase type II variants studied did not show links with prostate hyperplasia. The androgen receptor gene CAG repeat length showed a low correlation with the increase of prostate weight, suggesting some effect on age-related prostate growth. CONCLUSION: These results suggested that common variants of the CYP17 gene are associated with prostate enlargement and therefore may increase the risk of development of BPH in this population, while infrequent variants of the aromatase gene (CYP19) could be of a protective nature.

ObjectifsNNMT (nicotinamide N-méthyltransférase) est une enzyme de la voie des pyridines. Les études d’analyse protéomique ont démontré sa surexpression dans le carcinome rénal à cellules claires (CRCC). Des études de validation immunohistochimiques ont montré son association avec les tumeurs à risque d’évolution défavorable. Nous avons voulu étudier le lien entre la survie de patients atteints de CRCC et l’expression tissulaire de NNMT comme potentiel biomarqueur.MéthodesNous avons inclus de manière prospective au sein de la base de données nationale UroCCR 137 patients opérés d’un CRCC. Nous avons étudié l’intensité du marquage cellulaire intracytoplasmique de NNMT (cotée de 0 à 3) évaluée par le même pathologiste pour l’ensemble des tumeurs et nous avons étudié la corrélation entre cette donnée de pathologie cellulaire et la survie (globale et sans récidive) des patients en fonction de l’âge et de l’agressivité tumorale définie grâce au score SSIGN (pTNM, taille tumorale, grade histopronostique de Fuhrman et présence de nécrose). Le test du log rank et le modèle de Cox étaient utilisés.RésultatsNous avons inclus dans notre étude 126patients (onze patients avec des données manquantes). L’intensité du marquage tissulaire intracytoplasmique de NNMT était cotée à 0 (absente) dans 7cas, à 1 (faible) dans 20cas, à 1,5dans 28cas, à 2 (intermédiaire) dans 27cas, à 2,5dans 19cas et à 3 (élevée) dans 25cas. Un score SSIGN≤6était retrouvé dans 89cas et un score SSIGN>6dans 38cas. Durant la première année de suivi, une intensité cellulaire de NNMT>2,5était associée à un pronostic défavorable indépendamment du score SSIGN (p=10–3). Ce seuil d’intensité cellulaire était associé à des tumeurs de score SSIGN>6 (p=0,01) de moins bon pronostic.ConclusionNous avons démontré qu’une intensité intracytoplasmique élevée de NNMT, évaluée en anatomocytopathologie, était associée à une évolution péjorative des patients atteints d’un CRCC durant la première année de suivi indépendamment de l’agressivité de leur tumeur. Il s’agit d’un biomarqueur corrélé à des tumeurs agressives de score SSIGN>6ce qui souligne le rôle potentiel de NNMT comme biomarqueur histopronostique du CRCC. NNMT pourrait présenter un intérêt dans la sélection des patients nécessitant un traitement adjuvant.

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.

To investigate feasibility, safety, and efficacy of salvage radical prostatectomy (RP) for recurrent prostate cancer (PCa) after focal treatment with TOOKAD® Soluble vascular-targeted photodynamic therapy (VTP). Nineteen patients underwent RP after biopsy-proven PCa post-focal VTP. We reported: operation time, blood loss, transfusion, complications, urethral catheterization time, functional outcomes, and short-term oncologic outcomes. Median age was 64 years (58–70). Median PSA before VTP was 6.30 ng/ml (3.20–9.80). Median delay between VTP and RP was 17 months (8–48). Median blood loss was 400 ml (100–1,000). Median operation time was 150 min (90–210), median urethral catheterization time was 7 days (5–18), and median hospital stay was 7 days (4–21). There was no perioperative mortality. Three patients had related per-operative complications: one pelvic hematoma (150 cc) (Clavien IIIa), one per-operative transfusion (900 cc hemorrhage) (Clavien II), and one superficial wound infection (Clavien I). After a median follow-up of 10 months (1–46), 13 were completely continent (68 %), five needed ≤1 pad/day, and one needed 3 pads/day (Clavien I). Severe erectile dysfunction was observed before and after RP (respectively 8 and 18). Ten patients regained potency with appropriate treatment. Median postoperative PSA was 0.02 ng/ml (

Purpose To evaluate the 6-month effects of the recommended drug and light dosage in focal vascular-targeted photodynamic therapy (VTP) using TOOKAD® Soluble in patients with localized prostate cancer (LPCa). Methods We performed a pooled analysis of 117 men with LPCa, PSA

Ureteral stent placement is a key urologic procedure used to manage ureteral obstructions. It is usually performed under general anesthesia (GA) with its inherent risks. The objective was to evaluate safety, feasibility and tolerance of ureteral stent placement under local anesthesia (LA) in women.From January 2010 to January 2013, we prospectively and consecutively reviewed all female patients who had an urgent retrograde ureteral stent placement under LA. Only primary stent placements were included in the study. Pain was assessed after surgery by Visual Analog Scale (VAS) and pain and comfort assessment during stent placement were reported. We compared outcomes and tolerance with patients under general anesthesia (GA) matched by age and operatives indications during the same period.We included 36 patients (18 under LA and 18 under GA) with a mean age of 59.4 +/- 22.4 years. The mean operative time was 24.4 +/- 12.9 min and 18.8 +/- 6.5 min in LA group and GA group (p = 0.110), respectively. One patient needed GA due to a poor tolerance. The mean perioperative VAS scores under LA and GA were 5.89 +/-2.95 and 2.06 +/- 2.67 (p0.0001), respectively. There were no intraoperative complications in either group. The procedure was painful for 16 (88.8%) patients from the LA group and 9 (50%) patients would not accept to undergo this intervention under LA again.Ureteral stent placement under LA in women can be performed safely and effectively. However, this procedure is painful and should be proposed only to selected cases.

International audience; OBJECTIVE: To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management. METHODS: We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick's classification. RESULTS: Before TMT, thrombus level was staged I for 1 (7%), II for 10 (72%) and III (21%) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1-5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43%) patients had a measurable decrease, 6 (43%) had no change, and 2 (14%) had an increase in the thrombus. One patient (7%) had a downstage of thrombus level, 12 (85%) had stable thrombi, and 1 (7%) had an upstage. Regarding primary tumor, 7 (50%), 5 (36%) and 2 (14%) patients had a decrease, stabilization and an increase in tumor size, respectively. CONCLUSION: Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.

International audience; BACKGROUND: The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors \textgreater 7 cm. MATERIALS AND METHODS: We retrospectively analyzed data from 168 patients with tumors \textgreater 7 cm who were treated using NSS between 1998 and 2012. RESULTS: Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P = .001; hazard ratio [HR], 5) and tumor malignancy (P = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P = .023; HR, 4.2), positive surgical margin (P = .021; HR, 3.3), and Fuhrman grade \textgreater II (P = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P = .04; HR, 8.5) and Fuhrman grade \textgreater II (P = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. CONCLUSION: In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.

To evaluate the optimal treatment conditions and effects of TOOKAD(®) Soluble vascular-targeted photodynamic (VTP) therapy in patients with localised prostate cancer. To evaluate the safety and quality of life after TOOKAD(®) Soluble VTP treatment in patients with localised prostate cancer.Men (aged18 years) diagnosed with localised prostate cancer, who were suitable for active surveillance, were invited to take part in the study. Patients who had received prior or current treatment for their cancer were excluded. There were two parts to the study: in part one, patients were assigned to one of two treatment groups based on the size of their prostates (patients with prostate size60 mL would receive 4 mg/kg TOOKAD(®) Soluble and patients with prostate size ≥60 mL would receive 6 mg/kg TOOKAD(®) Soluble both activated with 200 J/cm light). In part two, patients were assigned to one of two treatment groups based on predefined criteria and received either 4 or 6 mg/kg TOOKAD(®) Soluble and 200 or 300 J/cm light. VTP was conducted under general anaesthesia using TOOKAD(®) Soluble administered intravenously and activated by light-diffusing fibres within the prostate via the perineum. Follow-up was conducted for 6 months. Magnetic resonance imaging (MRI) carried out at 1 week after VTP and transrectal prostate biopsy at 6 months were the key endpoints. Adverse event (AE) recording and patient-reported outcome measures were collected.In all, 86 patients were enrolled in the study and 85 patients received treatment. Of the 85 treated patients, one patient discontinued (due to withdrawal of consent). At 6 months, 61/83 (74%) patients who underwent prostate biopsy had histopathology that was negative for prostate cancer (95% confidence interval (CI) 62.7-82.6%). Considering patients who received 4 mg/kg TOOKAD(®) Soluble and 200 J/cm light (unilateral), which are considered optimal treatment parameters, 38/46 (83%) patients had histopathology from the biopsies that was negative for prostate cancer at 6 months (95% CI 68.6-92.2%; P0.001). The mean percentage of necrosis of the targeted prostate tissue at 7 days after VTP was 78% overall (83 patients) with extraprostatic necrosis reported in 76% (63/83) of patients. Considering patients who received 4 mg/kg TOOKAD(®) Soluble and 200 J/cm light (unilateral), the mean 7-day necrosis percentage was 88% (46 patients) with extraprostatic necrosis reported in 72% (33/46) of patients. All occurrences of extraprostatic necrosis were considered clinically acceptable and none were associated with any clinical sequelae. The mean percentage prostate necrosis at 7 days was statistically significantly higher (P0.001) in patients treated with a therapeutic light density index (LDI) of ≥1 than those treated with a LDI of1. The percentage of patients with negative biopsies at 6 months was also higher in patients treated with a therapeutic LDI of ≥1 than those treated with a LDI of1 (78.6% and 63.0%, respectively). In all, 87% (75/86) of patients reported at least one treatment-emergent AE during the study. Most AEs were mild or moderate in intensity and considered related to the technical procedures of the study. No treated patients had hypotension or discontinued due to AEs. Eight patients (9.3%) had serious AEs; none resulted in discontinuation from the study.Biopsy data, post-treatment dynamic contrast-enhancement MRI at 1 week after VTP and analysis of the safety data have shown that 4 mg/kg TOOKAD(®) Soluble and 200 J/cm light are the optimal treatment conditions for the VTP procedure resulting in80% of patients treated with this regimen having a negative biopsy at 6 months. Overall, the treatment was well tolerated and exhibited early signs of efficacy for minimally invasive focal treatment of localised prostate cancer.

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$

To evaluate the overall survival postnephrectomy for renal cancer for patients aged over 80 years, and to identify preoperative prognostic factors that might influence therapeutic strategies.In a retrospective study in five French departments of urology, 179 patients aged over 80 years with renal cell carcinoma underwent radical nephrectomy between 1990 and 2011. The following data were collected: age, sex, body mass index, Charlson Comorbidity Index, American Society of Anesthesiology class, Eastern Cooperative Oncology Group Performance Status, type of surgery, period of follow-up, survival, death etiology, symptoms, Fuhrman grade and tumor-nodes-metastasis stage.After a 29.6-month follow up, 89 patients (49.7%) died. Death etiologies were: cancer for 46 (52%) patients, immediate or distant perioperative complications for five patients (6%) and three patients (3%) respectively, cardiovascular disease for 16 patients (18%), other cancers for three patients (3%) and unknown for 16 patients (18%). In a multivariate analysis, T-stage, M-stage and Charlson Comorbidity Index were identified as independent prognostic factors. Patients were divided into three groups (good, intermediate and bad prognosis) with significantly different survivals of 91, 36 and 22 months (P0.0001), respectively.Preoperative data, including T-stage, M-stage and Charlson Comorbidity Index represent significant independent prognostic factors for survival for patients aged over 80 years. These data might help the clinician in selecting the most suitable candidates for radical nephrectomy among elderly patients with renal cancer.

To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transurethral plasma vaporization of the prostate in saline water (TUVis) and transurethral resection of the prostate (TURP).Between January and December 2009, 111 patients on OA therapy were treated with either TURP or TUVis in eight centers. Types of OA and perioperative management were collected. Postoperative outcomes were statistically compared between the two groups.A total of 57 (51%) and 54 (49%) patients were treated with TURP and TUVis, respectively. Types of OA were not significantly different between the two groups, but bladder catheterization prior to surgery was more frequently observed in the TUVis group. Before surgery, 28 patients were treated with warfarin alone, 74 with a platelet aggregation inhibitor (PAI) alone, and 9 with a combination of both. PAI was withdrawn preoperatively in 50 patients. All treatments with warfarin were switched for heparin. Comparison of the two groups showed significantly less hemorrhagic complications after TUVis. Patients treated with TUVis experienced less bladder washouts (2% versus 18%, p = 0.008), less late hematuria (4% versus 19%, p = 0.02), and lower decrease of serum hemoglobin (mean decrease of 0.66 versus 1.47 g/dL, p = 0.02). Postoperative bladder catheterization and hospital stay were significantly shorter, whereas the rate of urinary retention was significantly higher. Three months after surgery, functional results were not significantly different between the two groups.In patients on OA, TUVis led to significantly less bleeding, as well as shorter bladder catheterization and hospital stay than TURP.

PurposeTo guide ultrasound-driven prostate photodynamic therapy using information from MRI-based treatment planning. MethodsRobust points matching (RPM) and thin plate splines (TPS) are used to solve correspondences and to map optimally positioned landmarks from MR images to transrectal ultrasound (TRUS) images. The algorithm uses a reduced number of anatomical markers that are initialized on the images. ResultsBoth phantom and patient data were used to evaluate precision and robustness of the method. Mean registration error (?standard deviation) was of 2.18?0.25mm and 1.55?0.31mm for patient prostate and urethra, respectively. Repeated tests with different markers initialization conditions showed that the quality of registration was neither influenced by the number of markers nor to the human observer. ConclusionThis method allows for satisfyingly accurate and robust non rigid registration of MRI and TRUS and provides practitioners with substantial help in mapping treatment planning from pre-operative MRI to interventional TRUS.