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Our aim was to prospectively evaluate the diagnostic accuracy of sentinel lymph node biopsy-guided lymph node dissection compared to extended pelvic lymph node dissection in patients with intermediate- or high-risk prostate cancer.We conducted a prospective, single-arm, multicenter study at 3 tertiary centers in France between February 2012 and May 2019. Eligible patients had clinically localized intermediate- or high-risk prostate cancer. After intraprostatic injection of (99m)Tc-nanocolloid, the locations of the sentinel lymph nodes were defined by preoperative lymphoscintigraphy. Surgical excision of the sentinel lymph nodes was performed using intraoperative gamma probe guidance. After resection of the sentinel lymph nodes, extended pelvic lymph node dissection was performed in all patients. We assessed the diagnostic accuracy of the sentinel lymph node biopsy method using extended pelvic lymph node dissection as the reference standard. This trial was registered in ClinicalTrials.gov (NCT02732392).A total of 162 men cN0M0 (CT scan and bone scan) were enrolled: 106 (65.4%) and 56 (34.6%) patients had intermediate- and high-risk prostate cancer, respectively. The median number of nodes retrieved was 14 (mean 16, IQR 10-21) per patient. At final pathological analysis, 22 patients (13.6%) were pN+. Sensitivity, specificity, negative predictive value, and positive predictive value of sentinel lymph node biopsy method in detecting patients with at least 1 lymph node metastasis were 95.4% (95% CI, 75.1-99.7), 100% (95% CI, 96.6-100), 99.2% (95% CI, 95.5-99.9), and 100% (95% CI, 80.7-100), respectively.Our multicenter prospective study supports that sentinel lymph node biopsy is a very effective and sensitive method for pelvic lymph node staging in patients with intermediate- or high-risk localized prostate cancer.

PDF file 1160K, AM is a growth factor survival for LECs

PDF file 114K, described the legends of all the supplementary figures

Purpose: To study the role of the adrenomedullin system [adrenomedullin and its receptors (AMR), CLR, RAMP2, and RAMP3] in prostate cancer androgen-independent growth.Experimental Design: Androgen-dependent and -independent prostate cancer models were used to investigate the role and mechanisms of adrenomedullin in prostate cancer hormone-independent growth and tumor-associated angiogenesis and lymphangiogenesis.Results: Adrenomedullin and AMR were immunohistochemically localized in the carcinomatous epithelial compartment of prostate cancer specimens of high grade (Gleason score >7), suggesting a role of the adrenomedullin system in prostate cancer growth. We used the androgen-independent Du145 cells, for which we demonstrate that adrenomedullin stimulated cell proliferation in vitro through the cAMP/CRAF/MEK/ERK pathway. The proliferation of Du145 and PC3 cells is decreased by anti-adrenomedullin antibody (αAM), supporting the fact that adrenomedullin may function as a potent autocrine/paracrine growth factor for prostate cancer androgen-independent cells. In vivo, αAM therapy inhibits the growth of Du145 androgen-independent xenografts and interestingly of LNCaP androgen-dependent xenografts only in castrated animals, suggesting strongly that adrenomedullin might play an important role in tumor regrowth following androgen ablation. Histologic examination of αAM-treated tumors showed evidence of disruption of tumor vascularity, with depletion of vascular as well as lymphatic endothelial cells and pericytes, and increased lymphatic endothelial cell apoptosis. Importantly, αAM potently blocks tumor-associated lymphangiogenesis, but does not affect established vasculature and lymphatic vessels in normal adult mice.Conclusions: We conclude that expression of adrenomedullin upon androgen ablation in prostate cancer plays an important role in hormone-independent tumor growth and in neovascularization by supplying/amplifying signals essential for pathologic neoangiogenesis and lymphangiogenesis. Clin Cancer Res; 19(22); 6138–50. ©2013 AACR.

PDF file 97K, AM induced activation of MAPK pathway and Normal Vascularization is not disrupted by {alpha}AM treatment

Objectives To report the outcomes and feasibility of active surveillance (AS) of biopsy-proven renal oncocytomas. Methods Multicentric retrospective study (2010-2016) in 6 academic centers that included patients with biopsy-proven renal oncocytomas who were allocated to AS (imperative or elective indication) with a follow-up ≥1 year. Imaging was performed at least once a year, by CT-scan or ultrasound or MRI. Conversion to active treatment (surgical excision or ablative treatment) was at the discretion of the urologist. The primary endpoint was renal tumor growth (cm/year). Secondary outcomes included accuracy of biopsy, incidence, and reason to change AS to active treatment. Results Eighty-nine patients were included: Median age 67 years (26-89) and median tumor size 26 mm [15-90] on diagnosis. During a mean follow-up of 43 months’’ (median 36 [12-180]), mean tumor growth was 0.24 cm/year. No predictive factors (demographical, radiological or histologic) of tumor growth could be identified. Conversion from AS to active treatment occurred in 24 patients (27%) (13 surgical excisions, 11 ablative procedures), in a median time of 45 (12-76) months’’ after diagnosis. Tumor growth was the main indication to convert AS to active treatment (58%) with 8% of the patients opting to discontinue AS. No patient had metastatic progression nor disease-specific death. The correlation between biopsy and surgical specimen was 92%. Conclusion Active surveillance for biopsy-proven renal oncocytomas was oncologically safe and patient adherence was high. No predictive factor for tumor growth could be identified but the tumor growth rate was low, and biopsy efficacy was high.

Purpose To evaluate Hyperthermic-Intra-Vesical Chemotherapy (HIVEC) efficacy regarding 1-year disease-free survival (RFS) rate and bladder preservation rate in patients with High-risk Non-Muscle Invasive Bladder Cancer (NMIBC) who fail BCG therapy or are contraindicated to BCG. Methods Between June 2016 and October 2019, patients treated with HIVEC for mostly high-risk NMIBC who failed BCG or BCG-naive if BCG contraindicated have been included in our study. These patients had a theoretical indication for cystectomy but were ineligible for surgery or refused it. Results Fifty-three patients, median age 72 [39–93] years, were included in this study (n = 29 BCG-failure and n = 24 BCG-naive). The median follow-up was 18 months. The bladder preservation rate was 92.4%. The 12 months-RFS rate was 60.5%. The RFS rates for BCG-naive and BCG-failure groups were respectively 70% and 52.2% at 12 months. Three patients progressed to muscle infiltration, all in the BCG-failure group and all in the very high-risk EORTC group. Two of them developed metastatic disease and died from bladder cancer. Conclusion Chemohyperthermia using HIVEC achieved a RFS rate of 60% at 1 year and enabled a bladder preservation rate of 92%. Given the low risk of progression in the BCG-naive group, HIVEC could be a good alternative. Conversely, for patients with very high-risk tumors that fail BCG, cystectomy should remain the standard of care and HIVEC may be discussed cautiously for patients who are not eligible for surgery and well informed of the risk of progression to muscle-invasive disease.

OBJECTIVE To evaluate the renal function outcomes after selective trans-arterial embolization (SAE) of iatrogenic vascular lesions (IVL), including pseudoaneurysm and arteriovenous fistula, following partial nephrectomy (PN). MATERIALS AND METHODS A multi-institutional study was conducted including consecutive patients who underwent PN between January 2009 and March 2019. Two surgical approaches were used: open and robot-assisted PN. Patients with SAE were identified and matched (1:2) with patients without IVL. The matching criteria were age, gender, Charlson score, creatinine clearance, RENAL score, and tumor size. The primary outcome was the evolution of global renal function at 6-months postoperatively. RESULTS A total of 493 consecutive PN (360 open PN and 133 robot-assisted PN) were included. IVL occurred in 17 cases (3.4%) without statistical difference according to the surgical approach (P = .78). Patients from embolization group were matched to 34 cases without postoperative IVL. Groups were comparable concerning clinical, tumor and surgical characteristics. The clinical success of SAE, defined as the absence of recourse to a second embolization or a total nephrectomy, was obtained in 16 (94.1%) cases. No minor or major complications were reported after SAE. The preoperative estimated glomerular filtration rate (eGFR) was similar between control group (93 [85-102] ml/min) and embolization group (95 [83-102] ml/min) (P = .99). Median (IQR) eGFR between control group (87 [72-95] ml/min) and embolization group (83 [76-93] ml/min) at a follow-up of 6 months showed no significant difference (P = .73). CONCLUSION IVL are rare complications of PN. SAE is an effective and minimally invasive management tool, with no deleterious effect on global renal function.

To report the 10-year oncologic and functional outcomes of whole-gland HIFU as first-line treatment for localized prostate cancer (PCa).Patients were retrospectively included between January 2005 and July 2018 from a prospectively maintained database at a single academic institution. No patient underwent androgen deprivation therapy prior to HIFU. Primary endpoint was biochemical recurrence-free survival (BRFS). Secondary oncological endpoints included salvage treatment-free survival (STFS), cancer-specific survival (CSS) and overall survival (OS).A total of 97 patients met our inclusion criteria and were included in the final analysis. According to D'Amico classification, the numbers of patients with low-, intermediate-, and high-risk disease were 38 (39.2%), 52 (53.6%), and 7 (7.2%). A total of 21 (21.6%) patients received salvage treatment at a mean of 4.1 years (± 2.8) after HIFU. The 10-year OS, CSS and BRFS rates were 91.8%, 100% and 40.3% in the overall cohort, respectively. In multivariate analysis, predictive factors for biochemical recurrence were intermediate-risk group (RR = 2.065; 95% CI 1.008-4.230; p = 0.047) and PSA nadir 0.5 ng/mL (RR = 4.963; 95% CI 2.251-10.947; p 0.001). Symptoms related to bladder outlet obstruction were the most frequently recorded adverse events. In multivariate analysis, positive biopsy on the prostatic apex was predictor of obstructive complications (RR = 3.2, 95% CI 1.092-9.476, p = 0.034). Only four patients developed severe urinary incontinence ( 1 pad/day).HIFU showed low PCa-specific mortality, but biochemical recurrence rates were highly variable among patients. Future studies are needed to improve patient selection.

Purpose/objective: The association of 3D Conformal External Beam Radiotherapy (3D-CEBRT) with adjuvant Androgen Deprivation Therapy (ADT) proved to treat patients with intermediate- and high-risk localized prostate cancer (IR and HR). However, older patients were underrepresented in literature. We aimed to report the oncological results and morbidity 3D-CEBRT +ADT in &ge, 80 years patients. Material and Methods: From June 1998 to July 2017, 101 patients &ge, 80 years were included in a tertiary center. The median age was 82 years. ADT was initiated 3 months prior 3D-CEBRT in all patients, with a total duration of 6 months for IR prostate cancer (group A, n = 41) and 15 months for HR prostate cancer (group B, n = 60). Endpoints included overall survival (OS), metastasis-free survival (DMFS), biochemical recurrence-free survival (BRFS) and toxicity. Results: Five years-OS was 95% and 86.7% in groups A and B, respectively. Cardiovascular events occurred in 22.8% of &ge, 80 years patients with no impact on OS. In the multivariate analysis, age &lt, 82 years, Karnofsky index and normalization of testosterone levels were significantly associated with better OS. Conclusion: Age &ge, 80 years should not be a limitation for the treatment of IR and HR prostate cancer patients with 3D-CEBRT and ADT, but cardiovascular monitoring and prevention are mandatory.

To evaluate the performance of the Zumsteg classification to estimate the risk of lymph-node invasion (LNI) compared with the Briganti nomogram (BN) in prostatectomy patients with intermediate-risk prostate cancer (IRPC).We included consecutive patients who had extended pelvic lymph-node dissection associated with radical prostatectomy for IRPC. To be classified favorable intermediate risk (FIR), patients could only have one intermediate-risk factor, fewer than 50% positive biopsies and no primary Gleason score of 4.On the 387 patients included, 149 (38.5%) and 238 (54.3%) were classified FIR and unfavorable intermediate risk (UIR), respectively, and 212 (54.8%) had a BN inferior to 5%. Thirty-eight patients (9.8%) had LNI: 6 FIR patients (4.0%) versus 32 UIR patients (13.4%) and 14 patients (6.6%) with a BN inferior to 5% versus 24 patients (13.7%) with a BN superior to 5%. Eight patients with a BN inferior to 5%, but classified UIR, had LNI. Sensitivity to detect LNI was higher with the Zumsteg classification than with the BN: 84.2% (CI 95% [68-93]) versus 63.2% (CI 95% [46-78]). Both screening tests were concordant to predict LNI (kappa coefficient of 0.076, p 0.05 for Zumsteg and Briganti) CONCLUSIONS: Zumsteg classification appeared to be more sensitive and as effective (despite the impossibility to make decision curve analysis) than the BN to estimate the risk of LNI. Regarding the modest number of pN+ patients, further studies are needed to see the interest of proposing ePLND for UIR patients only.

Background To assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up. Methods This retrospective study analyzed 1275 RPs performed between January 1992 and December 2013 in two university centers in Marseille (France). The inclusion criteria were: follow-up > 24 months, undetectable postoperative prostate-specific antigen (PSA), no seminal vesicle (SV) invasion, no lymph node invasion confirmed by surgery (pN0) or imaging (pNx), and no neoadjuvant or adjuvant treatment. BR was defined by PSA level ≥ 0.2 ng/mL on two successive samples. We included 189 patients, divided into two groups: - Focal PSM (fPSM): single PSM (sPSM) ≤3 mm; - Extensive PSM (ePSM): sPSM with linear length > 3 mm or several margins regardless of the length. Results The median follow-up was 101 months (18–283) and the median age was 63 years (46–76). BR occurred in only 12.1% (14/115) of cases involving fPSM and in 54.1% (40/74) of cases involving ePSM. In the multivariate model, ePSM patients were significantly associated with increased BR compared to fPSM (hazard ratio [HR] = 6.11; 95% confidence interval [CI] = 3.25–11.49). The ePSM significantly decreased BR-free survival (p

There have recent reports in the literature of increased rates of bladder recurrence (BR) after radical nephroureterectomy (RNU) when diagnostic flexible ureteroscopy (DFU) was performed before RNU. The technical heterogeneity of DFU was a major bias in these studies. Our purpose was to evaluate the impact of a standardized DFU technique before RNU on the risk of BR. A retrospective monocenter study including patients who underwent RNU for upper tract urothelial carcinoma (UTUC) between 2005 and 2017. 171 patients were identified. 78 patients were excluded owing to a history of bladder cancer before RNU or neo-adjuvant/adjuvant chemotherapy. 93 included patients were stratified according to pre-RNU ureteroscopy (DFU + 70 patients) or no pre-RNU ureteroscopy (DFU—23 patients). The standardized DFU technique consisted of systematic ureteral sheath (ch9–10), flexible ureteroscopy, biopsy, and drainage with a mono-J/bladder catheter to avoid contact of contaminated urine of the upper tract with the bladder. Epidemiological, initial staging, and postoperative tumoral characteristics were similar in both groups. Mean follow-up was 35 months [2–166], 47(50%) BR occurred with 41(87%) in the DFU + group, and pre-RNU–DFU was an independent predictive factor of BR (OR = 4[1.4–11.9], P = 0.01) (Cox regression model). The characteristics of BR were similar in both groups, although BR occurred earlier in DFU + (427 days vs. 226 days (P = 0.07)). Bladder recurrence after diagnostic ureteroscopy + nephroureterectomy was high despite technical precautions to avoid contact of bladder mucosa with contaminated urine from the upper urinary tract. Post-DFU endovesical instillation should be investigated.

Resume Objectifs Evaluer l’efficacite d’une modification ou d’une initiation de traitement par un α-bloquant chez des patients deja traites medicalement pour des SBAU lies a une HBP, avec des symptomes urinaires persistants. Methodes Il s’agit d’une etude prospective observationnelle chez des medecins generalistes en France. Etaient inclus des patients de plus de 60 ans, ayant des SBAU lies a une HBP et traites medicalement depuis au moins 6 mois. Un traitement par un α-bloquant etait initie ou modifie si le PGI-I (Patient Global Impression of Improvement) n’objectivait aucune amelioration sous traitement et que le score IPSS etait ≥ 8. Les patients etaient ensuite suivis entre 1 et 3 mois apres l’inclusion. Le critere principal d’evaluation etait la frequence d’evolution non satisfaisante des patients, evalues par la persistance des symptomes urinaires sous traitement (IPSS ≥ 8 et PGI-I inchange ou aggrave). La progression des SBAU (IPSS et PGI-I) suite a la modification du traitement par α-bloquant, etait egalement evaluee lors de la visite de suivi. Resultats Trois cent cinquante-trois medecins ont inclus 1449 patients entre le 2 fevrier 2016 et le 9 mars 2017 (1380 patients ont ete analyses) : l’âge moyen etait de 70,0 ± 6,9 ans ; l’anciennete des SBAU etait de 4,1 ± 4,2 ans ; a l’inclusion, ils recevaient principalement des extraits de plantes (n = 744 ; 53,9 %) et des α-bloquants (n = 463 ; 33,6 %). Le score IPSS moyen etait de 16,4 ± 6,7, il n’etait pas correle avec l’anciennete des SBAU ; le PGI-I moyen etait de 2,6 ± 1,2. Au total, 48,8 % (612/1255) des patients ont eu une evolution non satisfaisante de leur SBAU traites medicalement depuis au moins 6 mois (critere principal de l’etude) ; 42,8 % (591/1380) des patients ont eu une modification de traitement selon le protocole : 385 (65,6 %) ont eu une initiation d’un α-bloquant, 202 (34,4 %) ont eu une modification du traitement par α-bloquant (4 donnees manquantes). L’α-bloquant etait en monotherapie pour 484 (81,9 %) patients. Lors de la visite de suivi (1 a 3 mois), le score IPSS moyen etait de 7,7 ± 4,8, significativement en baisse (18,7 ± 6,1 a l’inclusion) ; le PGI-I moyen de 1,2 ± 0,7 etait significativement en baisse (3,5 ± 0,8 a l’inclusion) ; la qualite de vie (Q8-IPSS) etait significativement amelioree. Pour les 345 patients sous extraits de plantes ayant change pour un α-bloquant, ainsi que pour les 67 patients sous α-bloquant ayant change pour un autre α-bloquant, les 3 scores avaient diminue significativement. Conclusion Une evaluation systematique du traitement medical de l’HBP a montre que 48,8 % des patients traites medicalement depuis au moins 6 mois n’etaient pas ameliores. Une modification de traitement par un alpha-bloquant (initiation ou modification) peut alors significativement ameliorer les SBAU.

International audience; Interventional radiology plays an important and increasing role in cancer treatment. Follow-up is important to be able to assess treatment success and detect locoregional and distant recurrence and recommendations for follow-up are needed. At ECIO 2018, a joint ECIO-ESOI session was organized to establish follow-up recommendations for oncologic intervention in liver, renal, and lung cancer. Treatments included thermal ablation, TACE, and TARE. In total five topics were evaluated: ablation in colorectal liver metastases (CRLM), TARE in CRLM, TACE and TARE in HCC, ablation in renal cancer, and ablation in lung cancer. Evaluated modalities were FDG-PET-CT, CT, MRI, and (contrast-enhanced) ultrasound. Prior to the session, five experts were selected and performed a systematic review and presented statements, which were voted on in a telephone conference prior to the meeting by all panelists. These statements were presented and discussed at the ECIO-ESOI session at ECIO 2018. This paper presents the recommendations that followed from these initiatives. Based on expert opinions and the available evidence, follow-up schedules were proposed for liver cancer, renal cancer, and lung cancer. FDG-PET-CT, CT, and MRI are the recommended modalities, but one should beware of false-positive signs of residual tumor or recurrence due to inflammation early after the intervention. There is a need for prospective preferably multicenter studies to validate new techniques and new response criteria. This paper presents recommendations that can be used in clinical practice to perform the follow-up of patients with liver, lung, and renal cancer who were treated with interventional locoregional therapies.

Summary Objectives To evaluate the efficacy of Continuous Saline Bladder Irrigation (CSBI) after blue light transurethral resection of bladder tumor (TURBT) to prevent recurrence of low- to intermediate-risk Non-Muscle Invasive Bladder Cancer (NMIBC). Patients and methods We conducted a retrospective study including patients with low- to intermediate-risk NMIBC who underwent TURBT in two urological centers between January 2017 and December 2018. Each TURBT was performed using blue light after intravesical instillation of hexaminolaevulinic acid. The experimental group included patients who received CSBI while the control group included patients without CSBI. When practice, CSBI was started immediately after the surgery and was interrupted 24 hours thereafter. Low-risk NMIBC had a surveillance while intermediate NMIBC had 8 adjuvant endovesical instillations of Mitomycin. The primary endpoint was bladder tumor recurrence free-survival which was defined as the time between the initial TURBT and the date of TURBT for bladder recurrence. Results A total of 167 patients (median age: 71 years) were included: 20% female, 15% low-risk, 85% intermediate-risk NMIBC. CSBI was performed in 95 cases (57%). No complication related to irrigation was reported. Bladder recurrence was observed in 55 cases (32.9%): 22 (23.1%) in the CSBI group vs. 33 (45.8%) in the control group (P = 0.002). Multivariate stepwise logistic regression analysis with backward selection revealed that CSBI (HR 0.47 [0.27–0.81]; P = 0.006) and MMC (HR 0.55 [0.31–0.95]; P = 0.034) were significantly associated with reduced risk of bladder recurrence. Conclusions Continuous saline bladder irrigation reduced the risk of bladder recurrence after blue light TURBT in patients with low- to intermediate-risk NMIBC while being safe. Prospective randomized study is needed to confirm these results. Level of evidence 3.

Resume Introduction L’observatoire REVELA13 est un outil epidemiologique unique recensant les nouveaux cas de tumeur du rein, de vessie et de leucemies aigues dans le departement des Bouches-du-Rhone. L’objectif de ce travail etait d’analyser pour la premiere fois les donnees de cet observatoire pour les nouveaux cas de tumeurs de vessie de la femme ≥T1 dans les Bouches-du-Rhone de 2012 a 2014. Materiel Il s’agissait d’une etude epidemiologique descriptive observationnelle. Quinze variables non nominatives de la base de donnees de REVELA13 ont ete analysees pour decrire les caracteristiques cliniques et anatomopathologiques des cas incidents ainsi que leur repartition spatio-temporelle. Les taux d’incidence exprimes en nouveaux cas par an pour 100 000 habitants ont ete standardises sur l’âge mondial, calcules avec leurs intervalles de confiance a 95 % et compares aux estimations nationales pour la meme periode. Resultats Au total, 291 nouveaux diagnostics de tumeurs vesicales ont ete enregistres soit une incidence standardisee sur l’âge mondial de 3,85 [3,32–4,37] nouveaux cas par an pour 100 000 habitants, superieure de 54 % aux estimations nationales de 2012 et 2015. Le sex-ratio etait de 19,41 % (F/H) et l’âge median de survenue de 75,9 ans. Les tumeurs etaient majoritairement sans infiltration du muscle (52 %), de haut grade (69 %) et sans carcinome in situ (Cis) associe (49 %). Les 2 territoires les plus touches etaient ceux de Marseille et d’Aubagne-La Ciotat. Conclusion L’observatoire REVELA13 a permis d’ameliorer nos connaissances epidemiologiques sur les tumeurs de vessie feminines dans les Bouches-du-Rhone et de mettre en evidence une sur-incidence locale. Niveau de preuve 3.

The IPSS (International Prostate Symptom Score), a structured self-administered questionnaire is the reference test for evaluation of lower urinary tract symptoms (LUTS). A 5-pictogram score entitled Score Visuel Prostatique en Images (SVPI) was proposed in France and evaluated by urologists. We assessed the interest of the SVPI for the identification and monitoring of benign prostatic hyperplasia (BPH)-related LUTS in general practice, and compared it with the IPSS.A prospective observational survey was carried out with general practitioners (GPs) throughout France. The first 4consecutive patients aged over 60years, with BPH-related LUTS (IPSS score greater than 8) for whom the GP freely intended to prescribe an alpha-blocker, were enrolled. Two self-administered questionnaires were used at baseline and at follow-up visit (between 1 and 3months): French language version of the IPSS (8questions) and the SVPI. The 5pictograms of the SVPI were: How many times do you urinate during the day (score of 0 to 5)? How many times do you urinate during the night (score of 0 to 5)? Do you experience an urgent need to urinate (score of 0 to 4)? How strong is the stream (response from 0 to 4)? Do you urinate in a satisfactory manner (score of 0 to 6)? The primary objective was to assess and validate the sensitivity to change of the SVPI at baseline and follow-up visit by the study of the correlation of its changes according to the changes of LUTS evaluated with the IPSS.Five hundred and forty seven GPs enrolled at least one patient and returned information. 2261patients completed the inclusion questionnaire, and 1359 were included in the statistical analysis. Under treatment with alpha-blocker, the IPSS average decreased from 17.7±4.9 to 10.5±4.4 (P0.0001) with an average diminution of 7.2±4.0, which corresponded to an improvement of 40.7%. This significant decrease of the IPSS involved all its components. The total SVPI was evaluated to 13.8±3.1, the irritative sub-score to 7.4±2.0, and the obstructive sub-score to 2.4±0.8. The internal consistency of the SVPI was good with a value of the Cronbach Alpha coefficient of 0.74. Under treatment with alpha-blocker, the value of the total SVPI decreased from 13.8±3.1 to 8.2±3.0 (P0.0001) between enrolment and the follow-up visit. The Pearson coefficients assessing the correlations in 1359 patients with benign prostatic hypertrophy were statistically significant at enrolment, and at the follow-up visit. Their variations were all significant. The correlations were weak for the obstructive subscores. Four hundred and fifty-one GPs gave their opinion on the SVPI compared to IPSS: for 36.8% of them, the SVPI was completed a little more rapidly than the IPSS, for 34.6% more rapidly, and for 22.8% of them the SVPI was completed much more rapidly. For 5.8% of them, there was no difference. With regard to ease of understanding for the patient, the 451 GPs responded: much easier for 27.3%, easier for 37.3%, a little easier for 27.1%, and 8.4% had no opinion.This study showed the SVPI to be a simple and useful tool for identifying and monitoring BPH-related LUTS. Total SVPI was correlated with total IPSS, even if the obstructive subscore correlation was weaker. The good sensitivity of the SVPI to change showed its potential interest for monitoring LUTS. Given the underuse of the IPSS and the interest expressed by GPs and urologists, the SVPI might be used alone to analyse patient complaints.

Resume Objectifs Notre objectif etait de valider le score SVPI (score visuel prostatique en images) en langue francaise dans la determination et le suivi des symptomes du bas appareil urinaire (SBAU) associes a une hyperplasie benigne de la prostate (HBP) en pratique urologique. Methodes Une enquete prospective observationnelle a ete realisee entre le 15 septembre 2014 et le 30 juillet 2015 aupres d’urologues. Les 4 premiers patients consecutifs de plus de 60 ans ayant des SBAU causes par une HBP et necessitant une prescription d’un alpha-bloquant ont ete inclus. Nous avons traduit et adapte en francais un ‘score visuel prostatique en images’ (SVPI). A la premiere visite et a la visite de suivi, le patient remplissait 2 questionnaires : l’IPSS en francais et le SVPI. Resultats Au total, 169 urologues ont inclus au moins un patient et renvoye les informations ; 550 questionnaires ont ete inclus dans l’analyse statistique. Les medianes des scores et sous-scores IPSS et SVPI,et de la qualite de vie ont toutes diminue significativement ( p Conclusions Cette etude a montre que le SVPI etait un outil simple et utile pour identifier et surveiller les SBAU associes a l’HBP. Niveau de preuve 4.

INTRODUCTION AND OBJECTIVES:Cryoablation (CA) and High-Intensity Focused Ultrasound (HIFU) are alternative treatments to surgery or radiotherapy in localized prostate cancer (PCa). Both techniques ...

Resume But Rapporter les resultats oncologiques d’une cohorte de patients atteints d’un cancer de la prostate et places en surveillance active (SA) selon les criteres SURACAP. Materiels et methodes Il s’agit d’une etude multicentrique reprenant les patients inclus dans le protocole SURACAP et evaluant de facon retrospective la duree de surveillance, les causes de sortie et le resultat anatomopathologique definitif lorsque le patient etait opere. Les facteurs predictifs de sortie de SA ont ete evalues a l’aide d’un modele univarie de Cox. La valeur predictive de l’IRM initiale a egalement ete analysee chez les patients ayant realise cet examen. Resultats Entre 2007 et 2013, 80 patients ont ete inclus pour un âge median de 64 ans [47–74]. Le suivi median etait de 52,9 mois [24–108]. A 5 ans de suivi, 43,4 % des patients etaient toujours en SA. Parmi les patients operes, 17,8 % avaient une extension extracapsulaire. Il n’y avait pas plus de risque de sortir de SA que l’on ait une taille tumorale de 2 ou 3 mm versus 1 mm (HR = 0,9 [0,46–1,75], p = 0,763), 2 carottes positives versus 1 (HR = 0,98 [0,48–2,02], p = 0,967), un stade T2a ou T1c (HR = 2,18 [0,77–6,18], p = 0,133), et quelle que soit la valeur du PSA initial (HR = 1 [0,96–1,15], p = 0,975) ou l’âge (HR = 1 [0,93–1,16], p = 0,966). Parmi les 50 patients ayant pratique une IRM initiale, le caractere normal ou anormal de cet examen n’etait pas un facteur predictif de sortie de SA (HR = 1,49 [0,63–3,52], p = 0,36). Conclusion Si cette etude met en evidence un taux de sortie tres important a 5 ans, le taux de tumeurs extracapsulaires recensees chez les patients operes fait partie des plus faibles de la litterature. Niveau de preuve 4.

Objectifs Une fistule uro-genitale (FUG) est une communication congenitale ou acquise entre les voies excretrices urinaires et l’appareil genital. Dans les pays riches, elles sont rares, souvent iatrogenes et responsables de recours medicolegaux. En France leur epidemiologie, le detail de leur prise en charge et de ses resultats sont peu etudies et restent mal connus. Methodes L’objectif de cette etude etait de recenser les patientes ayant eu un diagnostic ou une cure de FUG dans les services d’urologie d’un CHU francais de janvier 2010 a decembre 2019 et d’etudier leur devenir. Les FUG sur neovessie ou Bricker etaient exclues. Nous avons collige pour chaque patiente l’etiologie et le type de la fistule, le delai de prise en charge, la technique de traitement, les complications postoperatoires precoces (j30 Clavien–Dindo). Nous avons etudie le resultat postoperatoire sous deux aspects : la fermeture de la fistule et la presence de sequelles fonctionnelles aux dernieres nouvelles. Resultats Sur la decennie, 32 patientes ont ete traitees pour une FUG (27 FVV, 3 fistules uretero-vaginales, 1 fistule vesico-entero-vaginale, 1 fistule vesico-uterine) a un âge moyen au diagnostic de 49,2 ± 15,2 ans. Les causes etaient post-chirurgicales (n = 25), post-obstetricales (n = 4), post-radiotherapie (n = 1), post-sigmoidite (n = 1) et post-traumatique (n = 1). Le delai moyen de prise en charge etait de 131 ± 189 jours. Trois patientes ont ete traitees medicalement et 29 ont eu 37 interventions soit 1,28 ± 0,59 intervention/patiente (17 par voie basse, 17 par laparotomie, 2 par cœlioscopie et 1 par voie combinee). Le traitement a ete efficace chez 28/32 (87,5 %) 3 ont eu une derivation urinaire. Six ont eu des complications precoces Conclusion Trente-deux FUG ont ete traitees, dans nos centres depuis 2010. Elles etaient principalement iatrogenes. Le parcours de soins etait long, complexe avant un traitement laissant 1/3 de sequelles fonctionnelles. Un registre national prospectif permettrait d’affiner la connaissance des FUG (facteur de risque de survenue, d’echec de fermeture, de survenue de sequelle) et de faciliter leur prise en charge.

Objectifs La thermo-chimiotherapie est une alternative therapeutique chez les patients refractaires ou contre-indiques au BCG et non eligibles a la cystectomie. La thermo-chimiotherapie par HIVEC est encore peu evaluee, mais les premiers resultats semblent prometteurs, avec 60 % de survie sans recidive a 1 an. L’identification de facteurs predictifs de reponse a l’HIVEC pourrait permettre une meilleure selection des patients. Methodes L’objectif de notre etude etait d’identifier des facteurs de risque de recidive et de progression apres thermo-chimiotherapie par HIVEC. Il s’agit d’une etude retrospective multicentrique ayant inclus 53 patients pris en charge pour une tumeur de vessie non infiltrant le muscle (TVNIM) a haut risque, en echec de BCG ou contre-indiquee au BCG, et traites par HIVEC entre juin 2016 et octobre 2019. Tous les patients etaient consideres comme non eligibles a la cystectomie ou la refusant categoriquement. Le traitement a consiste en 6 instillations hebdomadaires de mitomycine chauffee a 43 ° C grâce au dispositif HIVEC. Un suivi cystoscopique et cytologique trimestriel a ete realise. Resultats Le suivi median etait de 18 mois. Le taux de survie sans recidive a 12 mois etait de 60,5 % dans la population globale. La survie sans recidive etait moins bonne dans le groupe de patients en echec de BCG, avec une survie sans recidive a 1 an de l’ordre de 52,2 %. En analyse univariee, seul le grade etait significativement associe au risque de recidive (p = 0,028). Les tumeurs de type CIS pur avaient un taux de recidive plus important que les tumeurs papillaires (66,7 % versus 36,4 %), mais cette difference n’etait pas significative (p = 0,09). Trois patients (5,7 %) ont progresse vers l’infiltration musculaire, tous du groupe EORTC a tres haut risque. Le groupe EORTC etait associe au risque de progression avec une tendance a la significativite (p = 0,058). Conclusion L’HIVEC pourrait etre une alternative a la cystectomie, chez les patients contre-indiques au BCG ou chez les patients recidivants sous la forme d’un bas grade. A l’inverse, la cystectomie doit rester le traitement de reference pour les patients a tres haut risque EORTC en echec de BCG, en raison du risque de progression.

Objectifs La procedure du ganglion sentinelle (GS) a prouve son interet dans la prise en charge de certains cancers en permettant d’eviter la morbidite d’un curage etendu inutile. L’objectif de cette etude est de valider le curage radioguide dans le cancer de la prostate (CaP) en montrant que les metastases ganglionnaires sont situees dans les GS preleves au sein du territoire du curage standard. Methodes Il s’agit d’une etude de cohorte prospective multicentrique issu d’un protocole hospitalier de recherche clinique. La procedure du GS etait faite par methode isotopique. Les ganglions marques etaient localises par SPECT-CT la veille de l’intervention. Les territoires concernes par ce curage devaient comprendre au minimum la fosse obturatrice, le territoire iliaque interne et externe. Une cartographie des ganglions preleves fixant (=GS) ou non fixant et positifs (=metastatiques) ou negatifs etait realisee. Le critere de jugement principal etait la sensibilite du curage radioguide pour detecter les patients avec des metastases ganglionnaires au sein du curage standard. Les complications etaient notees et un suivi de 1 an etait realise. Resultats Un total de 162 patients a eu une prostatectomie totale avec curage ganglionnaire pelvien avec marquage des ganglions au prealable. L’âge median lors de la chirurgie etait de 64 ans (47–73). Il n’y a eu aucune complication liee a l’injection intra-prostatique de nano-colloides radio-marques. Cent trente-sept (84,6 %) patients n’avaient aucune metastase ganglionnaire (=pN0) et 25 (15,4 %) patients etaient pN+. Cinq (20 %) patients avaient des ganglions positifs non sentinelles. La sensibilite du curage radioguide etait de 80 % (IC95 % : 60,9 ; 91,4). A 1 an, le taux de complications etait de 17,3 % (n = 28), le taux de re hospitalisation de 1,2 % (n = 2) et le taux de recidive biologique de 19,1 % (n = 31). Conclusion Le curage ganglionnaire pelvien dans la prise en charge chirurgicale des patients atteints de CaP de risque intermediaire et de haut risque est responsable de complications chez pratiquement 1 patient sur 5. La technique du GS est non morbide et fiable et pourrait permettre d’eviter ce geste a certains patients.

Resume But Comparer et valider les nomogrammes de Ohori et de Steuber sur la prediction de l’extension extra-prostatique (EEP) specifiquement au cote pour aider au choix de realiser ou non une conservation des bandelettes neurovasculaires (BNV) lors de la prostatectomie totale. Patients et methode Les nomogrammes ont ete utilises pour predire le risque d’EEP specifiquement au cote a partir du PSA, du stade clinique, du score de Gleason biopsique, du pourcentage de biopsies positives et de l’envahissement tumoral par biopsie. Une base de donnees de 968 lobes prostatiques a ete analysee pour cette validation externe a partir de 484 patients traites par prostatectomie totale par voie ouverte ou cœlioscopique robot-assiste pour un cancer de prostate localise. Resultat La capacite de prediction du nomogramme de Ohori a ete evaluee a 0,80 et celle du nomogramme de Steuber a 0,78 (comparaison > 0,05). La courbe de calibration du nomogramme de Ohori etait plus proche de la prediction ideale que celle du nomogramme de Steuber. Le meilleur seuil de prediction de l’EEP semblait etre ≤ 10 % pour le nomogramme de Ohori permettant de realiser une conservation des BNV pour 59,7 % des lobes prostatiques avec un taux de faux negatif de 10 %. Pour le nomogramme de Steuber, un seuil ≤ 8 % permettait une conservation des BNV pour 44 % des lobes prostatiques avec un taux de faux negatif de 12,5 %. Conclusion L’utilisation des nomogrammes de Ohori et de Steuber ont permis une prediction precise et comparable de l’extension extra-prostatique specifiquement au cote. Niveau de preuve 4.

This French observational, longitudinal, prospective study described the health-related quality of life (HRQoL) of elderly men (≥75 years old) with prostate cancer after initiating gonadotropin-releasing hormone (GnRH) agonist therapy. At baseline and 3-6 months after baseline, European Organisation for Research and Treatment of Cancer quality of life questionnaire-core 30 (QLQ-C30) and prostate-specific (QLQ-PR25) questionnaires were completed by patients. Data from 1276 patients were analyzed. At baseline, mean (±SD) age was 80 (±4.1) years, 29.1% of patients had Gleason scores ≥8 and 24.9% had metastases. At baseline, increasing age, presence of metastasis and presence of comorbidity had a negative impact on QLQ-C30 and QLQ-PR25 scores. At follow-up, improvement in emotional-functioning (2.8; p 0.001), social-functioning (1.7; p = 0.011), global HRQoL (1.6; p = 0.029), sleep-disturbance (-2.1; p = 0.011), appetite-loss (-4.0; p 0.001) and pain (-4.1; p 0.001) QLQ-C30 scores were observed. In addition, there was a worsening in treatment-related symptom (8.6; p 0.001), sexual-activity (-5.5; p 0.001) and sexual-functioning (-22.6; p 0.001) QLQ-PR25 scores, and an improvement in urinary symptoms (-3.7; p 0.001) and incontinence aid (-2.9; p = 0.023) QLQ-PR25 scores. This study shows that, apart from the expected impact on sexual functioning domains, HRQoL is not adversely affected by 3-6 months of GnRH agonist therapy in older men with prostate cancer.

Resume But Determiner les performances de l’IRM pour la detection d’un envahissement extracapsulaire en correlant, dans notre centre, resultats de l’IRM et analyses anatomopathologiques des pieces de prostatectomie Methodes De fevrier 2008 a juin 2012, tous nos patients operes d’une prostatectomie totale avaient une IRM prostatique en preoperatoire. Des sequences de diffusion, en ponderation T2 et T1 avec acquisition dynamique apres injection de gadolinium etaient faites sur une IRM 1,5 T avec une antenne externe. Toutes les IRM etaient interpretees par un radiologue specialise dans le domaine. Les pieces de prostatectomie etaient analysees en integralite, sous formes de megalames permettant une meilleure confrontation topographique. Le stade T anatomopathologique etait compare aux donnees de l’IRM. Nous avons etudie la capacite de l’IRM a determiner l’existence et la taille d’un franchissement capsulaire. Resultats Cent cinquante-huit patients (âge median 62 ans, PSA moyen 8,6 ng/mL) ont ete inclus dont 45 % de faible risque (FR) d’Amico et 55 % de risque intermediaire ou eleve. L’analyse histologique mettait en evidence 63 % de pT2 et 37 % de pT3. La sensibilite et la specificite de l’IRM pour determiner le franchissement capsulaire etaient de 0,30 et 0,85 (VPP 0,54 – VPN 0,67) avec une exactitude de 65 %. Dans le groupe FR, la sensibilite etait de 0,16. Conclusion Dans notre experience, les resultats de l’IRM n’etaient pas suffisamment fiables pour influencer le choix therapeutique. Sa realisation doit etre confiee a des radiologues experts qui sont encore peu nombreux

Objectifs Un homme sur trois presentera une recidive localisee d’un cancer de prostate apres traitement par radiotherapie. Pourtant, la majorite des patients seront traites par une privation androgenique palliative. L’objectif etait d’analyser des resultats fonctionnels (morbidite et qualite de vie), carcinologiques et facteurs predictifs de succes de high intensity focused ultrasound de rattrapage (HIFU-r) apres radiotherapie des recidives locales d’un cancer de prostate. Methodes Etude retrospective monocentrique incluant les patients traites par HIFU-r entre 2006 et 2016 pour recidive locale apres radiotherapie. La recidive etait definie soit biologiquement (psa nadir + 2 ng/mL), soit biopsies positives apres HIFU-r ou introduction d’un traitement adjuvant apres l’HIFU-r. Les effets indesirables etaient repertories au cours du suivi prospectif et la morbidite evaluee par le score de qualite de vie de l’eortc, l’incontinence urinaire (iu) par l’ics, la dysurie par l’ipss et la dyserection par l’iief5, avant traitement par HIFU-r puis a 6 mois, a 1 an et aux dernieres nouvelles (ddn). Kaplan–Meier a ete utilisee pour l’analyse de la survie sans recidive (ssr). Resultats Quarante-cinq patients ont ete inclus avec un suivi moyen de 2,6 ± 2,1 ans. La mediane du psa nadir apres HIFU etait de 0,58 ng/mL (0–6,5). Le taux de ssr etait de 82 % a 1 an, 53 % a 2 ans et 30 % a 3 ans. La ssr a 2 ans etait de 72,7 %, 47,1 % et 40,9 % pour les risques faibles de d’Amico, intermediaires et hauts risques. Avec un psa nadir inferieur ou egal a 0,5 ng/mL, la ssr etait de 100 % a 1 an, 92 % a 2 ans et 67,7 % a 3 ans (p = 0,001). Les scores ics pre- et post-HIFU augmentaient aux dernieres nouvelles (p = 0,03). L’iief5 s’aggravait a 6 mois (p = 0,016) et 1 an (p = 0,04), mais la qualite de vie pre- et post-HIFU-r etait conservee (p = 0,2) ( Fig. 1 et Tableau 1 , Tableau 2 ). Conclusion L’HIFU-r pour les recidives de cancer de prostate localise apres echec de radiotherapie etait associe a un taux de ssr a 2 ans superieur a 50 %. Ce traitement permettrait de retarder l’introduction de l’hormonotherapie palliative, au prix de morbidites non negligeables, mais une qualite de vie conservee. Une cohorte de patients et un suivi plus important permettraient d’affirmer ces resultats.

Objectifs L’objectif de notre etude etait d’etudier les resultats oncologiques et fonctionnels de l’HIFU en premiere intention en glande entiere dans le cancer de prostate localise. Methodes Inclusion des patients entre 2005 et 2015 traites en premiere intention d’un cancer de prostate localise par les ultrasons focalises de haute intensite (HIFU), avec l’ABLATERM jusqu’en 2015 puis le FOCAL-ONE. Les patients etaient selectionnes suivant les criteres du CCAFU et du Forfait Innovation HIFI : – âge > 70 ans, esperance de vie > 7 ans, PSA Resultats Quatre-vingt-dix-sept patients etaient evalues avec un suivi moyen de 7,2 ans(± 3,2). La survie globale et la survie specifique etaient respectivement de 91,8 % et 100 %. La survie sans recidive biochimique a 10 ans, en fonction du risque selon D’Amico, etait de 59,9 % pour les risques faibles, 38,4 % pour les risques intermediaires, 42,9 % pour les hauts risques. Quatre-vingt pour cent des patients avec un PSA nadir ≤ 0,3 ng/mL etaient sans recidive a 10 ans contre 20 % chez ceux avec un nadir > 0,5 ng/mL. Parmi les patients, 21,6 % ont eu un traitement de rattrapage avec un delai moyen de 4,1 ans (± 2,8). L’alteration des fonctions urinaires et sexuelles etait significative mais neanmoins 83,5 % de patients ne portaient pas de protection en fin d’etude. L’obstruction sous vesicale etait la complication la plus frequente (46,4 %). Conclusion Les resultats oncologiques et fonctionnels sont encourageants et semblent comparables aux resultats de la litterature pour les traitements de premiere intention. L’HIFU se presente donc comme une veritable option pour le traitement du cancer de prostate localise chez l’homme de plus de 70 ans.

To validate the Heidenreich criteria for patient selection for unilateral retroperitoneal lymph node dissection (RPLND) for residual masses after chemotherapy for nonseminomatous germ cell tumor (NSGCT).For validation, the data of 59 patients who underwent RPLND for residual masses of NSGCT were used. Of these patients, 23 (39 %) qualified for a modified RPLND, the others had an indication for a bilateral dissection. Results from histopathology after RPLND and follow-up data for relapse inside or outside the zone of the resection template were considered for validation.In the study cohort, median age at time of RPLND was 31 years. The 2-year disease-free survival was 90 and 96 % for the bilateral and the unilateral RPLND patients, respectively. Overall, 8 (14 %) relapses were observed after a median follow-up of 54 month. Of these, 6 were outside of the resection field and 2 were in-field. Of the 23 patients with indication for a modified RPLND, 1 patient relapsed in the contralateral testis and 1 inside the modified RPLND template. No relapse was observed outside the modified RPLND field and inside the untouched contralateral RPLND field. The Heidenreich criteria did therefore not misclassify a single patient.The Heidenreich criteria for the selection of candidates for unilateral RPLND for residual masses after chemotherapy allow a highly reliable selection of patients. The application of the Heidenreich criteria can help to reduce comorbidity and invasiveness of RPLND.

In 2010, in France, 8,790 men died from prostate cancer despite a low and decreasing mortality rate. The individual risk/benefit ratio of prostate cancer screening is the focus of controversy and currently not in favor of a systematic screening program. Therefore, only prevention could reduce incidence, side effects of treatment and related mortality. Interestingly, prostate cancer prevention is also a field of controversy mainly about 5-alpha-reductase inhibitors. However, it could be expected that pharmaco- or diet-based prevention will be a huge tool for cancer control, even more for prostate cancer burden. This review comprehensively analyses which molecules or compounds could be used in preventive trials. With regard to pharmaco-prevention, three different kinds of drugs could be identified. First drugs, which aim at mainly or even solely reduce prostate cancer risk such as 5-alpha-reductase inhibitors and selective estrogen receptor modulators. Drugs, which aim at wider preventive impact such as: nonsteroidal anti-inflammatory drugs or difluoromethylornithine. Lastly, drugs for which reducing prostate cancer incidence is merely a side effect such as statins, metformin or histones desacetylase inhibitors. With regard to diet-based prevention, two main approaches could be identified: aliments and nutriments, on one hand, and vitamin and minerals, on the other. Interestingly if compounds reach experimental plausibility, natural foods or even global diet seem to have a higher impact. Lastly, besides assessment of efficacy, effectiveness required the critical step of compliance, which might actually be the weakest link of the prevention chain.

Resume Objectif Evaluer l’effet sur la survie des marges chirurgicales positives (R+) et des adenopathies metastatiques (pN+) pour des patients traites par cystectomie totale (CT) par laparotomie pour tumeur de vessie infiltrant le muscle (TVIM). Patients et methodes Les dossiers de 242 patients consecutifs ayant eu une CT pour TVIM entre janvier 2005 et juin 2009 ont ete revus. Les parametres etudies ont ete : âge, PSAt, stade anatomo-pathologique (pT et pN), grade histologique de la piece operatoire, nombre (nb) de ganglions (ggs) dans le curage, nb de ggs metastatiques (nb gg+), diametre du gg+ le plus grand, densite ganglionnaire, nb de gg en rupture capsulaire, CIS associe, ADK de prostate associe, suivi, survies globale (SG) et specifique (SS), date et cause du deces. Resultats Au total, 59 (24,4 %) patients etaient pN+ et 22 (9,1 %) avaient des marges chirurgicales positives (R+). L’existence de pN+ etait significativement associee a des SG et SS plus pejoratives ( p p Conclusion Le statut pN+ et/ou R+ sur les pieces de CT conferait un risque significatif et independant de SG et SS reduites chez les patients traites pour TVIM. Il en etait de meme pour la rupture capsulaire, la densite ganglionnaire superieure ou egale a 0,10 et le nb de ggs dans le curage inferieur a 14 chez les patients pN+.

Objectifs Evaluer la valeur pronostic de l’etendue et de la localisation des marges chirurgicales positives (MCP) apres prostatectomie radicale (PR) sur la recidive biologique (RB). Methodes Analyse retrospective a partir d’une base de donnees de 1275 PR realisees entre janvier 1992 et decembre 2013 dans 4 centres universitaires. Les criteres d’inclusion etaient : suivi > 18 mois, PSA postoperatoire indosable, absence d’envahissement des vesicules seminales (VS), absence d’envahissement ganglionnaire confirme par chirurgie (pN0) ou par imagerie (cN0) et absence de traitement neoadjuvant ou adjuvant. La RB etait definie par un PSA ≥ 0,2 sur 2 dosages. Les patients ont ete repartis en 2 groupes : – MCP focale (MCPf) : MCP unique (MCPu) ≤ 3 mm ; – MCP etendue (MCPe) : marge unique de longueur continue > 3 mm ou marges multiples quelle que soit la longueur. La localisation des MCP etait relevee pour chaque patient. Resultats Cent quatre-vingt-neuf patients ayant des MCP ont ete inclus. Le suivi median etait de 101 mois (18–283), le PSA median preoperatoire etait de 7,7 ng/mL (1,8–27) et l’âge median etait de 63 ans (46–76). La RB etait survenue uniquement dans 12,1 % (14/115) pour les MCPf contre 54,1 % (40/74) en cas MCPe. Dans le modele multivarie, les MCPe etaient significativement associees a une augmentation de la RB par rapport aux MCPf (HR = 6,29 ; IC = 3,32–11,93). Les MCPe diminuaient significativement la SSRB ( p p Conclusion Nous avons montre, avec un recul median de 8 ans, que les MCPe etaient fortement associees a la RB alors que les MCPf ne constituaient pas un facteur de mauvais pronostic. Il parait donc licite de surveiller ces patients a faible risque de RB mais de traiter precocement les patients ayant une MCPe.

We examined the incidence of asymptomatic and symptomatic lower extremity venous thromboembolism in patients who underwent urological surgery for cancer, and identified preoperative and operative risk factors predictive of the thromboembolism.A cohort of 583 consecutive patients undergoing urological cancer surgery was prospectively assessed using complete lower limb ultrasound at postoperative day 7 from January 2005 to July 2009. In all patients heparin and mechanical thromboprophylaxis were prescribed until complete ambulation. Potential variables predictive of venous thrombosis were analyzed.Complete data were available in 538 patients (463 male and 75 female), of whom 177 underwent nephrectomy, 86 radical cystectomy and 275 radical prostatectomy. A total of 40 deep venous thrombosis cases were found (7.4%), most of which were asymptomatic (92%) and limited to deep calf veins (80%). Of those asymptomatic deep venous thrombosis cases 86% were limited to deep calf veins. In all, 12 pulmonary embolisms were diagnosed, of which 4 were lethal. On multivariate analysis history of venous thromboembolism (OR 5.16, p = 0.02) and radical cystectomy (OR 3.47, p = 0.002) were independently associated with venous thromboembolism.Lower extremity venous thromboembolism has a high rate of occurrence after urological surgery for cancer despite the recommended venous thromboembolism prophylaxis. Most cases are asymptomatic and limited to deep calf veins. Our results suggest that complete lower limb ultrasound should be performed early after radical cystectomy and in patients with a personal history of venous thromboembolism.

Study Type – Therapy (individual cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Seminal vesicle invasion in prostate cancer has a poor prognosis. Nowadays, there is no consensus about the best adjuvant treatment after radical prostatectomy when seminal vesicle invasion is observed in the specimen. To our knowledge, this is the first comparative study between different adjuvant treatments after radical prostatectomy when seminal vesicle invasion is observed in the specimen. OBJECTIVE • To evaluate the biochemical-failure free survival according to different adjuvant treatments in patients who underwent radical prostatectomy (RP) with seminal vesicle invasion (SVI). PATIENTS AND METHODS • Between 1994 and 2008, 4090 men underwent RP in nine centres. Of these, 310 men had a SVI. • Exclusion criteria were: detectable postoperative prostate-specific antigen, lymph node metastases and follow-up

Resume La nephrectomie cytoreductrice a montre son importance dans le traitement du cancer du rein metastatique chez des patients bien selectionnes et traites par immunotherapie. Avec l’avenement des anti-angiogeniques, son interet a ete de nouveau remis en question. Cette revue reprend le role de la nephrectomie cytoreductrice a l’ere de l’immunotherapie et fait le point sur sa place actuelle a l’ere des therapies ciblees. En attendant les resultats d’essais prospectifs randomises, cette revue etudie aussi la chronologie optimale d’un traitement souvent multimodal, la place de la metastasectomie, les facteurs pronostiques des patients qui tireront un benefice de cette chirurgie, ainsi que le role de la nephrectomie cytoreductrice partielle et laparoscopique.

Objectifs Evaluer l’efficacite d’une modification ou d’une initiation de traitement par un α-bloquant chez des patients deja traites medicalement pour des sbau lies a une hbp. Methodes Au total, 1449 patients inclus ≥ 60 ans, avec sbau lies a une hbp et traites medicalement depuis ≥ 6 mois. Un traitement par α-bloquant etait initie ou modifie si le pgi-i n’objectivait aucune amelioration sous traitement et si ipss > 8. Patients suivis entre 1 et 3 mois. Âge moyen : 70,0 ± 6,9 ans ; anciennete des sbau : 4,1 ± 4,2 ans ; a l’inclusion, ils recevaient des plantes (53,9 %), des α-bloquants (33,6 %), des 5-ari (5,9 %) ou une association (6,6 %). Score ipss moyen : 16,4 ± 6,7, non correle avec l’anciennete des sbau ; pgi-i moyen : 2,6 ± 1,2. Resultats Au total, 42,8 % des patients (591/1380 patients analyses) ont eu une modification de leur traitement et une visite de suivi : 385 (65,6 %) ont eu une initiation d’un α-bloquant, 202 (34,4 %) une modification, principalement en monotherapie (81,9 %). Lors de la visite de suivi, 520 patients ont complete le questionnaire ; le score ipss moyen etait de 7,7 ± 4,8, significativement en baisse (18,7 ± 6,1 a l’inclusion) ; le pgi-i moyen de 1,2 + 0,7 etait significativement en baisse (3,5 ± 0,8 a l’inclusion) ; la qualite de vie (q8-ipss) etait significativement amelioree. Pour les 346 patients sous plantes ayant change pour un α-bloquant, ainsi que pour les 67 patients sous α-bloquant ayant change pour un autre α-bloquant, les 3 scores avaient diminue significativement. Conclusion Une evaluation systematique du traitement medical de l’hbp a montre que 42,8 % des patients n’etaient pas ameliores. Un traitement par un α-bloquant (initiation ou modification) peut ameliorer les sbau.

Renal artery pseudoaneurysm (RAP) is a well-documented complication of percutaneous urologic procedures (biopsy, nephrostomy, nephrolithotomy) and renal trauma. Only few cases occurring after partial nephrectomy for cancer have been reported in the literature. We describe the case of one patient who presented with postoperative haemorrhage due to a RAP after partial nephrectomy. He has been successfully treated by angiographic selective embolization. This complication is rare but potentially life threatening. We describe its clinical and radiological diagnosis, and its management along with the current medical literature.

Resume But Evaluer les resultats carcinologiques de la prostatectomie totale (PT) chez les patients atteints d’un cancer localise de prostate (CaP) a haut risque (HR) et etudier les facteurs pronostiques de recidive biologique (RB). Materiel et Methode Entre 1996 et 2006, 81 PT consecutives, dont 65 avec curage standard, ont ete realisees dans un seul centre par un seul chirurgien pour un CaP classe a HR selon d’Amico. Aucun patient n’avait recu de traitement neo-adjuvant. Le recul minimum etait de deux ans. La RB etait definie par un antigene specifique de prostate (PSA) superieur a 0,2 ng/ml sur deux dosages consecutifs. Quarante patients ont eu un traitement adjuvant immediat et 34 ont eu un traitement de rattrapage. Les facteurs pronostiques suivants ont ete etudies en analyse multivariee : l’âge, le stade clinique, le PSA pretherapeutique et a six semaines postoperatoire, le score de Gleason (SG) biopsique et pathologique, le nombre de carottes biopsiques positives, le nombre de facteurs de HR, les marges chirurgicales positives, le statut ganglionnaire et la prescription d’un traitement adjuvant immediat. Resultats L’âge median etait de 64 ans et le suivi moyen de 71 mois. Quarante-neuf patients etaient classes pT3 (60,5 %), sept etaient pN + (8,7 %) et 40 avaient des marges positives (49,4 %). A cinq ans, le taux de survie sans RB etait de 42 %. Le SG pathologique ( p = 0,003, RR = 1,688, IC = 1,193–2,387), le PSA pretherapeutique ( p = 0,001, RR = 1,06, IC = 1,032–1,089) et le nombre de carottes biopsiques positives ( p = 0,006, RR = 5,316, IC = 1,605–17,607) etaient des facteurs pronostiques independants de RB. Le nombre de facteurs de HR, les marges chirurgicales positives et la prescription d’un traitement adjuvant immediat n’etaient pas des facteurs pronostiques independants de RB. Conclusion La PT dans la prise en charge du cancer de prostate a HR a permis un controle carcinologique sans RB a cinq ans chez 42 % des patients. Ce taux n’etait influence ni par le nombre de facteur de HR, ni par les marges chirurgicales positives, ni par la prescription d’un traitement adjuvant immediat.

Resume Objectifs Evaluer les resultats carcinologiques et fonctionnels de patients ayant subi une chirurgie conservatrice du rein pour tumeur et en etudier la morbidite per- et postoperatoire. Materiel et methodes Etude retrospective, monocentrique, concernant 40 patients consecutifs ayant subi une chirurgie conservatrice pour tumeur renale, entre mars 1997 et juillet 2006. L’âge moyen des patients etait de 60 ans (26 a 81 ans) et l’indication chirurgicale etait elective dans 75 % des cas (n = 30) et de necessite dans 25 % des cas (n = 10). La creatininemie et la clairance de la creatinine preoperatoires moyennes etaient, respectivement, de 101 μmol/l (53 a 237 μmol/l) et de 80 ml/min (35 a 147 ml/min). Les tumeurs se repartissaient selon la classification TNM 2002 en stade T1a (75 %), T1b (20 %) et T2 (5 %). Une ponction-biopsie renale etait realisee de maniere orientee chez 80 % des patients. Les criteres d’evaluation principaux etaient l’existence de marges chirurgicales positives, de recidives locoregionales, de complications peroperatoires et l’etude de la fonction renale postoperatoire. Les criteres d’evaluation secondaires etaient la survenue de complications postoperatoires, la necessite d’une transfusion sanguine, d’une reprise chirurgicale, la duree operatoire et d’hospitalisation, l’apparition de metastases et la survie globale et specifique. L’etude statistique a ete realisee a l’aide du logiciel SPSS 13.0.1. Resultats Apres un suivi moyen de 44 mois (15 a 134 mois), un patient (2,5 %) a eu une recidive locale. Le taux de marges chirurgicales positives etait de 5 % et les survies globale et specifique etaient de 97,5 %. Aucune evolution metastatique n’a ete notee. La creatininemie etait augmentee et la clairance diminuee de maniere significative (p Conclusion La chirurgie renale conservatrice, dans ses indications de necessite, relatives ou electives, a eu des resultats carcinologiques et fonctionnels au moins equivalents a la nephrectomie elargie, avec l’avantage d’une epargne nephronique. Elle doit etre evoquee en premiere intention, des que cela est possible et meme si le rein controlateral est sain.

Resume Objectif Evaluer l’interet de la biopsie renale percutanee diagnostique dans les tumeurs solides du rein inferieures ou egales a 4 cm ainsi que son influence sur la prise en charge therapeutique effectuee. Materiels et methode De janvier 2001 a octobre 2006, nous avons biopsie de maniere systematique les tumeurs solides du rein inferieures ou egales a 4 cm par voie percutanee sous controle tomodensitometrique. Soixante-six tumeurs ont ete biopsiees chez 65 patients (une tumeur bilaterale). Quatre patients ont eu une deuxieme biopsie. Au total, 70 biopsies ont ete realisees. Resultats Parmi les biopsies, 18 % (12/66) etaient non contributives. Quatre ont ete renouvelees et ont permis d’etablir un diagnostic dans 50 % des cas. Deux patients avec biopsies non contributives ont ete perdus de vue. Sept tumeurs benignes (10,9 %) et 54 tumeurs malignes ont ete diagnostiquees. La biopsie renale a diagnostique 91 % (52/57) des tumeurs malignes et 57 % (4/7) des tumeurs benignes. La concordance entre les resultats des biopsies et ceux de l’anatomopathologie etait de 90,7 % pour le type histologique tumoral et de 64 % pour le grade nucleaire de Fuhrman. Le type histologique et le grade tumoral n’ont pas influence le type de chirurgie pratiquee (51 patients operes, 29 chirurgies conservatrices dont sept cas de necessite). Quatre patients (6,3 %) pour lesquels une tumeur benigne a ete diagnostiquee a la biopsie ont ete surveilles, evitant ainsi une chirurgie. Conclusion Dans notre serie, nous retrouvons 10,9 % de tumeurs benignes dont seulement 57 % ont ete diagnostiquees par la biopsie. La prise en charge n’a ete modifiee que pour quatre patients (6,3 %). La biopsie renale reste une option dans le bilan pretherapeutique des tumeurs renales inferieures ou egales a 4 cm, mais ne peut etre proposee de facon systematique.

The status of surgical margins after radical prostatectomy is a major prognostic factor. The role of several technical aspects of radical prostatectomy, such have surgical access, bladder neck preservation or neurovascular bundle sparing, in generating supplementary positive margins has been controversial for many years. Positive margins along with other poor prognostic factors are important elements in the decision to perform adjuvant therapy after radical prostatectomy. This review of the literature, based on a Medline search, was designed to update these various issues encountered by urologists in their everyday practice.