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Summary Background Whether multiparametric MRI improves the detection of clinically significant prostate cancer and avoids the need for systematic biopsy in biopsy-naive patients remains controversial. We aimed to investigate whether using this approach before biopsy would improve detection of clinically significant prostate cancer in biopsy-naive patients. Methods In this prospective, multicentre, paired diagnostic study, done at 16 centres in France, we enrolled patients aged 18–75 years with prostate-specific antigen concentrations of 20 ng/mL or less, and with stage T2c or lower prostate cancer. Eligible patients had been referred for prostate multiparametric MRI before a first set of prostate biopsies, with a planned interval of less than 3 months between MRI and biopsies. An operator masked to multiparametric MRI results did a systematic biopsy by obtaining 12 systematic cores and up to two cores targeting hypoechoic lesions. In the same patient, another operator targeted up to two lesions seen on MRI with a Likert score of 3 or higher (three cores per lesion) using targeted biopsy based on multiparametric MRI findings. Patients with negative multiparametric MRI (Likert score ≤2) had systematic biopsy only. The primary outcome was the detection of clinically significant prostate cancer of International Society of Urological Pathology grade group 2 or higher (csPCa-A), analysed in all patients who received both systematic and targeted biopsies and whose results from both were available for pathological central review, including patients who had protocol deviations. This study is registered with ClinicalTrials.gov, number NCT02485379, and is closed to new participants. Findings Between July 15, 2015, and Aug 11, 2016, we enrolled 275 patients. 24 (9%) were excluded from the analysis. 53 (21%) of 251 analysed patients had negative (Likert ≤2) multiparametric MRI. csPCa-A was detected in 94 (37%) of 251 patients. 13 (14%) of these 94 patients were diagnosed by systematic biopsy only, 19 (20%) by targeted biopsy only, and 62 (66%) by both techniques. Detection of csPCa-A by systematic biopsy (29·9%, 95% CI 24·3–36·0) and targeted biopsy (32·3%, 26·5–38·4) did not differ significantly (p=0·38). csPCa-A would have been missed in 5·2% (95% CI 2·8–8·7) of patients had systematic biopsy not been done, and in 7·6% (4·6–11·6) of patients had targeted biopsy not been done. Four grade 3 post-biopsy adverse events were reported (3 cases of prostatitis, and 1 case of urinary retention with haematuria). Interpretation There was no difference between systematic biopsy and targeted biopsy in the detection of ISUP grade group 2 or higher prostate cancer; however, this detection was improved by combining both techniques and both techniques showed substantial added value. Thus, obtaining a multiparametric MRI before biopsy in biopsy-naive patients can improve the detection of clinically significant prostate cancer but does not seem to avoid the need for systematic biopsy. Funding French National Cancer Institute.

Introduction Postoperative ileus(POI) and anastomotic leakage(AL) are highly associated but the direction of this link is unknown. Indeed, it has traditionally been stated that AL leads to POI(secondary POI). The objective was to statistically determine the best model of link between POI and AL by comparing different Structural Equation Models(SEM). Methods This is a retrospective analysis of a prospective multicentric database from the Francophone Group for Enhanced Recovery after surgery(GRACE) including patients undergoing colorectal resection or Hartmann reversal between 2014 and 2017. The main outcome measure was the occurrence of postoperative ileus defined by the absence of Gastrointestinal (GI)-3 recovery in or after postoperative day 4 and the occurrence of AL. Results Among the 2227 patients included, 223 patients experienced POI (10 %) and 72 patients experienced anastomotic leakage (3.2 %). In all the models, POI was significantly increased in case of male gender, older age, opioids consumption, right colectomy, chronic obstructive bronchopneumopathy disease and performance of a stoma, and reduced by Enhanced Recovery Programs (ERP) compliance ≥ 70 % and intake of Non-Steroidal Anti-Inflammatory Drugs. Open surgery was not significantly associated with POI in all the models. In contrast, the male gender was the only factor increasing AL in the model drawn with ERP risk factors for AL. In all the models, POI was highly associated with AL and statistical analyses advocate for POI leading to AL. Conclusion The findings of the present large study suggest that the more statistically probable model is the one in which POI come first before AL.

Prostate Cancer (PCa) is the second most frequent cancer in men worldwide and the fifth leading cause of cancer death with an incidence rate of 13.5%. PCa is driven by multiple genomic alterations, with distinct patterns and clinical implications. These genomic alterations occurring both early and later in the natural history of the disease (ranging from localized disease, initially responsive to androgen deprivation therapy, to Castrate Resistant Prostate Cancers -CRPC) allow classification of PCa in several molecular subtypes with potential clinical relevance. Patient-Derived Xenograft (PDX) models have become the most reliable in vivo human cancer models. Developing such models that capture the biological heterogeneity and mutational landscape of PCa, remains a challenge, but is essential for delivery of precision medicine in metastatic castrate resistant stages. In this study, we present the genomic and transcriptomic landscapes, as well as the pharmacological status of an established bank of seven (7) prostate PDX models ranging from hormone naïve to hormone-resistance PCa specimens. Samples of PCa along with normal corresponding tissues were obtained directly from patients at surgery. Fragments were subcutaneously xenografted into immunocompromised mice to establish PDX models. After the first growth in mice, they were serially passaged in vivo and considered to be established from P3. To ensure model stability, PDX tumors at multiple passages and patients' primary tumors were processed for histological, transcriptomic (Affymetrix U133 plus 2.0 microarray) and STR profile analyses. Genomic characteristics (WES, CNA) were also investigated. Finally, the responses of the PDX models to androgen deprivation and docetaxel were also evaluated. 7 PDX models were successfully established (> P3 in mice) out of 253 primary prostatic tumors collected from surgery. Within those models, one matched pair of responsive adenocarcinoma and neuroendocrine castration-resistant (NE-CRPC) models from the same patient was generated. Histological, transcriptomic and STR profiling validated the stability of the models compared to the parental tumor. The genomic analyses revealed i) the mutational burden rise with the resistance to treatments of the models, correlating with clinical results ii) an increase of metastatic genes loss in the NE-CRPC compared to the corresponding hormone sensitive adenocarcinoma. Furthermore, for all the PDX models generated, genomic and mutational analyses revealed specific molecular features and allowed molecular classification depending on tumor stage. Based on the molecular taxonomy of primary prostate cancers, the presented panel covers the different progression steps of the pathology. Considering the scarcity of useful models for PCa and the difficulties to develop such models, the prostate PDX models collection presented here should clearly help understanding disease progression and supporting precision medicine approaches for patients with advanced PCa. Citation Format: Myriam Lassalle, Claire Béraud, Hervé Lang, Véronique Lindner, Yves Allory, Eric Potiron, Thierry Massfelder, Philippe Lluel, Yolande Misseri. Mutational landscape and pharmacological profiling of a panel of prostate PDX models including hormone-naïve, hormone-sensitive and castrate-resistant prostate cancer specimens [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1668.

Lymph node metastasis is an important prognostic factor in prostate cancer (PC). The aim of this prospective study was to validate, through laparoscopic surgery, the accuracy of the isotopic sentinel lymph node (SLN) technique correlated with hyperextensive pelvic resection (extended pelvic lymphadenectomy dissection) in patients with localized PC, candidates for local curative treatment. Methods: A transrectal ultrasound-guided injection of 99mTc-sulfur rhenium colloid (0.3 mL/100 MBq) in each prostatic lobe was performed the day before surgery. Detection was performed intraoperatively with a laparoscopic probe, followed by extensive resection. SLN counts were performed in vivo and confirmed ex vivo. Histologic analysis was performed by hematoxylin-phloxine-safran staining, followed by immunohistochemistry if the SLN was free of metastasis. Results: Two hundred three patients with PC at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 96% (195/203). Thirty-five patients had lymph node metastases, 19 only in the SLN. The false-negative rate was 8.5% (3/35). Unilateral surgical SLN detection did not validate bilateral pelvic lymph node status, and extended pelvic lymphadenectomy dissection was necessary on the opposite side of detection to minimize the false-negative rate (2.8% [1/35]). A significant metastatic sentinel invasion in the common iliac region existed (9.3%) but was always associated with other metastatic node areas. The internal iliac region was the primary metastatic site (40.7%). Finally, this series invalidated any justification for a standard or limited dissection, which would have missed 51.9% and 74.1% of lymph node metastases, respectively. Conclusion: The radioisotope SLN identification method up to the common iliac region is successful to identify sentinel nodes during laparoscopic surgery per hemipelvis to be acceptably considered as an isolated procedure and should be validated for intermediate- and high-risk patients.

Resume Objectifs L’atteinte ganglionnaire metastatique est un facteur pronostique important dans le cancer de la prostate (PC). Le but de cette etude prospective etait d’evaluer la pertinence de la technique du ganglion sentinelle par voie laparoscopique dans la stadification locoregionale chez les patients avec PC cliniquement localise. Patients et methodes Une injection par voie transrectale echoguidee de 0,3 mL/100 MBq de 99mTc-sulfure de rhenium colloidal dans chaque lobe prostatique a ete realisee la veille de l’intervention. La radiodetection peroperatoire etait realisee avec une sonde laparoscopique (Clerad® Gamma Sup) suivie d’un curage extensif. Les comptages des GS etaient realises in vivo et confirmes ex vivo. L’analyse anatomopathologique etait realisee par hematoxyline-phloxine-safran et suivie d’un immunomarquage si GS indemnes. Resultats Soixante-dix patients ayant d’un cancer de la prostate a risque intermediaire ou eleve de metastases ganglionnaires ont ete inclus. Le taux de detection peroperatoire etait de 68/70 (97,0 %). Quatorze patients avaient des metastases ganglionnaires, six uniquement dans les GS. Le taux de faux-negatifs etait de 2/14 (14,0 %). La region iliaque interne etait le premier site metastatique (40,9 %). Une atteinte sentinelle metastatique de la region iliaque commune au-dela du croisement ureteral etait presente dans 18,2 %. Un curage limite ou standard aurait ignore respectivement 72,7 % et 59,0 % des metastases ganglionnaires. Conclusion La voie laparoscopique etait adaptee a un large reperage des GS et un curage cible de ces ganglions limitait significativement le risque chirurgical du curage etendu tout en maintenant la precision de l’information.

Objectifs Evaluer l’apport de l’IRM de prostate avant premiere serie de biopsies. Methodes Au total, 225 patients adresses pour une premiere biopsie de prostate (âge ≤ 75 ans, PSA ≤ 20 ng/mL, TR ≤ T2c) ont ete inclus dans cette etude prospective multicentrique (16 centres). Apres IRM multi-parametrique, un premier operateur sans connaissance de l’IRM a preleve 12 biopsies systematiques (plus deux biopsies optionnelles guidees par echographie). Un second operateur a obtenu des biopsies sur une ou deux cibles suspectes (Likert ≥ 3/5, 3 biopsies par cible). Les biopsies ciblees ont ete realisees sous guidage cognitif (4 centres), fusion echo/IRM (11 centres) ou echographie de contraste (1 centre). Le cancer significatif (CS) etait defini selon 3 definitions : CS-A, ISUP grade groupe (GG) ≥ 2 ou ISUP GG 1 avec invasion maximale ≥ 6 mm ; CS-B, ISUP GG ≥ 2 ; CS-C, ISUP GG ≥ 3. Resultats Le taux de biopsies positives etait de 128/225 (56,9 %) pour tous cancers, 96/225 (42,7 %) pour les CS-A, de 87/225 (38,7 %) pour les CS-B et de 47/225 (20,9 %) pour CS-C. L’IRM etait negative (Likert ≤ 2/5) chez 45 patients (20 %). Suivant la definition du CS, la valeur predictive negative de l’IRM etait de 88,9–95,6 %. Le nombre de patients detectes par les biopsies systematiques seules, les biopsies ciblees seules et les deux types de biopsies etaient de 15, 19 et 62, respectivement pour les CS-A. Il etait respectivement de 12, 18 et 57 pour les CS-B et de 3, 15 et 29 patients pour les CS-C. Conclusion Suivant la definition du CS, les biopsies ciblees ont detecte un CS qui aurait ete rate par les biopsies systematiques chez 6,7–8,4 % des 225 patients. Omettre les biopsies systematiques aurait fait rater un CS chez 1,3-6,7 % des 225 patients.

Objectifs Rapporter les modifications engendrees par l’utilisation du protoxyde d’azote (N2O) durant l’anesthesie generale dans le cadre d’un traitement par HIFU (Focal One) en premiere intention chez des patients presentant un cancer de prostate localise. Les donnees quantitatives ont ete analysees par un test t de Student. Methodes De septembre 2015 a decembre 2016, 99 patients ont ete traites en premiere intention par HIFU avec le systeme Focal One pour un adenocarcinome prostatique. L’intervention a ete realisee soit avec l’utilisation d’un melange de protoxyde d’azote/oxygene (N2O/O2 : 50 %/50 %), soit sans utilisation de N2O. Nous avons analyse les differents parametres du traitement par HIFU : duree d’intervention et vitesse du traitement (volume traite par heure), nombre et duree des pauses, et variation du PSA postoperatoire a 1, 3 et 6 mois. Les donnees quantitatives ont ete analysees par un test t de Student. Resultats Les caracteristiques de la population et du traitement sont presentees dans le Tableau 1 . A volume prostatique similaire, la duree moyenne d’intervention etait significativement plus courte en l’absence de N2O et la vitesse de traitement etait significativement plus elevee en l’absence d’utilisation de N2O (p Fig. 1 ). Conclusion L’utilisation du N2O semble diminuer l’efficacite du traitement par HIFU, en augmentant les phenomenes de cavitation, entrainant l’augmentation de la duree du traitement, le nombre et la duree des pauses. Il semble exister une moins grande efficacite du traitement par HIFU sur le plan carcinologique avec diminution moins importante du PSA postoperatoire.

Kidney, prostate and bladder cancers (KCa, PCa and BCa, respectively) represent 1 700 000 cases and 450 000 deaths worldwide per year, with an incidence rising yearly by 1-10%. Surgery is usually curative at early and localized stages but there are no efficient therapies at advanced and metastatic stages for any of them. Although genetically-modified and/or chemically-induced avatar models do exist for these cancers and may help to identify new therapeutic targets, they suffer from a lack of an extended biological concordance with the natural history and heterogeneity of the diseases. Patient-derived tumor xenograft models are now well recognized as reliably reproducing tumor heterogeneity and have become over the past few years the preclinical tools of choice to test drugs and identify biomarkers. Since 10 years, we are continuously developing a unique panel of PDX models for these major urological cancers. Tumor tissues along with normal corresponding tissues were obtained from patients at surgery. Patient informed consent and clinical history are available for all patients. Tumor tissues pieces were xenografted subcutaneously in the interscapular space of nude mice, and serially passaged into mice after the first engraftment, up to passage 10. To ensure model stability between primary tumors and tumors growing in mice but also from passage to passage, we performed various analyses at histopathological, genetic (short tandem repeat fingerprinting) and molecular (cDNA profiling) levels. In addition, growth characteristics and responses to standards of care (SOCs) were examined. Finally, specific molecular characteristics were also explored including expression of the androgen receptor, PSA and pan-cytokeratin for PCa models and hotspot mutations of FGFR3, PIK3CA, K/N/H-RAS for BCa models. Up to now, we have xenografted 336 (on 569 samples), 247 and 152 KCa, PCa and BCa tumor tissues, and developed 30 (8.9% success rate), 6 (2.1%) and 30 (19.7%) PDX models, respectively. We recently published part of the KCa PDX models collection (Lang et al., Oncotarget, 2016). Characterization studies showed that PDX models are stable at all levels analyzed considering concordance to primary tumors and from passage to passage; and less than 5% of genes were differentially expressed between the primary tumors and PDX tumors at various passages. Responses to SOCs recapitulated the clinical state. Only for KCa PDX models, the take rate was correlated to tumor stage and grade, and sarcomatoid components. Importantly, several molecular subtypes were defined in our collection of BCa PDX models including PDXs with FGFR3 mutations and PDXs of basal subtype, the most aggressive one. Overall, this panel of PDX models for urological cancers should definitely help to find molecularly guided targeted therapies for these still incurable cancers at metastatic stages. Citation Format: Hervé Lang, Claire Béraud, Myriam Lassalle, Isabelle Bernard-Pierrot, Véronique Lindner, Yves Allory, Michel Soulié, Xavier Gamé, Pascal Rischmann, Eric Potiron, François Radvanyi, Philippe Lluel, Thierry Massfelder. A comprehensive patient-derived tumor xenograft (PDX) collection representing the heterogeneity of kidney, prostate and bladder cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1035.

OBJECTIVES To determine the diagnostic performance of dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) in the identification of intraprostatic cancer foci related to cancer volume at histopathology, in patients with clinically localized cancer treated by radical prostatectomy, with whole-mount histopathologic sections as the reference standard. METHODS Eighty-three consecutive radical prostatectomy specimens from patients referred for a prostate-specific antigen elevation were correlated with prebiopsy MRI. MRI results ranked on a 5-point scale were correlated with the findings of histopathology maps in 8 prostate sectors, including volume, largest surface area, and percentage of Gleason grade 4/5. The area under the receiver operating characteristic curve was used. RESULTS Median prostate-specific antigen was 8.15 ng/mL. DCE-MRI was suspicious in 55 (66%) out of 83 patients. A separate cancer foci (mean 2.55 per patient) was present in 212 (34%) of 664 octants and DCE-MRI was suspicious in 68 of 212. Sensitivity and specificity of DCE-MRI at score 3.4 or 5 for identification of cancer foci at any volume was 32% and 95%, respectively. For identification of cancer foci > 0.5 mL, the sensitivity and specificity were 86% and 94%, respectively, with the under the receiver operating characteristic curve of 0.874. Mean volume of DCE-MRI detected and missed cancers were 2.44 mL (0.02-14.5) and 0.16 mL (0.005-2.4), respectively. Sensitivity and specificity of DCE-MRI for identification of > 10% of Gleason grade 4/5 were 81% and 82%, respectively. CONCLUSIONS DCE-MRI can accurately identify intraprostatic cancer foci. Possible applications are guidance for biopsies, selection of patients for watchful waiting, and focal treatment planning.

BACKGROUND To describe the precise location of peripheral zone (PZ) prostate cancers at various stages of development and to demonstrate their pattern of intraprostatic spread from their site of origin. METHODS PZ cancers defined as cancers located in peripheral zone (PZ) including the anterolateral part of PZ, were identified from radical prostatectomy specimens. PZ cancers morphometric histopathological study included largest surface area, volume and spatial distribution. RESULTS Out of 188 PZ cancers, 179 were

BACKGROUND To describe the precise location of transition zone (TZ) and anterior fibromuscular stroma (AFMS) prostate cancers (TZ/AFMS) within histological zones at various stages of development and to demonstrate their pattern of intraprostatic spread from their site of origin. METHODS Anterior TZ/AFMS cancers excluding the anterolateral part of peripheral zone, were identified from radical prostatectomy specimens. Morphometric histopathological study included largest surface area, volume and spatial distribution. RESULTS Out of 91 TZ/AFMS cancers, 79 were

International audience; Aim In intermediate- or high-risk prostate cancer (PC) patients, to avoid extended pelvic lymph node dissection (ePLND), the updated Briganti nomogram is recommended with the cost of missing 1.5 % of patients with lymph node invasion (LNI). Is it possible to reduce the percentage of unexpected LNI patients (nomogram false negative)? We used the isotopic sentinel lymph node (SLN) technique systematically associated with laparoscopic ePLND to assess the potential value of isotopic SLN method to adress this point. Methods Two hundred and two consecutive patients had procedures with isotopic SLN detection associated with laparoscopic ePLND for high or intermediate risk of PC. The area under the curve (AUC) of the receiver operating characteristics (ROC) analysis was used to quantify the accuracy of different models as: the updated Brigantinomogram, the percentage of positive cores, and an equation of the best predictors of LNI. We tested the model cutoffs associated with an optimal negative predictive value (NPV) and the best cutoff associated with avoiding false negative SLN detection, in order to assist the clinician’s decision of when to spare ePLND. Results LNI was detected in 35 patients (17.2 %). Based on preoperative primary Gleason grade and percentage of positive cores, a bivariate model was built to calculate acombined score reflecting the risk of LNI. For the Briganti nomogram, the 5 % probability cutoff avoided ePLND in 53 % (108/202) of patients, missing three LNI patients (8.6 %), but all were detected by the SLN technique. For our bivariate model, the best cutoff was

Objectifs Le statut du ganglion sentinelle (GS) est pronostique du curage ganglionnaire loco-regional dans le cancer de la prostate mais ce statut a-t-il un impact sur l’evolution clinique des patients ? Le but de cette etude est d’analyser les donnees de survie de patients ayant beneficies d’une prostatectomie radicale cœlioscopique avec reperage des GS et curage pelvien extensif. Methodes De juin 2008 a decembre 2014, 227 patients consecutifs ont ete inclus, dont 49 patients (21,58 %) porteurs de metastases ganglionnaires. Le suivi median etait de 3,94 ans [3,72–4,23]. La survie sans recidive (SSR) et la survie globale (SG) ont ete analysees selon Kaplan–Meier et differents parametres histopathologiques par analyse uni- et multivariee (analyse par Cox regression). Resultats Une moyenne de 26,4 ± 10,5 ganglions retires lors du curage extensif, dont 5,72 ± 3,75 GS. Au dernier suivi, 24,9 % (62/227) des patients avaient recidive et 2 etaient decedes specifiquement du cancer prostatique. En analyse univariee, le stade clinique, le score de Gleason, le % biopsies positives et les marges chirurgicales affectaient significativement la SSR ( p −4 a 10 −6 ). En cas d’atteinte ganglionnaire metastatique, les donnees les plus significatives etaient le nombre total de ganglions metastatiques (GS et non GS) et la presence de macro-metastases ganglionnaires dans le GS ( p −12 a 10 −15 ). En analyse multivariee, la presence de micro- ou de macrometastases dans les GS (quelque soit l’atteinte non GS) etait le critere pronostique le plus pejoratif de la SSR, avec un hazard ratio de 5,25 [95 % CI : 2,83–9,74] ( p −6 ). Conclusion Le GS dans le cancer de la prostate localise semble etre porteur d’informations decisives de l’evolution clinique des patients puisqu’une atteinte metastatique GS a un impact important sur la SSR. Ceci souleve la question d’un traitement adjuvant plus precoce pour les patients avec atteinte metastatique des GS1.

Objectifs Evaluer l’interet de l’utilisation d’un masque sensoriel d’auto-hypnose (HYPNOS Pro) lors de la realisation d’une fibroscopie vesicale en soins externes afin de diminuer l’anxiete du patient et la sensation douloureuse de l’examen. Methodes Etude prospective de mars a mai 2016. Nous avons propose au patient lors de la consultation la possibilite de beneficier d’un masque sensorielle d’auto-hypnose durant la realisation d’un examen endoscopique (fibroscopie vesicale associee a une anesthesie locale ± masque d’auto-hypnose). L’IDE de la consultation etait formee a la communication hypnotique. Nous avons evalue la connaissance du patient sur l’hypnose, son niveau d’anxiete avant et apres l’examen, la satisfaction du patient lors de l’utilisation du masque et son interet dans la procedure endoscopique. Resultats Quarante-cinq patients ont ete inclus pour cette etude. Vingt-neuf patients ont souhaite utiliser le masque sensoriel HYPNOS Pro ( Figure 1 ). Chez plus de 60 % des patients, l’utilisation du masque d’auto-hypnose a permis de diminuer l’anxiete liee au geste endoscopique. Ce geste est alors considere comme legerement ou nullement anxiogene chez pres de 96 % des patients utilisant le masque contre seulement 75 % des patients sans masque d’auto-hypnose. Pres de 93 % des patients testeurs souhaiteraient reutiliser le masque d’auto-hypnose lors de leur prochain examen et pres de 96,5 % le conseillerait a leur entourage pour la realisation d’un soin equivalent ( Tableau 1 ). Conclusion L’utilisation de masque sensoriel d’auto-hypnose HYPNOS Pro semble ameliorer la qualite du soin proposee lors de la realisation d’un geste endoscopique en diminuant l’anxiete vecue par le patient lors de cet examen. Ces resultats preliminaires devront etre controles par une evaluation plus approfondie de cet outil, qui pourraient s’integrer dans le cadre de l’amelioration de la bientraitance du patient.

The electrochemical oxidation of aqueous solutions of mixtures of VOSO 4 and MSO 4 (M=Ni, Cu or Mn) leads to solid deposits on the electrode, of general formulation M x V 2 O 5+ y . n H 2 O. These compounds present great similarities with the layered hydrated vanadic acids e-V 2 O 5 obtained when oxidizing pure VOSO 4 solutions. In the case of solutions containing NiSO 4 and CuSO 4 , the M 2+ cations are incorporated, without any change in their oxidation state, into the interlayer space of the vanadic acid, thus replacing a part of the exchangeable protons of e-V 2 O 5 . In the case of mixtures of VOSO 4 and MnSO 4 , there is simultaneous oxidation of Mn 2+ and of VO 2+ , leading to a vanadic acid in which the exchangeable protons of the interlayer space are replaced by Mn IV cations. As for e-V 2 O 5 compounds, the electrochemical intercalation of lithium into these compounds shows two main phenomena in the 4–2 V/Li range. Among the title materials, the manganese-containing compound presents the largest reversible capacity (1.6 Li per formula unit in the 4–2 V/Li voltage range at C/10), with the best cycling behavior. Whereas, by annealing at 400 and 450°C, respectively, the copper and nickel-containing compounds transform irreversibly to a mixture of α-V 2 O 5 and MV 2 O 6 , annealing the manganese-containing compound at 300°C leads to a new material structurally related to α-V 2 O 5 but with a completely different lithium intercalation behavior.

The electrochemical oxidation of vanadyl cations in aqueous solution leads to a solid deposit on the working electrode, called electrolytic vanadium oxide (e-V2O5). The electrodeposition reaction occurs in two steps including an oxidation into soluble species followed by a precipitation. Electrodeposited compounds are mixed valence, hydrated vanadic acids. Their chemical formula can be written H0.4V2O5.2−δ·nH2O with 0.04 The electrochemical intercalation of lithium into these compounds shows two main single phase phenomena near 2.6 and 3.1 V/Li. This reduction induces a lengthening of the average vanadium oxygen bond, and a decrease of the lithium diffusion coefficient. e-V2O5 compounds reversibly intercalate 1.4≅Li per formula unit at an average voltage of 2.8≅V/Li, at a rate of C/50 in the 4–2 V range, and this capacity is maintained during several tens of discharge/charge cycles. The electrochemical behavior is slightly dependent on the VIV content and the crystallization state of the compounds.

Objectifs Determiner la place de l’index PHI dans le diagnostic moderne du cancer de la prostate (CaP) guide par l’IRM. Methodes Il s’agit d’une etude prospective en cours d’inclusion (janvier 2016), multicentrique. Les patients avaient avant la realisation de biopsies ciblees (systeme koelis) un dosage de l’index PHI. Les donnees recueillies etaient l’ âge, les antecedents familiaux de CaP, les antecedents personnels de biopsies, le statut du toucher rectal et un dosage du PSA total/libre. Les donnees quantitatives et qualitatives etaient analysees respectivement par t test de student et de test de Fisher exact ou Chi2. La precision diagnostique de l’index PHI etait definie par l’aire sous la courbe ROC. Plusieurs scenarios ont ete construits afin de determiner la meilleure place de l’index phi. Resultats Quatre-vingt treize patients ont ete inclus, 40 (43 %) avaient eu un premiere biopsie negative. Le taux de biopsies positive etait de 47,3 % (n = 44). Les caracterisitiques de la population sont presentees dans le Tableau 1 . Les patients ayant des biopsies positives avaient un volume prostatique diminue, un index PHI eleve et plus frequement un scoring PiRads IRM > 3 que les patients sains. L’aire sous la courbe de l’index PHI etait de 0,68 (p = 0,002). Le taux de detection biopsique le nombre de biospies evitees, le taux de cancer non diagnostique (total, score de Gleason ≥ 7) de chaque scenario ( Fig. 1 ) sont rapportes dans le Tableau 2 . Conclusion L’index PHI de diminuer le taux de cancer prostatique non detectes par l’IRM tout en evitant environ 50 % de biopsies inutiles. En cas d’IRM peu suspecte (PiRads ≤ 3), l’utilisation de l’index PHI permet de reorienter certains patients vers la realisation de biopsies pour ne pas negliger des cancers de score de Gleason ≥ 7.

Objectifs Le systeme de traitement par HIFU Focal One permet l’utilisation des cartographies biopsiques prostatiques Koelis, avec la realisation en peroperatoire d’une fusion elastique 3D et une echographie realisee durant la phase de traitement. Methodes Le systeme de traitement par HIFU Focal One permet la realisation d’une fusion elastique 3D avec les cartographies Koelis. La fusion necessite la validation de l’ensemble des biopsies Koelis et son exportation sur le systeme Focal One . Une fois l’acquisition echographique realisee, un contourage de la prostate est realise avec la determination de l’apex, de la base prostatique et de trois contours prostatiques. Apres realisation de la fusion Koelis- Focal One , il sera possible de faire apparaitre, au niveau de l’ecran de planification, les contours prostatiques, les differentes biopsies (positives et negatives), ainsi que les zones cibles determinees en IRM. Resultats La fusion de la cartographie Koelis, durant la phase de traitement par HIFU, permet une meilleure localisation des zones tumorales symbolisees par les cibles IRM et la distribution 3D de l’ensemble des biopsies. Cela permettra d’adapter au mieux les marges de traitement notamment au niveau de l’apex ( apex-sparing ) ou au niveau des bandelettes neurovasculaires ( nerve-sparing ). Cette cartographie pourra aussi etre utilisee lors de la realisation de l’echographie de contraste pour controler la qualite du traitement et decider en peroperatoire de l’interet d’un retraitement immediat en cas de sous traitement (biopsies positives ou cibles en dehors de la zone devascularisee). Conclusion La fusion elastique Koelis/ Focal One est une nouvelle option permettant d’ameliorer le guidage du traitement par HIFU Focal One . Son utilisation, lors de la realisation de l’echographie de controle, permettrait de diminuer le risque de sous traitement.

Objectifs L’evolution des recommandations sont marquees par l’extension des indications de la nephrectomie partielle. L’assistance robotique semble permettre une diminution de la courbe d’apprentissage, des durees d’ischemie chaudes, des durees operatoires, des taux de complications perioperatoires et de marges positives comparees a la laparoscopie pure. L’objectif de cette video est de partager notre technique reproductible, alternative au traitement par voie anterieure. Methodes La chirurgie renale robot assistee par voie retroperitoneale a ete effectuee a l’aide du systeme robotise DaVinci Si 3 bras, les pinces utilisees pour le robot etaient : 1 ciseaux, 1 porte-aiguille, 1 pince bipolaire (maryland), trocarts sterilisables, clamps (bulldogs) sterilisables, pas d’utilisation de ballon de dissection. L’indication de chirurgie partielle est decrite avec son iconographique par scanner et l’intervention filmee comporte l’installation du patient, la mise en place des trocarts et le positionnement du robot ainsi que les temps forts de l’intervention et les principales suites operatoires. Resultats Cette video de nephrectomie partielle renale par voie retroperitoneale a permis de preciser d’une part, la position des trocarts et du robot pour eviter les conflits, mais a egalement montre l’apport du robot en terme d’ergonomie, de dissection et de suture dans une zone anatomique restreinte, avec conservation des objectifs oncologiques, fonctionnels (ischemique et comorbidites) et de duree operatoire. Conclusion Cette video met en evidence l’apport du systeme robotique dans la chirurgie partielle du rein par voie retroperitoneale, permettant notamment le gain ergonomique sans alteration des imperatifs oncologiques et fonctionnels. La voie d’abord ne doit pas modifier l’indication chirurgicale et la voie retroperitoneale peut ainsi permettre une plus grande modulation des indications en chirurgie mini-invasive.

The lymph node metastasis is an important prognostic factor in prostatic cancer. The aim of this prospective study was to evaluate the relevance of the sentinel lymph node biopsy by laparoscopy in staging locoregional patients with clinically localized PC.A transrectal ultrasound-guided injection by 0.3 mL/100 MBq (99m)Tc-sulfur rhenium colloid in each prostatic lobe was performed the day before surgery. The detection was realized intraoperatively with a laparoscopic probe (Clerad(®) Gamma Sup) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by hematoxyline-phloxine-safran staining and followed by immunochemistry if SLN is free.Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 68/70 (97%). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14%). The internal iliac region was the first metastatic site (40.9%). A metastatic sentinel node in common iliac region beyond the ureteral junction was present in 18.2%. A non-negligible sentinel metastatic region was the common iliac area (18.2%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59% of lymph node metastases.The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limited the risk of surgical extended dissection while maintaining the accuracy of the information.

Objectifs L’objectif de cette etude prospective est de tester 3 differents nomogrammes, Briganti [1] , Cagiannos [2] et Roach [3] et de developper un modele simple d’evaluation de la probabilite d’atteinte ganglionnaire metastatique pour des patients a risque intermediaire ou eleve traites par curage pelvien extensif et detection isotopique sentinelle. Methodes Au total, 202 patients consecutifs ont ete inclus. Une analyse multivariee a recherche un ou des facteurs predictifs d’une atteinte ganglionnaire metastatique (N+). L’exactitude des differents nomogrammes, parametres predictifs isoles et d’un modele combinant les parametres predictifs, a ete realisee par une analyse de l’aire sous les courbes Receiver Operating Characteristics (ROC). Nous avons determine, pour les meilleurs outils, les meilleurs seuils associes a la valeur predictive negative (VPN) optimale associee a une absence de faux negatifs en technique isotopique sentinelle pour aider le clinicien a decider de la realisation ou non du curage extensif. Resultats Trente-cinq patients N+ (17,2 %) et nombre median de 5 SLN retires [3–8]. Le premier chiffre de Gleason et le pourcentage de biopsies positives etaient des facteurs predictifs du statut ganglionnaire N+ conduisant a un modele predictif a 2 variables. Les meilleures exactitudes (courbes ROC) etaient de 81,39 et 81,80 % pour le nomogramme de Briganti1 et notre modele respectivement. Pour le nomogramme de Briganti1, le seuil avec la meilleure VPN etait Conclusion La technique du ganglion sentinelle permet de pallier « aux cas oublies » par le nomogramme de Briganti1 ou notre modele predictif avec un nombre limite de ganglions preleves (sentinelles).

Objectifs Etudier la faisabilite, la securite et l’efficacite de la prostatectomie totale laparoscopique (PT) de rattrapage de la recidive du cancer de prostate (CaP) apres traitement focal par phototherapie dynamique (VTP) ou HIFU avec Focal One. Methodes Cinq patients ont ete operes par PT pour recidive de cancer de prostate confirme par biopsie apres traitement focal (un VTP et 4 HIFU). La duree operatoire, les pertes sanguines, le taux de transfusion, la duree de sondage, les resultats fonctionnels, et les resultats oncologiques a court terme ont ete rapportes. Resultats L’âge median etait de 61 ans. Le PSA median avant traitement etait de 2,7 ng/mL (0,65–5,85). Le delai median entre le traitement focal et la PT etait de 11 mois. Le temps operatoire median etait de 120 min. La duree mediane d’hospitalisation etait de 9 jours, la duree mediane de sondage urinaire etait de 11 jours. Apres un suivi median de 8 mois, Le PSA postoperatoire etait indetectable et le stade etait pT2c pour tous les patients, le score de Gleason etait 3 + 3 et 3 + 4 pour 1 et 4 patients, respectivement. Un patient presentait une marge positive focale et aucun n’a eu de traitement adjuvant. A 6 mois, tous les patients etaient continents, pour les deux patients avec IIEF > 17 en preoperatoire, le score IIEF etait superieur a 17. Conclusion Dans notre experience, la PT laparoscopique est faisable, sure et efficace en traitement de rattrapage du traitement focal du cancer de prostate localise. Les resultats oncologiques et fonctionnels a court terme sont prometteurs, des etudes complementaires sont necessaires.

Objectifs Evaluer de facon prospective les resultats des biopsies prostatiques systematisees(BS) et dirigees(BD) apres fusion echo-IRM avec realisation d’une cartographie 3D complete des biopsies. Methodes De mars 2013 a fevrier 2014, 250 patients presentant une indication de biopsies prostatiques (PSA > 4 et/ou anomalie au toucher rectal) ont ete inclus prospectivement. Il s’agissait d’une premiere serie de biopsies dans 207 cas, d’une serie iterative dans 49 cas. Une IRM multiparametrique puis des biopsies selon le schema etendu de 12 biopsies completees par 4 biopsies anterieures ont ete realisees. En cas de lesion suspecte en IRM (score ≥ 3), 2 a 4 BD etaient realisees a la place des biopsies du secteur systematise correspondant. Toutes les biopsies ont ete realisees avec un guidage par la fusion echographie-IRM permettant la realisation d’une cartographie 3D. Resultats Les biopsies etaient positives dans 59,6 % des cas et 51,3 % en cas d’anomalie sur l’IRM. Le nombre moyen des biopsies positives etait de 4,8 par patient avec une longueur moyenne 7,3 mm pour la plus grande biopsie. Les biopsies dirigees etaient les plus grandes dans 69 % des cas et les seules positives chez 32 patients (17,3 %). Le taux moyen de BD positives etait de 49,6 % en cas de 1re serie et 57 % 2e ou 3e serie. Conclusion La realisation d’une cartographie 3D permettant la realisation de biopsies ciblees en cas d’anomalie a l’IRM, parallelement aux biopsies systematisees ameliore significativement la reconnaissance du cancer de la prostate, notamment en cas de premieres series negatives, et permet la mise en place des strategies de traitement focalise, par les donnees topographiques obtenues.

Objectifs Evaluer le traitement par HIFU focalise du cancer de prostate localise avec des lesions visualisees en IRM et des biopsies de prostate ciblees positives (procede de fusion echographie-IRM) apres 6 mois de suivi. Methodes Une etude prospective monocentrique a ete realisee de fevrier a mai 2014 avec pour criteres d’inclusion : stade T1c ou T2, PSA

Electrolytic V2O5 materials were prepared by electrochemical oxidation of vanadyl ions in aqueous solution. The electrodeposition reaction includes two steps: an oxidation into soluble species followed by a precipitation. With the use of various electrodeposition conditions and subsequent heat treatment it is possible to obtain e-V2O5 compounds with different VIV and water contents.e-V2O5 compounds are mixed valence, hydrated vanadic acids and their formula can be written as H0.4V2O5.2−δ.nH2 with 0.042O5 starting at 240°C.The electrochemical intercalation of lithium into these compounds shows two main single phase phenomena at ≈3.2V/Li and ≈2.6V/Li. Their capacity retention is better than that of other V2O5 reference compounds, but the reversible capacity down to 2V is only ≈100Ah/kg at a rate faster than C/5, due to kinetic limitations.