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The main objective of the French GETUG/AFU V05 VESPER randomized phase III study was to assess the efficacy of dd-MVAC and GC in term of progression-free survival in patients for whom chemotherapy has been decided, before or after surgery.A total of 500 patients have been randomized in 28 reference centers. Inclusion criteria were urothelial carcinoma without neuro-endocrine variant, disease defined by a T2, T3 or T4a N0 (pelvic lymph node ≤ 10 mm on CT scan) M0 staging for patients receiving neoadjuvant chemotherapy or pT3 or pT4 or pN+ and M0 for patients receiving adjuvant chemotherapy. Secondary endpoints include overall survival, safety, response rate. The peri-operative chemotherapy schedule was experimental arm dd-MVAC for a total of 6 cycles versus standard arm GC 4 cycles. The toxicity was evaluated according to NCI CTCAE (v 4.0). The progression-free survival rate will be estimated at 3 years by the Kaplan-Meier method. All the patients will be followed for 5 years.The last patient was randomized in March 2018 and the primary endpoint results are expected for mid-2021. As the dd-MVAC schedule is associated with higher response rates in metastatic disease, the real question today is to confirm such benefit in the peri-operative setting, taking also in consideration the chemotherapy toxicity. Tomorrow, the challenge may be the best chemotherapy and immunotherapy association, the authors hope that final Vesper Trial results will help to determine the gold standard chemotherapy. Keywords: Bladder cancer, Peri-operative chemotherapy

Introduction et but de l’etude Les modalites principales du traitement de cancer de prostate localise sont la radiotherapie et la chirurgie. Notre objectif etait de realiser une evaluation medicoeconomique des alternatives therapeutiques du cancer de prostate localise, a savoir la radiotherapie stereotaxique robotisee par comparaison a la prostatectomie totale robot-assistee, afin d’estimer l’impact sur la qualite de vie du patient et fournir un outil d’aide pour les decideurs en sante. Materiel et methodes L’analyse cout–efficacite en perspective societale a compare ces deux alternatives therapeutiques, en integrant des informations issues de sources bibliographiques multiples pour estimer les couts et les resultats attendus avec des donnees dispersees entre plusieurs etudes. Le modele de Markov a quatre etats a ete modelise sur un horizon temporel de dix ans avec le logiciel TreeAge Pro version 2019. La population d’analyse correspondait aux patients atteints de cancer de la prostate localise a bas risque selon la classification de D’Amico et pour lesquels la decision therapeutique etait l’intervention robot-assistee. Resultats et analyse statistique Nous avons constate une difference de cout (2079€) et d’utilite (0,653 quality-adjusted life year [QALY]) sur 10 ans correspondant a un ratio differentiel couts–resultats de 3184€/QALY. Selon l’analyse de sensibilite probabiliste de Monte-Carlo, la dispersion des 1000 iterations de ratio differentiel couts–resultats est faible. La conclusion selon laquelle la radiotherapie stereotaxique robotisee est plus chere et plus efficace que la prostatectomie totale robot-assistee est donc robuste dans notre scenario. Selon l’analyse de sensibilite unifactorielle, les parametres ayant le plus d’impact sur le modele sont les couts de l’etat initial quelle que soit l’intervention choisie. Enfin, la courbe d’acceptabilite met en evidence qu’a partir du seuil de 3184€ sur 10 ans (correspondant a une « volonte de payer » du decideur financier), la strategie de la radiotherapie stereotaxique robotisee en perspective societale devient efficace en termes de couts par rapport a la strategie de prostatectomie totale dans notre modele. Conclusion Cette evaluation medicoeconomique des strategies therapeutiques comparant la radiotherapie stereotaxique robotisee et la prostatectomie totale robot assistee est un travail preliminaire d’analyse et d’evaluation de technologies de sante utilisees dans le traitement du cancer de la prostate en France. Elle suggere que la radiotherapie stereotaxique robotisee peut etre une technique efficace en termes de cout par rapport a la prostatectomie totale robot assistee, malgre des couts initiaux legerement plus eleves de la radiotherapie.

The incidence of cancer increases with age, especially for urological cancers. The frailty of the elderly persons may expose them to more postoperative complications resulting in prolonged hospitalization, increased morbidity or even increased mortality, and delayed or impossible return to normal life. In such cases, the benefit of surgery and therefore its realization can be questioned.This article reports the experience of a pre-operative risk assessment in a population of elderly patients treated for urologic cancer. This retrospective study aims to report the feasibility and the main results of this systematic preoperative multi-professional evaluation.Between April 2016 and February 2017, 31 elderly patients were evaluated. The evaluation revealed: moderate to severe malnutrition in 59 % of cases, a patient judged from a geriatric point of view fit, intermediate or fragile in respectively 25 %, 35 % and 40 % of cases. This evaluation led to propose a modification of an element of care for 66 % of patients and to propose therapeutic abstention for only 3 patients.An evaluation whose purpose is to adapt to the physiological age of patients and their overall state of health, surgical treatment and postoperative management is feasible and seems to help unmask elements of fragility usually not detected.4.

To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms.This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit.Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly.A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.

Assess the early morbidity after HOLEP, the urinary incontinence in particular, and specify its different types, evolution, and predictive factors.We conducted an observational, analytical, retrospective, monocentric study including all patients undergoing surgery for benign prostatic hypertrophy (HBP) by HoLEP between November 2015 and January 2017. The data were collected pre-, per- and postoperatively. The follow-up was for 6 months.One hundred and seventy one patients were included. 23 patients (14.6%) had a complication according to Clavien-Dindo classification [4]: 19 (83%) Clavien 2, 1 (4%) Clavien 3b et 3 (13%) Clavien 4. At one month of the surgery, 64 (42.7%) patients had urinary incontinence of which 55 (86.1%) presented pure stress urinary incontinence. 18 (32.7%) were still incontinent at 6 months of the surgery. The delivered amount of energy during the surgery and the preoperative IIEF5 score were statistically significantly associated with the occurrence rate of stress urinary incontinence. There was no correlation between the surgeon's learning curve and the occurrence of incontinence.The occurrence rate of urinary incontinence post HoLEP might be related to the adopted surgical technique ; It is crucial to keep the patient well informed of the risk of this complication postoperatively.4.

Our objective was to validate the VPSS (visual prostatic symptom score) score in the French language for the identification and monitoring of BPH-related LUTS in urological practice.A prospective observational survey was carried out between September the 15th 2014 and July the 30th 2015 in urology practices. The first 4 consecutive patients aged over 60 years, with BPH-related LUTS requiring prescription of an alpha-blocker, were enrolled. We translated a "visual prostatic symptom score" (VPSS) into French and adapted it slightly. At the first visit and follow-up visit (1-3 months after the first visit), the patient completed 2 questionnaires: the French language version of the IPSS and the VPSS.Of the urologists contacted, 169 enrolled at least one patient and returned information; 550 questionnaires were included in the statistical analysis. The median IPSS and VPSS total scores, subscores and quality of life scores all decreased significantly (P0.0001) between enrolment and the follow-up visit 1-3 months later. Correlations between the IPSS and VPSS at enrolment and the follow-up visit and their variation were all significant. Total VPSS was significantly correlated with total IPSS, as were the irritative, obstructive and quality of life subscores evaluated on the corresponding pictograms.This study showed the VPSS to be a simple and useful tool for identifying and monitoring BPH-related LUTS.4.

Background Radiotherapy of prostate cancers, over the last few years, has been an alternative choice to radical prostatectomy in the case of localised cancers as well as being the preferred treatment in both advanced localised cancers and those of the elderly. A conventional course of prostate radiotherapy consisting of four to five sessions a week, lasts between 7 and 8 weeks plus about one week of preparation. Materials and methods A systematic review of the scientific literature based on Pubmed, along with an exhaustive review of randomised studies presented at international congresses, have made it possible to analyse the numerous therapeutic regimens available other than the conventional normofractioned one (i.e. with doses per session ranging between 1.8 and 2.2 grays). Results Five randomised trials reported since 2005, plus several thousand patients treated by stereotaxic radiotherapy, have given rise to numerous scientific questions; these alternative hypofractioned courses (dose per fraction higher than 2.2 grays) have a potentially enhanced antitumoral efficacity along with the practical advantages of a shortened duration of radiotherapy. Conclusion The aim of this analysis of the scientific literature on hypofractioning in prostate cancer radiotherapy is to gather all the scientific evidence we currently have at our disposal. Further mature results of future randomised trials will have to be examined before modifying current practice.

Resume L'apport des analogues de la LHRH est immense pour la prise en charge, pratiquement a tous les stades, du cancer de la prostate, premier cancer de l'homme de plus de 50 ans. Ils permettent d'utiliser l'hormonotherapie de maniere fiable, peu morbide et reversible. Leur utilisation peut etre immediate ou differee, continue ou intermittente, associee ou non a un anti-androgene, et associee a la chimiotherapie pour les patients parvenus au stade d'echappement hormonal.

Resume Le rising PSA apres prostatectomie radicale correspond a une recidive biochimique, c'est-a-dire une re-ascension du taux de PSA. Plusieurs definitions de la recidive biochimique existent. Des elements predictifs permettent de differencier la recidive locale de la recidive a distance. Selon les cas, les options therapeutiques possibles pour la prise en charge de ces recidives sont la radiotherapie, l'hormonotherapie et la chimiotherapie.

To confirm gender specific differences in pathologic factors and survival rates of urothelial bladder cancer patients treated with radical cystectomy.We conducted a retrospective monocentric study on 701 patients treated with radical cystectomy and pelvic lymphadenectomy for muscle invasive bladder cancer. Impact of gender on recurrence rate, specific and non-specific mortality rate were evaluated using Cox regression models in univariate and multivariate analysis.We collected data on 553 males (78.9%) and 148 females (21.1%) between 1998 and 2011. Both groups were comparable at inclusion regarding age, pathologic stage, nodal status and lymphovascular invasion. Mean follow-up time was 45 months (interquartile 23-73) and by that time, 163 patients (23.3%) had recurrence of their tumor and 127 (18.1%) died from their disease. In multivariable Cox regression analyses, female gender was independently associated with disease recurrence (RR: 1.73; 95% CI 1.22-2.47; P=0.02) and cancer-specific mortality (RR=2.50, 95% CI=1.71-3.68; P0.001).We confirmed female gender to be an independent negative prognosis factor for patients following a radical cystectomy and lymphadenectomy for an invasive muscle bladder cancer.

Intermittent hormone therapy in prostate cancer consists in disrupting treatment after the nadir PSA has been reached, and reinitiating treatment when the PSA increases over a certain threshold. Theoretical advantages of intermittent hormone therapy are to delay the occurrence of hormone-independence and to decrease treatment-related side effects. Some phase II trials have demonstrated the feasibility of intermittent hormone therapy. The percent time without treatment varies between 40 and 50%. Oncologic results of intermittent hormone therapy are, at least, equivalent to those of continuous therapy. Moreover, the side effects of treatment are decreased and the quality of life is improved during off treatment phases. Due to the lack of comparative studies, the superiority of intermittent upon continuous treatment has not been established at long-term follow-up. Prospective comparative trials are ongoing; they will determine the true benefit of intermittent hormone therapy in prostate cancer.

Resume Objectif de l'etude Analyse retrospective des resultats de la cystectomie totale a visee curative a l'hopital Cochin. Patients et methodes Une cystectomie a visee curative a ete faite pour une tumeur de vessie chez 106 patients (97 hommes et neuf femmes) et realisee entre 1988 et 1993 dans le service d'urologie de l'hopital Cochin. Resultats L'examen anatomopathologique definitif a montre qu'il y avait 26 % de tumeurs de stade inferieur ou egal a pT1, 33 % de stade pT2 ou pT3a et 41 % de stade superieur ou egal a pT3b. La morbidite a interesse 19 % des patients avec un taux de reintervention precoce de 7,5 %. Trente et un pour cent des patients ont souffert d'une complication a long terme liee au traitement chirurgical de leur cancer de vessie, la stenose de l'anastomose ureteroileale etant la plus frequente. Trente-cinq pour cent des patients ont eu une recidive ou des metastases. Une recidive pelvienne isolee a ete observee dans 10,7 % des cas. Le taux de survie specifique a 5 ans etait de 88 % en cas de cancer de stade inferieur ou egal a pT1, de 81 % en cas de pT2 ou pT3a et de 42 % en cas de stade superieur ou egal a pT3b. Des facteurs de pronostic defavorable ont pu etre mis en evidence: presence d'emboles neoplasiques, tumeur depassant la paroi vesicale, association d'une uretrectomie a la cystectomie. Conclusion Ces taux de survie confirment que la cystectomie radicale reste actuellement le meilleur traitement des tumeurs de vessies infiltrantes.

Summary We report our preliminary experience in virtual endoscopy (VE) of the upper urinary tract (UUT) in an experimental model, a cadaver kidney and three patients with renal cavities filling defects (stones and tumor). The experimental model consists of a water-filled surgical glove containing a 2 mm calculi, a piece of red meat and a blood clot. A 2 mm stone was inserted in the pyeloureteral junction of a cadaver kidney. Three patients, one with a stone and an infiltrating tumor of the lower calices and two with a caliceal stone, were scanned. Single helical scanning using 3 mm slice thickness and 1:1 or1:1.5 pitch was performed in all cases, with a reconstruction pitch of 1 mm or 0.5 mm. Specific software allowed us to differentiate and to color the different filling defects according to their own densities. VE could be achieved in all cases. Although VE permits spectacular images, this technique does not produce any new information apart from that available in the axial slices. VE allows rapid evaluation of the complex morphology of hollow organs in a more “anatomical” fashion. VE permits the endoscopic evaluation of organs not routinely evaluated by endoscopy, such as the UUT. Further studies are needed to evaluate the clinical pertinence of VE.

Resume La validation psychometrique d'une echelle de qualite de vie specifique des troubles mictionnels est presentee. Cette echelle (echelle Ditrovie) s'avere sensible, specifique, fiable et cliniquement valide. Facile a utiliser (questionnaire autoadministre), courte (10 items), quantifiee (possibilite de score global) elle permet l'evaluation du retentissement des troubles vesicosphincteriens sur l'ensemble des dimensions testees (activites quotidiennes, retentissement emotionnel, image de soi, qualite du sommeil, bien-etre).

The objective of this study was to analyze the efficacy and safety of silodosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in current urologic practice.This was a prospective observational study conducted by 272 urologists on patients treated by silodosin for BPH. The parameters evaluated were the weighted IPSS score, the IPSS question 8 related to quality of life, the USP score and the Athens Insomnia Scale (AIS) measured at treatment initiation and after 3 months.Nine hundred and fourteen patients whose average age was 66 years with LUTS for 3.3 years were analyzed. After 3 months of treatment, a significant decrease in IPSS (from 16.2 ± 6.1 to 9.7 ± 5.5, P0.0001) and USP score (from 10.6 ± 5.1 to 6 0 ± 4.6, P0.0001) were observed, quality of life (from 67.1% to 14.4% of unsatisfied patients, P0.0001) and sleep were significantly improved (from 49.2% to 28.9% patients with insomnia, P0.0001). Among the patients, 21.2% experienced at least one adverse event. The most frequent were abnormal ejaculation (17.2%). And 7.1% discontinued the treatment for this reason. After 3 months of treatment silodosin was continued in 86.9% of patients.This large study confirmed the efficacy of silodosin in LUTS associated with BPH with a safety profile that does not affect patient satisfaction.

Upper tract urinary carcinoma (UTUC) pT3 tumors are a heterogeneous entity including tumors invading the renal parenchyma, tumors with peripelvic fat invasion or peri-ureteral fat invasion. The aim of this study was to evaluate the prognostic significance of these three different groups of pT3 tumors.Between 1998 and 2012, 205 patients with UTUC were operated in two centers, including 52 patients with pT3 tumor stage. pT3 tumors were divided into three groups: peri-ureteral fat invasion (pT3U, n = 16), peripelvic fat invasion (pT3G, n = 21), and renal parenchyma invasion (pT3P, n = 15). The prognostic significance of the type of tumor infiltration was evaluated on specific and disease-free survival.Median follow-up was 18.9 months [6-133.4]. In univariate analysis, renal parenchyma invasion was associated with a better prognostic in both specific (P = 0.026) and disease-free survival (P = 0.031) compared with peripelvic or peri-ureteral fat invasion. Mutivariate analysis retained the pT3 subgroup as an independant prognostic factor in both specific and disease-free survival (P = 0.02).pT3 tumors with renal parenchyma invasion had a better prognosis than those with peripelvic or peri-ureteral fat invasion. The heterogeneity of the pT3 group should be taken into account to improve the care of patients.

Objectives : In a European, prospective, 1 :2 randomized phase II multicentre study, 237 patients with advanced or metastatic prostate cancer were treated with either the 1M- (80 patients) or 3M-depot formulation (157 patients) of leuprorelin acetate for 9 months to compare efficacy and safety. Methods : Standard clinical investigations and methods were employed in the study. Leuprorelin levels were determined using a specially modified RIA. Results : The two formulations produced virtually identical effects with a pronounced fall in testosterone and gonadotropin serum levels and a marked reduction in PSA levels. After 9 months' treatment, PSA was normalized (≤4 ng/ml) in 65.2 and 66.1% of the 1M and 3M depot patients, respectively. The best response to 1M vs. 3M depot during the study was as follows : complete remission in 5 vs. 5.7%, partial remission in 36.3 vs. 33.8% and stabilization in 40.0 vs. 40.8%. The main side effects of both formulations were related to androgen deprivation. Conclusions : Comparable results were recorded for the two formulations ofleuprorelin acetate in terms of clinical response, endocrine effects and tolerability. The newly developed leuprorelin acetate 3M depot, as a refinement of the established 1M depot, offers an opportunity to improve patient compliance and provides individualized and optimized, patient-orientated treatment by reducing the number of injections to four per year.

Objectif de l’etude L’objectif principal de l’etude est de decrire la proportion de patients traites par une association de radiotherapie et d’un analogue de la LH-RH chez lesquels une modification du traitement hormonal initial (castration) est decidee au cours des 24 mois suivant son instauration. Materiel et methode Une etude de cohorte longitudinale de patients traites par analogue de la LH–RH a ete menee en France de juillet 2011 a janvier 2015. A l’inclusion et lors des visites de suivi tous les six mois, les donnees demographiques, cliniques, biologiques et therapeutiques ont ete recueillies ainsi que toute modification du traitement hormonal. Resultats Au total, les dossiers de 891 etaient evaluables a 24 mois. A l’inclusion, le traitement hormonal etait indique pour rechute biochimique (21,4 %), pour un cancer metastatique (24,2 %), pour une tumeur localement evoluee sans traitement local prevu (20,6 %) ou en situation adjuvante a la radiotherapie (31,6 %). Dans ce dernier groupe (279 patients), l’âge moyen des patients etait de 71,4 ± 6,9 ans et 72,8 % etaient au moins atteints d’une maladie associee. Le score de Gleason etait > 7, 7 (4 + 3), 7 (3 + 4) et Conclusion Cette etude observationnelle nationale renseigne sur la repartition des indications des analogues de la LH–RH en France : globalement, les agonistes des LH–RH sont prescrits dans 31,6 % des cas en association avec la radiotherapie. Une modification du traitement hormonal initialement prevue n’est observee que dans 37,6 % et porte essentiellement sur des modifications de formulation.

The aim of this study was to evaluate the prognostic significance of the ureteral location of the upper tract urinary carcinoma (UTUC).Between January 1998 and December 2007, 161 patients with UTUC were operated in our center. Tumors were located on renal pelvis in 51% of cases, on the ureter in 34% of cases and in both locations in 15% of cases. Nephroureterectomy was performed in 79.5% of cases (128/161) whereas a conservative treatment was performed in 20.5% of cases (33/161).In our series, 29.8% of patients had primary bladder cancer and 14.3% had synchronous bladder tumor. At a median follow-up of 42.5 months, 38.6% of patients developed bladder recurrence and 4.8% developed controlateral upper tract tumor. In multivariate analysis, ureteral location and existence of synchronous bladder tumor were independent prognostic factors of bladder recurrence (P=0.009 and P=0.025, respectively). Multivariate analysis retained T-stage and ureteral location as independent prognostic factors in both overall and disease-free survival (P=0.002 and P=0.0008 respectively for ureteral location).Ureteral location was an independent prognostic factor of bladder recurrence and was associated with a poorer prognosis.

Upper urinary tract urothelial carcinoma (UTUC) is a rare disease. Thus, little evidence-based data are available to guide clinical decision-making. The aim of the study was to provide an overview of the currently available prognostic factors for UTUC.A systematic literature search was conducted using the PubMed databases to identify original articles regarding prognostic factors in patients with UTUC.We divided the prognostic factors for UTUC in four different categories: clinical factors, preoperative characteristics, intraoperative/surgical factors and postoperative/pathologic factors. Prognostic factors described in order of importance are: tumor stage and grade, lymph node involvement, a concomitant cis, age at the diagnostic, lymphovascular invasion, tumor architecture and necrosis, tumor location and multifocality, gender. The impact of obesity, smoking and other comorbidities (ECOG, ASA) on outcomes has been recently reported but needs to be validated. The endoscopic approach of distal ureter management during radical nephroureterectomy has been shown to be at higher risk of bladder recurrence.The incorporation of such prognosticators into clinical prediction models might help to guide decision-making with regard to timing of surveillance, type of treatment, performance of lymphadenectomy, and consideration of neoadjuvant or adjuvant systemic therapies.

To evaluate the feasibility, tolerance and short-term efficacy of intra-prostatic UroLift(®) implants in four patients with symptomatic benign prostatic hyperplasia.Four patients with symptomatic BPH, already treated with alpha-blockers, were consecutively treated with intra-prostatic UroLift(®) implants under general anaesthesia. A bladder catheter was placed postoperatively. Alpha-blocker therapy was withdrawn 7 days postoperatively. The clinical and morphological characteristics of the patients were noted. Low urinary tract (IPSS) and sexual symptoms (IIEF5, MSHQ-EjD), maximum urinary flow rate and post voiding residual volume were evaluated preoperatively and at 1 month.Median age was of 69 [52-74] years old and median prostatic volume of 50 cm(3) [40-80]. Median procedure time was of 11 minutes [6-15]. Intra- and postoperative outcomes were uneventful. At 1 month, the mean IPSS and IPSS-QOL improvement were of 46 % and 58 %, respectively. One patient reported no improvement in his urinary and sexual symptoms. In the other three patients, the maximum urinary flow rate was improved, the post voiding residual improved in two patients and similar in one. No alteration in erection or ejaculation functions was reported.In our initial experience, intra-prostatic UroLift(®) implant procedure seemed feasible, efficacious for LUTS and well tolerated, especially concerning sexual outcomes. Further study of the UroLift(®) implant in France is currently being planned.

Radiotherapy of prostate cancers, over the last few years, has been an alternative choice to radical prostatectomy in the case of localised cancers as well as being the preferred treatment in both advanced localised cancers and those of the elderly. A conventional course of prostate radiotherapy consisting of four to five sessions a week, lasts between 7 and 8 weeks plus about one week of preparation.A systematic review of the scientific literature based on Pubmed, along with an exhaustive review of randomised studies presented at international congresses, have made it possible to analyse the numerous therapeutic regimens available other than the conventional normofractioned one (i.e. with doses per session ranging between 1.8 and 2.2 grays).Five randomised trials reported since 2005, plus several thousand patients treated by stereotaxic radiotherapy, have given rise to numerous scientific questions; these alternative hypofractioned courses (dose per fraction higher than 2.2 grays) have a potentially enhanced antitumoral efficacity along with the practical advantages of a shortened duration of radiotherapy.The aim of this analysis of the scientific literature on hypofractioning in prostate cancer radiotherapy is to gather all the scientific evidence we currently have at our disposal. Further mature results of future randomised trials will have to be examined before modifying current practice.

To evaluate the value of multiparametric MRI-targeted prostate biopsies in patients with suspected low-risk prostate cancer.Patients with normal digital rectal examination and a PSA level between 4 and 10 ng/mL were prospectively included. A multiparametric MRI of the prostate was performed prospectively before the biopsies. 12-core randomized biopsies were performed, with additional targeted samples in each suspicious area identified on MRI. Detected cancers and their histological characteristics were compared between those two biopsy protocols. A micro focal cancer (MFC) was defined by the presence of less than 4mm of Gleason score 3+3 cancer on a single core.Seventy-one consecutive patients were included. The overall detection rate was of 53% (38/71). It was of 70% (26/37) in the presence of suspicious area on MRI versus 35% (12/34) in the absence of any suspicious area (P=0.004). MRI-targeted biopsies alone detected three cancers, none of which was a MFC. 12-core biopsies alone detected 14 cancers, including ten MFC (71%). In 21 patients, prostate cancer was detected by both the MRI-targeted and 12-core biopsies. The Gleason score in the MRI-targeted area was the highest Gleason score in 90% of the cases. It was high (6) in 76% (16/21) of the patients.MRI-targeted biopsies detected less micro focal cancers than randomized 12-core biopsies. They did not seem however to decrease the detection of clinically significant cancers.

To evaluate biological free survival in patients with locally advanced prostate cancer treated with radical prostatectomy (RP) as sole treatment, and to analyse predictive factors of recurrence.We retrospectively studied patients treated between 1996 and 2006 for a pT3N0 prostate cancer with RP without any adjuvant treatment. The main endpoint was PSA relapse, defined as two successive elevations of PSA0.2 ng/mL. An association between PSA free survival and PSA, Gleason score, pathological stage and surgical margins status was statistically assessed.A total of 147 patients were included. Median preoperative PSA was of 10 ng/mL. Pathological stage was pT3b in 30% of the cases and surgical margins showed cancer involvement in 63% of the cases. Gleason score was ≥3+4 in 74% of the cases. Postoperative PSA was undetectable in 121 (82%) patients. Median follow up following RP was of 5 years. The 5-year-PSA free survival was of 48%. Multivariate analysis showed that preoperative and postoperative PSA, as well as Gleason score were predictors of PSA relapse (P0.05). In patients with undetectable postoperative PSA, 5-year-PSA free survival was of 56%. Seminal vesicle involvement and Gleason score ≥3+4 were the only independent predictors of PSA relapse.After RP for pT3N0 prostate cancer, the only predictive factors of recurrence were postoperative PSA and Gleason score. In case of undetectable postoperative PSA, surveillance seems acceptable if Gleason score is3+4 and in the absence of seminal vesicle involvement.

The urothelial carcinoma of the prostate is an entity which is necessary to recognize. The infiltration of the prostatic stroma is a major prognostic factor. The 2009 pTNM classification distinguish carcinoma in situ of the urethra with involvement of prostatic acini (pT2) from direct invasion of prostatic stroma through outside involvement (pT4). In case of non metastatic muscle invasive bladder cancer with major lymphatic invasion, the standard treatment remains neoadjuvant chemotherapy followed by radical cystectomy and extended lymphadenectomy. Only some patients can hope a complete response after neoadjuvant chemotherapy. For these responders, we can sometimes discuss, at an individual level, a bladder conservative strategy with an intensive surveillance.

In the era of new-targeted therapies and neoadjuvant strategies, this article highlights the role of angiogenesis in the process of physiological wound healing with a review of literature about parietal complications under anti-angiogenic therapies.Research on Medline was carried out using the terms renal cell carcinoma, angiogenesis, wound healing, targeted therapies, and complications.The frequency of these complications varies between 5 and 50% in recent series. These results depend on half-lives of each drug and perioperative management (before and after surgical procedure).In the absence of current recommendations, it is advised to stop bevacizumab at least five weeks before a surgical intervention and to take it back 4 weeks later. For the tyrosine kinase inhibitors, the treatment can be stopped 24-48 hours before the surgery and taken back 3-4 weeks later. Finally, for the mTOR inhibitors, it is advised to stop the treatment 7-10 days before and to take back it at least 3 weeks later.

Immediate intravesical chemotherapy after transurethral resection decrease recurrences in non-muscle-invasive bladder cancer. Guidelines recommend immediate, intravesical instillation for all patients with Ta/T1 tumours. Instillation has to be avoided when there is a bladder perforation, a large resection (3cm) or gross haematuria. Tolerance is good and morbidity is low.

The treatment of prostate cancer is experiencing important innovations. Hormone therapy includes a new class of drugs: LHRH antagonists, which induce a rapid, fast and sustained reduction of testosterone levels. Active surveillance enables to avoid an aggressive treatment without decreasing survival, provided that strict eligibility and follow-up criteria are applied. New imaging techniques and laboratory assays lead to early diagnosis of small size tumors. Lastly, focal therapy has the potential to target localized cancers without deterioration of surrounding structures. These concomitant improvements offer the clinician and the patient attractive options for prostate cancer management. However, they are not devoid of limitations and constraints. Thus, it is crucial to define the most appropriate patient's profile for each therapeutic option, taking into account the objective characteristics of the tumor and the psychological features of the patient.

Renal hybrid tumors (HT) are characterized by the association of both oncocytes- and chromophobe-cells within the same tumor. They have been reported in patients with Birt-Hogg-Dube (BHD) syndrome. The aim of this report was to describe two cases of HT and summarize recent literature.Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database.Two patients were diagnosed with multiple but small tumors of the kidney, and were treated with partial nephrectomy. Pathological analysis of these tumors showed oncocytoma-like and chromophobe-like cells intermixed in the same stroma.HT may constitute a spectrum of tumors between renal oncocytoma and chromophobe renal cell carcinoma. From a pragmatic management perspective, it would be appropriate to consider such tumors as chromophobe carcinoma. In case of HT, a genetic study for BHD syndrome can be proposed to family relatives.

to clarify the patterns of diagnosis and management of adult spermatic cord sarcoma.between 1996 and 2009, seven patients with spermatic cord sarcoma were treated at Cochin hospital. After updating the pathological diagnosis according to the new classification of sarcoma we found that all patients had well-differentiated or dedifferentiated liposarcoma. We analysed their clinical presentation, management and carcinological outcome.the patients' age ranged from 51 to 77 years, and their follow-up from 7 to 68 months. In five patients, the diagnosis of well-differentiated liposarcoma (lipoma-like) with some dedifferentiated sectors was made straightaway. In the two other patients, the initial diagnosis was that of leiomyosarcoma, which was reconsidered as dedifferentiated liposarcoma according to the cytogenetical and immunohistochemical techniques available since 2005. In 6/7 patients, a tumour resection with an orchiectomy at the same time (four patients) or secondarily (two patients) was performed. In one patient, only a tumour resection, without orchiectomy, was made. Multiple recurrences were observed in the two patients who were initially diagnosed as leiomyosarcoma. They needed multiple reintervention. One of them died after 68 months of evolution, the other one was treated with chemotherapy and died after 47 months of evolution. Four patients are out of recurrence. One patient was lost to follow-up.the diagnosis of liposarcoma must be considered in all adult patients aged of more than 50 with fatty-shaped or containing fibomuscular nodules paratesticular tumours. The surgeon and the pathologist must be well informed and an early and wide resection of fatty masses of the sperm cord with negative margins is advocated. The quality of resection is crucial but its appreciation and carrying out are difficult. The role of complementary treatments, especially radiotherapy, has to be determined.

The utilization of androgen deprivation therapy in prostate cancer has evolved over time. Unquestionably considered first line treatment in metastatic cancers or in case of lymph node involvement, it is increasingly used in locally advanced and high-risk cancers, combined with radiation therapy. However, the practical modalities of treatment are still controversial (neoadjuvant, concomitant/adjuvant) and should be discussed on a case-by-case basis, taking into account tumor stage and risk level, which depends mainly on Gleason score and PSA levels and kinetics. Hormone therapy is also indicated in case of systemic relapse, especially if PSA doubling time is less than 12 months. LHRH agonists have become the standard care; antiandrogens can be added at the beginning of the LHRH agonist therapy to obtain a complete androgen blockade. Intermittent androgen deprivation therapy has recently proved efficacious and might be more widely used in the future, provided that strict prescription and follow-up recommendations are clearly established.

Chemotherapy is indicated in metastatic castration-refractory prostate cancer. It aims at alleviating symptoms and increasing survival, without impairing quality of life. Docetaxel is considered as the reference treatment in this indication. However, several studies demonstrated the relevance of associating estramustin with docetaxel, due to the synergistic effect of the combination and the action of estramustin on resistance mechanisms. Moreover, the addition of estramustin to chemotherapy demonstrated a survival benefit for patients. Thrombotic events are frequent in patients with advanced prostate cancer and estramustine is known to increase the risk. Optimization of treatment requires a thorough assessment of the individual risk in each patient as well as the prescription of an anti-thrombotic prophylaxis, which should be currently based on low molecular weight heparin.

Primary urethral melanoma is a rare pathology for which treatment strategies are controversial. The aim of this work was to report a case of metastatic primary urethral melanoma, and to discuss recent data available from literature.Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database.We reported the case of an 89-year-old woman who died from a primary metastatic melanoma of the urethra. This pathology encounters for less than 1% of melanomas and has an adverse prognosis. In case of metastasis, specific survival is only of a few months. When localized to the urethra, treatment relies on radical urethrectomy, followed by adjuvant chemo- and immunotherapy.The modalities of treatment of primary urethral melanoma rely only on reported case studies. When diagnosed at the metastatic stage, reported specific survival does not exceed a few months.