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International audience; Purpose: the purpose of this multicenter study was to evaluate the clinical success at three months of prostate artery embolization (PAE), assess PAE safety in centers with various experiences and identify factors associated with PAE success.Patients and methods: this multicenter, retrospective study included patients who underwent PAE for lower urinary tract symptoms (LUTS) including those with indwelling urinary catheter. PAE clinical success was defined as either 25% improvement of the International Prostate Symptom Score (IPSS) or 1-point improvement of quality of life (QoL) score, or catheter removal at three months. Multivariable analyses were performed using a logistic regression adjusted on patient variables, technical parameters and center experience in PAE.Results: a total of 383 men (mean age, 68.4±9.7 [standard deviation] years; range: 46-94) with LUTS, including 99 (25.8%) patients with indwelling urinary catheter, were included in seven centers from January 2017 to March 2019. Five patients reported major complications (1.3%), three (0.8%) penile ulceration, three (0.8%) acute urinary retention, one (0.3%) prostatic abscess, and 56 (14.6%) minor complications. Follow up data were available for 271 patients (center 1: n= 159; other centers: n= 112). Clinical success was reported in 232 patients (85.6%). In multivariable analyses, presence of cardiovascular comorbidities (diabetes, stroke history, myocardial infarction and lower limb artery disease) was the single independent variable inversely associated with PAE clinical success (odds ratio= 0.396; 95% confidence interval: 0.17-0.91; P= 0.029). There was no center effect.Conclusion: our results show that PAE is safe and effective in centers with various PAE experiences. Cardiovascular comorbidity is the single independent variable associated with PAE failure.

The effect of prostate artery embolization (PAE) on male sexual function is currently the subject of debate in the literature. The main purpose of this study was to define changes in all domains of sexual activity after PAE, using the international index of erectile function score (IIEF-15). A single-center retrospective study was conducted on 129 patients (mean age of 65.5 ± 7 years), who underwent PAE from February 2014 to January 2017 for symptomatic benign prostatic hyperplasia (BPH). Fifty consecutive patients fulfilling the inclusion criteria were evaluated before and after PAE follow-up using the IIEF-15, IPSS, prostate volume (PV) and cardiovascular risk factor and BPH drugs. The IIEF-15 domains analyzed were: erectile function (EF) ejaculation and orgasm (Ej/O), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A paired sample t test or Wilcoxon signed-rank test was used to compare IIEF-15 between baseline and follow-up. The study showed nonsignificant change in IIEF-15 total score (58.0 ± 13.8 SD; p = 0.71) and the five domains (EF 24.5 ± 7.0 SD, p = 0.82; EJ/O 8.2 ± 2.3 SD, p = 0.50; SD 7.2 ± 2.7 SD, p = 0.57; IS 10.3 ± 3.0 SD, p = 0.77; OS 8.2 ± 2.7 SD; p = 0.11) after PAE. We also found a significant improvement in IPSS score after PAE. Based on the IIEF-15 questionnaire, PAE was showed to allow good urinary symptoms results and no deterioration in sexual function.

International audience; Background: Benign prostatic hyperplasia (BPH) is commonly responsible for lower urinary tract symptoms (LUTS) in men aged 50 or over. Sexual dysfunctions, such as ejaculatory disorders (EjD), go along with LUTS but are frequently overlooked in the initial evaluation. This review aimed to detail BPH-related EjD, as well as their modifications by medical, surgical, and interventional treatments. Methods: We conducted a narrative review looking for publications between 1990 and 2020, regarding physiopathology, epidemiology, evaluation, and therapeutic management (medical, surgical, and interventional) of BPH-related EjD. Results: Sixty-five articles were included in our final analysis. Forty-six percent of men presenting with LUTS reported EjD. If the prevalence increases with age and LUTS severity, the functional impairment is not correlated with age. Several self-questionnaires evaluated the sexual function, but only four approaches are specific to EjD. Medical therapies were exposed to anejaculation, rather than retrograde ejaculation (RE) (4–30% (alpha-blockers), 4–18% (5-alpha-reductase inhibitors)). Regarding surgical therapies, trans-urethral resection of the prostate (TURP) and incision of the prostate (TUIP) are associated with 50–70% and 21–35% of RE. The RE rate is important after open simple prostatectomy but can be reduced with robotic approaches and urethral sparing techniques (19%). Anatomic endoscopic enucleation of the prostate (AEEP) with or without a laser source is associated with an 11–36% RE rate, according to supramontanal preservation. Recent surgical techniques (Rezum©, Aquablation©, or Urolift©) were developed to preserve antegrade ejaculation with promising short-term results. Regardless of the surgical approach, anatomic studies suggest that the preservation of peri-montanal tissue (7.5 mm laterally; 10 mm proximally) is primordial to avoid post-operative RE. Finally, prostate artery embolization (PAE) limits the RE rate but exposes it to a 12 months 10% re-intervention rate. Conclusion: EjD concerns almost half of the patients presenting BPH-related LUTS. Initial evaluation of EjD impairment is primordial before medical or surgical therapy. Peri-montanal tissue preservation represents a key point for antegrade ejaculation preservation, regardless of the surgical option.

BACKGROUND More than half of transgender (TG) men wish to have children. Until recently, TG people in France were rarely offered gamete donation, mainly because the Bioethics Law allows the use of assisted reproductive technologies (ART) only in infertile couples. The only option currently available for heterosexual couples with a TG man is ART with sperm donation. The Center for Study and Preservation of Eggs and Sperm (CECOS) of the Cochin Hospital is the first French center to propose sperm donation to such couples, and has done so since 1999. OBJECTIVES To determine the main characteristics and intentions of 43 couples, including a TG man and his cisgender female partner awaiting sperm donation. MATERIALS AND METHODS A retrospective analysis was carried out on the records from October 2010 to December 2019, of 43 couples with a TG man who applied for sperm donation at the CECOS of the Cochin Hospital (Paris, France). RESULTS The mean age of TG men and cisgender women was 32 ± 6.6 and 29.7 ± 4.6 years, respectively. In 77% of cases, the couple met before the man's transition. Eighty-one percent of the couples were in a stable relationship for at least 3 years, and 94% wished to have a child for no more than 5 years. Almost all of the couples (95%) intended to inform their child of their conception by sperm donation and the father's transidentity (92%). DISCUSSION Due to restrictive French legislation, the profile of our couples probably does not reflect that of all couples consisting of a TG man and a cisgender woman. The study took place over a long period of time and the characteristics of the couples could probably change over time. CONCLUSION The couples often met before the man's transition, cohabited for several years, intended to inform their child of sperm donation and the father's transidentity.

Erdheim-Chester disease (EC) is a rare disease that is included in Group L in the 2016 revised classification of Langheransian histiocytoses. This disease may be clinically asymptomatic or manifest as a multi-systemic and life-threatening condition. All organs can be affected but typically there is bone involvement, retroperitoneal fibrosis, pituitary involvement, involvement of large vessels, lung, pleura or central nervous system. We are reporting a 70-year-old patient who, as of 2014, had a pelvic mass with retroperitoneal fibrosis and large vessel vasculitis without a definite diagnosis. Histological and molecular examination of the surgical specimen of the pelvic mass with the discovery of the BRAF V600E mutation provided new elements for the definitive diagnosis of Erdheim-Chester disease. We will describe the clinical, histological and molecular features to be known in EC disease.

Benign Prostatic Hyperplasia (BPH) concerns 50% of men older that 60 Years old and can induce symptoms also earlier. Medical treatment are mostly alpha blockers (AB), 5-alpha reductase inhibitors (5ARI) and phospho-diesterase inhibitors. In case of failure or poor tolerance of drug treatment, surgery can be indicated, after evaluation of the Bladder Outlet Obstruction (BOO), based on urodynamic studies. Endoscopic or open surgery is selected according to the size of the prostate, the expertise of the urologist and patient preference. Surgical treatment is very efficient but carries frequent complications, especially retrograde ejaculation which is very frequent and can compromise fertility and sexual pleasure. Prostatic Artery Embolisation, an outpatient intervention performed by Interventional Radiologists and available in France since 2012 is a new alternative to surgery in case of failure or poor tolerance of medical treatment. It consists in super-selective injection of calibrated micro-particles into both prostatic arteries after femoral artery puncture at the groin. It is safe and efficient and provides appropriate symptomatic improvement BOO related to BPH.

To evaluate trimodal conservative treatment as an alternative to radical surgery for urothelial muscle-invasive bladder cancer (MIBC). This retrospective study reported the carcinologic and functional results of patients (pts) presenting a cT2/T3 N0M0 operable MIBC and fit for surgery, treated by a conservative strategy. Treatment consisted of a transurethral resection (TURB) followed by concomitant bi-fractionated split-course radiochemotherapy (RCT) with 5FU-Cisplatine. A control cystoscopy was performed six weeks after the induction RCT (eq45Gy) with systematic biopsies. Patients with complete histologic response achieved RCT protocol. Salvage surgery was proposed to pts with persistent tumor. 313 pts (83% cT2 and 17% cT3) treated between 1988 and 2013 were included, with a median follow-up of 59 months and 67-year mean age. After the induction RCT, the histologic response rate was 83%. After five years, overall, disease-free, and functional bladder-intact survival rates were respectively 69%, 61%, and 69%, significantly better for pts in complete response after induction RCT. Late urinary and digestive toxicities were limited, with respective rates of 4% and 1.5% of grade 3 toxicity. Trimodal strategy with RCT after TURB showed interesting functional and oncologic results and should be considered as an alternative to surgery in well-selected pts.

Male infertility is responsible for approximately half of all cases of reproductive issues. Spermatogenesis originates in a small pool of spermatogonial stem cells (SSCs), which are of interest for therapy of infertility but remain not well defined in humans. Using multiparametric analysis of the side population (SP) phenotype and the α-6 integrin, THY1, and β-2 microglobulin cell markers, we identified a population of human primitive undifferentiated spermatogonia with the phenotype β-2 microglobulin (β-2M)

The development of prostatic artery embolization has led to better understand the complex male pelvic arterial anatomy. To the best of our knowledge, there is still no precise description of the distribution of the branches of the prostatic artery (PA) after its origin. In this study, the patterns of prostatic feeders near to and into the prostate were analyzed, and a classification was proposed. This study is based on angiograms of 101 consecutive male patients, mean age 70, who underwent PAE between December 2013 and June 2016, to treat symptomatic benign prostatic hyperplasia. The proposed classification is derived from the analysis of 143 solitary PAs from 199 hemipelves (72%). Pattern A was defined as an artery feeding only the prostate, patterns B and C as a PA with a concomitant large supply to the penis (pattern B) or to the rectum (pattern C). A pattern A was found in 89/143 (62%), a pattern B in 16/143 (12%) and pattern C in 38/143 (26%). Protection of a penile/rectal supply was never required in pattern A, while it was performed in 14/16 (87%) of pattern B, and in 7/38 (18%) of pattern C PAs. The PErFecTED technique could be performed in 51%, 50 and 55% of cases in pattern A to C. This study proposes a new classification of intra-/extra-prostatic arterial distribution of the PA that could be helpful to prevent complications of PAE. Further prospective angiographic investigations are necessary to confirm its clinical value.

La embolizacion arterial de la prostata es una nueva modalidad terapeutica minimamente invasiva propuesta en el marco de ensayos, que esta en fase de validacion en el tratamiento de la hiperplasia benigna de prostata desde 2010. La hiperplasia benigna de prostata (HBP) es una patologia muy frecuente en los varones mayores de 50 anos. Esta entidad se define por una serie de argumentos que engloban la asociacion de signos funcionales urinarios con un aumento del volumen prostatico. Afecta al 50% de los varones de forma muy variable y puede tener una gran repercusion sobre la calidad de vida. La HBP puede tener una repercusion negativa sobre el reservorio vesical y, excepcionalmente, sobre el aparato urinario superior. El papel del urologo en el tratamiento de la HBP es acompanar a su paciente durante la evolucion de esta patologia tratando los sintomas molestos a la vez que se conserva el aparato urinario, pero tambien la funcion sexual. Ante un fracaso, la mala tolerabilidad de los tratamientos farmacologicos o una HBP complicada (retencion de orina, calculos vesicales, insuficiencia renal obstructiva, infecciones repetidas, etc.), la cirugia es la opcion clasica, pero puede presentar un riesgo elevado de morbilidad segun el contexto o alterar la funcion sexual. La embolizacion arterial de la prostata es una nueva alternativa a la cirugia, que aun no forma parte de los tratamientos de referencia. Este nuevo tratamiento minimamente invasivo, con escasa morbilidad pero muy tecnico, podria permitir, en indicaciones bien seleccionadas, evitar o retrasar la cirugia cuando se establezca la indicacion en el marco de un equipo multidisciplinario urologico y radiologico.

Resume Introduction Les patients âges representent une part de la population grandissante pour laquelle la strategie du traitement des tumeurs renales localisees doit integrer la morbidite liee au choix therapeutique et a la fonction renale. L’objectif etait d’analyser les resultats oncologiques et fonctionnels de la chirurgie conservatrice (NP) versus ablation par radiofrequence (RFA). Materiel et methodes Tous les patients de plus de 75 ans traites par NP et RFA entre 2007 et 2014 pour une tumeur renale localisee dans notre centre ont ete inclus. Les caracteristiques des patients et des tumeurs ont ete comparees et les criteres suivants ont ete analyses : survie (globale et sans recidive) et perte de fonction renale (delta MDRD en pre- et postoperatoire). Resultats Cent patients ont ete inclus (26 nephrectomies partielles groupe 1, et 74 radiofrequences, groupe 2) avec un suivi moyen de 32 mois. L’âge moyen et la taille tumorale differaient significativement entre les deux groupes (respectivement 78 ans versus 81 ans, p = 0,001, 38 mm versus 29 mm, p = 0,003). Les resultats perioperatoires etaient comparables dans les deux groupes en termes de complications. En revanche, le taux de transfusion et la duree d’hospitalisation etaient significativement superieurs dans le groupe NP. Les medianes de survie etaient respectivement de 45 mois vs 27 mois en survie globale ( p = 0,23) et de 28 mois vs 10 mois en survie sans recidive ( p = 0,34) pour les deux groupes (NP vs RFA) respectivement. En analyse multivariee, le mode operatoire (NP vs RF) n’etait pas significativement associe a la survie (HR 2,37 [IC95 % : 0,66 a 8,5]) pour la survie du groupe RFA vs NP ( p = 0,19). La perte de debit de filtration glomerulaire calculee etait de 1,5 ± 14 mL/min/1,73 m 2 pour les NP et de 3 ± 14 mL/min/1,73 m 2 pour les RFA ( p = 0,69). Conclusion Notre etude a retrouve des resultats perioperatoires meilleurs pour la RFA par rapport a la NP sans difference significative de survie. La perte de fonction renale etait minime et comparable dans les deux groupes. Niveau de preuve 4.

Objectifs Plusieurs pathologies testiculaires peuvent conduire a la realisation d’une orchidectomie totale. La pose d’une prothese est frequemment proposee a visee cosmetique et psychologique. Cependant, aucune etude n’a etudie l’interet de fixer ou non la prothese. L’objectif de cette etude etait d’evaluer la satisfaction des patients apres mise en place d’une prothese testiculaire, selon qu’elle a ete fixee ou non. Methodes Il s’agit d’une etude retrospective, monocentrique, incluant tous les patients ayant eu une prothese testiculaire entre janvier 2010 et decembre 2019. L’indication operatoire, l’âge du patient et la fixation ou non la prothese ont ete analyses. Les patients ont ete contactes pour un entretien telephonique au cours duquel un questionnaire standardise leur a ete pose. Quatorze questions evaluaient la satisfaction des patients concernant la taille, le poids, la forme, la consistance, la position, les douleurs, la traction postoperatoire, la vie sexuelle et l’image corporelle. Resultats Au total, 169 patients ont ete inclus. L’orchidectomie etait en rapport avec une tumeur (76 %), une torsion (12 %), une atrophie/cryptorchidie (10 %) ou un traumatisme (2 %). La prothese etait fixee chez 69 patients (35 %). Sur 146 patients (86 %) ayant repondu au questionnaire, 74 % etaient tres satisfaits et 96 % referaient l’intervention. La majorite des patients etait satisfaite du poids (93 %), de la forme (76 %) ou de la consistance (93 %) de la prothese. Vingt-deux pour cent des patients la trouvaient trop petite, 37 % trop haute et 23 % se sont dit genes par l’attache situee a l’extremite de la prothese. Les patients chez qui la prothese etait fixee signalaient davantage de douleur (33 % vs 10 %, p = 0,001). La traction reguliere de la prothese n’a pas montre d’effet sur la position ou la douleur ( Fig. 1 ). Conclusion La prothese testiculaire est associee a un taux de satisfaction eleve. Les douleurs semblent plus importantes lorsque la prothese est fixee. Par consequent, il ne semble pas necessaire de fixer les protheses testiculaires et les industriels pourraient supprimer l’attache genante situee a son extremite.

The effect of prostate artery embolization (PAE) on male sexual function is currently the subject of debate in the literature. The main purpose of this study was to define changes in all domains of sexual activity after PAE, using the international index of erectile function score (IIEF-15).A single-center retrospective study was conducted on 129 patients (mean age of 65.5 ± 7 years), who underwent PAE from February 2014 to January 2017 for symptomatic benign prostatic hyperplasia (BPH). Fifty consecutive patients fulfilling the inclusion criteria were evaluated before and after PAE follow-up using the IIEF-15, IPSS, prostate volume (PV) and cardiovascular risk factor and BPH drugs. The IIEF-15 domains analyzed were: erectile function (EF) ejaculation and orgasm (Ej/O), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A paired sample t test or Wilcoxon signed-rank test was used to compare IIEF-15 between baseline and follow-up.The study showed nonsignificant change in IIEF-15 total score (58.0 ± 13.8 SD; p = 0.71) and the five domains (EF 24.5 ± 7.0 SD, p = 0.82; EJ/O 8.2 ± 2.3 SD, p = 0.50; SD 7.2 ± 2.7 SD, p = 0.57; IS 10.3 ± 3.0 SD, p = 0.77; OS 8.2 ± 2.7 SD; p = 0.11) after PAE. We also found a significant improvement in IPSS score after PAE.Based on the IIEF-15 questionnaire, PAE was showed to allow good urinary symptoms results and no deterioration in sexual function.

PURPOSE To study the subscore improvement in International Prostate Symptom Scores (IPSS) after prostatic artery embolization (PAE). MATERIALS AND METHODS A single-center retrospective study was carried out with follow-up from December 2013 to July 2019 in 37 consecutive patients (66.0 ± 8.8 years old) who underwent PAE, comparing resultant scores before and after PAE. IPSS were divided into storage (IPSS-s) subscores and voiding (IPSS-v) subscores. The changes between IPSS-s and IPSS-v at 1, 3, 6, and 12 months' follow-up as well as the last follow-up were compared with baseline scores. The changes in percentages of IPSS-s and IPSS-v and the changes in average IPSS-s-to-total IPSS ratios (IPSS-s/IPSS-t) and IPSS-v-to-IPSS-t ratios (IPSS-v/IPSS-t) were also analyzed. RESULTS In the study population, consisting of 37 patients, IPSS-t significantly decreased from 16.5 ± 7.2 at baseline to 8.3 ± 5.7 at the last follow-up (4 years later) (P < .0001). Additionally, the changes in IPSS-v symptoms were greater than the changes in IPSS-s symptoms at 1, 3, 6, and 12 months' follow-up, reaching a statistical significance at 6 months with a decrease of 72.9% ± 42.4% for IPSS-v and a decrease of 50.1% ± 52.2% for IPSS-s (P = .009). CONCLUSIONS PAE can successfully reduce both IPSS-s and IPSS-v with predominant IPSS-v reduction. The improvements in both subscores were sustained for up to 4 years of follow-up.

Background This prospective study assessed the efficacy of prostate artery embolization after failure of a trial without catheter in patients suffering a first episode of acute urinary retention as a result of benign prostatic hyperplasia (BPH). Methods Patients with failure of a trial without catheter despite alpha-blocker therapy were invited to participate in this protocol. Twenty patients were included in the study, and all underwent prostate artery embolization with calibrated polyvinyl alcohol (PVA) microspheres (Bead Block, BTG Ltd., Farnham, UK). Results Successful removal of the indwelling bladder catheter and spontaneous voiding was achieved in 15 of 20 (75%) patients, and the overall clinical success at 6 months after prostate embolization was 14 of 20 (70%). No patient experienced severe adverse events. Conclusions Prostate artery embolization might be a valuable treatment after a failure of a trial without catheter. Further studies are needed to better define its place in this setting.

During PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE.We treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015. The procedure involved the exclusion of an extra-prostatic shunt originating from the PA, prior to complete bilateral PAE. We compared the safety and efficacy of the 11 shunt exclusions followed by embolization of the PA to the other 44 basic PAE. Clinical success was defined as a decrease of 25 % or eight points of IPSS, QoL 3 or a one-point decrease, and a Qmax improvement of 25 % or 2.5 mL/s.We had a 100 % rate of occlusion of the anastomosis. Bilateral embolization of the PA was performed in all patients with no additional time of procedure (p = 0.18), but a significant increase of dose area product (p = 0.03). Distal (PErFecTED) embolization was possible in 64 %. There was no worsening of erectile dysfunction, no rectal or penile necrosis, no immediate or late other clinical complications. Clinical success was 91 % (mean follow-up: 3.5 months), compared to 78 % for the entire PAE group.PAE using the protection technique in case of large extra-prostatic shunts is as safe and effective as basic procedures and does not induce any additional time of procedure.

To analyse long-term overall survival, relapse-free survival and late toxicities in a series of 675 patients treated between 1999 and 2003, with a median follow-up of 132 months.The cohort included low-risk patients and a selection of "favourable-intermediate" risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125 iodine seeds. Hormone therapy, consisting most often of an anti-androgen alone, was given in 393 patients (58%).The 10-year overall survival was 92% (95% confidence interval [CI]: 90-94) without a significant difference between the low and the select intermediate-risk groups (P=0.17). The 10-year relapse-free survival rate for the entire cohort was 82% (95% CI: 79-85), and was significantly higher in the low-risk group than in the intermediate one (87 vs 71%; P0.0001). Twenty-six percent of the relapses observed in this series occurred after more than 10 years of follow-up. The 10-year cumulative incidence of grade 3-4 urinary toxicity (whatever the delay and the recovery) was 5.78%. The cumulative incidence of grades 3-4 rectal toxicity in the present series was 1.65% at 10 years. As for sexual toxicity, 61% of our patients retained an erectile capacity at 10 years (with or without oral medication), with age being a major factor.With a median follow-up of more than 11 years, this series appears to confirm the excellent long-term results of low-dose rate prostate brachytherapy, both in terms of survival and in terms of toxicity.

To assess the impact of prostatic arterial embolisation (PAE) on various prostate gland anatomical zones. We retrospectively reviewed paired MRI scans obtained before and after PAE for 25 patients and evaluated changes in volumes of the median lobe (ML), central gland (CG), peripheral zone (PZ) and whole prostate gland (WPV) following PAE. We used manual segmentation to calculate volume on axial view T2-weighted images for ML, CG and WPV. We calculated PZ volume by subtracting CG volume from WPV. Enhanced phase on dynamic contrasted-enhanced MRI was used to evaluate the infarction areas after PAE. Clinical results of International Prostate Symptom Score and International Index of Erectile Function questionnaires and the urodynamic study were evaluated before and after PAE. Significant reductions in volume were observed after PAE for ML (26.2 % decrease), CG (18.8 %), PZ (16.4 %) and WPV (19.1 %; p

Objectifs Evaluer la pertinence des traitements chirurgicaux de sauvetage des patients en recidive biologique (RB) de cancer de la prostate apres prostatectomie, decide sur la base des resultats du TEP/TDM au 68Ga-PSMA-11. Methode A partir de la base de donnees des patients ayant eu au sein de l’institution une TEP/TDM au 68Ga-PSMA-11 entre avril 2016 et avril 2018, ont ete revus les patients en RB apres prostatectomie radicale et ayant beneficie d’un traitement de sauvetage chirurgical. Resultats Treize patients en RB âges en moyenne de 70 ans [53–78] et ayant un grade histologique initial ISUP 1 pour 3 d’entre eux, ISUP 2 pour 5 et ISUP3 pour 5 ont ete inclus. La valeur mediane du PSA etait de 1,23 ng/mL [0,2–12,5] et son temps de doublement de 6,4 mois [0,6–33,6]. La TEP/TDM au 68Ga-PSMA-11 a permis une prise en charge chirurgicale dans 11 cas : 6 curages ganglionnaires pelviens etendu et 1 lombo-aortique, 2 orchidectomies, 2 electroporations, 1 cryotherapie et 1 chirurgie de carcinose. Les resultats histologiques retrouvaient un adenocarcinome prostatique sur les 7 curages ganglionnaires, la carcinose et une orchidectomie. L’efficacite du traitement base sur un PSA indosable apres traitement etait notee dans 8 cas sur 11. La duree mediane de suivi etait de 9 mois ( Fig. 1 ). Conclusion L’acces a la TEP/TDM aux ligands du PSMA, encore limite en France, apporte des elements informatifs pour la prise en charge de la recidive biologique apres chirurgie et guide le traitement en ameliorant le controle de la maladie a court terme. Le suivi a moyen/long terme et l’inclusion d’autres patients confirmeront la prise en compte de cet examen.

Resume Nous rapportons trois observations de fistules uretero-iliaques (FUI) chez des patients adresses pour prise en charge therapeutique d’une hematurie macroscopique. Bien qu’il s’agisse d’une etiologie classique d’hematurie, le diagnostic est souvent difficile et la prise en charge n’est pas encore standardisee. Un bilan diagnostique associe a une prise en charge multidisciplinaire ameliore le pronostic des patients. Le traitement curatif par voie endovasculaire est efficace et sure, avec une evolution rapidement favorable chez tous nos patients. L’utilisation de stent-couverts associes a l’Amplatzer™ vascular plug rende la procedure aisee et sure.

Purpose To analyse the rate of secondary malignancies observed in a series of 675 prostate cancer patients who underwent a permanent implant brachytherapy between 1999 and 2003, and to compare the incidence with the expected rate in a matched general French population. Material and methods The cohort included low-risk patients and a selection of “favourable-intermediate” risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125-iodine seeds and a prescription dose of 145 Gy. The mean follow-up was 132 months. Results The 10-year overall survival for the entire cohort was 92% (95% confidence interval [CI]: 90–94). The 10-year relapse-free survival rate was 82% (95% CI: 79–85). Overall, 61 second cancers were registered. When comparing with a matched general French population, the standard incidence ratio (SIR) for bladder cancer was 1.02 (95% CI: 0.46–1.93). For colorectal cancer, the SIR was 0.45 (95% CI: 0.19–0.89). For lung cancer, the SIR was 0.38 (95% CI: 0.17–0.76). The SIR for all cancers was 0.61 (95% CI: 0.47–0.79). When excluding secondary colorectal and lung cancers (both with low SIRs in this series), the SIR for all cancers was 1.06 (95% CI: 0.77–1.29). Conclusion With a mean follow-up of more than 11 years, this series does not detect any excess risk of second cancers associated with permanent implant prostate brachytherapy. However, due to power limitation, a small increase in the risk of secondary malignancies cannot be totally ruled out.

Peri-prostatic shunts are frequent during PAE, carrying the risk of non-target embolization of penis/corpus cavernosum or rectum but also the potential advantage to irrigate the contralateral lobe. Sometimes, bilateral embolization is impossible, carrying the risk of limited clinical success. The possibility to reach contralateral prostatic territory from the ipsilateral prostatic artery (PA) and embolize it via peri/intra-prostatic anastomoses could be of interest in this situation. We describe a series of three consecutive patients (among 89 consecutive patients treated by PAE for symptomatic BPH) who underwent successful embolization of both prostatic lobes through catheterization of a PA on only one side. All patients had clinical success after a mean follow-up of 3.3 months. Dosimetry of these three procedures indicates that there may be radiation dose savings.

Background: Androgens play a role in the development of both androgenic alopecia, commonly known as male pattern baldness, and prostate cancer. We set out to study if early-onset androgenic alopecia was associated with an increased risk of prostate cancer later in life. Patients and methods: A total of 669 subjects (388 with a history of prostate cancer and 281 without) were enrolled in this study. All subjects were asked to score their balding pattern at ages 20, 30 and 40. Statistical comparison was subsequently done between both groups of patients. Results: Our study revealed that patients with prostate cancer were twice as likely to have androgenic alopecia at age 20 [odds ratio (OR) 2.01, P = 0.0285]. The pattern of hair loss was not a predictive factor for the development of cancer. There was no association between early-onset alopecia and an earlier diagnosis of prostate cancer or with the development of more aggressive tumors. Conclusions: This study shows an association between early-onset androgenic alopecia and the development of prostate cancer. Whether this population can benefit from routine prostate cancer screening or systematic use of 5-alpha reductase inhibitors as primary prevention remains to be determined.

Objective To collect follow-up data for infertile men with Y microdeletion. Design Retrospective, observational survey. Setting Multicenter IVF units associated with genetics laboratories. Patient(s) Sixty-three patients with Y microdeletion. Intervention(s) Karyotype analysis, Y microdeletion screening, and assisted reproductive technology. Main Outcome Measures Medical history, karyotype, nature of the AZF deletion, semen parameters, testis biopsy results, choice of assisted reproductive technology, and results of intracytoplasmic sperm injection (ICSI). Results Abnormal karyotypes were found in 8 men (12.7%), who were azoospermic except 1. Of these 8 men, 5 presented a combined AZFb+c deletion, and 3 had a deletion in AZFc only. Most men (39 of 63) were azoospermic, 3 were cryptoazoospermic, and 19 had extreme oligozoospermia (sperm concentration ≤1.10 6 /mL). Sperm concentration above 1.10 6 /mL was found for 2 men (3.1%). A testis biopsy was performed in 27 azoospermic men, resulting in positive sperm extraction in 6 cases. To date, 42 ICSI cycles with either testicular (n = 5) or ejaculated spermatozoa (n = 37) have been carried out in 23 couples with male partners with AZFc deletion. Eighteen clinical pregnancies were obtained, leading to the birth of 14 babies. Donor insemination had been chosen by 28 couples, leading to the birth of 9 children. Conclusion Karyotype analysis should be systematically performed in Y microdeleted men. Intracytoplasmic sperm injection can be offered to half of AZFc-deleted patients, providing real opportunities to have a child.

Resume Objectif Evaluer l’impact de l’indication imperative sur le taux de complication et les resultats carcinologiques a long terme apres nephrectomie partielle (NP). Patients et methodes Entre 1985 et 2005, tous les patients operes d’une NP pour cancer localise dans deux centres ont ete revus. Les taux de complication global, hemorragique et urinaire ont ete compares entre le groupe I (indication elective) et le groupe II (indication imperative). Les survies sans recidive et specifique a cinq, dix et 20 ans ont ete comparees entre ces deux groupes. Une analyse multivariee selon le modele de Cox a ete realisee pour rechercher les facteurs associes a la recidive et au deces sur l’ensemble de la serie. Resultats Trois cent cinq patients ont ete inclus dans l’etude. Aucune difference significative n’a ete retrouvee entre le groupe I et le groupe II en ce qui concerne le taux de complication global (17 vs 20 %), le taux de complication hemorragique (3,5 vs 3,8 %) et le taux de complication urinaire (3,9 vs 2,5 %). Les patients operes pour une indication imperative avaient des survies sans recidive et specifique significativement plus faibles a cinq, dix et 20 ans. Sur l’ensemble de la serie, l’indication imperative etait le seul facteur independant associe a la recidive et au deces en analyse multivariee. Conclusions Si le taux de complication ne semblait pas significativement associe a l’indication operatoire, les patients a l’indication imperative representaient un groupe heterogene de moins bon pronostic. Ce facteur devrait etre pris en compte dans les etudes portant sur la NP.

Resume Avec maintenant plus de 20 ans d’experience pour les equipes pionnieres americaines et europeennes (et plus de dix ans en France), la curietherapie par implantation permanente de grains d’iode 125 s’est imposee en 2008 comme une alternative incontournable a la chirurgie pour les cancers de prostate localises a bas risque. Il existe une tendance actuelle pour elargir les indications de cette curietherapie exclusive vers certains patients strictement selectionnes atteints de cancer localise de pronostic intermediaire. Enfin, pour les cancers de prostate localises a haut risque, l’adjonction d’une curietherapie a l’irradiation externe pourrait permettre une escalade de dose dont pourraient beneficier certains patients. Diverses techniques peuvent etre utilisees : avec ou non preplanification, avec grains libres ou lies, avec injection automatique des grains ou non. Le point capital est ici la parfaite maitrise de la procedure et la capacite de repondre a des contraintes dosimetriques precises recemment reactualisees par le Groupe europeen de curietherapie - European Society for Therapeutic Radiology and Oncology (GEC-ESTRO). L’analyse des resultats a moyen–long terme disponibles dans la litterature indique des taux de survie sans recidive de l’ordre de 90 % a 5–10 ans, d’autant meilleurs que les criteres dosimetriques etaient satisfaisants. En termes de complications, quelques etudes comparatives ont confirme des taux d’incontinence et d’impuissance qui semblent significativement inferieurs a ceux des procedures chirurgicales. En revanche, il existe apres curietherapie un risque de retention urinaire, qui ne devrait pas depasser 3–5 %, et un syndrome irritatif urinaire qui peut etre majeur et durer plusieurs mois. Malgre ces inconvenients, la curietherapie par implants permanents, forte de ses resultats a long terme et de ses taux limites d’incontinence et d’impuissance, devrait voir ses indications se multiplier dans les annees a venir.

Resume Objectif Preciser les indications, les resultats et la place de la nephrectomie pour polykystose autosomique dominante de l’adulte (Prada) par rapport a la transplantation renale. Materiel et methodes Entre octobre 1998 et fevrier 2006, 145 patients atteints de Prada etaient suivis dans notre institution. Parmi eux, 38 patients ont eu une nephrectomie par voie sous-costale, principalement en preparation a la greffe. La decision de nephrectomie en preparation a l’implantation etait prise en fonction de l’examen clinique et des donnees tomodensitometriques. Resultats Les indications de nephrectomies etaient pour la preparation a la greffe : n = 28 (68 %) ; pour des complications urologiques severes : n = 12 et pour une tumeur maligne : n = 1. Nous avons realise 41 nephrectomies, 36 en pretransplantation (88 %) et cinq en post-transplantation chez trois patients. Le taux de nephrectomies etait de 26 %. Le poids median des reins etait de 2800 grammes. La duree operatoire moyenne etait de 100 minutes, les pertes sanguines moyennes de 76 ml. La morbidite globale etait de 36,6 % dont 7,3 % de complications graves. La duree moyenne d’hospitalisation a ete de 14,5 jours. Aucun patient nephrectomise avant la greffe ( n = 13) n’a presente de complications sur le rein natif controlateral avec un recul moyen de 33 mois. Le delai moyen entre la mise en dialyse et la greffe, d’une part, et entre la nephrectomie et la greffe, d’autre part, etait respectivement de 30 et 16 mois. Conclusions La question du moment et de la voie d’abord de la nephrectomie pour Prada reste d’actualite. En l’absence de complication urologique, la nephrectomie, dont la morbidite est consequente, ne doit etre realisee que lorsque les reins tres volumineux genent vraiment l’implantation du greffon. Ainsi, la nephrectomie systematique uni ou bilaterale ne doit plus etre proposee. Afin d’eviter les complications de l’anephrie, nous recommandons d’attendre, si possible, la mise en dialyse du patient, mais le developpement des greffes preemptives pose la question de la nephrectomie concomitante a la greffe qui merite d’etre debattue.

Resume Introduction Recemment, plusieurs equipes ont confirme la faisabilite technique de la nephrectomie partielle laparoscopique (NPL). Toutefois, cette intervention reste encore peu pratiquee car difficile techniquement et grevee d’un taux de complication hemorragique important meme pour des equipes entrainees. Dans cette etude, nous avons etudie la courbe d’apprentissage de la NPL sur un modele porcin d’un interne d’urologie. Les criteres etudies etaient le temps operatoire, le temps d’ischemie chaude et le saignement per- et postoperatoire. Materiels et methodes Quarante NPL ont ete realisees par le meme operateur. Toutes les interventions etaient realisees apres clampage arterielle et heparinisation de l’animal. La section renale etait toujours la meme, elle emportait 40 % du rein et interessait toujours les voies excretrices (VE). Un surjet continu sur les VE, puis des points separes sur le parenchyme etaient realises. Les temps operatoires et d’ischemie chaude etaient releves. Les animaux etaient surveilles pendant dix jours. Le saignement per- et postoperatoire par les drainages etait comptabilise et une opacification retrograde etait faite au dixieme jour pour verifier l’etancheite des VE. Des tests statistiques de regression lineaire ont recherche une correlation entre ces differents criteres et le nombre de cas realises. Resultats La duree totale d’intervention, le temps d’ischemie chaude et le saignement global (per- et postoperatoire) etaient en moyenne de 108 minutes (70–140 minutes), 38 minutes (22–50 minutes) et 95 ml (10–300 ml), respectivement. L’analyse de regression statistique retrouvait une correlation directe entre le nombre de cas effectues et le saignement peroperatoire ( p p Conclusion Le temps operatoire et la duree d’ischemie chaude ont ete directement correles au nombre de cas effectues. Un entrainement sur un modele porcin nous a semble etre un bon moyen de reduire la courbe d’apprentissage chez l’homme. Dix interventions ont ete necessaires pour acquerir les differents temps operatoires.

Resume Objectif de l’etude Decrire les modalites therapeutiques pour les cancers localises de la prostate traites par irradiation conformationnelle de 76 Gy avec ou sans hormonotherapie. Evaluer les resultats preliminaires en termes de survie, de controle biochimique et de toxicite. Patients et methode Entre janvier 1998 et juin 2001, 321 patients atteints d’un cancer localise de la prostate ont ete irradies a l’institut Curie. Pour cette etude, les tumeurs ont ete stratifiees selon les trois groupes pronostiques du Memorial Sloan-Kettering Cancer Center (1998) : favorable (23 %), intermediaire (36,5 %), defavorable (40,5 %). Une privation androgenique, principalement neoadjuvante, inferieure ou egale a un an a ete prescrite a 93,8 % des patients (72,6 % inferieure ou egale a six mois). Les doses d’irradiation prescrites dans les volumes cibles previsionnels etaient les suivantes : prostate : 76 Gy ; vesicules seminales : 56 a 76 Gy ; ganglions pelviens : 44 Gy pour 16,8 % des patients. Resultats La probabilite de survie actuarielle globale a cinq ans etait de 94 % (intervalle de confiance a 95 % : 90–97 %). La duree mediane du suivi post-therapeutique etait de 36 mois (neuf a 66 mois). Les probabilites de survie actuarielle sans echec biochimique a 48 mois etaient statistiquement differentes entre les trois groupes pronostiques, que ce soit selon la definition de l’echec biologique proposee par le consensus de l’American Society for Therapeutic Radiology and Oncology (ASTRO) de 1997 ou celle du Fox Chase Cancer Center (FCCC) de 2000, respectivement 87 et 94 %, 78 et 84 %, 54 et 58 % dans les groupes favorable, intermediaire et defavorable (p Conclusions Ces resultats sont comparables a ceux des series publiees precedemment pour un suivi equivalent. L’impact de l’escalade de dose associee a une courte privation androgenique sur le controle local, la survie et les complications necessitent un suivi de longue duree et une analyse approfondie.

Resume Par arrete en date du 3 fevrier 2005, les grains d'iode 125 de plusieurs fabricants pour implantation permanente en curietherapie prostatique ont ete inscrits sur la liste des produits et prestations remboursables (LPP). Dans ce cadre, le Comite economique des produits de sante (CEPS) a demande qu'un rapport annuel lui soit fourni sur le suivi de l'utilisation de ces grains, avec publication des resultats. Ce rapport a pour objectifs essentiels de s'assurer que les patients traites correspondaient bien aux criteres d'inclusion definis par les instances nationales et internationales, de controler les criteres de qualite dosimetriques des implantations, et enfin d'analyser les donnees relatives aux effets secondaires et aux complications, voire aux accidents ou incidents en rapport avec ces implantations. Nous rapportons donc ici le bilan clinique et dosimetrique de 469 patients traites en France dans neuf centres en 2005 a l'aide des grains d'iode 125 IsoSeed Bebig. Ce bilan montre : 1) que les recommandations nationales pour l'inclusion des patients ont ete respectees dans la quasi-totalite des cas (97 %) ; 2) que les criteres de qualite des implantations etaient optimaux dans la tres grande majorite des cas de cette serie ; 98 % des patients avaient une D90 superieure a 145 Gy et 96 % des patients un V100 superieur a 95 % ; 3) que la toxicite precoce se situe dans la fourchette basse des donnees de la litterature, avec en particulier un taux de retention urinaire precoce de seulement 2,4 %.

Resume Objectifs Evaluer la frequence du phenomene de « rebond » (elevation secondaire transitoire de la concentration serique du PSA) du PSA apres curietherapie de prostate et rechercher une correlation entre le rebond et les parametres cliniques et dosimetriques. Evaluer comment ce rebond du PSA peut mimer les criteres de rechute biochimique. Patients et methodes De mai 1998 a mai 2005, 1000 patients ont eu une curietherapie pour un cancer localise de la prostate de bas risque a l'institut Curie. Apres l'implantation, un dosage serique de PSA a ete realise tous les six mois. Nous avons defini le « rebond » comme toute augmentation du PSA d'au moins 0,1 ng/ml, suivie d'une diminution spontanee de celui-ci. Nous avons utilise les criteres de rechute biochimique definis par le consensus de l'ASTRO (trois elevations successives de la concentration serique de PSA), et analyse les correlations entre les rebonds de PSA, les parametres cliniques et dosimetriques, en analyse multifactorielle. Pour evaluer le phenomene de rebond avec un recul suffisant, cette serie a donc porte sur les patients traites par la technique en temps reel, avec grains libres d'125I (Isoseed, Bebig), jusqu'a decembre 2001. Dans ce groupe de 295 patients, la duree moyenne de suivi a ete de 40,3 mois (9–66 mois). Resultats Dans notre serie, 161 patients (55 %) ont eu une elevation transitoire de la concentration serique de PSA (« rebond ») d'au moins 0,1 ng/ml ; 145 patients (49 %) un rebond d'au moins 0,2 ng/ml, 93 patients (32 %) un rebond d'au moins 0,4 ng/ml, 43 patients (15 %) un rebond d'au moins 1 ng/ml. Le delai moyen d'apparition de cette elevation a ete de 19 mois (6–58), et la duree moyenne de six mois. L'amplitude moyenne de l'elevation a ete de 0,8 ng/ml (0,1–4,1 ng/ml). Trente-deux patients, soit 11 % du nombre total des patients, ont eu trois elevations successives du PSA avec un intervalle significatif entre les dosages (trois mois) et etaient donc en situation de rechute biochimique selon les criteres de l'ASTRO. Parmi ces 32 patients, 18 (56 %) ont vu leur PSA se normaliser completement et spontanement. Au total, seuls dix patients ont vu leur concentration serique de PSA continuer a augmenter et ont donc eu une authentique recidive biochimique. Pour les quatre derniers patients, la situation restait encore ambigue compte tenu des fluctuations persistantes du PSA et du recul insuffisant. En analyse multifactorielle, l'âge inferieur a 70 ans (p Conclusions Dans notre serie, 32 % des patients ont eu un rebond de la concentration serique de PSA d'au moins 0,4 ng/ml, en accord avec les donnees de la litterature. Ce rebond a ete observe jusqu'a cinq ans apres l'implantation, a atteint jusqu'a 4 ng/ml, et a dure six mois en moyenne. Parmi les 32 patients avec les criteres de rechute biochimique de l'ASTRO, 18 (56 %) avaient en fait un simple rebond. Les criteres de l'ASTRO ne sont donc pas adaptes au suivi biolochimique precoce apres curietherapie de prostate, et les resultats de la curietherapie doivent etre evalues avec un recul suffisant pour tenir compte du phenomene de rebond. Cela a des consequences cliniques pratiques evidentes, sur le diagnostic de recidive et la decision d'un eventuel traitement complementaire.

Prostatic artery embolization (PAE) has been performed for a few years, but there is no report on PAE using the PErFecTED technique outside from the team that initiated this approach. This single-center retrospective open label study reports our experience and clinical results on patients suffering from symptomatic BPH, who underwent PAE aiming at using the PErFecTED technique. We treated 32 consecutive patients, mean age 65 (52–84 years old) between December 2013 and January 2015. Patients were referred for PAE after failure of medical treatment and refusal or contra-indication to surgery. They were treated using the PErFecTED technique, when feasible, with 300–500 µm calibrated microspheres (two-night hospital stay or outpatient procedure). Follow-up was performed at 3, 6, and 12 months. We had a 100 % immediate technical success of embolization (68 % of feasibility of the PErFecTED technique) with no immediate complications. After a mean follow-up of 7.7 months, we observed a 78 % rate of clinical success. Mean IPSS decreased from 15.3 to 4.2 (p = .03), mean QoL from 5.4 to 2 (p = .03), mean Qmax increased from 9.2 to 19.2 (p = .25), mean prostatic volume decreased from 91 to 62 (p = .009) mL. There was no retrograde ejaculation and no major complication. PAE using the PErFecTED technique is a safe and efficient technique to treat bothersome LUTS related to BPH. It is of interest to note that the PErFecTED technique cannot be performed in some cases for anatomical reasons.

Prostate artery embolization (PAE) is a new approach to improve lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. PAE results in global reduction of prostate volume (PV). There are no data available on the efficacy of PAE in reducing intra-vesical prostatic protrusion (IPP), an anatomic feature that is clinically related with bladder outlet obstruction and LUTS. To assess the results of PAE in patients with significant IPP due to median lobe hyperplasia and to compare the IPSS decrease and IPP change. Prospective analysis of 18 consecutive patients with significant IPP (>5 mm) related to median lobe hyperplasia undergoing PAE using 30–500-μm-calibrated trisacryl microspheres. We measured IPP on sagittal T2-weighted images before and 3 months after PAE. IPSS and clinical results were also evaluated at 3 months. PAE resulted in significant IPP reduction (1.57 cm ± 0.55 before PAE and 1.30 cm ± 0.46 after PAE, p = 0.0005) (Fig. 1) with no complication. IPSS, quality of life (QoL), total prostate-specific antigen (PSA) level, and PV showed significant reduction after PAE, and maximum urinary flow rate (Q max) showed significant increase after PAE. No significant change of International Index of Erectile Function (IIEF) for clinical evaluation after PAE. A significant correlation was found between the IPP change and the IPSS change (r = 0.636, p = 0.0045). Patients had significant IPP reduction as well as significant symptomatic improvement after PAE, and these improvements were positively correlated.

To review current knowledge on clinical outcomes and peri-operative complications of prostatic arterial embolization (PAE) in patients treated for lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). A systematic review of the literature published from January 2008 to January 2015 was performed on PubMed/MEDLINE. Fifty-seven articles were identified, and four were selected for inclusion in this review. Only one randomized clinical trial compared transurethral resection of the prostate (TURP) to PAE. At 3 months after the procedure, mean IPSS reduction from baseline ranged from 7.2 to 15.6 points. Mean urine peak-flow improvement ranged from +3.21 ml/s to +9.5 ml/s. When compared to TURP, PAE was associated with a significantly lower IPSS reduction 1 and 3 months after the procedure. A trend toward similar symptoms improvement was however reported without statistical significance from 6 to 24 months. Major complications were rare with one bladder partial necrosis due to non-selective embolization. Mild adverse events occurred in 10 % of the patients and included transient hyperthermia, hematuria, rectal bleeding, painful urination or acute urinary retention. Further comparative studies are mandatory to assess post-operative rates of complications, especially acute urinary retention, after PAE and standard procedures. Early reports suggest that PAE may be a promising procedure for the treatment of patients with LUTS due to BPO. However, the low level of evidence and short follow-up of published reports preclude any firm conclusion on its mid-term efficiency. Further clinical trials are warranted before any use in clinical practice.

Objectives To evaluate prospectively a healthy parenchymal safety margin during conservative surgery for renal cell carcinoma. Methods From 1997 to 2001, elective nephron-sparing surgery was performed through a flank incision in 61 consecutive patients (mean age 59.4 years, range 34.2 to 78.5). The mean tumor size was 32 mm (range 12 to 50). The tumor localization was juxtahilar in 10 and distant in 51. Prospective margin assessment used the following protocol. Margins were evaluated macroscopically by the surgeon, controlled by frozen section analysis, and subsequently measured during histologic examination. All patients were monitored with computed tomography scans, with a mean follow-up of 72.5 months (range 46 to 95). Results The histologic type was clear cell in 42 patients, papillary in 17, and chromophobic cell in 2. Of the 61 patients, 57 had 1997 TNM Stage pT1 and 4 had Stage pT2. The Furhman grade was grade 1 in 16, grade 2 in 35, and grade 3 in 10. No tumor margin was positive. Frozen section analysis and routine histologic examination yielded 53 complete and 8 incomplete margins compared with 51 and 10, respectively, as assessed by the surgeons. The mean peritumoral margin was 7 mm (range 4 to 10) for the cortex and 2 mm (range 0 to 5) for the deep part. No patient developed locoregional or metastatic relapse. Conclusions No apparent relationship was observed between peritumoral margin width and the risk of disease progression, even for tumors abutting the hilum, rendering illusory a safety margin greater than 1 cm. Although the surgeons’ macroscopic margin evaluations were accurate, frozen section analysis is mandatory when the margin status is in doubt. In all cases, margin negativity remains an oncologic imperative.

To assess the frequency and features of the PSA bounce phenomenon in a series of patients treated with permanent implant brachytherapy for prostate cancer, and to evaluate the percentage of cases in which this bounce could have mimicked a biochemical relapse according to the American Society for Therapeutic Radiology and Oncology consensus criteria.From January 1999 to December 2001, 295 patients were treated with a permanent prostate implantation (real-time technique, with free (125)I seeds) by the Paris Institut Curie/Hospital Cochin/Hospital Necker Paris group. Duration of followup is 40.3 months (9-66 months). PSA level was reported at intervals not exceeding 6 months. Bounce was defined by temporary elevation in PSA level, followed by a spontaneous decrease.In our series, 161 patients (55%) showed a transitory PSA increase (bounce) of at least 0.1 ng/mL; 145 patients (49%) a bounce of 0.2 ng/mL; 93 patients (32%) a bounce of 0.4 ng/mL; and 43 patients (15%) a bounce of at least 1 ng/mL. Mean PSA bounce was 0.8 ng/mL (0.1-4.1), and mean time to bounce was 19 months. Thirty-two patients (11% of total) presented three successive PSA increases, and therefore were to be considered as experiencing a biochemical relapse according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria. Among those 32 patients, 18 (56%) subsequently showed, without any treatment, a complete normalization of their PSA. In multivariate analysis, age70 (p0.0001) and D90200Gy (p0.003) were identified as independent factors for a PSA bounce of at least 0.4 ng/mL.The observed rate of 32% of patients showing a PSA bounce of at least 0.4 ng/mL in our series is in good agreement with what has been previously reported in the literature. Among 32 patients fulfilling the classical ASTRO criteria for a biochemical relapse, 18 (56%) subsequently showed a spontaneous PSA decrease, questioning the ASTRO consensus for the biochemical followup of patients undergoing permanent implant prostate brachytherapy.

BACKGROUND: Sterility in men with cystic fibrosis (CF) raises the question of the use of assisted reproductive techniques (ART). A multidisciplinary network including adult CF centre and reproductive medicine units was set up to answer requests for ART. METHODS: This retrospective study included 25 men with CF between 1994 and 2004. Clinical status, semen analysis, CF mutations analysis and artificial insemination by donor (AID) or ICSI after surgical retrieval of sperm were monitored. RESULTS: All CF men had azoospermia. Two chose AID first (one delivery); 23 chose ICSI. Sperm were surgically retrieved in 21 cases, and ICSI was performed in 19. Pregnancies occurred in 12 of these 19 couples (63%) (two ectopic pregnancies, two spontaneous abortions, one termination of pregnancy for polymalformed twins and 11 single deliveries in nine couples). Two couples tried AID after ICSI failed; one had twins. Another adopted a child, and two had a spontaneous pregnancy. After a follow-up of 4.1±2.3 years, two patients died, two underwent lung transplantation and 21 remained stable. CONCLUSION: ART can help men with CF to become a father, but their health status and short survival need careful counselling and multidisciplinary medical care.

For more than 60 years, the treatment of metastatic prostate cancer has been based on andro- gen deprivation. In the case of asymptomatic metastatic disease, the timing of hormonal therapy remains controversial. No evidence of a beneficial effect of neoadjuvant hormonal therapy before radical prostatectomy has been docu- mented. Radical prostatectomy and adjuvant therapy cannot be consi- dered as a standard treatment. There is a general consensus at this time that patients with high-grade localized tumors benefit from hormone therapy (2-3 years) in conjunction with external beam radiation therapy.