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Many patients in the favorable International Metastatic renal cell carcinoma (RCC) Data Base Consortium group (F-MRC) may have a relatively indolent disease course. Surveillance and delay of systemic therapy could be an option in this specific population. However, the question whether this delay could alter patients' outcome remains unanswered. Our objective was to determine if delaying first-line treatment influences the survival of F-MRC patients.We performed a retrospective multicenter national study involving the French Network for Research on Kidney Cancer UroCCR (NCT03293563). We included treatment naive F-MRC patients. We compared the overall survival of patients with immediate medical treatment (IMT) (started less than 3 months after metastatic diagnosis) to those with delayed medical treatment (DMT).We included 90 patients treated between 2009 and 2018. The median time before occurrence of metastases from diagnosis was 28 (12-137) months. The two groups (IMT vs. DMT) were comparable for follow-up, age, sarcomatoid feature, number, and localization of metastatic sites and ECOG performance status. IMT was given in 25 (27.8 %) patients. Local treatment of metastasis (LTM) was performed in 47 (52%) patients. Patients with DMT had more LTM (63% vs. 24%, P = .001). Among patients with DMT (n = 65); 27 (41%) received a systemic treatment and median systemic treatment-free survival was 39 months (95% CI, 26.3-51.6). Median overall survival from metastasis disease diagnosis was 55 months (95% CI, 42.4-67.5) in the IMT group and 88 months (95%CI, 64-111.9) in the DMT group (P = .028). In multivariable analysis LTM was the only prognostic factor associated to survival improvement (HR: 0.33; P = .024).Selected Patients with F-MRC may safely undergo DMT. LTM positively impacted survival in this population and should be considered whenever possible. Prospective trial with a larger population is needed to confirm these results.

Sarcopenia is defined as a loss of muscle mass and strength. Its effects on postoperative outcomes in oncology and geriatrics have already been shown. Approximately 40% of patients in end-stage renal failure are affected with sarcopenia. A recent study suggests that sarcopenia could predict surgical complications after renal transplantation in obese patients. The aim of this study was to evaluate the effect of sarcopenia on parietal complications (eg, wound healing, lymphocele, hematoma).Two indices of muscle fat infiltration (intra-muscular adipose content [IMAC], Hounsfield unit average calculation [HUAC]) and 3 of muscle mass index (total psoas index [TPI], visceral fat area/total abdominal muscle area [VFA/TAMA], and skeletal muscle mass index [SMMI]) were retrospectively measured on pretransplant computed tomography scans for patients undergoing kidney transplantation between 2007 and 2017. Patients were considered sarcopenic when the index was above the third quartile for muscle fat infiltration (IMAC, HUAC) and VFA/TAMA, and under the first quartile for muscle mass (TPI, SMMI). The occurrence of wound healing, collection (hematoma and lymphocele), and acute rejection were compared between sarcopenic and nonsarcopenic patients.Of 484 transplanted patients, 117 patients had a computed tomography scan before transplantation. Patients with a high HUAC had significantly more collections (P = .02) and total parietal complications (P = .09). Patients with a high IMAC had significantly more acute rejection (P = .001).Muscle fat infiltration appears to influence the outcome of renal transplantation. The management of sarcopenia in pretransplantation should be a subject of further research.

HALLMARK gene set

ADT reduces tumor proliferation measured by Ki67

Purpose: WST11 vascular targeted photodynamic therapy (VTP) is a local ablation approach relying upon rapid, free radical-mediated destruction of tumor vasculature. A phase III trial showed that VTP significantly reduced disease progression when compared with active surveillance in patients with low-risk prostate cancer. The aim of this study was to identify a druggable pathway that could be combined with VTP to improve its efficacy and applicability to higher risk prostate cancer tumors.Experimental Design: Transcriptome analysis of VTP-treated tumors (LNCaP-AR xenografts) was used to identify a candidate pathway for combination therapy. The efficacy of the combination therapy was assessed in mice bearing LNCaP-AR or VCaP tumors.Results: Gene set enrichment analysis identifies the enrichment of androgen-responsive gene sets within hours after VTP treatment, suggesting that the androgen receptor (AR) may be a viable target in combination with VTP. We tested this hypothesis in mice bearing LNCaP-AR xenograft tumors by using androgen deprivation therapy (ADT), degarelix, in combination with VTP. Compared with either ADT or VTP alone, a single dose of degarelix in concert with VTP significantly inhibited tumor growth. A sharp decline in serum prostate-specific antigen (PSA) confirmed AR inhibition in this group. Tumors treated by VTP and degarelix displayed intense terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling staining 7 days after treatment, supporting an increased apoptotic frequency underlying the effect on tumor inhibition.Conclusions: Improvement of local tumor control following androgen deprivation combined with VTP provides the rationale and preliminary protocol parameters for clinical trials in patients presented with locally advanced prostate cancer. Clin Cancer Res; 24(10); 2408–16. ©2018 AACR.

Pathologic nodal invasion at prostatectomy is frequently associated with persistently elevated prostate-specific antigen (PSA) and with increased risk of disease recurrence. Management strategies for these patients are poorly defined. We aimed to explore the long-term oncologic outcomes and patterns of disease progression.We included men treated between 2000 and 2017 who had lymph node invasion at radical prostatectomy and persistently detectable prostate-specific antigen post-prostatectomy. Postoperative imaging and management strategies were collated. Patterns of recurrence and probability of metastasis-free survival, prostate cancer-specific survival, and overall survival (OS) were assessed.Among our cohort of 253 patients, 126 developed metastasis. Twenty-five had a positive scan within 6 months of surgery; of these, 15 (60%) had a nodal metastasis, 10 (40%) had a bone metastasis, and 4 (16%) had local recurrence. For metastasis-free survival, 5- and 10-year probabilities were 52% (95% CI 45%, 58%) and 37% (95% CI 28%, 46%), respectively. For prostate cancer-specific survival, 5- and 10-year probabilities were 89% (95% CI 84%, 93%) and 67% (95% CI 57%, 76%), respectively. A total of 221 patients proceeded to hormonal deprivation treatment alone. Ten patients received postoperative radiotherapy.Biochemical persistence in patients with lymph node invasion is associated with high risk of disease progression and reduced prostate cancer-specific survival. Management was hindered by the limitation of imaging modalities utilized during the study period in accurately detecting residual disease. Novel molecular imaging may improve staging and help design a therapeutic strategy adapted to patients' specific needs.

Partial nephrectomy is the treatment of choice for small localized renal tumors. In case of doubt, a biopsy can confirm the diagnosis. The aim of this study was to evaluate the impact of a delayed time to partial nephrectomy on cancer development.Our single center study enrolled localized renal tumor patients who underwent a partial nephrectomy between 2015 and 2020; the collected data were included in the uroCCR prospective database. The histopathological stage of the tumors and the recurrence rate in patients treated with surgery90 days after diagnosis were investigated. The impact a preoperative biopsy on was also explored. Statistical significance was tested using Student's t-test and Chi-squared test (SPSS software).The cohort consisted of 179 patients, among which 41 (23 %) received a preoperative biopsy. 89 patients (50 %) were treated surgically3 months after diagnosis. The median time to nephrectomy was 86 days (13-1 037). A delayed time to surgery did not lead to significantly higher recurrence rates (P=0.66). Preoperative biopsy led to a doubling time to surgery (P0.001) but was neither correlated to a more severe tumor stage (P=0.944) nor to a higher recurrence rate (P=0.08). Tumor growth was not significantly different with or without the presence of a biopsy (P=0.122).Our data evidence that a substantial delayed time to partial nephrectomy does not result in a negative impact on cancer prognosis in localized renal tumor patients.

International audience; Although several studies have examined the relationship between organochlorine pesticides (OCPs) and prostate cancer (PCa) risk, no data are available concerning the association between OCPs concentrations in periprostatic adipose tissue (PPAT), which reflects cumulative exposure, and PCa aggressiveness. Moreover, no previous study has compared OCPs exposure in two distinct ethno-geographical populations. The objectives were to analyze OCPs in PPAT of PCa patients from either Mainland France or French West Indies in correlation with features of tumor aggressiveness, after adjusting for potential confounders such age, BMI, and polyunsaturated fatty acid (PUFA) content of PPAT. PPAT was analyzed in 160 patients (110 Caucasians and 50 African-Caribbeans), 80 with an indolent tumor (ISUP group 1 + pT2), and 80 with an aggressive tumor (ISUP group more than 3 + pT3). The concentrations of 29 OCPs were measured in PPAT concomitantly with the characterization of PUFA content. Exposure patterns of OCPs differed according to the ethno-geographical origin. Most OCPs were found at higher concentration in Caucasian patients, whereas pp’-DDE content was twice as high in African-Caribbeans. Chlordecone was only detected in PPAT from African-Caribbean patients. Most OCP concentrations were positively correlated with age, and some with BMI. After adjusting for age, BMI, and PUFA composition of PPAT, no significant association was found between OCPs content and risk of aggressive disease, except of mirex which appeared inversely associated with aggressive features of PCa in Caucasian patients. These results highlight a significant ethno-geographic variation in internal exposure to OCPs, which likely reflects differences in consumption patterns. The inverse relationship observed between mirex concentration and markers of PCa aggressiveness need to be further investigated.

Hypothesis: Partial Nephrectomy is oncological safe in patients with pT3a RCC. Purpose: To compare the oncological and functional outcomes of patients with pT3a RCC scheduled for PN and RN. Materials and Methods: We retrospectively reviewed patients with pT3a N0 M0 RCC who underwent partial or radical nephrectomy from 2005 to 2016. Perioperative characteristics, including estimated glomerular filtration rate, tumor size, pathological histology, and RENAL nephrometry score, were compared between patients scheduled for partial or radical nephrectomy. We used multivariable Cox proportional hazards regression models to compare overall survival, cancer-specific survival, and recurrence-free survival between planned procedure type. Results: Of the 589 patients, 369 (63%) and 220 (37%) were scheduled for radical and partial nephrectomy, respectively; 26 (12%) of the scheduled partial nephrectomy cases were intraoperatively converted to radical nephrectomy. After adjusting for tumor size and histology, there were no statistically significant differences in overall survival (hazard ratio 0.66; 95% CI, 0.38–1.13), cancer-specific survival (hazard ratio 0.53; 95% CI, 0.16–1.75), or recurrence-free survival (hazard ratio 0.66; 95% CI, 0.34–1.28) between patients scheduled for partial or radical nephrectomy. Fewer patients scheduled for partial nephrectomy had estimated glomerular filtration rate reductions 3 to 9 months after surgery than patients scheduled for radical nephrectomy. Conclusion: We found no evidence that patients scheduled to undergo partial nephrectomy had poorer oncologic outcomes than patients scheduled to undergo radical nephrectomy. In select patients with pT3a renal cell carcinoma in whom partial nephrectomy is deemed feasible by the surgeon, partial nephrectomy should not be discouraged.

Purpose: Almost half of the patients have had recurrent nephrolithiasis despite undergoing effective treatment. Our objective is to determine the recurrence rate of lithiasis after endourological management of nephrolithiasis and identify the risk factors for these recurrences.Methods: Data were gathered retrospectively from all patients who were treated for nephrolithiasis by endourological management from May 2014 to January 2017 in our university hospital. All patients who had postoperative renal colic and/or stone upon an imaging study were considered to have recurrent disease. The patients were devised into two groups: with and without recurrence. Many variables were also compared between these two groups.Results: A total of 190 patients were included in our study. At the end of a median follow-up of 32 months (range, 13–61 months), 25.8% of patients had a recurrent stone. In the multivariate analysis, the risk factors for recurrence were diabetes (HR: 7.9; p ) and smoking (HR: 3.5; p ). While the body mass index greater than 25 kg/m2 (HR: 2; p p p Conclusion: Stone recurrence is common after the management of urinary stones. In this study 25.8% of patients had recurred stone disease after endourological management with a median follow-up of 32 months. Our study findings showed that diabetes and smoking are risk factors for recurrence, while age and blood hypertension are protective factors that decreased the risk of recurrence.

Background and objective To assess the medium-term tumor control in patients with localized prostate cancer (PCa) treated with vascular-targeted photodynamic (VTP) therapy with TOOKAD Soluble WST11 (VTP) and to assess the medium-term tolerability of the treatment. Design, setting, participants, and intervention During the clinical phase II studies, 68 patients were treated with VTP under optimal treatment conditions (WST11 at 4 mg/kg, light energy at 200 J/cm, and a light density index ≥1) and have been included in a 3.5-yr follow-up. Outcome measurements and statistical analysis Post-interventional visits were scheduled every 6 mo and conducted as per local standard practice in each study center. Cancer-free status was assessed by means of prostate-specific antigen kinetics, multiparametric magnetic resonance imaging and/or prostate biopsies. Results and limitations At the end of the 3.5-yr follow-up, overall successful focal ablation was achieved for 51 patients (75%). Cancer was identified in the untreated lobe in 17 patients (25%). In total, 34 patients (50%) were cancer-free in both the prostate lobes. In case of recurrent/persistent malignancy, the Gleason score remained consistent or changed at the maximum by one point (upgrading by 1 Gleason point to 3 + 4 for eight patients and 4 + 3 for two patients). There were 64 related adverse events (AEs): 48% were Clavien grade I, 47% were grade II, and 5% were grade III. There were no Clavien grade IV and V AEs. Limitations included small sample size and heterogeneity in the follow-up for some centers. Conclusions VTP is a safe and efficient treatment and represents an alternative option for localized low-risk PCa management over the medium term. Precise diagnostic methods and imaging tools are thereby essential requirements to ensure safe and complete targeted therapy. Patient summary In this report, we looked at the medium-term outcomes of focal photodynamic therapy for early-stage prostate cancer. We found that this form of treatment is efficient and might have the potential to become a therapeutic option for low-risk cancer. Effectiveness depends on precise diagnostic methods, such as magnetic resonance imaging and accurate biopsy.

Purpose: Vascular targeted photodynamic therapy (VTP) is a nonsurgical tumor ablation approach used to treat early-stage prostate cancer and may also be effective for upper tract urothelial cancer (UTUC) based on preclinical data. Toward increasing response rates to VTP, we evaluated its efficacy in combination with concurrent PD-1 inhibitor/OX40 agonist immunotherapy in a urothelial tumor-bearing model. Experimental design: In mice allografted with MB-49 UTUC cells, we compared the effects of combined VTP with PD-1 inhibitor/OX40 agonist with those of the component treatments on tumor growth, survival, lung metastasis, and antitumor immune responses. Results: The combination of VTP with both PD-1 inhibitor and OX40 agonist inhibited tumor growth and prolonged survival to a greater degree than VTP with either immunotherapeutic individually. These effects result from increased tumor infiltration and intratumoral proliferation of cytotoxic and helper T cells, depletion of Treg cells, and suppression of myeloid-derived suppressor cells. Conclusions: Our findings suggest that VTP synergizes with PD-1 blockade and OX40 agonist to promote strong antitumor immune responses, yielding therapeutic efficacy in an animal model of urothelial cancer.

Script Concordance Testing (SCT) is a method for clinical reasoning assessment in the field of health-care training. Our aim was to assess SCT acceptability and utility with a survey and an institutional prospective evaluation of students’ scores.With a user’s online survey, we collected the opinions and satisfaction data of all graduate students and teachers involved in the SCT setting. We performed a prospective analysis comparing the scores obtained with SCT to those obtained with the national standard evaluation modality.General opinions about SCT were mostly negative. Students tended to express more negative opinions and perceptions. There was a lower proportion of negative responses in the teachers’ satisfaction survey. The proportion of neutral responses was higher for teachers. There was a higher proportion of positive positions towards all questions among teachers. PCC scores significantly increased each year, but SCT scores increased only between the first and second tests. PCC scores were found significantly higher than SCT scores for the second and third tests. Medical students’ and teachers’ global opinion on SCT was negative. At the beginning SCT scores were found quite similar to PCC scores. There was a higher progression for PCC scores through time.

The 3D Navigo™ system is a magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion device for prostate targeted biopsies (TB). Our aim was to evaluate the clinically significant prostate cancer (CSC) detection rate of TB using the 3D Navigo™ system. Patients who underwent TB with the 3D Navigo™ system in our center between June 2014 and May 2018 were prospectively included, excluding those who have previously received treatment for prostate cancer. A 3-Tesla MRI imaging was performed before biopsies; findings were reported according to the Prostate Imaging Reporting and Data System version 2 (PIRADS). CSC was defined by an ISUP score ≥ 2. 304 patients underwent TB. Median age was 66 years (51–84). Median PSA was 7.75 ng/ml (0.6–70.0). Median prostate volume was 45.0 ml (15.9–221.7). PCa and CSC were found in 70.4% (214/304) and 47.7% (145/304) of the patients, respectively. The proportion of patients diagnosed with CSC among those with PCa was 67.8% (145/214). There was a significant risk of having a CSC in case of PIRADS score ≥ 4 and 5 (OR 5.0, 95% CI [2.7–9.2], P

International audience; Objectifs : rapporter les résultats à 1 an du traitement mini-invasif de l’hyperplasie bénigne de prostate (HBP) par thermothérapie convective à la vapeur d’eau (système REZUM).Méthodes : cette technique a été proposée dans 2 centres français aux patients ayant une HBP symptomatique ou compliquée, en alternative à un traitement chirurgical ablatif classique ou à un traitement médicamenteux refusé. L’évaluation pré- et postopératoire de la symptomatologie urinaire a été basée sur le questionnaire IPSS, le débit urinaire maximal (Qmax) et le résidu post-mictionnel (RPM). L’évaluation des fonctions érectile et éjaculatoire a été basée sur les questionnaires IIEF5 et MSHQejd. Les taux de retraitement et les complications ont été rapportés. L’analyse statistique a été réalisée par un test t de Student ou par le test des rangs signés de Wilcoxon selon que les variables suivaient une loi de distribution normale ou non. Une valeur seuil de p < 0,01 a été considérée comme significative.Résultats : soixante-neuf patients ont été traités, en ambulatoire, d’octobre 2018 à novembre 2019. Huit patients étaient porteurs d’une sonde vésicale à demeure. Le volume prostatique médian préopératoire était de 47 (27–200) mL. À 6 mois postopératoire, le score IPSS était significativement diminué de 13,9 points (68,1 %, p < 0,001) et à 12 mois de 12 points (61,5 %, p < 0,001). À un an, le score de Qualité de vie a diminué de 3,2 points (p < 0,001) et le Qmax a été amélioré de 6 mL/s (p < 0,001). Tous les patients en rétention urinaire ont été sevrés de leurs sondes vésicales. Aucun effet indésirable grave (> Clavien II) n’a été observé. Aucune dysfonction érectile de novo et 10 % d’anéjaculation rétrograde ont été rapporté. Le taux de retraitement chirurgical à un an a été de 2,1 % (Tableau 1).Conclusion : les résultats à court terme de notre étude objectivent une amélioration significative de la symptomatologie urinaire et un respect de la fonction sexuelle. Cette étude suggère ainsi la reproductibilité, sur la population française en pratique courante, des résultats obtenus dans les études contrôlées randomisées nord américaines. Nous faisons toutefois état d’un taux de complications et notamment d’anéjaculation supérieurs à ceux rapportés dans ces mêmes études. La poursuite du suivi de notre cohorte est nécessaire afin d’évaluer l’évolution à moyen et long terme.

International audience; Purpose: To report the results of convective radiofrequency (RF) water vapor thermal therapy in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) with one-year follow-up evaluation.Material and method: The study was conducted in 2 French hospitals, for men with moderate to severe LUTS secondary to BPH, as an alternative to classical surgery treatment. The pre- and postoperative evaluation of urinary symptomatology was based on the International Prostate Symptom Score (IPSS) questionnaire, measures of peak urinary flow rate (Qmax) and post-void residual volume (PVR). Erectile and ejaculatory functions were evaluated via the IIEF5 and MSHQ-ejd questionnaires. Rates of retreatment and complications were also reported.Results: Sixty-two outpatients including 8 with urinary retention were treated. The median preoperative prostate volume was 47 (27-200) mL. At 6months postoperative, the IPSS had decreased significantly by 13.9 points (68.1%, PClavien II) were observed. No cases of de novo erectile dysfunction and an anejaculation rate of 10.8% was reported. The surgical retreatment rate at one year was 2.1%.Conclusion: The short-term results are encouraging, with significant efficacy on urinary symptoms and respect of sexual function. Nevertheless, it will be necessary to pursue the follow-up of this cohort to evaluate the mid-term and long-term evolution.

To determine whether immersive virtual patient simulation (IVPS) on the MedicActiv platform is influential in improving student academic performance in module validation tests.In this prospective randomized controlled study a comparison was made between IVPS training combined with regular faculty courses versus courses alone. The primary endpoint was module validation grades. Secondary endpoints were satisfaction scores (overall interest, ergonomics, realism, immersion, and training efficiency).Angers School of Medicine, France.2018 to 2019 class of fourth-year students, included on a voluntary basis. In the first semester 51 students were included, of whom 13 were excluded for lack of compliance (6 and 7 from the IVPS and control groups, respectively). In the second semester we included 57 students, of whom 10 were excluded for lack of compliance (2 and 8 from the IVPS and control groups, respectively).Mean age was 21 years (±0.8). There were 85 female and 23 male students. In the first semester mean grades were 13.4 ± 1.6 versus 11/.9 ± 2.4 in the IVPS and control groups, respectively (p = 0.038). In the second semester mean grades were 15.3 ± 2.5 versus 11.9 ± 3.6 in the IVPS and control groups, respectively p0.001. The entire study population was pooled (n = 85): mean grades were 14.5 ± 2.4 versus 11.9 ± 3 in the IVPS group and the control group, respectively, p0.001. The satisfaction questionnaire response rate was 54% (46/85). Score percentages ≥4 regarding overall interest, ergonomics, realism, immersion and training efficiency were 89%, 85%, 100%, 93%, and 93% respectively.Complementing conventional university education with simulation of virtual consultation cases on the MedicActiv platform improved student academic performance as compared with students studying regular courses. Students reported high levels of satisfaction with overall interest, ergonomics, realism, immersion and training efficiency on the MedicActiv platform.

INTRODUCTION AND OBJECTIVE:In a recent Phase III randomized controlled trial, TOOKAD-VTP has showed great efficacy in low risk (GG1) prostate cancer patients. However, about 28% of these patients p...

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

Resume Introduction Actuellement, environ 50 % des cancers de la prostate nouvellement diagnostiques sont localises a la glande prostatique et de faible risque selon la classification de d’Amico. Les therapies focales, dont l’objectif est le traitement de la seule lesion index du cancer, apparaissent comme une nouvelle alternative en cours d’evaluation dans la prise en charge de ces cancers. Outre l’interet dans le controle de la maladie, ces therapies focales presentent un tres faible risque de morbidite. La phototherapie dynamique a visee vasculaire (VTP) est l’une de ces nouvelles therapies emergentes. Methode Une revue exhaustive de la litterature concernant la VTP en cancerologie prostatique a ete realisee. Une recherche par les mots cles suivant « low-risk prostate cancer », « focal treatment », « vascular targeted photodynamic therapy » « TOOKAD » a ete realisee dans Pubmed et Embase. Resultats Dans les differentes etudes de phase II, la VTP a montre un taux de 80 % de biopsies negatives a 6 mois, avec une bonne tolerance clinique. L’etude europeenne de phase III, prospective randomisee comparant le VTP a la surveillance active, a montre une plus faible proportion de progression, ainsi qu’une duree avant progression plus importante pour la VTP. Les evenements indesirables sont majoritairement moderes et transitoires. La qualite de vie des patients est preservee, avec un impact modere sur les fonctions erectiles et urinaires. Conclusion La VTP semblent etre une nouvelle approche prometteuse dans le cancer de la prostate localise de faible risque.

Vascular-targeted photodynamic therapy (VTP) induces rapid destruction of targeted tissues and is a promising therapy for prostate cancer. However, the resulting immune response, which may play an important role in either potentiating or blunting the effects of VTP, is still incompletely understood. Myeloid cells such as myeloid-derived suppressor cells (MDSCs) and macrophages are often found in tumors and are widely reported to be associated with cancer angiogenesis, tissue remodeling, and immunosuppression. These cells are also known to play a critical role in wound-healing, which is induced by rapid tissue destruction. In this study, we investigated the effects of VTP on the recruitment of tumor-infiltrating myeloid cells, specifically MDSCs and tumor-associated macrophages (TAMs), in the Myc-Cap and TRAMP C2 murine prostate cancer models. We report that VTP increased the infiltration of myeloid cells into the tumors, as well as their expression of CSF1R, a receptor required for myeloid differentiation, proliferation, and tumor migration. As anti-CSF1R treatment has previously been used to deplete these cells types in other murine models of prostate cancer, we hypothesized that combining anti-CSF1R with VTP therapy would lead to decreased tumor regrowth and improved survival. Importantly, we found that targeting myeloid cells using anti-CSF1R in combination with VTP therapy decreased the number of tumor MDSCs and TAMs, especially M2 macrophages, as well as increased CD8(+) T cell infiltration, decreased tumor growth and improved overall survival. These results suggest that targeting myeloid cells via CSF1R targeting is a promising strategy to potentiate the anti-tumor effects of VTP.

Lower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. The GreenLight PVP is usually considered as an interesting surgical option for patients treated via oral anticoagulants (OACs) with regard to its haemostatic properties. The aim of this study was to assess the impact of maintaining OAC treatment in patients undergoing PVP. This study is a multicentre, open-label, randomized controlled trial (RCT) designed to show the non-inferiority of PVP surgery in patients with BPO treated with OACs. This study is designed to enrol 386 OAC-treated patients (treated with vitamin K antagonists and direct oral anticoagulants) who are undergoing PVP for BPO. Patients will be randomized (1:1) to either maintain or stop OAC treatment during the perioperative course. The intervention group will maintain OAC treatment until the day before surgery and resume OAC treatment the day after surgery, whereas the control group will stop OAC treatment (with or without low-molecular-weight heparin bridging therapy) according to the anaesthesia guidelines. The primary outcome of interest to be assessed is the 30-day complications rate according to the Clavien-Dindo classification. The secondary endpoint will examine the 30-day rate of haemorrhagic and thrombotic events. This study will provide 80% power to show non-inferiority, defined as not worse than a 10% (non-inferiority margin) inferior change in the proportion of patients with good outcomes (Clavien-Dindo score

International audience; PURPOSE:Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management.METHODS:A systematic review of the literature was carried out on the PubMed database using the following MESH terms: "Prostatic Hyperplasia/surgery" and "Ejaculation", in combination with the following keywords: "ejaculation preservation", "photoselective vaporization of the prostate", "photoselective vapo-enucleation of the prostate", "holmium laser enucleation of the prostate", "thulium laser", "prostatic artery embolization", "urolift", "rezum", and "aquablation".RESULTS:The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively.CONCLUSIONS:Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.

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

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

We report the case of a 23-year-old woman treated by mesalazine for ulcerative colitis and who subsequently presented recurrent renal colic due to mesalazine urinary stones. This is the second case described in the literature.Mesalazine stones are soft, friable and have an orange-beige color. They are not visible on non-contrast computed tomography (CT). Their diagnosis is based on morpho-constitutional analysis and CT-urography. Patients treatedby mesalazine who present renal colic should undergo CT-urography in order to make the diagnosis.

Resume But Evaluer l’accessibilite previsible au post-internat pour les internes d’urologie terminant leur internat entre novembre 2013 et 2016. Materiel De septembre a novembre 2013, les representants des internes d’urologie inscrits en DESC dans chaque region ont ete contactes pour participer a l’etude. Un questionnaire leur a ete soumis afin de recenser localement le nombre d’internes prevoyant de terminer leur internat entre novembre 2013 et 2016, ainsi que le nombre de postes de chef de clinique-assistant (CCA) et d’assistant specialiste (AS) d’urologie permanents et provisoires dans la region, et leur occupation prevue durant la meme periode. Resultats En novembre 2013, notre etude a recense 334 urologues en formation (197 internes inscrits en DESC, 81 CCA, 56 AS). Cinquante-cinq internes ont termine leur internat en novembre 2013, alors que 67, 50, 77 internes ont prevu de terminer leur formation respectivement de novembre 2014 a 2016. L’accessibilite previsible au post-internat d’urologie a ete evaluee a 96,4 %, 82,1 %, 90,0 %, 74,0 % respectivement pour les internes terminant leur formation de novembre 2013 a 2016. Le deficit previsible de postes de post-internat a ete calcule a –2, –12, –5, –20 postes respectivement de novembre 2013 a 2016. Conclusion Le nombre previsible de postes de post-internat d’urologie reste insuffisant en France pour la periode 2013–2016. En raison d’un flux non stabilise d’internes prevoyant de terminer leur internat de novembre 2014 a 2016, leur accessibilite immediate a un post-internat a ete mesuree a 82,1 %, 90,0 %, 74,0 % respectivement sur la meme periode. Niveau de preuve 5.

Resume Introduction L’objectif de ce travail de l’AFUF etait d’etablir un etat des lieux des remunerations des gardes et astreintes des internes, assistants et chefs de clinique d’urologie en France. Materiel et methodes Les donnees ont ete recueillies de fevrier a mai 2013 par l’intermediaire d’un questionnaire envoye a tous les membres de l’AFUF (327 membres). Les remunerations etaient donnees en valeurs brutes. Resultats Quarante-trois internes ont participe a l’etude, 16 assistants et 16 chefs de clinique, permettant d’obtenir une representativite nationale de 62 % (54 hopitaux sur les 92 centres pratiquant l’urologie en France). La majorite des repondants etait d’astreinte operationnelle ou de securite. Vingt hopitaux (38 %) avaient une activite de prelevements multi-organes (PMO). Les remunerations medianes des internes etaient de 59,51 € par astreinte deplacee (demi-garde) et de 119,02 € par garde. Les assistants et chefs de clinique etaient remuneres de maniere forfaitisee pour 37,5 % d’entre eux (140 € pour les assistants [avec des variabilites de 40 a 195 €] et 130 € pour les chefs de clinique [42,5–180]) ou selon un tarif qui dependait du nombre ou du temps de deplacement pour les autres (62,5 %) : les deux premiers deplacements ou un deplacement e ou au-dela de 3 h et 365 et 473 € respectivement au-dela de 8 h. Les PMO etaient egalement remuneres de maniere forfaitisee (60 %) ou au tarif horaire (40 %). Au-dela d’un seuil de 2–3 heures, la remuneration horaire etait plus interessante que la remuneration forfaitisee. Conclusion Des disparites de remuneration des astreintes et gardes d’urologie ont ete mises en evidence. Les plus grandes variabilites concernaient la remuneration des astreintes forfaitisees au-dela d’un certain seuil d’heures deplacees et les astreintes de PMO des assistants et chefs de clinique. Ces differences meritent d’etre reconsiderees en vue d’une harmonisation nationale. Niveau de preuve 3.

Resume Objectif Evaluer les motivations, l’organisation pratique et le financement du Master 2 chez les jeunes urologues francais. Materiels et methodes Un questionnaire electronique a ete diffuse aux membres de l’AFUF ainsi qu’aux participants du seminaire de formation a la recherche « Graines et Sol » de l’AFU, entre juillet et septembre 2013. Les resultats sont presentes sous forme de mediane (ecart interquartile). Resultats Soixante reponses sur 115 etudiants ayant fait un Master 2 (52 %) ont ete analysees. L’âge median etait de 29 ans (28–30) lors de la realisation du Master 2 et la proportion masculine de 75 %. La bourse de l’AFU etait obtenue par 57,4 % des postulants, 56,4 % pour les diverses bourses et 47,6 % pour la bourse annee recherche. Le montant median brut annuel etait de 29 870 € (22 710–30 195) sans difference significative entre les subdivisions. Les complements financiers provenaient essentiellement de gardes (26,2 %), d’astreintes (28,6 %) et de remplacements (25 %). L’annee de Master 2 etait le plus souvent realisee entre la quatrieme et la cinquieme annee d’internat (53 %), pour une duree d’un an (96,7 %) et en France (86,6 %). La cancerologie urologique (60 %) etait la thematique la plus etudiee. Le Master 2 etait realise dans un projet de carriere hospitalo-universitaire (31,7 %) ou dans l’attente d’un post-internat (20,8 %). Environ un quart se voyait proposer un poste de CCA avant le Master 2. Cette annee etait source de publication pour 76,7 %. La these de Sciences interessait 63,3 % des repondants. Conclusion Cette etude confirmait l’interet des jeunes urologues francais pour une annee de Master 2. Le financement grâce aux bourses facilitait le deroulement de cette annee dans l’optique d’une carriere universitaire pour nombre d’entre eux. Niveau de preuve Niveau 3.

Resume Objectifs Les objectifs de cette etude etaient d’evaluer la place de la simulation dans la formation initiale des jeunes urologues francais. Materiels et methodes Un questionnaire electronique a ete diffuse a l’ensemble des internes et chefs de clinique, membres de l’AFUF entre fevrier et mai 2013. Les resultats sont presentes sous forme de mediane (ecart interquartile). Resultats Les reponses de 125 urologues en formation ont ete analysees (taux de reponse 38 %). Il s’agissait d’internes dans 90 cas (72 %), et de chefs de clinique ou assistants dans 35 cas (28 %). L’âge median etait de 29 ans (27–30), la proportion masculine de 77 %. Tous les CHU etaient representes. Quatre-vingt-dix (72 %) d’entre eux avaient acces a un pelvi-trainer et 66 (53 %) a des modeles animaux ou cadaveriques, mais ne l’utilisaient jamais ou moins d’une fois par mois dans 83 et 97 % des cas, respectivement. Soixante-douze (58 %) avaient utilise au moins une fois un simulateur utilisant la realite virtuelle et 38 (30 %) y avaient acces regulierement, mais sans encadrement dans 64 % des cas. Les facteurs limitant l’entrainement sur simulateur etaient l’absence de simulateur a disposition (70 %), le manque de temps (58 %), d’incitation (34 %) et d’encadrement (20 %). Si ces conditions etaient reunies, 86 % des jeunes urologues seraient prets a consacrer plus d’une heure par semaine a l’entrainement sur simulateur. Conclusion Cette etude a revele parmi l’echantillon interroge une sous-utilisation de la simulation dans la formation pratique. Cela etait explique par un manque d’accessibilite, mais surtout d’utilisation des moyens a disposition. Niveau preuve 3

To assess if the presence of a lower pole stone (LPS) decreases the stone-free (SF) rate following retrograde intrarenal surgery (RIRS). The second purpose was to assess the result of RIRS for LPS and to identify predictors of SF status.We retrospectively analyzed 205 procedures in 162 patients with renal stones treated by RIRS between January 2010 and January 2013 at a single institute. The SF status was defined as no residual fragments. Independent-sample t-tests and Chi-square tests were used for comparisons of means and proportions, respectively, between patients with or without LPS. Logistic regression models were used to assess prognostic factors influencing SF status in cases of LPS.LPS were present in 89 (54.9%) patients. There were no differences between patients with or without LPS regarding the mean operative time (p=0.77), the surgeon's experience (p=0.522), the length of hospital stay (p=0.269), and the SF rate (p=0.224). SF status after RIRS in patients with or without LPS was 74.1% and 78% (p=0.224), respectively. In the case of LPS, the presence of multiple stones and a history of percutaneous nephrolithotomy (PCNL) were predictive factors for occurrence of residual fragments in univariate analysis (p=0.037 and p=0.015). In multivariable analysis, only the presence of multiple stones remained as a predictive factor (p=0.027; HR=3.2), whereas a trend was observed when there was a history of PCNL (p=0.07; HR=3).The presence of a LPS does not alter the SF rate of RIRS even in cases of early experience. RIRS for LPS appears to be an effective technique, but special attention should be given to patients with multiple stones and/or a history of PCNL.