Nicolas Henry

Inappropriate treatment of prostate cancer caused by heterophilic antibody interference

Background A 58-year-old man, without any personal or familial risk factors for prostate cancer, visited his primary care physician for a first routine prostate cancer screening with a serum PSA test.Investigations Serum PSA test, digital rectal examination, prostate biopsy and pathological analysis, repeat serum PSA tests and pathological re-evaluation, abdominal tomodensitometry, whole-body bone scan and prostatic MRI.Diagnosis Highly elevated serum PSA indicative of advanced prostate cancer at high risk for metastasis.Management The patient was started on androgen deprivation therapy with goserelin acetate and bicalutamide. At 3 months, he was asymptomatic, his prostate was atrophic on digital rectal examination and he had suppressed serum testosterone. However, his serum PSA level remained highly elevated in the absence of any radiographic evidence of advanced cancer. A repeat PSA test using a different assay returned a negligible PSA concentration; evaluation with blocker agents revealed the presence of heterophilic antibody interference with the original PSA assay. The patient was rediagnosed as having a likely low-grade prostate adenocarcinoma; androgen deprivation therapy was stopped, and he was deemed a candidate for watchful waiting. At 15 months, his serum PSA level remained stable at a low level, and prostatic dynamic MRI showed no sign of tumor in the prostate or in the pelvis.

Perforations vésicales au cours d’une résection trans-uréthrale de tumeur de vessie

Resume La resection trans-urethrale de tumeur de vessie est une intervention frequente (10 711 nouveaux cas de tumeur de vessie diagnostiques en France, en 2000), non denuee de morbidite. La perforation de la paroi vesicale, qu’elle soit intra- ou extra-peritoneale, est une des complications possibles. Le diagnostic est generalement porte en per-operatoire et une cystographie sur table peut etre realisee pour objectiver le diametre de la perforation. Les perforations extra-peritoneales relevent dans la majorite des cas d’un traitement conservateur par drainage simple de la vessie. Les perforations intra-peritoneales peuvent necessiter une reparation chirurgicale. Actuellement, la Iaparoscopie tend a supplanter la chirurgie ouverte dans ces reparations. Par ailleurs, un des risques de la perforation est la dissemination et la greffe de cellules neoplasiques hors de la vessie. Il semble que les metastases liees a la perforation soient rares et apparaissent precocement imposant une surveillance rapprochee.