Paul Van Cangh

Identification of Patients With Prostate Cancer Who Benefit From Immediate Postoperative Radiotherapy: EORTC 22911

PURPOSEnThe randomized controlled European Organisation for Research and Treatment of Cancer (EORTC) trial 22911 studied the effect of radiotherapy after prostatectomy in patients with adverse risk factors. Review pathology data of specimens from participants in this trial were analyzed to identify which factors predict increased benefit from adjuvant radiotherapy.nnnPATIENTS AND METHODSnAfter prostatectomy, 1,005 patients with stage pT3 and/or positive surgical margins were randomly assigned to a wait-and-see (n = 503) and an adjuvant radiotherapy (60 Gy conventional irradiation) arm (n = 502). Pathologic review data were available for 552 patients from 11 participating centers. The interaction between the review pathology characteristics and treatment benefit was assessed by log-rank test for heterogeneity (P < .05).nnnRESULTSnMargin status assessed by review pathology was the strongest predictor of prolonged biochemical disease-free survival with immediate postoperative radiotherapy (heterogeneity, P < .01): by year 5, immediate postoperative irradiation could prevent 291 events/1,000 patients with positive margins versus 88 events/1,000 patients with negative margins. The hazard ratio for immediate irradiation was 0.38 (95% CI, 0.26 to 0.54) and 0.88 (95% CI, 0.53 to 1.46) in the groups with positive and negative margins, respectively. We could not identify a significant impact of the positive margin localization.nnnCONCLUSIONnProvided careful pathology of the prostatectomy is performed, our results suggest that immediate postoperative radiotherapy might not be recommended for prostate cancer patients with negative surgical margins. These findings require validation on an independent data set.

Free to total prostate-specific antigen (PSA) ratio improves the discrimination between prostate cancer and benign prostatic hyperplasia (BPH) in the diagnostic gray zone of 1.8 to 10 ng/mL total PSA.

OBJECTIVESnImproved discrimination between prostate cancer (PC) and benign prostatic hyperplasia (BPH) is clearly needed. Our aim in this study was to evaluate whether the free to total prostate-specific antigen (PSA) ratio would be useful in the gray zone of 1.8-10 ng/mL total PSA range.nnnMETHODSnIn a consecutive series of 435 clinic patients referred for prostate evaluation, 308 had a total PSA < 10 ng/mL (92 had PC and 216 BPH). Free and total PSA were measured, and the free to total PSA ratio calculated.nnnRESULTSnTotal PSA values were significantly different between the two groups. For the 200 patients with a total PSA < 6 ng/mL, no significant difference in total PSA values were seen (P = 0.411), whereas free to total PSA ratios remained statistically different (P < 0.001). Receiver operating characteristic (ROC) curve analysis comparing the performances of total PSA over the ratio of free to total PSA showed a clear advantage for the ratio at all sensitivity levels.nnnCONCLUSIONSnThese data demonstrate that in a significant number (n = 308) of prostatic patients in the diagnostic gray zone of 1.8-10 ng/mL total PSA, the routine use of free to total PSA might be advantageous in discriminating between cancer and benign hyperplasia. This advantage remained for total PSA < 4 ng/mL. Further study is warranted to confirm these findings in an unselected population.

Polyorchidism: report of three cases and further embryological considerations.

We report 3 new cases of polyorchidism. Review of the literature allows two groups of anatomical variations to be identified: (1) where the Wolffian duct is duplicated longitudinally or absent, and (2) where the two testes are drained by the same epididymis and vas deferens. We postulate that the first group results from a primary anteroposterior division of the genital ridge, whereas the second group is the result of a transverse duplication.

Do seminal or prostatic secretions play a role in local recurrence after radical prostatectomy for localized prostate cancer

Neoplastic cellular contamination of the surgical bed may be responsible for late local failure after radical prostatectomy. Cytology analysis of the seminal and prostatic fluid collected intraoperatively was undertaken in 30 patients. Neoplastic cells were found in 2 patients both with seminal vesicle involvement. Although it is difficult to admit that tumor spillage during surgery would be a major cause of local recurrence, the presence of tumor cells in the ejaculate may be diagnostic of seminal vesicle invasion. All patients with pathologic stage T2 had a negative cytologic finding.

Neutron Therapy of Bladder-carcinoma - Can a High-rate of Severe Complications Be Avoided in Neutron Therapy

We reviewed retrospectively a series of 58 patients with deeply invasive bladder cancer treated with fast neutron therapy (p(65) + Be) in order to evaluate its tolerance and side effects. Patients were divided into three groups according to treatment technique. Patients of group A received whole pelvis irradiation up to 50 Gy photon equivalent followed by a boost to the bladder up to 57-66 Gy photon equivalent (40-56 days). Group B patients were treated by a split course regimen of 30 Gy photon equivalent on the whole pelvis at 3-4 weeks interval (66-108 days). Group C patients, not suitable for radical treatment, received only 40-54 Gy photon equivalent (26-70 days). The overall 5-year actuarial survival rate was 30% (SE 8%). As expected, T stage was a statistically significant prognostic factor. The overall local control rate reached 21% at 4 years. Acute and late side effects were minimal to moderate. These results suggest that high-energy neutron beam treatment is at least as effective as photon beam treatment for bladder carcinoma, without a higher incidence of major side effects.

Laparoscopic pyeloplasty or antegrade endopyelotomy for the treatment of ureteropelvic junction obstruction

Laparoscopic pyeloplasty or antegrade endopyelotomy for the treatment of ureteropelvic junction obstruction?

Radioimmunodetection of Primary and Metastatic Germ-cell Tumors Containing Alpha-fetoprotein

Radioimmunodetection with an 131I anti-alpha-fetoprotein (alpha FP) has been performed in 5 patients with germ cell tumors. In 3 of them, 5 of 6 recognized or suspected tumor sites could be demonstrated. In 1 of these patients, a clinically non-apparent primary tumor was detected by this method. The 2 other patients had received intensive chemotherapy and had a persistent elevation of serum alpha FP, although usual paraclinical examinations were normal. In these patients, the labelled antibody scan did not show any abnormality. These results suggest that radioimmunodetection can be useful in patients with nonseminomatous gonadal and extragonadal tumors at the time of presentation. Usefulness of radioimmunodetection in the follow-up of these patients remains to be determined. Even in our limited series, radioimmunodetection was of no help on localizing the sites of alpha FP secretion in treated patients in whom other methods had also failed to recognize the site of abnormal alpha FP synthesis.