S.J. Drouin

Oncological control after radical prostatectomy in men with clinical T3 prostate cancer: a single-centre experience.

To determine the effectiveness of cancer control afforded by radical prostatectomy (RP) in patients with clinical stage T3 prostate cancer.

Quantitative RT‐PCR analysis of PSA and prostate‐specific membrane antigen mRNA to detect circulating tumor cells improves recurrence‐free survival nomogram prediction after radical prostatectomy

Circulating tumor cell (CTC) analysis is a potential new biomarker in prostate cancer. We hypothesize that quantitative detection of CTCs in patients pre‐ and post‐radical prostatectomy (RP) using quantitative TaqMan® fluorogenic RT‐PCR will improve the accuracy of the Kattan nomogram to predict the probability of recurrence‐free survival (RFS) post‐RP.

Formation et avenir des internes et chefs de clinique d’urologie en France : résultats d’une enquête nationale auprès de 154 urologues en formation

PURPOSE To raise an appraisal of French urologist resident and chief residents demographic characteristics, activity, post-residency project, career desires and factors associated with obtaining a fellowship. METHODS An electronic questionnaire was sent by email between June 2009 and January 2010 to the 288 French urologists currently in training. Items analysed included demographics, achievement of academic works and post-residency projects. RESULTS Overall, we obtained 156 answers (response rate of 54%). Our population was composed by 47 (27%) fellows and 114 (73%) residents. They work 68.1 hours per week and 31 (20%) leave the hospital after an on-call night. Thirty-two (20.5%) have validated a master 2. Among the resident, 54 (47.3%) are certain to have the opportunity to be a chief resident. Regarding residents, factors significantly associated with the fact to obtain a fellowship in multivariate analysis were: to gain a master 2, working more than 65 hours per week and achieving academics works. Installation in a general hospital, a university hospital and a private clinic was considered by respectively 21.7%, 41.6% and 67.3% of young urologists. CONCLUSION French urologist resident and chief residents work an average 68 hours per week. The determining factors in obtaining a fellowship are the realization of a master 2, a workweek exceeding 68 hours and the achievement of academic work. After completing their academic training, a majority of young urologists are attracted by private practice.

Résultats carcinologiques et fonctionnels de la prostatectomie totale laparoscopique robot-assistée

The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. From 1992, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface, are some reasons that explain the worldwide widespread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared to other approaches. Intermediate oncological and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP do not allow to draw any definitive statement in comparison with conventional techniques.

Current role of image‐guided robotic radiosurgery (Cyberknife®) for prostate cancer treatment

To describe the most recent data from phase I and II clinical trials of stereotactic body radiation therapy (SBRT) using image‐guided robotic radiosurgery, specifically the Cyberknife® (Accuracy Incorporated, Sunnyvale, CA, USA). To better determine thecurrent role of this type of radiosurgery in prostate cancer (PCa) management.

Article de revueRésultats carcinologiques et fonctionnels de la prostatectomie totale laparoscopique robot-assistéeOncologic and functional outcomes after robot-assisted laparoscopic radical prostatectomy

The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. From 1992, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface, are some reasons that explain the worldwide widespread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared to other approaches. Intermediate oncological and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP do not allow to draw any definitive statement in comparison with conventional techniques.

Cross‐cultural validation of a prognostic tool: example of the Kattan preoperative nomogram as a predictor of prostate cancer recurrence after radical prostatectomy

To establish the predictive accuracy of the Kattan preoperative nomogram by comparing predictions at 5 years with actual progression in patients who had a radical prostatectomy (RP).

Low circulating free and bioavailable testosterone levels as predictors of high-grade tumors in patients undergoing radical prostatectomy for localized prostate cancer

OBJECTIVE Controversy exists regarding the propensity of hypogonadism and metabolic disorders to promote the development of high-risk prostate cancer (PCa). Our aim was to prospectively test whether preoperative circulating testosterone levels, obesity, and metabolic syndrome (MetS) were correlated with aggressive pathological features after radical prostatectomy (RP). MATERIAL AND METHODS Overall, 354 patients undergoing robot-assisted RP at our academic institution, between 2010 and 2013, to treat clinically localized PCa were included in this prospective study. Pelvic lymphadenectomy was performed in 116 (32.8%) patients and confirmed the absence of nodal metastases in all of them. Cardiovascular risk factors and body-mass index (BMI) were used to define MetS and obesity, respectively. Total testosterone (TT) levels were assessed using an immunoassay method, whereas bioavailable testosterone (BT) and free testosterone (FT) levels were estimated using Vermeulen׳s formula. Multivariate logistic regression analyses assessed independent predictors for postoperative aggressive pathological features (i.e., a pathological Gleason score [GS] ≥ 7, extracapsular extension [ECE], seminal vesicle invasion [SVI], and positive surgical margins [PSM]) and GS upgrading. RESULTS Low TT, BT, and FT levels were found in 54 (15.2%), 70 (19.8%), and 62 (17.5%) patients, respectively. Median BMI was 26.3 kg/m(2) (range: 17.4-43.9), and prevalence of MetS was 18.9%. Significantly higher rates of pathological GS ≥ 7 were observed in groups with a low TT level (46.3% vs. 33.3%; P = 0.01), low BT level (44.3% vs. 33.1%; P<0.001), and low FT level (46.8% vs. 32.9%; P = 0.001). Multivariate analyses demonstrated that only low BT and FT levels were independent predictors of pathological GS ≥ 7 (odds ratio [OR] = 1.76; P<0.001 and OR = 1.39; P<0.001, respectively) and GS upgrading (OR = 2.82; P<0.001 and OR = 1.71; P<0.001, respectively), but there was no significant correlation between low circulating testosterone levels and ECE, SVI, or PSM. Furthermore, BMI (OR = 1.28; P = 0.04) and MetS (OR = 1.19; P = 0.01) were only correlated with PSM. CONCLUSION Hypogonadism, obesity, and MetS were not independent predictors of pathological GS ≥ 7, ECE, or SVI after RP. Our data suggest that only low BT and FT levels, which might logically result in an active androgen-depleted environment, were linked with high-grade PCa.

Cancers de la vessie chez les patients neurologiques : analyse d’une série monocentrique

Resume Objectif Rapporter la prevalence, les etiologies et l’evolution des cancers de la vessie dans notre population de patients neurologiques. Materiels et methodes Les dossiers des 1825 patients neurologiques suivis dans notre service entre 2000 et 2006 ont ete revus retrospectivement. En cas de tumeur vesicale, les donnees suivantes ont ete relevees : âge, sexe, tabagisme, etiologie de la maladie neurologique, mode de vidange vesical, duree d’evolution de la vessie neurologique, mode de decouverte, type histologique, grade, stade TNM, traitement entrepris et evolution. Resultats Huit patients (0,44%) neurologiques ont eu un cancer de la vessie. L’âge moyen a ete de 58,8 ± 13,7 ans (36-72). Le rapport homme/femme a ete de 3. Les vessies neurologiques concernaient : des blessures medullaires (n=4), une sclerose en plaque (n=l), un spina bifida (n=l), une paraplegie spastique familiale (n=l) et un syndrome peripherique idiopathique (n=l). Trois cas de cancers epidermoides (37,5%) ont ete diagnostiques. Sept tumeurs etaient de haut grade et 7 etaient invasives ( pT2). Le recul moyen a ete de 27,8 ± 23,5 mois (14-71). Trois patients etaient decedes. Conclusion Les cancers de la vessie chez les patients neurologiques avaient une incidence proche de celle de la population generale. En revanche, il y avait davantage de carcinomes epidermoides invasifs d’emblee, necessitant des traitements agressifs. Pour autant, seul le GENULF a publie a ce jour un protocole de surveillance adapte a cette population base sur une cystoscopie/cytologie annuelle au-dela de 15 ans d’evolution.

Hipertrofia benigna de próstata

La hipertrofia benigna de prostata afecta a casi el 50% de los varones de mas de 50 anos y representa la primera causa de disuria masculina. Su etiologia es multiple y todavia se conoce mal. Es responsable de una obstruccion a la vez estatica y dinamica del tracto urinario inferior. Los sintomas obstructivos y/o irritativos pueden ser invalidantes y, en general, son el principal motivo de consulta, aun cuando la hipertrofia benigna de prostata todavia se diagnostica a veces en la fase de complicaciones (retencion urinaria, calculos, insuficiencia renal, etc.). El volumen de la prostata no siempre es predictivo de la magnitud de las manifestaciones clinicas. Por eso, no debe instaurarse ningun tratamiento en ausencia de sintomas del tracto urinario inferior o de complicaciones. La evaluacion de la enfermedad comprende la anamnesis, la exploracion fisica y, mejor, una flujometria. Las pruebas complementarias se recomiendan sobre todo en las formas complicadas. El arsenal terapeutico actual para la hipertrofia benigna de prostata es amplio y debe elegirse en cada caso, si bien existen recomendaciones generales. En los pacientes menos sintomaticos puede implementarse la vigilancia, pero en los que presentan complicaciones hay que recurrir de entrada a la cirugia. Sin embargo, en la gran mayoria de los pacientes se instaura un tratamiento medico con alfabloqueantes o inhibidores de la 5-alfa reductasa. Esto se debe a una hipertrofia benigna de prostata que, si bien no esta complicada, se expresa por sintomas del tracto urinario inferior que causan molestias.