OBJECTIVES:To present the long-term outcomes of men with Grade Group (GG) 1 prostate cancer (PCa), included in the Prostate Cancer Research International Active Surveillance (PRIAS) study, and to assess the effect of the inclusion of magnetic resonance imaging (MRI) within the active surveillance (AS) protocol. PATIENTS AND METHODS:The PRIAS study is a multicentre, prospective, web-based cohort study monitoring patients on AS. In total, 8910 men with GG1 PCa were followed in 169 centres worldwide. The cumulative incidences of definitive treatment, metastasis and PCa-specific mortality (PCSM) were estimated using competing risk analyses. Additionally, multivariable analysis was performed to assess the risk of reclassification, stratified by MRI performed around the time of diagnosis. RESULTS:The cumulative incidence of definitive treatment 15 years post-diagnosis was 55% (95% confidence interval [CI] 53-57). For metastasis, the 15-year cumulative incidence was 2.7% (95% CI 1.5-4.4). Eight men of died from PCa, resulting in a 15-year cumulative PCSM incidence of 0.23% (95% CI 0.09-0.54). Compared to men with no MRI around the time of diagnosis, those who underwent MRI during the first 18 months of AS were associated with a significantly higher risk of reclassification to ≥GG2, while men with a positive MRI before diagnosis were associated with a higher risk of reclassification to GG2, but not to ≥GG3. Men with GG2 PCa on MRI-targeted rebiopsy who underwent definitive treatment did not show a statistically significant higher risk of 5-year disease recurrence compared to those who had GG1 PCa on last biopsy during AS. CONCLUSIONS:Our study confirms the safety of AS for GG1 PCa, with low metastasis and PCSM rates over 15 years. Furthermore, the inclusion of MRI in AS prompts increased detection of GG2, leading to increased treatment rates despite similar short-term risks. To minimise overtreatment, expanding eligibility for AS and the uptake of AS in men with favourable GG2 PCa is crucial to address the stage shift resulting from the increased accuracy of MRI.

INTRODUCTIONHigh-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the detection of clinically significant prostate cancer.METHODSWe included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI targets (PI-RADS >3 and micro-ultrasound targets (PRIMUS >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2.RESULTSOverall, 39.5% were positive for clinically significant prostate cancer. Micro-ultrasound and mpMRI sensitivity was 94% vs. 90%, respectively (p=0.03), and NPV was 85% vs. 77%, respectively. Specificities of micro-ultrasound and MRI were both 22%, with similar PPV (44% vs. 43%). This represents the initial experience with the technology at most of the participating sites and, therefore, incorporates a learning curve. Number of cores, diagnostic strategy, blinding to MRI results, and experience varied between sites.CONCLUSIONSIn this initial multicenter registry, micro-ultrasound had comparable or higher sensitivity for clinically significant prostate cancer compared to mpMRI, with similar specificity. Micro-ultrasound is a low-cost, single-session option for prostate screening and targeted biopsy. Further larger-scale studies are required for validation of these findings.

296 Background: This study aims to compare the sensitivity, specificity, NPV and PPV of mpMRI with the novel high-resolution micro-ultrasound imaging modality. This approach offers the benefits of simplicity, a single intervention for imaging and biopsy, leveraging the low cost of ultrasound. Micro-ultrasound may be used to image suspicious lesions and target biopsies in real-time with or without additional MRI-based targets. Methods: Data from 9 sites was aggregated, totaling 866 subjects presenting for ExactVu micro-ultrasound guided biopsy with available mpMRI studies. Samples in all subjects were taken from mpMRI targets and micro-ultrasound targets, with up to 12 systematic samples filled in. Various strategies were used for mpMRI target sampling including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was considered any Gleason Sum > 6 and targeted samples were taken for PI-RADS > 2 or PRI-MUS1 > 2 lesions. Results: Overall, 39% of all biopsy cases were positive for clinically significant PCa. mpMRI demonstrated 89% sensitivity and NPV of 77%. Compared to mpMRI, micro-ultrasound sensitivity (95%) and NPV (87%) were higher. Micro-ultrasound was less specific (21% vs 23% for mpMRI) with similar PPV (44% vs 43%). The aggregate effect demonstrates higher sensitivity for csPCa with micro-ultrasound compared to mpMRI (p<0.01). Conclusions: Micro-ultrasound is an attractive option for screening and targeted biopsy. Sensitivity and NPV appear superior to MRI, but specificity is mildly reduced. Further larger-scale studies are required for validation of these findings. References: Ghai, S. et al., “Assessing Cancer Risk in Novel 29 MHz Micro-Ultrasound Images of the Prostate”, Journal of Urology, 2016 Aug;196(2):562-9. Clinical trial information: NCT03938376.

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (MP23)1 Apr 2020MP23-05 THE UTILITY OF MICRO-ULTRASOUND IN PATIENTS UNDER ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER: A PRIAS STUDY EXTENSION Davide Maffei*, Frédéric Staerman, Marco Paciotti, Piergiuseppe Colombo, Maria Grazia Elefante, Luigi Domanico, Ferrero Regis, Guilio Bevilacqua, Vittorio Fasulo, Massimo Lazzeri, Rodolfo Hurle, Alberto R. Saita, Paolo Casale, Nicolò Buffi, Giorgio F. Guazzoni, and Giovanni Lughezzani Davide Maffei*Davide Maffei* More articles by this author , Frédéric StaermanFrédéric Staerman More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Piergiuseppe ColomboPiergiuseppe Colombo More articles by this author , Maria Grazia ElefanteMaria Grazia Elefante More articles by this author , Luigi DomanicoLuigi Domanico More articles by this author , Ferrero RegisFerrero Regis More articles by this author , Guilio BevilacquaGuilio Bevilacqua More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Alberto R. SaitaAlberto R. Saita More articles by this author , Paolo CasalePaolo Casale More articles by this author , Nicolò BuffiNicolò Buffi More articles by this author , Giorgio F. GuazzoniGiorgio F. Guazzoni More articles by this author , and Giovanni LughezzaniGiovanni Lughezzani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000856.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) represents an important alternative to active treatment strategies in patients diagnosed with low-risk prostate cancer (PCa). We investigated the diagnostic performance of micro-ultrasound (microUS), a new high-resolution imaging modality for transrectal ultrasonography (TRUS) and real-time target biopsies, within a contemporary cohort of AS patients. METHODS: Between October 2017 and April 2019, two PRIAS participating sites prospectively enrolled a combined 118 patients for reclassification biopsy as part of the PRIAS protocol for AS of low-risk PCa. MicroUS TRUS was performed and PRI-MUS protocol applied to identify suspicious lesions (i.e. PRIMUS score ≥3). All patients were subjected to targeted biopsy of any microUS or mpMRI lesions (PI-RADSv2≥3, 68/118) and up to 12 systematic biopsies. The proportion of patients excluded from AS either due to upgrading (detection of PCa GS ≥7) or upsizing (>2 GS=6 PCa positive cores) at confirmatory biopsies was determined, and the diagnostic performance of microUS evaluated. RESULTS: Median patient age was 67 (IQR 61-72) years, median total PSA was 6.5 (IQR 4.765 – 9.18) ng/mL and median prostate volume was 45 (IQR 36 – 62) mL. MicroUS detected prostate lesions with a PRI-MUS score of 3, 4 and 5 in respectively 17, 50, and 28 patients, while in 23 subjects no lesions were identified. PCa detection rate was (78/118) 66.1%; 31 patients were upgraded to a Gleason Score ≥7 cancer, while 7 showed more than two GS 6 positive cores, resulting in 38 individuals excluded from AS consistent with PRIAS criteria. The sensitivity of microUS in detecting individuals excluded from AS was 96.8 %. 26 csPCA (GS ≥7) would have not have been upgraded without microUS, including 2 microUS GS 7 cases not found on mpMRI. The overall sensitivity and specificity of microUS in detecting PCa was 88.5% and 30% respectively. CONCLUSIONS: Micro-ultrasound may represent a promising new imaging modality in the detection of clinical significant PCa in patient under AS. Adoption of microUS-TRUS during reclassification biopsies may allow for better selection of patient who would benefit from remaining in AS as opposed to undergoing active treatment. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e339-e339 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Davide Maffei* More articles by this author Frédéric Staerman More articles by this author Marco Paciotti More articles by this author Piergiuseppe Colombo More articles by this author Maria Grazia Elefante More articles by this author Luigi Domanico More articles by this author Ferrero Regis More articles by this author Guilio Bevilacqua More articles by this author Vittorio Fasulo More articles by this author Massimo Lazzeri More articles by this author Rodolfo Hurle More articles by this author Alberto R. Saita More articles by this author Paolo Casale More articles by this author Nicolò Buffi More articles by this author Giorgio F. Guazzoni More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: High-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the detection of clinically significant prostate cancer. Methods: We included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI CUAJ – Original Research Klotz et al Comparing micro-ultrasound and mpMRI for prostate cancer 2 © 2020 Canadian Urological Association targets (PI-RADS >3 and micro-ultrasound targets (PRIMUS >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2. Results: Overall, 39.5% were positive for clinically significant prostate cancer. Microultrasound and mpMRI sensitivity was 94% vs. 90%, respectively (p=0.03), and NPV was 85% vs. 77%, respectively. Specificities of micro-ultrasound and MRI were both 22%, with similar PPV (44% vs. 43%). This represents the initial experience with the technology at most of the participating sites and, therefore, incorporates a learning curve. Number of cores, diagnostic strategy, blinding to MRI results, and experience varied between sites. Conclusions: In this initial multicenter registry, micro-ultrasound had comparable or higher sensitivity for clinically significant prostate cancer compared to mpMRI, with similar specificity. Micro-ultrasound is a low-cost, single-session option for prostate screening and targeted biopsy. Further larger-scale studies are required for validation of these findings. Introduction About 15% of men will be diagnosed with prostate cancer at some point during their lifetime. While mortality has improved substantially, attributed to early detection and improved treatment, it remains the second leading cause of cancer death in men. Accurate biopsy derived histopathology is a key determinant in treatment selection along with patient-physician shared decision making. Most men with localized, low risk disease are managed via active surveillance, while those with localized, higher risk disease are treated with surgery, radiation, or focal therapy regimens. Accurate biopsy techniques are crucial for determining the optimal treatment path for each patient. Historically, prostate cancer diagnosis has been predicated upon TRUS guided systematic biopsies initiated due to PSA abnormal values and/or an abnormal prostate exam. The limitations of this approach are a high rate of clinically insignificant cancers, especially when performed solely for PSA abnormalities, as well as the potential for missing clinically significant cancer in 25-30% of biopsied patients. Recent randomized studies have demonstrated the superiority of mpMRI guided targeted biopsies in correctly identifying clinically significant cancer and reducing the rate of diagnosis of insignificant cancer. The European Association of Urology (EAU) currently recommends mpMRI imaging prior to all prostate biopsies, with the caveat that systematic biopsy is acceptable if mpMRI is unavailable. The National Comprehensive Cancer Network (NCCN) recommends MRI-assisted biopsy for patients with a prior negative systematic biopsy and CUAJ – Original Research Klotz et al Comparing micro-ultrasound and mpMRI for prostate cancer 3 © 2020 Canadian Urological Association clinical suspicion of cancer. This poses many challenges in terms of access, cost, and expertise. High resolution 29 MHz micro-ultrasound, a novel imaging modality, aims to improve the diagnostic accuracy of prostate biopsy while maintaining the affordability and convenience of ultrasound. Micro-ultrasound operates at 29 MHz, compared to traditional ultrasound systems that operate at frequencies of 6-9MHz. The axial resolution is improved from 200 μm with conventional ultrasound to <70 μm with micro-ultrasound with a similar improvement in lateral resolution due to 90 μm crystal spacing. This resolution is approximately the diameter of a prostatic duct and allows for the visualization of subtle changes in ductal anatomy associated with cancer. Diffusion-weighted imaging (DWI) is based upon measuring the random Brownian motion of water molecules within a voxel of tissue. Highly cellular tissues exhibit lower diffusion coefficients. Both technologies thus identify changes associated with high grade cancer. Real-time targeted biopsy can be performed, avoiding the need for a 2 procedure. A grading system, PRI-MUS, analogous to the PI-RADS system, has been developed to stratify micro ultrasound images according to the risk of significant cancer. This study sought to compare the sensitivity, specificity, NPV and PPV of mpMRI with highresolution micro-ultrasound in patients referred for biopsy who had a prior MRI.

You have accessJournal of UrologyProstate Cancer: Detection & Screening VIII (MP81)1 Apr 2020MP81-10 RISK STRATIFICATION FOR EQUIVOCAL PI-RADS 3 RESULTS: CAN MICRO-ULTRASOUND HELP DETERMINE WHICH MEN TO BIOPSY? Georg Salomon*, Giovanni Lughezzani, Hannes Cash, Laura Wiemer, Robin Heckmann, Sebastian Hofbauer, Ander Astobieta, Andrea Sánchez, Frédéric Staerman, Laurent Lopez, Richard Gaston, Thierry Piéchaud, Gregg Eure, Eric Klein, Robert Abouassaly, and Sangeet Ghai Georg Salomon*Georg Salomon* More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Hannes CashHannes Cash More articles by this author , Laura WiemerLaura Wiemer More articles by this author , Robin HeckmannRobin Heckmann More articles by this author , Sebastian HofbauerSebastian Hofbauer More articles by this author , Ander AstobietaAnder Astobieta More articles by this author , Andrea SánchezAndrea Sánchez More articles by this author , Frédéric StaermanFrédéric Staerman More articles by this author , Laurent LopezLaurent Lopez More articles by this author , Richard GastonRichard Gaston More articles by this author , Thierry PiéchaudThierry Piéchaud More articles by this author , Gregg EureGregg Eure More articles by this author , Eric KleinEric Klein More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , and Sangeet GhaiSangeet Ghai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000973.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reducing unnecessary prostate biopsy procedures is an important clinical goal to reduce pain and anxiety for the patient, as well as the risk of infection and overtreatment. Multiparametric (mpMRI) has been proposed as an effective strategy to reduce the need for a prostate biopsy both in the initial and in the repeat biopsy setting. However, indeterminate or equivocal findings at mpMRI can pose a diagnostic challenge. We aimed to determine whether micro-ultrasound could help to further stratify the need for a prostate biopsy in patients with PIRADS 3 lesion at mpMRI. METHODS: This study was based on a retrospective series of patients presenting with at least one PI-RADS 3 lesion at mpMRI at one of 7 international sites. All patients were imaged with micro-ultrasound using the ExactVu™ (Exact Imaging, Markham, Canada) system, and the presence of suspicious lesions was determined and graded according to the PRI-MUS™ (Prostate risk identification using micro-ultrasound)1 protocol. Maximum PRI-MUS score for each subject was used to determine whether the case was non-suspicious on micro-ultrasound (PRI-MUS 1 or 2), equivocal (PRI-MUS 3), or suspicious (PRI-MUS 4 or 5). All patients with a suspicious (PRI-MUS >2) lesion were subjected to a micro-ultrasound guided targeted biopsy. In addition, mpMRI targeted biopsies on PI-RADS 3 lesions were also obtained either with a cognitive or with a fusion biopsy technique according to each center protocol. RESULTS: 144 subjects were included. Overall prostate cancer detection rate for PI-RADS 3 subjects was 48% (69/144), while 20% (29/144) of patients were diagnosed with a clinically significant prostate cancer defined as a ISUP Grade Group (GG) > 1 tumor. PRI-MUS was able to provide significant risk stratification in this population, with non-suspicious micro-ultrasound imaging reducing the risk of finding GG>1 cancer by more than half to 5% (1/19). Equivocal micro-ultrasound provided little additional information with a GG>1 detection rate of 14% (5/35), while suspicious micro-ultrasound imaging resulted in a significant 17% relative increase in GG>1 detection rate to 26% (29/90, p=0.02). CONCLUSIONS: Micro-ultrasound imaging and PRI-MUS protocol findings appear to provide useful additional information in the case of equivocal mpMRI results. When combined with other clinical risk indicators such as PSA, PSA density and family history, it may be possible to better advise patients on the necessity of a biopsy using this data. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1240-e1240 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georg Salomon* More articles by this author Giovanni Lughezzani More articles by this author Hannes Cash More articles by this author Laura Wiemer More articles by this author Robin Heckmann More articles by this author Sebastian Hofbauer More articles by this author Ander Astobieta More articles by this author Andrea Sánchez More articles by this author Frédéric Staerman More articles by this author Laurent Lopez More articles by this author Richard Gaston More articles by this author Thierry Piéchaud More articles by this author Gregg Eure More articles by this author Eric Klein More articles by this author Robert Abouassaly More articles by this author Sangeet Ghai More articles by this author Expand All Advertisement PDF downloadLoading ...

La micro-échographie haute résolution est une nouvelle technique ultrasonore 29 MHz pour les biopsies de prostate ciblées en temps réel. La résolution micro-échographique de 70 microns permet de visualiser les caractéristiques tissulaires. Il a été démontré que la micro-échographie avait une sensibilité supérieure à l’échographie conventionnelle pour la détection du cancer de la prostate. Les images de 16 patients ayant subi une prostatectomie radicale après une biopsie de prostate guidée par micro-échographie (ExactVu, Exact Imaging Markham, Canada) ont été utilisées. Les images micro-échographiques de tous les sujets ont été évaluées pour prédire l’extension extra-prostatique à l’aide de l’image caractéristique en halo antérieur/apical et/ou de rétrécissement ou interruptions de la capsule postérieure. Les comptes rendus anatomopathologiques des prostatectomies radicales ont été utilisés comme références. Les comptes rendus anatomopathologiques des pièces de prostatectomies radicales rapportaient une extension extra-prostatique dans 15/32 lobes de prostate chez 11/16 patients. La sensibilité globale pour la détection de l’extension extra-prostatique était de 91 % (10/11 patients) avec des valeurs prédictives positive et négative de 91 % (10/11) et 80 % (4/5 patients) respectivement. En analysant chaque lobe prostatique de façon indépendante, la sensibilité était de 87 % (13/15 lobes) et les valeurs prédictives positive et négative de 87 % (13/15) et 88 % (15/17). La micro-échographie 29 MHz apparaît comme un bon outil prédictif de l’extension extra-prostatique en antérieur comme en postérieur. L’extension extra-prostatique est caractérisée en micro-échographie par un halo épais ou irrégulier le long de la capsule apicale et/ou antérieure, caractéristique n’ayant pas été décrite auparavant en échographie conventionnelle. L’analyse d’une base de données plus importante permettra de corroborer ces résultats.

La surveillance active (SA) est une recommandation de première intention chez les patients ayant un cancer de prostate à faible risque évolutif. Il est démontré qu’il n’y a pas de risque à court terme de résultats anatomopathologiques dégradés du fait du délai d’intervention par rapport au diagnostic. Cependant, ce risque n’est pas connu à moyen terme. Au total, 102 patients (pts) avec un recul théorique d’au moins 5 ans (inclusion jusqu’en 12/2012), issus d’une base observationnelle de 189 pts en sa inclus depuis 2007 pour un cancer de prostate à faible risque initial (critères prias) font l’objet de cette étude. L’âge médian était de 65,2 ans [48,3–79,7]. Au total, 89,2 % étaient classés t1c et 10,8 % t2a. Un total de 85,76 % ont un recul de suivi > 1 an. Durant celui-ci,27 pts ont eu une prostatectomie totale de 2e intention. Le motif était: choix personnel (6 pts), recommandation du protocole (12 pts), choix du chirurgien (9 pts). Les résultats anatomopathologies des pièces de prostatectomie sont classés en favorable (pt2 et score de Gleason 3 + 3) 12 pts (44 %) dont 11 r0, intermédiaire (pt2 et score de Gleason 3 + 4) 4 pts (15 %) dont 2 r0, défavorable (≥ pt3 ou score de Gleason ≥ 4 + 3) 11 pts (41 %) dont 3 r0. Concernant le groupe de résultats favorables pouvant potentiellement poursuivre la sa, il s’agissait d’un choix personnel (83 %), du chirurgien (67 %) ou du protocole (25 %). Pour le groupe défavorable, 6 étaient ≥ pt3 (aucun pt3b), 2 avaient un score de Gleason 4 + 3 et 3 un score de Gleason ≥ 4 + 4. Parmi les pts ayant eu une prostatectomie de 2e intention, 44 % avaient un résultat favorable permettant théoriquement la poursuite la sa. Il s’agissait souvent d’un choix personnel du patient ou du chirurgien. L’amélioration de l’information au patient et des outils de surveillance (notamment l’IRM) devrait permettre de réduire la part des traitements curatifs sans risque carcinologique supplémentaire.

Introduction. - Penile rehabilitation is defined as the use of any drug or device to maximise the recovery of spontaneous erectile function after radical prostatectomy. Experimental studies support the use of phophodiesterase 5 inhibitors (PDE5Is) in penile rehabilitation in order to maintain tissue oxygenation. Proposed to patients by 54 to 87% of urologists in the postoperative period, clinical effectiveness is discussed.Methods. - A critical review of the literature regarding penile rehabilitation with PDE5Is, protaglandin E1 intracavemous injections and vacuum erection device (VED) between 2000 et 2013 is proposed.Results. - Results from 3 prospective randomized studies using PDE5Is are contradictory despite animal data supporting penile rehabilitation. No long-term effect of daily or on-demand administration was found compared with placebo. Selection criteria to identify patients most suitable for penile rehabilitation have been individualized but still have to be confirmed. Use of prostaglandin intracorporeal injections and VED are questionable due to the lack of well-designed studies. PDE5Is prevent penile length changes after radical prostatectomy.Discussion. - Patients should be informed of the uncertainties of penile rehabilitation modalities before to be engaged in. When used, they should be combined with other treatments modalities that induce erections allowing sexual intercourse to motivate couples and reduce drop out rates. (C) 2014 Elsevier Masson SAS. All rights reserved.

La surveillance active (SA) est une option de prise en charge avec traitement différé à un stade potentiellement curable si nécessaire. L’objectif est d’évaluer les résultats anatomo-pathologiques après biopsie prostatique à 1 an, dans une cohorte issue d’un protocole prospectif de surveillance active (SA) (critères d’inclusion PRIAS) pour les adénocarcinomes de prostate à faible risque évolutif. Étude observationnelle prospective (2008–2014) de 116 patients en SA (inclus dans l’étude internationale PRIAS) pour un adénocarcinome de prostate T1c/T2 à faible risque. Les critères d’inclusion étaient : PSA initial ≤10 ng/mL, densité du PSA < 0,2, score de Gleason biopsique ≤3 + 3 = 6 et une ou deux carottes biopsiques positives et temps de doublement du PSA (PSADT) < 0,2. Le protocole de surveillance comportait un PSA/3 mois pendant 2 ans puis/6 mois, un TR/6 mois, une biopsie de contrôle à 1 an puis/3 ans. À l’inclusion 61,21 % des patients avaient 1 biopsie positive, et 38,79 %, 2 biopsies positives avec un PSA médian à 5,5 ng/mL et un âge médian de 64,7 ans. Au TR, 88,8 % étaient T1c et 11,2 % T2a. À 1 an, 83 patients ont été biopsiés (33 manquants : 6 inclusions < 1 an, 5 refus, 14 perdus de vue, 7 arrêts de SA, 1 décès d’autre cause). 32,53 % des biopsies étaient négatives (27 patients) et 22,89 % (19 patients) avaient plus de 2 carottes positives. Le score de Gleason était stable dans 54,22 %, montrait une progression dans 9,63 %. Les patients à BP négative à 1 an, au terme du suivi étaient : 21 en SA, 1 poursuivait la SA malgré la nécessité d’un traitement curateur, 2 PR, 1 curietherapie (choix personnel), 1 arrêt de SA pour AVC (Tableau 1, Tableau 2). Les biopsies à 1 an étaient négatives dans 1/3 des cas et montrent une progression dans 36,14 % soit par le nombre de carottes ou le score de Gleason ou les deux. Les patients choisissant la SA doivent être informés initialement de la nécessité d’un contrôle biopsique à court terme et des résultats à en attendre.

Évaluer les résultats à court terme d’un protocole prospectif de surveillance active (SA) (critères d’inclusion PRIAS) pour l’adénocarcinome de prostate à faible risque évolutif. Étude observationnelle prospective (2008–2014) de 116 patients en SA (inclus dans l’étude internationale PRIAS) pour un adénocarcinome de prostate T1c/T2 à faible risque. Les critères d’inclusion étaient : PSA initial ≤ 10 ng/ml, densité du PSA < 0,2, score de Gleason biopsique ≤3 + 3 = 6 et une ou deux carottes biopsiques positives. Le protocole de surveillance comportait un PSA/3 mois pendant 2 ans puis/6 mois, un TR/6 mois, une biopsie de contrôle à 1an puis/3 ans. L’objectif principal était la survie sans traitement et les objectifs secondaires les motifs d’abandon de la SA, l’évolution du PSA et le résultat biopsique à 1 an. Le PSA médian au diagnostic était de 5,5 ng/ml et l’âge médian était de 64,7 ans. Au TR, 88,8 % étaient T1c et 11,2 % T2a. Avec un recul médian de 23,8 mois, 73 patients (62,9 %) étaient toujours en SA pour un PSA médian de 6 ng/ml. Trente-trois pts (28,45 %) ont eu un traitement curatif en moyenne 25 mois après l’inclusion (23 PR, 4RTE, 5 curiethérapies, 1 traitement focal) motivé par la progression pour 23 patients, par des choix personnels pour 10 patients. 8,62 % des patients ont arrêté la SA par stress et ont eu un traitement curatif et 3,4 % la poursuivaient malgré une progression. Les biopsies à 1 an étaient négatives dans 1/3 des cas. 2 patients étaient perdus de vue. Deux tiers des patients sont toujours en SA avec un recul moyen de plus de 2 ans. Les informations données par l’urologue ont une influence dans la décision. Sous réserve du respect des critères d’inclusion, la SA est une option sans risque sur le court terme permettant de sélectionner les cancers de prostate évolutifs et d’éviter un sur-traitement aux autres.

La surveillance active (SA) est une option de prise en charge avec traitement différé à un stade potentiellement curable si nécessaire. L’objectif est d’évaluer les résultats anatomo-pathologiques après prostatectomie totale (PR) issus d’une cohorte prospective de 116 patients en surveillance active (inclus dans l’étude PRIAS). Au total, 116 patients ont été inclus entre 2007 et 2014 dans une étude observationnelle prospective de surveillance active pour un cancer de prostate cliniquement localisé à faible risque (critères d’inclusion PRIAS : PSA ≤ 10, T1c ou T2, Gleason ≤ 6 et 2 biopsies max, PSAD < 0,2). Un traitement différé était recommandé en cas de progression anatomopathologique (score Gleason > 6 ou au moins 3 carottes biopsiques positives) ou un PSADT < 3 ans. Trente-trois patients (28,4 %) ont eu un traitement différé dont 23 PR (69,7 %). La décision était basée sur le protocole de SA chez 18 patients (78,3 %). Le délai médian début SA-PR était de 19 mois (1,17–72) pour un recul médian des patients en SA de 23,8 mois. Toutes les PR avant 1 an de suivi l’étaient pour des raisons personnelles (5 pts). 17 (73,9 %) étaient pT2 (3 R1) et 6 (26,1 %) pT3a (3 R1). Le score de Gleason était 3 + 3, 3 + 4, 4 + 3 et 5 + 3 dans 15 (65,2 %), 5 (21,7 %), 2 (8,7 %), et 1 (4,3 %) cas respectivement. L’augmentation du Gleason entre la dernière biopsie et la pièce était de 21,7 %. Tous les pT3a R1 avaient une progression anatomo-pathologique associée à un PSADT < 3 ans. Les résultats anatomo-pathologiques après PR pour les patients initialement en SA montrent un stade pT et un score de Gleason le plus souvent favorable identiques aux séries de faibles risques opérés sans SA préalable. Une amélioration de la sélection des patients devrait pouvoir être obtenue par l’IRM dynamique introduite récemment dans le protocole de surveillance active.

Androgen deficiency of the aging male is a pathological syndrome and should not be viewed simply as a stage in physiological aging. It is often overlooked despite evidence for a deleterious impact on many physiological processes and on quality of life. Its identification should be part of the routine practice of physicians in charge of this population, in particular general practitioners and specialists treating associated comorbidities (e.g. metabolic syndrome, diabetes, cardiovascular disorders) or sexual dysfunction. The consultant urologist has a key role to play in prostate surveillance before and during treatment. Treatment is often simple with few side-effects. However, long-term benefits and side effects need to be investigated in prospective studies.