Le cancer de la prostate, le plus fréquent des cancers chez l’homme, est un adénocarcinome sensible, dans plus de 80 % des cas, à la castration chimique, en raison de son hormonodépendance. L’hormonothérapie androgénosuppressive est le traitement des formes évoluées du cancer et peut être associée à la radiothérapie en évoluée. Le choix thérapeutique, pluridisciplinaire, est fondé sur l’âge et les maladies associées du patient, et le stade clinique. L’impact de l’hormonothérapie confère au patient des effets secondaires variés et ceux cardiovasculaires sont maintenant mieux connus. Les mécanismes responsables de cette cardiotoxicité sont à la fois directs et indirects par effets métaboliques thermogéniques. L’analyse de ces effets cliniques ou biologiques, leurs corrélations au type d’hormonothérapie utilisé et les précautions possibles de prescription seront détaillés dans cette synthèse de la littérature. La collaboration du cancérologue ou de l’urologue avec le cardiologue devient nécessaire et l’existence d’une unité d’oncocardiologie pourrait améliorer l’évaluation de la balance bénéfice–risque et la tolérance du traitement.

Prostate cancer, the most frequent cancer in man, is an adenocarcinoma sensible to chemical castration in more than 80% of cases due to its hormonal dependency. Androgen deprivation is the treatment for advanced cancer and can be associated with radiotherapy locally or in locally advanced situations. Multidisciplinary therapeutic choice depends on patient age and co-morbidities and clinical stage. The impact of hormonal treatment confers varied side effects and cardiovascular effects are now better known. Responsible mechanisms of this cardiotoxicity are at the same time direct but also indirect by metabolic thermogenic effects. Analysis of these clinical or biological effects, their correlations to the used type of hormonal treatment and the possible precautions of prescription will be detailed in this analysis of the literature. The collaboration of the oncologist or the urologist with the cardiologist becomes necessary and the existence of a unit of oncocardiology could improve the evaluation of the risk-benefit balance and the tolerance of the treatment. (C) 2016 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

‘Toxic discourse’ has a long history in the context of India's urban environment. Using the examples of the two leading metropolitan centres, Bombay and Calcutta, this article shows how the diverse and changing problem of pollution was identified and addressed over time. Ideas of pollution and poisoning were closely associated in the nineteenth century, and related to human as well as animal waste, and, increasingly, to industrial activity and mechanized transport. Many of these developments and their intended solutions mirrored European experience, but in India ‘pollution’ served as an environmental as well as a ritual concept: it could be deployed to exoticize and exceptionalize India or to oppose, complement and qualify the Western understanding of the term. The invocation of toxicity in colonial pharmacology and medical jurisprudence partly overlapped with the evolving environmental discourse on poisoning and pollution but became increasingly distinct from it by the early 1900s as toxicology acquired a more precise meaning and distinct technical agency.

Objectives. - Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer.Patients and methods. - In a series of 270 sexually active men treated by prostate brachytherapy (1251 permanent implantation), 241 (89%), mean age of 65 (43-80), participated in a mailed survey about sexual function after a mean time of 36 months (9-70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often).Results. - After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P = 0.0001). More than 50% of the patients had an altered orgasm (weak, difficult, absent) after brachytherapy, vs 16% before implantation (P = 0.001). Men with a diminished ejaculation volume often had a weak/difficult orgasm (P = 0.007). Neoadjuvant hormonal therapy did not seem to impact the quality of orgasm or the frequency of painful ejaculation. Patients who had an IIEF-5 score higher than 12 had frequently intense orgasm (26.7% vs 2.7%; P < 0.001) after brachytherapy. Sixty patients (30.3%) experienced often/sometimes painful ejaculation 12.9% (n = 31) before implantation (P = 0.0001).Conclusion. - Most of the patients treated by prostate brachytherapy conserved orgasm after treatment. However, most of the patients described a deterioration of the quality of orgasm. (C) 2011 Elsevier Masson SAS. All rights reserved.

To compare T2-weighted MRI and functional MRI techniques in guiding repeat prostate biopsies.

PURPOSE:Determine the feasibility of dynamic gadolinium enhanced MRI and spectroscopic imaging in routine clinical practice using standard equipment and its usefulness for patients with negative biopsies and high degree of suspicion of prostate cancer.PATIENTS AND METHODS:Fifty five patients underwent endorectal MRI using T2W spin echo (SE) imaging, dynamic gadolinium enhanced imaging and proton spectroscopic imaging before repeat US-guided transrectal biopsies. The statistical analysis consisted in the correlation of the results obtained with each of the two MRI techniques and the results of the biopsies in the corresponding prostate lobe.RESULTS:32 patients were included in the analysis. Biopsies revealed cancer for 15 patients. The statistical analysis showed a lack of significant correlation between T2W-SE imaging and biopsy results. A correlation with statistical significance was found between dynamic gadolinium enhanced imaging and biopsies (p=0,0018) and between spectroscopic imaging results and biopsies in the corresponding lobe (p=0,0001).CONCLUSION:Endorectal MRI with a standard clinical equipment using dynamic gadolinium enhanced imaging and spectroscopic imaging may be used in clinical routine to improve detection and localization in prostate cancer compared to T2 weighted spin echo imaging.

Déterminer si l'IRM dynamique avec injection de Gadolinium et l'IRM spectroscopique sont applicables en routine avec un équipement standard et utiles aux patients en cas de biopsies négatives avec persistance de suspicion d'un cancer de la prostate. Cinquante quatre patients ont été examinés par IRM endorectale avec imagerie T2-SE, imagerie dynamique avec injection de Gadolinium et imagerie spectroscopique-proton avant de nouvelles biopsies transrectales échoguidées. L'analyse statistique a étudié la corrélation entre le résultat de chacune des 2 méthodes d'IRM et le résultat des biopsies dans le lobe considéré. Trente deux patients ont été inclus dans l'analyse. Un cancer a été découvert par biopsie après IRM chez 15 patients. L'analyse statistique a montré l'absence de corrélation significative entre l'imagerie T2-SE et les résultats des biopsies. Une corrélation statistiquement significative a été mise en évidence entre les résultats de l'imagerie dynamique et les biopsies (p = 0,018) et entre l'imagerie spectroscopique et les biopsies dans le lobe considéré (p = 0,0001). L'IRM endorectale au moyen d'un équipement standard avec imagerie dynamique et spectroscopique peut être appliquée en routine clinique. Elle améliore la détection et la localisation du cancer par rapport à l'imagerie T2-SE. Determine the feasibility of dynamic gadolinium enhanced MRI and spectroscopic imaging in routine clinical practice using standard equipment and its usefulness for patients with negative biopsies and high degree of suspicion of prostate cancer. Fifty five patients underwent endorectal MRI using T2W spin echo (SE) imaging, dynamic gadolinium enhanced imaging and proton spectroscopic imaging before repeat US-guided transrectal biopsies. The statistical analysis consisted in the correlation of the results obtained with each of the two MRI techniques and the results of the biopsies in the corresponding prostate lobe. 32 patients were included in the analysis. Biopsies revealed cancer for 15 patients. The statistical analysis showed a lack of significant correlation between T2W-SE imaging and biopsy results. A correlation with statistical significance was found between dynamic gadolinium enhanced imaging and biopsies (p=0,0018) and between spectroscopic imaging results and biopsies in the corresponding lobe (p=0,0001). Endorectal MRI with a standard clinical equipment using dynamic gadolinium enhanced imaging and spectroscopic imaging may be used in clinical routine to improve detection and localization in prostate cancer compared to T2 weighted spin echo imaging.

Objective: The concept of therapeutic angiogenesis with vascular endothelial growth factor (VEGF) has been validated in peripheral arterial disease. Its use in myocardial ischemia may be delayed as the result of the description in a porcine model of peripheral vasodilation after intraluminal injections of VEGF resulting in a 50% fatality rate by hypotension. We carried out this study to test whether VEGF-induced hypotension (1) is species specific, (2) is mediated by the receptor mediating angiogenesis, (3) is prevented by inhibition of nitric oxide synthase. Methods: In the rabbit corneal pocket assay we tested whether a previously published anti-idiotypic antibody (AIA) agonist of the VEGF receptor Flk-1/KDR could elicit angiogenesis. Various doses of recombinant VEGF or AIA were injected into anesthetized normotensive Wistar-Kyoto rats and the mean arterial blood pressure (MABP) was recorded. To test the implication of nitric oxide in VEGF-induced hypotension we treated the animals with a competitive inhibitor of nitric oxide synthase prior to the injection of VEGF. Results: Both VEGF and AIA induce angiogenesis but only intravenous injections of VEGF induced a rapid, transient and dose-dependent decrease in MABP. The ED50 was 0.5 mu g. The interval between two VEGF injections required to lead to a decrease of MABP was 40 minutes. Nitric oxide synthesis inhibitor prevented, in a reversible fashion, the effect of VEGF. Conclusion: VEGF-induced hypotension is not species specific. It is prevented by nitric oxide inhibition. VEGF-induced angiogenesis and hypotension are not mediated in vivo by the same VEGF receptor. (C) 1997 Elsevier Science B.V.

The hypothesis that tumor growth is angiogenesis dependent has been documented by a considerable body of direct and indirect experimental data. A prerequisite for the development of novel anti-angiogenic agents is the design of drugs that would be active only on those endothelial cells with an angiogenic phenotype. We took advantage of the anti-idiotypic strategy to obtain circulating agonists specific for the vascular endothelial growth factor receptor KDR/flk-1 (J-IgG). They induced in the absence of VEGF cell proliferation in vitro and angiogenesis in the corneal pocket assay either through local or systemic delivery. Intraperitoneal injections of J-IgG in nude mice grafted with a prostatic adenocarcinoma led to tumor enlargement associated with an increase in both tumor vascularization and proliferation. In contrast KDR/flk-1 overstimulation had no detectable effect on normal tissues. These data underline that KDR/flk-1 is a functional marker of the angiogenic phenotype of endothelial cells.