Background: There is ongoing discussion whether a multivariable approach including magnetic resonance imaging (MRI) can safely prevent unnecessary protocol-advised repeat biopsy during active surveillance (AS).Objective: To determine predictors for grade group (GG) reclassification in patients undergoing an MRI-informed prostate biopsy (MRI-Bx) during AS and to evaluate whether a confirmatory biopsy can be omitted in patients diagnosed with upfront MRI.Design, setting, and participants: The Prostate cancer Research International: Active Surveillance (PRIAS) study is a multicenter prospective study of patients on AS (www. prias-project.org). We selected all patients undergoing MRI-Bx (targeted +/- systematic biopsy) during AS.Outcome measurements and statistical analysis: A time-dependent Cox regression anal-ysis was used to determine the predictors of GG progression/reclassification in patients undergoing MRI-Bx. A sensitivity analysis and a multivariable logistic regression analysis were also performed.Results and limitations: A total of 1185 patients underwent 1488 MRI-Bx sessions. The time-dependent Cox regression analysis showed that age (per 10 yr, hazard ratio [HR] 0.84 [95% confidence interval {CI} 0.71-0.99]), MRI outcome (Prostate Imaging Reporting and Data System [PIRADS] 3 vs negative HR 2.46 [95% CI 1.56-3.88], PIRADS 4 vs negative HR 3.39 [95% CI 2.28-5.05], and PIRADS 5 vs negative HR 4.95 [95% CI 3.25-7.56]), prostate-specific antigen (PSA) density (per 0.1 ng/ml cm3, HR 1.20 [95% CI 1.12-1.30]), and percentage positive cores on the last systematic biopsy (per 10%, HR 1.16 [95% CI 1.10-1.23]) were significant predictors of GG reclassification. Of the patients with negative MRI and a PSA density of <0.15 ng/ml cm3 (n = 315), 3% were reclassified to GG >= 2 and 0.6% to GG >= 3. At the confirmatory biopsy, reclassification to GG >= 2 and >= 3 was observed in 23% and 7% of the patients diagnosed without upfront MRI and in 19% and 6% of the patients diagnosed with upfront MRI, respectively. The multivariable analysis showed no significant difference in upgrading at the confirmatory biopsy between patients diagnosed with or without upfront MRI.Conclusions: Age, MRI outcome, PSA density, and percentage positive cores are signifi-cant predictors of reclassification at an MRI-informed biopsy. Patients with negative MRI and a PSA density of <0.15 ng/ml cm3 can safely omit a protocol-based prostate biopsy, whereas in other patients, a multivariable approach is advised. Being diagnosed with upfront MRI appears not to significantly affect reclassification risk; hence, a confir-matory MRI-Bx cannot totally be omitted yet.Patient summary: A protocol-based prostate biopsy while on active surveillance can be omitted in patients with negative magnetic resonance imaging (MRI) and prostate -specific antigen density <0.15 ng/ml cm3. A confirmatory biopsy cannot simply be omit-ted in all patients diagnosed with upfront MRI.(c) 2022 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

You have accessJournal of UrologyCME1 May 2022MP43-05 UPFRONT MRI IS THE NEW STANDARD, HAVE CONFIRMATORY BIOPSIES BECOME OBSOLETE? Henk Luiting, Ivo Izaak de Vos, Sebastiaan Remmers, Egbert Boevé, Chris Bangma, Riccardo Valdagni, Peter Chiu, Axel Semjonow, Viktor Berge, Karl Tully, Antti Rannikko, Frédéric Staerman, and Monique Roobol Henk LuitingHenk Luiting More articles by this author , Ivo Izaak de VosIvo Izaak de Vos More articles by this author , Sebastiaan RemmersSebastiaan Remmers More articles by this author , Egbert BoevéEgbert Boevé More articles by this author , Chris BangmaChris Bangma More articles by this author , Riccardo ValdagniRiccardo Valdagni More articles by this author , Peter ChiuPeter Chiu More articles by this author , Axel SemjonowAxel Semjonow More articles by this author , Viktor BergeViktor Berge More articles by this author , Karl TullyKarl Tully More articles by this author , Antti RannikkoAntti Rannikko More articles by this author , Frédéric StaermanFrédéric Staerman More articles by this author , and Monique RoobolMonique Roobol More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The AUA guidelines recommend confirmatory biopsies in all patients within two years after diagnosis whereas the EAU guidelines recommend refraining from confirmatory biopsies during active surveillance (AS) in patients diagnosed with upfront MRI. Data on these recommendations is conflicting and limited to highly experienced centers. The objective of this study is to add to the current evidence and to determine the risk difference for grade group (GG) reclassification on confirmatory biopsies between patients included with and without upfront MRI. METHODS: The PRIAS study is a multicenter prospective study providing clinical data of patients on AS. The inclusion criteria and recommended follow up schedule are available on www.prias-project.org. In this analysis, we selected patients diagnosed with or without upfront MRI, who underwent (a second) MRI before confirmatory biopsies. All subsequently underwent targeted biopsies (±systematic biopsies (SBx)) in lesions PIRADS ≥3, or SBx in case of no lesion. Multivariable logistic regression analysis was performed to determine the risk difference for GG reclassification at confirmatory biopsies between patients included with and without upfront MRI. RESULTS: In total, 732 patients underwent MRI informed confirmatory biopsies at a median PSA of 6.4 (interquartile range 4.6-8.4) ng/ml. 524 patients were diagnosed without upfront MRI and 208 with upfront MRI. Biopsy outcome and the outcome of multivariable logistic regression analysis are shown in Figure 1. At confirmatory biopsy, 108 (21%) patients without upfront MRI reclassified whereas 39 (19%) patients with upfront MRI reclassified. Reclassification to GG ≥3 was seen in 6% and 7% of the patients without and with upfront MRI respectively. No significant difference in risk for reclassification at confirmatory biopsies was seen between the two groups (OR 1.11 (95%CI 0.72-1.73), p=0.6), whereas MRI outcome, DRE outcome and PSA density were significant predictors for reclassification. CONCLUSIONS: Our results show that upfront MRI does not reduce reclassification rates at confirmatory biopsy and as such does not support the EAU guidelines recommendation to simply omit confirmatory biopsies if upfront MRI is used. In preventing unnecessary biopsies during AS, our results highlight the importance of MRI outcome. Source of Funding: - © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e741 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henk Luiting More articles by this author Ivo Izaak de Vos More articles by this author Sebastiaan Remmers More articles by this author Egbert Boevé More articles by this author Chris Bangma More articles by this author Riccardo Valdagni More articles by this author Peter Chiu More articles by this author Axel Semjonow More articles by this author Viktor Berge More articles by this author Karl Tully More articles by this author Antti Rannikko More articles by this author Frédéric Staerman More articles by this author Monique Roobol More articles by this author Expand All Advertisement PDF downloadLoading ...

1 Urology department, Sorbonne University, GRC n 5, PREDICTIVE ONCO-UROLOGY, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France; 2 Service d’urologie, Clinique Pasteur, Royan, France; GRC n 5 PREDICTIVE ONCO-UROLOGY, Sorbonne Université, APHP, Hôpital Tenon, Paris, France; 3 GRC n 5 PREDICTIVE ONCO-UROLOGY, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France; CeRePP, Paris, France; 4 GRC n 5 PREDICTIVE ONCO-UROLOGY, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France; 5 Service d’urologie et d’andrologie de la polyclinique de Reims Bezannes, Reims, France; 6 GRC n 5 PREDICTIVE ONCO-UROLOGY, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France; CeRePP, Paris, France; Urology department, Sorbonne University, GRC n 5, PREDICTIVE ONCO-UROLOGY, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France

Often contraindicated because of the theoretical risk of progression based on the dogma of hormone dependent prostate cancer (CaP), testosterone replacement therapy (TRT) is increasingly discussed and proposed for hypogonadal patients with localized CaP. To perform a systematic literature review to determine the relationship between TRT and the risk of CaP with a focus on the impact of TRT in the setting of previous or active localized CaP. As of October 15, 2019, systematic review was performed via Medline Embase and Cochrane databases in accordance with the PRISMA guidelines. All full text articles in English published from January 1994 to February 2018 were included. Articles were considered if they reported about the relationship between total testosterone or bioavailable testosterone and CaP. Emphasis was given to prospective studies, series with observational data and randomized controlled trials. Articles about the safety of the testosterone therapy were categorized by type of CaP management (active surveillance or curative treatment by radical prostatectomy, external radiotherapy or brachytherapy). Until more definitive data becomes available, clinicians wishing to treat their hypogonadal patients with localized CaP with TRT should inform them of the lack of evidence regarding the safety of long-term treatment for the risk of CaP progression. However, in patients without known CaP, the evidence seems sufficient to think that androgen therapy does not increase the risk of subsequent discovery of CaP. (C) 2020 Elsevier Inc. All rights reserved.

INTRODUCTION:We assess midterm morbidity and functional outcomes using the Prolift (Gynecare/Ethicon, Somerville, NJ) system and identify potential related risk factors. The Prolift mesh system to treat genital prolapse was introduced in 2005. It was withdrawn from the market in early 2013 after rising doubts about safety.METHODS:Over a 7-year period, we retrospectively analyzed a cohort of 112 consecutive patients who underwent the Prolift procedure since 2006. Intraoperative and postoperative complications, anatomical and functional outcomes were recorded.RESULTS:The median follow-up was 49.5 months (range: 16-85). The mean age was 64.7 ± 10.9 years (range: 40-86). Of the 112 patients, 74 patients had stage 3 (66.1%) and 8 patients had stage 4 (7.14%) vaginal prolapse. Prolift surgery was performed for pro-lapse recurrence for 26 patients (23.2%). Total mesh was used in 32 patients (29%), an isolated anterior mesh in 57 patients (51%) and an isolated posterior mesh in 23 patients (21%). Concomitant surgical procedures were performed for 44 patients (39.3%). Overall, 72% (18/25) of the complications were managed medically. We reported a failure rate of 8% (n = 9) occurring after a median follow-up of 9.5 months (range: 1-45). Among the 64 patients who had preoperative sexual activity (57.1%), de novo dyspareunia occurred in 9 patients (16.07%). We extracted predictive factors concerning failure, complications and sexuality.CONCLUSION:Despite its market withdrawal, the Prolift system was associated with good midterm anatomic outcomes and few severe complications. Long-term follow-up data are still lacking, but surgeons and patients may be reassured.

To assess oncologic outcomes after salvage radiotherapy (SRT) without androgen deprivation therapy (ADT) in patients with persistently detectable PSA after radical prostatectomy (RT).Two hundred and one patients who failed to achieve an undetectable PSA received SRT without ADT. The primary endpoint was failure to SRT that was defined by clinical progression or use of second-line ADT. Clinicopathological parameters, 6-week PSA level, PSAV and pre-SRT PSA levels were assessed using time-dependent analyses.Median postoperative 6-week PSA and pre-SRT PSA levels were 0.25 and 0.48 ng/mL, respectively. Median time between surgery and SRT was 7 months. Failure to SRT was reported in 42.8 % of cases with the need for second-line ADT in 26.9 % of cases. Pre-SRT PSA was strongly correlated with postoperative 6-week PSA (p < 0.001) but not with PSAV. The risk of SRT failure was increased by threefold in case of Gleason score 8-10 (p = 0.036) or pT3b cancer (p = 0.006). Risk group classification based on these prognostic factors improved SRT failure prediction. Survival curves confirmed that 5-year ADT-free survival rates were significantly influenced by PSAV (p = 0.002) and pre-SRT PSA (p = 0.030).In patients with persistently detectable PSA after RP and selected for local salvage treatment, SRT offers good oncologic clinical outcomes. The most powerful pathologic predictive factors of SRT failure include a pT3b stage, a Gleason score 8 or more cancer and high PSAV and pre-SRT PSA levels. Patients having a high PSAV > 0.04 ng/mL/mo would be potentially better candidates for a systemic therapy due to a high SRT failure rate.

PURPOSE:We identified factors predicting oncologic outcomes in cases of persistently detectable prostate specific antigen.MATERIALS AND METHODS:We reviewed the charts of patients treated with radical prostatectomy between 1998 and 2011 at a total of 14 centers. Study inclusion criteria were radical prostatectomy for presumed localized prostate cancer, absent positive nodes and detectable prostate specific antigen, defined as prostate specific antigen 0.1 ng/ml or greater 6 weeks postoperatively. Of the 9,735 radical prostatectomy cases reviewed 496 (5.1%) were eligible for analysis. Predictive factors for oncologic outcomes were assessed in time dependent analyses using the Kaplan-Meier method and Cox regression models.RESULTS:At 6 weeks prostate specific antigen was 0.1 to 6.8 ng/ml. Biochemical progression was noted in 74.4% of patients and clinical metastasis was noted in 5%. The 2 most powerful predictors of general salvage treatment (vs radiotherapy) were postoperative prostate specific antigen greater than 1 ng/ml (OR 3.46, p=0.032) and prostate specific antigen velocity greater than 0.2 ng/ml per year (HR 6.01, p=0.001). Positive prostate specific antigen velocity was the single factor that independently correlated with the risk of failed salvage therapy (HR 2.6, p=0.001). The 5-year disease-free survival rate was 81.0% in patients with stable or negative prostate specific antigen velocity compared with 58.4% in those with positive prostate specific antigen velocity (p<0.001).CONCLUSIONS:Patients with detectable prostate specific antigen after radical prostatectomy have a poor biochemical outcome. We identified postoperative prostate specific antigen and prostate specific antigen velocity as independent predictors of progression and failed salvage treatment. In addition to pathological prognostic factors, these factors should be considered early to better stratify patients for adjuvant therapy.

Background: Little is known about the outcome of radical prostatectomy (RP) in men initially followed on active surveillance (AS) for low-risk prostate cancer (PCa).Objective: Evaluate pathology findings after RP in our prospective AS cohort.Design, setting, and participants: All men participated in the Prostate Cancer Research International: Active Surveillance (PRIAS) study. Eligible men were initially diagnosed with low-risk PCa (clinical stage <= T2, prostate-specific antigen [PSA] <= 10 ng/ml, PSA density <0.2 ng/ml per ml, one or two positive biopsy cores, and Gleason score <= 6) and underwent RP between December 2006 and July 2011. The study protocol recommends RP in case of risk reclassification on repeat biopsy (Gleason score >6 and/or more than two positive cores) or a PSA doubling time <= 3 yr.Measurements: Descriptive statistics were used to report on pathology findings for staging and grading.Results and limitations: Pathology results were available in 167 out of 189 RP cases (88.4%). Median time to RP was 1.3 yr (range: 1.1-1.9). Protocol-based recommendations led to deferred RP in 143 men (75.7%); 24 men (12.7%) switched because of anxiety, and 22 (11.6%) had other reasons. Pathology results showed 134 (80.8%) organ-confined cases and 32 (19.2%) cases with extracapsular extension. Gleason scores <= 6, 3 + 4, 4 + 3, and 8 were found in 79 (47.3%), 64 (38.3%), 21 (12.6%), and 3 (1.8%) cases, respectively. Unfavourable RP results (pT3-4 and/or Gleason score >= 4 + 3) were found in 49 patients (29%), of whom 33 (67%) had a biopsy-related reason for deferred RP.Conclusions: RP results in men initially followed on AS show organ-confined disease and favourable Gleason grading in a majority of cases. Most men in our cohort had a protocol-based reason to switch to deferred RP. A main focus for AS protocols should be to improve the selection of patients at the time of inclusion to minimise reclassification of risk and preserve the chance for curative treatment, if indicated. (C) 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Background: Overdiagnosis and subsequent overtreatment are important side effects of screening for, and early detection of, prostate cancer (PCa). Active surveillance (AS) is of growing interest as an alternative to radical treatment of low-risk PCa.Objective: To update our experience in the largest worldwide prospective AS cohort.Design, setting, and participants: Eligible patients had clinical stage T1/T2 PCa, prostate-specific antigen (PSA) <= 10 ng/ml, PSA density <0.2 ng/ml per milliliter, one or two positive biopsy cores, and Gleason score <= 6. PSA was measured every 3-6 mo, and volume-based repeat biopsies were scheduled after 1, 4, and 7 yr. Reclassification was defined as more than two positive cores or Gleason >6 at repeat biopsy. Recommendation for treatment was triggered in case of PSA doubling time <3 yr or reclassification.Outcome measurements and statistical analysis: Multivariate regression analysis was used to evaluate predictors for reclassification at repeat biopsy. Active therapy-free survival (ATFS) was assessed with a Kaplan-Meier analysis, and Cox regression was used to evaluate the association of clinical characteristics with active therapy over time.Results and limitations: In total, 2494 patients were included and followed for a median of 1.6 yr. One or more repeat biopsies were performed in 1480 men, of whom 415 men (28%) showed reclassification. Compliance with the first repeat biopsy was estimated to be 81%. During follow-up, 527 patients (21.1%) underwent active therapy. ATFS at 2 yr was 77.3%. The strongest predictors for reclassification and switching to deferred treatment were the number of positive cores (two cores compared with one core) and PSA density. The disease-specific survival rate was 100%. Follow-up was too short to draw definitive conclusions about the safety of AS.Conclusions: Our short-term data support AS as a feasible strategy to reduce overtreatment. Clinical characteristics and PSA kinetics during follow-up can be used for risk stratification. Strict monitoring is even more essential in men with high-risk features to enable timely recognition of potentially aggressive disease and offer curative intervention. Limitations of using surrogate end points and markers in AS should be recognized.

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Artifical Urinary Sphincter (AUS) is the treatment of choice for moderate to severe post‐radical prostatectomy incontinence with good long‐term outcomes despite risk of complications. We report preliminary results of a new preconnected AUS (ZSI 375). Main change with the device currently available is the replacement of the abdominal reservoir by a pressure‐regulated spring in the intrascrotal pump avoiding abdominal approach. OBJECTIVE To assess retrospectively the safety and efficacy of an artificial urinary sphincter, the ZSI 375 device (Zephyr Surgical Implants, Geneva, Switzerland), in male patients with moderate‐to‐severe stress urinary incontinence after a prostate or bladder intervention. PATIENTS AND METHODS The ZSI 375 device is a one‐piece device consisting of an adjustable cuff, moulded to fit around the urethra, which is connected by a tube to a pump and a pressure‐regulating tank. It has no abdominal reservoir. Patients underwent a perineal incision for cuff placement and an inguinal incision for pump and tank scrotal placement. Complications and pads used to manage incontinence were recorded. RESULTS Between May 2009 and April 2011, 36 patients underwent ZSI 375 device placement. The median (range) follow‐up was 15.4 (6–28) months. No patient experienced bladder overactivity, chronic urinary retention, or any other adverse effect after device activation. Complications leading to device removal arose in four patients (one case of erosion, three cases of infection). Social continence (0 or 1 pad/day) was achieved in 28/36 patients (78%) at 3 months and 26/36 patients (73%) at 6 months after device activation. In 12/14 patients for a sphincter closure pressure range of 60–70 cm H 2 O, in 3/3 patients for a range of 70–80 cm H 2 O and in 2/11 for a range of 90–100 cm, H 2 O social continence was achieved only after increasing the pressure of the cuff by trans‐scrotal injection of saline. CONCLUSIONS The ZSI 375 device is safe and effective but our follow‐up may not have been long enough to identify all potential complications. Further research is needed to confirm these results and extend our investigation, for instance, to the peno‐scrotal approach.

INTRODUCTION Patients with erectile dysfunction (ED) after radical prostatectomy (RP) may benefit from penile prosthesis (PP) implantation after failure of less invasive treatments. Aim.  To assess surgical outcomes and satisfaction after PP implantation in RP patients and compare the results with those in patients with vasculogenic ED (controls). METHODS A database of 415 consecutive PPs (January 1996-December 2008) was used to collate data on preimplantation ED treatments, surgical complications, satisfaction, and International Index of Erectile Function (IIEF) scores before and 3 months after implantation. The results for 90 post-RP implants (79 primary, 11 secondary) and 131 implants for vasculogenic ED were compared. MAIN OUTCOME MEASURES The main outcome measures of this study are intra- and postoperative complications and IIEF domain scores. RESULTS Mean follow-up of RP patients was 37.6 ± 26.8 months. Mean interval between RP and PP implantation was 31.5 ± 28.7 months. Nearly all primary implants (96.2%) were inflatable (3-piece, 70.1%; 2-piece, 24.1%). There was no significant difference between groups in terms of rates of infection (1.1%), mechanical failure (3.3%), and other surgical complications requiring revision surgery (migration, auto-inflation) (4.4%). For primary implants, the mean preimplantation IIEF score (all items) was significantly lower in RP patients than in controls (14.7 ± 5.9 vs. 22.6 ± 10.8, P = 0.003), chiefly because of significantly lower scores for erectile function, intercourse satisfaction, and orgasmic function. After PP implantation in RP patients, the scores for all domains improved, but the total score remained significantly lower than in controls (63.1 ± 7.0 vs. 68.5 ± 6.9, P = 0.005). The orgasmic function score was significantly lower (P < 0.001). Overall satisfaction rate was 86.1% in RP patients and 90.7% in controls (P = 0.3). CONCLUSIONS PP implantation after RP is associated with low morbidity and high satisfaction. It improves the scores for all IIEF domains and, in particular, erectile function. Fibrosis of the retropubic space may require a second incision for reservoir placement or implantation of a 2-piece PP.

You have accessJournal of UrologyProstate Cancer: Advanced1 Apr 2011643 WHAT ABOUT REPRODUCIBILITY OF DECISION MADE AT MULTIDISCIPLINARY TEAM MANAGEMENT? Younes Bayoud, Johann Menard, Thomas Ripert, Marie Dominique Azemar, Rabah Messaoudi, and Frederic Staerman Younes BayoudYounes Bayoud Reims, France More articles by this author , Johann MenardJohann Menard Reims, France More articles by this author , Thomas RipertThomas Ripert Reims, France More articles by this author , Marie Dominique AzemarMarie Dominique Azemar Reims, France More articles by this author , Rabah MessaoudiRabah Messaoudi Reims, France More articles by this author , and Frederic StaermanFrederic Staerman Reims, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1545AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES to evaluate the reproducibility of thérapeutic decisions made at multidisciplinary team management (MDTM). We compared therapeutic decision of prostate cancer by presenting the same file of patient under a false identity, after a period of first presentation at MDTM. METHODS Forty-nine file of radical prostatectomy (RP) (28 pT2, 21 pT3) performed for clinical loalised prostate cancer were represented at MDTM. Patient's File was identical but the identitiy was false. Patients were represented at MDTM 6 to 12 months after the first presentation. The MDTM included urologist, oncologist, pathologist and radiologist. Therapeutic decisions were analysed using criteria as: TNM stage, Gleason score, margin status. The reproducibility was assessed statistically by Kappa (k) coefficient. RESULTS Forty-nine patients were presented a second time at MDTM. The distribution of cohort was as follows: 28 pT2c and 21 pT3 (14 pT3a, 7 pT3b). The mean age was similar in both groups. The mean PSA was 8.32 ng/ml (3.56–19.5) in pT2 group and 9.4ng/ml (3.8–22) in pT3 group. The margin status was positive in 25% and 47.6% respectively in pT2 and pT3 group. Decision made for pT2 group were the same in 100% case with k=1. In the group of pT3 (n=7), 33% of decision were different at second presentation at MDTM, especially for pT3b with only 29% reproducible decision with k= 0.1. Concerning a group of pT3a, 86% of decision were reproducible with k= 0.74. CONCLUSIONS This study showed a reliability and reproducibility of decision made at MDTM when guidelines were well defined. The therapeutic attitude were less reproducible in locally advanced prostate cancer but the decision concerning those cases should be made in the set of guidelines at MDTM. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e260 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Younes Bayoud Reims, France More articles by this author Johann Menard Reims, France More articles by this author Thomas Ripert Reims, France More articles by this author Marie Dominique Azemar Reims, France More articles by this author Rabah Messaoudi Reims, France More articles by this author Frederic Staerman Reims, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Background: The objective of this study is to evaluate the feasibility,tolerance and efficacy of salvage external beam radiotherapy(EBRT) in persistent or recurrent prostate cancer after failed highintensity focused ultrasound (HIFU) therapy.Methods: We reviewed data on tolerance and oncologic outcomesfor all patients with biopsy-proven locally recurrent or persistentprostate cancer who underwent salvage EBRT in our departmentbetween April 2004 and June 2008. Minimum follow-up for inclusionwas 2 years. Failure with EBRT was defined as biochemicalrelapse (Phoenix definition) or introduction of androgen deprivationtherapy (ADT). Gastrointestinal and urinary toxicity and urinary stressincontinence were scored at 12 and 24 months (Radiation TherapyOncology Group and Ingelman Sundberg rating, respectively).Results: The mean age of the patients was 68.8 years (range: 60-79).Mean prostate-specific antigen (PSA) before EBRT was 5.57 ng/mL(range: 2.5-14.8). Median follow-up was 36.5 ± 10.9 months(range: 24-54). No patient received adjunctive ADT. The EBRTcourse was well-tolerated and completed by all patients. The meanPSA nadir was 0.62 ng/mL (range: 0.03-2.4) and occurred after amedian of 22 months (range: 12-36). One patient experiencedbiochemical failure and was prescribed ADT 30 months after EBRT.The disease-free survival rate was 83.3% at 36.5 months. Therewas no major EBRT-related toxicity at 12 or 24 months.Conclusions: Our early clinical results confirm the feasibilityand good tolerance of salvage radiotherapy after HIFU failure.Oncological outcomes were promising. A prospective study withlonger follow-up is needed to identify factors predictive of successfor salvage EBRT therapy after HIFU failure.

BACKGROUND:Calcinosis cutis (CC) encompasses debilitating complications of connective tissue disorders and chronic venous insufficiency. Extracorporeal shock-wave lithotripsy (ESWL) is an effective treatment for urolithiasis, pancreatolithiasis, and calcified tendinitis. This study prospectively evaluated ESWL efficacy and tolerance for patients with CC. METHODS:This monocentric prospective study included all consecutive patients with CC progressing for at least 3 months, while their underlying causal disease was not. They underwent 3 ESWL sessions at 3-week intervals. The CC area and associated pain (visual analog scale score and analgesic consumption) were recorded before and 6 months after ESWL. RESULTS:Eight patients were included: 4 with chronic venous insufficiency, 3 with systemic scleroderma, and one with dermatomyositis. ESWL was used to treat 10 CC lesions. Seven patients completed 3 ESWL sessions. Six months after ESWL, the median CC area had decreased from 3.1 to 1.9 cm(2). visual analog scale-assessed pain scores declined dramatically, from 7 to 2 of 10, as did analgesia consumption, without any difference according to the causal disease. LIMITATIONS:Only 8 consecutive patients have been included and treated by ESWL during our study. CONCLUSION:This evaluation of ESWL efficacy and tolerance for the treatment of CC found no difference between the different underlying CC causal diseases in terms of efficacy. Based on our observations, ESWL efficacy was better against small, ulcerated, and radiopaque CC, and it had an analgesic effect that might make subsequent surgical excision of CC fragments easier. Ergonomic adaptations are required to facilitate and expand ESWL use in dermatology.

Background: Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours.Objective: Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population.Design, setting, and participants: Twenty-four French university departments of urology participated in this retrospective study.Intervention: All patients were treated according to current European Association of Urology guidelines.Measurements: Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods.Results and limitations: The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 +/- 12 yr vs 62 +/- 12 yr); mean tumour size was smaller (3.7 +/- 2.6 cm vs 7.3 +/- 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (>= 3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1-299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design.Conclusions: RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.

You have accessJournal of UrologyProstate Cancer: Basic Research IV1 Apr 2010552 IMMUNOHISTOCHEMICAL EXPRESSION AND PROGNOSTIC VALUE OF ENDOTHELIN-1 AND ENDOTHELIN-A RECEPTOR IN CLINICALLY LOCALIZED PROSTATE CANCER Marie-Dominique Azémar, Johann Ménard, Anne Durlach, Renaud Fay, Philippe Birembaut, and Frédéric Staerman Marie-Dominique AzémarMarie-Dominique Azémar Reims, France More articles by this author , Johann MénardJohann Ménard Reims, France More articles by this author , Anne DurlachAnne Durlach Reims, France More articles by this author , Renaud FayRenaud Fay Nancy, France More articles by this author , Philippe BirembautPhilippe Birembaut Reims, France More articles by this author , and Frédéric StaermanFrédéric Staerman Reims, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.772AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examined the expression of endothelin-1 (ET-1) and endothelin-A receptor (ET-A-R) in clinically localized prostate cancer and we investigated the utility of ET-1 and ET-A-R immunostaining in the prediction of biochemical failure after radical prostatectomy (RP). METHODS This retrospective study was carried out in 90 patients who had undergone RP for clinically localized prostate cancer (pT2 and pT3a, with negative surgical margins). Biochemical relapse was defined as serum PSA value ≤ 0.2 ng/ml, concerning 27 patients of the 90 included. Mean follow-up was 62.9±26.2 months. A semi-quantitative immunohistochemical study of ET-1 and ET-A-R was performed on RP specimens by one pathologist blinded to the clinical data. Adenocarcinoma tissue and normal gland adjacent to tumor regions were both analyzed for each specimen. For ET-1, intensity of immunoreactivity was scored from 0 (no staining) to 3 (strong staining). For ET-A-R, the stronger intensity of the core was scored from 0 to 3 and percentage of cells stained with this intensity were reported. Then a combined score for ET-A-R was determined by multiplying the intensity and percentage (from 0 to 300). RESULTS Mean age at radical prostatectomy was 64.7±6.5 years. Mean preoperative serum PSA was 9.0±5.3 ng/ml. Extraprostatic extension (pT3a) was found in 16.7% of RP specimens. Gleason sum was < 7 in 53.9% of the specimens. Median time to biochemical failure was 35.8 months. ET-1 staining intensity was moderate to strong in 80% of carcinoma tissue and in only 2.2% of normal adjacent to tumor regions. ET-A-R stronger intensity was moderate to strong in 90.8% of carcinoma tissue and in 65.5% of normal adjacent to tumors regions. Mean preoperative serum PSA (p=0.0008), Gleason sum (p=0.005), and ET-A-R expression in tumoral tissue (p=0.0012) were significantly higher in case of recurrence. In univariate analysis, preoperative PSA level (p=0.008), extracapsular extension (p=0.013) and ET-A-R immunostaining combined score in tumoral tissue (p=0.006) were statistically significant. ET-1 expression was not a prognostic marker of biochemical relapse. In multivariate analysis, only Gleason sum (p=0.013) and ET-A-R overexpression in tumoral glands (p=0.026) were independent prognostic factors of biochemical failure after RP. CONCLUSIONS ET-1 and ET-A-R are overexpressed in clinically localized prostate cancer. In this study, ET-A-R expression on RP specimen is an independent marker of biochemical failure after RP. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e217 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marie-Dominique Azémar Reims, France More articles by this author Johann Ménard Reims, France More articles by this author Anne Durlach Reims, France More articles by this author Renaud Fay Nancy, France More articles by this author Philippe Birembaut Reims, France More articles by this author Frédéric Staerman Reims, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...