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Cornud F, Lefevre A, Camparo P, Barat M, Dumonceau O, Galiano M, Flam T, Soyer P, Barral M. Post-MRI transrectal micro-ultrasonography of transition zone PI-RADS > 2 lesions for biopsy guidance. Eur Radiol 2022; 32:7504-7512. [PMID: 35451606 DOI: 10.1007/s00330-022-08788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To prospectively determine the value of post-MRI micro-ultrasonography (microUS) in the diagnosis of transition zone (TZ) significant prostate cancer (sPCa). PATIENTS AND METHODS Eighty-four consecutive men (66 ± 6.3 years) with a mean PSA level of 10.2 ± 7.4 ng/mL and at least one TZ-PI-RADS > 2 lesion were included. All patients had MRI-directed microUS and biopsy. Sensitivity and specificity of post-MRI microUS to visualize PI-RADS > 2 TZ lesions, the cancer detection rate of TZ-sPCa, and tumor characteristics according to their visibility on microUS were evaluated. Interreader agreement for detecting microUS+ lesions was evaluated using Cohen's kappa test. RESULTS Of the 92 PI-RADS > 2 lesions, 71 (71/92; 77%) were visible on microUS and biopsy was performed without image fusion, which was required for the 21 invisible lesions (21/92; 22.8%). TZ-sPCa detection rate was 51.1% (47/92). Sensitivity and specificity of MRI-directed microUS were 83% (39/47; 95% CI: 69.2-92.4%) and 28.9% (13/45; 95% CI: 16.4-44.3%), on a per-lesion basis and 86.4% (38/45; 95% CI: 72.6-94.8%) and 27.5% (11/40; 95% CI: 14.6-43.9%) on a per-patient basis. Visible tumors on microUS exhibited a larger volume and a lower mean ADC value than non-visible tumors (15.8 ± 5.1 vs. 12.5 ± 3.6 mm and 0.82 ± 1.1 × 103 vs. 0.9 ± 1.4 × 10-3 mm2/s) (p = 0.02). Non-visible tumors showed a heterogeneous non-specific echotexture or were masked by the shadowing caused by corpora amylacea. Interreader agreement was almost perfect (kappa = 0.88; 95% CI: 0.79-0.95). The main limitation is the single-center feature of the study. CONCLUSION MRI-targeted transrectal microUS is effective to detect TZ-sPCa. TRUS-MRI image fusion helps overcome limitations due to TZ tissue heterogeneity. KEY POINTS microUS can visualize the majority of MRI-detected PI-RADS > 2 TZ lesions (sensitivity = 83%). Interreader agreement of MRI-directed microUS in the detection of TZ lesions appears excellent (kappa = 0.88). In 77% of PI-RADS > 2 TZ lesions, biopsy was performed under microUS visual control. MRI fusion system was only used to overcome limitations due to tissue heterogeneity of benign prostatic hyperplasia.
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Affiliation(s)
- François Cornud
- Department of Radiology, Clinique de l'Alma, 75007, Paris, France
| | - Arnaud Lefevre
- Department of Radiology, Clinique de l'Alma, 75007, Paris, France
| | | | - Maxime Barat
- Department of Radiology, Hôpital Cochin, 75014, Paris, France
| | | | - Marc Galiano
- Department of Urology, Clinique de l'Alma, Paris, France
| | - Thierry Flam
- Department of Urology, Clinique de l'Alma, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, 75014, Paris, France
| | - Matthias Barral
- Service de Radiologie, Department of Radiology, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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Neuzillet Y, Dreyfus JF, Raynaud JP, Rouanne M, Schneider M, Roupret M, Drouin S, Galiano M, Cathelineau X, Lebret T, Botto H. Relationship of preoperative androgen levels and metabolic syndrome with quality of life and erectile function in patients who are to undergo radical prostatectomy. Asian J Androl 2021; 23:520-526. [PMID: 33762475 PMCID: PMC8451490 DOI: 10.4103/aja.aja_3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study aims to investigate whether clinical and biological preoperative characteristics of patients who were to undergo radical prostatectomy were associated with impairment in patient-reported quality of life (QoL) and erectile dysfunction immediately before intervention. We evaluated patient-reported outcomes among 1019 patients (out of 1343) of the AndroCan study, willing to score the Aging Male Symptom (AMS) and the International Index of Erectile Function 5-item (IIEF-5) auto-questionnaires. Univariate linear regression and robust multiple regression were used to ascertain the relationship between demographic, clinical, and hormonal parameters and global AMS or IIEF-5 scores. As a result, most patients (85.1%) of the Androcan cohort agreed to complete questionnaires. Significantly higher IIEF-5 global scores were found in non-Caucasian and obese patients, with larger waist circumference, metabolic syndrome, diabetes mellitus, cardiovascular disease, hypertension, high blood sugar, concomitant medications, and hypogonadism, while the AMS global score was significantly higher in patients with larger waist circumference, metabolic syndrome, high blood pressure, raised glycemia, and concomitant medication. The IIEF-5 global score was correlated to age, dehydroepiandrosterone (DHEA), fat mass percentage, and androstenediol (D5). The AMS global score was significantly correlated to DHEA, D5, and DHEA sulfate. Finally, the multivariate models showed that QoL and erectile function were significantly affected, before surgery, by symptoms and signs that are usually considered as pertaining to the metabolic syndrome, while sexual hormones are essentially correlated to erectile dysfunction.
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Affiliation(s)
- Yann Neuzillet
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Jean-François Dreyfus
- Department of Clinical Research and Innovation, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | | | - Mathieu Rouanne
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Marc Schneider
- Department of Urology, Hôpital Louis Pasteur, Colmar 68000, France
| | - Morgan Roupret
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris 75013, France
| | - Sarah Drouin
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris 75013, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris 75014, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris 75014, France
| | - Thierry Lebret
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Henry Botto
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
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Neuzillet Y, Rouanne M, Dreyfus JF, Raynaud JP, Schneider M, Roupret M, Drouin S, Galiano M, Cathelinau X, Lebret T, Botto H. Metabolic syndrome, levels of androgens, and changes of erectile dysfunction and quality of life impairment 1 year after radical prostatectomy. Asian J Androl 2021; 23:370-375. [PMID: 33565427 PMCID: PMC8269836 DOI: 10.4103/aja.aja_88_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Robust data evaluating the association of preoperative parameters of the patients with quality of life after radical prostatectomy are lacking. We investigated whether clinical and biological preoperative characteristics of the patients were associated with impaired patient-reported quality of life (QoL) and sexual outcomes 1 year after radical prostatectomy. We evaluated patient-reported outcomes among the 1343 men participating in the AndroCan trial (NCT02235142). QoL and erectile dysfunction (ED) were assessed before and 1 year after radical prostatectomy using validated self-assessment questionnaires (Aging Male's Symptoms [AMS] and the 5-item abridged version of the International Index of Erectile Function [IIEF5]). At baseline, 1194 patients (88.9%) accepted to participate. A total of 750 (55.8%) patients answered the 1-year postoperative questionnaires. Out of them, only 378 (50.4% of responders) provided answers that could be used for calculations. One year after prostatectomy, ED had worsened by 8.0 (95% confidence interval [CI]: 7.3–8.7; P < 0.0001) out of a maximum of 20. The global AMS score has worsened by 2.8 (95% CI: 1.7–3.8; P < 0.0001). ED scores 1 year postsurgery were positively correlated with preoperative age and percentage of fat mass, and negatively correlated with total cholesterol, dehydroepiandrosterone (DHEA), and androstenediol (D5); AMS were poorly correlated with preoperative parameters. QoL and sexual symptoms significantly worsened after radical prostatectomy. Baseline bioavailable testosterone levels were significantly correlated with smaller changes on AMS somatic subscores postprostatectomy. These findings may be used to inform patients with newly diagnosed prostate cancer.
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Affiliation(s)
- Yann Neuzillet
- Department of Urology, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Mathieu Rouanne
- Department of Urology, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Jean-François Dreyfus
- Department of Clinical Research and Innovation, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | | | - Marc Schneider
- Department of Urology, Hospital Louis Pasteur, Colmar 68000, France
| | - Morgan Roupret
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris 75013, France
| | - Sarah Drouin
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris 75013, France
| | - Marc Galiano
- Department of Urology, Montsouris Institute, Paris-Descartes University, Paris 75014, France
| | - Xavier Cathelinau
- Department of Urology, Montsouris Institute, Paris-Descartes University, Paris 75014, France
| | - Thierry Lebret
- Department of Urology, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Henry Botto
- Department of Urology, Hospital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
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Cornud F, Lefevre A, Flam T, Dumonceau O, Galiano M, Camparo P, Soyer P. Transition zone prostate cancer: Detection by second-look micro-ultrasonography after biparametric MRI. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ahallal Y, Mellouki A, Sanchez-Salas R, Rozet F, Galiano M, Chevallier D, Tibi B, Cathelineau X, Durand M, Barret E. L’impact psychologique et fonctionnel des différentes modalités thérapeutiques du cancer de prostate localisé de faible risque. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lefevre A, Camparo P, Dumonceau O, Galiano M, Flam T, Cornud F. Cancer de la prostate de la zone transition : détection par micro-échographie de seconde intention après IRM biparamétrique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cornud F, Lefevre A, Flam T, Dumonceau O, Galiano M, Soyer P, Camparo P, Barral M. MRI-directed high-frequency (29MhZ) TRUS-guided biopsies: initial results of a single-center study. Eur Radiol 2020; 30:4838-4846. [PMID: 32350662 DOI: 10.1007/s00330-020-06882-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/25/2020] [Accepted: 04/09/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the ability of high-frequency (29 MHz) transrectal micro-ultrasound (microUS) as a second-look examination after biparametric MRI (bp-MRI) and to reidentify focal lesions seen on diagnostic MRI and to detect new ones METHODS: A total of 118 consecutive men (mean age, 66 ± 13 [SD] years; range, 49-93 years) with a mean prostate-specific antigen level of 11 ± 19 (SD) ng/mL (range, 2-200 ng/mL) and at least one focal lesion (MRI+) with a score > 2 on bp-MRI were included. Of these, 79/118 (66.9%) were biopsy-naïve and 102/118 (86.5%) had non-suspicious rectal examination. All patients had MRI-directed microUS-guided biopsy using a 29-MHz transducer. All lesions visible on micro-ultrasound (microUS+) were targeted without image fusion, which was only used for MRI+/microUS- lesions. Significant prostate cancer (sPCa) was defined by a Gleason score ≥ 7 or a maximum cancer core length > 3 mm. RESULTS A total of 144 focal prostatic lesions were analyzed, including 114 (114/144, 79.2%) MRI+/microUS+ lesions, 13 MRI+/microUS- lesions (13/144, 9%), and 17 MRI-/microUS+ lesions (17/144, 11.8%). Significant PCa was detected in 70 MRI+/microUS+ lesions (70/114, 61.4%), in no MRI+/microUS- lesion (0/13, 0%), and in 4 MRI-/microUS+ lesions (4/17, 23.5%). The sensitivity and specificity of microUS on a per-patient and a per-lesion basis were 100% (95% CI, 84.9-100%) and 22.8% (95% CI, 12.5-35.8%) and 100% (95% CI, 85.1-100%) and 22.6% (95% CI, 12.3-36.2%), respectively. CONCLUSION MicroUS, as a second-look examination, may show promise to localize targets detected on bp-MRI. KEY POINTS • Used as a second-look examination, microUS-guided biopsies have a 100% detection rate of sCa originating in the PZ or lower third of the TZ, without microUS-MRI image fusion. • MicroUS results may provide additional information about lesions visible on MRI. • MicroUS may provide the ability to detect small PZ lesions undetected by bp-MRI.
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Affiliation(s)
- François Cornud
- Department of Radiology, Clinique de l'Alma, Paris, France. .,Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France.
| | - Arnaud Lefevre
- Department of Radiology, Clinique de l'Alma, Paris, France
| | - Thierry Flam
- Department of Urology, Clinique St Jean de Dieu, Paris, France
| | | | - Marc Galiano
- Department of Urology, Clinique de l'Alma, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France.,Université de Paris Descartes Paris V, Paris, France
| | | | - Matthias Barral
- Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France
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Neuzillet Y, Dreyfus J, Rouanne M, Raynaud J, Schneider M, Rouprêt M, Drouin S, Galiano M, Cathelineau X, Lebret T, Botto H. Statut gonadique des cancers de prostate localisé et prise de statines. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rouanne M, Neuzillet Y, Dreyfus J, Raynaud J, Schenider M, Roupret M, Drouin S, Galiano M, Cathelineau X, Lebret T, Botto H. Qualité de vie des patients après prostatectomie totale : résultats de l’étude ANDROCAN. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Galiano M, Miah S, Akinbami O, Gonzalez Gonoggia S, Ellis J, Zambon M. A29 Genetic heterogeneity of influenza A (H3N2) viruses in the United Kingdom, 2016–8. Virus Evol 2019. [PMCID: PMC6735920 DOI: 10.1093/ve/vez002.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For the last four influenza seasons in the UK, genetic characterization of seasonal influenza viruses has shifted from single hemagglutinin (HA) and neuraminidase (NA) genes to whole genome (WG) analysis, allowing for better insight into the evolutionary dynamics of this virus. Sequences (WG or HA/NA) were obtained from >900A (H3N2) viruses sampled in the UK during influenza seasons 2016/7 and 2017/8 and the inter-seasonal period. Viral RNA was extracted from clinical samples and amplified using a multi-segment RT-PCR. Amplicons were sequenced using Nextera library preparation for Illumina MiSeq sequencing. Sequence data ????were processed using BAM-SAM tools and PHE in-house scripts. Phylogenetic analysis of the HA gene indicates that they belong to genetic group 3C.2a, which has circulated since 2014. Season 2016/7 was characterized by the emergence of cluster 3C.2a.1; further genetic heterogeneity was seen with 6 new subclusters within 3C.2a and 3C.2a.1, with predominance of those characterized by amino acid changes N121K and S144K (3C.2a) and N121K, N171K, I406K, G484E (3C.2a.1). The NA genes clustered with a similar topology to the HA. Season 2017/8 was characterized by persistence of some clades from previous season with further diversification. Three of the 3C.2a clusters continued to circulate, with predominance of clade showing T131K, R142K, and R261Q (clade 3C.2a.2). The majority of HA sequences in 3C.2a1 fall into a new subcluster which has become predominant within this subgroup, with amino acid changes E62G, K92R, and T135K (3C.2a.1b). The topology of NA and internal gene trees showed evidence of reassortment events occurring at some point between the two seasons, with group 3C.2a2 acquiring NA and some internal genes from 3C.2a1 lineage viruses. The predominance of this group during 2017–8 might be due to fitness advantage related to the new genetic constellation. Emerging viruses from group 3C.3a also have acquired genes from lineage 3C.2a1, which could be the reason for their increased frequency to 20 per cent by the end of season 2017–8. Molecular epidemiology indicates emerging genetic diversity in A(H3N2) viruses during the period of study, leading to co-circulation of variants. The frequency of circulating HA genetic groups was quite variable, with rapidly changing patterns of predominance. Evidence of reassortment events was observed which could be responsible for the rise and predominance of some clades, and might predict the emergence of other variants.
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Affiliation(s)
- M Galiano
- Respiratory Virus Unit (National Influenza Centre), Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - S Miah
- Respiratory Virus Unit (National Influenza Centre), Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - O Akinbami
- Respiratory Virus Unit (National Influenza Centre), Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - S Gonzalez Gonoggia
- Respiratory Virus Unit (National Influenza Centre), Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - J Ellis
- Respiratory Virus Unit (National Influenza Centre), Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - M Zambon
- Respiratory Virus Unit (National Influenza Centre), Virus Reference Department, National Infection Service, Public Health England, London, UK
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Senguttuvan Karthikeyan V, Mallya A, Sivaraman A, Galiano M, Rozet F, Cathala N, Barret E, Mombet A, Prapotnich D, Sanchez-Salas R, Cathelineau X. Oncological outcomes and pathological characteristics of cT1 upstaging to pT3a renal cell carcinoma compared with de novo pT3a tumors. Actas Urol Esp 2019; 43:234-240. [PMID: 30857765 DOI: 10.1016/j.acuro.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The significance of upstaging of cT1 renal tumors to pT3a is not clear. We evaluate the incidence of upstaging, identify predictors and analyze oncological outcomes of these patients versus those who did not upstage. We also compared the oncological outcomes of cT1 upstaging to pT3a with de novo pT3a renal tumors. METHODS From a database of 1021 renal tumors with complete available follow-up data, 517 patients had cT1. Patients upstaging to pT3a were compared to those who did not. Baseline clinical, perioperative, histopathologic features and oncological outcomes were analysed. RESULTS Out of 517 cT1 patients, 105 (20.3%) upstaged to pT3a and 412 (79.7%) did not. Proportion of patients in each group undergoing partial and radical nephrectomy, postoperative tumor size, histology, margin status and lymph node involvement were similar. Among upstaged, 9 patients (8.6%) developed first recurrence as compared to only 3 (0.7%) in those not upstaging (P <0.001). The median time to recurrence (57 vs. 107 months; P <0.001) was lesser in de novo pT3a renal tumors. CONCLUSIONS Pathological upstaging from cT1 to pT3a and necrosis on histopathology were associated with recurrence. Advanced age, smoking, necrosis on histopathology, clear cell histology and higher Fuhrman grades contributed to pathological upstaging of cT1 tumors. De novo pT3a RCC had worse survival when compared to cT1 patients upstaging to pT3a RCC.
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Neuzillet Y, Raynaud JP, Dreyfus JF, Radulescu C, Rouanne M, Schneider M, Krish S, Rouprêt M, Drouin SJ, Comperat E, Galiano M, Cathelineau X, Validire P, Molinié V, Fiet J, Giton F, Lebret T, Botto H. Aggressiveness of Localized Prostate Cancer: the Key Value of Testosterone Deficiency Evaluated by Both Total and Bioavailable Testosterone: AndroCan Study Results. Discov Oncol 2018; 10:36-44. [PMID: 30293206 DOI: 10.1007/s12672-018-0351-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/28/2018] [Indexed: 12/23/2022] Open
Abstract
Failure rates after first-line treatment of localized prostate cancer (PCa) treatment remain high. Improvements to patient selection and identification of at-risk patients are central to reducing mortality. We aimed to determine if cancer aggressiveness correlates with androgen levels in patients undergoing radical prostatectomy for localized PCa. We performed a prospective, multicenter cohort study between June 2013 and June 2016, involving men with localized PCa scheduled to undergo radical prostatectomy. Clinical and hormonal patient data (testosterone deficiency, defined by total testosterone (TT) levels < 300 ng/dL and/or bioavailable testosterone (BT) levels < 80 ng/dL) were prospectively collected, along with pathological assessment of preoperative biopsy and subsequent radical prostatectomy specimens, using predominant Gleason pattern (prdGP) 3/4 grading. Of 1343 patients analyzed, 912 (68%) had prdGP3 PCa and 431 (32%) had high-grade (prdGP4, i.e., ISUP ≥ 3) disease on prostatectomy specimens. Only moderate concordance in prdGP scores between prostate biopsies and prostatectomy specimens was found. Compared with patients with prdGP3 tumors (i.e., ISUP ≤ 2), significantly more patients with prdGP4 cancers had demonstrable hypogonadism, characterized either by BT levels (17.4% vs. 10.7%, p < 0.001) or TT levels (14.2% vs. 9.7%, p = 0.020). BT levels were also lower in patients with prdGP4 tumors compared to those with prdGP3 disease. Testosterone deficiency (defined by TT and/or BT levels) was independently associated with higher PCa aggressiveness. BT is a predictive factor for prdGP4 disease, and evaluating both TT and BT to define hypogonadism is valuable in preoperative assessment of PCa (AndroCan Trial: NCT02235142).
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Affiliation(s)
- Yann Neuzillet
- Department of Urology, Hôpital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 Rue Worth, 92150, Suresnes, France.
| | | | - Jean-François Dreyfus
- Department of Clinical Research and Innovation, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | | | - Mathieu Rouanne
- Department of Urology, Hôpital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 Rue Worth, 92150, Suresnes, France
| | - Marc Schneider
- Department of Urology, Louis Pasteur Hospital, Colmar, France
| | - Sylvie Krish
- Department of Pathology, Louis Pasteur Hospital, Colmar, France
| | - Morgan Rouprêt
- Department of Urology, Pitié Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Sarah J Drouin
- Department of Urology, Pitié Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Eva Comperat
- Department of Pathology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - Pierre Validire
- Department of Pathology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - Vincent Molinié
- Department of Pathology, Centre Hospitalier de Martinique, Le Lamentin, France
| | - Jean Fiet
- Inserm U955, Eq07, Recherches Translationnelles en oncogenèse génitale, Créteil, France
| | - Franck Giton
- Inserm U955, Eq07, Recherches Translationnelles en oncogenèse génitale, Créteil, France
| | - Thierry Lebret
- Department of Urology, Hôpital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 Rue Worth, 92150, Suresnes, France
| | - Henry Botto
- Department of Urology, Hôpital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 Rue Worth, 92150, Suresnes, France
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Tourinho-Barbosa R, Srougi V, Nunes-Silva I, Baghdadi M, Rembeyo G, Eiffel SS, Barret E, Rozet F, Galiano M, Cathelineau X, Sanchez-Salas R. Biochemical recurrence after radical prostatectomy: what does it mean? Int Braz J Urol 2018; 44:14-21. [PMID: 29039897 PMCID: PMC5815528 DOI: 10.1590/s1677-5538.ibju.2016.0656] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/02/2017] [Indexed: 01/19/2023] Open
Abstract
Background Radical prostatectomy (RP) has been used as the main primary treatment for prostate cancer (PCa) for many years with excellent oncologic results. However, approximately 20-40% of those patients has failed to RP and presented biochemical recurrence (BCR). Prostatic specific antigen (PSA) has been the pivotal tool for recurrence diagnosis, but there is no consensus about the best PSA threshold to define BCR until this moment. The natural history of BCR after surgical procedure is highly variable, but it is important to distinguish biochemical and clinical recurrence and to find the correct timing to start multimodal treatment strategy. Also, it is important to understand the role of each clinical and pathological feature of prostate cancer in BCR, progression to metastatic disease and cancer specific mortality (CSM). Review design A simple review was made in Medline for articles written in English language about biochemical recurrence after radical prostatectomy. Objective To provide an updated assessment of BCR definition, its meaning, PCa natural history after BCR and the weight of each clinical/pathological feature and risk group classifications in BCR, metastatic disease and CSM.
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Affiliation(s)
- Rafael Tourinho-Barbosa
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.,Divisão de Urologia, Faculdade de Medicina ABC, São Paulo, Brasil
| | - Victor Srougi
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.,Divisão de Urologia, Universidade de São Paulo, São Paulo, Brasil
| | - Igor Nunes-Silva
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Gregory Rembeyo
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Sophie S Eiffel
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Eric Barret
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Francois Rozet
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
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Bakavicius A, Sanchez-Salas R, Dell'Oglio P, Garcia-Barreras S, Castro-Alfaro A, Rozet F, Ingels A, Barret E, Galiano M, Sapetti J, Mombet A, Cathala N, Prapotnich D, Cathelineau X. PD34-06 COMPREHENSIVE EVALUATION OF COMPLICATIONS OF FOCAL THERAPY: A STANDARDIZED METHODOLOGY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Garcia-Barreras S, Sanchez-Salas R, Sivaraman A, Barret E, Secin F, Nunes-Silva I, Linares-Espinós E, Rozet F, Galiano M, Cathelineau X. Comparative Analysis of Partial Gland Ablation and Radical Prostatectomy to Treat Low and Intermediate Risk Prostate Cancer: Oncologic and Functional Outcomes. J Urol 2018; 199:140-146. [DOI: 10.1016/j.juro.2017.08.076] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Silvia Garcia-Barreras
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - Igor Nunes-Silva
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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Capogrosso P, Barret E, Sanchez-Salas R, Nunes-Silva I, Rozet F, Galiano M, Ventimiglia E, Briganti A, Salonia A, Montorsi F, Cathelineau X. Oncological and functional outcomes of elderly men treated with HIFU vs. minimally invasive radical prostatectomy: A propensity score analysis. Eur J Surg Oncol 2017; 44:185-191. [PMID: 29223469 DOI: 10.1016/j.ejso.2017.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/24/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022] Open
Abstract
AIM To assess outcomes of whole gland high-intensity focused ultrasound (HIFU) as compared with minimally-invasive radical prostatectomy (MIRP) in elderly patients. MATERIALS & METHODS Patients aged ≥70 years with, cT1-cT2 disease, biopsy Gleason score (GS) 3 + 3 or 3 + 4 and preoperative PSA ≤10 ng/mL were submitted to either whole-gland HIFU or MIRP. Propensity-score matching analysis was performed to ensure the baseline equivalence of groups. Follow-up visits were routinely performed assessing PSA and urinary function according to the International Continence Score (ICS) and the International Prostatic Symptoms Score (IPSS) questionnaires. Estimated rates of salvage-treatment free survival (SFS) overall-survival (OS), cancer-specific survival (CSS) and metastasis-free survival (MTS) were assessed and compared. RESULTS Overall, 84 (33.3%) and 168 (66.7%) patients were treated with HIFU and MIRP, respectively. MIRP was associated with a 5-yrs SFS of 93.4% compared to 74.8% for HIFU (p < 0.01). The two groups did not differ in terms of OS and MTS. No cancer-related deaths were registered. Patients treated with HIFU showed better short-term (6-mos) continence outcomes [mean-ICS: 1.7 vs. 4.8; p = 0.005] but higher IPSS mean scores at 12-mos assessment. A comparable rate of patients experiencing post-treatment Clavien-Dindo grade ≥III complications was observed within the two groups. CONCLUSIONS Whole-gland HIFU is a feasible treatment in elderly men with low-to intermediate-risk PCa and could be considered for patients either unfit for surgery, or willing a non-invasive treatment with a low morbidity burden, although a non-negligible risk of requiring subsequent treatment for recurrence should be expected.
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Affiliation(s)
- Paolo Capogrosso
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy; Institut Mutualiste Montsouris, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | - Eugenio Ventimiglia
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy
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Redondo C, Srougi V, da Costa JB, Baghdad M, Velilla G, Nunes-Silva I, Bergerat S, Garcia-Barreras S, Rozet F, Ingels A, Galiano M, Sanchez-Salas R, Barret E, Cathelineau X. Focal cryotherapy: step by step technique description. Int Braz J Urol 2017; 43:995-996. [PMID: 28727387 PMCID: PMC5678538 DOI: 10.1590/s1677-5538.ibju.2016.0664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/20/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Focal cryotherapy emerged as an efficient option to treat favorable and localized prostate cancer (PCa). The purpose of this video is to describe the procedure step by step. MATERIALS AND METHODS We present the case of a 68 year-old man with localized PCa in the anterior aspect of the prostate. RESULTS The procedure is performed under general anesthesia, with the patient in lithotomy position. Briefly, the equipament utilized includes the cryotherapy console coupled with an ultrasound system, argon and helium gas bottles, cryoprobes, temperature probes and an urethral warming catheter. The procedure starts with a real-time trans-rectal prostate ultrasound, which is used to outline the prostate, the urethra and the rectal wall. The cryoprobes are pretested and placed in to the prostate through the perineum, following a grid template, along with the temperature sensors under ultrasound guidance. A cystoscopy confirms the right positioning of the needles and the urethral warming catheter is installed. Thereafter, the freeze sequence with argon gas is started, achieving extremely low temperatures (-40ºC) to induce tumor cell lysis. Sequentially, the thawing cycle is performed using helium gas. This process is repeated one time. Results among several series showed a biochemical disease-free survival between 71-93% at 9-70 month- follow-up, incontinence rates between 0-3.6% and erectile dysfunction between 0-42% (1-5). CONCLUSIONS Focal cryotherapy is a feasible procedure to treat anterior PCa that may offer minimal morbidity, allowing good cancer control and better functional outcomes when compared to whole-gland treatment.
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Affiliation(s)
- Cristina Redondo
- Hospital Universitario de Getafe - Servicio de Urología, Getafe, Spain
| | - Victor Srougi
- Hospital das Clínicas da Faculdade de Medicina da USP - Urologia, São Paulo, Brasil
| | - José Batista da Costa
- Institut Mutualiste Montsouris Ringgold standard institution, Paris, Île-de-France, France
| | | | - Guillermo Velilla
- Institut Mutualiste Montsouris Ringgold standard institution, Paris, Île-de-France, France
| | - Igor Nunes-Silva
- Institut Mutualiste Montsouris Ringgold standard institution, Paris, Île-de-France, France
| | - Sebastien Bergerat
- Institut Mutualiste Montsouris Ringgold standard institution, Paris, Île-de-France, France
| | - Silvia Garcia-Barreras
- Institut Mutualiste Montsouris Ringgold standard institution, Paris, Île-de-France, France
| | - François Rozet
- Institut Mutualiste Montsouris Ringgold standard institution, Paris, Île-de-France, France
| | | | - Marc Galiano
- L'Institut Mutualiste Montsouris - Urology, Paris, France
| | | | - Eric Barret
- L'Institut Mutualiste Montsouris - Urology, Paris, France
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Bergerat S, Rozet F, Barret E, Batista da Costa J, Galiano M, Ingels A, Sanchez Salas R, Cathelineau X. Technique modifiée de York Mason pour la cure de fistule urétro rectale iatrogène. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nunes-Silva I, Barret E, Srougi V, Baghdadi M, Capogrosso P, Garcia-Barreras S, Kanso S, Tourinho-Barbosa R, Carneiro A, Sanchez-Salas R, Rozet F, Galiano M, Cathelineau X. Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy. J Urol 2017; 198:1069-1076. [DOI: 10.1016/j.juro.2017.05.071] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Igor Nunes-Silva
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Victor Srougi
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mohammed Baghdadi
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Paolo Capogrosso
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan, Italy
| | - Silvia Garcia-Barreras
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Solange Kanso
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Ariê Carneiro
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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Barret E, Sanchez-Salas R, Galiano M, Cathala N, Mombet A, Prapotnich D, Rozet F, Gangi A, Lang H, Cathelineau X. [Management of ablative therapies in prostate cancer]. Prog Urol 2017; 27:909-925. [PMID: 28918872 DOI: 10.1016/j.purol.2017.07.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the specific modalities of ablative therapies management in prostate cancer. MATERIALS AND METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 61 articles were analysed. RESULTS Development of innovations such as ablative therapies in prostate cancer induces specific modalities in their management, during pre-, per- and post-procedure. More than for classical and well-known treatments, the decision to propose an ablative therapy requires analysis and consensus of medical staff and patient's agreement. Patient's specificities and economical aspects must also be considered. Procedures and follow-up must be realized by referents actors. CONCLUSION Indication, procedure and follow-up of ablative therapies in prostate cancer require specific modalities. They must be respected in order to optimize the results and to obtain a precise and objective evaluation for defining future indications.
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Affiliation(s)
- E Barret
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - R Sanchez-Salas
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - M Galiano
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - N Cathala
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Mombet
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - D Prapotnich
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - F Rozet
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Gangi
- Service de radiologie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France.
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Abstract
Frosted branch angiitis is a special form of retinal vasculitis, which has only rarely been reported in the literature. Although the majority of cases of frosted branch angiitis are idiopathic, a systematic clinical work-up should be done in order to exclude other causes, such as infectious and autoimmune diseases. The aim of this study was to correlate the clinical findings with the images obtained during follow-up by spectral domain optical coherence tomography (OCT).
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Affiliation(s)
- A Bergua
- Augenklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland.
| | - M Galiano
- Kinderklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - B Hohberger
- Augenklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - M Rudolph
- Augenklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland
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Srougi V, Barret E, Nunes-Silva I, Baghdadi M, Garcia-Barreras S, Pierrat N, Rozet F, Galiano M, Sanchez-Salas R, Cathelineau X, Cosset JM. Focal brachytherapy for localized prostate cancer: Urinary toxicity depends on tumor location. Brachytherapy 2017. [DOI: 10.1016/j.brachy.2017.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Palazzetti A, Sanchez-Salas R, Capogrosso P, Barret E, Cathala N, Mombet A, Prapotnich D, Galiano M, Rozet F, Cathelineau X. Systematic review of perioperative outcomes and complications after open, laparoscopic and robot-assisted radical cystectomy. Actas Urol Esp 2017; 41:416-425. [PMID: 27908634 DOI: 10.1016/j.acuro.2016.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 11/30/2022]
Abstract
Radical cystectomy and regional lymph node dissection is the standard treatment for localized muscle-invasive and for high-risk non-muscle-invasive bladder cancer, and represents one of the main surgical urologic procedures. The open surgical approach is still widely adopted, even if in the last two decades efforts have been made in order to evaluate if minimally invasive procedures, either laparoscopic or robot-assisted, might show a benefit compared to the standard technique. Open radical cystectomy is associated with a high complication rate, but data from the laparoscopic and robotic surgical series failed to demonstrate a clear reduction in post-operative complication rates compared to the open surgical series. Laparoscopic and robotic radical cystectomy show a reduction in blood loss, in-hospital stay and transfusion rates but a longer operative time, while open radical cystectomy is typically associated with a shorter operative time but with a longer in-hospital admission and possibly a higher rate of high grade complications.
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Affiliation(s)
- A Palazzetti
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - R Sanchez-Salas
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia.
| | - P Capogrosso
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - E Barret
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - N Cathala
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - A Mombet
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - D Prapotnich
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - M Galiano
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - F Rozet
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
| | - X Cathelineau
- Departamento de Urología, L'Institute Mutualiste Montsouris, París, Francia
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Audenet F, Rozet F, Resche-Rigon M, Bernard R, Ingels A, Prapotnich D, Sanchez-Salas R, Galiano M, Barret E, Cathelineau X. Grade Group Underestimation in Prostate Biopsy: Predictive Factors and Outcomes in Candidates for Active Surveillance. Clin Genitourin Cancer 2017; 15:e907-e913. [PMID: 28522288 DOI: 10.1016/j.clgc.2017.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We intended to analyze the outcomes and predictive factors for underestimating the prostate cancer (PCa) grade group (GG) from prostate biopsies in a large monocentric cohort of patients treated by minimally invasive radical prostatectomy (RP). MATERIALS AND METHODS Using a monocentric prospectively maintained database, we included 3062 patients who underwent minimally invasive RP between 2006 and 2013. We explored clinicopathologic features and outcomes associated with a GG upgrade from biopsy to RP. Multivariate logistic regression was used to develop and validate a nomogram to predict upgrading for GG1. RESULTS Biopsy GG was upgraded after RP in 51.5% of cases. Patients upgraded from GG1 to GG2 or GG3 after RP had a longer time to biochemical recurrence than those with GG2 or GG3 respectively, on both biopsy and RP, but a shorter time to biochemical recurrence than those who remained GG1 after RP (P < .0001). In multivariate analyses, variables predicting upgrading for GG1 PCa were age (P = .0014), abnormal digital rectal examination (P < .0001), prostate-specific antigen density (P < .0001), percentage of positive cores (P < .0001), and body mass index (P = .037). A nomogram was generated and validated internally. CONCLUSIONS Biopsy grading system is misleading in approximately 50% of cases. Upgrading GG from biopsy to RP may have consequences on clinical outcomes. A nomogram using clinicopathologic features could aid the probability of needing to upgrade GG1 patients at their initial evaluation.
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Affiliation(s)
- François Audenet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
| | - Matthieu Resche-Rigon
- Department of Biostatistics, Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - Rémy Bernard
- Department of Biostatistics, Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - Alexandre Ingels
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Dominique Prapotnich
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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Srougi V, Barret E, Baghdadi M, Nunes-Silva I, Garcia-Barreras S, Rembeyo G, Rozet F, Galiano M, Sanchez-Salas R, Cosset J, Cathelineau X. PD72-09 EARLY OUTCOMES OF FOCAL BRACHYTHERAPY FOR LOCALIZED PROSTATE CANCER: COMPARISON WITH WHOLE GLAND BRACHYTHERAPY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Botto H, Neuzillet Y, Schneider M, Rouprêt M, Drouin S, Galiano M, Cathelineau X, Molinié V, Radulescu C, Comperat E, Giton F, Fiet J, Lebret T, Raynaud JP. PD33-10 PREOPERATIVE SEX HORMONES PROFILES AND PATHOLOGICAL FEATURES OF LOCALIZED PROSTATE CANCER ARE RELATED TO BOTH TOTAL AND BIOAVAILABLE TESTOSTERONE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sivaraman A, Sanchez-Salas R, Prapotnich D, Yu K, Olivier F, Secin FP, Barret E, Galiano M, Rozet F, Cathelineau X. Learning curve of minimally invasive radical prostatectomy: Comprehensive evaluation and cumulative summation analysis of oncological outcomes. Urol Oncol 2017; 35:149.e1-149.e6. [DOI: 10.1016/j.urolonc.2016.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/08/2016] [Accepted: 10/23/2016] [Indexed: 12/30/2022]
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Nunes-Silva I, Barret E, Baghdadi M, Srougi V, Garcia-Barreras S, Carneiro A, Capogrosso P, Rembeyo G, Sanchez-Salas R, Rozet F, Galiano M, Cathelineau X. PD56-06 NEW FRONTIERS AHEAD FOCAL THERAPY POSTOPERATIVE FOLLOW-UP: WHAT IS THE REAL ROLE OF MRI IN THIS SETTING? J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Saad M. M, Sanchez-Salas R, Barret E, Galiano M, Rozet F, Cathala N, Mombet A, Prapotnich D, Cathelineau X, Saad M. M, Sanchez-Salas R, Barret E, Galiano M, Rozet F, Cathala N, Mombet A, Prapotnich D, Cathelineau X. PD67-03 THE ONCOLOGICAL IMPACT OF TRANSURETHRAL ENDOSCOPIC RESECTION OF THE PROSTATE VERSUS MILLIN'S ADENOMECTOMY IN PROSTATE SPARING CYSTECTOMY CASES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Carneiro A, Sivaraman A, Sanchez-Salas R, Nunes-Silva I, Baghdadi M, Srougi V, di Trapani E, Uriburu Pizzaro F, Doizi S, Barret E, Rozet F, Galiano M, Cathelineau X. Higher number of transrectal ultrasound guided prostate biopsy cores is associated with higher blood loss and perioperative complications in robot assisted radical prostatectomy. Actas Urol Esp 2017; 41:155-161. [PMID: 27890493 DOI: 10.1016/j.acuro.2016.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 08/12/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy. OBJECTIVES To evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP). MATERIAL AND METHODS A prospectively maintained database of 2,054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications. RESULTS A total number of 1,042 patients in the group 1 (≤12 cores) and 1,012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; P=.03), but high grade complication (Clavien 3-4) were similar (G1 1.4 vs. G2 2.2%; P=.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; P=.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP. CONCLUSION Higher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results.
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Garcia-Barreras S, Sanchez-Salas R, Nunes-Silva I, Secin F, Srougi V, Baghdadi M, Barret E, Rozet F, Galiano M, Cathelineau X. PD51-09 CONDITIONAL PROBABILITY OF BIOCHEMICAL RECURRENCE-FREE SURVIVAL AND CANCER-SPECIFIC MORTALITY AFTER RADICAL PROSTATECTOMY AT LONG TERM FOLLOW-UP. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Saad M. M, Sanchez-Salas R, Barret E, Galiano M, Rozet F, Cathala N, Mombet A, Prapotnich D, Cathelineau X. PD67-01 LONG-TERM FUNCTIONAL OUTCOMES AND MORBIDITY OF PROSTATE SPARING CYSTECTOMY VERSUS CYSTOPROSTATECTOMY: A CASE CONTROLLED STUDY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lizée D, Salas R, Barret E, Galiano M, Di Trapani E, Montorsi F, Cathelineau X. Impact of neoadjuvant chemotherapy on complications of minimally invasive radical cystectomy. Actas Urol Esp 2017; 41:88-96. [PMID: 27908636 DOI: 10.1016/j.acuro.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/12/2016] [Accepted: 05/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NC) before minimally invasive radical cystectomy (MIRC) is considered a standard of care in muscle-invasive bladder cancer or recurrent high-risk non-muscle-invasive bladder cancer. OBJECTIVE To evaluate the impact of NC on morbidity and mortality after MIRC. DESIGN, SETTING, AND PARTICIPANTS We prospectively evaluated 135 patients who underwent MIRC (laparoscopic: n=100; robotic: n=35) between 2007 and 2013 with ≥90 days of follow-up (median age: 66 year). Complications were analyzed and graded according to the Clavien Dindo classification system. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression models were used to evaluate the impact of NC on postoperative complications. Kaplan-Meier methods with the log-rank test were used for cancer-specific survival probabilities and differences between the 2groups (MIRC with and without NC). RESULTS AND LIMITATIONS Sixty-two of 135 patients received NC. A total of 118 patients (87.4%) developed 179 complications, chiefly infectious (48.0%) or gastrointestinal (21.2%), ≤90 days after surgery; 3 patients died <90 days after cystectomy (none had NC). NC had no impact on the incidence of postoperative complications but was associated with fewer positive nodes (P=.004) compared with patients without NC. The median duration of follow-up was 17.2 months. Overall survival rates were 83% and 79% at 2 year in patients with NC and without NC, respectively. CONCLUSIONS NC does not affect postoperative morbidity or postoperative mortality. Longer follow-up is needed to evaluate the impact of NC on oncologic outcomes. PATIENT SUMMARY Perioperative complications of radical cystectomy were compared for patients with bladder cancer who had NC versus no NC. We did not find any significant differences in terms of early or late complications, length of stay, or reintervention. The oncologic outcomes regarding NC were encouraging.
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Srougi V, Tourinho-Barbosa RR, Nunes-Silva I, Baghdadi M, Garcia-Barreras S, Rembeyo G, Eiffel SS, Barret E, Rozet F, Galiano M, Sanchez-Salas R, Cathelineau X. The Role of Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer. J Endourol 2017; 31:229-237. [DOI: 10.1089/end.2016.0659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Victor Srougi
- Department of Urology, Institut Montsouris, Paris, France
- Division of Urology, University of Sao Paulo, Sao Paulo, Brazil
| | - Rafael R. Tourinho-Barbosa
- Department of Urology, Institut Montsouris, Paris, France
- Division of Urology, ABC Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Eric Barret
- Department of Urology, Institut Montsouris, Paris, France
| | - Francois Rozet
- Department of Urology, Institut Montsouris, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Montsouris, Paris, France
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Barreras SG, Sanchez-Salas R, Nunes-Silva I, Secin FP, Srougi V, Baghdadi M, Barret E, Rozet F, Galiano M, Cathelineau X. Conditional biochemical recurrence-free survival and cancer-specific mortality after radical prostatectomy at long term follow-up. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
55 Background: To estimate the conditional biochemical recurrence-free survival (BCR) rates and cancer-specific mortality (CSM) for men with clinically localized prostate cancer (PCa) treated with radical prostatectomy (RP) at our institution. Methods: A total of 3576 patients underwent laparoscopic radical prostatectomy (LARP) and 2619 men were treated with robotic radical prostatectomy (RARP) in the last 15 years. BCR of primary treatment was defined as PSA > 0.2 ng/dl. PCa death was defined as patients who died with metastasis in an androgen independent setting. Kaplan-Meier and Cox regression methods were used to estimate the conditional survival probabilities and CSM. Results: The median follow-up was 8.49 years (IQR 4.01-12.97). A total of 92 (1.48%) patients (80 LARP and 12 RARP) died of disease. Positive surgical margins (PSM) were identified in 1202 patients (19.4%); of these, 664 (55.24%) had organ confined disease and 523 (43.51%) had extraprostatic extension (EPE). BCR-free survival rate was found significantly higher with RARP (83% vs 77% for LARP at 10 years; p < 0.001). For patients with PSA < 10 ng/dl BCR-free survival at 10 years was 80% vs 64% for PSA 10-20 ng/dl, and 59% for PSA > 20ng/dl; p > 0.001. Conditional probability of BCR after surgery 1st year was 6.7%. Those who reach the 2nd year of surgery without recurrence had a relapse probability of 4%, (cumulative probability 9.8%) That probability falls to 3.5% after the 3rd year (cumulative probability 13%), 2% after the 4th year (cumulative probability 15%) and is 2.1% after the 5th year (cumulative probability 17%). After 10 years of follow-up without recurrence, the possibility of relapse was 0.8%, (cumulative probability 21%). Men without BCR had a clinical trend of higher CSM at 10 years (7% vs 2% no BCR; p 0.06). Within the patients who develop BCR, those with BCR in the first three years of follow-up had higher CSM (9% vs 4% for BCR after 3 years; p 0.04). Conclusions: BRC free survival outcomes are affected by risk factors associated with type of surgery and prognosis in PCa. The period elapsed from RP is associated with BCR-free survival and the risk of recurrence decrease with increasing survival.
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Affiliation(s)
| | | | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Fernando P. Secin
- CEMIC University Hospital and San Lazaro Foundation, Capital Federal, Argentina
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - François Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Barreras SG, Nunes-Silva I, Sanchez-Salas R, Secin FP, Srougi V, Baghdadi M, Barret E, Rozet F, Galiano M, Cathelineau X. Defining predictors of early, intermediate, and late biochemical recurrence in men with clinically localized prostate cancer treated with minimally invasive radical prostatectomy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
113 Background: Follow up after radical prostatectomy should be tailored to clinical and pathologic characteristics. To determine predictive factors for early, intermediate and late biochemical recurrence (BCR) after minimally invasive radical prostatectomy (MIRP: lap and robot) in patients with localized prostate cancer (PCa). Methods: Prospective clinical, pathologic, and outcome data were collected for 6195 patients with cT1-3N0M0 PCa treated with MIRP at our institution from 2000 to 2016. None of them received neoadjuvant therapy. BCR was defined as PSA level greater than 0.2 ng/ml. Time to BCR was divided in terciles to identify variables associated with early ( < 12 months), intermediate (12-36 months) and late BCR ( > 36 months). Comparisons among groups were performed using ANOVA or Chi square test. Logistic regression models were built to determine risk factors associated with BCR at each time interval. Results: We identified 1148 (19%) patients with BCR. Median time to BCR was 24 months. Statistically significant differences were found between the groups concerning PSA preoperative, D’Amico risk, type of surgery, pT stage, pathological Gleason, positive margins and extracapsular extension. Multivariable logistic regression analysis showed preoperative PSA, positive nodes, positive surgical margins and laparoscopic surgery were associated with early BCR. Laparoscopic surgery was the only risk factor associated with intermediate term BCR. Significant predictors of late BCR included Gleason ≥ 7, ≥ pT3, positive surgical margins, lymph node dissection performance and laparoscopic surgery. Conclusions: Patients with high risk features like Gleason ≥ 7, ≥ pT3 and or positive surgical margins may develop late recurrence and deserve long term follow up. Identify patients with higher PSA and lymph node invasion has an important predictive role due to the risk of BCR within the first year. The association between laparoscopic technique and late BCR deserves further evaluation.
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Affiliation(s)
| | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - Fernando P. Secin
- CEMIC University Hospital and San Lazaro Foundation, Capital Federal, Argentina
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Francois Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Nunes-Silva I, Barret E, Srougi V, Baghdadi M, Barreras SG, Capogrosso P, Rembeyo G, Carneiro A, Sanchez-Salas R, Rozet F, Galiano M, Cathelineau X. Can focal therapy impact perioperative, oncological, and functional outcomes in men who underwent focal therapy salvage robotic-assisted radical prostatectomy? A retrospective matched-pair comparative study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
76 Background: Salvage surgery is an option for recurrent prostate cancer(PCa) after focal therapy(FT). This is the first study to assess the impact of FT on surgical outcomes comparing salvage robotic-assisted radical prostatectomy(S-RARP) versus primary-RARP(P-RARP). We aimed to compare the impact of FT on perioperative, oncological and functional outcomes in men underwent S-RARP versus P-RARP. Methods: Prospective data of 2775 men underwent RARP for localized PCa from 2000 to 2016 were reviewed. Twenty-five men underwent S-RARP after FT failure(S-RARP group). Total 2750 underwent RARP as primary treatment. Matched-pair 1:2 selection of 44 out of 2750 patients by age, IPSS and IIEF5 defined P-RARP group. Primary endpoint was between-groups differences on functional outcomes. Secondary endpoint was oncological data. p < 0.05 was significant. Results: Surgical time, transfusion and complication rates were comparable(p > 0.05). Rates of continence probability[49.5%(SE 0.13) versus 62.4%(SE 0.08), p = 0.8 and 73%(SE 0.14) versus 76.5%(SE 0.07), p = 0.8, at 1 and 2 years, respectively] and the chance for achieving continence[HR 1.062, 95%CI 0.54-2.08, p = 0.861] were comparable between-groups. Potency recovery was significant lower on S-RARP[3±2 versus 9.22±6.55, p = 0.008]. S-RARP showed significant lower rates of cumulative BCR-free survival probability[67.6%(SE 0.12) versus 95.1%(SE 0.03), p = 0.001 and 56.3%(SE 0.15) versus 92.4%(SE 0.04), p = 0.001, at 1 and 2 years, respectively]. S-RARP presented significant increased risk of BCR[HR 4.8, 95%CI 1.67-13.76, p = 0.004]. Upstaging was an independent predictor factor for BCR on S-RARP[HR 14.65, 95%CI 1.46-146.37, p = 0.022] (Table 1). Conclusions: Salvage-RARP following FT failure is feasible and safe with acceptable complications rates. Patients assigned to FT should be previously advised about lower erectile recovery rates in case of a salvage surgery. Urologists may be warned about the risk of undertreatment in patients presenting failure along FT follow-up.
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Affiliation(s)
- Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele Universita Vita-Salute San Raffaele, Milan, Italy
| | - Gregory Rembeyo
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - François Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Barreras SG, Sanchez-Salas R, Sivaraman A, Barret E, Secin FP, Redondo C, Velilla G, Nunes-Silva I, Srougi V, Rembeyo G, Baghdadi M, Rozet F, Galiano M, Cathala N, Mombet A, Prapotnich D, Cathelineau X. Prospective comparative analysis of oncologic and functional outcomes between focal therapy and robotic radical prostatectomy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
90 Background: Focal therapy (FT) is an emerging treatment alternative for organ-confined Prostate cancer (PCa). The aim is to perform a non-randomized prospective analysis to compare oncological, functional and morbidity outcomes after FT and robotic radical prostatectomy (RARP). Methods: From July 2009 to September 2015, 1883 patients underwent RARP and 373 FT. Of those, we selected 1410 men (1222 RARP and 236 FT) according to the NCCN PCa risk classification: 402(27.5%),388(26.6%) and 668(45.8%) patients were very low risk, low risk and intermediate risk, respectively. Within FT, 188 men underwent focal high-intensity focused ultrasound (HIFU) and 48 cryotherapy. Oncologic outcomes were analyzed in terms of biochemical recurrence (BCR) free survival (Phoenix definition for FT, and PSA >0.2 ng/dl in RARP), and the need for further treatment. FT failure was defined as any positive control biopsy after treatment. Overall suvival and metastasis free survival were estimated using Cox regression and Kaplan-Meier methods. Complications were graded as Clavien-Dindo classification. Functional outcomes were assessed with validated questionnaries for genitourinary symptoms and sexual function. Results: Median follow-up was 45.4 mo (IQR: 25.3-65.5). BCR-free survival was comparable among RARP and FT ( 10.6% RARP vs 9% FT, p 0.69). Patients with intermediate risk PCa were significantly associated with BCR in both groups (HR 8.47;95% CI 4.57-15.71; p< 0.001). In FT group positive biopsy in the treated lobe was seen in 42(17.7%) men. No differences were found in overall survival, neither mestastases free survival between treatments; (p 0.85 and p 0.142 respectively). FT was associated with higher risk of further treatments (HR 5.21; 95% CI 3.7-7.35; p <0.001). FT had higher rates of complications (15.3% vs 9% for RARP, p 0.004). RARP was associated with less continence recovery vs FT at 3, 6 and 12 mo (p <0.001). Potency is higher between FT men at 3,6 and 12 mo (<p 0.001). Conclusions: For selected patients with organ confined PCa, RARP and FT offered comparable oncological control with FT requiring higher additional treatments. Potency and continency appears to be better preserved in FT patients.
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Affiliation(s)
| | | | | | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Fernando P. Secin
- CEMIC University Hospital and San Lazaro Foundation, Capital Federal, Argentina
| | - Cristina Redondo
- Institut Mutualiste Monstsouris, University Paris-Descartes, Paris, France
| | - Guillermo Velilla
- Institut Mutualiste Monstsouris, University Paris-Descartes, Paris, France
| | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Gregory Rembeyo
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - François Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Nathalie Cathala
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Annick Mombet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Dominic Prapotnich
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Baghdadi M, Barret E, Sivaraman A, Sanchez-Salas R, Nunes-Silva I, Srougi V, Ahallal Y, Rembeyo G, Barreras SG, Rozet F, Galiano M, Cathelineau X. Focal cryo-hemiablation to treat unilateral localized prostate cancer: A prospective midterm oncologic and functional outcomes. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.e537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e537 Background: We report our mid-term oncologic and functional outcomes of focal cryo-hemiablation (FC-HA) for unilateral localized low-risk prostate cancer (PCa). Methods: Prospective single-arm interventional study analyzing mid-term data of PCa patients treated at our institution with FC-HA of diseased lobe. Inclusion criteria were men with unilateral localized cancer, PSA < 15 ng/ml, clinical stage T1c-T2a, Gleason score ≤ 7 (3+4), maximum number of cancer-cores < 33%, maximum cancer involvement in a single core < 50%, no extra prostatic extension in mp-MRI, no previous PCa-related treatment and life expectancy ≥10 yr. PSA was measured every 3 mo during 1st yr post treatment, and biannually thereafter. mp-MRI and biopsy of both lobes were routinely done at 12 mo, while repeat biopsies were driven by PSA elevations. Continence, urinary and erectile functions were assessed using ICS, IPSS and IIEF-5 questionnaires, respectively. Treatment failure (primary outcome) was defined as residual cancer in treated lobe at follow up. Results: We studied 52 men with mean (SD) age of 65.8 (7.2) yrs and median (IQR) follow-up of 31 (21-44) mo. Baseline criteria were: median (IQR) of PSA of 6.8 (5.4–8.0) ng/ml, total number of cancer-cores of 2 (1-3) and percentage cancer-cores of 17% (8-25), and total cancer-core length of 7 (3-12) mm. Gleason score was 6 (3+3) in 33 (63.5%) and 7 (3+4) in 19 (36.5%) patients. Follow-up biopsies were done in 1st, 2nd and 3rd yrs for 52 (100%), 28 (53.8%) and 15 (28.8%) patients, respectively, revealing cancer-cores in 13/52 (25%) patients. 6 (11.5%), 5 (9.6%) and 2 (3.8%) patients showed cancer in ipsilateral lobe, contralateral lobe and bilaterally, respectively. Treatment failure was observed in the treated lobe in 8 (15.4%) patients. Median (IQR) PSA significantly (p < 0.0001) declined to nadir PSA of 2.9 (1.5-4.2) ng/ml (57.4% reduction) at 3 mo. None of patients demonstrated undetectable PSA. All patients maintained continence with insignificant worsening of IPSS (p <0.92) and IIEF-5 (p <0.07) and low toxicity. Conclusions: FC-HA appears to maintain acceptable oncologic control in mid-term follow-up with preserved genitourinary functions and low toxicity.
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Affiliation(s)
- Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | | | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Youness Ahallal
- Department of Urology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris ,France, Paris, France
| | - Gregory Rembeyo
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - François Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Srougi V, Sanchez-Salas R, Secin FP, Nunes-Silva I, Baghdadi M, Barreras SG, Rembeyo G, Rozet F, Galiano M, Barret E, Cathelineau X. The importance of surgical margins for biochemical recurrence in high-risk prostate cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
75 Background: High-risk prostate cancer (PCa) is associated with greater risk of biochemical recurrence and cancer specific lethality. A multi-modal treatment is required for this group of patients, comprising surgery as part of it. However, the role of surgery as monotherapy is still under investigation. The purpose of this study is to analyze the influence of surgical margins on biochemical recurrence (BCR) among patients with high-risk prostate cancer (PCa) treated with robot assisted radical prostatectomy (RARP) since the start of our robotic program. Methods: We retrospectively analyzed our prospectively collected database of 5695 minimally invasive prostatectomies performed between 2000 and 2015. Clinical, pathological and oncological outcomes were evaluated in patients fulfilling Damico´s high risk characteristics. Primary endpoint was BCR, defined as post-operative PSA ≥ 0,2. Patients with neoadjuvant or adjuvant therapy were excluded. BCR was estimated with Kaplan-Meier curves. Cox proportional hazards regression was used to estimate variables associated with BCR. Results: We identified 199 high-risk PCa patients treated with RARP during the study period. Gleason score ≥ 8, PSA ≥ 20 and clinical stage ≥ T2c were present in 44%, 35% and 11% of the patients, respectively. The rate of positive surgical margins was 25%. With a median follow-up of 23 months (interquartile 12 – 34 months), 31% of the patients had BCR. Five-year BCR-free survival was 34,5%. Gleason score ≥ 8, PSA ≥ 20 and positive surgical margins were not predictors of BCR. A positive correlation of pathological stage ≥ T3 and BCR was found with (HR = 2.9; 95% CI = 1.2-6.9). Conclusions: The 5-years BCR-free survival was poor despite a low rate of positive surgical margins, when compared to historical series. We found that pathological stage ≥ T3 has a significant correlation with the BCR and that negative surgical margins do not assure good prognosis for high-risk patients.
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Affiliation(s)
- Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | | | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - Gregory Rembeyo
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Francois Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Nunes-Silva I, Barret E, Baghdadi M, Srougi V, Barreras SG, Carneiro A, Capogrosso P, Rembeyo G, Sanchez-Salas R, Rozet F, Galiano M, Cathelineau X. New frontiers ahead focal therapy postoperative follow-up: What is the real role of MRI in this setting? J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.e539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e539 Background: Magnetic resonance imaging (MRI) plays an important role as a treatment-monitoring tool along focal therapy (FT) follow-up. This is the first study to assess MRI ability to correctly predict prostate cancer (PCa) local T-stage in the FT postoperative scenario. We aimed to describe MRI effectiveness in predicting upstaging in two groups of men: 1) men who failure after primary FT and then underwent salvage robotic-assisted radical prostatectomy (S-RARP) and 2) men who underwent RARP as primary treatment (P-RARP). Methods: Prospective data of 2775 men underwent RARP for localized PCa from 2000 to 2016 were reviewed. Twenty-two men underwent S-RARP after FT failure (S-RARP group). Total 2750 underwent RARP as first treatment. Matched-pair 1:2 selection of 44 out of 2750 patients by age defined primary RARP group (P-RARP). All patients underwent MRI immediately before RARP. MRI findings were confronted with final surgical pathology. Primary endpoint: sensitivity, specificity, positive and negative predictive values; positive (+LR) and negative (-LR) likelihood ratio regarding upstaging analysis on S-RARP. Secondary endpoint: same effectiveness analysis on P-RARP. Results: Preoperative MRI failed in predicting upstaging in 80% versus 91.7% of patients (p = 0.515) that presented final pathological status ≥ pT3a on S-RARP and P-RARP groups, respectively. On the other hand, when final pathology described a localized disease T2a-T2c, MRI correctly predicted the final pathological status in 81.8% versus 95.2% of patients (p = 0.27) on S-RARP and P-RARP groups, respectively. Between-group analysis, showed sensitivity and specificity rates of 20% versus 8.33% and 81.8% versus 95.23%, respectively; Positive and negative predictive values of 33.33% versus 50% and 69.23% versus 64.51%, respectively; Positive (+LR) and negative (-LR) likelihood ratio of 1.1 versus 1.74 and 0.98 versus 0.96, respectively. Conclusions: MRI has shown to be a weak diagnostic tool for predicting extra-prostatic disease along FT follow-up. Urologists may be warned about the risk of underdiagnosis and undertreatment in patients presenting failure after FT.
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Affiliation(s)
- Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele Universita Vita-Salute San Raffaele, Milan, Italy
| | - Gregory Rembeyo
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - François Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Barreras SG, Rozet F, Nunes-Silva I, Srougi V, Baghdadi M, Sanchez-Salas R, Barret E, Galiano M, Prapotnich D, Cathelineau X. Predictive factors and the important role of detectable prostatic specific antigen for the detection of clinical recurrence following robot-assisted radical prostatectomy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.e567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e567 Background: To evaluate predictive factors associated with detectable prostate-specific antigen (PSA) and clinical recurrence (CR) after robot assisted radical prostatectomy (RARP). Methods: The study included 2500 patients who were treated with RARP between 2000 and 2016. Patients were divided into two groups according to PSA value at 6 weeks after surgery: undetectable PSA (PSA < 0.1 ng/dl) and PSA persistently elevated (PSA ≥ 0.1 ng/dl). Logistic regression analysis was used to evaluate association between covariates and: (1) detectable PSA, (2) CR (positive imaging during follow up) in persistently elevated PSA group. Kaplan-Meier analyses were used to assess CR and cancer-specific mortality (CSM) rates according to PSA persistence after surgery. Results: Overall, 229 patients (9.16%) experienced PSA persistence and from them, 38 (16.5%) had CR. Inside the group of detectable PSA ,146 men (63.75%) received adjuvant treatments and 44 (19.21%) salvage therapies. Gleason ≥ 7, ≥ pT3a, PSA > 10 ng/dl and positive margins were found as significant predictive factors of detectable PSA after surgery (all p < 0.001). Within patients with detectable PSA, stage ≥ pT3a (HR: 2.71; 95% CI, 1.10-6.67; p < 0.029) and to received adjuvant ADT (HR: 13.36; 95% CI, 5.18-34.48; p < 0.001) were associated with CR. CR-free survival in Gleason ≤ 6 at 3-year was 100% vs 60% for Gleason 7(4+3) and 20% for Gleason ≥ 8, (p 0.02). Men aged < 65 years had higher 3-year CR-free survival than older (35% vs 20%, p 0.05). 10-year CSM rates were higher for patients with CR (25% vs 0% no CR; p < 0.001), for men with Gleason ≥ 8 (10% at 10-y; p 0.003) and pathological stage ≥ pT3a (9% at 10-y; p 0.05). CSM rate for patients who received adjuvant ADT+ RT was 20%, 10% for men with ADT and 0% for patients without adjuvant treatment at 10-year (p 0,03). Conclusions: A detectable PSA is clearly affected by factors associated with high risk prostate cancer. Stage pT3 and adjuvant ADT have an important prognostic value in the prediction of CR. Patients with CR , Gleason ≥ 8, pathologic stage ≥ pT3 and those who are treated with adjuvant ADT+ RT must have a close monitoring due to the high rate of mortality.
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Affiliation(s)
| | - François Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Dominic Prapotnich
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Srougi V, Bessa J, Baghdadi M, Nunes-Silva I, Barreras SG, Barret E, Rozet F, Galiano M, Sanchez-Salas R, Cathelineau X. A systematic review and meta-analysis to evaluate the influence of surgical method on specimen margins and biochemical recurrence after radical prostatectomy for high-risk prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
65 Background: To date there is no robust evidence comparing the outcomes of robotic and open radical prostatectomies in patients with high-risk prostate cancer. The purpose of this study is to perform a meta-analysis comparing the rates of positive surgical margins (PSM) and biochemical recurrence (BCR) between open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) in patients with high-risk prostate cancer. Methods: A systematic review was performed on Pubmed, Embase and Scopus databases in August 2016, according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. References retrieved were evaluated using the Newcastle-Ottawa scale and the Black and Down’s tool for quality assessment. Nine retrospective cohorts comparing ORP and RARP were selected and included in the meta-analysis. Results: Nine studies reported the PSMs. Patients treated with RARP presented less risk of PSMs (risk difference -0.04, p 0.02) than those treated with ORP. Five articles reported hazard ratios for BCR-free survival. Patients treated with RARP had less risk of BCR (HR 0.72, 95% CI 0.58-0.89) than those treated with ORP. Reports for PSM assessment were considered of adequate quality, while the studies retrieved for BCR assessment were considered limited because of the heterogeneity of their results. Conclusions: Patients with high-risk prostate cancer treated with RARP have less risk of having PSM and BCR when compared to those treated with ORP. A strong conclusion is precluded due to the observational nature of the studies retrieved for our analysis.
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Affiliation(s)
- Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Jose Bessa
- Federal University of Feira de Santana, Feira De Santana, Brazil
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Francois Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Perez-Reggeti JI, Sanchez-Salas R, Sivaraman A, Linares Espinos E, de Gracia-Nieto AE, Barret E, Galiano M, Rozet F, Fregeville A, Renard-Penna R, Cathala N, Mombet A, Prapotnich D, Cathelineau X. High intensity focused ultrasound with Focal-One ® device: Prostate-specific antigen impact and morbidity evaluation during the initial experience. Actas Urol Esp 2016; 40:608-614. [PMID: 27543259 DOI: 10.1016/j.acuro.2016.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We report our initial experience in the treatment of prostate cancer (PCa) with high-intensity focused ultrasound (HIFU) using the Focal-One® device. MATERIAL AND METHODS Retrospective review of the prospectively populated database. Between June 2014 to October 2015, 85 patients underwent HIFU (focal/whole-gland) treatment for localized PCa. Preoperative cancer localization was done with multiparametric magnetic resonance imaging (mpMRI) and transperineal mapping biopsies. Treatment was carried out using the Focal-One® device under general anesthesia. Oncological follow-up: PSA measurement and control biopsy with mpMRI according to protocol. Questionnaire-based functional outcome assessment was done. Complications were reported using Clavien classification. RESULTS The median PSA was 7.79ng/ml (IQR 6.32-9.16), with a median prostate volume of 38cc (IQR: 33-49.75). Focal and whole-gland therapy was performed in 64 and 21 patients respectively. Ten patients received salvage HIFU. Complications were encountered in 15% of cases, all Clavien 2 graded. Mean hospital stay was 1.8 days (0-7) and bladder catheter was removed on day 2 (1-6). Mean percentage reduction of PSA was 54%. Median follow-up was 3 months (IQR: 2-8). Functional outcomes: All patients were continents at 3 months and potency was maintained in 83% of the preoperatively potent. CONCLUSIONS Focal-One® HIFU treatment appears to be a safe procedure with few complications. Functional outcomes proved no urinary incontinence and sexual function were maintained in 83%.
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Affiliation(s)
- J I Perez-Reggeti
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - R Sanchez-Salas
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia.
| | - A Sivaraman
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - E Linares Espinos
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | | | - E Barret
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - M Galiano
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - F Rozet
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - A Fregeville
- Departamento de Radiología, Institut Mutualiste Montsouris, París, Francia
| | - R Renard-Penna
- Departamento de Radiología, Pitié-Salpêtrière Hospital, París, Francia
| | - N Cathala
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - A Mombet
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - D Prapotnich
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - X Cathelineau
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
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Ahallal Y, Sanchez-Salas R, Sivaraman A, Barret E, Secin F, Validire P, Rozet F, Galiano M, Cathelineau X. Clinical performance of transperineal template guided mapping biopsy for therapeutic decision making in low risk prostate cancer. Actas Urol Esp 2016; 40:615-620. [PMID: 27527686 DOI: 10.1016/j.acuro.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the role of Transperineal Template guided Mapping Biopsy (TTMB) in determining the management strategy in patients with low risk prostate cancer (PCa). METHODS We retroscpectively evaluated 169 patients who underwent TTMB at our institution from February 2008 to June 2011. Ninety eight of them harbored indolent PCa defined as: Prostate Specific Antigen<10ng/ml, Gleason score 6 or less, clinical stage T2a or less, unilateral disease and a maximum of one third positive cores at first biopsy and<50% of the core involved. TTMB results were analyzed for Gleason score upgrading and upstaging as compared to initial TransRectal UltraSound (TRUS) biopsies and its influence on the change in the treatment decisions. RESULTS TTMB detected cancer in 64 (65%) patients. The upgrade, upstage and both were noted in 33% (n=21), 12% (n=8) and 7% (n=5) respectively of the detected cancers. The disease characteristics was similar to initial TRUS in 30 (48%) patients and TTMB was negative in 34 (35%) patients. Prostate volume was significantly smaller in patients with upgrade and/or upstage noted at TTMB (45.4 vs 37.9; P=.03). TTMB results influenced 73.5% of upgraded and/or upstaged patients to receive radical treatment while 81% of the patients with unmodified stage and/or grade continued active surveillance or focal therapy. CONCLUSIONS In patients with low risk PCa diagnosed by TRUS, subsequent TTMB demonstrated cancer upgrade and/or upstage in about one-third of the patients and resulted in eventual change in treatment decision.
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Linares Espinós E, Barret E, Sivaraman A, Pérez-Reggeti JI, Sánchez-Salas R, Rozet F, Galiano M, Cathelineau X. [Localized prostate cancer Focal Therapy: "A la carte" Model]. ARCH ESP UROL 2016; 69:345-352. [PMID: 27416638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Focal therapy has settled as an alternative to radical treatment in selected cases of localized prostate cancer. The selection of patients who are candidates for focal therapy is based on imaging diagnosis relying on multiparametric MRI and image fusion techniques. Thanks to the oncological results and safety profiles of initial series, various energy sources have been developed over the last years. The availability of multiple types of energy sources for focal therapy, commits us to evaluate what type of energy would be the optimal depending on patient's profile and type of lesion. A unique energy for focal therapy would be ideal, but facing the research of the various types of energy we must identify which one is recommended for each lesion. With the experience of our center in different approaches of focal therapy we propose the "A LA CARTE" MODEL based on localization of the lesion. We present the criteria the "a la carte" model is based on, supported by the published evidence on the use of different ablative therapies for the treatment of localized prostate cancer. Lesion localization, technical characteristics of each type of energy, patient's profile and secondary effects must be considered in every choice of focal therapy.
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Affiliation(s)
- E Linares Espinós
- Hospital Universitario Infanta Sofía. Universidad Europea de Madrid. Madrid. España
| | - E Barret
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | - A Sivaraman
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | | | - R Sánchez-Salas
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | - F Rozet
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | - M Galiano
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | - X Cathelineau
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
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Linares Espinos E, Sivaraman A, Sanchez-Salas R, Perez-Reggeti JI, Pamela A, Barret E, Galiano M, Rozet F, Prapotnich D, Cathala N, Mombet A, Cathelineau X. MP40-04 MINIMALLY INVASIVE SALVAGE PROSTATECTOMY AFTER PRIMARY RADIATION OR ABLATION TREATMENT: COMPLICATIONS, FUNCTIONAL AND LONG-TERM ONCOLOGICAL OUTCOMES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sivaraman A, Ahallal Y, Sanchez-Salas R, Linares Espinos E, Perez-Reggeti JI, Russo A, Armando Hernandez Palacios G, Barret E, Galiano M, Rozet F, Cathelineau X. MP16-11 ROUTINE USE OF MAGNETIC RESONANCE IMAGING IN PROSTATE CANCER FACILITATES BETTER CANDIDATE SELECTION FOR ACTIVE SURVEILLANCE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Karthikeyan VS, Mallya A, Sivaraman A, Sanchez-Salas R, Galiano M, Rozet F, Barret E, Cathelineau X. MP75-01 RECURRENCE IN PATHOLOGIC UPSTAGING TO PT3A IN CT1 RENAL TUMORS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Galiano M, Guillot-Tantay C, Sivaraman A, Slaoui H, Barret E, Rozet F, Sanchez-Salas R, Cathelineau X. Superficial Implantation of the I-Stop TOMS Transobturator Sling in the Treatment of Postprostatectomy Urinary Incontinence: Description of a Novel Technique and 1-Year Outcomes. Urology 2016; 90:195-8. [DOI: 10.1016/j.urology.2015.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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