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To analyze, in patients with prostate cancer (PC) potentially eligible for active surveillance (AS), whether multiparametric-MRI (mp-MRI) predicts presence of clinically significant cancer on radical prostatectomy (RP) specimen.We identified 77 men with PC eligible for AS (PSA≤15ng/mL, stage≤T2a, Gleason score≤6, up to 3 positive cores, maximal cancer core length≤5mm) who underwent RP between 01/2008 and 08/2015. All patients had prebiopsy mp-MRI followed by systematic±targeted biopsies. For each patient, the likelihood of the presence of cancer on mp-MRI was assigned using Likert scale (1 to 5). The predictive factors for the presence of significant cancer on RP specimen (Gleason score≥7 and/or tumoral maximal diameter10mm) were evaluated using logistic regression.Median age was 61 and median PSA was 6.7ng/mL. Overall, 49 (64%) patients had a positive mp-MRI (score≥3). Clinically significant cancer on RP specimen was found in 45 (58%) patients (69% in MRI-positive patients vs 39% in MRI-negative patients). In multivariate analysis, a positive MRI was a predictive factor for the presence of significant cancer on the surgical specimen (OR=3.0; CI95% [1.01-8.88]; P=0.04), as was age (OR=1.17; CI95% [1.05-1.31]; P=0.004) and PSAD (OR=1.10; CI95% [1.01-1.20]; P=0.02).Mp-MRI is a useful exam for selecting patients eligible for AS even if the situation remains unclear after prostate biopsies including targeted biopsies. Upon confirmation by further studies, mp-MRI should be considered as an independent criterion before entering an AS program.4.

To evaluate the contribution of multiparametric MRI (MRI) and targeted biopsies (TB) in the selection and follow-up of patients under active surveillance (AS).A single-center, retrospective cohort study on 131 patients in AS, with following criteria:≤cT2 stage, PSA≤15ng/mL, Gleason score≤6,≤3 positive biopsies and maximum tumor length≤5mm. Patients' selection and follow-up was performed by the combination of systemic biopsies (SB) and mpMRI±TB. Reclassification was defined by a Gleason score6 and/or a maximum tumor length5mm.Overall, 29 patients (22.1 %) were reclassified. Reclassification free survival rate was 93 % and 70 % at 1 year and 4 years respectively. Reclassification independent risk factors were: PSA density0.15ng/mL/cmFor patients under AS, mpMRI decreases reclassification rates over time through better initial detection of significant cancers. Its high NPV makes it an efficient monitoring tool to distinguish patients with low risk of reclassification.4.

Salvage radical prostatectomy (sRP) for radiorecurrent prostate cancer (PCa) is a challenging procedure. To report our experience with sRP for selected patients with local recurrence after primary treatment for localised PCa.From 2005 to 2015, 24 patients underwent sRP for recurrent PCa in our center and were included in this retrospective study. Local recurrence was suspected by PSA increasenadir+2ng/mL and was confirmed by biopsy. Perioperative complications according to Clavien-Dindo classification, oncological and functional results were analysed.Overall, 24 patients with a median age of 59 years (IQR: 55-60) were included. Median follow-up was 25 months (IQR: 9-26). Procedures were performed with open-retropubic approach in 50 % and robot-assisted laparoscopic approach in 50 %. Overall, 5 (21 %) and 2 (8 %) patients experienced grade≤IIIa and grade≥IIIb postoperative complication, respectively. Surgical margins were positive in 46 % of cases. Three out of 4 patients with postoperatively detectable PSA (0.2ng/mL) had positive surgical margins. Seven patients experienced biochemical recurrence in a median delay of 19 months (9-62). Seventy-one percent (5) of these patients experienced clinical recurrence in a median delay of 24 months (10-113). Severe urinary incontinence (≥3 pads/day) and erectile dysfunction were reported in 25 % and 63 %, respectively.sRP for patients is a feasible procedure with encouraging local control rate and acceptable morbidity. This technique should be discussed as a treatment option for locally recurrent PCa in well-selected patients.4.

Objectifs L’objectif de cette etude etait d’evaluer l’apport de l’IRM multiparametrique comme parametre a part entiere pour predire la presence de cancer significatif sur piece de prostatectomie, et donc pour influencer la decision de traitement chez les patients presentant un cancer de prostate potentiellement eligible a une surveillance active (SA) apres realisation de biopsies systematisees + -ciblees. Methodes Etude retrospective de 77 patients potentiellement eligibles a une SA pour un cancer de prostate localise (PSA ≤15 ng/mL, stade ≤ T2a, score de Gleason = 6, 1 a 3 biopsies positives et une longueur tumorale maximale ≤ 5 mm) et traites par prostatectomie totale (PT) entre 01/2008 et 08/2015. Tous les patients ont eu une IRM et des biopsies systematisees ± ciblees. Pour chaque patient, un score de suspicion IRM etait attribue selon une echelle 1 a 5. Les facteurs predictifs de la presence de cancer significatif sur les pieces de PT (score de Gleason ≥ 7 et/ou diametre tumoral maximal >10 mm) etaient evalues par une regression logistique. Resultats L’âge median etait de 61 ans et le PSA median de 6,7 ng/mL. Au total, 49 (64 %) patients presentaient une IRM positive (score ≥ 3). Un cancer significatif etait retrouve dans 45 (58 %) cas. Le taux de cancer significatif etait plus eleve chez les patients presentant une IRM positive (76 % vs 46 % ; p = 0,009). En analyse multivariee, une IRM positive etait un facteur predictif de la presence d’un cancer significatif sur la piece operatoire (OR = 3,0 ; p = 0,04), tout comme l’âge (OR = 1,17 ; p = 0,004) et la densite du PSA (OR = 1,10 ; p = 0,02).( Fig. 1 ) Conclusion Notre etude a montre que l’IRM est un examen fiable pour selectionner les patients eligibles a une SA meme en cas de doute apres realisation de biopsies prostatiques comprenant des biopsies ciblees. Cet examen pourrait constituer un critere a part entiere en vue d’une inclusion en SA.