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Prostate cancer is a problem of public health; the relevance of its mass screening remains to be demonstrated by the conclusions of ongoing randomized prospective studies of which the preliminary results are promising. Yet, non-randomised and/or retrospective studies report a benefit of screening-related mortality. On such basis, French scientific authorities currently recommend individual screening.

Resume Les traumatismes des bourses sont peu frequents. Ils sont causes le plus souvent par des traumatismes fermes avec choc direct propulsant le testicule contre l'arche pubienne. L'exploration chirurgicale precoce a considerablement ameliore le pronostic de ces traumatismes et reduit le taux d'orchidectomie. L'arrivee de l'echographie a elle aussi permis une meilleure prise en charge des traumatismes du scrotum. Cependant, il persiste une controverse quant a la fiabilite de l'echographie a predire la presence ou l'absence de fracture testiculaire. L'echographie ne doit pas remettre en cause le dogme de l'exploration chirurgicale systematique des hematoceles et des grosses bourses. Les complications a long terme (atrophie testiculaire, infertilite) pourraient etre plus frequentes que ce qui etait jusqu'alors admis et doivent etre depistees.

To study the pathologic features of radical prostatectomy (RP) specimens of patients operated on the basis of a potentially "Insignificant" prostate cancer (Ca P) characterized by one single focus (less than 3mm) of moderately differentiated adenocarcinoma - Gleason scoreor =6, out of 6-10 biopsies and to determine which characteristics, if any, are predictive of the presence of a "non significant" prostate cancer in the specimen characterized by a low volume (0.5 ml) moderately differentiated organ confined, cancer (Gleason score less than 6).PSA, biopsy features, and surgical specimens of a series of 56 patients submitted to RP for "insignificant Ca P" on TRUS prostate biopsies between 1988 and 2004 were compared regarding the number of tumor foci, Gleason grade and score, tumor volume determined by the cylinder method, as well as extraprostatic extension (EPE) and positive surgical margins (P.SM.).70% of the patients had multifocal microfocal cancer apart from the index tumor. The presence of grade 4 was ignored by the biopsy in 50% of the cases, however the primary grade was correctly evaluated in more than 70% of the biopsy sets. 42% of the patients had a cancer volume less than 0.5 ml and 29% met the definition of insignificant/unimportant cancer characterized by a moderately differentiated (Gleason scoreor =6) of low volume (less than 0.5 ml) however no feature accurately predictive of insignificant cancer could be individualized. In this whole series, only 8% of the patients had EPE. When the pre-operative PSA was10 ng/ml, 98% of the patients had an organ confined tumor.Patients diagnosed with prostate cancer on the basis of one single focus less than 3 mm of moderately differentiated (Gleasonor =6) prostate cancer have 30% of chances of harboring an insignificant tumor in their prostate and are therefore, at risk of being overtreated, however there is at this time no specific feature able to identify these patients pre operatively.

More accurate pre-treatment staging of prostate cancer allows an appropriate selection of therapy and increases the likelihood of favourable treatment outcome. Indeed, tables and nomograms do not incorporate imaging staging although these explorations could be useful. Traditional transrectal ultrasonography does not offer additional information compared to DRE and CTscan is not useful in local staging. MRI eventually completed by metabolic informations could help but only for patients with high risk features in whom microscopic local extension has not been detected. Routine studies (CTscan and MRI) are disappointing for lymph node assessment. Performed in high risk patients they can detect nodal metastasis, but their normality does not allow the practitioner to avoid pelvic lymphadenectomy. Ultra small paramagnetic oxide (USPIO) is very promising but still experimental. In high risk patients, radionuclide bone scan has to be performed. In case of abnormalities, confirmatory studies (X-rays, CTscan or MRI) are requested.

Nous rapportons le cas d’un jeune homme de 25 ans qui a presente une thrombose de la veine dorsale superficielle de la verge ou maladie de Mondor, une maladie rare associant une douleur et une induration de la partie dorsale de la verge, ses principales etiologies, le diagnostic, le traitement et le suivi.

To evaluate retrospectively the efficacy of adjuvant radiation therapy (ART) in patients with T1–T2 prostate cancer (CaP) in whom extracapsular cancer (pT3) was detected after radical prostatectomy (RP), together with biochemical failure characterized by a recurrent level of serum prostate-specific antigen (PSA)>0.1 ng/mL. Twenty-two patients with T1–T2 CaP treated by RP who subsequently were found to have pT3 CaP with (13) or without (9) positive surgical margins and/or seminal vesicle invasion, exhibited biochemical failure characterized by a recurrent level of serum PSA, 2–40 (mean: 25) months after RP and were treated with ART (65 Gy). Bone and CT scans were negative in every patient, 15 of whom were submitted to TRUS biopsy (Bx) of the anastomosis (resection site), which was positive in 8. Patients were followed up for between 6 and 60 (mean: 32.5) months. Transient side effects (urgency, proctitis, diarrhea) were experienced by 9 patients after ART. A decrease in serum PSA was observed in 19 patients; however, only 14 of these achieved an undetectable level (

Up to 30% of patients complain about urine leakage after radical prostatectomy, but persistent stress incontinence (beyond 1 year) affects5% of them. This complication is mainly caused by sphincter dysfunction. Some preventive measures have been described to decrease the risk of incontinence after radical prostatectomy, but with conflicting results. The effectiveness of preoperative and early postoperative physiotherapy is controversial. Moreover, while meticulous apical dissection of the prostate significantly improves postoperative continence, the benefit of other surgical techniques, e.g. preserving the bladder neck and the neurovascular bundles, is under debate. The treatment of persistent stress urinary incontinence is mainly based on surgery, as this type of incontinence usually does not respond to physiotherapy and anticholinergic medication. While injection therapy is safe and well tolerated, its effect on postoperative continence is limited and decreases with time. The best results are achieved by implanting an artificial urinary sphincter, but with significant complication and revision rates.

Information regarding the quantity of biopsy material invaded by cancer may supplement the usual criteria for the preoperative staging of patients suffering from clinically localized prostate carcinoma (T1-T2). However, conflicting conclusions have been drawn and this topic needs further investigation.A total of 170 patients had radical prostatectomy for T1-T2 prostate carcinoma. Patients' mean age (+/- standard deviation [SD]) was 66.05 +/- 6.12 years and mean prostate specific antigen (PSA) level (+/- SD) was 22.5 +/- 21.4 ng/mL (Yang Proscheck). Of the patients, 110 underwent transrectal ultrasound-guided biopsy with removal of 6 cores, from whom we had the percentage of biopsy, material invaded by cancer, the Gleason score, and the preoperative PSA. These parameters were compared with the pathologic features of the surgical specimen (capsule penetration, surgical margins, and Gleason score) and biologic progression (defined as persistent/recurrent postoperative PSA0.1 ng/mL).The most valid threshold of biopsy material invaded by cancer for predicting surgical margins and capsule status, as well as biologic progression, was 10%. When10% of biopsy material was invaded by cancer, positive surgical margins (SM+) were present in 30.3%, capsular penetration (pT3, pathologic extracapsular involvement) in 27.3%, and biologic progression (P+) in 21.7%. The Gleason score did not improve this prognostic evaluation. The mean quantities of tissue invaded by cancer differed significantly between positive and negative surgical margin groups, between pT2 and pT3 groups, and between P- and P+ groups (no biologic progression/biologic progression). There was statistical significance (log rank test, P = 0.0320 in the survival without biologic postoperative progression between patients withor = or10% of one core biopsy invaded by tumor. Ifor = 10% of tissue in only 1 of 6 cores of a biopsy was invaded by tumor, the status was pT2, SM-, and P- in 87.5% of the patients.On an individual basis, the percent of tissue containing carcinoma in core biopsies was a factor that lacked the statistical power to predict the status of the capsule and surgical margins, and the biologic progression. The finding ofor = 10% of carcinoma in 1 of 6 cores of a biopsy was correlated with a good prognosis.