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Spread evaluation of Prostate Cancer (PC) in French Guyana is bothered by the lack of bone scintigraphy. The availability of 4 MRI allows to develop alternatives using Axial Skeleton MRI (AS MRI). We report the related results.AS MRI was done in patients with diagnosis of high risk PC: PSA=10ng/ml and/or Gleason Score=7 (predominant Gleason grade 4) and/or clinical T2b and/or T2b/T3 MRI and/or50% positive biopsies. AS MRI was including spine, pelvis and skull assessement.The results were systematically compared to the clinical, biological and biopsy features.Amongst 163 AS MRI performed, 30 were positive and 133 negative. Of these 133 patients, 60 were submited to radical prostatectomy with or without lymphadenectomy. In these 133 patients with negative AS MRI, median PSA was 11ng/ml (1-51) and 27 (20,3%) had PSA20ng/ml. In patients with positive AS MRI, only 1 had PSA20ng/ml and predominant Gleason grade 3.Our study shows that AS MRI assessement is especially usefull in patients who are most likely to have bone metastasis that is to say those with PSA20ng/ml and/or predominant Gleason grade 4.3.

French Guyana is 83,500 kmThe study is retrospective (2018-2019), and includes 125 patients. Among these patients, 19.2% live in Kourou, 71.1% live 40 to 100km from the hospital and 9.7% beyond 100km. Every patient had an outpatient procedure for rigid and/or flexible URS to treat stone disease, including in lower calyx [LC] (38.4%). Ambulatory surgery was also proposed to the patients living away with the usual restrictions. Complications, results and switch to conventional hospitalisation (CH) were studied.Mean stone size was 10,5mm (4-30), stone density was 1030 UH (470-1700). The postoperative complication rate was 4%. There were 90.4% 'stone free' patients (85.4% for LC). One patient was rehospitalised within 48hours for acute flank pain and 9 patients had a switch of ambulatory to CH: 6 for discharge too late and 3 for complication (fever and/or pain). Distance between home and hospital was linked neither to complication rate, nor to switch to CH.Ambulatory URS is possible without further complications in selected patients living beyond 100km from the hospital, because of a specific organisation and an appropriate training of the caregivers involved in postoperative patient care.3.

Epidemiology of prostate cancer (PCa) in French Guyana (FG) is not well documented yet. It differs from the reported one in French West Indies due to a younger population, less exposed to agricultural pesticides with also much lower level of medical information and care.The incidence and mortality rates available in the regional register of cancers are reported for the period 2010-2014. The characteristics of 242 consecutive prostate biopsy series performed between 2017 January and 2019 October for abnormal digital rectal examination (DRE) and/or PSA4ng/mL are also described.PCa incidence in FG is 94.4°/°°°° and specific mortality 16.9°/°°°°. Among the biopsies, 77.7% (188/242) are positive with a mean PSA of 72.6ng/mL (1-4000) at a mean age of 66years (50-89), 34% (64/188) with an abnormal DRE, 12.3% (23/188) with a PSA50ng/mL and 28.2% (53/188) with a Gleason score≥8.In spite of young population, less exposure to environmental risk factors and high rate of racial mixing, the early PCa diagnosis is still a challenge in FG. The observed incidence and mortality rates suggest underestimation of PCa cases and too late specific care what is also suggested by adverse pathological and biological characteristics of the tumors at the time of diagnosis.3.

Our objective was to describe the progressive introduction of photoselective vaporization of the prostate (PVP) in an academic department of urology in an outpatient care setting and report our outcomes after the first 100 cases.Since May 2014, XPS GreenLight™ (Boston Scientific-AMS, USA) PVP in the treatment of benign prostatic hyperplasia was introduced in our department. A prospective local registry was opened to collect patients' demographics, preoperative characteristics and surgical outcomes including operative time, length of stay, catheterization time, and postoperative complications as well as functional outcomes. We also assessed limitations to the outpatient care setting.Conversion to TURP was reported in 6 % for uncontrolled bleeding. Overall, 21 % patients needed more than 1-day catheterization. After 6 months of follow-up, 3 patients (prostate volume 50, 117, and 178mL) had reintervention (second PVP). Ninety days' complications were reported to be up to 6 % (3 urinary obstructions, 1 prostatitis, 1 transfusion and a severe sepsis). After 8 months, an 80 % plateau of outpatient care setting was achieved. Anesthesiologists counter-indicated outpatient care in 59 % of the cases.A progressive introduction of the PVP in an outpatient care setting is associated with a low complication rate. A plateau was achieved in less than 100 procedures. The major limitation of the outpatient care setting was patients' competitive comorbidities and not disease characteristics.4.

The aim of this literature review was to focus on the new highlights regarding oncologic and safety outcomes depending on the type of castration used.Literature search using various algorithms "prostate cancer", "castration", "agonist", "antagonist", "orchiectomy", "GnRH", "FSH", "androgen deprivation therapy" has been performed in April 2015, through the PubMed and Embase databases.GnRH agonists and antagonists are both currently used in clinical practice. Nevertheless, differences regarding their pharmacologic properties have been highlighted in recent studies, specifically regarding the rapidity, sustainability and depth of the castration, but also the decrease in FSH level. Such differences may have oncological impact on the patient, regarding the disease biological control and the time to progression, and a tolerability impact, especially on the cardiovascular risks. The role of the depth and the sustainability of the castration in one hand, the FSH impact in the other hand, as well as a direct inhibition on extra-pituitary GnRH receptors by antagonist might explain these differences.Recent studies suggest differences between GnRH agonists and antagonist that could impact the patient clinical outcomes. However, further high level of evidence comparative studies remains warranted.

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.

The fear of the deterioration of the patient's condition related to the toxicity of neoadjuvant chemotherapy is a barrier to its development. This multicenter retrospective study aims to present the secondary effects of neoadjuvant chemotherapy and its impact on the achievement of cystectomy.Patients with urothelial carcinoma classified cT2 to cT4a N0M0 were included. Chemotherapy with 6 cycles of MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) followed by a cysto-prostatectomy or anterior pelvectomy was scheduled.A total 32 patients were included. Six cycles of neoadjuvant chemotherapy were performed in all 11 patients. Shutdown causes were toxicity in 85% of cases. Cystectomy was performed in 86.6% of patients. Surgery was not performed in 6 patients. The reasons were the alteration of the general condition in 2 cases, 2 patients had advanced cancers diagnosed intraoperatively, and 2 refused surgery. Complications of grades 3 and 4 according to the classification of Clavien and Dindo had occurred respectively in 15.3% and 11.5%.This study reports results close to what is found in the literature on the effects of neoadjuvant chemotherapy on achieving cystectomy, but it has some limitations: the retrospective analysis of data on surgery and the lack of control group. In addition, the short follow-up does not yet allow to know the long-term oncological results.This study supports the fact that the toxicity of neoadjuvant chemotherapy does not seem to cause a significant risk of non-completion of cystectomy.4.

The sub Comittee prostate of the CCAFU established guidelines for diagnostic, treatment, evaluation and standart of care of prostate cancer.Guidelines 2010 were updated based on systematic literature search performed by the sub-Comittee in Medline and PubMed databases to evaluate references, levels of evidence and grade of recommandation.Pathological examination of the tissue specimens was defined specifically for Gleason score according to ISP 2005 recommandations. Prostate and pelvis RMN became the reference in terms of radiological exam. Individual and early diagnosis of prostate cancer was defined and role of PSA was precised. Active surveillance became one of the standart of care of low-risk tumors, radical prostatectomy remained one of the options for all risk group tumors, length of hormonotherapy in association with radiotherapy was precised according to the risk group. Side effects of hormonotherapy treament needed specific supervision ; hormonotherapy had no indication in case of non metastatic tumors and intermittent hormonotherapy in metastatic tumors. New hormonal drugs in pre and post chemotherapy and bone target drugs opened new therapeutics pathways.From 2010 to 2013, standarts of care of prostate cancer were modified because of results of prospective studies and new therapeutics. They allowed precise treatments for each specific clinical situation. In the future, multidisciplinary treatments for high risk tumors, time of adjuvant treatment and sequencies of new hormonal treatment had to be defined.

To assess the frequency, circumstances, and possible medico-legal consequences of the pT0 prostate cancer, defined by the absence of tumor in a radical prostatectomy specimen.Six centers retrospectively identified all cases of pT0 and selectionned those that occurred without prior hormone therapy or prostate resection. Preoperative data, histological report and clinical and biological outcome were analyzed. The lawsuits' registry in pathology were consulted at insurance companies.Thirty cases of pT0 prostate cancer (0.4%) were reported on 7693 patients. The median age was 63years, PSA 7.4ng/mL. The number of positive preoperative biopsies ranged from one to four for a median tumor length of 1mm (0.3 to 18mm). The biopsy Gleason score was 3+3 for 23 patients, less than 5 for six others and included a contingent of grade 4 in two patients. With a median follow-up of 82months, no clinical or biochemical recurrence was observed. One patient complaint for pT0 prostate was found in the insurances registry.The occurrence of a prostate pT0 called into question all the diagnostic procedures and surgical indication. To avoid a forensic procedure, urologists should inform patients of the possibility of this situation before radical prostatectomy.

Recently, new agents have been developed in the treatment of prostate cancer. Our aim was to review phase III studies that involved novel agents in the treatment of castration resistant prostate cancer.PubMed databases were searched for original articles published with the search terms: prostate cancer, castration resistant, metastatic, targeted therapy, biologic agents, immunotherapy and clinical trials. Proceedings from 2008 of conferences of the American Society of Clinical Oncology, American Urological Association, and the European Association of Urology were also searched. We included phase III studies that involved: abiraterone, MDV 3100, cabazitaxel, sipuleucel-T, radium-223, and denosumab.Abiraterone and MDV 3100 are two new hormotherapies that showed an increased overall survival of 15 and 18 months respectively before after docetaxel based chemotherapy in randomized trials. Cabazitaxel became the standard second line chemotherapy after docetaxel. Sipuleucel-T has emerged as the first approved vaccine in prostate cancer. It showed a 22 % reduction of mortality and a prolonged survival time of 4.1 months compared to placebo. A radium-223 based metabolic radiotherapy has showed a better overall survival, delayed and reduced skeletal-related events in placebo controlled randomized trials. Denosumab also delayed the first skeletal-related event in a zoledronic acid controlled trial (20.7 versus 17.1 months, P=0.0002). Moreover, Denosumab delays bone metastases by 4.1 months compared to placebo.The novel agents that emerged in the treatment of prostate cancer showed an efficacy in placebo controlled trials. They added new tools in the armamentarium of therapies of castration resistant prostate cancer.

Chemotherapy is indicated in metastatic castration-refractory prostate cancer. It aims at alleviating symptoms and increasing survival, without impairing quality of life. Docetaxel is considered as the reference treatment in this indication. However, several studies demonstrated the relevance of associating estramustin with docetaxel, due to the synergistic effect of the combination and the action of estramustin on resistance mechanisms. Moreover, the addition of estramustin to chemotherapy demonstrated a survival benefit for patients. Thrombotic events are frequent in patients with advanced prostate cancer and estramustine is known to increase the risk. Optimization of treatment requires a thorough assessment of the individual risk in each patient as well as the prescription of an anti-thrombotic prophylaxis, which should be currently based on low molecular weight heparin.

Among the different options recommended for locally advanced prostate cancer (LAPC), radical prostatectomy (RP) is a relatively infrequent option because its role is still controversial. The results of clinical trials combining an external radiotherapy to a long-term androgen deprivation sustain the principle of a multidisciplinary management of LAPC. Impact of surgery on the risk of progression and local recurrence is important in selected patients with low grade and small tumoral volume. Clinical and histological data associated to the MRI assessment remain essential and enhance the preoperative multidisciplinary decision. Oncological results from recent series show 10-year and 15-year specific survival rates around 85 and 75%, respectively. Moreover, approximately 20 to 30% of patients initially presented with cT3 tumours have finally an organ-confined disease on pathological examination. Morbidity of the procedure is similar to RP for organ-confined tumours despite more erectile dysfunction due to non-sparing RP in most of cases. An enlarged RP with an extended pelvic lymphadenectomy can be considered as a viable alternative to radiotherapy and hormonal therapy in patients with long life expectancy presenting cT3 tumour with a high risk of local progression and a low risk of metastatic disease. Comparative and combined treatments including RP have to be prospectively investigated in clinical trials in terms of oncological outcome and quality of life.

Study about the efficacy of salvage radiotherapy (RT), in terms of biochemical disease free survival (bDFS), according to ASTRO and Phoenix (nadir+2) definitions, for persistent or rising PSA after radical prostatectomy.Retrospective analysis of 59 patients who underwent RT between 1990 and 2003 for PSA recurrence after radical prostatectomy. Patients received a median of 66Gy to the prostate bed with 3D or 2D RT. The main end point was bDFS according to ASTRO and Phoenix (nadir+2) definitions. Different criterion sets were analysed to calculate bDFS and pretreatment factors that might predict biochemical relapse were sought for each.After a 38-month median follow-up, the 3-year bDFS rates were: 60 and 72% for ASTRO and Phoenix (nadir+2 ng/ml) definitions respectively. According to univariate analysis, pre-RT PSAor =1 ng/ml and seminal vesicle involvement were associated with biochemical relapse. Multivariate analysis retained only pre-RT PSAor =1 ng/ml as an independent predictor of biochemical relapse for the two definitions.Salvage RT is an effective treatment after radical prostatectomy according to ASTRO or Phoenix definitions. Only pre-RT PSAor =1 ng/ml predicted relapse.

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.

Scrotal traumas are rare. Most are blunt traumas caused by a direct blow on the scrotum. The testicle is projected against the pubic arch. Early surgical investigation has considerably improved the prognosis of testicular trauma, and reduced orchidectomy rate. ULtrasonography has also improved the management of scrotal trauma. But there is a controversy about accuracy of ultrasonography in predicting presence or absence of testicular disruption. ULtrasonography should not challenge the dogma regarding systematic surgical investigation of hematocele and enlarged scrotum. Long term outcomes (testicular atrophy, infertility) may be more frequent as previously thought and should be detected.

We evaluated the ability of an extended, 32-core repeat transrectal ultrasound prostate biopsy protocol to improve the characterization of low volume, well differentiated disease in men with a diagnosis of potentially insignificant microfocal prostate cancer, as defined by 1 single focus positive core of 10 with less than 5 mm of Gleason score 6 or less tumor on primary biopsy.A total of 35 consecutive patients, who were 62 to 75 years old, had a median serum prostate specific antigen of 8 ng/ml (range 0.5 to 14) and a diagnosis of minimal prostate cancer, and were willing to consider observation with delayed treatment at progression, were offered repeat saturation prostate biopsy with a median of 32 cores (range 18 to 36) under local anesthesia. This biopsy was to determine whether more extensive prostate sampling would confirm or disprove the initial diagnosis of microfocal, well differentiated prostate cancer.The procedure was aborted in 1 patient because of massive rectal hemorrhage. Another patient had acute prostatitis with gram-negative sepsis. Of 34 evaluable biopsy sets 11 (32%) were negative for cancer, suggesting that tumor detected at the primary biopsy was probably of low volume and amenable to observation with delayed treatment. Of the biopsies 23 (68%) were positive, 17 were at multiple sites and 7 were upgraded to Gleason score 7 or greater. These patients were then considered to have significant tumors and were offered active treatment.This study is to our knowledge the first to describe the clinical use of prostate saturation biopsies for re-evaluating potentially insignificant prostate cancer. Of patients with minimal disease on standard 10-core biopsy, results show that this technique may be helpful for distinguishing the 30% who probably have minimal disease based on negative repeat saturation biopsy from the 70% who almost certainly have a significant tumor, as characterized by multiple positive cores, with or without an increased Gleason score. The latter patients should be offered active therapy.

We examine the relationship of nonsteroidal anti-inflammatory drugs and finasteride on the risk of prostate cancer.Participants in this case control study using a prospective collection of data were drawn from consecutive patients who underwent prostate biopsy at 12 different departments of urology from January 1999 to June 2000. Medication use was assessed by self-questionnaire as well as questions about dietary and lifestyle factors that might be relevant for prostate cancer risk.The study included 639 patients with prostate cancer and 659 cancer-free controls. Univariate analysis showed no significant impact of aspirin and finasteride on prostate cancer risk while the nonaspirin nonsteroidal anti-inflammatory drug users had a lower risk (OR 0.80, 95% CI 0.64-0.99). After adjusting for potential confounders, the protective effect of nonaspirin nonsteroidal anti-inflammatory drugs was no longer significant (OR, 0.84, 95% CI 0.66-1.07), while finasteride showed a significant protective effect (OR 0.58, 95% CI 0.37-0.92).The results suggest that finasteride could have a chemopreventive role in prostate cancer. While aspirin did not show any impact on prostate cancer risk, the role of nonaspirin nonsteroidal anti-inflammatory drugs warrants further studies.

Biochemical relapse after radical prostatectomy is not exceptional, ranging from 10 to 40% in the literature. To prevent this biochemical failure, adjuvant radiotherapy was proposed to patients with a high risk of relapse. No phase III trial has actually validated this attitude. Best indications for adjuvant irradiation seem to be patients with an extensive extracapsular extension or multiple positive margins. Historical comparisons seems to confer, in these case, a benefit in biochemical control for adjuvant irradiation versus observation. Others authors prefer immediate post-operative irradiation, a delayed treatment, when biochemical relapse has occurred. This attitude has spared some patients irradiation useless. This salvage irradiation lowered the PSA level in 40 to 70% of the cases, but long-term efficiency is obtained only in the case of a low value of the PSA before irradiation. Delayed radiotherapy is, therefore, justified only if a close follow-up is performed, with repeated dosage of PSA. Whatever the case, it is important to differentiate between local and distant relapse: patients with positive nodes at the time of surgery are most likely at risk of distant relapse. It seems that patients with seminal vesicles involvement are also at high risk for distant relapse, but this must be confirmed.

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.

The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical speciality societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery.Produce clinical practice guidelines for the radiotherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project.The FNCLCC and the French Urology Association (AFU) designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers.The main recommendations are: 1/ a minimal dose of 70 Gy must be used, whatever the prognostic factors; 2/ it appeared that patients with favourable prognostic indicators (stage T1-2, PSAor = 10 micrograms/L and Gleason scoreor = 6) do not benefit from a dose escalation effect for doses over 70-74 Gy; 3/ patients with intermediate prognosis are the ones who benefit most from the dose escalation effect over 74 Gy, provided they receive exclusive radiation therapy; 4/ whenever possible, patients should be included in controlled trials designed to assess the effects of dose escalation and hormonotherapy.

To define the anatomical landmarks allowing precise vesiculectomy to be performed during radical prostatectomy for cancer.12 non-formalin-preserved anatomical subjects were dissected as during retropubic and perineal prostatectomy, with and without coloured latex vascular injection.Three anatomical landmarks were defined: 1) Denonvilliers' fascia; 2) vas deferens; 3) arteries supplying the seminal vesicles.These three anatomical landmarks ensure: complete resection, preservation of adjacent anatomical structures and elective haemostasis.

The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical specialty societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by a critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery.Produce clinical practice guidelines for the brachytherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project.The FNCLCC and the French Urology Association (AFU) first designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers.The main recommendations are: 1/Brachytherapy with permanent seeds alone is a possible curative treatment for prostate cancer patients with the following prognosis factors: tumour stage T1 or T2a (TNM 1992), Gleason scoreor = 6 and PSA10 micrograms/L. 2/Combined treatment with brachytherapy and hormonal therapy could be more efficient than brachytherapy alone for prostate cancer patients with Gleason score7 and/or PSA10.3/Combination of brachytherapy and external beam radiation therapy can be proposed to prostate cancer patients with intermediate prognosis. 4/Before and after seed implantation, risks of infection must be prevented by appropriate antibiotic therapy (recommendation). 5/Brachytherapy must not be performed within 2 months of transurethral prostate resection. 6/The height of the urethra receiving more than 200% of the prescribed dose must be reported. The portion of the rectum receiving 100 and 120% of the prescribed dose must be limited to 10 and 5 mm length, respectively.

The authors describe the surgical technique used in liver transplantation and its application to treat retroperitoneal tumours. This technique comprises primary mobilization of the liver with easy vascular control. This technique, used in 29 patients, is simple, facilitates exposure of great vessels which can be controlled and allows excellent exposure in difficult cases. Analysis of the postoperative course emphasized the absence of hepatic and renal complications, as reflected by normal renal function and liver enzymes. The use of this technique for renal and adrenal surgery avoids the need for extracorporeal circulation and a thoracophrenoabdominal approach, thereby limiting the specific complications related to these two procedures.

Invasiveness, delayed morbidity, and the high cost of transurethral resection of the prostate (TURP) have resulted in the proposal of transurethral microwave thermotherapy (TUMT) as an alternative and less invasive treatment.Only a few randomized studies have evaluated the functional results of TUMT vs. TURP. Despite restricted inclusion criteria, they all concluded that TUMT is as effective as TURP in relieving subjective symptoms, but that it generally leads to less improvement in objective symptoms.TUMT results seem to last at least 36 months; at 1-year follow-up, the rate of repeat treatment is 3.2%. The rates of morbidity in both groups are roughly in the same range. Acute urinary retention (10-13.5%) and postoperative voiding discomfort are the main occurrences after TUMT; bleeding, retrograde ejaculation (50-80%), and urethral strictures (3.1-6.6%) occur after TURP. Cost evaluation, related only to Targis and U.S. data, favors TUMT. However, it seems likely that the overall cost of TUMT procedures may decrease if TUMT becomes a widely used technique, including fair reimbursement from private insurance companies or from social security departments in European countries. TUMT is safe and effective to treat BPH.Nevertheless, to date, the improvement that occurs in most variables seems to be less than that after TURP.

The aim of this study was to evaluate the usefulness of gadolinium-enhanced time-of-flight magnetic resonance venography (MRV) in the diagnosis of bland thrombosis/tumoral invasion in the preoperative assessment of renal cell carcinoma. Preoperative precontrast and enhanced GRE fast low-angle shot (FLASH) images of 36 patients with renal adenocarcinoma were reviewed and compared with pre- and post-contrast T1-weighted images. All patients underwent surgery, and MR findings were blindly and prospectively compared with surgical and pathologic data, considered the standard. Renal vein and vena cava were involved in 17 and 9 patients, respectively; right atrial extension was present in one patient. Precontrast spin-echo (SE) and FLASH images were 88 % sensitive and 100 % specific in the detection of venous involvement, respectively, and enhanced FLASH images 100 % sensitive and 96 % specific. The nature of thrombus (neoplastic or bland) was more accurately assessed (McNemar's, p < 0.05) with FLASH-enhanced MR images (sensitivity 89 %; specificity 96 %) than with SE and precontrast FLASH images (sensitivity 79 %; specificity 94 %). Our data suggest that use of Gd-enhanced MRV might improve preoperative assessment of vascular involvement in renal carcinoma.

To evaluate the clinical, laboratory and histological characteristics of prostate cancer at the time of diagnosis and after radical treatment in various ethnically different patient groups.Prostatic biopsies were performed in 466 consecutive patients because of an abnormal digital rectal examination and/or isolated elevation of PSA (greater than 3 ng/ml). In this series, 40 patients were Black and 426 were Caucasian. The other aspect of the study concerns 320 patients undergoing radical prostatectomy for stage T1 T2 prostatic tumour (25 Black, 295 Caucasian). In the biopsied group, we analysed mean age, mean PSA, mean cancer length on biopsies and mean Gleason score. In the operated group, we studied preoperative characteristics, histological stage, resection margin status, laboratory progression (PSA greater than 0.05 ng/ml) and time to progression.At the time of diagnosis, the mean age was 61.4 years (48-73) for Blacks and 65.2 years (42-87) for Caucasians (p0.05). The median Gleason score was 7 in the two groups. The PSA was 13.4 (1.7-105) ng/ml versus 14.4 (0.4-600) ng/ml, respectively. The mean percentage of invaded tissue on biopsies was 24% versus 18.8% and the mean percentage of positive biopsies was 53% versus 39%, respectively. In the operated group, capsular effraction rates were 39% in Blacks and 48.1% in Caucasians. Positive resection margin rates were 21.7% versus 36.6%, respectively. The laboratory progression rate with a mean follow-up of 33 months (6-126) was identical in the 2 groups (42.1% versus 41.1%), but the time to progression was shorter for Blacks (9 months versus 12.3 months).In this patient series, Black patients had the same laboratory profile as Caucasian patients at the time of diagnosis. However, they were younger at the time of discovery of the disease, had more positive biopsies and more tumour-invaded tissue on biopsies, and Black patients undergoing radical prostatectomy developed laboratory recurrence more rapidly.

The purpose of this article is to review the available means to investigate whether an elevated serum prostate-specific antigen (PSA) after radical prostatectomy may be explained by the presence of residual benign tissue. To answer this question, one may consider the following features: the kinetics of recurrent/ persistent PSA, the incidence of rising PSA in the presence of capsular incisions exposing benign glands only, the level of urinary PSA and the ratio of free/total PSA in the urine, the results of anastomotic biopsy samples, and the detection of circulating prostate cells by PSA reverse transcriptase-polymerase chain reaction (RT-PCR) after surgery. Capsular incisions exposing benign tissue are not associated with a significant risk of biochemical failure. In case of an organ-confined cancer with negative surgical margins but a rising postoperative PSA, the systematic reevaluation of the initial pathological slides constantly shows capsular effraction or focal positive margins that have been overlooked at the first evaluation. Even when anastomotic biopsies document only benign tissue, the study of PSA doubling time is usually characteristic of the coexistence of residual tumoral cells. However, in a few cases, the persistent negative results of the detection of circulating prostate cells by PSA, RT-PCR in patients with organ-confined cancer and negative margins but elevated postoperative PSA might be explained by the presence of residual benign prostatic hyperplasia tissue. Most of the data in the literature are in favor of the responsibility of persistent/recurrent cancer in the recurring PSA rather than that of benign prostatic hyperplasia/normal residual tissue. Therefore, a persistent/recurrent detectable level of PSA is the serum after radical prostatectomy characterizes biochemical failure.

Indinavir-induced lipodystrophy constitutes a new complication of this therapeutic category. It is characterized by loss of fat from the face and limbs and accumulation of fat in the abdominal wall (possibly simulating an abdominal mass), but also in the abdominal cavity (retroperitoneum, greater omentum, mesocolon, mesentery). This complication, whose frequency is currently assessed to be between 24 to 64%, occurs an average of 10 months after starting treatment. It is often accompanied by laboratory abnormalities, such as hypertriglyceridaemia, hypercholesterolaemia or insulin resistance. The pathophysiology and long-term consequences of this complication are still poorly understood.

Surveillance with deferred treatment in patients with clinically prostate-confined prostate cancer is a controversial subject. The policy of prostate cancer screening for increasingly low PSA levels and the use of more extensive biopsy protocols result in the detection of a large number of small tumours, probably early in their subclinical course. Conversely, some patients who receive initial active treatment are understaged by the pretreatment assessment and develop treatment-related adverse effects without any oncological benefit. The main published series concerning surveillance were analysed with particular emphasis on those with the longest observation periods. Data concerning specific survival and progression-free survival are discussed, together with the results obtained in terms of the quality of life of patients submitted to surveillance. Analysis of these data show a potential benefit of surveillance in elderly patients (over the age of 70 years) with small, low-grade prostatic tumours.

Primary small cell carcinomas of the bladder differ from transitional cell carcinomas by their rarity, histological characteristics, malignant potential and treatment. This study analysed the diagnostic criteria and therapeutic results obtained in a consecutive patient series over a 6-year period.7 patients (6 men and one woman) suffering from primary small cell carcinoma of the bladder were evaluated. Histological slides, treatment modalities and duration of survival were reviewed.The commonest clinical presentation was macroscopic haematuria. All tumours were invasive at the time of diagnosis. Two patients were treated by partial cystectomy, one of whom also received adjuvant chemotherapy. One patient was treated by radical cystectomy and 4 also received adjuvant chemotherapy, including 2 with neoadjuvant radiotherapy at a dosage of 65 Gy. The three patients treated by a single treatment modality (surgery alone or chemotherapy alone) had a shorter survival, in contrast with patients treated by a combination of chemotherapy and/or surgery.Primary small cell carcinomas of the bladder are rare and have a poor prognosis. Treatment must consist of a combination of neoadjuvant or adjuvant chemotherapy and surgery or radiotherapy to achieve the best results.

Human complement factor H-related protein (hCFHrp) is produced by several bladder cancer cell lines and may be useful as a cancer marker. The aim of this study was to compare urinary hCFHrp and cytology for the detection of bladder cancer found by cystoscopy in patients with suggestive signs, symptoms, or preliminary test results.The BTA TRAK assay, a quantitative enzyme immunoassay for the bladder tumor-associated antigen in urine, was compared with exfoliative cytology in 220 patients (155 men, 65 women; mean age, 64.2 years) presenting with signs, symptoms, or preliminary diagnostic results suggestive of this disease. Cystoscopy was the standard of detection.In the 100 patients found to have bladder cancer, the overall sensitivities of the BTA TRAK assay (at a previously determined decision threshold of 14 kilounits/L) and cytology were 66% (66 of 100) and 33% (33 of 100), respectively (P0.001). The BTA TRAK assay proved to be statistically more sensitive than cytology for tumor grades I and II and for stage Ta and T1 tumors. In contrast, the overall specificity of the BTA TRAK assay in the 120 patients without cystoscopically confirmed bladder cancer was 69% (83 of 120) and that of cytology was 99% (119 of 120; P0.001). The specificity of the BTA TRAK assay was higher in patients without benign or malignant genitourinary disease other than bladder cancer (76%; n = 89) than in patients with these conditions. When the BTA TRAK assay and cytology were used together such that a positive result in either test was scored as positive and the results compared with those of the BTA TRAK assay alone, increases in overall sensitivity and equivalent specificity were observed.Because of its relatively high sensitivity, the BTA TRAK assay could complement cytology as an adjunct to cystoscopy in the diagnosis and follow-up of most patients with bladder cancer.

To compare the BTA stat test (BTA stat), a new one-step immunochromatographic assay that can be performed in the urologist's office or in the laboratory, to voided urine cytology and bladder wash cytology (cytology) in the diagnosis and monitoring of cancer of the bladder (BC).BTA stat and cytology were performed in a double-blinded, prospective, clinical study on specimens from 240 subjects (68 females; mean age of subjects: 64 years) suspected of having BC.In 107 subjects with final diagnoses of BC confirmed by cystoscopy or cystoscopy and biopsy, the overall sensitivities of BTA stat and cytology were 65 and 33%, respectively. For tumor grades I, II, and III, the sensitivities of BTA stat were 39, 67 and 83%, respectively. Those of cytology were 4, 20 and 69%. Nine subjects had a diagnosis of 'suspicious for bladder cancer'. The specificities of BTA stat and cytology in the 124 subjects without BC were 64 and 99%, respectively. In the subjects with a history of BC (n = 74), the specificities of BTA stat and cytology were 72 and 99%, respectively. The specificity of BTA stat was lower in subjects with benign or malignant genitourinary disease other than BC (46%) than in subjects without genitourinary disease (71%).The BTA stat test is considerably more sensitive than cytology in the detection of BC and can replace cytology as an adjunct to cystoscopy in the diagnosis and follow-up of patients with BC. However, due to low specificity, BTA stat should not be used without first ruling out potential interferences such as infections, renal disease and cancer, or genitourinary trauma.

To study the improvement of prostatic cancer detection provided by ten strictly systematized transrectal prostatic biopsies.This prospective study was conducted in 162 patients submitted to a series of 10 ultrasound-guided transrectal prostatic biopsies due to the presence of elevated PSA and/or an abnormality on digital rectal examination. Five biopsies were taken from different sites in each lobe: 2 biopsies were inserted between the 3 biopsies usually performed in the standard protocol, while maintaining the angle of entry of the needle recommended in this protocol.The complication rate was 1.85% with the 10-biopsy technique. Prostatic cancer was detected in 40.1% of the 162 patients. The percentage diagnostic improvement provided by the 10-biopsy protocol in the overall patient population was +3.1% compared to the standard protocol. The highest percentage diagnostic improvement was observed in the group of patients with PSAor = 10 ng/ml (+4.9%) and in the group of patients with an ultrasound prostatic volumeor = 40 cc (+4%).The most marked diagnostic improvement appears to be related more to sampling of prostatic zones presenting a statistically increased risk of cancer (peripheral zone) than to the increased number of prostatic biopsies performed.

Evaluate the frequency and assess curative and preventive measures against urinary lithiasis in patients treated with indinavir.Fourteen HIV seropositive patients who developed severe and acute flank pain were included. Four of the patients receiving 800 mg indinavir t.i.d. had fever (38.5 degrees C) or delayed secretion (2 h). Delay from indinavir treatment onset was 1 to 321 days. During the same period, 155 patients had been treated with indinavir. Clinical features, radiology and laboratory results were recorded in addition to an analysis of the lithiasis if possible.Transient moderate renal failure occurred in 8 patients. Mean urine pH was 6. Serum phosphorus, calcium, and uric acid, liver tests and urinalysis were normal. A JJ ureteral stent was inserted in 4 cases due to complications. In all cases, fluids, analgesics and antispasmodics provided favorable outcome. Inversely, nonsteroid antiinflammatory drugs given in 2 patients had a deleterious effect on renal function. The lithiasis was eliminated in 3 cases and infrared spectrophotometry demonstrated a structure compatible with indinavir monohydrate.The formation of urinary lithiasis is a frequent complication of indinavir therapy (9%). Hyperhydration and urine acidification are usually successful but emergency drainage is required in approximately 3% of cases. Nonsteroidal antiinflammatory drugs should be avoided due to the risk of renal toxicity. A precise evaluation of fluid intake and diet, drug associations and personal history is needed to recognize patients at risk of recurrent lithiasis formation.

Inverted Y partial ureteric duplication corresponds to the presence of a variable length of duplicated ureter before entering the bladder in an orthotopic or ectopic position. A case od inverted Y partial ureteric duplication with ureteric confluence in the hilum of the kidney associated with anastomosis of an ectopic ureter in the epididymis is reported. The description of this original case is compared with the data of the literature.

To compare positive resection margin rates in tumour tissue and healthy tissue according to whether total prostatectomy for cancer is performed via a retropubic or transperineal approach.This retrospective, non-randomized study was based on 94 patients suffering from clinically localized cancer (T1-T2) of the prostate operated either via a retropubic (46: group 1) or perineal (48: group II) approach. All slides were reviewed by two pathologists not informed about the clinical course. The frequency of tumour margins associated with extracapsular invasion, capsular incision, without extracapsular extension of the tumour, and finally the incidence of capsular incisions exposing tumour tissue, were determined.While the number of positive resection margins was equivalent in the two groups (61% for group I versus 56% for group II), it was higher in the perineal group (43% versus 29%, p0.05) when the tumour was confined to the gland (pT2). A higher incidence of resection margins in healthy tissue was also observed in group II (90% versus 37%).Transperitoneal prostatectomy is associated with a higher incidence of resection margins in tumour tissue in patients with prostate-confined cancer. Analysis of the resection margins in healthy tissue suggests that the surgical incision is a predisposing factor to their creation.

The use of absorbable staples for enterocystoplasty allows a marked reduction of the operating time. The long-term results on continence need to be evaluated at result term before adopting this technique.Eight patients underwent "W" enterocystoplasty performed with absorbable staples according to the so-called "Detroit" technique, with direct uretero-ileal anastomosis. The continence of these patients was evaluated by clinical follow-up and urodynamic assessment (3 patients). Quality of life was studied by a questionnaire sent to the patient.The mean operating time was 5 hours 20 minutes, the plasty was performed in 25 to 35 minutes. The mean follow-up was 18.7 months, during which two uretero-ileal strictures were diagnosed. 7 of the 8 patients have a good diurnal continence (no leaks) and 1 patient has moderate continence (1 protection). Nocturnal continence was considered to be good in 3 cases, moderate in 2 cases and poor in 3 cases (1 protection). Four of the patients evaluated by questionnaire reported urinary disorders.The use of absorbable staples allows a definite reduction of the operating time, for a modes excess cost and satisfactory functional results.

Despite the improvement current evaluation techniques, approximately 30% of prostatic cancers clinically localized to the gland are understaged. RT-PCR is a sensitive and specific screening method for circulating prostatic cells, proposed as a molecular staging tool. The results obtained with this method and reported in the literature are critically discussed. These results, concerning the detection of circulating PSA- or PSMA-positive prostatic cells, are only indicative, as none of the teams used the same method. No consensus has been reached concerning the equipment used, the choice of oligonucleotide primers, the number of cycles to be applied or even the type of method, classical or "nested". Another possible application of this method is early detection of circulating prostatic cells, possibly neoplastic, during the follow-up of patients treated by radical prostatectomy. Once again, the results of the literature are contradictory. The reliability and reproducibility of molecular biology techniques in routine practice must therefore be demonstrated before these techniques can influence the therapeutic decision concerning prostatic cancer.

The treatment of locally advanced stage T3 prostate carcinoma remains controversial. The reliability of the clinical assessment of extracapsular extension by digital rectal examination (DRE) is therefore crucial. Results from series of patients with T3 prostate cancer treated by radical prostatectomy indicate that DRE has shown a wide range of accuracy from 44% to 82%. The assessment of capsule perforation on biopsy provides a 96% specificity rate and a positive predictive value of 60%. Furthermore, if the apparent clinical status of the seminal vesicle is incorrect, sampling errors on biopsy may be substantial. Biopsy therefore appears to provide a more accurate assessment of the capsule than of the seminal vesicle. Information regarding the correlation between T3 clinical staging and conventional/endorectal coil magnetic resonance imaging staging is still needed. Finally, the accuracy rate of DRE for T3 staging increases to more than 90% if the prostate-specific antigen level is greater than 15 ng/mL.

High-pressure dilatation catheters have been proposed as an alternative to open surgery in the treatment of ureteric strictures because of the low morbidity and short hospital stay. The objective of this study was to evaluate the results of this technique in patients with inflammatory ureteric strictures or uretero-ileal strictures.From April 1991 to September 1996, 25 strictures were treated by antegrade or retrograde dilatation with a high-pressure balloon catheter followed by stenting with a double J stent for an average of 2.1 months (1-5): 14 uretero-ileal strictures (tuberculosis, schistosomiasis, iatrogenic, radiotherapy). A good immediate result was defined as intraoperative rupture of the stricture under fluoroscopic control. A good long-term result was defined as absence of recurrence of the stricture, evaluated clinically and radiologically (IVU and/or ultrasonography).The good immediate result rate was 82% (19 out of 23 strictures, with 2 non-evaluable cases). One intraoperative complication was observed (double J stent advanced too for into the ureter). 22 strictures were evaluable after removal of the double J stent and the good long-term result rate was 64% with a mean follow-up of 8.5 months (0.3-24). 8 patients developed a recurrence: 4 after Bricker, 3 with inflammatory strictures after radiotherapy and J with peritoneal carcinomatosis.This study shows that high-pressure balloon catheter dilatation of non-neoplastic ureteric strictures provides good results and can be considered to be the first-line treatment for these lesions.

Prostate-specific antigen (PSA) forms in serum two stable complexes with alpha 1-antichymotrypsin and alpha 2-macroglobulin. PSA complexed to alpha 1-antichymotrypsin is the predominant fraction of PSA. A minor fraction of serum PSA is not associated with proteinase inhibitors. These molecular differences explain the possibility to distinguish free from total PSA (F/T ratio). Free and complexed PSA have different clearances and significant differences between clearance of free PSA after radical prostatectomy (RP) and after open surgery for benign prostatic hyperplasia (BPH) are observed. These differences are explained by the entire removal of prostatic cells responsible for PSA synthesis and storage during RP, i.e. the source of free PSA present in the intravascular pool. The proportion of free PSA is significantly lower in patients with prostate cancer than in patients with BPH. Thus, the mean F/T ratio in prostate cancer is lower than that in BPH and may be helpful to distinguish cancer from BPH especially in the gray zone of total PSA (4-10 ng/ml). The reason why complexed PSA increases in patients with prostate cancer remains unknown but could be explained by the requirement of an enzymatically active PSA released by the malignant prostate tissue to bind to alpha 1-antichymotrypsin. However, a consensual threshold value for L/T ratio is yet to be found to be of widespread clinical use in the differential diagnosis between cancer and BPH.

Prostate specific antigen (PSA) has become essential to the follow-up of radical treatment for T1-T2 tumours. Various assays are available, but require a correlation coefficient to homogenize their results. PSA is probably the most reliable marker for the follow-up of radical prostatectomy (RP), as this operation should make PSA undetectable after 3 weeks. Highly sensitive tests, with a limit of detection of 0.1 ng/ml, allow the earlier laboratory detection of tumour escape (20 to 45%). Anastomotic biopsies are positive in 35 to 50% of cases. Seminal vesicle invasion and positive resection margins are more frequently associated with recurrence. The doubling time and rate of progression of PSA after RP can be used to distinguish local recurrence from metastasis. Urinary PSA is not useful in the follow-up of RP, as it is secreted by the periurethral glands. The use of the PSA after radical radiotherapy is less clearly established, as this treatment is not designed to eliminate all prostatic tissue or render PSA undetectable. Therapeutic efficacy is situated between 1 and 1.5 ng/ml according to the tests and is achieved in approximately 40% of cases after 4 years. A PSA level greater than 3 ng/ml at 3 months is indicative of a poor prognosis. Prospects for the future include the use of highly sensitive assays and reverse transcriptase polymerase chain reaction (RT-PCR) to detect circulating prostatic cells. The use of PSA has led to a re-evaluation of the efficacy of radical treatments and could influence the indications for adjuvant treatments.

Early diagnosis of prostate cancer is based on determination of serum prostate specific antigen (PSA) and digital rectal examination (DRE). In men with PSA values above 10 ng/ml and where there is a positive DRE, the indication for prostatic biopsy is given. However, there is controversy as to whether men with an intermediate PSA level of 4-10 ng/ml should undergo further evaluation. Since cancer secretes 12 times more serum PSA per volume than benign prostatic hyperplasia, PSA density (PSAD, serum PSA divided by the volume of the entire prostate) has been suggested as an additional diagnostic criterion. In 153 men with prostatism and PSA values between 4 and 10 ng/ml (Hybritech assay), the volume of the prostate was determined by transrectal ultrasonography and 6 systematic biopsies were performed. The groups with positive and negative biopsies respectively were compared according to age of the patient, results of DRE and PSAD. Histological grade of positive biopsies and pathological stage of patients who underwent radical prostatectomy were also compared with diagnostic criteria. Prostate cancer was found in 45 of 153 men (29.4%). Patient's age had no influence on detection rates. The positive predictive value of a PSAD of 0.2 or more was twice the value of a PSAD below 0.2, irrespective of DRE findings. An increasing number of positive biopsies was associated with increasing PSAD and histological grade. Only half of the tumors operated on were still confined to the prostate. Pathological stage could be predicted by the number of positive biopsies. We conclude that PSAD may be useful as a diagnostic parameter in men with prostatism and PSA values of 4-10 ng/ml. The prostate cancers that were detected in this setting are of clinical significance.

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.

To evaluate whether the percentage of biopsy tissue invaded by tumour provides any supplementary information to laboratory and/or biopsy data (Gleason, number...) in the preoperative staging of patients with localized prostatic cancer (T1-T2).170 patients with a mean age of 65.05 +/- 6.12 years and a mean PSA of 22.5 +/- 21.4 ng/mL were submitted to radical prostatectomy (RP) for T1-T2 prostatic cancer. 110 patients were submitted to a series of 6 transrectal prostatic biopsies to establish the diagnosis. We evaluated the percentage of biopsy tissue invaded. This parameter, as well as the Gleason score and the preoperative PSA, were studied in comparison with pathological criteria of the operative specimen (capsule status, resection margins) and postoperative PSA.The cut-off value of 10% of invaded biopsy tissue was calculated as being the most discriminant for the prediction of resection margins, capsule status and progression of laboratory parameters. When less than 10% of biopsy tissue was invaded, there were 31.2% positive margins (RM+). 28% of invaded capsules (pT3), and 21.7% of laboratory progression (P+) versus 44.1%, 71.4% and 47%, respectively, when more than 10% of tissue was invaded. The Gleason score of the biopsy did not improve this prognostic evaluation. The mean quantities of invaded biopsy tissue were statistically different between pT3 and pT2, RM+ and RM-and P+ and P-. When only one positive biopsy was invaded by less than 10%, 87.5% of these operated patients remained stable, RM- and pT2.On an individual level, the percentage of invaded tissue does not reflect the degree of extension or progression of localized prostatic cancer. Only a single positive biopsy invaded over less than 10% of its length is statistically correlated with a good prognosis.

Determine the incidence of prostate cancer in patients consulting for common miction disorders and serum prostatic specific antigen (PSA) between 4 and 10 ng/ml.A total of 153 patients consulted for miction disorders. In 107 of them, the digital examination was abnormal and PSA was between 4 and 10 ng/ml. Transrectal sonography and prostatic biopsies were performed in these 107 patients. We determined the number of cancers detected and assessed the contribution of PSA density (PSAD) to diagnosis. In patients undergoing radical prostatectomy, invasion of the capsule (C+) and positive exeresis section (M+) were recorded.Cancer of the prostate was diagnosed in 29.4% of the patients on the basis of at least 1 of the 6 biopsies. This rate was 47.8% in patients with an abnormal and 21.5% with a normal digital examination. Radical prostatectomy was performed in 32 patients: 50% of them were C+ and 33% M+.Biopsy of the prostate is indicated in patients with an abnormal prostate at digital examination when PSA is between 4 and 10 ng/ml. When the prostate appears to be normal, PSAD may be helpful in determining when to perform a biopsy. Intermediary serum PSA levels do not guarantee favorable pathological characteristics.

To evaluate whether or not a single positive prostatic biopsy out of six systematic ultrasound-guided biopsies, is reliably correlated manner with favourable histopathological features of the tumour on the radical prostatectomy (RP) specimen.In a series of 158 patients undergoing RP for clinically localized prostatic cancer, 15.2% had only one positive biopsy out of 6 systematic biopsies. We compared the rates of capsular effraction (C+) and positive resection margins (RM+), assessed on the operative specimen, in this group of patients with a single positive biopsy (group 1) and in the group (group 2) diagnosed by more than one positive biopsy. The postoperative biological progression rate (P+), defined as an immediate or secondary postoperative elevation of PSA beyond 0.1 ng/ml by polyclonal assay, was also evaluated in the two groups. The Gleason score was evaluated and compared on biopsies and on RP specimens.29.2 of cases were C+, 16.7% were RM+ and 26% were P+ in group 1, versus 70%, 46.5% and 49.5%, respectively, in group 2. All differences were statistically significant. All patients in group 1 with less than 10% of prostatic tissue invaded on the positive biopsy had stage P2, while all patients with 100% of the length of the biopsy invaded by tumour had stage P3. The Gleason score was accurately predicted by the positive biopsy in 39% of cases and was underestimated in 39% of cases.A single positive prostatic biopsy out of six systematic biopsies is a useful predictive factor of local extension, but, in the individual patient, does not guarantee favourable histopathological characteristics of the tumour, nor a favourable course of the disease.