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OBJECTIVE: To establish an external validation of the new nomogram from Gandaglia et al which provides estimates of the probability of pathological favorable disease in pre-operatively defined intermediate-risk PCa. PATIENTS AND METHODS: Overall, 2928 intermediate-risk PCa patients according to the D'Amico classification undergoing RP and bilateral lymph node dissection in seven academic centres between 2000 and 2011. Pathologically favorable PCa was defined as low-grade organ-confined disease. The Receiver Operating Characteristic (ROC) curve was obtained to quantify the overall accuracy (Area Under the Curve, AUC) of the model to predict specimen-confined (SC) disease. Calibration curve was then constructed to illustrate the relationship between the risk-estimates obtained by the model and the observed proportion of SC disease. Kaplan-Meier method was used for PSA recurrence-free survival (PSA-RFS) assessment. RESULTS: Median age was 68 years. 10.6% patients finally presented pathologically favorable disease characteristics at RP. A higher PSAD (OR = 0.01; 95%CI = 0.00-0.04; P < 0.0001) and percentage of positive cores (OR = 0.97; 95%CI = 0.96-0.98; P < 0.0001) were associated with a reduced probability of favorable disease at RP in multivariate analysis. ROC curve analysis showed strongest accuracy of the model (AUC = 0.82; 95%CI = 0.79-0.84). Favorable PCa had a significantly better PSA recurrence-free survival rates as compared to unfavorable PCa after RP (94.2% vs 74.4% at 4 years, P < 0.0001). CONCLUSIONS: This external validation of the Gandaglia nomogram shows relevant accuracy with one out of ten patients in this intermediate risk PCa group with pathologically proven organ-confined disease. This validated risk calculator can help physician to distinguish favorable intermediate risk PCa that can be treated by conservative approach or safer nerve-sparing surgery.

Resume Objectif Le but du Comite de cancerologie de l’Association francaise d’urologie est de proposer une mise a jour des recommandations dans la prise en charge du cancer de la prostate. Methodes Une revue systematique (Medline) de la litterature de 2016 a 2018 a ete conduite par le CCAFU concernant les elements du diagnostic, les options de traitement et la surveillance du cancer de la prostate, en evaluant les references avec leur niveau de preuve. Resultats Les recommandations precisent la genetique, l’epidemiologie et les moyens diagnostiques du cancer de la prostate. L’IRM, examen d’imagerie de reference du cancer localise, est recommandee avant la realisation de biopsies prostatiques. Le score de Gleason est redefini par l’ISUP en 5 groupes pronostiques. Les moyens therapeutiques sont detailles, puis recommandes en fonction des situations cliniques. La surveillance active est une option therapeutique de reference pour les tumeurs de faible risque evolutif. La chirurgie reste une solution therapeutique majeure du cancer de la prostate localise. Elle doit etre envisagee dans un cadre multimodal pour les formes a haut risque. La radiotherapie doit utiliser une technique conformationnelle tridimensionnelle si possible en modulation d’intensite a une dose ≥ 76 Gy. L’hypofractionnement modere apporte un controle biochimique equivalent sans augmentation majeure de la toxicite. L’hormonotherapie courte peut etre associee a l’irradiation pour les tumeurs de risque intermediaire « fort ». Pour les formes a haut risque, l’association a une hormonotherapie longue reste la reference. L’hormonotherapie est le traitement de fond au stade metastatique. La prevention des effets secondaires de l’hormonotherapie est fondamentale. L’hormono-chimiotherapie de premiere ligne pour le traitement des cancers de la prostate metastatiques hormono- et chimio-naifs est un traitement standard en cas de cancer d’emblee metastatique chez les patients dont l’etat de sante est compatible avec l’usage de docetaxel. Dans cette situation, l’association de l’hormonotherapie a l’abiraterone devient egalement un nouveau standard therapeutique. Chez les patients presentant un cancer de prostate resistant a la castration (CPRC), l’apport des nouvelles therapies qui ont emerge ces dernieres annees, aide a mieux controler la progression tumorale et a ameliorer la survie. Conclusion Cette actualisation des recommandations francaises doit contribuer a ameliorer la prise en charge des patients porteurs d’un cancer de la prostate.

Background: Published data on prostate magnetic resonance imaging (MRI) during follow-up of men on active surveillance are lacking. Current guidelines for prostate MRI reporting concentrate on prostate cancer (PCa) detection and staging. A standardised approach to prostate MRI reporting for active surveillance will facilitate the robust collection of evidence in this newly developing area. Objective: To develop preliminary recommendations for reporting of individual MRI studies in men on active surveillance and for researchers reporting the outcomes of cohorts of men having MRI on active surveillance. Design, setting, and participants: The RAND/UCLA Appropriateness Method was used. Experts in urology, radiology, and radiation oncology developed a set of 394 statements relevant to prostate MRI reporting in men on active surveillance for PCa. Each statement was scored for agreement on a 9-point scale by each panellist prior to a panel meeting. Each statement was discussed and rescored at the meeting. Outcome measurements and statistical analysis: Measures of agreement and consensus were calculated for each statement. The most important statements, derived from both group discussion and scores of agreement and consensus, were used to create the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) checklist and case report form. Results and limitations: Key recommendations include reporting the index lesion size using absolute values at baseline and at each subsequent MRI. Radiologists should assess the likelihood of true change over time (ie, change in size or change in lesion characteristics on one or more sequences) on a 1-5 scale. A checklist of items for reporting a cohort of men on active surveillance was developed. These items were developed based on expert consensus in many areas in which data are lacking, and they are expected to develop and change as evidence is accrued. Conclusions: The PRECISE recommendations are designed to facilitate the development of a robust evidence database for documenting changes in prostateMRI findings over time ofmen on active surveillance. If used, they will facilitate data collection to distinguish-measurement error and natural variability in MRI appearances from true radiologic progression. Patient summary: Few published reports are available on how to use and interpret magnetic resonance imaging for men on active surveillance for prostate cancer. The PRECISE panel recommends that data should be collected in a standardised manner so that natural variation in the appearance and measurement of cancer over time can be distinguished from changes indicating significant tumour progression. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

INTRODUCTION 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. METHODS 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 increase>nadir+2ng/mL and was confirmed by biopsy. Perioperative complications according to Clavien-Dindo classification, oncological and functional results were analysed. RESULTS 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. CONCLUSION 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. LEVEL OF EVIDENCE 4.

PURPOSE To quantify and compare the histological components and architectural patterns of Gleason grades in cancerous areas with restriction on apparent diffusion coefficient (ADC) maps. MATERIALS AND METHODS Twelve consecutive cases with 14 separate ADC restriction areas, positive for cancer in the peripheral zone (PZ) and transition zone (TZ) were included. All had 3 Tesla MRI and radical prostatectomy. Ten regions of interest (ROIs) within and outside the 14 ADC restriction areas positive for cancer were selected. For each ROI, we performed quantitative analysis of (a) prostate benign and malignant histological component surface ratios, including stroma, glands, epithelium, lumen, cellular nuclei; (b) percent of Gleason grades and measures of ADC values. Means of histological components according to ADC restriction for cancerous area were compared with analyses of variance with repeated measures. RESULTS Independent predictors of the probability of cancer were median epithelium/ROI ratio (P = 0.001) and nuclei/ROI ratio (P = 0.03). Independent predictors of the probability of ADC restriction were malignant glands/ROI and luminal space/ROI (P

The wide and fast spread of COVID-19 around the world has led to a dramatic increase in the need for protection products both for carers and for populations. Surgical team protection includes a systematic screening of patients, wearing protection devices by all the operating staff, and adequate management of aerosols. The risk of aerosol dispersal is particularly high during laparoscopic and robotic surgeries due to the interaction between circulating CO2 and surgical smoke that may contain small viral particles. To decrease the risk of virus transmission, many recommendations have been implemented including the use of integrated insufflation devices comprising smoke evacuation and filtration mode. Such devices are lacking in many centers around the world and to overcome this urgent unmet need, we designed a cost-effective filtrating suction as a more readily available alternative.

Summary Context The role of radical prostatectomy (RP) in high-risk prostate cancer (PCa) is increasing. Purpose To review the existing literature and determine the value of RP in high-risk and locally advanced PCa. Documentary source MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from 01/2000 through 05/2016 according to the PRISMA guidelines. Selection of studies Forty-two studies describing outcomes of RP among 52,546 patients with high-risk and locally advanced PCa. Results Mortality was approximately 0–1% and Clavien ≥ 3 complications ranged from 1.8% to 12%. Biochemical recurrence-free and metastasis-free survival ranged from 40 to 94% and 90 to 96.1% at 5 years and from 27 to 68% and 64.4 to 85.1% at 10 years, respectively. Overall and cancer specific survival ranged from 55.2 to 98.6% and 89.8 to 100% at 5 years and from 58 to 84% and 65 to 96% at 10 years, respectively. The 12-mo continence rates ranged from 32% to 96.2% and the erectile function recovery ranged from 60% to 64%. Limits Studies were heterogeneous especially regarding the definition of high-risk disease and the use of adjuvant treatments. Conclusions The utilization of RP in high-risk and locally advanced PCa is increasing. Existing data support the advantages of RP in this group of patients. However, uniformity in definitions and indications are a prerequisite in order to establish its role as an important therapeutic arm in a multimodality management strategy.

Objective To describe a step-by-step guide to robot-assisted anterior partial prostatectomy (RA-APP) for isolated magnetic resonance imaging (MRI)-detected anterior prostate cancer (APC). Patients and methods After Institutional Review Board approval, over an 8-year period (2008-2015), 17 consenting patients were enrolled in a prospective, single-arm, single-centre, Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery (IDEAL) phase 2a study. The inclusion criteria comprised pre-urethral, low-intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone (TZ) enucleation, and distal peripheral zone (PZ) sectioning; (ii) antegrade, at the bladder neck (BN) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 years, respectively. Results The RA-APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN, prostate adenoma (TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. The posterolateral parts of the PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien-Dindo grade II. RA completion of prostatectomy was feasible in the four cases with cancer recurrence. Conclusion PZ prostate-sparing RA-APP for isolated APC is feasible and safe, and represents an option for highly selected men with APCs as an alternative to other focal ablative therapy.

Purpose Using a limited temporal resolution dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) dataset to assess the impact of the arterial input function (AIF) choice on the transfer constant (Ktrans) to distinguish prostate carcinoma (PCa) from benign tissue. Materials and Methods Thirty-eight patients with clinically important peripheral PCa (≥0.5 cc) were retrospectively studied. These patients underwent 1.5T multiparametric prostate MR with PCa and benign regions of interest (ROIs) selected using a visual registration with morphometric reconstruction obtained from radical prostatectomy. Using three pharmacokinetic (PK) analysis software programs, the mean Ktrans of ROIs was computed using three AIFs: an individual AIF (Ind-AIF) and two literature population average AIFs of Weinmann (W-AIF) and of Fritz-Hansen (FH-AIF). A pairwise comparison of the area under the receiver operating characteristic curves (AUROCC) obtained with different AIFs was performed. Results AUROCCs obtained with W-AIF (ranging from 0.801 to 0.843) were significantly higher than FH-AIF (ranging from 0.698 to 0.780, 0.002 ≤ P ≤ 0.045) and similar to or higher than Ind-AIF (ranging from 0.591 to 0.839, 0.014 ≤ P ≤ 0.9). Ind-AIF and FH-AIF provided similar AUROCC (0.34 ≤ P ≤ 0.81). The pairwise correlation of Ktrans values was moderate to very strong when comparing W-AIF with FH-AIF (the Spearman's correlation coefficients [SCCs] ranged from 0.55 to 0.93) and very weak to moderate when comparing W-AIF with Ind-AIF (the SCCs ranged from 0.018 to 0.59) or FH-AIF with Ind-AIF (the SCCs ranged from 0.30 to 0.51). Conclusion W-AIF yielded a higher performance than FH-AIF and a similar or higher performance than Ind-AIF in distinguishing PCa from benign tissue. J. Magn. Reson. Imaging 2015.

Resume Introduction L’association entre syndrome de Lynch et cancer de prostate a ete etudiee aussi bien sur le plan epidemiologique que genetique. Des etudes recentes rapportent une association entre ces deux pathologies. Patients et methode Une revue de la litterature sur la base de recherche PubMed a ete effectuee en utilisant les mots cles suivants : Lynch syndrome et prostate cancer. Resultats Huit articles etudiant des cohortes de sujets porteurs du syndrome de Lynch ont ete analyses incluant 6786 patients et 175 cancers. Les cancers de prostate etaient plus frequents avec un rapport d’incidence standardise (RIS) entre 0,93 (IC 95 % : 0,19–2,7) et 5,9 (IC 95 % : 4,1–17,1) et survenant a un âge plus jeune que dans la population generale principalement pour les mutations du gene MSH2. Conclusions Le cancer de prostate semblerait plus frequent et surviendrait plus tot chez les sujets porteurs d’une mutation du gene MSH2 alors qu’il ne semble pas exister de difference par rapport a la population generale pour les autres mutations du syndrome de Lynch.

Resume Objectif Evaluer la survie sans recidive biologique a long terme apres prostatectomie totale pour cancer stratifiee, selon la voie d’abord ouverte et laparoscopique avec ou sans assistance robotisee et le stade clinico-pathologique. Materiels et methodes Etude de suivi de cohorte monocentrique de 1313 patients consecutifs traites par PT pour cancer de prostate localise ou localement avance entre 2000 et 2013. Les interventions etaient realisees par voie ouverte (63,7 %), laparoscopique (10 %) et laparoscopique robot-assistee (26,4 %). La recidive biologique etait definie par un PSA > 0,1 ng/mL. La survie sans recidive biologique etait decrite par la methode de Kaplan Meier et les facteurs pronostiques etaient analyses par le modele de Cox. Resultats Le suivi median etait de 57 mois (EIQ : 31–90). La survie sans recidive biologique a 10 ans etait de 89 %, 72 % et 54 % respectivement pour les groupes a risque faible, intermediaire et eleve de D’Amico. En analyse multivariee, le facteur pronostique le plus pejoratif etait le score de Gleason ( p p p = 0,06) et le taux de marges chirurgicales positives ( p = 0,87) n’etaient pas differents en fonction des 3 voies d’abord. Conclusion Nos resultats de survie sans recidive biologique apres prostatectomie totale ne different pas selon la voie d’abord et sont proches des series publiees. La survie sans recidive biologique a 10 ans pour les tumeurs a risque eleve sans hormonotherapie est de 54 % justifiant la place de la chirurgie dans la discussion therapeutique pour ce groupe de tumeur. Niveau de preuve 3.

Objective To evaluate the impact of radical prostatectomy on lower urinary tract symptoms by using the International Prostate Symptom Score and International Prostate Symptom Score quality of life. Methods The present prospective study comprised 804 patients having localized prostate cancer who underwent radical prostatectomy. International Prostate Symptom Score and International Prostate Symptom Score quality of life were recorded preoperatively, and at 1, 3, 6, 12 and 24 months. Two study groups were considered: group 1 included patients with International Prostate Symptom Score ≤7 (mild) and group 2 included patients with International Prostate Symptom Score ≥8 (moderate to severe). Student's t-test and logistic regression were carried out to detect a predictive factor of International Prostate Symptom Score ≤7 at 24 months. Results The mean International Prostate Symptom Score was 5.58 ± 6.6, 11.12 ± 7.1 and 7.62 ± 6 at baseline, 1 month and 3 months, respectively (P

Resume But Decrire l’epidemiologie, les facteurs de risque et les facteurs genetiques incrimines dans la carcinogenese des tumeurs des voies excretrices urinaires superieures (TVES). Materiel et methodes Une recherche bibliographique a ete effectuee a partir de la base de donnees bibliographique Medline (PubMed) et des sites de la HAS et de l’ANSM avec les mots cles suivants : epidemiologie ; facteurs de risque ; tabac ; acide aristolochique ; carcinome urothelial ; uretere ; bassinet. La recherche etait centree sur l’epidemiologie, les facteurs de risque genetiques et environnementaux des TVES. Resultats L’incidence estimee des TVES est de 1,2 cas pour 100 000 habitants par an en Europe. L’incidence des tumeurs pyelocalicielles est stable depuis 30 ans alors que la frequence des localisations ureterales est en augmentation avec le temps. Les stades et grades avances seraient plus frequents au diagnostic. Celui-ci aurait lieu a un âge moyen plus tardif (> 70 ans). Le ratio homme/femme est de l’ordre de 2. Les principaux carcinogenes de l’urothelium restent le tabac et l’exposition professionnelle. Il existe des facteurs environnementaux specifiques aux TVES. L’exposition a l’acide aristolochique (nephropathie des Balkans et herbes chinoises) est a l’origine d’une carcinogenese specifique du haut appareil urinaire. Les formes familiales ont des caracteristiques epidemiologiques distinctes des formes sporadiques. Les TVES sont la troisieme localisation tumorale dans le syndrome de Lynch. Conclusion Les TVES sont des tumeurs rares comportant des caracteristiques epidemiologiques et des facteurs de risques a la fois communs aux carcinomes urotheliaux vesicaux et specifiques a leur localisation.

Computer technology is widely used for multimodal image analysis of the prostate gland. Several techniques have been developed, most of which incorporate a priori knowledge extracted from organ features. Knowledge extraction and modeling are multi-step tasks. Here, we review these steps and classify the modeling according to the data analysis methods employed and the features used. We conclude with a survey of some clinical applications where these techniques are employed. Complete and up to date review of prostate modeling.Description as three main steps: characteristics extraction, analyses and modeling.Classification and linkage with the main clinical applications.

Multiparametric MR of the prostate provides an extremely accurate diagnosis and offers an excellent negative predictive value for cancers which biopsies struggle to detect. Combined with biopsies they consolidate both positive and negative biopsy results and allow patients to be offered more appropriate treatments (active monitoring, radical treatment in full knowledge of the topography of the lesions involved, or local treatment, etc.). The investigation does not require advanced equipment and can be carried out in any MR centre although it needs to follow a technical protocol described in the European guidelines (ESUR 2012). Interpretation should be standardized to facilitate communication of clear and consistent information between practitioners.

Objective To evaluate the impact of ‘hereditary-like’ status in upper tract urothelial carcinoma (UTUC) on the survival of patients who have undergone radical nephroureterectomy (RNU) and adjuvant chemotherapy. Patients and Methods A multicentre retrospective study was performed on all patients with high-risk UTUC who underwent RNU and adjuvant cisplatin-based chemotherapy. Using a patient risk identification tool, we distinguished tumours suspected to be hereditary from sporadic tumours and compared survival rates. Results A total of 112 patients with a median age of 67 years were included. Hereditary-like tumour status was detected in 35 patients (31.3%), while 77 patients (68.7%) had sporadic tumours. The median age was significantly younger in the hereditary-like tumour group (56.0 vs 69.8 years, P < 0.001). Overall survival (OS) after chemotherapy was significantly better in the group with hereditary-like tumours than in the group with sporadic tumours (5-year OS: 48.2 vs 32%; P = 0.008). The cancer-specific survival (CSS) rate was significantly better in the group with ‘hereditary-like’ tumours than in the group with sporadic tumours (5-year CSS: 58 vs 35%; P = 0.006). Although there was a trend in favour of the hereditary-like tumours, we observed no significant difference regarding progression-free survival (PFS) between the two groups (5-year PFS: 71 vs 52%; P = 0.07). Conclusion Adjuvant chemotherapy after RNU improves survival outcomes in patients with hereditary-like UTUC compared with those with sporadic tumours.

To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targeted biopsy (TB) with that of extended systematic biopsy (SB) in prostate cancer (PCa) detection.This institutional review board-approved multicenter prospective study (May 2009 to January 2011) included 95 patients with informed consent who were suspected of having PCa, with a suspicious abnormality (target) at prebiopsy MR. Patients underwent 12-core SB and four-core TB with transrectal ultrasonographic (US) guidance, with two cores aimed visually (cognitive TB [TB-COG]) and two cores aimed using transrectal US-MR fusion software (fusion-guided TB [TB-FUS]). SB and TB positivity for cancer and sampling quality (mean longest core cancer length, Gleason score) were compared. Clinically significant PCa was any 3 mm or greater core cancer length or any greater than 3 Gleason pattern for SB or any cancer length for TB. Statistical analysis included t test, paired χ(2) test, and κ statistic. Primary end point (core cancer length) was calculated (paired t test).Among 95 patients (median age, 65 years; mean prostate-specific antigen level, 10.05 ng/mL [10.05 μg/L]), positivity rate for PCa was 59% (n = 56) for SB and 69% (n = 66) for TB (P = .033); rate for clinically significant PCa was 52% (n = 49) for SB and 67% (n = 64) for TB (P = .0011). Cancer was diagnosed through TB in 16 patients (17%) with negative SB results. Mean longest core cancer lengths were 4.6 mm for SB and 7.3 mm for TB (P.0001). In 12 of 51 (24%) MR imaging targets with positive SB and TB results, TB led to Gleason score upgrading. In 79 MR imaging targets, positivity for cancer was 47% (n = 37) with TB-COG and 53% (n = 42) with TB-FUS (P = .16). Neither technique was superior for Gleason score assessment.Prebiopsy MR imaging combined with transrectal US-guided TB increases biopsy performance in detecting PCa, especially clinically significant PCa. No significant difference was observed between TB-FUS and TB-COG for TB guidance.

Objective To assess the prognostic significance of positive surgical margins (PSMs) after minimally invasive radical prostatectomy (MIRP) in interaction with other established prognosis factors. Patients and Methods We retrospectively analysed data prospectively collected between 1998 and 2010 for 4628 consecutive patients who underwent MIRP for clinically localized prostate cancer. The impact of PSM on biochemical recurrence (BCR), defined as prostate-specific antigen (PSA) >0.2 ng/mL, was evaluated using multivariable Cox proportional hazards regression. Estimates of BCR-free survival were generated using the Kaplan–Meier method and compared among groups using the log-rank test. Results The median follow-up was 55 months. On multivariable analysis, PSM was an independent prognostic factor for BCR (adjusted hazard ratio: 2.14 for PSMs vs negative surgical margins (NSMs); 95% confidence interval [CI]: 1.86–2.45; P < 0.001). Other independent predictors for BCR were preoperative PSA, date of surgery, pT stage, Gleason score and lymph node involvement (all P < 0.001). The 5-year BCR-free probability was 80.6% (95% CI: 79–82.2) for NSMs vs 51% (95% CI: 47–55) for PSMs (log-rank P < 0.001). Patients with pT2 and pT3a PSMs had a similar prognosis to those with pT3a and pT3b NSMs, respectively (log-rank P ≥ 0.05). Conclusion A PSM after MIRP is associated with 2.14-fold increased risk of BCR. In patients with pT2 and pT3a disease, a PSM could be considered a pathological upstaging.

To evaluate the long-term outcomes of patients with prostate cancer who have pathological pT3b N0-Nx, with postoperative PSA0.1 ng/ml and no systematic adjuvant treatment.Using a monocentric prospectively maintained database, we identified among 2,142 men who underwent minimally invasive radical prostatectomy, 104 pT3b N0-Nx patients, with postoperative PSA0.1 ng/ml and at least 5 years of follow-up. Patients were considered for salvage treatment at biochemical recurrence (PSA ≥ 0.2 ng/ml).The median time of follow-up was 83.5 months (interquartile range [IQR]: 69-99). Overall, 102 patients (98 %) had T2 clinical stage or less. Specimen Gleason score was 7 in 71 patients (68 %) and7 in 15 (14 %). Thirty-eight patients (37 %) were upgraded for Gleason score after radical prostatectomy. The overall 5-year probability of freedom from biochemical recurrence for the entire cohort was 55.8 % (95 % CI 45.8-65.8) and 73.3 % for patients who had specimen Gleason score7 (p = 0.005). In univariate analysis, specimen Gleason score and surgical margin status were significant predictors for biochemical failure after radical prostatectomy (p = 0.05 and 0.007, respectively). In multivariate analysis, only specimen Gleason score7 was significantly associated with biochemical failure (p = 0.009).SVI is an adverse prognostic factor, but it is not associated with a uniformly poor prognosis. Specimen Gleason score and surgical margin status are significant predictors of recurrence after radical prostatectomy in patients with prostate cancer and SVI.

To assess the risk factors of metastasis relapse in pT2-3 upper tract urothelial carcinomas (UTUCs) treated by radical nephroureterectomy (RNU) without lymphadenectomy (LN). A multicentric retrospective study was performed for pT2-3 pNx UTUCs treated by RNU between 1995 and 2010. The following criteria were retrieved: age, gender, American Society of Anaesthesiologists physical status, surgical approach, preoperative hydronephrosis, stage, grade, tumor location, surgical margin, lymphovascular invasion (LVI) status and outcomes. Metastasis-free survival (MFS) was measured by Kaplan–Meier method with the log-rank test. Overall, 151 patients were included. The median follow-up was 18.5 months (IQR 9.5–37.9). The 2- and 5-year MFS were 69 % ± 4.5 and 54.1 % ± 5.8, respectively. In univariate analysis, ureteral location, pT3 stage, positive LVI status and positive surgical margin were significantly associated with worse MFS (p = 0.03; 0.02; 0.01 and 0.006, respectively). In the multivariate analysis of ureteral location and pT3 stage were independent prognostic factors (p = 0.03 and 0.03, respectively). Based on the results of the univariate analysis, we proposed a risk model predicting MFS, which classifies patients into 3 categories with different overall survival (p

Objectives To assess the impact of lymphovascular invasion (LVI) on upper urinary tract urothelial carcinomas (UTUCs) in a multicentre study on cancer-specific survival (CSS), recurrence-free survival and metastasis-free survival (MFS). To show the negative impact of LVI for patients with pN0/x disease and to stratify these patients into risk groups for metastatic relapse. Patients and Methods A multicentre retrospective study was performed on patients who underwent radical nephroureterectomy between 1995 and 2010. LVI status was evaluated as a prognostic factor for survival using univariate and multivariate Cox regression analysis. Results Overall, 551 patients were included and were divided into two groups: those without LVI (LVI−), n = 388 and those with LVI (LVI+), n = 163. LVI+ status was associated with high stage and grade UTUC and lymph node metastasis (P

Focal therapy (FT) may offer a promising treatment option in the field of low to intermediate risk localized prostate cancer. The aim of this concept is to combine minimal morbidity with cancer control as well as maintain the possibility of retreatment. Recent advances in MRI and targeted biopsy has improved the diagnostic pathway of prostate cancer and increased the interest in FT. However, before implementation of FT in routine clinical practice, several challenges are still to overcome including patient selection, treatment planning, post-therapy monitoring and definition of oncologic outcome surrogates. In this article, relevant questions regarding the key steps of FT are critically discussed and the main available energy modalities are analyzed taking into account their advantages and unmet needs.

Resume Objectif Le but du Comite de cancerologie de lʼAssociation francaise dʼurologie etait de proposer une mise a jour des recommandations dans la prise en charge du cancer de la prostate (CaP). Methodes Une revue systematique (Medline) de la litterature de 2013 a 2016 a ete conduite par le CCAFU concernant les elements du diagnostic, les options de traitement et la surveillance du CaP, en evaluant les references avec leur niveau de preuve. Resultats Les recommandations precisent la genetique, lʼepidemiologie et les moyens diagnostiques du CaP. Lʼimagerie par resonance magnetique (IRM) est lʼexamen dʼimagerie de reference du cancer localise. Le score de Gleason a ete redefini par lʼInternational Society of Urological Pathology (ISUP) en cinq groupes pronostiques. Les moyens therapeutiques ont ete detailles, puis recommandes en fonction des situations cliniques. La surveillance active (SA) est une option therapeutique de reference pour les tumeurs de faible risque evolutif. La chirurgie reste une solution therapeutique majeure du CaP localise. Elle doit etre envisagee dans un cadre multimodal pour les formes a haut risque. La radiotherapie doit utiliser une technique conformationnelle tridimensionnelle si possible en modulation dʼintensite a une dose > 76 Gy. Lʼhypofractionnement modere apporte un controle biochimique equivalent sans augmentation majeure de la toxicite. LʼHT courte peut etre associee a lʼirradiation pour les tumeurs de risque intermediaire « fort ». Pour les formes a haut risque, lʼassociation a une HT longue reste la reference. LʼHT est le traitement de fond au stade metastatique. La prevention des effets secondaires de lʼHT est fondamentale. Lʼhormonochimiotherapie de premiere ligne pour le traitement des CaP metastatiques hormono- et chimio-naifs est le traitement standard en cas de cancer dʼemblee metastatique chez les patients dont lʼetat de sante est compatible avec lʼusage de docetaxel. Chez les patients presentant un cancer de prostate resistant a la castration (CPRC), lʼapport des nouvelles therapies qui ont emerge ces dernieres annees aide a mieux controler la progression tumorale et a ameliorer la survie. Conclusions Cette actualisation des recommandations francaises doit contribuer a ameliorer la prise en charge des patients porteurs dʼun CaP. © 2016 Elsevier Masson SAS. Tous droits reserves.

International audience; OBJECTIVE:The purpose of the guidelines national committee CCAFU on bladder cancer was to propose updated french guidelines for non-muscle invasive (NMIBC) and invasive (MIBC) bladder cancers.METHODS:A Medline search was achieved between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.RESULTS:Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment : instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan; MRI and FDG-PET remain optional. Cystectomy associated with extensive pelvic lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples. The interest of neoadjuvant chemotherapy is well known for all MIBC, wathever the stage. Thus, neoadjuvant chemotherapy is recommended for all eligible patients according PS (PS 60ml/mn). As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC). In second line treatment, only chemotherapy using vinflunine has been validated to date, even if results of immunotherapy clinical trials are encouraging.CONCLUSION:These updated french guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC. © 2016 Elsevier Masson SAS. All rights reserved.

RésuméLe diagnostic du cancer de la prostate est le plus souvent porté à l’occasion d’un dosage élevé de PSA, fait dans le cadre du dépistage individuel, et repose sur la réalisation de «biopsies systématisées» par voie transrectale avec guidage échographique. Cette stratégie classique entraîne un risque de sur-diagnostic de cancers cliniquement non significatifs [microfoyers], ainsi qu’une non-détection de certains cancers cliniquement significatifs situés en dehors des zones prélevées. La réalisation d’une IRM prostatique avant les biopsies a tout changé. Elle augmente la détection des cancers de volume significatif grâce aux «biopsies ciblées» sur les anomalies vues à l’IRM. Elle améliore l’estimation de leur grade, de leur taille et permet de préciser leur localisation et contour. Elle permettrait aussi de diminuer la détection des cancers non significatifs, si les biopsies systématisées n’étaient plus faites en cas d’IRM sans cible suspecte. Les applications thérapeutiques de l’IRM sont déterminantes pour l’essor des options récentes de prise en charge comme la sélection des patients pour la surveillance active ainsi que pour l’indication de traitement focal. Les modalités de réalisation et d’interprétation de l’IRM ont été publiées en 2016 sous forme d’une mise à jour du score PI-RADS [Prostate Imaging Reporting and Data System version 2]. Cette standardisation aide les radiologues à proposer aux cliniciens urologues et radiothérapeutes les éléments nécessaires pour le diagnostic et le traitement des cancers de la prostate.AbstractProstate cancer is most commonly diagnosed on the basis of an increased serum prostate specific antigen (PSA) level, through individual screening, and is carried out following systematic transrectal ultrasound-guided prostate biopsies. This strategy is associated with risks of overdiagnosing clinically non significant cancers, as well as missing clinically significant ones. Performing a prostate magentic resonance imaging (MRI) prior to prostate biopsies modifies the way of diagnosing prostate cancer. It increases the detection rate of clinically significant cancers by using targeted biopsies focused on lesions that are detected on MRI. It enhances the estimation of grade, size, location and boundaries of the lesions. It may be used to reduce the detection rate of clinically non significant cancers if the systemic biopsies were not performed in patients without any suspect MRI lesion. Therapeutic use of MRI includes screening of patients eligible for active surveillance or focal treatment. MRI protocols and interpretation have been published in 2016 as an update of the PI-RADS score (Prostate Imaging Reporting and Data System version 2). Standardising the acquisition, interpretation and reporting of prostate MRI is useful for urologists and radiation oncologists in order to diagnose and treat prostate cancer.

Background The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery. Objective To determine the clinical feasibility and safety of single-port urologic procedures by using a novel robotic surgical system. Design, setting, and participants This was a prospective institutional review board–approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. Intervention Different types of urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port. Outcome measurements and statistical analysis The main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes. Results and limitations A total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38min. At 3-yr follow-up all patients presented a preserved renal function; none had tumor recurrence. Study limitations include the small sample and the lack of a control group. Conclusions We describe the first clinical application of a novel robotic platform specifically designed for single-port urologic surgery. Major urologic procedures were successfully completed without conversions. Further assessment is warranted to corroborate these promising findings. Patient summary A novel purpose-built robotic system enables surgeons to perform safely and effectively a variety of major urologic procedures through a single small abdominal incision. Trial registration The study was registered on www.ClinicalTrials.gov (NCT02136121).

Prognoses for intermediate-risk prostate cancer (PCa) remain heterogeneous. Improved substratification could optimize treatment and monitoring strategies. The objective was to validate this subclassification in a radical prostatectomy (RP) series. Between 2000 and 2011, 4038 patients who underwent RP for intermediate-risk PCa in seven French academic centers were included. Unfavorable intermediate-risk (UIR) PCa was defined as having a primary Gleason score of 4, ≥50% positive biopsy cores (PPBC), or more than one D’Amico intermediate-risk factor (i.e., cT2b, PSA 10–20, or Gleason score 7). Remaining PCa cases were classified as favorable. Main endpoints were pathologic results (pT stage, final Gleason score, surgical margin status), and oncologic outcomes were assessed according to PSA recurrence-free survival (PSA-RFS). Univariate and multivariate analyses were performed using the log-rank test and the Cox proportional hazards model. Median follow-up was 48 months (95% CI = [45–49]). Patients with UIR had worse PSA-RFS (68.17 vs. 81.98% at 4 years, HR = 1.97, 95% CI = [1.71; 2.27], p

Recent publications have assessed the prognostic significance of hydronephrosis in the outcome of upper tract urothelial carcinoma (UUT-UC). Our study sought to determine the prognostic impact of hydronephrosis on UUT-UC survival and its relationship to the clinicopathological features.A retrospective, multi-institutional French study was conducted on 401 patients who underwent radical nephroureterectomy for non-metastatic UUT-UC. Hydronephrotic status was determined using preoperative imaging reports. Univariate and multivariate analyses were conducted to identify factors associated with survival.Preoperative hydronephrosis was present in 74 patients. Median follow-up was 26 months. Hydronephrosis was associated only with ureteral localisation (p 0.001). No difference was observed in 5-year cancer-specific survival (CSS) between the hydronephrosis group (80.1 %) and the no hydronephrosis group (83.6 %) (p 0.05). Only age (p = 0.02) and pT stage (p = 0.01) were independent predictors of CSS. Hydronephrosis was not a significant predictor of CSS in the univariate and multivariate analyses (p = 0.87 and p = 0.66). No significant difference was observed for 5-year metastasis-free survival (MFS) between the hydronephrosis group (69.8 % ± 6.6 %) and the no hydronephrosis group (80.5 % ± 3 %) (p = 0.052). Hydronephrosis was not a significant predictor of MFS in the univariate and multivariate analyses (p = 0.16 and p = 0.36). Multifocality (p = 0.02), pT stage (p 0.001) and positive surgical margins (p = 0.02) were independent predictors of MFS. For the pelvic tumours subgroup, hydronephrosis was an independent predictor of MFS (p = 0.01) but not CSS (p = 0.86).Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal tumours appear to have a worse prognosis than ureteral tumours.

Resume Objectif L’objectif etait de decrire les caracteristiques cliniques orientant la therapeutique des petites masses renales de moins de 4 cm vers une exerese chirurgicale (tumorectomie ou nephrectomie totale) ou vers une technique ablative (radiofrequence) ou vers une surveillance dans un centre regional de reference en cancerologie. Patients et methodes Etude retrospective de 2000 a 2010, incluant 253 patients consecutifs ayant une masse renale suspecte de moins de 4 cm. Les patients ayant une tumeur de moins de 3 cm ont ete compares a ceux qui avaient une tumeur de 3 a 4 cm. Une analyse des donnees cliniques, pathologiques, de la prise en charge et du suivi a ete realisee, en fonction du traitement fait (exerese chirurgicale, radiofrequence ou surveillance). Resultats Un traitement chirurgical a ete realise pour 214 patients (84,6 %), une radiofrequence pour 15 patients (5,9 %) et une surveillance pour 24 patients (9,5 %). La prise en charge therapeutique des deux groupes de patients ayant une petite masse renale ( Conclusion L’âge et l’etat general des patients ayant une petite masse renale de moins de 4 cm etaient des caracteristiques orientant significativement la therapeutique vers un traitement chirurgical, une radiofrequence ou une surveillance. L’utilisation d’echelles de morbidite geriatrique comme l’indice Charlson ou de Lee devrait permettre de mieux guider le choix therapeutique des sujets âges.

Summary Background Photodynamic therapy (PDT) is an innovative technique in oncologic urology. Its application appears increasingly realistic to all kind of cancers with technological progress made in treatment planning and light delivery associated with the emergence of novel photosensitizers. The aim of this study is to review applications of this technique in urology. Materials and methods We reviewed the literature on PDT for urological malignancies with the following key words: photodynamic therapy, prostate cancer, kidney cancer, urothelial cancer, penile cancer and then by cross-referencing from previously identified studies. Results Focal therapy of prostate cancer is an application of PDT. Clinical studies are ongoing to determine PDT efficacy and safety. PDT as salvage treatment after radiotherapy has been tested. Oncologic results were promising but important side effects were reported. Individual dosimetric planning is necessary to avoid toxicity. PDT was tested to treat superficial bladder carcinoma with promising oncologic results. Serious side effects have limited use of first photosensitizers generation. Second generation of photosensitizer allowed reducing morbidity. For upper urinary tract carcinoma and urethra, data are limited. Few studies described PDT application in penile oncology for conservative management of carcinoma in situ and premalignant lesions. For renal cancer, PDT was only tested on preclinical model despite of its potential application. No data is available concerning PDT application for testicular cancer. Conclusion PDT clinical applications in urology have proved a kind of efficiency balanced with an important morbidity. Development of new photosensitizer generations and improvement in illumination protocols should permit to decrease side effects.

Study Type – Diagnostic (exploratory cohort) Level of Evidence 3a What's known on the subject? and What does the study add? Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is an autosomal dominant multi-organ cancer syndrome. Upper urinary tract urothelial carcinomas belong to HNPCC-related tumours and rank third within this group after colorectal and endometrial cancer. However, many urologists are not aware of this association and it is presumed that some hereditary cancers are misclassified as sporadic and that their incidence is underestimated. Consequently, family members of patients with upper urinary tract urothelial carcinomas secondary to HNPCC may be denied appropriate surveillance and early detection. A significant proportion of patients (21.3%) with newly diagnosed upper urinary tract urothelial carcinomas may have underlying HNPCC. Demographic and epidemiological characteristics suggest different mechanisms of carcinogenesis among this population. Recognition of such potential is essential for appropriate clinical and genetic management of patients and family. In order to help to identify these patients, we propose a patient-specific checklist. OBJECTIVE • To identify, based on previously described clinical criteria, hereditary upper urinary tract urothelial carcinomas (UUT-UCs) that are likely to be misclassified as sporadic although they may belong to the spectrum of hereditary non-polyposis colorectal cancer (HNPCC) associated cancers. PATIENTS AND METHODS • We identified, using established clinical criteria, suspected hereditary UUT-UC among 1122 patients included in the French national database for UUT-UC. • Patients were considered at risk for hereditary status in the following situations: age at diagnosis

Study Type – Prognosis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinoma (UUT-UC) is a rare disease, usually treated by nephroureterectomy, occurring in a population with a median age of 70 years and with frequent tobacco use and other comorbidities. We know that the American Society of Anesthesiologists (ASA) score has prognostic value in urological oncology but this has not been assessed in UUT-UC. Using a multi-institutional French database, we have shown that the 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). OBJECTIVE • To evaluate the impact of American Society of Anesthesiologists (ASA) scores on the survival of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC). PATIENTS AND METHODS • A retrospective multi-institutional cohort study of the French collaborative national database of UUT-UC treated by RNU in 20 centres from 1995 to 2010. • The influence of age, gender and ASA score on survival was assessed using a univariable and multivariable Cox regression analysis with pathological features used as covariables. RESULTS • Overall, 554 patients were included. The median follow-up was 26 months (10–48 months), and the median age was 69.5 years (61–76 years). In total, 114 (20.6%) patients were classified as ASA 1, 326 (58.8%) as ASA 2 and 114 (20.6%) as ASA 3. • The 5-year recurrence-free survival (P= 0.21) and metastasis-free survival (P= 0.22) were not significantly different between ASA 1 (52.8% and 76%), ASA 2 (51.9% and 75.3%) and ASA 3 patients (44.1% and 68.2%, respectively). • The 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P= 0.01). • ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P= 0.04). CONCLUSIONS • ASA classification correlates significantly with cancer-specific survival after RNU for UUT-UC. • It is a further pre-operative clinical variable that can be incorporated into future risk prediction tools for UUT-UC to improve their accuracy.

Resume Objectif Analyser l’impact pronostique des emboles vasculaires tumoraux (EVT) en cas de tumeur des voies excretrices urinaires superieures (TVEUS). Patients et methodes Etude retrospective d’une population de 83 patients consecutifs ayant une TVEUS traites chirurgicalement entre janvier 1998 et octobre 2008. L’interet pronostique des facteurs histopathologiques (stade, grade, EVT, carcinome in situ [CIS], architecture tumorale, localisation, envahissement ganglionnaire et statut des marges chirurgicales) etait evalue, en analyse uni- et multivariee par regression selon le modele de Cox. Les survies specifiques (SSP), sans recidive (SSR) et sans metastase (SSM) etaient calculees selon la methode de Kaplan-Meier et le test de Log-Rank. Resultats Des EVT etaient observes chez 26,5 % des patients apres relecture histopathologique. Les SSP, SSR et SSM a deux ans etaient de 93 %, 76 % et 96 %, respectivement sans EVT, comparees a 40 %, 13 % et 38 % en cas d’EVT ( p p p p p = 0,002 ; 0,002 et 0,001 respectivement pour les SSP, SSR et SSM). Conclusion Les EVT etaient un facteur pronostique pejoratif en cas de TVEUS. Ce critere doit etre systematiquement recherche et figurer sur le compte rendu anatomopathologique.

This paper aims to argue the advantages of using routine multiparametric MRI (mp-MRI) prior to the first series of biopsies in patients with suspected cancer of the prostate indicated by a rise in Prostatic Specific Antigen (PSA). Using biopsy targeted onto a lesion seen by MRI, this diagnostic strategy could increase detection of significant cancers and improve evaluation of their grade and size. This strategy would also mean that the detection of insignificant cancers (microfoci detected by chance during systematic biopsy) would decrease, since if the mp-MRI did not give rise to suspicion, the indications for biopsy would be reduced. It could also reduce the number of biopsies to be performed even when the mp-MRI is suspicious, by resorting solely to targeted biopsies. This review does not evaluate the role of mp-MRI in locoregional staging.

Study Type – Therapy (multi-centre retrospective cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinomas (UUT-UCs) are rare tumours. Because of the aggressive pattern of UC, radical nephroureterectomy (RNU) with bladder cuff removal remains the ‘gold-standard’ treatment. However, conservative strategies, such as segmental ureterectomy (SU) or endourological management, have also been developed in patients with imperative indications. Some teams are now advocating the use of conservative management more commonly in cases of elective indications of UUT-UCs. Due to the paucity of cases of UUT-UC, only limited data are available on the oncological outcomes afforded by conservative management. We retrospectively investigated the oncological outcomes after SU and RNU in a large multi-institutional database. Overall, 52 patients were treated with SU and 416 with RNU. There was no statistical difference between the RNU and SU groups for the 5-year probability of cancer-specific survival, recurrence-free survival and metastasis-free survival. The type of surgery was not a significant prognostic factor in univariate analysis. The results were the same in a subgroup analysis of only unifocal tumours of the distal ureter with a diameter of

Background: Owing to the scarcity of upper urinary tract urothelial carcinoma (UUT-UC) it is often necessary for investigators to pool data. A patient-specific survival nomogram based on such data is needed to predict cancer-specific survival (CSS) post nephroureterectomy (NU). Herein, we propose and validate a nomogram to predict CSS post NU. Patients and methods: Twenty-one French institutions contributed data on 1120 patients treated with NU for UUT-UC. A total of 667 had full data for nomogram development. Study population was divided into the nomogram development cohort (397) and external validation cohort (270). Cox proportional hazards regression models were used for univariate and multivariate analyses and to build a nomogram. A reduced model selection was performed using a backward step-down selection process, and Harrell's concordance index (c-index) was used for quantifying the nomogram accuracy. Internal validation was performed by bootstrapping and the reduced nomogram model was calibrated. Results: Of the 397 patients in the nomogram development cohort, 91 (22.9%) died during follow-up, of which 66 (72.5%) died as a consequence of UUT-UC. The actuarial CSS probability at 5 years was 0.76 (95% CI, 71.62-80.94). On multivariate analysis, T stage (P

Resume Contexte Le carcinome a cellules renales (CCR) du sujet de moins de 40 ans est une entite dont les caracteristiques clinicopathologiques sont peu connues. Le but de cette etude etait d’evaluer ces caracteristiques en comparaison avec celles d’une cohorte de patients âges de 58 et 62 ans. Methode Etude retrospective des patients âges de moins de 40 ans (groupe 1, n = 44) et des patients âges de 58 a 62 ans (groupe 2, n = 106) traites chirurgicalement pour masse renale de janvier 2000 a juillet 2009. Une analyse comparative des caracteristiques clinicopathologiques et de la survie specifique a ete realisee. La survie specifique etait calculee selon la methode de Kaplan-Meier et comparee entre les groupes par le test de Log-Rank. Des analyses uni- et multivariees, selon le modele de Cox, ont ete realisees pour evaluer et quantifier l’amplitude de l’effet de l’âge sur la survie specifique du CCR. Resultats Les caracteristiques cliniques et pathologiques etaient comparables ( p > 0,05) dans les deux groupes hormis le type histologique (56 % de CCR a cellules claires et 23 % de CCR a translocation, pour le groupe 1 versus 82 % et 0 % respectivement, pour le groupe 2, p p = 0,58). Seul le grade de Fuhrman etait un facteur pronostique independant de survie specifique ( p = 0,001). Conclusion Dans cette etude, les patients de moins de 40 ans avaient des proportions de types histologiques de CCR differentes des patients de 58 a 62 ans, notamment le CCR a translocation. La survie specifique liee au cancer etait similaire dans les deux groupes. Seule la recherche systematique de la translocation par immuno-histochimie specifique chez les patients de 40 ans ou moins permettra d’evaluer l’incidence reelle et le pronostic de cette entite.

Objectifs Etablir une validation externe du nouveau nomogramme de Gandaglia et al. qui estime la probabilite d’avoir un CaP localise et favorable chez les patients a risque intermediaire. Methodes Au total, 2928 patients atteints de CaP du groupe risque intermediaire selon d’Amico ont ete traites par PT et curage ganglionnaire bilateral entre 2000 et 2011 (base multicentrique). Le CaP favorable etait defini comme une maladie de bas grade et localisee (pT2 et SG6). La courbe sensibilite/specificite ROC a ete obtenue pour quantifier la precision globale (zone sous la courbe [AUC]) du modele afin de predire la probabilite d’avoir une maladie confinee a la prostate. La methode de Kaplan–Meier a ete utilisee pour l’evaluation de survie sans recidive (SSRB) de PSA. Resultats Parmi les patients, 10,6 % presentaient finalement des caracteristiques pathologiques favorables dans ce groupe intermediaire. L’âge median etait de 68 ans. L’analyse de la courbe ROC montre une bonne precision du modele (AUC = 0,82 ; IC 95 % = 0,79–0,84). Les facteurs independants de CaP non favorable etaient le PSAD (OR = 0,01 ; IC 95 % = 0,00–0,04 ; p p p Fig. 1 ). Conclusion Cette validation externe du nomogramme de Gandaglia et al. montre une precision satisfaisante. Un patient sur dix dans ce groupe CaP a risque intermediaire presentait une CaP favorable et pathologiquement prouvee. L’utilisation de ce nomogramme permet de distinguer les patients avec un CaP favorable qui pourraient etre traites par une approche conservatrice.

Objectifs Le traitement optimal des angiomyolipomes (AML) du rein reste debattu. Historiquement, une intervention etaient recommandee lorsque la taille etait superieure a 4 cm. Les deux options therapeutiques les plus repandues sont la nephrectomie partielle (PN) et l’arterio-embolisation selective (AES). Cependant, les etudes comparatives sur leurs indications, avantages et efficacite sont rares. Dans cette etude, notre objectif etait de comparer ces deux options therapeutiques. Methodes Les resultats de patients qui ont ete pris en charge pour des AML par une NP (n = 191) ou AES (n = 51) ont ete analyses retrospectivement. Le critere de jugement principal etait le succes therapeutique defini comme l’absence d’un traitement secondaire du meme type ou de type different (absence de reintervention). Les criteres secondaires etaient les complications post-interventionnelles et la preservation de la fonction renale (perte de DFG). Les complications et la fonction renale etaient evaluees selon la classification de Clavien-Dindo et la formule MDRD, respectivement. Un modele de regression logistique uni- et multivarie a ete utilise pour predire les facteurs de reintervention. Resultats Les caracteristiques generales de la population etudiee sont resumees dans le Tableau 1 . La duree d’hospitalisation etait plus courte dans le groupe AES (moyennes : 4,3 ± 1,6 vs 3,14 ± 3,5 jours ; p = 0,004) de meme que les pertes sanguines. Les complications post-interventionnelles prises globalement (PN :15, 1 vs AES : 13,3 % p = 0,09) ou stratifiees selon la classification de Clavien-Dindo (p = 0,62) etaient identiques dans les deux groupes. Apres un suivi moyen identique entre les deux groupes (33 ± 44 vs 40 ± 44 mois ; p = 0,3), il existait une perte globale moyenne de DFG de 7,7 ± 26 mL/min/1,73 m2 (p = 0,001). Cette perte etait identique entre les deux options therapeutiques (PN : 6,87 ± 26 vs AES : 11,56 ± 23 ; p = 0,36). En revanche, le nombre de reinterventions etait plus important dans le groupe AES (41,6 % vs 4,7 ; p Tableau 2 ). Conclusion Cette etude a permis de mettre en evidence les avantages et les inconvenients des deux traitements les plus frequents de l’angiomyolipome. La PN a plus de morbidite operatoire avec des pertes sanguines et une duree d’hospitalisation plus longue. L’AES permet de controler rapidement les hematomes du retroperitoine mais elle est associee a un taux de reintervention plus important. Enfin, les deux traitements semblent avoir les memes resultats sur la preservation de la fonction renale.

What's known on the subject? and What does the study add? Much of our understanding of the pathological basis of prostate cancer comes from our analysis of radical prostatectomy specimens. Prostate cancer diagnosed by transrectal ultrasonography-guided biopsy is more likely to be posterior and basal in orientation rather than anterior or apical. Quantitative tissue analyses have not been undertaken both with details and in an unselected population, e.g. prostate specimens from autopsy cystoprostatectomy series from bladder cancer. Quantitative tissue analysis of incidentally detected prostate cancer such as largest cancer surface area, volume, site of origin, multifocality and laterality could be of paramount importance when trying to understand the findings of screen-detected programmes and focal therapy. Cancers were found in 30% of prostates. In the 96 prostates, 215 cancer foci were identified (mean 2.24). Prostate cancer was multifocal in 60% and bilateral in 80% of cases. The site of origin was in the peripheral and transition zone (TZ) in 75% and 25%, respectively. Overall, 90% of cancer foci were clinically insignificant with volume of 2 mL (eight patients) were excluded from morphometric study. Quantitative tissue analysis of 3-mm step-sectioned glands included largest cancer surface area, volume, site of origin, multifocality and laterality. RESULTS • In the 96 prostates, 215 cancer foci were identified (mean 2.24). Prostate cancer was multifocal in 58% and bilateral in 79% of cases. • Of the 215 cancers, 90% were

Extramedullary hematopoiesis (EMH) refers to the location of hematopoietic elements in locations other than the bone marrow medullary space. EMH is an uncommonly isolated disease and it usually occurs during chronic hematologic disorders due to hematopoiesis hyperstimulation. Reticuloendothelial system is the most common site of EMH whereas the kidney is an extremely rare location. EMH lesions are frequently asymptomatic, nevertheless hemorrhagic manifestations can be observed. Patient history can help for making a diagnosis, which can be established by CT scan and/or MRI. Surveillance is recommended for asymptomatic cases while local therapies such as low dose radiation or surgery can be used to treat bleeding lesions. Systemic therapies using iron supplementation or blood transfusion are helpful to avoid disease recurrence. We report a case of pyelocaliceal EMH managed with laser vaporization during ureteroscopy procedures.

Background Primary small cell carcinoma of the upper urinary tract (UUT-SCC) is an extremely uncommon disease. The current knowledge of these rare tumors is mainly based on case reports or small series. Methods We reported two cases and performed a systematic literature search from 1970 to 2010 for articles on UUT-SCC. Overall, 40 patients with UUT-SCC were reviewed, a database was generated to analyze clinical characteristics, pathological features and therapy outcomes and to attempt in identifying prognostic factors. Results For the 39 cases with available data, median age was 66.5years and male–female ratio was 2:1. An Asian ethnic background was more common (59%). Surgery was the standard treatment given to all patients. In 67% of cases, SCC coexisted with another malignant component, including urothelial carcinoma in 62% of patients. Overall median survival was 15months and the 1-, 2- and 3-year survival rates were 58.4%, 38.1% and 23.8%, respectively. Of all cases, 53.8% developed detectable metastasis in a median delay of 13months. Pathological stage was the only significant prognostic factor found ( p =0.01). Patients who received adjuvant chemotherapy seem to have a higher median survival comparatively to those who did not receive chemotherapy but this was not statistically significant (24 vs. 12months, p =0.56). Conclusions UUT-SCC is an extremely rare tumor characterized by an aggressive clinical course. Local or distant metastases are frequent and survival is poor. Pathological stage appeared to be a prognostic factor for overall survival.

BACKGROUND: Urothelial carcinoma of the upper urinary tract (UUT-UC) was a rare, aggressive urologic cancer with a propensity for multifocality, local recurrence, and metastasis. High-risk patients had poor outcomes. Because of the rarity of these tumors, randomized clinical trials and data regarding adjuvant chemotherapy in locally advanced tumors are currently unavailable. Our objective was to assess the effect of adjuvant chemotherapy and the impact of potential prognostic factors on survival in high-risk, postsurgical UUT-UC patients. METHODS: Using a multi-institutional, international retrospective database, identified were 627 patients with high risk UUT-UCs (pT3N0, pT4N0 and/or N+ and/or M+) who underwent surgical removal. Only patients who received adjuvant chemotherapy were included. RESULTS: Overall, 140 patients (22.6%) with a median age of 67 years were included. The median follow-up was 22.5 months. The 5-year, overall survival for the entire cohort was 43%, the 5-year recurrence-free survival was 54%, and metastasis-free survival was 53% at 5 years. Positive surgical margins were an independent prognostic factor for recurrence (P = .06), cancer-specific mortality (P = .05), and overall mortality (P = .02) of any cause. Adjuvant chemotherapy was not linked with overall or cancer-specific survival in patients with high risk disease (adjuvant chemotherapy [n = 140] vs no treatment [n = 487]) (P >.5). CONCLUSIONS: Adjuvant postoperative chemotherapy did not offer any significant benefit to overall survival in our population. Additional data were necessary, and studies enrolling patients at high risk in clinical trials investigating neoadjuvant chemotherapy in conjunction with chemotherapy should have been highly encouraged. Cancer 2011;. © 2011 American Cancer Society.

Resume Introduction La phototherapie dynamique (PDT) est une modalite therapeutique innovante en cancerologie urologique. Materiel et methode Une revue exhaustive de la litterature concernant les principes et modalites d’utilisation de la PDT en cancerologie prostatique a ete realisee. Resultats La therapie focale du cancer de prostate est un champ d’application de la PDT. Des etudes cliniques de phase II sont en cours pour determiner son efficacite therapeutique et sa tolerance dans cette indication. L’utilisation de la PDT comme traitement de rattrapage apres radiotherapie prostatique a ete etudiee. Les resultats carcinologiques etaient encourageants au prix d’une toxicite importante. La planification dosimetrique individuelle doit permettre de limiter celle-ci. Conclusion Les premieres applications cliniques de la PDT pour le cancer de prostate montrent sa faisabilite technique. De nombreuses voies de recherche sont a l’etude afin d’en ameliorer l’efficacite carcinologique et limiter les effets indesirables.

Resume Objectif Ces recommandations ont pour objectif la realisation des biopsies prostatiques de facon optimale pour une meilleure efficacite diagnostique et pour une moindre morbidite. Methodes Enquete de pratique, analyse des recommandations existantes et des textes reglementaires, completees par une revue de la litterature avec affectation d’un niveau de preuve. Resultats L’information du patient doit etre prealable a l’acte de biopsie et delivree en consultation par le medecin indiquant les biopsies. La recherche de facteurs de risque de complications (allergique, hemorragique, infectieux) repose sur l’interrogatoire cible et se fait par le medecin lors de la consultation prebiopsique. Une antibioprophylaxie est recommandee par prise unique de fluoroquinolone systemique orale (niveau de preuve 2). Les biopsies doivent etre realisees dans un environnement interventionnel hospitalier pour en assurer la securite. La voie transrectale et le guidage echographique sont recommandes. Une anesthesie locale par bloc periprostatique est recommandee (niveau de preuve 1). Lors d’une premiere serie de biopsies, le schema etendu de 12 prelevements est recommande. Le taux des complications infectieuses severes et de retention aigue d’urines rapportees apres biopsies prostatiques est inferieur a 5 %. La prise en charge optimale des complications infectieuses repose sur une information du patient, une hospitalisation et une antibiotherapie adaptee. Conclusions Pour atteindre une sensibilite optimale et pour diminuer les risques, la realisation des biopsies prostatiques doit suivre une procedure bien definie.

ResumeBut Valider la classification de D’Amico sur une serie consecutive francaise et analyser les facteurs de risque de recidive apres prostatectomie totale (PT) pour cancer. Patients Etude retrospective incluant 730 patients consecutifs ayant eu une PT pour cancer de prostate localise ou localement avance (cT1–cT3) dans notre centre entre octobre 2000 et mai 2009. La recidive biologique etait definie par une valeur d’antigene specifique de prostate (PSA) superieur a 0,1 ng/ml confirmee par deux augmentations a deux dosages successifs. La survie sans recidive etait calculee selon la methode de Kaplan-Meier apres stratification des patients selon les groupes a risque de D’Amico. La concordance statistique de la survie predite par le modele de D’Amico et la survie observee etait mesuree avec l’indice C de Harrell. L’impact des differentes variables pathologiques sur la recidive biologique a ete evalue en analyse univariee et multivariee selon le modele de Cox. Resultats Le suivi median etait de 30 mois [ecart interquartile : 13–51]. La survie sans recidive biologique a trois et cinq ans etait de 85 % (intervalle de confiance [IC] a 95 %, 81–88 %) et 78 % (IC 95 %, 74–83 %), respectivement. La survie sans recidive biologique a cinq ans pour les groupes a risque faible, intermediaire et eleve etait respectivement de 92 % (IC 95 %, 88–97 %), 73 % (IC 95 %, 65–81 %) et 44 % (IC 95 %, 28–59 %) (p

International audience; PURPOSE: We conceived and proposed a unique and optimized nomogram to predict cancer specific survival after radical nephroureterectomy in patients with upper tract urothelial carcinoma by merging the 2 largest multicenter data sets reported in this population. MATERIALS AND METHODS: The international and the French national collaborative groups on upper tract urothelial carcinoma pooled data on 3,387 patients treated with radical nephroureterectomy for whom full data for nomogram development were available. The merged study population was randomly split into the development cohort (2,371) and the external validation cohort (1,016). Cox regressions were used for univariable and multivariable analyses, and to build different models. The ultimate reduced nomogram was assessed using Harrell's concordance index (c-index) and decision curve analysis. RESULTS: Of the 2,371 patients in the nomogram development cohort 510 (21.5%) died of upper tract urothelial carcinoma during followup. The actuarial cancer specific survival probability at 5 years was 73.7% (95% CI 71.9-75.6). Decision curve analysis revealed that the use of the best model was associated with benefit gains relative to the prediction of cancer specific survival. The optimized nomogram included only 5 variables associated with cancer specific survival on multivariable analysis, those of age (p = 0.001), T stage (p