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Resume Introduction L’observatoire REVELA13 est un outil epidemiologique unique recensant les nouveaux cas de tumeur du rein, de vessie et de leucemies aigues dans le departement des Bouches-du-Rhone. L’objectif de ce travail etait d’analyser pour la premiere fois les donnees de cet observatoire pour les nouveaux cas de tumeurs de vessie de la femme ≥T1 dans les Bouches-du-Rhone de 2012 a 2014. Materiel Il s’agissait d’une etude epidemiologique descriptive observationnelle. Quinze variables non nominatives de la base de donnees de REVELA13 ont ete analysees pour decrire les caracteristiques cliniques et anatomopathologiques des cas incidents ainsi que leur repartition spatio-temporelle. Les taux d’incidence exprimes en nouveaux cas par an pour 100 000 habitants ont ete standardises sur l’âge mondial, calcules avec leurs intervalles de confiance a 95 % et compares aux estimations nationales pour la meme periode. Resultats Au total, 291 nouveaux diagnostics de tumeurs vesicales ont ete enregistres soit une incidence standardisee sur l’âge mondial de 3,85 [3,32–4,37] nouveaux cas par an pour 100 000 habitants, superieure de 54 % aux estimations nationales de 2012 et 2015. Le sex-ratio etait de 19,41 % (F/H) et l’âge median de survenue de 75,9 ans. Les tumeurs etaient majoritairement sans infiltration du muscle (52 %), de haut grade (69 %) et sans carcinome in situ (Cis) associe (49 %). Les 2 territoires les plus touches etaient ceux de Marseille et d’Aubagne-La Ciotat. Conclusion L’observatoire REVELA13 a permis d’ameliorer nos connaissances epidemiologiques sur les tumeurs de vessie feminines dans les Bouches-du-Rhone et de mettre en evidence une sur-incidence locale. Niveau de preuve 3.

Resume Objectifs Notre objectif etait de valider le score SVPI (score visuel prostatique en images) en langue francaise dans la determination et le suivi des symptomes du bas appareil urinaire (SBAU) associes a une hyperplasie benigne de la prostate (HBP) en pratique urologique. Methodes Une enquete prospective observationnelle a ete realisee entre le 15 septembre 2014 et le 30 juillet 2015 aupres d’urologues. Les 4 premiers patients consecutifs de plus de 60 ans ayant des SBAU causes par une HBP et necessitant une prescription d’un alpha-bloquant ont ete inclus. Nous avons traduit et adapte en francais un ‘score visuel prostatique en images’ (SVPI). A la premiere visite et a la visite de suivi, le patient remplissait 2 questionnaires : l’IPSS en francais et le SVPI. Resultats Au total, 169 urologues ont inclus au moins un patient et renvoye les informations ; 550 questionnaires ont ete inclus dans l’analyse statistique. Les medianes des scores et sous-scores IPSS et SVPI,et de la qualite de vie ont toutes diminue significativement ( p Conclusions Cette etude a montre que le SVPI etait un outil simple et utile pour identifier et surveiller les SBAU associes a l’HBP. Niveau de preuve 4.

International audience; BACKGROUND:Early risk-stratified chemotherapy is a standard treatment for breast, colorectal, and lung cancers, but not for high-risk localised prostate cancer. Combined docetaxel and estramustine improves survival in patients with castration-resistant prostate cancer. We assessed the effects of combined docetaxel and estramustine on relapse in patients with high-risk localised prostate cancer.METHODS:We did this randomised phase 3 trial at 26 hospitals in France. We enrolled patients with treatment-naive prostate cancer and at least one risk factor (ie, stage T3-T4 disease, Gleason score of ≥8, prostate-specific antigen concentration >20 ng/mL, or pathological node-positive). All patients underwent a staging pelvic lymph node dissection. Patients were randomly assigned (1:1) to either androgen deprivation therapy (ADT; goserelin 10·8 mg every 3 months for 3 years) plus four cycles of docetaxel on day 2 at a dose of 70 mg/m(2) and estramustine 10 mg/kg per day on days 1-5, every 3 weeks, or ADT only. The randomisation was done centrally by computer, stratified by risk factor. Local treatment was administered at 3 months. Neither patients nor investigators were masked to treatment allocation. The primary endpoint was relapse-free survival in the intention-to-treat population. Follow-up for other endpoints is ongoing. This study is registered with ClinicalTrials.gov, number NCT00055731.FINDINGS:We randomly assigned 207 patients to the ADT plus docetaxel and estramustine group and 206 to the ADT only group. Median follow-up was 8·8 years (IQR 8·1-9·7). 88 (43%) of 207 patients in the ADT plus docetaxel and estramustine group had an event (relapse or death) versus 111 (54%) of 206 in the ADT only group. 8-year relapse-free survival was 62% (95% CI 55-69) in the ADT plus docetaxel and estramustine group versus 50% (44-57) in the ADT only group (adjusted hazard ratio [HR] 0·71, 95% CI 0·54-0·94, p=0·017). Of patients who were treated with radiotherapy and had data available, 31 (21%) of 151 in the ADT plus docetaxel and estramustine group versus 26 (18%) of 143 in the ADT only group reported a grade 2 or higher long-term side-effect (p=0·61). We recorded no excess second cancers (26 [13%] of 207 vs 22 [11%] of 206; p=0·57), and there were no treatment-related deaths.INTERPRETATION:Docetaxel-based chemotherapy improves relapse-free survival in patients with high-risk localised prostate cancer. Longer follow-up is needed to assess whether this benefit translates into improved metastasis-free survival and overall survival.FUNDING:Ligue Contre le Cancer, Sanofi-Aventis, AstraZeneca, Institut National du Cancer.

Resume L’objectif de cette etude etait d’analyser l’efficacite et la tolerance de la silodosine chez des patients ayant des symptomes du bas appareil urinaire (SBAU) associes a une hypertrophie benigne de la prostate (HBP) en pratique urologique courante. Methode Etude observationnelle prospective realisee aupres de 272 urologues et dediee au suivi des patients traites pour une HBP par la silodosine. Les parametres etudies etaient le questionnaire International Prostate Symptom Score (IPSS) pondere et la question 8 sur la qualite de vie, le score du Urinary Symptom Profile (USP) et l’echelle d’Insomnie d’Athenes (AIS) evalues a l’instauration du traitement et a trois mois. Resultats Neuf cent quatorze patients dont l’âge moyen etait de 66 ans et ayant des SBAU depuis 3,3 ans en moyenne ont ete analyses. Apres 3 mois de traitement, on observait une diminution significative du score IPSS (16,2 ± 6,1 a 9,7 ± 5,5, p p p p Conclusion Cette etude a confirme l’efficacite de la silodosine dans les SBAU associes a une HBP avec un profil de tolerance n’affectant pas la satisfaction des patients. Niveau de preuve 5.

This French observational, longitudinal, prospective study described the health-related quality of life (HRQoL) of elderly men (≥75 years old) with prostate cancer after initiating gonadotropin-releasing hormone (GnRH) agonist therapy. At baseline and 3-6 months after baseline, European Organisation for Research and Treatment of Cancer quality of life questionnaire-core 30 (QLQ-C30) and prostate-specific (QLQ-PR25) questionnaires were completed by patients. Data from 1276 patients were analyzed. At baseline, mean (±SD) age was 80 (±4.1) years, 29.1% of patients had Gleason scores ≥8 and 24.9% had metastases. At baseline, increasing age, presence of metastasis and presence of comorbidity had a negative impact on QLQ-C30 and QLQ-PR25 scores. At follow-up, improvement in emotional-functioning (2.8; p 0.001), social-functioning (1.7; p = 0.011), global HRQoL (1.6; p = 0.029), sleep-disturbance (-2.1; p = 0.011), appetite-loss (-4.0; p 0.001) and pain (-4.1; p 0.001) QLQ-C30 scores were observed. In addition, there was a worsening in treatment-related symptom (8.6; p 0.001), sexual-activity (-5.5; p 0.001) and sexual-functioning (-22.6; p 0.001) QLQ-PR25 scores, and an improvement in urinary symptoms (-3.7; p 0.001) and incontinence aid (-2.9; p = 0.023) QLQ-PR25 scores. This study shows that, apart from the expected impact on sexual functioning domains, HRQoL is not adversely affected by 3-6 months of GnRH agonist therapy in older men with prostate cancer.

INTRODUCTION The objective was to update the guidelines of the French Urological Association Cancer Committee for upper tract urothelial carcinoma (UTUC). METHODS A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Total nephro-urectomy remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed : unifocal tumour and diameter < 1 cm and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary. CONCLUSION These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for UTUC.

BCG therapy, which is the standard treatment for non-muscle invasive bladder tumours with high risk of recurrence and progression, has potential life-threatening adverse effects (AEs). Rapid deterioration of general condition in a patient with history of bladder tumour should question about an ongoing treatment with BCG and specify the date of the last instillation. Trauma during catheterization and untreated concomitant urinary infection upon instillations are risk factors of severe AEs. In emergency, the diagnosis of severe AEs of BCG therapy is only based on the medical questioning with the notion of current BCG treatment and risk-bearing event upon instillation. Management of AEs is related to their pathophysiological mechanisms and relies on a combination of antibiotics against BCG, the symptomatic treatment, and corticosteroid therapy which has shown to improve patient outcomes.

Resume Introduction La BCG therapie avec traitement d’entretien est le traitement de reference des tumeurs de vessie n’infiltrant pas le muscle a haut risque de recidive et de progression. Dans la pratique, les effets indesirables (EI) de la BCG therapie ont pu restreindre sa prescription par les urologues. Cet article presente une revue de ces EI et leur prise en charge therapeutique. Materiels et methodes Une recherche bibliographique en langue francaise et anglaise par Medline ® et Embase ® en utilisant les mots cles BCG, bladder , complication , toxicity , adverse reaction , prevention et treatment a ete effectuee. Resultats Les mecanismes des principaux EI de la BCG therapie sont infectieux (cystite, fievre), immuno-allergiques (prostatite granulomateuse, orchi-epididymite, reactions granulomateuses) et auto-immuns (arthralgies, rash). La prise en charge des EI est fonction de leurs mecanismes physiopathologiques. La classification des EI de la BCG therapie basee sur la clinique permet d’adapter leur traitements. Conclusion L’association d’une polyantibiotherapie dirigee contre le BCG, d’anti-inflammatoires steroidien ou non steroidien et du traitement symptomatique constitue actuellement la triade sur laquelle repose la prise en charge adaptee des EI severes. La reduction des doses de BCG et l’administration d’ofloxacine apres l’instillation diminuent la frequence et la severite des EI mineurs et moderes. Les EI infectieux severes ou durant plus de sept jours, les EI immuno-allergiques ou les EI auto-immuns durant plus de sept jours imposent un arret definitif de la BCG therapie.

Several types of gastrointestinal complications can occur during treatment with targeted therapies: diarrhoea, nausea and vomiting, abnormalities in hepatic and pancreatic profiles, etc. Gastrointestinal problems in targeted therapy can have a significant impact on the general status of patients, their weight and their adherence to the treatment. The prevention, screening and rapid treatment of these side-effects are essential elements of patient care and can limit the associated dose reductions and loss of therapeutic benefit. In the case of diarrhoea, treatment must be started at the onset of grade 1 or 2 diarrhoea (four to six stools per day), with loperamide or racecadotril. Treatment with targeted therapy must be stopped if there is diarrhoea of grade 3 or 4 (more than six stools per day). In the case of nausea/vomiting or burning pain in the oesophagus, symptomatic treatment without stopping the targeted therapy is recommended. Biological assessment including transaminases, total and conjugated bilirubin should be prescribed before treatment initiation with targeted therapy. An elevation in alkaline phosphatases without elevation of transaminases suggests primarily the existence of hepatic metastases. In the event of worsening of the hepatic profile, if ALT greater than 5N, treatment must be stopped and specialist advice sought.

Tx Tumeur primitive non evaluable .T0 Tumeur primitive non retrouvee .Ta Carcinome papillaire non invasif .Tis Carcinome in situ « plan » .T1 Tumeur envahissant le chorion .T2 Tumeur envahissant la musculeuse – T2a Tumeur envahissant le muscle superficiel (moitie interne) – T2b Tumeur envahissant le muscle profond (moitie externe) .T3 Tumeur envahissant le tissu peri-vesical – T3a Envahissement microscopique – T3b Envahissement extra-vesical macroscopique .T4 Tumeur envahissant une structure peri-vesicale – T4a Prostate, vagin ou uterus – T4b Paroi pelvienne ou abdominale

Resume Le traitement du cancer de la prostate est appele a connaitre des innovations importantes : nouvelle classe therapeutique en hormonotherapie avec les antagonistes de la luteinizing hormone–releasing hormone qui permettent d’obtenir une reduction immediate, profonde et durable de la testosterone ; definition de criteres stricts d’eligibilite et de suivi dans des protocoles de surveillance active qui evitent au patient un traitement agressif sans diminuer ses chances de survie ; progres techniques de l’imagerie et des dosages biologiques permettent de diagnostiquer plus tot des tumeurs de petite taille ; revolution dans les traitements focalises, ciblant les cancers sans alterer les structures environnantes. Ces avancees concomitantes offrent au clinicien et au patient des options seduisantes de prise en charge. Mais il faut en connaitre les limites et les contraintes. Il faut egalement definir les profils de patients les plus adaptes a chaque type de traitement, prenant en compte les caracteristiques objectives de la tumeur et les caracteristiques psychologiques du patient.

Resume La place de l’hormonotherapie dans la strategie therapeutique du cancer de la prostate a evolue au cours du temps. Indiquee de facon indiscutable dans les cancers metastatiques et en cas d’envahissement ganglionnaire, elle est aussi utilisee dans les tumeurs localement avancees et a haut risque, combinee a la radiotherapie, mais les modalites d’association (neoadjuvante, concomitante et/ou adjuvante) restent a discuter au cas par cas en fonction du stade de la tumeur et du niveau de risque represente essentiellement par le score de Gleason, la valeur et la cinetique du PSA. L’hormonotherapie est aussi indiquee en cas de recidive biologique de type systemique, notamment quand le temps de doublement du PSA est inferieur a 12 mois. Elle repose le plus souvent sur l’utilisation des analogues de la GnRH auxquels sont associes en debut de traitement des anti-androgenes de facon a obtenir un blocage androgenique complet. Enfin, l’orientation se fait progressivement vers des traitements intermittents qui ont recemment montre la preuve de leur efficacite a condition de respecter des conditions de prescription et de suivi rigoureuses.

Resume La mise en evidence de genes de fusion constitue un progres majeur dans la connaissance des evenements moleculaires precoces de la carcinogenese du cancer de la prostate. L’existence de fusion TMPRSS2–ETS dans plus de 50 % des cancers de la prostate en fait probablement le rearrangement genetique le plus frequent des tumeurs epitheliales humaines. La presence de genes de fusion TMPRSS2–ERG pourrait avoir une valeur pronostique pejorative dans les tumeurs localisees traitees par prostatectomie totale. Cette decouverte devrait conduire dans un proche avenir a des traitements cibles.

Resume La concordance des augmentations de l’esperance de vie a la naissance et de l’incidence globale des cancers laisse augurer d’une augmentation tres significative des cancers de la personne âgee. En particulier, l’augmentation de l’incidence du cancer de la prostate dans la population âgee (45 % des diagnostics sont poses apres 75 ans) contraste avec la pauvrete des connaissances scientifiques solides sur ce sujet. Parallelement, l’approche oncogeriatrique se developpe depuis plusieurs annees sous l’egide de la Societe internationale d’oncogeriatrie (SIOG). Cette demarche veut repondre a la prise en charge defectueuse des cancers chez la personne âgee. Les explications de cette prise en charge defectueuse sont a chercher tant dans les caracteristiques des patients âges que dans la formation des soignants. Les auteurs rappellent les principes de l’evaluation oncogeriatrique et de la classification des patients qui est maintenant proposee. Ils passent ensuite en revue les differentes options therapeutiques et leurs resultats dans la population âgee et ils decrivent le processus decisionnel therapeutique. Enfin, ils proposent une serie de recommandations sur le diagnostic du cancer de la prostate, l’evaluation des patients et le traitement de la maladie dans la population âgee. Le cancer de la prostate est un modele quasi ideal pour l’oncogeriatrie. Les urologues doivent rester a la pointe de sa prise en charge, quel que soit l’âge de leur patient.

Resume Objectif Realiser une enquete aupres des urologues francais pour connaitre les pratiques des instillations intravesicales de BCG et mitomycine C dans le traitement des tumeurs de vessie n’infiltrant pas le muscle (TVNIM). Materiel et methode L’enquete a ete realisee en 2008 aupres des urologues qualifies sur la liste de l’Association francaise d’urologie (Afu), par questionnaires auto-administres sur Internet. Resultats Cent cinquante-six urologues ont repondu a cette enquete. Les indications rapportees des instillations en fonction du type de TVNIM rejoignaient majoritairement les recommandations de l’Afu mais un quart des urologues interroges en restaient eloignes. Soixante-dix-neuf pour cent des urologues repondeurs consideraient que l’induction associee a l’entretien par BCG donnait de meilleurs resultats carcinologiques que l’induction seule. En revanche, 46 % consideraient l’entretien difficile a faire accepter au patient, 28 % difficile a mettre en place en pratique et 56 % pas tres bien, voire mal tolere. Quatre-vingt-huit pour cent des urologues repondeurs disaient utiliser l’ofloxacine pour prevenir les effets secondaires du BCG, mais selon un protocole mal defini. La definition donnee par les urologues de l’echec du BCG etait proche de celle des recommandations de l’Afu, mais la conduite therapeutique etait heterogene. Conclusion Les reponses des 156 urologues ayant repondu a cette enquete ont permis d’evaluer les pratiques des urologues francais concernant les instillations intravesicales dans le traitement des TVNIM. Sans s’eloigner de facon majeure des recommandations de l’Afu, les pratiques des urologues etaient souvent heterogenes. Des points necessitant une clarification ont ete mis en lumiere.

Resume Les indications de l’hormonotherapie dans le traitement du cancer de la prostate sont en mutation. Initiee en 1941 dans les formes metastatiques du cancer de la prostate, la castration chimique trouve aujourd’hui egalement sa place dans les formes localement avancees. La prescription d’une hormonotherapie prolongee en combinaison avec la radiotherapie ou la chirurgie a prouve un gain pour la survie sans progression. Dans les formes localisees, la place de l’hormonotherapie est encore debattue, que ce soit en cas de recidive biologique ou clinique apres traitement de premiere ligne par irradiation externe conformationnelle ou prostatectomie totale ou meme dans une indication neoadjuvante. Des essais complementaires sont en cours et l’analyse de leurs resultats sera indispensable dans l’optique d’etablir de nouvelles recommandations. L’hormonotherapie n’est desormais plus seulement un traitement palliatif du cancer de la prostate. Elle a sa place dans l’arsenal therapeutique de l’urologue pour les formes localisees ou localement avancees a haut risque.

Malignant tumours may have a cystic appearance. They are dominated by multilocular cystic renal cell carcinoma, usually low-grade, which rarely metastasize. The Bosniak classification distinguishes non suspicious lesions (type I and II) from suspicious lesions (type III and IV) requiring resection and lesions requiring follow-up (type IIF). The main feature suggestive of malignancy is the enhancement of the septa and the walls of the cyst. Renal cysts classified as IIF require surveillance by contrast-enhanced imaging (CT, MRI or ultrasound). The treatment of cystic tumours is based on surgery. Partial nephrectomy is recommended in this type of tumour regardless of the size. Laparoscopy is a validated technique in experienced hands. Aspiration is not very effective for the treatment of benign cysts, but may be useful for diagnosis. Surgical resection of the roof of the cyst is the most effective technique.

Resume Introduction L’information sur les pathologies de la prostate, incluant le cancer de la prostate, est soutenue par l’Association Francaise d’Urologie (AFU) depuis plusieurs annees mais se developpe lentement en France. En 2005, une premiere communication etait consacree au public masculin et avait identifie les raisons de son fatalisme, et paradoxalement, pourquoi la prostate incarne la vulnerabilite de son capital sexuel. Dans une seconde phase, cet article presente les resultats d’une etude complementaire conduite aupres de medecins generalistes ayant pour but d’identifier leurs attentes et les leviers les plus adaptes pour favoriser le depistage. Materiel et Methode La societe Ipsos a developpe un protocole qualitatif Krisis™ realisee en octobre 2005 (apres la premiere journee nationale de la prostate du 15 septembre 2005). Trois groupes de medecins generalistes ont ete constitues : des medecins tres actifs en matiere de depistage, des medecins mal a l’aise avec ce probleme ou des medecins s’en remettant systematiquement aux Urologues. Resultats Les pathologies prostatiques abordees en consultation dependaient de l’aisance du medecin ce qui est liee a sa formation et ses liens avec les urologues. Pour entamer la question du depistage, les generalistes impliques posaient des questions simples a propos de pratiques quotidiennes sans crainte d’etre ludiques ou de s’appuyer sur la mediatisation de la pathologie. Le toucher rectal apparaissait comme un des elements cliniques importants mais pas toujours facile a realiser. Le PSA apparaissait comme un examen pas toujours approprie et caracterise par un deficit d’informations sur les conditions de sa prescription, son utilite et sa pertinence par rapport au depistage. L’echographie pouvait etre une astuce pour alerter le patient sans dramatiser et faire faire le toucher rectal par un Urologue. Les medecins genera listes femmes prefeaient le PSA et l’echographie. Les medecins interroges attenaient une mediatisation des pathologies de la prostate, une grande interactivite avec les urologues et des documents, des brochures a mettre en salle d’attente pour relayer les messages. Conclusion Les Medecins generalistes avaient besoin que leurs instances, les specialistes et les institutions de sante publique developpent et mediatisent l’andrologie au meme titre que la gynecologie. Les Urologues ont un role majeur d’accompagnement par le biais de conferences, enseignements postuniversitaires ou par des invitations initiees par l’AFU.

The status of surgical margins after radical prostatectomy is a major prognostic factor. The role of several technical aspects of radical prostatectomy, such have surgical access, bladder neck preservation or neurovascular bundle sparing, in generating supplementary positive margins has been controversial for many years. Positive margins along with other poor prognostic factors are important elements in the decision to perform adjuvant therapy after radical prostatectomy. This review of the literature, based on a Medline search, was designed to update these various issues encountered by urologists in their everyday practice.

Several types of gastrointestinal complications can occur during treatment with targeted therapies: diarrhoea, nausea and vomiting, abnormalities in hepatic and pancreatic profiles, etc. Gastrointestinal problems in targeted therapy can have a significant impact on the general status of patients, their weight and their adherence to the treatment. The prevention, screening and rapid treatment of these side-effects are essential elements of patient care and can limit the associated dose reductions and loss of therapeutic benefit. In the case of diarrhoea, treatment must be started at the onset of grade 1 or 2 diarrhoea (four to six stools per day), with loperamide or racecadotril. Treatment with targeted therapy must be stopped if there is diarrhoea of grade 3 or 4 (more than six stools per day). In the case of nausea/vomiting or burning pain in the oesophagus, symptomatic treatment without stopping the targeted therapy is recommended. Biological assessment including transaminases, total and conjugated bilirubin should be prescribed before treatment initiation with targeted therapy. An elevation in alkaline phosphatases without elevation of transaminases suggests primarily the existence of hepatic metastases. In the event of worsening of the hepatic profile, if ALT greater than 5N, treatment must be stopped and specialist advice sought.

After cystectomy, the urine is eliminated by the uretra (orthotopic neobladder) or through a stoma. Orthotopic neobladder is done by priority when feasible. Practical aspects have to be managed very strictly by the urologist and the staff nurse. Side effects and complications are quite frequent (incontinence, retention, infection, diminished renal function, metabolic disorders, stoma complications) and need an adapted follow-up to propose adapted management if necessary.

Objectives: To define the profile of patients with prostate cancer (PCa) receiving a 3-month or 6-month formulation of luteinizing hormone-releasing hormone (LHRH) agonist in France and the reasons for choosing between formulations. Methods: This prospective 1-year observational study included patients with PCa starting LHRH agonist therapy in everyday practice. Reasons for prescription and patient preference were recorded at inclusion, 3 or 6 months, and 12 months. The percentage of patients with a renewed initial prescription was recorded during follow up. Results: A total of 1438 patients with PCa were included. Hormonotherapy was initiated more frequently with a 6-month ( n = 903; 62.8%) than with a 3-month formulation ( n = 535; 37.2%). The initial prescription was renewed in most patients after 3 or 6 months (86.1%) and 12 months (71%); 170 patients switched from a 3-month to a 6-month formulation during follow up. Presence of metastases influenced initial prescription (odds ratio 0.439; 95% confidence interval 1.095–1.892), with a 3-month formulation more often prescribed than a 6-month formulation to men with metastatic PCa at diagnosis (21.3% versus 15.8%, respectively). The most frequent reasons given by physicians for choosing the 6-month formulation were ‘simplification of therapeutic regimen’ (86.9%) or ‘fewer unnecessary visits’ (46.8%). Similar reasons were given for switching from a 3-month to a 6-month formulation during follow up. The most frequent reasons given by physicians to initiate therapy with a 3-month formulation were ‘usual practice/habit’ (55.5%) or ‘closer patient management’ (46.2%). ‘Closer patient management’ and ‘reassuring effect upon patient’ were the main reasons for switching from a 6-month to a 3-month formulation during follow up. Approximately 80% of patients were satisfied with the formulation they were prescribed and patients’ reasons for preferring one formulation over another were similar to the physicians’ reasons for prescribing these formulations. Conclusions: Slow-release formulations of LHRH agonists are useful therapies for physicians treating patients with PCa and there may be a preference for the 6-month formulation.

Resume Lors des congres de l’EAU et de l’AUA 2009, les principaux travaux concernant les carcinomes urotheliaux s’interessait a l’interet de la classification T1a/b et ses consequences therapeutiques, aux dernieres donnees des resultats de la BCG therapie et au diagnostic photodynamique. A l’ASCO, les principaux travaux presentes portaient sur les traitements systemiques en adjuvants, en premiere ligne dans le traitement du cancer de vessie metastatique, notamment avec l’adjonction d’anti-angiogenique a la chimiotherapie, et dans le traitement conservateur en association a la radiotherapie.

We assessed the results and prognostic factors in patients with bladder cancer treated conservatively with concurrent cisplatin and radiotherapy.A total of 109 patients with localized muscle invasive bladder cancer who were not candidates for radical cystectomy underwent concomitant chemotherapy and radiation. Median patient age was 70 years. Of the patients 36% had stages T3B and 4 tumors, and 37% had benefited from prior macroscopically complete transurethral resection. Pelvic irradiation consisted of 40 to 45 Gy., and was followed by a boost to the bladder to a total dose of 55 to 60 Gy. Continuous infusion cisplatin (20 to 25 mg./m.2 daily for 5 days) was delivered during weeks 2 and 5 of radiation therapy.Median followup was 54.8 months. The projected 4-year locoregional control rate was 47.6% for the 109 patients and 61.2% for 76 with a complete response. Projected overall 4-year survival was 41.9% for all patients and 51.4% for complete responders. Univariate analysis of prognostic factors was done for local control and survival. Local control was statistically better in patients with a good performance status, stages T2 and 3A disease, complete initial transurethral resection and without hydronephrosis. In terms of overall survival 4 factors were significant: 1) performance status, 2) T stage, 3) absence of hydronephrosis and 4) complete response. By multivariate analysis performance status, hydronephrosis and T stage were significant factors for local control, while T stage and complete response were the strongest determinants for survival.Concurrent cisplatin and radiation therapy is a potentially curative and conservative treatment for patients with localized muscle invasive bladder cancer who are not candidates for radical surgery, particularly those with intravesical stages T2 and T3A tumors.

BCG therapy, which is the standard treatment for non-muscle invasive bladder tumours with high risk of recurrence and progression, has potential life-threatening adverse effects (AEs). Rapid deterioration of general condition in a patient with history of bladder tumour should question about an ongoing treatment with BCG and specify the date of the last instillation. Trauma during catheterization and untreated concomitant urinary infection upon instillations are risk factors of severe AEs. In emergency, the diagnosis of severe AEs of BCG therapy is only based on the medical questioning with the notion of current BCG treatment and risk-bearing event upon instillation. Management of AEs is related to their pathophysiological mechanisms and relies on a combination of antibiotics against BCG, the symptomatic treatment, and corticosteroid therapy which has shown to improve patient outcomes.

Background This study evaluates feasibility and results of combined treatment of cisplatin and radiation therapy for patients with inoperable invasive bladder carcinoma. Methods From January 1988 to October 1991, 69 patients received radiation therapy and concomitant cisplatin. Median age was 71 years. Most tumors were locally advanced and high grade. A macroscopically complete transurethral resection was performed initially in 18 patients. Dose of pelvic radiation ranged from 40 Gy to 45 Gy, and total dose to the bladder ranged from 55 Gy to 60 Gy. Concomitant continuous cisplatin infusion at a dose of 20-25 mg/m2/day for 5 days was delivered during the 2nd and 5th weeks of radiation. Results As of April 1993, the median follow-up time was 36.4 months (range, 18-70 months). Ninety-one percent of the patients completed radiation therapy as planned, and 78.3% completed two courses of chemotherapy. Despite one treatment-related death due to renal failure, toxicity was generally mild and acceptable. Sixty-three patients were evaluable for response. Forty-eight patients (76.2%) achieved a complete response. Actuarial overall 3-year survival rate was 37.1% for all patients. Among the patients who experienced complete response, the 3-year actuarial local control and disease-free survival rates were 65.4% and 56.3%, respectively. Twenty-six patients (37.7%) are alive and disease-free with bladder preservation. One patient is alive and disease-free after salvage cystectomy. Conclusions Concomitant cisplatin and radiation therapy offers high probability of complete response and local control in patients with invasive bladder cancer unsuitable for surgery. These results provide a basis for randomized studies comparing this approach with conventional therapy for patients with operable carcinoma.

Objectifs Valider, a grande echelle, en medecine generale, l’utilisation d’une EVA dans la determination et le suivi de la severite des SBAU associes a une HBP ; cette echelle comporte comme le score IPSS 35 points, et a fait l’objet d’une validation dans une etude pilote pauci-centrique en 2004 aupres d’urologues (Teillac P et al., 2004). Methodes Etude prospective realisee par 707 medecins generalistes aupres de 2900 patients âges de plus de 60 ans, traites pour des SBAU associes a une HBP, chez qui une mesure simultanee du score d’EVA et d’IPSS et ont ete effectuees, a l’inclusion puis 1 et 3 mois apres mise en route d’un traitement par ?-bloquant. Resultats Un total, 2019 patients (âge 69 ± 6,6 ans), ayant des SBAU depuis 3,8 ans en moyenne, ont ete analyses. A l’inclusion, les medianes du score EVA et IPSS etaient de 20 [0–35] et 19 [9–35] respectivement et ont diminue significativement apres 1 a 3 mois de traitement par ?-bloquant ( p Fig. 1 ) Conclusion Les correlations obtenues a l’inclusion entre les scores EVA et IPSS n’ont pas permis de valider, sur une large population, l’utilisation de cette EVA en remplacement du questionnaire IPSS. Toutefois, les donnees du suivi temoignent d’une bonne sensibilite au changement et soulignent l’interet potentiel de cet outil dans l’evaluation du traitement des SBAU associes a l’HBP et dans leur suivi.

To assess the oncological safety of laparoscopic procedures for the management of urothelial carcinomas of the urinary tract. Data on laparoscopic management of urothelial carcinomas in the literature were analysed using MEDLINE and by matching the following keywords: urological malignancies, upper tract tumours, bladder carcinomas, laparoscopic approach, recurrence, follow-up and metastasis site. Minimally invasive techniques are being used increasingly in the management of these tumours and successfully achieving the benefits of lower blood loss and more rapid patient recovery. To date, no evidence level 1 information is available and published series of these technically challenging cases are small and follow-up limited. Short to medium term follow-up appears encouraging in terms of recurrence and survival rates, but long-term data are immature compared to the established open techniques these procedures seek to duplicate. Specific concerns in terms of the oncologic safety of laparoscopy, especially with regard to the pneumoperitoneum, tumour manipulation and specimen extraction are addressed. Port-site metastases and tumour seeding are rare events and appear to be mainly related to the grade and stage of the tumour. Specific precautions are required to minimise these risks. Oncological results of the laparoscopic approach are difficult to compare with those of open surgery. However, recent series have not reported unusual tumour dissemination or a higher rate of recurrence with this approach. Laparoscopic techniques are not yet standard of care in invasive urothelial carcinomas. Long-term assessment is ongoing and awaited.

We discuss the efficacy and safety of high-intensity focused ultrasound (HIFU) in patients with prostate cancer, to define the best indications for HIFU in daily clinical practice as primary therapy. We searched Medline and Embase for clinical studies evaluating the efficacy and safety of HIFU in prostate cancer (July 2007), and abstracts presented at the 2005-2007 annual meetings of the European Association of Urology and American Urological Association were screened. In all, 37 articles/abstracts were selected. As the data on HIFU as salvage therapy were limited, we focused on HIFU as primary therapy. Studies consisted of case series only. Included patients were approximately 70 years old with T1-T2 N0M0 disease, Gleason Scoreor=7, a prostate-specific antigen (PSA) level ofor=28 ng/mL and a prostate volume ofor=40 mL. Negative biopsy rates with the Ablatherm device (EDAP TMS S.A., Vaulx-en-Velin, France) were 64-93%, and a PSA nadir ofor=0.5 ng/mL was achieved in 55-84% of patients. The 5-year actuarial disease-free survival rates were 60-70%. The most common complications were stress urinary incontinence, urinary tract infection, urethral/bladder neck stenosis or strictures, and erectile dysfunction. For the Ablatherm device, the rate of complications has been significantly reduced over the years, due to technical improvements in the device and the use of transurethral resection of the prostate before HIFU. In conclusion, HIFU as primary therapy for prostate cancer is indicated in older patients (or=70 years) with T1-T2 N0M0 disease, a Gleason score of7, a PSA level of15 ng/mL and a prostate volume of40 mL. In these patients HIFU achieves short-term cancer control, as shown by a high percentage of negative biopsies and significantly reduced PSA levels. The median-term survival data also seem promising, but long-term follow-up studies are needed to further evaluate cancer-specific and overall survival rates before the indications for primary therapy can be expanded.

Information on prostate diseases, including prostate cancer, has been promoted by the Association Française d'Urologie (AFU) for several years, but is developing slowly in France. In 2005, a first communication was targeted to the male public and identified the reasons for the fatalistic attitude of men, and paradoxically, why the prostate incarnates the vulnerability of their sexual capital. As part of a second phase, this article presents the results of a complementary study conducted among general practitioners to identify their expectations and the most appropriate levers to promote screening.The Ipsos survey company developed a Krisis qualitative protocol in October 2005 (after the first French prostate day on 15 September 2005). Three groups of general practitioners were defined: doctors who are very active in terms of screening, doctors who are uncomfortable with this problem and doctors who systematically refer their patients to urologists.The management of prostate diseases often highlights the ageing process for the patient. The ability to discuss these problems during the consultation depended on the doctor's degree of comfort with this subject, which is related to his/her training and relationships with urologists. To initiate the question of screening, general practitioners involved in this process asked simple questions about everyday practices without being afraid of making jokes or basing their approach on mediatization of the disease. Digital rectal examination is one of the important clinical elements but is not always easy to perform. PSA was found to be an examination that is not always appropriate, characterized by a lack of information on the conditions for ordering this test, its usefulness and its relevance for screening. Ultrasound could be a way of alerting the patient without dramatizing the situation, letting the urologist perform digital rectal examination. Female general practitioners preferred PSA and ultrasound. The doctors surveyed relied on mediatization of prostate diseases, a high level of interactivity with urologists and documents and brochures to be placed in waiting rooms to relay screening messages.General practitioners need their authorities, specialists and public health institutions to develop and mediatize andrology in the same way as gynaecology. Urologists play a major supportive role by means of conferences, postgraduate training or AFU invitations.

The status of surgical margins after radical prostatectomy is a major prognostic factor. The role of several technical aspects of radical prostatectomy, such have surgical access, bladder neck preservation or neurovascular bundle sparing, in generating supplementary positive margins has been controversial for many years. Positive margins along with other poor prognostic factors are important elements in the decision to perform adjuvant therapy after radical prostatectomy. This review of the literature, based on a Medline search, was designed to update these various issues encountered by urologists in their everyday practice.

Prostate carcinoma is the most frequent cancer in French men. Prostate carcinoma in elderly is the topic of this review. The review included chapters on age as the main factor for prostate carcinoma, the modification of disease presentation or PSA level depending on age, and then the challenge of age in therapeutic decisions. Finally, we evaluate the place of elderly patients in prospective trials and in adjustable therapies.

Positive margins after total prostatectomy are frequently observed (10% to 40% of cases) in the everyday practice of urologists treating prostate cancer The presence of positive margins is correlated with the presence of residual tumour in about 50% of cases. It is difficult to clearly define optimal management in view of the marked heterogeneity of the published data concerning the significance and prognosis of positive margins. The objective of this review article was to analyse the various aspects of this situation and to propose practical management guidelines. This analysis was based on data of the literature derived from Medline. In practice, it is essential to more precisely define the concept of positive margins in histological terms by specifying the unifocal or multfocal nature, the total length of positive margins and their site. The decision to perform adjuvant or deferred therapy is based on these histopathological elements together with other prognostic criteria determined after total prostatectomy: pathological stage and Gleason score, tumour volume and postoperative PSA.