The sub Comittee prostate of the CCAFU established guidelines for diagnostic, treatment, evaluation and standart of care of prostate cancer.
Guidelines 2010 were updated based on systematic ...literature search performed by the sub-Comittee in Medline and PubMed databases to evaluate references, levels of evidence and grade of recommandation.
Pathological examination of the tissue specimens was defined specifically for Gleason score according to ISP 2005 recommandations. Prostate and pelvis RMN became the reference in terms of radiological exam. Individual and early diagnosis of prostate cancer was defined and role of PSA was precised. Active surveillance became one of the standart of care of low-risk tumors, radical prostatectomy remained one of the options for all risk group tumors, length of hormonotherapy in association with radiotherapy was precised according to the risk group. Side effects of hormonotherapy treament needed specific supervision ; hormonotherapy had no indication in case of non metastatic tumors and intermittent hormonotherapy in metastatic tumors. New hormonal drugs in pre and post chemotherapy and bone target drugs opened new therapeutics pathways.
From 2010 to 2013, standarts of care of prostate cancer were modified because of results of prospective studies and new therapeutics. They allowed precise treatments for each specific clinical situation. In the future, multidisciplinary treatments for high risk tumors, time of adjuvant treatment and sequencies of new hormonal treatment had to be defined.
Studies on the role of introduced rabbits, Oryctolagus cuniculus, on islands have mainly focused on their negative impacts on vegetation. However, little attention has been paid to their influence on ...vertebrate communities. On Ile Verte (148 ha) in the sub‐Antarctic Kerguelen Archipelago, rabbits are the only mammal that have been introduced. The long‐term consequences of their eradication in 1992 on both native, burrowing seabird prey populations and their predator, the brown skua Catharacta skua, were investigated between 1991 and 2005. Densities of breeding petrels were followed on site with three plant communities differing in their soil depth. In addition, the diet and breeding activities of skuas were evaluated on the entire island area. The density of breeding pairs of the most abundant petrel species, the blue petrel Halobaena caerulea, which only nested at the site with deep‐soil, increased by approximately eightfold during the 6 years following the rabbit eradication. Of the other species nesting in deep soil, there was an approximately fourfold reduction in the Antarctic prion, Pachyptila desolata, but such a decrease in breeding pair densities was not observed in areas with shallow soils. The South‐Georgian diving petrels, Pelecanoides georgicus, was the rarest species, nesting only on mineral soils, and for which breeding pairs did not vary through time. The total numbers of fledged chicks of skua on the island significantly increased during the study period, but not the total number of breeding pairs. Thus, brown skuas were not affected by the disappearance of rabbits and rather benefited from an increase of their preferred prey. Blue petrels recovered quickly to sites with deep‐soil, benefiting from the rabbit eradication and the cessation of burrow disturbance. The decrease of Antarctic prions could have been the result of an exclusion process from nesting areas on the deep soil site by blue petrels.
Summary Objectives To evaluate photodynamic therapy (PDT) using 5-ALA-induced protoporphyrin IX (PPIX) in an in vivo hypoxic tumor model and its monitoring using MRI. Materiel and methods Dunning ...R3327-AT2 tumors were grafted in the neck of Copenhagen rats. PDT using 150 mg 5-ALA/kg i.v. was performed by focal interstitial illumination of the photosensitized tumor ( λ = 633 nm; fluence = 100 J/cm2 ). MRI at baseline and 2 days after treatment (T1, T2 and dynamic gadolinium enhanced sequences) were performed. Necrosis volumes were determined on post-procedure MRI. Tumors were resected 2 days post-PDT and obtained necrosis was determined histopathologically. Intra-tumoral PPIX distribution was evaluated using confocal microscopy and tissue porphyrin quantification. Results Twenty rats were treated divided into three groups: continuous ( n = 7), fractionated illumination ( n = 7), and a control group receiving only light or only ALA or neither ( n = 6). Baseline MRI confirmed the hypoxic character of tumors. Necrosis volumes determined on posttreatment MRI were not reproducible and presented with important geometric and volumetric variability. Average necrosis volumes of 0.39 cc (0–0.874 cc) in the continuous group, 0.24 cc (0.107–0.436 cc) in the fractionated group and 0.012 cc (0–0.071 cc) in the control group were observed. Intra-tumoral PPIX distribution was heterogeneous and PPIX quantification revealed low intra-tumoral concentration. Conclusion Necrosis volumes induced by 5-ALA-mediated PDT were highly variable and non reproducible, probably because of lack of intra-tissular oxygen. Photosensitizer was poorly represented inside the tumor and its distribution was heterogeneous. Our study suggests that 5-ALA-mediated PDT might not be the best management option for hypoxic prostatic adenocarcinoma.
Le 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.
Prostate 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 magnetic 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.
To evaluate the contribution of multiparametric MRI (MRI) and targeted biopsies (TB) in the selection and follow-up of patients under active surveillance (AS).
A single-center, retrospective cohort ...study on 131 patients in AS, with following criteria:≤cT2 stage, PSA≤15ng/mL, Gleason score≤6,≤3 positive biopsies and maximum tumor length≤5mm. Patients' selection and follow-up was performed by the combination of systemic biopsies (SB) and mpMRI±TB. Reclassification was defined by a Gleason score>6 and/or a maximum tumor length>5mm.
Overall, 29 patients (22.1 %) were reclassified. Reclassification free survival rate was 93 % and 70 % at 1 year and 4 years respectively. Reclassification independent risk factors were: PSA density>0.15ng/mL/cm
(RR=2.75), PSA doubling time<3 years (RR=9.28), suspicious lesion on MRI diagnosis (RR=2.79) and occurrence of MRI progression during follow-up (RR=2). Sensitivity, specificity, PPV and NPV of MRI to assess progression for reclassification were 61 %, 69 %, 45 % and 81 %, respectively.
For patients under AS, mpMRI decreases reclassification rates over time through better initial detection of significant cancers. Its high NPV makes it an efficient monitoring tool to distinguish patients with low risk of reclassification.
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Abstract Purpose The objective was to define the trends of PN use over time at six tertiary care European centers. Methods Data were retrieved from institutional databases for patients treated with ...either PN or radical nephrectomy (RN) for stages T1–2 N0 M0 renal cell carcinoma (RCC) between 1987 and 2007. For purpose of temporal trend analyses patients were divided into five equally sized groups according to the date of surgery. Categorical and multivariable logistic regression analyses assessed predictors of PN use. Results Overall 597 (31.7%) patients were treated with PN. Overall, a 4.5-fold increase of PN was recorded. The absolute increases were 41.7–86.3%, 14.9–69.3% and 8.1–35.3% for lesions ≤2 cm, 2.1–4 cm and 4.1–7 cm (chi-square trend test p < 0.001), respectively. In multivariable logistic regression models, decreasing tumor size, younger age, more contemporary date of surgery, male gender and institutional PN rate represented independent predictors of the individual probability of treatment with PN. Lack of data from community hospitals limits the generalizability of our findings. Conclusion Based on data from six tertiary care centers, the contemporary rate of PN ranges from 86 to 35% for renal masses ≤2 cm to 4.1–7 cm and is indicative of excellent quality of care.
European Randomized Study of Screening for Prostate Cancer (ERSPC) mortality results were reported for 7 European countries (excluding France) and showed a significant reduction in Prostate cancer ...(PCa) mortality. As those results have not been part of the global ERSPC results, it is of interest to report PCa mortality at a median follow-up of 9 years for French section of ERSPC.
Two administrative departments were involved in the study. Only men after randomization in the screening group were invited by mail to be screened by PSA testing with two rounds at 4-6 year intervals. Biopsy was recommended if PSA>=3.0 ng/mL. No information other that the French Association of Urology recommandations on the use of PSA was offered to the control group (own decision of physicians and patients). Follow up was based on cancer registry database. Contamination defined as the receipt of PSA testing in control arm was measured. Poisson regression models were used to estimate the Rate Ratio (RR) of PCa mortality and incidence in the screening vs. control arm.
Starting from 2003, 80,696 men aged 55-69 years were included. The percentage of men in the screening arm with at least one PSA test (compliance) was 31%. Compared to the control arm, PCa incidence increased by 10% in the screening arm (RR=1.10; 95% CI=1.04-1.16, P=0.001), but PCa mortality did not differ (0.222 and 0.215 deaths/1000 person-years; RR=1.030.75-1.42, P=0.9).
Limitations include low participation rate. PSA testing in the control arm was observed in 32% of men (contamination).
Contamination in control group led to no effect of PSA-based screening on prostate cancer mortality at 9 years follow-up.
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