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.
Abstract 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.
The role of radical prostatectomy (RP) in high-risk prostate cancer (PCa) is increasing.
To review the existing literature and determine the value of RP in high-risk and locally advanced PCa.
...MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from 01/2000 through 05/2016 according to the PRISMA guidelines.
Forty-two studies describing outcomes of RP among 52,546 patients with high-risk and locally advanced PCa.
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%.
Studies were heterogeneous especially regarding the definition of high-risk disease and the use of adjuvant treatments.
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.
Purpose
To evaluate utility of diffusion-weighted magnetic resonance imaging (DWI) to detect and predict the histological characteristics of upper urinary tract urothelial carcinomas (UTUCs).
...Materials and methods
We retrospectively evaluated 20 suspicious lesions from 19 patients. MRI study included conventional sequences and DWI with apparent diffusion coefficient (ADC) maps calculated between
b
= 0 and
b
= 1,000. ADC values were measured within two different regions of interest (ROI): a small identical ROI placed in the most restrictive part of the tumour and a larger ROI covering two-thirds of the mass surface. The mean ADC values of the tumours were compared with that of normal renal parenchyma using an unpaired Student’s
t
test. Association between ADC values and histological features was tested using non-parametric tests.
Results
Overall, 18 tumours were confirmed histologically as UTUCs. DWI failed to detect two cases of UTUCs (one CIS and one small tumour of 5 mm). There was no statistically significant difference in ADC values measured with the small or large ROI (
p
= 0.134). The mean ADC value of UTUC was significantly lower than that of the normal renal parenchyma (
p
< 0.001). No statistical association was found between ADC values and pathological features (location,
p
= 0.35; grade,
p
= 0.98; muscle-invasive disease,
p
= 0.76 and locally advanced stage,
p
= 0.57).
Conclusion
DWI may be interesting tool for detecting UTUCs regarding the difference of ADC values between the tumours and surrounding healthy tissues. In regard to low frequency of UTUCs, the association of ADC values and histological characteristics need further investigations in a large prospective multi-institutional study.
To describe the epidemiology, the risk and genetic factors involved in carcinogenesis pathways of upper urinary tumors UTUCs.
A systematic review of the scientific literature was performed from the ...database Medline (National Library of Medicine, PubMed) and websites of the HAS and the ANSM using the following keywords: epidemiology; risk factor; tobacco; aristolochic acid; urothelial carcinoma; ureter; renal pelvis. The search was focused on the characteristics, the mode of action, the efficiency and the side effects of the various drugs concerned.
The estimated UTUC incidence is 1.2 cases/100,000 inhabitant per year in Europe. The incidence of renal pelvis tumor has been stable for 30years, while the frequency of ureteric locations has increased over time. Locally advanced stage and high grade are more frequent at the time of diagnosis. The median age for diagnosis is 70-years-old. Male-to-female ratio is nearly 2. Main carcinogenic factors are tobacco consumption and occupational exposure. There are specific risk factors for UTUC such acid aristolochic (balkan's nephropathy and Chinese herbs nephropathy). Familial cases are distinct from sporadic cases. UTUCs belong to the HNPCC syndrome and they rank third in its tumor spectrum.
UTUCs are scarce tumors with specific epidemiologic characteristics. UTUCs share common risk factors with other urothelial carcinomas such as bladder tumors but have also specific risk factors that clinicians should know.
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.
4.
Objectives
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.
Materials and methods
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.
Results
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).
Conclusion
Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal tumours appear to have a worse prognosis than ureteral tumours.
Report the reasons that lead families to refuse organ donation during their close solicitation by hospital coordination.
A retrospective study was conducted between 2012 and 2015, including 148 (34%) ...refusal of organ donation among 426 patients identified in a state of brain death. A questionnaire of the family was completed for each interview. Collected data concerned patient characteristics, cause of death, description of the interview and reasons for refusal. A descriptive statistical analysis was performed.
The median age of patients was 50 years with a sex ratio of 1.4 men to 1 woman. The most common reason for non-donor family was the desire to maintain the integrity of the body of the patient (28%) followed by a religious order pattern (11%), brutality and suddenness of death (9%), the denial of death (6%) and early age of the donor (5%). In 39% of cases, the family said that the donor had expressed a written or oral refusal in his lifetime.
A better understanding of the reasons leading to the refusal of non-donor family could provide assistance to the medical team on actions to general public with the aim to reduce the refusal rate.
4.
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