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C C Abbou

Publications and source records attributed to C C Abbou.

At least 109 records · Page 6Linked to original sources
PubMed1998

[Treatment of superficial tumors of the bladder].

Superficial bladder cancer includes T1, Ta, TIS transitional cell carcinomas of the TNM classification. These tumors represent a spectrum disease with different biological behavior. Some tumors may recur on the same mode for years, others have a definite metastatic risk in the short range. The main difficulty in the management of these tumors is to predict their potential aggressiveness based on clinicopathological parameters. Their management is based on the initial endoscopy and histopathological analysis. Molecular markers will reach the clinical level in order to better predict the prognosis and improved the non invasive tools for follow-up. For low risk tumors, transurethral resection (TUR) and surveillance allow an adequate tumor control. For high risk tumors, conservative treatment is based on a complete transurethral resection which need confirmation by a second look TUR and prophylactic endovesical instillations of bacille Calmette Guérin (BCG). The response to the first BCG cycle represent a crucial indicator of tumor behavior. For intermediate risk lesions, the advantage of prophylactic endovesical instillations have been finally established either using BCG or chemotherapy (Mitomycine C). However in this setting, various therapeutic modalities (maintenance therapy, dose, repeat cycles) are proposed and their relative efficacy remain to be established. For this later group of tumor it is more likely that the use of maintenance therapy or repeated courses increase the chance of conservative treatment. Other therapeutic modalities exist (oral interferon inductors, photochemotherapy) but remain second line or investigative therapies. In conclusion, progress in the understanding of the natural history of bladder cancer allow a better management of these tumor in order to optimize the ratio between the oncologic efficacy and quality of life.

Administration, Intravesical↗
PubMed1998

[Value of biopsies in staging of prostatic cancer before radical prostatectomy].

The diagnosis of prostate cancer is confirmed by histological examination of prostate biopsies. In cases of localized prostate cancer, in which radical prostatectomy can be proposed as curative treatment, these biopsies, directly reflecting the cancer, can provide important prognostic elements, by specifying the tumour staging, allowing better patient selection and guiding surgical techniques in order to improve the postoperative histological results either by decreasing the number of pT3 tumours (extraprostatic) or the positive resection margin rate. Only pejorative elements are a good indicator of extraprostatic spread of the tumour: a Gleason score greater than 7, the presence of extracapsular invasion, perineural invasion, seminal vesicle invasion, 66% of positive biopsies are in favour of extraprostatic tumour. In contrast, the presence of apparently favourable prognostic elements, such as a low Gleason score, one out of six positive biopsies, limited invasion of biopsies cannot confirm the presence of a minimally aggressive, intraprostatic tumour (pT2). Other prognostic criteria may be discovered in the future, which will confirm with greater precision the extraprostatic or intraprostatic nature of localized prostatic tumours.

Biopsy↗
PubMed1998

[Does PSA of less than 20 ng/ml exclude the diagnosis of metastatic prostate cancer?].

OBJECTIVES: To demonstrate the considerable risk of bone metastases from clinically localized prostatic cancer with PSA greater than 20 ng/ml. MATERIAL AND METHODS: Patients presenting an indication for radical prostatectomy (younger than 70, with localized prostate cancer, less than 6 out of 9 positive biopsies) and PSA less than 20 ng/ml (Tandem) were selected for this intent-to-treat study. RESULTS: Seven of the 210 patients corresponding to the selection criteria presented with bone metastases and 4 of them had a PSA less than 10 ng/ml. None had lymph node metastases. CONCLUSION: The risk of bone metastases despite PSA less than 20 ng/ml is therefore not negligible. In our opinion, it is necessary therefore to continue to include bone scan in the staging assessment of clinically localized prostate cancer.

Aged↗
PubMed1998

[In vitro detection of prostate cancer circulating cells by immunocytochemistry, flow cytometry and RT-PCR PSA].

OBJECTIVE: To evaluate 3 in vitro methods detection (immunocytochemistry, flow cytometry and RT-PCR PSA) of circulating prostate cancer cells from a model of uncap dilution in immortalised lymphocytes. METHODS: In vitro comparison of 3 techniques (immunocytochemistry, flow cytometry, RT-PCR PSA) was performed from a range of dilutions of LbCap cells in immortalised human lymphocytes (concentration range: 1 LnCap cell per 100 lymphocytes to 1 LnCap cell per 100 million lymphocytes). Cells were detected by anti-PSA (prostate specific antigen) and PAP (prostatic acid phosphatase) antibody by immunochemistry, by fluorescent linked antipancytokeratin antibody by flow cytometry and RT-PCR PSA. RESULTS: The limit of detection was 1 LnCap cell per 200,000 lymphocytes (1/2.10(5)) for immunochemistry, 1 LnCap cell per 1,000 lymphocytes (1/1.10(3)) for flow cytometry and 1 LnCap cell per 10 million lymphocytes (1/10(7)) for RT-PCR PSA. CONCLUSION: RT-PCR, due to its most perceptible limit of detection, appears to be the method of choice for the detection of prostatic epithelial cells. Immunocytochemistry has the advantage of providing a quantitative approach. Flow cytometry is limited by the limit of detection of the apparatus used. The prognostic significance of detection of circulating prostate cancer cells remains to be clarified, but the detection of these cells and their correlation with the primary tumour will provide a better understanding of metastatic phenomena.

Acid Phosphatase↗
PubMed1997

Clonality of tumor-infiltrating lymphocytes in human urinary bladder carcinoma.

The immune system has been implicated in the control of bladder tumor growth. To evaluate the clonality of bladder tumor-infiltrating T lymphocytes (TILs) in vivo, we studied the T-cell antigen receptor (TCR) repertoire in tumor biopsy specimens from 10 patients with transitional-cell carcinoma (TCC) of the bladder. Nine patients had a primary tumor, and one had a multifocal disease, consisting of two bladder tumors and three bilateral upper urinary tract sites of involvement. The following specimens from the nine patients with a primary tumor also were analyzed: a recurrent tumor from four patients, a metastatic lymph node from one patient, and peripheral blood from five patients. We used a high-resolution polymerase chain reaction (PCR) method to determine CDR3 (complementarity-determining region 3) size lengths of TCR beta-chain transcripts. Oligoclonal T-cell expansion was identified in all specimens, with a larger number of expanded clones in the tumors than in peripheral blood. Expanded clones were identified in several beta-chain variable region (BV) subfamilies and varied from one patient to the next and also in different specimens from the same patient. However, a number of clones with the same VJ combination and the same CDR3 size were identified in a given patient (in specimens collected either simultaneously or at different times), suggesting homogeneity in the immunogenic environment. Clonal T-cell expansion in patients with bladder cancer may reflect prolonged exposure of T lymphocytes to tumor antigens. Our findings provide a basis for functional studies to elucidate T lymphocyte-bladder tumor cell interactions.

Aged↗
PubMed1997

Influence of urological complications on the prognosis of prostate cancer.

Urological complications, essentially bladder outflow obstruction and hydronephrosis, are caused by the local extension and lymphatic spread of prostate cancer. Although bladder outflow obstruction is a very common finding at diagnosis, results from clinical studies have revealed that it is not a prognostic factor for response to androgen blockade. Hydronephrosis has been shown to have an independent prognostic value for progression after hormonal treatment and correlates also with time to death from prostate cancer. Furthermore, persistent or newly developed hydronephrosis during treatment also predicts a shorter time to progression. The incidence of bladder outflow obstruction is significant in advanced prostatic cancer and may be a source of morbidity, which will impact on the patient's quality of life. Decompression of ureteric obstruction in hormone-refractory cancer decreases the length of hospital stay, thereby improving quality of life. Finally, hydronephrosis, but not bladder outflow obstruction, can be considered to be an independent prognostic variable for the response to androgen blockade. This paper reviews the incidence of urethral and ureteric obstruction in patients with advanced prostate cancer, evaluates the prognostic significance of these urinary complications and discusses the therapeutic strategies available for treating patients with this disease.

Humans↗
PubMed1997

Effect of androgen deprivation therapy on local symptoms and tumour progression in men with metastatic carcinoma of the prostate.

OBJECTIVE: To evaluate and compare the effects of medical or surgical castration combined with either nilutamide (Anandron) or placebo on symptoms of local tumour progression in men with carcinoma of the prostate. METHODS: The results from twin, randomised, prospective, placebo-controlled trials were analysed. 434 patients received nilutamide 300 mg/day for 1 month and 150 mg thereafter, and 434 received a matched placebo from either the day of orchidectomy or the first leuprolide injection. Before treatment, and at months 1, 3, 6 and every 6 months thereafter, urinary obstruction and tumour volume were evaluated. Data on adverse or intercurrent events affecting the urological system were documented. RESULTS: Before treatment, urinary obstructive symptoms and tumour volume were similar in both treatment groups. After treatment, improvement in urinary obstructive symptoms accompanied a decrease in prostate volume. The majority of men in both treatment groups reported an improvement in obstructive voiding symptoms. However, total adverse events secondary to local symptoms were significantly less frequent in the nilutamide-treated patients (20%) compared with the placebo-treated patients (35%). Only a small percentage of men in both treatment groups had disabling local symptoms and only 2% experienced problems with incontinence. CONCLUSIONS: Local symptoms from primary tumour growth are relatively common in patients with metastatic carcinoma of the prostate and are favourably influenced by hormonal therapy. In these trials, the problems resulting from local tumour progression were significantly fewer in the group treated with castration plus nilutamide compared with the group treated with castration plus placebo.

Aged↗
PubMed1997

Serum markers as a predictor of response duration and patient survival after hormonal therapy for metastatic carcinoma of the prostate.

PURPOSE: Prostate specific antigen (PSA), prostatic acid phosphatase and alkaline phosphatase were analyzed in 2 large prospective multicenter and multinational trials to assess their correlation with time to progression and overall survival after hormonal therapy for metastatic carcinoma of the prostate. MATERIALS AND METHODS: A total of 868 patients who underwent medical or surgical castration was randomized to receive an oral antiandrogen (nilutamide) or placebo. The serum markers under study were measured at baseline and at 1, 3, 6 and every 6 months thereafter. RESULTS: At baseline the strongest predictive factor was serum alkaline phosphatase. Patients with an alkaline phosphatase of 2 or less times normal lived almost twice as long as those with a level of more than 2 times normal (p < 0.0001). The longer survival was observed in patients whose PSA became normal 3 months after initiation of hormonal therapy compared to those whose PSA never reached normal (p < 0.0001). CONCLUSIONS: Serum markers at baseline and during the few months after initiation of hormonal therapy can provide prognostic information for the clinical treatment of patients with metastatic carcinoma of the prostate. In addition, the PSA level at month 3 can serve as a surrogate end point in clinical trials.

Acid Phosphatase↗
PubMed1997

[Volume and spatial representation of tumors in the core of the prostate gland].

OBJECTIVES: To describe a method of calculation of prostatic tumour volume allowing spatial representation of the tumour within the prostate gland. METHODS: 60 radical prostatectomy specimens were studied. Each specimen was processed according to the Stanford technique, and each prostatic section was also divided into two parts, anterior and posterior, according to a sagittal plane through the urethra. 5 microns thick serial sections were performed every 3 mm. The tumour surface area was calculated under light microscopy on each slide. The tumour volume between two consecutive slides was considered to be the volume of a truncated cone. The overall volume obtained was then equal to the sum of these various partial volumes. Spatial representation was performed according to two axes for each of the anterior and posterior parts of the prostatic sections: x-axis represented the prostate from the base to the apex, and the y-axis represented the tumour surface area in each prostatic section. RESULTS: The tumour volume ranged from 0.01 cm3, from 0.21 cm3 for pT2A to 1.98 cm3 for pT3C. pT3 tumours corresponded to the largest volumes, but some pT3 had a small volume. pT3 tumours were preferentially located close to Denonvilliers fascia : 40% of posterior tumours were pT3 versus 9% of anterior tumours (p = 0.01). CONCLUSION: The tumour volume on prostatectomy specimens can be evaluated by routine preparations and represents an additional element allowing better assessment of the TNM classification, as well as the predictive value of the information provided by prostatic biopsies.

Biopsy↗
PubMed1997

[Diagnosis of cancer of the prostate (I): Advancements in knowledge and practice since the consensus conference of 1989. The "Cancer of the Prostate" subcommittee of the Committee of Oncology of the French Association of Urology].

The prostatic cancer screening policy in France is defined by recommendations established at the 1989 consensus conference. Mass or individual screening by serum specific prostatic antigen (PSA) assay is not recommended. The Oncology Committee of the Association Française d'Urologie has up-dated the knowledge concerning prostatic cancer screening since 1989. The results are published in the form of a series of articles referring to the criteria used as prerequisites for cancer screening programmes. This article describes: 1) Current screening and treatment recommendations in France and in other countries. 2) The progress in our understanding of the prognosis, diagnosis and treatment of prostatic cancer, justifying revision of the screening policy. 3) The methodology and results of prospective screening studies and the projections of these results on the basis of the French population. Despite the 1989 recommendations, individual screening by serum PSA assay is widely performed both due to the characteristics of the test (simple blood test, low cost, high positive predictive value) and information of the public by the media concerning the morbidity and mortality related to prostatic cancer. The current data of the literature are unable to define the impact of PSA screening on the morbidity and mortality of prostatic cancer. Randomized prospective studies are currently underway. The absence of proof of a favourable impact of PSA screening is only one of the causes of the controversy concerning this screening technique, as another source of controversy is the magnitude of iatrogenic disorders induced by screening. In patients with raised PSA, the diagnostic examinations (biopsy) and curative treatments (surgery or radiotherapy) proposed are invasive, responsible for considerable morbidity and non-negligible mortality. Finally, the cost of screening remains unknown. Future recommendations must adapt their conclusions to changes in the current situation, in which prostatic cancer is simultaneously considered to be a non-serious disease which does not justify screening and a serious disease, as soon as the diagnosis is made, justifying, for 95% of urologists, an invasive and mutilating treatment in men with a life expectancy of more than 10 years.

Attitude to Health↗
PubMed1997

[The PSA gene: value in detection of circulating prostate cancer cells].

There has been a renewed interest in detection of circulating cancer cells due to the simplicity, specificity and sensitivity of a molecular biology technique: RT-PCR. This detection is based on the concept of specificity of an RNA sequence expressed by a cancer cell. PSA appears to be the ideal marker for circulating prostate cancer cells due to its specificity. The authors review the genes of the kallikrein family and discuss the advantages and difficulties involved in the use of PSA messenger RNA as a marker for circulating prostate cancer cells.

Blotting, Northern↗
PubMed1997

[Retropubic and perineal approach: plea for perineal radical prostatectomy].

OBJECTIVES: Two surgical approaches are proposed for radical prostatectomy: the retropubic route and the perineal route. We compared the surgical, oncological and functional aspects of these two approaches and present arguments suggesting that the perineal approach is the preferred approach for radical prostatectomy. MATERIAL AND METHODS: 55 retropubic radical prostatectomies were retrospectively compared to 55 perineal radical prostatectomies and performed between March 1992 to December 1995. The clinical TNM, preoperative PSA, results of 6 systematized intrarectal biopsies, operating time, intraoperative bleeding, number of patients transfused and number of packed cell units per patient transfused, medical and surgical complications, catheterization time and length of hospital stay, incidence of urethrovesical anastomosis leak and stenosis, analysis of the prostatectomy specimen, course of PSA, continence and erection were studied. RESULTS: Statistically significant differences were observed for the retropubic and perineal approaches, respectively: preoperative PSA (24 vs 15 ng/mL), intraoperative bleeding (2664 vs 1071 mL), number of patients transfused (91% vs 28%), number of packed cell units per patient transfused (3.9 vs 2.7), medical and surgical complications (56.9 vs 29.1%), anastomotic leak (24.1 vs 7.2%), anastomotic stenosis (31.5 vs 1.8%), duration of catheterization (18 vs 13 days) and length of hospital stay (14 vs 8 days). At 2 years, PSA remained less than 0.5 ng/mL in both groups. CONCLUSION: Even taking the learning period into account, the perineal approach provides the same results as the retropubic approach in terms of functional and oncological parameters, with a simpler postoperative course for patient.

Aged↗
PubMed1997

[Tolerance and clinical and biological responses during the first 6 months of treatment with 1-month sustained release LHRH agonists leuprolerin and triptolerin in patients with metastatic prostate cancer].

OBJECTIVES: Comparative efficacy and safety of 2 LHRH analogues in metastatic prostatic carcinoma. METHODS: 68 patients received monthly injections for 6 months (randomization): either subcutaneous leuprolide 3.75 mg LP (n = 36), or intramuscular triptorelin 3.75 mg LP (n = 32). (Flare-up prevention: nilutamide). Parameters re-evaluated at 1.3 and 6 months: centralized assays of plasma testosterone (T), LH and serum PSA; clinical symptoms. Main criterion: proportion of patients with T < or = 0.5 ng/mL. RESULTS: The percentages of patients with T < or = 0.50 ng/mL was not significantly different between the two groups and were equal to 100 and 90%, 97 and 100%, and 100 and 96% at the 3 study times, for leuprolide or triptorelin, respectively. The difference was significant at 1 month on complementary analysis at the limit of T < 0.30 ng/mL: 86% with leuprolide versus 60% with triptorelin (p = 0.02) and for mean plasma testosterone: 0.16 +/- 0.10 ng/mL versus 0.33 +/- 0.44 ng/mL, respectively (p = 0.02). The clinical subjective efficacy was not significantly different. CONCLUSION: Both treatments were effective, although plasma testosterone fell more rapidly with leuprolide. No conclusion about the possible clinical or survival benefits can be formulated. Overall safety was satisfactory.

Adenocarcinoma↗
PubMed1997

[Detection of circulating epithelial cells in prostate cancer].

INTRODUCTION: The prostate cancer, which is the second cause of cancer, is in constant increase. This is linked to the ageing of population which is in fact a medical and socioeconomic problem. The curative therapeutic attitude of the localized prostate cancer are either wath-full waiting, radiotherapy or radical prostatectomy. With the actual clinical and radiological techniques of stadification, 40% of the localized prostate cancer are extraglandular on the prostatectomy specimen. Recently, the RT-PCR seems to be a more specific and sensitive technique to detect circulating epithelial cells compared to others techniques (immunocytochemistry or flow cytometry). The detection of these circulating cells, would be correlated to the anatomopathologic stage. The use of RT-PCR as a tool of molecular stadification should be considered. METHODS: This study evaluates and compares with in vitro pattern, the different techniques of separation (ficoll, gradient, osmotic shock) and detection (immunocytochemistry, flow cytometry and RT-PCR). RESULTS: The ficoll gradient is the best technique of cellular separation preserving cellular morphology and RNA. The detection level are 1 cell LnCap per 40,000 lymphocytes cell by immunocytochemistry, 1/1000 by flow cytometry, 1/10,000 to 1/1,000,000 by RT-PCR. CONCLUSION: The RT-PCR with its low detection level and its high specificity, is the best technique of detection of epithelial circulating cells in localized stage. The advantage of immunocytochemistry is its simplicity. Its use for circulating cells caracterization can be considered for metastatic stage.

Cell Count↗
PubMed1996

Retroperitoneoscopy: a laparoscopic approach for adrenal and renal surgery.

OBJECTIVES: Retroperitoneoscopy has gained acceptance for urologic surgery. We assessed the safety and efficacy of this procedure for renal and adrenal surgery. METHODS: Since December 1994, 20 patients (18 to 75 years old) have undergone laparoscopic adrenalectomy and nephrectomy, including simple nephrectomy in 8, partial nephrectomy in 1, radical nephrectomy in 2, tumorectomy with cyst excision in 1, and adrenalectomy in 8. The retroperitoneal space was created by blunt dissection with the index finger, completed by insufflation, without balloon dissection. RESULTS: Average kidney size was 65 m (range 50 to 108), and average adrenal tumor size was 31 mm (range 20 to 40). The average operating time was 127 minutes (range 60 to 180) for nephrectomy and 84 minutes (range 45 to 140) for adrenalectomy. The average hospital stay was 3 days (range 1 to 7) for nephrectomy and 2.4 days (range 1 to 4) for adrenalectomy. Average blood loss was 65 mL for both nephrectomy and adrenalectomy. Conversion from the laparoscopic procedure to open surgery was never required. Peritoneal effraction and ureteral injury occurred in only 4 patients and 1 patient, respectively. CONCLUSIONS: The laparoscopic retroperitoneal approach is safe and effective for simple renal nephrectomy and for excision of small adrenal tumors. Perioperative morbidity and hospital stay are reduced.

Adolescent↗
PubMed1996

Genitourinary tuberculosis: rapid diagnosis using the polymerase chain reaction.

We present the case of a patient with suspected genitourinary tuberculosis in whom confirmation by direct smear examination was negative. Detection of mycobacterial DNA by use of the polymerase chain reaction (PCR) established the diagnosis, which was confirmed by culture 4 weeks later. Given its very high sensitivity and positivity, PCR may become the method of choice for rapid diagnosis of genitourinary tuberculosis and institution of therapy.

Adult↗
PubMed1996

[Antiandrogen withdrawal syndrome in the hormonal treatment of metastatic prostatic cancer in hormonal escape].

A fall in the PSA level after stopping antiandrogens has been described at the stage of hormonal escape of prostatic cancer treated by complete androgen inhibition. The authors report a new case. The patient was offtially treated by pulpectomy and nitulamide for N+ prostatic carcinoma (PSA: 165 ng/ml). At the stage of hormonal escape, discontinuation of nitulamide induced a reduction of the PSA. Replacement of nitulamide by cytoproterone acetate was followed by a renewed increase of PSA, which again decreased after stomming cyproterone acetate. Three years later, the PSDA level was 3.5 ng/mg. This syndrome is probably due to mutation of the androgen receptor. In hormonal escape, suspension of all antiandrogens apart from LHRH analogues is recommended and can be followed by a temporary fall of PSA. No other antiandrogen must be administered in the place of the previous drug.

Adenocarcinoma↗