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Biomedical subjects

L Boccon-Gibod

Publications and source records attributed to L Boccon-Gibod.

At least 109 records · Page 6Linked to original sources
PubMed1996

Early detection of prostate cancer in men with prostatism and intermediate prostate-specific antigen levels.

OBJECTIVES: To determine the prevalence of prostate cancer and the diagnostic ability of prostate-specific antigen density (PSAD) in men with lower urinary tract symptoms and intermediate prostate-specific antigen (PSA) levels of 4 to 10 ng/mL (Hybritech assay) and to assess the clinical significance of prostate cancers in men who subsequently underwent radical prostatectomy. METHODS: Six systematic transrectal ultrasonography (TRUS)-guided biopsies were performed in 153 symptomatic men (mean age, 66 years) with PSA levels between 4 and 10 ng/mL, irrespective of digital rectal examination (DRE) findings. Prostate volume was also determined by TRUS and PSAD was calculated (serum PSA divided by volume of entire prostate). The rate of positive biopsies was compared with PSAD (more than 0.2 versus less than 0.2), DRE (positive versus negative), and patient's age (more than 70 years versus 61 to 70 versus 60 or less). Eligible patients with cancer underwent radical prostatectomy, and specimens were analyzed with regard to clinical significance of tumors. RESULTS: The overall cancer detection rate was 29.4%. PSAD and DRE, but not age, were both statistically significant in differentiating negative from positive biopsies. Independent of DRE findings, mean PSAD was significantly lower in biopsy-negative cases (0.29 +/- 0.17 and 0.25 +/- 0.16) than it was in positive cases (0.34 +/- 0.17 and 0.35 +/- 0.15). Half of the patients who underwent radical prostatectomy had pathologically nonorgan-confined disease (more than pT3), 34% had positive margins, and 47% had a Gleason score of 8 to 10. PSAD, DRE, and age could not predict outcome, probably owing to the small number of patients. However, the number of positive biopsies (1 or 2 versus 3 to 6) was able to predict pathologic stage. CONCLUSIONS: In men with lower urinary tract symptoms and intermediate PSA levels of 4 to 10 ng/mL, PSAD may be useful in the selection of patients for prostate biopsy. Carcinomas found using these criteria are of clinical importance.

Adult↗
PubMed1996

Rhabdoid tumour of the kidney: a clinicopathological study of 22 patients from the International Society of Paediatric Oncology (SIOP) nephroblastoma file.

We present 22 (0.9%) cases of rhabdoid tumour of the kidney diagnosed amongst 2392 renal tumours in children. The patients ages ranged from 3 weeks to 94 months (median 7 months) and the female:male ration was 1.2:1. Clinically, they presented with an abdominal mass but four (18%) children also had hypercalcaemia and one (4.5%) developed a brain tumour (primitive neuroectodermal tumour). None of the children presented with stage I disease, five (23%) had stage II, ten (46%) stage III, and five (23%) stage IV disease. Two (9%) patients had bilateral tumours. Histologically, the vast majority (20/22) of the tumours exhibited a classical pattern but other histological patterns were also noted. Immunohistochemical studies performed in 12 cases showed vimentin positivity in all cases, CAM 5.2 in eight, epithelial membrane antigen in six, neuron specific enolase in four, S-100 protein in eight, and desmin in one case. In only 12 of the 22 tumours was there agreement between the reporting pathologist and the panel on a diagnosis of rhabdoid tumour of the kidney. Eight tumours originally diagnosed as rhabdoid tumour of the kidney were found to be other renal tumours and in another ten cases the initial diagnosis was changed by the panel to rhabdoid tumour. Metastases developed in 18 (82%) of the children--in eight they were present at the time of diagnosis and in 10 they developed from 2 weeks to 9 months after initial diagnosis. Metastases were found in the lung, abdomen, lymph nodes, liver, bone and brain. Of the 19 children with adequate follow-up, only two (10.5%) with stage II disease are alive, while 17 (89.5%) died 2 weeks to 20 months after the diagnosis.

Adolescent↗
PubMed1996

A single positive prostate biopsy in six does not predict a low-volume prostate tumour.

OBJECTIVE: To evaluate whether a single positive prostate biopsy in six systematic transrectal ultrasonography (TRUS)-guided biopsies is predictive of a small tumour volume in a subsequent radical prostatectomy (RP) specimen. PATIENTS AND METHODS: Of 158 patients submitted to RP for T1-T2 prostate cancer, 15.2% had one positive biopsy. The rate of positive margins (M+) and extra-capsular involvement (C+) were assessed on the RP specimen in those with one positive biopsy (group I) and in those diagnosed by more than one positive biopsy (group II). The percentage of those with postoperative biological progression (P+), having a prostate-specific antigen (PSA) level > 0.1 ng/mL, was evaluated in both groups. The Gleason scores in biopsies and specimens were also compared. Fifteen patients diagnosed by a single positive biopsy were management conservatively. RESULTS: The percentage of patients who were categorized C+, M+ and P+ was 29.2, 16.7 and 26% in group I and 70, 46.5 and 49.5%, respectively, in group II. All patients with < 10% of the biopsy core length invaded by cancer had intracapsular (P2) disease, whereas if all the core length was invaded by tumour, all patients had extracapsular (P3) disease. The Gleason scores for biopsy cores and whole specimens were identical in 38.7% of the cases; the Gleason score was underestimated on biopsy in 48.4% of cases. In the group treated conservatively, nine of 15 patients were in biological progression, with a mean follow-up of 22 months. CONCLUSION: A single positive needle-biopsy in six systematic TRUS-guided prostate biopsies is not predictive of low-volume prostate cancer on an individual basis and does not guarantee a favourable outcome after RP.

Aged↗
PubMed1996

The value of split renal function in severe neonatal and infant pelviureteric obstruction managed by percutaneous nephrostomy.

A percutaneous nephrostomy (PCN) was inserted as part of the management in 17 newborns and infants with severe pelviureteric junction obstruction between 1981 and 1993. Nephrectomy was performed in eight cases and pyeloplasty in nine cases, successfully in six cases (mean follow-up: 7.7 years). PCN was useful for predicting that no non-functioning kidney on intravenous pyelography (IVP) in this series should have been preserved. Among the kidneys with a high excretion delay on IVP, PCN showed that only those that had a split creatinine clearance of more than 1 ml/min/1.73 m2, or theoretical clearance for age and weight of over 6%, should be preserved.

Creatinine↗
PubMed1996

Advances in the assessment of clinically localized prostate cancer.

OBJECTIVE: We review the advances in pathology, biology, and radiology which could improve the detection of extracapsular prostate cancer preoperatively. METHOD: The experiences of others are compared to ours to give a topical overview of advances in the assessment of clinically localized prostate cancer. RESULTS: Despite new technologies, such as colour Doppler and endorectal magnetic resonance imaging, radiology does not enhance the ability to detect small invasion through the prostatic capsule. Biopsy features are one of the new fields of investigation. The number of positive sextant biopsies and the analysis of periprostatic spaces on biopsies appear to be major prognosis factors. In our experience, capsular perforation on biopsy is very powerful with respect to the proportion of positive biopsies ( > 66.7%) and serum PSA ( > 25 ng/ml, polyclonal assay) to predict biological progression after radical prostatectomy. The utility of the proportion of invaded tissue on biopsy is still debated. CONCLUSIONS: Despite technical improvements, the staging of clinically confined prostate cancer is still a major issue. The best hope comes from the study of biopsy features in addition to PSA.

Biopsy↗
PubMed1996

The management of localised cancer of the prostate.

Localised prostate cancer (T1/T2) can be managed using a conservative (expectant) approach or by radical treatment with curative intent. Expectant management involves observation until symptoms of local/distant progression appear. Radical treatment with intent to cure is based on the destruction (radiation therapy or cryosurgery) or removal (surgery) of the tumour. Many options are offered to patients with T1/T2 prostate cancer. Expectant therapy may be considered in patients with limited life expectancy, curative treatment should be considered in the others, taking into account the high rate of cancer-related deaths after 10 years. Moreover, accurate staging should lead to a better selection of patients likely to be cured by monotherapy (surgery or radiation therapy depending on the patient's and doctor's biases). Surgery probably offers the advantage of the certainty of removal over the hypothetical destruction of the whole tumour provided by radiation therapy.

Androgen Antagonists↗
PubMed1996

Maximum androgen blockade in 1996.

OBJECTIVES: To review the current status of maximal androgen blockade (MAB) in the treatment of patients with prostate cancer. INTRODUCTION: Ten years after its launch, the concept of MAB remains open to many questions regarding its modalities and efficacy. Although more than 5,000 patients with metastatic prostate cancer have been entered in trials which have matured enough to be clinically meaningful, many uncertainties persist. CONCLUSIONS: It is now accepted that MAB with steroidal antiandrogens has limited, if any, efficacy. Nonsteroidal antiandrogens appear to be the drugs of choice if MAB is considered. Apart from differences in the nature of the side effects, today there appears to be no major difference between the various types of nonsteroidal antiandrogens (flutamide, nilutamide, bicalutamide). Overall, the impact of MAB on survival and progression-free survival is at best marginal when considering the results of the large meta-analysis published in July 1995. There is undoubtedly a trend in favor of MAB, which hopefully will be confirmed at the next meta-analysis. However, the real target of MAB (patients with minimal disease?) has yet to be defined more accurately as it becomes clear that many patients will not benefit from MAB and should be spared the side effects and cost of antiandrogens. A further point of concern is that continuous administration of any antiandrogen can induce mutations in the androgen receptor, transforming the antiandrogen into an agonist so that the first therapeutic action to be taken in case of progression would be the withdrawal of the antiandrogen. The so-called antiandrogen withdrawal syndrome is, however, less frequent than initially thought.

Androgen Antagonists↗
PubMed1996

Prostate specimen reevaluation in patients with organ confined prostate cancer and postoperative biological recurrence.

PURPOSE: We evaluated whether detectable levels of prostate specific antigen after radical prostatectomy for stage P2 disease are associated with unconfined cancer overlooked at pathological examination. MATERIALS AND METHODS: Among 129 patients with stages T1 and T2 prostate cancer treated with radical prostatectomy 60 had stage P2 disease. The initial slides from the 7 patients with biological failure were carefully reviewed and, if necessary, the embedded blocks were sectioned every 2 mm. RESULTS: The disease was upstaged histologically from P2 to P3 in 6 of 7 patients by reinspecting the initial slides (3) and examining new slides (3). CONCLUSIONS: A postoperative detectable prostate specific antigen level in cases of stage P2 cancer reflects the presence of unconfined disease that may be overlooked by histopathological examination.

Aged↗
PubMed1996

[A single positive prostatic biopsy out of six systematic biopsies is not correlated with the intracapsular nature of the tumor on an individual level].

OBJECTIVE: To evaluate whether or not a single positive prostatic biopsy out of six systematic ultrasound-guided biopsies, is reliably correlated manner with favourable histopathological features of the tumour on the radical prostatectomy (RP) specimen. MATERIALS AND METHODS: In a series of 158 patients undergoing RP for clinically localized prostatic cancer, 15.2% had only one positive biopsy out of 6 systematic biopsies. We compared the rates of capsular effraction (C+) and positive resection margins (RM+), assessed on the operative specimen, in this group of patients with a single positive biopsy (group 1) and in the group (group 2) diagnosed by more than one positive biopsy. The postoperative biological progression rate (P+), defined as an immediate or secondary postoperative elevation of PSA beyond 0.1 ng/ml by polyclonal assay, was also evaluated in the two groups. The Gleason score was evaluated and compared on biopsies and on RP specimens. RESULTS: 29.2 of cases were C+, 16.7% were RM+ and 26% were P+ in group 1, versus 70%, 46.5% and 49.5%, respectively, in group 2. All differences were statistically significant. All patients in group 1 with less than 10% of prostatic tissue invaded on the positive biopsy had stage P2, while all patients with 100% of the length of the biopsy invaded by tumour had stage P3. The Gleason score was accurately predicted by the positive biopsy in 39% of cases and was underestimated in 39% of cases. CONCLUSION: A single positive prostatic biopsy out of six systematic biopsies is a useful predictive factor of local extension, but, in the individual patient, does not guarantee favourable histopathological characteristics of the tumour, nor a favourable course of the disease.

Aged↗
PubMed1996

Micturition disturbances and human immunodeficiency virus infection.

PURPOSE: Human immunodeficiency virus (HIV) infections often lead to urological disorders, including tumors, infections and micturitional disturbances. It often is difficult to identify the origin of voiding disorders but the most frequent causes are infections (prostatitis and so forth), obstruction (cervico-prostatic or urethral) and neurological (encephalitis, myelitis, polyradiculoneuritis and so forth). We determined the etiologies, therapy and clinical outcome of micturitional disturbances in the acquired immunodeficiency syndrome. MATERIALS AND METHODS: Between February 1989 and September 1992 we studied prospectively 39 HIV positive patients with voiding symptoms, such as straining, urinary retention, frequency and urgency. Each patient underwent a thorough neurological and urological examination, along with radiological evaluation of the urogenital tract and nervous system. Urodynamic evaluation was performed to specify the etiology and type of disturbance before treatment. The patients were followed for 2 to 24 months (mean 9) and 34 (87%) had urodynamic abnormalities, including a hyperactive bladder, bladder sphincter dyssynergia and a hypoactive bladder. RESULTS: The cause of the voiding disorder was neurological in 61.5% of the cases, and the 2 most frequent disorders were cerebral toxoplasmosis and HIV encephalitis. Treatment was usually given to relieve symptoms with drugs acting on the detrusor-sphincter complex. A total of 22 patients (57%) had lasting improvement, while 17 (43%) died 2 to 24 months (mean 8) after onset of the voiding symptoms. CONCLUSIONS: A micturition problem is an unfavorable event since it usually indicates a neurological cause.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Nephrogenic nephroma. Apropos of a case diagnosed by needle biopsy].

A 13-year-old boy presented with a well limited, juxta-hilar intrarenal mass. Needle biopsy suggested a nephrogenic nephroma. The child underwent tumorectomy. The tumor was composed of uniform metanephric tubules with small calcospherites. This rare entity is known for benign course. Half of its cases have been described in children, the other half in adults, mainly women in their fifties.

Adolescent↗
PubMed1996

[Does the proportion of tumor tissue in biopsies reflect the extent of localized prostate cancer?].

OBJECTIVES: To evaluate whether the percentage of biopsy tissue invaded by tumour provides any supplementary information to laboratory and/or biopsy data (Gleason, number...) in the preoperative staging of patients with localized prostatic cancer (T1-T2). MATERIALS AND METHODS: 170 patients with a mean age of 65.05 +/- 6.12 years and a mean PSA of 22.5 +/- 21.4 ng/mL were submitted to radical prostatectomy (RP) for T1-T2 prostatic cancer. 110 patients were submitted to a series of 6 transrectal prostatic biopsies to establish the diagnosis. We evaluated the percentage of biopsy tissue invaded. This parameter, as well as the Gleason score and the preoperative PSA, were studied in comparison with pathological criteria of the operative specimen (capsule status, resection margins) and postoperative PSA. RESULTS: The cut-off value of 10% of invaded biopsy tissue was calculated as being the most discriminant for the prediction of resection margins, capsule status and progression of laboratory parameters. When less than 10% of biopsy tissue was invaded, there were 31.2% positive margins (RM+). 28% of invaded capsules (pT3), and 21.7% of laboratory progression (P+) versus 44.1%, 71.4% and 47%, respectively, when more than 10% of tissue was invaded. The Gleason score of the biopsy did not improve this prognostic evaluation. The mean quantities of invaded biopsy tissue were statistically different between pT3 and pT2, RM+ and RM-and P+ and P-. When only one positive biopsy was invaded by less than 10%, 87.5% of these operated patients remained stable, RM- and pT2. CONCLUSIONS: On an individual level, the percentage of invaded tissue does not reflect the degree of extension or progression of localized prostatic cancer. Only a single positive biopsy invaded over less than 10% of its length is statistically correlated with a good prognosis.

Adult↗
PubMed1996

[Post-treatment PSA, indicator of radical treatment effectiveness of localized cancer of the prostate].

Prostate specific antigen (PSA) has become essential to the follow-up of radical treatment for T1-T2 tumours. Various assays are available, but require a correlation coefficient to homogenize their results. PSA is probably the most reliable marker for the follow-up of radical prostatectomy (RP), as this operation should make PSA undetectable after 3 weeks. Highly sensitive tests, with a limit of detection of 0.1 ng/ml, allow the earlier laboratory detection of tumour escape (20 to 45%). Anastomotic biopsies are positive in 35 to 50% of cases. Seminal vesicle invasion and positive resection margins are more frequently associated with recurrence. The doubling time and rate of progression of PSA after RP can be used to distinguish local recurrence from metastasis. Urinary PSA is not useful in the follow-up of RP, as it is secreted by the periurethral glands. The use of the PSA after radical radiotherapy is less clearly established, as this treatment is not designed to eliminate all prostatic tissue or render PSA undetectable. Therapeutic efficacy is situated between 1 and 1.5 ng/ml according to the tests and is achieved in approximately 40% of cases after 4 years. A PSA level greater than 3 ng/ml at 3 months is indicative of a poor prognosis. Prospects for the future include the use of highly sensitive assays and reverse transcriptase polymerase chain reaction (RT-PCR) to detect circulating prostatic cells. The use of PSA has led to a re-evaluation of the efficacy of radical treatments and could influence the indications for adjuvant treatments.

Forecasting↗
PubMed1995

[Prostate specific antigen. Clinical applications of ultrasensitive assay].

Recent progress in the techniques used to assay prostate specific antigen (PSA) have made this diagnostic tool even more useful in the management of patients with cancer of the prostate. However, although "ultrasensitive" methods can now detect minute levels, there still is no widely accepted definition of the detection threshold making it difficult to compare results reported with the different techniques. Ultrasensitive assay is particularly interesting in patients who have had radical prostatectomy, offering complementary information to the pathology examination of the surgical specimen. Used as a tool for following disease course after surgery, ultrasensitive PSA is currently the most sensitive measure of disease recurrence. Ultrasensitive assay can also give an evaluation of the effect of post-surgery complementary radiotherapy. Inversely, it adds no further information compared with regular assay before surgery. Thus, ultrasensitive assay is not indicated for differential diagnosis or screening programmes but is a valuable tool for evaluating the effectiveness of curative surgery or exclusive curative radiotherapy.

Humans↗
PubMed1995

[Prostate-specific antigen or PSA. Facts and probabilities].

The introduction of prostatic specific antigen (PSA) assay as an organ-specific marker has totally modified our approach to diseases of the prostate gland. PSA is an exocrine secretion of the normal epithelium of the prostate and any infectious, dystrophic or tumoural processes involving the gland can lead to an increased level in the blood stream. PSA is the most effective means of following the curative effect of treatment for prostate cancer. After radical prostatectomy, PSA should be undetectable with hypersensitive tests (detection threshold < 0.1 ng/ml) 6 weeks after the operation. The persistence or reappearance of the marker in the blood stream is a clear indication of recurrence. A drop off in PSA under laboratory normal levels is an effective marker of the efficacy of hormone treatment for metastatic cancer but does not signify cure. There are still several points of debate. Serum PSA does increase with prostate volume but there is no apparent linear relationship. PSA is an important factor in early diagnosis of prostate cancer but must always be interpreted in light of the patient's age. In patients treated for cancer of the prostate, PSA is insufficient to determine tumour extension. The relationship between the PSA level and prostate volume could be a way of suspecting cancer, but the operator-dependent results of echography hinder application. Finally, search for circulating secretory cells with reverse transcriptase polymerase chain reactions still requires validation, but could be used for assessing cancer extension.

Humans↗