Will robotic surgery become the gold standard for radical prostatectomy?
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Humans↗
Biomedical subjects
Michaël Peyromaure
Publications and source records attributed to Michaël Peyromaure.
Can pT0 stage of prostate cancer be predicted before radical prostatectomy?
OBJECTIVES: To report our experience with biopsy-proven pT0 prostate cancer over the last 10 yr. METHODS: We retrospectively analysed a series of 1950 consecutive patients treated with radical prostatectomy (RP) for clinically localized prostate cancer between 1996 and 2005 at our institution. The patients without residual tumour on RP specimen were defined as pT0 patients. The group of pT0 patients was compared with a control group of 295 patients operated consecutively during the same period. RESULTS: Overall, 11 (0.5%) patients were classified as pT0 on pathologic examination of the RP specimen. There was no pT0 tumour in the control group. Among the pT0 patients, five characteristics were particularly frequent: T1c clinical stage (90.9%), prostate-specific antigen (PSA) or=60 g (100%). All these characteristics were present in 8 of the 11 (72.7%) pT0 patients, while they were present in only 12 of the 295 (4.1%) controls. These parameters, when combined together, had a sensitivity of 72%, a specificity of 96%, and an accuracy of 99% for the prediction of pT0 stage. With a mean follow-up of 30 months after RP, no pT0 patient had clinical or biologic evidence of prostate cancer. CONCLUSIONS: In our experience, the rate of pT0 tumours after RP is 0.5%. The combination of clinical stage, preoperative PSA, number of positive biopsy cores, Gleason score, and prostate weight could help to predict pT0 stage after RP.
Aged↗
Spontaneous dissection of branch renal artery- is conservative management safe and effective?
PURPOSE: We analyzed the long-term results of conservative management for spontaneous branch renal artery dissection. MATERIALS AND METHODS: In the last 6 years 8 patients were treated for acute spontaneous branch renal artery dissection at our department. The diagnosis was established by angiography, which showed primary branch artery dissection in all cases. All patients were treated with antihypertensive and platelet anti-aggregate therapy. None of them underwent surgery. After treatment patients were evaluated for blood pressure and renal function and by abdominal computerized tomography angiography with 3-dimensional reconstruction. RESULTS: Median followup was 72.3 months. In 6 patients blood pressure was controlled with a single antihypertensive agent. In another patient 3 antihypertensive agents were required. The remaining patient continued to have labile hypertension because of poor compliance with treatment. Renal function was normal in 7 patients. Control computerized tomography angiography showed proximal arterial remodeling in 6 patients and persistent occlusion of primary branches in 2. CONCLUSIONS: In our experience conservative management of spontaneous branch renal artery dissection is safe and effective. Surgical treatment should be proposed at the acute stage only in patients with malignant hypertension or renal failure and at the chronic stage in those with refractory renovascular hypertension.
Adult↗
Role of vascular endothelial growth factor in prostate cancer.
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Humans↗
[Place of contrast imaging in prostate cancer detection].
Contrast imaging of the prostate is based on rapid-sequence MRI after dynamic Gadolinium injection and contrast ultrasound after injection of microbubbles. MRI can be performed routinely on all available machines. Contrast ultrasound requires specific software not yet available on all machines. The two techniques are designed to improve the reliability of imaging, as a complement to MR spectroscopy, to localize prostate cancer MRI can detect suspicious enhancement in the peripheral zone, but especially in the transitional zone after one or a series of negative posterior biopsies to target a new series of biopsies. The sensitivity and specificity of the technique have yet to be determined. The objective of contrast ultrasound is to improve cancer detection on the first series of biopsies by multiplying sextant biopsies in sites where the contrast kinetics are suggestive of a primary lesion. However, this technique cannot yet be recommended in routine practice, as the modalities of injection of the latest generation of microbubbles (bolus or infusion) need to be evaluated.
Contrast Media↗
[Sarcomatoid carcinoma with heterologous osteoid differentiation].
Sarcomatoid carcinomas of the bladder with heterologous osteoid differentiation are exceptional, aggressive tumors with a poor prognosis. We report a new case, and discuss the clinical and pathological characteristics of this tumor.
Aged↗
[Bilateral pyelonephritis and emphysematous cystitis: an exceptional association].
The authors report the case of a patient hospitalized for bilateral pyelonephritis and emphysematous cystitis requiring bilateral nephrostomy. This rare disease occurs in diabetic patients and is essentially due to Escherichia coli and Klebsiella pneumoniae. Treatment consists of antibiotics and renal drainage or nephrectomy. The prognosis is poor with a mortality rate greater than 50%.
Aged, 80 and over↗
Evolution of health-related quality of life two to seven years after retropubic radical prostatectomy: evaluation by UCLA prostate cancer index.
To determine changes in health-related quality of life (HRQOL) in patients treated with retropubic radical prostatectomy (RP) between two and seven years after surgery. A questionnaire from the University of California Los Angeles Prostate Index was sent to 142 patients previously treated with retropubic RP as mono-therapy for clinically localized prostate cancer. Patients were divided into five groups according to time from surgery. Demographics, clinical and pathological characteristics of patients were compared between these groups. Correlation coefficients controlled for age at the time of questionnaire between HRQOL scores and time from RP were assessed. A total of 105 patients (74%) returned the questionnaire. The mean time from surgery was 48 months (range 25-84). Demographics, clinical and pathological characteristics of patients were not statistically different between time groups. Several recoding items were found to decrease significantly with the time from RP including physical functioning, role limitations due to physical health problem, vitality, and general health. In contrary, urinary, bowel and sexual scores were not significantly correlated to time from RP. Although sexual, urinary and bowel scores seem to remain stable from 2 to 7 years following RP, general health appears to significantly deteriorate with time after RP, independent of the patient's age at the time of the questionnaire.
Aged↗
Trastuzumab (Herceptin) in metastatic transitional cell carcinoma of the urinary tract: report on six patients.
OBJECTIVE: To report our preliminary experience with trastuzumab (Herceptin) in the management of metastatic transitional cell carcinoma of the urinary tract. PATIENTS AND METHODS: From november 2001 to august 2002, six patients received trastuzumab for metastatic transitional cell carcinoma of the bladder (n=5) or renal pelvic cancer (n=1). Trastuzumab was administered as a first-line therapy in 2 patients, a second-line therapy in 3, and a third-line therapy in 1. Each patient received a weekly intravenous administration of trastuzumab (initial dose of 4 mg/kg, followed by 2mg/kg for other courses). A total of 6 courses was given. In 4 patients, trastuzumab was administered in association with paclitaxel (175 mg/m2) and carboplatin (area under the curve of 6). One patient received the same combination of trastuzumab and paclitaxel, but without carboplatin. The remaining patient received only trastuzumab. RESULTS: The trastuzumab-based regimen achieved partial regression of metastases in all patients. Initial regression of metastases varied between 30% and 80%. The therapy was well tolerated. Treatment-related toxicity was moderate in all patients, except for one who experienced transient grade 4 neutropenia. Five patients died from cancer. The interval between trastuzumab initiation and patient death ranged from 8 to 22 months. The remaining patient was still alive 28 months after trastuzumab initiation. CONCLUSIONS: Our preliminary data suggest that trastuzumab-based therapy may be safe and effective in metastatic transitional cell carcinoma of the urinary tract. Prospective trials are needed to further investigate this therapeutic option.
Aged↗
Outcome of patients with fortuitous prostate cancer after radical cystoprostatectomy for bladder cancer.
OBJECTIVES: To analyze the outcome of patients after fortuitous diagnosis of prostate cancer (PCa) on cystoprostatectomy (CPT) specimen. METHODS: The medical charts of 141 male patients who underwent radical CPT for urothelial cell carcinoma of the bladder between january 1995 and april 2000 were retrospectively reviewed. None of the patients had preoperative clinical or biological suspicion of PCa. RESULTS: Pathological examination of the CPT specimens showed PCa in 20 patients (14.2%). Of these, 6 had a microfocal PCa, 10 had a pT2a tumour, 2 had a pT2b tumour, and 2 had a pT3a tumour. The Gleason score was < or =5 in 5 cases, 6 in 13 cases, and 7 in 2 cases. Two patients were lost to follow-up. Ten patients died of bladder cancer after a median follow-up of 13 months. Eight patients remained free of disease after a median follow-up of 64.5 months. None of the 20 patients experienced PCa recurrence during follow-up. CONCLUSIONS: In our experience, the rate of unsuspected PCa on cystoprostatectomy specimens was 14.2%. The majority of these PCas were organ-confined, and there was no PCa recurrence during follow-up.
Aged↗
Pro PSA : a "pro cancer" form of PSA?
Pro PSA, the precursor of PSA, is an inactive 244-amino acid protein secreted by prostatic cells. Pro PSA, a distinct molecular form of free PSA in serum, includes native as well as several truncated forms. Clinical studies have recently provided evidence that pro PSA is associated with prostate cancer (PCa). The truncated (-2) pro PSA form accounts for only 6-19% of free PSA in the serum of patients without PCa, but it represents up to 25-95% of free PSA in that of PCa patients. In the PSA range of 2-10 ng/ml, it has been suggested that pro PSA may be useful to detect PCa, and to spare 10-20% of unnecessary prostate biopsies. However, only scant information about the role of pro PSA is available to date, and its real impact on PCa detection remains to be determined. Furthermore, it is questionnable whether pro PSA could be predictive of tumor recurrence of PCa after therapy. Prospective clinical studies with long term followup are needed to clarify this point.
Biomarkers, Tumor↗
Intermittent androgen deprivation for biologic recurrence after radical prostatectomy: long-term experience.
OBJECTIVES: To analyze the oncologic results of intermittent androgen deprivation (IAD) for biochemical recurrence after radical prostatectomy (RP). METHODS: A total of 57 patients with biochemical recurrence after RP have been treated with IAD at our institution. The 57 patients were divided into two groups: group 1 comprised 29 patients who received salvage radiotherapy after RP; group 2 comprised 28 patients who did not receive salvage radiotherapy. Hormonal therapy during the first treatment phase consisted of an antiandrogen alone. This treatment was maintained for 3 months after the prostate-specific antigen (PSA) level had become undetectable and was then discontinued. Hormonal therapy was resumed when the PSA level exceeded 4 ng/mL; treatment was discontinued when the PSA level dropped to less than 1 ng/mL. RESULTS: The patients in group 1 had less favorable characteristics than those in group 2 in terms of pathologic stage and Gleason score. Overall, the median follow-up after starting hormonal therapy was 92 months (range 36 to 176). The percentage of each cycle that was spent "off" treatment decreased from 60% to 50%. During follow-up, 38.6% of patients required a luteinizing hormone-releasing hormone analog for nonresponse to the antiandrogen alone, and 15.8% experienced metastatic progression. The cancer-specific mortality rate was 12.3%; all patients who died of prostate cancer were from group 1. The median interval between initiation of hormonal therapy and cancer-related death was 86 months. CONCLUSIONS: In our experience, IAD for biochemical recurrence after RP provided satisfactory long-term oncologic results. Our data suggest that IAD can be initiated with an antiandrogen alone.
Aged↗
Serum levels of vascular endothelial growth factor in patients undergoing prostate biopsy for suspicion of prostate cancer.
OBJECTIVES: To analyze the correlation between serum levels of vascular endothelial growth factor (VEGF) and biopsy findings in patients with a suspicion of prostate cancer. METHODS: Serum levels of VEGF were measured on frozen, archival serum obtained before prostate biopsy in 47 patients with clinical and/or biologic suspicion of prostate cancer. VEGF-A levels were measured using an enzyme-linked immunosorbent assay. RESULTS: The prostate biopsies showed cancer in 27 patients (group 1) and benign tissue in the remaining 20 patients (group 2). No statistically significant difference was found between the two groups in age, digital rectal examination findings, total prostate-specific antigen (PSA) levels, free PSA levels, and complexed PSA levels. The mean prostate volume was significantly lower in group 1 (45.5 g versus 53.9 g; P = 0.04), and the mean percentage of free PSA (free PSA/total PSA) was significantly lower in group 1 (11.3% versus 19%; P = 0.0003). Serum VEGF-A levels were not significantly different between the two groups. The mean VEGF level was 90.6 pg/mL in group 1 and 107.9 pg/mL in group 2 (P = 0.55). Multivariate analysis showed that VEGF-A levels were not predictive of prostate cancer. CONCLUSIONS: Our findings suggest that serum VEGF-A is not helpful to predict prostate cancer in patients with clinical and/or biologic suspicion of prostate cancer.
Aged↗
Management of prostate cancer in China: a multicenter report of 6 institutions.
PURPOSE: In China the incidence of prostate cancer (PCa) is low and sparse data are available regarding its management. We analyzed the management of PCa at 6 Chinese urological institutions. MATERIALS AND METHODS: A retrospective analysis was performed of 431 consecutive patients treated for PCa at 6 Chinese institutions, including 5 in the divisions of Shanghai and 1 in the province of Chongqing, between January 2000 and December 2004. Tumor characteristics, therapeutic options and patient outcomes were recorded. RESULTS: At diagnosis median patient age was 72 years and median prostate specific antigen was 46.1 ng/ml. Most PCa cases were revealed by urinary symptoms (75.9%) or bone pain (12.8%). PCa was palpable on digital rectal examination in 74% of cases. At least 44 patients (10.2%) had metastases to lymph nodes at diagnosis and 112 (26%) had bone metastases. A total of 236 patients underwent bilateral orchiectomy and 100 received medical hormone therapy, which in 75% consisted of antiandrogen alone. At a median followup of 16.8 months 60% of these patients experienced biological recurrence. Radical prostatectomy was performed in 24 patients as monotherapy or in combination with bilateral orchiectomy. No patient with clinically localized PCa experienced biological recurrence after radical prostatectomy. CONCLUSIONS: The management of PCa in China differs from that in Western countries. To date surgical castration represents standard treatment. Screening detection of PCa could help detect earlier stage tumors and improve the outcome in patients.
Age Distribution↗
[Results of open radical nephrectomy in a series of 230 patients].
OBJECTIVE: To analyse the oncological results of open radical nephrectomy for renal cancer PATIENTS AND METHODS: Between December 1989 and June 2003, open radical nephrectomy for renal cancer was performed by the same operator in 230 patients. Cancers treated by partial nephrectomy were excluded from this study. The operation was performed via a lumbar incision in 95.7% of cases. Surveillance consisted of clinical examination and thoracic and abdominopelvic computed tomography twice a year for the first two years, then annually for 3 years, and then at 7 years and at 10 years in the absence of recurrence. RESULTS: With a median follow-up of 63.1 months, the 5-year and 10-year recurrence-free survival rates were 88.4% and 67.2%, respectively. Tumour size, tumour stage (TNM 1997), Fuhrman's nuclear grade, histological type of cancer, and the presence of suggestive signs were correlated with the recurrence-free survival rate. The 10-year recurrence-free survival rate was zero in patients with visceral or lymph node metastases at the time of diagnosis. The patient's age at the time of diagnosis and the presence of a paraneoplastic syndrome did not influence recurrence free survival in this series. CONCLUSIONS: This study confirms the data of the literature: tumour size, tumour stage, nuclear grade, histological type, and suggestive signs are prognostic factors of renal cancer. Radical nephrectomy ensures a global 5-year recurrence-free survival rate higher than 85%.
Adult↗
[Results of the AMS 800 artificial urinary sphincter in men, based on a series of 47 patients].
INTRODUCTION: Male urinary incontinence due to sphincter incompetence is usually secondary to prostate surgery. After failure of other treatments, severe sphincter incompetence requires placement of an artificial urinary sphincter The authors present the results of the AMS 800 artificial urinary sphincter based on a series of 47 consecutively operated patients. PATIENTS AND METHODS: From 1990 to 2003, 47 AMS 800 were inserted by the same operator and according to the same technique. The aetiologies of urinary incontinence were: radical prostatectomy (45% of cases), transurethral resection of the prostate (36%), open prostatectomy (10.5%), and others (8.5%). RESULTS: The mean age of the patients was 65 years. The mean follow-up was 36 months. The mean time to insertion was 3 years and 10 months (range: 5 months-15 years). 23.4% of patients presented one or several complications (mechanical failure: 19%; infection; 10.6%; erosion: 4%; bladder stones: 2%), 21% of patients required one or several surgical revisions after a mean interval of 25.5 months (range: 2-80 months). The actuarial 5-year revision rate was 25.5%. With a mean follow-up of 36 months, 98% of patients had a functioning artificial urinary sphincter and 83% still had their original artificial urinary sphincter Social continence and patient satisfaction rates were 87% and 95.7%, respectively. CONCLUSION: These results are comparable to those of similar published series. The AMS 800 is associated with high continence and patient satisfaction rates and currently remains the reference treatment for refractory sphincter incompetence in men.
Adult↗
[Leiomyosarcoma of the renal pelvis].
Leiomyosarcoma of the renal pelvis is an exceptional tumour, as only 3 cases have been reported in the literature. The authors report a new case and discuss the differential diagnoses and prognosis of this lesion.
Aged↗
[Indications and current results of substitution enteroplasty following radical cystectomy].
Radical cystectomy is the standard treatment for muscle-invasive bladder cancer. Today, most patients can undergo substitution enteroplasty following cystectomy. Recto-colic urinary diversions and cutaneous ureterostomy are now uncommon. An ileal conduit (Bricker) may be proposed to patients with urethral involvement, as well as to elderly patients and to women who are at a high risk of severe urine leakage following enteroplasty. Thanks to progress in anesthesia, surgical techniques and intensive care, cystectomy with substitution enteroplasty is now a routine procedure. For localized bladder cancer (pT2N0M0 stage), this intervention is associated with a 10-year survival rate of about 80%. The mean length of stay in the intensive care unit varies between 1 and 7 days, and the mean total hospital stay ranges from 10 to 13 days. Early complications, which occur in less than 30% of cases, are mainly medical; the most common are cardiovascular complications, pulmonary embolism, disorientation and urinary tract and pulmonary infections. Late complications are less common and are mainly surgical; they include uretero-ileal stenoses (-10% of cases), uretero-ileal stenosis (4%), and intestinal obstruction (4%). Urinary and sexual disorders are frequent after radical cystectomy and substitution enteroplasty. Early postoperative incontinence occurs in more than 50% of cases but often responds to physiotherapy. In contrast, most male patients remain impotent. Simple transurethral resection of the prostate with cystectomy may be used instead of radical cystoprostatectomy in order to reduce the risks of incontinence and impotence, but this approach is controversial, as some authors have reported an increased risk of recurrence and metastasis.
Cystectomy↗