PSA velocity and prostate cancer detection: the absence of evidence is not the evidence of absence.
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Biomarkers, Tumor↗
Biomedical subjects
Paul Perrin
Publications and source records attributed to Paul Perrin.
French claims data as a source of information to describe cancer incidence: predictive values of two identification methods of incident prostate cancers.
Claims data from the "Programme de Médicalisation du Système d'Information" (PMSI) have been commonly used for several years to complement cancer registries and describe cancer incidence in France. It is less clear whether or not it is possible to use these data as an independent source of information to assess cancer incidence, in the absence of a regional cancer registry. Following a similar study on breast cancer, we present a study which aimed to evaluate two methods of identifying incident prostate cancer using claims data. These methods were developed using claims data from the Hospices Civils de Lyon (HCL) and their validity was tested against medical records. The first method (M1) identified incident patients as those who had at least one stay with a principal diagnosis of prostate cancer. The second method (M2) had a prostate cancer treatment code in addition to the criteria for the first method. Both methods of identification had similar results, indicating a low rate of false negatives (negative predictive values: M1 = 100 [CI95: 93.8-100], M2 = 98.6 [CI95: 90.1-99.6]) and a high rate of false positives (positive predictive values: M1 = 33.3 [CI95: 23.2-42.1], M2 = 33.7 [CI95: 24.2-43.2]). The sample size did not allow us to produce consistent estimates of sensitivity and specificity. Our results showed that an estimation of the number of incident cases of prostate cancer using both methods of identification would be biased because of the high rate of false positives. Statistical methods that correct identification errors should be used.
France↗
Discovery of a pituitary adenoma following treatment with a gonadotropin-releasing hormone agonist in a patient with prostate cancer.
We report the case of a T3 prostate cancer in a 70-year-old white man. Hormone therapy represents a prominent branch in the treatment of locally advanced and metastatic prostate cancer. Gonadotropin-releasing hormone agonists have been proven to have a double effect on androgen metabolism: an initially stimulating, followed by an inhibitory, effect on the pituitary gland. This phenomenon may be noxious in the case of gonadotroph adenoma, with subsequent symptoms of intracranial hypertension. Gonadotropin-releasing hormone antagonists (abarelix), by avoiding the flare-up reaction, might be used in such instances.
Adenocarcinoma↗
Discovery of a pituitary adenoma following a gonadotropin-releasing hormone agonist in a patient with prostate cancer.
Gonadotropin-releasing hormone (GnRH) agonists have become the treatment of choice for locally advanced and metastatic prostate cancer. We report a case of prostate cancer in which this treatment led to severe symptoms of intracranial hypertension due to the concomitant presence of an asymptomatic functional pituitary adenoma. A 70-year-old white man was initially evaluated for a multifocal adenocarcinoma, Gleason score 6 (3+3) with perineural invasion suggesting an extracapsular extension. A conformational external beam radiation (74 Gy) with a concomitant GnRH agonist (leuprolide) was initiated. Almost 10 days after the administration of leuprolide the patient complained of visual disturbance, diplopia and other symptoms of intracranial hypertension. Magnetic resonance imaging (MRI) of the brain demonstrated a large sella mass lesion. To relieve the patient's symptoms, a transsphenoidal subtotal tumorectomy was necessary. The histopathological examination revealed an invasive gonadotroph pituitary adenoma. Two years later, there is no sign of progression either on his prostatic disease (prostate-specific antigen of 0.21 ng/mL) or on his pituitary disease (FSH, 4.7 UI/L, LH, 3.1 UI/L and total testosterone, 627 ng/dL) with values of the hypothalamic-pituitary axis in the normal range. We advocate that a high index of suspicion of pituitary tumor must be considered in any case of intracranial hypertension following the administration of GnRH agonist. Abarelix could have a place in such cases.
Adenocarcinoma↗
The epidemiology of trauma of the genitourinary system after traffic accidents: analysis of a register of over 43,000 victims.
OBJECTIVE: To analyse the frequency and type of injury to the genitourinary system, by user category, after traffic accidents. PATIENTS AND METHODS: The register which forms the basis of this study is unique in Europe and includes 43,056 victims of road traffic accidents, and was compiled between 1996 and 2001. The categories of road users included: motorists, motorcyclists, cyclists, pedestrians, van and bus users, and roller skaters. The urological complication rate was analysed for each category. RESULTS: In all, 199 cases of trauma of the genitourinary system (0.46%) were recorded. The most frequent urological complications were renal (43%) and testicular trauma (24%), the former most frequent in motorists (65%) and pedestrians (29%), and the latter in motorcyclists (41%). CONCLUSIONS: An analysis of this register provides better knowledge of the urogenital injuries after traffic accidents. Renal and testicular injuries are the most frequent.
Accidents, Traffic↗
[Management of corpus cavernosum trauma].
Rupture of the tunica albuginea of the corpus cavernosum of the penis is a rare disease, usually occurring in young adults during sexual intercourse. In Western countries, the most frequent causes is coital injuries. Ultrasound, cavernography or magnetic resonance imaging of the penis can be performed to determine the exact site of the fracture. Treatment is usually elective surgery and consists of evacuating the subcutaneous haematoma and suturing the tear of the tunica albuginea. An associated rupture of the urethra must be excluded. Complications of these fractures of the tunica albuginea especially comprise erectile dysfunction, deviation of the erect penis, development of plaques resembling those of La Peyronie disease, urethro-cavernous or urethro-cutaneous fistula or dysuria secondary to urethral stricture.
Adolescent↗
[A modified IPSS score: value of a choice of qualitative answers].
INTRODUCTION: The IPSS score is a self-administered questionnaire considered to be the reference instrument to evaluate the impact of lower urinary tract symptoms in men. However; patients may encounter difficulties answering the standard questionnaire. This study was designed to analyse whether modification of these "standard" (or numerical, N) items by a choice of literal (L) answers induced any modifications of the psychometric characteristics of the IPSS questionnaire. MATERIAL AND METHODS: This prospective single-centre study compared the two questionnaires applied in the same order to a cohort of 109 patients with voiding disorders. These questionnaires were administered to the patients on two occasions at an interval of 15 days. RESULTS: Cronbach's coefficient alphas calculated on D0 were 0.78 (L) and 0.81 (N). Pearson's correlation coefficients between the two IPSS scores on D0 and D15 were high (0.89 and 0.95). The comparison of the N and L questionnaires shows a mean difference -0.25 between the scores with a normal fluctuation interval [-7.6; 7.1] on D0 and -0.89 [-6.3; -4.5] on D15. Test-retest on the 15th day showed a good correlation for the two questionnaires (0.87 for N and 0.85 for L). CONCLUSION: The proposed modification of the choice of answers to the IPSS questionnaire does not alters its psychometric qualities. Patients appear to prefer the literal version of the questionnaire compared to the standard questionnaire (62% versus 31%).
Adult↗
[Lower urinary tract symptoms are poorly correlated with erectile dysfunction].
OBJECTIVE: To estimate the correlation between the frequency of lower urinary tract symptoms (LUTS) associated with BPH and the quality of the patient's sexuality. METHODS: The IPSS IIEF BSIA and SPI questionnaires were proposed to 930 patients with voiding disorders. Correlation coefficients between these scores were determined on inclusion and after 18 and 36 months of follow-up. RESULTS: Poor correlations were demonstrated between the IPSS and IIEF scores. Correlations of the variations of these scores confirmed the low degree of dependence between IPSS and IIEF Adjustment for age had little impact on this relationship. CONCLUSION: LUTS are not a major predictive factor of the patient's sexuality and prognosis. However in view of the frequency of sexual disorders in this age-group, it is to evaluate the impact of treatments of BPH on the patient's sexuality.
Adult↗
[Vaginal metastases from renal cell carcinoma].
Renal cell carcinoma rarely metastasizes to the vagina, as only 80 cases have been reported in the literature. Due to the anatomical features of the venous drainage of the left kidney, most vaginal metastases are derived from left renal tumours. Renal imaging looking for a renal tumour must be performed in the presence of a vaginal adenocarcinoma or undifferentiated carcinoma.
Aged↗
[Types and mechanisms of 54 cases of kidney trauma in car drivers injured by road accident].
PURPOSE: To analyse the types, mechanisms and severity of kidney trauma in injured car drivers and the effects of the presence or absence of the safety belt on the renal lesions observed. MATERIAL AND METHODS: 64,325 road accident victims were reported between 1996 and 2002. Data collection was performed in 96 primary care departments, 160 inpatient departments and 11 convalescence centres. Among the 33,431 injured car drivers, 54 presented kidney trauma (0.16%). The AAST classification was used to analyse these cases of RESULTS: The 54 cases of kidney trauma was classified as grade I and II in 39 cases, grade III in 6 cases, grade IV in 5 case, and grade V in 4 cases. Nine patients died with a kidney lesion. This lesion was never isolated, as it was associated with rupture of the spleen in 8 cases, head injury in 6 cases and chest injury in 4 cases. The mechanism of these fatal accidents was a head-on collision in every case. CONCLUSION: Kidney trauma in the car drivers of our series was rare (0.160%) and benign (72% of grade I and II lesions). Patients with a kidney lesion who died always presented multiple injuries. Renal pedicle lesions are usually observed in car drivers not wearing a
Accidents, Traffic↗
[Comparison of the response to I-PSS according to the mode of administration of the questionnaire: by the doctor or self-assessment by the patient].
OBJECTIVE: To compare the response to I-PSS according to its mode of administration (by the doctor versus self-assessment). METHODS: 388 patients were included during the 3 months following a diagnosis of benign prostatic hyperplasia. The general practitioner completed the I-PSS and gave an I-PSS questionnaire to the patient to be completed at home and returned in a reply-paid envelope to the data entry centre. The Bland & Altman method was used to visualize individual differences and to quantify the bias between the two modes of evaluation. RESULTS: The doctor overestimated the I-PSS by an average of 1.3 points [95% CI: 0.9-1.7]. In 42% of patients, these individual differences were 3 points or more. Significant overestimation was confirmed at 6, 12 and 18 months of follow-up. CONCLUSION: A significant bias was demonstrated according to the mode of administration of the I-PSS. We therefore recommend that the same mode of administration should be maintained during clinical trials.
Data Collection↗
[Well differentiated paratesticular liposarcoma in adults].
The authors report a case of well differentiated paratesticular liposarcoma in a 41-year-old patient. This is a rare tumour (about one hundred cases have been reported in the literature), which essentially arises from the spermatic cord. Clinical and radiological signs are nonspecific and the diagnosis is generally based on histological examination of the operative specimen. Due to the histological similarities, all specimens of benign lipoma must be examined for the presence of well differentiated liposarcoma. Treatment consists of transinguinal radical orchidectomy, sometimes with resection of adjacent structures. The prognosis is generally better than that of other paratesticular sarcomas. Adjuvant radiotherapy may be indicated in locally advanced masses or in the case of incomplete resection.
Adult↗
[Urinary incontinence in the adult. Diagnostic management].
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Adult↗
Evaluation of the clinical benefit of permixon and tamsulosin in severe BPH patients-PERMAL study subset analysis.
OBJECTIVE: To compare the efficacy of the lipido-sterolic extract of Serenoa repens, Permixon, to that of the alpha-blocker, tamsulosin, in the treatment of severe low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). METHODS: In a 12-month, double-blind, randomized study that showed equivalent efficacy of Permixon 320 mg/day and tamsulosin 0.4 mg/day ("PERMAL study"), 685 BPH patients with IPSS > or =10 had been analyzed for efficacy. Of these, the 124 patients with severe LUTS (IPSS >19) at randomization were retained for this subset analysis. After a 4-week run-in period, 59 and 65 patients had been randomized to tamsulosin and Permixon groups, respectively. Both treatment groups were compared regarding the evolution from baseline of total IPSS and its irritative and obstructive subscores, LUTS-related QoL, prostate volume, Q(max) and MSF-4 (sexual activity questionnaire) at different time points over 1 year. An analysis of variance of changes from baseline to end point was performed for all the parameters. The over-time evolutions of total, irritative and obstructive IPSS were further compared using a variance analysis for repeated measurements. RESULTS: At 12 months, total IPSS decreased by 7.8 with Permixon and 5.8 with tamsulosin (p=0.051); the irritative symptoms improved significantly more (p=0.049) with Permixon (-2.9 versus -1.9 with tamsulosin). The superiority of Permixon in reducing irritative symptoms appeared as soon as month 3 and was maintained up to month 12 (p=0.03). CONCLUSION: Permixon 320 mg/day was shown to be slightly superior to tamsulosin 0.4 mg/day in reducing LUTS in severe BPH patients after 3 months and up to 12 months of treatment.
Adrenergic alpha-Antagonists↗
[Contribution of fluorescence immunocytochemistry (uCyt+TM) in the postoperative surveillance of bladder cancer].
OBJECTIVE: To assess 1) the value of fluorescence immunocytochemistry (uCyt+ test, DiagnoCure Inc., Quebec) in the detection of recurrent bladder tumour after transurethral resection (TUR) and 2) the predictive value of a positive uCyt+ test in patients with negative cystoscopy. MATERIAL AND METHODS: This study was based on 132 patients with a mean follow-up of 21.9 weeks after TUR. The initial tumours were pTa G1-2 in 66.7% of cases, and G3 in 28.8% of cases. Cystoscopy, urine cytology (UC) and uCyt+ test data were collected on the day of the first control visit (D0), and the patients were then reviewed at 6 and 12 months. All lesions detected on cystoscopy were biopsed. RESULTS: The mean sensitivity of UC was 47.4% and the mean sensitivity of uCyt+ was 73.7% (84.2% in combination). In patients with negative cystoscopy on D0, a positive uCyt+ test has no predictive value at 6 months. At 12 months, 20.0% of patients with positive UC had relapsed, versus 16.7% of patients with negative UC (p = ns). On the other hand, at 12 months, 50.0% of patients with negative cystoscopy but positive uCyt+ test had relapsed, versus 16.4% of patients with a negative uCyt+ test (p < 0.01). CONCLUSIONS: The uCyt+ test allows assessment of the risk of recurrence at I year, while UC alone only has a diagnostic value. These results raise the possibility of combining the tests in order to decrease the frequency of follow-up cystoscopy.
Adult↗
[Evaluation of the clinical benefit of Permixon and tamsulosin in severe BPH patients--PERMAL study subset analysis].
OBJECTIVE: To compare the efficacy of the lipido-sterolic extract of Serenoa repens, Permixon, to that of the a-blocker, tamsulosin, in the treatment of severe low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). METHODS: In a 12-month, double-blind, randomized study that showed equivalent efficacy of Permixon 320 mg/day and tamsulosin 0.4 mg/day ("PERMAL study"), 685 BPH patients with IPSS > 10 had been analyzed for efficacy. Of these, the 124 patients with severe LUTS (IPSS > 19) at randomization were retained for this subset analysis. After a 4-week run-in period, 59 and 65 patients had been randomized to tamsulosin and Permixon groups, respectively. Both treatment groups were compared regarding the evolution from baseline of total IPSS and its irritative and obstructive subscores. LUTS-related QpL, prostate volume, Qmax and MSF-4 (sexual activity questionnaire) at different time points over 1 year An analysis of variance of changes from baseline to end point was performed for all the parameters. The over-time evolutions of total, irritative and obstructive IPSS were further compared using a variance analysis for repeated measurements. RESULTS: At 12 months, total IPSS decreased by 7.8 with Permixon and 5.8 with tamsulosin (p = 0.051); the irritative symptoms improved significantly more (p = 0.049) with Permixon (- 2.9 versus - 1.9 with tamsulosin). The superiority of Permixon in reducing irritative symptoms appeared as soon as month 3 and was maintained up to month 12 (p = 0.03). CONCLUSION: Permixon 320 mg/day was shown to be slightly superior to tamsulosin 0.4 mg/day in reducing LUTS in severe BPH patients after 3 months and up to 12 months of treatment.
Adrenergic alpha-Antagonists↗
Immunocyt test improves the diagnostic accuracy of urinary cytology: results of a French multicenter study.
PURPOSE: The limitations of urinary cytology and the invasiveness of cystoscopy generate an increasing interest in noninvasive diagnostic tools for the management of transitional cell carcinoma. We assess the clinical performance of ImmunoCyt (DiagnoCure, Inc., Saint-Foy, Canada) in the detection of bladder cancer in a 10-center French trial. MATERIALS AND METHODS: From October 2000 to April 2001, 694 patients undergoing cystoscopy were prospectively included in the study. Of the patients 458 (66%) had been previously treated for superficial transitional cell carcinoma and 236 (34%) were referred for symptoms suggestive of bladder cancer. All patients underwent ImmunoCyt test and standard urinary cytology from voided urine as well as a complete evaluation including cystoscopy and transurethral resection or biopsy of suspicious lesions. Sensitivity and specificity values of urinary cytology and ImmunoCyt whether or not combined were calculated using cystoscopy as the gold standard and histopathology when available. RESULTS: A total of 85 recurrent and 58 newly diagnosed bladder tumors were diagnosed by cystoscopy and histologicaly confirmed. Overall sensitivity of urinary cytology was 17.9%, 46.3% and 63.8% respectively, for G1, G2 and G3 transitional cell carcinoma, whereas that of ImmunoCyt was 60.7%, 75.6% and 76.8%. Sensitivity of the combined tests was 66.7%, 78% and 87%, respectively. Moreover, 10 of 55 (18.2%) new pT1 and pT2 or greater tumors were diagnosed by ImmunoCyt alone. Specificity of urinary cytology was 94.5%, whereas that of ImmunoCyt was 84.2%. Specificity of the combined tests was 80.7%. Marked variations in urinary cytology sensitivity were observed among the different centers (27.3% to 66.7%), whereas combined assays (urinary cytology and ImmunoCyt) enhanced the overall sensitivity in the 80% range at most centers. CONCLUSIONS: This prospective multicenter series confirmed a marked increase in sensitivity without significant loss in specificity when including ImmunoCyt in standard urinary cytology protocol. This increased sensitivity was observed in high grade lesions (with 100% sensitivity for carcinoma in situ) as well in low grade, low stage tumors.
Adult↗
[Kidney tumors].
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Diagnosis, Differential↗