0000000000739398
AUTHOR
Luc Cormier
Photovaporisation prostatique au laser Greenlight® : comparaison des couts (microcosting) et des recettes (t2a)
Objectifs Depuis une vingtaine d’annees, la chirurgie de l’HBP est marquee par le developpement de techniques lasers sans GHS specifique necessitant un dispositif medical couteux ( fibre laser ) non rembourse en sus des GHS. L’objectif a ete d’evaluer le cout d’une telle intervention en hospitalisation complete afin de le comparer aux recettes percues (GHS) et aux couts estimes par l’etude nationale des couts a methodologie commune (ENCC). Methodes C’est une etude prospective, observationnelle et descriptive des couts de prise en charge. Les ressources medicales directes et indirectes ont ete identifiees et valorisees. Chaque sejour a ete decompose en deux periodes. Les couts de la phase pe…
Salvage reirradiation for locoregional failure after radiation therapy for prostate cancer: Who, when, where and how?
Even in the current era of dose-escalated radiotherapy for prostate cancer, biochemical recurrence is not uncommon. Furthermore, biochemical failure is not specific to the site of recurrence. One of the major challenges in the management of prostate cancer patients with biochemical failure after radiotherapy is the early discrimination between those with locoregional recurrence only and those with metastatic disease. While the latter are generally considered incurable, patients with locoregional disease may benefit from emerging treatment options. Ultimately, the objective of salvage therapy is to control disease while ensuring minimal collateral damage, thereby optimizing both cancer and t…
Robot-assisted or pure laparoscopic nerve-sparing radical prostatectomy: What is the optimal procedure for the surgical margins? A single center experience
Objectives: To compare positive surgical margin rates after robot-assisted and pure laparoscopic radical prostatectomy when neurovascular bundles are preserved, and to identify parameters affecting surgical margin status. Methods: From March 2004 to January 2009, 279 consecutive prostatectomies with preservation of neurovascular bundles were carried out by the same surgeon: 175 robot-assisted radical prostatectomies and 104 laparoscopic radical prostatectomies. An intraperitoneal Montsouris's technique was used for all cases. Patient's age, body mass index, prostate weight, prostate-specific antigen level, clinical stage, preoperative and postoperative Gleason score, percentage of positiv…
Multiparametric MRI and post implant CT-based dosimetry after prostate brachytherapy with iodine seeds: The higher the dose to the dominant index lesion, the lower the PSA bounce
Abstract Purpose To determine whether post-implant MRI-based dosimetry of the Dominant Intra-prostatic Lesion (DIL) could best predict the occurrence of PSA bounce after prostate brachytherapy. Methods and materials We selected 66 patients with a low risk prostate cancer treated with 125 I prostate brachytherapy as monotherapy. Post-implant dosimetry based on day 30 CT-scan and multiparametric MRI co-registration was generated: planned D 90, D 95, V 100, V 150 values were calculated for each DIL. Bounce was defined as a PSA elevation ⩾0.2ng/mL from the previous baseline value followed by a decrease to or below the prior nadir with no additional treatment. Results After a median follow-up of…
Focal or whole-gland salvage prostate brachytherapy with iodine seeds with or without a rectal spacer for postradiotherapy local failure: How best to spare the rectum?
International audience; PURPOSE: Salvage prostate permanent implant (sPPI) for postradiation local failure provides high rates of biochemical control. The cumulative dose delivered to the prostate and the rectum is still unknown. METHODS AND MATERIALS: We reviewed the postimplant CT-based dosimetry of 18 selected patients who underwent sPPI with I-125 seeds for isolated biopsy-proven local failure several years after external beam radiation therapy. Ten patients had whole-prostate sPPI, and 8 patients had multiparametric MRI-based focal sPPI. In 8 patients, hyaluronic acid (HA) gel was injected into the prostate rectum space. RESULTS: The median cumulative biological effective dose after EB…
18F-Choline PET/CT and multiparametric MRI for the detection of local recurrence of prostate cancer initially treated by radiotherapy: comparison with systematic transperineal mapping biopsy
International audience
Pattern of occult nodal relapse diagnosed with 18F-fluoro-choline PET/CT in prostate cancer patients with biochemical failure after prostate-only radiotherapy
Abstract Introduction The purpose of this study was to describe the pattern of nodal relapse with 18 F-fluoro-choline (FCH) Positron Emission Tomography/Computerized Tomography (PET/CT) in prostate cancer patients after radiotherapy. Materials and methods Eighty-three patients had a FCH PET/CT at time of biochemical failure. Of 65 patients with positive findings, 33 had positive nodes. This analysis included 31 patients who had undergone prior prostate-only radiotherapy with or without a prior radical prostatectomy. Each FCH positive node was assigned to a lymph node station with respect to the CTV defined by the RTOG guidelines (CTV RTOG ). 3D mapping was performed after each node was manu…
Visceral fat area as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma treated with antiangiogenic agents.
Abstract Purpose. A better identification of patients who are more likely to benefit from vascular endothelial growth factor–targeted therapy is warranted in metastatic renal cell carcinoma (mRCC). As adipose tissue releases angiogenic factors, we determined whether parameters such as visceral fat area (VFA) were associated with outcome in these patients. Experimental Design. In 113 patients with mRCC who received antiangiogenic agents (bevacizumab, sunitinib, or sorafenib) (n = 64) or cytokines (n = 49) as first-line treatment, we used computed tomography to measure VFA and subcutaneous fat area (SFA). We evaluated associations linking body mass index (BMI), SFA, and VFA to time to progres…
Correlation between clinical prognostic factors and MR spectroscopy-based biomarkers determined at 3.0 T without endorectal coils for patients with localised prostate cancer
International audience
Automatic Evaluation of Histological Prognostic Factors Using Two Consecutive Convolutional Neural Networks on Kidney Samples
BACKGROUND AND OBJECTIVES: The prognosis of patients undergoing kidney tumor resection or kidney donation is linked to many histologic criteria. These criteria notably include glomerular density, glomerular volume, vascular luminal stenosis, and severity of interstitial fibrosis/tubular atrophy. Automated measurements through a deep-learning approach could save time and provide more precise data. This work aimed to develop a free tool to automatically obtain kidney histologic prognostic features. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 241 samples of healthy kidney tissue were split into three independent cohorts. The “Training” cohort (n=65) was used to train two convoluti…
Metronomic oral cyclophosphamide prednisolone chemotherapy is an effective treatment for metastatic hormone-refractory prostate cancer after docetaxel failure.
There is currently no standard of treatment for patients with hormone refractory prostate cancer (HRPC) after failure of docetaxel-based chemotherapy. The purpose of this study was to assess the anticancer activity and tolerance of metronomic cyclophosphamide prednisolone combination in this setting.From 2005 to 2010, patients with HRPC who failed at least docetaxel-based chemotherapy were proposed metronomic cyclophosphamide-prednisolone regimen, and were prospectively registered. Twenty-three patients received 50 mg cyclophosphamide and 10 mg prednisolone per os daily until disease progression. Treatment tolerance and efficacy on PSA decrease and pain were studied.Metronomic cyclophospham…
Traitement du cancer de la prostate : comment les patients font-ils leur choix ?
Resume Le cancer de la prostate demeure un probleme de sante publique en France chez les hommes de 50 a 70 ans. Pour le cancer localise de la prostate de bon pronostic ou de pronostic intermediaire, il existe une pluralite de possibilites therapeutiques. Objectif. Identifier, dans le discours des patients, les mecanismes et les logiques intervenant dans la decision therapeutique. Methode. etude qualitative aupres de 15 hommes âges de 53 a 70 ans, traites pour un cancer de la prostate de stade precoce, par entretiens abordant l’itineraire diagnostique, la representation et le vecu de la maladie, les facteurs decisionnels en matiere de traitement. Resultats. Les hommes ont elabore leur choix …
EARLY CHOLINE LEVELS FROM 3-TESLA MR SPECTROSCOPY AFTER EXCLUSIVE RADIATION THERAPY IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER ARE PREDICTIVE OF PLASMATIC LEVELS OF PSA AT 1 YEAR
International audience; Abstract: Purpose: To investigate the time course response of prostate metabolism to irradiation using magnetic resonance spectroscopy (MRS) at 3-month intervals and its impact on biochemical control. Methods and Materials: Between January 2008 and April 2010, 24 patients with localized prostate cancer were prospectively enrolled in the Evaluation of the Response to Irradiation with MR Spectroscopy (ERIS) trial. All the patients had been treated with intensity-modulated radiation therapy with or without long-term adjuvant hormonal therapy (LTHT) and underwent 3-T MRS and prostate-specific antigen (PSA) assays at baseline and every 3 months thereafter up to 12 months.…
Le robot améliore-t-il la prostatectomie totale laparoscopique dans les cas complexes ?
Resume La prostatectomie totale est le traitement de reference du cancer de prostate de l’homme jeune. Mais dans les cas difficiles, les patients peuvent etre orientes vers une autre option therapeutique. Objectif Evaluation de la qualite de l’anastomose dans les cas complexes de chirurgie comparant la voie laparoscopique PTL a la voie laparoscopique assistee du robot PTLR. Materiel Trois cent quatre-vingt dix-sept patients ont ete operes de mars 2004 a aout 2009, 176 PTL et 221 PTLR de maniere consecutive par un meme chirurgien. Les antecedents pouvant compliquer le geste chirurgical ont ete analyses : volume prostatique superieur a 80 cc, antecedent de cure de hernie inguinale avec prothe…
Inferring postimplant dose distribution of salvage permanent prostate implant (PPI) after primary PPI on CT images
International audience; PURPOSE:To evaluate the dose distribution of additional radioactive seeds implanted during salvage permanent prostate implant (sPPI) after a primary permanent prostate implant (pPPI).METHODS AND MATERIALS:Patients with localized prostate cancer were primarily implanted with iodine-125 seeds and had a dosimetric assessment based on day 30 postimplant CT (CT1). After an average of 6 years, these patients underwent sPPI followed by the same CT-based evaluation of dosimetry (CT2). Radioactive seeds on each CT were detected. The detected primary seeds on CT1 and CT2 were registered and then removed from CT2 referred as a modified CT2 (mCT2). Dosimetry evaluations (D90 and…
Transcatheter embolization of a renal artery pseudoaneurysm after open partial nephrectomy.
Twelve days after an open partial nephrectomy, a 31-year-old man was re-admitted urgently for acute lumbar pain. An emergent helical computed tomography scan with intravenous contrast revealed a 3-cm renal artery pseudoaneurysm at the site of the partial nephrectomy, which was responsible for a large perirenal hematoma. Transarterial hyperselective embolization successfully occluded the pseudoaneurysm with less than 1 mL of N-butyl-2-cyanoacrylate, an embolizing agent less costly than coils. The kidney parenchyma was fully preserved.
Évaluation par questionnaire des pratiques de la curiethérapie de prostate en France
Resume Introduction La curietherapie des cancers de la prostate s’est progressivement implantee dans l’arsenal therapeutique comme une alternative a la prostatectomie radicale et a la radiotherapie externe. Dans le groupe des patients presentant un cancer de pronostic favorable, les survies specifiques depassent 95 % a 10 ans. L’objectif de cette etude est de decrire la place actuelle et les pratiques de la curietherapie en France. Materiel et methodes Un questionnaire realise en association avec l’Association francaise d’urologie (AFU) et la Societe francaise de radiotherapie oncologique (SFRO) et evaluant les differentes pratiques de la curietherapie en France a ete adresse a tous les uro…
Computer-aided diagnosis system for characterizing ISUP grade≥2 prostate cancers at multiparametric MRI: A cross-vendor evaluation.
International audience; Purpose: To assess the performance of a computer-aided diagnosis (CADx) system trained at characterizing International Society of Urological Pathology (ISUP) grade >= 2 peripheral zone (PZ) prostate cancers on multiparametric magnetic resonance imaging (mpMRI) examinations from a different institution and acquired on different scanners than those used for the training database.Patients and methods: Preoperative mpMRIs of 74 men (median age, 65.7 years) treated by prostatectomy between 2014 and 2017 were retrospectively selected. One radiologist outlined suspicious lesions and scored them using Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2); their CA…