Prostate cancer outcomes in France: treatments, adverse effects and two-year mortality

BACKGROUND: This very large population-based study investigated outcomes after a diagnosis of prostate cancer (PCa) in terms of mortality rates, treatments and adverse effects. METHODS: Among the 11 million men aged 40 years and over covered by the general national health insurance scheme, those with newly managed PCa in 2009 were followed for two years based on data from the national health insurance information system (SNIIRAM). Patients were identified using hospitalisation diagnoses and specific refunds related to PCa and PCa treatments. Adverse effects of PCa treatments were identified by using hospital diagnoses, specific procedures and drug refunds. RESULTS: The age-standardised two-year all-cause mortality rate among the 43,460 men included in the study was 8.4%, twice that of all men aged 40 years and over. Among the 36,734 two-year survivors, 38% had undergone prostatectomy, 36% had been treated by hormone therapy, 29% by radiotherapy, 3% by brachytherapy and 20% were not treated. The frequency of treatment-related adverse effects varied according to age and type of treatment. Among men between 50 and 69 years of age treated by prostatectomy alone, 61% were treated for erectile dysfunction and 24% were treated for urinary disorders. The frequency of treatment for these disorders decreased during the second year compared to the first year (erectile dysfunction: 41% vs 53%, urinary disorders: 9% vs 20%). The frequencies of these treatments among men treated by external beam radiotherapy alone were 7% and 14%, respectively. Among men between 50 and 69 years with treated PCa, 46% received treatments for erectile dysfunction and 22% for urinary disorders. For controls without PCa but treated surgically for benign prostatic hyperplasia, these frequencies were 1.5% and 6.0%, respectively. CONCLUSIONS: We report high survival rates two years after a diagnosis of PCa, but a high frequency of PCa treatment-related adverse effects. These frequencies remain underestimated, as they are based on treatments for erectile dysfunction and urinary disorders and do not reflect all functional outcomes. These results should help urologists and general practitioners to inform their patients about outcomes at the time of screening and diagnosis, and especially about potential treatment-related adverse effects

Traitement chirurgical endoscopique des symptômes du bas appareil urinaire consécutifs ou non à une hypertrophie bénigne de la prostate par photovaporisation laser au laser Greenlight

La prise en charge des symptômes du bas appareil urinaire (SBAU) chez l homme en cas d hyperplasie bénigne de la prostate obstructive est médico-chirurgicale. Les options chirurgicales classiques sont actuellement concurrencées par des techniques innovantes, dont la photovaporisation de la prostate par laser Greenlight (PVP). L état des connaissances permet de formuler l hypothèse que la PVP a une efficacité similaire à celle des méthodes classiques. La PVP permet de réduire les complications immédiates (en particulier chez les patients à haut risque hémorragique) et de la durée d hospitalisation. Son impact sur la sexualité reste mal connu. Sur le plan médico-économique, la technique est prometteuse mais toujours en attente d une tarification spécifique. Une étude prospective de cohorte chez 234 patients opérés d une PVP entre 2006 et 2012 dans un centre expert a mis en évidence des résultats satisfaisants chez les patients de plus de 80 ans et chez ceux ayant un volume prostatique de plus 80mL. Les troubles irritatifs post-opératoires évalués par un questionnaire dédié étaient plus importants que ceux rapportés dans la littérature. La sexualité semblait améliorée surtout par le biais de l amélioration des symptômes urinaires, mais de plus amples études sont nécessaires pour confirmer ces hypothèses. La PVP semble fiable et efficace pour le traitement des SBAU de vidange chez l homme, mais de nombreux aspects restent à explorer. Les plus grands défis de la technique sont de prouver clairement sa pertinence du point de vue médico-économique et de déterminer sa place par rapport aux autres techniques innovantes, en particulier la résection bipolaire et l énucléation Holmium.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Traitement chirurgical endoscopique des symptômes du bas appareil urinaire consécutifs ou non à une hypertrophie bénigne de la prostate par photovaporisation laser au laser Greenlight

La prise en charge des symptômes du bas appareil urinaire (SBAU) chez l homme en cas d hyperplasie bénigne de la prostate obstructive est médico-chirurgicale. Les options chirurgicales classiques sont actuellement concurrencées par des techniques innovantes, dont la photovaporisation de la prostate par laser Greenlight (PVP). L état des connaissances permet de formuler l hypothèse que la PVP a une efficacité similaire à celle des méthodes classiques. La PVP permet de réduire les complications immédiates (en particulier chez les patients à haut risque hémorragique) et de la durée d hospitalisation. Son impact sur la sexualité reste mal connu. Sur le plan médico-économique, la technique est prometteuse mais toujours en attente d une tarification spécifique. Une étude prospective de cohorte chez 234 patients opérés d une PVP entre 2006 et 2012 dans un centre expert a mis en évidence des résultats satisfaisants chez les patients de plus de 80 ans et chez ceux ayant un volume prostatique de plus 80mL. Les troubles irritatifs post-opératoires évalués par un questionnaire dédié étaient plus importants que ceux rapportés dans la littérature. La sexualité semblait améliorée surtout par le biais de l amélioration des symptômes urinaires, mais de plus amples études sont nécessaires pour confirmer ces hypothèses. La PVP semble fiable et efficace pour le traitement des SBAU de vidange chez l homme, mais de nombreux aspects restent à explorer. Les plus grands défis de la technique sont de prouver clairement sa pertinence du point de vue médico-économique et de déterminer sa place par rapport aux autres techniques innovantes, en particulier la résection bipolaire et l énucléation Holmium.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Impact of lower urinary tract symptoms on discomfort in men aged between 50 and 80 years.

International audienceBACKGROUND/AIMS: There are only a few surveys on the prevalence of lower urinary tract symptoms (LUTS) among the general population. The aim of this survey was to assess the prevalence of LUTS and their impact on discomfort in men. METHODS: A questionnaire was mailed to 3,877 men aged 50-80 years, which included questions on their medical history, demographic and sociological status, and also the International Prostate Symptom Score (IPSS) with additional questions on discomfort related to urinary symptoms. RESULTS: The response rate was 81.5%. Prevalence of mild and severe IPSS was 89.2%. Specific bother for each urinary symptom depended on symptom frequency: urgency, frequency, weak stream, nocturia, incomplete emptying, intermittency and straining 1 time out of 5 were responsible for discomfort in respectively 4.9, 6.1, 7.1, 7.5, 8.7 and 9.9%; the same symptoms more than half of the time were responsible for discomfort in respectively 32.8, 38, 45.3, 45.6, 53.2 and 58.7%. Urgency was much more deeply implicated in discomfort than frequency of nocturia. CONCLUSIONS: Urinary symptoms in men are very common. Nocturia is the most frequent but has a low impact on discomfort. Urgency has a higher impact on discomfort and should therefore be considered in treatment decision-making

DNA nuclear targeting sequences for enhanced non-viral gene transfer: An in vitro and in vivo study

International audienceAn important bottleneck for non-viral gene transfer commonly relates to translocation of nucleic acids into the nuclear compartment of target cells. So-called 3NFs are optimized short nucleotide sequences able to interact with the transcription factor nuclear factor κB (NF-κB), which can enhance the nuclear import of plasmid DNA (pDNA) carrying such motifs. In this work, we first designed a consistent set of six pDNAs featuring a common backbone and only varying in their 3NF sequences. These constructions were then transfected under various experimental settings. In vitro, cationic polymer-assisted pDNA delivery in five human-derived cell lines showed the potential advantage of 3NF carrying pDNA in diverse cellular contexts. In vivo, naked pDNAs were hydrodynamically delivered to muscle hindlimbs in healthy mice; this direct accurate comparative (in the absence of any gene carrier) revealed modest but consistent trends in favor of the pDNAs equipped with 3NF. In summary, the results reported emphasize the implications of various parameters on NF-κB-mediated pDNA nuclear import; under specific conditions, 3NF can provide modest to substantial advantages for pDNA gene transfer, in vitro as well as in vivo. This study thus further underscores the potential of optimized nuclear import for more efficient non-viral gene transfer applications