FGFR1 and WT1 are markers of human prostate cancer progression

BACKGROUND: Androgen-independent prostate adenocarcinomas are responsible for about 6% of overall cancer deaths in men. METHODS: We used DNA microarrays to identify genes related to the transition between androgen-dependent and androgen-independent stages in the LuCaP 23.1 xenograft model of prostate adenocarcinoma. The expression of the proteins encoded by these genes was then assessed by immunohistochemistry on tissue microarrays (TMA) including human prostate carcinoma samples issued from 85 patients who had undergone radical prostatectomy. RESULTS: FGFR1, TACC1 and WT1 gene expression levels were associated with the androgen-independent stage in xenografts and human prostate carcinoma samples. MART1 protein expression was correlated with pT2 tumor stages. CONCLUSION: Our results suggest that each of these four genes may play a role, or at least reflect a stage of prostate carcinoma growth/development/progression

MRI-targeted or standard biopsy for prostate-cancer diagnosis

Background Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography-guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited. Methods In a multicenter, randomized, noninferiority trial, we assigned men with a clinical suspicion of prostate cancer who had not undergone biopsy previously to undergo MRI, with or without targeted biopsy, or standard transrectal ultrasonography-guided biopsy. Men in the MRI-targeted biopsy group underwent a targeted biopsy (without standard biopsy cores) if the MRI was suggestive of prostate cancer; men whose MRI results were not suggestive of prostate cancer were not offered biopsy. Standard biopsy was a 10-to-12-core, transrectal ultrasonography-guided biopsy. The primary outcome was the proportion of men who received a diagnosis of clinically significant cancer. Secondary outcomes included the proportion of men who received a diagnosis of clinically insignificant cancer. Results A total of 500 men underwent randomization. In the MRI-targeted biopsy group, 71 of 252 men (28%) had MRI results that were not suggestive of prostate cancer, so they did not undergo biopsy. Clinically significant cancer was detected in 95 men (38%) in the MRI-targeted biopsy group, as compared with 64 of 248 (26%) in the standard-biopsy group (adjusted difference, 12 percentage points; 95% confidence interval [CI], 4 to 20; P=0.005). MRI, with or without targeted biopsy, was noninferior to standard biopsy, and the 95% confidence interval indicated the superiority of this strategy over standard biopsy. Fewer men in the MRI-targeted biopsy group than in the standard-biopsy group received a diagnosis of clinically insignificant cancer (adjusted difference, -13 percentage points; 95% CI, -19 to -7; P<0.001). Conclusions The use of risk assessment with MRI before biopsy and MRI-targeted biopsy was superior to standard transrectal ultrasonography-guided biopsy in men at clinical risk for prostate cancer who had not undergone biopsy previously. (Funded by the National Institute for Health Research and the European Association of Urology Research Foundation; PRECISION ClinicalTrials.gov number, NCT02380027 .)

Neuromodulation sacrée S3 et troubles mictionnels réfractaires@ (technique chirurgicale et résultats)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Évaluation préliminaire de l'impact d'un stage pilote d'initiation à la gestuelle chirurgicale sur l'acquisition des habiletés techniques de base par les internes de chirurgie de premier semestre

Contexte : L'apprentissage de l'habileté technique chirurgicale (HTC) dans le système français de formation en chirurgie repose essentiellement sur l'immersion en situation réelle et le compagnonnage. De nouvelles contraintes pèsent sur l'exercice de la chirurgie dans les centres hospitaliers universitaires et pourraient réduire l'efficience de ce mode unique de transmission de l'HTC. Objectif : Évaluer l'impact sur l'acquisition de gestes chirurgicaux élémentaires (suture, ligature) d'un stage d'initiation à la gestuelle chirurgicale (SIGC) basé sur l'apprentissage et l'entraînement sur modèle inanimé hors bloc opératoire en complément du mode habituel d'apprentissage par immersion compagnonnage. Méthodes : Nous avons comparé lors d'un exercice standardisé de suture et ligature proposé 3 mois après le début du premier stage hospitalier, les performances (scores et durée) d'un groupe d'internes premier semestre exposé au SIGC, à celles d'un groupe d'internes premier semestre non exposés. Résultats : La moyenne du score de performance obtenu, était de 23,9 (15–28) pour le groupe exposé contre 17,1 (2–24) pour le groupe non exposé (p=0{,}036). Le test de connaissance du matériel était aussi en faveur du groupe exposé. Le temps moyen de suture ne montrait qu'une tendance en faveur du groupe exposé. Conclusion : Nos résultats suggèrent un impact positif et mesurable d'un stage de technique préliminaire en début d'internat de chirurgie sur la rapidité d'acquisition de gestes de base de chirurgie. Ce type d'enseignement basé sur la simulation pourrait être un complément essentiel au principe d'immersion/compagnonnage pour la transmission de l'HTC

Predicting Gleason Score of Prostate Cancer Patients Using Radiomic Analysis

<p>Purpose: Use of quantitative imaging features and encoding the intra-tumoral heterogeneity from multi-parametric magnetic resonance imaging (mpMRI) for the prediction of Gleason score is gaining attention as a non-invasive biomarker for prostate cancer (PCa). This study tested the hypothesis that radiomic features, extracted from mpMRI, could predict the Gleason score pattern of patients with PCa.</p><p>Methods: This analysis included T2-weighted (T2-WI) and apparent diffusion coefficient (ADC, computed from diffusion-weighted imaging) scans of 99 PCa patients from The Cancer Imaging Archive (TCIA). A total of 41 radiomic features were calculated from a local tumor sub-volume (i.e., regions of interest) that is determined by a centroid coordinate of PCa volume, grouped based on their Gleason score patterns. Kruskal-Wallis and Spearman's rank correlation tests were used to identify features related to Gleason score groups. Random forest (RF) classifier model was used to predict Gleason score groups and identify the most important signature among the 41 radiomic features.</p><p>Results: Gleason score groups could be discriminated based on zone size percentage, large zone size emphasis and zone size non-uniformity values (p < 0.05). These features also showed a significant correlation between radiomic features and Gleason score groups with a correlation value of −0.35, 0.32, 0.42 for the large zone size emphasis, zone size non-uniformity and zone size percentage, respectively (corrected p < 0.05). RF classifier model achieved an average of the area under the curves of the receiver operating characteristic (ROC) of 83.40, 72.71, and 77.35% to predict Gleason score groups (G1) = 6; 6 < (G2) < (3 + 4) and (G3) ≥ 4 + 3, respectively.</p><p>Conclusion: Our results suggest that the radiomic features can be used as a non-invasive biomarker to predict the Gleason score of the PCa patients.</p

LHRH agonists in prostate cancer:frequency of treatment, serum testosterone measurement and castrate level: consensus opinion from a roundtable discussion

Background: Options for lowering testosterone in patients with prostate cancer include bilateral orchiectomy, oestrogens and luteinising hormone-releasing hormone (LHRH) agonists. LHRH agonists have become widely used in the treatment of prostate cancer. Roundtable assembly: In May 2006, a team of experts convened a roundtable assembly to discuss key issues associated with the use of LHRH agonists in the treatment of prostate cancer. Roundtable discussion: The discussion centred on the frequency of treatment with LHRH agonists, the role of serum testosterone (ST) measurement as part of routine follow-up, and the recommended castrate level of ST. Several formulations of LHRH agonists are available, including 3-month depots that coincide with visit frequency for prostate-specific antigen (PSA) testing. Appropriate monitoring of patients receiving LHRH agonists continues to be based on PSA levels. ST determination is not recommended as part of routine follow-up, and does not provide additional prognostic benefit or improved overall management for the majority of patients. However, determination of ST may be useful in selected patients, such as those with rising PSA levels or in cases where there is doubt over LHRH agonist administration or absorption. Achieving levels of ST similar to those obtained after orchiectomy is important for patient outcomes, although there is no evidence that a lower ST level (<50 ng/dl) results in additional clinical benefits. Conclusions: LHRH agonists should be considered first-choice testosterone-lowering therapy for the treatment of prostate cancer, with the 3-month depot formulation providing optimal convenience and flexibility. Assessment of patients receiving LHRH agonists should be based on PSA levels rather than ST levels, although levels of ST similar to those obtained after orchiectomy still need to be achieved. Further studies are warranted before the potential therapeutic benefit of considerably lowered ST levels can be fully assessed

Towards automatic recognition of pure and mixed stones using intra‐operative endoscopic digital images

International audienceObjective: To assess automatic computer-aided in situ recognition of the morphological features of pure and mixed urinary stones using intra-operative digital endoscopic images acquired in a clinical setting.Materials and methods: In this single-centre study, a urologist with 20 years' experience intra-operatively and prospectively examined the surface and section of all kidney stones encountered. Calcium oxalate monohydrate (COM) or Ia, calcium oxalate dihydrate (COD) or IIb, and uric acid (UA) or IIIb morphological criteria were collected and classified to generate annotated datasets. A deep convolutional neural network (CNN) was trained to predict the composition of both pure and mixed stones. To explain the predictions of the deep neural network model, coarse localization heat-maps were plotted to pinpoint key areas identified by the network.Results: This study included 347 and 236 observations of stone surface and stone section, respectively; approximately 80% of all stones exhibited only one morphological type and approximately 20% displayed two. A highest sensitivity of 98% was obtained for the type 'pure IIIb/UA' using surface images. The most frequently encountered morphology was that of the type 'pure Ia/COM'; it was correctly predicted in 91% and 94% of cases using surface and section images, respectively. Of the mixed type 'Ia/COM + IIb/COD', Ia/COM was predicted in 84% of cases using surface images, IIb/COD in 70% of cases, and both in 65% of cases. With regard to mixed Ia/COM + IIIb/UA stones, Ia/COM was predicted in 91% of cases using section images, IIIb/UA in 69% of cases, and both in 74% of cases.Conclusions: This preliminary study demonstrates that deep CNNs are a promising method by which to identify kidney stone composition from endoscopic images acquired intra-operatively. Both pure and mixed stone composition could be discriminated. Collected in a clinical setting, surface and section images analysed by a deep CNN provide valuable information about stone morphology for computer-aided diagnosis