[High-intensity focused ultrasound for locally prostate cancer: An Afro-Caribbean single-center study]

National audienceINTRODUCTION: High-intensity focused ultrasound (HIFU) has proved to be effective in the treatment of localized prostate cancer. The aim of this prospective study is to assess their first oncological and functional results in an Afro-Caribbean population. METHODS: From May 2018 to January 2020, 77 patients issued from French West Indies were included. Several treatments were carried out: whole-gland treatment hemi or focal ablation; in a primary setting (group I) or a salvage therapy (group II). PSA level was assessed at 2, 6, 9 and 12 months. MpMRI and post HIFU biopsy were performed between 6 and 9 months postoperatively. Continence, urinary end erectile functions were assessed by ICS, IPSS and IIEF scores. RESULTS: Groupe I included 71.2% patients, group II, 28.8%. The median age was 75.4 years [IQR 69.6-79.4]. The median follow-up was 8.3 months [IQR 3.5-12.25]. At inclusion, PSA was 7.7ng/ml [IQR 5.5-11.2] in group I, and 5.9ng/ml [IQR 4.4-7.9] in group II. In the whole population, there was 73.5% negative biopsies; 14.7% of the biopsies were positive in treated zone and 11.8% in non-treated zone. Regarding morbidities, urinary incontinence appeared in 7.5% and erectile dysfunction rate was 13.2%. CONCLUSION: Our study reveals the first experience of HIFU by Focal One® device in an Afro-Caribbean population. It seems to be a safe and reproducible treatment with acceptable oncological results and low genitourinary morbidity. Long term follow-up and a higher number of patients are necessary to validate these results

Mesures pelvimétriques prédictives de marges chirurgicales au décours d’une prostatectomie totale robot-assitée pour cancer prostatique

International audienc

Epidemiology of urolithiasis in French West Indies A retrospective study

National audienc

Active surveillance in prostate cancer is possible for Afro-Caribbean population: Comparison of oncological outcomes with a Caucasian cohort

International audienceBackground - Prostate cancer is supposedly more aggressive among Afro-Caribbean men. There is a lack of data in this population for active surveillance. Published series are retrospective or have small samples and results are discordant. The objective was to determinate whether actual active surveillance modalities can be applied for Afro-Caribbean men by comparing their oncological outcomes with Caucasian men. Methods - A total of 449 consecutive patients who underwent active surveillance for favorable-risk prostate cancer in two French University-Medical-Centers between 2005 and 2018: 261 in Guadeloupe, French West Indies, and 188 in Bordeaux, metropolitan France. Median follow-up was 56 months, (95% CI [32-81]) and 52 months (95% CI [30-75]), respectively (P=0.07). Curative treatment was given in case of histological, biological, or imaging progression, or upon patient demand. Primary endpoints were treatment-free, overall and specific survival. Secondary outcomes were reasons of discontinuating active surveillance, histological poor prognosis factors after prostatectomy, CAPRA-S score, biochemical-recurrence-free after treatment and metastasis-free survival. Kaplan-Meier method was used. Results - Median treatment free survival was 58.4 months (CI 95% [48.6-83.1]) for ACM and not reached at 120 months for CM (P=0.002). Overall survival (P=0.53), and specific survival (P=0.21) were similar in the two groups. CM were likely to have poor prognosis factor on prostatecomy piece (57 vs 30%, P=0.01). No difference for repartition of the CAPRA-S score (P=0.86), biochemical-recurrence-free (P=0.92) and metastasis-free (P=0.44) survival. Conclusions - Oncological outcomes for active surveillance of Afro-Caribbean and Caucasian men were similar in terms of mortality, recurrence and metastasis in our bicentric study, showing usability of current criteria for Afro-Caribbean. The higher rate of disease progression in the Afro-Caribbean population requires close monitoring. Level of evidence - 3

Practice and results of retrograde intra-renal surgery using the Uscope PU3022a single-use flexible ureteroscope and Holmium laser in the management of upper urinary tract stones: observation of a reference centre in Guadeloupe, France

International audienceBackground:With the advancement of technology, single-use flexible ureteroscopes (suf-URS) are beginning to occupy an important place in the management of lithiasis disease. In addition to the satisfactory outcome they offer, they have the advantage of bypassing the traditional problems posed by reusable flexible ureteroscopes (rf-URS). Recently, a 9.2 FR single-use flexible ureteroscope (Uscope PU3022a) was introduced to the market by PUSENTM. The purpose of this study was to report our practice and outcome with the Uscope PU3022a using a Holmium laser in the management of upper urinary tract stones.Methods:From January 2021 to June 2022, 109 patients meeting the criteria were included in the study. Patient characteristics, stone characteristics, procedure, outcome, and complications were studied.Results:The mean age of the patients at the time of surgery was 62 years. The sex ratio was in favour of men (64.2%). More than half of the patients had a history of calculus (52.3%). The mean size of the stone was 13 mm (4–28 mm). The mean density was 1 112 HU (300– 1 900 HU). The average procedure time was 70 minutes (30–130 minutes). In the majority of cases, the stone was solitary (n = 72; 66.1%). The location of the stone was caliceal in 51.4% of cases. A double JJ catheter was placed in 96 (88.1%) patients before the suf-URS. A ureteral access sheath (UAS) was used in 95.4% of cases. Perioperative difficulties were encountered in 16.5% of the procedures.Conclusion:In our series, retrograde intrarenal surgery (RIRS) using the Uscope PU3022a in the management of upper urinary tract stones gives a good stone-free rate at the first session. It can be used for stones larger than 20 mm. Further large randomised studies are needed to assess the use of this type of suf-URS. The stone-free rate was 73.4%. Postoperative complications were reported in 5.5% of patients