Influence of statin use on clinicopathological characteristics of localized prostate cancer and outcomes obtained after radical prostatectomy: a single center study

To assess the impact of statin use on biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP)

Investigating the risks of disease recurrence and progression after radical nephrourectomy for upper tract urothelial carcinoma

Même si la néphrourétérectomie totale représente le traitement de référence des tumeurs de la voie excrétrice urinaire supérieure (TVEUS), il existe un risque élevé de récidive post-opératoire qui peut survenir soit au niveau de la vessie soit dans la loge de résection et/ou sur le plan systémique. L’objectif de ce travail était de caractériser ces différents modes évolutifs. En ce qui concerne la récidive intra-vésicale, une revue systématique de la littérature avec méta-analyse a permis d’identifier les principaux facteurs de risque à la fois cliniques et anatomopathologiques. Par ailleurs, une seconde analyse de cohorte suggère que, sur le plan biologique, cet événement pourrait être en rapport avec une mutation du gène FGFR3 identifiable à partir de l’ADN urinaire. En ce qui concerne la récidive locorégionale et métastatique, une relecture centralisée de lames de TVEUS classées pT3 a permis de proposer une sous-classification pronostique sur la base de l’étendu de l’envahissement du parenchyme rénal et/ou de la graisse péripyélique (pT3a vs. pT3b) afin de mieux adapter la prise en charge post-opératoire. Cependant, l’analyse d’un registre américain a montré que l’utilisation d’une chimiothérapie adjuvante pour le traitement des tumeurs localement avancées pT3-T4 et/ou pN+ serait associée à un bénéfice en termes de survie globale pour l’ensemble de ces patients. Enfin, l’étude préliminaire d’une large cohorte nationale de cas de TVEUS a permis de valider la technique de TMA avec des coupes de 2 mm au seuil de 5% pour l’analyse pronostique de l’expression de PD-L1 sur les cellules tumorales avec l’anticorps 28.8, et de l’expression de PD-1 sur les TILs avec l’anticorps NAT105.Although radical nephroureterectomy remains currently considered as the standard of care for upper tract urothelial carcinoma (UTUC), there is a high risk of postoperative recurrence, which can occur either within the bladder or the surgical field and/or distant sites. The aim of our study was to investigate and better characterize these events. With regards to intra-vesical recurrence, a systematic review and meta-analysis was conducted to identify all significant clinical and pathological predictors. Moreover, an additional cohort study suggested that, from a biological perspective, such an event could be related to the presence of the FGFR3 mutation detected from urinary DNA. With regards to locoregional and/or distant recurrence, a central pathology review of UTUC patients with pT3 disease showed that there may be a prognostic interest in stratifying these individuals based on the extent of local invasion (pT3a vs. pT3b) to propose a risk-adapted strategy for postoperative management. Nonetheless, an US hospital-based registry study revealed that all patients with pT3-T4 and/or pN+ UTUC could derive an overall survival benefit from adjuvant chemotherapy. Finally, a preliminary analysis from a large French cohort of UTUC patients established that the 2 mm TMA technique can be used to assess the prognostic interest of determining PDL1 expression on tumor cells with 28.8 antibody and PD-1 expression on TILs with NAT105 antibody, both at the 5% threshold for positivity

Caractérisation de l’évolution des tumeurs urothéliales de la voie excrétrice urinaire supérieure après néphrourétérectomie totale

Although radical nephroureterectomy remains currently considered as the standard of care for upper tract urothelial carcinoma (UTUC), there is a high risk of postoperative recurrence, which can occur either within the bladder or the surgical field and/or distant sites. The aim of our study was to investigate and better characterize these events. With regards to intra-vesical recurrence, a systematic review and meta-analysis was conducted to identify all significant clinical and pathological predictors. Moreover, an additional cohort study suggested that, from a biological perspective, such an event could be related to the presence of the FGFR3 mutation detected from urinary DNA. With regards to locoregional and/or distant recurrence, a central pathology review of UTUC patients with pT3 disease showed that there may be a prognostic interest in stratifying these individuals based on the extent of local invasion (pT3a vs. pT3b) to propose a risk-adapted strategy for postoperative management. Nonetheless, an US hospital-based registry study revealed that all patients with pT3-T4 and/or pN+ UTUC could derive an overall survival benefit from adjuvant chemotherapy. Finally, a preliminary analysis from a large French cohort of UTUC patients established that the 2 mm TMA technique can be used to assess the prognostic interest of determining PDL1 expression on tumor cells with 28.8 antibody and PD-1 expression on TILs with NAT105 antibody, both at the 5% threshold for positivity.Même si la néphrourétérectomie totale représente le traitement de référence des tumeurs de la voie excrétrice urinaire supérieure (TVEUS), il existe un risque élevé de récidive post-opératoire qui peut survenir soit au niveau de la vessie soit dans la loge de résection et/ou sur le plan systémique. L’objectif de ce travail était de caractériser ces différents modes évolutifs. En ce qui concerne la récidive intra-vésicale, une revue systématique de la littérature avec méta-analyse a permis d’identifier les principaux facteurs de risque à la fois cliniques et anatomopathologiques. Par ailleurs, une seconde analyse de cohorte suggère que, sur le plan biologique, cet événement pourrait être en rapport avec une mutation du gène FGFR3 identifiable à partir de l’ADN urinaire. En ce qui concerne la récidive locorégionale et métastatique, une relecture centralisée de lames de TVEUS classées pT3 a permis de proposer une sous-classification pronostique sur la base de l’étendu de l’envahissement du parenchyme rénal et/ou de la graisse péripyélique (pT3a vs. pT3b) afin de mieux adapter la prise en charge post-opératoire. Cependant, l’analyse d’un registre américain a montré que l’utilisation d’une chimiothérapie adjuvante pour le traitement des tumeurs localement avancées pT3-T4 et/ou pN+ serait associée à un bénéfice en termes de survie globale pour l’ensemble de ces patients. Enfin, l’étude préliminaire d’une large cohorte nationale de cas de TVEUS a permis de valider la technique de TMA avec des coupes de 2 mm au seuil de 5% pour l’analyse pronostique de l’expression de PD-L1 sur les cellules tumorales avec l’anticorps 28.8, et de l’expression de PD-1 sur les TILs avec l’anticorps NAT105

Re: Alexandre R. Zlotta, Leslie K. Ballas, Anderzej Niemierko, et al. Radical Cystectomy Versus Trimodality Therapy for Muscle-invasive Bladder Cancer: A Multi-institutional Propensity Score Matched and Weighted Analysis. Lancet Oncol 2023;24:669–81

International audienceNo abstract availabl

Trends in the placement of penile prostheses over the last 17 years in France

International audienceErectile dysfunction (ED) currently affects 152 million men worldwide and this number is likely to reach 322 million by 2025. Penile prostheses (PP) placement remains a lastresort option in cases where organic ED has not been cured by previous medications, notably intracavernosal injection and oral phosphodiesterase type-5 inhibitor. France ended 2013 with a population of 66 million inhabitants. In our study, we obtained data through the French national code registry database programme de médicalisation des systèmes d’information and from the patient-information forms filled out by the surgeon at the time of the implant. For claim purposes, this system comprehensively records information concerning every surgical procedure that is performed in a private or public hospital in France. Data were extracted for all patients who had undergone a penile implantation between 1997 and 2013

Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer

International audienceThe sentinel lymph node dissection (SLND) concept relies on the accurate detection of primary nodal landing sites and could represent a major advancement towards accurate, non-invasive pelvic staging in prostate cancer (PCa). Different iterations of the technique have now been validated and reproduced mostly in large-volume centres. The existing evidence denotes the feasibility and sensitivity of SLND, with encouraging pre- and intraoperative detection rates of 98% and 96%. Yet, current surgical practice mandates a backup template dissection due to a false negative rate, up to 7.1%, of tracer-guided surgery. In practice, SLND failed to achieve nodal detection in up to 20% of pelvic sidewalls. Despite scarce validated evidence, current consensus mainly attributes these false negative cases to altered prostatic drainage secondary to malignant obliteration of lymphovascular structures. In parallel, multiple SLND studies have highlighted the complex and variable drainage pathways from the prostate, furthering the established anatomical atlases. The most promising approach may therefore rely in magnetic nanoparticles and PCa-targeting ligands. However, in the absence of a clear sentinel node or region for the prostate, formal SLND is difficult to integrate in routine surgical practice for now. As such, tracer-guided dissection is only used as a complementary intervention to highlight first- echelon nodes and aberrant lymphatic pathways found beyond the commonly adopted pelvic lymphadenectomy templates

Contemporary Trends in the Incidence of Metastatic Prostate Cancer Among US Men: Results from Nationwide Analyses.

Studies have noted contrasting findings with regard to the contemporary incidence of metastatic prostate cancer (PCa) in the USA, especially in light of the United States Preventive Services Task Force (USPSTF) recommendations against prostate-specific antigen (PSA) screening in recent years. We used data from the 18 population- based tumor registries of the Surveillance, Epidemiology and End Results (SEER) 2004-2013 database to study trends in the incidence of metastatic PCa among men stratified by age and race. Joinpoint regression analyses were performed to identify time points associated with any statistically significant change in incidence. Overall, there was a significant increase in incidence between 2009 and 2013 (annual percentage change [APC] 3.10%; p\u3c0.05). In age-stratified analyses, there was a continuous increase in the incidence of metastatic PCa from 2004 to 2013 among men aged 45-54 yr and 55-64 yr (APC 1.77% and 1.43% respectively; both p\u3c0.05). For men aged ≥75 yr there was a significant decline in the incidence of metastatic PCa from 2004 to 2011 (APC -2.07%; p\u3c0.05) and a nonsignificant increase from 2011 onwards (APC 6.09%). Distinct incidence trends were noted for white and black men. While it is too early to presume that the recent decline in PSA screening secondary to the USPSTF statement is causally associated with our findings, our results highlight a concerning trend of increasing metastatic disease. Our results thus warrant validation in future longer-term studies on the contemporary incidence and mortality of metastatic PCa. PATIENT SUMMARY: We noted increasing incidence of metastatic prostate cancer from 2009 onwards among US men (especially those aged 45-74 yr) in a population-based tumor registry. Pending validation in longer-term studies, our results suggest the need for close surveillance of trends for metastatic prostate cancer incidence and mortality

Current role of image-guided robotic radiosurgery (cyberknifetextregistered) for prostate cancer treatment

International audienc