Prostate biopsies guided by three-dimensional real-time (4-D) transrectal ultrasonography on a phantom: comparative study versus two-dimensional transrectal ultrasound-guided biopsies

OBJECTIVE: This study evaluated the accuracy in localisation and distribution of real-time three-dimensional (4-D) ultrasound-guided biopsies on a prostate phantom. METHODS: A prostate phantom was created. A three-dimensional real-time ultrasound system with a 5.9MHz probe was used, making it possible to see several reconstructed orthogonal viewing planes in real time. Fourteen operators performed biopsies first under 2-D then 4-D transurethral ultrasound (TRUS) guidance (336 biopsies). The biopsy path was modelled using segmentation in a 3-D ultrasonographic volume. Special software was used to visualise the biopsy paths in a reference prostate and assess the sampled area. A comparative study was performed to examine the accuracy of the entry points and target of the needle. Distribution was assessed by measuring the volume sampled and a redundancy ratio of the sampled prostate. RESULTS: A significant increase in accuracy in hitting the target zone was identified using 4-D ultrasonography as compared to 2-D. There was no increase in the sampled volume or improvement in the biopsy distribution with 4-D ultrasonography as compared to 2-D. CONCLUSION: The 4-D TRUS guidance appears to show, on a synthetic model, an improvement in location accuracy and in the ability to reproduce a protocol. The biopsy distribution does not seem improved

Promoter hypermethylation of HS3ST2, SEPTIN9 and SLIT2 combined with FGFR3 mutations as a sensitive/specific urinary assay for diagnosis and surveillance in patients with low or high-risk non-muscle-invasive bladder cancer

International audienceBackgroundNon-muscle-invasive bladder cancer (NMIBC) is a high incidence form of bladder cancer (BCa), where genetic and epigenetic alterations occur frequently. We assessed the performance of associating a FGFR3 mutation assay and a DNA methylation analysis to improve bladder cancer detection and to predict disease recurrence of NMIBC patients.MethodsWe used allele specific PCR to determine the FGFR3 mutation status for R248C, S249C, G372C, and Y375C. We preselected 18 candidate genes reported in the literature as being hypermethylated in cancer and measured their methylation levels by quantitative multiplex-methylation specific PCR. We selected HS3ST2, SLIT2 and SEPTIN9 as the most discriminative between control and NMIBC patients and we assayed these markers on urine DNA from a diagnostic study consisting of 167 NMIBC and 105 controls and a follow-up study consisting of 158 NMIBC at diagnosis time’s and 425 at follow-up time. ROC analysis was performed to evaluate the diagnostic accuracy of each assay alone and in combination.ResultsFor Diagnosis: Using a logistic regression analysis with a model consisting of the 3 markers’ methylation values, FGFR3 status, age and known smoker status at the diagnosis time we obtained sensitivity/specificity of 97.6 %/84.8 % and an optimism-corrected AUC of 0.96. With an estimated BCa prevalence of 12.1 % in a hematuria cohort, this corresponds to a negative predictive value (NPV) of 99.6 %. For Follow-up: Using a logistic regression with FGFR3 mutation and the CMI at two time points (beginning of the follow-up and current time point), we got sensitivity/specificity/NPV of 90.3 %/65.1 %/97.0 % and a corrected AUC of 0.84. We also tested a thresholding algorithm with FGFR3 mutation and the two time points as described above, obtaining sensitivity/specificity/NPV values of, respectively, 94.5 %/75.9 %/98.5 % and an AUC of 0.82.ConclusionsWe showed that combined analysis of FGFR3 mutation and DNA methylation markers on urine can be a useful strategy in diagnosis, surveillance and for risk stratification of patients with NMIBC. These results provide the basis for a highly accurate noninvasive test for population screening and allowing to decrease the frequency of cystoscopy, an important feature for both patient quality of life improvement and care cost reduction

Salvage radiotherapy for patients with PSA relapse after radical prostatectomy: a single institution experience

<p>Abstract</p> <p>Background</p> <p>To assess the efficacy of salvage radiotherapy (RT) for persistent or rising PSA after radical prostatectomy and to determine prognostic factors identifying patients who may benefit from salvage RT.</p> <p>Methods</p> <p>Between 1990 and 2003, 59 patients underwent RT for PSA recurrence after radical prostatectomy. Patients received a median of 66 Gy to the prostate bed with 3D or 2D RT. The main end point was biochemical failure after salvage RT, defined as an increase of the serum PSA value >0.2 ng/ml confirmed by a second elevation.</p> <p>Results</p> <p>Median follow-up was 38 months. The 3-year and 5-year bDFS rates were 56.1% and 41.2% respectively. According to multivariate analysis, only preRT PSA ≥1 ng/ml was associated with biochemical relapse.</p> <p>Conclusion</p> <p>When delivered early, RT is an effective treatment after radical prostatectomy. Only preRT PSA ≥1 ng/ml predicted relapse.</p

Le Cancer de la prostate des afro-antillais résident en France

1) objectifs : Evaluer les caractéristiques cliniques, biologiques, anatomopathologiques et pronostiques du cancer de la prostate au moment du diagnostic et après prostatectomie radicale chez des patients afro-antillais vivant en France métropolitaine comparativement à une population caucasienne de référence. 2) Patients & méthodes : 618 patients consécutifs (dont 518 caucasiens et 64 afro-antillais) ont été soumis à des biopsies de prostate (BP) pour une anomalie du toucher rectal (TR) et/ou une élévation isolée du PSA. Par ailleurs nous avons étudié 445 patients consécutifs traités par prostatectomie radicale pour un cancer de prostate T1 T2 (dont 404 caucasiens et 39 afro-antillais). Dans le groupe biopsé, ont été analysées les données pré BP (âge, TR, PSA, volume prostatique), le rendement des BP (taux de positivité, nombre de carottes envahies) et les résultats histologiques (Gleason, dysplasie, inflammation, statut capsulaire). Dans le groupe des patients opérés, ont égalementété analysées les données histologiques de la pièce (poids, PTNM, Gleason, statut de la capsule, engainement des filets nerveux, marges d'exérèse) et les données du suivi (suivi moyen, taux et délai moyens de progression biologique et statut au terme du suivi). 3) Résultats : Parmis les patients afro-antillais biopsés, on observe un âge plus jeune au moment du diagnostic (61.59 vs 65.54 ans, p=0.01), un volume échographique moindre uniquement en cas de biopsies négatives (38.22 vs 48.97 cc, p=0.0005), et un recours plus fréquent à l'immunohistochimie afin d'établir le diagnostic (31.43 vs 24.68%, p=0.02). Dans le groupe des patients opérés, les afro-antillais sont plus jeunes (61,2 vs 64,8 ans, p=0.002), ont un volume prostatique échographique moindre (29.72 vs 40.09 cc, p=0.001) mais des pièces opératoires de même poids (34.3 vs 41.63 g, p=0.07) et une densité de PSA plus élevé (0.36 vs 0.30, p=0.01). Il n'a pas été mis en évidence de différences significatives concernant les autres items étudiés...PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Facteurs prédictifs de récidive biologique après prostatectomie radicale chez les patients ayant une tumeur intra-prostatique avec marges d'exérèse chirurgicales positives

PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Organisation et résultats de la surveillance active pour cancer de la prostate à l hôpital Bichat

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF