[The French preliminary experience of the use of a seed-projector for exclusive iodine 125 prostate brachytherapy: feasibility and acute toxicity]. / L'expérience française de l'utilisation d'un projecteur de source pour la curiethérapie prostatique exclusive par implants permanents d'iode radioactif: faisabilité et données de toxicité aiguë.

PURPOSE: To analyse a new technique for prostate brachytherapy with permanent Iodine implants characterized by the use of a seed projector after a 3D dosimetric peroperative treatment planning (FIRST technique). PATIENTS AND METHOD: 395 patients have been treated in France with this technique in six radiotherapy centres between November 2002 and December 2005 for a localized prostate cancer. RESULTS: Thirteen patients (3.3%) developped a urinary retention, and respectively 7.8 and 26.5% an acute RTOG grade 3 and 2 toxicity. The 6-weeks IPSS score was equal or lower to 15 in 73% with a 11 median IPSS value. A failure of the loading with the seed-projector, leading to a manual loading of the seeds, occurred in 9 patients (2.3%) in two centres, directly related to the loading procedure with the seed-projector in 5 cases. The median duration of the procedure was reduced by 30 minutes for the patients treated in 2005. CONCLUSIONS: This multicenter study establishes the feasibility of the routine use of a seed projector for permanent iodine 125 prostate implants with an initial tolerance similar to the best results published for other implants techniques.

[Progression after radical prostatectomy of cancer of the prostate: prognostic criteria and the role of PSA in monitoring]. / Progression après prostatectomie radicale pour cancer de la prostate: critères pronostiques et place du PSA dans la surveillance.

Progression after radical prostatectomy, evaluated by a rise in plasma PSA and/or the appearance of a pelvic nodule positive on biopsy and/or the presence of bone metastases confirmed by bone scan, was studied in a series of patients with prostatic cancer with a follow-up of between 6 months and 5 years. The progression-free survival rate was 86% at 1 year and 60% at 5 years. A progression-free survival rate and the relative risk of progression were established on the basis of the morphological characteristics (anatomical stage, tumour volume, seminal vesicle invasion, condition of the prostatic capsule and lymph nodes, positive resection margins at the apex) and histological features (Gleason's score) of the cancer, allowing determination of the influence of prognostic criteria on the outcome. The positive resection margins at the apex were due to preservation of the nervi erigentes. The preservation of the neurovascular pedicles may not be justified in the case of a tumour confined to the prostatic apex.

Screening for prostate cancer. Comparison of transrectal ultrasound, prostate specific antigen and rectal examination.

In seeking to define the relative value of transrectal ultrasound (TRUS), prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of prostatic cancer, 863 patients were studied and the findings compared. DRE detected malignancy in 0.3% of the population of asymptomatic "normal" men undergoing routine health screening, and in 1.6% of patients who consulted their General Practitioner for one reason or another. In patients who attended our out-patient department with a variety of urological symptoms (not necessarily prostatic), TRUS suggested malignancy in 2% of those glands which were pronounced normal on DRE. Significantly elevated PSA detected malignancy in 0.3% of the patients undergoing routine health screening. (Although this figure equals the pick-up rate by DRE in this group, they were not necessarily the same patients). When these 3 investigations are summated, the pick-up rate is twice as high as when a single parameter is used.

[Circulating prostate cancer specific antigens in benign hypertrophy and localized cancer of the prostate]. / L'antigène prostatique spécifique circulant dans l'hypertrophie bénigne et le cancer localisé de la prostate.

In benign hypertrophy of the prostate (88 patients) there is a good correlation between the circulating specific prostate antigen (SPA) and the size of the prostate or of the adenoma. This correlation disappears with an adenocarcinoma where tumor volume increases (46 patients). Used as a screening test for cancer, serum levels of SPA, with a threshold value of 2.5 ng/ml, has a 91 per cent sensitivity and a 37 per cent specificity. At 15 ng/ml the sensitivity is 50 per cent and the specificity is 85 per cent. Alone, the SPA level is a poor diagnostic tool: using the low threshold (2.5 ng/ml) leads to needle biopsy in most all benign hypertrophies; with the high threshold (15-23 ng/ml), 50 per cent of the localized cancers go undetected. However, for a level greater than 15 ng/ml, SPA is an argument strongly suggesting prostate adenocarcinoma. The capacity of benign hypertrophy of the prostate to "secrete" SPA is 5 times greater than the normal peripheral prostate; the capacity of cancer is 20 times greater than that of the adenoma. Individual variability in serum levels of SPA, expressed per cm3 of prostate tissue is too great to give a precise interpretation as a function of volume.

[Circulating prostatic-specific antigen in benign hypertrophy and localized prostate cancer: can PSA be considered a screening examination for localized cancer?]. / Le PSA circulant dans l'hypertrophie bénigne et le cancer localisé de la prostate: le PSA peut-il être considéré comme un examen de dépistage du cancer localisé?

Prostate-specific antigen (PSA) is increasingly used in the diagnosis of prostatic pathology. Its usefulness in the early diagnosis of prostatic cancer is controversial. The aim of the study is to evaluate the sensitivity and specificity of PSA in a population with prostate diseases. Moreover, we wanted to know if the measure of the prostate volume may increase the sensitivity of the test. In benign prostatic hypertrophy (88 patients), a good correlation exists between circulating PSA and the prostatic volume or the volume of the adenoma. This correlation disappears in the presence of an adenocarcinoma at the profit of the tumor volume (46 patients). Used as a means of screening for cancer, the serum level of PSA with a threshold value of 2.5 ng/ml has a sensitivity of 91% and a specificity of 32%. The sensitivity is 50% and the specificity is 85% at a level of 15 ng/ml. Taken alone, the level of PSA is inadequate for diagnosis: If the lower level is chosen (2.5 ng/ml), the majority of benign prostatic hypertrophies will be the object of a biopsy. If the higher level is chosen (15-23 ng/ml), 50% of localized cancers of the prostate will escape detection. Nevertheless, a level of PSA < 15 ng/ml is an argument for a strong suspicion in favor of an adenocarcinoma of the prostate. The capacity of BPH to "secrete" serum PSA is five times greater than that of the normal peripheral prostate, and the capacity of cancer is 20 times greater than that of an adenoma. The individual variability of serum PSA per cubic centimeter of prostatic tissue is too great to allow a precise interpretation as a function of volume.

Repair of hypospadias using a bladder mucosal graft in 76 cases.

A bladder mucosal graft was used to repair hypospadias in 76 patients. Indications included 19 hypospadias cripples and 57 primary repairs. Of the operations 53 were completely successful, while 20 patients required a secondary minor procedure and 3 required more than a minor procedure. There were no cases of stenosis of the proximal anastomosis. Attention is focused on certain points of the technique to avoid fistulas and meatal problems. Mucosal grafts provide excellent functional and cosmetic results with only a small percentage of complications. Therefore, we use a mucosal graft not only in patients without available preputial skin but also for primary repair when a flip-flap technique is not possible.

[Results of bladder and urethra reconstruction for exstrophy]. / Résultats de la reconstruction vésicale et urétrale pour exstrophie.

Sixty-one patients with classical bladder exstrophy were seen at our institution over the last twenty-two-years. Five patients underwent primary urinary diversion, in six reconstruction according Couvelaire--Arap method was attempted without success. For fifty patients a staged approach to functional closure was elected. A review of the success, failures and complications provides the bases for treatment now being used on new patients. The technical aspects of this treatment that provide the best chance for continence without renal damage and satisfactory external genitalia are discussed. An excellent surgical result, defined as achievement of a day time dry interval for 3 hours with normal social life and without renal damage was achieved in 74% of children (100% of girls).

[Cancer and gastric sarcoidosis]. / Cancer et sarcoïdose gastrique.

A 63-year-old woman treated 28 years ago for pulmonary sarcoidosis was operated upon for gastric cancer. Histology showed combined lesions of gastric sarcoidosis and adenocarcinoma. This is an exceptional association, and the relation between the two affections is discussed, the most likely hypothesis being a sarcoid reaction to the cancer.