[Evolution of the number of incident cases of prostate cancer in France from 2001 to 2012 from 5 hospital centers]. / Évolution du nombre de cas incidents de cancer de la prostate en France de 2001 à 2012 à partir de données hospitalières de 5 centres.

OBJECTIVES: The main objective is the study of the evolution of the number of incident cases of prostate cancer in France from 2001 to 2012 from 5 hospital centers of urology. The secondary objective is to describe the characteristics of the incident cases and to compare them to those of the patients of the national registers of cancer for the period. MATERIAL AND METHODS: Prospective observational multicentric study from 01/01/2001 to 31/12/2012 of databases in 5 French, public and private hospital centers of urology. The inclusive centers were selected outside departments with cancer register. The collected data were the prostatic biopsies performed in every center and the number of positive biopsies. The biopsies in cases of already known cancer and in re-evaluation were excluded. The data of age and stage (PSA and Gleason grade) were collected. The estimation of the incidence standardized in France is established after a period of observation of 3 years. The data updated in 2009 show a peak of incidence in 2005 then a decrease from 2006 (64,518 cases) until 2009 (53,465 cases). The median age in the diagnosis was of 70 years in 2005. RESULTS: Overall, 18,392 prostatic biopsies were included in the analysis. The average rate of positive biopsies was stable over the period 51.41% (IQR 0,02). The total number of cases of positive biopsies increased from 2001 to 2007 (482 cases in 1028 cases) in 2007, then decreased from 2008 to 2012 (649 cases). There was no difference in this variation between the centers. The median age in the diagnosis was of 70 years (EIQ=1.5) in 2001 and 68 years (EIQ=2.75) in 2012. PSA at diagnosis was<10ng/mL in 65% of cases and 10 to 20ng/mL in 22% of cases in 2012. The population of patients of the study differed significantly from that of FRANCIM on the distribution by age ranges (year 2005, P<0.0001 and year 2009, P<0.001), which explains the gap of one year (on 2007 instead of 2006) of the peak of incidental cases. CONCLUSION: The evolution of the number of incidental cases of prostate cancer in France from 2001 to 2012 from hospital data of 5 centers are similar to those of the network of registers representative of the French population. This observed evolution represents data available for cancer registers to estimate incidence variation between 2 publications. LEVEL OF EVIDENCE: 4.

[Epidemiology of urinary stones in the French military during the operation Serval]. / Épidémiologie de la lithiase urinaire chez les militaires français au cours de l'opération Serval.

OBJECTIVES: The renal colic crisis is a pathology frequently encountered in foreign operations recently conducted by the French army and often requires a medical repatriation in mainland France. Soldiers deployed in arid areas are at increased risk of developing urolithiasis. The purpose of our study is to analyze the risk factors, the frequency and the methods of management of symptomatic urinary stone disease for French military returnees for renal colic during Serval operation. METHODS: Our study focused on French soldiers repatriated from Mali for a renal colic care between January 11th and November 30th, 2013. For each patient, we recorded: age, sex, deployment date, crisis date, personal and family histories of urolithiasis, initial medical treatment, diagnosis and treatment to return to France. RESULTS: Three hundred and forty-eight soldiers were evacuated during Serval operation, among which 41 were due to the occurrence of renal colic crisis (11.7%). Twenty-nine percent of patients had a personal history of kidney stone disease symptomatically. The average residence time when the crisis appears is 60 days (10-120 days). Ninety-five percent of patients were asymptomatic at their arrival in France and 39% of patients had no stone found in CT scan. The average size of the stones found on the imaging was 2.71 mm (1-8mm). One patient required drainage by JJ ureteral endoprothese in order to have a quick ureteroscopy for recovery of its capacity. CONCLUSION: The French military sent to Serval operation are exposed to multiple contributing factors of urolithiasis as the dehydration and the strong temperature. The analysis of our series reveals that the history of renal stone disease is the main factor favoring and the medical treatment is effective in almost all renal colic cases. The operational impact associated with this common condition in the Sahel region deserves an awareness of field practitioners to the screening and management of this disease in a precarious situation and a reflection of the staffs concerning the access onto the operating theater to appropriate diagnostic and therapeutic means that could facilitate the return to the combat unit.

[Use of [-2] pro PSA and phi index for early detection of prostate cancer: a prospective of 452 patients]. / Place du -2proPSA et de l'index phi dans la détection précoce du cancer de prostate : évaluation sur une série de 452 patients.

INTRODUCTION: Early detection of prostate cancer (Pca) is a real challenge to reduce morbidity and mortality while avoiding over-diagnosis and over-treatment. The prostate specific antigen (PSA) is characterized by its imperfections justifying the evaluation of new serum or urinary specific markers allowing a better selection of patients at risk of developing aggressive Pca. AIM: To compare the value of -2pro PSA and phi index to total and free PSA. METHODS: Serum sampled from 452 patients from two university centers were used to determine levels of PSA before performing biopsies. The patients were included in this study based on the PSA serum concentration between 1.6 ng/mL and 8 ng/mL according to the WHO international standard. All biopsies were performed according to a standardized protocol consisting of 12 cores or more. Sera were analyzed centrally in one of the two institutions with on a single analyzer. Sera from 243 prostate cancer and 208 negative biopsies patients have been taken into account. RESULTS: Sera were analyzed blinded for total PSA, free PSA and [-2] proPSA using Access(®) immunoassay method from Beckman Coulter. The Prostate Health Index (phi) was calculated using the formula phi=([-2] proPSA/fPSA)×sqrt (PSA). The median value of the phi index is significantly (P>0.0001) higher for patients with cancer (phi=65.8) compared to patients with negative biopsies (phi=40.6). At a given sensitivity, the phi index significantly increases the specificity of detection of prostate cancer compared to other markers. CONCLUSION: The phi index currently appears as the best predictor of prostate cancer for patients with a total PSA between 1.6 and 8 ng/mL according to the WHO standard. The improvement in specificity of the phi index over tPSA could reduce significantly the numbers of unnecessary biopsies. Whether this new biomarker could be an indicator of aggressive prostate cancer remains to be confirmed.

[Growing teratoma syndrome]. / Le growing teratoma syndrome.

Growing teratoma syndrome (GTS) is a rare entity, characterized by enlarging masses of the retroperitoneum or other location occurring during or after systemic chemotherapy for the treatment of non-seminomatous germ cell of the testis (NSGCT). Three criteria define this syndrome: enlarging metastatic masses, normalized serum markers and no component of viable germ cell tumor in this mature teratoma. Prognostic is excellent after the resection of these masses, but this surgery has to be as much complete as possible. Surgical excision of large GTS lesions is technically challenging, a serious intraoperative complications may occur, that's why the treatment must not be delayed.

[Renal pseudotumoral actinomycosis: a case report]. / Actinomycose rénale d'aspect tumoral: à propos d'un cas.

We report the case of a 66-year-old man, presenting a right kidney mass with an alteration of the clinical status, treated by radical nephrectomy. Pathology reported that it was a pseudotumoral form of a bacterial infection: actinomycosis. This is an uncommon disease in this location. The authors wonder if it is possible to avoid nephrectomy with a preoperative diagnosis, especially with renal biopsy. The patient was well doing after 18 months thanks to long-lasting and effective postoperative antibiotics (Dhanani et al., 2004).

[Stage I seminoma: therapeutic strategy: surveillance, radiotherapy, chemotherapy. A case-report]. / Séminome de stade I: les choix thérapeutiques: surveillance, radiothérapie, chimiothérapie. À propos d'un cas.

The management guide-lines about stage I seminoma (pT1 à pT4, No, Mo) recommend to perform a surveillance, an adjuvant chemotherapy based on carboplatine, or a radiotherapy. However, these options are not equivalent for side effects and relapse risk. Debates are in progress in order to simplify the surveillance protocols which remain essential because of the tumoral relapses for 15% of the patients. The occurrence of a tumoral relapse during the follow-up does not decrease the specific survival. The para-aortic 20 Gy radiotherapy is efficient on the seminoma and decreases the relapse risk. Its main side-effect is a long-term risk of secondary cancer. Carboplatine chemotherapy is also an efficient option which provides good results on the specific survival and the survival without progression. Very few studies assess the long-term side effects of chemotherapy. In the end, the therapeutic decision must be taken with the patient after informing him about all the therapeutic options.

[Place of sclerotherapy in the treatment of chronic chyluria]. / Place de la sclérothérapie dans le traitement des chyluries chroniques.

Chyluria is rare. The parasite that causes filariasis is the most common cause while the non-parasitic causes is anecdotal. Medical treatment is often insufficient to treat cases of chronic chyluria for which the standard treatment is surgical lymphatic disconnection renovascular. However, sclerotherapy by instillation of a sclerosing agent kidney may represent an alternative to surgery. This technique has the advantage of being less invasive than surgery and has a proven efficacy in the literature.

[Scrotal pilomatrixoma: a case report and review of the literature]. / Pilomatricome scrotal : à propos d'un cas et revue de la littérature.

Pilomatrixoma, calcifying epithelioma of Malherbe, is a cutaneous tumor, originating from the hair matrix, mostly affecting pediatric population. We report a particularly uncommon location of pilomatrixoma: the scrotal skin. A 46-year-old man, without history, has developed a scrotal, multinodular firm tumor, measuring 10 cm. Most often, its preoperative diagnosis is not possible, because of its clinical polymorphism. The precise diagnosis is histological, by the revealing of mummified cells. The treatment is surgical, with only purpose to perform complete removal of pathologic tissue, allowing to decrease the rate of local relapse.

[Predictive value of the asymptomatic prostatic inflammation in the development of prostate cancer]. / Valeur prédictive de l'inflammation prostatique asymptomatique dans la survenue du cancer de la prostate.

OBJECTIVE: Several studies have tried to show a link between inflammation and cancer. In prostate cancer (PCa) development, this question is still not completely elucidated. The aim of the study was to investigate, whether the presence of inflammation in the first series of prostate biopsies was a factor of risk. PATIENTS AND METHODS: In this retrospective study, we examined prostate biopsy specimen of 220 consecutive patients, who had undergone repeat prostate biopsies in our department. The first screening round was performed between 2000 and 2005. These first prostate biopsies were examined by two pathologists blinded to the patient's follow-up. Inflammation and several histological criterions were evaluated: acute/chronic and focal/diffuse inflammation, atrophy, high grade PIN (HGPIN) and ASAP. We compared PCa incidences rates (IR) for the different histologic markers using chi(2) analysis and estimated the relative risk (RR) of PCa. RESULTS: Two hundred and one patients were included definitively with a median follow-up of 2.1 years (42 days - 8.9 years, period between the first and the last biopsy). One hundred and twenty-six patients (62.7%) were identified with inflammation in the first biopsies (inflammatory group [IG]). Ninety-seven patients (48.3%) had PCa, 58 from the IG. PCa IR did not differ significantly between patients with or without inflammation (RR: 0.9, p=0.6). CONCLUSIONS: According to these data, the presence and type of histological inflammation on initial prostate biopsies did not seem to be a risk factor for the development of PCa.

[Total urethral rupture during sexual intercourse]. / Faux-pas du coït et rupture urétrale complète.

The authors report the case of a bilateral rupture of the corpora cavernosa associated to a total disruption of the urethra resulting from blunt trauma during sexual intercourse. This association is a rare urologic case of emergency which most often take place during sexual intercourse (0.4% of the urologic cases of emergency). When both corpora cavernosa and urethra are fully disrupted, an internal penis amputation appears, compromising the vascularization and the erectional and micturitional prognosis. The rupture of the urethra is the first complication to search. Early diagnosis and surgical treatment allow a precise assessment of the lesions and a good functional result.

[Surgical management of retroperitoneal metastases from germ cell cancers]. / Prise en charge chirurgicale des métastases rétropéritonéales des tumeurs germinales du testicule.

The surgery of residual retroperitoneal tumors is a compulsory prolongation of chemotherapy in non seminomatous germ cell tumors. The requirements of total resection must be respected. High morbidity of bilateral lymphadenectomy for large bulky disease is possible and implies specialised surgery. The extent of surgery can be limited to a template area in specific circumstances.

[Correct use of prostate-specific antigen in office practice]. / Du bon usage de l'antigène spécifique prostatique en pratique de ville.

OBJECTIVE: To standardize interpretation and comments of prostate-specific antigen (PSA) assay results by clinical pathology laboratories in office practice. MATERIAL: From September 2004 to May 2006, interpretation and comments of PSA assay results performed by 100 different laboratories were analysed retrospectively. RESULTS: Nineteen different PSA assay kits were used. The so-called "normal" value for total PSA was less than 4 ng/ml for two-thirds of kits. Determination of the free PSA/total PSA ratio (91 cases) was based on a cut-off value ranging from 10 to 25% and the frequent laboratory comments (89 cases) more often referred to benign prostatic hyperplasia (51 case) than prostate cancer (nine cases). CONCLUSION: The marked diversity of PSA assay techniques currently used and the divergent interpretations by various laboratories lead to problems of interpretation for both practitioners and patients.

[Management of testicular seminoma with elevation of alpha fetoprotein. A case report]. / Prise en charge d'un séminome testiculaire avec élévation de l'alpha-foetoprotéine. A propos d'un cas.

The authors report a case of stage N3 pure testicular seminoma associated with paradoxical elevation of alphafoetoprotein (AFP). Despite the absence of histological arguments after review of the slides, this lesion was considered to be a stage pT1 N3 M0 S3 non seminomatous germ cell tumour with a poor prognosis. Simple surveillance was proposed following normalization of tumour markers, regression of retroperitoneal masses and negative PET scan. Laboratory and then clinical relapse at three months was treated by salvage chemotherapy followed by retroperitoneal lymph node dissection. The presence of embryonic carcinoma in one of the residual masses led to a revision of the initial histological diagnosis. The rare data of the literature indicate a variable approach according to alphafoetoprotein levels.

[Prostate cancer and disseminated intravascular coagulation: review of the literature]. / Cancer de prostate et coagulation intravasculaire disséminée: une revue de la littérature.

Disseminated intravascular coagulation is a rare complication of prostatic cancer evolution. Occurring on hormonorefractory phase, it remains most often infraclinic. Cases of acute, severe intravascular disseminated coagulation at first presentation are life-threatening because of hemorragic and thrombotic complications, justifying emergency medical treatment. In the light of a review of literature, we insist on epidemiological features, physiopathology and therapeutics of intravascular disseminated coagulation. In spite of a pejorative prognosis, this could help to achieve a period of remission.

[Management of pure teratoma of the testis in adult, results of a multicenter study over 15 years]. / Prise en charge du tératome pur testiculaire postpubertaire à propos d'une série multicentrique sur 15 ans.

OBJECTIVE: To analyze cases of pure teratoma of the testis (PTT) of a large population-based study, as such tumors are rare, and to make an update on the topic. PATIENTS AND METHODS: We retrospectively reviewed the records of patients treated for PTT from 1987 to 2003 in the French Midi-Pyrenees region (southwestern France) and in the Val-de-Grâce military hospital, Paris. Among more than 1000 cases of testis cancer, we identified 20 cases of PTT (4% of the whole population). For each patient, the orchiectomy specimen was reviewed and a clinical and imaging re-evaluation was performed. RESULTS: The pathological re-evaluation revealed non-teratomatous components in three patients (excluded from a following analysis). For the localized PTT patients, four out of eight out of 8 were on surveillance only after the orchiectomy, and the remaining four received adjuvant chemotherapy. None of them received any lymphadenectomy for staging. All patients with the metastatic disease were treated by chemotherapy followed by surgical removal of residual tumor masses. With a mean of 125 months follow-up, 85% of the population did not relapse after treatment. At the last contact, all were alive, without the disease. CONCLUSION: We confirm that PTT is a malignant disease with a good prognosis. As its management differs from the other non-seminomatous germ cell tumors, the diagnosis of PTT must be with certainty. The retrospective analysis of a series over two decades highlights the deviations from current guidelines. We propose that this rare tumor of young man should be treated in specialized centers to get the optimal management.

[What about lombo-aortic curage in the treatment of testicle cancer?]. / Que reste-t-il du curage lomboaortique dans le traitement du cancer du testicule?

The indications and techniques of retroperitoneal lymphadenectomy in stage I non seminomatous germ cell tumours have markedly evolved over the past ten years. A literature review allows noticing that historical radical retroperitoneal dissection has been replaced by more limited techniques, known as nerve sparing and nerve preserving lymph node dissection. Stage I non seminomatous germ cell tumours are classified according to the risk of retroperitoneat lymph node involvement; they constitute three groups: low, intermediate and high risk tumours. Retroperitoneal lymph node dissection is considered for low risk patients in case of non compliance or difficult follow-up, and for intermediate risk patients (vascular invasion with presence of high percentage of teratomatous component).