[Evaluation of the French practices in brachytherapy using surveys]. / Évaluation par questionnaire des pratiques de la curiethérapie de prostate en France.

INTRODUCTION: Prostate cancer brachytherapy can be used as an alternative to the radical prostatectomy and radiotherapy. In the low-risk group, specific survivals are up to 95% after 10years. The aim of the study is to describe the practices in brachytherapy in France. MATERIALS AND METHODS: A survey made by AFU (French Urologic Association) and SFRO (French Society Of Oncological Radiotherapy) assessing the practices in brachytherapy in France was sent to all the urologists and radiotherapists even if they did not practice it. RESULTS: In total, 1417 surveys were sent, 285 were received coming from 211 urologists (74%) and 74 radiotherapists (26%). Sixty (21%) practiced brachytherapy (31 urologists, 29 radiotherapists). Low dose rate with permanent implants was used in 83,3%. Brachytherapy was advised for low-risk group by 90% who responded the survey, 73% used it in intermediate risk and only 13% in high risk. CONCLUSION: Brachytherapy is hardly used in low risk prostate cancer. It probably needs a reconsideration of recommendations due to the good results in association with a good picking. The urologist-radiotherapist couple is essential in the overall care of the patient. LEVEL OF EVIDENCE: 4.

Current practice and access to prostate MR imaging in France.

PURPOSE: To obtain an overview of the degree of discrepancy between current clinical practice of prostate magnetic resonance imaging (MRI) in France and recommendations. MATERIALS AND METHODS: A brief survey was sent to 1229 members of the French society of urology in order to identify their indications of prostate MRI and its impact on patient management. The urologists were asked to answer several questions regarding age, practice modality, prostate MRI examinations (technique, indication before first biopsy, second biopsy, cancer staging, active surveillance, recurrence, focal therapy) and quality of reports. RESULTS: A total of 445 responses were received (participation rate of 36%). The mean delay for obtaining an appointment for prostate MRI ranged between 15-30 days in 54%. Fifty-four percent of MRI reports contained a PIRADS score and 23% a Likert score. The indications of multiparametric-MRI were tumor detection/location prior to repeat biopsy (90%), cancer staging (85%), management of patients under active surveillance (85%), selection of candidates to focal therapy (63%), tumor detection/location in biopsy naïve patients (53%), detection of local recurrence after radical (51%). Only 119 urologists (28.6%) had access to image fusion (MRI and transrectal ultrasound) and 351 (85.4%) used cognitive fusion. Mostly, targeted biopsies are done by urologists alone (nearly 80%), a very few are done by radiologists (8%) or by the two of them in collaboration (12%). CONCLUSION: The majority of urologists consider that prostate MRI is essential for the management of patients with prostate cancer. Practices are ahead of recommendations particularly before the first biopsy and in active surveillance.

[Salvage radical prostatectomy after external radiotherapy for prostate cancer: indications, morbidity and results. Review from CCAFU prostate section]. / Prostatectomie de rattrapage après échec de radiothérapie externe pour cancer de la prostate localisé : enquête de pratique, indications, morbidité et résultats. Travail du CCAFU sous-comité prostate.

Local recurrence after external radiotherapy for prostate cancer occurs in 30 to 50 % and is often diagnosed by a rising PSA. The absence of local control after radiotherapy is a risk factor of metastases and specific mortality. There are several therapeutic options to treat these patients: surveillance, hormonotherapy and salvage therapies (radical prostatectomy, cystoprostatectomy, brachytherapy, high intensity focused ultrasound [HIFU] and cryotherapy). Hormonotherapy is not a curative treatment and after a couple of years, the disease will progress again. Local salvage therapies are the only treatment to have the potential to cure these patients with the condition of very strict inclusion criteria. Among these therapies, only radical prostatectomy demonstrated his efficacity with a follow-up of 10 years on specific survival and survival without biological progression respectively from 70 to 77 % and from 30 to 43 %. During last decade, morbidity of RP has strongly decreased with a percentage of rectal and ureteral injury at 3 %. Nevertheless, percentage of urinary incontinence remains high from 29 to 50 %. Salvage mini-invasive therapies (cryotherapy, HIFU and cryotherapy) are under constant evolution due to progress of technology. Functional and oncological results are better with last generation devices but need to be evaluated and compared with radical prostatectomy.