A switch from GnRH agonist to GnRH antagonist in castration-resistant prostate cancer patients leads to a low response rate on PSA.

PURPOSE: At the time of castration resistance, it is recommended to realize hormonal manipulations before chemotherapy. We evaluated the impact of a switch from GnRH agonist to antagonist in patients with castration-resistant prostate cancer on PSA and testosterone levels at 3 months. METHODS: Retrospectively, 17 patients from 5 different centers undergoing androgen deprivation therapy and presenting rising PSA confirmed on 3 blood samples 2 weeks apart and despite a castrate testosterone level (<0.5 ng/ml) were reviewed. Antiandrogen withdrawal syndrome had been tested before the switch. Degarelix was administered as followed: 240 mg for the first injection and then 80 mg every month, subcutaneously. We evaluated the PSA and testosterone level variation 3 months after the switch. Patients who experienced a variation in PSA of less than 10% compared to the baseline or who had a more than 10% PSA decrease were defined as responders. RESULTS: Mean PSA level at the switch was 34.3 ± 50.3 ng/ml, with a mean testosterone level of 0.21 ± 0.13 ng/ml. Three months after the switch, mean PSA level was 59.9 ± 81.6 ng/ml (P = 0.061), with a mean testosterone level of 0.19 ± 0.08 ng/ml (P = 0.086). At 3 months, 4 patients (23%) responded to therapy. Thirteen patients (77%) experienced a rise in PSA of more than 10% compared to baseline; 41% of patients decreased their testosterone level. The limitations of this study are its retrospective nature and the limited number of patients. CONCLUSION: Switch from an agonist to an antagonist of GnRH has a limited impact on PSA at 3 months in castration-resistant prostate cancer patients.

The role of tumor-free status in repeat resection before intravesical bacillus Calmette-Guerin for high grade Ta, T1 and CIS bladder cancer.

PURPOSE: We evaluated the outcome of repeat transurethral bladder tumor resection for high risk nonmuscle invasive bladder cancer before induction and maintenance bacillus Calmette-Guerin. MATERIALS AND METHODS: Included in the study were 151 consecutive patients with a mean age of 68.6 years (range 32 to 86) with primary high grade, nonmuscle invasive (Ta, T1 or CIS) bladder cancer. All patients underwent repeat transurethral bladder tumor resection and were shown by repeat resection to be tumor-free or have residual tumor before bacillus Calmette-Guerin. The bacillus Calmette-Guerin response was evaluated by disease recurrence and progression. RESULTS: A total of 70 tumor-free patients and 47 with residual tumor received bacillus Calmette-Guerin induction and maintenance therapy after repeat transurethral bladder tumor resection, of whom 84 (71.8%) were disease-free during followup. In the tumor-free group 11.4% of tumors recurred compared with 27.7% in the residual tumor group (p <0.05). Progression was noted in 5.7% of tumor-free cases vs 17.0% of residual tumor cases (p <0.05). Time to recurrence was significantly less in the residual tumor group than in the tumor-free group (17.8 vs 23.9 months, p <0.001). CONCLUSIONS: Tumor-free status at repeat transurethral bladder tumor resection improves the bacillus Calmette-Guerin response rate and delays tumor recurrence. During followup recurrence in residual tumor-free patients develop more likely as low grade lesions than in patients with residual tumor at repeat transurethral bladder tumor resection.

Prognostic significance of microscopic bladder neck invasion in prostate cancer.

OBJECTIVE: To assess the prognostic significance of microscopic bladder neck invasion (BNI+) after radical prostatectomy (RP). PATIENTS AND METHOD: From January 1988 to December 2006, 1480 patients with clinically localized prostate cancer were surgically treated at one tertiary university hospital. The risk of biochemical progression, defined as a prostate-specific antigen (PSA) level after RP of >0.2 ng/mL, was assessed with univariate and multivariate analyses for clinical and pathological variables. We compared the biochemical progression-free survival (bPFS) of patients with BNI+ vs stages pT2, pT3a, pT3b and positive lymph nodes (N+). In a second analysis, we evaluated the bPFS of patients in different stages associated with BNI+ and compared them with those in the same stages with no BNI. RESULTS: BNI+ was found in 132 (9%) patients; the 5-year bPFS was 86%, 54%, 26% and 10% for stages pT2, pT3a, pT3b and N+, respectively, while it was 30% for BNI+ (P < 0.001). There was no difference in the 5-year bPFS between stage pT2 and pT2 + BNI (P = 0.32). Stages pT3a and pT3b had a better 5-year bPFS than stage pT3a + BNI (P = 0.003) and pT3b + BNI (P = 0.001), respectively. In the univariate analysis all variables were associated with BP. In the multivariate analysis, only BNI+ had no association with BP (odds ratio 1.14, 95% confidence interval 0.70-1.85; P = 0.59). CONCLUSIONS: Microscopic BNI+ in prostate cancer is not an independent risk factor for biochemical progression and should be regarded as a factor that worsens the prognosis of the underlying tumour stage. A longer follow-up is necessary to confirm these findings.

[Management of pelvic disorders]. / Prise en charge de l'incontinence urinaire de l'adulte.

Micturition physiology is a complex phenomenon and, for this reason, the management of its disorders is difficult. The initial step in the treatment of urinary incontinence is the identification of type of incontinence, focusing on the origin (medical history, physical examination, additional tests) in order to distinguish between stress and urge urinary incontinence. In the treatment of female stress urinary incontinence due to urethral hypermobility, physical therapy and sling surgical techniques are successful in 90% of patients. In case of male or female urinary incontinence due to intrinsic sphincter deficiency, the treatment of choice is an artificial sphincter. However, another validated techniques or in validation, may be useful, such as intra-urethral bulking agents or microparticles. Finally, urge urinary incontinence is more often treated with antimuscarinic agents. Refractory cases will be successively treated with sacral neuromodulation, Botulinum toxin intravesical injection and, in some cases, with augmentation enterocystoplasty.

[Home hospitalisation in urological cancer: assessment of the first 5 years and a satisfaction survey]. / Hospitalisation à domicile en onco-urologie: bilan des 5 premières années et enquête de satisfaction.

INTRODUCTION: The Cancer Plan emphasizes the importance of home hospitalisation. Over the last 5 years, our department has developed this mode of hospitalisation for patients with urological cancer in order to perform chemotherapy or palliative care. The objective of this study was to determine the growth of the number of patients hospitalised at home over the last 5 years and to evaluate the satisfaction of patients hospitalised in 2005 by means of a self-administered questionnaire. METHODS: A retrospective study was conducted to identify patients hospitalised at home between 2001 and 2005. A satisfaction questionnaire was sent to 58 patients hospitalised in 2005 to evaluate the degree of satisfaction, management and coordination of all medical and paramedical personnel and the advantages perceived by the patients. RESULTS: Between 2001 and 2005, 178 patients were hospitalised at home, for chemotherapy in 59% of cases and for palliative care in 41% of cases; 56% of patients were followed for prostate cancer. Among the 58 patients contacted, 44 questionnaires were returned (response rate: 76%) : 43 patients were globally satisfied with their management (28 very satisfied, 13 satisfied and 2 moderately satisfied) and would recommend home hospitalisation to their relatives. No difficulties contacting the nurse, the oncologist or the urologist were reported. The advantages emphasized by patients were maintenance in their usual environment (92%) allowing continuation of daily activities (85%), limitation of ambulance transfers to hospital and decreased waiting time in hospital (90%), as well as the involvement of the general practitioner, freely chosen by the patient, in follow-up (62.5%) ; 98% of patients would not have preferred to be managed by conventional hospitalisation for the treatment received. CONCLUSION: Home hospitalisation for chemotherapy or palliative care appears to be an effective alternative to conventional hospitalisation requiring good collaboration by the office-hospital network.

[Polycythaemia and renal cancer. Report of 5 cases]. / Polyglobulie et cancer du rein: à propos de 5 cas.

The authors report 5 cases of polycythaemia associated with renal cancer. This paraneoplastic syndrome is present in less than 5% of all renal cancers. It is considered to be a factor of poor prognosis, as it is often associated with metastatic and/or high-grade cancer Polycythaemia, secondary to secretion of erythropoietin (EPO) by the tumour, is reversible after nephrectomy. The persistence or recurrence of polycythaemia after nephrectomy may indicate incomplete local resection or the presence of EPO-secreting metastases.