[Indirect consequences of PSA testing for prostate cancer screening]. / Conséquences indirectes du dosage du PSA dans le dépistage du cancer de la prostate.

Prostate cancer screening remains controversial as the reduction in mortality is outweighed by overdiagnosis and overtreatment. Prostate specific antigen (PSA) testing remains a recurring issue for primary care physicians. Although the last guidelines recommend against the screening, everyone agreed on the importance of the shared decision-making process to inform the patient about the potential benefits and harms of screening. Existing decision support tools can help in this complex discussion. This clinical case report depicts the infectious risks of prostate biopsy that are often underestimated.

Le dépistage du cancer prostatique reste controversé car la baisse de la mortalité est contrebalancée par les inconvénients de la surdétection et du surtraitement. La question du dosage du PSA (prostate specific antigen) revient toutefois de manière récurrente lors des consultations des médecins de premier recours. Bien que les recommandations récentes parlent plutôt en défaveur du dépistage, tous les acteurs concernés s'accordent sur l'importance de la décision partagée pour éclairer le patient sur les implications du dosage du PSA. Des outils d'aide à la décision existent et peuvent être utiles dans cette discussion complexe. La vignette clinique ci-après illustre les risques infectieux, souvent sous-estimés, de la biopsie de prostate consécutive à un dosage du PSA.

Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques.

INTRODUCTION: The study aimed to evaluate 3 different modalities of transrectal ultrasound (TRUS)-guided prostate biopsies (PBs; 2D-, 3D- and targeted 3D-TRUS with fusion to MRI - T3D). Primary end point was the detection rate of prostate cancer (PC). Secondary end point was the detection rate of insignificant PC according to the Epstein criteria. PATIENTS AND METHODS: Inclusion of 284 subsequent patients who underwent 2D-, 3D- or T3D PB from 2011 to 2015. All patients having PB for initial PC detection with a serum prostate-specific antigen value ≤20 ng/ml were included. Patients with T4 and/or clinical and/or radiological metastatic disease, so as these under active surveillance were excluded. RESULTS: Patients with T3D PB had a significantly higher detection rate of PC (58 vs. 19% for 2D and 38% for 3D biopsies; p = 0.001), with no difference in Gleason score distribution (p = 0.644), as well as detection rate of low-risk cancers (p = 0.914). Main predictive factor for positive biopsies was the technique used, with respectively a 3- and 8-fold higher detection rate in the 3D- and T3D group. For T3D-PB, there was a significant correlation between radiological cancer suspicion (Prostate Imaging Reporting and Data System Score) and cancer detection rate (p = 0.02). CONCLUSIONS: T3D PB should be preferred over 2D PB and 3D PB in patients with suspected PC as it improves the cancer detection rate.

Accuracy of Magnetic Resonance Imaging/Ultrasound Fusion Targeted Biopsies to Diagnose Clinically Significant Prostate Cancer in Enlarged Compared to Smaller Prostates.

PURPOSE: We assessed the accuracy of magnetic resonance imaging/transrectal ultrasound fusion biopsies to diagnose prostate cancer according to gland size. MATERIALS AND METHODS: A prospective study was performed in 232 men with a first round biopsy, multiparametric magnetic resonance imaging with a lesion, a Likert score of 2 or greater and prostate specific antigen less than 10 ng/ml. All men underwent a standard 12-core protocol plus a protocol of 2 or 3 targeted cores. Significant prostate cancer was defined as at least 1 core with a Gleason score of 7 (3 + 4) or 6 with a greater than 4 mm maximal cancer core length. RESULTS: Mean ± SD patient age was 64 ± 6.4 years, mean prostate specific antigen was 6.65 ± 1.8 ng/ml and mean prostate volume was 40 ± 24.3 ml. The overall detection rate of clinically significant prostate cancer was 44%. The detection rate of clinically significant prostate cancer by magnetic resonance imaging-transrectal ultrasound fusion guided biopsy was 77% for prostate glands less than 30 cm(3), and 61%, 47% and 34% for glands 30 to less than 38.5, 38.5 to less than 55 and 55 to 160 cm(3), respectively (p = 0.001). Differences in prostate cancer detection rates between the standard and targeted protocols were not significant for patients with a prostate volume of 40 cm(3) or less (p = 0.8). Conversely 12 patients with a prostate volume greater than 40 cm(3) had clinically significant prostate cancer using the targeted but not the standard protocol and in 3 prostate cancer was detected by the standard but not the targeted protocol (p = 0.04). CONCLUSIONS: Magnetic resonance imaging-transrectal ultrasound fusion biopsies increased the yield of first round prostate biopsies in patients with a prostate volume greater than 40 cm(3).

First round of targeted biopsies using magnetic resonance imaging/ultrasonography fusion compared with conventional transrectal ultrasonography-guided biopsies for the diagnosis of localised prostate cancer.

OBJECTIVES: To assess the accuracy of magnetic resonance imaging (MRI)/transrectal ultrasonography (TRUS) fusion to guide first-round biopsies in the diagnosis of localised prostate cancer (PCa) in men with a prostate-specific antigen (PSA) ≤10 ng/mL. PATIENTS AND METHODS: A prospective study was conducted on men who met the following criteria: first-round biopsy, multiparametric MRI (mpMRI) showing a lesion with a Likert score ≥2 and a PSA <10 ng/mL. All men underwent a extended 12-core protocol plus a protocol of two or three targeted cores on the mpMRI index lesion. The UroStation (Koelis, Grenoble, France) and a V10 ultrasound system with an end-fire three-dimensional TRUS transducer were used for the fusion imaging procedure. Significant PCa was defined as: at least one core with a Gleason score of 3 + 4 or 6 with a maximum cancer core length ≥4 mm. RESULTS: A total of 152 men, whose median PSA level was 6 ng/mL, were included in the study. The proportion of positive cores was significantly higher with the targeted-core protocol than with the extended 12-core protocol (P < 0.001). The proportion of men with clinically significant PCa was higher with the targeted-core protocol than with the extended 12-core protocol (P = 0.03). The proportion of patients having at least one positive biopsy (targeted-core protocol) was significantly different among the Likert score categories (P < 0.001). CONCLUSIONS: For the first round of biopsies, MRI/TRUS-fusion targeted biopsies detected more men with clinically significant PCa than did standard extended 12-core biopsy alone.

[Scrotal pain and/or enlargement: initial diagnostic and therapeutic management by the general practitioner]. / Douleurs et tuméfactions scrotales: prise en charge initiale diagnostique et thérapeutique par le generalist.

Although the issue is specifically urologic, scrotal pain and/or enlargement is not an exception at the general practitioner's outpatient clinic. Besides testicular torsion, usually managed in an emergency division setting, there are four frequent diagnoses: testicular tumor, orchi-epididimytis, hydrocele or spermatocele, so as varicocele. The purpose of this article is to provide an update and allow to easily identify serious or frequent scrotal pathologies in primary care medecine.

[3D ultrasound guidance for prostate biopsy with MRI-image fusion]. / Biopsies de la prostate sous guidage échographique 3D avec fusion à l'IRM.

Endorectal prostate biopsies by using 2D ultrasound guidance remain the gold standard for diagnosing prostate cancer. However this technique is limited by a low yield knowing that only 20-30% of all prostate biopsies detect prostate cancer. Since a few years it is possible to do these biopsies by using 3D endorectal ultrasound guidance with fusion to MRI images in order to increase the yield. This new technique permits to visualize the exact localization of all biopsies and gives the certitude of a good mapping of the prostate tissue increasing the yield up to 40%. By fusioning images of the MRI with the 3D ultrasound, it is even possible to target suspect lesions visualized on the MRI, which permits to increase the yield up to 100% in favorable cases.

[Primary care management of hematuria: is it obvious?]. / Prise en charge de l'hématuri par le praticien généraliste Une démarche diagnostique qui coule de source?

Hematuria is frequent and its diagnostic array is wide, ranging from benign pathologies such as infections or stones to neoplasia, sometimes also including some nephropathies. Twenty per cent of patients presenting with macro-hematuria harbour a urologic tumor. This validates an in-depth evaluation, classicaly associating contrast studies and cystoscopy. The occurrence of hematuria in patients on anticoagulants and/or antithrombotics should never be overlooked, since post work-up etiologies are as significant as these outlined in patients not under such prescriptions. Microhematuria also requires a distinct work-up, especially when there are risk factors for a urothelial neoplasia.