[Total or partial nephrectomy for renal tumors?] / Néphrectomie totale ou partielle dans le cancer du rein ?

Total or partial nephrectomy for renal tumors? Due to the raising incidence of small renal masses in the past decades and long term consequences of enlarged nephrectomy on renal function, partial nephrectomy has been recommended as reference treatment for renal tumors less than 4 cm. Partial nephrectomy has shown to allow equivalent oncological control compared to enlarged nephrectomy and allows preservation of the patient's nephronic capital. However, this surgery is technically demanding and requires experience and rapidity to limit renal ischemia.

Néphrectomie totale ou partielle dans le cancer du rein ? L'augmentation de l'incidence des tumeurs rénales de petite taille et les conséquences à long terme de la néphrectomie élargie sur la fonction rénale ont conduit la chirurgie partielle à s'imposer comme traitement de référence des tumeurs rénales de moins de 4 cm. La néphrectomie partielle a démontré être équivalente d'un point de vue carcinologique à la néphrectomie élargie et permet une préservation du capital néphronique du patient. Elle n'en reste pas moins une chirurgie techniquement difficile nécessitant expérience et rapidité d'exécution afin de limiter la durée d'ischémie rénale.

Operative and oncological results and impact on treatment strategy of systematic renal tumor biopsy: Comparison between patients < and >75 years old.

BACKGROUND: Proper usage of renal tumor biopsy (RTB) remains to be determined in the setting of renal tumors diagnosis, particularly in the elderly population. The aim of the study was to evaluate the perioperative and pathological results of RTB in a population of patients over 75 and to compare the performance of the procedure to their younger counterparts. MATERIAL AND METHODS: Systematic RTB were prospectively performed in a single center between 2009 and 2012. Patients' and tumor characteristics, operative and pathological results were collected. Data were compared between patients under and over 75 years old. Particular attention was paid to influence of RTB on treatment decision-making. RESULTS: A total of 180 patients were included (137 patients <75 years and 43 > 75 years). Size of tumor, clinical stage, radiological aspect and RENAL score were not statistically different between patients under or over 75 years. No difference was observed between the 2 groups regarding complication rate (2.9% vs. 0%, respectively, P = 0.625). One hundred fifty-seven patients (87.2%) had a positive diagnosis at first RTB, with no difference between the 2 groups regarding histology (P = 0.942). After biopsy, only 73.1% of patients <75 years and 70.7% of patients >75 years had concordance between radiological and histological findings (P = 0.919). Treatment decision was challenged after RTB in 21.8% of patients <75 years and in 25.0% of patients >75 years. CONCLUSIONS: RTB was as safe and accurate in the eldest population, as it is in the general population, and should be performed routinely considering its influence on patient management strategy.

Active surveillance for low-risk prostate cancer in African American men: a multi-institutional experience.

OBJECTIVE: To compare the outcomes of active surveillance (AS) series between African American men (AAM) and non-AAM diagnosed with low-risk prostate cancer at 3 medical centers. METHODS: Between 2005 and 2012, 214 men accepted AS on the basis of favorable clinical features and parameters after initial and repeat biopsy. Failure was defined as increase in Gleason score >6, total positive cores >33%, maximum cancer volume in any core >50%, or a prostate-specific antigen >10 ng/mL. Disease progression and overall AS failure were compared between the 2 groups. RESULTS: Of 214 men, 75 were excluded, leaving 67 AAM and 72 non-AAM on AS. Median age at diagnosis was 64 and 67 years for AAM and non-AAM, respectively, and median follow-up was 34 and 46 months, respectively. During this time, 44 AAM (66%) remained on AS, and 23 (34%) underwent treatment, of whom 6 (26%) were treated by patient choice and 17 (74%) because of disease progression. In the non-AAM group, 59 (82%) men remained on AS, and 13 (18%) underwent treatment, 8 (62%) were treated by patient choice and 5 (38%) because of disease progression. The 3-year freedom from overall treatment was 74% and did not differ by race (P = .06). The 3-year freedom from disease progression was 85%, where AAM were at significantly higher risk of disease progression (hazard ratio = 3.8; 95% confidence interval: 1.4-10.4; P = .01). CONCLUSION: Our study suggests a higher disease progression rate in AAM who choose AS for low-risk prostate cancer compared with non-AAM, signifying a potential need for closer follow-up and more stringent enrollment criteria in AAM.