Focal cryoablation: a treatment option for unilateral low-risk prostate cancer.

OBJECTIVES: To assess oncological (biochemical and histological recurrence) and functional (urinary and potency) outcomes in patients with unilateral low-risk organ-confined prostate cancer (PCa) treated with focal cryoablation (FC). PATIENTS AND METHODS: From January 2009 to March 2012, patients with localized PCa who refused active surveillance were assigned to a FC protocol. This was a prospective, single-arm cohort study. Inclusion criteria were: unilateral disease, clinical stage T1c to T2a, prostate-specific antigen (PSA) concentration <10 ng/mL, low volume index lesion and Gleason score ≤6 (3+3). Hemi-ablation was carried out using the Precise(TM) cryoablation system (Galil Medical, Inc., Arden Hills, MN, USA). Oncological (PSA values) and functional (International Prostate Symptom Score and International Index of Erectile Function (IIEF)-5 score) outcomes were analysed at 3-, 6- and 12-month follow-up. The primary endpoint for oncological efficacy, no cancer in ipsilateral side, was based on the 12-month mandatory biopsy. RESULTS: A total of 48 consecutive patients with a mean age of 67 years were included. The median (interquartile range) follow-up was 13.2 (7.4-26.5) months. Follow-up prostate biopsies were negative for the treated lobe in 86% of patients. The mean PSA concentration dropped significantly at 3 months (by 55%) but did not correlate well with positive biopsy results. Urinary symptoms were unchanged. A slight decrease in the IIEF-5 score was present at 3 months, but did not differ significantly from baseline at 6-month follow-up. There were 15% grade 1 and 4% grade 2 complications (Clavien classification). CONCLUSIONS: Focal cryoablation is a low-morbidity option in selected patients with low-risk PCa. We showed PSA concentration to be an unreliable marker for monitoring FC and recommend a protocol of mandatory biopsies for follow-up. A multicentre randomized controlled trial is necessary to confirm the low-morbidity and the biopsy-proven PCa cure rates.

Evaluation of erectile function after laparoscopic radical prostatectomy in a single center.

INTRODUCTION: To evaluate erectile function among men who had undergone laparoscopic radical prostatectomy and received postoperative medical therapy for erectile dysfunction. MATERIALS AND METHODS: We performed a prospective study in men who underwent laparoscopic radical prostatectomy between September 2003 and November 2005 at our center and who received penile rehabilitation after surgery. All patients had antegrade interfascial dissection. They received 10 mg tadalafil on the fifth postoperative day and continued to receive it every other day, regardless of erectile function. Intracavernous injection of alprostadil was initiated at 3 or 6 months depending on response to treatment with tadalafil. Follow up evaluations were done at 3, 6, 12, 18 and 24 months. Oncologic and functional outcomes and compliance were assessed. Patients filled in International Index of Erectile Function-5 (IIEF-5) questionnaires. RESULTS: Of 1078 men who underwent laparoscopic radical prostatectomy during this time, 586 patients met inclusion criteria, complied with the study medication, and had complete data for 24 months. The patients had a median preoperative baseline IIEF-5 score of 22. A total of 150 patients (26%) underwent unilateral nerve-sparing surgery, while 436 patients (74%) had bilateral nerve-sparing surgery. At 24 months, 35% of patients who underwent unilateral nerve-sparing surgery and 68% of patients who underwent bilateral nerve-sparing surgery reported having sufficient erectile function for intercourse without using intracavernous injection of alprostadil. At 24 months after surgery, the median IIEF-5 score was 13 (1-25) for the whole cohort, 5 (1-25) for patients who had undergone unilateral nerve-sparing surgery, and 15 (1-25) for patients who had undergone bilateral nerve-sparing surgery. CONCLUSIONS: The findings suggest that adequate patient selection and postoperative medical intervention allows the preservation or recovery of erectile function after laparoscopic radical prostatectomy. Inaccurate selection of patients and postoperative assessment might explain inferior erectile function results following this surgery.

Comparison of the rate, location and size of positive surgical margins after laparoscopic and robot-assisted laparoscopic radical prostatectomy.

OBJECTIVE: • To review and compare the rate, location and size of positive surgical margins (PSMs) after pure laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP). PATIENTS AND METHODS: • The study comprised 200 patients who underwent RALP and 200 patients who underwent LRP up to January 2008. • We compared patient age, body mass index, preoperative prostate-specific antigen (PSA), preoperative stage and grade, prostate size, pathological stage and grade and neurovascular bundle preservation, as well as PSM rate, size and location. • Continuous and categorical data were compared using Student's t-test and Pearson's chi-squared test. • Multivariate regression analyses were used to identify preoperative and intraoperative predictors of PSMs. RESULTS: • Although the PSM rate was similar between the two groups (LRP: 12% vs RALP: 13.5%; P = 0.76), location and size were not. PSMs after LRP were mostly at the apex (58.3%; P = 0.038), while most PSMs after RALP were posterolateral ([PL] 48%; P = 0.046). • In addition, the median margin size after RALP was significantly smaller than after LRP (RALP: 2 mm vs LRP: 3.5 mm; P = 0.041). • In univariate and multivariate analyses, tumour-node-metastasis (TNM) stage and preoperative PSA were the only independent preoperative predictors of PSMs (P = 0.044 and P = 0.01, respectively). CONCLUSION: • The PSM risk is dependent on TNM stage and preoperative PSA and not the surgical technique, when comparing LRP with RALP.

Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly. A feasibility study with 10 years follow-up.

PURPOSE: To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA ≤ 10 ng/mL, ≤ 3 positive biopsies with only 1 lobe involved, clinical stage ≤ T2a, Gleason score ≤ 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm® device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy. RESULTS: Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91%) patients. Overall survival was 83% (10/12) and cancer specific survival was 100% at 10 years. Two patients died from other causes. Recurrence free survival was 90% (95% CI; 0.71-1) at 5 years, and 38% (95% CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention. CONCLUSIONS: Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate long-term cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.

[Advocating a new health order]. / Plaidoyer pour un nouvel ordre sanitaire.

Le système de santé français reste à ce jour encore trop médico-centré Une véritable révolution doit s'opérer afin de le faire évoluer, nécessitant de revoir nos schémas de pensée habituels et d'intégrer les évolutions technologiques telles que l'intelligence artificielle D'autres acteurs peuvent y contribuer, comme les infirmiers en pratique avancée, grâce à une formation solide et une volonté politique forte.

Laparoscopic radical prostatectomy is feasible and effective in 'fit' senior men with localized prostate cancer.

OBJECTIVE To assess the effect of age and comorbidity on short-term complications, long-term continence and oncological outcome after laparoscopic radical prostatectomy (LRP) for localized prostate cancer. PATIENTS AND METHODS In all, 2048 consecutive men underwent LRP for localized prostate cancer in one institution. Comorbidity was assessed using the Charlson index. Short-term postoperative complications, transfusion rate, duration of hospital stay, long-term continence and oncological outcome were analysed by age and comorbidity classes. RESULTS Of the 2048 men, 297 were aged ≥ 70 years and 281 had a Charlson index of >0 (mainly diabetes 31%, chronic pulmonary disease 26%, prior other nonmetastatic cancer 16%, prior myocardial infarction 12%). Compared with younger men, senior men had significantly higher pathological stages and tumor grades. Of those 297 men aged ≥ 70 years, 90 (30.3%) developed biochemical relapse, none died from prostate cancer and five (1.7%) died from another cause over a median follow-up of 5 years. The occurrence and severity of short-term postoperative complications were more strongly related to comorbidity than chronological age. Multivariate analysis with stepwise regression confirmed that most important predictors of short-term postoperative complications were a Charlson index of ≥ 2, prostate weight of >80 g, obesity and age of ≥ 70 years. Postoperative continence significantly declined with age (ranging from 87% in men aged <60 years to 67.5% in men aged ≥ 70 years). Predictors of long-term incontinence were age of ≥ 70 years, obesity and need for perioperative transfusion. CONCLUSIONS LRP is feasible and effective in fit senior men (aged ≥ 70 years) with localized prostate cancer, including those at high risk of dying from it.

Radical prostatectomy: evolution of surgical technique from the laparoscopic point of view.

PURPOSE: To review the literature and present a current picture of the evolution in radical prostatectomy from the laparoscopic point of view. MATERIALS AND METHODS: We conducted an extensive Medline literature search. Articles obtained regarding laparoscopic radical prostatectomy (LRP) and our experience at Institut Montsouris were used for reassessing anatomical and technical issues in radical prostatectomy. RESULTS: LRP nuances were reassessed by surgical teams in order to verify possible weaknesses in their performance. Our basic approach was to carefully study the anatomy and pioneer open surgery descriptions in order to standardized and master a technique. The learning curve is presented in terms of an objective evaluation of outcomes for cancer control and functional results. In terms of technique-outcomes, there are several key elements in radical prostatectomy, such as dorsal vein control-apex exposure and nerve sparing with particular implications in oncological and functional results. Major variations among the surgical teams' performance and follow-up prevented objective comparisons in radical prostatectomy. The remarkable evolution of LRP needs to be supported by comprehensive results. CONCLUSIONS: Radical prostatectomy is a complex surgical operation with difficult objectives. Surgical technique should be standardized in order to allow an adequate and reliable performance in all settings, keeping in mind that cancer control remains the primary objective. Reassessing anatomy and a return to basics in surgical technique is the means to improve outcomes and overcome the difficult task of the learning curve, especially in minimally access urological surgery.

Current status of natural orifice trans-endoscopic surgery (NOTES) and laparoendoscopic single site surgery (LESS) in urologic surgery.

Laparoendoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09. Search terms included single port, single site, NOTES, LESS and single incision. A total of 412 manuscripts were initially identified. Out of these, 64 manuscripts were selected based in their urological content. The manuscript features subheadings for experimental and clinical studies, as NOTES-LESS is a new surgical technique and its future evolution will probably rely in initial verified feasibility. A subheading for reviews presents information regarding common language and consensus for the techniques. The issue of complications published in clinical series and the future needs of NOTES-LESS, are also presented.

Modified York-Mason technique for repair of iatrogenic rectourinary fistula: the montsouris experience.

PURPOSE: Rectourinary fistula is a devastating complication of rectal and genitourinary surgery. Spontaneous closure is rarely successful and failure in conservative management calls for surgical intervention. We present our experience with rectourinary fistula repair using a modified York-Mason technique. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all 12 patients who underwent modified York-Mason repair at our institution between 1998 and 2008. Rectourinary fistula developed in 10 patients after radical prostatectomy and in 2 following high intensity focused ultrasound. Six patients were initially treated with fecal diversion. Our approach begins with a transanal incision at the 2 o'clock position representing a modification of the classically described midline incision extending from the coccyx to the anal verge. Key aspects of the York-Mason procedure are maintained. However, we do not close the urethra after fistula excision, and instead perform a multilayer, nonoverlapping closure of the anterior rectal wall only. RESULTS: With a median followup of 22 months we observed the complete resolution of rectourinary fistula in all 12 patients. Three patients required multiple York-Mason procedures to achieve resolution of symptoms. All patients reported intact fecal continence. Median operative time and estimated blood loss were 63 minutes and 100 ml, respectively. Median hospital stay was 4 days. CONCLUSIONS: Our modified York-Mason technique is safe and effective for the repair of small, iatrogenic rectourinary fistula. We report 75%, 92% and 100% rectourinary fistula resolution after 1, 2 and 3 York-Mason procedures, respectively, with 100% fecal continence. This technique can be performed multiple times without a significant increase in operative time, estimated blood loss or fecal incontinence.

A 16-year clinical experience with intermittent androgen deprivation for prostate cancer: oncological results.

OBJECTIVE: To present oncological results with intermittent androgen deprivation (IAD) in a single center. METHODS: Between 1992 and 2008, 566 patients with prostate cancer (PC) were selected for a non-randomized study of IAD. Two hundred and eighteen patients had biochemical recurrence (BCR) after local treatment for PC and 348 patients had micro- or macro-metastatic disease. On-treatment period (ONTP) consisted of three-monthly injections of gonadatropin-releasing hormone (GnRH) agonist combined with daily oral androgen receptor antagonist. Off-treatment period (OFTP) was indicated when prostate-specific antigen (PSA) was <4 ng/ml. Criteria for resumption of hormonal therapy were PSA >20 ng/ml or clinical symptoms. Cancer specific survival curves were computed according to the Kaplan-Meier method. RESULTS: Median follow-up was 81 months (12-230). Median age was 74.7 years (52-92). Median Gleason score at diagnosis was 7 (3-9). Median initial PSA was 17 ng/ml (0.4-433). Cycle duration decreased progressively from 23 months for the 1st cycle to 10 months at 12th cycle. The number of patients who became hormone resistant was 182 (32%). Median cancer specific survival probability for the series is 12 (10.8-infinity) years. No previous treatment group showed a higher cancer specific survival probability (log rank test, CI 95%, P = 0.003) versus BCR group. Multivariate analysis of cancer specific survival demonstrates age, initial Gleason score and initial PSA level as significant factors affecting mortality (P < 0.05). CONCLUSIONS: Intermittent androgen deprivation is an acceptable treatment in different stages of PC. Duration of cycle decreased progressively during therapy. Age, Gleason score and PSA are factors predicting mortality.

Role of robotics for prostate cancer.

PURPOSE OF REVIEW: To describe how robotics became involved in prostate cancer as well as to highlight the most important developments in robotic prostate cancer treatment during the last year. RECENT FINDINGS: Refinements in technique during robotic-assisted laparoscopic prostatectomy have improved the early return of continence postoperatively. Mean positive surgical margin rates were lowest for robotic-assisted laparoscopic prostatectomy as compared to pure laparoscopic or open radical prostatectomy series. Sexual potency rates were similar among all surgical treatments of prostate cancer. SUMMARY: As the implementation of robotic technologies to treat prostate cancer continues to grow, randomized controlled trials will eventually provide a better comparison of results. The role of robotics in prostate cancer treatment is established, and continued technical advancements will ultimately improve patient outcomes.

Metastatic renal cell carcinoma management.

PURPOSE: To assess the current treatment of metastatic renal cell carcinoma, focusing on medical treatment options. MATERIAL AND METHODS: The most important recent publications have been selected after a literature search employing PubMed using the search terms: advanced and metastatic renal cell carcinoma, anti-angiogenesis drugs and systemic therapy; also significant meeting abstracts were consulted. RESULTS: Progress in understanding the molecular basis of renal cell carcinoma, especially related to genetics and angiogenesis, has been achieved mainly through of the study of von Hippel-Lindau disease. A great variety of active agents have been developed and tested in metastatic renal cell carcinoma (mRCC) patients. New specific molecular therapies in metastatic disease are discussed. Sunitinib, Sorafenib and Bevacizumab increase the progression-free survival when compared to therapy with cytokines. Temsirolimus increases overall survival in high-risk patients. Growth factors and regulatory enzymes, such as carbonic anhydrase IX may be targets for future therapies. CONCLUSIONS: A broader knowledge of clear cell carcinoma molecular biology has permitted the beginning of a new era in mRCC therapy. Benefits of these novel agents in terms of progression-free and overall survival have been observed in patients with mRCC, and, in many cases, have become the standard of care. Sunitinib is now considered the new reference first-line treatment for mRCC. Despite all the progress in recent years, complete responses are still very rare. Currently, many important issues regarding the use of these agents in the management of metastatic renal cancer still need to be properly addressed.

Health and quality of life in urology: issues in general urology and urological oncology.

OBJECTIVES: Frequently, the term "quality of life" has been used to justify personal and professional decisions in all fields of medicine. Nowadays, quality of life studies are based on development and validation of sensitive measures of patient outcomes, incorporating functional status and perceived health status. Thus, quality of life has become an outcome as important as survival and effectiveness. METHODS: A systematic review using Pubmed and Medline was performed, searching for papers concerning health related quality of life and urology. The most relevant articles where questionnaires and interviews were described and validated were listed. RESULTS: Based on psychometric properties, a search between 1970 and 2007 identified a total of 25 recommendable articles with generic inventories and specific modules that have been developed, validated and used in clinical practice or research. Historical aspects, quality of life concepts, validation of questionnaires and structured interviews, and most used instruments in generic health-related quality of life, general urology and urological oncology have been discussed. CONCLUSIONS: A brief review of historic background of health related quality of life and urology was performed.

[Intermittent androgen deprivation (IAD) for advanced prostate cancer. Why not the standard of therapy?]. / Bloqueo androgénico intermitente (BAI) en cáncer de próstata avanzado. Por qué no el tratamiento estándar?

SUMMARY OBJECTIVES: To review the literature and present a contemporary image of androgen deprivation for prostate cancer. METHODS: We conducted a PubMed search on intermittent androgen deprivation. Articles obtained on intermittent androgen deprivation (IAD) and the experiences at Institut Montsouris were used for the review. RESULTS: IAD is an approach to hormonal deprivation that holds effective cancer control while preventing the morbidity associated with continuous androgen blockade. IAD nuances have been assessed by urological community teams in order to verify its possible potential benefits. Evidence based approach supports the idea of IAD as a standard of therapy for advanced prostate cancer requiring hormone deprivation. Variation among medical teams' criteria for the treatment and surveillance await standardization. CONCLUSIONS: Reassessing the gold standard of hormonal blockade in advanced prostate cancer is mandatory.The undeniable evolution of IAD needs to be embraced by the urological community.

Differential expression of genes related to androgen and estrogen metabolism in hereditary versus sporadic prostate cancer.

The hereditary predisposition to prostate cancer is rare and accounts for <5% of cases. Except for younger age at diagnosis, no phenotypic features have been clearly associated with hereditary prostate cancer. The aim of the study was to analyze the expression of genes related to androgen and estrogen metabolism in both hereditary and sporadic prostate cancers in patients matched for clinicopathologic features. Tissues were obtained from patients included in a national familial prostate cancer registry. From the 120 cases of hereditary forms suggesting autosomal dominant Mendelian inheritance, 21 patients were treated by radical prostatectomy for whom formalin-fixed tissue was available. Twenty-one sporadic cases were then matched according to age, Gleason score, and pathologic stage. Immunohistochemistry was done on tissue microarray using antibodies directed against androgen receptor (AR), estrogen receptor alpha (ERA), estrogen receptor beta, 5alpha-reductase I and II, aromatase, and the proliferation marker Ki67. The percentage of AR-positive cancer cells was higher in hereditary cancer compared with sporadic cases (P < 0.004). In contrast, the mean number of ERA-positive stromal cells was lower in hereditary versus sporadic cancer (P < 0.03). This differential expression of AR and ERA suggests that a specific pattern of hormone receptors is associated with hereditary predisposition to prostate cancer.

Oncological evaluation of prostate sparing cystectomy: the Montsouris long-term results.

PURPOSE: Prostate sparing cystectomy provides an alternative therapeutic option in highly selected patients with invasive bladder cancer who wish to avoid the significant functional side effects of traditional surgery. Concern exists regarding the oncological safety of this technique especially with regard to the presence of prostatic urothelial cancer and incidental prostate adenocarcinoma. We present the long-term oncological outcomes of a large series of patients treated at a single institution. MATERIALS AND METHODS: Between October 1992 and June 2004 a total of 117 patients were selected for prostate sparing cystectomy after meeting the inclusion criteria. RESULTS: Nine patients underwent radical cystoprostatectomy after prostate urothelial carcinoma was diagnosed intraoperatively. Long-term oncological results (2 years minimum followup [mean 55 months]) are presented here for the remaining patients. The rate of local and distant recurrence was 4.7% and 34%, respectively, at 20 months. Overall survival at 5 years in our study was 67%, and 5-year disease-free survival rates were 77% for pT2 N0 or less, 44% for pT3 N0 or greater and 22% for pN+ disease. Of 6 patients found to have prostate adenocarcinoma in transurethral prostate resection specimens 1 was treated with high intensity focused ultrasound and 5 were followed with active surveillance, 2 of whom later died of bladder cancer. CONCLUSIONS: We report oncological data on the largest prospective cohort of patients, with the longest followup, treated by prostate sparing cystectomy to date. Outcomes are comparable with the largest published series of cystoprosatectomies. With appropriate screening the risk of a clinically significant prostate cancer appears to be low. For certain selected patients this technique represents a valuable additional option for treatment.

Alfuzosin 10 mg once daily for treating benign prostatic hyperplasia: a 3-year experience in real-life practice.

OBJECTIVES: To assess the 3-year efficacy and safety of the selective alpha(1)-blocker alfuzosin at 10 mg once daily in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) in 'real-life practice'. The influence of treatment response on the risk of acute urinary retention (AUR) and BPH-related surgery was also analysed. PATIENTS AND METHODS: In all, 689 European men (mean age 67.6 years) were enrolled by general practitioners in a 3-year open-label study with alfuzosin at 10 mg once daily. They were asked to complete the International Prostate Symptom Score (IPSS), its eighth question (bother score), and the Danish Prostatic Symptom Score for sexual function (DAN-PSSsex). Efficacy was analysed at the endpoint in the intent-to-treat population. The impact of baseline variables (age, PSA level, IPSS and bother severity) and dynamic variables (IPSS worsening of >or=4 points and bother at the last available assessment under treatment) on the risk of AUR and BPH-related surgery was evaluated. RESULTS: With alfuzosin, IPSS improved by 6.4 points (-33.4%) from baseline (P < 0.001), reaching >or=3 points and >6 points in 71.3% and 47.2% of men, respectively. There were also significant (P < 0.001) improvements from baseline in nocturia (-0.8, -25.5%), bother score (-1.7, -40.7%) and DAN-PSSsex weighted scores with treatment. Symptom relief was rapid and maintained over 3 years. Overall, 78 men (12.4%) had an IPSS worsening of >or=4 points, 16 (2.6%) had AUR, and 36 (5.7%) required BPH-related surgery. Symptom deterioration during treatment and high baseline PSA values were the best predictors of AUR and BPH-related surgery. Alfuzosin was well tolerated, dizziness being the most frequent adverse event (4.5%) possibly related to vasodilatation. Ejaculatory disorders were uncommon (0.4%). Changes in blood pressure remained marginal, including in men aged >or=65 years and those receiving antihypertensive agents. CONCLUSION: Alfuzosin administered for 3 years at 10 mg once daily in real-life practice is effective and well tolerated. High PSA values and symptom worsening under treatment appear the best predictors of AUR and BPH-related surgery in the long term. Treatment with alfuzosin might thus help to identify patients at risk of LUTS/BPH progression in order to optimize their management.

Molecular detection of localized prostate cancer using quantitative methylation-specific PCR on urinary cells obtained following prostate massage.

PURPOSE: The diagnosis of localized prostate cancer is difficult due to a lack of cancer-specific biomarkers. Many patients require repeat prostate biopsies to diagnose the disease. We investigated whether aberrant promoter hypermethylation in prostatic fluid could reliably detect prostate cancer. EXPERIMENTAL DESIGN: Urine samples were collected after prostate massage from 95 patients with localized prostate cancer undergoing radical prostatectomy (63 pT(1), 31 pT(2), and 1 pT(3)) and from 38 control patients. Ten genes (GSTP1, RASSF1a, ECDH1, APC, DAPK, MGMT, p14, p16, RARbeta2, and TIMP3) were investigated using quantitative real-time methylation-specific PCR. Receiver operator curves were generated. RESULTS: The frequency of gene methylation ranged from 6.3% (p14) to 83.2% (GSTP1) in prostate cancer patients. At least one gene was hypermethylated in 93% of cancer patients. The specificity of methylation was 0.74. Methylation was significantly more frequent (P < 0.05) in cancer than control patients for all genes except p14 and p16. According to receiver operator curve analysis, the four-gene combination of GSTP1 (0.86), RASSF1a (0.85), RARbeta2 (0.80), and APC (0.74) best discriminated malignant from nonmalignant cases. The sensitivity and accuracy of this four-gene set were 86% and 89%, respectively. CONCLUSIONS: The presence of aberrant methylation in urinary cells obtained after prostate massage is significantly associated with prostate cancer. A panel of four genes could stratify patients into low and high risk of having prostate cancer and optimize the need for repeat prostatic biopsies.

Is laparoscopy dying for radical prostatectomy?

Training in laparoscopic urology, extensive experimental work, and dedicated surgical performance constitute the foundation of advanced laparoscopic urology, which is currently a reasonable surgical option in pediatrics, reconstructive surgery, and oncology. This article discusses topics related to laparoscopic approaches for radical prostatectomy, focusing on their introduction, development, accomplishments, and current standards and future goals for the minimally invasive treatment of urologic diseases. We highlight the dynamic status of the laparoscopic approach for radical prostatectomy (pure or robotic-assisted) that constitutes one of the most rapidly evolving fields in urology.

[Treatment of localized prostate cancer]. / Les traitements du cancer localisé de la prostate.

Treatments for localized prostate cancer include radical prostatectomy, brachytherapy, conformal external beam irradiation, and focused ultrasound. This paper describes the oncologic and functional results of each approach. The treatment choice depends on the patient's general status and on the results of biopsy and imaging studies. Watchful waiting and hormone therapy are other options for elderly patients.