Base bibliographique

Sommaire :

Place et modalités de la chirurgie des métastases hépatiques des cancers urologiques
2008
- Réf : Prog Urol, 2008, 18, S256, suppl. S7
       

The liver is the third localisation of metastatic urological tumours after the bone and the lungs. Most frequently, it occurs as a multimetastatic disease for which surgery is not feasible. Nevertheless, when the metastasis is unique and when resection can be complete, it can be proposed if the localisation and the global prognosis permit. Recent therapeutic progress, including new improved drugs, progress in surgical procedures and the multisciplinary approach, lead to propose tumorectomy or hepatectomy for a few selected patients with hepatic metastasis from urological tumours.

Place et Modalités de la chirurgie des métastases vertébrales des cancers urologiques
2008
- Réf : Prog Urol, 2008, 18, S239, suppl. S7
       

The improved survival rate in urologic carcinoma notably due to anti-angiogenic drugs is directly associated with increased incidence of spinal metastases. During spinal metastasis cord compression it has been proved that surgery associated with radiotherapy gives better results that radiotherapy alone. The neurotoxic risk of the spine metastasis must be evaluated before neurological signs appear in order to propose, if necessary decompressive surgery with stabilisation of the lesion. The choices of therapeutic approach are quite large ranging from percutaneous cimentoplasty to vertebral replacement. It is essential that the initial treatment of metastasis be discussed before neurologic signs appear.

Prise en charge chirurgicale des métastases rétropéritonéales des tumeurs germinales du testicule
2008
- Réf : Prog Urol, 2008, 18, S382, suppl. S7
       

The surgery of residual retroperitoneal tumors is a compulsory prolongation of chemotherapy in non seminomatous germ cell tumors. The requirements of total resection must be respected. High morbidity of bilateral lymphadenectomy for large bulky disease is possible and implies specialised surgery. The extent of surgery can be limited to a template area in specific circumstances.

Prise en charge des métastases cérébrales des cancers urologiques
2008
- Réf : Prog Urol, 2008, 18, S234, suppl. S7
       

Brain metastases account for 30 to 40% of all brain tumors in adults. Even if urological carcinomas are not very common, anti-angiogenic drugs have transformed their prognosis, leading physicians to consider their specific treatment.

For the majority of cases, surgery is quite simple with low associated morbidity. Depending on the size and the location, surgery or stereotaxic radiotherapy should be discussed. As soon as the metastasis is suspected a neurosurgerical opinion must be sought before beginning any treatment to coordinate the global management.

Prise en charge du cancer de prostate métastasé androgéno-indépendant
2008
- Réf : Prog Urol, 2008, 18, S343, suppl. S7
       

After first line hormonal therapy (agonist LHRH), metastasic prostate cancer becomes androgen independent in a period of 18 months on average. After this period and after having verified the castration by blood testosterone level, a few options are possible: either inhibit adrenal androgens by maximum androgen blockage (+anti androgens) or by specific adrenal androgen inhibitors. It is also possible to use estrogen or, in a few cases, to propose chemotherapy.

Prise en charge du cancer rénal métastatique
2008
- Réf : Prog Urol, 2008, 18, S298, suppl. S7
       

Metastatic renal carcinoma concerns 30 to 50% of patients. The principal localisations are lung, liver, bone and brain. In case of unique localisation the treatment is almost surgical whatever the organ may be with sometimes long remissions. In case of many localisations, targeted therapy is the gold standard of treatment in first or second line. In France, today, 4 drugs are currently approved (sunitinib, sorafenib, temsirolimus, bevacizumab). Because of a poor prognosis trials testing combinaison of therapies are required to benefit patients. At least nephrectomy is necessary looking forward prospective studies to estimate its real impact.

Sites métastatiques atypiques des tumeurs germinales du testicule
2008
- Réf : Prog Urol, 2008, 18, S388, suppl. S7
       

Testicular carcinoma metastatic are most frequently localized in lungs, liver, brain or bone. Nevertheless many other areas have also been described. Using Pubmed and Cochrane the most exhaustive research possible has been carried out to list these secondary prostate carcinoma lesions.

Sites métastatiques atypiques des tumeurs urothéliales
2008
- Réf : Prog Urol, 2008, 18, S289, suppl. S7
       

The liver, the lungs lung and bone are the most frequent sites for urothelial carcinoma metastasis. Nevertheless many other areas have also been described. Using Pubmed and Cochrane the most exhaustive research possible has been carried out to list these secondary urothelial carcinoma lesions.

Sites métastatiques atypiques du cancer du pénis
2008
- Réf : Prog Urol, 2008, 18, S396, suppl. S7
       

The liver, the lungs lung and bone are the most frequent sites for urothelial carcinoma metastasis. Nevertheless many other areas have also been described. Using Pubmed and Cochrane the most exhaustive research possible has been carried out to list these secondary urothelial carcinoma lesions.

Sites métastatiques atypiques du cancer du rein
2008
- Réf : Prog Urol, 2008, 18, S320, suppl. S7
       

The lung, the liver, the bone tissue and the brain are the most frequent site for renal cell carcinoma metastasis. Nevertheless many other areas have also been described. Using Pubmed and Cochrane the most exhaustive research possible has been carried out to list these secondary renal carcinoma lesions.

Thérapies ciblées
2008
- Réf : Prog Urol, 2008, 18, S228, suppl. S7
       

The definition of targets in the metastatic process has been a major step. Targeted therapy is composed of molecules which block these targets including ligand-binding antibody or receptor–inhibitors. Their mechanisms of action are not limited to angiogenesis but also concern apoptosis, bone marrow progenitor stem cells, vascularisation and immune response. An important number of drugs is still approved. However the metastatic disease is not yet curable. A better understanding will lead to develop others new targeted molecules or more efficient combination therapy.

Traitement chirurgical des métastases des os longs des cancers urologiques
2008
- Réf : Prog Urol, 2008, 18, S246, suppl. S7
       

Orthopedic surgery is an important part in the treatment of metastatic bone disease of urologic cancers. It integrates in with the multidisciplinary care focused on the improvement of the patient’s comfort and autonomy. The long bones affect presents a grave fractural risk that is sometimes difficult to evaluate. There are several different therapeutic possibilities: prophylactic internal fixation, stabilisation of pathologic fracture, orthopedic cement filling, resection arthroplasty and en bloc resection. The choice of surgical treatment stresses the survival and fonctional risk of the metastasis. From palliative to curative, surgical treatment is evolving with the use of newer chemotherapies.

Traitement médical des tumeurs germinales testiculaires au stade métastatique
2008
- Réf : Prog Urol, 2008, 18, S376, suppl. S7
       

The treatment options in metastatic testicular germ cell cancer are based on prognostic the factor-based staging system from IGCCCG. Since 1987 (!), the optimal chemotherapy regimen has been BEP with a weekly administration of 30mg of bleomycine, and a 3 or 5-day schedule of 500mg/m2 etoposide and 100mg/m2 cisplatin. Dose reduction of this regimen or use of carboplatin provide lower efficacy and should be abandoned.

As a first line treatment, 3 cycles of BEP should be used in good-risk metastatic nonseminomatous germ cell tumours whereas 4 cycles of BEP are mandatory in poor-risk nonseminomatous cancers. No other chemotherapy regimen has proven superior efficacy. In the lack of specific controlled studies, metastatic seminoma should be treated as nonseminomatous tumours. As second line treatment, VeIP, high-dose chemotherapy with autologous stem cell transplantation and paclitaxel are the main options. Precise predictive factors of recurrence are needed to better define indications of first and other lines of treatment in specific situations such as non-resected residual seminoma.

Y-a-t-il une place pour la chirurgie dans les tumeurs urothéliales métastasées ?
2008
- Réf : Prog Urol, 2008, 18, S285, suppl. S7
       

Although surgery has a limited role in the management of metastatic urothelial carcinoma patients, it can be envisaged in association with chemotherapy. In highly symptomatic patients and for complete response patients, cystectomy can be part of a multimodal approach. Metastasis resection can also be proposed in association with chemotherapy in case of complete response. In case of non responsive metastasis, metastasectomy can also de discussed in order to improve quality of life.

Cancer de prostate : actualités 2008 : Prostate cancer: news in 2008
2008
- Réf : Prog Urol, 2008, 18, S116, suppl. S6
       

In 2007, prostate cancer was the subject of a large number of communications in international conferences. The most innovating studies that are likely to modify patient management were selected. The topics included cancer detection, active surveillance, surgery and treatment of urinary incontinence after prostatectomy, radiotherapy, and high-intensity focalized ultrasound (HIFU). Current hormone treatment modalities as well as the new therapies for hormone-resistant prostate cancer management were also evaluated in detail.

Cancer de vessie : actualités 2008
2008
- Réf : Prog Urol, 2008, 18, S125, suppl. S6
       

In 2007, urothelial cancers were the subject of a large number of varied communications in international conferences. Some of the most innovating studies likely to modify patient management were selected. Regarding non muscle-invading tumors, maintenance treatments using intravesical instillations were emphasized. Laser and laparoscopy were assessed in urothelial tumors of the upper urinary tract. Finally, new radiochemotherapy protocols have appeared for infiltrating bladder tumors. Extended lymphadenectomy and laparoscopy were also evaluated in detail.

Cancer du rein : actualités 2008
2008
- Réf : Prog Urol, 2008, 18, S135, suppl. S6
       

The most innovating studies presented at the 2007 international conferences in the field of kidney cancer were selected. The notable topics presented covered diagnostic biopsies and the growing place of conservative surgery and laparoscopy in kidney cancer management. For cases with poor prognosis, the new anti-angiogenic therapies were thoroughly evaluated.

Cancers du pénis et du testicule : actualités 2008
2008
- Réf : Prog Urol, 2008, 18, S130, suppl. S6
       

In the 2007 international conferences, a certain number of communications were devoted to the cancers of the male external genital organs. The most innovating studies were selected. In the pure testicular seminomas, radiotherapy was compared to carboplatin in adjuvant treatment. Active surveillance of stage la germinal tumors was evaluated. In penis cancer management, curietherapy in early-stage treatment was reported, and sentinel lymph node detection was covered in many studies.

Éditorial
2008
- Éditorial
- Réf : Prog Urol, 2008, 18, S115, suppl. S6
         
Intérêt des anti-angiogéniques dans le cancer du rein localement avancé et métastatique en situation néo-adjuvante : à propos de 2 cas
2008
- Réf : Prog Urol, 2008, 18, S88, suppl. S4




 


New antiangiogenic molecules have proven an advantage in term of survival in metastatic renal cell carcinoma. We describe herein two clinical cases showing the efficacy of antiangiogenic agent in locally advanced or metastatic renal cell carcinoma. In this cases the surgical management has been altered in front of an important tumor necrosis provided by this treatment. The role of antiangiogenic agents as adjuvant or neo adjuvant therapy has not yet been defined precisely. However, these new molecules open new perspectives in the therapeutic field of metastatic renal cell carcinoma notably in case of bulky tumors which appeared difficult to remove surgically at first look or in case of early recurrence after radical nephrectomy.

Les anti-angiogéniques : de nouveaux standards thérapeutiques dans le cancer du rein métastatique
2008
- Réf : Prog Urol, 2008, 18, S69, suppl. S4




 


Since 2004, the treatment of metastatic renal cell carcinoma is in deep mutation. Before, the Management was mostly relying on the use of cytokines in association with radical nephrectomy. From 2004, studies of new antiangiogenic molecules, acting on the pVHL-HIF way, VEGF, PDGF or tyrosine-kinase receptors have modified the management of metastatic patients. Antiangiogenic agents improve progression-free survival as shown with sunitinib, in first line treatment, or sorafenib, as second line treatment. The m-TOR inhibitors (Temsirolimus), can be used with a benefit on overall survival in case of poor prognosis renal cell carcinoma or non clear cell carcinoma. Lastly, bevacizumab, an antibody re-combining humanized monoclonal, is able to target VEGF. Side effects are different for each molecule and are not negligible. Nevertheless, the place of these molecules have to be defined in the sequence of the treatment.

Prise en charge du cancer du rein en 2007 : actualités et recommandations
2008
- Réf : Prog Urol, 2008, 18, S81, suppl. S4




 


In case of a single renal cell carcinoma strictly located in the kidney, the radical nephrectomy remains the treatment of choice. However, it has been estimated that nearly 30 to 40 % of renal cell carcinoma are about to recur after primitive surgery. In certain cases, conservative surgery can be discussed as an alternative to radical treatment, especially in case of exophytic renal tumour or less than 4 cm in diameter. New ablative techniques (radiofrequency and cryoablation) have shown promising results but the follow-up is still very limited. French national recommendation regarding kidney cancer have been updated in 2007 and following the development of clinical trials using antiangiogenic agents. Regarding the use of antiangiogenic agents, several points have to be taken into account: existence of renal cell carcinoma, presence of metastasis, number of metastasis, location and risk factor prognosis determination.

Traitement anti-angiogénique et cancer du rein : essais en cours et perspectives d'avenir
2008
- Réf : Prog Urol, 2008, 18, S77, suppl. S4
       

Anti-angiogenic agents have modified therapeutic strategies in the management of metastatic renal cell carcinoma. Regarding molecules that already available such as sunitinib, sorafenib, temsirolimus and bevacizumab, clinical trials are now focused on the improvement of their effectiveness, overall survival, response’s criteria and toxicity. In the light of recent data, these treatments will be tested in adjuvant situation to radical nephrectomy, but also as an alternative option to radical surgery. The place of radical nephrectomy in metastatic renal cell carcinoma has been recently strongly discussed. I n the future, the systematic radical surgery will not be a rule any more. From now on, renal cell carcinoma patients have to be included in numerous ongoing therapeutic trials to manage anti-angiogenic agents in the best manner.

Apport de l'étude PCPT dans le traitement par finastéride des troubles mictionnels liés à l'hyperplasie bénigne de la prostate
2008
- Réf : Prog Urol, 2008, 18, 53-57, suppl. S3




 


Two landmark multi-centre trials, MTOPS and PCPT, have shown that finasteride is an effective treatment of micturitional disorders due to benign prostatic hyperplasia, reducing the clinical progression of BPH. The MTOPS trial showed for the first time the medium term benefit which patients could obtain with combined treatment in reducing the risks of the symptoms aggravating, urinary retention, surgery, renal failure, infection and incontinence. The PCPT trial showed finasteride to be beneficial in reducing the clinical progression of BPH. These trials defined risk factors for progression: PSA concentration over 1.6 ng/ml, prostate volume over 31 ml, urine output less than 10.6 ml/sec, age over 62 years old and post-micturitional residual volume of more than 39 ml. A 19% reduction in prostatic volume was also seen at 4.5 years on finastéride compared to a 24% increase on placebo. According to recommendations, the use of combined treatment is reserved for patients with moderate to severe urinary disorders after failure of first line monotherapy.

Aspects économiques et politiques de la prévention du cancer de la prostate
2008
- Réf : Prog Urol, 2008, 18, 66-68, suppl. S3




 


Deciding on a health policy in practice means dedicating human and financial resources and prioritising spendings. The economic evaluation of prevention strategies attempts to establish a relationship between the medical benefit of prevention and its additional cost (or in some cases cost reduction) compared to no prevention. Decisions on reimbursing drugs, interventions or funding health programmes do not usually follow efficiency criteria which define economic rationality. Politics may for example decide to make prostate cancer a public health priority if mortality in a country or in some regions of the country appears to be excessively high. Economic rationality alone is not an appropriate factor on which to base a decision which may be purely political, reflecting the actual values of the society at a given point in time.

Éditorial
2008
- Éditorial
- Réf : Prog Urol, 2008, 18, 39, suppl. S3


Étude PCPT : les biais attendus et leur gestion
2008
- Réf : Prog Urol, 2008, 18, 44-46, suppl. S3




 


The aim of the PCPT trial was to compare the incidence of prostate cancer in men treated with finasteride or placebo. The study protocol contains some methodological difficulties. Solutions were adopted designed to minimise damaging bias which could have incorrectly suggested that finasteride was beneficial, or masked a benefit of the drug. As finastéride reduced PSA by an average of 50% the PSA values were interpreted against a new threshold to provide as many biopsies in the finasteride arm as in the placebo arm. In view of the reduction in gland volume, the biopsy protocol was modified to prioritise lateral peripheral cores. Patient adherence to treatment in the finasteride arm and contamination of the placebo arm by people taking finasteride retrospectively after randomisation were taken into account. The increase in sensitivity of rectal examination and in the number of prostatic resections in the placebo arm were also two sources of bias in favour of finasteride. The different envisaged sources of bias were analysed and plans were adopted to manage these wherever possible. Analysis of the sources of bias led to the conclusion that systematic end of trial biopsies constituted the most robust end point.

L'étude PCPT
2008
- Réf : Prog Urol, 2008, 18, 40-43, suppl. S3




 


The PCPT trial is the first phase III trial with the principal objective of examining the hypothesis that the use of chemoprevention could prevent the development of prostate cancer. This is a large scale randomised clinical trial comparing finasteride (5-⍺ reductase inhibitor) to placebo. A total of 18,882 men aged 55 years old or above with unremarkable rectal examination and serum PSA below 3 ng/ml were randomised between daily treatment with 5 mg of finasteride or placebo for 7 years. The incidence of prostate cancer diagnosed by biopsy was 24.4% in the placebo group compared to 18.4% in the finasteride group. The incidence of high Gleason grade cancers (7-10) in the finasteride group (6.4%) appeared to be higher than in the placebo group (5.1%) although it was subsequently shown that these results were not significant. Sexual adverse effects were more common in the finasteride group and urinary symptoms were more common in the placebo group than in the finasteride group. The volumes of prostates treated with finasteride were reduced by 24% compared to the placebo arm. It does not therefore appear at present appropriate to give finasteride to prevent the development of prostate cancer until more detailed results are available about the nature of the cancers which may possibly have been detected or avoided.

Le point de vue du pathologiste concernant l'étude PCPT
2008
- Réf : Prog Urol, 2008, 18, 47-52, suppl. S3




 


The PCPT (Prostate Cancer Prevention Trial) trial which compared 5 mg/d of finastéride to placebo in men over 55 years old showed that active treatment reduced the incidence of prostate cancer from 24.4 to 18.4%. Paradoxically, the incidence of high grade cancers (Gleason score ≥ 7) was higher in the finasteride group (6.4%) than in the placebo group (5.1%). Histological interpretation of the radical prostatectomy specimens showed an overestimation of Gleason score on biopsy both in the finasteride and placebo group. The high grade cancers on total prostatectomy specimens were not more aggressive in the finasteride arm than in the placebo arm. There is no argument to suggest that long term finasteride may promote the development of highly aggressive cancer. Urologists must clearly be aware that finasteride treatment may result in morphological changes in order to inform the pathologist that this drug is being taken. If a prostate cancer with a Gleason score ≥ 7 is diagnosed in a treated patient, the pathologist will perform a double reading of the slides to confirm the score.

Pertinence d'une chimioprévention à partir de l'étude PCPT
2008
- Réf : Prog Urol, 2008, 18, 63-65, suppl. S3




 


Chemoprevention involves the active use of a drug inhibiting carcinogenesis in order to prevent the development of cancer. Prostate cancer has a high prevalence, long latent period and screening is inadequate. The morbidity and mortality of prostate cancer are significant, making it a good candidate for chemoprevention. Finasteride meets most of the necessary criteria for a chemoprevention agent. Nevertheless, some further information still needs to be obtained before considering its use in practice: the real nature of the increase in Gleason score, envisaged health savings, side effects on sexuality, impact on patient survival and the ideal target population.