Base bibliographique

Sommaire :

Projection de l'incidence et de la mortalité par cancer urologique en France en 2010
- Réf : Prog Urol, 2010, 20, S211, suppl. S4


Recommandations de bonnes pratiques cliniques : diagnostic, traitement et suivi des cancers urologiques chez l'homme et la femme
- Réf : Prog Urol, 2010, 20, S205, suppl. S4


Recommandations en Onco-Urologie 2010 : Cancer de la prostate
- Réf : Prog Urol, 2010, 20, S217, suppl. S4


Recommandations en Onco-Urologie 2010 : Cancer du rein
- Réf : Prog Urol, 2010, 20, S319, suppl. S4


Recommandations en Onco-Urologie 2010 : Tumeurs germinales du testicule
- Réf : Prog Urol, 2010, 20, S297, suppl. S4


Recommandations en Onco-Urologie 2010 : Tumeurs malignes du pénis
- Réf : Prog Urol, 2010, 20, S279, suppl. S4


Recommandations en Onco-Urologie 2010 : Tumeurs urothéliales
- Réf : Prog Urol, 2010, 20, S255, suppl. S4


Sarcomes du rétropéritoine : Contribution du CCAFU au référentiel INCa
- Réf : Prog Urol, 2010, 20, S290, suppl. S4


Tumeurs malignes de la surrénale : Contribution du CCAFU au référentiel INCa
- Réf : Prog Urol, 2010, 20, S310, suppl. S4


Actualités dans les cancers de prostate non localisés : diagnostic, traitement et voies d'avenir
- Réf : Prog Urol, 2010, 20, S198, suppl. S3


Incidence of prostate cancer is constantly growing no matter of the stage of the disease. Locally advanced tumours and metastatic stages of the disease are not exception. Nevertheless, management of advanced prostate cancer is still uncertain. Thus, non invasive molecular or imaging techniques have been proposed to optimize the diagnosis of advanced prostate cancer. The debate is still ongoing regarding therapeutic options to offer to the patient to obtain the optimal oncologic control. Radical prostatectomy can now be considered as an option in certain cases of high-risk prostate cancer, on the basis of a multimodal treatment. The field of hormonotherapy is also evolving. New molecules (GnRH Antagonists, anti androgen) or new modalities of prescription (six-month GnRH agonist) appear. The prescription modalities evolve as well (e.g.; intermittent treatment). Lastly, chemotherapy is now proposed for metastatic symptomatic prostate cancer but also for locally advanced disease. Basic research and genetic investigations are still ongoing to explore pathways and factors of progression to the metastatic status and to find the most appropriate treatment for each patient.

Chimiothérapie en phase précoce d'hormonorésistance des cancers de prostate métastatiques : quelles indications ?
- Réf : Prog Urol, 2010, 20, S192, suppl. S3


Treatment of hormone-refractory prostate cancer remains a source of debate. Since 2004, docétaxel-based chemotherapy has become the standard treatment as it has demonstrated efficacy on overall survival in two randomized studies. In some studies, chemotherapy seems to be also effective on pain relief. The adverse effects occur more frequently than with others chemotherapy (mitoxantrone) but are moderated and aren’t responsible of specific mortality. These facts encourage to begin the chemotherapy as earlier as possible even before metastases appear. Some studies have even raised the issue of an initiation of chemotherapy before the onset of hormone independence. However these arguments might be use with caution. The treated patients have a limited life expectancy and a 2 months gain of survival may be of limited value. Furthermore, even low side effects can generate a morbidity on these fragile patients especially when they are initially asymptomatic. Thus, an early initiation of chemotherapy must be discussed case by case, on an individual basis. The prognosis factors and alternative therapeutic options based on new molecules used in metastatic cancer might also be considered for the therapeutic decision.

Hormonothérapie combinée à la radiothérapie externe dans le cancer de prostate localement avancé : les effets secondaires contrecarrent-ils les bénéfices ?
- Réf : Prog Urol, 2010, 20, S186, suppl. S3


Used for more than 60 years in metastatic prostate cancers, hormone therapy is nowadays also an option for the treatment of locally advanced prostate cancer. Adjuvant androgen deprivation combined with external beam radiotherapy has become the gold standard treatment in locally advanced prostate cancer. Combined therapy has been extensively investigated and has shown to improve oncologic outcomes. However, its toxicity is not negligible. Several side effects can be encountered: cardiovascular, bone depletion, metabolic changes and neuropsychologic effects. They may overlap treatment benefits and be responsible of a specific mortality. Nevertheless, randomized studies have demonstrated that there was no increase of specific mortality from combined treatments compared to patients treated by radiotherapy alone. Therefore, these side effects might not be a barrier to adjuvant androgenic deprivation. However, long-term results are still needed and also accurate morbidity studies. In addition, the debate is still ongoing regarding the appropriate duration of hormone therapy.

Surveillance active du cancer de prostate localisé
- Réf : Prog Urol, 2010, 20, S181, suppl. S3


The widespread application of PSA screening has led to an important increase of the small and well-differentiated prostate cancer. Despite natural history of prostate cancer has not been completely elucidated; it has been proved that the evolution of low grade tumours was favorable and that some of them remain indolent. In these cases, curative therapies and their associated morbities might be considered as overtreatment. Active surveillance should be an option to limit this overtreatment. It is obvious that the initial risk stratification used for active surveillance wasn’t enough restrictive. From now on, it seems that a PSA<10 ng/ml, a Gleason score<7 and more than 10 prostate biopsies are the good criteria to propose for the selection of eligible patients. However, the debate about adequate and accurate criteria is still ongoing between several teams worldwide involved in active surveillance. International prospective studies are in progress and are necessary to establish selections criteria and modalities of surveillance and predictors of active treatment. We need to wait for conclusion from prospective studies results. However, it appears that active surveillance offers yet the possibility to delay active treatment and its complications in selected cases.

Avancées et synthèse des derniers congrès : ASCO-GU, EAU, AUA, ASCO concernant la prise en charge médicale des cancers urothéliaux
- Réf : Prog Urol, 2010, 20, S38, suppl. S1


During the EAU and AUA congress in 2009, major work about the urothelial carcinoma was interested in the classification T1a / b and its therapeutic consequences, the last results of BCG therapy and photodynamic diagnosis. At ASCO congress, the main studies presented focused on the systemic treatment, in adjuvant situation, in first line treatment of metastatic bladder cancer, particularly with the addition of anti-angiogenic to chemotherapy, and in conservative treatment in association with radiotherapy.

Avancées et synthèse des derniers congrès : ASCO-GU, EAU, AUA, ASCO concernant la prise en charge médicale du cancer du rein localement avancé ou métastatique
- Réf : Prog Urol, 2010, 20, S11, suppl. S1


During the recent congress of urology and oncology key topics discussed were the evolution of survival data in metastatic kidney cancer which median is now around 40 months, persistent questions about the role of nephrectomy, including access to the systemic treatment of nephrectomized patients and tumor resectability induced by systemic therapies, the emergence of new prognostic models which are adapted to new therapeutic standards, and the emergence of promising new drugs including pazopanib. This article describes these advances.

Cancer de la prostate localement avancé et hormonothérapie
- Réf : Prog Urol, 2010, 20, S68, suppl. S1


In case of biochemical recurrence after radical prostatectomy, hormonal treatments are equally efficient. Early hormonal treatment after biochemical recurrence reduces specific mortality, local and metastatic progression. In locally advanced prostate cancer, adjuvant radiation therapy after biochemical recurrence reduces local and metastatic recurrence. Withdrawal of the steroid hormone should be the first maneuver after primary hormonal therapy failure. Second generation anti-androgens (abiraterone and MDV 3100) should be released soon. These new hormonal agents are in clinical trials and show promising activity in patients with CRPC.

Cancer du rein : quels sont les critères pour juger de l'échec d'un traitement anti-angiogénique ? À propos d'un cas
- Réf : Prog Urol, 2010, 20, S23, suppl. S1


Failure criteria of antiangiogenic treatment that must make envisage a change of molecule are still difficult to define. Concerning the evaluation of the response, if the RECIST criteria seem to be limited, several other tools of evaluation (clinical, radiological or biological tools) can be interesting. It is the case of contrast-enhanced ultra-sonography, but a precise definition of functional parameters should be defined and a standardization of the technique is necessary.

Side effects do not translate necessarily a treatment failure. They must be estimated by taking into account the frequency of some of symptoms. Asthenia is noticed in more than 50% of the patients ; it is however necessary to exclude another aetiology, in particular iatrogenic hypothyroidism.

Cancer du rein : traitements anti-angiogéniques et gestion des complications. À propos d'un cas
- Réf : Prog Urol, 2010, 20, S27, suppl. S1


Direct side effects of the inhibition of activation of VEGF receptors are well known and could be easily explained (HTA). The indirect toxicity of the inhibitors of tyrosinekinases is much less known and several hypotheses appear. Usually, the common side effects of the inhibitors of tyrosine-kinases can be easily managed and are reversible when the treatment is stopped.

Their management is essentially based on prevention measures. It is necessary to stop definitively or temporarily the treatment in case of intensification of pre-existing comorbidities or side effects of rank 3 or 4. There is no predictive factor of treatment toxicity and, at the moment, there is thus no indication in a previous dose adaptation.

Cancer du rein métastatique : bilan préthérapeutique, instauration et suivi d'un traitement anti-angiogénique. À propos d'un cas
- Réf : Prog Urol, 2010, 20, S16, suppl. S1


Antiangiogenic treatment initiation justifies a clinical and biological pretherapeutic assessment and a close follow-up of side effects according to each drug. Because of potential healing complications, a deadline of 4 weeks after surgery is recommended before starting antiangiogenic treatment. The optimal sequence and the potential role of neo-adjuvant therapies remain to define. In the absence of prospective data, nephrectomy is still recommended in renal cell carcinoma management

Diffusion métastatique, angiogenèse et métastasogenèse
- Réf : Prog Urol, 2010, 20, S5, suppl. S1


Metastatic diffusion is the result of a progressive, well structured and organized cascade of steps. The angiogenesis, the epithelial mesenchymal transition, the premetastatic niche or the metastatic signature theory are considered as new concepts which participate in an irreversible process which escapes from the host control. The capacity to colonize one organ and not another could be explained by the “seed and soil” theory which postulates that tumor cells (the seed) will only grow in an appropriate tissue microenvironment (the soil). At the opposite, the concept of a metastatic gene expression pattern which is (or is not) expressed in the primary tumor is in opposition with the classical clonal selection hypothesis.

Inhibiteurs du récepteur A de l'endothéline
- Réf : Prog Urol, 2010, 20, S77, suppl. S1


Endothelin-1 (ET-1) is a vasoactive peptide but also mitogenic and pro-angiogenic. ET-1 exerts its actions via two G protein-coupled receptors, ETA and ETB. ET-1 is involved in the progression of prostate cancer. Its actions affect the tumor cell proliferation, inhibition of apoptosis, angiogenesis, migration, invasion, metastasis to the bone growth. Inhibitors of receptors of ET-1 in clinical development are the atrasentan and ZD4054. This article reports on controlled, randomized, phase II and III studies on this new therapeutic class.

La néphrectomie est-elle indispensable en cas de métastases ?
- Réf : Prog Urol, 2010, 20, S33, suppl. S1


Cytoredutive nephrectomy is a component of metastatic renal cell carcinoma management. This procedure can induce a spontaneous regression of metastases in a small number of cases. It increases the overall survival of correctly selected patients treated with immunotherapy. However, we still do not know if this benefit remains for patient treated with targeted therapies.

In the three main prospective randomized studies evaluating targeted therapies, the majority of included patients have had prior nephrectomy. However, this surgical procedure is not without risk and could delay initiation of medical treatment. Age of patient, comorbidities, histologic pattern and surgical difficulties should be taken into account.

Until results of prospective studies, the cytoreductive nephrectomy should be still considered as component of the treatment of metastatic renal cell carcinoma.

La vie d'une molécule, des essais à l'enregistrement : spécificité de l'oncologie
- Réf : Prog Urol, 2010, 20, S1, suppl. S1


Pharmaceutical research and development in France is an important and dynamic economic sector that places France among the countries most involved in research. However, economic constraints have precipitated major changes in this industry. The costs associated with the genesis of a drug, from discovery to marketing, are increasing, forcing the industry to adapt. Here we discuss the motivations of the pharmaceutical industry in oncology so that the medico-surgical specialist of the cancers of the genito-urinary tract can best understand the situation.

Le point sur les indications de l'Hexvix ® en 2009
- Réf : Prog Urol, 2010, 20, S50, suppl. S1


Fluorescence cystoscopy improves the detection of non-muscle-invasive bladder cancer, particularly carcinoma in situ, and reduces recurrence. The technique is well tolerated with few side effects. Guidelines recommend fluorescence cystoscopy in multifocal tumors, tumors >3cm, early recurrence, High grade cytology, follow-up of high-risk bladder cancer (T1G3 and CIS).

Les essais cliniques français GETUG et AFU en cours concernant les carcinomes urothéliaux et les cancers du rein et de prostate
- Réf : Prog Urol, 2010, 20, S84, suppl. S1


The collaboration of the Association Française d’Urologie (AFU) and of the Groupe d’Etude des Tumeurs Uro-Genital (GETUG) has lead to increase more and more the credibility of French clinical trials in onco-urology. These trials are on the same level ast North American or European studies. The involvement of urologists is essential. Therefore it seemed necessary to do an update on ongoing trials to further increase recruitment from all practitioners involved in onco-urology.

Les nouveautés 2009 sur le cancer de la prostate : les points forts de l'ASTRO, l'EAU, l'ASCO et l'AUA
- Réf : Prog Urol, 2010, 20, S61, suppl. S1


In 2009, prostate cancer was the subject of a large number of communications in international urologic, oncologic and radiation therapy conferences. The most interesting studies that are likely to modify physician’s daily practice were selected. This year the results from the European (ERSPC) and the American (PLCO) mass screening studies. Many abstract on prevention, natural history and tumor markers such as PCa3 and fusion gene TMPRSS2 : ERG were presented. Adjuvant hormonal treatment was evaluated in high-risk patients. Hormonal and radiation therapy association reduces recurrence, specific and overall mortality in locally advanced prostate cancer. Intermittent hormonal treatment is an option in hormone sensitive metastatic patients. toremifene and denosumab were evaluated in the prevention of fracture risk in patients under androgen deprivation therapy. The mechanism of tumor proliferation in castrate resistant prostate cancer further explained and 2 new molecules abiraterone and MDV 3100 were presented.

Les vraies contre-indications du BCG dans le traitement des tumeurs de vessie
- Réf : Prog Urol, 2010, 20, S41, suppl. S1


The contra-indications of BCG instillations were described at commercialization in 1996 and have not been revised since. The objective of this review has been to revise the rational of the contra-indications of BCG and then to review the reported cases of transgressions against them.

The definite contra-indication remain: a history of systemic reaction to BCG, tuberculosis, fever with unknown etiology, alteration of the urine/blood barrier from trauma or cystitis (infectious or radiation), the deficits of cellular immunity, the combined deficits and defects in phagocytosis. However, there were no serious adverse effects of BCG therapy with immunosuppressive treatment for organ transplantation or in case of chronic inflammatory disease, nor with previous irradiation of the bladder area without radiation cystitis. These specific circumstances require more studies and data if they are no longer to be considered as a contra-indication.

Place de la chimiothérapie par docétaxel dans le cancer de la prostate. À propos d'un cas
- Réf : Prog Urol, 2010, 20, S80, suppl. S1


There is nothing to support Docetaxel as a first line treatment in metastatic prostate cancer. Hormonal treatment is still the gold standard. Chemotherapy should be initiated in symptomatic patients or if patients are at high risk of developing metastasis (PSADT < 3 months). Quality of life is the main endpoint of chemotherapy in metastatic prostate cancer, that should be monitored clinically. The dose of Docetaxel should be adapted according to the geriatric evaluation in elderly patients. Estramustine is still under evaluation. There is no gold standard for second line chemotherapy in castrate resistant prostate cancer. In this situation patients should be included in protocols.

Prise en charge des métastases osseuses du cancer de la prostate. À propos d'un cas
- Réf : Prog Urol, 2010, 20, S72, suppl. S1


Androgen deprivation therapy with LHRH agonists is the gold standard in the treatment of metastatic prostate cancer. This treatment leads to decrease the bone mass, thus bone mineral density evaluation is recommended after one year of hormonal treatment to measure bone loss. Bisphosphonate is recommended when metastasis occurred during hormonal resistance phase to reduce bone events. The necessity of preventive treatment and the appropriate schedule is not well established. Long term fracture risk should be ideally evaluated with a CT scan and an MRI. Fragmented and focal radiotherapy is considered as the treatment of choice to decrease localized pain. Metastasis surgery has functional results and should be performed before major neurologic symptoms occur. Metabolic radiotherapy is an option for multifocal bone metastases.

Prise en charge des tumeurs vésicales non-infiltrant le muscle vésical. TaG1 : intérêt de l'IPOP ?
- Réf : Prog Urol, 2010, 20, S46, suppl. S1


Immediate intravesical chemotherapy after transurethral resection decrease recurrences in non-muscle-invasive bladder cancer. Guidelines recommend immediate, intravesical instillation for all patients with Ta/T1 tumours. Instillation has to be avoided when there is a bladder perforation, a large resection (>3cm) or gross haematuria. Tolerance is good and morbidity is low.