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Fritz H Schröder,
Jonas Hugosson,
Monique J Roobol,
Teuvo L J Tammela,
Stefano Ciatto,
Vera Nelen,
Maciej Kwiatkowski,
Marcos Lujan,
Hans Lilja,
Marco Zappa, [......],
Theodorus van der Kwast,
Paula M Kujala,
Bert G Blijenberg,
Ulf-Hakan Stenman,
Andreas Huber,
Kimmo Taari,
Matti Hakama,
Sue M Moss,
Harry J de Koning,
Anssi Auvinen
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ABSTRACT: Several trials evaluating the effect of prostate-specific antigen (PSA) testing on prostate-cancer mortality have shown conflicting results. We updated prostate-cancer mortality in the European Randomized Study of Screening for Prostate Cancer with 2 additional years of follow-up.
The study involved 182,160 men between the ages of 50 and 74 years at entry, with a predefined core age group of 162,388 men 55 to 69 years of age. The trial was conducted in eight European countries. Men who were randomly assigned to the screening group were offered PSA-based screening, whereas those in the control group were not offered such screening. The primary outcome was mortality from prostate cancer.
After a median follow-up of 11 years in the core age group, the relative reduction in the risk of death from prostate cancer in the screening group was 21% (rate ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.001), and 29% after adjustment for noncompliance. The absolute reduction in mortality in the screening group was 0.10 deaths per 1000 person-years or 1.07 deaths per 1000 men who underwent randomization. The rate ratio for death from prostate cancer during follow-up years 10 and 11 was 0.62 (95% CI, 0.45 to 0.85; P=0.003). To prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected. There was no significant between-group difference in all-cause mortality.
Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality. (Current Controlled Trials number, ISRCTN49127736.).
New England Journal of Medicine 03/2012; 366(11):981-90. · 53.30 Impact Factor
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ABSTRACT: Prostate cancer is an important disease in terms of economic implications because of its increasing incidence and health care costs. We assessed the direct costs of the clinical management of prostate cancer in France. A retrospective study based on population-based data was carried out. Eight hundred and seventy-nine cases of prostate cancer diagnosed in five departments were included in a 5-year follow-up study. The economic analysis adopted the health-care payer's perspective and took into account only the direct costs. The mean cost of managing patients was estimated at euro12,731. It is composed of 49 to 82% of initial treatments according to the therapeutic strategy. The follow-up constituted between 3 and 11%, the costs of treatments for side effects between 1 and 3% and the travel cost between 3 and 7%. Cumulative total costs over 5 years for each treatment group showed variation in costs. Costs were highest for patients who were treated with external-beam radiotherapy and lowest for those with watchful waiting. The cost burden of prostate cancer is high and varies according to the treatment type. This study yielded a cost analysis of the different management practices of patients with prostate cancer.
The European Journal of Health Economics 08/2011; 12(4):363-71. · 1.50 Impact Factor
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Guillaume Ploussard,
Alexandra Masson-Lecomte,
Jean-Baptiste Beauval,
Adil Ouzzane,
Romain Bonniol,
François Buge,
Saad Fadli,
Morgan Rouprêt, Xavier Rebillard,
Nicolas Gaschignard,
Christian Pfister,
Arnauld Villers,
Michel Soulié,
Laurent Salomon
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ABSTRACT: To estimate the effect of predictive factors for oncologic outcomes after radical prostatectomy (RP) for high-risk prostate cancer (PCa).
A total of 813 patients underwent RP for high-risk PCa in a national retrospective multi-institutional study. High-risk PCa was defined as follows: prostate-specific antigen (PSA) level>20 ng/mL, Gleason score 8-10, and/or clinical Stage T2c-T4 disease. The preoperative criteria of high-risk PCa were studied in a logistic regression model to assess the correlations with the pathologic findings in the RP specimens. The predictive factors isolated or combined in scores were assessed by Cox multivariate and Kaplan-Meier analyses in predicting PSA failure (recurrence-free survival [RFS]) and overall survival (OS).
The median follow-up was 64 months. Organ-confined disease was reported in 36.5%. The 5-year RFS, metastasis-free survival, and OS rate was 74.1%, 96.1%, and 98.6%, respectively. Each preoperative criteria of high-risk PCa was an independent predictor of PSA failure. The PSA failure risk was increased by 1.5- and 2.8-fold in men with 2 and 3 criteria, respectively. The RFS, but not the OS, was significantly different according to the preoperative score (P<.001). The postoperative score was significantly predictive for RFS and OS (P<.001 and P<.035, respectively). The risk of PSA failure was significantly increased with an increasing postoperative score (2-4.6-fold).
National data support evidence that RP can result in encouraging midterm oncologic outcomes for the management of high-risk PCa. At 5 years after surgery, 75% of patients remain disease free. Our easy-to-use risk stratification might help clinicians to better predict the clinical and PSA outcomes of high-risk patients after surgery.
Urology 07/2011; 78(3):607-13. · 2.43 Impact Factor
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Roman Ganzer,
Cary N Robertson,
John F Ward,
Stephen C W Brown,
Giario N Conti,
Francois J Murat,
Gilles Pasticier, Xavier Rebillard,
Stefan Thuroff,
Wolf F Wieland,
Andreas Blana
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ABSTRACT: •To determine if the prostate-specific antigen (PSA) nadir after high-intensity focused ultrasound (HIFU) can be used as a predictor of the biochemical disease-free survival rate (DFSR).
•Patient data were derived from the multicentre-based @-Registry, the largest registry to report outcomes in patients with localized prostate cancer after Ablatherm® HIFU. •PSA level was measured at 3-month intervals. Patients were stratified into four PSA nadir groups: group 1, ≤0.2 ng/mL; group 2, 0.21-0.5 ng/mL; group 3, 0.51-1 ng/mL; and group 4, >1 ng/mL. •Biochemical treatment failure was defined according to the Stuttgart definition (PSA nadir + 1.2 ng/mL) and the Phoenix definition (PSA nadir + 2 ng/mL). •Biopsy was performed at 3-6 months post-HIFU or if a PSA level was recorded that was considered clinically relevant.
•The present study included 804 patients. Biochemical treatment success rates at 5 years according to the Stuttgart definition for the four PSA nadir sub-groups were as follows: 84, 64, 40 and 30% for groups 1-4, respectively. •The equivalent 5-year biochemical success rates using the Phoenix definition were 94, 74, 66 and 47%, respectively. •Significantly more patients had a negative biopsy in the lowest PSA nadir group than in the other sub-groups (91.6 vs 73.1%; P < 0.001). •The present study is limited by its retrospective nature and variations in clinical practice across participating centres.
•This multicentre analysis confirms that PSA nadir after HIFU predicts biochemical DFSR in a statistically significant manner.
BJU International 02/2011; 108(8 Pt 2):E196-201. · 2.84 Impact Factor
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ABSTRACT: To assess the safety and to obtain preliminary data on the efficacy of the three-drug combination chemotherapy with gemcitabine, oxaliplatin and vinorelbine in patients with metastatic bladder cancer.
Patients with metastatic or locally unresectable advanced bladder cancer who had received either no or one previous systemic chemotherapy regimen were eligible. All patients received intravenous gemcitabine 700 mg/m(2) and vinorelbine 25 mg/m(2) on day 1, then intravenous oxaliplatin 85 mg/m(2) on day 2, every 14 days.
Fifteen patients were enrolled. Twelve patients were unfit for cisplatin. A median of five cycles per patient were delivered. The most common toxicities were neutropenia, nausea and vomiting, mucositis and diarrhoea. Two complete responses and one partial response were observed for an overall response rate of 23%. Median progression-free survival was 5.7 months and overall survival was 8.6 months.
Although active and tolerable, the described three-drug combination chemotherapy showed no obvious incremental increase in efficacy compared with two-drug regimens. Further clinical trials are not recommended.
Anticancer research 11/2010; 30(11):4711-5. · 1.73 Impact Factor
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ABSTRACT: High-intensity focused ultrasound (HIFU) is an emerging treatment for select patients with localized prostate cancer (PCa).
To report the oncologic outcome of HIFU as a primary care option for localized prostate cancer from a multicenter database.
Patients with localized PCa treated with curative intent and presenting at least a 2-yr follow-up from February 1993 were considered in this study. Previously irradiated patients were excluded from this analysis. In case of any residual or recurrent PCa, patients were systematically offered a second session. Kaplan-Meier analysis was performed to determine disease-free survival rates (DFSR).
Prostate-specific antigen (PSA), clinical stage, and pathologic results were measured pre- and post-HIFU.
A total of 803 patients from six urologic departments met the inclusion criteria. Stratification according to d'Amico's risk group was low, intermediate, and high in 40.2%, 46.3%, and 13.5% of patients, respectively. Mean follow-up was 42+/-33 mo. Mean PSA nadir was 1.0+/-2.8 ng/ml with 54.3% reaching a nadir of < or =0.3 ng/ml. Control biopsies were negative in 85% of cases. The overall and cancer-specific survival rates at 8 yr were 89% and 99%, respectively. The metastasis-free survival rate at 8 yr was 97%. Initial PSA value and Gleason score value significantly influence the DFSR. The 5- and 7-yr biochemical-free survival rates (Phoenix criteria) were 83-75%, 72-63%, and 68-62% (p=0.03) and the additional treatment-free survival rates were 84-79%, 68-61%, and 52-54% (p<0.001) for low-, intermediate-, and high-risk patients, respectively. PSA nadir was a major predictive factor for HIFU success: negative biopsies, stable PSA, and no additional therapy.
Local control and DFSR achieved with HIFU were similar to those expected with conformal external-beam radiation therapy (EBRT). The excellent cancer-specific survival rate is also explained by the possibility to repeat HIFU and use salvage EBRT.
European urology 10/2010; 58(4):559-66. · 7.67 Impact Factor
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ABSTRACT: We analyzed preoperative data, pathological results and followup of pT0 tumors after radical prostatectomy for prostate cancer diagnosed on previous positive biopsy.
At 6 centers a total of 30 of 7,693 radical prostatectomy specimens were classified as pT0 despite prior biopsy proven prostate cancer. No patients were diagnosed after transurethral prostate resection or received neoadjuvant hormonal treatment. All biopsy cores and radical prostatectomy specimens were reanalyzed by a second pathologist. Followup comprised clinical examination and postoperative prostate specific antigen assay at 1 and 3 months, and every 6 months thereafter.
Median patient age was 63 years (range 46 to 73). Median preoperative prostate specific antigen was 7.4 ng/ml (range 1.3 to 23). Of the cases 24 were T1c and 6 were T2a. The median number of biopsy cores was 10 (range 6 to 21) with 1 positive (range 1 to 4). On biopsies median tumor length was 1 mm (range 0.3 to 18) and there was tumor in 11.1% (range 3.4% to 64%). In 25 cases (83.3%) there was only 1 positive biopsy. Gleason score was 3 + 3 in 23 cases and less than 6 in 5 with grade 4 in 2. Only 9 cases filled all nonsignificant tumor criteria. Median specimen weight was 61 gm (range 40 to 160). At a median 82-month followup (range 14 to 226) there was no biochemical progression.
After biopsy proven cancer pT0 prostate cancer is an unpredictable pathological finding. Despite its excellent prognosis it has medicolegal repercussions that justify DNA based tissue analysis. There is no evidence that finding focal cancer after extensive prostate resection changes patient prognosis and postoperative treatment.
The Journal of urology 03/2010; 183(3):958-62. · 4.02 Impact Factor
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Monique J Roobol,
Melissa Kerkhof,
Fritz H Schröder,
Jack Cuzick,
Peter Sasieni,
Matti Hakama,
Ulf Hakan Stenman,
Stefano Ciatto,
Vera Nelen,
Maciej Kwiatkowski, [......],
Paula Kujala,
Chris H Bangma,
Gunnar Aus,
Teuvo L J Tammela,
Arnauld Villers, Xavier Rebillard,
Sue M Moss,
Harry J de Koning,
Jonas Hugosson,
Anssi Auvinen
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ABSTRACT: Prostate-specific antigen (PSA) based screening for prostate cancer (PCa) has been shown to reduce prostate specific mortality by 20% in an intention to screen (ITS) analysis in a randomised trial (European Randomised Study of Screening for Prostate Cancer [ERSPC]). This effect may be diluted by nonattendance in men randomised to the screening arm and contamination in men randomised to the control arm.
To assess the magnitude of the PCa-specific mortality reduction after adjustment for nonattendance and contamination.
We analysed the occurrence of PCa deaths during an average follow-up of 9 yr in 162,243 men 55-69 yr of age randomised in seven participating centres of the ERSPC. Centres were also grouped according to the type of randomisation (ie, before or after informed written consent).
Nonattendance was defined as nonattending the initial screening round in ERSPC. The estimate of contamination was based on PSA use in controls in ERSPC Rotterdam.
Relative risks (RRs) with 95% confidence intervals (CIs) were compared between an ITS analysis and analyses adjusting for nonattendance and contamination using a statistical method developed for this purpose.
In the ITS analysis, the RR of PCa death in men allocated to the intervention arm relative to the control arm was 0.80 (95% CI, 0.68-0.96). Adjustment for nonattendance resulted in a RR of 0.73 (95% CI, 0.58-0.93), and additional adjustment for contamination using two different estimates led to estimated reductions of 0.69 (95% CI, 0.51-0.92) to 0.71 (95% CI, 0.55-0.93), respectively. Contamination data were obtained through extrapolation of single-centre data. No heterogeneity was found between the groups of centres.
PSA screening reduces the risk of dying of PCa by up to 31% in men actually screened. This benefit should be weighed against a degree of overdiagnosis and overtreatment inherent in PCa screening.
European urology 08/2009; 56(4):584-91. · 7.67 Impact Factor
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Andreas Blana,
Stephen C W Brown,
Christian Chaussy,
Giario N Conti,
James A Eastham,
Roman Ganzer,
Francois J Murat,
Gilles Pasticier, Xavier Rebillard,
John C Rewcastle,
Cary N Robertson,
Stefan Thuroff,
John F Ward
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ABSTRACT: To compare the specificity and sensitivity of different definitions of biochemical failure in patients treated with high-intensity focused ultrasound (HIFU) for prostate cancer, to identify the most accurate predictor of clinical failure after HIFU.
Consecutively treated patients who underwent HIFU between October 1997 and July 2006 at two centres (Lyon, France; and Regensburg, Germany) were prospectively maintained within a central database and retrospectively reviewed for this study. Clinical failure was defined as a positive prostate biopsy after treatment, radiographic evidence of lymphatic or bony metastatic disease, or salvage treatment for prostate cancer (surgery, radiation, hormonal therapy or second HIFU). The serum prostate-specific antigen (PSA) values after HIFU were assessed as a biochemical surrogate of a therapeutic success or failure. PSA threshold values, 'PSA nadir plus', PSA velocity, PSA doubling time and the American Society or Therapeutic Radiotherapy and Oncology and Phoenix definition of biochemical failure were all considered. The sensitivity, specificity, positive predictive value and negative predictive value of each biochemical definition for predicting clinical failure were determined.
The data from 285 patients (stage <or= T2, PSA <15 ng/mL, Gleason score <or=7) were analysed. The median (range) follow-up was 4.7 (2-10.9) years. The median PSA nadir was 0.13 ng/mL, which occurred at a median of 12.9 weeks after HIFU, and the median PSA at the last follow-up was 0.76 (1.6-2.7) ng/mL. Clinical failure occurred in 71 patients (25%); 24 due to a positive biopsy and 47 through the use of an additional therapy. Biochemical events that best predicted clinical failure were 'PSA nadir plus' values of 1.1-1.3 ng/mL, PSA velocities of <0.3 ng/mL/year and PSA doubling times of 1.25-1.75 years.
A new definition of biochemical failure that is specific to patients treated with HIFU therapy is established, i.e. the 'Stuttgart definition', the 'PSA nadir plus 1.2 ng/mL'.
BJU International 05/2009; 104(8):1058-62. · 2.84 Impact Factor
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Fritz H Schröder,
Jonas Hugosson,
Monique J Roobol,
Teuvo L J Tammela,
Stefano Ciatto,
Vera Nelen,
Maciej Kwiatkowski,
Marcos Lujan,
Hans Lilja,
Marco Zappa, [......],
Liisa Määttänen,
Chris H Bangma,
Gunnar Aus,
Arnauld Villers, Xavier Rebillard,
Theodorus van der Kwast,
Bert G Blijenberg,
Sue M Moss,
Harry J de Koning,
Anssi Auvinen
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ABSTRACT: The European Randomized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specific-antigen (PSA) testing on death rates from prostate cancer.
We identified 182,000 men between the ages of 50 and 74 years through registries in seven European countries for inclusion in our study. The men were randomly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening. The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years. The primary outcome was the rate of death from prostate cancer. Mortality follow-up was identical for the two study groups and ended on December 31, 2006.
In the screening group, 82% of men accepted at least one offer of screening. During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; adjusted P=0.04). The absolute risk difference was 0.71 death per 1000 men. This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer. The analysis of men who were actually screened during the first round (excluding subjects with noncompliance) provided a rate ratio for death from prostate cancer of 0.73 (95% CI, 0.56 to 0.90).
PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis. (Current Controlled Trials number, ISRCTN49127736.)
New England Journal of Medicine 04/2009; 360(13):1320-8. · 53.30 Impact Factor
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ABSTRACT: Circulating cell-free DNA in the blood of cancer patients harbors tumor-specific aberrations. Here, we investigated whether this DNA might also reflect the presence of circulating tumor cells (CTC).
To identify the source of cell-free DNA in blood, plasma derived from 81 patients with prostate cancer was examined for CTCs and cell-free DNA. An epithelial immunospot assay was applied for detection of CTCs, and a PCR-based fluorescence microsatellite analysis with a panel of 14 polymorphic markers was used for detection of allelic imbalances (AI).
The plasma DNA levels significantly correlated with the diagnosis subgroups of localized (stage M0, n = 69) and metastasized prostate cancer (stage M1, n = 12; P = 0.03) and with the tumor stage of these patients (P < 0.005). AI was found on cell-free DNA in plasma from 45.0% and 58.5% of M0 and M1 patients, respectively. Detection of CTCs showed that 71.0% or 92.0% of the M0 and M1 patients harbored 1 to 40 CTCs in their blood, respectively. The occurrence of CTCs correlated with tumor stage (P < 0.03) and increasing Gleason scores (P = 0.04). Notably, significant associations of the number of CTCs with the AI frequencies at the markers D8S137 (P = 0.03), D9S171 (P = 0.04), and D17S855 (P = 0.02) encoding the cytoskeletal protein dematin, the inhibitor of the cyclin-dependent kinase CDKN2/p16 and BRCA1, respectively, were observed.
These findings show, for the first time, a relationship between the occurrence of CTCs and circulating tumor-associated DNA in blood, which, therefore, might become a valuable new source for monitoring metastatic progression in cancer patients.
Clinical Cancer Research 02/2009; 15(3):1032-8. · 7.74 Impact Factor
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Vincent Molinié,
Marc de Fromont,
Agnès Lesourd,
Catherine Mazerolles,
Gaëlle Fromont,
Michel Soulié,
Nicolas Mottet,
Jacques Irani,
Arnaud Méjean, Xavier Rebillard,
Jean-Louis Davin
Annales de Pathologie 11/2008; 28(5):429-58. · 0.25 Impact Factor
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Laurent Molinier MD,
Eric Bauvin MD,
Christophe Combescure PhD,
Christel Castelli PhD,
Xavier Rebillard MD,
Michel Soulié MD,
PhD Jean-Pierre Daurès MD,
PhD Pascale Grosclaude MD,
Laurent Molinier,
Eric Bauvin,
Christophe Combescure,
Christel Castelli, Xavier Rebillard,
Michel Soulié,
Jean‐Pierre Daurès,
Pascale Grosclaude
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ABSTRACT: Objectives: Cost-of-illness (COI) studies estimate the overall economic burden of a specific disease, rather than simply treatment-related costs. While having been criticized for not allowing resource prioritization, COI studies can provide useful guidance, so long as they adhere to accepted methodology. Prostate cancer is an important disease in terms of economic implications because of its increasing incidence and health-care costs and therefore provides a relevant example with which to review COI study methodologies. The aim of this study was to review published COI studies on prostate cancer to analyze the methods used.Methods: First, we provide a general description of the COI method. COI studies relating to prostate cancer were then systematically reviewed, focussing on an analysis of the different methods used.Results: The methods, data sources, and estimated cost categories in each study varied widely. The review showed that COI studies adopted significantly different approaches to estimate the costs of prostate cancer, reflecting a lack of consensus on the methodology of COI studies in this area.Conclusion: To increase its credibility, closer agreement among researchers on the methodological principles of the COI studies would be desirable.
Value in Health 08/2008; 11(5):878 - 885. · 2.19 Impact Factor
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ABSTRACT: Cost-of-illness (COI) studies estimate the overall economic burden of a specific disease, rather than simply treatment-related costs. While having been criticized for not allowing resource prioritization, COI studies can provide useful guidance, so long as they adhere to accepted methodology. Prostate cancer is an important disease in terms of economic implications because of its increasing incidence and health-care costs and therefore provides a relevant example with which to review COI study methodologies. The aim of this study was to review published COI studies on prostate cancer to analyze the methods used.
First, we provide a general description of the COI method. COI studies relating to prostate cancer were then systematically reviewed, focussing on an analysis of the different methods used.
The methods, data sources, and estimated cost categories in each study varied widely. The review showed that COI studies adopted significantly different approaches to estimate the costs of prostate cancer, reflecting a lack of consensus on the methodology of COI studies in this area.
To increase its credibility, closer agreement among researchers on the methodological principles of the COI studies would be desirable.
Value in Health 06/2008; 11(5):878-85. · 2.19 Impact Factor
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ABSTRACT: Accurate identification of loss of heterozygosity (LOH) on circulating free DNA is often restricted by technical limitations such as poor quality and quantity of tumor-specific DNA and contamination by normal DNA. However, plasma DNA may harbor tumor-specific genetic alterations and could therefore be an interesting target for noninvasive examinations of tumor DNA.
By PCR-based fluorescence microsatellite analysis using 12 polymorphic markers, we investigated LOH on cell-free DNA in blood plasma from 59 patients with localized prostate cancer (PCa) and 12 with metastatic disease (MPCa). In addition, plasma DNA from 21 PCa patients was fractionated into high- and low-molecular-weight DNA by 2 different column systems. To avoid appearance of artificial allelic loss and stabilize the amplification, TMAC (tetramethylammonium chloride) was added to each PCR.
Overall incidences of LOH at all markers analyzed were 10% in PCa and 12% in MPCa samples. Highest frequencies were found at markers D11S898 (28%) in PCa and D6S1631 (27%) in MPCa. Statistical evaluation showed significant associations between LOH and increasing Gleason scores for the marker combinations D6S1631*D8S286*D9S171 (P = 0.03) and D8S286*D9S171 (P = 0.05). Fractionation of plasma DNA resulted in a higher overall LOH frequency in the low-molecular-weight DNA fraction (23%) compared with the high-molecular-weight DNA (7%).
LOH analysis of circulating DNA can provide tumor-specific genetic information on PCa patients. Fractionation of plasma DNA and addition of TMAC improved LOH detection and general assay performance.
Clinical Chemistry 05/2008; 54(4):688-96. · 7.91 Impact Factor
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ABSTRACT: We discuss the efficacy and safety of high-intensity focused ultrasound (HIFU) in patients with prostate cancer, to define the best indications for HIFU in daily clinical practice as primary therapy. We searched Medline and Embase for clinical studies evaluating the efficacy and safety of HIFU in prostate cancer (July 2007), and abstracts presented at the 2005-2007 annual meetings of the European Association of Urology and American Urological Association were screened. In all, 37 articles/abstracts were selected. As the data on HIFU as salvage therapy were limited, we focused on HIFU as primary therapy. Studies consisted of case series only. Included patients were approximately 70 years old with T1-T2 N0M0 disease, Gleason Score <or=7, a prostate-specific antigen (PSA) level of <or=28 ng/mL and a prostate volume of <or=40 mL. Negative biopsy rates with the Ablatherm device (EDAP TMS S.A., Vaulx-en-Velin, France) were 64-93%, and a PSA nadir of <or=0.5 ng/mL was achieved in 55-84% of patients. The 5-year actuarial disease-free survival rates were 60-70%. The most common complications were stress urinary incontinence, urinary tract infection, urethral/bladder neck stenosis or strictures, and erectile dysfunction. For the Ablatherm device, the rate of complications has been significantly reduced over the years, due to technical improvements in the device and the use of transurethral resection of the prostate before HIFU. In conclusion, HIFU as primary therapy for prostate cancer is indicated in older patients (>or=70 years) with T1-T2 N0M0 disease, a Gleason score of <7, a PSA level of <15 ng/mL and a prostate volume of <40 mL. In these patients HIFU achieves short-term cancer control, as shown by a high percentage of negative biopsies and significantly reduced PSA levels. The median-term survival data also seem promising, but long-term follow-up studies are needed to further evaluate cancer-specific and overall survival rates before the indications for primary therapy can be expanded.
BJU International 05/2008; 101(10):1205-13. · 2.84 Impact Factor
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Progrès en Urologie 12/2007; 17(6):1019-21. · 0.58 Impact Factor
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Marc de Fromont,
Agnès Lesourd,
Catherine Mazerolles,
Vincent Molinié,
Jean-Jacques Voigt,
Gaëlle Fromont,
Michel Soulié,
Nicola Mottet,
Jacque Irani,
Arnaud Méjean, Xavier Rebillard,
Jean-Louis Davin
Progrès en Urologie 12/2007; 17(6):1026. · 0.58 Impact Factor
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ABSTRACT: The measurement of PSA serum levels is central to all early detection programs for prostate cancer. Although individual PSA values were known to fluctuate in the short and long term, the influence of insolation and seasons on PSA had not been addressed to date. To assert the relationship between total and free PSA and meteorological data in 8644 participants (55-70 years) in the French arm of the ERSPC study.
Blood sample was taken at the local laboratory after informed consent and frozen sera were sent for central testing of total and free PSA. PSA measurement was performed within 7 days on the Access 1.0 automat with Hybritech reagents. Monthly meteorological data -- insolation, daily temperatures and rain precipitations -- were obtained from the local branches of the National Meteorology Agency.
Total PSA -- but not free PSA -- was correlated with insolation, that is the monthly accrual in hours of sunshine during which the intensity was higher than 120 Watt x m(-2) (r = 0.05 (95%CI: 0.03-0.07; p < 0.0001)) while no relationships were shown between insolation and percent-free PSA (free PSA divided by the total PSA). Interdependence between total PSA and insolation was also apparent with respect to the 3 ng/mL ERSPC cutoff for recommending biopsies (213.1 vs. 206.2 hours, p = 0.004). Such relationship was even more evident in summer when the tested participants more often had a PSA > 3 ng/mL (17.1% vs. 14.3%, p = 0.0006) than in the rest of the year, resulting in 23% more chances of being referred for biopsies (Odds ratio 1.23, 95%CI: 1.10-1.40).
Total PSA was shown to be strongly associated with insolation and seasons while the percent-free PSA was not influenced.
European Urology 10/2007; 52(3):708-14. · 8.49 Impact Factor
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Bardon Yves,
Alexandre de la Taille,
Emmanuel Chartier-Kastler,
Jean-Luc Moreau,
Jean-Louis Davin,
Jean-Pierre Mignard,
Christian Coulange,
Jean-Paul Allegre,
Michel Averous,
Henry Botto, [......],
Philippe Grise,
Georges Kouri,
Hervé Le Doze,
Thierry Piechaud,
Denis Prunet,
Jean-Jacques Rambeaud, Xavier Rebillard,
Michel Soulie,
Benoît Vignes,
Arnauld Villers
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ABSTRACT: Information on prostate diseases, including prostate cancer, has been promoted by the Association Française d'Urologie (AFU) for several years, but is developing slowly in France. In 2005, a first communication was targeted to the male public and identified the reasons for the fatalistic attitude of men, and paradoxically, why the prostate incarnates the vulnerability of their sexual capital. As part of a second phase, this article presents the results of a complementary study conducted among general practitioners to identify their expectations and the most appropriate levers to promote screening.
The Ipsos survey company developed a Krisis qualitative protocol in October 2005 (after the first French prostate day on 15 September 2005). Three groups of general practitioners were defined: doctors who are very active in terms of screening, doctors who are uncomfortable with this problem and doctors who systematically refer their patients to urologists.
The management of prostate diseases often highlights the ageing process for the patient. The ability to discuss these problems during the consultation depended on the doctor's degree of comfort with this subject, which is related to his/her training and relationships with urologists. To initiate the question of screening, general practitioners involved in this process asked simple questions about everyday practices without being afraid of making jokes or basing their approach on mediatization of the disease. Digital rectal examination is one of the important clinical elements but is not always easy to perform. PSA was found to be an examination that is not always appropriate, characterized by a lack of information on the conditions for ordering this test, its usefulness and its relevance for screening. Ultrasound could be a way of alerting the patient without dramatizing the situation, letting the urologist perform digital rectal examination. Female general practitioners preferred PSA and ultrasound. The doctors surveyed relied on mediatization of prostate diseases, a high level of interactivity with urologists and documents and brochures to be placed in waiting rooms to relay screening messages.
General practitioners need their authorities, specialists and public health institutions to develop and mediatize andrology in the same way as gynaecology. Urologists play a major supportive role by means of conferences, postgraduate training or AFU invitations.
Progrès en Urologie 05/2007; 17(2):199-202. · 0.58 Impact Factor
