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Marra G, Rajwa P, Filippini C, Ploussard G, Montefusco G, Puche-Sanz I, Olivier J, Zattoni F, Moro FD, Magli A, Dariane C, Affentranger A, Grogg JB, Hermanns T, Chiu PK, Malkiewicz B, Kowalczyk K, Van den Bergh RCN, Shariat SF, Bianchi A, Antonelli A, Gallina S, Berchiche W, Sanchez-Salas R, Cathelineau X, Afferi L, Fankhauser CD, Mattei A, Karnes RJ, Scuderi S, Montorsi F, Briganti A, Deandreis D, Gontero P, Gandaglia G. The Prognostic Role of Preoperative PSMA PET/CT in cN0M0 pN+ Prostate Cancer: A Multicenter Study. Clin Genitourin Cancer 2024; 22:244-251. [PMID: 38155081 DOI: 10.1016/j.clgc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/30/2023]
Abstract
CONTEXT Despite negative preoperative conventional imaging, up to 10% of patients with prostate cancer (PCa) harbor lymph-node involvement (LNI) at radical prostatectomy (RP). The advent of more accurate imaging modalities such as PET/CT improved the detection of LNI. However, their clinical impact and prognostic value are still unclear. We aimed to investigate the prognostic value of preoperative PET/CT in patients node positive (pN+) at RP. EVIDENCE SYNTHESIS We retrospectively identified cN0M0 patients at conventional imaging (CT and/or MRI, and bone scan) who had pN+ PCa at RP at 17 referral centers. Patients with cN+ at PSMA/Choline PET/CT but cN0M0 at conventional imaging were also included. Systemic progression/recurrence was the primary outcome; Cox proportional hazards models were used for multivariate analysis. EVIDENCE ACQUISITION We included 1163 pN+ men out of whom 95 and 100 had preoperative PSMA and/or Choline PET/CT, respectively. ISUP grade ≥4 was detected in 66.6%. Overall, 42% of patients had postoperative PSA persistence (≥0.1 ng/mL). Postoperative management included initial observation (34%), ADT (22.7%) and adjuvant RT+/-ADT (42.8%). Median follow-up was 42 months. Patients with cN+ on PSMA PET/CT had an increased risk of systemic progression (52.9% vs. 13.6% cN0 PSMA PET/CT vs. 21.5% cN0 at conventional imaging; P < .01). This held true at multivariable analysis: (HR 6.184, 95% CI: 3.386-11-295; P < .001) whilst no significant results were highlighted for Choline PET/CT. No significant associations for both PET types were found for local progression, BCR, and overall mortality (all P > .05). Observation as an initial management strategy instead of adjuvant treatments was related with an increased risk of metastases (HR 1.808; 95% CI: 1.069-3.058; P < .05). CONCLUSIONS PSMA PET/CT cN+ patients with negative conventional imaging have an increased risk of systemic progression after RP compared to their counterparts with cN0M0 disease both at conventional and/or molecular imaging.
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Affiliation(s)
- Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy.
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Medical University of Silesia, Zabrze, Poland
| | - Claudia Filippini
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | | | - Gabriele Montefusco
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Ignacio Puche-Sanz
- Department of Urology, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Alessandro Magli
- Dipartimento di Radioterapia Oncologica, Ospedale Santa Maria della misericordia, Udine, Italia
| | - Charles Dariane
- Department of Urology, Hôpital européen Georges-Pompidou, Université de Paris, Paris, France
| | | | | | | | - Peter K Chiu
- Division of Urology, Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Bartosz Malkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology Wroclaw Medical University, Wroclaw, Poland
| | - Kamil Kowalczyk
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology Wroclaw Medical University, Wroclaw, Poland
| | | | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alberto Bianchi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sebastian Gallina
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - William Berchiche
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Rafael Sanchez-Salas
- Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada
| | | | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Simone Scuderi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Désirée Deandreis
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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2
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Revel M, Rezola Artero M, Hamidi H, Grunenwald A, Blasco L, Vano YA, Marie Oudard S, Sanchez-Salas R, Macek P, Rodriguez Sanchez L, Cathelineau X, Vedié B, Sautes-Fridman C, Herman Fridman W, Roumenina LT, Dragon-Durey MA. Humoral complementomics - exploration of noninvasive complement biomarkers as predictors of renal cancer progression. Oncoimmunology 2024; 13:2328433. [PMID: 38487624 PMCID: PMC10939156 DOI: 10.1080/2162402x.2024.2328433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
Despite the progress of anti-cancer treatment, the prognosis of many patients with solid tumors is still dismal. Reliable noninvasive biomarkers are needed to predict patient survival and therapy response. Here, we propose a Humoral Complementomics approach: a work-up of assays to comprehensively evaluate complement proteins, activation fragments, and autoantibodies targeting complement proteins in plasma, which we correlated with the intratumoral complement activation, and/or local production, focusing on localized and metastatic clear cell renal cell carcinoma (ccRCC). In two prospective ccRCC cohorts, plasma C2, C5, Factor D and properdin were elevated compared to healthy controls, reflecting an inflammatory phenotype that correlated with plasma calprotectin levels but did not associate with CRP or with patient prognosis. Conversely, autoantibodies against the complement C3 and the reduced form of FH (a tumor neo-epitope reported in lung cancer) correlated with a favorable outcome. Our findings pointed to a specific group of patients with elevated plasma C4d and C1s-C1INH complexes, indicating the initiation of the classical pathway, along with elevated Ba and Bb, indicating alternative pathway activation. Boostrapped Lasso regularized Cox regression revealed that the most predictive complement biomarkers were elevated plasma C4d and Bb levels at the time of surgery, which correlated with poor prognosis. In conclusion, we propose Humoral Complementomics as an unbiased approach to study the global state of the complement system in any pathological plasma sample and disease context. Its implementation for ccRCC revealed that elevated C4d and Bb in plasma are promising prognostic biomarkers, correlating with shorter progression-free survival.
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Affiliation(s)
- Margot Revel
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
| | - Mikel Rezola Artero
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
- Department of Bacteriology and Immunology, Haartman Institute, and Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Houcine Hamidi
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
- Laboratoire d’Immunologie, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Anne Grunenwald
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
- Department of Nephrology and Hemodialysis, Service de néphrologie - hémodialyse, Poissy, France
| | - Loris Blasco
- Laboratoire d’Immunologie, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Yann A. Vano
- Hôpital Européen Georges-Pompidou, Oncology Department, Assistance Publique Hopitaux de Paris, Université Paris Cité, Paris, France
| | - Stephane Marie Oudard
- Hôpital Européen Georges-Pompidou, Oncology Department, Assistance Publique Hopitaux de Paris, Université Paris Cité, Paris, France
| | | | - Petr Macek
- Department of Urology Institut Mutualiste Montsouris, Paris, France
| | | | | | - Benoit Vedié
- Hôpital Européen Georges-Pompidou, Department of Biochemistry, Assistance Publique Hopitaux de Paris, Paris, France
| | - Catherine Sautes-Fridman
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
- Equipe labellisée Ligue contre le Cancer, Paris
| | - Wolf Herman Fridman
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
- Equipe labellisée Ligue contre le Cancer, Paris
| | - Lubka T. Roumenina
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
| | - Marie-Agnes Dragon-Durey
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
- Laboratoire d’Immunologie, Hôpital Européen Georges Pompidou, APHP, Paris, France
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3
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Tourinho-Barbosa R, Sanchez-Salas R, Sivaraman A, Borges RC, Candela L, Batista LT, Cathala N, Mombet A, Marra G, Sanchez LR, Boumezrag CB, Lanz C, Macek P, Cathelineau X, Korkes F. Urinary Symptoms Change and Quality of Life After Robotic Radical Prostatectomy: A Secondary Analysis of a Randomized Controlled Trial. Urology 2024; 185:73-79. [PMID: 38281669 DOI: 10.1016/j.urology.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/26/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To present the patient-reported quality of life (QoL) outcomes from a prospective, randomized controlled trial comparing the use of pelvic floor muscle training (PFMT) and duloxetine after robot-assisted radical prostatectomy (RARP). METHODS We identified 213 men with organ-confined disease having post-RARP urinary incontinence who were randomly assigned to received PFMT, duloxetine, combined PFMT-duloxetine and pelvic floor muscle home exercises. Urinary symptoms burden was measured by marked clinical important difference improvement (MCID) defined by using the International Prostate Symptom Score (IPSS) difference of - 8 points (ΔIPSS ≤-8). QoL was assessed according to Visual Analog Scale (VAS), King's Health Questionnaire (KQH), and International Index of Erectile Function (IIEF-5). Multivariable regression analyses aimed to predict MCID, burden of urinary symptoms (IPSS ≥8), and patients reporting to be satisfied (IPSS QoL ≤2) or comfortable (VAS ≤1) post-RARP. RESULTS Moderate to severe urinary symptoms decreased from 48% preoperatively to 40%, 34%, and 23% at 3, 6, and 12months post-RARP. After surgery, MCID improvement was observed in 19% of patients, and deterioration in 3.3%. Large prostate was the only factor associated to MCID (OR 1.03 [95%CI 1.01-1.05], P = .005). At 6months, patients reached the same degree of preoperative satisfaction. Neurovascular bundle preservation was the only predictor of being comfortable regarding urinary symptoms postoperatively (OR 12.8 [CI95% 1.47-111.7], P = .02 at 3months) and was also associated to higher median postoperative IIEF-5. CONCLUSION Despite urinary incontinence following RARP, patients with larger prostates experience a reduction of lower urinary tract symptoms within a year, which subsequently elevates QoL. Furthermore, nerve-sparing surgery augments erectile function and urinary outcomes, shaping postoperative QoL.
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Affiliation(s)
- Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil; Department of Urology, Hospital Cardio Pulmonar, Salvador, Brazil
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada.
| | - Arjun Sivaraman
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Castilho Borges
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Luigi Candela
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Lara Rodriguez Sanchez
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Chahrazad Bey Boumezrag
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Fernando Korkes
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
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4
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Sanchez-Salas R, Tourinho-Barbosa R, Sivaraman A, Borges RC, Candela L, Cathala N, Mombet A, Marra G, Sanchez LR, Boumezrag CB, Lanz C, Macek P, Korkes F, Cathelineau X. Assessing the efficacy of pelvic floor muscle training and duloxetine on urinary continence recovery following radical prostatectomy: A randomized clinical trial. Prostate 2024; 84:158-165. [PMID: 37904330 DOI: 10.1002/pros.24634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Urinary incontinence (UI) can negatively impact quality of life (QoL) after robot-assisted radical prostatectomy (RARP). Pelvic floor muscle training (PFMT) and duloxetine are used to manage post-RARP UI, but their efficacy remains uncertain. We aimed to investigate the efficacy of PFMT and duloxetine in promoting urinary continence recovery (UCR) after RARP. METHODS A randomized controlled trial involving patients with urine leakage after RARP from May 2015 to February 2018. Patients were randomized into 1 of 4 arms: (1) PFMT-biofeedback, (2) duloxetine, (3) combined PFMT-biofeedback and duloxetine, (4) control arm. PFMT consisted of pelvic muscle exercises conducted with electromyographic feedback weekly, for 3 months. Oral duloxetine was administered at bedtime for 3 months. The primary outcome was prevalence of continence at 6 months, defined as using ≤1 security pad. Urinary symptoms and QoL were assessed by using a visual analogue scale, and validated questionnaires. RESULTS From the 240 patients included in the trial, 89% of patients completed 1 year of follow-up. Treatment compliance was observed in 88% (92/105) of patients receiving duloxetine, and in 97% (104/107) of patients scheduled to PFMT-biofeedback sessions. In the control group 96% of patients had achieved continence at 6 months, compared with 90% (p = 0.3) in the PMFT-biofeedback, 73% (p = 0.008) in the duloxetine, and 69% (p = 0.003) in the combined treatment arm. At 6 months, QoL was classified as uncomfortable or worse in 17% of patients in the control group, compared with 44% (p = 0.01), 45% (p = 0.008), and 34% (p = 0.07), respectively. Complete preservation of neurovascular bundles (NVB) (OR: 2.95; p = 0.048) was the only perioperative intervention found to improve early UCR. CONCLUSIONS PFMT-biofeedback and duloxetine demonstrated limited impact in improving UCR after RP. Diligent NVB preservation, along with preoperative patient and disease characteristics, are the primary determinants for early UCR.
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Affiliation(s)
- Rafael Sanchez-Salas
- Department of Surgery, Division of Urology, McGill University, Montreal, Canada
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Arjun Sivaraman
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Castilho Borges
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Luigi Candela
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Lara Rodriguez Sanchez
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Chahrazad Bey Boumezrag
- Department of Research, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Fernando Korkes
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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5
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Deivasigamani S, Kotamarti S, Rastinehad AR, Salas RS, de la Rosette JJMCH, Lepor H, Pinto P, Ahmed HU, Gill I, Klotz L, Taneja SS, Emberton M, Lawrentschuk N, Wysock J, Feller JF, Crouzet S, Kumar M P, Seguier D, Adams ES, Michael Z, Abreu A, Jack Tay K, Ward JF, Shinohara K, Katz AE, Villers A, Chin JL, Stricker PD, Baco E, Macek P, Ahmad AE, Chiu PKF, Crawford ED, Rogers CG, Futterer JJ, Rais-Bahrami S, Robertson CN, Hadaschik B, Marra G, Valerio M, Chong KT, Kasivisvanathan V, Tan WP, Lomas D, Walz J, Guimaraes GC, Mertziotis NI, Becher E, Finelli A, Kasraeian A, Lebastchi AH, Vora A, Rosen MA, Bakir B, Arcot R, Yee S, Netsch C, Meng X, de Reijke TM, Tan YG, Regusci S, Benjamin TGR, Olivares R, Noureldin M, Bianco FJ, Sivaraman A, Kim FJ, Given RW, Dason S, Sheetz TJ, Shoji S, Schulman A, Royce P, Shah TT, Scionti S, Salomon G, Laguna P, Tourinho-Barbosa R, Aminsharifi A, Cathelineau X, Gontero P, Stabile A, Grummet J, Ledbetter L, Graton M, Stephen Jones J, Polascik TJ. Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer: A Focal Therapy Society Best Practice Statement. Eur Urol 2023; 84:547-560. [PMID: 37419773 DOI: 10.1016/j.eururo.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
CONTEXT Whole-gland ablation is a feasible and effective minimally invasive treatment for localized prostate cancer (PCa). Previous systematic reviews supported evidence for favorable functional outcomes, but oncological outcomes were inconclusive owing to limited follow-up. OBJECTIVE To evaluate the real-world data on the mid- to long-term oncological and functional outcomes of whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in patients with clinically localized PCa, and to provide expert recommendations and commentary on these findings. EVIDENCE ACQUISITION We performed a systematic review of PubMed, Embase, and Cochrane Library publications through February 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. As endpoints, baseline clinical characteristics, and oncological and functional outcomes were assessed. To estimate the pooled prevalence of oncological, functional, and toxicity outcomes, and to quantify and explain the heterogeneity, random-effect meta-analyses and meta-regression analyses were performed. EVIDENCE SYNTHESIS Twenty-nine studies were identified, including 14 on cryoablation and 15 on HIFU with a median follow-up of 72 mo. Most of the studies were retrospective (n = 23), with IDEAL (idea, development, exploration, assessment, and long-term study) stage 2b (n = 20) being most common. Biochemical recurrence-free survival, cancer-specific survival, overall survival, recurrence-free survival, and metastasis-free survival rates at 10 yr were 58%, 96%, 63%, 71-79%, and 84%, respectively. Erectile function was preserved in 37% of cases, and overall pad-free continence was achieved in 96% of cases, with a 1-yr rate of 97.4-98.8%. The rates of stricture, urinary retention, urinary tract infection, rectourethral fistula, and sepsis were observed to be 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively. CONCLUSIONS The mid- to long-term real-world data, and the safety profiles of cryoablation and HIFU are sound to support and be offered as primary treatment for appropriate patients with localized PCa. When compared with other existing treatment modalities for PCa, these ablative therapies provide nearly equivalent intermediate- to long-term oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncological and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values. PATIENT SUMMARY Cryoablation and high-intensity focused ultrasound are minimally invasive treatments available to selectively treat localized prostate cancer, considering their nearly comparable intermediate- to long term cancer control and preservation of urinary continence to other radical treatments in the primary setting. However, a well-informed decision should be made based on one's values and preferences.
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Affiliation(s)
| | - Srinath Kotamarti
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | | | | | - Herbert Lepor
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hashim U Ahmed
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | - Inderbir Gill
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Laurence Klotz
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Samir S Taneja
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Mark Emberton
- Division of Surgery, University College London, London, UK
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Wysock
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | | | | | | | - Denis Seguier
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, University Lille Nord de France, Lille, France
| | - Eric S Adams
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Zoe Michael
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Andre Abreu
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - John F Ward
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Katsuto Shinohara
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Aaron E Katz
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Arnauld Villers
- Department of Urology, University Lille Nord de France, Lille, France
| | - Joseph L Chin
- Department of Urology, University of Western Ontario, London, Ontario, Canada
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Petr Macek
- Department of Urology, Institute Mutualiste Montsouris, Paris, France
| | - Ardalan E Ahmad
- Department of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter K F Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - E David Crawford
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Jurgen J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Cary N Robertson
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Giancarlo Marra
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Massimo Valerio
- Service of Urology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | | | - Wei Phin Tan
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Derek Lomas
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Jochen Walz
- Department of Urology, Paoli-Calmettes Institute Cancer Center, Marseille, France
| | | | | | | | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | | | - Amir H Lebastchi
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anup Vora
- Chesapeake Urology, Silver Spring, MD, USA
| | - Mark A Rosen
- Department of Urology, Sutter Health, Sacramento, CA, USA
| | - Baris Bakir
- Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Rohit Arcot
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Samuel Yee
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | | | - Xiaosong Meng
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Theo M de Reijke
- Department of Urology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore
| | - Stefano Regusci
- Department of Interventional Oncology, Swiss International Prostate Centelenor, Geneva, Switzerland
| | | | - Ruben Olivares
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Fernando J Bianco
- Urological Research Network, Urologist Specialist Group, Miami Lakes, FL, USA
| | - Arjun Sivaraman
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center and University of Colorado Hospital, Denver, CO, USA
| | | | - Shawn Dason
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Tyler J Sheetz
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, Tokyo, Japan
| | - Ariel Schulman
- Department of Urology, Maimonides Health Medical Center, New York, NY, USA
| | - Peter Royce
- Division of Urology, Monash University, Melbourne, Australia
| | - Taimur T Shah
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Alireza Aminsharifi
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Paolo Gontero
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Armando Stabile
- Unit of Urology/Division of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jeremy Grummet
- Division of Urology, Monash University, Melbourne, Australia
| | - Leila Ledbetter
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Margaret Graton
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | - Thomas J Polascik
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA.
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6
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Kwong JCC, Khondker A, Meng E, Taylor N, Kuk C, Perlis N, Kulkarni GS, Hamilton RJ, Fleshner NE, Finelli A, van der Kwast TH, Ali A, Jamal M, Papanikolaou F, Short T, Srigley JR, Colinet V, Peltier A, Diamand R, Lefebvre Y, Mandoorah Q, Sanchez-Salas R, Macek P, Cathelineau X, Eklund M, Johnson AEW, Feifer A, Zlotta AR. Development, multi-institutional external validation, and algorithmic audit of an artificial intelligence-based Side-specific Extra-Prostatic Extension Risk Assessment tool (SEPERA) for patients undergoing radical prostatectomy: a retrospective cohort study. Lancet Digit Health 2023; 5:e435-e445. [PMID: 37211455 DOI: 10.1016/s2589-7500(23)00067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/11/2023] [Accepted: 03/22/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Accurate prediction of side-specific extraprostatic extension (ssEPE) is essential for performing nerve-sparing surgery to mitigate treatment-related side-effects such as impotence and incontinence in patients with localised prostate cancer. Artificial intelligence (AI) might provide robust and personalised ssEPE predictions to better inform nerve-sparing strategy during radical prostatectomy. We aimed to develop, externally validate, and perform an algorithmic audit of an AI-based Side-specific Extra-Prostatic Extension Risk Assessment tool (SEPERA). METHODS Each prostatic lobe was treated as an individual case such that each patient contributed two cases to the overall cohort. SEPERA was trained on 1022 cases from a community hospital network (Trillium Health Partners; Mississauga, ON, Canada) between 2010 and 2020. Subsequently, SEPERA was externally validated on 3914 cases across three academic centres: Princess Margaret Cancer Centre (Toronto, ON, Canada) from 2008 to 2020; L'Institut Mutualiste Montsouris (Paris, France) from 2010 to 2020; and Jules Bordet Institute (Brussels, Belgium) from 2015 to 2020. Model performance was characterised by area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), calibration, and net benefit. SEPERA was compared against contemporary nomograms (ie, Sayyid nomogram, Soeterik nomogram [non-MRI and MRI]), as well as a separate logistic regression model using the same variables included in SEPERA. An algorithmic audit was performed to assess model bias and identify common patient characteristics among predictive errors. FINDINGS Overall, 2468 patients comprising 4936 cases (ie, prostatic lobes) were included in this study. SEPERA was well calibrated and had the best performance across all validation cohorts (pooled AUROC of 0·77 [95% CI 0·75-0·78] and pooled AUPRC of 0·61 [0·58-0·63]). In patients with pathological ssEPE despite benign ipsilateral biopsies, SEPERA correctly predicted ssEPE in 72 (68%) of 106 cases compared with the other models (47 [44%] in the logistic regression model, none in the Sayyid model, 13 [12%] in the Soeterik non-MRI model, and five [5%] in the Soeterik MRI model). SEPERA had higher net benefit than the other models to predict ssEPE, enabling more patients to safely undergo nerve-sparing. In the algorithmic audit, no evidence of model bias was observed, with no significant difference in AUROC when stratified by race, biopsy year, age, biopsy type (systematic only vs systematic and MRI-targeted biopsy), biopsy location (academic vs community), and D'Amico risk group. According to the audit, the most common errors were false positives, particularly for older patients with high-risk disease. No aggressive tumours (ie, grade >2 or high-risk disease) were found among false negatives. INTERPRETATION We demonstrated the accuracy, safety, and generalisability of using SEPERA to personalise nerve-sparing approaches during radical prostatectomy. FUNDING None.
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Affiliation(s)
- Jethro C C Kwong
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Meng
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Nicholas Taylor
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cynthia Kuk
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Theodorus H van der Kwast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Amna Ali
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Munir Jamal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Frank Papanikolaou
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Thomas Short
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Valentin Colinet
- Division of Urology, Department of Surgery, Jules Bordet Institute, Brussels, Belgium
| | - Alexandre Peltier
- Division of Urology, Department of Surgery, Jules Bordet Institute, Brussels, Belgium
| | - Romain Diamand
- Division of Urology, Department of Surgery, Jules Bordet Institute, Brussels, Belgium
| | - Yolene Lefebvre
- Department of Medical Imagery, Jules Bordet Institute, Brussels, Belgium
| | - Qusay Mandoorah
- Division of Urology, Department of Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Petr Macek
- Division of Urology, Department of Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Xavier Cathelineau
- Division of Urology, Department of Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Alistair E W Johnson
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Vector Institute, Toronto, ON, Canada
| | - Andrew Feifer
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.
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Berchiche W, Long Depaquit T, Baboudjian M, Barret É, Rozet F, Cathelineau X, Bastide C. Mid-term oncologic outcomes of radical prostatectomy in lymph node metastatic prostate cancer patients. Prog Urol 2023:S1166-7087(23)00090-8. [PMID: 37248105 DOI: 10.1016/j.purol.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/05/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Lymph node invasion (LNI) has been reported in 10-15% of pelvic lymph node dissection during radical prostatectomy (RP). The objective of this study was to describe the mid-term oncological outcomes in prostate cancer (PCa) patients with metastatic lymph node. METHODS We conducted a retrospective study at two French referral centers including consecutive cN0 PCa patients who underwent RP and extended pelvic lymph node dissection and had lymph node metastases on final pathological analysis (pN1) between January 2000 and May 2020. Follow-up was per institution, which generally included a PSA level measurement every 3 to 12 months for 5 years and annually thereafter. RESULTS A total of 123 patients were included: two (1.6%) low-risk, 64 (52%) intermediate-risk and 57 (46.4%) high-risk PCa according to the D'Amico risk classification. The median number of nodes removed and metastatic nodes per patient was 15 (IQR 11-22) and 1 (IQR 1-2), respectively. Adverse pathological features, i.e., ≥pT3a stage, ISUP grade ≥3, and positive surgical margins were reported in 113 (91.9%), 103 (83.7%), and 73 (59%) of cases, respectively. Postoperative treatment was administered in 104 patients, including radiotherapy alone (n=6), androgen deprivation therapy alone (n=27) or combination with androgen deprivation therapy and radiotherapy (n=71). The mean follow-up was 42.7 months. The estimated 3-year biochemical-free survival, clinical recurrence-free survival, and cancer-specific survival was 66% and 85% and 98.8%, respectively. In Cox regression analysis, the number of metastatic nodes was associated with clinical recurrence (P=0.04) and a persistently elevated PSA with biochemical recurrence (P<0.001). CONCLUSION The management of lymph node metastatic PCa patients is challenging. Risk stratification of node-positive patients, based on postoperative PSA levels and pathologic features being identified, should help physicians determine which patient would best benefit from multimodal treatment. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- W Berchiche
- Department of Urology, Hôpital Nord, AP-HM, Marseille, France.
| | - T Long Depaquit
- Department of Urology, Hôpital Nord, AP-HM, Marseille, France
| | - M Baboudjian
- Department of Urology, Hôpital Nord, AP-HM, Marseille, France; Department of Urology and Kidney Transplantation, Hôpital de la Conception, AP-HM, Marseille, France
| | - É Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - F Rozet
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - X Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - C Bastide
- Department of Urology, Hôpital Nord, AP-HM, Marseille, France
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8
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Kwong J, Khondker A, Meng E, Taylor N, Perlis N, Kulkarni G, Hamilton R, Fleshner N, Finelli A, Van Der Kwast T, Srigley J, Jamal M, Colinet V, Peltier A, Diamand R, Lefebvre Y, Mandoorah Q, Sanchez-Salas R, Macek P, Cathelineau X, Eklund M, Johnson A, Feifer A, Zlotta A. SEPERA – a novel artificial intelligence-based side-specific extra-prostatic extension risk assessment tool for patients undergoing radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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9
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Sanchez-Salas R, Tourinho-Barbosa R, Sivaraman A, Pascuali C, Candela L, Cathala N, Mombet A, Marra G, Rodriguez Sanchez L, Chahrazad Bey Boumezrag C, Macek P, Lanz C, Korkes F, Cathelineau X. The IMPROVE Trial: Surgical technique remains the most important factor associated with recovery of urinary continence after radical prostatectomy. EUR UROL SUPPL 2023. [DOI: 10.1016/s2666-1683(23)00050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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10
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Marra G, Rajwa P, Montefusco G, Van Den Bergh R, Zattoni F, Dal Moro F, Magli A, Affentranger A, Grogg J, Hermanns T, Malkiewicz B, Kowalczyk K, Shariat S, Bianchi A, Antonelli A, Gallina S, Berchiche W, Cathelineau X, Afferi L, Fankhauser C, Mattei A, Scuderi S, Briganti A, Gontero P, Gandaglia G. Impact of pre-operative PSMA PET/CT for men with cN0M0 conventional imaging and pN+ prostate cancer: Results from a multicenter study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00296-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Dias N, Colandrea G, Botelho F, Rodriguez-Sanchez L, Lanz C, Macek P, Cathelineau X. Diagnostic accuracy and clinical utility of micro-ultrasound guided biopsies in patients with suspected prostate cancer. Cent European J Urol 2023; 76:25-32. [PMID: 37064256 PMCID: PMC10091889 DOI: 10.5173/ceju.2023.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/29/2022] [Accepted: 12/18/2022] [Indexed: 03/08/2023] Open
Abstract
Introduction New technologies to improve quality of prostate biopsies are appearing in clinical practice.We evaluate the performance of a micro-ultrasound device and the Prostate Risk Identification using MicroUltraSound (PRI-MUS) score in detecting clinically significant prostate cancer (csPCa). Material and methods We retrospectively reviewed data of 139 biopsy- naïve patients with suspicion of prostate cancer, who underwent diagnostic MRI and micro-ultrasonography (microUS), followed by transrectal prostatic biopsy (systematic ±targeted) under local anesthetic. The main objective was to evaluate the performance of the Prostate Risk Identification using MicroUltraSound (PRI-MUS) score in detecting csPCa, defined as International Society of Urological Pathology (ISUP) ≥2. Results Of all patients, 97 (70%) were found to have PCa, and 62 (45%) having csPCa.Among 100 patients with positive microUS (PRI-MUS score ≥3), 23 (23%) had ncsPCa and 57 (57%) were diagnosed with csPCa (ISUP ≥2); and in 39 patients with negative microUS, 12 (31%) were diagnosed with ncsPCa and 5 (13%) with csPCa.A PRI-MUS score ≥3 presented a sensitivity, specificity, positive predictive value and negative predictive value of 92%, 44%, 57% and 95%, respectively, for the detection of csPCa.The PRI-MUS score had higher areas under the curve than Prostate Imaging Reporting & Data System (PI-RADS) both for targeted (AUC 0.801 vs 0.733) and systematic + targeted (AUC 0.776 vs 0.694) biopsies for csPCa detection. Conclusions In our cohort, microUS performed well as a diagnostic tool through an easily implementable scale. MicroUS presented similar sensitivity and higher specificity than MRI in detecting csPCa. Further multicenter prospective studies may clarify its role in prostate cancer diagnosis.
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Affiliation(s)
- Nuno Dias
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Gianmarco Colandrea
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Unit of Urology, Division of Experimental Oncology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francisco Botelho
- Department of Urology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
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12
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Dias N, Colandrea G, Botelho F, Rodriguez-Sanchez L, Barbé Y, Macek P, Cathelineau X. Accuracy of PET-choline in nodal staging of localized very high-risk prostate cancer. Arch Ital Urol Androl 2022; 94:401-405. [PMID: 36576464 DOI: 10.4081/aiua.2022.4.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/30/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Localized very high-risk prostate cancer (VHR PCa) has long suffered from the inex-istence of good lymph node staging methods other than invasive surgery, as computed tomogra-phy has low sensitivity for nodal disease. With the rising use of positron emission tomography (PET), it is clinically meaningful to know its value for these patients. Our goal was to evaluate the real-life diagnostic accuracy of PET Choline in nodal staging, comparing it with the gold standard of extended pelvic lymph node dissection (ePLND). MATERIALS AND METHODS We reviewed data from a high-volume center, including patients with VHR PCa according to current NCCN guidelines who underwent community 18F-fluorocholine PET/CT; followed by ro-botic assisted laparoscopic prostatectomy (RALP) and ePLND between 2010 and 2021. RESULTS We included 44 patients and 88 lymph node regions. Among those, 14/44 (31.8%) patients and 20/88 (22.7%) regions had nodal disease present on definitive pathology. In comparison with ePLND, we found a sensitivity of 64.3% (95% CI, 39.2-89.4%), specificity of 83.3% (95% CI, 70.0- 96.7%), PPV of 64.3% (95% CI, 39.2-89.4%), and NPV of 83.3% (95% CI, 70.0-96.7%) for nodal disease on a patient-based analysis; and sensitivity of 35.0% (95% CI, 14.1-60.0%), specificity of 88.2% (95% CI, 80.6-95.9%), PPV of 46.7% (95% CI, 21.4-71.9%), and NPV of 82.2% (95% CI, 73.4-91.0%) on a region-based analysis. CONCLUSIONS In our view 18F-fluorocholine PET/CT doesn't meet the criteria to be a standard exam for pre-operative staging for patients with VHR PCa, mostly due to its low sensitivity. However, other radiotracers should continue to be investigated in this setting.
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Affiliation(s)
- Nuno Dias
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Urology Department, São João Hospitalar and University Center, Porto.
| | - Gianmarco Colandrea
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Unit of Urology, Division of Experimental Oncology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan.
| | - Francisco Botelho
- Urology Department, São João Hospitalar and University Center, Porto; Institute for Life and Health Sciences Investigation, School of Medicine, Minho University, Braga.
| | | | - Yann Barbé
- Urology Department, Institut Mutualiste Montsouris, Paris.
| | - Petr Macek
- Urology Department, Institut Mutualiste Montsouris, Paris.
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Dias N, Rodriguez-Sanchez L, Colandrea G, Macek P, Cathelineau X. Medium-term oncological outcomes of intermediate-risk prostate cancer treated with HIFU or cryotherapy. A single center 10-year experience. Arch Ital Urol Androl 2022; 94:413-419. [PMID: 36576465 DOI: 10.4081/aiua.2022.4.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/30/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Focal therapies (FTs) are promising techniques for the treatment of localized prostate cancer. We assessed the medium-term oncological outcomes of intermediate-risk prostate cancer (PCa) treated with HIFU or cryotherapy. MATERIALS AND METHODS One-hundred and fifty consecutive patients with intermediate-risk PCa, treated between 2009 and 2018 at a single center were included. Primary study outcome was failure-free survival (FFS), defined as absence of additional treatment, systemic progression or prostate cancer related death. RESULTS Thirty-seven (25%) patients underwent cryotherapy and 113 (75%) HIFU. Median age was 69 (IQR 62-72) years, with 36 (24%) presenting palpable disease on rectal examination, and median total PSA of 7.85 (IQR 5.75-10.62) ng/mL. Patients were followed for a median of 61 (IQR 48-82) months. FFS at 2 and 4 years was of 75.6% and 53.6%, respectively. Survival from whole gland or systematic treatment at 2 and 4 years was of 78.9% and 53.9%, respectively. Patients with FFS presented lower total PSA nadir (1.89 vs 3.25 ng/mL, p < 0.001), higher % PSA reduction at 3 months (66.1% vs 49.3%, p < 0.001), and at nadir (75.5% vs 55.8%, p < 0.001). Other characteristics such has the treatment modality, age, prostate size, initial total PSA, cT stage, International Society of Urological Pathology (ISUP), tumor location and biopsy results by region did not differ between patients failing and not failing FT. Complications were uncommon (13%), with only onr (1%) patient having Clavien-Dindo grade > II. No deaths due to treatment were registered. CONCLUSIONS At medium-term, FTs for intermediate-risk PCa presented good oncological results, with an excellent safety profile.
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Affiliation(s)
- Nuno Dias
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Urology Department, São João Hospitalar and University Center, Porto.
| | | | - Gianmarco Colandrea
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Unit of Urology, Division of Experimental Oncology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan.
| | - Petr Macek
- Urology Department, Institut Mutualiste Montsouris, Paris.
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14
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Marra G, Soeterik T, Oreggia D, Tourinho-Barbosa R, Moschini M, Stabile A, Filippini C, van Melick HH, van den Bergh RC, Gontero P, Pasquali C, Macek P, Cathala N, Sanchez-Salas R, Cathelineau X. Focal High-Intensity Focused Ultrasound vs. Active Surveillance for ISUP Grade 1 Prostate Cancer: Medium-Term Results of a Matched-Pair Comparison. Clin Genitourin Cancer 2022; 20:592-604. [PMID: 35918262 DOI: 10.1016/j.clgc.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION/BACKGROUND Only 1 randomized controlled trial has compared focal therapy and active surveillance (AS) for the low-risk prostate cancer (PCa). We investigated whether focal HIFU (fHIFU) yields oncologic advantages over AS for low-risk PCa. MATERIALS AND METHODS We included 2 non-randomized prospective series of 132 (fHIFU) and 421 (AS) consecutive patients diagnosed with ISUP 1 PCa between 2008 and 2018. A matched pair analysis was performed to decrease potential bias. Study main outcomes were freedom from radical treatment (RT) or androgen-deprivation therapy (ADT), treatment-free survival (TFS), time to metastasis, and overall survival (OS). RESULTS Median fHIFU follow-up was 50 months (interquartile range, 29-84 months). Among matched variables, no major differences were recorded except for AS having more suspicious digital rectal examination findings (P = .0074) and recent enrollment year (P = .0005). Five-year intervention-free survival from RT or ADT was higher for the fHIFU cohort (67.4% vs. 53.8%; P = .0158). Time to treatment was approximately 10 months shorter for AS than for fHIFU (time to RT, P = .0363; time to RT or ADT, P = .0156; time to any treatment, P = .0319). No differences were found in any-TFS (fHIFU, 61.4% vs. AS, 53.8%; P = .2635), OS (fHIFU, 97% vs. AS, 97%; P = .9237), or metastasis (n = 0 in fHIFU and n = 2 in AS; P = .4981). Major complications (≥ Clavien 3) were rare (n = 4), although 36.4% of men experienced complications. No relevant changes were noted in continence (P = .3949). CONCLUSION At a 4-year median follow-up, fHIFU for mainly low-risk PCa (ISUP grade 1) is safe, may decrease the need for radical treatment or ADT and may allow longer time to treatment compared to AS. Nonetheless, no advantages are seen in PCa progression and/or death (OS).
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France; Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin Italy; Department of Urology and Clinical Research Group on predictive onco-urology, APHP. Sorbonne University, Paris, France.
| | - Timo Soeterik
- Department of Urology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands
| | - Davide Oreggia
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Armando Stabile
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Claudia Filippini
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin Italy
| | - Harm He van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands
| | | | - Paolo Gontero
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin Italy
| | - Caio Pasquali
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
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15
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Marra G, Laguna MP, Walz J, Pavlovich CP, Bianco F, Gregg J, Lebastchi AH, Lepor H, Macek P, Rais-Bahrami S, Robertson C, Rukstalis D, Salomon G, Ukimura O, Abreu AL, Barbe Y, Cathelineau X, Gandaglia G, George AK, Gomez Rivas J, Gupta RT, Lawrentschuk N, Kasivisvanathan V, Lomas D, Malavaud B, Margolis D, Matsuoka Y, Mehralivand S, Moschini M, Oderda M, Orabi H, Rastinehad AR, Remzi M, Schulman A, Shin T, Shiraishi T, Sidana A, Shoji S, Stabile A, Valerio M, Tammisetti VS, Phin Tan W, VAN DEN Bos W, Villers A, Willemse PP, DE LA Rosette J, Polascik T, Sanchez-Salas R. Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society. Minerva Urol Nephrol 2022; 74:581-589. [PMID: 33439577 DOI: 10.23736/s2724-6051.20.04160-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Focal therapy (FT) for prostate cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localized PCa. METHODS A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, 1) the current/present role; 2) the potential/future role; 3) the recommended features for future studies. Consensus was defined using a 70% agreement threshold. RESULTS Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (N.=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (N.=3), a consensus on a partial agreement (N.=1), and a consensus on uncertainty (N.=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localized PCa. Research efforts in this field should be considered a priority. CONCLUSIONS The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.,D epartment of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maria P Laguna
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Jochen Walz
- Department of Urology, Paoli-Calmettes Institute, Marseille, France
| | | | - Fernando Bianco
- Urological Research Network, Nova University, Miami, FL, USA
| | - Justin Gregg
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir H Lebastchi
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Daniel Rukstalis
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Georg Salomon
- Martini Clinic, Prostate Cancer Center, Hamburg, Germany
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Andre L Abreu
- Department of Urology, Keck School of Medicine, University of South California, Los Angeles, CA, USA
| | - Yann Barbe
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Arvin K George
- Division of Urologic Oncology, Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Rajan T Gupta
- Department of Radiology, Duke University, Durham, NC, USA
| | | | | | - Derek Lomas
- Department of Urology, San Raffaele Hospital, Milan, Italy
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Daniel Margolis
- Department of Radiology, Weill Cornell Imaging, Cornell University, New York, NY, USA
| | - Yoh Matsuoka
- Urology at Tokyo Medical and Dental University, Tokyo, Japan
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marco Moschini
- Department of Urology, San Raffaele Hospital, Milan, Italy.,Department of Urology, Lucerne Kanton Hospital, Lucerne, Switzerland
| | - Marco Oderda
- D epartment of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Hazem Orabi
- Department of Urology, Duke University, Durham, NC, USA.,Department of Urology, University of Assiut, Assiut, Egypt
| | | | - Mesut Remzi
- Department of Urology, Döbling Hospital, Vienna, Austria
| | - Ariel Schulman
- Department of Urology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Abhinav Sidana
- Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sunao Shoji
- Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | | | - Massimo Valerio
- Department of Urology, Vaudois University Center Hospital, Lausanne, Switzerland
| | - Varaha S Tammisetti
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei Phin Tan
- Department of Urology, Duke University, Durham, NC, USA
| | | | | | | | - Jean DE LA Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
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16
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Sanchez-Salas R, Marra G, Oreggia D, Tourinho-Barbosa R, Moschini M, Stabile A, Filippini C, Van Melick H, Van Den Bergh R, Gontero P, Pasquali C, Macek P, Mombet A, Cathala N, Cathelineau X. Focal high-intensity focused ultrasound vs. active surveillance for ISUP grade 1 prostate cancer: Medium-term results of a prospective matched-pair comparison. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Arora A, Zugail AS, Pugliesi F, Cathelineau X, Macek P, Barbé Y, Karnes RJ, Ahmed M, Di Trapani E, Soria F, Alvarez-Maestro M, Montorsi F, Briganti A, Necchi A, Pradere B, D'Andrea D, Krajewski W, Roumiguié M, Bajeot AS, Hurle R, Contieri R, Carando R, Teoh JYC, Roupret M, Benamran D, Ploussard G, Mir MC, Sanchez-Salas R, Moschini M. Neoadjuvant chemotherapy does not increase peri-operative morbidity following radical cystectomy. World J Urol 2022; 40:1697-1705. [PMID: 35488914 DOI: 10.1007/s00345-022-04012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether use of neoadjuvant chemotherapy (NAC) is associated with a higher risk of post-operative complications following radical cystectomy (RC) for bladder cancer (BCa). MATERIALS AND METHODS We retrospectively reviewed records of patients undergoing RC for non-metastatic urothelial BCa at 13 tertiary care centres from 2007-2019. Patients who received NAC ('NAC + RC' group) were compared with those who underwent upfront RC ('RC alone' group) for intra-operative variables, incidence of post-operative complications as per the Clavien-Dindo classification (CDC) and rates of re-admission and re-intervention. Multivariable logistic regression analysis was performed to determine predictors of CDC overall and CDC major (grade III-V) complications. We also analysed the trend of NAC utilization over the study period. RESULTS Of the 3113 patients included, 968 (31.1%) received NAC while the remaining 2145 (68.9%) underwent upfront RC for BCa. There was no significant difference between the NAC + RC and RC alone groups with regards to 30-day CDC overall (53.2% vs 54.6%, p = 0.4) and CDC major (15.5% vs 16.5%, p = 0.6) complications. The two groups were comparable for the rate of surgical re-intervention (14.6% in each group) and re-hospitalization (19.6% in NAC + RC vs 17.9% in RC alone, p = 0.2%) at 90 days. On multivariable regression analysis, NAC use was not found to be a significant predictor of 90-day CDC overall (OR 1.02, CI 0.87-1.19, p = 0.7) and CDC major (OR 1.05, CI 0.87-1.26, p = 0.6) complications. We also observed that the rate of NAC utilization increased significantly (p < 0.001) from 11.1% in 2007 to 41.2% in 2019, reaching a maximum of 48.3% in 2018. CONCLUSION This large multicentre analysis with a substantial rate of NAC utilization showed that NAC use does not lead to an increased risk of post-operative complications following RC for BCa. This calls for increasing NAC use to allow patients to avail of its proven oncologic benefit.
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Affiliation(s)
- Amandeep Arora
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. .,Department of Uro-Oncology, Tata Memorial Hospital, HBNI, Dr. Earnest Borges Road, Parel, Mumbai, 400012, India.
| | - Ahmed S Zugail
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.,Department of Urology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Felipe Pugliesi
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.,Division of Urology, Men's Health Centre, Hospital Brigadeiro, São Paulo, SP, Brazil
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Yann Barbé
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | | | | | - Ettore Di Trapani
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Molinette Hospital, Turin, Italy
| | - Mario Alvarez-Maestro
- Department of Urology, La Paz University Hospital, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wrocław, Poland
| | - Mathieu Roumiguié
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | | | - Rodolfo Hurle
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberto Contieri
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberto Carando
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H.Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Morgan Roupret
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, 75013, Paris, France
| | - Daniel Benamran
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, 75013, Paris, France.,Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | | | - M Carmen Mir
- Department of Urology, Foundation Instituto Valenciano Oncologia, Valencia, Spain
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.,Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
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18
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Meylan M, Petitprez F, Becht E, Bougoüin A, Pupier G, Calvez A, Giglioli I, Verkarre V, Lacroix G, Verneau J, Sun CM, Laurent-Puig P, Vano YA, Elaïdi R, Méjean A, Sanchez-Salas R, Barret E, Cathelineau X, Oudard S, Reynaud CA, de Reyniès A, Sautès-Fridman C, Fridman WH. Tertiary lymphoid structures generate and propagate anti-tumor antibody-producing plasma cells in renal cell cancer. Immunity 2022; 55:527-541.e5. [PMID: 35231421 DOI: 10.1016/j.immuni.2022.02.001] [Citation(s) in RCA: 182] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/09/2021] [Accepted: 02/02/2022] [Indexed: 12/30/2022]
Abstract
The presence of intratumoral tertiary lymphoid structures (TLS) is associated with positive clinical outcomes and responses to immunotherapy in cancer. Here, we used spatial transcriptomics to examine the nature of B cell responses within TLS in renal cell carcinoma (RCC). B cells were enriched in TLS, and therein, we could identify all B cell maturation stages toward plasma cell (PC) formation. B cell repertoire analysis revealed clonal diversification, selection, expansion in TLS, and the presence of fully mature clonotypes at distance. In TLS+ tumors, IgG- and IgA-producing PCs disseminated into the tumor beds along fibroblastic tracks. TLS+ tumors exhibited high frequencies of IgG-producing PCs and IgG-stained and apoptotic malignant cells, suggestive of anti-tumor effector activity. Therapeutic responses and progression-free survival correlated with IgG-stained tumor cells in RCC patients treated with immune checkpoint inhibitors. Thus, intratumoral TLS sustains B cell maturation and antibody production that is associated with response to immunotherapy, potentially via direct anti-tumor effects.
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Affiliation(s)
- Maxime Meylan
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Florent Petitprez
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, 75013 Paris, France; MRC Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Etienne Becht
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, 75013 Paris, France
| | - Antoine Bougoüin
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Guilhem Pupier
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Anne Calvez
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Ilenia Giglioli
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Virginie Verkarre
- Département de pathologie, Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris - Paris Centre, 75015 Paris, France; Université de Paris, 75006 Paris, France; PARCC, INSERM, Equipe Labellisée Ligue contre le Cancer, 75015 Paris, France
| | - Guillaume Lacroix
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Johanna Verneau
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Chen-Ming Sun
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Pierre Laurent-Puig
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, EPIGENETEC, 75006 Paris, France
| | - Yann-Alexandre Vano
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France; Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, 75013 Paris, France; MRC Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh EH16 4TJ, UK; Département d'oncologie médicale, Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris - Paris Centre, F-75015 Paris, France; Université de Paris, 75006 Paris, France; PARCC, INSERM, Equipe Labellisée Ligue contre le Cancer, 75015 Paris, France
| | - Reza Elaïdi
- Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie, 75015 Paris, France
| | - Arnaud Méjean
- Département d'urologie, Hôpital européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Rafaël Sanchez-Salas
- Département d'urologie, Institut Mutualiste Montsouris, Université de Paris, 75014 Paris, France
| | - Eric Barret
- Département d'urologie, Institut Mutualiste Montsouris, Université de Paris, 75014 Paris, France
| | - Xavier Cathelineau
- Département d'urologie, Institut Mutualiste Montsouris, Université de Paris, 75014 Paris, France
| | - Stephane Oudard
- Département d'oncologie médicale, Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris - Paris Centre, F-75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Claude-Agnès Reynaud
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMRS8253, Université de Paris, 75015 Paris, France
| | - Aurélien de Reyniès
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, 75013 Paris, France; MRC Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh EH16 4TJ, UK; Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, EPIGENETEC, 75006 Paris, France; Université de Paris, 75006 Paris, France
| | - Catherine Sautès-Fridman
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France
| | - Wolf Herman Fridman
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Equipe labellisée Ligue Contre le Cancer, 75006 Paris, France.
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Castilho Borges R, Kauffman Ortega C, Rocha Tourinho Barbosa R, Pugliesi F, Haiquel L, Candela L, Lanz C, Rodriguez Sanchez L, Rojas Claros O, Sanchez-Salas R, Macek P, Cathelineau X. Micro-ultrasound-guided biopsy for prostate cancer reduces underestimation of index lesion extension at final pathology compared to mri/ultrasound prostate fusion biopsy: Impact on ablation therapy templates. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
INTRODUCTION The therapeutic role of pelvic lymph node dissection (PLND) in prostate cancer (PCa) is unknown due to absence of randomized trials. OBJECTIVE to present a critical review on the therapeutic benefits of PLND in high risk localized PCa patients. MATERIALS AND METHODS A search of the literature on PLND was performed using PubMed, Cochrane, and Medline database. Articles obtained regarding diagnostic imaging and sentinel lymph node dissection, PLND extension, impact of PLND on survival, PLND in node positive "only" disease and PLND surgical risks were critically reviewed. RESULTS High-risk PCa commonly develops metastases. In these patients, the possibility of presenting lymph node disease is high. Thus, extended PLND during radical prostatectomy may be recommended in selected patients with localized high-risk PCa for both accurate staging and therapeutic intent. Although recent advances in detecting patients with lymph node involvement (LNI) with novel imaging and sentinel node dissection, extended PLND continues to be the most accurate method to stage lymph node disease, which may be related to the number of nodes removed. However, extended PLND increases surgical time, with potential impact on perioperative complications, hospital length of stay, rehospitalization and healthcare costs. Controversy persists on its therapeutic benefit, particularly in patients with high node burden. CONCLUSION The impact of PLND on biochemical recurrence and PCa survival is unclear yet. Selection of patients may benefit from extended PLND but the challenge remains to identify them accurately. Only prospective randomized study would answer the precise role of PLND in high-risk pelvis confined PCa patients.
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Affiliation(s)
- Luciano Haiquel
- Sanatorio Las Lomas de San IsidroDepartment of UrologyBuenos AiresArgentinaDepartment of Urology, Sanatorio Las Lomas de San Isidro, Buenos Aires, Argentina
| | - Xavier Cathelineau
- Université Paris DescartesL’Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L’Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Université Paris DescartesL’Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L’Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Petr Macek
- Université Paris DescartesL’Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L’Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Fernando Secin
- Universidad de Buenos AiresDiscipline of UrologyArgentinaDiscipline of Urology, Universidad de Buenos Aires, Argentina
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21
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Colomer Gallardo A, Candela L, Buisan Rueda O, Freixa Sala R, Elias Cañavera J, Moschini M, Macek P, Bennamoun M, Mombet A, Cathelineau X, Areal Calama JJ, Sánchez-Salas R. The Cancer of the Bladder Risk Assessment (COBRA) score accurately predicts cancer-specific survival after radical cystectomy: external validation and lymphovascular invasion assessment value to improve its performance. Clin Genitourin Cancer 2021; 20:199-209. [DOI: 10.1016/j.clgc.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/03/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022]
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22
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Deleuze C, Barret E, Rozet F, Barbe Y, Cathala N, Mombet A, Macek P, Cathelineau X. Prise en charge des récidives après traitement focal du cancer de prostate par ultrasons focalisés de haute intensité (HIFU). Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Lainé C, Rozet F, Mombet A, Cathala N, Barret E, Sanchez Salas R, Macek P, Barbe Y, Cathelineau X. [Rectourethral fistula treatment using the modified York Mason technique: Failure factors assessment]. Prog Urol 2021; 32:139-145. [PMID: 34373197 DOI: 10.1016/j.purol.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess surgical outcomes and failure factors in the management of rectourethral fistulas treated surgically with the modified York Mason technique based on our center's 25 years of experience. METHODS From 1997 to 2021, in a single center study, a total of 35 consecutive patients, underwent rectourethral fistula cure, using the modified York Mason technique. Preoperative patient data, surgical outcomes and failure factors were assessed. RESULTS Of the 35 patients, 28 were successfully managed without the need of further intervention (80%). Median age was 67 years (IQR 62-72) and median follow-up time was 71 months (IQR 30-123). There was no significant difference between the patients that had recurrence or not after the first York Mason. CONCLUSIONS The modified York Mason technique offers a high success rate for the cure of iatrogenic rectourethral fistulas. No predictive factor of failure, after a first cure of recto-uretral fistula by modified York-Mason technique was reported. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- C Lainé
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - F Rozet
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
| | - A Mombet
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - N Cathala
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - E Barret
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - R Sanchez Salas
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - P Macek
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Y Barbe
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - X Cathelineau
- Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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24
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Daugan MV, Revel M, Thouenon R, Dragon-Durey MA, Robe-Rybkine T, Torset C, Merle NS, Noé R, Verkarre V, Oudard SM, Mejean A, Validire P, Cathelineau X, Sanchez-Salas R, Pickering MC, Cremer I, Mansuet-Lupo A, Alifano M, Sautès-Fridman C, Damotte D, Fridman WH, Roumenina LT. Intracellular Factor H Drives Tumor Progression Independently of the Complement Cascade. Cancer Immunol Res 2021; 9:909-925. [PMID: 34039652 DOI: 10.1158/2326-6066.cir-20-0787] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
The complement system is a powerful and druggable innate immune component of the tumor microenvironment. Nevertheless, it is challenging to elucidate the exact mechanisms by which complement affects tumor growth. In this study, we examined the processes by which the master complement regulator factor H (FH) affects clear cell renal cell carcinoma (ccRCC) and lung cancer, two cancers in which complement overactivation predicts poor prognosis. FH was present in two distinct cellular compartments: the membranous (mb-FH) and intracellular (int-FH) compartments. Int-FH resided in lysosomes and colocalized with C3. In ccRCC and lung adenocarcinoma, FH exerted protumoral action through an intracellular, noncanonical mechanism. FH silencing in ccRCC cell lines resulted in decreased proliferation, due to cell-cycle arrest and increased mortality, and this was associated with increased p53 phosphorylation and NFκB translocation to the nucleus. Moreover, the migration of the FH-silenced cells was reduced, likely due to altered morphology. These effects were cell type-specific because no modifications occurred upon CFH silencing in other FH-expressing cells tested: tubular cells (from which ccRCC originates), endothelial cells (human umbilical vein endothelial cells), and squamous cell lung cancer cells. Consistent with this, in ccRCC and lung adenocarcinoma, but not in lung squamous cell carcinoma, int-FH conferred poor prognosis in patient cohorts. Mb-FH performed its canonical function of complement regulation but had no impact on tumor cell phenotype or patient survival. The discovery of intracellular functions for FH redefines the role of the protein in tumor progression and its use as a prognostic biomarker or potential therapeutic target.See article by Daugan et al., p. 891 (36).
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Affiliation(s)
- Marie V Daugan
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Margot Revel
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Romane Thouenon
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Marie-Agnès Dragon-Durey
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Department of Biologic Immunology, Hôpital Européen Georges-Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - Tania Robe-Rybkine
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Carine Torset
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Nicolas S Merle
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Rémi Noé
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Virginie Verkarre
- Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - Stephane Marie Oudard
- Université de Paris, Paris, France.,Department of Oncology, Hôpital Européen Georges-Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - Arnaud Mejean
- Université de Paris, Paris, France.,Department of Urology, Hôpital Européen Georges-Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - Pierre Validire
- Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | - Xavier Cathelineau
- Université de Paris, Paris, France.,Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Mathew C Pickering
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
| | - Isabelle Cremer
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Audrey Mansuet-Lupo
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Departments of Pathology and Thoracic Surgery, Hôpital Cochin, Assistance Publique Hopitaux de Paris, Paris, France
| | - Marco Alifano
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Departments of Pathology and Thoracic Surgery, Hôpital Cochin, Assistance Publique Hopitaux de Paris, Paris, France
| | - Catherine Sautès-Fridman
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Diane Damotte
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Departments of Pathology and Thoracic Surgery, Hôpital Cochin, Assistance Publique Hopitaux de Paris, Paris, France
| | - Wolf H Fridman
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Lubka T Roumenina
- Team Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.
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25
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Daugan MV, Revel M, Russick J, Dragon-Durey MA, Gaboriaud C, Robe-Rybkine T, Poillerat V, Grunenwald A, Lacroix G, Bougouin A, Meylan M, Verkarre V, Oudard SM, Mejean A, Vano YA, Perkins G, Validire P, Cathelineau X, Sanchez-Salas R, Damotte D, Fremeaux-Bacchi V, Cremer I, Sautès-Fridman C, Fridman WH, Roumenina LT. Complement C1s and C4d as Prognostic Biomarkers in Renal Cancer: Emergence of Noncanonical Functions of C1s. Cancer Immunol Res 2021; 9:891-908. [PMID: 34039653 DOI: 10.1158/2326-6066.cir-20-0532] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 02/05/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022]
Abstract
The complement system plays a complex role in cancer. In clear cell renal cell carcinoma (ccRCC), local production of complement proteins drives tumor progression, but the mechanisms by which they do this are poorly understood. We found that complement activation, as reflected by high plasma C4d or as C4d deposits at the tumor site, was associated with poor prognosis in two cohorts of patients with ccRCC. High expression of the C4-activating enzyme C1s by tumor cells was associated with poor prognosis in three cohorts. Multivariate Cox analysis revealed that the prognostic value of C1s was independent from complement deposits, suggesting the possibility of complement cascade-unrelated, protumoral functions for C1s. Silencing of C1s in cancer cell lines resulted in decreased proliferation and viability of the cells and in increased activation of T cells in in vitro cocultures. Tumors expressing high levels of C1s showed high infiltration of macrophages and T cells. Modification of the tumor cell phenotype and T-cell activation were independent of extracellular C1s levels, suggesting that C1s was acting in an intracellular, noncanonical manner. In conclusion, our data point to C1s playing a dual role in promoting ccRCC progression by triggering complement activation and by modulating the tumor cell phenotype and tumor microenvironment in a complement cascade-independent, noncanonical manner. Overexpression of C1s by tumor cells could be a new escape mechanism to promote tumor progression.See related Spotlight by Magrini and Garlanda, p. 855. See article by Daugan et al., p. 909 (40).
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Affiliation(s)
- Marie V Daugan
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Margot Revel
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Jules Russick
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Marie-Agnès Dragon-Durey
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Université de Paris, Paris, France.,Hôpital Européen Georges-Pompidou, Biological Immunology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | | | - Tania Robe-Rybkine
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Victoria Poillerat
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Anne Grunenwald
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Guillaume Lacroix
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Antoine Bougouin
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Maxime Meylan
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Virginie Verkarre
- Université de Paris, Paris, France.,Hôpital Européen Georges-Pompidou, Pathology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | - Stephane M Oudard
- Université de Paris, Paris, France.,Hôpital Européen Georges-Pompidou, Oncology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | - Arnaud Mejean
- Université de Paris, Paris, France.,Hôpital Européen Georges-Pompidou, Urology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | - Yann A Vano
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Université de Paris, Paris, France.,Hôpital Européen Georges-Pompidou, Oncology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | - Geraldine Perkins
- Hôpital Européen Georges-Pompidou, Gastroenterology and Hepatology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | - Pierre Validire
- Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | - Xavier Cathelineau
- Université de Paris, Paris, France.,Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Diane Damotte
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Université de Paris, Paris, France.,Hôpital Cochin, Departments of Pathology and Thoracic Surgery, Assistance Publique Hopitaux de Paris, Paris, France
| | - Veronique Fremeaux-Bacchi
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Hôpital Européen Georges-Pompidou, Biological Immunology Department, Assistance Publique Hopitaux de Paris, Paris, France
| | - Isabelle Cremer
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Catherine Sautès-Fridman
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Wolf H Fridman
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Lubka T Roumenina
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.
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26
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Marra G, Soeterik T, Oreggia D, Tourinho-Barbosa R, Moschini M, Filippini C, van Melick HHE, van den Bergh RCN, Gontero P, Cathala N, Macek P, Sanchez-Salas R, Cathelineau X. Long-term Outcomes of Focal Cryotherapy for Low- to Intermediate-risk Prostate Cancer: Results and Matched Pair Analysis with Active Surveillance. Eur Urol Focus 2021; 8:701-709. [PMID: 33926838 DOI: 10.1016/j.euf.2021.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To date, only one trial compared focal therapy and active surveillance (AS) for low-risk prostate cancer (PCa). In addition, long-term outcomes of focal cryotherapy (FC) are lacking. OBJECTIVE Our aim was to evaluate long-term outcomes of FC and compare them with AS. DESIGN, SETTING, AND PARTICIPANTS We included two prospective series of 121 (FC) and 459 (AS) consecutive patients (2008-2018) for low- to intermediate-risk PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Study outcomes were radical therapy-free or androgen deprivation therapy (ADT)-free, any treatment-free, metastasis-free, and overall survival. A matched pair analysis was performed using seven covariates. RESULTS AND LIMITATIONS The median FC follow-up was 85 mo (interquartile range 58-104); 92 (76%) men had International Society of Urological Pathology (ISUP) grade 1. Among matched variables, no significant differences were present except for cT stage and year of entry (both p < 0.01). Ten-year radical therapy-free or ADT-free, any treatment-free, metastasis-free, and overall survival were 51%, 40.2%, 93.9%, and 97%, respectively for FC. No differences were noted with AS (all p > 0.05), with the exception of time to radical therapy, time to radical therapy and ADT, and time to any treatment, all being shorter for AS (all p < 0.01). Freedom from radical treatment or ADT was higher for FC (AS 10 yr 39.3%; p = 0.04). Complications were relatively rare (26.5%) and mainly of low grade (Clavien >2, n = 3); three men developed incontinence (p = 0.0814), while both International Index of Erectile Function 5 and International Prostate Symptom Score scores increased (p = 0.0287 and p = 0.0165, respectively). Limitations include absence of randomization. CONCLUSIONS At an early long-term follow-up, FC in the context of mainly low-risk PCa is safe and increases time to radical therapy but does not provide meaningful oncological advantages compared with AS. PATIENT SUMMARY We compared focal cryotherapy with active surveillance mainly for low-risk prostate cancer. Focal cryotherapy, despite having fewer complications, did not yield meaningful advantages over active surveillance at 10 yr. Active surveillance should be preferred to focal cryotherapy for these patients.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France; Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy.
| | - Timo Soeterik
- Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Davide Oreggia
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Claudia Filippini
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | | | | | - Paolo Gontero
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
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27
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Rodríguez Sánchez L, Mottrie A, Graefen M, Cathelineau X, Breda A, Sanchez-Salas R. Re: Evaluation of Patient- and Surgeon-specific Variations in Patient-reported Urinary Outcomes 3 Months After Radical Prostatectomy from a Statewide Improvement Collaborative. Eur Urol 2021; 80:258-259. [PMID: 33895010 DOI: 10.1016/j.eururo.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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28
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Bakavicius A, Marra G, Macek P, Robertson C, Abreu AL, George AK, Malavaud B, Coloby P, Rischmann P, Moschini M, Rastinehad AR, Sidana A, Stabile A, Tourinho-Barbosa R, de la Rosette J, Ahmed H, Polascik T, Cathelineau X, Sanchez-Salas R. Available evidence on HIFU for focal treatment of prostate cancer: a systematic review. Int Braz J Urol 2021; 48:263-274. [PMID: 34003610 PMCID: PMC8932027 DOI: 10.1590/s1677-5538.ibju.2021.0091] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Prostate cancer (PCa) is the second most common oncologic disease among men. Radical treatment with curative intent provides good oncological results for PCa survivors, although definitive therapy is associated with significant number of serious side-effects. In modern-era of medicine tissue-sparing techniques, such as focal HIFU, have been proposed for PCa patients in order to provide cancer control equivalent to the standard-of-care procedures while reducing morbidities and complications. The aim of this systematic review was to summarise the available evidence about focal HIFU therapy as a primary treatment for localized PCa. MATERIAL AND METHODS We conducted a comprehensive literature review of focal HIFU therapy in the MEDLINE database (PROSPERO: CRD42021235581). Articles published in the English language between 2010 and 2020 with more than 50 patients were included. RESULTS Clinically significant in-field recurrence and out-of-field progression were detected to 22% and 29% PCa patients, respectively. Higher ISUP grade group, more positive cores at biopsy and bilateral disease were identified as the main risk factors for disease recurrence. The most common strategy for recurrence management was definitive therapy. Six months after focal HIFU therapy 98% of patients were totally continent and 80% of patients retained sufficient erections for sexual intercourse. The majority of complications presented in the early postoperative period and were classified as low-grade. CONCLUSIONS This review highlights that focal HIFU therapy appears to be a safe procedure, while short-term cancer control rate is encouraging. Though, second-line treatment or active surveillance seems to be necessary in a significant number of patients.
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Affiliation(s)
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Andre L Abreu
- Department of Urology, Keck School of Medicine and University of South California, CA, USA
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Patrick Coloby
- Department of Urology, Centre Hospitalier René-Dubos (Pontoise), France
| | - Pascal Rischmann
- Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Urology, Lucerne Kanton Hospital, Lucerne, Switzerland
| | | | - Abhinav Sidana
- Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rafael Tourinho-Barbosa
- Departamento de Urologia, Faculdade de Medicina do ABC (Faculdade de Medicina do ABC), São Paulo, Brasil
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | - Hashim Ahmed
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, United Kingdom
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29
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Céspedes MS, Radtke JP, Cathelineau X, Sanchez-Salas R. Prostate specific membrane antigen (PSMA) and Prostate Cancer Staging: is our current conventional staging obsolete? Int Braz J Urol 2021; 47:1243-1249. [PMID: 33861056 PMCID: PMC8486444 DOI: 10.1590/s1677-5538.ibju.2020.0997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Xavier Cathelineau
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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30
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Neuzillet Y, Dreyfus JF, Raynaud JP, Rouanne M, Schneider M, Roupret M, Drouin S, Galiano M, Cathelineau X, Lebret T, Botto H. Relationship of preoperative androgen levels and metabolic syndrome with quality of life and erectile function in patients who are to undergo radical prostatectomy. Asian J Androl 2021; 23:520-526. [PMID: 33762475 PMCID: PMC8451490 DOI: 10.4103/aja.aja_3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study aims to investigate whether clinical and biological preoperative characteristics of patients who were to undergo radical prostatectomy were associated with impairment in patient-reported quality of life (QoL) and erectile dysfunction immediately before intervention. We evaluated patient-reported outcomes among 1019 patients (out of 1343) of the AndroCan study, willing to score the Aging Male Symptom (AMS) and the International Index of Erectile Function 5-item (IIEF-5) auto-questionnaires. Univariate linear regression and robust multiple regression were used to ascertain the relationship between demographic, clinical, and hormonal parameters and global AMS or IIEF-5 scores. As a result, most patients (85.1%) of the Androcan cohort agreed to complete questionnaires. Significantly higher IIEF-5 global scores were found in non-Caucasian and obese patients, with larger waist circumference, metabolic syndrome, diabetes mellitus, cardiovascular disease, hypertension, high blood sugar, concomitant medications, and hypogonadism, while the AMS global score was significantly higher in patients with larger waist circumference, metabolic syndrome, high blood pressure, raised glycemia, and concomitant medication. The IIEF-5 global score was correlated to age, dehydroepiandrosterone (DHEA), fat mass percentage, and androstenediol (D5). The AMS global score was significantly correlated to DHEA, D5, and DHEA sulfate. Finally, the multivariate models showed that QoL and erectile function were significantly affected, before surgery, by symptoms and signs that are usually considered as pertaining to the metabolic syndrome, while sexual hormones are essentially correlated to erectile dysfunction.
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Affiliation(s)
- Yann Neuzillet
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Jean-François Dreyfus
- Department of Clinical Research and Innovation, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | | | - Mathieu Rouanne
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Marc Schneider
- Department of Urology, Hôpital Louis Pasteur, Colmar 68000, France
| | - Morgan Roupret
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris 75013, France
| | - Sarah Drouin
- Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris 75013, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris 75014, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Paris-Descartes University, Paris 75014, France
| | - Thierry Lebret
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
| | - Henry Botto
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes 92150, France
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Sivaraman A, Marra G, Stabile A, Mombet A, Macek P, Lanz C, Cathala N, Moschini M, Carneiro A, Sanchez-Salas R, Cathelineau X. Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center. Int Braz J Urol 2021; 46:984-992. [PMID: 32822127 PMCID: PMC7527093 DOI: 10.1590/s1677-5538.ibju.2019.0682] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Focal therapy (FT) for localized prostate cancer (PCa) treatment is raising interest. New technological mpMRI-US guided FT devices have never been compared with the previous generation of ultrasound-only guided devices. Materials and Methods We retrospectively analyzed prospectively recorded data of men undergoing FT for localized low- or intermediate-risk PCa with US- (Ablatherm®-2009 to 2014) or mpMRI-US (Focal One®-from 2014) guided HIFU. Follow-up visits and data were collected using internationally validated questionnaires at 1, 2, 3, 6 and 12 months. Results We included n=88 US-guided FT HIFU and n=52 mpMRI-US guided FT HIFU respectively. No major baseline differences were present except higher rates of Gleason 3+4 for the mpMRI-US group. No major differences were present in hospital stay (p=0.1), catheterization time (p=0.5) and complications (p=0.2) although these tended to be lower in the mpMRI-US group (6.8% versus 13.2% US FT group). At 3 months mpMRI-US guided HIFU had significantly lower urine leak (5.1% vs. 15.9%, p=0.04) and a lower drop in IIEF scores (2 vs. 4.2, p=0.07). Of those undergoing 12-months control biopsy in the mpMRI-US-guided HIFU group, 26% had residual cancer in the treated lobe. Conclusion HIFU FT guided by MRI-US fusion may allow improved functional outcomes and fewer complications compared to US- guided HIFU FT alone. Further analysis is needed to confirm benefits of mpMRI implementation at a longer follow-up and on a larger cohort of patients.
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Affiliation(s)
- Arjun Sivaraman
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.,Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Armando Stabile
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Petr Macek
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Nathalie Cathala
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Arie Carneiro
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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Marra G, Laguna MP, Walz J, Pavlovich CP, Bianco F, Gregg J, Lebastchi AH, Lepor H, Macek P, Rais-Bahrami S, Robertson C, Rukstalis D, Salomon G, Ukimura O, Abreu AL, Barbe Y, Cathelineau X, Gandaglia G, George AK, Rivas JG, T Gupta R, Lawrentschuk N, Kasivisvanathan V, Lomas D, Malavaud B, Margolis D, Matsuoka Y, Mehralivand S, Moschini M, Oderda M, Orabi H, Rastinehad AR, Remzi M, Schulman A, Shin T, Shiraishi T, Sidana A, Shoji S, Stabile A, Valerio M, Tammisetti VS, Tan WP, Van Den Bos W, Villers A, Willemse PP, de la Rosette J, Polascik T, Sanchez-Salas R. Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society. Minerva Urol Nefrol 2021. [PMID: 33439577 DOI: 10.23736/s0393-2249.20.04160-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Focal Therapy (FT) for Prostate Cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localised PCa. MATERIALS AND METHODS A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, i) the current/present role; ii) the potential/future role; iii) the recommended features for future studies. Consensus was defined using a 70% agreement threshold. RESULTS Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (n=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (n=3), a consensus on a partial agreement (n=1), and a consensus on uncertainty (n=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localised PCa. Research efforts in this field should be considered a priority. CONCLUSIONS The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.,Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maria Pilar Laguna
- Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | | | - Fernando Bianco
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | | | - Amir H Lebastchi
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Herbert Lepor
- Martini Clinic, Prostate Cancer Center, Hamburg, Germany
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Soroush Rais-Bahrami
- Department of Urology, Oita University Faculty of Medicine, Yufu-shi Oita, Japan
| | | | - Daniel Rukstalis
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Osamu Ukimura
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andre L Abreu
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yann Barbe
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Giorgio Gandaglia
- Department of Urology, Lucerne Kanton Hospital, Lucerne, Switzerland
| | - Arvin K George
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Juan Gomez Rivas
- Department of Urology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rajan T Gupta
- Urology at Tokyo Medical and Dental University, Tokyo, Japan -
| | - Nathan Lawrentschuk
- Department of Urology, Keck School of Medicine and University of South California, CA, USA
| | - Veeru Kasivisvanathan
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Derek Lomas
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bernard Malavaud
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel Margolis
- Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yoh Matsuoka
- Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | | | - Marco Moschini
- Department of Urology, Lucerne Kanton Hospital, Lucerne, Switzerland.,Department of Urology, Duke University, Durham, NC, USA
| | - Marco Oderda
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Hazem Orabi
- Department of Urology, CHU de Lille, Lille, France
| | | | - Mesut Remzi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ariel Schulman
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Toshitaka Shin
- Urological Research Network, Nova University, Miami, FL, USA
| | - Takumi Shiraishi
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Sunao Shoji
- Department of Urology, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Armando Stabile
- Department of Urology, Lucerne Kanton Hospital, Lucerne, Switzerland
| | | | - Varaha S Tammisetti
- Department of Radiology, Weill Cornell Imaging, Cornell University, New York, NY, USA
| | - Wei Phin Tan
- Department of Urology, CHU de Lille, Lille, France
| | | | | | | | - Jean de la Rosette
- Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
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Ta MH, Nunes-Silva I, Barret E, Renard-Penna R, Rozet F, Mombet A, Cathala N, Sanchez-Salas R, Créhange G, Cathelineau X, Cosset JM. Focal Brachytherapy for Localized Prostate Cancer: Midterm Outcomes. Pract Radiat Oncol 2021; 11:e477-e485. [PMID: 33422681 DOI: 10.1016/j.prro.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Focal brachytherapy (F-BT) is a suitable technique for focal therapy in localized prostate cancer. It has the ability to adapt the seed implantation to the volume and location of the tumor. The aim of this study was to assess F-BT oncologic, functional, and toxicity midterm outcomes in men who underwent prostate cancer treatment. METHODS AND MATERIALS The study included 39 men with low- to intermediate-risk prostate cancer treated with F-BT between 2010 and 2015. The dose prescription was 145 Gy. Failure was defined as the presence of any residual prostate cancer in the treated area. The primary and secondary endpoints were the F-BT oncologic and functional outcomes, respectively. A 2-sided P value < .05 indicated statistical significance. RESULTS The mean follow-up time was 65 months (range, 43-104 months). After 24 months, 34 patients underwent control biopsies and 5 patients refused. The biopsies were negative in 27 cases (79%) and positive in 7 cases (21%), all outside the volume treated. Biochemical relapse-free survival at 5 years, disease-free survival, and overall survival were 96.8% ± 0.032%, 79.5% ± 0.076%, and 100%, respectively. The mean International Prostate Symptom Score at 2 months was significantly higher than initially (P = .0003), with no significant difference later. No late urinary, sexual, or rectal toxicity was observed. Salvage treatment was possible with good tolerance at 3.4 years of follow-up. Limitations of this study include the retrospective nature and lack of randomization. CONCLUSIONS F-BT is a safe and effective treatment for selected patients presenting with low- or intermediate-risk localized prostate cancer.
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Affiliation(s)
- Minh-Hanh Ta
- Radiotherapy Department, SNC Charlebourg, Amethyst Group, La Garenne-Colombes, France
| | - Igor Nunes-Silva
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Urology Department, Arnaldo Vieira de Carvalho Cancer Institute, Sao Paulo, Brazil
| | - Eric Barret
- Urology Department, Institut Mutualiste Montsouris, Paris, France.
| | | | - François Rozet
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | - Annick Mombet
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | - Nathalie Cathala
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | | | - Gilles Créhange
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Oncology/Radiotherapy Department, Institut Curie, Paris, France
| | | | - Jean-Marc Cosset
- Radiotherapy Department, SNC Charlebourg, Amethyst Group, La Garenne-Colombes, France; Urology Department, Institut Mutualiste Montsouris, Paris, France; Oncology/Radiotherapy Department, Institut Curie, Paris, France
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34
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Macek P, Sanchez-Salas R, Cathelineau X. Re: High Intensity Focused Ultrasound Hemigland Ablation for Prostate Cancer. Initial Outcomes of a United States Series. Eur Urol 2020; 79:554-555. [PMID: 33308906 DOI: 10.1016/j.eururo.2020.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Petr Macek
- Department of Urology, Institut Montsouris and Université de Paris, Paris, France.
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Montsouris and Université de Paris, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Montsouris and Université de Paris, Paris, France
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35
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Ahallal Y, Mellouki A, Sanchez-Salas R, Rozet F, Galiano M, Chevallier D, Tibi B, Cathelineau X, Durand M, Barret E. L’impact psychologique et fonctionnel des différentes modalités thérapeutiques du cancer de prostate localisé de faible risque. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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36
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Tourinho-Barbosa RR, Batista LT, Cathelineau X, Sanchez-Macias J, Sanchez-Salas R. Ablative options for prostate cancer management. Turk J Urol 2020; 47:S49-S55. [PMID: 33052840 DOI: 10.5152/tud.2020.20390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
This review provides an overview of the available ablative options for prostate cancer (PCa) management. It contemplates the ablative concepts and the role of prostate ablation in different settings, from primary treatment to repeat ablation, and as an alternative to radiorecurrent disease. Improvements in prostate imaging have allowed us to ablate prostate lesions through thermal, mechanical, and vascular-targeted sources of energy. Partial gland ablation (PGA) has an emerging role in the management of localized PCa because toxicity outcomes have been proven less harmful compared with whole-gland treatments. Although long-term oncological outcomes are yet to be consolidated in comparative studies, recent large series and prospective studies in PGA have reported encouraging results. A second ablation after disease recurrence has demonstrated low toxicity, and future studies must define its potential to avoid radical treatments. PGA is an attractive option for PCa management in different scenarios because of its low-toxicity profile. As expected, recurrence rates are higher than those seen in whole-gland procedures. Long-term oncological outcomes of primary and salvage options are required to endorse it among the standard treatments.
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Affiliation(s)
- Rafael R Tourinho-Barbosa
- Department of Urology, Institute Mutualiste Montsouris, Université Paris-Descartes, Paris, France.,Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Department of Urology, Hospital Cardiopulmonar, Salvador, Brazil
| | | | - Xavier Cathelineau
- Department of Urology, Institute Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Javier Sanchez-Macias
- Department of Urology, Hospital Clinic de Barcelona, Universidad de Barcelona, Barcelone, Spain
| | - Rafael Sanchez-Salas
- Department of Urology, Institute Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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Moschini M, Afferi L, Gandaglia G, D'Andrea D, Zamboni S, Di Bona C, Mordasini L, Mattei A, Baumeister P, Martini A, Burgio G, Shariat SF, Sanchez-Salas R, Cathelineau X, Stabile A, Zaffuto E, Salonia A, Colombo R, Necchi A, Montorsi F, Briganti A, Gallina A. Prediction of the Need for an Extended Lymphadenectomy at the Time of Radical Cystectomy in Patients with Bladder Cancer. Eur Urol Focus 2020; 7:1067-1074. [PMID: 33020030 DOI: 10.1016/j.euf.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A prospective randomized trial (LEA AUO AB 25/02) found no survival benefit in extended compared with limited pelvic lymph node dissection (PLND) templates in bladder cancer (BCa) patients treated with radical cystectomy (RC). However, the rate of lymph node invasion (LNI) in the standard and extended templates was lower than estimated. OBJECTIVE To assess the accuracy of preoperative clinical and pathological parameters to predict LNI and to develop a model to preoperatively select candidates for the extended PLND templates. DESIGN, SETTING, AND PARTICIPANTS A total of 903 BCa patients treated at a single institution were retrospectively identified. The primary outcome was to identify preoperatively the risk of LNI to tailor the type of PLND. The extended PLND templates consisted in the removal of pelvic lymph nodes together with the common iliac, presacral, para-aortocaval, interaortocaval, and paracaval sites up to the inferior mesenteric artery. INTERVENTION A total of 903 BCa patients were treated with RC and bilateral extended PLND templates. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Several models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots and decision curve analyses. A nomogram predicting LNI in the extended pattern was developed and validated internally. RESULTS AND LIMITATIONS Overall, 55 patients (6.1%) had LNI in the extended PLND templates at RC. The median number of nodes removed was 19 (interquartile range: 13-26). A model including age, clinical T stage, clinical node stage, lymphovascular invasion, and presence of carcinoma in situ at the last transurethral resection before RC was developed. The AUC of this model is 73%. Using a cutoff of 3%, 108 extended PLNDs (12%) would be spared and only two LNIs (3%) would be missed. The main limitations of our model are the retrospective nature of the data, lack of external validation, and low rate of LNI. CONCLUSIONS This is the first proposed model to predict LNI in the extended PLND templates. This model might help urologists identify which patients might benefit from an extended PLND at the time of RC, reserving a standard PLND for all the others. PATIENT SUMMARY We developed the first nomogram to predict lymph node invasion (LNI) in the extended pelvic lymph node dissection templates in bladder cancer patients treated with radical cystectomy. The adoption of our model to identify candidates for the extended pelvic lymph node dissection templates could avoid up to 12% of these procedures at the cost of missing only 3% of patients with LNI.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Luca Afferi
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Giorgio Gandaglia
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Carlo Di Bona
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Livio Mordasini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Alberto Martini
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Giusy Burgio
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Armando Stabile
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Zaffuto
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Renzo Colombo
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Necchi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
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Arora A, Pugliesi F, Zugail AS, Moschini M, Pazeto C, Macek P, Stabile A, Lanz C, Mombet A, Bennamoun M, Sanchez-Salas R, Cathelineau X. Comparing Perioperative Complications Between Laparoscopic and Robotic Radical Cystectomy for Bladder Cancer. J Endourol 2020; 34:1033-1040. [DOI: 10.1089/end.2020.0112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amandeep Arora
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Felipe Pugliesi
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, Brazil
| | - Ahmed S. Zugail
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marco Moschini
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Cristiano Pazeto
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Armando Stabile
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Mostefa Bennamoun
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France
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Arora A, Pugliesi F, Zugail AS, Moschini M, Pazeto C, Macek P, Stabile A, Lanz C, Cathala N, Bennamoun M, Sanchez-Salas R, Cathelineau X. Higher nodal yield with robot-assisted pelvic lymph node dissection for bladder cancer compared to laparoscopic dissection: implications for more accurate staging. Arab J Urol 2020; 19:92-97. [PMID: 33763254 PMCID: PMC7954504 DOI: 10.1080/2090598x.2020.1824570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives To compare the lymph node (LN) yield and adequacy of laparoscopic pelvic lymph node dissection (L-PLND) and robot-assisted PLND (R-PLND), as PLND is a fundamental component of radical cystectomy (RC) for bladder cancer (BCa), where a positive status is the most powerful predictor of disease recurrence and survival. Patents and methods We retrospectively reviewed patients undergoing RC with PLND for BCa from January 2007 to July 2019 and grouped them in to L- and R-PLND. Until 2011, patients underwent a standard PLND (S-PLND) with the cranial limit as bifurcation of common iliac artery. Since 2012, an extended PLND (E-PLND) up to aortic bifurcation has been performed. An adequate S- and E-PLND were defined as those that yielded at least 10 and 16 LNs, respectively. The groups were compared for LN yield and adequacy of PLND. Results During the study period, 305 patients underwent minimally invasive RC in our centre, of which 274 (89.8%) underwent a concomitant PLND (98 L-PLND, 176 R-PLND). R-PLND resulted in a significantly greater median LN yield compared to L-PLND, both in the S-PLND (16 vs 11, P < 0.001) and the E-PLND (19 vs 14, P < 0.001) eras. Also, a significantly higher proportion of patients in the R-PLND group had an adequate PLND compared to the L-PLND group. Surgical approach to PLND (R- vs L-PLND) was the only variable that was significantly associated with an adequate PLND on both univariable (odds ratio [OR] 1.860, 95% confidence interval [CI] 1.114–3.105; P = 0.01) and multivariable (OR 2.109, 95% CI 1.222–3.641; P = 0.007) analyses. Conclusion R-PLND leads to a higher LN yield and a greater probability of an adequate PLND compared to L-PLND for both standard and extended templates. Therefore, the robot-assisted approach would lead to more accurate staging following RC with PLND.
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Affiliation(s)
- Amandeep Arora
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.,Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Felipe Pugliesi
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.,Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, Brazil
| | - Ahmed S Zugail
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.,Department of Urology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marco Moschini
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.,Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Cristiano Pazeto
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Armando Stabile
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.,Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Mostefa Bennamoun
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France
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Stabile A, Gandaglia G, Fossati N, Scuderi S, Barletta F, Nocera L, Leni R, Robesti D, Mazzone E, Rosiello G, Bandini M, Bravi C, Suardi N, Moschini M, Karakiewicz P, Macek P, Cathala N, Cathelineau X, Briganti A, Montorsi F, Salas R. Focal therapy for prostate cancer: do apical lesions correlate with worse outcomes? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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41
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Cathelineau X, Sanchez-Salas R. Editorial Comment. J Urol 2020; 204:949. [PMID: 32985925 DOI: 10.1097/ju.0000000000001133.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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Klotz L, Lughezzani G, Maffei D, Sánchez A, Pereira JG, Staerman F, Cash H, Luger F, Lopez L, Sanchez-Salas R, Abouassaly R, Shore ND, Eure G, Paciotti M, Astobieta A, Wiemer L, Hofbauer S, Heckmann R, Gusenleitner A, Kaar J, Mayr C, Loidl W, Rouffilange J, Gaston R, Cathelineau X, Klein E. Comparison of micro-ultrasound and multiparametric magnetic resonance imaging for prostate cancer: A multicenter, prospective analysis. Can Urol Assoc J 2020; 15:E11-E16. [PMID: 32701437 DOI: 10.5489/cuaj.6712] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION High-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the detection of clinically significant prostate cancer. METHODS We included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI targets (Prostate Imaging-Reporting and Data System [PI-RADS] >3 and micro-ultrasound targets (Prostate Risk Identification using Micro-ultrasound [PRIMUS] >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2. RESULTS Overall, 39.5% were positive for clinically significant prostate cancer. Micro-ultrasound and mpMRI sensitivity was 94% vs. 90%, respectively (p=0.03), and NPV was 85% vs. 77%, respectively. Specificities of micro-ultrasound and MRI were both 22%, with similar PPV (44% vs. 43%). This represents the initial experience with the technology at most of the participating sites and, therefore, incorporates a learning curve. Number of cores, diagnostic strategy, blinding to MRI results, and experience varied between sites. CONCLUSIONS In this initial multicenter registry, micro-ultrasound had comparable or higher sensitivity for clinically significant prostate cancer compared to mpMRI, with similar specificity. Micro-ultrasound is a low-cost, single-session option for prostate screening and targeted biopsy. Further larger-scale studies are required for validation of these findings.
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Affiliation(s)
| | | | | | | | | | | | - Hannes Cash
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Rob Abouassaly
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, United States
| | - Gregg Eure
- Urology of Virginia, Virginia Beach, VA, United States
| | | | | | - Laura Wiemer
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Jasmin Kaar
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | - Clemens Mayr
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | - Wolfgang Loidl
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | | | | | | | - Eric Klein
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States
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Baccaglini W, Glina FA, Pazeto CL, Medina LG, Korkes F, Bernardo WM, Sotelo R, Glina S, Marra G, Moschini M, Cathelineau X, Sanchez-Salas R. Accuracy of MRI-guided Versus Systematic Prostate Biopsy in Patients Under Active Surveillance: A Systematic Review and Meta-analysis. Clin Genitourin Cancer 2020; 19:3-11.e1. [PMID: 32839133 DOI: 10.1016/j.clgc.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Abstract
This meta-analysis focuses on the accuracy of upgrading to clinically significant prostate cancer (PCa) by multiparametric magnetic resonance imaging-targeted biopsy (MRI-TB) versus systematic biopsy (SB). We searched the Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Literatura Latino Americana em Ciências da Saúde databases through January 2020 for comparative, retrospective/prospective, paired-cohort, and randomized clinical trials with paired comparisons. The population consisted of patients with low-risk PCa in active surveillance with at least 1 index lesion on imaging. We evaluated the quality of evidence by using the Quality Assessment of Diagnostic Accuracy Studies-2 score. Group comparisons considered the differences between the area under the curve summary receiver operating characteristic curve in a 2-tailed method. We also compared the positive predictive value of the best single method (MRI-TB or SB) and the referral study test (combined biopsy, a combination of MRI-TB and SB). The meta-analysis included 6 studies enrolling 741 patients. The pooled sensitivity for the 2 groups was 0.79 (95% confidence interval, 0.74-0.83; I2 = 75%) and 0.67 (95% confidence interval, 0.63-0.74; I2 = 55.4%), respectively. The area under the curve for the MRI-TB and SB groups were 0.99 and 0.92 (P < .001), respectively. The positive predictive value for the MRI-TB and combined biopsy groups were similar. The accumulated evidence suggests better results for MRI-TB compared with SB. Therefore, use of MRI-TB alone may be preferable in patients in active surveillance harboring low-risk PCa.
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Affiliation(s)
- Willy Baccaglini
- Department of Urology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Department of Urology, L'Institut Mutualiste Montsouris, Paris, France; Department of Urology, Hospital Albert Einstein, São Paulo, Brazil
| | - Felipe A Glina
- Department of Urology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Department of General Surgery, Faculdade de Medicina de Jundiaí, Jundiaí, São Paulo, Brazil
| | - Cristiano Linck Pazeto
- Department of Urology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
| | - Luis G Medina
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Fernando Korkes
- Department of Urology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Department of Urology, Hospital Albert Einstein, São Paulo, Brazil
| | - Wanderley M Bernardo
- Department of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rene Sotelo
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Sidney Glina
- Department of Urology, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Giancarlo Marra
- Department of Urology, L'Institut Mutualiste Montsouris, Paris, France
| | - Marco Moschini
- Department of Urology, L'Institut Mutualiste Montsouris, Paris, France
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Sanchez LR, Cathelineau X, Pinto AMA, Borque-Fernando Á, Gil MJ, Yee CH, Sanchez-Salas R. Clinical and Surgical Assistance in Prostate Cancer during the COVID-19 Pandemic: Implementation of assistance protocols. Int Braz J Urol 2020; 46:50-61. [PMID: 32549073 PMCID: PMC7720002 DOI: 10.1590/s1677-5538.ibju.2020.s106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. MATERIAL AND METHODS We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. RESULTS Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. CONCLUSIONS Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged.
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Affiliation(s)
- Lara Rodriguez Sanchez
- Université Paris-DescartesL'Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Hospital Universitario Miguel ServetDepartment of UrologyZaragozaSpainDepartment of Urology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Xavier Cathelineau
- Université Paris-DescartesL'Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Alexis M. Alva Pinto
- Clínica OncosaludDepartment of UrologyLimaPeruDepartment of Urology, Clínica Oncosalud, Lima, Peru
| | - Ángel Borque-Fernando
- Hospital Universitario Miguel ServetDepartment of UrologyZaragozaSpainDepartment of Urology, Hospital Universitario Miguel Servet, Zaragoza, Spain
- IIS-AragonZaragozaSpainIIS-Aragon, Zaragoza, Spain
| | - Maria Jesús Gil
- Hospital Universitario Miguel ServetDepartment of UrologyZaragozaSpainDepartment of Urology, Hospital Universitario Miguel Servet, Zaragoza, Spain
- IIS-AragonZaragozaSpainIIS-Aragon, Zaragoza, Spain
| | - Chi-Hang Yee
- The Chinese University of Hong KongS.H. Ho Urology CentreDepartment of SurgeryHong KongDepartment of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Rafael Sanchez-Salas
- Université Paris-DescartesL'Institut Mutualiste MontsourisDepartment of UrologyParisFranceDepartment of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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Stabile A, Gandaglia G, Fossati N, Orczyk C, Giganti F, Scuderi S, Cucchiara V, Robesti D, Zaffuto E, Barletta F, Sorce G, Pellegrino F, Moschini M, Cathala N, Macek P, Ahmed H, Emberton M, Cathelineau X, Briganti A, Montorsi F, Sanchez-Salas R, Moore C. The relationship between percentage PSA reduction and rate of failure after focal therapy for prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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46
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Nunes-Silva I, Ta MH, Barret E, Rozet F, Macek P, Mombet A, Sanchez-Salas R, Cathala N, Cathelineau X, Cosset JM. Focal brachytherapy for localized prostate cancer: Mid-term outcomes. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Amaral B, Macek P, Sanchez-Salas R, Linck Pazeto C, Zugail A, Arora A, Fregeville A, Marinho F, Lefevre M, Cathala N, Mombet A, Cathelineau X. Renal tumor biopsy: Rationale to avoid surgery in small renal masses. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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48
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Afferi L, Moschini M, Mattei A, Montorsi F, Briganti A, Cathelineau X, Sanchez-Salas R. Re: Adjuvant Chemotherapy in Upper Tract Urothelial Carcinoma (the POUT Trial): A Phase 3, Open-label, Randomised Controlled Trial. Eur Urol 2020; 78:289-290. [PMID: 32359702 DOI: 10.1016/j.eururo.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France.
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Carando R, Afferi L, Marra G, Krajewski W, Pagliarulo V, Abufaraj M, Xylinas E, Cathelineau X, Sanchez-Salas R, Moschini M. The effectiveness of multiparametric magnetic resonance imaging in bladder cancer (Vesical Imaging-Reporting and Data System): A systematic review. Arab J Urol 2020; 18:67-71. [PMID: 33029409 PMCID: PMC7473244 DOI: 10.1080/2090598x.2020.1733818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective To evaluate the role of the Vesical Imaging-Reporting and Data System (VI-RADS) score in the diagnostic pathway of bladder cancer. Methods A systemic search of the contemporary literature was performed in December 2019 using the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), and Web of Science databases focussing on all available articles on VI-RADS. Results Overall, six of 15 articles were included. All the available articles evaluated the ability of radiologists to use the VI-RADS score for discriminating non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC). Considering a cut-off VI-RADS score of >2, the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were 78-91.9%, 85-91%.1, 69-78%, and 88-97.1%, respectively. Considering a VI-RADS score cut-off of >3, the sensitivity, specificity, PPV and NPV were 77-94.6%, 43.9-96.5%, 51.6-86%, and 63.7-93%, respectively. Good interobserver agreement was demonstrated in the evaluated studies with a κ score of 0.73-0.89. Only one study evaluated the utility of VI-RADS in determining the presence of MIBC in patients treated with transurethral resection of the bladder diagnosed with high-grade T1 before the second transurethral resection using a VI-RADS score cut-off of >2; the sensitivity, specificity, PPV and NPV were 85%, 93.6%, 74.5%, and 96.6%, respectively. Conclusion The VI-RADS score, using multiparametric magnetic resonance imaging, showed excellent results in discriminating MIBC from NMIBC. Preliminary results have been reported for its use in patients with high-grade T1 bladder cancer. These results need to be validated in high-quality real-world settings. Abbreviations DCE: dynamic contrast enhancement; DWI: diffusion-weighted imaging; (N)MIBC: (non-)muscle-invasive bladder cancer; mpMRI: multiparametric MRI; TURBT: transurethral resection of bladder tumour; (N)(P)PV: (negative) (positive) predictive value; SC: structural category; T2W: T2-weighted; VI-RADS: vesical imaging-reporting and data system.
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Affiliation(s)
- Roberto Carando
- Department of Urology, Clinica Luganese Moncucco, Lugano, Switzerland.,Clinica S. Anna, Swiss Medical Group, Sorengo, Switzerland.,Ward of Surgery and Urology, Clinica S. Chiara, Locarno, Switzerland.,Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | | | - Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
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Lanz C, Bennamoun M, Macek P, Cathelineau X, Sanchez-Salas R. The importance of antiandrogen in prostate cancer treatment. Ann Transl Med 2020; 7:S362. [PMID: 32016080 DOI: 10.21037/atm.2019.09.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Camille Lanz
- Department of Urology, Mutualist Montsouris Institute, 42 Boulevard Jourdan, Paris, France
| | - Mostefa Bennamoun
- Department of Oncology, Mutualist Montsouris Institute, 42 Boulevard Jourdan, Paris, France
| | - Petr Macek
- Department of Urology, Mutualist Montsouris Institute, 42 Boulevard Jourdan, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Mutualist Montsouris Institute, 42 Boulevard Jourdan, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Mutualist Montsouris Institute, 42 Boulevard Jourdan, Paris, France
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