Prostatic Neoplasms: Villers A

Soulie M, Beuzeboc P, Richaud P, Villers A, Kassab-Chahmi D, Bataillard A, Anonymous00082, Anonymous00083. · Comité rédacteur SOR, INCA, FNCLCC, La Ligue, FHF FNCHRU, FFC et AFU. · Prog Urol. · Pubmed #17633990 No free full text.

Abstract: This paper is based on the bulletin of synthesis 2005. Management of non metastatic prostate cancer. Recommendations for clinical practice of the French Urologial Association and the National Federation of Anticancer Centers.

Bourguet P, Planchamp F, Montravers F, Vincendeau S, Courbon F, Edeline V, Helal BO, Rossi D, Villers A, Anonymous00504, Anonymous00505, Anonymous00506, Anonymous00507, Anonymous00508, Anonymous00509, Anonymous00510, Anonymous00511. · Centre Eugène-Marquis, Rennes. · Bull Cancer. · Pubmed #17191352 links to  free full text

This publication has no abstract.

Richaud P, Moreau JL, Beuzeboc P, Rébillard X, Villers A, Peyromaure M, Cornud F, Soulié M, Davin JL, Anonymous00194. · Comité Prostate du CCAFU. · Prog Urol. · Pubmed #16459666 No free full text.

Abstract: The follow-up of prostate cancer is especially justified now that effective treatment options are available in the case of recurrence. Conditions of follow-up of patients with prostate cancer vary according to age, comorbidities, tumour stage, prognostic factors at diagnosis and the pervious treatment sequence.

Soulié M, Barré C, Beuzeboc P, Chautard D, Cornud F, Eschwege P, Fontaine E, Molinié V, Moreau JL, Péneau M, Ravery V, Rébillard X, Richaud P, Ruffion A, Salomon L, Staerman F, Villers A, Anonymous00315. · No affiliation provided · Prog Urol. · Pubmed #15779654 No free full text.

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Villers A, Pommier P, Bataillard A, Fervers B, Bachaud JM, Berger N, Bertrand AF, Bouvier R, Brune D, Daver A, Fontaine E, Haillot O, Lagrange JL, Molinie V, Muratet JP, Pabot du Chatelard P, Peneau M, Prapotnich D, Ravery V, Richaud P, Rossi D, Soulie M, Anonymous00438, Anonymous00439. · CHRU Hôpital Huriez, Lille, France. · Br J Cancer. · Pubmed #12915903 links to  free full text

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Villers A, Rébillard X, Soulié M, Davin JL, Coloby P, Moreau JL, Mejean A, Irani J, Coulange C, Mangin P, Anonymous00331. · No affiliation provided · Prog Urol. · Pubmed #12765053 No free full text.

Abstract: Prostate cancer has become the most frequent cancer and the second cause of cancer mortality in men. This public health problem is becoming increasingly important due to the increasing life expectancy. At the present time, prostate cancer will be discovered in one in every eight men during their lifetime. Prostate cancer represents 25% of all new cases of male cancers. Prostate cancer screening is designed to detect early stage, asymptomatic prostate cancer, as the patient's chances of cure are higher when the cancer is diagnosed at an early stage. The conclusions of the ANAES evaluation in 1998 did not recommend mass screening for prostate cancer. Several international prospective randomized studies based on serum PSA assay, sometimes associated with digital rectal examination, are currently underway. France is participating in the European ERSPC study (European Randomized Study of Screening for Cancer Prostate) and is organizing a national study on high-risk populations. While waiting for the final results of these studies, a recommendation needs to be proposed to inform general practitioners and specialists about optimal use of the currently available tests. Based on the conclusions of its oncology committee (composed of urologists, medical oncologists, radiotherapists, pathologists and radiologists), the Association Française d'Urologie proposes a recommendation concerning prostate cancer screening and defines its modalities, especially concerning the target population, screening tests and the information given to men before screening. The Association Française d'Urologie recommends prostate cancer screening by PSA assay (prostate specific antigen) and digital rectal examination annually between the ages of 50 and 75 years, and from the age of 45 years in men with a family or ethnic risk. If total PSA is above the normal value of the test or if digital rectal examination is abnormal, referral to a urologist is recommended. Information concerning the limits, benefits and risks of screening and the available treatment options must be given before performing these examinations.

Molinié V, Vieillefond A, Cochand-Priollet B, Dauge-Geffroy MC, Lefrère-Belda MA, de Fromont M, Lesourd A, Toublanc M, Berger N, Bouvier R, Villers A. · Services d'Anatomie et de Cytopathologie Pathologiques Hôpital Foch, 40, rue Worth, 92151 Suresnes cedex. · Ann Pathol. · Pubmed #10617819 No free full text.

Abstract: The purpose of these recommendations proposed by the members of the <<comités de Cancérologie de l'Association Française d'Urologie>>, is to provide an informative report for the clinician and the pathologist, in the management of patients with prostate cancer. These recommendations are common to the ADSAP and UICC recommendations on prostate cancer. Standardized forms are recommended to be included in every report.

Villers A, Lemaitre L, Haffner J, Puech P. · Department of Urology, Centre Hospitalier Régional Universitaire de Lille, Lille, France. · Curr Opin Urol. · Pubmed #19325494 No free full text.

Abstract: PURPOSE OF REVIEW: To review the current status of MRI techniques in identification of organ-confined prostate cancer with a focus on their implication for focal therapy and active surveillance. RECENT FINDINGS: MRI is currently focusing on intraprostatic prostate cancer identification and at 1.5T, it provides excellent imaging of the whole gland including the challenging anterior part. Improvements in accuracy for cancer detection and volume estimation result from dynamic contrast-enhanced and diffusion-weighted MRI sequences. 3T MRI might improve cancer identification. Histological correlations showed high sensitivity and specificity for significant volume cancers larger than 0.5 cm3. Important knowledge on modelling of cancer morphology such as zone of origin and intraprostatic patterns of spread at histopathology was made available for imaging interpretation and treatment planning decision. MRI results allow focused use of biopsy which led to better cancer characterization such as extent and grade. Ongoing focal therapy protocols and active surveillance treatments should benefit from these imaging advances. SUMMARY: At present, high-resolution MRI with pelvic coil appears to offer the most readily available and useful imaging. Future studies should work towards helping define standard, reproducible approaches to imaging and image reporting for research and clinical practice.

Puech P, Huglo D, Petyt G, Lemaitre L, Villers A. · Department of Radiology, Centre Hospitalier Régional Universitaire de Lille, Lille, France. · Curr Opin Urol. · Pubmed #19188771 No free full text.

Abstract: PURPOSE OF REVIEW: To review the current status of advanced imaging techniques in identification of organ-confined prostate cancer with a focus on their impact on patient management. RECENT FINDINGS: Transrectal ultrasound suffers from poor accuracy despite significant technical improvements. Generally used to distinguish cancers with extraprostatic spread, MRI is now focusing on intraprostatic prostate cancer identification. At 1.5T, the most recent high-resolution pelvic phased-array coils provide excellent imaging of the whole gland, including this challenging anterior part. Improvements in accuracy for cancer detection and volume estimation result from dynamic contrast-enhanced and diffusion-weighted imaging sequences. Histological correlations showed high sensitivity/specificity for significant volume cancers. 3T MRI scanners will improve these results. Most of the recent PET/computed tomography imaging studies use choline derivatives ((11)C-choline and (18)F-fluorocholine). Their results are promising but insufficient to be currently recommended in routine practice. SUMMARY: Considerable advances have been made in the identification of organ-confined prostate cancer with multiparametric MRI. Only prebiopsy MRI can provide best quality of cancer assessment and allows for targeting biopsies. It is hoped that advances in 3T MRI as well as in radiotracers for PET/computed tomography will further improve diagnosis, treatment selection, planning and outcomes.

Cornud F, Villers A, Mongiat-Artus P, Rebillard X, Soulie M, Anonymous00034. · Centre d'imagerie de Tourville, 19, avenue de Tourville, 75007 Paris, France. · Prog Urol. · Pubmed #18971104 No free full text.

Abstract: Prostate magnetic resonance imaging (MRI) has taken advantage of recent technological developments that increase the field of its indications. Available improvements concern functional MRI based on dynamic MRI (after intravenous injection of gadolinium), diffusion-weighted imaging and, possibly, spectroscopy to localise an undiagnosed prostate cancer on a first series of biopsies and differentiate tumors of significant volume from indolent or latent tumors. The combination of dynamic MRI and diffusion-weighted imaging seems to be the most accurate for the time being. An optimal accuracy to assess local tumor staging can only be obtained with the surface endorectal coil. Future advances concern lymph node extension following an intravenous injection of iron particles and detection of bone metastases by whole-body MRI.

Benchikh El Fegoun A, Villers A, Moreau JL, Richaud P, Rebillard X, Beuzeboc P. · Service d'urologie, hôpital Claude-Huriez, 2, avenue Oscar-Lambret, 59037 Lille cedex, France. · Prog Urol. · Pubmed #18472065 No free full text.

Abstract: A first serum total PSA assay is recommended during the first three months after treatment. When PSA is detectable, PSA assay should be repeated three months later to confirm this elevation and to estimate the PSA doubling time (PSADT). In the absence of residual cancer, PSA becomes undetectable by the first month after total prostatectomy: less than 0.1 ng/ml (or less than 0.07 ng/ml) for the ultrasensitive assay method and less than 0.2 ng/ml for the other methods. In the presence of residual cancer, PSA either does not become undetectable or increases after an initial undetectable period. A consensus has been reached to define recurrence as PSA greater than 0.2 ng/ml confirmed on two successive assays. After external beam radiotherapy, PSA can decrease after a mean interval of one to two years to a value less than 1 ng/ml (predictive of recurrence-free survival). Biochemical recurrence after radiotherapy is defined by an increase of PSA by 2 ng or more above the PSA nadir, whether or not it is associated with endocrine therapy. After endocrine therapy, the PSA nadir is correlated with recurrence-free survival. PSA is decreased for a mean of 18 to 24 months followed by a rise in PSA, corresponding to hormone-independence. The time to recurrence or the time to reach the nadir and the PSA doubling time after local therapy with surgery or radiotherapy have a diagnostic value in terms of the site of recurrence, local or metastatic and a prognostic value for survival and response to complementary radiotherapy or endocrine therapy. A PSADT less than eight to 12 months is correlated with a high risk of metastatic recurrence and 10-year mortality. The histological and biochemical characteristics in favour of local recurrence are Gleason score less or equal to seven (3+4), elevation of PSA after a period greater than 12 months and PSADT greater than 10 months. In other cases, recurrence is predominantly metastatic. The risk of demonstrating metastasis in the case of biochemical recurrence after total prostatectomy and before endocrine therapy depends on the PSA level and the PSADT. No consensus has been reached concerning the indication for complementary investigations by bone scan and abdominopelvic CT in patients with biochemical recurrence after treatment of localized cancer without endocrine therapy. However, when PSADT greater than six months, the risk of metastasis is less than 3% even for PSA greater than 30 ng/ml. When PSADT less than six months and PSA greater than 10 ng/ml, the risk of metastasis is close to 50%.

Benchikh El Fegoun A, Villers A. · Service d'urologie, CHRU Lille, France. · Prog Urol. · Pubmed #17489311 No free full text.

Abstract: Molecular forms of serum PSA (prostate specific antigen) have been developped to improve total PSA sensitivity and specificity in prostate cancer diagnosis and staging. Total PSA is measured in bound (complexed PSA) and unbound (free PSA) molecular forms. Their levels in absolute values and in relation to total PSA (f/t PSA and c/t PSA) have been evaluated. The percentage of free PSA is more specific but less sensitive than tPSA and it is not recommended as a first line diagnostic test. It may be useful as a second-line test, prescribed by the urologist after a first series of negative biopsies. There is general agreement that at high sensitivity, cPSA provides higher specificity compared with tPSA in the gray zone (2-10 ng/ml). Nevertheless the widespread use of tPSA an the small benefit in terms of specificity explains why cPSA is not generally recommanded. Molecular derivates of free PSA have been identified: proPSA (precursor inactive form of PSA), intact PSA (an additionnal form of proPSA that is found intact and inactive), human Kallikrein 2 and BPSA (for benign PSA wich is associated to BPH) have been evaluated. Preliminary studies did not have demonstrate their ability to discriminate between cancer and BPH, and did not define cutoff values.

Zerbib M, Fizazi K, Hennequin C, Villers A. · Service d'urologie, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France. · Ann Urol (Paris). · Pubmed #17361918 No free full text.

Abstract: Difficult clinical cases of locally advanced prostate cancer at high-risk of progression should be discussed during a collegial decision-making process with different clinical specialists (surgeon, radiotherapist, oncologist, chemotherapist). Scientific consensus exists to give an adjuvant therapy after initial curative local treatment in patients with unfavourable prognostic features. For patients with locally advanced prostate cancer extending beyond the capsule (pT3) or with positive surgical margins, studies have shown that immediate postoperative radiotherapy is to eradicate the microscopic disease left in the surgical bed. Studies have shown the potential benefit of cytotoxic chemotherapy in terms of overall survival and median time to progression in patients with metastatic hormone-refractory prostate cancer. Active clinical research is underway to study neoadjuvant systemic chemotherapy before radical prostatectomy. There are also currently several clinical trials that are investigating the addition of chemotherapy in patients at high-risk of progression in the postprostatectomy setting. Antiandrogen therapy after radical prostatectomy has been shown in randomised studies to significantly reduce the risk of objective clinical progression in patients with high-risk localized prostate cancer. Immediate hormonal therapy with bicalutamide is a valuable therapeutic option in men having prostate cancer with such clinicopathological features.

Cornud F, Rebillard X, Villers A, Peyromaure M, Soulié M, Sous-Comité de Prostate du CCAFU. · Service de Radiologie, Paris, France. · Prog Urol. · Pubmed #16821336 No free full text.

Abstract: Contrast imaging of the prostate is based on rapid-sequence MRI after dynamic Gadolinium injection and contrast ultrasound after injection of microbubbles. MRI can be performed routinely on all available machines. Contrast ultrasound requires specific software not yet available on all machines. The two techniques are designed to improve the reliability of imaging, as a complement to MR spectroscopy, to localize prostate cancer MRI can detect suspicious enhancement in the peripheral zone, but especially in the transitional zone after one or a series of negative posterior biopsies to target a new series of biopsies. The sensitivity and specificity of the technique have yet to be determined. The objective of contrast ultrasound is to improve cancer detection on the first series of biopsies by multiplying sextant biopsies in sites where the contrast kinetics are suggestive of a primary lesion. However, this technique cannot yet be recommended in routine practice, as the modalities of injection of the latest generation of microbubbles (bolus or infusion) need to be evaluated.

Villers A, Berthon N. · Service d'urologie, centre hospitalier régional et universitaire, hôpital Claude-Huriez, 59037 Lille Cedex. · Rev Prat. · Pubmed #16775986 No free full text.

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Lemaître L, Villers A, Mouton D, Puech P. · Service de Radiologie et d'Imagerie Médicale, Hôpital Claude Huriez, 59037 Lille Cedex. · J Radiol. · Pubmed #16484945 links to  free full text

Abstract: This review describes the transrectal ultrasound (TRUS) features of prostate cancer (PC), discusses the role of TRUS in the detection of PC and defines the modalities of biopsies in patients with suspected PC, particularly concerning prevention of complications, the number of biopsies and the biopsy schemes ensuring an optimal cancer detection rate. TRUS alone has limited potential to identify PC because of frequent multifocality of cancer within the prostate, the variable sonographic appearance of prostatic tumors, the poor specificity of focal US abnormalities, and the substantial percentage of isoechoic PC. Over the past decade, the sextant biopsy technique has emerged as the standard of care in the detection of PC. However, limitations in cancer detection have been appreciated, particularly a false-negative rate approaching 20%. This high failure rate has led investigators to refine biopsy techniques to improve cancer detection and to increase the total number of cores. Currently, recommendations include increasing the biopsy number to a minimum of 10-12 cores, including sampling of the lateral prostate. Refinements in imaging technologies (power Doppler sonography, microbubble intravenous sonographic contrast agents, and MR spectroscopy or dynamic contrast MR imaging) should eventually improve targeting of prostate needle biopsy and reduce false-negative biopsies.

Puech P, Villers A, Mouton D, Leroy X, Lemaître L. · Service de Radiologie urogénitale et ORL, CHRU de Lille, rue Michel-Polonowski, 59037 Lille. · J Radiol. · Pubmed #16484944 links to  free full text

Abstract: Medical imaging has an important role in the diagnosis and treatment options of prostate cancer (TRUS guided biopsies, MRI). The knowledge of the different types of cancers, their preferred topography, imaging features, extension pattern, and also the important items that may help the surgical procedure (or any other treatment) are as many crucial key points for optimal management of patients.

Soulié M, Rebillard X, Villers A. · No affiliation provided · Prog Urol. · Pubmed #15816404 No free full text.

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Ruffion A, Villers A, Molinié V. · No affiliation provided · Prog Urol. · Pubmed #15816403 No free full text.

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Zini L, Villers A, Leroy X, Ballereau C, Lemaitre L, Biserte J. · Service d'Urologie, CHRU Lille. · Prog Urol. · Pubmed #15373189 No free full text.

Abstract: Cystic prostate cancer is a rare entity. Ductal adenocarcinoma, formerly known as endometrioid adenocarcinoma, is a clinical and histological variant of prostatic carcinoma. The authors report two cases of cystic prostate cancer, in which histological examination demonstrated the predominance of a ductal carcinoma contingent. A review of the literature revealed 8 cases of cystic prostate cancer, including 3 cases that also presented a ductal contingent. The cystic appearance of the peripheral prostatic zone appears to be a distinct clinical and morphological entity of ductal carcinomas. This entity has never been previously reported.

Peneau M, Villers A, Molinié V, Theis D, Soulié M. · Service d'Urologie, CHR Orléans La Source, France. · Prog Urol. · Pubmed #15373168 No free full text.

Abstract: INTRODUCTION: Pelvic lymphadenectomy for localized prostate cancer (stage T1-T2) provides prognostic information. It can be performed by laparoscopy or by open surgery. Systematic lymphadenectomy is controversial and should be performed according to the stage of the tumour and the type of management. Frozen section examination of lymph nodes during total prostatectomy is also controversial due to its low sensitivity (66%). The objective of this article is to define the indications for lymphadenectomy and frozen section examination. METHODS: Systematic review of the literature. RESULTS: Recommendations concerning the indications for bilateral pelvic lymphadenectomy and frozen section examination for stage T1-T2 prostate cancer as a function of the risk of lymph node metastases. A low risk (<5%) of lymph node metastases is defined by an initial PSA < 10 ng/ml, a Gleason score of biopsies < 7 (3 + 4 or < 50% of grade 4) and possibly non-suspicious lymph node imaging. In this case, prior pelvic lymphadenectomy either some time before or immediately before local treatment is optional (Level of Evidence III-2). Due to the morbidity related to lymphadenectomy, the benefit of the procedure is not justified. However, the following situations are distinguished for open or laparoscopic total prostatectomy: --if open total prostatectomy is considered, exploration of the lymph nodes by palpation at the beginning of the operation is recommended. If exploration does not suggest any lymph node invasion, lymphadenectomy is then optional (without frozen section examination). If exploration shows induration or a mass deforming the shape of the lymph nodes, lymphadenectomy is recommended. Frozen section examination is requested only when the surgeon decides not to perform prostatectomy in the case of lymph node invasion. Lymphadenectomy without frozen section examination is optional in the case of laparoscopic total prostatectomy. Macroscopic examination of any lymph node invasion is less accurate via laparoscopy. A high risk (> 5%) of lymph node metastases is defined by a PSA > 10 ng/ml and/or a Gleason score > 7 (4 + 3 or > 50% of grade 4), and/or suspicious lymph node imaging. Pelvic lymphadenectomy is then recommended (Level of Evidence III-2). The following situations can be distinguished according to the type of treatment envisaged (total prostatectomy or external radiotherapy): when the surgeon decides not to perform total prostatectomy in the case of microscopic or macroscopic lymph node invasion (pN1), lymphadenectomy (open or laparoscopic) may be performed either before or at the same time as prostatectomy with frozen section examination. In the case of external radiotherapy, laparoscopic (or open) lymphadenectomy is recommended (without frozen section examination) when it is decided to extend the irradiation field to pelvic lymph nodes in the case of stage pN1 (1st option) or withhold radiotherapy (2nd option). Lymphadenectomy is optional in other cases, as lymphadenectomy induces considerable morbidity and the benefit of systematic pelvic lymph node irradiation has not been demonstrated. It should be stressed that all indications for lymphadenectomy for localized prostate cancer proposed in the literature are based on the results of standard or limited pelvic lymphadenectomy. These indications could be revised if it is confirmed that lymphadenectomy extended to the internal iliac nodes, for patients at high risk of lymph node invasion, is truly informative and contributive to the treatment decision.

Schröder FH, Denis LJ, Roobol M, Nelen V, Auvinen A, Tammela T, Villers A, Rebillard X, Ciatto S, Zappa M, Berenguer A, Paez A, Hugosson J, Lodding P, Recker F, Kwiatkowski M, Kirkels WJ, Anonymous00276. · Department of Urology, Erasmus Medical Centre, Rotterdam, the Netherlands. · BJU Int. · Pubmed #14983946 No free full text.

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Soulié M, Villers A, Richaud P, Prapotnich D, Ruffion A, Grosclaude P. · Service de Chirurgie Urologique et d'Andrologie, CHU Rangueil, 31403 Toulouse. · Prog Urol. · Pubmed #11859652 No free full text.

Abstract: OBJECTIVES: The treatment decision taken by a multidisciplinary meeting for patients with localized prostate cancer must take into account the clinical stage of the cancer and its histological characteristics, but also the patient's age, general state and any concomitant diseases, as treatment is only beneficial when it induces a reduction of morbidity and specific mortality. The specific survival with or without recurrence after treatment for localized prostate cancer is long, at least more than 10 years. Curative treatment is generally not proposed to men with localized prostate cancer when his probability of survival related to a competitive morbidity (intercurrent medical disease) is estimated to be less than 10 years. The objective of this study was to measure the increase or reduction of the survival probability of a patient with localized prostate cancer according to his competitive morbidity, based on the mean life expectancy of the general population. METHODS: Review of the literature. RESULTS: Studies describing the natural history of prostate cancer show that the impact of treatment on morbidity of the cancer (local and/or metastatic) requires a life expectancy of about 8 to 10 years. The impact of a treatment on specific survival requires a life expectancy of about 13 to 15 years. The exact prevalence of diseases coexisting with prostate cancer is unknown. In the USA, The Index of Coexisting Disease (ICD), which takes into account 14 diseases, appears to be the most reliable tool to measure the competitive morbidity in patients with localized prostate cancer. Each disease is classified into 4 levels of severity (score 0 to 3). A table indicates estimated life expectancies by age-group and by ICD score. All men with a high score (2 to 3) die within 10 years after diagnosis, men with a score of 0 have a better estimated life expectancy according to age than that of the general population. CONCLUSION: The upper age limit, theoretically set at 70 years, in order to propose curative treatment for localized prostate cancer needs to be reviewed (the mean life expectancy for a 70-year-old man is 12.9 years in France). According to the ICD, the life expectancy at 70 years is 14.8 years in the case of a score of 0 and 8.4 years in the case of a score of 2. In the case of a score of 2, the impact of curative treatment on localized prostate cancer would be real on morbidity, but not on specific mortality.

Chauvet B, Villers A, Davin JL, Nahon S. · Institut Sainte-Catherine, BP 846, 84082 Avignon Cedex. 2. · Bull Cancer. · Pubmed #11847025 links to  free full text

Abstract: Recent progress in management of prostate cancer concern screening and treatment. The use of PSA and rectal examination advances the diagnosis by 5 to 10 years and shift the stage at the time of diagnosis toward curative localized intraprostatic disease. The impact of systematic screening remains controversial. However, individual screening explains, at least in part, the decrease of specific mortality due to prostatic cancer, recently observed in USA. PSA and lymphadenectomy have also contributed to a better selection of patients referred for local treatment by prostatectomy or radiotherapy. Radical prostatectomy is recommended for patients before 70 with T2 or less, Gleason score less than 8 and PSA less than 15 ng/ml. With that selection, disease-free survival reaches 75 to 80% at 10 years. Recently, dramatic improvement in radiotherapy techniques have been achieved, leading to a better local control by increasing the dose over 70 Gy without additional toxicity. Brachytherapy is also widely used for good prognosis localized disease. Limitant acute urinary side effects have been reported and results seem similar to those reported after prostatectomy or conformal radiotherapy. Recent randomized trials have demonstrated a benefit of early hormonal therapy concurrent with radiotherapy for patients with poor prognosis localized disease. For hormonoresistant metastatic disease, chemotherapy has been used with limited palliative benefit. New drugs are currently evaluated.

Ravery V, Fontaine E, Villers A. · Service d'Urologie, Hôpital Bichat, Paris, France. · Prog Urol. · Pubmed #11217574 No free full text.

Abstract: Histological examination of prostate biopsies is necessary for the diagnosis of prostate cancer. The technical modalities and examination conditions of prostate biopsies were evaluated in the light of a review of the literature and the conclusions are presented in the form of standards, options and recommendations. STANDARDS: The standard or modified protocol of 6 sextant biopsies, applied as first-line investigation in all cases of stage T1c or T2 prostate cancer is a standard procedure and remains a reproducible, effective and well tolerated method for diagnosis and staging. Rectal preparation by enema and prophylactic antibiotics before the examination decrease the risk of infectious complications. In its usual modality used for the majority of patients, biopsies are performed as an outpatient procedure, with or without local anaesthesia, with ultrasound guidance via a transrectal approach using an 18 Gauge needle (pink colour code), mounted on an automatic biopsy gun and especially sampling the posterior and lateral zone. The patient must be given written information explaining the risks and management of possible complications following this examination. OPTIONS: Local, regional or general anaesthesia may be necessary in a minority of cases, either in the context of a protocol of extensive systematized biopsies (more than 10 biopsies), or in the case of repeated examination, or when preferred by the patient. Modified extensive protocols (sextant plus posterolateral zones or sextant plus anterior zones) applied to all cases as first-line procedure is a useful option, particularly when: 1) a first series of biopsies was negative 2) PSA is < or = 10 ng/ml and digital rectal examination is normal (sextant plus posterolateral zones) 3) the prostate is larger than 50 cm3 (sextant plus anterior zones). The transperineal approach is less reliable for detection and staging, and is used when the transrectal approach is contraindicated. When curative treatment is not considered (life expectancy < 10 years, patient's choice, stage T3, T4), the number of biopsies can be decreased. Transurethral resection of the prostate is not recommended as first-line procedure for the diagnosis of prostate cancer. RECOMMENDATIONS: Written information given to the patient during the visit prior to biopsy to explain the objectives, practical modalities and risks of prostate biopsies facilitates the patient's cooperation during the examination and increases its tolerance.