[Radical prostatectomy in patients with Gleason 6 (ISUP 1) prostate cancer: 10-year follow-up]. / Recul à 10 ans des patients opérés pour un cancer de prostate Gleason 6 (ISUP1).

OBJECTIVE: To evaluate extraprostatic extension and 10 years cancer specific survival in a population of patients with Gleason 6 (ISUP 1) prostate cancer (PCa) treated by radical prostatectomy (RP) in two French third referral centers. MATERIALS AND METHODS: The data were extracted from 2 university hospital databases according to the following criteria: PCa classified ISUP 1 following both biopsy (PB) and surgery (RP) between 1998 and 2008. Pathology slides of patients having presented an extraprostatic extension and/or a recurrence were reviewed by a uropathologist. RESULTS: Among the 534 patients who met the inclusion criteria, 66 (12.2%) had a pT3 stage. One patient out of 198 who received lymph node dissection had a positive node. Median follow-up was 10.3 years. Only one patient presented with metastatic progression. No cancer specific death was observed. An independent pathologist reviewed the slides of 58 out of the 70 patients who presented pT3 disease and/or a recurrence (in 12 cases, pathological material was not available). After review, all pT3b stages and 12 pT3a (out of 14) were upgraded to ISUP2 or higher. Similarly, the patient with a positive node and the patient who progressed towards a metastatic disease were both upgraded to ISUP 3. CONCLUSION: No pT3b or pN+stage was associated with ISUP 1 PCa in our study. With a median follow-up of more than 10 years, biological progression was the only type of progression observed.

Effects of providing hospital-based doulas in health maintenance organization hospitals.

OBJECTIVE: To evaluate whether providing doulas during hospital-based labor affects mode of delivery, epidural use, breast-feeding, and postpartum perceptions of the birth, self-esteem, and depression. METHODS: This was a randomized study of nullipara enrollees in a group-model health maintenance organization who delivered in one of three health maintenance organization-managed hospitals; 149 had doulas, and 165 had usual care. Study data were obtained from the mothers' medical charts, study intake forms, and phone interviews conducted 4-6 weeks postpartum. RESULTS: Women who had doulas had significantly less epidural use (54.4% versus 66.1%, P < .05) than women in the usual-care group. They also were significantly (P < .05) more likely to rate the birth experience as good (82.5% versus 67.4%), to feel they coped very well with labor (46.8% versus 28.3%), and to feel labor had a very positive effect on their feelings as women (58.0% versus 43.7%) and perception of their bodies' strength and performance (58.0% versus 41.0%). The two groups did not differ significantly in rates of cesarean, vaginal, forceps, or vacuum delivery, oxytocin administration; or breast-feeding, nor did they differ on the postpartum depression or self-esteem measures. CONCLUSION: For this population and setting, labor support from doulas had a desirable effect on epidural use and women's perceptions of birth, but did not alter need for operative deliveries.