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1.
Cancer ; 112(2): 433-42, 2008 Jan 15.
Article in English | MEDLINE | ID: mdl-18041056

ABSTRACT

BACKGROUND: Tumor angiogenesis is a dynamic process that plays a major role in cancer progression. Vascular endothelial growth factor (VEGF) and its receptors play a pivotal role in angiogenesis. The expression of VEGF and its receptors VEGFR-1 and VEGFR-2 in renal cell carcinoma (RCC) was investigated in the perspective of anti-VEGF treatments. METHODS: Total VEGF protein levels were quantified by enzyme-linked immunosorbent assay (ELISA) in tumor tissue samples from surgical specimens of 65 patients with clear cell RCC. At the cellular level the VEGF isoforms VEGFR-1 and VEGFR-2 mRNA were quantified by real-time quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) in laser-microdissected tumoral epithelial as stromal cells and in corresponding normal tissue compartments. Colocalization of VEGF and VEGFR-1 proteins was studied by triple immunofluorescent labeling. RESULTS: Protein VEGF in cytosolic extracts was significantly higher in tumoral than in nontumoral tissue (P< .0001). Event-free survival was significantly longer for patients with cytosolic VEGF lower than the cutoff (75th percentile of VEGF protein levels, P= .02). In laser-microdissected epithelial cells, VEGF(121) and VEGFR-1 mRNA expressions were higher in RCC than in corresponding nontumoral kidney (P= .007 and P= .002, respectively); they were also higher in stromal cells of RCC compared with nontumoral kidney (P= .02 and P= .003, respectively). There was no differential VEGFR-2 expression in epithelial or in stromal cells of tumoral or nontumoral kidney. By immunofluorescent labeling VEGF and VEGFR-1 colocalized on RCC tumor epithelial and stromal cells. CONCLUSIONS: Combined laser microdissection and quantitative RT-PCR, as triple immunofluorescent labeling, underlined the preferential expression of the most soluble VEGF isoform, VEGF(121), and its receptor VEGFR-1, but not VEGFR-2, in epithelial and stromal cells of RCC.


Subject(s)
Carcinoma, Renal Cell/chemistry , Kidney Neoplasms/chemistry , Vascular Endothelial Growth Factor A/analysis , Vascular Endothelial Growth Factor Receptor-1/analysis , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell/pathology , Epithelial Cells/chemistry , Female , Fluorescent Antibody Technique , Humans , Keratins/analysis , Keratins/genetics , Kidney Neoplasms/pathology , Male , Microdissection , Middle Aged , RNA, Messenger/analysis , Reverse Transcriptase Polymerase Chain Reaction , Stromal Cells/chemistry , Vascular Endothelial Growth Factor A/genetics , Vascular Endothelial Growth Factor Receptor-1/genetics , Vascular Endothelial Growth Factor Receptor-2/analysis , Vascular Endothelial Growth Factor Receptor-2/genetics
3.
J Endourol ; 21(2): 173-6, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17338616

ABSTRACT

PURPOSE: To improve the quality of life of patients with palliative definitive percutaneous nephrostomy, we prospectively evaluated a subcutaneous ureteral bypass using a newly designed ureteral prosthesis. PATIENTS AND METHODS: A series of 19 patients receiving 27 subcutaneous tubes in replacement for percutaneous nephrostomy were evaluated. The ureteral prosthesis (Detour), a silicone tube glued inside a polyester tube, is inserted percutaneously into the renal pelvis to replace an established nephrostomy, tunneled subcutaneously, and introduced into the bladder through a small incision. All patients were followed every 3 months for 18 months or until death from tumor. Quality of life was assessed using the EORTC QLC-30 questionnaire; ultrasonography, intravenous urography, or both were used to assess the position and patency of the tubes. RESULTS: There was no failure of insertion and no operative or immediate complication. The mean follow-up was 7.8 months, 6.6 months for the 15 patients who died from their tumors and 1 year for the 4 patients still alive at the end of the study. Suprapubic parietal infection occurred in three patients with altered bladders (radiation cystitis or tumor progression). There was an improvement of the function scale as a result of the elimination of the external percutaneous tube and a parallel worsening of the symptom scale secondary to the progression of disease. Patient ratings of the global quality of life and satisfaction with the urinary diversion were improved because of the absence of the percutaneous tube. CONCLUSION: The subcutaneous pyelovesical bypass provides a better quality of life than a standard percutaneous nephrostomy tube in terminally ill patients by making them external-tube free.


Subject(s)
Nephrostomy, Percutaneous , Quality of Life , Aged , Female , Humans , Male , Palliative Care , Prospective Studies , Prosthesis Implantation , Urography
4.
Prog Urol ; 17(1): 60-4, 2007 Feb.
Article in French | MEDLINE | ID: mdl-17373239

ABSTRACT

OBJECTIVE: To prospectively evaluate the quality of life of cancer patients at the palliative stage after implantation of an extra-anatomical ureteric prosthesis as an alternative to permanent percutaneous nephrostomy (PCN). MATERIAL AND METHODS: A series of 27 prostheses in 19 patients with PCN was prospectively evaluated. The ureteric prosthesis (Detour) consists of two concentric tubes glued to each other. The inner tube is made of silicone and the outer tube is made of polyester. This prosthesis is introduced percutaneously into the renal pelvis as an alternative to nephrostomy. It is tunnelled subcutaneously and is introduced into the bladder via a short incision. Patients were reviewed every three months for 18 months or until death. The EORTC QLQ-C30 self-administered questionnaire was used to evaluate the patients' quality of life. The functioning and position of the prostheses were verified by ultrasound and/or intravenous urography (IVU). RESULTS: There were no failures of prosthesis placement and no intraoperative or early postoperative complications. Injection of the suprapubic incision was observed in 3 cases, in patients with pre-existing bladder disease (radiation cystitis or bladder tumour). The mean follow-up was 7.8 months: 6.6 months for the group of patients who died (15) and 12 months for the 4 patients still alive at the end of the study. Functional scores improved due to elimination of the external nephrostomy tube. In parallel, physical score deteriorated due to disease progression. Overall quality of life and index of satisfaction were improved by elimination of the external diversion. CONCLUSION: Subcutaneous pyelovesical diversion ensures a better quality of life than classical percutaneous nephrostomy in cancer patients at the palliative stage.


Subject(s)
Palliative Care , Prostheses and Implants , Quality of Life , Ureter/surgery , Ureteral Neoplasms/surgery , Urinary Diversion/methods , Aged , Female , Humans , Kidney Pelvis/surgery , Male , Prospective Studies , Urinary Bladder/surgery
5.
Prog Urol ; 17(1): 92-7, 2007 Feb.
Article in French | MEDLINE | ID: mdl-17373244

ABSTRACT

OBJECTIVE: To compare the level of surgical training of French interns with that of interns in other European countries. MATERIAL AND METHODS: Between 2005 and 2006, an exhaustive questionnaire (www.esnz.net) was sent to 288 young urologists in 30 different European countries. Interns were classified into 3 groups: France (group 1, n = 28), Western Europe (group 2, n = 75) and Eastern Europe (group 3, n = 85). Items concerning surgical practice were analysed. RESULTS: The mean age of the interns was 30.8 years (25.7-35.8), 34.6 years (27.4-48.0) and 31.3 years (25.3-51.3) in groups 1 to 3, respectively. The mean number of months of urology training was 28 months (6-60), 44 months (6-72) and 37 months (2-120), respectively. The mean of weekly working time was 70 hours (40-90), 60 hours (35-90) and 65 hours (40-100). French interns were technically more at ease than interns in groups 2 or 3 for all surgical procedures (open, laparoscopic, endourological). Certain criteria were significantly (p < 0.05) associated with a better level of technical skills: the number of weekly working hours, the small number of interns per department, the diversity of internships, the use of the intern record and the presence of an active tutor CONCLUSION: French interns appear to learn urological surgical procedures more easily than other European interns. However the scientific training of interns must also be evaluated in order to propose a global assessment system of urology training in Europe.


Subject(s)
General Surgery/education , Urology/education , Adult , Europe , France , Humans , Middle Aged , Prospective Studies , Surveys and Questionnaires
6.
Eur Urol ; 50(3): 555-61; discussion 562, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16782265

ABSTRACT

OBJECTIVES: Knowledge of the clinical profile of the population with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) is important for health care management, impacting on manpower requirements, pharmacologic demands and health service costs. Data collected by the TransEuropean Research Into the Use of Management Policies for LUTS suggestive of BPH in Primary Health care project were used to profile 4979 patients from six European countries newly presenting with LUTS/BPH to general practitioners or office-based urologists. METHODS: At recruitment, the clinician completed a questionnaire detailing the treatment provided, examination results, and covariates including age, initial symptom severity and comorbidities. The patient completed an International Prostate Symptom Score/quality-of-life questionnaire. RESULTS: The majority of patients (77%) sought medical advice because of the bothersomeness of their symptoms, and presented at ages between 58 and 71 years. Small but statistically significant differences among countries were found in initial symptom severity, initial quality of life and age at diagnosis, but these are not thought to be clinically significant. There were marked national differences in patient management, with, for example, 10% of patients in France reporting no examinations, compared with 0.5% in Poland, while free-flow measurements varied from less than 1% in France to 35% in Poland. CONCLUSIONS: Patient heterogeneity does not explain the differences in patient management among countries, which undoubtedly is the result of differences in health care traditions, infrastructure and socioeconomic factors, as well as patient preference.


Subject(s)
Prostatic Hyperplasia/complications , Prostatic Hyperplasia/epidemiology , Urologic Diseases/complications , Urologic Diseases/epidemiology , Aged , Comorbidity , Europe/epidemiology , France/epidemiology , Humans , Italy/epidemiology , Male , Mass Screening/methods , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Patient Selection , Poland/epidemiology , Referral and Consultation , Spain/epidemiology , United Kingdom/epidemiology
7.
Virchows Arch ; 449(2): 238-43, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16639607

ABSTRACT

Hereditary nonpolyposis colon cancer (HNPCC) syndrome is the most frequent hereditary cancer syndrome predisposing to cancers of various locations, especially colon, endometrium, stomach, and upper urinary tract. Carcinomas of the kidney parenchyma are not considered as an HNPCC-related tumor. HNPCC tumors are characterized by microsatellite instability (MSI) due to a defect in mismatch repair (MMR) and carry somatic frameshift mutations in mononucleotide repeats within the coding regions of key genes. We report the first case of a papillary carcinoma of the kidney in an HNPCC patient who developed carcinomas of the upper urinary tract, endocervix, and colon. Whereas the HNPCC-related tumors demonstrated MSI phenotype, loss of MSH2 protein expression, and frameshift mutations in several of the 13 target genes analyzed, the kidney cancer displayed MSS phenotype, normal MMR protein expression, and no frameshift mutation in target genes. Our observations do not support the possibility that papillary carcinomas are part of HNPCC syndrome.


Subject(s)
Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Colorectal Neoplasms/genetics , Kidney Neoplasms/genetics , Neoplasms, Second Primary/genetics , Urologic Neoplasms/genetics , Uterine Cervical Neoplasms/genetics , Colorectal Neoplasms/pathology , Colorectal Neoplasms, Hereditary Nonpolyposis/pathology , DNA-Binding Proteins/genetics , Female , Humans , Immunohistochemistry , Kidney Neoplasms/pathology , MRE11 Homologue Protein , Microsatellite Repeats , Middle Aged , Neoplasms, Second Primary/pathology , Urologic Neoplasms/pathology , Uterine Cervical Neoplasms/pathology , bcl-2-Associated X Protein/genetics
8.
Eur Urol ; 49(4): 685-90, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16413104

ABSTRACT

OBJECTIVE: Defects in the DNA mismatch repair result in microsatellite instability (MSI), which characterise most tumours related to the hereditary non-polyposis colorectal cancer syndrome and some sporadic tumours. Several studies have reported the occurrence of MSI in urothelial cell carcinoma (UCC) of the bladder with a particularly high incidence in tumours from young patients. In this study, we have evaluated the occurrence of MSI in primary bladder UCC arising in seventeen young patients selected for being below 45 years of age at diagnosis. METHODS: Microsatellite analysis has been performed using the panel of five quasimonomorphic mononucleotide repeats (BAT-25, BAT-26, NR-21, NR-24, NR-27) recently recommended to detect MSI tumours. The original Bethesda panel including BAT-25, BAT-26 and three dinucleotide repeats (D2S123, D5S346, D17S250) has further been studied in 10 UCC samples. RESULTS: MSI has been observed in only one of the 17 bladder UCC studied. Using the original Bethesda panel, identical results were obtained, indicating that the panel of five mononucleotide markers adequately detected MSI in UCC tumours. CONCLUSIONS: Our data indicate that classical MSI affecting mono- or di-nucleotides are rarely involved in bladder UCC developing in young patients. Further studies using gold standard criteria would help clarifying the involvement of MSI in the pathogenesis of bladder UCC.


Subject(s)
Carcinoma, Transitional Cell/genetics , Microsatellite Instability , Urinary Bladder Neoplasms/genetics , Adult , Carcinoma, Transitional Cell/pathology , DNA Mismatch Repair , Female , Humans , Male , Middle Aged , Neoplasm Staging , Urinary Bladder Neoplasms/pathology
9.
Urol Int ; 75(4): 322-6, 2005.
Article in English | MEDLINE | ID: mdl-16327299

ABSTRACT

UNLABELLED: Large pelvic stones are frequently managed with percutaneous nephrolithotomy (PCNL) but laparoscopic transperitoneal pyelolithotomy (LTP) can be an alternative. We compared PCNL and LTP for the treatment of pelvic stones >20 mm in diameter. PATIENTS AND METHODS: Between November 1999 and November 2004, 16 consecutive patients, mean age 42, with a single pelvic stone >20 x 10 mm (group I), underwent LTP as first-line treatment or after shockwave lithotripsy failure. They were compared with a similar population of 16 consecutive patients, mean age 45 (group II), who underwent PCNL for the same indication and were assessed retrospectively. We evaluated operative characteristics, complications, and results for each technique. RESULTS: There was no difference between the two groups regarding the characteristics of patients and stones. Operative time duration was significantly longer in group I (129 vs. 75 min; p = 0.001) and conversion was required in 2 patients (12%). The main postoperative complications were urinary leakage (2 patients, 12%) in group I and bleeding (3 patients, 18%) in group II, but only 1 required blood transfusion. Mean hospital stay was respectively 6.5 and 5.6 days in groups I and II (p = 0.17). Stone-free rates were assessed at 3 months and were not different between group I and group II (88 vs. 82%). CONCLUSIONS: The operative time of LTP is longer and the results of both techniques are comparable but postoperative morbidity is different. Specific indications of each technique must be determined although PCNL remains the gold standard for most large pelvic stones.


Subject(s)
Decision Making , Kidney Calculi/surgery , Laparoscopy/methods , Nephrostomy, Percutaneous/methods , Adult , Aged , Follow-Up Studies , Humans , Kidney Calculi/diagnostic imaging , Length of Stay , Middle Aged , Peritoneal Cavity/surgery , Radiography , Retrospective Studies , Severity of Illness Index , Treatment Outcome
10.
Prog Urol ; 15(3): 525-8, 2005 Jun.
Article in French | MEDLINE | ID: mdl-16097165

ABSTRACT

The authors report the case of a 51-year-old man with a history of trichloroethylene (TCE) poisoning. He was treated by radical nephrectomy after discovery ofa right renal mass corresponding to renal cell carcinoma. The objective of this study is to discuss the role of TCE abuse as a renal carcinogen. TCE is an excellent solvent used to degrease metal parts. It can enter the body by inhalation, ingestion or cutaneous contact, but the respiratory tract is the main route of absorption of TCE. Many epidemiological studies have been conducted on workers exposed to TCE, but they have not been able to clearly establish a link between exposure by inhalation to TCE and cancer. The International Agency for Research on Cancer has accumulated sufficient evidence to consider TCE to be carcinogenic to animals and considers that TCE is probably carcinogenic to humans. Toxic metabolites derived from TCE induce chronic renal tubular lesions and may exert a genotoxic effect on the proximal convoluted tubule. The initial genotoxic effect appears to be related to mutations of the VHL suppressor gene. The chronic toxic effects and the possible role of TCE in the development of cancer have not been specifically studied in the context of TCE abuse behaviour. To our knowledge, this is the first case of renal cell carcinoma reported in a TCE addict.


Subject(s)
Carcinoma, Renal Cell/chemically induced , Kidney Neoplasms/chemically induced , Solvents/toxicity , Substance-Related Disorders/complications , Trichloroethylene/toxicity , Carcinoma, Renal Cell/surgery , Humans , Kidney Neoplasms/surgery , Male , Middle Aged , Nephrectomy , Substance-Related Disorders/therapy
11.
Eur Urol ; 48(2): 269-76, 2005 Aug.
Article in English | MEDLINE | ID: mdl-15939527

ABSTRACT

OBJECTIVES: Sexual function is one of the aspects in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) that has gained increasing attention. We compared the influence on men's sexuality of Permixon, a lipido-sterolic extract of Serenoa Repens, with Tamsulosin and Finasteride using a specific validated questionnaire exploring patient's sexual functions. METHODS: A database was created comprising patients from 3 main double-blind, randomized studies - Permixon vs. Finasteride, Permixon vs. Tamsulosin and Permixon 160 mg vs. 320 mg including a total of 2511 patients. Three hundred fifty four were on Tamsulosin, 545 on Finasteride and 1612 patients on Permixon. LUTS were assessed using the I-PSS questionnaire. Peak flow rates and prostate volume were recorded. The MSF-4 questionnaire, including 4 items that explore the patient's interest in sex, quality of erection, achievement of orgasm and ejaculation, was used across the studies. This questionnaire was demonstrated as highly reproducible and both psychometrically and clinically valid across different cultures. Correlation coefficients were given to assess the linear relationship between continuous variables. RESULTS: At 3 months, there were no statistically significant differences between the three treatment groups in terms of I-PSS or Qmax evolutions (all p values > 0.05). At 6 months, as compared to pretreatment data, there was a slight increase in sexual disorders in Tamsulosin (+0.3) and Finasteride (+0.8) treated patients while it slightly improved with Permixon therapy (-0.2). Ejaculation disorders were the most frequently reported side effects after Tamsulosin or Finasteride (both +0.2 on the specific MSF-4 question 4). There was no correlation between the evolution of the MSF-4 scores and the evolution in I-PSS neither in patients treated with Permixon, Finasteride or Tamsulosin. However, there was a slight correlation between the MSF-4 score at baseline and the I-PSS at baseline (r2 = 0.032). Although there was a correlation between the MSF-4 and age at baseline (r2 = 0.1452), there was no correlation between the evolution in MSF-4 during therapy and the age of the patients. CONCLUSION: The present study demonstrates that Permixon therapy has no negative impact on male sexual function. Both Finasteride and Tamsulosin had a slight impact on sexual function, especially on ejaculation, although these effects were rare and in line with previous reports about these two drugs.


Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Androgen Antagonists/therapeutic use , Enzyme Inhibitors/therapeutic use , Finasteride/therapeutic use , Plant Extracts/therapeutic use , Prostatic Hyperplasia/drug therapy , Sexual Behavior/drug effects , Sulfonamides/therapeutic use , Adrenergic alpha-Antagonists/adverse effects , Androgen Antagonists/adverse effects , Enzyme Inhibitors/adverse effects , Finasteride/adverse effects , Humans , Male , Plant Extracts/adverse effects , Randomized Controlled Trials as Topic , Serenoa/adverse effects , Sulfonamides/adverse effects , Surveys and Questionnaires , Tamsulosin , Treatment Outcome , Urodynamics/drug effects
12.
Clin Ther ; 27(3): 273-85, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15878381

ABSTRACT

BACKGROUND: More patients are being diagnosed with prostate cancer at an earlier age with earlier stage disease because of advances in screening and detection. Investigators continue to explore the use of hormone therapy, particularly luteinizing hormone-releasing hormone (LHRH) analogues, earlier in the course of disease. OBJECTIVE: This review summarizes clinical evidence regarding the safety and efficacy of LHRH analogues in the treatment of locoregional disease or following biochemical failure. METHODS: Relevant information from clinical studies was identified through a MEDLINE search of the medical literature published in English in the last 5 years (search terms: LHRH and prostate cancer). The search included prospective and retrospective clinical studies on LHRH therapy in locally advanced prostate cancer. Additional relevant publications published before 1999 were identified from citations in the resulting articles. RESULTS: The available clinical evidence suggests that the use of LHRH analogues as adjuvant or neoadjuvant therapy in conjunction with radiation therapy may improve survival outcomes. Few studies have evaluated the use of LHRH analogues after biochemical failure. However, several related studies indicate that initiating hormone therapy earlier rather than later may provide some clinical benefit. When considering early initiation of LHRH therapy, the potential risks of long-term treatment must be considered. Physiologic changes, such as deterioration of body composition and bone quality, may have important effects on the risk of developing cardiovascular disease and osteoporosis. CONCLUSIONS: Although some clinical evidence supports the use of LHRH analogues as adjuvant or neoadjuvant therapy or following biochemical failure, further study is needed. In the meantime, clinicians should carefully weigh the potential benefits and risks of early hormone therapy when making treatment decisions.


Subject(s)
Gonadotropin-Releasing Hormone/therapeutic use , Prostate-Specific Antigen/blood , Prostatic Neoplasms/drug therapy , Chemotherapy, Adjuvant , Clinical Trials as Topic , Combined Modality Therapy , Gonadotropin-Releasing Hormone/administration & dosage , Gonadotropin-Releasing Hormone/adverse effects , Humans , Male , Orchiectomy , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/surgery , Risk Assessment , Treatment Outcome
14.
Horm Res ; 62(5): 252-8, 2004.
Article in English | MEDLINE | ID: mdl-15499224

ABSTRACT

AIMS: The objective of the study was to assess the pharmacodynamic equivalence of LHRH analogue triptorelin 3-month and 28-day SR formulations. METHODS: Patients with documented locally advanced or metastatic prostate cancer were randomized to receive one injection of the 3-month formulation (n = 63) or three injections at 28-day intervals of the 28-day formulation (n = 68). Group-chemical castration rates defined as the percentage of patients reaching a testosterone plasma level

Subject(s)
Antineoplastic Agents, Hormonal/pharmacology , Neoplasms, Hormone-Dependent/drug therapy , Prostatic Neoplasms/drug therapy , Triptorelin Pamoate/pharmacology , Aged , Antineoplastic Agents, Hormonal/administration & dosage , Antineoplastic Agents, Hormonal/pharmacokinetics , Delayed-Action Preparations , Drug Administration Schedule , Humans , Luteinizing Hormone/blood , Male , Middle Aged , Neoplasms, Hormone-Dependent/blood , Orchiectomy , Prostatic Neoplasms/blood , Testosterone/blood , Therapeutic Equivalency , Triptorelin Pamoate/administration & dosage , Triptorelin Pamoate/pharmacokinetics
15.
Expert Opin Pharmacother ; 5(10): 2171-9, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15461552

ABSTRACT

The high incidence of prostate cancer makes it a major healthcare problem and the second leading cancer-related cause of death among men in developed countries. The hormonal treatment of prostate cancer is indicated for the palliation of symptomatic and metastatic disease in older patients, and as neoadjuvant treatment of different modalities of radiotherapy. This hormonal treatment is based on the study conducted by Huggins in 1940 and consists of androgen suppression. Since the clinical availability of the first luteinising hormone-releasing hormone (LHRH) agonist, no significant improvement has been made in the field of medical castration. Taking these data into consideration, the recent approval of abarelix by the FDA, the first gonadotrophin-releasing hormone (GnRH) antagonist, appears to be promising news. The pharmacology of the molecule and the clinical studies that led to FDA approval will be reviewed. The place of GnRH antagonists in the treatment modalities of prostate cancer will then be discussed.


Subject(s)
Gonadotropin-Releasing Hormone/antagonists & inhibitors , Oligopeptides/therapeutic use , Prostatic Neoplasms/drug therapy , Animals , Clinical Trials, Phase III as Topic , Drug Hypersensitivity/etiology , Follicle Stimulating Hormone/blood , Gonadotropin-Releasing Hormone/agonists , Humans , Luteinizing Hormone/blood , Male , Oligopeptides/adverse effects , Oligopeptides/pharmacokinetics , Palliative Care , Prostatic Neoplasms/blood , Testosterone/blood
16.
Prog Urol ; 14(3): 326-31, 2004 Jun.
Article in French | MEDLINE | ID: mdl-15373174

ABSTRACT

OBJECTIVE: To compare the efficacy of the lipido-sterolic extract of Serenoa repens, Permixon, to that of the a-blocker, tamsulosin, in the treatment of severe low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). METHODS: In a 12-month, double-blind, randomized study that showed equivalent efficacy of Permixon 320 mg/day and tamsulosin 0.4 mg/day ("PERMAL study"), 685 BPH patients with IPSS > 10 had been analyzed for efficacy. Of these, the 124 patients with severe LUTS (IPSS > 19) at randomization were retained for this subset analysis. After a 4-week run-in period, 59 and 65 patients had been randomized to tamsulosin and Permixon groups, respectively. Both treatment groups were compared regarding the evolution from baseline of total IPSS and its irritative and obstructive subscores. LUTS-related QpL, prostate volume, Qmax and MSF-4 (sexual activity questionnaire) at different time points over 1 year An analysis of variance of changes from baseline to end point was performed for all the parameters. The over-time evolutions of total, irritative and obstructive IPSS were further compared using a variance analysis for repeated measurements. RESULTS: At 12 months, total IPSS decreased by 7.8 with Permixon and 5.8 with tamsulosin (p = 0.051); the irritative symptoms improved significantly more (p = 0.049) with Permixon (- 2.9 versus - 1.9 with tamsulosin). The superiority of Permixon in reducing irritative symptoms appeared as soon as month 3 and was maintained up to month 12 (p = 0.03). CONCLUSION: Permixon 320 mg/day was shown to be slightly superior to tamsulosin 0.4 mg/day in reducing LUTS in severe BPH patients after 3 months and up to 12 months of treatment.


Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Androgen Antagonists/therapeutic use , Plant Extracts/therapeutic use , Prostatic Hyperplasia/drug therapy , Sulfonamides/therapeutic use , Aged , Double-Blind Method , Humans , Male , Middle Aged , Serenoa , Severity of Illness Index , Tamsulosin
17.
Eur Urol ; 45(6): 773-9; disucssion 779-80, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15149751

ABSTRACT

OBJECTIVE: To compare the efficacy of the lipido-sterolic extract of Serenoa repens, Permixon, to that of the alpha-blocker, tamsulosin, in the treatment of severe low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). METHODS: In a 12-month, double-blind, randomized study that showed equivalent efficacy of Permixon 320 mg/day and tamsulosin 0.4 mg/day ("PERMAL study"), 685 BPH patients with IPSS > or =10 had been analyzed for efficacy. Of these, the 124 patients with severe LUTS (IPSS >19) at randomization were retained for this subset analysis. After a 4-week run-in period, 59 and 65 patients had been randomized to tamsulosin and Permixon groups, respectively. Both treatment groups were compared regarding the evolution from baseline of total IPSS and its irritative and obstructive subscores, LUTS-related QoL, prostate volume, Q(max) and MSF-4 (sexual activity questionnaire) at different time points over 1 year. An analysis of variance of changes from baseline to end point was performed for all the parameters. The over-time evolutions of total, irritative and obstructive IPSS were further compared using a variance analysis for repeated measurements. RESULTS: At 12 months, total IPSS decreased by 7.8 with Permixon and 5.8 with tamsulosin (p=0.051); the irritative symptoms improved significantly more (p=0.049) with Permixon (-2.9 versus -1.9 with tamsulosin). The superiority of Permixon in reducing irritative symptoms appeared as soon as month 3 and was maintained up to month 12 (p=0.03). CONCLUSION: Permixon 320 mg/day was shown to be slightly superior to tamsulosin 0.4 mg/day in reducing LUTS in severe BPH patients after 3 months and up to 12 months of treatment.


Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Androgen Antagonists/therapeutic use , Plant Extracts/therapeutic use , Prostatic Hyperplasia/drug therapy , Sulfonamides/therapeutic use , Aged , Double-Blind Method , Humans , Male , Middle Aged , Serenoa , Severity of Illness Index , Tamsulosin
18.
J Urol ; 171(2 Pt 2): S10-3; discussion S13-4, 2004 Feb.
Article in English | MEDLINE | ID: mdl-14713746

ABSTRACT

PURPOSE: Despite advances in the detection and management of prostate cancer, this disease remains a major cause of morbidity and mortality in men. Increasing attention has focused on the role of chemoprevention for prostate cancer, ie the administration of agents that inhibit 1 or more steps in the natural history of prostate carcinogenesis. We review prostate cancer chemoprevention studies in Europe. MATERIALS AND METHODS: Published studies were identified in a search of MEDLINE. Information about ongoing studies was provided by author access to protocols. RESULTS: A variety of chemoprevention studies have focused on the role of dietary factors, vitamins and trace elements in prostate cancer. Some of these studies have been prospective, randomized and double-blinded, while others have used retrospective or epidemiological approaches. Large scale randomized studies are also evaluating the role of 5alpha-reductase inhibitors, which inhibit the conversion of testosterone to the more potent androgen dihydrotestosterone. CONCLUSIONS: Robust evidence is lacking for the value of chemopreventive agents in prostate cancer. Current evidence does suggest that vitamin E and selenium may have a role in prostate cancer chemoprevention. Data from 2 studies, 1 examining the type 1 5alpha-reductase selective inhibitor finasteride and the other using the dual 5alpha-reductase inhibitor dutasteride, will determine the benefits of androgen inhibition strategies for prostate cancer chemoprevention.


Subject(s)
Anticarcinogenic Agents/therapeutic use , Prostatic Neoplasms/prevention & control , Antioxidants/therapeutic use , Azasteroids/therapeutic use , Carotenoids/therapeutic use , Dutasteride , Enzyme Inhibitors/therapeutic use , Finasteride/therapeutic use , Humans , Lycopene , Male , Vitamin E/therapeutic use
19.
Prog Urol ; 14(4): 493-500; discussion 499, 2004 Sep.
Article in French | MEDLINE | ID: mdl-15776898

ABSTRACT

PURPOSE: One half of French patients over the age of 50 with BPH are not diagnosed. Real difficulties are also currently encountered in the use of the I-PSS in general practice. In this context, the objective of this pilot study was to evaluate the concordance between the I-PSS score and a visual analogue scale (VAS), proposed as a new, precise and easy to use aid to the diagnosis of BPH. PATIENTS AND METHODS: Sixty five patients (mean age: 66 +/- 9 years, mean I-PSS: 13.6 +/- 7.0) recruited by two urology departments quantified their urinary symptoms by answering the question "How much difficulty do you have problems to urinate?": 7 patients used a 10 cm and a 35 cm VAS, 30 patients used a 15 cm VAS and 28 patients used a 20 cm VAS. All patients also completed the self-administered I-PSS questionnaire. RESULTS: The VAS scores were independent the patient's age. The 4 classes of I-PSS severity were also represented in the VAS groups (p=0.999). The strongest correlation with the I-PSS score was observed with the 20 cm VAS (R=0.91, p<0.0001). This coefficient was 0.26, 0.67 and 0.72 for the 10 cm, 15 cm and 35 cm VAS, respectively. A very close correlation was observed between the evaluation on the 20 cm VAS and the classes of the I-PSS score. Finally, the relationship between the I-PSS subscores and the 20 cm VAS was statistically significant (p<0.0001) with high correlation coefficients (R=0.75 and R=0.87 for irritative and obstructive symptoms, respectively). This VAS did not appear to favour one type of symptoms over another. CONCLUSION: This pilot study on a small number of patients showed that a 20 cm VAS can constitute a simple and precise aid to the detection of BPH. These results must now be validated by a large-scale study, under real general practice conditions.


Subject(s)
Prostatic Hyperplasia/complications , Prostatic Hyperplasia/diagnosis , Severity of Illness Index , Surveys and Questionnaires , Aged , Cross-Sectional Studies , Humans , Male , Pilot Projects , Prospective Studies
20.
Prog Urol ; 13(1): 121-2, 2003 Feb.
Article in French | MEDLINE | ID: mdl-12703367

ABSTRACT

The constant shortage of renal transplants has led to the selection of unusual donors. We report a case of renal transplantation using a renal transplant that had already been transplanted 29 months previously. To our knowledge, this constitutes the first case of retransplantation of the same organ after long-term implantation in a first recipient.


Subject(s)
Kidney Transplantation/methods , Cadaver , Humans , Male , Middle Aged , Reoperation , Tissue Donors
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