Focal therapy for prostate cancer: Making the punishment fit the crime.

BACKGROUND: Focal therapy is recently gaining popularity as an intermediate option between active surveillance and whole-gland treatment for localized prostate cancer. OBJECTIVE: This comprehensive review aims to present the different focal therapy technologies available to date while tackling the rationale for focal treatment, its indications, principles and outcomes of each technique. EVIDENCE ACQUISITION: A comprehensive review of the PubMed, Embase, and Web of Science was done. Keywords used for research were: "prostate cancer"; "focal therapy"; "focal treatment"; "High-Intensity Focal Ultrasound"; "cryotherapy"; "photodynamic therapy"; "focal laser ablation"; "irreversible electroporation"; "focal brachytherapy" and "gold nanoparticle directed therapy". Accepted languages were English and French. EVIDENCE SYNTHESIS: Choosing the best candidate for focal therapy is crucial (localized small to medium sized Gleason≤7 lesions). Focal high-intensity focal ultrasound has shown excellent survival rates at 5 years, while maintaining good functional outcomes (urinary continence and erectile function). Focal cryotherapy, one of the oldest focal treatments for prostate cancer, has shown good oncologic outcomes, with good continence rates and fair erectile function rates. Focal laser ablation seems a safe and feasible technique, with promising results. Irreversible electroporation has demonstrated good survival outcomes with no biochemical recurrence or disease relapse in the preliminary studies. Focal brachytherapy has a good toxicity profile, a good biochemical outcome, and gives a sustained quality of life. Finally, gold nanoparticle directed therapy is safe and is being studied in current trials. CONCLUSION: While proven to be safe in terms of continence and sexual aspects, the challenge remains to better assess oncological outcomes of these techniques in randomized longer follow-up studies.

Disección de los ganglios linfáticos pélvicos en el cáncer de próstata: la laparoscopia no ha muerto / Pelvic lymph node dissection in prostate cancer: Laparoscopy is not dead

CONTEXTO: La disección de los ganglios linfáticos pélvicos (DGLP) en el cáncer de próstata localizado es viable mediante un abordaje abierto, laparoscópico o asistido por robot. La información sobre la comparación de los 3 enfoques es escasa. OBJETIVO: Realizar una revisión para comparar la efectividad de los diferentes enfoques de la DGLP. Adquisición de la evidencia: Se realizó una búsqueda incluyendo las siguientes palabras: («disección de ganglios linfáticos pélvicos») o («linfadenectomía pélvica») y («francés» [Idioma] o «inglés» [Idioma]) y («1990» [Fecha-Publicación]: «3000» [Fecha-Publicación]) y prostatectomía [Título]). Finalmente, se incluyeron 29 artículos en la síntesis cualitativa. Síntesis de la evidencia: Al compararla con un abordaje abierto, la linfadenectomía pélvica laparoscópica en el cáncer de próstata es un procedimiento mínimamente invasivo con un tiempo operatorio relativamente corto, un sangrado mínimo, un nivel más bajo de dolor, una estancia hospitalaria más corta y menos complicaciones perioperatorias. Esta técnica es más rentable que el abordaje asistido por robot. CONCLUSIÓN: La linfadenectomía pélvica laparoscópica debe ser conocida e implementada por los urólogos para el tratamiento del cáncer de próstata localizado

CONTEXT: Pelvic lymph node dissection (PLND) in localized prostate cancer is feasible through an open, laparoscopic or robot-assisted approach. Data comparing the three approaches is sparse. OBJECTIVE: To perform a review in order to compare the effectiveness of the different PLND approaches. Acquisition of evidence: A search was performed including the following words: ("pelvic lymph node dissection") OR ("pelvic lymphadenectomy") AND ("French"[Language] OR "English"[Language]) AND ("1990"[Date-Publication]: "3000"[Date-Publication]) AND prostatectomy[Title]). Twenty-nine articles were finally included in the qualitative synthesis. Evidence synthesis: Laparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with a relatively short operative time, minimal blood loss, lower level of pain, shorter hospital stay, and fewer perioperative complications when compared to an open approach. This technique is more cost-effective than a robot-assisted approach. CONCLUSION: Concerning the treatment of localized prostate cancer, laparoscopic pelvic lymph node dissection should be learned and applied by urologists

Pelvic lymph node dissection in prostate cancer: Laparoscopy is not dead. / Disección de los ganglios linfáticos pélvicos en el cáncer de próstata: la laparoscopia no ha muerto.

CONTEXT: Pelvic lymph node dissection (PLND) in localized prostate cancer is feasible through an open, laparoscopic or robot-assisted approach. Data comparing the three approaches is sparse. OBJECTIVE: To perform a review in order to compare the effectiveness of the different PLND approaches. ACQUISITION OF EVIDENCE: A search was performed including the following words: ("pelvic lymph node dissection") OR ("pelvic lymphadenectomy") AND ("French"[Language] OR "English"[Language]) AND ("1990"[Date-Publication]: "3000"[Date-Publication]) AND prostatectomy[Title]). Twenty-nine articles were finally included in the qualitative synthesis. EVIDENCE SYNTHESIS: Laparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with a relatively short operative time, minimal blood loss, lower level of pain, shorter hospital stay, and fewer perioperative complications when compared to an open approach. This technique is more cost-effective than a robot-assisted approach. CONCLUSION: Concerning the treatment of localized prostate cancer, laparoscopic pelvic lymph node dissection should be learned and applied by urologists.

Chemotherapy-induced differentiation to cure botryoid rhabdomyosarcoma: a case report and review of the literature.

Rhabdomyosarcoma (RMS) occurs rarely in adults and constitutes 2-6% of all uterine neoplasms. The authors report the case of a 26-year-old woman diagnosed with botryoid RMS that presented discordant progression results on follow up imaging and cytodifferentiation on pathologic control. This case showed that radiological evaluation could be misleading as the tumor demonstrated chemotherapy-induced differentiation without volume reduction. This case illustrates the limitations of using the imaging anatomical dimensions of sarcomas for treatment planning and highlights the potential role of functional imaging to assess the response to treatment.

[Radical surgical treatment of vulvar epidermoid cancer]. / Le traitement chirurgical radical du cancer épidermoïde de la vulve.

During an eighteen-year period, forty-nine patients with invasive epidermoid carcinoma of the vulva were treated by a radical vulvectomy at the Hôtel-Dieu de France hospital in Beirut. The age, the clinical presentation, and the lymph nodes involvement were close to what was published in the literature. The overall five-year survival rate was 72%. Those with stage I disease lesions had an excellent survival rate. A review of the literature would indicate that a conservative approach in the treatment of early invasive lesions can give satisfactory results, and that adjuvant radiotherapy is more beneficial than pelvic lymph nodes dissection when there is a high risk of pelvic involvement.