[Peroperative biopsy of the sub-apical urethra during prostatectomy for cancer]. / Etude par biopsie extemporanée de l'urètre sous-apexien au cours de la prostatectomie pour cancer.

INTRODUCTION AND OBJECTIVES: Between 35 to 45% of radical prostatectomies (RP) will show positive margins and approximately 50% of patients with positive margins will progress following RP. Peroperative diagnosis of positive margin possibly can improve the currability of RP. We report here the incidence and management of positive urethral margins diagnosed by frozen sections during radical prostatectomy. METHODS: Frozen sections were performed systematically to analyse the surgical margins during 130 RP performed for localized prostate cancer from january 1989 to december 1993. Peroperative analysis of distal (urethral) and proximal (bladder neck) margins, as well as posterior (Denonvilliers fascia) margins, and every surrounding tissue that was macroscopically abnormal were performed. RESULTS: Analysis of the distal margins showed no prostatic gland in 68 cases (52%), normal prostatic glands in 56 cases (43%) and neoplastic prostate glands in 6 cases (5%). Further urethral sections with frozen section analysis were performed in 62 cases until the distal margin was free of prostatic glands. Three out of six patients with positive urethral margins had another positive margin that was excised as well. Five out of six patients with positive urethral margins were pT3, NO, MO and one pT2, NO, MO. In the group of patients, with positive urethral margins, the average preoperative PSA serum level was 37 ng/ml and the average tumor weight was 14 g. Postoperative pelvic radiation therapy (45 grays) was performed in 5 of these patients. The mean follow-up is 36 months (12-68). PSA serum level is undetectable in 4 cases, and 0.4 ng/ml in 1 case. Urinary PSA level is undetectable in 5 out of 6 cases. CONCLUSION: Peroperative analysis of surgical margins, and particularly urethral margins, during RP allows to a better staging and to perform any tumor excision complement if possible. Surgical margins analysis when performed during surgery should help for the choice of the most adapted surgical procedure. In our experience, nerve-sparing RP are performed only when surgical margins are negative on frozen sections.

[Extemporaneous histological control of margins in prostatectomy for cancer]. / Le contrôle histologique extemporané des marges dans la prostatectomie pour cancer.

A histological study of the margins of radical prostatectomy specimens has been made intraoperatively by frozen section in a series of 66 patients. In 8 of them (12% of all) a positive margin was discovered 10 times at the urethral [3], vesical [2], deferential [1] level, at the level of the Santorini [1] and of the rectoprostatic wall [3]. Further resection was immediately performed until histologically normal tissue was reached in 6 of these patients, for whom positive margins were thus made negative; and the prostatectomy was performed. The prostate was not removed in two patients. Only one positive margin not screened intraoperatively was discovered on definitive specimen examination. The rate of postoperative PSA was lowered in the 6 patients whose margins had been made negative, which is compatible with complete resection. However, 7 of these 8 patients received radiation (45 gray). We made a comparison between the groups with negative (57 patients) and positive margins (9 patients) for preoperative PSA levels, Gleason's scores, and invasion of the capsule, of the seminal vesicles and of the lymph nodes. There was no significant difference between both groups for the PSA levels, Gleason's score and the involvement of the seminal vesicles. Conversely, there was a significant difference between both groups (corrected chi 2 test) for invasion of the capsule (p = 0.02) and of lymph nodes (p = 0.02). Intraoperative histological control allows immediately recognizing and treating some positive margins, in order to choose during the operation whether resection should be widened or abandoned.

[Total prostatectomy for stage D1 cancers]. / La prostatectomie totale dans les stades D1.

Nineteen patients with stage D1 (TXN/MO) prostatic adenocarcinomas were treated with radical prostatectomy and adjuvant radiation therapy. The latter was aortoiliac for stage B tumors and aortoiliac plus pelvic for stage C tumors. No hormonal therapy was associated to this. Lymph node invasion was multifocal in 10 of 19 cases, bilateral in 3 cases, and massive with rupture of the capsule and invasion of the fat surrounding the lymph nodes in 3. The maximum follow-up was 17 years, with a minimum follow-up of 1 year. The dosage of the prostatic specific antigen (PSA) has been an essential element of surveillance since 1987. Eight patients died of their cancer, 11 are alive, including 9 alive and healthy (47%). Among the latter, 5 (26%) are alive without any treatment, with a prostatic antigen level around zero at a follow-up of 6 to 12 years. The review of the literature shows that nonsurgical treatments have a palliative effect for stage D1 tumors, and that surgery alone is not always sufficient. Surgery must be followed by radiation therapy, the only modality likely to complete the effect of radical surgery with the same curative purpose.

[Primary neuroblastoma. A new form of median line cerebral calcification]. / Le neuroblastome primitif. Une forme nouvelle de calcification cérébrale de la ligne médiane.

Based on a series of 7 cases the original characteristics of neuroblastomas are described, these tumors being of neuronal origin and exhibiting such constant calcifications and median line sites that they can be evoked in spite of their rareness.