Anatomical variations of the renal artery based on the surgeon's direct observation: A French perspective.

INTRODUCTION: Renal arterial vasculature presents a great anatomical variation. A good knowledge of this anatomy is essential in the field of kidney transplantation. The aim of this study is to describe the anatomical variations of the renal arterial vasculature based on the retrieved but not transplanted kidneys (RNTK) and their contralateral grafted kidneys (CGK), which anatomy is described by surgeons themselves after aortic dissection during multi-organ procurement (MOP). MATERIAL AND METHODS: Using the "Crystal" database of the French "Agence de la biomédecine" (ABM), all RNTK were retrospectively selected over one year. Then, the arterial anatomy of each RNTK and their CGK was studied using the surgical and the histopathological reports. The surgical report was completed by the surgeon at the end of the MOP from deceased donors. The qualitative variables were expressed in numbers (percentage of the population) and were compared by a Chi2 test or an exact Fisher test depending on the sample size. A P-value of less than 0.05 was considered statistically significant. RESULTS: In total, 356 kidneys were studied (241 RNTK - 115 CGK), 69% had a single artery and 31% had multiple arteries (26% with two arteries and 5% with three or more). The incidence of multiple arteries was similar between the right and left kidneys (32% vs. 30% respectively). A modal arrangement with 1 artery on each side was present in 51% of cases. Thus, 1 in 2 donors had at least 2 arteries on one side. Multiple arteries were bilateral in 12% of cases. The RNTK group presented more kidneys with multiple arteries than the CGK group (35% vs. 22%). CONCLUSION: Our study shows a higher incidence of multiple renal arteries than the literature (31% vs. 25%). Thus, MOP can be considered as an accurate and reliable method of describing renal arterial anatomy, especially that some small arteries may be missed when using radiological or cadaveric dissection techniques.

[Local analgesia during flexible cystoscopy in male patients: A non-inferiority study comparing Xylocaine® gel to Instillagel® Lido]. / Anesthésie locale pour fibroscopie chez l'homme : étude de non-infériorité comparant le Xylocaine® gel à l'Instillagel® Lido.

INTRODUCTION: Local anesthesia using urethral gel has been proven to reduce discomfort of male patients during flexible cystoscopy. This study was a non-inferiority study between two lidocain-containing urethral gel (Instillagel® Lido and Xylocaine® gel). METHODS: A prospective single center study was conducted between June 2014 and November 2014. Male patients seen in the office and in whom a flexible cystoscopy was planned were included in the present study and received urethral instillation of either Xylocaine® gel or Instillagel® Lido at least 5minutes before flexible cystoscopy. No other anesthetic agent was used. Primary endpoint was pain during the procedure, assessed through visual analog scale (VAS) from 0 to 10. RESULTS: Four hundred and sixty-one men were included: 233 in the Instillagel® Lido group and 228 in the Xylocaine® gel group. Indications of flexible cystoscopy non-muscle invasive bladder cancer follow-up in 44 % of cases, hematuria work-up in 21 % of cases and lower urinary tract symptoms work-up in 35 %. Patients' age was comparable betwwen both groups: 64.5 years (±1.1) in the Instillagel® Lido group and 66.2 years (±1.1) in the Xylocaine® gel group (P=0.29). The mean VAS was 0.8 (±0.1) in the Instillagel® Lido group and 0.6 (±0.1) in the Xylocaine® gel group (P=0.10). The non-inferiority criterion was reached (P<0.001) as the average difference in VAS between the two groups was 0.2 with a confidence interval not comprising 1 (CI 97.5 %: -0.47; 0.07). CONCLUSION: In this prospective study, Instillagel® Lido was not inferior to Xylocaine® gel for local analgesia during flexible cystoscopy in male patients. LEVEL OF EVIDENCE: 4.

[Functional outcomes obtained after vesicoureteral reimplantation surgery in adults: A review]. / Étiologies et résultats fonctionnels après réimplantation urétéro-vésicale chez l'adulte : revue de la littérature.

OBJECTIVES: Vesico-ureteral reimplantations (VUR) for adults are complex procedures, often practicing for distal ureteral lesions. Our goal was to synthesis the main indications for VUR, different techniques and their functional outcomes. MATERIAL AND METHODS: A literature review in English by Medline, Embase and Google scholar was performed using the following keywords: ureter; laparoscopy; robotics, reimplantation; surgery; obstruction; morbidity; complications; psoas hitch; Boari flap; ureteroneocystostomy. RESULTS: In more than half of the cases, aetiology was a iatrogenic ureteral lesion. When the ureteral defect was less than 2 cm, direct or non-refluxing VUR was the technique of choice. If defect was superior than 2 cm the Boari flap or vesicopsoas hitch were preferred. Several surgical approaches were feasible: open, laparoscopic only, robot assisted laparoscopic. Estimated blood loss, pain and mean hospital stay seemed better with conventional or robotic coelioscopy. Nevertheless, complications, pre-/post-operative renal function and mean operative time seemed similar. The most frequent major complication was the anastomotic urine leakage. CONCLUSIONS: The VUR techniques are well codified now even if it's a rare procedure. Functional outcomes are satisfied according to literature and morbidity is more and more decreasing but the level of evidence of the studies is low.

[Prognostic factors of upper tract urothelial carcinomas and impact on survival: a systematic review for the yearly scientific report of the French National Association of Urology]. / Facteurs pronostiques des tumeurs de la voie excrétrice supérieure et impact sur la survie: une revue systématique pour le rapport annuel de l'Association française d'urologie.

AIM: To describe the main prognostic factors with an impact on survival of patients diagnosed with upper tract urothelial carcinomas (UTUC). MATERIAL AND METHODS: A systematic review of the literature has been performed using Pubmed without timeline restriction with the following keywords (MeSH): urothelial carcinoma; ureter; renal pelvis; prognosis; recurrence; survival; predictive models; nomogram. RESULTS: The level of evidence was low (3) in every available studies. There were 4 categories of prognostic factors in UTUCs: clinical (patient and tumor characteristics); surgical; pathological and molecular. The most important pre-operative prognostic factors were: size>3cm, grade (biopsy and cytology); multifocality; important hydronephrosis; co-morbidity (ASA), ECOG status, and a surgical delay of no more than 3months. After surgery, the most important prognostic factors are: stage, grade, carcinoma in situ, lymphovascular invasion and lymph node involvement. Serum markers from inflammation (CRP) could be useful for the prediction of advanced stages. Molecular markers are still under evaluation. CONCLUSION: The identification of prognostic factors in UTUC has improved over the past years. These prognostic factors can be considered alone but also as a panel or inside predictive tools to predict accurately patient's survival.

[Last resort surgical management of postradiation urinary cystitis after external beam radiation for prostate cancer: a monocentric analysis]. / Traitement chirurgical de dernier recours en cas de cystite radique après radiothérapie externe du cancer de la prostate : analyse monocentrique.

PURPOSE: To assess functional outcomes obtained after surgical management of post-radiation urinary incontinence after prostate cancer. PATIENTS AND METHOD: A retrospective review of the data from patients treated in our centre between September 2004 and February 2012 by surgery for vesicosphincteric injuries after prostatic external beam radiation therapy was performed. RESULTS: A total of seven men with a median age of 70 years ± 4.1 were included. Mean follow-up was 32.3 months ± 29 (3-86). All patients underwent a partial cystectomy and augmentation enterocystoplasty. The vesicocutaneous fistula rate was 33% occurring within a mean time of 18.5 days ± 2.1 (17-20). The mean length of urinary catheter and hospital stay were respectively 16 days ± 8.4 (12-35) and 18 days ± 7.8 (13-37). Five patients underwent asynchronous insertion of artificial urinary sphincter. The success rate of partial cystectomy and augmentation enterocystoplasty with asynchronous implantation of artificial urinary sphincter to treat post-radiation urinary incontinence was 71.5%. The median time between partial cystectomy and augmentation enterocystoplasty and artificial urinary sphincter implantation was 27.6months ± 26.4 (7-72). CONCLUSION: Surgical management of post-radiation urinary cystitis offers good functional outcomes albeit its morbidity is not negligible. It should be proposed only in expert surgical centres.

[Influence of plasmatic testosterone during natural history of prostate cancer: a review]. / Influence de la testostérone plasmatique au cours de l'histoire naturelle du cancer de la prostate : analyse de la littérature.

INTRODUCTION: Prostate cancer (PCa) is the most common disease in male patients and it has the particularity to be androgen dependent. The aim of the current study was to provide an overview about the interest of testosterone dosage during the management of PCa regardless of the stage of the disease. PATIENTS ET METHODS: A systematic review of the literature was done from the PubMed database by searching the following key words alone or in combination: prostate cancer; testosterone; risk; aggressiveness; hormonotherapy; active surveillance; prognosis; androgen; cardiovascular risk; biochemical recurrence. RESULTS: The level of plasmatic testosterone depends on the moment of the day with a peak between the end of the night and in the morning. We can test either the whole testosterone level, the free testosterone level or the bioavailable testosterone. The bioavailable testosterone is more representative of the presence of androgen in tissues but a specialized laboratory is mandatory. The testosterone plasmatic rate is potentially useful during several steps of the PCa management: in localized prostate cancer cases, men with low testosterone levels are more likely to have an aggressive disease and are therefore not good candidates for active surveillance. An extensive radical prostatectomy should be considered in case of young men since these patients are more likely to recur subsequently; in advanced prostate cancer cases, a testosterone level has to be less or equal to 0.2 ng/mL to guarantee an appropriate castration when a patient is undergoing an androgen deprivation treatment. A dissociation between the trend of PSA and testosterone levels can be the starting point of the castration-resistant period of the disease. CONCLUSION: The testosterone level can bring useful information regarding the profile of PCa and its ability to evolve during the whole natural history of the disease.

[Prognostic influence of prostate gland invasion by bladder tumour and/or prostate cancer in cystoprostatectomy specimen: a review]. / Influence pronostique de l'envahissement tumoral de la glande prostatique par la tumeur de vessie et/ou du cancer de la prostate découvert après cystoprostatectomie : analyse de la littérature.

INTRODUCTION: Cystoprostatectomy (CPT) is the gold standard surgical treatment for muscle invasive bladder cancer (MIBC). In certain cases, MIBC can invade the prostate gland and/or a prostate cancer (PCa) can be discovered fortuitously on the pathologic specimen. The aim of the current study was to report the prognostic influence of PCa in patients who underwent a CPT for MIBC. MATERIALS AND METHODS: A systematic review of the scientific literature was achieved in the Pubmed database, using the following keywords: prostatic neoplasm; urinary bladder neoplasm; cystectomy; surgery; recurrence; prognosis; survival. Clinical cases and series of less than five cases were deliberately excluded herein. RESULTS: Overall, ten studies published between 2004 and 2011 and involving 2196 patients were selected. Only retrospective studies of low level of evidence (NP 4) were available. The incidence of neoplastic invasion of the prostate gland by MIBC ranged from 25 to 48%. Preoperative predictors were multiple BC, recurrent, location in the trigone and existence of CIS. Overall survival at 3 years was significantly affected by the invasion of the prostate gland (pT4a) in these patients. The incidence of PCa discovered incidentally pathologic specimen CPT ranged from 14 to 49%. Only age was found as a positive predictor. The diagnosis of PCa did not influence survival of patients with MIBC and no specific PCa adjuvant treatment was systematically advocated. CONCLUSION: Fortuitous diagnosis of PCa and/or neoplastic invasion of the prostatic gland by BC on CPT specimen is not uncommon but this is variable across studies, depending on the quality of the pathological analysis. The invasion of the prostate gland by MIBC is a serious situation (pT4a) and linked with a poor prognosis. In case of concomitant PCa and MIBC, the prognosis is much more related to the natural history of the bladder tumour.

[Objective evaluation and comparison of the scientific publication from the departments of the Assistance publique-Hôpitaux de Paris: analysis of the SIGAPS score]. / Évaluation comparative et objective de la production scientifique des services hospitaliers au sein de l'Assistance publique-Hôpitaux de Paris: analyse des scores SIGAPS.

PURPOSE: To analyze the results of the bibliometric system (SIGAPS score) of scientific publications in the Assistance publique-Hôpitaux de Paris (AP-HP) and to compare the scientific production among the various medical and surgical specialties of the academic hospitals of Paris. METHODS: All the publications imported from Pubmed between 2006 and 2008 were included. The following data were taken into account and analysed: the hospital department of origin, the number of articles published, the number of full-time physicians, the SIGAPS score. RESULTS: Thirty-eight thousand, seven hundred and nine publications were included. The departments were consisted of 747 full-time practitioners 5719 (1895 Professors [33.1%], 2772 Assistant Professors [48.4%] and 1052 fellows [18.4%]). The average number of full-time practitioner by department was 7.7±6.7 (range 1-69). The average total number of articles published in a department was 51.8±49.4 (range 1-453). The average SIGAPS score was more important in medicine than in surgery (621.2±670.1 vs. 401±382.2; P=0.01) but not the average number of article per practitioner (8.1±8.3 vs. 6.6±6.2; P=0.0797). The mean number of publication by full-time practitioner was 7.9±7.8 (1-45), or an average of 2.7±2.6 for each full-time practitioner each year. CONCLUSION: Academic hospitals in Paris have a reasonably scientific output but with a mean of 2.7 articles per full-time practitioner per year. No major differences between medical and surgical disciplines were observed.

[Analysis of the bibliometrics score of surgical department from the academic hospitals of Paris: what is the rank of urology?]. / Analyse des scores SIGAPS des services de chirurgie au sein des hôpitaux universitaires de l'Assistance publique-Hôpitaux de Paris : quelle est la place de l'urologie ?

OBJECTIVES: Analyze the results of the bibliometric system and analysis of scientific publications (SIGAPS) in the Assistance publique-Hôpitaux de Paris (AP-HP) and compare the scientific production among the various surgical disciplines of the academic hospitals of Paris and define the place of urology. METHODS: The publications from 115 surgical departments between 2006 and 2008 were included. Only surgical departments were considered in the current study. The following data were taken into account: the hospital department of origin, the number of articles published, the number of first place, last places, the number of full-time unit, the SIGAPS score. Statistical analysis focused on the quality and on the quantity of published articles per surgeons and per department. There were eight academic departments of urology identified within the AP-HP. RESULTS: The database contained information for 115 surgical departments. The mean number of articles published by department was 42.89±27.34 (13.2 to 110.75). The mean number of publications per full-time surgeon was 6.7±2.59 (3.77 to 12.84), or a mean of 2.25±0.86 released by full-time and by year. The median score SIGAPS of surgery was 304 with a wide interval (122 to 903.5). Urology was the specialty with the highest median score compared to other surgical specialties. The department, which published the most, was the center 1, in comparison with the center 6 which was publishing the most in A/B ranking journals. CONCLUSION: Urology was the absolute leader by far in terms of scientific publications in the AP-HP when compared to other surgical disciplines. The discipline is organized efficiently to juggle clinical work and research indicating a certain dynamism of the teams that invest there to fulfill the missions assigned to them in the University Hospital and the part of the autonomy of the universities.

[Training and future of urologist residents and chief residents in France: results from a national survey among 154 urologists in training]. / Formation et avenir des internes et chefs de clinique d'urologie en France: résultats d'une enquête nationale auprès de 154 urologues en formation.

PURPOSE: To raise an appraisal of French urologist resident and chief resident's demographic characteristics, activity, post-residency project, career desires and factors associated with obtaining a fellowship. METHODS: An electronic questionnaire was sent by email between June 2009 and January 2010 to the 288 French urologists currently in training. Items analysed included demographics, achievement of academic works and post-residency projects. RESULTS: Overall, we obtained 156 answers (response rate of 54%). Our population was composed by 47 (27%) fellows and 114 (73%) residents. They work 68.1 hours per week and 31 (20%) leave the hospital after an on-call night. Thirty-two (20.5%) have validated a master 2. Among the resident, 54 (47.3%) are certain to have the opportunity to be a chief resident. Regarding residents, factors significantly associated with the fact to obtain a fellowship in multivariate analysis were: to gain a master 2, working more than 65 hours per week and achieving academics works. Installation in a general hospital, a university hospital and a private clinic was considered by respectively 21.7%, 41.6% and 67.3% of young urologists. CONCLUSION: French urologist resident and chief resident's work an average 68 hours per week. The determining factors in obtaining a fellowship are the realization of a master 2, a workweek exceeding 68 hours and the achievement of academic work. After completing their academic training, a majority of young urologists are attracted by private practice.

Oncological outcomes in patients undergoing radical nephrectomy and vena cava thrombectomy for renal cell carcinoma with venous extension: a single-centre experience.

OBJECTIVE: To report on the effectiveness of the surgical management of renal cell carcinoma (RCC) in patients with a neoplastic thrombus of the vena cava. PATIENTS AND METHODS: We examined pre- and post-operative clinical data for all patients who had received a nephrectomy for the management of RCC with a neoplastic thrombus of the vena cava between spanning 10 years. The procedure depended on the exact location and size of the thrombus according to the Mayo Clinic and the 2009 TNM classifications. RESULTS: A total of 32 patients underwent surgery. Eight of these patients had stage I, nine had stage II, six had stage III and nine had stage IV thrombi according to the Mayo Clinic staging, and twenty were T3b, eight were T3c and four were T4 according to the 2009 TNM classifications. An open abdominal approach was performed in patients with stage I and II thrombi, whereas five of the stage III patients and all of the stage IV patients required combined sternotomies. Five patients whose thrombi extended to the right atrium were treated with a cardiac bypass. The complication rate was 53% and the peri-operative mortality rate was 12.5%. The median follow-up interval was 64 months. The overall and cancer-specific five-year survival rates for all stages combined were 47% and 52%, respectively. CONCLUSION: Surgical resection remains the first-line treatment for patients with RCC infiltrating the vena cava, but surgical morbidity is prevalent and survival is poor.

[Active surveillance for localized prostate cancer]. / Surveillance active du cancer de prostate localisé

The widespread application of PSA screening has led to an important increase of the small and well-differentiated prostate cancer. Despite natural history of prostate cancer has not been completely elucidated; it has been proved that the evolution of low grade tumours was favorable and that some of them remain indolent. In these cases, curative therapies and their associated morbidities might be considered as overtreatment. Active surveillance should be an option to limit this overtreatment. It is obvious that the initial risk stratification used for active surveillance wasn't enough restrictive. From now on, it seems that a PSA<10 ng/ml, a Gleason score<7 and more than 10 prostate biopsies are the good criteria to propose for the selection of eligible patients. However, the debate about adequate and accurate criteria is still ongoing between several teams worldwide involved in active surveillance. International prospective studies are in progress and are necessary to establish selections criteria and modalities of surveillance and predictors of active treatment. We need to wait for conclusion from prospective studies results. However, it appears that active surveillance offers yet the possibility to delay active treatment and its complications in selected cases.

[Combined hormonotherapy with external beam radiotherapy in locally advanced prostate cancer: do side effects overlap the advantages?]. / Hormonothérapie combinée à la radiothérapie externe dans le cancer de prostate localement avancé: les effets secondaires contrecarrent-ils les bénéfices?

Used for more than 60 years in metastatic prostate cancers, hormone therapy is nowadays also an option for the treatment of locally advanced prostate cancer. Adjuvant androgen deprivation combined with external beam radiotherapy has become the gold standard treatment in locally advanced prostate cancer. Combined therapy has been extensively investigated and has shown to improve oncologic outcomes. However, its toxicity is not negligible. Several side effects can be encountered: cardiovascular, bone depletion, metabolic changes and neuropsychologic effects. They may overlap treatment benefits and be responsible of a specific mortality. Nevertheless, randomized studies have demonstrated that there was no increase of specific mortality from combined treatments compared to patients treated by radiotherapy alone. Therefore, these side effects might not be a barrier to adjuvant androgenic deprivation. However, long-term results are still needed and also accurate morbidity studies. In addition, the debate is still ongoing regarding the appropriate duration of hormone therapy.

[Chemotherapy in early stage of hormone-resistant metastatic prostate cancer: what are the indications?]. / Chimiothérapie en phase précoce d'hormonorésistance des cancers de prostate métastatiques: quelles indications?

Treatment of hormone-refractory prostate cancer remains a source of debate. Since 2004, docétaxel-based chemotherapy has become the standard treatment as it has demonstrated efficacy on overall survival in two randomized studies. In some studies, chemotherapy seems to be also effective on pain relief. The adverse effects occur more frequently than with others chemotherapy (mitoxantrone) but are moderated and aren't responsible of specific mortality. These facts encourage to begin the chemotherapy as earlier as possible even before metastases appear. Some studies have even raised the issue of an initiation of chemotherapy before the onset of hormone independence. However these arguments might be use with caution. The treated patients have a limited life expectancy and a 2 months gain of survival may be of limited value. Furthermore, even low side effects can generate a morbidity on these fragile patients especially when they are initially asymptomatic. Thus, an early initiation of chemotherapy must be discussed case by case, on an individual basis. The prognosis factors and alternative therapeutic options based on new molecules used in metastatic cancer might also be considered for the therapeutic decision.

[Update about advanced prostate cancer: diagnosis, treatment and ongoing perspectives]. / Actualités dans les cancers de prostate non localisés: diagnostic, traitement et voies d'avenir.

Incidence of prostate cancer is constantly growing no matter of the stage of the disease. Locally advanced tumours and metastatic stages of the disease are not exception. Nevertheless, management of advanced prostate cancer is still uncertain. Thus, non invasive molecular or imaging techniques have been proposed to optimize the diagnosis of advanced prostate cancer. The debate is still ongoing regarding therapeutic options to offer to the patient to obtain the optimal oncologic control. Radical prostatectomy can now be considered as an option in certain cases of high-risk prostate cancer, on the basis of a multimodal treatment. The field of hormonotherapy is also evolving. New molecules (GnRH Antagonists, anti androgen) or new modalities of prescription (six-month GnRH agonist) appear. The prescription modalities evolve as well (e.g.; intermittent treatment). Lastly, chemotherapy is now proposed for metastatic symptomatic prostate cancer but also for locally advanced disease. Basic research and genetic investigations are still ongoing to explore pathways and factors of progression to the metastatic status and to find the most appropriate treatment for each patient.

[News aspects on surgical management of localized prostate cancer]. / Actualités concernant la prise en charge non chirurgicale du cancer de la prostate localisé

During the last decade, several new non-surgical treatments have emerged for the management of localized prostate cancer. External radiotherapy and radical prostatectomy are still gold-standard and effective treatments but often associated with morbidities and side-effects. Consequently, less invasive treatments such as high-intensity focused ultrasound and brachytherapy have been progressively developed in order to decrease the complication rate associated with standard therapies as well as developing an effective oncological treatment. Later on, concepts of << watchful waiting >> and/or << active surveillance >> have been proposed to decrease overtreatment for patients with indolent disease. Despite promising results, further studies with long term follow up are strongly needed to better evaluate the cancer control and the quality of outcomes afforded with theses new therapeutics and before considering to alter the current guidelines for localized prostate cancer.

[Medical castration in the treatment of locally advanced or metastatic prostate cancer: an update]. / Indications de l'hormonotherapie dans le traitement du cancer de la prostate localement avancé ou metastatique.

Indications for hormonotherapy in prostate cancer are in deep mutation and are constantly evolving. Used initially (1941) in metastatic stages, hormone therapy is used nowadays in locally advanced prostate cancer and aggressive localized disease. Its prescription in association with radiotherapy or surgery has provided a benefit regarding survival free progression. The place of hormone therapy in localized prostate cancer is not well defined and the debate is still ongoing, especially in case of biochemical recurrence after irradiation or radical prostatectomy and even in neoadjuvant cases. Additional and further studies are ongoing and are strongly needed to establish new guidelines. Nevertheless, hormone therapy is not restricted any more to palliative cases and is part of the current therapeutic arsenal of the urologist for high risk localized and/or locally advanced prostate cancers.

[Observational study CAPITAL and prescription of hormonotherapy by French urologists in daily practice]. / Etude observationnelle CAPITAL et prescription de l'hormonotherapie par les urologues français dans la pratique quotidienne.

Prostate cancer is a heterogeneous disease with different stages subject to a broad range of appropriate therapies to the patient or to the point in the disease course. Hormonotherapy has been developed for metastatic cancer and palliative therapy but is commonly used to treat all stages of prostate cancer nowadays. However its toxicity is not negligible and the cardiovascular, bone and metabolic side-effects are mainly responsible of a decrease of the benefits and in observance. The observational study CAPITAL has defined the conditions of prescriptions of androgen-deprivation therapy by physicians (n=208) in France (i.e., urologists and oncologists) and the effects of hormonotherapy in a population of more than 1,000 patients. Androgen-deprivation therapy was mainly given in case of biochemical recurrence after first-line treatment (32.2 %) or for metastasis (32.9 %). Overall, 83 % patients were satisfied of LH-RH agonists. Hormone therapy might be debated especially in young men with prostate cancer whose quality of life should be reduced. The prescription has to be associated with a global personal and stringent follow-up to prevent and reduce the toxicity.

[Epidemiology, diagnosis and prognosis of localized prostate cancer: what's new?]. / Epidemiologie, diagnostic et pronostic du cancer de prostate localisé : état des lieux.

Detection and diagnosis of prostate cancer has challenged researchers and clinicians for several years, particularly with the increase of its incidence. With the advent of optimal treatments for each patient, diagnosis and prognostic tools arouse more and more interest. Effectively, it becomes necessary to assess even better the aggressiveness of the tumour in order to choose the most appropriate treatment and, thus to make a correlation between the phenotype and the genotype. The biological screening relies on PSA alone currently but should know another era soon with the advent of new markers, such as urinary gene PCA3, usefull for patients with previous negative biopsies. The techniques of biopsies and medical imaging are also going through multiple changes and evolutions that are about to increase their reliability. The optimization of MRI allows more precise diagnosis of local invasion and is usefull to optimize. Finally, the emergence of biological prognostic markers, such as endothelin or semaphorin 3A, whose expressions differ according to the type of cancer, should help to predict disease's gravity and outcome. The comprehension and the understanding of carcinogenesis pathways leads to new perspectives for targeted and earlier cancer therapies.

[Surgical's innovations and perspectives in management of localized prostate cancer]. / Innovations chirurgicales et perspectives dans la prise en charge du cancer de la prostate localisé

Incidence of prostate cancer is constantly increasing, notably localized cancer cases in young men:As a direct consequence of PSA-driven screening. Recent researchers and clinicians efforts have greatly improved the options and the indications of the treatment, particularly in surgery. The development of the video assisted technologies, with encouraging oncological outcomes and promising functional results are establishing evidences of the evolution of prostate surgery. In daily practice, the strategy for the surgical management of postoperative incontinence, when required, is also more established and represents another challenge took up by the urologists. Besides, the emergence of new innovations:As one-trocar system for laparoscopy or 3-D vision for laparoscopy, confirms the idea of a deep and perpetual mutation in the area of prostate cancer surgery.