Publications by authors named "Jean-Baptiste Beauval"

57 Publications

Deep Neural Networks Outperform the CAPRA Score in Predicting Biochemical Recurrence After Prostatectomy.

Front Oncol 2020 11;10:607923. Epub 2021 Feb 11.

Department of Urology, CHU de Toulouse, Toulouse, France.

Background: Use of predictive models for the prediction of biochemical recurrence (BCR) is gaining attention for prostate cancer (PCa). Specifically, BCR occurs in approximately 20-40% of patients five years after radical prostatectomy (RP) and the ability to predict BCR may help clinicians to make better treatment decisions. We aim to investigate the accuracy of CAPRA score compared to others models in predicting the 3-year BCR of PCa patients.

Material And Methods: A total of 5043 men who underwent RP were analyzed retrospectively. The accuracy of CAPRA score, Cox regression analysis, logistic regression, K-nearest neighbor (KNN), random forest (RF) and a densely connected feed-forward neural network (DNN) classifier were compared in terms of 3-year BCR predictive value. The area under the receiver operating characteristic curve was mainly used to assess the performance of the predictive models in predicting the 3 years BCR of PCa patients. Pre-operative data such as PSA level, Gleason grade, and T stage were included in the multivariate analysis. To measure potential improvements to the model performance due to additional data, each model was trained once more with an additional set of post-operative surgical data from definitive pathology.

Results: Using the CAPRA score variables, DNN predictive model showed the highest AUC value of 0.7 comparing to the CAPRA score, logistic regression, KNN, RF, and cox regression with 0.63, 0.63, 0.55, 0.64, and 0.64, respectively. After including the post-operative variables to the model, the AUC values based on KNN, RF, and cox regression and DNN were improved to 0.77, 0.74, 0.75, and 0.84, respectively.

Conclusions: Our results showed that the DNN has the potential to predict the 3-year BCR and outperformed the CAPRA score and other predictive models.
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http://dx.doi.org/10.3389/fonc.2020.607923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906005PMC
February 2021

Complete Transurethral Resection before Radical Cystectomy May Improve Oncological Outcomes.

Urol Int 2021 Feb 24:1-8. Epub 2021 Feb 24.

Department of Urology, University Hospital of Rennes, Rennes, France.

Objectives: The objective of this study was to assess the impact of complete transurethral resection of bladder tumors (TURBTs) before radical cystectomy on pathological and oncological outcomes of patients with muscle-invasive bladder cancer (MIBC) and high-risk non-MIBC.

Materials And Methods: The charts of all patients who underwent radical cystectomy for bladder cancer in 2 academic departments of urology between 1996 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the completeness of the last endoscopic resection before radical cystectomy: macroscopically complete transurethral resection (complete) or macroscopically incomplete transurethral resection (incomplete). The primary end point was the recurrence-free survival (RFS). Secondary end points included cancer-specific survival (CSS) and rates of pT0 and downstaging.

Results: Out of 486 patients included for analysis, the TURBT immediately preceding radical cystectomy was considered macroscopically complete in 253 patients (52.1%) and incomplete in 233 patients (47.9%). In multivariate analysis, macroscopically complete TURBT was the strongest predictor of both pT0 disease (OR = 3.1; p = 0.02) and downstaging (OR = 7.1; p < 0.0001). After a median follow-up of 41 months, macroscopically complete TURBT was associated with better RFS (5-year RFS: 57 vs. 37%; p < 0.0001) and CSS (5-year CSS: 70.8 vs. 54.5%; p = 0.002). In multivariate analysis adjusting for multifocality, weight of endoscopic resection specimen, cT4 stage on preoperative imaging, interval between endoscopic resection and radical cystectomy, neoadjuvant chemotherapy, pT stage, and associated carcinoma in situ, macroscopically complete endoscopic resection remained the main predictor of better RFS (HR = 0.4; p = 0.0003) and the only preoperative factor associated with CSS (HR = 0.5; p = 0.01).

Conclusion: A macroscopically complete TURBT immediately preceding radical cystectomy may improve pathological and oncological outcomes in patients with MIBC and high-risk MIBC.
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http://dx.doi.org/10.1159/000512053DOI Listing
February 2021

The prognostic value of high-grade prostate cancer pattern on MRI-targeted biopsies: predictors for downgrading and importance of concomitant systematic biopsies.

World J Urol 2021 Feb 20. Epub 2021 Feb 20.

Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France.

Purpose: To assess the proportion and risk factors for downgrading and reclassification to favorable disease in patients having high-grade (HG) prostate cancer (PCa) pattern on magnetic resonance imaging (MRI)-targeted-biopsy (TB).

Methods: From a radical prostatectomy (RP) cohort, we included patients with pre-biopsy positive MRI and HG [defined by Grade Group (GG) ≥ 3] PCa on MRI-TB. All patients also underwent concomitant systematic biopsy (SB). The main endpoints were the rates of downgrading to GG2, overall downgrading, favorable disease (pT2 and GG2) on RP specimens, and biochemical recurrence-free-survival (RFS). We studied the correlations between HG on concomitant SB, final pathological outcomes and biochemical RFS curves.

Results: Overall downgrading, downgrading to GG2 disease and favorable disease were noted in 36.2%, 24.1%, and 15.4% respectively. HG on concomitant SB was correlated with pT3-4 disease (p < 0.001), pN1 disease (p < 0.001), positive surgical margins (p = 0.043), PSA recurrence (p = 0.003). In multivariable analysis, the presence of GG4-5 on TB (p = 0.013; OR 0.263) and the presence of HG on concomitant SB (p = 0.010; OR 0.269) were negatively and independently correlated with the risk of downgrading to GG2. The presence of HG on concomitant SB independently predicted RFS with a hazard ratio of 2.173 (p = 0.049; 95% CI 1.005-4.697).

Conclusions: Our data shows that a limited HG restricted to TB can often be associated with a favorable grade in almost a quarter of the cases and downgraded in almost half of the cases. Detailed SB features, mainly the presence of HG on concomitant SB, was associated with a more accurate pathology and oncologic outcomes prediction, pleading for the maintenance of SB in MRI-positive patients.
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http://dx.doi.org/10.1007/s00345-021-03631-7DOI Listing
February 2021

Evaluation of oncological outcomes of robotic partial nephrectomy according to the type of hilar control approach (On-clamp vs Off-clamp), a multicentric study of the French network of research on kidney cancer-UROCCR 58-NCT03293563.

World J Urol 2021 Feb 19. Epub 2021 Feb 19.

Department of Urology, Andrology and Renal Transplant, Pasteur II University Hospital, 30 Avenue Romaine, 06001, Nice, France.

Purpose: To compare off-clamp vs on-clamp robotic partial nephrectomy (RPN) for renal cell carcinoma (RCC) in terms of oncological outcomes, and to assess the impact of surgical experience (SE).

Methods: We extracted data of a contemporary cohort of 1359 patients from the prospectively maintained database of the French national network of research on kidney cancer (UROCCR). The primary objective was to assess the positive surgical margin (PSM) rate. We also evaluated the oncological outcomes regardless of the surgical experience (SE) by dividing patients into three groups of SE as a secondary endpoints. SE was defined by the caseload of RPN per surgeon per year. For the continuous variables, we used Mann-Whitney and Student tests. We assessed survival analysis according to hilar control approach by Kaplan-Meier curves with log rank tests. A logistic regression multivariate analysis was used to evaluate the independent factors of PSM.

Results: Outcomes of 224 off-clamp RPN for RCC were compared to 1135 on-clamp RPN. PSM rate was not statistically different, with 5.6% in the off-clamp group, and 11% in the on-clamp group (p = 0.1). When assessing survival analysis for overall survival (OS), local recurrence-free survival (LR), and metastasis-free survival (MFS) according to hilar clamping approach, there were no statistically significant differences between the two groups with p value log rank = 0.2, 0.8, 0.1, respectively. In multivariate analysis assessing SE, hilar control approach, hospital volume (HV), RENAL score, gender, Age, ECOG, EBL, BMI, and indication of NSS, age at surgery was associated with PSM (odds ratio [OR] 1.03 (95% CI 1.00-1.04), 0.02), whereas SE, HV, and type of hilar control approach were not predictive factors of PSM.

Conclusion: Hilar control approach seems to have no impact on PSM of RPN for RCC. Our findings were consistent with randomized trials.
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http://dx.doi.org/10.1007/s00345-020-03558-5DOI Listing
February 2021

Same Day Discharge versus Inpatient Surgery for Robot-Assisted Radical Prostatectomy: A Comparative Study.

J Clin Med 2021 Feb 9;10(4). Epub 2021 Feb 9.

Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France.

(1) Background: no study has compared outcomes of same day discharge (SDD) versus inpatient robot-assisted radical prostatectomy (RARP) in homogenous cohorts. Our aim was to compare perioperative outcomes and urinary continence recovery between SDD and inpatient RARP in contemporary, comparable patients. (2) Methods: we included consecutive patients undergoing RARP between 2018 and 2020 ( 376). Only patients eligible for SDD (no oral anticoagulant, distance home-hospital <150 km) and having >6-month follow-up were included ( = 180). All patients underwent RARP with or without lymph node dissection. Comparisons were performed between SDD ( 42) and inpatient RARP ( 138). Primary outcomes were 90-day complication and readmission rates and continence rates at 1 and 6 months. (3) Results: median patient age was 66.7 years. Median duration of surgery and blood loss was 134 min and 200 mL, respectively. Lymph node dissection and nerve-sparing procedures were performed in 76.7% and 82.2% of cases, respectively. Median follow-up was 19.5 months. No difference was seen regarding patient features, peri-operative outcomes, and pathology parameters between both groups. The proportion of SDD RARP was stable over time (23.5%). The 90-day unplanned visits, readmission and complication rates were 9.5%, 7.1%, and 19.0% in SDD patients versus 14.5% ( = 0.407), 10.1% ( = 0.560), 28.3% ( = 0.234) for inpatient RARP, respectively. Trends favoring SDD were not statistically significant. Continence rates at 1-( = 0.589) and 6-months ( = 0.674) were comparable between SDD and inpatient RARP. The main limitation was the lack of randomization. (4) Conclusions: this multi-surgeon comparative study confirms the safety of routine SDD RARP in terms of perioperative and functional outcomes. Trends favoring SDD in terms of complications, emergency visits and readmission have to be confirmed.
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http://dx.doi.org/10.3390/jcm10040661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914654PMC
February 2021

MRI Characteristics Accurately Predict Biochemical Recurrence after Radical Prostatectomy.

J Clin Med 2020 Nov 26;9(12). Epub 2020 Nov 26.

Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France.

Background: After radical prostatectomy (RP), biochemical recurrence (BCR) is associated with an increased risk of developing distant metastasis and prostate cancer specific and overall mortality.

Methods: The two-centre study included 521 consecutive patients undergoing RP for positive pre-biopsy magnetic resonance imaging (MRI) and pathologically proven prostate cancer (PCa), after which a combination scheme of fusion-targeted biopsy (TB) and systematic biopsy was performed. We assessed correlations between MRI characteristics, International Society of Urological Pathology (ISUP) grade group in TB, and outcomes after RP. We developed an imaging-based risk classification for improving BCR prediction.

Results: Higher Prostate Imaging and Reporting and Data System (PI-RADS) score ( = 0.013), higher ISUP grade group in TB, and extracapsular extension (ECE) on the MRI were significantly associated with more advanced disease (pTstage), higher ISUP grade group ( = 0.001), regional lymph nodes metastasis in RP specimens ( < 0.001), and an increased risk of recurrence after surgery. A positive margin status was significantly associated with ECE-MRI ( < 0.001). Our imaging-based classification included ECE on MRI, ISUP grade group on TB, and PI-RADS accurately predicted BCR (AUC = 0.714, < 0.001). This classification had more improved area under the curve (AUC) than the standard d'Amico classification in our population. Validation was performed in a two-centre cohort.

Conclusions: In this cohort, PI-RADS score, MRI stage, and ISUP grade group in MRI-TB were significantly predictive for disease features and recurrence after RP. Imaging-based risk classification integrating these three factors competed with d'Amico classification for predicting BCR.
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http://dx.doi.org/10.3390/jcm9123841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760513PMC
November 2020

Prognostic Implications of Multiparametric Magnetic Resonance Imaging and Concomitant Systematic Biopsy in Predicting Biochemical Recurrence After Radical Prostatectomy in Prostate Cancer Patients Diagnosed with Magnetic Resonance Imaging-targeted Biopsy.

Eur Urol Oncol 2020 12 23;3(6):739-747. Epub 2020 Aug 23.

Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.

Background: The prognostic role of multiparametric magnetic resonance imaging (mpMRI) and systematic biopsy in predicting biochemical recurrence (BCR) after radical prostatectomy (RP) in prostate cancer (PCa) patients has not been addressed yet.

Objective: To develop a risk tool predicting BCR after RP in patients diagnosed with magnetic resonance imaging (MRI)-targeted biopsy.

Design, Setting, And Participants: A total of 804 patients with a clinical suspicion of PCa and positive mpMRI diagnosed with MRI-targeted plus concomitant systematic biopsy treated with RP were identified.

Outcome Measurements And Statistical Analyses: The outcome was represented by BCR defined as two prostate-specific antigen (PSA) values ≥0.2ng/ml after surgery. Multivariable Cox regression analyses assessed the predictors of BCR. A risk tool model based on imaging and biopsy parameters was developed and validated internally. The c-index, calibration plot, and decision curve analyses were used to assess discrimination, calibration, and the net benefit associated with its use in predicting BCR at 36 mo.

Results And Limitations: Median (interquartile range) follow-up was 28 (25-29) mo, and 89 patients experienced BCR. The 36-mo BCR-free survival rate was 89%. The maximum diameter of the index lesion and seminal vesicle invasion (SVI) at mpMRI as well as the presence of clinically significant PCa at systematic biopsy (defined as a grade group of >2) were associated with BCR (all p≤0.03). A model based on PSA, Prostate Imaging Reporting and Data System score, SVI at mpMRI, diameter of the index lesion, grade group at MRI-targeted biopsy, and clinically significant PCa at systematic biopsy achieved the highest discrimination (77%) among all clinical models, as well as the European Association of Urology risk groups (62%) and the Cancer of the Prostate Risk Assessment (CAPRA) score (60%). This tool was characterized by excellent calibration at internal validation and the highest net benefit when predicting BCR for the threshold risk between 0% and 30%.

Conclusions: The adoption of predictive models accounting for mpMRI and MRI-targeted biopsy-derived variables and concomitant systematic biopsy would improve clinicians' ability to identify patients at a higher risk of early recurrence after surgery.

Patient Summary: The use of information obtained at multiparametric magnetic resonance imaging (mpMRI), and MRI-targeted and concomitant systematic biopsy would improve clinicians' ability to identify prostate cancer patients at a higher risk of experiencing early biochemical recurrence after surgery.
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http://dx.doi.org/10.1016/j.euo.2020.07.008DOI Listing
December 2020

Subsphincteric Anastomosis During Laparoscopic Robot-Assisted Radical Prostatectomy and Its Positive Impact on Continence Recovery.

J Endourol 2020 12 7;34(12):1235-1241. Epub 2020 Sep 7.

Department of Urology Uro.Sud, RGDS la Croix du Sud Clinic, Quint Fonsegrives/Toulouse, France.

To assess the interest of a new sphincter preserving anastomosis technique for continence recovery after robot-assisted laparoscopic radical prostatectomy (RALP). : We performed a monocentric single-operator study on 187 consecutive RALP. Patients were divided into two groups: Group 1 (standard anastomosis, until December 2017) and Group 2 (subsphincteric anastomosis [SSA], since January 2018). The SSA consisted in respecting the sphincteric sleeve during the anastomosis suturing only the internal layer of the urethra with the bladder and thereby avoiding the loss of sphincteric length induced by the suture. Pre-, intra-, and postoperative data were prospectively collected and compared. Criteria of continence were as follows: no pad use and complete absence of leakage at catheter removal at 1 month and 1 year. The two groups were comparable in terms of prostate-specific antigen, gland volume, and Gleason score. In Group 2 (SSA), we observed a complete continence recovery in 75.6% at catheter removal ( = 0.0000035), in 82.9% at 1 month ( = 0.000092), and in 97.5% at 1 year ( = 0.028), independently of bladder neck preservation ( = 0.388). There was also a significant difference between the two groups concerning urinary reeducation requirement ( = 0.0006), pad use, and urinary quality of life ( = 0.0000002). No anastomosis complication was reported. The SSA significantly improved the rates of immediate, early, and 1-year continence recovery after RALP. These results need further study among larger numbers of patients.
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http://dx.doi.org/10.1089/end.2020.0379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757522PMC
December 2020

A combination of enhanced recovery after surgery and prehabilitation pathways improves perioperative outcomes and costs for robotic radical prostatectomy.

Cancer 2020 Sep 8;126(18):4148-4155. Epub 2020 Jul 8.

Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France.

Background: An enhanced recovery after surgery (ERAS) pathway has shown benefit in oncologic surgery. However, literature is scarce regarding the impact of this pathway, alone or combined with prehabilitation (PreHab) programs, on outcomes after robot-assisted radical prostatectomy (RARP).

Methods: Included in this study were 507 consecutive patients undergoing RARP from 2014 to 2019. The primary endpoint was duration of hospital stay. Secondary outcomes included intraoperative blood loss, operative duration, readmission rate, and overall costs. Univariate and multivariate comparisons were performed according to the ERAS and PreHab program status.

Results: ERAS patients had shorter hospital stays (P < .001), reduced operative times (P < .001), and decreased blood loss (P < .001) in comparison with non-ERAS patients. Shorter hospital stays were not associated with an increased readmission rate (7.9% [stable over time]; P = .757). Patients from an ERAS-/PreHab- group had a longer hospital stay (4.7 days) than those from an ERAS+/PreHab- group (3.5 days) and those from an ERAS+/PreHab+ group (1.6 days; P < .001). In a multivariate analysis, operative time and perioperative pathway (odds ratio for ERAS, 0.144; P < .001; odds ratio for ERAS and PreHab, 0.025; P < .001) were independently predictive for a prolonged length of stay (P < .001). Costs significantly decreased when ERAS and PreHab pathways were combined.

Conclusions: The implementation of ERAS and PreHab programs significantly changes the postoperative course of patients and may synergistically optimize RARP outcomes. The combination of these pathways improves patient recovery and is associated with reduced lengths of stay, blood loss, operative times, and costs without an increase in the postdischarge readmission rate.
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http://dx.doi.org/10.1002/cncr.33061DOI Listing
September 2020

Survival Outcomes of Patients with Pathologically Proven Positive Lymph Nodes at Time of Radical Cystectomy with or without Neoadjuvant Chemotherapy.

J Clin Med 2020 Jun 23;9(6). Epub 2020 Jun 23.

Department of Oncology, IUCT-O, 31000 Toulouse, France.

Background: To compare overall survival (OS) outcomes in pN1-3 disease at the time of radical cystectomy (RC) for muscle invasive bladder according to the neoadjuvant chemotherapy (NAC) status.

Materials And Methods: This multicenter study included 450 consecutive patients undergoing RC for muscle-invasive urothelial bladder cancer with pN1-3 pM0 disease from 2010 to 2019. NAC consisted in platinum-based chemotherapy. The primary endpoint was the comparison between NAC and non-NAC in terms of death from any cause. OS was assessed using the Kaplan-Meier method and multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios.

Results: Median age was 69 years. Patients receiving NAC were younger ( = 0.051), and more likely had downstaging to non-muscle invasive disease (10.7% versus 4.3%, = 0.042). Median OS was 26.6 months. NAC patients had poorer OS compared with those who did receive NAC (Hazard ratio (HR) 1.6; = 0.019). The persistence of muscle-invasive bladder in RC specimens was also significantly associated with OS (HR 2.40). In the NAC cohort, the two factors independently correlated with OS were the number of positive lymph nodes ( = 0.013) and adjuvant chemotherapy (AC) (HR 0.31; = 0.015).

Conclusions: Persistent nodal disease in RC specimens after NAC was associated with poor prognosis and lower OS rates compared with pN1-3 disease after upfront RC. In this sub-group of NAC patients, AC was independently associated with better OS.
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http://dx.doi.org/10.3390/jcm9061962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356776PMC
June 2020

Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients: the European experience.

World J Urol 2020 Jun 19. Epub 2020 Jun 19.

Department of Urology and Kidney Transplantation, University Hospital of Rangueil, Toulouse, France.

Purpose: The main objective was to compare minor (Clavien I-II) and major (Clavien ≥ III) intra- and postoperative complications of living donor robotic assisted kidney transplantation (RAKT) in obese (≥ 30 kg/m BMI), overweight (< 30/ ≥ 25 kg/m BMI) and non-overweight recipients (< 25 kg/m BMI).

Methods: For the present retrospective study, we reviewed the multi-institutional ERUS-RAKT database to select consecutive living donor RAKT recipients. Functional outcomes, intra- and postoperative complications were compared between obese, overweight and non-overweight recipients.

Results: 169 living donor RAKTs were performed, by 10 surgeons, from July 2015 to September 2018 in the 8 European centers. 32 (18.9%) recipients were obese, 66 (39.1%) were overweight and 71 (42.0%) were non-overweight. Mean follow-up was 1.2 years. There were no major intra-operative complications in either study group. Conversion to open surgery occurred in 1 obese recipient, in 2 overweight recipients and no conversion occurred in non-overweight recipients (p = 0.3). Minor and major postoperative complications rates were similar in the 3 groups. At one-year of follow-up, median eGFR was similar in all groups [54 (45-60) versus 57 (46-70) versus 63 (49-78) ml/min/1.73 m in obese, overweight and non-overweight recipient groups, respectively, p = 0.5]. Delayed graft function rate was similar in the 3 groups. Only the number of arteries was an independent predictive factor of suboptimal renal function at post-operative day 30 in the multivariate analysis.

Conclusion: RAKT in obese recipients is safe, compared to non-overweight recipients and yields very good function, when it performed at high-volume referral centers by highly trained transplant teams.
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http://dx.doi.org/10.1007/s00345-020-03309-6DOI Listing
June 2020

Intercenter reproducibility of software-based fusion biopsies for grade group prediction when targeting suspicious MRI lesions.

Urol Oncol 2020 09 17;38(9):734.e11-734.e17. Epub 2020 Apr 17.

Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France.

Purpose: To assess the intercenter reproducibility of software-based fusion targeted biopsy (TB) for grade-group assessment and pretherapeutic evaluation of highly suspicious MRI lesions.

Patients And Methods: In this study, were included 380 consecutive patients who underwent radical prostatectomy (RP) after prostate cancer diagnosis and a prebiopsy MRI showing Prostate Imaging-Reporting and Data System (PIRADS) score 4 or 5 lesions. All patients underwent systematic biopsies (SB) combined with software-based fusion TB in the 2 centers. Biopsies were only performed by expert urologists or radiologists in a contemporary time frame. The primary endpoint was the center difference of concordance/upgrading rates between biopsy and RP specimens.

Results: Pathological features on biopsy and RP specimens were significantly different among centers with more unfavourable disease in center 1. The rate of TB upgrading was 33.6% in center 1 vs. 35.4% (P = 0.860) in center 2. Grading concordance was also comparable among centers (50.0% vs. 47.1%) as well as the SB upgrading rate. Regression analysis did not find any baseline characteristics (Age, prostate-specific antigen, MRI lesions, center) predictive for TB upgrading. These findings were achieved by using fewer TB per lesion in center 1 (2.3 vs. 5.0, P < 0.001), at the expense of more SB cores (14.4 vs. 8.5, P < 0.001). The influence of MRI characteristics (lesion size and number, PIRADS score) on upgrading rates was consistent among centers.

Conclusions: Software-based fusion TB technique leads to comparable outcomes in terms of grade group prediction accuracy in PIRADS 4 to 5 lesions, insignificant between centers, in spite of different non imaging-based aggressiveness features.
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http://dx.doi.org/10.1016/j.urolonc.2020.03.023DOI Listing
September 2020

Same-day discharge surgery for robot-assisted radical prostatectomy in the era of ERAS and prehabilitation pathways: a contemporary, comparative, feasibility study.

World J Urol 2020 Feb 17. Epub 2020 Feb 17.

Department of Urology, La Croix du Sud Hospital, Toulouse, 52, chemin de Ribaute, 31130, Quint Fonsegrives, France.

Purpose: To assess the feasibility of same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) in the context of enhanced recovery after surgery (ERAS) and prehabilitation pathways.

Materials And Methods: For 1 year, we prospectively assessed the feasibility of SDD RARP in the context of ERAS and prehabilitation pathways. SDD patients were compared to overnight patients operated during the same period by the same surgeon. Primary outcomes were complication and 90-day readmission rates.

Results: Of the overall cohort, 51.9% were discharged home the day of surgery. Both cohorts were comparable in terms of pre-operative and intra-operative characteristics. There was a not significant trend towards shorter operative time in the SDD cohort (93.7 versus 105.2 min, p = 0.077). Mean blood loss was comparable between both cohorts. No significant difference in terms of complication (p = 0.606; 16.0% versus 11.1%) and readmission rates (< 4%) was noted. There was a not significant trend towards faster continence recovery for patients included in the SDD cohort, compared with those in the inpatient cohort. The overall cost per patient was reduced by 10.8% with SDD surgery with no increased cost due to emergency visits or readmissions CONCLUSIONS: Implementation of SDD RARP in the context of ERAS and prehabilitation pathways is safe, reduces cost and does not compromise the post-operative course. Proportion of patients undergoing SDD continuously increased to reach 60% of the surgeon cohort at the end of the study period. The trend suggesting a faster continence recovery after SDD has to be confirmed in a larger cohort.
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http://dx.doi.org/10.1007/s00345-020-03119-wDOI Listing
February 2020

Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction.

J Clin Med 2020 Jan 15;9(1). Epub 2020 Jan 15.

Department of Urology, Institut Universitaire du Cancer Toulouse-Oncopole, 31000 Toulouse, France.

Background: To study the impact of MRI characteristics and of targeted biopsy (TB) core number on the final grade group (GG) prediction.

Materials And Methods: The cohort was 478 consecutive patients who underwent radical prostatectomy (RP) after positive mpMRI (multiparametric magnetic resonance imaging) followed by fusion TB. Endpoints were the upgrading and concordance rates between TB and RP specimens.

Results: Upgrading rate after TB was 40.6%. Patients with upgrading had lower PIRADS (Prostate Imaging-Reporting and Data System) scores ( < 0.001), smaller lesion size ( = 0.017), fewer TB cores ( < 0.001), and lower TB density ( = 0.015) compared with cases with grade concordance. There was a significant continuous improvement in upgrading rate when TB core number per lesion increased from 56.3% to 25.6% when <2 or ≥5 TB cores were taken, respectively ( = 0.002). The minimal TB number per lesion to reduce upgrading risk to approximately 30%was 4 in PIRADS 3, and 3 in PIRADS 4-5 cases.

Conclusions: Grade group prediction by TB is significantly improved by higher PIRADS score, larger lesion size, and increased TB per lesion. At least four TB cores should be taken in PIRADS 3 score lesions, whereas three cores seem enough in PIRADS 4-5 cases to improve GG prediction and limit upgrading risk.
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http://dx.doi.org/10.3390/jcm9010225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019328PMC
January 2020

Improvement of the intermediate risk prostate cancer sub-classification by integrating MRI and fusion biopsy features.

Urol Oncol 2020 05 13;38(5):386-392. Epub 2020 Jan 13.

Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France. Electronic address:

Introduction: Treatment decision-making for intermediate-risk prostate cancer (CaP) is mainly based on grade and tumor involvement on systematic biopsy. We aimed to assess the added value of multi-parametric magnetic resonance imaging (mpMRI) and targeted biopsy (TB) features for predicting final pathology and for improving the well-established favourable/unfavourable systematic biopsy-based sub-classification.

Materials And Methods: From a prospective database of 377 intermediate risk CaP cases, we evaluated the performance of the standard intermediate risk classification (IRC), and the predictive factors for unfavourable disease on final pathology aiming to build a new model. Overall unfavourable disease (OUD) was defined by any pT3-4 and/or pN1 and/or grade group (GG) ≥ 3.

Results: The standard IRC was found to be predictive for unfavourable disease in this population. However, in multivariable analysis regression, ECE on mpMRI and GG ≥3 on TB remained the 2 independent predictive factors for OUD disease (HR = 2.7, P = 0.032, and HR = 2.41, P = 0.01, respectively). By using the new IRC in which unfavorable risk was defined by ECE on mpMRI and/or GG ≥3 on TB, the proportion of unfavorable cases decreased from 62.3% to 34.1% while better predicting unfavorable disease in RP speciments. The new model displayed a better accuracy than the standard IRC for predicting OUD (AUC: 0.66 vs. 0.55).

Conclusions: The integration of imaging and TB features drastically improves the intermediate risk sub-classification performance and better discriminates the unfavourable risk group that could benefit from more aggressive therapy such as neo-adjuvant and/or adjuvant treatment, and the favourable group that could avoid over-treatment. External validation in other datasets is needed.
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http://dx.doi.org/10.1016/j.urolonc.2019.12.018DOI Listing
May 2020

Impact of MRI and Targeted Biopsies on Eligibility and Disease Reclassification in MRI-positive Candidates for Active Surveillance on Systematic Biopsies.

Urology 2020 03 30;137:126-132. Epub 2019 Dec 30.

Department of Urology, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France; Department of Urology, CHU Toulouse, Toulouse, France.

Objective: To assess the impact of concomitant targeted biopsies (TB) for predicting final disease reclassification in MRI-positive low-risk prostate cancer patients eligible for active surveillance (AS) on systematic biopsies (SB).

Materials And Methods: From a prospective database, we included all prebiopsy MRI-positive men fulfilling AS criteria at diagnosis (Toronto [n = 114], UCSF [n = 82], or PRIAS [n = 60] criteria) on SB. All patients underwent a combination of SB and software-based fusion TB, and an immediate radical prostatectomy. The primary endpoints were the pathologic upgrading and upstaging rates.

Results: Biopsy grade group was upgraded to grade group (GG) 2 and to GG≥3 on TB in 65.9%-76.7% and in 12.2-16.7%, respectively. The rate of GG ≥3 in radical prostatectomy specimens varied from 31.6% to 43.3% with no relation between strictest criteria and lower upgrading rates. The proportion of not organ-confined disease (35%-39%) was comparable among the AS cohorts. Negative TB was strongly associated with the absence of final GG ≥3. Tumor grade on TB was significantly correlated with the risk of final GG ≥3 in both Toronto and UCSF cohorts, not in the PRIAS cohort. In the PRIAS cohort, the only independent predictive factor for GG ≥3 disease was the maximal tumor length in any core (P = .034).

Conclusion: In MRI-positive patients, the risk of disease reclassification was comparable whatever the SB-based AS criteria used. TB were predictive of final upgrading, with a varied impact according to the AS criteria. SB features remained relevant for reclassification prediction even in case of positive TB. The risk of upstaged disease remains important, approximately one third, and neither TB/SB parameters nor MRI findings could accurately predict it.
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http://dx.doi.org/10.1016/j.urology.2019.10.039DOI Listing
March 2020

Decreased accuracy of the prostate cancer EAU risk group classification in the era of imaging-guided diagnostic pathway: proposal for a new classification based on MRI-targeted biopsies and early oncologic outcomes after surgery.

World J Urol 2020 Oct 14;38(10):2493-2500. Epub 2019 Dec 14.

Department of Urology, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France.

Purpose: To assess the performance of EAU risk classification in PCa patients according to the biopsy pathway (standard versus MRI guided) and to develop a new, more accurate, targeted biopsy (TB)-based classification.

Materials And Methods: We included 1345 patients consecutively operated by radical prostatectomy (RP) since 2014, when MRI and TB were introduced in the diagnostic pathway. Patients underwent systematic biopsy (SB) only (n = 819) or SB and TB (n = 526) prior to RP during the same time period. Pathological and biochemical outcomes were compared between PCa men undergoing SB (SB cohort) and a combination of TB and SB (TB cohort). Kaplan-Meier and Cox regression models were used to assess biochemical recurrence-free survival (RFS).

Results: Both cohorts were comparable regarding final pathology and RFS (p = 0.538). The EAU risk classification accurately predicted outcomes in SB cohort, but did not significantly separate low from intermediate risk in TB cohort (p = 0.791). In TB cohort, the new proposed three-group risk classification significantly improved the recurrence risk prediction compared with the EAU risk classification: HR 4 (versus HR 1.2, p = 0.009) for intermediate, and HR 15 (versus HR 6.5, p < 0.001) in high-risk groups, respectively. A fourth group defining very high-risk cases (≥ T2c clinical stage or grade group 5) was also proposed.

Conclusions: The new classification integrating TB findings we propose meaningfully improves the recurrence prediction after surgery in patients undergoing a TB-based diagnostic pathway, compared with standard EAU risk classification which is still relevant for patients undergoing only SB. External validation is needed.
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http://dx.doi.org/10.1007/s00345-019-03053-6DOI Listing
October 2020

Laparoscopy for living donor left nephrectomy: Comparison of three-dimensional and two-dimensional vision.

Clin Transplant 2019 12 13;33(12):e13745. Epub 2019 Nov 13.

Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France.

The main objective of this preliminary study was to evaluate the feasibility and safety of 3-D laparoscopic living donor left nephrectomy (LDLN). The secondary objective was to compare intraoperative and postoperative outcomes between 3-D and 2-D laparoscopic LDLN. All patients who underwent a laparoscopic LDLN from January 2015 to April 2018 in a university center were included. All surgeries were performed by three experienced surgeons. Seventy three patients were included the following: 16 underwent a 3-D laparoscopic LDLN (3-D group), and 57 underwent a 2-D laparoscopic LDLN (2-D group). Operative time and warm ischemia time (WIT) were significantly lower in the 3-D group (operative time: 80.9 ± 10.2 vs 114.1 ± 32.3 minutes in the 3-D and 2-D groups, P = .0002) (WIT: 1.7 ± 0.6 vs 2.3 ± 0.9 minutes in the 3-D and 2-D groups, P = .02). No conversion to open surgery occurred in both groups. Length of hospital stay was significantly shorter in the 3-D group. No major postoperative complications (Clavien ≥ III) occurred. One-year postoperative GFR was similar to 3-D and 2-D groups. Our preliminary study demonstrates that 3-D laparoscopic LDLN is a feasible and safe surgical procedure. Intraoperative and postoperative outcomes were similar in both 2-D and 3-D vision systems, but 3-D vision systems allow reduction in WIT and operative time.
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http://dx.doi.org/10.1111/ctr.13745DOI Listing
December 2019

Active surveillance eligibility of MRI-positive patients with grade group 2 prostate cancer: a pathological study.

World J Urol 2020 Jul 14;38(7):1735-1740. Epub 2019 Oct 14.

Department of Urology, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France.

Purpose: To assess the final pathology risk in MRI-positive grade group (GG) 2 prostate cancer (PCa) patients undergoing targeted (TB) and systematic (SB) biopsies, and thereby, the possibility of active surveillance (AS) in this population.

Patients And Methods: We included 242 consecutive men diagnosed with GG2 PCa by a combination of SB and software-based fusion TB undergoing a radical prostatectomy (RP). The primary endpoints were the pathological findings in RP specimens, including favourable disease which was defined by a pT2 and GG1-2 disease.

Results: The rate of upgrading was 33% including 3% of GG 4-5 disease. MRI lesion size (p = 0.038) and tumor length per core (p < 0.001) were significantly lower in case of favourable pathology. Only 34.2% of not organ-confined disease was reported when only SB were positive, compared with 45.7% and 57.1% when GG2 was detected on TB only and on TB plus SB, respectively (p = 0.035). The number of positive cores on SB was significantly higher in not organ-confined disease (4.3 versus 2.9; p = 0.005). The risk of not organ-confined disease was only 20.8% in men who had a PSAD ≤ 0.20 ng/ml/gr, 1-2 positive biopsies and a maximal tumor length ≤ 6 mm per core, compared with 52.3% in men who did not fulfil all these criteria (p = 0.003).

Conclusions: This study identified clinical, imaging, and pathological factors that were significantly associated with the final pathology risk. In case of positive MRI followed by TB showing GG2, AS could be offered in patients having a PSAD ≤ 0.20, a tumor length ≤ 6 mm and 1-2 positive cores.
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http://dx.doi.org/10.1007/s00345-019-02973-7DOI Listing
July 2020

The Key Combined Value of Multiparametric Magnetic Resonance Imaging, and Magnetic Resonance Imaging-targeted and Concomitant Systematic Biopsies for the Prediction of Adverse Pathological Features in Prostate Cancer Patients Undergoing Radical Prostatectomy.

Eur Urol 2020 06 21;77(6):733-741. Epub 2019 Sep 21.

Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address:

Background: The combined role of multiparametric magnetic resonance imaging (mp-MRI), and magnetic resonance imaging (MRI)-targeted and concomitant systematic biopsies in the identification of prostate cancer (PCa) patients at a higher risk of adverse pathology at radical prostatectomy (RP) is still unclear.

Objective: To develop novel models to predict extracapsular extension (ECE), seminal vesicle invasion (SVI), or upgrading in patients diagnosed with MRI-targeted and concomitant systematic biopsies.

Design, Setting, And Participants: We included 614 men with clinical stage≤T2 at digital rectal examination who underwent MRI-targeted biopsy with concomitant systematic biopsy.

Outcome Measurements And Statistical Analyses: Logistic regression analyses predicting ECE, SVI, and upgrading (ie, a shift from biopsy International Society of Urological Pathology grade group to any higher grade at RP) based on clinical variables with or without mp-MRI features and systematic biopsy information (the percentage of cores with grade group ≥2 PCa) were developed and internally validated. The area under the curve (AUC) was used to identify the models with the highest discrimination. Decision-curve analyses (DCAs) determined the net benefit associated with their use.

Results And Limitations: Overall, 333 (54%), 88 (14%), and 169 (27%) patients had ECE, SVI, and upgrading at RP, respectively. The inclusion of mp-MRI data improved the discrimination of clinical models for ECE (67% vs 70%) and SVI (74% vs 76%). Models including mp-MRI, and MRI-targeted and concomitant systematic biopsy information achieved the highest AUC at internal validation for ECE (73%), SVI (81%), and upgrading (73%) and represented the basis for three risk calculators that yield the highest net benefit at DCA.

Conclusions: Not only mp-MRI and MRI-targeted sampling, but also concomitant systematic biopsies provide significant information to identify patients at a higher risk of adverse pathology. Although omitting systematic prostate sampling at the time of MRI-targeted biopsy might be associated with a reduced risk of detecting insignificant PCa and lower patient discomfort, it reduces the ability to accurately predict pathological features.

Patient Summary: The combination of multiparametric magnetic resonance imaging (mp-MRI) with accurate biopsy information on MRI-targeted and systematic biopsies improves the accuracy of multivariable models based on clinical and mp-MRI data alone. Correct mp-MRI interpretation and proper extensive prostate sampling are both needed to predict adverse pathology accurately at radical prostatectomy.
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http://dx.doi.org/10.1016/j.eururo.2019.09.005DOI Listing
June 2020

Added Value of Concomitant Systematic and Fusion Targeted Biopsies for Grade Group Prediction Based on Radical Prostatectomy Final Pathology on Positive Magnetic Resonance Imaging.

J Urol 2019 12 27;202(6):1182-1187. Epub 2019 Jun 27.

Department of Urology, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France.

Purpose: We assessed the added value of concomitant systematic biopsy for final grade group prediction in patients with positive magnetic resonance imaging who were undergoing targeted biopsy.

Materials And Methods: Included in study were 478 consecutive patients with prebiopsy positive multiparametric magnetic resonance imaging and a greater than 10-core systematic biopsy combined with fusion targeted biopsy who underwent radical prostatectomy. The primary end point was the grade group concordance between biopsy and radical prostatectomy pathology according to the biopsy technique. Clinical and biological factors associated with the performance of systematic biopsy were analyzed.

Results: Adding systematic biopsy to targeted biopsy modified the d'Amico risk classification toward more intermediate and high risk in 7.8% of cases, mainly from low to intermediate risk with low risk prostate cancer on targeted biopsy in 44.3%. This reclassification was significantly higher in patients with lower prostate specific antigen and with prostate specific antigen density less than 0.20 ng/ml/gm (11.7% vs 2.4%, p <0.001). The concordance rate between biopsy pathology and radical prostatectomy pathology significantly differed between targeted biopsy and targeted biopsy plus systematic biopsy (45.2% and 51.7%, respectively). The upgrading rate in radical prostatectomy specimens decreased by 22% when systematic biopsy was added to targeted biopsy. Patients in whom systematic biopsy did not modify grading were more likely to have pT3-4 and/or pN1 disease on final pathology (56.9% vs 38.3%, p=0.007).

Conclusions: Grading concordance between biopsy pathology and radical prostatectomy pathology was improved by adding systematic biopsy in all patient subgroups. Patients with prostate specific antigen density less than 0.20 ng/ml/gm benefited the most from this combined biopsy strategy. Systematic biopsy reclassified a nonnegligible number of cases toward a higher risk category, mainly the low risk cases. Thus, systematic biopsy could modify treatment decision making.
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http://dx.doi.org/10.1097/JU.0000000000000418DOI Listing
December 2019

Performance of systematic, MRI-targeted biopsies alone or in combination for the prediction of unfavourable disease in MRI-positive low-risk prostate cancer patients eligible for active surveillance.

World J Urol 2020 Mar 13;38(3):663-671. Epub 2019 Jun 13.

Department of Urology, Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France.

Purpose: To assess the upstaging/upgrading rates of low-risk prostate cancer (PCa) according to the biopsy scheme used (systematic (SB), targeted biopsies (TB), or both) in the setting of positive pre-biopsy MRI.

Patients And Methods: We included 143 consecutive men fulfilling the Toronto University active surveillance (AS) criteria who underwent a pre-biopsy positive MRI, a combination of SB and software-based fusion TB, and a radical prostatectomy, in two expert centres. The primary endpoints were the pathological upgrading and upstaging rates. Overall unfavourable disease (OUD) was defined by any pT3-4 and/or pN1 and/or ≥ GG 3.

Results: Using TB alone would have missed 21.7% of cancers including 16.7% of ≥ GG 3. The use of TB was significantly associated with a lower risk of ≥ Grade Group (GG) 3 disease (p < 0.006) in RP specimens. Combination of SB and TB lowered this risk by 39%, compared with TB alone. The biopsy scheme did not affect the upstaging rates which were substantial even in case of combination scheme (from 37 to 46%). OUD was detected in approximately 50% of cases. The presence of high grade on TB was the only independent predictive factor for both ≥ GG 2 (p = 0.015) and ≥ GG 3 (p = 0.023) in RP specimens.

Conclusions: High grade on TB biopsies represented the major predictor of upgrading. Combination of SB and TB better defined the sub-group of patients having the lowest risk of reclassification, compared with TB or SB alone. The risk of non-organ-confined disease remained high, and could not be accurately predicted by MRI or systematic/targeted biopsy features.
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http://dx.doi.org/10.1007/s00345-019-02848-xDOI Listing
March 2020

A preoperative nomogram to predict major complications after robot assisted partial nephrectomy (UroCCR-57 study).

Urol Oncol 2019 09 8;37(9):577.e1-577.e7. Epub 2019 Jun 8.

Department of Urology, University of Rennes, Rennes, France.

Objective: To generate a nomogram based on preoperative parameters to predict the occurrence of a major complication within 30-days of robotic partial nephrectomy.

Materials And Methods: The study included 1,342 patients with a clinically localized renal tumor who underwent robotic partial nephrectomy (RPN) between 2010 and 2017 at 7 academic centers. The primary outcome was the major complication rate. A multivariable logistic regression model was fitted to predict the risk of major complications after RPN. Model-derived coefficients were used to calculate the risk of major complications. Local regression smoothing technique was used to plot the observed rate against the predicted risk of major complications.

Results: In multivariate logistic regression, male gender (odds ratio [OR]: 2.93; P = 0.03), Charlson comorbidity index (OR: 1.13; P = 0.05), ECOG PS (OR: 1.66; P = 0.02), low hospital volume (P < 0.05), and high RENAL score (OR: 4.73; P = 0.01) were significant predictors of major postoperative complications. A preoperative nomogram incorporating these risk factors was constructed with an area under curve of 75%.

Conclusions: Using standard preoperative variables from this multi-institutional RPN experience, we constructed and validated a nomogram to predict postoperative complications after RPN. We believe this tool can be relevant to help weighing treatment options for a more tailored management of patients with small renal masses.
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http://dx.doi.org/10.1016/j.urolonc.2019.05.007DOI Listing
September 2019

Outcomes after salvage radical prostatectomy and first-line radiation therapy or HIFU for recurrent localized prostate cancer: results from a multicenter study.

World J Urol 2019 Aug 21;37(8):1491-1498. Epub 2019 Feb 21.

Department of Urology, Sorbonne Université, GRC n5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 83 bvd hospital, 75013, Paris, France.

Introduction: Despite no consensus on the optimal management of recurrent prostate cancer after primary radiation or HIFU therapy, salvage prostatectomy (sRP) is reserved for only 3% of patients because of technical challenges and frequent post-operative complications. We assessed outcomes after sRP in a series of patients with localized PCa and that had received radiation therapy or HIFU as a first-line treatment.

Materials And Methods: Data from nine French referral centers on patients treated with sRP between 2005 and 2017 were collected. Pre- and post-operative data, including oncological and functional outcomes after first treatment and sRP, were analyzed to determine the predictors for biochemical recurrence (BCR) and cancer-specific survival (CSS) after sRP.

Results: First-line treatments were external beam-radiation therapy (EBRT) for 30 (55%), brachytherapy (BT) for 10 (18%), and high-intensity focused ultrasound (HIFU) for 15 (27%). Median (IQR) PSA at diagnosis was 6.4 (4.9-9.5) ng/mL, median PSA at nadir was 1.9 (0.7-3.0) ng/mL, and median (IQR) to first BCR was 13 (6-20) months. Of the 55 patients, 44 (80%) received robot-assisted salvage radical prostatectomy and 11 (20%) received salvage retropubic radical prostatectomy. Restoration of continence was achieved in 90% of preoperatively continent patients; 24% that had received nerve-sparing (NS) procedures were potent after surgery. Prolonged catheterization due to anastomotic leakage was the most common complication. Age, preoperative clinical stage, NS procedure, and a pathological Gleason score were predictors for BCR.

Conclusions: sRP was safe, feasible, and effective using either an open or robot-assisted approach, in experienced hands. Age, preoperative clinical stage, NS procedure, and pathological GS were linked with BCR after sRP.
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http://dx.doi.org/10.1007/s00345-019-02683-0DOI Listing
August 2019

Evaluation of the impact of a clinical pathway on the progression of acute urinary retention.

Neurourol Urodyn 2019 01 12;38(1):387-392. Epub 2018 Nov 12.

Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France.

Aims: The management of acute urinary retention (AUR) revolves around trial without catheter (TWOC) after prescription of an alpha-blocker. This study evaluates the implementation of a clinical pathway for AUR.

Methods: Specific clinical pathways for AUR was established between the Emergency Department and the Department of Urology in order to reduce the duration of bladder drainage that included standard prescriptions, an information sheet, and a note to be faxed to scheduling nurses to organize the trial without catheter (TWOC). The main endpoint was the reduction in the time between the AUR episode and TWOC, without decreasing urination.

Results: Between April 2015 and December 2016, 248 patients were treated in the Emergency Department, and externally, for AUR. One hundred and seventy patients were enrolled in the pathway group and 78 in the control group. The mean duration of urinary catheterization decreased by 5.5 days as did the number of patients lost to follow-up (32% vs 76%), without decreasing the successful voiding (46% vs 36%). The duration of the urinary catheterization was not related to the chance of successful voiding regardless of the urine volume and a drainage time of over 10 days significantly reduced the chance of success (68%, n = 26 versus 42%, n = 76; P = 0.0038).

Conclusion: The implementation of a clinical pathway for AUR reduced the number of patients lost to follow-up and the catheterization duration, thus optimizing the management of these patients.
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http://dx.doi.org/10.1002/nau.23873DOI Listing
January 2019

A Novel Nomogram to Identify Candidates for Extended Pelvic Lymph Node Dissection Among Patients with Clinically Localized Prostate Cancer Diagnosed with Magnetic Resonance Imaging-targeted and Systematic Biopsies.

Eur Urol 2019 03 17;75(3):506-514. Epub 2018 Oct 17.

Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address:

Background: Available models for predicting lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) might not be applicable to men diagnosed via magnetic resonance imaging (MRI)-targeted biopsies.

Objective: To assess the accuracy of available tools to predict LNI and to develop a novel model for men diagnosed via MRI-targeted biopsies.

Design, Setting, And Participants: A total of 497 patients diagnosed via MRI-targeted biopsies and treated with RP and extended pelvic lymph node dissection (ePLND) at five institutions were retrospectively identified.

Outcome Measurements And Statistical Analyses: Three available models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analyses. A nomogram predicting LNI was developed and internally validated.

Results And Limitations: Overall, 62 patients (12.5%) had LNI. The median number of nodes removed was 15. The AUC for the Briganti 2012, Briganti 2017, and MSKCC nomograms was 82%, 82%, and 81%, respectively, and their calibration characteristics were suboptimal. A model including PSA, clinical stage and maximum diameter of the index lesion on multiparametric MRI (mpMRI), grade group on targeted biopsy, and the presence of clinically significant PCa on concomitant systematic biopsy had an AUC of 86% and represented the basis for a coefficient-based nomogram. This tool exhibited a higher AUC and higher net benefit compared to available models developed using standard biopsies. Using a cutoff of 7%, 244 ePLNDs (57%) would be spared and a lower number of LNIs would be missed compared to available nomograms (1.6% vs 4.6% vs 4.5% vs 4.2% for the new nomogram vs Briganti 2012 vs Briganti 2017 vs MSKCC).

Conclusions: Available models predicting LNI are characterized by suboptimal accuracy and clinical net benefit for patients diagnosed via MRI-targeted biopsies. A novel nomogram including mpMRI and MRI-targeted biopsy data should be used to identify candidates for ePLND in this setting.

Patient Summary: We developed the first nomogram to predict lymph node invasion (LNI) in prostate cancer patients diagnosed via magnetic resonance imaging-targeted biopsy undergoing radical prostatectomy. Adoption of this model to identify candidates for extended pelvic lymph node dissection could avoid up to 60% of these procedures at the cost of missing only 1.6% patients with LNI.
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http://dx.doi.org/10.1016/j.eururo.2018.10.012DOI Listing
March 2019

Management of non-metastatic castrate-resistant prostate cancer: A systematic review.

Cancer Treat Rev 2018 Nov 21;70:223-231. Epub 2018 Sep 21.

Department of Oncology, Antoine-Lacassagne Center, Nice, France.

Management of non metastatic castrate resistant prostate cancer is challenging for clinicians due to the heterogeneity of the disease and to the scarce clinical data available in this setting. Recent results obtained with the new generation hormone therapies (NGHT) apalutamide and enzalutamide bring a new perspective for the treatment strategy. The authors present here a systematic review of the treatment options.
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http://dx.doi.org/10.1016/j.ctrv.2018.09.006DOI Listing
November 2018

Total intracorporeal robotic renal auto-transplantation: A new minimally invasive approach to preserve the kidney after major ureteral injuries.

Int J Surg Case Rep 2018 3;49:176-179. Epub 2018 Jul 3.

University Hospital of Poitiers, 2 Rue de la Milétrie, 86021 Poitiers, France. Electronic address:

Background: Renal auto-transplantation is a suitable option for managing patients with major ureteric injury. Conventional Renal auto-transplantation is however, underutilized because of its invasiveness. Completely intra-corporeal robotic renal auto-transplantation is a suitable option to decrease the morbidity. In this case, we report the first use of total intra-corporeal robotic renal auto-transplantation outside of North America.

Case Report: A 30-year-old woman presented with an extensive upper left ureter defect, following a high kinetic energy trauma. She underwent 2 median laparotomies, with extensive resection of small intestine, and 1 transverse laparotomy to repair a massive rupture of abdominal muscles. The procedure was performed via a transperitoneal approach, with the assistance of the da Vinci Si robot (Intuitive Surgical Inc. Sunnyvale, CA, USA). The renal auto-transplantation was conducted entirely robotically, in 2 separate stages, using a 4 robotic arm approach. Total operative time was 300 min: 150 min to harvest the kidney including adhesiolysis, 20 min to reposition the patient, and 130 min for the robot assisted kidney transplantation (RAKT). The total ischemia time was 96 min (3 min of warm ischemia, no cold ischemia, 93 min of rewarming time). The estimated blood loss was 150 mL.

Conclusion: To our knowledge, this is the first case successfully performed as a total robotic approach outside of North America.
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http://dx.doi.org/10.1016/j.ijscr.2018.06.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070672PMC
July 2018

Intraoperative Cyst Rupture during Partial Nephrectomy for Cystic Renal Masses-Does it Increase the Risk of Recurrence?

J Urol 2018 12 20;200(6):1200-1206. Epub 2018 Jun 20.

Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France.

Purpose: Our objective was to assess the prevalence of intraoperative cyst rupture and its impact on oncologic outcomes.

Materials And Methods: All patients who underwent partial nephrectomy for a cystic renal mass via an open or robot-assisted approach at a total of 8 academic institutions were included in this retrospective study. All operative reports were carefully reviewed and any description of cyst rupture, cyst effraction or local spillage intraoperatively was recorded as cyst rupture. Multivariate logistic regression analysis was done to assess the variables associated with cyst rupture. Recurrence-free, cancer specific and overall survival was estimated by the Kaplan-Meier method and compared with the log rank test.

Results: Overall 268 patients were included in study. There were 50 intraoperative cyst ruptures (18.7%) in the whole cohort. No preoperative parameter was significantly associated with a risk of intraoperative cyst rupture on univariate or multivariate analysis. Of the cystic renal masses 75% were malignant on the final pathology report. At a median followup of 32 months 5 patients (2.5%) had local recurrence while progression to metastasis was observed in 2%. There were no peritoneal carcinomatosis nor port site metastasis. There was also no local or metastatic recurrence in the subgroup with intraoperative cyst rupture. Estimated recurrence-free survival did not differ significantly between patients with vs without intraoperative cyst rupture at 100% vs 92.7% at 5 years (p = 0.20).

Conclusions: Intraoperative cyst rupture during partial nephrectomy is a relatively common occurrence but with few oncologic implications.
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http://dx.doi.org/10.1016/j.juro.2018.06.025DOI Listing
December 2018