Publications by authors named "Serge Brunelle"

16 Publications

  • Page 1 of 1

PD-L1 expression and pattern of immune cells in pre-treatment specimens are associated with disease-free survival for HR-NMIBC undergoing BCG treatment.

World J Urol 2020 Jul 14. Epub 2020 Jul 14.

Urology Department, GRC n°5, PREDICTIVE ONCO-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France.

Purpose: To assess the association between PD-L1 expression and disease-free survival (DFS) in High-Risk Non-Muscle Invasive Bladder Cancer (HR-NMIBC) patients treated with intravesical Bacillus Calmette-Guerin (BCG) instillations (IBI).

Methods: Retrospective study in five French centres between 2001 and 2015. Participants were 140 patients with histologically confirmed HR-NMIBC. All patients received induction and maintenance IBI. Pathological stage/grade, concomitant carcinoma in situ, lesion number and tumour size were recorded. CD3, CD8 and PD-L1 expression in tumour cells and in T cells in the tumour microenvironment (TME) was determined immunohistochemically. Median follow-up was 54.2 months. The primary outcome measure was DFS. Univariable and multivariable analyses were performed using the log rank test and Cox proportional hazards model.

Results: Of the 140 NMIBC, 52 (37.1%) were Ta, 88 (62.9%) were T1 and 100% were high grade. Median number of maintenance IBI was six (range 1-30). Twenty-five (17.9%) patients had recurrence/progression. In multivariable analysis, age (HR 1.07 [95% CI 1.02-1.13], p = 0.009), PD-L1 expression in tumour cells (HR per 10 units = 1.96 [95% CI 1.28-3.00], p = 0.02) and CD3/CD8 ratio (HR per 10 units = 3.38 [95% CI 1.61-7.11], p = 0.01) were significantly associated with DFS. However, using the cut-off corresponding for each PD-L1 antibodies, PD-L1 + status was not associated with DFS.

Conclusion: Despite an association between PD-L1 expression and BCG failure in HR-NMIBC, the PD-L1 + status was not a prognostic factor in the response of BCG. Moreover, we confirmed the key role played by the IC within the microenvironment in BCG treatment. These findings highlighted the rationale to combine BCG and PD-L1/PD-1 antibodies in early bladder cancer.
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http://dx.doi.org/10.1007/s00345-020-03329-2DOI Listing
July 2020

Metastatic hormone sensitive prostate cancer: local treatment strategies.

World J Urol 2021 Feb 25;39(2):327-337. Epub 2020 Jun 25.

Department of Medical Oncology, Institut Paoli-Calmettes Cancer Centre, Marseille, France.

Purpose: The landscape of the management of metastatic prostate cancer is changing rapidly and there is growing interest in the local treatment of the primary in these patients. The effect of local treatment on the outcome of metastatic prostate cancer patients was addressed based on retrospective analysis but now also based on prospective randomized trials. This article provides an overview of the currently available literature in this field.

Methods: A literature review was done searching the Medline database for English language articles using the keywords "metastatic prostate cancer", and "local treatment", "radiotherapy", "prostatectomy". The data of prospective randomized studies and the data of case-control studies or retrospective analysis were summarized in a narrative fashion.

Results: Data from two prospective randomized trials exploring the effect of local treatment of the prostate in hormone-sensitive metastatic prostate cancer showed no improvement of overall survival in the individual overall cohorts as well as in the pooled analysis (HR 0.92, 95% CI 0.81-1.04). There was an improvement of failure-free survival (pooled analysis HR 0.76, 95% CI 0.69-0.0.84). There was also an improved overall survival associated with radiotherapy in patients with < 5 metastases and with low volume disease. Data from prospective non-randomized or retrospective studies are inconclusive and underlies major selection biases.

Conclusion: Based on prospective randomized trials, local treatment by radiotherapy does not improve the overall survival in unselected metastatic prostate cancer patients. An effect can be seen in low volume patients or patients with < 5 metastases.
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http://dx.doi.org/10.1007/s00345-020-03296-8DOI Listing
February 2021

Impact of sarcopenia status of muscle-invasive bladder cancer patients on kidney function after neoadjuvant chemotherapy and post cystectomy complications.

Minerva Urol Nefrol 2020 Feb 19. Epub 2020 Feb 19.

Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France -

Background: Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy (RC). The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and RC for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC or surgery.

Methods: Between 2012 and 2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers. We defined severe sarcopenia as SMI <50 cm2/m2 for men and SMI <35 cm2/m2 for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models.

Results: According to the SMI, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients' characteristics between sarcopenic and non- sarcopenic patients were not significantly different except for BMI (p<0.001). Among patients non-sarcopenic before NAC, 9 (25.7%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (p=0.02). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (p=0.01 and p=0.03 respectively).

Conclusions: We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.
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http://dx.doi.org/10.23736/S0393-2249.20.03616-4DOI Listing
February 2020

Imaging protocols for renal multiparametric MRI and MR urography: results of a consensus conference from the French Society of Genitourinary Imaging.

Eur Radiol 2020 Apr 3;30(4):2103-2114. Epub 2020 Jan 3.

Academic Department of Radiology, Hôpital Pitié-Salpêtrière and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.

Objectives: To develop technical guidelines for magnetic resonance imaging aimed at characterising renal masses (multiparametric magnetic resonance imaging, mpMRI) and at imaging the bladder and upper urinary tract (magnetic resonance urography, MRU).

Methods: The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Two separate questionnaires were issued for renal mpMRI and for MRU. Consensus was strictly defined using a priori criteria.

Results: Forty-two expert uroradiologists completed both survey rounds with no attrition between the rounds. Fifty-six of 84 (67%) statements of the mpMRI questionnaire and 44/71 (62%) statements of the MRU questionnaire reached final consensus. For mpMRI, there was consensus that no injection of furosemide was needed and that the imaging protocol should include T2-weighted imaging, dual chemical shift imaging, diffusion-weighted imaging (use of multiple b-values; maximal b-value, 1000 s/mm) and fat-saturated single-bolus multiphase (unenhanced, corticomedullary, nephrographic) contrast-enhanced imaging; late imaging (more than 10 min after injection) was judged optional. For MRU, the patients should void their bladder before the examination. The protocol must include T2-weighted imaging, anatomical fast T1/T2-weighted imaging, diffusion-weighted imaging (use of multiple b-values; maximal b-value, 1000 s/mm) and fat-saturated single-bolus multiphase (unenhanced, corticomedullary, nephrographic, excretory) contrast-enhanced imaging. An intravenous injection of furosemide is mandatory before the injection of contrast medium. Heavily T2-weighted cholangiopancreatography-like imaging was judged optional.

Conclusion: This expert-based consensus conference provides recommendations to standardise magnetic resonance imaging of kidneys, ureter and bladder.

Key Points: • Multiparametric magnetic resonance imaging (mpMRI) aims at characterising renal masses; magnetic resonance urography (MRU) aims at imaging the urinary bladder and the collecting systems. • For mpMRI, no injection of furosemide is needed. • For MRU, an intravenous injection of furosemide is mandatory before the injection of contrast medium; heavily T2-weighted cholangiopancreatography-like imaging is optional.
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http://dx.doi.org/10.1007/s00330-019-06530-zDOI Listing
April 2020

Imaging protocols for CT urography: results of a consensus conference from the French Society of Genitourinary Imaging.

Eur Radiol 2020 Mar 17;30(3):1387-1396. Epub 2019 Dec 17.

Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France.

Objectives: To develop technical guidelines for computed tomography urography.

Methods: The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Consensus was strictly defined using a priori criteria.

Results: Forty-two expert uro-radiologists completed both survey rounds with no attrition between the rounds. Ninety-six (70%) of the initial 138 statements of the questionnaire achieved final consensus. An intravenous injection of 20 mg of furosemide before iodinated contrast medium injection was judged mandatory. Improving the quality of excretory phase imaging through oral or intravenous hydration of the patient or through the use of an abdominal compression device was not deemed necessary. The patient should be imaged in the supine position and placed in the prone position only at the radiologist's request. The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. Repeated single-slice test acquisitions should not be performed to decide of the timing of excretory phase imaging; instead, excretory phase imaging should be performed 7 min after the injection of the contrast medium. The optimal combination of unenhanced, corticomedullary phase and nephrographic phase imaging depends on the context; suggestions of protocols are provided for eight different clinical situations.

Conclusion: This expert-based consensus conference provides recommendations to standardise the imaging protocol for computed tomography urography.

Key Points: • To improve excretory phase imaging, an intravenous injection of furosemide should be performed before the injection of iodinated contrast medium. • Systematic oral or intravenous hydration is not necessary to improve excretory phase imaging. • The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation.
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http://dx.doi.org/10.1007/s00330-019-06529-6DOI Listing
March 2020

Vitiligo Adverse Event Observed in a Patient With Durable Complete Response After Nivolumab for Metastatic Renal Cell Carcinoma.

Front Oncol 2019 9;9:1033. Epub 2019 Oct 9.

Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France.

Renal cell carcinoma is the third most prevalent urological cancer worldwide and about 30% of patients present with metastatic disease at the time of diagnosis. Systemic treatments for metastatic renal cell carcinoma have improved recently. Vascular endothelial growth factor targeting therapies were the previous standard of care. However, immune checkpoint inhibitors used in second line therapy have now been shown to improve patient survival. We report a case of metastatic renal cell carcinoma with nivolumab as a second-line therapy after progression with tyrosine kinase inhibitor therapy. Unusual adverse events in metastatic renal cell carcinoma, such as vitiligo, were observed in this patient who developed a remarkable documented pathological complete response to his renal tumor. A 60-year-old caucasian male was diagnosed with a pulmonary metastatic clear cell renal cell carcinoma. Sunitinib was used as first line treatment without success. He received nivolumab in second-line treatment. He developed several immune-related adverse events, most notably vitiligo. The patient had a radiological complete response on metastatic sites, with a significant decrease of renal tumor volume and underwent cytoreductive nephrectomy after 2 years of treatment, confirming the pathological complete response. The patient remains disease-free for 10 months without further systemic therapy after nivolumab discontinuation. Pathological complete response with nivolumab in metastatic renal cell carcinoma is rare. This case further highlights the potentially predictive role of immune-related adverse events during nivolumab therapy for metastatic renal cell carcinoma and raises questions concerning the role of nephrectomy after immune checkpoint inhibitor therapy. Further studies are needed to better identify predictive factors for treatment response to immunotherapy in metastatic renal cell carcinoma, and to better understand the role of nephrectomy after nivolumab treatment.
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http://dx.doi.org/10.3389/fonc.2019.01033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795279PMC
October 2019

Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes.

Int J Hyperthermia 2019 ;36(1):1065-1071

Department of Radiology, Institut Paoli-Calmettes , Marseille , France.

To evaluate the safety, functional and oncological outcomes associated with percutaneous cryoablation of stage T1b renal cell carcinoma (RCC). Institutional database was reviewed to identify patients treated by percutaneous CT-guidance cryoablation between 2013 and 2018 for biopsy-proven RCC tumors measuring 4.1-7.0 cm. The main outcome parameters analyzed were primary and secondary technique efficacy, progression-free survival (PFS), cancer-specific survival (CSS), loss of estimated glomerular filtration rate (eGFR) and complications. PFS and CSS were estimated by the Kaplan-Meier method. Complications were graded by the Clavien-Dindo system. Twenty-three consecutive patients were included (mean tumor diameter: 45.6 ± 6.2 mm; mean RENAL score: 8.1 ± 1.8). The technical success rate was 95.7%. Primary and secondary technique efficacy rates were 86.3 and 100%, respectively. Three patients found to have incomplete ablations at 3 months were successfully treated by repeat cryoablation. Median duration follow-up was 11 months (range: 3-33). Imaging showed PFS to be 85.7% at 6 months, 66.7% at 12 months and 66.7% at 24 months. One patient with a local recurrence at 12 months was treated by radical nephrectomy. One patient died from progression of disease within 12 months. One patient reported a complication grade ≥ II (4.3%). Mean eGFR loss was 4.4 ± 8.5 ml/min/1.73m, which was significantly higher among those treated for central tumors ( < .05). Cryoablation for stage T1b renal tumors is technically feasible, with favorable oncological and perioperative outcomes. Longer-term studies are needed to verify our findings.
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http://dx.doi.org/10.1080/02656736.2019.1675913DOI Listing
April 2020

Long-term efficacy of crizotinib in a metastatic papillary renal carcinoma with MET amplification: a case report and literature review.

BMC Cancer 2018 Nov 22;18(1):1159. Epub 2018 Nov 22.

Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd de Sainte-Marguerite, 13009, Marseille, France.

Background: Papillary renal cell carcinoma (pRCC) is the 2nd most frequent histological type of kidney cancer and accounts for approximately 15% of all renal cell carcinoma. It has a poorer prognosis than clear cell RCC (ccRCC) with a lack of standard treatments.

Case Presentation: We report the case of a 51 year old man with a metastatic pRCC (hepatic dome and left colonic peritoneal carcinomatosis) progressive after sunitinib, with a MET amplification. The patient was enrolled in the UNICANCER-sponsored AcSé crizotinib trial (NCT02034981), designed to give an access to crizotinib for patients with tumors harboring a genomic alteration on one of the biological targets of the drug. With 2nd line crizotinib (250 mg twice/day), the patient had a very good tolerance, a partial response in the target lesions using RECIST 1.1, and a 19 months' clinical efficacy.

Conclusions: In metastatic pRCC with a MET amplification, crizotinib maybe a potential met-inhibitory therapeutic option.
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http://dx.doi.org/10.1186/s12885-018-5049-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251103PMC
November 2018

Targeted NGS, array-CGH, and patient-derived tumor xenografts for precision medicine in advanced breast cancer: a single-center prospective study.

Oncotarget 2016 Nov;7(48):79428-79441

Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France.

Background: Routine feasibility and clinical impact of genomics-based tumor profiling in advanced breast cancer (aBC) remains to be determined. We conducted a pilot study to evaluate whether precision medicine could be prospectively implemented for aBC patients in a single center and to examine whether patient-derived tumor xenografts (PDX) could be obtained in this population.

Results: Thirty-four aBC patients were included. Actionable targets were found in 28 patients (82%). A targeted therapy could be proposed to 22 patients (64%), either through a clinical trial (n=15) and/or using already registered drugs (n=21). Ten patients (29%) eventually received targeted treatment, 2 of them deriving clinical benefit. Of 22 patients subjected to mouse implantation, 10 had successful xenografting (45%), mostly in triple-negative aBC.

Methods: aBC patients accessible to tumor biopsy were prospectively enrolled at the Institut Paoli-Calmettes in the BC-BIO study (ClinicalTrials.gov, NCT01521676). Genomic profiling was established by whole-genome array comparative genomic hybridization (aCGH) and targeted next-generation sequencing (NGS) of 365 candidate cancer genes. For a subset of patients, a sample of fresh tumor was orthotopically implanted in humanized cleared fat pads of NSG mice for establishing PDX.

Conclusions: Precision medicine can be implemented in a single center in the context of clinical practice and may allow genomic-driven treatment in approximately 30% of aBC patients. PDX may be obtained in a significant fraction of cases.
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http://dx.doi.org/10.18632/oncotarget.12714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346725PMC
November 2016

Is negative multiparametric magnetic resonance imaging really able to exclude significant prostate cancer? The real-life experience.

BJU Int 2017 03 4;119(3):449-455. Epub 2016 Oct 4.

Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France.

Objectives: To evaluate the histopathological results after radical prostatectomy (RP) in patients that had normal preoperative multiparametric magnetic resonance imaging (mpMRI), in order to determine whether they had significant or insignificant disease. Moreover, we evaluated the influence of the expertise of the radiologist on the results.

Patients And Methods: We retrospectively included patients who underwent RP in our centre and who had a preoperative negative mpMRI. The MRIs were considered negative when no suspicious lesion was seen or when the Prostate Imaging Reporting and Data System version 1 score was <7. We used Pathological tumour-node-metastasis staging and Gleason score on pathology reports, and whole-mount sections to calculate tumour volume.

Results: We identified 101 patients from 2009 to 2015. Final pathology showed that 16.9% had extraprostatic extension, 13.8% had primary Gleason pattern 4 (4 + 3 and above), 47.5% had secondary Gleason pattern 4 or 5, and 55.9% and 20.6% had a main tumour volume of ≥0.5 and ≥2 mL, respectively. When limiting the analysis to expert reading only, the numbers improved: only one patient (3.4%) had extraprostatic extension (P < 0.05), one patient (3.4%) had primary Gleason pattern 4 (P = 0.05), and 64.7% and 5.9% had a main tumour volume of ≥0.5 and ≥2 mL, respectively (P = 0.01).

Conclusion: A negative MRI does not guarantee the absence of significant prostate cancer.
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http://dx.doi.org/10.1111/bju.13657DOI Listing
March 2017

Inherent and Tumor-Driven Immune Tolerance in the Prostate Microenvironment Impairs Natural Killer Cell Antitumor Activity.

Cancer Res 2016 04 5;76(8):2153-65. Epub 2016 Apr 5.

Centre de Recherche en Cancérologie de Marseille, INSERM U1068/CNRS U7258, Marseille, France. Institut Paoli-Calmettes, Marseille, France. Aix Marseille Université, Marseille, France.

The field of immunotherapy for solid tumors, such as prostate cancer, has been recently focusing on therapies that can counter tumor-mediated immunosuppression. Precise quantification and characterization of the immune infiltrates in tumors is crucial to improve treatment efficacy. Natural killer (NK) cells, major components of the antitumor immune system, have never been isolated from prostate tumors, despite their suspected role in disease progression. Here, we examined the frequency, phenotype, and functions of NK cells infiltrating control and tumor prostate tissues. NK cell infiltrates in prostate tissues were mainly CD56 (NCAM1)-positive and displayed an unexpected immature, but activated, phenotype with low or no cytotoxic potential. Furthermore, we show that TGFβ1 (TGFB1) is highly secreted into the prostate environment and partly mediates the immunosuppressive effects on NK cells. In addition to this basal level of immunotolerance to NK cells, the prostate environment became further resistant to NK cell-mediated immunity upon cancer cell infiltration. Coculture experiments revealed that prostate cancer cells induced the expression of inhibitory receptor (ILT2/LILRB1) and downregulated the expression of activating receptors NKp46 (NCR1), NKG2D (KLRK1), and CD16 (FCGR3) by NK cells, thus preventing their recognition of tumor cells. Notably, blood levels of NKp46 were also decreased in prostate cancer patients and were inversely correlated with levels of prostate-specific antigen, the main prognostic factor in prostate cancer. Our study shows that a strong immunosuppressive environment impairs NK cell function at multiple levels in prostate cancer and provides a rationale for the design of therapies that restore NK cell efficiency in the prostate tumor microenvironment. Cancer Res; 76(8); 2153-65. ©2016 AACR.
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http://dx.doi.org/10.1158/0008-5472.CAN-15-1965DOI Listing
April 2016

METRO1: A Phase I Study of Metronomic Chemotherapy in Adults with Advanced Refractory Solid Tumors.

Anticancer Res 2016 Jan;36(1):293-9

Department of Oncology, Institut Paoli-Calmettes, Marseille, France Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, Marseille, France Aix-Marseille Université, Marseille, France.

Background: The present monocentric and prospective phase 1 study evaluated the safety of a metronomic chemotherapy in refractory tumors.

Patients And Methods: Patients with advanced solid cancer refractory to standard therapy received a combination of low-dose vinorelbine, cyclophosphamide and interferon-alpha. A dose escalation model with 3 levels was planned. The primary end-point was safety and tolerability, secondary end-points were treatment continuation rate at 4 months, progression-free survival (PFS), overall survival (OS), radiological assessment (MRI) of anti-angiogenic effect.

Results: Thirty patients were enrolled. No dose-limiting toxicity was observed. All but two adverse events were toxicities of grade 1-2. Treatment continuation rate at 4 months was 6.67% (2 out of 30 patients). Median PFS and OS were 1.6 and 6.1 months. Exploratory MRI analyses related to anti-angiogenic effect did not show any relevant modification.

Conclusion: This combination of metronomic chemotherapy is well-tolerated and deserves to be deeply explored in refractory solid tumors.
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January 2016

Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies.

World J Urol 2014 Aug 12;32(4):847-58. Epub 2014 Jun 12.

Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite, BP 156, 13273, Marseille, France.

Objective: The clinical utility of image-targeted biopsies can only be judged by a comparison of the current standard of systematic 10-12 core biopsy schemes. The aim of this review was to gather the current evidence in favor of or against targeted biopsies in the detection of prostate cancer based on well-designed, controlled studies, in order to draw clinical relevant conclusions.

Subjects/patients And Methods: A systematic literature review was performed addressing studies that compared the prostate cancer detection rates of targeted and systematic biopsy schemes using the imaging techniques of elastography, contrast-enhanced ultrasound, histoscanning and multiparametric MRI. Only well-designed, controlled studies were included and the results summarized.

Results: All imaging techniques are associated with varying results regarding better or poorer detection rates relative to systematic biopsies. No technique provides a clear trend in favor of or against image-targeted biopsies. In almost all studies, the combination of targeted and systematic biopsies provided sometimes a substantial, increase in the detection rate relative to systematic biopsies alone. MRI-targeted biopsies show no advantage in the initial biopsy setting, whereas in the repeat biopsy setting improvements in the detection rates are often observed relative to systemic biopsies.

Conclusion: Based on well-designed, controlled studies no clear advantage of targeted biopsies over the current standard of systematic biopsies can be observed. Therefore, targeted biopsies cannot replace systematic biopsies in the diagnosis of prostate cancer. In all indications, the combination of systematic and targeted biopsy schemes provides the highest detection rate.
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http://dx.doi.org/10.1007/s00345-014-1332-3DOI Listing
August 2014

Identification of the prostate cancer index lesion by real-time elastography: considerations for focal therapy of prostate cancer.

World J Urol 2011 Oct 26;29(5):589-94. Epub 2011 May 26.

Department of Urology, Institut Paoli-Calmettes, 232, Boulevard Ste. Marguerite/B.P.: 156, 13273 Marseille, France.

Introduction: Focal therapy of prostate cancer is gaining more and more interest. One of the drawbacks of focal therapy of prostate cancer is the problem of correct identification of prostate cancer lesions. The aim of the study was to evaluate the ability of real-time elastography to correctly identify the prostate cancer index lesion.

Materials And Methods: In 32 patients, real-time elastography was performed the day before prostatectomy. During the examination, the location of the main lesion suspicious for prostate cancer was prospectively recorded. Moreover, the results of the randomized multicore biopsies were also used to predict the location of the index lesion. The preoperative elastography results, the biopsy results, and a combined use of elastography and biopsy results were then compared with the pathological results to calculate the diagnostic values for correct index lesion identification.

Results: When using real-time elastography alone to identify the prostate cancer index lesion, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 58.8, 43.3, 54.1, 48.1, and 51.6%, respectively. Data from randomized biopsies alone achieved 67.8, 48.4, 56.8, 60.0, and 58.1%, respectively. The combination of elastography and biopsy data increased the values to, respectively, 84.9, 48.4, 61.9, 75.0, and 66.1%.

Conclusion: In this study, real-time elastography alone did not allow to identify the prostate cancer index lesion with satisfactory reliability. The combination of real-time elastography and data from randomized 12 core biopsies allows promising ability to correctly identify the prostate cancer index lesion.
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http://dx.doi.org/10.1007/s00345-011-0688-xDOI Listing
October 2011

Radioguided sentinel lymph node dissection in patients with localised prostate carcinoma: influence of the dose of radiolabelled colloid to avoid failure of the procedure.

Eur J Nucl Med Mol Imaging 2008 Jan 9;35(1):32-8. Epub 2007 Sep 9.

Department of Nuclear Medicine, Institut Paoli-Calmettes, Regional Cancer Center, Université de la Méditerranée, 232 Bd. Sainte Marguerite, 13273, Marseille Cedex 9, France.

Introduction: The purpose of this study was to determine the role of the injected dose of tracer in the non-detection of pelvic sentinel lymph nodes (SLN) in patients with prostate carcinoma.

Methods: Data were evaluated from 100 patients (age range 43-77, mean 63 years). The first 72 patients (group 1) received 2 x 0.3 ml of 30 MBq-nanocolloid-99 mTc and the remaining 28 patients (group 2) received 2 x 0.3 ml of 100 MBq. Surgery consisted of the detection and dissection of lymph nodes identified as sentinel nodes, followed by an extended lymphadenectomy.

Results: SLNs were located in the interiliac group in 54.2% of patients, in the obturator fossa in 30.7%, in the external iliac group in 10.9% and in the common iliac group in 4.2% of cases. Lymph node involvement was observed in 12% of patients. But there was a 30.6% (22/72) failure rate of the SLN procedure in group 1 and 7.1% (2/28) in group 2. An increased risk of unsuccessful SLN procedure was statistically associated with the low dose of MBq-nanocolloids (p < 0.017). Statistical correlation is also found after the exclusion of the first 30 patients from the study (learning phase of the team) (p < 0.034). None of the other parameters showed a statistical association (age, p < 0.9; Gleason score, p < 0.3; grade pT, p < 0.7). A higher grade or a greater extension of cancer inside the prostate are not responsible for the failure of the SLN procedure.

Conclusion: It seems necessary to inject at least 200 MBq inside the prostate to avoid a failed SLN procedure.
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http://dx.doi.org/10.1007/s00259-007-0516-0DOI Listing
January 2008