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1.  Bladder cancer in HIV-infected adults: an emerging concern? 
Journal of the International AIDS Society  2014;17(4Suppl 3):19647.
As HIV-infected patients get older more non-AIDS-related malignancies are to be seen. Cancer now represents almost one third of all causes of deaths among HIV-infected patients [1]. Albeit bladder cancer is one of the most common malignancy worldwide [2], only 13 cases of bladder cancer in HIV-infected patients have been reported in the literature so far [3].
Materials and Methods
We conducted a monocentric study in our hospital. We selected all patients who were previously admitted (from 1998 to 2013) in our hospital with diagnoses of HIV and bladder cancer. The objective was to assess the prevalence and characteristics of bladder cancers in HIV-infected patients in our hospital.
Based on our administrative HIV database (6353 patients), we found 15 patients (0.2%) with a bladder cancer. Patients’ characteristics are presented in Table 1. Patients were mostly men and heavy smokers. Their median nadir CD4 cell count was below 200 and most had a diagnosis of AIDS. A median time of 14 years was observed in those patients, between the diagnosis of HIV-infection and the occurrence of bladder cancer, although in patients much younger (median age 56) than those developing bladder cancer without HIV infection (71.1 years) [4]. Haematuria was the most frequent diagnosis circumstance in HIV-infected patients who had relatively preserved immune function on highly active antiretroviral therapy (HAART). Histopathology showed relatively advanced cancers at diagnosis with a high percentage of non transitional cell carcinoma (TCC) tumor and of TCC with squamous differentiation, suggesting a potential role for human papilloma virus (HPV) co-infection. Death rate was high in this population.
Bladder cancers in HIV-infected patients remain rare but occur in relatively young HIV-infected patients with a low CD4 nadir, presenting with haematuria, most of them being smokers, and have aggressive pathological features that are associated with severe outcomes.
PMCID: PMC4224926  PMID: 25394151
2.  Contemporary pathologic characteristics and oncologic outcomes of prostate cancers missed by 6- and 12-core biopsy and diagnosed with a 21-core biopsy protocol 
World Journal of Urology  2011;31(4):869-874.
To assess the pathological and the oncologic outcomes of the Prostate Cancer (PCa) missed by 6 and 12-core biopsy protocols by using a reference 21-core scheme.
Materials and methods
Between 2001 and 2009, all patients who had PCa detected in an initial 21-core TRUS biopsy scheme and were treated by a radical prostatectomy (RP) were included. Patients were sorted in 3 groups according to the diagnosis site: sextant (6 first cores; group 1), peripheral zone (12 first cores; group 2) or midline/transitional zone (after 21 cores; group 3). Demographics, pathological features in biopsy and RP specimens and follow-up after RP were analyzed. The 5-year progression free survival (PFS) was studied in the 3 groups.
During the study period, 443 patients were included. Among them, 67 %, 23.7 % and 9.2% were respectively diagnosed in group 1, 2 and 3. Among PCa diagnosed in midline/transition zone cores, 42 % were intermediate or high risk. Unfavorable disease was more frequently reported in group 1 in terms of extraprostatic extension (p=0.001), high Gleason score (p=0.001) and progression (p=0.001). No significant difference was observed between group 2 and 3 in terms of pathological features in RP specimens and oncologic outcome. The 5-year PFS was 89.7% and not significantly different in patients diagnosed with a 12-core scheme compared to those diagnosed only with 21-core scheme (p=0.332).
Our findings emphasize that PCa diagnosed only in a 21-core protocol is at least as aggressive as PCa detected in a 12-core scheme. This study invalidates the widespread idea sustaining that cancers diagnosed by more than 12 biopsies are less aggressive.
PMCID: PMC3907356  PMID: 22116600
Prostate Biopsy; Prostate cancer; Diagnosis Yield
3.  Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience 
Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program.
Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months.
The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/min without severe postoperative renal failure.
RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.
PMCID: PMC3854474  PMID: 24319515
4.  Hepatitis C Transmission after Prostate Biopsy 
Case Reports in Urology  2013;2013:797248.
Prostate biopsy is a current and well-codified procedure; antibiotic prophylaxis and rectal enema limit the risk of infection. To date, there has been no reported viral transmission between patients due to a contaminated ultrasound probe. In this study, we report the case of a patient who contracted the hepatitis C virus after transrectal prostate biopsy as part of an individual screening for prostate cancer.
PMCID: PMC3600139  PMID: 23533934
5.  Class III beta-tubulin expression predicts prostate tumor aggressiveness and patient response to docetaxel-based chemotherapy 
Cancer Research  2010;70(22):9253-9264.
Expression of class III β-tubulin (βIII-tubulin) correlates with tumor progression and resistance to taxane-based therapies for several human malignancies but its use as a biomarker of tumor behaviour in prostate cancer (PCa) remains largely unexplored. Here, we describe βIII-tubulin immunohistochemical staining patterns of prostate tumors obtained from a broad spectrum of PCa patients, some of whom subsequently received docetaxel therapy for castration-resistant prostate cancer (CRPC). Elevated βIII-tubulin expression was significantly associated with tumor aggressiveness in PCa patients with presumed localized disease as it was found to be an independent marker of biochemical recurrence after treatment. Additionally, βIII-tubulin expression in tumor cells was an independent predictor of lower overall survival for patients receiving docetaxel-based chemotherapy for CRPC. Manipulation of βIII-tubulin expression in human prostate cancer cell lines using a human βIII-tubulin expression vector or βIII-tubulin siRNA altered cell survival in response to docetaxel treatment in a manner that supports a role for βIII-tubulin expression as a mediator of PCa cell resistance to docetaxel therapy. Our findings suggest a role for βIII-tubulin as candidate theranostic biomarker to predict the response to docetaxel-based chemotherapy as well as to target for treatment of docetaxel-resistant CRPC.
PMCID: PMC3290526  PMID: 21045157
Aged; Antineoplastic Agents; therapeutic use; Cell Line, Tumor; Cell Survival; drug effects; genetics; Drug Resistance, Neoplasm; genetics; Humans; Immunoblotting; Immunohistochemistry; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Orchiectomy; Prognosis; Prostate; drug effects; metabolism; surgery; Prostatectomy; Prostatic Neoplasms; drug therapy; metabolism; pathology; RNA Interference; Survival Analysis; Taxoids; therapeutic use; Tubulin; biosynthesis; genetics; Tumor Markers, Biological; biosynthesis; genetics; class III β-tubulin; prostate cancer; predictive value; docetaxel; therapeutic resistance; prognosis
6.  Prevalence and spectrum of microsatellite alterations in nonmuscle invasive bladder cancers 
We aimed to identify interesting deleted chromosomal regions for bladder cancer diagnosis and carcinogenesis, and to evaluate the association between loss of heterozygosity (LOH) and clinico-pathological parameters. Microsatellite analysis was performed on urine sediment and tumor tissue from 43 consecutive patients with superficial transitional cell carcinoma (TCC) and from 42 consecutive controls. Informative cases were scored as LOH or allelic loss (AL) according to the decrease of the allelic-imbalance ratio. The prevalence of LOH and AL was 39.5% and 86%, respectively. Chromosome 9 was the most frequently altered, especially at 9p (35%). The total number of microsatellite alterations per analysis was correlated with age, grade, stade and EAU classification. The locus 17p13.1 was strongly associated with high-stage (p=0.01) and high-grade tumors (p=0.02). Specificity and sensitivity of LOH was 100% and 39.3% for diagnosis of malignant urinary disease. Specificity and sensitivity of AL was 73.8% and 88%, respectively. Allelic losses are a frequent and early event in bladder cancer, especially at 9p. Thanks to its high specificity, LOH may serve as a complementary tool for non invasive diagnosis of bladder cancer. Further study is warranted to evaluate the prognostic value of LOH on recurrence, progression and muscle invasion.
PMCID: PMC3189821  PMID: 21994900
Bladder cancer; microsatellite; loss of heterozygosity; allelic loss
7.  The prognostic value of FGFR3 mutational status for disease recurrence and progression depends on allelic losses at 9p22 
Developing molecular markers that define high-risk lesions is clinically critical for improving the prognosis determination of the tumors and their treatment. We decided to focus on the two pathways involving FGFR3 and allelic losses at 9p22 to identify a potential combined role in predicting tumor recurrence, progression and/or muscle. Microsatellite and mutational FGFR3 status analyses was performed in tumor tissue of 58 patients in a prospective unicentre study. The results of microsatellite and FGFR3 analyses were dichotomized as follows: loss of heterozygos-ity (LOH) versus retention of heterozygosity (ROH) on the one hand; mutant FGFR3 (mtFGFR3) versus wild-type FGFR3 (wtFGFR3) on the other hand. The combined 9p22/FGFR3 status was strongly correlated with stage (p=0.001) and grade (p<0.001) whereas the single FGFR3 mutational status was not able to predict recurrence, progression or muscle invasion. The survival curves corresponding to each combined status (mtFGFR3/ROH, wtFGFR3/ROH, mtFGFR3/LOH, wtFGFR3/LOH) were significantly different for recurrence (p=0.008), progression (p=0.046) and progression to muscle invasive disease (p=0.004). In case of 9p22 LOH, the FGFR3 mutational status was strongly associated with different clinical outcomes. In a multivariate model, the combined wtFGFR3/9p22 LOH status remained significant in predicting oncologic outcomes. FGFR3 mutations strongly characterize tumors with low malignant potential and favourable clinical outcome in case of allelic losses at 9p22, whereas its prognostic value becomes null or slightly inverts in case of allelic stability. Thus, our findings may also lead to further experiments in order to study interactions between FGFR3 and genes located at 9p22, as CDKN2A.
PMCID: PMC3186048  PMID: 21984968
Bladder cancer; FGFR3; loss of heterozygosity; prognosis; mutations
8.  Pilot trial of adjuvant paclitaxel plus androgen deprivation for patients with high-risk prostate cancer after radical prostatectomy: results on toxicity, side effects and quality-of-life 
Therapeutic strategy remains unclear with no clear consensus for men with high-risk prostate cancer after radical prostatectomy. We aimed to evaluate into a prospective randomized trial the effectiveness and the feasibility of adjuvant weekly paclitaxel combined with androgen deprivation therapy (ADT) in these patients. 47 patients with high risk prostate cancer were randomized 6 weeks after radical prostatectomy: ADT alone versus combination of ADT and weekly paclitaxel. Toxicity, quality-of-life and functional results were compared between the two arms. All 23 patients completed 8 cycles of paclitaxel. Toxicity was predominantly of grade 1–2 severity. There were no differences in EORTC QLQ-C30 scores between the two groups and between baseline and last assessment at 24 months after surgery. Urinary continence was complete at one year after surgery for all patients and no significant differences was noted at each assessment between the two groups. The interim analysis of this trial confirms the feasibility of weekly paclitaxel in combination with androgen deprivation therapy in men at high risk prostate cancer with curative intent. This adjuvant combined therapy does no alter quality-of-life and continence recovery after surgery plus ADT. A larger cohort is awaited to determine the oncological outcomes of this strategy.
PMCID: PMC2891708  PMID: 19935771
Aged; Androgen Antagonists; therapeutic use; Combined Modality Therapy; Humans; Male; Middle Aged; Paclitaxel; adverse effects; therapeutic use; Pilot Projects; Prostate; pathology; Prostate-Specific Antigen; analysis; Prostatectomy; Prostatic Neoplasms; drug therapy; surgery; Risk; Urinary Incontinence; chemically induced; prostate cancer; radical prostatectomy; high risk; adjuvant chemotherapy; paclitaxel
9.  High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on initial 21-core extended biopsy scheme: incidence and implications for patient care and surveillance 
World Journal of Urology  2009;27(5):587-592.
To evaluate the incidence of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) in initial 21-core extended biopsy scheme and to determine the prostate cancer detection rate in the repeated biopsy.
Between 2002 and 2008, 2,006 patients underwent a first 21-core extended biopsy scheme. Incidences of cancer, ASAP and HGPIN were studied. Cancer detection rate in the repeated 21-core extended biopsy for ASAP and HGPIN was reported and compared with those obtained on repeated biopsy for clinico-biological indications.
Incidences of HGPIN and ASAP were 1.7% and 1.1%, respectively. The 6-core and 12-core biopsy schemes detecting HGPIN would have missed the diagnosis of cancer in 10% and 3.6% of cases, compared to a 21-core biopsy protocol, respectively. The cancer detection rate on repeated biopsy for HGPIN was 19% and not significantly different compared with the detection rate on repeated biopsy for clinico-biological indications (16.8%, p=0.77). Seven prostate cancers were found among the 17 re-biopsies for ASAP revealing a detection rate of 41.2% (p=0.01). All detected cancers were organ-confined. No clinico-pathological data was independent predictor of cancer on repeated biopsy.
Our report demonstrates the different risk profiles for HGPIN and ASAP in a 21-core extended biopsy scheme. Presence of HGPIN does not imply a higher risk for cancer detection at immediate re-biopsy compared to other patients for who repeated biopsies were indicated for increasing or persistently increased PSA levels. Repea biopsy is warranted when ASAP is diagnosed because of a high risk of prostate cancer.
PMCID: PMC2825569  PMID: 19373471
Aged; Biopsy; Humans; Incidence; Male; Middle Aged; Population Surveillance; Prostatic Intraepithelial Neoplasia; epidemiology; pathology; Prostatic Neoplasms; epidemiology; pathology; atypical small acinar proliferation; high grade intraepithelial neoplasia; prostate cancer; saturation biopsy
10.  Analysis of complications from 600 retroperitoneoscopic procedures of the upper urinary tract during the last 10 years 
World Journal of Urology  2008;26(6):523-530.
The aim of this study is to review 10 years experience of retroperitoneoscopy procedures.
600 patients treated between 1995 and 2007 netroperitoneoscopy (nephrectomy, partial and total nephrectomy, adrenalectomy, pyeloplasty, renal cyst, calyceal diverticulectomy) were reviewed for per, peri and post operative complications including patients in the learning curve.
The mean blood loss was 159mL. Conversion to open surgery was required in 28 patients (4.6%) primarily due to technical problems during dissection (elective). There were 32 (5.3%) surgical complications, including bleeding or hematomas in 12 cases and 2 of them required reintervention, urinomas in 8 which were treated by installation of a ureteral drainage (JJ stent). Wound or deep abscesses happened in 4, urinary fistula in 1 and pancreatic fistula in another. Evisceration (hernias) was seen in 3 patients. Intestinal injury occurred in 2. The complication rate depended on the difficulty of the procedure and learning curve of the surgeon. Twenty eight patients (4.6%) presented medical post-operative complications (hyperthermias, deep venous thrombosis, pyelonephritis, pulmonary superinfections, pulmonary atelectasia and transient vascular ischemic accident). Mean postoperative hospital stay was 6.2 days (ranged from 2 to 20).
Retroperitoneoscopy can be the technique of choice for accessing and carrying out all the surgery of the upper urinary tract respecting the principles of oncological surgery. After experience with 600 cases during the last 10 years the technique has become safe, simplified, reproducible and effective although not easy. Most complications are minor and easily managed.
PMCID: PMC2773248  PMID: 18807049
Adrenalectomy; adverse effects; Adult; Female; Humans; Laparoscopy; adverse effects; Length of Stay; statistics & numerical data; Male; Middle Aged; Nephrectomy; adverse effects; Postoperative Complications; Retroperitoneal Space; surgery; Urologic Diseases; surgery; Urologic Surgical Procedures; adverse effects; Nephrectomy; complications; partial nephrectomy; retroperitoneoscopy

Results 1-10 (10)