Debré Bernard | Search PubMed

PubMed2006

[Does transrectal MRI before radical prostatectomy modify the operative technique to decrease the positive margin rate?].

OBJECTIVE: To determine the value of magnetic resonance imaging (MRI) in the surgical management of prostate cancer patients. PATIENTS AND METHODS: 159 patients with prostate cancer underwent transrectal MRI before retropubic radical prostatectomy (RP). Patients operated despite a suspicion of extraprostatic extension on MRI had a modified non-nerve-sparing surgical technique. Postoperative histological findings were compared to MRI data. RESULTS: 34/159 patients (21.4%) had suspected extraprostatic extension in MRI. The pT3 rate on the RP specimen was significantly higher for patients with abnormal MRI than for patients with normal MRI (61% versus 39%, p = 0.02). Among pT3 patients, the positive surgical margin rate was significantly lower in the group with abnormal MRI than in the group with normal MRI (24% versus 51%, p = 0.035). CONCLUSIONS: Among patients with stage pT3 on the RP specimen, those in whom extraprostatic extension was suspected on MRI were treated by a modified surgical technique resulting in a lower positive surgical margin rate.

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PubMed2004

Post-brachytherapy transurethral resection of the prostate in patients with localized prostate cancer.

PURPOSE: We assessed the rate and results of transurethral resection of the prostate (TURP) in patients previously treated with brachytherapy as monotherapy for localized prostate cancer. MATERIALS AND METHODS: From May 1998 to May 2003, 600 patients with localized prostate cancer were treated with brachytherapy at our institution. Brachytherapy was performed as monotherapy with curative intent for clinically localized prostate cancer without adjuvant treatment in patients with clinical stages T1c (68.4%) or T2a (31.6%) disease. -Iodine and palladium implants were used in 583 and 7 patients, respectively. A real-time interactive implantation technique was used in all but the first 17 patients, who were treated using a preplanned technique. RESULTS: Of the 600 patients 19 (3.1%) underwent TURP after brachytherapy. Among the patients with acute urinary retention the median interval between prostate brachytherapy and urinary retention was 2 months (range 0.5 to 32). No TURP was done within 6 months after implant. The median interval between prostate brachytherapy and TURP was 7 months (range 6 to 41) and median prostate specific antigen (PSA) before TURP was 0.5 ng/ml (range 0.04 to 3.4). In the 19 patients the median weight of resected prostatic tissue was 8 gm (range 2 to 19) and 1 to 11 seeds were removed (median 5). The perioperative and postoperative courses were uneventful. There was no TURP related incontinence. With a median followup of 28 months after brachytherapy (range 7 to 48) no patient had clinical or biochemical evidence of disease progression, and for the group of 19 patients who underwent TURP median serum PSA at the end of followup was 0.38 ng/ml (range 0.03 to 3.4). CONCLUSIONS: After brachytherapy as monotherapy, TURP can be done safely if indicated. In our experience the resection of prostatic tissue along with a limited number of seeds at least 6 months after implantation did not impair PSA based biological and clinical results of brachy-therapy.

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