OBJECTIVE: Information on bladder cancer (BC) according to the risk scoring for recurrence or progression in a general population is scarce despite its clinical relevance. The objective was to describe the characteristics of incident BC in a general population, with a focus on the initial management of high-risk non-muscle invasive BC (HR-NMIBC).
METHODS: BC incident in 2011-2012 recorded in a population-based cancer registry were studied. Data was extracted from medical files. NMIBC were classified according to potential risk for recurrence/progression. Individual and tumor characteristics of incident BC were described. Incidence, initial management and survival (12/31/2021) of HR-NMIBC were assessed.
RESULTS: Among 538 BC cases, 380 were NMIBC [119 low (22.1%), 163 intermediate (30.3%), 98 high (18.2%) risk] and 147 (27.3%) were MIBC. HR-NMIBC diagnostic and therapeutic management [imaging, re-TUR, multidisciplinary team meetings (MDT) assessment, specific treatment] revealed discrepancies with guidelines recommendations. Seventy-two out of 98 cases were assessed in an MDT with a median time from diagnosis of 18days [first quartile: 12-third quartile: 32]. Globally, treatment agreed with MDT decisions. Intravesical instillation was the most common treatment (n=56) but 27 HR-NMIBC did not receive specific treatment after TUR. Five and 10years overall survival was 52% [42-63] and 41% [31-51], respectively. Five years net survival was 63% [47-75].
CONCLUSIONS: Despite National cancer plans aiming to improve care giving and despite the severity of HR-NMIBC, guideline-recommended patterns of care were underused in this region. This may deserve attention to identify obstacles to guideline adoption to try to improve BC patient care and survival.
METHODS:

OBJECTIVE: Stereotactic body radiation therapy has been used for prostate cancer. However, the bulk of published studies on stereotactic body radiation therapy for prostate cancer has involved the irradiation of the prostate alone, without irradiation of the pelvic lymph nodes. We report our preliminary experience with this approach.
METHODS: The files of patients with biopsy-proven prostate cancer treated with stereotactic body radiation therapy in our institution were reviewed. Stereotactic body radiation was delivered with intensity modulated-volumetric arctherapy with daily image-guidance. The prostate planning target volume included the prostate plus a margin of 5mm in all directions. The pelvic planning target volume included pelvic nodes plus an expansion of 6 to 7mm in all directions. The prostate planning target volume received a total dose of 36.25Gy delivered in five fractions on alternate days. The nodal planning target volume received a dose of 25Gy in the same five fractions. Patients were followed during treatment, after 1, and 3 months and every 6 months thereafter. Gastrointestinal and genitourinary toxicity was prospectively graded according to Common Terminology Criteria for Adverse Events.
RESULTS: Among the 188 patients, 80 received stereotactic body radiation to the prostate and the pelvic nodes, while 108 received stereotactic body radiation to the prostate target only. Grade 2 acute gastrointestinal toxicity was 4% in both groups, and grade 2 acute genitourinary toxicity was 27% and 20% (P=0.9) for prostate only versus prostate and pelvis respectively. There was no grade 3 or higher acute gastrointestinal or genitourinary toxicity.
CONCLUSIONS: Stereotactic body radiation therapy in five fractions including the prostate and pelvic nodes, in patients with high-risk prostate cancer, has been feasible and safe in terms of acute toxicity.

BACKGROUND: High risk localized and locally advanced forms are responsible for the vast majority of specific deaths from prostate cancer among non-metastatic diseases at diagnosis. No randomized study has yet been published to establish the best local treatment in terms of survival.
OBJECTIVE: Conduct a large-volume cohort study with long-term follow-up to analyze specific and overall survival outcomes after surgery.
METHODS: A single-center retrospective study of all patients operated on for localized high-risk and locally advanced prostate cancer was performed. Actuarial survival analyses and multivariate analyses were performed to discern predictive risk factors.
RESULTS: Five hundred patients were included. MRI stage was≥iT3a in 40.7% of cases and 50.2% of patients had a Gleason score≥8 on biopsy. The mean follow-up was 63.1 months. The overall, specific and biological recurrence-free survival were respectively 77.6%, 93.9% and 26.8% at 10 years. A PSA level≥20, a Gleason score on biopsy≥9 and a MRI stage≥iT3a were significantly associated with the 10-years biological recurrence risk.
CONCLUSIONS: This study shows very good long-term oncological results. In the absence of a randomized controlled trial, these results suggest the primary role of surgery in this indication and support the evolution of current practices. We pointed out very pejorative features that might help selection of the best candidates for surgical treatment.
METHODS:

BACKGROUND: The risk of recurrence is increased in localized high-risk prostate cancer (PCa). The implementation of an appropriate diagnostic and therapeutic strategy is essential. The objective of this update by the Prostate Committee of the French Association of Urology was to report the most recent data in the management of localized high-risk PCa.
METHODS: This update is based on the data available in the literature on localized high-risk PCa. A PubMed search and narrative review of the recent data were performed in March 2022.
RESULTS: Compared with conventional imaging, PET-PSMA is more effective for the diagnosis of lymph nodes and distant metastases. Two recent randomized clinical trials have failed to prove the oncologic benefit of extended pelvic lymph node dissection during radical prostatectomy (RP). Postoperatively, early salvage radiotherapy is the standard of care, with adjuvant radiotherapy becoming an option in case of unfavorable pathological criteria (ISUP 4-5, pT3±positive margins) in young patients. Although promising, perioperative systemic therapies (chemotherapy, second-generation hormonotherapy) cannot be recommended at this time when the patient is treated by RP. Regarding radiotherapy, prophylactic lymph node irradiation during prostatic irradiation was associated with improved biochemical and metastasis-free survival in a recent randomized trial but it is still controversial. Since the publication of the results of the STAMPEDE trial, the addition of abiraterone acetate to radiation-hormone therapy should be considered the new standard of care for patients with localized (very) high-risk PCa, according to the inclusion criteria of the study.
CONCLUSIONS: The most recent data of the literature regarding the management of high-risk localized PCa redefine the diagnostic performance of molecular imaging, the timing of postoperative radiotherapy, the oncologic benefit of pelvic lymph node treatment, and the intensification of systemic therapies.

Management of high-risk prostate cancers is still a subject of debate, because of the lack of randomized trial comparing surgery and radiotherapy. If external beam radiotherapy is proposed, it must be associated with a long-term androgen deprivation therapy, at least 18-months. Irradiation of pelvic lymph nodes seems to improve distant metastasis-free survival and is so indicated in most of the cases. Moderate hypofractionation is not validated for pelvic lymph nodes irradiation. A combination of external beam radiotherapy and brachytherapy improved biochemical control in randomized trials without impact on survival. But this combination has been evaluated in large retrospective studies and seems to improve specific and overall survivals. An integrated boost on the MRI-defined index lesion is another way of dose escalation and improved also biochemical control. Stereotactic radiotherapy is not a validated option at this moment. For each patient, according to the extension of the disease, age, comorbidities and also his willingness, the best approach must be chosen, ideally in multidisciplinary meeting.

The management of high-risk prostate cancer has greatly evolved in recent years. Advances in imaging helps to better define the actual aggressiveness of the disease, to plan the surgical procedure, and to improve the prognostic evaluation of this high-risk of recurrence disease. The information obtained by MRI and by targeted biopsies improves management before surgery. Advances in nuclear medicine and generalization of PSMA-PET scans are beginning to improve the initial stage of diagnosis, thanks to a better detection of lymph node and distant metastases. The oncological interest of these new imaging techniques, which then influence the therapeutic plan, remains to be defined. The curative impact of an extensive lymph node dissection, as currently recommended, remains to be proved, and recently published randomized trials do not provide firm conclusions. The new hormone therapies pave the way for an intensification of perioperative systemic treatment, with a significant action on the tumor tissue, but an impact on survival, which remains to be defined in the context of ongoing randomized trials.

Prostate cancer is a sensitive adenocarcinoma, in more than 80 % of cases, to chemical castration, due to its hormone dependence. Locally advanced and/or high-risk cancer is defined based on clinical stage, initial PSA value or high Gleason score. Hormone therapy associated with radiation therapy is the standard of management and improves local control, reduces the risk of distant metastasis and improves specific and overall survival. Duration of hormone therapy, dose level of radiation therapy alone or associated with brachytherapy are controversial data in the literature. Radical prostatectomy surgery is a therapeutic option that must be performed with extensive lymph node dissection and is often part of a multimodal care sequence. The therapeutic choice, multidisciplinary, depends on the age and co-morbidity of the patient, the prognostic criteria of the pathology and the urinary function of the patient. Current research focuses on optimizing local and distant control of these aggressive forms and incorporates neo-adjuvant or adjuvant chemotherapy and also new hormone therapies.

BACKGROUND: High-risk pulmonary embolism (PE) accounts for 5% of total acute PE and is a life-threatening emergency requiring immediate therapeutic management by fibrinolysis. The objective of this work is to describe the experience of thrombolysis in high-risk PE in a cardiology department in Togo.
METHODS: This is an analytical and descriptive study carried out in the cardiology department of the Campus teaching hospital of Lomé over a period of 5 years (August 2012 to July 2017) concerning patients hospitalized for high-risk mortality PE and having undergone streptokinase thrombolysis.
RESULTS: Twenty-eight of the 102 PE were at high risk of mortality (27.5%). They were 9 men and 19 women with an average age of 61.9±14.1 years. The mean systolic blood pressure was 65mmHg and 50% of the patients were placed on dobutamine. Thrombolysis was performed in 22 of the 28 patients (78.6%). Eighteen patients had a short protocol and 4 a long protocol. The mortality rate was 32.1% or 13.6% in the thrombolysis PE versus 100% in the non-thrombolysis PE (P=0.01). Causes of death in thrombolysis were persistent shock (2 cases) at the end of thrombolysis and sudden death occurred 1 month after hospitalization. The average hospital stay was 18.8 days.
CONCLUSIONS: The high-risk PE remains today a pathology burdened with heavy mortality. Thrombolysis remains the first treatment to reduce this mortality.

BACKGROUND: The role of radical prostatectomy (RP) in high-risk prostate cancer (PCa) is increasing.
OBJECTIVE: To review the existing literature and determine the value of RP in high-risk and locally advanced PCa.
UNASSIGNED: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from 01/2000 through 05/2016 according to the PRISMA guidelines.
METHODS: Forty-two studies describing outcomes of RP among 52,546 patients with high-risk and locally advanced PCa.
RESULTS: Mortality was approximately 0-1% and Clavien≥3 complications ranged from 1.8% to 12%. Biochemical recurrence-free and metastasis-free survival ranged from 40 to 94% and 90 to 96.1% at 5 years and from 27 to 68% and 64.4 to 85.1% at 10 years, respectively. Overall and cancer specific survival ranged from 55.2 to 98.6% and 89.8 to 100% at 5 years and from 58 to 84% and 65 to 96% at 10 years, respectively. The 12-mo continence rates ranged from 32% to 96.2% and the erectile function recovery ranged from 60% to 64%.
CONCLUSIONS: Studies were heterogeneous especially regarding the definition of high-risk disease and the use of adjuvant treatments.
CONCLUSIONS: The utilization of RP in high-risk and locally advanced PCa is increasing. Existing data support the advantages of RP in this group of patients. However, uniformity in definitions and indications are a prerequisite in order to establish its role as an important therapeutic arm in a multimodality management strategy.

OBJECTIVE: There are only few predictive factors for response of non-musculo-invasive bladder cancer (NMIBC) to Bacillus Calmette-Guérin (BCG) therapy. Our study analyzed the results of the sequencing of new generation (NGS) targeted on 50 genes of oncological interest obtained on bladder resection parts in high-risk NMIBC patients treated with BCG, to describe this population from a molecular point of view and try to correlate these results in patients who present or not recurrence after BCG.
METHODS: We reviewed 63 patients with high grade NMIBC treated between 2014 and 2016 with BCG after endoscopic resection. Each one had NGS analysis. Association tests between mutations detected by NGS and recurrence or progression were realized.
RESULTS: The 45 remaining patients were fully analysed. For 73% of cases a mutation has been found, most frequent one\'s being FGFR3, TP53 and PIK3CA. With a median follow-up of 24 months (4-40), recurrence was present in 15 patients (33.3%), with 10 NMIBC (22.2%) and 5 progressions to muscular-invasive cancer (11.1%). If some mutations were more frequent in different prognostic groups no significant association has been found. No patient presenting CIS had FGFR3 mutation (P<0.0001).
CONCLUSIONS: Next generation sequencing in NMIBC could be a supplementary aid in treatment decision making in the future. In an area where personalized medicine is rapidly growing in importance we need larger studies to define molecular characteristics in tumours to detect genomic associations between clinical phenotypes and recurrence or progression of the disease.
METHODS: 3.