Current Urology Reports

, Volume 13, Issue 2, pp 179–186

Radical Prostatectomy as Primary Treatment of High-risk Prostate Cancer

  • Alexandre Ingels
  • Alexandre de la Taille
  • Guillaume Ploussard
Prostate Cancer (R Reiter, Section Editor)

Abstract

High-risk prostate cancer (PCa), established according to the d’Amico criteria or other prognostic tools, remains very heterogeneous, including a third of patients with excellent prognosis in whom surgical treatment can result in long-term progression-free survival. In contrast, a substantial proportion of high risk will not be cured by local treatment alone and might benefit from a more aggressive multimodal adjuvant treatment strategy. However, to date, except in one adjuvant radiotherapy series, no neoadjuvant or adjuvant therapy has shown a survival improvement after radical prostatectomy for high-risk PCa. Recent observational studies tend to prove that radical prostatectomy may offer benefits over radiotherapy in disease-free and overall survival. However, good Level 1 evidence is lacking and further prospective studies are warranted to directly compare the outcomes of radical prostatectomy to combined radiation and hormonal therapy in high-risk patients.

Keywords

Prostate cancer Radical prostatectomy High-risk prostate cancer Outcomes Adjuvant Radiotherapy Adjuvant hormone therapy Treatment Combination therapy Gleason score Staging Radical prostatectomy 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Kattan MW, Wheeler TM, Scardino PT. Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol. 1999;17(5):1499–507.PubMedGoogle Scholar
  2. 2.
    Roehl KA, Han M, Ramos CG, Antenor JAV, Catalona WJ. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol. 2004;172(3):910–4.PubMedCrossRefGoogle Scholar
  3. 3.
    D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280(11):969–74.PubMedCrossRefGoogle Scholar
  4. 4.
    Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D. Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med. 1999;341(24):1781–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G, et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006;7(6):472–9.PubMedCrossRefGoogle Scholar
  6. 6.
    McLeod DG, Iversen P, See WA, Morris T, Armstrong J, Wirth MP. Bicalutamide 150 mg plus standard care vs standard care alone for early prostate cancer. BJU Int. 2006;97(2):247–54.PubMedCrossRefGoogle Scholar
  7. 7.
    Kibel AS, Rosenbaum E, Kattan MW, Picus J, Dreicer R, Klein EA, et al. Adjuvant weekly docetaxel for patients with high risk prostate cancer after radical prostatectomy: a multi-institutional pilot study. J Urol. 2007;177(5):1777–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Thompson IM, Carroll PR, Carducci MA. Recommendations for defining and treating high risk localized prostate cancer. J Urol. 2006;176(6 Pt 2):S6–10. quiz S3–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Donohue JF, Bianco Jr FJ, Kuroiwa K, Vickers AJ, Wheeler TM, Scardino PT, et al. Poorly differentiated prostate cancer treated with radical prostatectomy: long-term outcome and incidence of pathological downgrading. J Urol. 2006;176(3):991–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Yossepowitch O, Eggener SE, Bianco Jr FJ, Carver BS, Serio A, Scardino PT, et al. Radical prostatectomy for clinically localized, high risk prostate cancer: critical analysis of risk assessment methods. J Urol. 2007;178(2):493–9. discussion 499.PubMedCrossRefGoogle Scholar
  11. 11.
    Ward JF, Slezak JM, Blute ML, Bergstralh EJ, Zincke H. Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int. 2005;95(6):751–6.PubMedCrossRefGoogle Scholar
  12. 12.
    D’Amico AV, Moul J, Carroll PR, Sun L, Lubeck D, Chen M-H. Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol. 2003;21(11):2163–72.PubMedCrossRefGoogle Scholar
  13. 13.
    D’Amico AV, Chen M-H, Roehl KA, Catalona WJ. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med. 2004;351(2):125–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Scardino P. Update: NCCN prostate cancer Clinical Practice Guidelines. J Natl Compr Canc Netw. 2005;3 Suppl 1:S29–33.PubMedGoogle Scholar
  15. 15.
    Clark PE, Peereboom DM, Dreicer R, Levin HS, Clark SB, Klein EA. Phase II trial of neoadjuvant estramustine and etoposide plus radical prostatectomy for locally advanced prostate cancer. Urology. 2001;57(2):281–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 1999;281(17):1591–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ, Dotan ZA, DiBlasio CJ, et al. Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol. 2005;23(28):7005–12.PubMedCrossRefGoogle Scholar
  18. 18.•
    Nguyen CT, Reuther AM, Stephenson AJ, Klein EA, Jones JS. The specific definition of high risk prostate cancer has minimal impact on biochemical relapse-free survival. J Urol. 2009;181(1):75–80. This study showed that biochemical recurrence-free survival following radiotherapy did not vary significantly based on six different definitions.PubMedCrossRefGoogle Scholar
  19. 19.
    Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, et al. EAU guidelines on prostate cancer. Eur Urol. 2008;53(1):68–80.PubMedCrossRefGoogle Scholar
  20. 20.
    Meng MV, Elkin EP, Latini DM, Duchane J, Carroll PR. Treatment of patients with high risk localized prostate cancer: results from cancer of the prostate strategic urological research endeavor (CaPSURE). J Urol. 2005;173(5):1557–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Bastian PJ, Gonzalgo ML, Aronson WJ, Terris MK, Kane CJ, Amling CL, et al. Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative Gleason sum of 8 to 10. Cancer. 2006;107(6):1265–72.PubMedCrossRefGoogle Scholar
  22. 22.
    Carver BS, Bianco Jr FJ, Scardino PT, Eastham JA. Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer. J Urol. 2006;176(2):564–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Freedland SJ, Partin AW, Humphreys EB, Mangold LA, Walsh PC. Radical prostatectomy for clinical stage T3a disease. Cancer. 2007;109(7):1273–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Spahn M, Joniau S, Gontero P, Fieuws S, Marchioro G, Tombal B, et al. Outcome predictors of radical prostatectomy in patients with prostate-specific antigen greater than 20 ng/ml: a European multi-institutional study of 712 patients. Eur Urol. 2010;58(1):1–7. discussion 10–1.PubMedCrossRefGoogle Scholar
  25. 25.
    Loeb S, Schaeffer EM, Trock BJ, Epstein JI, Humphreys EB, Walsh PC. What are the outcomes of radical prostatectomy for high-risk prostate cancer? Urology. 2010;76(3):710–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Ploussard G, Salomon L, Allory Y, Terry S, Vordos D, Hoznek A, et al. Pathological findings and prostate-specific antigen outcomes after laparoscopic radical prostatectomy for high-risk prostate cancer. BJU Int. 2010;106(1):86–90.PubMedCrossRefGoogle Scholar
  27. 27.
    • Ploussard G, Masson-Lecomte A, Beauval J-B, Ouzzane A, Bonniol R, Buge F, et al. Radical prostatectomy for high-risk prostate cancer defined by preoperative criteria: oncologic follow-up in national multicenter study in 813 patients and assessment of easy-to-use prognostic substratification. Urology. 2011;78(3):607–13. This is one of the largest retrospective studies of outcomes for high-risk prostate cancer after RP.PubMedCrossRefGoogle Scholar
  28. 28.
    van den Ouden D, Hop WC, Schröder FH. Progression in and survival of patients with locally advanced prostate cancer (T3) treated with radical prostatectomy as monotherapy. J Urol. 1998;160(4):1392–7.PubMedCrossRefGoogle Scholar
  29. 29.
    •• Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol. 2011;59(1):88–95. This nationwide retrospective study from the United Stated emphasized that disease-specific mortality was lowest in the RP group than in the EBR or observational groups.PubMedCrossRefGoogle Scholar
  30. 30.
    •• Cooperberg MR, Vickers AJ, Broering JM, Carroll PR. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010;116(22):5226–34. This is a second study revealing a significant benefit of RP versus EBR or ADT in high-risk prostate cancer patients.PubMedCrossRefGoogle Scholar
  31. 31.
    Briganti A, Joniau S, Gontero P, Abdollah F, Passoni NM, Tombal B, et al. Identifying the best candidate for radical prostatectomy among patients with high-risk prostate cancer. European Urology [Internet]. 2011 Dec 2 [cited 2012 Jan 6];Available from: http://www.ncbi.nlm.nih.gov/pubmed/22153925.
  32. 32.
    Zelefsky MJ, Eastham JA, Cronin AM, Fuks Z, Zhang Z, Yamada Y, et al. Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol. 2010;28(9):1508–13.PubMedCrossRefGoogle Scholar
  33. 33.
    Boorjian SA, Karnes RJ, Viterbo R, Rangel LJ, Bergstralh EJ, Horwitz EM, et al. Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer. Cancer. 2011;117(13):2883–91.PubMedCrossRefGoogle Scholar
  34. 34.
    Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet. 2005;366(9485):572–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, et al. Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA. 2006;296(19):2329–35.PubMedCrossRefGoogle Scholar
  36. 36.
    Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Störkel S, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 2009;27(18):2924–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Morgan SC, Waldron TS, Eapen L, Mayhew LA, Winquist E, Lukka H. Adjuvant radiotherapy following radical prostatectomy for pathologic T3 or margin-positive prostate cancer: a systematic review and meta-analysis. Radiother Oncol. 2008;88(1):1–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Zincke H, Lau W, Bergstralh E, Blute ML. Role of early adjuvant hormonal therapy after radical prostatectomy for prostate cancer. J Urol. 2001;166(6):2208–15.PubMedCrossRefGoogle Scholar
  39. 39.
    Dorff TB, Flaig TW, Tangen CM, Hussain MHA, Swanson GP, Wood DP, et al. Adjuvant androgen deprivation for high-risk prostate cancer after radical prostatectomy: SWOG S9921 study. J Clin Oncol. 2011;29(15):2040–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Petrylak DP, Tangen CM, Hussain MHA, Lara PN, Jones JA, Taplin ME, et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med. 2004;351(15):1513–20.PubMedCrossRefGoogle Scholar
  41. 41.
    Loeb S, Roehl KA, Viprakasit DP, Catalona WJ. Long-term rates of undetectable PSA with initial observation and delayed salvage radiotherapy after radical prostatectomy. Eur Urol. 2008;54(1):88–94.PubMedCrossRefGoogle Scholar
  42. 42.
    Trock BJ, Han M, Freedland SJ, Humphreys EB, DeWeese TL, Partin AW, et al. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA. 2008;299(23):2760–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Song DY, Thompson TL, Ramakrishnan V, Harrison R, Bhavsar N, Onaodowan O, et al. Salvage radiotherapy for rising or persistent PSA after radical prostatectomy. Urology. 2002;60(2):281–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Ploussard G, Agamy MA, Alenda O, Allory Y, Mouracade P, Vordos D, et al. Impact of positive surgical margins on prostate-specific antigen failure after radical prostatectomy in adjuvant treatment-naïve patients. BJU Int. 2011;107(11):1748–54.PubMedCrossRefGoogle Scholar
  45. 45.
    Wirth MP, Weissbach L, Marx F-J, Heckl W, Jellinghaus W, Riedmiller H, et al. Prospective randomized trial comparing flutamide as adjuvant treatment versus observation after radical prostatectomy for locally advanced, lymph node-negative prostate cancer. Eur Urol. 2004;45(3):267–70. discussion 270.PubMedCrossRefGoogle Scholar
  46. 46.
    Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009;181(3):956–62.PubMedCrossRefGoogle Scholar
  47. 47.
    Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351(15):1502–12.PubMedCrossRefGoogle Scholar
  48. 48.
    Sokoloff MH, Rinker-Schaeffer CW, Chung LWK, Brendler CB. Adjunctive therapy for men with high risk localized and locally advanced prostate cancer: targeting disseminated tumor cells. J Urol. 2004;172(6 Pt 2):2539–44.PubMedCrossRefGoogle Scholar
  49. 49.
    Cetnar JP, Malkowicz SB, Palmer SC, Wein AJ, Vaughn DJ. Pilot trial of adjuvant paclitaxel plus estramustine in resected high-risk prostate cancer. Urology. 2008;71(5):942–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Montgomery B, Lavori P, Garzotto M, Lee K, Brophy M, Thaneemit-Chen S, et al. Veterans Affairs Cooperative Studies Program study 553: Chemotherapy after prostatectomy, a phase III randomized study of prostatectomy versus prostatectomy with adjuvant docetaxel for patients with high-risk, localized prostate cancer. Urology. 2008;72(3):474–80.PubMedCrossRefGoogle Scholar
  51. 51.
    Ploussard G, Paule B, Salomon L, Allory Y, Terry S, Vordos D, et al. 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. Prostate Cancer Prostatic Dis. 2010;13(1):97–101.PubMedCrossRefGoogle Scholar
  52. 52.
    Kumar S, Shelley M, Harrison C, Coles B, Wilt TJ, Mason MD. Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer. Cochrane Database Syst Rev. 2006;4:CD006019.PubMedGoogle Scholar
  53. 53.
    Shelley MD, Kumar S, Wilt T, Staffurth J, Coles B, Mason MD. A systematic review and meta-analysis of randomised trials of neo-adjuvant hormone therapy for localised and locally advanced prostate carcinoma. Cancer Treat Rev. 2009;35(1):9–17.PubMedCrossRefGoogle Scholar
  54. 54.
    Klotz LH, Goldenberg SL, Jewett MA, Fradet Y, Nam R, Barkin J, et al. Long-term followup of a randomized trial of 0 versus 3 months of neoadjuvant androgen ablation before radical prostatectomy. J Urol. 2003;170(3):791–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Womble PR, VanVeldhuizen PJ, Nisbet AA, Reed GA, Thrasher JB, Holzbeierlein JM. A phase II clinical trial of neoadjuvant ketoconazole and docetaxel chemotherapy before radical prostatectomy in high risk patients. J Urol. 2011;186(3):882–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Shepard DR, Dreicer R, Garcia J, Elson P, Magi-Galluzzi C, Raghavan D, et al. Phase II trial of neoadjuvant nab-paclitaxel in high risk patients with prostate cancer undergoing radical prostatectomy. J Urol. 2009;181(4):1672–7. discussion 1677.PubMedCrossRefGoogle Scholar
  57. 57.
    Vuky J, Porter C, Isacson C, Vaughan M, Kozlowski P, Picozzi V, et al. Phase II trial of neoadjuvant docetaxel and gefitinib followed by radical prostatectomy in patients with high-risk, locally advanced prostate cancer. Cancer. 2009;115(4):784–91.PubMedCrossRefGoogle Scholar
  58. 58.
    Chi KN, Chin JL, Winquist E, Klotz L, Saad F, Gleave ME. Multicenter phase II study of combined neoadjuvant docetaxel and hormone therapy before radical prostatectomy for patients with high risk localized prostate cancer. J Urol. 2008;180(2):565–70. discussion 570.PubMedCrossRefGoogle Scholar
  59. 59.
    Pilepich MV, Winter K, Lawton CA, Krisch RE, Wolkov HB, Movsas B, et al. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma–long-term results of phase III RTOG 85–31. Int J Radiat Oncol Biol Phys. 2005;61(5):1285–90.PubMedCrossRefGoogle Scholar
  60. 60.
    Mason M, Warde P, Sydes M, Cowan R, James N, Kirkbride P, et al. Defining the need for local therapy in locally advanced prostate cancer: an appraisal of the MRC PR07 study. Clin Oncol (R Coll Radiol). 2005;17(4):217–8.CrossRefGoogle Scholar
  61. 61.
    Widmark A, Klepp O, Solberg A, Damber J-E, Angelsen A, Fransson P, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009;373(9660):301–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Horwitz EM, Bae K, Hanks GE, Porter A, Grignon DJ, Brereton HD, et al. Ten-year follow-up of radiation therapy oncology group protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol. 2008;26(15):2497–504.PubMedCrossRefGoogle Scholar
  63. 63.
    Bolla M, de Reijke TM, Van Tienhoven G, Van den Bergh ACM, Oddens J, Poortmans PMP, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med. 2009;360(24):2516–27.PubMedCrossRefGoogle Scholar
  64. 64.
    Zelefsky MJ, Yamada Y, Kollmeier MA, Shippy AM, Nedelka MA. Long-term outcome following three-dimensional conformal/intensity-modulated external-beam radiotherapy for clinical stage T3 prostate cancer. Eur Urol. 2008;53(6):1172–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff R-O, Storme G, et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol. 2010;11(11):1066–73.PubMedCrossRefGoogle Scholar
  66. 66.
    Zurlo A, Collette L, van Tienhoven G, Blank L, Warde P, Dubois J, et al. Acute toxicity of conventional radiation therapy for high-risk prostate cancer in EORTC trial 22863. Eur Urol. 2002;42(2):125–32.PubMedCrossRefGoogle Scholar
  67. 67.
    Hamstra DA, Bae K, Pilepich MV, Hanks GE, Grignon DJ, McGowan DG, et al. Older age predicts decreased metastasis and prostate cancer-specific death for men treated with radiation therapy: meta-analysis of radiation therapy oncology group trials. Int J Radiat Oncol Biol Phys [Internet]. 2011 Mar 31;Available from: http://www.ncbi.nlm.nih.gov/pubmed/21458924.
  68. 68.
    Widmark A, Klepp O, Solberg A, Damber J-E, Angelsen A, Fransson P, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009;373(9660):301–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Van Poppel H, Vekemans K, Da Pozzo L, Bono A, Kliment J, Montironi R, et al. Radical prostatectomy for locally advanced prostate cancer: results of a feasibility study (EORTC 30001). Eur J Cancer. 2006;42(8):1062–7.PubMedCrossRefGoogle Scholar
  70. 70.
    Loeb S, Smith ND, Roehl KA, Catalona WJ. Intermediate-term potency, continence, and survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer. Urology. 2007;69(6):1170–5.PubMedCrossRefGoogle Scholar
  71. 71.
    Studer UE, Whelan P, Albrecht W, Casselman J, de Reijke T, Hauri D, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer (EORTC) Trial 30891. J Clin Oncol. 2006;24(12):1868–76.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Alexandre Ingels
    • 1
  • Alexandre de la Taille
    • 1
  • Guillaume Ploussard
    • 1
    • 2
  1. 1.Department of UrologyAPHP, CHU Henri MondorCréteilFrance
  2. 2.INSERM U955CréteilFrance

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