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Gobbo A, Fasulo V, Contieri R, Uleri A, Avolio PP, Frego N, Lughezzani G, Saitta C, Taverna G, Zanoni M, Mancon S, Colombo P, Valeri M, Saita A, Lazzeri M, Buffi NM, Hurle R, Casale P. Clinical and pathological predictors of persistent T1 HG at second resection. Urologia 2023:3915603231181619. [PMID: 37341094 DOI: 10.1177/03915603231181619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND T1 high-grade (HG) non-muscle invasive bladder cancer (NMIBC) has a significant risk of recurrence and progression, and the European Association of Urology recommends a second transurethral resection of the bladder (ReTUR). Stage at ReTUR has been shown to be a reliable predictor of survival, therefore, we sought to assess clinical and pathological predictors associated with the persistence of T1 at ReTUR in our retrospective multicentric cohort. METHODS This is a retrospective multicentric study of T1 HG patients at transurethral resection of the bladder (TURB) who underwent subsequent ReTUR. All histological samples were sub-classified according to Rete Oncologica Lombarda (ROL) T1 sub-staging system. RESULTS One hundred and sixty-six patients were enrolled. Forty-four (26.5%) had T1 HG tumor at ReTUR while 93 (56%) had residual tumor of any stage. Lesion size was significantly greater in T1 HG patients at ReTUR, as well as the prevalence of multifocality. The multivariable logistic regression model showed lesion dimension and multifocality as predictors of T1 HG at ReTUR, after adjusting for significant covariables (CIS and detrusor muscle presence). ROL sub-staging system was not a significant predictor, but ROL2 prevalence was higher in the T1 HG at ReTUR group. CONCLUSIONS Lesion size and multifocality were independent predictors of T1 HG persistence at ReTUR, and patients at risk should be promptly identified and treated accordingly. Our results could help physicians make patient-tailored decisions by identifying those most likely to benefit from a second resection.
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Chiancone F, Persico F, Fabiano M, Meccariello C, Giannella R, Fedelini M, Lughezzani G, Fedelini P. Comparison of laparoscopic versus open simple nephrectomy in patients with xanthogranulomatous pyelonephritis: A singlecenter analysis of outcomes and predictors of surgical approaches and complications. Curr Urol 2023; 17:135-140. [PMID: 37691987 PMCID: PMC10489480 DOI: 10.1097/cu9.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to compare the outcomes of open simple nephrectomy and laparoscopic simple nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) in a single-institutional retrospective study and to identify predictive factors of surgical approaches and complications. Materials and methods We retrospectively analyzed the data of 67 consecutive patients with a histopathological diagnosis of XGP who underwent either open simple nephrectomy (ON) or laparoscopic simple nephrectomy (LN) from January 2014 to April 2020. The primary endpoint was the evaluation of perioperative outcomes and complications. Secondary endpoints were to define factors influencing the surgical approach and the likelihood of postoperative complications. Results Overall, 44 out of 67 patients (65.67%) underwent ON, while 23 (34.33%) underwent LN. Patients in the ON group experienced more postoperative pain according to the visual analogic scale (p = 0.032). Moreover, time to deambulation and time to return to full daily activities, assessed according to the 12-Item Short Form Survey physical and mental component summary scores questionnaires, were significantly shorter in the LN group (p = 0.021, p < 0.001, and p < 0.001, respectively). Of note, there were no significant differences in intraoperative and postoperative complication rates among the groups (p = 0.258 and p = 0.317, respectively). No conversion to open surgery was described. Logistic regression analysis demonstrated that urgency (p = 0.025) was the only predictor associated with a higher risk of intraoperative complications. However, no independent factors associated with postoperative complications or with the surgical approach of choice were found. Conclusions Based on our results, laparoscopic treatment of XGP represents a feasible alternative to ON, resulting in less postoperative pain and faster recovery. In skilled hands, LN should be considered as the treatment of choice for XGP.
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Saitta C, De Simone I, Fasulo V, Corbetta M, Duga S, Chiereghin C, Colombo FS, Benetti A, Contieri R, Avolio PP, Uleri A, Saita A, Guazzoni GF, Hurle R, Colombo P, Buffi NM, Casale P, Lughezzani G, Asselta R, Soldà G, Lazzeri M. Evaluation of Semen Self-Sampling Yield Predictors and CTC Isolation by Multi-Color Flow Cytometry for Liquid Biopsy of Localized Prostate Cancer. Cancers (Basel) 2023; 15:2666. [PMID: 37345004 DOI: 10.3390/cancers15102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 06/23/2023] Open
Abstract
Liquid biopsy (LB) for prostate cancer (PCa) detection could represent an alternative to biopsy. Seminal fluid (SF) is a source of PCa-specific biomarkers, as 40% of ejaculate derives from the prostate. We tested the feasibility of an SF-based LB by evaluating the yield of semen self-sampling in a cohort of >750 patients with clinically localized PCa. The overall SF collection yield was 18.2% (39% when considering only compliant patients), with about a half of the patients (53.15%) not consenting to SF donation. Independent favorable predictors for SF collection were younger age and lower prostate volume. We implemented a protocol to enrich prostate-derived cells by multi-color flow cytometry and applied it on SF and urine samples from 100 patients. The number of prostate-enriched cells (SYTO-16+ PSMA+ CD45-) was variable, with higher numbers of cells isolated from SF than urine (p value < 0.001). Putative cancer cells (EpCAMhigh) were 2% of isolated cells in both specimens. The fraction of EpCAMhigh cells over prostate-enriched cells (PSMA+) significantly correlated with patient age in both semen and urine, but not with other clinical parameters, such as Gleason Score, ISUP, or TNM stage. Hence, enumeration of prostate-derived cells is not sufficient to guide PCa diagnosis; additional molecular analyses to detect patient-specific cancer lesions will be needed.
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Frego N, Labban M, Stone BV, Koelker M, Alkhatib K, Lughezzani G, Buffi NM, Lipsitz SR, Weissman JS, Fletcher SA, Kibel AS, Trinh QD, Cole AP. Effect of type of definitive treatment on race-based differences in prostate cancer-specific survival. Prostate 2023. [PMID: 37150867 DOI: 10.1002/pros.24552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Racial and ethnic disparities in prostate cancer (PCa) mortality are partially mediated by inequities in quality of care. Intermediate- and high-risk PCa can be treated with either surgery or radiation, therefore we designed a study to assess the magnitude of race-based differences in cancer-specific survival between these two treatment modalities. METHODS Non-Hispanic Black (NHB) and non-Hispanic White (NHW) men with localized intermediate- and high-risk PCa, treated with surgery or radiation between 2004 and 2015 in the Surveillance, Epidemiology and End Results database were included in the study and followed until December 2018. Unadjusted and adjusted survival analyses were employed to compare cancer-specific survival by race and treatment modality. A model with an interaction term between race and treatment was used to assess whether the type of treatment amplified or attenuated the effect of race/ethnicity on prostate cancer-specific mortality (PCSM). RESULTS 15,178 (20.1%) NHB and 60,225 (79.9%) NHW men were included in the study. NHB men had a higher cumulative incidence of PCSM (p = 0.005) and were significantly more likely to be treated with radiation than NHW men (aOR: 1.89, 95% CI: 1.81-1.97, p < 0.001). In the adjusted models, NHB men were significantly more likely to die from PCa compared with NHW men (aHR: 1.18, 95% CI: 1.03-1.35, p = 0.014), and radiation was associated with a significantly higher odds of PCSM (aHR: 2.10, 95% CI: 1.85-2.38, p < 0.001) compared with surgery. Finally, the interaction between race and treatment on PCSM was not significant, meaning that no race-based differences in PCSM were found within each treatment modality. CONCLUSIONS NHB men with intermediate- and high-risk PCa had a higher rate of PCSM than NWH men in a large national cancer registry, though NHB and NHW men managed with the same treatment achieved similar PCa survival outcomes. The higher tendency for NHB men to receive radiation was similar in magnitude to the difference in cancer survival between racial and ethnic groups.
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Maffei D, Fasulo V, Avolio PP, Saitta C, Paciotti M, De Carne F, Colombo P, Pasini L, De Zorzi SZ, Saita A, Hurle R, Lazzeri M, Guazzoni GF, Casale P, Buffi NM, Lughezzani G. Diagnostic performance of Micro-Ultrasound at MRI-guided confirmatory biopsy in patients under active surveillance for low-risk prostate cancer. Prostate 2023; 83:886-895. [PMID: 36960788 DOI: 10.1002/pros.24532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/22/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Active surveillance (AS) represents a standard of care of low-risk prostate cancer (PCa). However, identification and monitoring of AS candidates remains challenging. Micro-ultrasound (microUS) is a novel high-resolution imaging modality for transrectal ultrasonography (TRUS). We explored the impact of microUS TRUS and targeted biopsies in mpMRI-guided confirmatory biopsies. METHODS Between October 2017 and September 2021 we prospectively enrolled 100 patients scheduled for MRI-guided confirmatory biopsy at 1 year from diagnosis of ISUP 1 PCa. TRUS was performed using the ExactVu microUS system; PRI-MUS protocol was applied to identify suspicious lesions (i.e. PRIMUS score ≥3). All patients received targeted biopsies of any identified microUS and mpMRI lesions and complementary systematic biopsies. The proportion of patients upgraded to clinically significant PCa (defined as ISUP≥2 cancer; csPCa) at confirmatory biopsies was determined, and the diagnostic performance of microUS and mpMRI were compared. RESULTS 92 patients had a suspicious MRI lesion classified PI-RADS 3, 4 and 5 in respectively 28, 16 and 18 patients. MicroUS identified 82 patients with suspicious lesions, classified as PRI-MUS 3, 4 and 5 in respectively 20, 50 and 12 patients, while 18 individuals had no lesions. 34 patients were upgraded to ISUP≥2 cancer and excluded from AS. MicroUS and mpMRI showed a sensitivity of 94.1% and 100% and a NPV of 88.9% and 100% respectively in detecting ISUP≥2 patients. A microUS-mandated protocol would have avoided confirmatory biopsies in 18 patients with no PRI-MUS ≥3 lesions at the cost of missing 4 upgraded patients. CONCLUSIONS MicroUS and mpMRI represent valuable imaging modalities showing high sensitivity and NPV in detecting csPCa, thus allowing their use for event-triggered confirmatory biopsies in AS patients. MicroUS offers an alternative imaging modality to mpMRI for the identification and real-time targeting of suspicious lesions in AS patients. This article is protected by copyright. All rights reserved.
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Buffi N, Uleri A, Paciotti M, Lughezzani G, Casale P, Diana P, DE Groote R, Sarchi L, Mottaran A, Bravi C, DE Backer P, Amparore D, Fiori C, Porpiglia F, Mottrie A. Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses. Minerva Urol Nephrol 2023; 75:223-230. [PMID: 36847584 DOI: 10.23736/s2724-6051.23.05161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Patients with multiple ipsilateral renal masses have an augmented risk of metachronous contralateral lesions and are likely to undergo repeated surgeries. We report our experience with the technologies currently available and the surgical techniques to preserve healthy parenchyma while guaranteeing oncological radicality during robot-assisted partial nephrectomy (RAPN). METHODS The data were collected at three tertiary-care centers, where 61 patients with multiple ipsilateral renal masses were treated with RAPN between 2012 and 2021. RAPN was performed with da Vinci Si or Xi surgical system using TilePro (Life360; San Francisco, CA, USA), indocyanine green fluorescence and intraoperative ultrasound. Three-dimensional reconstructions were built in some cases preoperatively. Different techniques were employed for hilum management. The primary endpoint is to report intra- and postoperative complications. Secondary endpoints were the estimated blood loss (EBL), warm ischemia time (WIT) and positive surgical margins (PSM) rate. RESULTS Median preoperative size of the largest mass was 37.5 mm (24-51) with a median PADUA and R.E.N.A.L. score of 8 (7-9) and 7 (6-9). One hundred forty-two tumors were excised, with a mean number of 2.32. The median WIT was 17 (12-24) minutes, and the median EBL was 200 (100-400) mL. Intraoperative ultrasound was employed in 40 (67.8%) patients. The rate of early unclamping, selective clamping and zero-ischemia were respectively 13 (21.3%), 6 (9.8%) and 13 (21.3%). ICG fluorescence was employed in 21 (34.42%) patients and three-dimensional reconstructions were built in 7 (11.47%) patients. Three (4.8%) intraoperative complications occurred, all classified as grade-1 according to EAUiaiC. Postoperative complications were reported in 14 (22.9%) cases with 2 Clavien-Dindo grade >2 complications. Four (6.56%) patients had PSM. Mean period of follow-up was 21 months. CONCLUSIONS In experienced hands, with the employment of the currently available technologies and surgical techniques, RAPN can guarantee optimal outcomes in patients with multiple ipsilateral renal masses.
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Paciotti M, Alkhatib KY, Nguyen DD, Yim K, Lipsitz SR, Mossanen M, Casale P, Pierorazio PM, Kibel AS, Trinh QD, Buffi NM, Lughezzani G, Cole AP. Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy? Cancers (Basel) 2023; 15:cancers15051373. [PMID: 36900166 PMCID: PMC10000204 DOI: 10.3390/cancers15051373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75-0.88; p < 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88; p = 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86; p < 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38; p = 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04; p = 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (p < 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.
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Lazzeri M, Fasulo V, Buffi N, Lughezzani G, Casale P, Benetti A, Saita A, Hurle R, Guazzoni GF, Chiarelli G, Asselta R, Soldà G. Awareness of genetic risk for prostate cancer (PCa) in men from families with germline mutations in DNA-repair genes. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
328 Background: Although one of the most important risk factors for prostate cancer (PCa) is a family history of the disease, there is a poor awareness of genetic risk. The aim of the current study is to investigate the awareness of genetic risk for PCa in men belonging to female families with germline variants in DNA-repair genes (DRGs). Methods: Data were extracted by a prospective observational study designed to select men with germline pathogenic variants (PVs) and offer them a dedicated PCa screening. The selection of probands was performed by genetic counseling and testing of male grade I relatives of female patients with a PVs. Male candidates were identified after reviewing the genealogical trees of all women who had received the diagnosis of breast and/or ovarian cancer and tested positive for a PVs. All the probands, 35-69 yrs old, who resulted positive for PVs were offered to participate to a specific PCa screening based on annually digital rectal examination (DRE), detection of PHI, which is a blood test including total PSA, free PSA, free/total PSA and -2proPSA, and multiparametric MRI. The primary outcome was the “willing to be tested”, defined as a proxy for male awareness of PCa risk. The secondary endpoint was the acceptance rate to be screened. Results: We reviewed the genealogical trees of breast/ovarian cancer female patients from January 2017 to December 2021 and we identified, over 1256 families, 139 positive cases for PVs in DRGs. Among 139 families, we identified 378 “healthy” 35-69 yrs old men, who were offered a genetic counseling, and if they agree a genetic testing. Overall 117/378 (31%) healthy males declared to be interested to be tested. Out of the 51 new tests (66 men already tested out of the study), we found 30 (58.8%) positive men. All the new positive tested men accepted to attend the PCa screening. Living in Northern Italy, having at least one child and higher (degree) level of education were the strongest predictors of willing for testing (p<0.01). Conclusions: Our data reveals a limited will to be tested, but all men tested positive for PVs accepted to participate to the PCa screening. These findings strongly support the urgent need to implement awareness of genetic risk for PCa.
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Lazzeri M, Rescigno M, Guazzoni GF, Casale P, Buffi N, Lughezzani G, Mancon S, Fasulo V, Saita A, Hurle R. Randomized phase III clinical trial of neoadjuvant intravesical mitomycin C (MMC) treatment in patients with primary treatment-naïve non-muscle invasive bladder cancer (NMIBC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.tps578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
TPS578 Background: Approximately 75-85% of vesical urothelial carcinomas are non-muscle invasive bladder cancers (NMIBC). The primary treatment is transurethral resection (TUR) followed by adjuvant intravesical therapies with immunotherapy (BCG) and/or chemotherapy agents (i.e. mitomycin C - MMC). Unfortunately, the response to intravesical treatments is variable and incomplete and there is a un-met clinical need to improve its efficacy for reducing the recurrence rate and progression to muscle invasive BC (MIBC). Recently, has been showed that MMC induces immunogenic cell death (ICD), determining the expression of specific damage signals, like HMGB1 molecule, that favors the phagocytosis of dying tumor cells, the activation of innate immune cells and the presentation of tumor antigens to T lymphocytes [1]. The identification of ICD as a novel immune-related mechanism of action of MMC could provide opportunities to optimize bladder cancer management by proposing the use of MMC in a “neoadjuvant” setting. The aim of current clinical trial is to test the hypothesis that the neoadjuvant instillation of MMC in patients with NMIBC may reduce the recurrence rate and/or progression to MIBC. Methods: This is a prospective phase III randomized clinical trial in patients with primary treatment-naïve NMIBC recruiting since March 2022 (EudraCT 2021-003751-42_studio ICH-013-MMC). Patients are randomized 1:1 to neo-adjuvant MMC or standard of care. Patients enrolled in the neo-MMC group receive two intravesical instillations of MMC (40 mg/40 ml saline) in the 2 weeks before (days: -14 and -7) the scheduled TUR (day: 0). After TUR, as for clinical practice, both controls and neoMMC subjects, undergo adjuvant treatment, if required, based on the histological evaluation of the tumor and following EAU/PMID: 33040478 guidelines. The primary endpoint of the study is to evaluate the efficacy of MMC neoadjuvant treatment in reducing the recurrence rate of BC calculated as the proportion of patients who achieve a complete response (no evidence of BC after 3, 6, 12 and 24 mo.). The secondary clinical endpoint will be the analysis of the rate of grade and stage progression to MIBC in case of recurrence and the correlation with specific biomarker (i.e. expression of HMGB1). Consider that the primary aim of the study is to see a reduction of relapse, leading to an HR of 0.6, estimating on the control group a 30% relapse free at 12 months. With equal-sized group, a two-sided significance level test (α =0.05) with power 80% power (β=0.2), and assume that recruitment was to be terminated after 12 months, with a 2-year follow up, the required sample size is approximate 160 patient, 80 in each group (control / neoMMC). References: 1. Oresta B, et al Sci Transl Med. Jan 6;13(575):eaba6110 Clinical trial information: EudraCT 2021-003751-42_studio ICH-013 (MMC) .
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Arena P, Fasulo V, Chiarelli G, Frego N, De Carne F, Maffei D, Jandric J, Gelardi F, Garofano G, Saitta C, Mancon S, Sordelli F, Beatrici E, Hurle R, Saita A, Lazzeri M, Guazzoni G, Buffi N, Lughezzani G, Casale P. Prospective evaluation of the diagnostic accuracy of different PSMA PET/CT tracers for the nodal staging of radical prostatectomy candidates: A single institutional analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Pandini M, Carriero R, Buffi N, Carvetta M, Iovino M, Casale P, Lughezzani G, Hurle R, Alberto S, Fasulo V, Guazzoni G, Elefante G, Colombo P, Basso G, Marchini S, Kunderfranco P, Di Mitri D, Lazzeri M. Single cell-based immune profiling of the tumor and its immune microenvironment revealed differences between non-muscle invasive and muscle invasive bladder cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Frego N, Maffei D, Fasulo V, Paciotti M, Diana P, Avolio P, Chiarelli G, Arena P, Beatrici E, De Carne F, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Is micro-ultrasound a reliable tool for prostate cancer diagnosis? results from a single-institution cohort of over 1,000 men. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Contieri R, Martini A, Beatrici E, Frego N, Diana P, Paciotti M, Mancon S, Lazzeri M, Saita A, Lughezzani G, Buffi N, Casale P, Kamat A, Hurle R. Implementing the Active Surveillance (AS) follow-up schedule for low-grade Non- Muscle-Invasive Bladder Cancer (NMIBC) tumors. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Avolio P, Fasulo V, Maffei D, Saitta C, Frego N, Paciotti M, Contieri R, De Carne F, Lazzeri M, Saita A, Hurle R, Casale P, Buffi N, Lughezzani G. Clinical and high-resolution micro-ultrasound risk factors for detecting clinically significant prostate cancer in men with PI-RADS 3 lesions: Update from a large single center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Paciotti M, Diana P, Gaglioli A, De Groote R, Farinha R, Ficarra V, Gaston R, Gontero P, Hurle R, Martínez-Piñeiro L, Minervini A, Pansadoro V, Van Cleynenbreugel B, Wiklund P, Casale P, Lughezzani G, Mancon S, Uleri A, Mottrie A, Palou J, Gallagher A, Breda A, Buffi N. International experts consensus on performance metrics for a transurethral resection of bladder (TURB). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Zanoni M, Chiarelli G, Arena P, Clementi M, Mazzieri C, Vota P, Toia G, Casale P, Lughezzani G, Buffi N, Taverna G. Thulium laser enucleation (ThuLEP) versus transurethral prostate resection (TURP): Impact on erectile function. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Frego N, De Carne F, Fasulo V, Maffei D, Avolio P, Arena P, Chiarelli G, Beatrici E, Paciotti M, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Head-to-head comparison between microUS, the partin tables and memorial sloan kettering cancer center nomogram in predicting extraprostatic disease in patients undergoing robot-assisted radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Chiarelli G, Fasulo V, Zuradelli M, Arena P, Beatrici E, Gobbo A, Saitta C, Hurle R, Saita A, Maura F, Asselta R, Soldà G, Casale P, Guazzoni G, Lughezzani G, Buffi N, Lazzeri M. A dedicated screening for early detection of prostate cancer in men with germline mutations in DNA-repair genes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Avolio P, Fasulo V, Maffei D, Frego N, Paciotti M, Lazzeri M, Saita A, Hurle R, Casale P, Buffi N, Lughezzani G. Impact of a structured rehabilitation program on the functional outcomes of patients undergoing robot-assisted radical prostatectomy: A single tertiary-care center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00540-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Frego N, Chiarelli G, Fasulo V, Maffei D, Arena P, Avolio P, Beatrici E, Paciotti M, De Carne F, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Comparison of the diagnostic performance between multiparametric MRI and microUS in the detection of clinically significance prostate cancer among patients with previous negative biopsy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Buffi N, Paciotti M, Gallagher AG, Diana P, De Groote R, Lughezzani G, Gallioli A, Casale P, Palou J, Mottrie A, Breda A. European training in urology (ENTRY): quality-assured training for European urology residents. BJU Int 2023; 131:177-178. [PMID: 36337002 PMCID: PMC10099734 DOI: 10.1111/bju.15928] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fasulo V, Arena P, Chiarelli G, De Carne F, Garofano G, Maffei D, Gelardi F, Jandric J, Sordelli F, Frego N, Mancon S, Avolio P, Saitta C, Saita A, Hurle R, Casale P, Lazzeri M, Buffi N, Lughezzani G. Comparison of the diagnostic accuracy of PSMA PET/CT scan and Briganti nomogram to predict lymph node invasion in candidates to robot-assisted radical prostatectomy: A single institutional analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lopci E, Lazzeri M, Disconzi L, Maffei D, Fasulo V, Avolio P, Paciotti M, Pasini L, Benetti A, Hurle R, Saita A, Colombo P, Marzo K, Leonardi L, Balzarini L, Chiti A, Guazzoni G, Casale P, Buffi N, Lughezzani G. Prospective comparison of PSMA PET/CT vs. mpMRI in patients with a high suspicion of prostate cancer and previously negative biopsy: Preliminary data from PROSPET-BX trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lopci E, Lazzeri M, Colombo P, Casale P, Buffi NM, Saita A, Peschechera R, Hurle R, Marzo K, Leonardi L, Morenghi E, Balzarini L, Disconzi L, Guazzoni G, Chiti A, Lughezzani G. Diagnostic Performance and Clinical Impact of PSMA PET/CT versus mpMRI in Patients with a High Suspicion of Prostate Cancer and Previously Negative Biopsy: A Prospective Trial (PROSPET-BX). Urol Int 2023; 107:433-439. [PMID: 36724746 DOI: 10.1159/000528720] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND This prospective single-arm study is designed to compare in parallel 68Ga-PSMA PET/TRUS (transrectal or transperineal) fusion biopsy ("experimental test") with multiparametric MRI (mpMRI)/TRUS fusion prostate biopsy ("standard test") in men with a high suspicion of prostate cancer (PCa) after at least one negative biopsy. The primary objective was to evaluate the diagnostic performance of 68Ga-PSMA PET/TRUS fusion prostate biopsy in comparison to mpMRI/TRUS fusion prostate biopsy analyzed in parallel. Secondarily, we aimed to determine the relationship between the "experimental test" and the histopathological characteristics of the specimen, along with the clinical utility of the "experimental test" compared to the "standard test." SUMMARY To test the superiority of 68Ga-PSMA PET/CT compared to mpMRI, we will enroll a minimum cohort of 128 patients. Inclusion criteria comprise: age >18 years; blood PSA level >4.0 ng/mL; free-to-total PSA ratio <20%; progressive rise of PSA levels in two consecutive blood samples despite antibiotics; serum blood tests suspicious for PCa; at least one previous negative biopsy; ASAP and/or high-grade PIN; negative digital rectal examination. All eligible patients will undergo 68Ga-PSMA PET/CT and mpMRI scans within 1 month's distance from each other, followed by biopsy session to be completed within 1 month's distance. Targeted TRUS fusion needle biopsy will be performed for all lesions detected with PET and mpMRI. The total duration of the study is 36 months. KEY MESSAGES By comparing the "experimental test" and the "standard test" in parallel, we will be able to determine the superior diagnostic performance of 68Ga-PSMA PET/CT over mpMRI in detecting PCa, and in particular clinically significant PCa, in the specific cohort of patients with a high suspicion of PCa who are candidates to re-biopsy. The clinical impact of the "experimental test" will be subsequently analyzed in terms of the number of prostate biopsies that could be spared, time-consuming, patient friendliness, and cost-effectiveness.
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Avolio PP, Lazzeri M, Buffi NM, Lughezzani G. Micro-ultrasound may significantly reduce the proportion of unnecessary prostate biopsies in patients with PI-RADS 3 lesions. Cancer 2023; 129:320-321. [PMID: 36427000 DOI: 10.1002/cncr.34549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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