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Lozano-Lorca M, Barrios-Rodríguez R, Redondo-Sánchez D, Cózar JM, Arrabal-Martín M, García-Caballos M, Salcedo-Bellido I, Sánchez MJ, Jiménez-Moleón JJ, Olmedo-Requena R. Health-related quality of life in patients newly diagnosed with prostate cancer: CAPLIFE study. Qual Life Res 2023; 32:977-988. [PMID: 36409391 PMCID: PMC10063519 DOI: 10.1007/s11136-022-03302-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To analyse the Health-Related Quality of Life (HRQoL) at diagnosis of patients with prostate cancer (PCa) according to tumour extension and urinary symptomatology and to explore factors associated with HRQoL. METHODS 408 Controls and 463 PCa cases were included. Eligibility criteria were a new diagnosis of PCa (cases), 40-80 years of age, and residence in the participating hospitals' coverage area for ≥ 6 months before recruitment. HRQoL was evaluated using the 12-Item Short-Form Health Survey, Mental (MCS) and Physical Component Summaries (PCS), and urinary symptoms with the International Prostate Symptom Score. HRQoL scores for all PCa cases, according to tumour extension and urinary symptoms, were compared with controls. In addition, information about lifestyles and comorbidities was collected and its association with low HRQoL (lower scores) were explored using logistic regression models. RESULTS Overall cases had similar PCS score, but lower MCS score than controls. The lowest standardised scores for both PCS and MCS were reached by cases with severe urinary symptoms and a metastatic tumour [mean (SD); PCS: 41.9 (11.5), MCS: 42.3 (10.3)]. Having "below" PCS and MCS scores was associated with the presence of three or more comorbidities in the cases [aOR = 2.86 (1.19-6.84) for PCS and aOR = 3.58 (1.37-9.31) for MCS] and with severe urinary symptomatology [aOR = 4.71 (1.84-12.08) for PCS and aOR = 7.63 (2.70-21.58) for MCS]. CONCLUSION The mental dimension of HRQoL at diagnosis of patients with PCa was lower than in controls, especially for cases with severe urinary symptoms and a metastatic tumour. Comorbidities and urinary symptoms were variables associated with the HRQoL of PCa cases.
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Affiliation(s)
- Macarena Lozano-Lorca
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18014, Granada, Spain
| | - Rocío Barrios-Rodríguez
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18014, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
| | - Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18014, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
- Andalusian School of Public Health (EASP), Campus Universitario de Cartuja, C/Cuesta del Observatorio 4, 18080, Granada, Spain
| | - José-Manuel Cózar
- Urology Department, Virgen de las Nieves University Hospital, 18014, Granada, Spain
| | | | - Marta García-Caballos
- Cartuja Primary Health Care Centre, Distrito Sanitario Granada-Metropolitano, 18013, Granada, Spain
| | - Inmaculada Salcedo-Bellido
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18014, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
| | - María-José Sánchez
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18014, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
- Andalusian School of Public Health (EASP), Campus Universitario de Cartuja, C/Cuesta del Observatorio 4, 18080, Granada, Spain
| | - José-Juan Jiménez-Moleón
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18014, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
| | - Rocío Olmedo-Requena
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, 18016, Granada, Spain.
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18014, Granada, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain.
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Inflammation and Prostate Cancer: Pathological Analysis from Pros-IT CNR 2. Cancers (Basel) 2023; 15:cancers15030630. [PMID: 36765589 PMCID: PMC9913270 DOI: 10.3390/cancers15030630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Extensive research effort has been devoted to investigating the link between inflammation and PCa. However, this relationship remains unclear and controversial. The aim of our multi-center study was to investigate this association by histologically evaluating the distribution of PI and PCA in prostate biopsy cores from patients of eight referral centers in Italy. RESULTS We evaluated 2220 cores from 197 patients; all the frustules were re-evaluated by dedicated pathologists retrospectively. Pathologists assigned IRANI scores and determined the positions of PIs; pathologists also re-evaluated the presence of PCa and relative ISUP grade. PCa was recorded in 749/2220 (33.7%). We divided this sample into a PCa PI group (634/749 cores [84.7%]) and a non-PCa + PI group (1157/1471 cores [78.7%]). We observed a statistically significant difference in the presence of inflammation among cores with cancer (p < 0.01). Moreover, periglandular inflammation was higher in the cores with neoplasia, while stromal inflammation was higher in cores without neoplasia (38.5% vs. 31.1% and 55.4% vs. 63.5% p < 0.01). CONCLUSIONS In our experience, there is evidence of an association between PI and PCa at a tissue level. Further studies are needed to confirm our findings and to identify patients who might benefit from target therapies to prevent PCa occurrence and/or progression.
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Patient-Factors Influencing the 2-Year Trajectory of Mental and Physical Health in Prostate Cancer Patients. Curr Oncol 2022; 29:8244-8260. [PMID: 36354711 PMCID: PMC9689299 DOI: 10.3390/curroncol29110651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
This study aimed to examine the physical and mental Quality of Life (QoL) trajectories in prostate cancer (PCa) patients participating in the Pros-IT CNR study. QoL was assessed using the Physical (PCS) and Mental Component Score (MCS) of Short-Form Health Survey upon diagnosis and two years later. Growth mixture models were applied on 1158 patients and 3 trajectories over time were identified for MCS: 75% of patients had constantly high scores, 13% had permanently low scores and 12% starting with low scores had a recovery; the predictors that differentiated the trajectories were age, comorbidities, a family history of PCa, and the bowel, urinary and sexual functional scores at diagnosis. In the physical domain, 2 trajectories were defined: 85% of patients had constantly high scores, while 15% started with low scores and had a further slight decrease. Two years after diagnosis, the psychological and physical status was moderately compromised in more than 10% of PCa patients. For mental health, the trajectory analysis suggested that following the compromised patients at diagnosis until treatment could allow identification of those more vulnerable, for which a level 2 intervention with support from a non-oncology team supervised by a clinical psychologist could be of help.
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Banno T, Nakamura K, Kaneda Y, Ozaki A, Kouchi Y, Ohira T, Shimmura H. Detection rate and variables associated with incidental prostate cancer by holmium laser enucleation of the prostate. Int J Urol 2022; 29:860-865. [PMID: 35584916 DOI: 10.1111/iju.14917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/17/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Holmium laser enucleation of the prostate is well-established and effective for bladder outlet obstruction due to benign prostatic hyperplasia. The objective of this study was to examine the detection rate of incidental prostate cancer by holmium laser enucleation of the prostate and variables associated with them. METHODS A total of 612 patients were enrolled. We retrospectively examined the detection rate of incidental prostate cancer and perioperative variables associated with them. RESULTS Forty-nine of 612 patients were diagnosed with incidental prostate cancer. Univariate logistic regression analysis showed that higher prostate-specific antigen density (odds ratio 3.34, 95% confidence interval 1.02-10.94, P = 0.05), higher prostate-specific antigen density of the transition zone (odds ratio 2.28, 95% confidence interval 1.02-5.09, P = 0.04), and findings of the prostate cancer on magnetic resonance imaging (peripheral zone: odds ratio 4.71, 95% confidence interval 1.70-13.1, P = 0.003; transition zone: odds ratio 3.46, 95% confidence interval 1.74-6.86, P < 0.001; peripheral and transition zones: odds ratio 6.00, 95% confidence interval 1.51-23.8, P = 0.01) were significantly associated with incidental prostate cancer. Multivariate logistic regression analysis showed that findings of the prostate cancer on magnetic resonance imaging (peripheral zone: odds ratio 4.36, 95% confidence interval 1.49-12.8, P = 0.001; transition zone: odds ratio 3.54, 95% confidence interval 1.75-7.16, P < 0.001; peripheral and transition zones: odds ratio 6.14, 95% confidence interval 1.53-24.5, P = 0.01) was an independent risk factor for incidental prostate cancer. CONCLUSION The detection rate of incidental prostate cancer was 8.0%, and findings of the prostate cancer on magnetic resonance imaging were an independent predictive factor for incidental prostate cancer.
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Affiliation(s)
- Taro Banno
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Kazutaka Nakamura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yukiko Kouchi
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
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Trinh L, Sabiston CM, Alibhai SMH, Jones JM, Arbour-Nicitopoulos KP, Mina DS, Campbell K, Faulkner GE. A distance-based, randomized controlled trial for reducing sedentary behavior among prostate cancer survivors: a study protocol. BMC Public Health 2022; 22:855. [PMID: 35484523 PMCID: PMC9047476 DOI: 10.1186/s12889-022-13218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Prostate cancer survivors (PCS) experience long-term side effects beyond treatment such as fatigue, depression and anxiety. Quality and engaging supportive care programs are needed to reduce these chronic and debilitating effects. Independent of physical activity (PA), high volumes of sedentary behavior (SB) are associated with chronic disease-related risk factors and poorer cancer-specific quality of life (QoL). Simultaneously increasing PA and decreasing SB may be an effective health promotion strategy. Given that PCS may face several barriers to engaging in supervised programs, there is a need to develop and assess the efficacy of interventions that employ distance-based approaches for behavior change. The primary aim of this study is to determine the effects of a 12-week intervention (Fitbit + behavioral counselling) vs. Fitbit-only control group in reducing SB among PCS. Secondary outcomes include light-intensity PA, QoL, motivational outcomes, and patient satisfaction. Methods This two-armed, randomized controlled trial will recruit inactive PCS (stage I-IV) across Canada who self-report engaging in >8 hours/day of SB. Participants will be randomized to the intervention (n=60; Fitbit and behavioral support) or active control group (n=60; Fitbit-only). The intervention consists of the use of a Fitbit and a series of six behavioral support sessions (two group, four individual) to aid PCS in gradually replacing SB with light-intensity PA by increasing their daily step counts to 3,000 steps above their baseline values. The Fitbit-only control condition will receive a Fitbit and public health PA resources. The primary outcome is change in SB measured objectively using activPAL inclinometers. All secondary outcomes will be measured via self-report, except for PA which will be measuring using Fitbits. Data will be collected at baseline, post-intervention, and at 6-month post-intervention. Discussion Reducing SB and increasing light-intensity PA plays an important, yet often undervalued role in the health and well-being of PCS. This study will create a unique distance-based platform that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for PCS. Trial Registration ClinicalTrials.gov Identifier NCT05214937. Registered January 28, 2022 Protocol version: v.1
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Affiliation(s)
- Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada.
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | - Shabbir M H Alibhai
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.,Toronto General Research Institute, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada
| | - Kelly P Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | - Kristin Campbell
- Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Guy E Faulkner
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada
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Akin-Odanye EO, Ogo CN, Sulaiman FA, Suleiman L, Ogunsanya ME, Odedina FT. Examining the influence of illness perception and financial toxicity on the quality of life of prostate cancer patients. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00173-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
Cancer of the prostate (CaP) is a public health problem that affects the male genitourinary system causing a significant threat to men’s quality of life (QoL). Experiencing financial constraints and poor illness perception may further compromise the QoL of men with CaP.
Methods
Aim: To examine the relationship between financial toxicity and illness perception with quality of life in men with CaP. The descriptive cross-sectional study used simple random sampling technique to recruit 173 men with CaP from four tertiary health facilities in Nigeria. Data were collected with the comprehensive score for financial toxicity (COST-FACIT), the brief illness perception questionnaire (Brief IPQ) and the functional assessment of cancer therapy-prostate (FACT-P). Analysis of data was carried out using analysis of variance, correlation and hierarchical regression analyses.
Results
The 173 participants had an average age of 71.57 ± 11.18, and 53.18% had one comorbid disease. Significant difference was found in overall QoL based on treatment site and number of comorbid diseases (P < 0.01). QoL had a significant inverse relationship with all the illness perception variables and a significant linear relationship with lower financial toxicity (P < 0.01). Furthermore, financial toxicity (P < 0.05) and four illness perception variables: consequences, identity, concern and illness understanding (P < 0.01), had significant individual influences on QoL of men with CaP.
Conclusions
Quality of life in men with CaP may be improved through mitigating the financial toxicity associated with accessing care and providing appropriate counseling about the illness and what to expect following prostate cancer diagnosis and during treatment.
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D'Agostino D, Colicchia M, Corsi P, Romagnoli D, Del Rosso A, Modonutti D, Busetto GM, Ferro M, Schiavina R, Molinaroli E, Artibani W, Porreca A. The combination of waterjet ablation (Aquabeam ®) and holmium laser power for treatment of symptomatic benign prostatic hyperplasia: early functional results. Cent European J Urol 2021; 74:222-228. [PMID: 34336242 PMCID: PMC8318024 DOI: 10.5173/ceju.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to assess the short-term functional outcomes and the efficacy of hemostasis performed with holmium laser performed following prostatic hydroablation with the Aquabeam® system. Material and methods Between June 2019 and July 2020, 53 consecutive patients underwent Aquabeam® with our modified hemostasis approach with holmium laser. The following standard preoperative assessments were retrospectively recorded: prostate volume; International Prostate Symptom Score (IPSS) and Quality of Life (IPSS-QoL); uroflowmetry including Qmax and post void residual volume (PVR). Results Fifty-three patients consecutively underwent aquablation and holmium laser hemostasis. Median age at surgery, median prostate-specific antigen (PSA) and median prostate volume were 62 years (IQR: 57-66), 2.95 ng/ml (IQR: 1.6-4.8) and 55 ml (IQR: 43-65), respectively.Median operative time was 60 minutes (IQR: 40-80). Median catheterization time and length of hospital stay were 2 days (IQR: 1-3) for both parameters. The median hemoglobin decrease between the preoperative values and those assessed on the second day was equal to 1.25 g/dl (IQR: 0.7-1.85).Continence rate was 100% at catheter removal. Thirty-six patients (72%) reported anterograde ejaculation preservation. IPSS (6, 3-21) and Qmax (19, 9-26) changed dramatically between baseline and 3 months follow-up. Conclusions The combination of Aquabeam® and holmium laser energy for hemostasis is a safe, reproducible technique to relieve moderate lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) while preserving ejaculation in younger and sexually active individuals. The short-term results showed a lower rate of complications; the encouraging functional results confirm that this can be a valid surgical approach for treatment of BPH.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Michele Colicchia
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Alessandro Del Rosso
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Daniele Modonutti
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | | | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Riccardo Schiavina
- Department of Urology, Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Enrico Molinaroli
- Department of Urology, Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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Impact of Gastrointestinal Side Effects on Patients' Reported Quality of Life Trajectories after Radiotherapy for Prostate Cancer: Data from the Prospective, Observational Pros-IT CNR Study. Cancers (Basel) 2021; 13:cancers13061479. [PMID: 33806994 PMCID: PMC8004900 DOI: 10.3390/cancers13061479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy (RT) represents an important therapeutic option for the treatment of localized prostate cancer. The aim of the current study is to examine trajectories in patients' reported quality of life (QoL) aspects related to bowel function and bother, considering data from the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study, analyzed with growth mixture models. Data for patients who underwent RT, either associated or not associated with androgen deprivation therapy, were considered. QoL outcomes were assessed over a 2-year period from the diagnosis, using the Italian version of the University of California Los Angeles-Prostate Cancer Index (Italian-UCLA-PCI). Three trajectories were identified for the bowel function; having three or more comorbidities and the use of 3D-CRT technique for RT were associated with the worst trajectory (OR = 3.80, 95% CI 2.04-7.08; OR = 2.17, 95% CI 1.22-3.87, respectively). Two trajectories were identified for the bowel bother scores; diabetes and the non-Image guided RT method were associated with being in the worst bowel bother trajectory group (OR = 1.69, 95% CI 1.06-2.67; OR = 2.57, 95% CI 1.70-3.86, respectively). The findings from this study suggest that the absence of comorbidities and the use of intensity modulated RT techniques with image guidance are related with a better tolerance to RT in terms of bowel side effects.
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Ergani B, Ozbilen MH, Yalcın MY, Boyacıoglu H, Ilbey YO. The effect of the type of surgery performed due to prostate cancer on preoperative patient anxiety, a prospective study. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:88-95. [PMID: 33816697 PMCID: PMC8012827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Anxiety level in prostate cancer patients is common due to the increase in the incidence of prostate cancer diagnosis. We aimed to search for answers to the following questions such as whether there is preoperative anxiety in patients who will be operated for prostate cancer, what are the risk factors that may cause disease-induced anxiety and the type of surgery especially does robotic surgery reduce patient anxiety. METHOD The patients who were taken into operation were divided into 2 groups as Open Radical Retropubic Prostatectomy-Group 1 and Robot-Assisted Laparoscopic Radical Prostatectomy-Group 2. Age, active surveillance history, preoperative prostate spesific antigen (PSA) level, prostate biopsy pathology result, time between prostate biopsy and operation, state and trait anxiety scores of these patients were recorded. RESULT The study was conducted with a total of 149 patients; 61 patients in Group 1 and 88 patients in Group 2. The presence of active surveillance history, time between prostate biopsy and operation and state and trait anxiety levels were not found to be significant between both groups. However, it was concluded that the patients in Group 2 were significantly younger and operated with lower PSA and Gleason scores. The type of surgery had no effect on anxiety levels. CONCLUSION Preoperative information about the surgical procedure was found to be an effective factor in reducing anxiety. Regardless of the type of surgery we recommend that patients' anxiety should be reduced by explaining the surgical procedure to patients enough and in a way that they can understand.
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Affiliation(s)
| | - Mert Hamza Ozbilen
- University of Health Sciences Tepecik Training and Research Hospital Urology ClinicIzmir, Turkey
| | - Mehmet Yigit Yalcın
- University of Health Sciences Tepecik Training and Research Hospital Urology ClinicIzmir, Turkey
| | - Hayal Boyacıoglu
- Ege University Faculty of Science, Department of StatisticsIzmir, Turkey
| | - Yusuf Ozlem Ilbey
- University of Health Sciences Tepecik Training and Research Hospital Urology ClinicIzmir, Turkey
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Palumbo C, Bruni A, Antonelli A, Artibani W, Bassi P, Bertoni F, Borghetti P, Bracarda S, Cicchetti A, Corvò R, Gacci M, Ingrosso G, Magrini SM, Maruzzo M, Mirone V, Montironi R, Muto G, Noale M, Porreca A, Russi E, Triggiani L, Tubaro A, Valdagni R, Maggi S, Conti GN. Health-related quality of life 24 months after prostate cancer diagnosis: an update from the Pros-IT CNR prospective observational study. Minerva Urol Nephrol 2021; 74:11-20. [PMID: 33439570 DOI: 10.23736/s2724-6051.20.04032-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study analyzes patient health-related quality of life (QoL) 24-month after prostate cancer (PCa) diagnosis within the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study. METHODS Pros-IT CNR is an ongoing, longitudinal and observational study, considering a convenience sample of patients enrolled at PCa diagnosis and followed at 6, 12, 24, 36, 48 and 60 months from the diagnosis. Patients were grouped according to the treatment received: nerve sparing radical prostatectomy (NSRP), non-nerve sparing radical prostatectomy (NNSRP), radiotherapy (RT), RT plus androgen deprivation (RT plus ADT) and active surveillance (AS). QoL was measured through the Italian versions of SF-12 and UCLA-PCI questionnaires at diagnosis and at 6-12 and 24-month. The minimal clinically important difference (MCID) was defined as half a standard deviation of the baseline domain. RESULTS Overall, 1537 patients were included in the study. The decline in urinary function exceeded the MCID at each timepoint only in the NSRP and NNSRP groups (at 24 months -14.7, P<0.001 and -19.7, P<0.001, respectively). The decline in bowel function exceeded the MCID only in the RT (-9.1, P=0.02) and RT plus ADT groups at 12 months (-10.3, P=0.001); after 24 months, most patients seem to recover their bowel complaints. The decline in sexual function exceeded the MCID at each timepoint in the NNSRP, NSRP and RT plus ADT groups (at 6 months -28.7, P<0.001, -37.8, P<0.001, -20.4, P<0.001, respectively). CONCLUSIONS Although all the treatments were relatively well-tolerated over the 24 month period following PCa diagnosis, each had a different impact on QoL.
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Affiliation(s)
- Carlotta Palumbo
- Department of Urology, Maggiore della Carità Hospital, Novara, Italy
| | - Alessio Bruni
- Unit of Radiotherapy, University Hospital of Modena, Modena, Italy
| | | | | | - Pierfrancesco Bassi
- Department of Urology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Filippo Bertoni
- Prostate Group of the Italian Association for Radiation Oncology (AIRO), Milan, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | | | | | - Renzo Corvò
- Department of Radiation Oncology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Mauro Gacci
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianluca Ingrosso
- Section of Radiation Oncology, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
| | - Stefano M Magrini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, United Hospitals, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo University Hospital, Turin, Italy
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy -
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Elvio Russi
- Department of Radiotherapy, S. Croce e Carle Teaching Hospital, Cuneo, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Andrea Tubaro
- Unit of Urology, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
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11
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Gacci M, Greco I, Artibani W, Bassi P, Bertoni F, Bracarda S, Briganti A, Carmignani G, Carmignani L, Conti GN, Corvò R, DE Nunzio C, Fusco F, Graziotti P, Maggi S, Magrini SM, Mirone V, Montironi R, Muto G, Noale M, Pecoraro S, Porreca A, Ricardi U, Russi E, Salonia A, Simonato A, Serni S, Tubaro A, Zagonel V, Crepaldi G. The waiting time for prostate cancer treatment in Italy: analysis from the PROS-IT CNR Study. Minerva Urol Nephrol 2020; 74:38-48. [PMID: 33200896 DOI: 10.23736/s2724-6051.20.03925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate cancer (PCa) is the second most common neoplasm in male patients. To date, there's no certain indication about the maximum waiting time (WT) acceptable for treatment beginning and the impact on oncological and functional outcomes has not been well established. METHODS Data from the National Research Council PCa monitoring multicenter project in Italy (Pros-IT CNR) were prospectively collected and analyzed. WT was defined as the time from the bioptical diagnosis of PCa to the first treatment received. Patients were divided in two groups, using a time frame of 90 days. Quality of life was measured through the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and of the Short-Form Health Survey (SF-12). The occurrence of upgrading, upstaging, presence of lymph node metastasis and positive surgical margins at the final histopathological diagnosis, and PSA at 12 months follow-up were evaluated. RESULTS The overall median WT was 93 days. The logistic multivariable model confirmed that age, being resident in Southern regions of Italy and T staging at diagnosis were significantly associated with a WT>90 days. At 6 months from diagnosis the mean SF-12 score for the emotional-psychological component was significantly lower in WT≥90 days group (P=0.0428). Among patients treated with surgical approach, no significant differences in oncological outcomes were found in the two groups. CONCLUSIONS In our study age, clinical T stage and provenance from Southern regions of Italy are associated with a WT>90 days. WT might have no impact on functional and oncological outcome.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy -
| | - Isabella Greco
- Department of Urology, University of Florence, Florence, Italy
| | - Walter Artibani
- Urologic Clinic, Department of Oncological and Surgical Sciences, AOU Integrata and University of Verona, Verona, Italy
| | | | - Filippo Bertoni
- Italian Association for Radiation Oncology (AIRO), Milan, Italy
| | | | - Alberto Briganti
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Luca Carmignani
- Department of Urology, San Donato Policlinic Hospital, Milan, Italy
| | | | - Renzo Corvò
- Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Ferdinando Fusco
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | - Stefania Maggi
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
| | - Stefano M Magrini
- Radiation Oncology Unit, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas, Gradenigo Hospital, Turin, Italy
| | - Marianna Noale
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
| | | | - Angelo Porreca
- Department of Urology, Abano Terme General Hospital, Padua, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Elvio Russi
- Radiation Unit, San Croce e Carle Hospital, Cuneo, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alchiede Simonato
- Section of Urology, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Florence, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Vittorina Zagonel
- Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Gaetano Crepaldi
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
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12
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How radical prostatectomy procedures have changed over the last 10 years in Italy: a comparative analysis based on more than 1500 patients participating in the MIRROR-SIU/LUNA and the Pros-IT CNR study. World J Urol 2020; 39:1445-1452. [PMID: 32740803 DOI: 10.1007/s00345-020-03350-5] [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: 04/22/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. METHODS The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). RESULTS The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. CONCLUSIONS PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.
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D'Agostino D, Casablanca C, Mineo Bianchi F, Corsi P, Romagnoli D, Giampaoli M, Fiori C, Schiavina R, Brunocilla E, Artibani W, Porreca A. The role of magnetic resonance imaging-guided biopsy for diagnosis of prostate cancer; comparison between FUSION and "IN-BORE" approaches. Minerva Urol Nephrol 2020; 73:90-97. [PMID: 32456413 DOI: 10.23736/s2724-6051.20.03550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the present study is to evaluate the difference in terms of feasibility and detection rate of two magnetic resonance imaging (MRI) guided biopsy approaches (MRI fusion versus "in-bore" MRI) in a single tertiary center. METHODS We retrospectively identified 297 patients with suspected prostate cancer who underwent MRI based target prostate biopsy (FUSION or "in-bore" approaches) between January 2016 and January 2018 in a single tertiary center. RESULTS Lesion site (peripheral vs. central) and localization (anterior vs. posterior) were equally comparable among two groups, but maximum diameter of multiparametric-MRI Index lesion was slightly superior in the in-bore MRI-GB group (14 vs. 12 mm, P=0.002). Mean random biopsy cores taken were 11.2±2.1, with 1.3±2 positive cores in FUSION-GB group. Mean number of targeted biopsy cores taken was significantly superior in the FUSION-GB group as compared to the in-bore MRI-GB group (2.6±0.7 vs.1.7±1, P<0.001), whereas mean number of positive targeted biopsy cores was comparable between two groups (1±1.3 vs.1±0.9, P=0.1). 70 (45.5%) and 75 (52.8%) patients had positive targeted bioptic cores at pathologic examination among FUSION-GB and in-bore MRI-GB groups, respectively (P=0.2). Bioptical ISUP grade was also comparable among two groups (P=0.2) in multivariate analysis PI-RADS Score (OR=3.04 and OR=8.32 for PI-RADS 4 and 5, respectively) and PSA density (OR=2.69) were identified as independent predictors of positive targeted cores at histological examination (P<0.001 and P=0.01, respectively). CONCLUSIONS In-bore MRI-GB approaches represent a promising technique that may offer some advantages compared to standard systematic FUSION-GB despite higher costs of in bore-procedure. Our experience, although not showing a clear advantage between the FUSION technique and the "in-bore" technique, resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of prostate especially in a subgroup of patient with clinically significant disease. Further investigations are needed in order to identify the best approach for MRI-GB.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy -
| | | | | | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
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Alitto AR, Tagliaferri L, Lancellotta V, D'Aviero A, Piras A, Frascino V, Catucci F, Fionda B, Staackmann C, Saldi S, Valentini V, Kovacs G, Aristei C, Mantini G. BIT-ART: Multicentric Comparison of HDR-brachytherapy, Intensity-modulated Radiotherapy and Tomotherapy for Advanced Radiotherapy in Prostate Cancer. In Vivo 2020; 34:1297-1305. [PMID: 32354922 PMCID: PMC7279807 DOI: 10.21873/invivo.11905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM The aim of the study was to evaluate acute and late genitourinary (GU) and gastrointestinal (GI) toxicity in patients with high- or intermediate-risk prostate cancer. PATIENTS AND METHODS We evaluated data of patients from three Radiation Oncology Departments (Rome, Lübeck and Perugia). Patients treated in Rome underwent exclusive intensity-modulated-radiotherapy (IMRT) or IMRT plus high-dose-rate interventional radiotherapy (HDR-IRT). IMRT plus two fractions HDR-IRT was performed in Lübeck, while in Perugia Helical Tomotherapy was performed. The Common Toxicity Criteria for Adverse Event (Version 4.03) scale was used to describe acute and late toxicity. RESULTS At a median follow-up of 28 months, all 51 patients were alive and disease-free. Patients treated by HDR-IRT plus VMAT showed only G1-2 genitourinary- gastrointestinal (GU-GI) acute and late toxicity. Univariate analysis showed a lower risk of acute GU toxicity (p=0.048) in IMRT+HDR-IRT. CONCLUSION Low grade and less acute GU toxicity was observed in patients undergoing HDR-IRT boost.
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Affiliation(s)
- Anna Rita Alitto
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | | | | | - Vincenzo Frascino
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Catucci
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Bruno Fionda
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Christian Staackmann
- Interdisciplinary Brachytherapy Unit, University of Lübeck - University Hospital S-H, Campus Lübeck, Lübeck, Germany
| | - Simonetta Saldi
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gyorgy Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck - University Hospital S-H, Campus Lübeck, Lübeck, Germany
- Università Cattolica del Sacro Cuore, Educational Program Director Gemelli-INTERACTS, Rome, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Giovanna Mantini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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15
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D'Agostino D, Romagnoli D, Giampaoli M, Bianchi FM, Corsi P, Del Rosso A, Schiavina R, Brunocilla E, Artibani W, Porreca A. "In-Bore" MRI-Guided Prostate Biopsy for Prostate Cancer Diagnosis: Results from 140 Consecutive Patients. Curr Urol 2020; 14:22-31. [PMID: 32398993 DOI: 10.1159/000499264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/04/2019] [Indexed: 12/26/2022] Open
Abstract
Objectives Transrectal ultrasound-guided biopsy (TRUS-GB) is the current reference standard procedure for diagnosis of prostate cancer (PCa) but this procedure has limitations related to the low detection rate (DR) described in the literature. The aim of the study was to evaluate the DR efficiency, and complication rate in a pure "in-bore" magnetic resonance imaging-guided biopsy (MRI-GB) series according to the Prostate Imaging Reporting and Data System, version 2 (PI-RADS v2). Materials and Methods From July 2015 to April 2018, a series of 142 consecutive patients undergoing MRI-GB were prospectively enrolled. According to the European Society of Urogenital Radiology guidelines, the presence of clinically significant PCa (csPCa) on multiparametric magnetic resonance imaging was defined as equivocal, likely, or highly likely according to a PI-RADS v2, score of 3, 4, or 5, respectively. Results Of 142 patients, 76 (53.5%) were biopsy naive and 66 (46.5%) had ≤ 1 previous negative set of random TRUS-GB findings. The MRI-GB findings were positive in 75 of 142 patients with a DR of 52.8%. Of the 76 patients with ≤ 1 previous set of TRUS-GB, 43 had PCa found by MRI-GB, with a DR of 57.3%. The DR in the 66 biopsy-naive patients was 48% (32/66). Of the 75 patients with positive biopsy findings, 54 (80.5%) were found to have csPCa on histological examination. Of these 54 patients, 28 had an International Society of Urological Pathology grade 2; 5 had grade 3, 19 had grade 4, and 2 had grade 5. Considering the anatomic distribution of the index lesions using the PI-RADS v2 scheme, the probability of PCa was greater for lesions located in the peripheral zone (55 of 75, 73.3%) than for those in the central zone (20 of 75, 26.7%). Conclusions Our study conducted on 142 patients confirmed the greater DR of csPCa by MRI-GB, with a very low number of cores needed and a negligible incidence of complications, especially in patients with a previous negative biopsy. MRI-GB is optimal for the diagnosis of anterior and central lesions.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | | | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | | | | | | | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
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16
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Busetto GM, Del Giudice F, Virmani A, Sciarra A, Maggi M, Ferro M, Porreca A, Chung BI, Agarwal A, De Berardinis E. Body mass index and age correlate with antioxidant supplementation effects on sperm quality: Post hoc analyses from a double-blind placebo-controlled trial. Andrologia 2020; 52:e13523. [PMID: 32017167 PMCID: PMC7065376 DOI: 10.1111/and.13523] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 01/03/2023] Open
Abstract
Spermatozoa are vulnerable to lack of energy and oxidative stress as a result of elevated levels of reactive oxygen species. Therefore, it is essential that appropriate nutrients are available during maturation. This randomised, double‐blind, placebo‐controlled trial investigated the effect of 6‐month supplementation with carnitines and other micronutrients on sperm quality in 104 subjects with oligo‐ and/or astheno‐ and/or teratozoospermia with or without varicocele. Semen analyses were done at the beginning and end of the treatment. In addition to main analyses, post hoc analyses for age and body mass index (BMI) were carried out. Results were interpreted by dividing the population into two age and BMI classes. In 94 patients who completed the study, all sperm parameters increased in supplemented patients compared to the placebo group. A significant (p = .0272) difference in supplementation efficacy was observed for total motility on patients with varicocele and BMI < 25. In the same group, also the progressive motility was significantly superior (p = .0159). For Responder analysis, total motility results were confirmed in both the cited group (p = .0066) and in the varicocele group with BMI < 25 and age < 35 (p = .0078). This study suggests that supplementation is more effective in subjects with varicocele younger than 35 years with BMI < 25.
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Affiliation(s)
| | | | | | | | - Martina Maggi
- Department of Urology, Sapienza Rome University, Rome, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Andrology Center, Cleveland, OH, USA
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17
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Antonelli A, Palumbo C, Noale M, Artibani W, Bassi P, Bertoni F, Bracarda S, Bruni A, Corvò R, Gacci M, Magrini SM, Montironi R, Porreca A, Tubaro A, Zagonel V, Maggi S. Overview of potential determinants of radical prostatectomy versus radiation therapy in management of clinically localized prostate cancer: results from an Italian, prospective, observational study (the Pros-IT CNR study). MINERVA UROL NEFROL 2020; 72:595-604. [PMID: 31920063 DOI: 10.23736/s0393-2249.19.03637-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We assessed patients and tumor characteristics, as well as health-related quality of life (HRQoL) items, associated with curative intent treatment decision-making in clinically localized prostate cancer (PCa) patients. METHODS Clinically localized PCa treated with either radical prostatectomy (RP) or radiation therapy (RT) within 12 months from diagnosis were abstracted from The PROState cancer monitoring in ITaly, from the National Research Council (Pros-IT CNR) database. Multivariable logistic regression (MLR) models predicting RT vs. RP were fitted, after adjustment for HRQoL items, patients and tumor characteristics. RESULTS Of 1041 patients, 631 (60.2%) were treated with RP and 410 (39.8%) with RT. Relative to RT, RP patients were younger age (mean age 64.5±6.6 vs. 71.4±4.9, P<0.001) and had higher rates of D'Amico low-intermediate risk groups (31.8 vs. 21.9% low, 46.3% vs. 43.5% intermediate and 21.9% vs. 34.6% high risk, P<0.001). Overall, 93.2% of RP patients were enrolled by urologists and 82.7% of RT patients by radiation oncologists. RP patients had generally higher means values of HRQoL items. In MLR models, higher RT rates were independently associated with more advanced age (odds ratio [OR] 6.14, P<0.001) and BMI≥30 kg/m<sup>2</sup> (OR 1.78, P<0.001). Conversely, lower rates of RT were independently associated with married (OR 0.55, P=0.01) and worker status (OR 0.52, P=0.004), enrollment in academic centers (OR 0.59, P=0.005) and higher physical composite score (OR 0.88, P=0.03) and baseline sexual function items (OR 0.92, P<0.001). CONCLUSIONS Most patients with clinically localized prostate cancer undergoing definitive treatment at Italian institutions receive RP instead of RT. Moreover, those who are younger, married, working, as well as those with better physical and sexual function are more likely to undergo surgery.
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Affiliation(s)
- Alessandro Antonelli
- Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy -
| | - Carlotta Palumbo
- Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Marianna Noale
- Aging Branch, Neuroscience Institute, Section of Padua, National Research Council of Italy, Padua, Italy
| | - Walter Artibani
- Unit of Urology, University Hospital of Verona, Verona, Italy
| | - Pierfrancesco Bassi
- Department of Urology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Filippo Bertoni
- Prostate Group of AIRO (Italian Association for Radiation Oncology), Milan, Italy
| | - Sergio Bracarda
- Department of Medical Oncology, USL Toscana Sud-Est, IRCCS Istituto Nazionale Tumori Foundation, Arezzo, Italy
| | - Alessio Bruni
- Unit of Radiotherapy, University Hospital of Modena, Modena, Italy
| | - Renzo Corvò
- Unit of Radiation Oncology, IRCCS San Martino University Hospital, Genoa, Italy
| | - Mauro Gacci
- Unit of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Stefano M Magrini
- Unit of Radiation Oncology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, United Hospitals, Marche Polytechnic University, Ancona, Italy
| | - Angelo Porreca
- Unit of Urology, Polyclinic of Abano Terme, Padua, Italy
| | - Andrea Tubaro
- Unit of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Stefania Maggi
- Aging Branch, Neuroscience Institute, Section of Padua, National Research Council of Italy, Padua, Italy
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18
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Buglione M, Noale M, Bruni A, Antonelli A, Bertoni F, Corvo’ R, Ricardi U, Borghetti P, Maddalo M, Simeone C, Mazzeo E, Porreca A, Serni S, Bassi P, Gacci M, Mirone V, Montironi R, Tubaro A, Berruti A, Conti GN, Maggi S, Magrini SM, Triggiani L. Treatment paths for localised prostate cancer in Italy: The results of a multidisciplinary, observational, prospective study (Pros-IT CNR). PLoS One 2019; 14:e0224151. [PMID: 31675380 PMCID: PMC6824566 DOI: 10.1371/journal.pone.0224151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/06/2019] [Indexed: 12/22/2022] Open
Abstract
Background There are several treatments available to newly diagnosed prostate cancer (PCA) patients. Although surgery and radiotherapy (RT) with or without androgen deprivation therapy (ADT) are widely adopted treatment options for localized PCA together with active surveillance (AS), there is no consensus nor randomised trials on treatment selection, prospective quality of life (QOL), along with toxicity outcomes and according to treatment modality in the Italian population. The current study aimed to describe clinical-therapeutic features and QOL at PCA diagnosis, according to different treatment patterns in a large prospective, Italian population, enrolled in the Pros-IT CNR study. Methods The Pros-IT CNR is an on-going national, multicenter, observational, prospective study on patients affected by PCA who have been referred by 97 Italian Urology, Radiation Oncology and Medical Oncology facilities participating in the project. The possible relationships between the treatment patterns reported in the 6 month follow-up case report form and patients’ features at diagnosis were evaluated using exploratory multiple correspondence analysis (MCA) and other data analysis method. Results At diagnosis, surgery and AS patients were significantly younger, had fewer comorbidities, lower PSA levels and Gleason Score (GS) values; they were also diagnosed at an earlier stage of disease with respect to the RT or ADT patients who showed significantly worse QoL scores at the time of diagnosis. Conclusions An analysis of the data collected at baseline and 6 months later uncovered substantial differences in ages, comorbidities, clinical and QOL features in the various treatment groups. These findings do not fully reflect the current PCA treatment guidelines and suggest the need for a multidisciplinary consensus guideline to ameliorate both the counselling and treatments of PCA patients.
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Affiliation(s)
- Michela Buglione
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Alessio Bruni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
- * E-mail:
| | | | - Filippo Bertoni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Renzo Corvo’
- Department of Radiation Oncology, University Hospital “Policlinico San Martino”, Genoa, Italy
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, School of Medicine—University of Turin, Turin, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - Marta Maddalo
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - Claudio Simeone
- Department of Urology, University and Spedali Civili Hospital, Brescia, Italy
| | - Ercole Mazzeo
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Sergio Serni
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | - Pierfrancesco Bassi
- Department of Urology, Catholic University of Rome, Policlinico Gemelli, Rome, Italy
| | - Mauro Gacci
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | | | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine–Ospedali Riuniti, Ancona, Italy
| | - Andrea Tubaro
- Urology Unit, Sant'Andrea Hospital, "La Sapienza" University, Rome, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, ASST-Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - Luca Triggiani
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
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19
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Giampaoli M, Bianchi L, D'agostino D, Corsi P, Romagnoli D, Mineo Bianchi F, Del Rosso A, Schiavina R, Brunocilla E, Artibani W, Porreca A. Can preoperative multiparametric MRI avoid unnecessary prostate biopsies before holmium laser enucleation of the prostate? Preliminary results of a multicentric cohort of patients. MINERVA UROL NEFROL 2019; 71:524-530. [PMID: 31166103 DOI: 10.23736/s0393-2249.19.03463-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) is a surgical technique that allows to safely and effectively treat bladder outlet obstruction due to benign prostate enlargement and retrieve an adequate surgical specimen. We investigated the role of multiparametric magnetic resonance imaging of the prostate (mpMRI) as a tool to exclude incidental prostate cancer (iPCa) and to compare mpMRI alone with a contextual transrectal ultrasound guided biopsy (TRUS-GB). METHODS Retrospective multicentric evaluation of 244 patients underwent to HoLEP with a suspicion of prostate cancer (PCa) due to raised PSA and/or abnormal digital rectal examination (DRE) and a negative mpMRI (PI-RADS score <3), was performed. Of these, 118 patients had only a negative mpMRI (MRI group) while 126 had a negative mpMRI and a contextual preoperative negative TRUS-GB (MRI + TRUS-GB group). Comparison between the two groups, univariate and multivariate analysis were conducted in order to identify any predictive factors of iPCa. RESULTS Median age, PSA, prostate volume and PSA density were 64.0 years (IQR: 58.0-69.0), 6.10 ng/mL (IQR: 4.76-9.65), 86.0 cc (IQR: 65.0-115.0), 50.0 cc (IQR: 37.5-80.0) and 0.08 ng/mL/cc (IQR: 0.06-0.10), respectively. In surgical specimen, iPCa was detected in 21 cases (8.8%). No statistically differences between MRI and MRI + TRUS-GB group were found in terms of iPCa (7.6% and 8.5%, respectively), pathological T stage and ISUP Grade Group. A contextual TRUS-GB added to mpMRI did not correlate to iPCa either at uni- and multivariate analysis while a significant correlation of a PSA density >0.15 ng/mL/cc was found only at univariate analysis. CONCLUSIONS Including a mpMRI in clinical evaluation of patients eligible to HoLEP with a preoperative PCa suspicion leads to low the rates of iPCa and might avoid unnecessary TRUS-GB.
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Affiliation(s)
- Marco Giampaoli
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy -
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Paolo Corsi
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Daniele Romagnoli
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | | | | | | | | | - Walter Artibani
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
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20
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Porreca A, Mineo Bianchi F, Romagnoli D, D'Agostino D, Corsi P, Giampaoli M, Salvaggio A, Bianchi L, Schiavina R, Brunocilla E, Artibani W. Robot-assisted radical cystectomy with totally intracorporeal urinary diversion: surgical and early functional outcomes through the learning curve in a single high-volume center. J Robot Surg 2019; 14:261-269. [PMID: 31124038 DOI: 10.1007/s11701-019-00977-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/21/2019] [Indexed: 12/19/2022]
Abstract
The aim of the study is to report surgical and early functional outcomes of first 100 patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) in a single center. The main surgeon (A.P.) attended a modular training program at a referring center mentored by a worldwide-recognized robotic surgeon (P.W.). The program consisted of: (a) 10 h of theoretical lessons; (b) video session (c) step-by-step in vivo modular training. Each procedure was performed as taught, without any technique variation. Demographics, intra-operative data and post-operative complications, along with early functional outcomes, were recorded for each patient. We retrospectively evaluated the first consecutive 100 patients submitted to RARC with totally ICUD from July 2015 to December 2018. Median age at surgery was 69 years (IQR 60-74). 52 (52%), 32 (32%), and 17 (17%) patients received orthotopic neobladder, ileal conduit and uretero-cutaneostomy, respectively. Median operative time was 410 min. A median number of lymph nodes retrieved were 27 and median estimated blood loss was 240 mL with median hospitalization time of 7 days. All procedures were completed successfully without open conversion. A statistically significant improvement was found in the late (30-90 post-operative days) post-operative complications (p = 0.02) and operative time for urinary derivation. At multivariate logistic regression model ASA score ≥ 3 (OR = 4.2, p = 0.002) and number of lymph nodes retrieved (OR = 1.16, p = 0.02) were found to be predictors of 90-day complications. An adequate modular training is paramount to obtain successful results and reduce the learning curve of RARC, as demonstrated by our experience.
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Affiliation(s)
- A Porreca
- Department of Urology, Policlinico Di Abano, Abano Terme, Italy
| | - F Mineo Bianchi
- Department of Urology, Policlinico Di Abano, Abano Terme, Italy.
- Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - D Romagnoli
- Department of Urology, Policlinico Di Abano, Abano Terme, Italy
| | - D D'Agostino
- Department of Urology, Policlinico Di Abano, Abano Terme, Italy
| | - P Corsi
- Department of Urology, Policlinico Di Abano, Abano Terme, Italy
| | - M Giampaoli
- Department of Urology, Policlinico Di Abano, Abano Terme, Italy
| | - A Salvaggio
- Department of Urology, Policlinico Di Abano, Abano Terme, Italy
| | - L Bianchi
- Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - R Schiavina
- Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - E Brunocilla
- Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - W Artibani
- Department of Urology, Policlinico Di Abano, Abano Terme, Italy
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21
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Bianchi FM, Romagnoli D, D'Agostino D, Corsi P, Giampaoli M, Salvaggio A, Schiavina R, Brunocilla E, Artibani W, Porreca A. Is robotic approach useful to palliate advanced bladder cancer? A monocentric single surgeon experience. Cent European J Urol 2019; 72:113-120. [PMID: 31482017 PMCID: PMC6715081 DOI: 10.5173/ceju.2019.1902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/20/2019] [Accepted: 04/22/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction The aim of this study was to assess surgical and functional outcomes of 17 consecutive patients undergoing robot- assisted radical cystectomy (RARC) with palliative intent in a monocentric single surgeon series. Material and methods We collected data from 17 consecutive patients who underwent RARC with palliative intent performed by a single surgeon at our institution. Patients undergoing palliative RARC were those with advanced bladder cancer (BC) or advanced comorbidities. Clinical, surgical and functional outcomes were prospectively collected. Patients completed a specific questionnaire (Functional Assessment of Cancer Therapy-Bladder Cancer, FACT-BL) before and after surgery to assess the role of palliative RARC in terms of quality of life improvement. Results Median age at surgery was 78 years, with median Charlson Comorbidity Index (CCI) and age-adjusted CCI of 3 and 7, respectively. Clinical stage was T2, T3 or T4 in 7, 8 and 2 patients respectively, with 52.9% and 29.4% with cN+ and cM+ disease. Median estimated blood loss was 200 ml, with 1 patient requiring intra-operative blood transfusion. Median hospital stay was 7 days. A total of 3 and 2 patients were re-hospitalized during the first 30 and 30–90 post-operative days, respectively. One major Clavien grade complication was recorded. At median follow-up of 8 months, 9 and 2 patients succumbed due to tumor progression and other causes. Pre-operative and post-operative FACT-BL scores improved significantly in each domain. Conclusions A RARC is a safe and feasible technique which could be offered as part of palliative care in patients with advanced BC or comorbidities. Precise guidelines for palliating BC patients should be better.
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Affiliation(s)
- Federico Mineo Bianchi
- Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Department of Urology, Bologna, Italy.,Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | | | | | - Paolo Corsi
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Marco Giampaoli
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | | | - Riccardo Schiavina
- Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Department of Urology, Bologna, Italy
| | - Eugenio Brunocilla
- Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Department of Urology, Bologna, Italy
| | - Walter Artibani
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Angelo Porreca
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
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22
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Porreca A, Giampaoli M, Bianchi L, D'Agostino D, Romagnoli D, Bianchi FM, Rosso AD, Corsi P, Schiavina R, Artibani W, Brunocilla E. Preoperative multiparametric prostate magnetic resonance imaging: a safe clinical practice to reduce incidental prostate cancer in Holmium laser enucleation of the prostate. Cent European J Urol 2019; 72:106-112. [PMID: 31482016 PMCID: PMC6715077 DOI: 10.5173/ceju.2019.1943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/20/2019] [Accepted: 04/21/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Purpose of the study was to investigate the correlation of a preoperative multiparametric magnetic resonance imaging of the prostate (mpMRI) in patients with a suspicion of prostate cancer and eligible for Holmium Laser Enucleation of the Prostate (HoLEP). Material and methods Data of 228 patients who had undergone HoLEP was selected and retrospectively analyzed from a multicentric database. All patients presented with a raised serum PSA and/or an abnormal digital rectal examination (DRE). Prostate cancer (PCa) was excluded either with a negative mpMRI (group ‘NEGATIVE MRI’ n = 113) or a standard biopsy (group ‘NO MRI’ n = 115). Preoperative characteristic surgical and histological outcomes were confronted. A univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa). Results Both groups presented with no statistical differences in preoperative characteristics besides previous acute urinary retention rates and post-voided residual volume, found to be higher (27.8% vs. 14.2% and median 120cc vs. 80cc) in NO MRI and NEGATIVE MRI respectively. No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate. Statistically lower rate of iPCa (p = 0.03) was detected in the NEGATIVE MRI group (6.2%) in comparison with NO MRI group (14.8%). In multivariate logistic regression only presence of a preoperative negative mpMRI correlated (p = 0.04) as an independent predictive factor (OR 2.63; 95% CI: 1.02–6.75). Conclusions A negative mpMRI might be a useful tool to be included in a novel preoperative assessment to patients eligible for HoLEP with a suspicion of PCa in order to avoid an incidental PCa.
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Affiliation(s)
- Angelo Porreca
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Marco Giampaoli
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Lorenzo Bianchi
- University of Bologna, Department of Urology, Bologna, Italy
| | | | | | | | | | - Paolo Corsi
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | | | - Walter Artibani
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
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