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Treacy PJ, Falagario UG, Magniez F, Ratnani P, Wajswol E, Martini A, Jambor I, Wiklund P, Bentellis I, Barthe F, Kyprianou N, Durand M, Steffens D, Karunaratne S, Leslie S, Thanigasalam R, Tewari A. Decipher Score predicts prostate specific antigen persistence after prostatectomy. Minerva Urol Nephrol 2023; 75:583-590. [PMID: 37728494 DOI: 10.23736/s2724-6051.23.05395-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The aim of this study was to evaluate genomic risk of patients with persistent prostate specific antigen (PSA) using mRNA expression analysis and a validated prognostic genomic-risk classifier. METHODS Monocentric retrospective study including all patients who underwent radical prostatectomy (RP) by one surgeon and Decipher Test from October 2013 to December 2018. PSA persistent population was defined as all patients with two consecutive PSA>0.1 ng/mL at follow-up after the surgery. Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) was performed intraoperatively for research of positive surgical margins. Multivariate analysis was performed for persistent PSA (pPSA) predictors. A specific localized, organ-confined, and negative margins sub-population with PSA persistence was compared to a similar sub-population without PSA persistence for genomic differential expression analyses. RESULTS A total of 564 patients were included and 61 of them had pPSA. Preoperative PSA was higher in the PSA persistent group (11.6 [6.4, 21.2] vs. 6.2 [4.7, 9.2] P=0.00010), as well as PSA density (PSAd) (0.3 [0.2, 0.5] vs. 0.2 [0.1, 0.3] P=0.0001). Postoperative characteristics, Gleason Score, and positive surgical margins were significantly higher in the PSA persistent population. 31 patients had pPSA in our specific subpopulation and were compared to 217 patients with no pPSA. On multivariate analysis, only Decipher Score (OR=5.64 [1.28; 24.89], P=0.022) and preoperative PSA (OR=1.06, [1.02; 1.09], P=0.001) were significant predictors for PSA persistence. We found two genes to be significantly upregulated with a 2.5-fold change in our specific subpopulation (SERPINB11 and PDE11A). CONCLUSIONS We found unique genomic features of patients with pPSA, whilst confirming previous clinical findings that this condition behaves to a worse prognosis. Given this high genomic risk, further imaging studies should be performed to select patients for early treatment intensification.
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Affiliation(s)
- Patrick-Julien Treacy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA -
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy -
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia -
| | - Ugo G Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - François Magniez
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ethan Wajswol
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Imad Bentellis
- Department of Urology and Organ Transplantation, Nice University Hospital, Nice, France
| | - Flora Barthe
- Department of Urology and Organ Transplantation, Nice University Hospital, Nice, France
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthieu Durand
- Department of Urology and Organ Transplantation, Nice University Hospital, Nice, France
| | - Daniel Steffens
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Sascha Karunaratne
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Scott Leslie
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Ruban Thanigasalam
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Chen TY, Mihalopoulos M, Zuluaga L, Rich J, Ganta T, Mehrazin R, Tsao CK, Tewari A, Gonzalez-Kozlova E, Badani K, Dogra N, Kyprianou N. Clinical Significance of Extracellular Vesicles in Prostate and Renal Cancer. Int J Mol Sci 2023; 24:14713. [PMID: 37834162 PMCID: PMC10573190 DOI: 10.3390/ijms241914713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/02/2023] [Accepted: 09/03/2023] [Indexed: 10/15/2023] Open
Abstract
Extracellular vesicles (EVs)-including apoptotic bodies, microvesicles, and exosomes-are released by almost all cell types and contain molecular footprints from their cell of origin, including lipids, proteins, metabolites, RNA, and DNA. They have been successfully isolated from blood, urine, semen, and other body fluids. In this review, we discuss the current understanding of the predictive value of EVs in prostate and renal cancer. We also describe the findings supporting the use of EVs from liquid biopsies in stratifying high-risk prostate/kidney cancer and advanced disease, such as castration-resistant (CRPC) and neuroendocrine prostate cancer (NEPC) as well as metastatic renal cell carcinoma (RCC). Assays based on EVs isolated from urine and blood have the potential to serve as highly sensitive diagnostic studies as well as predictive measures of tumor recurrence in patients with prostate and renal cancers. Overall, we discuss the biogenesis, isolation, liquid-biopsy, and therapeutic applications of EVs in CRPC, NEPC, and RCC.
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Affiliation(s)
- Tzu-Yi Chen
- Department of Pathology & Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (T.-Y.C.); (A.T.)
| | - Meredith Mihalopoulos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.M.); (L.Z.); (J.R.); (R.M.); (K.B.)
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.M.); (L.Z.); (J.R.); (R.M.); (K.B.)
| | - Jordan Rich
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.M.); (L.Z.); (J.R.); (R.M.); (K.B.)
| | - Teja Ganta
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (T.G.); (C.-K.T.)
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.M.); (L.Z.); (J.R.); (R.M.); (K.B.)
| | - Che-Kai Tsao
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (T.G.); (C.-K.T.)
| | - Ash Tewari
- Department of Pathology & Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (T.-Y.C.); (A.T.)
| | - Edgar Gonzalez-Kozlova
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Ketan Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.M.); (L.Z.); (J.R.); (R.M.); (K.B.)
| | - Navneet Dogra
- Department of Pathology & Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (T.-Y.C.); (A.T.)
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.M.); (L.Z.); (J.R.); (R.M.); (K.B.)
- The Tisch Cancer Institute, Mount Sinai Health, New York, NY 10029, USA
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Wagaskar VG, Zaytoun O, Bhardwaj S, Tewari A. 'Stealth' Prostate Tumors. Cancers (Basel) 2023; 15:3487. [PMID: 37444597 DOI: 10.3390/cancers15133487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/21/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the false negative rates of prebiopsy magnetic resonance imaging (MRI) and MRI-ultrasound (US) 12-core systematic prostate biopsy (PBx) by analyzing radical prostatectomy specimens. METHODS This retrospective study included 3600 prostate cancer (PCa) patients who underwent robot-assisted laparoscopic radical prostatectomy. Based on comparison of lobe-specific data on final pathology with preoperative biopsy and imaging data, the study population was subdivided into group I-contralateral (CL) benign PBx (n = 983), group II-CL and/or bilateral (BL) non-suspicious mpMRI (n = 2223) and group III-CL benign PBx + non-suspicious mpMRI (n = 688). This population was studied for the presence of PCa, clinically significant PCa (csPCa), extracapsular extension (ECE) (pathological stage pT3), positive frozen section and final positive surgical margin (PSM) in the CL lobe. Descriptive statistics were performed. RESULTS In subgroups I, II and III, PCa was respectively detected in 21.5%, 37.7% and 19.5% of cases, and csPCa in 11.3%, 16.3% and 10.3% of cases. CL pT3 disease was seen in 4.5%, 4% and 5.5%, and CL surgical margins and/or frozen section analysis were positive in 6%, 7% and 5% of cases in subgroups I, II and III, respectively. CONCLUSIONS There are still significant rates of false negatives in the standard care diagnostics of PCa. Further strategies are required to improve the accuracy of diagnosis and determination of tumor location.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
- Urology Department, Alexandria University, Alexandria 21113, Egypt
| | - Swati Bhardwaj
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
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Wagaskar VG, Zaytoun O, Kale P, Pedraza A, Haines K, Tewari A. Robot-assisted simple prostatectomy for prostates greater than 100 g. World J Urol 2023; 41:1169-1174. [PMID: 36929409 DOI: 10.1007/s00345-023-04326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/30/2022] [Indexed: 03/18/2023] Open
Abstract
PURPOSE Efforts are ongoing to treat severe benign prostatic hyperplasia as traditional endoscopic treatment options are often difficult to perform and associated with significant complications. This manuscript highlights our initial experience of robot-assisted simple prostatectomy [RASP] with minimum a year follow-up. We also compared our outcomes with published literature. METHODS After an Institution Review Board approval, we gathered data of 50 cases of RASP between Jan 2014 and May 2021. Patients with prostate volume > 100 cc [calculated from magnetic resonance imaging (MRI)] and prostate biopsy confirmed benign prostate were candidates for RASP. Patients underwent RASP via transperitoneal route either by suprapubic or trans-vesical approach. Preoperative demographics, peri-operative parameters and post-operative parameters such as hospital stay, catheter removal, urinary continence and uroflow were recorded in standard database and presented as descriptive statistics. RESULTS Patients presented with a baseline median International Prostate Symptom Score (IPSS) of 23 (inter-quartile range (IQR) 21,25) and a median PSA of 7.7 ng/ml (IQR 6.4,8.7). Median preoperative prostate volume was 167 ml (IQR, 136,198 ml). Median console time was 118 min, and median estimated blood loss was 148 ml (IQR 130, 167 ml). None of our cohort needed intraoperative transfusion, conversion to open surgery or developed any complications. Median time to Foley removal was 10 days (IQR 8,12). Significant drop in the IPSS score and improvement in Qmax was noted over the period of follow-up. CONCLUSION RASP is associated with considerable improvements in urinary symptoms. However, comparative studies with endoscopic treatment options of large prostatic adenomas are warranted and ideally include cost analysis of different procedures.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA.,Department of Urology, Alexandria, Egypt
| | - Priyanka Kale
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Adriana Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, 10029, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA.
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Tewari A. Phase I study of in-situ autologous vaccination for prostate cancer in a neo-adjuvant setting. EUR UROL SUPPL 2023. [DOI: 10.1016/s2666-1683(23)00044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Wagaskar VG, Levy M, Ratnani P, Sullimada S, Gerenia M, Schlussel K, Choudhury S, Gabriele M, Haas I, Haines K, Tewari A. Cover Image. Cancer Rep (Hoboken) 2023. [DOI: 10.1002/cnr2.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Wagaskar VG, Lantz A, Sobotka S, Ratnani P, Parekh S, Falagario UG, Li L, Lewis S, Haines Iii K, Punnen S, Wiklund P, Tewari A. Development and External Validation of a Prediction Model to Identify Candidates for Prostate Biopsy. Urol J 2022; 19:379-385. [PMID: 34978065 DOI: 10.22037/uj.v18i.6852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Prostate biopsies are associated with infectious complications and approximately 80% are either benign or clinically insignificant prostate cancer. Our aim is to develop and independently validate prediction model to avoid unnecessary prostate biopsies by predicting clinically significant prostate cancer (csPCa) Materials and Methods: Retrospective analysis of single-center cohort (Mount Sinai Hospital, NY) of 1632 men who underwent systematic or combined systematic and Magnetic Resonance Imaging (MRI)/ultrasound fusion targeted prostate biopsy between 2014-2020. External cohort (University of Miami) included 622 men that underwent biopsy. Outcome for predicting csPCa was defined as International Society of Urologic Pathology (ISUP) Gleason grade ≥ 2 on biopsy. Multivariable logistic regression analysis was performed to build nomogram using coefficients of logit function. Nomogram validation was performed in external cohort by plotting receiver operating characteristics (ROC). We also plotted decision curve analysis (DCA) and compared nomogram-predicted probabilities with actual rates of csPCa probabilities in external cohort. RESULTS Of 1632 men, 43% showed csPCa on biopsy. PSA density, prior negative biopsy, and Prostate Imaging and Reporting Data System (PI-RADS) scores 3, 4, and 5 were significant predictors for csPCa. ROC for prediction of csPCa was 0.88 in external cohort. There was agreement between predicted and actual rate of csPCa in external cohort. DCA demonstrated net benefit using the model. Using the prediction model at threshold of 30, 35% of biopsies and 46% of diagnosed indolent PCa could be avoided, while missing 5% of csPCa. CONCLUSION Using our prediction model can help reduce unnecessary prostate biopsies with minimal impact on csPCa detection rates.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Li Li
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Kenneth Haines Iii
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miller School of Medicine, Miami, USA.
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
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Wagaskar VG, Levy M, Ratnani P, Sullimada S, Gerenia M, Schlussel K, Choudhury S, Gabriele M, Haas I, Haines K, Tewari A. A SelectMDx/magnetic resonance imaging-based nomogram to diagnose prostate cancer. Cancer Rep (Hoboken) 2022; 6:e1668. [PMID: 36168681 PMCID: PMC9875685 DOI: 10.1002/cnr2.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND 70%-80% of prostate cancer (PCa) biopsies performed in the US annually may be unnecessary. Specific antigen testing (PSA) and tans rectal ultrasound (TRUS) are imprecise predictive methods for risk of PCa. Novel strategies are critical to guide biopsy decision-making. AIM We assessed the utility and accuracy of combining Select MDx and multiparametric magnetic resonance imaging (mpMRI) scores for predicting risk of PCa. METHODS AND RESULTS Our study was conducted at Mount Sinai hospital at Urology department in New York City from January 2020 to April 2021. Total 129 men performed select MDx test. Indications for prostate biopsy were high-risk Select MDx score, suspicious DRE, PI-RADS scores 3/4/5 on mpMRI, or any combination of these. Fifty-one percentage of 129 patients underwent systemic or combined systemic and MRI/US (ultrasound) fusion biopsy; All men underwent 3 T MRI of Prostate w/wo contrast using standard protocols prior to biopsy. A single surgeon performed prostate biopsies. Gleason score ≥3 + 3 on biopsy is defined as outcome. Descriptive statistics were calculated as cross tables. Binary logistic regression model is used to determine the outcome. The nomogram was based on the coefficients of the logit function. ROCs were plotted and decision curve analysis was performed. Using both high-risk Select MDx and PI-RADS scores of 4/5, 87% of biopsies could have been avoided, while detecting 64% of PCa and missing 36%. If biopsies were performed on men with positive Select MDx or PI-RADS 4/5 results, 16% of biopsies could have been avoided while detecting all PCa. Combining these scores improved specificity and accuracy for the detection of PCa over either used alone. Study limitations include limited sample size, sole institution study, and risk or overfitting for the proposed model which may limit generalizability. CONCLUSION Combining SelectMDx and mpMRI PI-PADS scores of 4/5 may be useful for PCa biopsy decision-making.
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Affiliation(s)
- Vinayak G. Wagaskar
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Micah Levy
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Parita Ratnani
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Sharmila Sullimada
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Mae Gerenia
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Kacie Schlussel
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Samia Choudhury
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Marla Gabriele
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Ian Haas
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Kenneth Haines
- Department of PathologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
| | - Ash Tewari
- Department of UrologyIcahn School of Medicine at Mount Sinai HospitalNew YorkNew YorkUSA
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Parekh S, Ratnani P, Falagario U, Lundon D, Kewlani D, Nasri J, Dovey Z, Stroumbakis D, Ranti D, Grauer R, Sobotka S, Pedraza A, Wagaskar V, Mistry L, Jambor I, Lantz A, Ettala O, Stabile A, Taimen P, Aronen HJ, Knaapila J, Perez IM, Gandaglia G, Martini A, Picker W, Haug E, Cormio L, Nordström T, Briganti A, Boström PJ, Carrieri G, Haines K, Gorin MA, Wiklund P, Menon M, Tewari A. The Mount Sinai Prebiopsy Risk Calculator for Predicting any Prostate Cancer and Clinically Significant Prostate Cancer: Development of a Risk Predictive Tool and Validation with Advanced Neural Networking, Prostate Magnetic Resonance Imaging Outcome Database, and European Randomized Study of Screening for Prostate Cancer Risk Calculator. EUR UROL SUPPL 2022; 41:45-54. [PMID: 35813258 PMCID: PMC9257660 DOI: 10.1016/j.euros.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 10/28/2022] Open
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Ratnani P, Dovey Z, Parekh S, Sobotka S, Shukla D, Davis A, Roshandel R, Wagaskar V, Jambor I, Lundon DJ, Wiklund P, Kyprianou N, Menon M, Tewari A. Prostate MRI percentage tumor involvement or "PI-RADS percent" as a predictor of adverse surgical pathology. Prostate 2022; 82:970-983. [PMID: 35437769 DOI: 10.1002/pros.24344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study assesses magnetic resonance imaging (MRI) prostate % tumor involvement or "PI-RADs percent" as a predictor of adverse pathology (AP) after surgery for localized prostate cancer (PCa). Two separate variables, "All PI-RADS percent" (APP) and "Highest PI-RADS percent" (HPP), are defined as the volume of All PI-RADS 3-5 score lesions on MRI and the volume of the Highest PI-RADS 3-5 score lesion each divided by TPV, respectively. METHOD An analysis was done of an IRB approved prospective cohort of 557 patients with localized PCa who had targeted biopsy of MRI PIRADs 3-5 lesions followed by RARP from April 2015 to May 2020 performed by a single surgeon at a single center. AP was defined as ISUP GGG ≥3, pT stage ≥T3 and/or LNI. Univariate and multivariable analyses were used to evaluate APP and HPP at predicting AP with other clinical variables such as Age, PSA at surgery, Race, Biopsy GGG, mpMRI ECE and mpMRI SVI. Internal and External Validation demonstrated predicted probabilities versus observed probabilities. RESULTS AP was reported in 44.5% (n = 248) of patients. Multivariable regression showed both APP (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 1.04-1.14, p = 0.0007) and HPP (OR: 1.10; 95% CI: 1.04-1.16; p = 0.0007) were significantly associated with AP with individual area under the operating curves (AUCs) of 0.6142 and 0.6229, respectively, and AUCs of 0.8129 and 0.8124 when incorporated in models including preoperative PSA and highest biopsy GGG. CONCLUSIONS Increasing PI-RADS Percent was associated with a higher risk of AP, and both APP and HPP may have clinical utility as predictors of AP in GGG 1 and 2 patients being considered for AS. PATIENT SUMMARY Using PIRADs percent to predict AP for presurgical patients may help risk stratification, and for low and low volume intermediate risk patients, may influence treatment decisions.
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Affiliation(s)
- Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Zach Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Devki Shukla
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Avery Davis
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Reza Roshandel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ivan Jambor
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Dara J Lundon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of Urology, Karolinska University Hospital Solna, Sweden
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Nasri J, Barthe F, Parekh S, Ratnani P, Pedraza AM, Wagaskar VG, Olivier J, Villers A, Tewari A. Nomogram predicting adverse pathology outcome on radical prostatectomy in low-risk prostate cancer men. Urology 2022; 166:189-195. [DOI: 10.1016/j.urology.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
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Lundon DJ, Kelly BD, Nair S, Bolton DM, Kyprianou N, Wiklund P, Tewari A. Early mortality risk stratification after SARS-CoV-2 infection. Med Intensiva 2021; 45:e40-e42. [PMID: 34717886 PMCID: PMC8549443 DOI: 10.1016/j.medine.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- D J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| | - B D Kelly
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - S Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - D M Bolton
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - N Kyprianou
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - P Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - A Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
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Cotter C, Rudd E, Williamson E, Philippidou M, Tewari A. Anti-Ku-positive juvenile dermatomyositis. Clin Exp Dermatol 2021; 47:425-427. [PMID: 34528293 DOI: 10.1111/ced.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Cotter
- Department of Dermatology, King's College Hospital, London, UK
| | - E Rudd
- Department of Dermatology, King's College Hospital, London, UK
| | - E Williamson
- Department of Dermatology, King's College Hospital, London, UK
| | - M Philippidou
- Department of Dermatology, King's College Hospital, London, UK
| | - A Tewari
- Department of Dermatology, King's College Hospital, London, UK
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Zahalka A, Fram E, Howard L, Garden E, Mohn L, Annam J, Reagan A, Eilender B, Dehoedt A, Wiggins E, Agalliu I, Freedland S, Tewari A, Watts K. MP62-18 ATENOLOL IS ASSOCIATED WITH REDUCED RISK OF PROSTATE CANCER UPGRADING: A MULTICENTER RETROSPECTIVE STUDY. J Urol 2021. [DOI: 10.1097/ju.0000000000002102.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wagaskar VG, Sobotka S, Ratnani P, Young J, Lantz A, Parekh S, Falagario UG, Li L, Lewis S, Haines K, Punnen S, Wiklund P, Tewari A. Cover Image. Cancer Rep (Hoboken) 2021. [DOI: 10.1002/cnr2.1529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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16
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Wagaskar VG, Ratnani P, Levy M, Moody K, Garcia M, Pedraza AM, Parekh S, Pandav K, Shukla B, Sobotka S, Haines K, Wiklund P, Tewari A. Clinical characteristics and oncological outcomes in negative multiparametric MRI patients undergoing robot-assisted radical prostatectomy. Prostate 2021; 81:772-777. [PMID: 34057211 DOI: 10.1002/pros.24174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Efforts are ongoing to try and find ways to reduce the number of unnecessary prostate biopsies without missing clinically significant prostate cancers (csPCa). The utility of multiparametric magnetic resonance imaging (mpMRI) in detecting prostate cancer (PCa) shows promise to be used as triage test for systematic prostate biopsy. Our aim is to Study clinical parameters and oncological outcomes in men with negative mpMRI (nMRI; PI-RADS v2 scores of ≤ 2) who underwent robot-assisted radical prostatectomy (RARP) to evaluate nMRI's practicality as a biopsy triage test. METHODS Retrospective analysis of 331 men with nMRI who underwent RARP between 2014 and 2020 compared with men with positive mpMRI (pMRI; PI-RADS v2 scores ≥ 3, N = 1770). csPCa was defined as Gleason score ≥ 3 + 4 and biochemical recurrence (BCR) was defined as PSA > 0.2 ng/ml on two occasions. Biopsies were graded with the International Society of Urologic Pathology [ISUP] grade. Descriptive statistics for nMRI and pMRI were performed. Mann-Whitney U test was used for continuous variables and χ 2 for categorical variables. Univariable and multivariable regression analyses were performed. RESULTS Univariable analysis shows statistically significant difference (p < .05) between median age (nMRI-61 years vs. pMRI 63 years), race (higher incidence of nMRI in African American men), use of 5-alpha reductase inhibitors (higher rate in nMRI). While incidence rates of family history of PCa, suspicious digital rectal examination (DRE) findings, median PSA levels and 4Kscore, were lower in nMRI versus pMRI. Rates of positive surgical margins and BCR were comparable in nMRI versus pMRI. Biopsy ISUP Grades I and II upgraded by 51% and 12%, respectively in final pathology. African American race and no history of the prior negative biopsy were significant predictors for upgrading. CONCLUSION Men with nMRI pose diagnostic challenges as they tend to be younger patients with lower rates of suspicious DRE findings and lower 4K scores, yet comparable oncological outcomes in csPCa rates, positive surgical margins, and BCR rates.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Kate Moody
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Mariely Garcia
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Adriana M Pedraza
- Department of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Bhavya Shukla
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
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von Felden J, Garcia-Lezana T, Dogra N, Gonzalez-Kozlova E, Ahsen ME, Craig A, Gifford S, Wunsch B, Smith JT, Kim S, Diaz JEL, Chen X, Labgaa I, Haber P, Olsen R, Han D, Restrepo P, D'Avola D, Hernandez-Meza G, Allette K, Sebra R, Saberi B, Tabrizian P, Asgharpour A, Dieterich D, Llovet JM, Cordon-Cardo C, Tewari A, Schwartz M, Stolovitzky G, Losic B, Villanueva A. Unannotated small RNA clusters associated with circulating extracellular vesicles detect early stage liver cancer. Gut 2021; 71:gutjnl-2021-325036. [PMID: 34321221 PMCID: PMC8795201 DOI: 10.1136/gutjnl-2021-325036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/15/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Surveillance tools for early cancer detection are suboptimal, including hepatocellular carcinoma (HCC), and biomarkers are urgently needed. Extracellular vesicles (EVs) have gained increasing scientific interest due to their involvement in tumour initiation and metastasis; however, most extracellular RNA (exRNA) blood-based biomarker studies are limited to annotated genomic regions. DESIGN EVs were isolated with differential ultracentrifugation and integrated nanoscale deterministic lateral displacement arrays (nanoDLD) and quality assessed by electron microscopy, immunoblotting, nanoparticle tracking and deconvolution analysis. Genome-wide sequencing of the largely unexplored small exRNA landscape, including unannotated transcripts, identified and reproducibly quantified small RNA clusters (smRCs). Their key genomic features were delineated across biospecimens and EV isolation techniques in prostate cancer and HCC. Three independent exRNA cancer datasets with a total of 479 samples from 375 patients, including longitudinal samples, were used for this study. RESULTS ExRNA smRCs were dominated by uncharacterised, unannotated small RNA with a consensus sequence of 20 nt. An unannotated 3-smRC signature was significantly overexpressed in plasma exRNA of patients with HCC (p<0.01, n=157). An independent validation in a phase 2 biomarker case-control study revealed 86% sensitivity and 91% specificity for the detection of early HCC from controls at risk (n=209) (area under the receiver operating curve (AUC): 0.87). The 3-smRC signature was independent of alpha-fetoprotein (p<0.0001) and a composite model yielded an increased AUC of 0.93. CONCLUSION These findings directly lead to the prospect of a minimally invasive, blood-only, operator-independent clinical tool for HCC surveillance, thus highlighting the potential of unannotated smRCs for biomarker research in cancer.
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Affiliation(s)
- Johann von Felden
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Teresa Garcia-Lezana
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Navneet Dogra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- IBM Thomas J Watson Research Center, Yorktown Heights, New York, USA
| | - Edgar Gonzalez-Kozlova
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mehmet Eren Ahsen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amanda Craig
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacey Gifford
- IBM Thomas J Watson Research Center, Yorktown Heights, New York, USA
| | - Benjamin Wunsch
- IBM Thomas J Watson Research Center, Yorktown Heights, New York, USA
| | - Joshua T Smith
- IBM Thomas J Watson Research Center, Yorktown Heights, New York, USA
| | - Sungcheol Kim
- IBM Thomas J Watson Research Center, Yorktown Heights, New York, USA
| | - Jennifer E L Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Xintong Chen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ismail Labgaa
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Philipp Haber
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reena Olsen
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dan Han
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paula Restrepo
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Delia D'Avola
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Liver Unit and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Clínica Universidad de Navarra, Pamplona, Spain
| | - Gabriela Hernandez-Meza
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kimaada Allette
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Sema4, Stamford, Connecticut, USA
| | - Behnam Saberi
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Parissa Tabrizian
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA
| | - Amon Asgharpour
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Josep M Llovet
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Liver Cancer Translational Research Laboratory, BCLC Group, IDIBAPS, CIBEREHD, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain
| | - Carlos Cordon-Cardo
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Myron Schwartz
- Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA
| | - Gustavo Stolovitzky
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- IBM Thomas J Watson Research Center, Yorktown Heights, New York, USA
| | - Bojan Losic
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Diabetes, Obesity and Metabolism Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Augusto Villanueva
- Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Aydin A, Ahmed K, Abe T, Raison N, Van Hemelrijck M, Ahmed H, Al-Jabir A, Brunckhorst O, Shinohara N, Zhu W, Zeng G, Sfakianos J, Tewari A, Gözen A, Rassweiler J, Skolarikos A, Kunit T, Knoll T, Moltzahn F, Thalmann G, Lantz Powers A, Chew B, Sarica K, Khan M, Dasgupta P. Simulation in urological training and Education (SIMULATE): A randomised controlled clinical and educational trial to determine the effect of simulation-based surgical training. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wagaskar VG, Levy M, Ratnani P, Moody K, Garcia M, Pedraza AM, Parekh S, Pandav K, Shukla B, Prasad S, Sobotka S, Haines K, Punnen S, Wiklund P, Tewari A. Clinical Utility of Negative Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer and Clinically Significant Prostate Cancer. EUR UROL SUPPL 2021; 28:9-16. [PMID: 34337520 PMCID: PMC8317880 DOI: 10.1016/j.euros.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Background Multiparametric magnetic resonance imaging (MRI) is increasingly used to diagnose prostate cancer (PCa). It is not yet established whether all men with negative MRI (Prostate Imaging-Reporting and Data System version 2 score <3) should undergo prostate biopsy or not. Objective To develop and validate a prediction model that uses clinical parameters to reduce unnecessary prostate biopsies by predicting PCa and clinically significant PCa (csPCa) for men with negative MRI findings who are at risk of harboring PCa. Design setting and participants This was a retrospective analysis of 200 men with negative MRI at risk of PCa who underwent prostate biopsy (2014-2020) with prostate-specific antigen (PSA) >4 ng/ml, 4Kscore of >7%, PSA density ≥0.15 ng/ml/cm3, and/or suspicious digital rectal examination. The validation cohort included 182 men from another centre (University of Miami) with negative MRI who underwent systematic prostate biopsy with the same criteria. Outcome measurements and statistical analysis csPCa was defined as Gleason grade group ≥2 on biopsy. Multivariable logistic regression analysis was performed using coefficients of logit function for predicting PCa and csPCa. Nomogram validation was performed by calculating the area under receiver operating characteristic curves (AUC) and comparing nomogram-predicted probabilities with actual rates of PCa and csPCa. Results and limitations Of 200 men in the development cohort, 18% showed PCa and 8% showed csPCa on biopsy. Of 182 men in the validation cohort, 21% showed PCa and 6% showed csPCa on biopsy. PSA density, 4Kscore, and family history of PCa were significant predictors for PCa and csPCa. The AUC was 0.80 and 0.87 for prediction of PCa and csPCa, respectively. There was agreement between predicted and actual rates of PCa in the validation cohort. Using the prediction model at threshold of 40, 47% of benign biopsies and 15% of indolent PCa cases diagnosed could be avoided, while missing 10% of csPCa cases. The small sample size and number of events are limitations of the study. Conclusions Our prediction model can reduce the number of prostate biopsies among men with negative MRI without compromising the detection of csPCa. Patient summary We developed a tool for selection of men with negative MRI (magnetic resonance imaging) findings for prostate cancer who should undergo prostate biopsy. This risk prediction tool safely reduces the number of men who need to undergo the procedure.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kate Moody
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Mariely Garcia
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Adriana M Pedraza
- Department of Urology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Bhavya Shukla
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sonya Prasad
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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20
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Cotter C, Howard E, Williamson E, Tewari A. Relapsing-remitting linear ecchymosis. Clin Exp Dermatol 2021; 46:931-932. [PMID: 33511668 DOI: 10.1111/ced.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- C Cotter
- Department of Paediatric Dermatology, St Johns Institute of Dermatology, London, UK
| | - E Howard
- Department of Paediatric Dermatology, St Johns Institute of Dermatology, London, UK
| | - E Williamson
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - A Tewari
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
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21
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Wagaskar VG, Sobotka S, Ratnani P, Young J, Lantz A, Parekh S, Falagario UG, Li L, Lewis S, Haines K, Punnen S, Wiklund P, Tewari A. A 4K score/MRI-based nomogram for predicting prostate cancer, clinically significant prostate cancer, and unfavorable prostate cancer. Cancer Rep (Hoboken) 2021; 4:e1357. [PMID: 33661541 PMCID: PMC8388161 DOI: 10.1002/cnr2.1357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background The detection of prostate cancer requires histological confirmation in biopsy core. Currently, number of unnecessary prostate biopsies are being performed in the United States. This is due to the absence of appropriate biopsy decision‐making protocol. Aim To develop and validate a 4K score/multiparametric magnetic resonance imaging (mpMRI)‐based nomogram to predict prostate cancer (PCa), clinically significant prostate cancer (csPCa), and unfavorable prostate cancer (uPCa). Methods and Results Retrospective, single‐center study evaluating a cohort of 574 men with 4K score test >7% or suspicious digital rectal examination (DRE) or Prostate Imaging Reporting and Data System (PI‐RADS) scores 3, 4, or 5 on mpMRI that underwent systematic and/or mpMRI/ultrasound fusion–targeted prostate biopsy between 2016 and 2020. External cohort included 622 men. csPCa and uPCa were defined as Gleason score ≥3 + 4 and ≥4 + 3 on biopsy, respectively. Multivariable logistic regression analysis was performed to build nomogram for predicting PCa, csPCa, and uPCa. Validation was performed by plotting the area under the curve (AUC) and comparing nomogram‐predicted probabilities with actual rates of PCa, csPCa, and uPCa probabilities in the external cohort. 4K score, a PI‐RADS ≥4, prostate volume and prior negative biopsy were significant predictors of PCa, csPCa, and uPCa. AUCs were 0.84, 0.88, and 0.86 for the prediction of PCa, csPCa, and uPCa, respectively. The predicted and actual rates of PCa, csPCa, and uPCa showed agreement across all percentage probability ranges in the validation cohort. Using the prediction model at threshold of 30, 30% of overall biopsies, 41% of benign biopsies, and 19% of diagnosed indolent PCa could be avoided, while missing 9% of csPCa. Conclusion This novel nomogram would reduce unnecessary prostate biopsies and decrease detection of clinically insignificant PCa.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - James Young
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sneha Parekh
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Li Li
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Sanoj Punnen
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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Tewari A, Khan I, Ostlere L. Type I and type IV systemic contact dermatitis to balsam of Peru with a particular reaction to cinnamyl alcohol. Clin Exp Dermatol 2020; 46:342-343. [PMID: 32357255 DOI: 10.1111/ced.14266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- A Tewari
- Department of Dermatology, St George's Hospital, London, UK
| | - I Khan
- Department of Dermatology, St George's Hospital, London, UK
| | - L Ostlere
- Department of Dermatology, St George's Hospital, London, UK
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Wagaskar VG, Mittal A, Sobotka S, Ratnani P, Lantz A, Falagario UG, Martini A, Dovey Z, Treacy PJ, Pathak P, Nair S, Roy B, Chakravarty D, Lewis S, Haines K, Wiklund P, Tewari A. Hood Technique for Robotic Radical Prostatectomy-Preserving Periurethral Anatomical Structures in the Space of Retzius and Sparing the Pouch of Douglas, Enabling Early Return of Continence Without Compromising Surgical Margin Rates. Eur Urol 2020; 80:213-221. [PMID: 33067016 DOI: 10.1016/j.eururo.2020.09.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND A common side effect following radical prostatectomy is urinary incontinence. Here, we describe a novel surgical technique to reduce postoperative urinary incontinence and facilitate early return of continence. OBJECTIVE To describe the novel "hood technique" for robotic-assisted radical prostatectomy (RARP). DESIGN, SETTING, AND PARTICIPANTS This is an institutional review board-approved prospective study of 300 patients (median age 64 yr) with localized prostate cancer treated with the RARP hood technique at a major urban hospital between April 2018 and March 2019. The exclusion criteria were as follows: patients with anterior tumor location based on biopsy or multiparametric magnetic resonance imaging. All but one patient participated in follow-up over 12 mo after the procedure. SURGICAL PROCEDURE The RARP "hood technique" was performed to preserve the detrusor apron, puboprostatic ligament complex, arcus tendineus, endopelvic fascia, and pouch of Douglas. MEASUREMENTS Clinical data collected included pre- and intraoperative variables, and postoperative functional and oncological outcomes and complications. Descriptive statistical analysis was performed. RESULTS AND LIMITATIONS Continence rates at 1, 2, 4, 6 12, 24, and 48 wk after catheter removal were 21%, 36%, 83%, 88%, 91%, 94%, and 95%, respectively. Positive surgical margin rate was 6%. Thirty patients (9.7%) experienced complications after RARP: 17 (5.7%), 11 (3.6%), and one (0.4%) had Clavien-Dindo grade I, II, and III complications, respectively. This study was conducted within a single health system and may not be generalizable. The study lacked randomization and a comparative arm. CONCLUSIONS Results indicate that the hood technique spares musculofascial structures anterior to the urethral sphincter complex with early return of continence after surgery, without compromising positive surgical margin rates. Exclusion of anterior tumor location contributed to a reduction in positive surgical margins. PATIENT SUMMARY By better preservation of anatomical structures around the urethra, we were able to achieve early return of urinary continence without a negative impact on complications and cancer outcomes.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, India
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Zach Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Patrick-Julien Treacy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Prachee Pathak
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Suit Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Berryhill Roy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Dimple Chakravarty
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Falagario UG, Lantz A, Jambor I, Martini A, Ratnani P, Wagaskar V, Treacy PJ, Veccia A, Bravi CA, Bashorun HO, Phillip D, Lewis S, Haines K, Cormio L, Carrieri G, Tewari A. Using biomarkers in patients with positive multiparametric magnetic resonance imaging: 4Kscore predicts the presence of cancer outside the index lesion. Int J Urol 2020; 28:47-52. [PMID: 32985040 DOI: 10.1111/iju.14385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/30/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate if the blood biomarker, 4Kscore, in addition to multiparametric magnetic resonance imaging information could identify patients who would benefit from undergoing only a targeted biopsy. METHODS We retrospectively analyzed a population of 256 men with positive multiparametric magnetic resonance imaging who underwent standard + targeted biopsy at Mount Sinai Hospital, New York, NY, USA. 4Kscore (OPKO Health, Miami, FL, USA) was sampled from all patients before biopsy. Uni- and multivariable binary logistic regression analyses were carried out to predict clinically significant prostate cancer, defined as International Society of Urological Pathology grade group ≥2, in standard biopsy cores. The model with the best area under the curve was selected and internal validation was carried out using the leave-one-out cross-validation. RESULTS The developed model showed an area under the curve of 0.86. Carrying out only targeted biopsy in patients with a model-derived probability <12.5% resulted in 39.5% (n = 101) fewer standard biopsies and a 33.9% (n = 20) reduction of detecting grade group 1 disease, while missing grade group ≥2 in 5.2% (n = 4) using standard biopsy only and 1.1% (n = 1) using standard biopsy + targeted biopsy. CONCLUSIONS 4Kscore in combination with multiparametric magnetic resonance imaging can help to reduce unnecessary standard biopsy and decrease detection of clinically insignificant prostate cancer.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, University of Turku, Turku, Finland
| | - Alberto Martini
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alessandro Veccia
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Hafis O Bashorun
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deron Phillip
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Falagario UG, Jambor I, Lantz A, Ettala O, Stabile A, Taimen P, Aronen HJ, Knaapila J, Perez IM, Gandaglia G, Fossati N, Martini A, Cucchiara V, Picker W, Haug E, Ratnani P, Haines K, Lewis S, Sujit N, Selvaggio O, Sanguedolce F, Macarini L, Cormio L, Nordström T, Tewari A, Briganti A, Boström PJ, Carrieri G. Combined Use of Prostate-specific Antigen Density and Magnetic Resonance Imaging for Prostate Biopsy Decision Planning: A Retrospective Multi-institutional Study Using the Prostate Magnetic Resonance Imaging Outcome Database (PROMOD). Eur Urol Oncol 2020; 4:971-979. [PMID: 32972896 DOI: 10.1016/j.euo.2020.08.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Previous studies suggested that prostate-specific antigen (PSA) density (PSAd) combined with magnetic resonance imaging (MRI) may help avoid unnecessary prostate biopsy (PB) with a limited risk of missing clinically significant prostate cancer (csPCa; Gleason grade group [GGG] >1). OBJECTIVE To define optimal diagnostic strategies based on the combined use of PSAd and MRI in patients at risk of prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of the international multicenter Prostate MRI Outcome Database (PROMOD), including 2512 men having undergone PSAd and prostate MRI before PB between 2013 and 2019, was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Rates of avoided PB, missed GGG 1, and csPCa according to 10 strategies based on PSAd values and MRI reporting scores (Prostate Imaging Reporting and Data System [PI-RADS]/Likert/IMPROD biparametric prostate MRI Likert). Decision curve analysis (DCA) was used to statistically compare the net benefit of each strategy. Combined systematic and targeted biopsies were used for reference. RESULTS AND LIMITATIONS According to DCA, the best strategy in biopsy-naive patients was #7 (PI-RADS/Likert 4-5 or PI-RADS/Likert 3 if PSAd >0.2), which avoided 41.2% PBs while missed 44% of GGG 1 and 10.9% of csPCa cases. From a clinical standpoint, however, strategies with a lower risk of missing csPCa included #10 (PI-RADS/Likert 4-5 or PI-RADS 3 if PSAd >0.10 or PSAd >0.2), which avoided 27% PBs while missing 24.4% GGG 1 and 4% csPCa cases, or #5 (PI-RADS/Likert 3-5 or PSAd>0.15), which avoided 14.7% PBs while missing 9.3% GGG 1 and 1.7% csPCa cases. Similar results were found in patients with a previous negative biopsy. This study is limited by its retrospective nature, and no central review of MRI and histopathological findings. CONCLUSIONS Combined PSAd and MRI findings allows individualization of the decision to perform PB on the basis of the risk of missing PCa that both patients and clinicians are ready to accept to avoid this procedure. PATIENT SUMMARY We compared several biopsy strategies based on a combination of prostate magnetic resonance imaging findings and prostate-specific antigen density, providing a readily available tool for each center and practicing urologist to counsel patients about their individual risk of significant prostate cancer.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Anna Lantz
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Armando Stabile
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland; Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Juha Knaapila
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Giorgio Gandaglia
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vito Cucchiara
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Erik Haug
- Section of Urology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nair Sujit
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oscar Selvaggio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | | | - Luca Macarini
- Department of Radiology, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy; Department of Urology, Bonomo Teaching Hospital, Andria, Italy
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Briganti
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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Pedregal Trujillo M, Ravi P, Shaw G, Markt S, Hamid A, Tewari A, Van Allen E, Sweeney C. 792P A retrospective review of the survival outcomes of patients with nonseminomatous germ cell tumors (NSGCTs) with and without teratoma in the primary. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lantz A, Falagario UG, Ratnani P, Jambor I, Dovey Z, Martini A, Lewis S, Lundon D, Nair S, Phillip D, Haines K, Cormio L, Carrieri G, Kryprianou N, Tewari A. Expanding Active Surveillance Inclusion Criteria: A Novel Nomogram Including Preoperative Clinical Parameters and Magnetic Resonance Imaging Findings. Eur Urol Oncol 2020; 5:187-194. [DOI: 10.1016/j.euo.2020.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 01/01/2023]
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Lundon DJ, Kelly BD, Shukla D, Bolton DM, Wiklund P, Tewari A. A Decision Aide for the Risk Stratification of GU Cancer Patients at Risk of SARS-CoV-2 Infection, COVID-19 Related Hospitalization, Intubation, and Mortality. J Clin Med 2020; 9:jcm9092799. [PMID: 32872607 PMCID: PMC7563697 DOI: 10.3390/jcm9092799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023] Open
Abstract
Treatment decisions for both early and advanced genitourinary (GU) malignancies take into account the risk of dying from the malignancy as well as the risk of death due to other causes such as other co-morbidities. COVID-19 is a new additional and immediate risk to a patient’s morbidity and mortality and there is a need for an accurate assessment as to the potential impact on of this syndrome on GU cancer patients. The aim of this work was to develop a risk tool to identify GU cancer patients at risk of diagnosis, hospitalization, intubation, and mortality from COVID-19. A retrospective case showed a series of GU cancer patients screened for COVID-19 across the Mount Sinai Health System (MSHS). Four hundred eighty-four had a GU malignancy and 149 tested positive for SARS-CoV-2. Demographic and clinical variables of >38,000 patients were available in the institutional database and were utilized to develop decision aides to predict a positive SARS-CoV-2 test, as well as COVID-19-related hospitalization, intubation, and death. A risk tool was developed using a combination of machine learning methods and utilized BMI, temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation. The risk tool for predicting a diagnosis of SARS-CoV-2 had an AUC of 0.83, predicting hospitalization for management of COVID-19 had an AUC of 0.95, predicting patients requiring intubation had an AUC of 0.97, and for predicting COVID-19-related death, the risk tool had an AUC of 0.79. The models had an acceptable calibration and provided a superior net benefit over other common strategies across the entire range of threshold probabilities.
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Affiliation(s)
- Dara J. Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA; (D.J.L.); (D.S.); (P.W.)
| | - Brian D. Kelly
- Department of Urology, Austin Health, Melbourne, VIC 3084, Australia; (B.D.K.); (D.M.B.)
| | - Devki Shukla
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA; (D.J.L.); (D.S.); (P.W.)
| | - Damien M. Bolton
- Department of Urology, Austin Health, Melbourne, VIC 3084, Australia; (B.D.K.); (D.M.B.)
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA; (D.J.L.); (D.S.); (P.W.)
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, NY 10029, USA; (D.J.L.); (D.S.); (P.W.)
- Correspondence:
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Lundon DJ, Kelly BD, Nair S, Bolton DM, Kyprianou N, Wiklund P, Tewari A. Early mortality risk stratification after SARS-CoV-2 infection. Med Intensiva 2020; 45:S0210-5691(20)30219-9. [PMID: 32912654 PMCID: PMC7334967 DOI: 10.1016/j.medin.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022]
Affiliation(s)
- D J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| | - B D Kelly
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - S Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - D M Bolton
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - N Kyprianou
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - P Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - A Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
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Treacy P, Martini A, Falagario U, Ratnani P, Horowitz A, Wajswol E, Begemann D, Beksac A, Durand M, Wiklund P, Nair S, Kyprianou N, Tewari A. The role of connective tissue in prostate cancer growth and progression. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dovey Z, Mohamed N, Gharib Y, Ratnani P, Hammouda N, Nair SS, Chakravarty D, Sobotka S, Lantz A, Wiklund P, Kyprianou N, Tewari A. Impact of COVID-19 on Prostate Cancer Management: Guidelines for Urologists. EUR UROL SUPPL 2020; 20:1-11. [PMID: 34173542 PMCID: PMC7296308 DOI: 10.1016/j.euros.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 01/08/2023] Open
Abstract
CONTEXT The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a global health emergency, the like of which has never been seen before. Prostate cancer (PCa) services across the globe have been on hold due to changing medical and surgical priorities. There is also epidemiological evidence that PCa patients have increased incidence and mortality from SARS-CoV-2 infection due to gender differences, age, and higher propensity for risk factors (eg, respiratory disease, obesity, hypertension, and smoking status). OBJECTIVE To contribute to the emerging body of knowledge on the risks of SARS-CoV-2 infection to PCa patients and, in the face of PCa treatment delays, provide evidence-based recommendations for ongoing management of specific PCa patient groups. EVIDENCE ACQUISITION A literature search was performed using all sources (MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries, and Web of Science) as well as the media to harness emerging data on the SARS-CoV-2 pandemic and its influence on PCa. Eligibility criteria were originality of data and relevance to PCa management. The authors note that during these unprecedented times, retrospective data are constantly being updated from multiple sources globally. EVIDENCE SYNTHESIS A total of 72 articles and data sources were found initially. Owing to repetition, lack of originality, or nonrelevance, six articles were rejected, leaving 23 retrospective studies, seven basic science research articles, 15 societal and journal guidelines, and 21 epidemiological data sources, from countries at different stages of SARS-CoV-2 pandemic. These were analyzed qualitatively to produce evidence-based guidelines for the management of PCa patients at different stages of the patient journey, with strategies to reduce the risk of viral spread. CONCLUSIONS PCa patients may have an increased risk of SARS-CoV-2 infection as well as morbidity and mortality if infected. Once appropriately triaged, and to reduce viral spread, PCa patients can have surveillance by telemedicine, and institute lifestyle changes and social quarantining measures. If risk stratification suggests that treatment should be planned, androgen deprivation therapy can be started, or potentially surgery or radiation therapy is possible on a case-by-case basis. PATIENT SUMMARY Prostate cancer patients can be followed up remotely until the severe acute respiratory syndrome coronavirus 2 pandemic resolves, but higher-risk cases may have treatment expedited to limit any negative impact on prostate cancer outcomes.
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Affiliation(s)
- Zachary Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nihal Mohamed
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yasmine Gharib
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nada Hammouda
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sujit S. Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dimple Chakravarty
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Lantz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Natasha Kyprianou
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Bustamante M, Hernandez‐Ferrer C, Tewari A, Sarria Y, Harrison G, Puigdecanet E, Nonell L, Kang W, Friedländer M, Estivill X, González J, Nieuwenhuijsen M, Young A. A study into how ultraviolet radiation from the sun effects genes in the skin. Br J Dermatol 2020. [DOI: 10.1111/bjd.19071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bustamante M, Hernandez‐Ferrer C, Tewari A, Sarria Y, Harrison G, Puigdecanet E, Nonell L, Kang W, Friedländer M, Estivill X, González J, Nieuwnhuijsen M, Young A. 太阳紫外线辐射如何影响皮肤基因的研究. Br J Dermatol 2020. [DOI: 10.1111/bjd.19083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cotter CL, Rivers E, Salisbury J, Duarte Williamson E, Tewari A. Neonatal erythroderma. Clin Exp Dermatol 2020; 45:646-649. [PMID: 32212273 DOI: 10.1111/ced.14206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- C L Cotter
- Department of Dermatology, King's College Hospital, London, UK
| | - E Rivers
- Department of Immunology, Great Ormond Street Hospital for Children, London, UK
| | - J Salisbury
- Department of Dermatology, King's College Hospital, London, UK
| | | | - A Tewari
- Department of Dermatology, King's College Hospital, London, UK
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Checcucci E, Autorino R, Cacciamani GE, Amparore D, De Cillis S, Piana A, Piazzolla P, Vezzetti E, Fiori C, Veneziano D, Tewari A, Dasgupta P, Hung A, Gill I, Porpiglia F. Artificial intelligence and neural networks in urology: current clinical applications. MINERVA UROL NEFROL 2019; 72:49-57. [PMID: 31833725 DOI: 10.23736/s0393-2249.19.03613-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION As we enter the era of "big data," an increasing amount of complex health-care data will become available. These data are often redundant, "noisy," and characterized by wide variability. In order to offer a precise and transversal view of a clinical scenario the artificial intelligence (AI) with machine learning (ML) algorithms and Artificial neuron networks (ANNs) process were adopted, with a promising wide diffusion in the near future. The present work aims to provide a comprehensive and critical overview of the current and potential applications of AI and ANNs in urology. EVIDENCE ACQUISITION A non-systematic review of the literature was performed by screening Medline, PubMed, the Cochrane Database, and Embase to detect pertinent studies regarding the application of AI and ANN in Urology. EVIDENCE SYNTHESIS The main application of AI in urology is the field of genitourinary cancers. Focusing on prostate cancer, AI was applied for the prediction of prostate biopsy results. For bladder cancer, the prediction of recurrence-free probability and diagnostic evaluation were analysed with ML algorithms. For kidney and testis cancer, anecdotal experiences were reported for staging and prediction of diseases recurrence. More recently, AI has been applied in non-oncological diseases like stones and functional urology. CONCLUSIONS AI technologies are growing their role in health care; but, up to now, their "real-life" implementation remains limited. However, in the near future, the potential of AI-driven era could change the clinical practice in Urology, improving overall patient outcomes.
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Affiliation(s)
- Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | | | | | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Pietro Piazzolla
- Department of Management and Production Engineer, Politechnic University of Turin, Turin, Italy
| | - Enrico Vezzetti
- Department of Management and Production Engineer, Politechnic University of Turin, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Domenico Veneziano
- Department of Urology and Renal Transplantation, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Ash Tewari
- Icahn School of Medicine of Mount Sinai, New York, NY, USA
| | | | - Andrew Hung
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Bustamante M, Hernandez-Ferrer C, Tewari A, Sarria Y, Harrison GI, Puigdecanet E, Nonell L, Kang W, Friedländer MR, Estivill X, González JR, Nieuwenhuijsen M, Young AR. Dose and time effects of solar-simulated ultraviolet radiation on the in vivo human skin transcriptome. Br J Dermatol 2019; 182:1458-1468. [PMID: 31529490 PMCID: PMC7318624 DOI: 10.1111/bjd.18527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 12/18/2022]
Abstract
Background Terrestrial ultraviolet (UV) radiation causes erythema, oxidative stress, DNA mutations and skin cancer. Skin can adapt to these adverse effects by DNA repair, apoptosis, keratinization and tanning. Objectives To investigate the transcriptional response to fluorescent solar‐simulated radiation (FSSR) in sun‐sensitive human skin in vivo. Methods Seven healthy male volunteers were exposed to 0, 3 and 6 standard erythemal doses (SED). Skin biopsies were taken at 6 h and 24 h after exposure. Gene and microRNA expression were quantified with next generation sequencing. A set of candidate genes was validated by quantitative polymerase chain reaction (qPCR); and wavelength dependence was examined in other volunteers through microarrays. Results The number of differentially expressed genes increased with FSSR dose and decreased between 6 and 24 h. Six hours after 6 SED, 4071 genes were differentially expressed, but only 16 genes were affected at 24 h after 3 SED. Genes for apoptosis and keratinization were prominent at 6 h, whereas inflammation and immunoregulation genes were predominant at 24 h. Validation by qPCR confirmed the altered expression of nine genes detected under all conditions; genes related to DNA repair and apoptosis; immunity and inflammation; pigmentation; and vitamin D synthesis. In general, candidate genes also responded to UVA1 (340–400 nm) and/or UVB (300 nm), but with variations in wavelength dependence and peak expression time. Only four microRNAs were differentially expressed by FSSR. Conclusions The UV radiation doses of this acute study are readily achieved daily during holidays in the sun, suggesting that the skin transcriptional profile of ‘typical’ holiday makers is markedly deregulated. What's already known about this topic? The skin's transcriptional profile underpins its adverse (i.e. inflammation) and adaptive molecular, cellular and clinical responses (i.e. tanning, hyperkeratosis) to solar ultraviolet radiation. Few studies have assessed microRNA and gene expression in vivo in humans, and there is a lack of information on dose, time and waveband effects.
What does this study add? Acute doses of fluorescent solar‐simulated radiation (FSSR), of similar magnitude to those received daily in holiday situations, markedly altered the skin's transcriptional profiles. The number of differentially expressed genes was FSSR‐dose‐dependent, reached a peak at 6 h and returned to baseline at 24 h. The initial transcriptional response involved apoptosis and keratinization, followed by inflammation and immune modulation. In these conditions, microRNA expression was less affected than gene expression.
Linked Comment:Hart. Br J Dermatol 2020; 182:1328–1329. Plain language summary available online Respond to this article
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Affiliation(s)
- M Bustamante
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - C Hernandez-Ferrer
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, MA, U.S.A
| | - A Tewari
- King's College London, St John's Institute of Dermatology, London, U.K
| | - Y Sarria
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G I Harrison
- King's College London, St John's Institute of Dermatology, London, U.K
| | - E Puigdecanet
- Servei d'Anàlisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - L Nonell
- Servei d'Anàlisi de Microarrays, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - W Kang
- Science for Life Laboratory, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - M R Friedländer
- Science for Life Laboratory, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - X Estivill
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Genetics Program, Sidra Medical Center, Al Rayyan Municipality, Qatar
| | - J R González
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - M Nieuwenhuijsen
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - A R Young
- King's College London, St John's Institute of Dermatology, London, U.K
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Treacy P, Pavlova I, Falagario U, Brody R, Epstein J, Cordero Bravo J, Barthe F, Wiklund P, Tewari A, Durand M. Mesure du collagène au sein d’un tissu cancéreux prostatique à l’aide du microscope multiphotonique : résultats préliminaires. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Treacy P, Martini A, Ratnani P, Nair S, Horowitz A, Wiklund P, Durand M, Tewari A. La signature transcriptomique des gènes du tissu conjonctif prédit des caractéristiques péjoratives chez les patients avec un cancer de prostate localisé. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Durand M, Bessede T, Treacy P, Bentellis I, Amiel J, Corcuera-solano I, Taouli B, Rastinehad A, Ying Tang C, Wang V, Reddy B, Raffaelli C, Fromont G, Puech P, Haines K, Tewari A, Villers A. Imagerie expérimentale ex vivo de haute résolution à 7 tesla du cancer localisé de la prostate. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Woo J, Santasusagna S, Banks J, Dominguez-Andres A, Yadav K, Pippa R, Carceles-Cordon M, Lallas C, Luyao G, Rodriguez-Bravo V, Tewari A, Pastor-Lopez S, Kelly W, Leiby B, Prats J, Gomella L, Domingo-Domenech J. Urine extracellular vesicle GATA2 mRNA alone and in a multigene test predicts initial prostate biopsy result. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jambor I, Falagario U, Ratnani P, Perez IM, Demir K, Merisaari H, Sobotka S, Haines GK, Martini A, Beksac AT, Lewis S, Pahikkala T, Wiklund P, Nair S, Tewari A. Prediction of biochemical recurrence in prostate cancer patients who underwent prostatectomy using routine clinical prostate multiparametric MRI and decipher genomic score. J Magn Reson Imaging 2019; 51:1075-1085. [PMID: 31566845 DOI: 10.1002/jmri.26928] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Biochemical recurrence (BCR) affects a significant proportion of patients who undergo robotic-assisted laparoscopic prostatectomy (RALP). PURPOSE To evaluate the performance of a routine clinical prostate multiparametric magnetic resonance imaging (mpMRI) and Decipher genomic classifier score for prediction of biochemical recurrence in patients who underwent RALP. STUDY TYPE Retrospective cohort study. SUBJECTS Ninety-one patients who underwent RALP performed by a single surgeon, had mpMRI before RALP, Decipher taken from RALP samples, and prostate specific antigen (PSA) follow-up for >3 years or BCR within 3 years, defined as PSA >0.2 mg/ml. FIELD STRENGTH/SEQUENCE: mpMRI was performed at 27 different institutions using 1.5T (n = 10) or 3T scanners and included T2 w, diffusion-weighted imaging (DWI), or dynamic contrast-enhanced (DCE) MRI. ASSESSMENT All mpMRI studies were reported by one reader using Prostate Imaging Reporting and Data System v. 2.1 (PI-RADsv2.1) without knowledge of other findings. Eighteen (20%) randomly selected cases were re-reported by reader B to evaluate interreader variability. STATISTICAL TESTS Univariate and multivariate analysis using greedy feature selection and tournament leave-pair-out cross-validation (TLPOCV) were used to evaluate the performance of various variables for prediction of BCR, which included clinical (three), systematic biopsy (three), surgical (six: RALP Gleason Grade Group [GGG], extracapsular extension, seminal vesicle invasion, intraoperative surgical margins [PSM], final PSM, pTNM), Decipher (two: Decipher score, Decipher risk category), and mpMRI (eight: prostate volume, PSA density, PI-RADv2.1 score, MRI largest lesion size, summed MRI lesions' volume and relative volume [MRI-lesion-percentage], mpMRI ECE, mpMRI seminal vesicle invasion [SVI]) variables. The evaluation metric was the area under the curve (AUC). RESULTS Forty-eight (53%) patients developed BCR. The best-performing individual features with TLPOCV AUC of 0.73 (95% confidence interval [CI] 0.64-0.82) were RALP GGG, MRI-lesion-percentage followed by biopsy GGG (0.72, 0.62-0.82), and Decipher score (0.71, 0.60-0.82). The best performance was achieved by feature selection of Decipher+Surgery and MRI + Surgery variables with TLPOCV AUC of 0.82 and 0.81, respectively DATA CONCLUSION: Relative lesion volume measured on a routine clinical mpMRI failed to outperform Decipher score in BCR prediction. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1075-1085.
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Affiliation(s)
- Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ugo Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland.,Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland
| | - Kadir Demir
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Harri Merisaari
- Department of Radiology, University of Turku, Turku, Finland.,Department of Future Technologies, University of Turku, Turku, Finland
| | - Stanislaw Sobotka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George K Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tapio Pahikkala
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sujit Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Falagario UG, Martini A, Wajswol E, Treacy PJ, Ratnani P, Jambor I, Anastos H, Lewis S, Haines K, Cormio L, Carrieri G, Rastinehad AR, Wiklund P, Tewari A. Avoiding Unnecessary Magnetic Resonance Imaging (MRI) and Biopsies: Negative and Positive Predictive Value of MRI According to Prostate-specific Antigen Density, 4Kscore and Risk Calculators. Eur Urol Oncol 2019; 3:700-704. [PMID: 31548130 DOI: 10.1016/j.euo.2019.08.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/19/2019] [Accepted: 08/30/2019] [Indexed: 11/25/2022]
Abstract
The 2019 European Association of Urology guidelines recommend multiparametric magnetic resonance imaging (mpMRI) for biopsy-naïve patients with clinical suspicion of prostate cancer (PC) and avoiding biopsy in patients with negative mpMRI and low clinical suspicion. However, consensus on the optimal definition of low clinical suspicion is lacking. We evaluated 266 biopsy-naïve patients who underwent mpMRI, the 4Kscore test, and prostate biopsy to define the best strategy to avoid unnecessary testing and biopsies. The European Randomized Study of Screening for Prostate Cancer risk calculator (ERSPC-RC) and prostate-specific antigen density (PSAd) were also considered. For men with Prostate Imaging-Reporting and Data System v2.0 (PI-RADS) 12 lesions, the highest negative predictive value was observed for those with low or intermediate 4Kscore risk (96.9% and 97.1%), PSAd <0.10ng/ml/cm3 (98.7%), and ERSPC-RC <2% (98.7%). For men with PI-RADS 35 lesions the lowest positive predictive value was observed for those with low 4Kscore risk (0%), PSAd <0.10ng/ml/cm3 (13.2%), and ERSPC-RC <2% (12.3%). The best biopsy strategy was an initial 4Kscore followed by mpMRI if the 4Kscore was>7.5% and a subsequent biopsy if the mpMRI was positive (PI-RADS 35) or the 4Kscore was 18%. This would result in missing 2.7% (2/74) of clinically significant PCs (csPCs) and avoiding 34.2% of biopsies. Initial mpMRI followed by biopsy for negative mpMRI (PI-RADS 12) if the 4Kscore was 18% or PSAd was 0.10ng/ml/cm3 resulted in a similar percentage of csPC missed (2.7% [2/74] and 1.3% [1/74]) but slightly fewer biopsies avoided (25.2% and 28.1%). Physicians should consider clinical risk screening tools when ordering and interpreting mpMRI results to avoid unnecessary testing and diagnostic errors. PATIENT SUMMARY: Performing the 4Kscore test in conjunction with multiparametric magnetic resonance imaging for men with a clinical suspicion of prostate cancer may help to reduce unnecessary biopsies.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ethan Wajswol
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Parita Ratnani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, University of Turku, Turku, Finland
| | - Harry Anastos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | | | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Weinstock TG, Tewari A, Patel H, Kelley K, Tananbaum R, Flores A, Shah AT, Abujaber SY, Khorashadi L, Shortsleeve MJ, Thomson CC. No stone unturned: Nodule Net, an intervention to reduce loss to follow-up of lung nodules. Respir Med 2019; 157:49-51. [PMID: 31518707 DOI: 10.1016/j.rmed.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/13/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Inadequate lung nodule surveillance leads to diagnostic delays. We implemented a retrospective intervention program, Nodule Net, to improve surveillance in our hospital. METHODS 9,224 Chest computed tomography (CT) scans between January 1, 2015 and December 31, 2016 were manually reviewed for lung nodules. For patients without follow-up, charts were reviewed to assess follow-up. If follow-up appeared indicated, the clinician or patient was contacted, and follow-up was tracked. RESULTS Lung nodules were identified on 5,101 (55%) of 9,224 scans. Follow-up was potentially indicated and not completed in 1,385 (27%). 183 (13%) were excluded after imaging review. 1,202 received outreach. Of the 801 (66%) with a provider in our system, 225 (27%) returned for follow-up. Nodules were stable in 199 (88%), new or growing in 23 (11%), resolved in 3 (1%), and stage 1 lung cancer in 2 (1%). 90 (11%) had follow-up outside our system and 431 (51%) had no follow-up due to a clinical contraindication. 55 (7%) have imaging pending and 14 (2%) are awaiting pulmonary evaluation. Of the 302 (25%) patients with providers outside our system, 121 (40%) had followed-up elsewhere. 146 (48%) had no follow-up due to a clinical reason. 35 (12%) providers did not respond to outreach. CONCLUSIONS We identified 1,202 patients with lung nodules who needed follow-up over a two-year period. Compliance was more successful with providers within our hospital system. We recommend robust surveillance for patients to ensure follow-up is completed and clinical contraindications are well documented.
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Affiliation(s)
- T G Weinstock
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA; Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - A Tewari
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
| | - H Patel
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - K Kelley
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA
| | - R Tananbaum
- Washington University, St. Louis, Missouri, USA
| | - A Flores
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA
| | - A T Shah
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - S Y Abujaber
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - L Khorashadi
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Mount Auburn Hospital, Cambridge, MA, USA
| | - M J Shortsleeve
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Mount Auburn Hospital, Cambridge, MA, USA
| | - C C Thomson
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA; Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
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Abstract
Foot-and-mouth disease (FMD) is a contagious and important transboundary disease of cloven-hoofed animals and ruminants. In ruminants, an animal is considered as a foot-and-mouth disease virus (FMDV) carrier if a live FMDV/FMDV RNA is obtained from the oro-pharyngeal fluid (OPF) beyond 28 days after infection. These carrier animals may pose a risk for causing outbreaks in healthy animals. Moreover, it is important to conduct serosurveillance to know the virus circulation. In the present study, an ELISA was developed using field samples to detect FMDV specific secretory IgA antibodies. These samples were also tested for the presence of FMDV RNA using quantitative real-time PCR (qRT-PCR). It was found that more carrier animals were detected by IgA ELISA in comparison to qRT-PCR. Thus, IgA ELISA is an important tool to detect FMD carriers. An ELISA based on detection of antibodies against FMDV 2B non-structural protein (NSP) was also used to confirm the results obtained from screening of 3AB3 NSP ELISA. These two new approaches (IgA ELISA and 2B ELISA) form important tools for detection of carriers and virus circulation, respectively, during FMD eradication program. Keywords: foot-and-mouth disease virus; carriers; IgA; 2B non-structural protein; 3AB3 non-structural protein.
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Zattoni F, Artibani W, Patel V, Montorsi F, Porpiglia F, Hampton LJ, Rocco B, Dasgupta P, Hemal AK, Mottrie A, Tewari A, Dal Moro F. Technical innovations to optimize continence recovery after robotic assisted radical prostatectomy. MINERVA UROL NEFROL 2019; 71:324-338. [DOI: 10.23736/s0393-2249.19.03395-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Narbutt J, Philipsen P, Harrison G, Morgan K, Lawrence K, Baczynska K, Grys K, Rogowski‐Tylman M, Olejniczak‐Staruch I, Tewari A, Bell M, O'Connor C, Wulf H, Lesiak A, Young A. Optimal sunscreen use prevents holiday erythema. Br J Dermatol 2019. [DOI: 10.1111/bjd.17556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Narbutt J, Philipsen P, Harrison G, Morgan K, Lawrence K, Baczynska K, Grys K, Rogowski‐Tylman M, Olejniczak‐Staruch I, Tewari A, Bell M, O'Connor C, Wulf H, Lesiak A, Young A. 优化防晒霜使用以防止假日红斑. Br J Dermatol 2019. [DOI: 10.1111/bjd.17572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tewari A, Alarcon L, Gordon K, Mansour S, Akhras V. Postzygotic mosaicism in a woman with Goltz syndrome mimics segmental angioma serpiginosum. Br J Dermatol 2019; 181:613-614. [PMID: 30801665 DOI: 10.1111/bjd.17823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Tewari
- Department of Dermatology, St George's Hospital, Tooting, London, U.K
| | - L Alarcon
- Department of Histopathology, St George's Hospital, Tooting, London, U.K
| | - K Gordon
- Department of Dermatology, St George's Hospital, Tooting, London, U.K
| | - S Mansour
- Department of Clinical Genetics, St George's Hospital, Tooting, London, U.K
| | - V Akhras
- Department of Dermatology, St George's Hospital, Tooting, London, U.K
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Lubotzky FP, Butow P, Hunt C, Costa DSJ, Laidsaar-Powell R, Carroll S, Thompson SR, Jackson M, Tewari A, Nattress K, Juraskova I. A Psychosexual Rehabilitation Booklet Increases Vaginal Dilator Adherence and Knowledge in Women Undergoing Pelvic Radiation Therapy for Gynaecological or Anorectal Cancer: A Randomised Controlled Trial. Clin Oncol (R Coll Radiol) 2018; 31:124-131. [PMID: 30580905 DOI: 10.1016/j.clon.2018.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/29/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
AIMS Women treated with pelvic radiation therapy (PRT) for gynaecological or anorectal cancer report a high number of sexual problems and unmet post-treatment psychosexual information needs. Currently, there is suboptimal adherence to recommended rehabilitation aids, such as vaginal dilators, and a paucity of resources to facilitate post-radiation rehabilitation and reduce distress in this population. This randomised controlled trial aimed to evaluate the effectiveness of a study-developed psychosexual rehabilitation booklet in this setting. MATERIALS AND METHODS Eighty-two women scheduled for PRT to treat gynaecological/anorectal cancer were randomised to receive the intervention booklet (n = 44) or standard information materials (n = 38). Self-report questionnaires administered at pre-treatment baseline and at 3, 6 and 12 months post-treatment assessed adherence with rehabilitation aids, booklet knowledge, anxiety, depression and sexual functioning/satisfaction. RESULTS Dilator adherence and booklet knowledge were significantly higher in the intervention group than in the control group (averaged over time points), with scores significantly increasing over time. Younger age and gynaecological cancer were significant predictors of greater dilator adherence. No significant group differences were found on psychological and sexual measures. CONCLUSIONS The psychosexual rehabilitation booklet was effective in educating women with gynaecological and anorectal cancers about PRT-related psychosexual side-effects and rehabilitation options, as well as promoting uptake of vaginal dilator use. Future research should elucidate the effectiveness of this booklet in women with greater psychological and sexual functioning needs.
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Affiliation(s)
- F P Lubotzky
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - P Butow
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - C Hunt
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - D S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - R Laidsaar-Powell
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - S Carroll
- Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - S R Thompson
- Radiation Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - M Jackson
- Radiation Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Tewari
- Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - K Nattress
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - I Juraskova
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia.
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Narbutt J, Philipsen PA, Harrison GI, Morgan KA, Lawrence KP, Baczynska KA, Grys K, Rogowski-Tylman M, Olejniczak-Staruch I, Tewari A, Bell M, O'Connor C, Wulf HC, Lesiak A, Young AR. Sunscreen applied at ≥ 2 mg cm -2 during a sunny holiday prevents erythema, a biomarker of ultraviolet radiation-induced DNA damage and suppression of acquired immunity. Br J Dermatol 2018; 180:604-614. [PMID: 30307614 DOI: 10.1111/bjd.17277] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Sun protection factor (SPF) is assessed with sunscreen applied at 2 mg cm-2 . People typically apply around 0·8 mg cm-2 and use sunscreen daily for holidays. Such use results in erythema, which is a risk factor for skin cancer. OBJECTIVES To determine (i) whether typical sunscreen use resulted in erythema, epidermal DNA damage and photoimmunosuppression during a sunny holiday, (ii) whether optimal sunscreen use inhibited erythema and (iii) whether erythema is a biomarker for photoimmunosuppression in a laboratory study. METHODS Holidaymakers (n = 22) spent a week in Tenerife (very high ultraviolet index) using their own sunscreens without instruction (typical sunscreen use). Others (n = 40) were given SPF 15 sunscreens with instructions on how to achieve the labelled SPF (sunscreen intervention). Personal ultraviolet radiation (UVR) exposure was monitored electronically as the standard erythemal dose (SED) and erythema was quantified. Epidermal cyclobutane pyrimidine dimers (CPDs) were determined by immunostaining, and immunosuppression was assessed by contact hypersensitivity (CHS) response. RESULTS There was no difference between personal UVR exposure in the typical sunscreen use and sunscreen intervention groups (P = 0·08). The former had daily erythema on five UVR-exposed body sites, increased CPDs (P < 0·001) and complete CHS suppression (20 of 22). In comparison, erythema was virtually absent (P < 0·001) when sunscreens were used at ≥ 2 mg cm-2 . A laboratory study showed that 3 SED from three very different spectra suppressed CHS by around ~50%. CONCLUSIONS Optimal sunscreen use prevents erythema during a sunny holiday. Erythema predicts suppression of CHS (implying a shared action spectrum). Given that erythema and CPDs share action spectra, the data strongly suggest that optimal sunscreen use will also reduce CPD formation and UVR-induced immunosuppression.
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Affiliation(s)
- J Narbutt
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Łódź, 90-647, Łódź, Poland
| | - P A Philipsen
- University of Copenhagen, Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
| | - G I Harrison
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K A Morgan
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K P Lawrence
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - K A Baczynska
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, OX11 0RQ, U.K
| | - K Grys
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | | | - I Olejniczak-Staruch
- Dermoklinika Centrum Medyczne, Łódź, 90-436, Poland.,Department of Dermatology and Venereology, Medical University of Łódź, 90-647, Łódź, Poland
| | - A Tewari
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
| | - M Bell
- Walgreens Boots Alliance Inc., Nottingham, NG90 5EF, U.K
| | - C O'Connor
- Walgreens Boots Alliance Inc., Nottingham, NG90 5EF, U.K
| | - H C Wulf
- University of Copenhagen, Bispebjerg Hospital, Department of Dermatological Research, Copenhagen, 2400, Denmark
| | - A Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Łódź, 90-647, Łódź, Poland
| | - A R Young
- King's College London, St John's Institute of Dermatology, London, SE1 9RT, U.K
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