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La Croce G, Roscigno M, Pellucchi F, Manica M, Catellani M, Sodano M, Saccà A, Naspro R, Da Pozzo L. Oncological outcomes of systematic ureteral frozen sections during radical cystectomy in pure urothelial bladder cancer and in histological variants. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01123-5] [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: 03/14/2023] Open
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2
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Mari A, Tellini R, Antonelli A, Porpiglia F, Schiavina R, Amparore D, Brunocilla E, Capitanio U, Checcucci E, Da Pozzo L, Di Maida F, Fiori C, Furlan M, Gontero P, Longo N, Roscigno M, Simeone C, Siracusano S, Ficarra V, Carini M, Minervini A. A nomogram for the prediction of long-term significant renal function loss after robot-assisted partial nephrectomy for localized renal tumors: a prospective multicenter observational study (RECORd2 project). EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00751-5] [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] Open
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3
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Di Maida F, Campi R, Tellini R, Lane B, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Mari A, Brookman-May S, Klatte T, Roscigno M, Akdogan B, Karakoyunlu N, Langenhuijsen H, Keeley F, Marszalek M, Capitanio U, Carini M, Kutikov A, Minervini A. Predictors of trifecta after open and robot partial nephrectomy for highly complex localized renal tumor: results from a large multicenter international prospective observational project (the surface-intermediate-base margin score consortium). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35482-3] [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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Roscigno M, Badenchini F, Napodano G, Borghesi M, Marenghi C, Magnani T, Simone G, Conti G, Guazzoni G, Tanello M, Ranieri A, Battaglia M, Lapini A, Altieri V, Bollito E, Cicchetti G, Colombo P, Colecchia M, Ditonno P, Fabiano M, Frego E, Rodolfo H, Montironi R, Patriarca C, Pili A, Paganelli A, Sanseverino R, Rancati T, Bangma C, Da Pozzo L, Valdagni R. Factors predicting active treatment free-survival and initial experience with mpMRI as a selection tool in patient undergoing active surveillance: 10-year follow-up of SIUrO PRIAS-ITA working group. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35566-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: 10/23/2022] Open
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Tellini R, Campi R, Mari A, Amparore D, Antonelli A, Brunocilla E, Capitanio U, Gontero P, Mirone V, Montanari E, Li Marzi V, Roscigno M, Montorsi F, Porpiglia F, Simeone C, Trombetta C, Artibani W, Volpe A, Ficarra V, Carini M, Minervini A. What are the predictors of oncocytoma histology at pathological analysis after partial nephrectomy for small renal masses? Insights from a large prospective multicentre study (RECORd2 project). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33208-0] [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] Open
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6
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Sacca A, La Croce G, Manica M, Nicolai M, Angiolilli D, Naspro R, Roscigno M, Rocchini L, Castellucci E, Deiana G, Belussi D, Pellucchi F, Da Pozzo L. 343 Hypogonadism post TESE: how much is it really worrying? J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.304] [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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Sacca A, La Croce G, Angiolilli D, Pellucchi F, Rocchini L, Belussi D, Nicolai M, Castellucci E, Deiana G, Naspro R, Roscigno M, Manica M, Da Pozzo L. 532 Time to first infertility diagnosis and sperm retrieval rate: results after 30 consecutive micro TESE in NOA patients. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.438] [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: 11/15/2022]
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Sacca A, La Croce G, Manica M, Nicolai M, Belussi D, Rocchini L, Pellucchi F, Deiana G, Castellucci E, Naspro R, Roscigno M, Angiolilli D, Da Pozzo L. 476 Sperm retrieval rate: comparative single surgeon results between first 30 consecutive c-TESE and first 30 m -TESE in NOA patients. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.383] [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: 10/28/2022]
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Vukcaj S, Perugini G, Muni R, Iannacone E, Takanen S, Piccoli F, Filippone F, Maffioletti L, Kalli M, Feltre L, Ghirardelli P, Querques G, Roscigno M, Da Pozzo L, Sironi S, Cazzaniga L. EP-1602: MPMRI planning in salvage radiotherapy of biochemical recurrence after radical prostatectomy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31911-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: 11/17/2022]
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Capitanio U, Stewart G, Larcher A, Ouzaid I, Akdogan B, Roscigno M, Marszalek M, Dell'Oglio P, Salagierski M, Volpe A, Mir M, Kriegmair M, Terrone C, Brookman-May S, Montorsi F, Klatte T. European temporal trends in the use of lymph node dissection in patients with renal cancer. Eur J Surg Oncol 2017; 43:2184-2192. [DOI: 10.1016/j.ejso.2017.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/02/2017] [Accepted: 07/18/2017] [Indexed: 11/15/2022] Open
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Capitanio U, Stewart G, Klatte T, Volpe A, Akdogan B, Roscigno M, Langenhuijsen H, Marszalek M, Rodriguez Faba O, Salagierski M, Minervini A, Brookman-May S. 522 Temporal trends in the rate of lymph node dissection for renal cell carcinoma. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1569-9056(16)60524-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Saccà A, Pastore AL, Roscigno M, Naspro R, Pellucchi F, Fuschi A, Maruccia S, Territo A, Pisano F, Zanga L, Capitanio E, Carbone A, Fusi F, Chinaglia D, Da Pozzo LF. Conventional testicular sperm extraction (TESE) and non-obstructive azoospermia: is there still a chance in the era of microdissection TESE? Results from a single non-academic community hospital. Andrology 2016; 4:425-9. [DOI: 10.1111/andr.12159] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/04/2015] [Accepted: 12/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Saccà
- Department of Urology; ASST Papa Giovanni XXIII; Bergamo Italy
| | - A. L. Pastore
- Urology Unit; Department of Medical-Surgical Sciences and Biotechnologies; Faculty of Pharmacy and Medicine; Sapienza University of Rome; Latina Italy
| | - M. Roscigno
- Department of Urology; ASST Papa Giovanni XXIII; Bergamo Italy
| | - R. Naspro
- Department of Urology; ASST Papa Giovanni XXIII; Bergamo Italy
| | - F. Pellucchi
- Department of Urology; ASST Papa Giovanni XXIII; Bergamo Italy
| | - A. Fuschi
- Urology Unit; Department of Medical-Surgical Sciences and Biotechnologies; Faculty of Pharmacy and Medicine; Sapienza University of Rome; Latina Italy
| | - S. Maruccia
- Department of Urology; IRCSS Policlinico San Donato; Milano Italy
| | - A. Territo
- Department of Urology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Pisano
- Department of Urology; AO Città della Salute e della Scienza; University of Torino; Torino Italy
| | - L. Zanga
- Department of Maternal and Pediatric; USSD Centro PMA; ASST Papa Giovanni XXIII; Bergamo Italy
| | - E. Capitanio
- Department of Maternal and Pediatric; USSD Centro PMA; ASST Papa Giovanni XXIII; Bergamo Italy
| | - A. Carbone
- Urology Unit; Department of Medical-Surgical Sciences and Biotechnologies; Faculty of Pharmacy and Medicine; Sapienza University of Rome; Latina Italy
| | - F. Fusi
- Department of Maternal and Pediatric; USSD Centro PMA; ASST Papa Giovanni XXIII; Bergamo Italy
| | - D. Chinaglia
- Department of Pathology; ASST Papa Giovanni XXIII; Bergamo Italy
| | - L. F. Da Pozzo
- Department of Urology; ASST Papa Giovanni XXIII; Bergamo Italy
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Brookman-May S, Langenhuijsen JF, Volpe A, Minervini A, Joniau S, Salagierski M, Roscigno M, Akdogan B, Vandromme A, Rodriguez-Faba O, Marszalek M. Management of localized and locally advanced renal tumors. A contemporary review of current treatment options. Minerva Med 2013; 104:237-259. [PMID: 23748279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
About 70% of patients with renal cell carcinoma present with localized or locally advanced disease at primary diagnosis. Whereas these patients are potentially curable by surgical treatment alone, a further 20% to 30% of patients are diagnosed with primary metastatic disease. Although over the past years medical treatment for metastatic patients has nearly completely changed from immunotherapy to effective treatment with targeted agents, metastatic disease still represents a disease status which is not curable. Also in patients with metastatic disease, surgical treatment of the primary tumor plays an important role, since local tumor related complications can be avoided or minimized by surgery. Furthermore, also improvement of overall survival has been proven for surgery in metastatic patients when combined with cytokine treatment. Hence, surgical combined with systemic treatment as a multi-modal, adjuvant, and neo-adjuvant treatment is also required in patients with advanced or metastatic disease. A growing number of elderly and comorbid patients are currently diagnosed with small renal masses, which has led to increased attention paid to alternative ablative treatment modalities as well as active surveillance strategies, which are applied in order to avoid unnecessary overtreatment in these patients. Since surgical treatment also might enhance the risk of chronic kidney disease with consecutive cardiac disorders as well as reduced overall survival, ablative techniques and active surveillance are increasingly applied. In this review article we focus on current surgical and none-surgical treatment options for the management of patients with localized, locally advanced, and metastatic renal cell carcinoma.
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Affiliation(s)
- S Brookman-May
- Department of Urology Ludwig‑Maximilians‑University CampusGrosshadern, Munich, Germany.
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Klatte T, Zigeuner R, Rouprêt M, Babjuk M, Capitanio U, Cha E, Colin P, Comploj E, Dalpiaz O, Fritsche HM, Herrmann T, Hora M, Hübner W, Merseburger A, Montorsi F, Nison L, Novara G, Roscigno M, Shariat S, Remzi M. 575 Segmental ureterectomy versus radical nephroureterectomy for urothelial cancer of the ureter: A matched-pair analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s1569-9056(13)61058-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Petralia G, Roscigno M, Zigeuner R, Strada E, Sozzi F, Da Pozzo L, Guazzoni G, Cestari A, Salonia A, Scattoni V, Montorsi F, Rigatti P, Bertini R. 450 COMPLETE METASTASECTOMY IS AN INDEPENDENT PREDICTOR OF CANCER-SPECIFIC SURVIVAL IN PATIENTS WITH CLINICALLY METASTATIC RENAL CELL CARCINOMA. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1569-9056(10)60446-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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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16
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Hellenthal N, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Bolenz C, Remzi M, Weizer A, Zigeuner R, Koppie TM. Adjuvant chemotherapy for high-risk upper tract urothelial carcinoma: Results from the Upper Tract Urothelial Carcinoma Collaboration. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5075 Background: There is relatively little literature regarding the use of adjuvant chemotherapy following radical nephroureterectomy in the management of patients with upper tract urothelial carcinoma (UTUC). Our goal was to determine the incidence of receipt of adjuvant chemotherapy in high-risk patients and the ensuing effect on overall- and cancer-specific survival. Methods: Using an international collaborative database, we identified 1390 patients who underwent nephroureterectomy for non-metastatic UTUC between the years of 1992 and 2006. Of these, 542 (39%) patients were classified as high-risk (pT3N0, pT4N0, and/or lymph node positive). These patients were separated into two groups—those who did and did not receive adjuvant chemotherapy—and were stratified by gender, age group, performance status, tumor grade and stage. Cox proportional hazard modeling and Kaplan-Meier analyses were used to determine overall- and cancer-specific survival amongst the cohorts. Results: Of the high-risk patients, 121 (22%) received adjuvant chemotherapy. Adjuvant chemotherapy was more commonly administered in the context of increased tumor grade and stage (p < 0.001). Median survival in the entire cohort was 24 months (range 0–231 months). There was no significant difference in overall- or cancer-specific survival between those who did and did not receive adjuvant chemotherapy; however age, performance status, tumor grade, and tumor stage were significant predictors of both overall and cancer-specific survival. Conclusions: Adjuvant chemotherapy is infrequently utilized in the treatment of patients with high-risk UTUC after nephroureterectomy. Despite this, it appears that adjuvant chemotherapy confers minimal impact on overall- or cancer-specific survival in this group. No significant financial relationships to disclose.
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Affiliation(s)
- N. Hellenthal
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - S. F. Shariat
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - V. Margulis
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - P. I. Karakiewicz
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - M. Roscigno
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - C. Bolenz
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - M. Remzi
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - A. Weizer
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - R. Zigeuner
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
| | - T. M. Koppie
- University of California, Davis, Sacramento, CA; University of Texas Southwestern, Dallas, TX; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Montreal, Montreal, QC, Canada; Vita-Salute University, Milan, Italy; Universitatsklinikum Mannheim, Mannheim, Germany; University of Vienna, Vienna, Austria; University of Michigan, Ann Arbor, MI; Medical University Graz, Graz, Austria
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Cestari A, Sangalli M, Buffi N, Lughezzani G, Riva M, Rigatti L, Nava L, Briganti A, Bertini R, Roscigno M, Montorsi F, Rigatti P, Guazzoni G. LAPAROSCOPIC RENAL CRYOABLATION (LRC) OF SMALL RENAL MASSES: LESSONS LEARNED FROM 104 CASES IN A 7-YEAR EXPERIENCE. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1569-9056(08)60484-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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18
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Roscigno M, Colombo R, Freschi M, Naspro R, Doglioni C, Zanni G, Bertini R, Ferla G, Montorsi F, Rigatti P. Bilateral renal mass suggestive of cancer: part 2. Eur Urol 2006; 49:918-20. [PMID: 16685759 DOI: 10.1016/j.eururo.2006.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M Roscigno
- Department of Urology, "Vita-Salute" University, San Raffaele Hospital, Milan, Italy
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Roscigno M, Colombo R, Freschi M, Naspro R, Doglioni C, Zanni G, Bertini R, Ferla G, Montorsi F, Rigatti P. Bilateral Renal Mass Suggestive of Cancer. Eur Urol 2006; 49:746-7. [PMID: 16497432 DOI: 10.1016/j.eururo.2005.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 12/01/2005] [Accepted: 12/05/2005] [Indexed: 10/25/2022]
Abstract
We present the case of a 44-year old man, presenting with acute left flank pain and gross haematuria, affected by bilateral renal mass and massive para-aortic and mediastinic lymphadenopathy, highly suspicious for metastatic renal cancer.
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Affiliation(s)
- M Roscigno
- Department of Urology, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
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Roscigno M, Sangalli M, Mazzoccoli B, Scattoni V, Da Pozzo L, Rigatti P. Medical therapy of prostate cancer. A review. MINERVA UROL NEFROL 2005; 57:71-84. [PMID: 15951731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Androgen ablation or blockade of androgen action through the androgen receptor (AR) has been the cornerstone of treatment of advanced prostate cancer. The relative merits of monotherapy or combined androgen blockade (CAB) are still the subject of debate. Each treatment strategy/hormonal agent has favourable and unfavourable effects. Patients with advanced prostate cancer will clearly benefit androgen deprivation-based treatment for palliating their symptoms and for improving their quality of life (QOL). However, whether these therapies prolong survival when administered before there are symptoms caused by disease progression remains controversial. Data from multiple recent studies indicate that an earlier treatment in patient's disease course likely leads to better outcome, but it is not easy to predict the best timing of hormonal therapy for asymptomatic advanced disease. For the purpose of delaying the onset of androgen-independent growth of prostate cancer, different regimen of intermittent androgen blockade (IAB) have been applied to patients. The use of IAB is increasing but, despite theoretical advantages in terms of patient QOL, clinical studies have yet to prove superiority over continuous therapy. The role of androgen deprivation in combination with surgery or radiotherapy has been also evaluated. While neoadjuvant hormonal therapy (NHT) can significantly decrease the incidence of positive margins at the time of radical prostatectomy (RP), 3 months of treatment is not long enough to have any significant effect on biochemical recurrence rates. The results of studies investigating longer courses (8 months) of NHT are awaited. High-risk patients should be considered for early adjuvant hormonal therapy (AHT) after surgery, as they may be most likely to benefit. The rationale for the use of NHT in combination with radiotherapy is that it reduces tumour volume and therefore the amount of radiation therapy that is needed to treat the tumour. It has been found that 3-4 months of hormonal treatment reduces prostate volume by 25-50%. Intermediate-risk patients treated with NHT and concomitant hormonal therapy have been found to have a 94% freedom for biochemical failure after 4 years, suggesting that this group is the ideal patient population to receive short-term hormonal therapy in combination with brachytherapy. Several studies suggested the current consensus that patients with clinically localized or locally advanced high-grade tumours benefit from definitive radiation therapy and long-term AHT. The current treatment for advanced prostate cancer remains essentially palliative. However, an increased understanding of the heterogeneous nature of the disease, the mechanisms that lead to hormone-refractory prostate cancer (HRPC) has identified novel therapeutic targets and led to the development of selective new therapies, that may help to prolong survival and maintain QOL for patients with HRPC.
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Affiliation(s)
- M Roscigno
- Department of Urology, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
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Cozzarini C, Fiorino C, Bolognesi A, Rosso A, Bertini R, Bua L, Colombo R, Da Pozzo L, Montorsi F, Roscigno M, Rigatti P, Villa E. Early adjuvant irradiation following radical surgery for PT3-PT4 pn0 adenocarcinoma of the prostate: Significant reduction of the risk of systemic failure with high doses and timely irradiation. A single institute experience on 175 cases. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.388] [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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Roscigno M, Scattoni V, Bertini R, Pasta A, Montorsi F, Rigatti P. Diagnosis of prostate cancer. State of the art. MINERVA UROL NEFROL 2004; 56:123-45. [PMID: 15195022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The widespread acceptance of prostate-specific antigen (PSA) measurement as an early detection method for prostate cancer (Pca), coupled with the recent heightened public awareness of Pca as a common disease, has led to an increase in the detection of Pca. It has been established that digital rectal examination (DRE) and PSA are the most useful front-line methods for assessing an individual's risk of Pca. In addition to an elevated PSA above 4 ng/mL and an abnormal DRE, the decision to proceed with TRUS-guided biopsy may also be supported by other factors. Determining the presence of a significant rise in PSA between tests, whether the degree of PSA is concordant with the size of the prostate, and age appropriate PSA may aid in the interpretation of this risk. Grayscale transrectal ultrasound (TRUS) has been established as the first choice imaging technique making it possible to take biopsies, measure the volume and obtain a general overview of the prostate. To improve, however, the TRUS detection rate of Pca, many ultrasonographic technique improvements have been introduced and continuously evaluated. As for prostate biopsy, in the prostate with visible lesions, lesion-guided biopsies only play a role in combination with systematic biopsies, while the systematic prostate biopsy scheme should at the present time include 10 or 12 cores according to prostatic weight. The other imaging techniques actually play a marginal role in Pca detection, but may be useful for staging newly diagnosed Pca or in patient re-staging in case of biochemical failure after radical treatment.
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Affiliation(s)
- M Roscigno
- Department of Urology, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
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Abstract
In the long-term there is biochemical evidence of recurrent prostate carcinoma in approximately 40% of patients after radical prostatectomy (RP). Detecting the site of recurrence (local vs distant) is critical for defining the optimum treatment. Pathological and clinical variables, e.g. Gleason score, involvement of seminal vesicles or lymph nodes, margin status at surgery, and especially the timing and pattern of prostate-specific antigen (PSA) recurrence, may help to predict the site of relapse. Transrectal ultrasonography (TRUS) of the prostatic fossa in association with TRUS-guided needle biopsy is considered more sensitive than a digital rectal examination for detecting local recurrence, especially if PSA levels are low. Although it cannot detect minimal tumour mass at very low PSA levels (< 1 ng/mL) TRUS biopsy is presently the most sensitive method for detecting local recurrence. Nevertheless, the conclusive role of biopsy of the vesico-urethral anastomosis remains unclear. However, 111In-capromab pendetide scintigraphy and [11C]-choline tomography (which are better than conventional imaging for detecting metastatic tumour), have low detection rates for local disease and are considered complementary to TRUS in this setting. Patients with a high PSA after RP may be managed with external beam salvage radiotherapy. An initial PSA of < 1 ng/mL, Gleason score < 8 and radiation dose of 66-70 Gy seem to be key factors in determining success. Although a positive TRUS anastomotic biopsy may predict a better outcome after radiation therapy, the need to take a biopsy in the event of PSA failure remains under investigation. The value of salvage radiation to the prostatic bed for PSA-only progression after RP remains in question.
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Affiliation(s)
- V Scattoni
- Department of Urology, University Vita-Salute, Scientific Institute H San Raffaele, Milan, Italy.
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Roscigno M, Scattoni V, Freschi M, Raber M, Colombo R, Bertini R, Ghezzi M, Montorsi F, Rigatti P. Follow-up of patients with isolated mono and plurifocal High Grade Prostatic Intraepithelial Neoplasia (HGPIN) on initial prostate needle biopsy. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1569-9056(02)80645-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Bertin R, Roscigno M, Colombo R, Spagnolo D, Ferrari A, Rigatti P. Herniation of the amniotic sac into the bladder through a vesico-uterine fistula in the 32nd week of pregnancy. BJOG 2001; 108:1300-1. [PMID: 11843396 DOI: 10.1111/j.1471-0528.2001.00287.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Bertin
- Department of Urology, Vita e Salute University, San Raffaele Hospital, Milan, Italy
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Colombo R, Brausi M, Da Pozzo L, Salonia A, Montorsi F, Scattoni V, Roscigno M, Rigatti P. Thermo-chemotherapy and electromotive drug administration of mitomycin C in superficial bladder cancer eradication. a pilot study on marker lesion. Eur Urol 2001; 39:95-100. [PMID: 11173946 DOI: 10.1159/000052419] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [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: 11/19/2022]
Abstract
OBJECTIVE To assess the feasibility and safety of two novel methods for intravesical chemotherapy administration in patients suffering from superficial bladder carcinomas. To draw preliminary considerations concerning the ablative effect on marker lesion using novel approaches compared to standard intravesical chemotherapy. METHODS Eighty patients suffering from single, recurrent, low-stage, low-grade superficial bladder tumor entered a prospective nonrandomized study. Thirty-six of them were treated by means of mitomycin C instillation as a standard procedure. In 29 patients mitomycin C solution was administered in combination with local microwave-induced hyperthermia and in 15 patients the mitomycin C solution was administered according to the electromotive drug procedure. The treatment was scheduled as a short term neo-adjuvant regimen prior to transurethral resection. Feasibility and safety of the different procedures were evaluated on an outpatients basis. The local toxicity induced by different approaches was defined and compared using a subjective questionnaire. RESULTS Both intravesical chemotherapy administered in combination with hyperthermia and according to the electromotive drug technique appeared to be feasible and safe. Local toxicity induced by thermo-chemotherapy was more severe than that registered for electromotive drug technique and standard intravesical chemotherapy. Local toxicity was always short and self healing without early or delayed major complications. A higher complete response rate on marker lesion was observed after thermo-chemotherapy compared to other administration methods. CONCLUSION The intravesical administration of mitomycin C can be safely performed in the form of both thermo-chemotherapy and electromotive drug approach with an increased ablative success rate on small superficial tumor involving only minimal local side effects.
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Affiliation(s)
- R Colombo
- Department of Urology, Scientific Institute, San Raffaele Hospital, Milan, Italy.
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27
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Colombo R, Bertini R, Salonia A, Da Pozzo LF, Montorsi F, Brausi M, Roscigno M, Rigatti P. Nerve and seminal sparing radical cystectomy with orthotopic urinary diversion for select patients with superficial bladder cancer: an innovative surgical approach. J Urol 2001; 165:51-5; discussion 55. [PMID: 11125362 DOI: 10.1097/00005392-200101000-00013] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [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: 11/26/2022]
Abstract
PURPOSE Radical cystectomy is advocated for high risk patients with superficial bladder cancer. To preserve complete urinary continence, normal sexual function and fertility in young patients, we developed an innovative technique based on nerve and seminal sparing radical cystectomy. MATERIALS AND METHODS Radical cystectomy was recommended for 8 patients with superficial bladder cancer that was not conservatively manageable. Average patient age was 44 years (range 36 to 48), and all patients were extremely anxious to maintain potency and fertility. The surgical procedure consisted of transurethral resection of the prostate, pelvic iliac lymph node dissection and extraperitoneal radical cystectomy performed while preserving the vas deferens seminal vesicles and neurovascular bundles. Urinary diversion was accomplished with a W-shaped ileal reservoir anastomosed to the prostatic capsule. RESULTS Patients were generally discharged from the hospital 15 days after surgery, and postoperative morbidity was limited. Daytime and nighttime continence was immediate and complete after catheter removal. Normal erectile function was clinically documented in all patients while fertility potential with semen retrieval via urine was recorded in 7. The quality of life, as reported by the patients, was highly satisfactory at 18-month followup. CONCLUSIONS The surgical approach we describe should be considered in young men with clinical, superficial bladder tumors refractory to conservative treatment who wish to maintain potency and fertility, and to guarantee as good a quality of life as possible. To ensure oncological success scrupulous patient selection is a primary step of this procedure.
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Affiliation(s)
- R Colombo
- Department of Urology, Scientific Institute H. San Raffaele, Milan, Italy
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