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Frego N, Contieri R, Fasulo V, Maffei D, Avolio PP, Arena P, Beatrici E, Sordelli F, De Carne F, Lazzeri M, Saita A, Hurle R, Buffi NM, Casale P, Lughezzani G. Development of a microultrasound-based nomogram to predict extra-prostatic extension in patients with prostate cancer undergoing robot-assisted radical prostatectomy. Urol Oncol 2024; 42:159.e9-159.e16. [PMID: 38423852 DOI: 10.1016/j.urolonc.2024.01.033] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To develop a microultrasound-based nomogram including clinicopathological parameters and microultrasound findings to predict the presence of extra-prostatic extension and guide the grade of nerve-sparing. MATERIAL AND METHODS All patients underwent microultrasound the day before robot-assisted radical prostatectomy. Variables significantly associated with extra-prostatic extension at univariable analysis were used to build the multivariable logistic model, and the regression coefficients were used to develop the nomogram. The model was subjected to 1000 bootstrap resamples for internal validation. The performance of the microultrasound-based model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA). RESULTS Overall, 122/295 (41.4%) patients had a diagnosis of extra-prostatic extension on definitive pathology. Microultrasound correctly identify extra-prostatic extension in 84/122 (68.9%) cases showing a sensitivity and a specificity of 68.9% and 84.4%, with an AUC of 76.6%. After 1000 bootstrap resamples, the predictive accuracy of the microultrasound-based model was 85.9%. The calibration plot showed a satisfactory concordance between predicted probabilities and observed frequencies of extra-prostatic extension. The DCA showed a higher clinical net-benefit compared to the model including only clinical parameters. Considering a 4% cut-off, nerve-sparing was recommended in 173 (58.6%) patients and extra-prostatic extension was detected in 32 (18.5%) of them. CONCLUSION We developed a microultrasound-based nomogram for the prediction of extra-prostatic extension that could aid in the decision whether to preserve or not neurovascular bundles. External validation and a direct comparison with mpMRI-based nomogram is crucial to corroborate our results.
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Affiliation(s)
- Nicola Frego
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Roberto Contieri
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Vittorio Fasulo
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Davide Maffei
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Pier Paolo Avolio
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Paola Arena
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Edoardo Beatrici
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Federica Sordelli
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Fabio De Carne
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy.
| | - Paolo Casale
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
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Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [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] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
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Beatrici E, Frego N, Chiarelli G, Sordelli F, Mancon S, Saitta C, De Carne F, Garofano G, Arena P, Avolio PP, Gobbo A, Uleri A, Contieri R, Paciotti M, Lazzeri M, Hurle R, Casale P, Buffi NM, Lughezzani G. A Comparative Evaluation of Multiparametric Magnetic Resonance Imaging and Micro-Ultrasound for the Detection of Clinically Significant Prostate Cancer in Patients with Prior Negative Biopsies. Diagnostics (Basel) 2024; 14:525. [PMID: 38472997 DOI: 10.3390/diagnostics14050525] [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: 01/30/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The diagnostic process for prostate cancer after a negative biopsy is challenging. This study compares the diagnostic accuracy of micro-ultrasound (mUS) with multiparametric magnetic resonance imaging (mpMRI) for such cases. METHODS A retrospective cohort study was performed, targeting men with previous negative biopsies and using mUS and mpMRI to detect prostate cancer and clinically significant prostate cancer (csPCa). RESULTS In our cohort of 1397 men, 304 had a history of negative biopsies. mUS was more sensitive than mpMRI, with better predictive value for negative results. Importantly, mUS was significantly associated with csPCa detection (adjusted odds ratio [aOR]: 6.58; 95% confidence interval [CI]: 1.15-37.8; p = 0.035). CONCLUSIONS mUS may be preferable for diagnosing prostate cancer in previously biopsy-negative patients. However, the retrospective design of this study at a single institution suggests that further research across multiple centers is warranted.
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Affiliation(s)
- Edoardo Beatrici
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giuseppe Chiarelli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Federica Sordelli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Stefano Mancon
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Fabio De Carne
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giuseppe Garofano
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Paola Arena
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
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Radtke G, Klotz S, Lazzeri M, Loubeyre P, Krisch M, Bossak A. Phonon Dispersion and Proton Disorder of Ice VII and VIII. Phys Rev Lett 2024; 132:056102. [PMID: 38364173 DOI: 10.1103/physrevlett.132.056102] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/29/2023] [Accepted: 11/16/2023] [Indexed: 02/18/2024]
Abstract
The phonon dispersion of ice VII and that of its proton-ordered analog ice VIII are investigated through a combination of inelastic x-ray scattering (IXS) measurements and first-principles calculations of the oxygen sublattice dynamic structure factor. Particular attention is devoted to hydrogen-disorder in ice VII, addressed theoretically through a statistical ensemble of fictitious ordered supercell configurations. Similar phonon densities of states are found in both phases but are significantly less structured in the case of ice VII. Our data further show that, despite a full proton disorder, the acoustic phonon branches in this phase clearly inherit the periodicity of its body-centered cubic oxygen lattice. The calculations predict, however, the presence of gap openings in the one-atom phonon dispersion. These predictions are supported by revisiting the analysis of previous single-crystal IXS measurements along the longitudinal [111] branch of ice VII.
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Affiliation(s)
- G Radtke
- Sorbonne Université, CNRS UMR 7590, MNHN, IRD, Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), 4 place Jussieu, CEDEX 05, 75252 Paris, France
| | - S Klotz
- Sorbonne Université, CNRS UMR 7590, MNHN, IRD, Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), 4 place Jussieu, CEDEX 05, 75252 Paris, France
| | - M Lazzeri
- Sorbonne Université, CNRS UMR 7590, MNHN, IRD, Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie (IMPMC), 4 place Jussieu, CEDEX 05, 75252 Paris, France
| | - P Loubeyre
- CEA, DAM, DIF, 91297 Arpajon Cedex, France and Université Paris-Saclay, CEA, Laboratoire Matière en Conditions Extrêmes, 91680 Bruyères le Châtel, France
| | - M Krisch
- European Synchrotron Radiation Facility (ESRF), 71 Avenue des Martyrs, 38000 Grenoble, France
| | - A Bossak
- European Synchrotron Radiation Facility (ESRF), 71 Avenue des Martyrs, 38000 Grenoble, France
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Avolio PP, Lazzeri M, Maffei D, Fasulo V, Frego N, Saitta C, de Carne F, Paciotti M, Saita A, Hurle R, Guazzoni G, Casale P, Buffi NM, Lughezzani G. Is multiparametric MRI always needed in biopsy-naïve patients with abnormal digital rectal examination? A single-institutional experience combining clinical and micro-ultrasonography-based factors to optimize prostate cancer detection. World J Urol 2024; 42:9. [PMID: 38183489 DOI: 10.1007/s00345-023-04722-3] [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] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/16/2023] [Indexed: 01/08/2024] Open
Abstract
PURPOSE To assess the diagnostic performance of microultrasound-targeted biopsy (microUSTBx) and systematic biopsy (SBx) in detecting clinically significant prostate cancer (csPCa) among men with abnormal digital rectal examination (DRE) and suspicious lesions at multiparametric magnetic resonance imaging (mpMRI), and to compare the diagnostic performance of this approach with a mpMRI-guided targeted biopsy (MTBx) plus SBx-based strategy. METHODS Biopsy-naïve men with suspicious lesions at mpMRI and abnormal DRE were prospectively evaluated between October 2017 and January 2023. csPCa detection rate by microUSTBx plus SBx and MTBx plus SBx was assessed and then compared by McNemar's test. The added value of prostate-specific antigen density (PSAd) was also evaluated. RESULTS Overall, 182 biopsy naïve men were included. MicroUSTBx plus SBx achieved comparable detection rate to MTBx plus SBx in diagnosis of ciPCa and csPCa (ciPCa: 9.3% [17/182] vs 10% [19/182]; csPCa: 63% [114/182] vs 62% [113/182]). MicroUSTBx outperformed MTBx (ciPCa: 5.5% [10/182] vs 6.0% [11/182]; csPCa: 57% [103/182] vs 54% [99/182]). Using microUSTBx plus SBx would have avoided 68/182 (37%) unnecessary mpMRI, while missing only 2/116 (1.7%) csPCa. The decision curve analysis of suspicious microUS plus PSAd ≥ 0.15 ng/ml showed higher net benefit in the ability to identify true positives and reduce the number of unnecessary prostate biopsy in this subcategory of patients. CONCLUSIONS The combination of microUSTBx and SBx showed equal diagnostic performance to an mpMRI-based approach in biopsy-naïve patients with an abnormal DRE. The combination of this approach with PSAd maximize the diagnostic accuracy while lowering the need for unnecessary biopsies.
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Affiliation(s)
- Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Fabio de Carne
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy.
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy.
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6
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Urso L, Bauckneht M, Albano D, Chondrogiannis S, Grassetto G, Lanfranchi F, Dondi F, Fornarini G, Lazzeri M, Evangelista L. The evolution of PET imaging in renal, bladder, upper urinary tract urothelial, testicular and penile carcinoma - Today's impact, tomorrow's potential. Expert Rev Med Devices 2024; 21:55-72. [PMID: 38072680 DOI: 10.1080/17434440.2023.2293919] [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] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/07/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The advancement of hybrid PET/CT or PET/MRI imaging for non-prostate genitourinary cancers has not experienced the rapid progress of prostate cancer. Nevertheless, these neoplasms are aggressive and reliable imaging plays a pivotal role in enhancing patients' quality of life and prognosis. AREAS COVERED the main evidence regarding [18F]FDG and non-[18F]FDG PET/CT or PET/MRI in non-prostate uro-oncological malignancies are summarized and discussed. Moreover, potential future directions concerning PET imaging in these neoplasms are debated, with the aim to stimulate future research projects covering these fields. EXPERT OPINION In Renal Cell Carcinoma (RCC), [18F]FDG PET/CT demonstrates varying efficacy in staging, restaging, and prognostic stratification, but PSMA PET/CT is emerging as a potential game-changer, particularly in advanced, high-grade aggressive clear cell RCC. [18F]FDG PET/CT may see an increased use in N and M-staging of bladder cancer, as well as for detecting recurrence and response to neoadjuvant chemotherapy. Preliminary data regarding [68Ga]-FAPI also looks promising in this context. [18F]FDG PET/MRI could be useful for the T-staging of bladder cancer, while upper tract urothelial carcinoma still lacks of molecular imaging literature reports. In testicular and penile cancer [18F]FDG PET/CT has demonstrated its usefulness in several clinical settings, although experiences with non-[18F]FDG radiotracers are lacking.
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Affiliation(s)
- Luca Urso
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Domenico Albano
- Nuclear Medicine Department, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Sotirios Chondrogiannis
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gaia Grassetto
- Department of Nuclear Medicine - PET/CT Center, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - Francesco Lanfranchi
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Francesco Dondi
- Nuclear Medicine Department, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
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7
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Avolio PP, Lughezzani G, Anidjar M, Hassan T, Rompré-Brodeur A, Buffi NM, Lazzeri M, Sanchez-Salas R. The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review. World J Urol 2023; 41:3267-3276. [PMID: 37555985 DOI: 10.1007/s00345-023-04521-w] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e., any Gleason score ≥ 7 PCa; csPCa) along with non-organ-confined disease in patients undergoing PBx. METHODS A PubMed literature search was performed using keywords: prostate cancer diagnosis, prostate cancer diagnosis surveillance, systematic biopsy, target biopsy, micro-ultrasound, and prostate risk identification using micro-ultrasound. RESULTS MicroUS could significantly improve multiparametric magnetic resonance imaging (mpMRI) findings by adding valuable anatomical and pathological information provided by real-time examination. Furthermore, microUS target biopsy could replace systematic biopsy in clinical practice by reducing the detection of clinically insignificant (ciPCa) and increasing that of csPCa. Finally, microUS may be useful in predicting the presence of non-organ confined PCa before radical prostatectomy and it could also be an effective add-on tool for patient monitoring within the active surveillance program. CONCLUSION MicroUS may represent an attractive step forward for the management of csPCa as a complementary or alternative tool to mpMRI. Nevertheless, further longitudinal studies are warranted, and the strength of the evidence is still suboptimal to provide clear recommendations for daily clinical practice.
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Affiliation(s)
- Pier Paolo Avolio
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Toufic Hassan
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Alexis Rompré-Brodeur
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Nicolò Maria Buffi
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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8
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Fasulo V, Buffi N, Chiarelli G, Lughezzani G, Zuradelli M, Ripamonti CB, Barile M, Bianchi P, Benetti A, Paciotti M, Uleri A, Avolio PP, Saita A, Hurle R, Maura F, Germagnoli L, Asselta R, Soldà G, Casale P, Lazzeri M. Male awareness of prostate cancer risk remains poor in relatives of women with germline variants in DNA-repair genes. BJUI Compass 2023; 4:738-745. [PMID: 37818031 PMCID: PMC10560622 DOI: 10.1002/bco2.252] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/25/2023] [Accepted: 05/07/2023] [Indexed: 10/12/2023] Open
Abstract
Abstract. Objective The aim of this study is to evaluate male awareness of developing prostate cancer (PCa) in families with germline DNA-repair genes (DRG) variants. Materials and methods Data were collected from a prospective, monocentric cohort study. The study was conducted in a university hospital with a multidisciplinary approach to the patient (collaboration of the Departments of Oncology, Urology, Pathology, Radiology, and Medical Genetics Laboratory). We recruited healthy males, relatives of families of women with breast or ovarian cancer who tested positive for pathogenic variants (PVs) or likely pathogenic variants (LPVs) in DRGs. A dedicated PCa screening was designed and offered to men aged 35 to 69 years, based on early visits with digital rectal examination (DRE), prostate health index (PHI) measurement, multiparametric magnetic resonance imaging (mpMRI) and, if necessary, targeted/systematic prostate biopsies. The primary endpoint was to evaluate the willingness of healthy men from families with a DRG variants detected in female relatives affected with breast and/or ovarian cancer to be tested for the presence of familial PVs. The secondary endpoints were the acceptance to participate if resulted positive and compliance with the screening programme. Results Over 1256 families, of which 139 resulted positive for PVs in DRGs, we identified 378 'healthy' men aged between 35 and 69 years old. Two hundred sixty-one (69.0%) refused to be tested for DRG variants, 66 (17.5%) declared to have been previously tested, and 51 (13.5%) males were interested to be tested. Between those previously tested and those who accepted to be tested, 62 (53.0%) were positive for a DRG variant, and all of them accepted to participate in the subsequent surveillance steps. The main limitation is that is a single-centre study and a short follow-up. Conclusions All men tested positive for a DRG variants agreed to go under the surveillance scheme. However, only 31% of 'men at risk' (i.e., relative of a DRG variant carrier) expressed their willingness to be tested for the familial DRG variant. This observation strongly supports the urgent need to implement awareness of genetic risk for PCa within the male population.
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Affiliation(s)
- Vittorio Fasulo
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - NicolòMaria Buffi
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giuseppe Chiarelli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giovanni Lughezzani
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Monica Zuradelli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Medical Oncology and Hematology UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | | | - Monica Barile
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Paolo Bianchi
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alessio Benetti
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Marco Paciotti
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alessandro Uleri
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Pier Paolo Avolio
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alberto Saita
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Rodolfo Hurle
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Federica Maura
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Luca Germagnoli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Rosanna Asselta
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giulia Soldà
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Paolo Casale
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Massimo Lazzeri
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
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9
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Sica A, Lazzeri M. Specialization determines outcomes in inflammation and cancer. Nat Immunol 2023; 24:1399-1401. [PMID: 37580608 DOI: 10.1038/s41590-023-01592-0] [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: 08/16/2023]
Affiliation(s)
- Antonio Sica
- Department of Pharmaceutical Sciences, University of Piemonte Orientale 'A. Avogadro', Novara, Italy.
- Humanitas Clinical and Research Center, Istituto di Ricovero e Cura a Carattere Scientifico, Rozzano, Milan, Italy.
| | - Massimo Lazzeri
- Department of Urology, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rozzano, Milan, Italy
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10
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Avolio PP, Fasulo V, Sanchez-Salas R, Maffei D, Frego N, Lazzeri M, Paciotti M, Saita A, Hurle R, Guazzoni G, Casale P, Buffi NM, Lughezzani G. Diagnostic accuracy of multiparametric MRI- and microultrasound-targeted biopsy in biopsy-naïve patients with a PI-RADS 5 lesion: a single-institutional study. World J Urol 2023; 41:2335-2342. [PMID: 37418017 DOI: 10.1007/s00345-023-04480-2] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI)- and microultrasound (microUS)-guided targeted biopsy (TBx) in detecting prostate cancer (PCa) and clinically significant (cs) PCa among men with Prostate Imaging Reporting and Data System (PI-RADS 5) lesions and to compare this combined TBx (CTBx) strategy with CTBx plus systemic biopsy (SBx). METHODS One hundred and thirty-six biopsy-naïve patients with PI-RADS 5 lesion at multiparametric MRI undergoing CTBx plus SBx were retrospectively evaluated. Analysis of diagnostic performance of microUS-TBx, MRI-TBx, CTBx, SBx and combined CTBx plus SBx was performed. Cost (downgrade, upgrade and biopsy core) to effectiveness (detection rate) was compared. RESULTS CTBx achieved a comparable detection rate to CTBx plus SBx in diagnosis of PCa and csPCa (PCa: 78.7% [107/136] vs 79.4% [108/136]; csPCa: 67.6% [92/136] vs 67.6% [92/136]; p > 0.05) and outperformed SBx (PCa: 58.8% [80/136]; csPCa: 47.8% [65/136]; p < 0.001). Using CTB would have avoided 41.1% (56/136) unnecessary SBx, without missing any csPCa. The rate of any upgrading or csPCa upgrading was significantly higher by SBx than by CTBx [33/65 (50.8%) vs 17/65 (26.1%) and 20/65 (30.8%) vs 4/65 (6.15%), respectively, p < 0.05]. Considering csPCa detection rate, microUS showed high sensitivity and positive predictive value (94.6%, 87.9%, respectively), with lower specificity and negative predictive value (25.0% and 44.4%, respectively). At multivariable logistic regression models, positive microUS was identified as an independent predictor of csPCa (p = 0.024). CONCLUSIONS A combined microUS/MRI-TBx approach could be the ideal imaging tool for characterizing primary disease in PI-RADS five patients, allowing SBx to be avoided.
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Affiliation(s)
- Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- , Via Rita Levi Montalcini, 4, 20090, Rozzano, MI, Italy.
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11
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Grizzi F, Bax C, Hegazi MAAA, Lotesoriere BJ, Zanoni M, Vota P, Hurle RF, Buffi NM, Lazzeri M, Tidu L, Capelli L, Taverna G. Early Detection of Prostate Cancer: The Role of Scent. Chemosensors 2023; 11:356. [DOI: 10.3390/chemosensors11070356] [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] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Prostate cancer (PCa) represents the cause of the second highest number of cancer-related deaths worldwide, and its clinical presentation can range from slow-growing to rapidly spreading metastatic disease. As the characteristics of most cases of PCa remains incompletely understood, it is crucial to identify new biomarkers that can aid in early detection. Despite the prostate-specific antigen serum (PSA) levels, prostate biopsy, and imaging representing the actual gold-standard for diagnosing PCa, analyzing volatile organic compounds (VOCs) has emerged as a promising new frontier. We and other authors have reported that highly trained dogs can recognize specific VOCs associated with PCa with high accuracy. However, using dogs in clinical practice has several limitations. To exploit the potential of VOCs, an electronic nose (eNose) that mimics the dog olfactory system and can potentially be used in clinical practice was designed. To explore the eNose as an alternative to dogs in diagnosing PCa, we conducted a systematic literature review and meta-analysis of available studies. PRISMA guidelines were used for the identification, screening, eligibility, and selection process. We included six studies that employed trained dogs and found that the pooled diagnostic sensitivity was 0.87 (95% CI 0.86–0.89; I2, 98.6%), the diagnostic specificity was 0.83 (95% CI 0.80–0.85; I2, 98.1%), and the area under the summary receiver operating characteristic curve (sROC) was 0.64 (standard error, 0.25). We also analyzed five studies that used an eNose to diagnose PCa and found that the pooled diagnostic sensitivity was 0.84 (95% CI, 0.80–0.88; I2, 57.1%), the diagnostic specificity was 0.88 (95% CI, 0.84–0.91; I2, 66%), and the area under the sROC was 0.93 (standard error, 0.03). These pooled results suggest that while highly trained dogs have the potentiality to diagnose PCa, the ability is primarily related to olfactory physiology and training methodology. The adoption of advanced analytical techniques, such as eNose, poses a significant challenge in the field of clinical practice due to their growing effectiveness. Nevertheless, the presence of limitations and the requirement for meticulous study design continue to present challenges when employing eNoses for the diagnosis of PCa.
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Affiliation(s)
- Fabio Grizzi
- Department of Immunology and Inflammation, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Carmen Bax
- Politecnico di Milano, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, 20133 Milan, Italy
| | - Mohamed A. A. A. Hegazi
- Department of Immunology and Inflammation, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Beatrice Julia Lotesoriere
- Politecnico di Milano, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, 20133 Milan, Italy
| | - Matteo Zanoni
- Department of Urology, Humanitas Mater Domini, 21100 Castellanza, Italy
| | - Paolo Vota
- Department of Urology, Humanitas Mater Domini, 21100 Castellanza, Italy
| | - Rodolfo Fausto Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Lorenzo Tidu
- Italian Ministry of Defenses, “Vittorio Veneto” Division, 50136 Firenze, Italy
| | - Laura Capelli
- Politecnico di Milano, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, 20133 Milan, Italy
| | - Gianluigi Taverna
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Department of Urology, Humanitas Mater Domini, 21100 Castellanza, Italy
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12
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Gobbo A, Fasulo V, Contieri R, Uleri A, Avolio PP, Frego N, Lughezzani G, Saitta C, Taverna G, Zanoni M, Mancon S, Colombo P, Valeri M, Saita A, Lazzeri M, Buffi NM, Hurle R, Casale P. Clinical and pathological predictors of persistent T1 HG at second resection. Urologia 2023:3915603231181619. [PMID: 37341094 DOI: 10.1177/03915603231181619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND T1 high-grade (HG) non-muscle invasive bladder cancer (NMIBC) has a significant risk of recurrence and progression, and the European Association of Urology recommends a second transurethral resection of the bladder (ReTUR). Stage at ReTUR has been shown to be a reliable predictor of survival, therefore, we sought to assess clinical and pathological predictors associated with the persistence of T1 at ReTUR in our retrospective multicentric cohort. METHODS This is a retrospective multicentric study of T1 HG patients at transurethral resection of the bladder (TURB) who underwent subsequent ReTUR. All histological samples were sub-classified according to Rete Oncologica Lombarda (ROL) T1 sub-staging system. RESULTS One hundred and sixty-six patients were enrolled. Forty-four (26.5%) had T1 HG tumor at ReTUR while 93 (56%) had residual tumor of any stage. Lesion size was significantly greater in T1 HG patients at ReTUR, as well as the prevalence of multifocality. The multivariable logistic regression model showed lesion dimension and multifocality as predictors of T1 HG at ReTUR, after adjusting for significant covariables (CIS and detrusor muscle presence). ROL sub-staging system was not a significant predictor, but ROL2 prevalence was higher in the T1 HG at ReTUR group. CONCLUSIONS Lesion size and multifocality were independent predictors of T1 HG persistence at ReTUR, and patients at risk should be promptly identified and treated accordingly. Our results could help physicians make patient-tailored decisions by identifying those most likely to benefit from a second resection.
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Affiliation(s)
- Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianluigi Taverna
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Matteo Zanoni
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Stefano Mancon
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italia
| | - Marina Valeri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italia
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicolò M Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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13
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Saitta C, De Simone I, Fasulo V, Corbetta M, Duga S, Chiereghin C, Colombo FS, Benetti A, Contieri R, Avolio PP, Uleri A, Saita A, Guazzoni GF, Hurle R, Colombo P, Buffi NM, Casale P, Lughezzani G, Asselta R, Soldà G, Lazzeri M. Evaluation of Semen Self-Sampling Yield Predictors and CTC Isolation by Multi-Color Flow Cytometry for Liquid Biopsy of Localized Prostate Cancer. Cancers (Basel) 2023; 15:2666. [PMID: 37345004 DOI: 10.3390/cancers15102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 06/23/2023] Open
Abstract
Liquid biopsy (LB) for prostate cancer (PCa) detection could represent an alternative to biopsy. Seminal fluid (SF) is a source of PCa-specific biomarkers, as 40% of ejaculate derives from the prostate. We tested the feasibility of an SF-based LB by evaluating the yield of semen self-sampling in a cohort of >750 patients with clinically localized PCa. The overall SF collection yield was 18.2% (39% when considering only compliant patients), with about a half of the patients (53.15%) not consenting to SF donation. Independent favorable predictors for SF collection were younger age and lower prostate volume. We implemented a protocol to enrich prostate-derived cells by multi-color flow cytometry and applied it on SF and urine samples from 100 patients. The number of prostate-enriched cells (SYTO-16+ PSMA+ CD45-) was variable, with higher numbers of cells isolated from SF than urine (p value < 0.001). Putative cancer cells (EpCAMhigh) were 2% of isolated cells in both specimens. The fraction of EpCAMhigh cells over prostate-enriched cells (PSMA+) significantly correlated with patient age in both semen and urine, but not with other clinical parameters, such as Gleason Score, ISUP, or TNM stage. Hence, enumeration of prostate-derived cells is not sufficient to guide PCa diagnosis; additional molecular analyses to detect patient-specific cancer lesions will be needed.
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Affiliation(s)
- Cesare Saitta
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Ilaria De Simone
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Marinella Corbetta
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Flow Cytometry Core, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Chiara Chiereghin
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | | | - Alessio Benetti
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Roberto Contieri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Pier Paolo Avolio
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Alessandro Uleri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giorgio Ferruccio Guazzoni
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Nicolò Maria Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Flow Cytometry Core, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giulia Soldà
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Flow Cytometry Core, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
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Contieri R, Lazzeri M, Hurle R. When and How To Perform Active Surveillance for Low-risk Non-muscle-invasive Bladder Cancer. Eur Urol Focus 2023:S2405-4569(23)00095-0. [PMID: 37059619 DOI: 10.1016/j.euf.2023.03.025] [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: 01/29/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
Active surveillance (AS) has been proposed as a possible management option for patients with recurrent low-grade non-muscle-invasive bladder cancer. Recent studies suggest that AS is a safe and effective management strategy. Nevertheless, a consensus statement is needed to standardize inclusion criteria and follow-up schedules.
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Affiliation(s)
- Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy.
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
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15
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Frego N, Contieri R, Diana P, Mancon S, Colombo P, Lazzeri M, Buffi NM, Casale P, Hurle R. Inflammatory Markers and Type 2 Diabetes as Prognostic Risk Factors in Low-Risk Bladder Cancer. BJU Int 2023. [PMID: 37017610 DOI: 10.1111/bju.16026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Nicola Frego
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberto Contieri
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pietro Diana
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Stefano Mancon
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolo Maria Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
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16
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Maffei D, Fasulo V, Avolio PP, Saitta C, Paciotti M, De Carne F, Colombo P, Pasini L, De Zorzi SZ, Saita A, Hurle R, Lazzeri M, Guazzoni GF, Casale P, Buffi NM, Lughezzani G. Diagnostic performance of Micro-Ultrasound at MRI-guided confirmatory biopsy in patients under active surveillance for low-risk prostate cancer. Prostate 2023; 83:886-895. [PMID: 36960788 DOI: 10.1002/pros.24532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 09/26/2022] [Revised: 01/22/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Active surveillance (AS) represents a standard of care of low-risk prostate cancer (PCa). However, identification and monitoring of AS candidates remains challenging. Micro-ultrasound (microUS) is a novel high-resolution imaging modality for transrectal ultrasonography (TRUS). We explored the impact of microUS TRUS and targeted biopsies in mpMRI-guided confirmatory biopsies. METHODS Between October 2017 and September 2021 we prospectively enrolled 100 patients scheduled for MRI-guided confirmatory biopsy at 1 year from diagnosis of ISUP 1 PCa. TRUS was performed using the ExactVu microUS system; PRI-MUS protocol was applied to identify suspicious lesions (i.e. PRIMUS score ≥3). All patients received targeted biopsies of any identified microUS and mpMRI lesions and complementary systematic biopsies. The proportion of patients upgraded to clinically significant PCa (defined as ISUP≥2 cancer; csPCa) at confirmatory biopsies was determined, and the diagnostic performance of microUS and mpMRI were compared. RESULTS 92 patients had a suspicious MRI lesion classified PI-RADS 3, 4 and 5 in respectively 28, 16 and 18 patients. MicroUS identified 82 patients with suspicious lesions, classified as PRI-MUS 3, 4 and 5 in respectively 20, 50 and 12 patients, while 18 individuals had no lesions. 34 patients were upgraded to ISUP≥2 cancer and excluded from AS. MicroUS and mpMRI showed a sensitivity of 94.1% and 100% and a NPV of 88.9% and 100% respectively in detecting ISUP≥2 patients. A microUS-mandated protocol would have avoided confirmatory biopsies in 18 patients with no PRI-MUS ≥3 lesions at the cost of missing 4 upgraded patients. CONCLUSIONS MicroUS and mpMRI represent valuable imaging modalities showing high sensitivity and NPV in detecting csPCa, thus allowing their use for event-triggered confirmatory biopsies in AS patients. MicroUS offers an alternative imaging modality to mpMRI for the identification and real-time targeting of suspicious lesions in AS patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Fabio De Carne
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Pathology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Luisa Pasini
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | | | - Alberto Saita
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Rodolfo Hurle
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Massimo Lazzeri
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Giorgio Ferruccio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Paolo Casale
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
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Lazzeri M, Fasulo V, Tinterri C. Eve's and Adam's rib for prostate cancer screening. BJU Int 2023; 131:637-638. [PMID: 36919875 DOI: 10.1111/bju.15999] [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] [Indexed: 03/16/2023]
Affiliation(s)
- Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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18
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Hurle R, Soria F, Contieri R, Avolio PP, Mancon S, Lazzeri M, Bernasconi V, Mazzoli S, Pizzuto G, De Bellis M, Rosazza M, Livoti S, Lupia T, Corcione S, Lillaz B, De Rosa FG, Buffi NM, Kamat AM, Gontero P, Casale P. Evaluating the Protective Effect of Intravesical Bacillus Calmette-Guerin against SARS-CoV-2 in Non-Muscle Invasive Bladder Cancer Patients: A Multicenter Observational Trial. Cancers (Basel) 2023; 15:cancers15051618. [PMID: 36900409 PMCID: PMC10000457 DOI: 10.3390/cancers15051618] [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: 12/23/2022] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
We aim to evaluate the potential protective role of intravesical Bacillus Calmette-Guerin (BCG) against SARS-CoV-2 in patients with non-muscle invasive bladder cancer (NMIBC). Patients treated with intravesical adjuvant therapy for NMIBC between January 2018 and December 2019 at two Italian referral centers were divided into two groups based on the received intravesical treatment regimen (BCG vs. chemotherapy). The study's primary endpoint was evaluating SARS-CoV-2 disease incidence and severity among patients treated with intravesical BCG compared to the control group. The study's secondary endpoint was the evaluation of SARS-CoV-2 infection (estimated with serology testing) in the study groups. Overall, 340 patients treated with BCG and 166 treated with intravesical chemotherapy were included in the study. Among patients treated with BCG, 165 (49%) experienced BCG-related adverse events, and serious adverse events occurred in 33 (10%) patients. Receiving BCG or experiencing systemic BCG-related adverse events were not associated with symptomatic proven SARS-CoV-2 infection (p = 0.9) nor with a positive serology test (p = 0.5). The main limitations are related to the retrospective nature of the study. In this multicenter observational trial, a protective role of intravesical BCG against SARS-CoV-2 could not be demonstrated. These results may be used for decision-making regarding ongoing and future trials.
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Affiliation(s)
- Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Roberto Contieri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Pier Paolo Avolio
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Stefano Mancon
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Correspondence:
| | - Valentina Bernasconi
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Simone Mazzoli
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Giuseppe Pizzuto
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Matteo De Bellis
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Matteo Rosazza
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Simone Livoti
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Beatrice Lillaz
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Nicolò Maria Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Ashish M. Kamat
- MD Anderson Cancer Center, University of Texas, Houston, TX 78712, USA
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
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Bandini M, Basile G, Lazzeri M, Montorsi F, Valli B, Balò S, Barbagli G. Optimizing decision-making after ventral onlay buccal mucosa graft urethroplasty failure. BJU Int 2023; 131:339-347. [PMID: 36114780 DOI: 10.1111/bju.15895] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate factors predicting recurrence after treatment and to assess the best rescue option for patients failing buccal mucosa graft (BMG) urethroplasty. MATERIALS AND METHODS We evaluated the data from 575 patients treated with ventral onlay BMG urethroplasty. Multivariable Cox regression analysis was performed to identify predictors of BMG urethroplasty failure, and their effect on failure risk was estimated using the Kaplan-Meier method and compared using log-rank tests. Then, for those patients who underwent a rescue treatment, namely, direct visual internal urethrotomy (DVIU) vs open urethroplasty, we assessed the probability of success after retreatment using the Kaplan-Meier method and regression tree analyses. RESULTS On multivariable Cox regression analysis, only stricture length ≥5 cm (hazard ratio 3.46, 95% confidence interval 1.50-7.94; P = 0.003) was a predictor of failure. A total of 103 patients had at least one re-intervention. Notably, 12-month success rates after first rescue DVIU, second rescue DVIU, third rescue DVIU, and fourth rescue DVIU were 66.3%, 62.5%, 37.5% and 25%, respectively. Conversely, for those patients who underwent open urethroplasty retreatment, success rates at 12 months were 83.3%, 79%, 92.3% and 75% after BMG ventral onlay, first rescue DVIU, second rescue DVIU and third rescue DVIU, respectively. These data were confirmed in regression tree analyses. CONCLUSION Ventral BMG urethroplasty fails in approximately one out of five patients. Despite DVIU as a rescue treatment being a good option, its success rate becomes lower as the number of DVIU treatments performed increases. Conversely, open urethroplasty improves patient outcomes in almost three out of four patients, even in the case of previous failed DVIU treatments for stricture recurrence.
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Affiliation(s)
- Marco Bandini
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.,Centro Chirurgico Toscano, Arezzo, Italy
| | - Giuseppe Basile
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Lazzeri
- Instituto Clinico Humanitas IRCCS-Clinical and Researcher Hospital, Rozzano, Italy
| | - Francesco Montorsi
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Sofia Balò
- Centro Chirurgico Toscano, Arezzo, Italy
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Lazzeri M, Fasulo V, Buffi N, Lughezzani G, Casale P, Benetti A, Saita A, Hurle R, Guazzoni GF, Chiarelli G, Asselta R, Soldà G. Awareness of genetic risk for prostate cancer (PCa) in men from families with germline mutations in DNA-repair genes. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
328 Background: Although one of the most important risk factors for prostate cancer (PCa) is a family history of the disease, there is a poor awareness of genetic risk. The aim of the current study is to investigate the awareness of genetic risk for PCa in men belonging to female families with germline variants in DNA-repair genes (DRGs). Methods: Data were extracted by a prospective observational study designed to select men with germline pathogenic variants (PVs) and offer them a dedicated PCa screening. The selection of probands was performed by genetic counseling and testing of male grade I relatives of female patients with a PVs. Male candidates were identified after reviewing the genealogical trees of all women who had received the diagnosis of breast and/or ovarian cancer and tested positive for a PVs. All the probands, 35-69 yrs old, who resulted positive for PVs were offered to participate to a specific PCa screening based on annually digital rectal examination (DRE), detection of PHI, which is a blood test including total PSA, free PSA, free/total PSA and -2proPSA, and multiparametric MRI. The primary outcome was the “willing to be tested”, defined as a proxy for male awareness of PCa risk. The secondary endpoint was the acceptance rate to be screened. Results: We reviewed the genealogical trees of breast/ovarian cancer female patients from January 2017 to December 2021 and we identified, over 1256 families, 139 positive cases for PVs in DRGs. Among 139 families, we identified 378 “healthy” 35-69 yrs old men, who were offered a genetic counseling, and if they agree a genetic testing. Overall 117/378 (31%) healthy males declared to be interested to be tested. Out of the 51 new tests (66 men already tested out of the study), we found 30 (58.8%) positive men. All the new positive tested men accepted to attend the PCa screening. Living in Northern Italy, having at least one child and higher (degree) level of education were the strongest predictors of willing for testing (p<0.01). Conclusions: Our data reveals a limited will to be tested, but all men tested positive for PVs accepted to participate to the PCa screening. These findings strongly support the urgent need to implement awareness of genetic risk for PCa.
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Affiliation(s)
| | | | | | | | - Paolo Casale
- IRCCS Humanitas Research Hospital, Rozzano, Italy
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21
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Lazzeri M, Rescigno M, Guazzoni GF, Casale P, Buffi N, Lughezzani G, Mancon S, Fasulo V, Saita A, Hurle R. Randomized phase III clinical trial of neoadjuvant intravesical mitomycin C (MMC) treatment in patients with primary treatment-naïve non-muscle invasive bladder cancer (NMIBC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.tps578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
TPS578 Background: Approximately 75-85% of vesical urothelial carcinomas are non-muscle invasive bladder cancers (NMIBC). The primary treatment is transurethral resection (TUR) followed by adjuvant intravesical therapies with immunotherapy (BCG) and/or chemotherapy agents (i.e. mitomycin C - MMC). Unfortunately, the response to intravesical treatments is variable and incomplete and there is a un-met clinical need to improve its efficacy for reducing the recurrence rate and progression to muscle invasive BC (MIBC). Recently, has been showed that MMC induces immunogenic cell death (ICD), determining the expression of specific damage signals, like HMGB1 molecule, that favors the phagocytosis of dying tumor cells, the activation of innate immune cells and the presentation of tumor antigens to T lymphocytes [1]. The identification of ICD as a novel immune-related mechanism of action of MMC could provide opportunities to optimize bladder cancer management by proposing the use of MMC in a “neoadjuvant” setting. The aim of current clinical trial is to test the hypothesis that the neoadjuvant instillation of MMC in patients with NMIBC may reduce the recurrence rate and/or progression to MIBC. Methods: This is a prospective phase III randomized clinical trial in patients with primary treatment-naïve NMIBC recruiting since March 2022 (EudraCT 2021-003751-42_studio ICH-013-MMC). Patients are randomized 1:1 to neo-adjuvant MMC or standard of care. Patients enrolled in the neo-MMC group receive two intravesical instillations of MMC (40 mg/40 ml saline) in the 2 weeks before (days: -14 and -7) the scheduled TUR (day: 0). After TUR, as for clinical practice, both controls and neoMMC subjects, undergo adjuvant treatment, if required, based on the histological evaluation of the tumor and following EAU/PMID: 33040478 guidelines. The primary endpoint of the study is to evaluate the efficacy of MMC neoadjuvant treatment in reducing the recurrence rate of BC calculated as the proportion of patients who achieve a complete response (no evidence of BC after 3, 6, 12 and 24 mo.). The secondary clinical endpoint will be the analysis of the rate of grade and stage progression to MIBC in case of recurrence and the correlation with specific biomarker (i.e. expression of HMGB1). Consider that the primary aim of the study is to see a reduction of relapse, leading to an HR of 0.6, estimating on the control group a 30% relapse free at 12 months. With equal-sized group, a two-sided significance level test (α =0.05) with power 80% power (β=0.2), and assume that recruitment was to be terminated after 12 months, with a 2-year follow up, the required sample size is approximate 160 patient, 80 in each group (control / neoMMC). References: 1. Oresta B, et al Sci Transl Med. Jan 6;13(575):eaba6110 Clinical trial information: EudraCT 2021-003751-42_studio ICH-013 (MMC) .
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Affiliation(s)
| | | | | | - Paolo Casale
- IRCCS Humanitas Research Hospital, Rozzano, Italy
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22
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Arena P, Fasulo V, Chiarelli G, Frego N, De Carne F, Maffei D, Jandric J, Gelardi F, Garofano G, Saitta C, Mancon S, Sordelli F, Beatrici E, Hurle R, Saita A, Lazzeri M, Guazzoni G, Buffi N, Lughezzani G, Casale P. Prospective evaluation of the diagnostic accuracy of different PSMA PET/CT tracers for the nodal staging of radical prostatectomy candidates: A single institutional analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Pandini M, Carriero R, Buffi N, Carvetta M, Iovino M, Casale P, Lughezzani G, Hurle R, Alberto S, Fasulo V, Guazzoni G, Elefante G, Colombo P, Basso G, Marchini S, Kunderfranco P, Di Mitri D, Lazzeri M. Single cell-based immune profiling of the tumor and its immune microenvironment revealed differences between non-muscle invasive and muscle invasive bladder cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Frego N, Maffei D, Fasulo V, Paciotti M, Diana P, Avolio P, Chiarelli G, Arena P, Beatrici E, De Carne F, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Is micro-ultrasound a reliable tool for prostate cancer diagnosis? results from a single-institution cohort of over 1,000 men. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Contieri R, Martini A, Beatrici E, Frego N, Diana P, Paciotti M, Mancon S, Lazzeri M, Saita A, Lughezzani G, Buffi N, Casale P, Kamat A, Hurle R. Implementing the Active Surveillance (AS) follow-up schedule for low-grade Non- Muscle-Invasive Bladder Cancer (NMIBC) tumors. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Avolio P, Fasulo V, Maffei D, Saitta C, Frego N, Paciotti M, Contieri R, De Carne F, Lazzeri M, Saita A, Hurle R, Casale P, Buffi N, Lughezzani G. Clinical and high-resolution micro-ultrasound risk factors for detecting clinically significant prostate cancer in men with PI-RADS 3 lesions: Update from a large single center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Frego N, De Carne F, Fasulo V, Maffei D, Avolio P, Arena P, Chiarelli G, Beatrici E, Paciotti M, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Head-to-head comparison between microUS, the partin tables and memorial sloan kettering cancer center nomogram in predicting extraprostatic disease in patients undergoing robot-assisted radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Chiarelli G, Fasulo V, Zuradelli M, Arena P, Beatrici E, Gobbo A, Saitta C, Hurle R, Saita A, Maura F, Asselta R, Soldà G, Casale P, Guazzoni G, Lughezzani G, Buffi N, Lazzeri M. A dedicated screening for early detection of prostate cancer in men with germline mutations in DNA-repair genes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Avolio P, Fasulo V, Maffei D, Frego N, Paciotti M, Lazzeri M, Saita A, Hurle R, Casale P, Buffi N, Lughezzani G. Impact of a structured rehabilitation program on the functional outcomes of patients undergoing robot-assisted radical prostatectomy: A single tertiary-care center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00540-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Frego N, Chiarelli G, Fasulo V, Maffei D, Arena P, Avolio P, Beatrici E, Paciotti M, De Carne F, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Comparison of the diagnostic performance between multiparametric MRI and microUS in the detection of clinically significance prostate cancer among patients with previous negative biopsy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Fasulo V, Arena P, Chiarelli G, De Carne F, Garofano G, Maffei D, Gelardi F, Jandric J, Sordelli F, Frego N, Mancon S, Avolio P, Saitta C, Saita A, Hurle R, Casale P, Lazzeri M, Buffi N, Lughezzani G. Comparison of the diagnostic accuracy of PSMA PET/CT scan and Briganti nomogram to predict lymph node invasion in candidates to robot-assisted radical prostatectomy: A single institutional analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lopci E, Lazzeri M, Disconzi L, Maffei D, Fasulo V, Avolio P, Paciotti M, Pasini L, Benetti A, Hurle R, Saita A, Colombo P, Marzo K, Leonardi L, Balzarini L, Chiti A, Guazzoni G, Casale P, Buffi N, Lughezzani G. Prospective comparison of PSMA PET/CT vs. mpMRI in patients with a high suspicion of prostate cancer and previously negative biopsy: Preliminary data from PROSPET-BX trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lopci E, Lazzeri M, Colombo P, Casale P, Buffi NM, Saita A, Peschechera R, Hurle R, Marzo K, Leonardi L, Morenghi E, Balzarini L, Disconzi L, Guazzoni G, Chiti A, Lughezzani G. Diagnostic Performance and Clinical Impact of PSMA PET/CT versus mpMRI in Patients with a High Suspicion of Prostate Cancer and Previously Negative Biopsy: A Prospective Trial (PROSPET-BX). Urol Int 2023; 107:433-439. [PMID: 36724746 DOI: 10.1159/000528720] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND This prospective single-arm study is designed to compare in parallel 68Ga-PSMA PET/TRUS (transrectal or transperineal) fusion biopsy ("experimental test") with multiparametric MRI (mpMRI)/TRUS fusion prostate biopsy ("standard test") in men with a high suspicion of prostate cancer (PCa) after at least one negative biopsy. The primary objective was to evaluate the diagnostic performance of 68Ga-PSMA PET/TRUS fusion prostate biopsy in comparison to mpMRI/TRUS fusion prostate biopsy analyzed in parallel. Secondarily, we aimed to determine the relationship between the "experimental test" and the histopathological characteristics of the specimen, along with the clinical utility of the "experimental test" compared to the "standard test." SUMMARY To test the superiority of 68Ga-PSMA PET/CT compared to mpMRI, we will enroll a minimum cohort of 128 patients. Inclusion criteria comprise: age >18 years; blood PSA level >4.0 ng/mL; free-to-total PSA ratio <20%; progressive rise of PSA levels in two consecutive blood samples despite antibiotics; serum blood tests suspicious for PCa; at least one previous negative biopsy; ASAP and/or high-grade PIN; negative digital rectal examination. All eligible patients will undergo 68Ga-PSMA PET/CT and mpMRI scans within 1 month's distance from each other, followed by biopsy session to be completed within 1 month's distance. Targeted TRUS fusion needle biopsy will be performed for all lesions detected with PET and mpMRI. The total duration of the study is 36 months. KEY MESSAGES By comparing the "experimental test" and the "standard test" in parallel, we will be able to determine the superior diagnostic performance of 68Ga-PSMA PET/CT over mpMRI in detecting PCa, and in particular clinically significant PCa, in the specific cohort of patients with a high suspicion of PCa who are candidates to re-biopsy. The clinical impact of the "experimental test" will be subsequently analyzed in terms of the number of prostate biopsies that could be spared, time-consuming, patient friendliness, and cost-effectiveness.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Nicolo M Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Katia Marzo
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Lorenzo Leonardi
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Luca Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Luca Disconzi
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giorgio Guazzoni
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Arturo Chiti
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Giovanni Lughezzani
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Avolio PP, Lazzeri M, Buffi NM, Lughezzani G. Micro-ultrasound may significantly reduce the proportion of unnecessary prostate biopsies in patients with PI-RADS 3 lesions. Cancer 2023; 129:320-321. [PMID: 36427000 DOI: 10.1002/cncr.34549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
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Hurle R, Lazzeri M. Editorial: New frontiers in "bladder sparing" treatments for high risk NMIBC. Front Oncol 2023; 12:1118940. [PMID: 36713569 PMCID: PMC9875292 DOI: 10.3389/fonc.2022.1118940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
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Uleri A, Diana P, Lughezzani G, Casale P, Saita A, Hurle R, Lazzeri M, Porpiglia F, Fiori C, Amparore D, Verri P, Rosiello G, Mottrie A, DE Naeyer G, DE Groote R, Porter J, Buffi N. Are nephrometry scores accurate for the prediction of outcomes in patients with renal angiomyolipoma treated with robot-assisted partial nephrectomy? A multi-institutional analysis. Minerva Urol Nephrol 2022; 74:730-737. [PMID: 35622350 DOI: 10.23736/s2724-6051.22.04848-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prediction of complications and surgical outcomes is of outmost importance even in patients with benign renal masses. The aim of our study is to test the PADUA, SPARE and R.E.N.A.L. scores to predict nephron sparing surgery (NSS) outcomes in patients presenting with renal angiomyolipoma (RAML). METHODS We retrospectively analyzed the clinical and pathological data of 93 patients with AML treated with robot-assisted partial nephrectomy (RAPN) at three tertiary care referral centers. Renal masses were classified according to the PADUA, SPARE and R.E.N.A.L. nephrometry scores. Surgical success was defined according to the novel Trifecta Score. Logistic regression models (LRM) were fitted to predict the achievement of novel Trifecta and the risk of high-grade Clavien-Dindo (CD) complication. The receiver operating characteristics (ROC) curve analysis was used to estimate the accuracy of LRMs. RESULTS Of 93 patients, 66 (69.9%) were females; median tumor size was 42 (36-48) mm. Novel Trifecta was achieved in 79 patients (84.9%) and postoperative complications classified as CD>2 occurred in 7 (7.5%) patients. At univariate and multivariate LRMs all three nephrometry scores were significantly associated with novel Trifecta achievement. Similar findings were observed for the prediction of CD>2 complications. The AUCs to predict optimal surgical outcomes and CD>2 complications were 0.791 and 0.912 for PADUA, 0.767 and 0.836 for SPARE and 0.756 and 0.842 for RENAL Score, respectively. CONCLUSIONS RAPN appears to be a feasible and safe surgical technique for the treatment of RAML. PADUA, SPARE and RENAL scores can be safely adopted to predict surgical outcomes, with the first one showing a higher accuracy.
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Affiliation(s)
- Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy - .,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Pietro Diana
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Casale
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alberto Saita
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giuseppe Rosiello
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Alex Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Geert DE Naeyer
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Ruben DE Groote
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - James Porter
- Department of Urology, Swedish Urology Group, Seattle, WA, USA
| | - Nicolomaria Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Chiarelli G, Fasulo V, Zuradelli M, Ripamonti C, Bianchi P, Buffi N, Casale P, Lughezzani G, Saita A, Hurle R, Santoro A, Lazzeri M. Male awareness of prostate cancer risk remains poor in families with germline DNA-repair genes mutations. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02464-8] [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: 11/11/2022] Open
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Garofano G, Diana P, Saitta C, Uleri A, Lughezzani G, Beatrici E, Chiarelli G, Frego N, Contieri R, Paciotti M, Fasulo V, Lazzeri M, Saita A, Hurle R, Casale P, Guazzoni G, Buffi N. The role of Mayo Adhesive Probability score in operative outcomes: A single center prospective analysis. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02548-4] [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: 11/11/2022] Open
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Diana P, Garofano G, Uleri A, Lughezzani G, Beatrici E, Saitta C, Chiarelli G, Frego N, Paciotti M, Fasulo V, Lazzeri M, Saita A, Hurle R, Casale P, Guazzoni G, Buffi N. Adherent perinephric fat as predictor of post-operative functional recovery after robot-assisted partial nephrectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02561-7] [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: 11/11/2022] Open
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Saitta C, Diana P, Lughezzani G, Casale P, Uleri A, Beatrici E, Chiarelli G, Garofano G, Fasulo V, Avolio P, Lazzeri M, Hurle R, Saita A, Giorgio G, Buffi N. Renal cell carcinoma with venous thrombus: A retrospective single center surgical and oncological analysis. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02550-2] [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: 11/11/2022] Open
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Bertelli M, Toniolo S, Gasperetti A, Schiavone M, Arosio R, Statuto G, Ziacchi M, Mitacchione G, Angeletti A, Spadotto A, Bartoli L, Lazzeri M, Carecci A, Forleo GB, Biffi M. Is less always more? A prospective two-centre study addressing clinical outcomes in leadless versus transvenous single-chamber pacemaker recipients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.490] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Transvenous (TV) pacemakers are a well established treatment of bradyarrhythmias yet their complications, namely bleeding, infection and pneumothorax, still pose challenges to modern cardiology. This applies particularly to the older patient subgroup requiring single-chamber pacing due to comorbid atrial fibrillation (AF). Furthermore, conditions such as superior venous access issues, high infectious, or bleeding risk may complicate or preclude transvenous lead implantation. While VVIR leadless (LL) pacemakers aim to tackle these shortcomings, a comparison with contemporary single-chamber TV cohorts is currently lacking thus hindering a clear definition of the scope of LL pacing in clinical practice.
Purpose
To prospectively analyse survival and complication rates in leadless versus transvenous single-chamber pacemaker recipients.
Methods
This is a prospective analysis of 344 consecutive patients who received single-chamber TV or LL pacemakers between June 2015 and May 2021 in two tertiary cardiology centres. Indications for single-chamber pacing were “slow” AF, atrio-ventricular block with comorbid AF (either permanent or accepted as “destination rhythm”) or with sinus rhythm in bedridden cognitively impaired patients. LL indications were ongoing or expected chronic haemodialysis (6.9%), superior venous access issues such as occlusion (11.1%) or need for its preservation (9.7%), active lifestyle with low amount of pacing expected (22.2%), frailty causing high bleeding and infectious risk (23.6%), as well as recent valvular endocarditis (2.8%) or implantable electronic device infection requiring extraction (5.6%).
Results
72 patients (20.9%) received LL and 272 (79.1%) TV single-chamber pacemakers. In keeping with LL indications, diabetes and ongoing haemodialysis were more prevalent in the LL population. No significant difference in overall complication rate was observed between LL and TV patients (5.6% vs. 5.1%, p=0.33) apart from haematomas, which occurred more frequently in the LL population. Only 1 haematoma in the TV group required surgical reintervention. TV recipients survival was lower with greater cardiovascular mortality, likely due to selection of significantly older patients.
Conclusions
Given the limited complication rate observed in this contemporary single-chamber TV cohort and low life expectancy of this particular population, extending LL indications to all VVIR candidates is unlikely to provide a clearcut survival advantage. Considering the higher costs of LL technology, these data prompt a careful selection of those cases where LL approach does indeed provide an advantage. In addition to the setting of vascular access issues and high bleeding or infectious risk, these may include patients with sufficient life expectancy where lead-related risks may indeed adversely affect prognosis. Based on our patient selection criteria, LL might account for approximately 20% of VVIR pacing recipients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Bertelli
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - S Toniolo
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - A Gasperetti
- ASST Fatebenefratelli Sacco, Cardiology , Milano , Italy
| | - M Schiavone
- ASST Fatebenefratelli Sacco, Cardiology , Milano , Italy
| | - R Arosio
- ASST Fatebenefratelli Sacco, Cardiology , Milano , Italy
| | - G Statuto
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - M Ziacchi
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - G Mitacchione
- ASST Fatebenefratelli Sacco, Cardiology , Milano , Italy
| | - A Angeletti
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - A Spadotto
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - L Bartoli
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - M Lazzeri
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - A Carecci
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
| | - G B Forleo
- ASST Fatebenefratelli Sacco, Cardiology , Milano , Italy
| | - M Biffi
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiology , Bologna , Italy
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Avolio P, Fasuolo V, Paciotti M, Diana P, Frego N, Maffei D, Contieri R, Uleri A, Saitta C, Beatrici E, Chiarelli G, De Carne F, Hurle R, Lazzeri M, Saita A, Casale P, Buffi N, Lughezzani G. Assessing the role of high-resolution micro-ultrasound among patients with a negative multiparametric MRI and persistent suspicion of prostate cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01288-5] [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: 11/05/2022] Open
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Contieri R, Gobbo A, Paciotti M, Avolio P, Fasulo V, Saitta C, Uleri A, Valeri M, Colombo P, Saita A, Lazzeri M, Lughezzani G, Buffi N, Casale P, Guazzoni G, Hurle R. Accuracy of AUA and EAU risk stratification groups in predicting early recurrence in HG TA non-muscle invasive bladder cancer: a comparison analysis. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01022-9] [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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Garofano G, Diana P, Uleri A, Lughezzani G, Beatrici E, Saitta C, Frego N, Paciotti M, Contieri R, Lazzeri M, Saita A, Hurle R, Guazzoni G, Buffi N. The relationship between adherent perinephric fat and the mayo adhesive probability (MAP) score and post-operative functional outcomes in patients subjected to robot-assisted partial nephrectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01188-0] [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: 11/06/2022] Open
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Maffei D, Saitta C, Avolio P, Fasulo V, Paciotti M, Frego N, Diana P, Lazzeri M, Hurle R, Saita A, Guazzoni G, Casale P, Buffi N, Lughezzani G. Diagnostic performance of micro-ultrasound guided reclassification biopsies in patients under active surveillance for prostate cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01139-9] [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: 11/06/2022] Open
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Beatrici E, Uleri A, Diana P, Saitta C, Chiarelli G, Arena P, Gobbo A, Fasulo V, Avolio P, D’Antuono F, Poretti D, Pedicini V, Lazzeri M, Saita A, Hurle R, Lughezzani G, Guazzoni G, Buffi N. Percutaneous microwave ablation may represent an effective treatment in selected patients with clinical T1 renal masses: a single-institutional experience. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01051-5] [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: 11/07/2022] Open
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Lazzeri M, Fasulo V, Lughezzani G, Benetti A, Soldà G, Asselta R, De Simone I, Paciotti M, Avolio PP, Contieri R, Saitta C, Saita A, Hurle R, Guazzoni G, Buffi NM, Casale P. Prospective evaluation of the role of imaging techniques and TMPRSS2:ERG mutation for the diagnosis of clinically significant prostate cancer. Front Oncol 2022; 12:968384. [PMID: 36147926 PMCID: PMC9487838 DOI: 10.3389/fonc.2022.968384] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To test the hypothesis of a relationship between a specific genetic lesion (T2:ERG) and imaging scores, such as PI-RADS and PRI-MUS, and to test the effectiveness of these parameters for the diagnosis of prostate cancer (PCa) and clinically significant PCa (csPCa). Materials and methods This is a prospective study of men with suspected PCa enrolled between 2016 and 2019 at a high-volume tertiary hospital. Patients underwent systematic US-guided biopsy, plus targeted biopsy if they were presenting with >=1 suspicious lesion (PI-RADS>2) at mpMRI or PR-IMUS >2 at micro-ultrasound assessment. For each patient, one core from the highest PI-RADS or PRI-MUS lesion was collected for T2:ERG analysis. Multivariable logistic regression models (LRMs) were fitted for csPCa with a clinical model (age, total PSA, previous biopsy, family history for PCa), a clinical plus PI-RADS, clinical plus T2:ERG, clinical plus PI-RADS plus T2:ERG, and T2:ERG plus PI-RADS alone. Results The cohort consists of 158 patients: 83.5% and 66.2% had respectively a diagnosis of PCa and csPCa after biopsy. A T2:ERG fusion was found in 37 men and 97.3% of these patients harbored PCa, while 81.1% were diagnosed with csPCa. SE of T2:ERG assay for csPCa was 28.8%, SP 87.0%, NPV 38.8%, and PPV 81.1%. Of 105 patients who performed mpMRI 93.% had PIRADS ≥3. SE of mpMRI for csPCa was 98.5%, SP was 12.8%, NPV was 83.3%, and PPV was 65.7%. Among 67 patients who were subjected to micro-US, 90% had a PRI-MUS ≥3. SE of micro-US for csPCa was 89.1%, SP was 9.52%, NPV was 28.6%, and PPV was 68.3%. At univariable LRM T2:ERG was confirmed as independent of mpMRI and micro-US result (OR 1.49, p=0.133 and OR 1.82, p=0.592, respectively). At multivariable LRM the clinical model alone had an AUC for csPCa of 0.74 while the clinical model including PI-RADS and T2:ERG achieved an AUC of 0.83. Conclusions T2:ERG translocation and imaging results are independent of each other, but both are related csPCa. To evaluate the best diagnostic work-up for PCa and csPCa detection, all available tools (T2:ERG detection and imaging techniques) should be employed together as they appear to have a complementary role.
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Affiliation(s)
- Massimo Lazzeri
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Vittorio Fasulo
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- *Correspondence: Giovanni Lughezzani,
| | - Alessio Benetti
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giulia Soldà
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Rosanna Asselta
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ilaria De Simone
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Paciotti
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pier Paolo Avolio
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberto Contieri
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Cesare Saitta
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Saita
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Paolo Casale
- Department of Urology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
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De Carlo C, Valeri M, Rudini N, Zucali PA, Cieri M, Elefante GM, D’antonio F, Hurle R, Giordano L, Bressan A, Lazzeri M, Perrino M, Guazzoni G, Terracciano LM, Colombo P. Intratumoral Switch of Molecular Phenotype and Overall Survival in Muscle Invasive Bladder Cancer. Cancers (Basel) 2022; 14:cancers14133256. [PMID: 35805028 PMCID: PMC9265094 DOI: 10.3390/cancers14133256] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 02/06/2023] Open
Abstract
In recent years, immunohistochemical protein expression was studied as a surrogate to the molecular classification of bladder cancer, although no tissue biomarkers are available for clinical use to predict survival or the response to neoadjuvant chemotherapy (CT) in UC, as the literature produced conflicting results. This retrospective study included TURB specimens harboring foci of HG pT2 muscle-invasive bladder carcinoma (MIBC) from 251 patients who subsequently underwent radical cystectomy. We performed immunohistochemical analysis on tumor samples, for relevant gene-expression-based markers for basal type (CD44, CK5/6) and luminal type (CK20 and pPARγ). Piescore, investigated in both non-muscle-invasive (NMI) and muscle-invasive (MI) components of the tumor, divided basal and luminal UC-types when at least three of the four markers were consistent with a specific phenotype, mixed types if one/two luminal and basal markers were present simultaneously, and neu-like types when all four markers investigated were negative. Eighteen selected cases were also investigated with RT-PCR to validate, and to increase the specificity of, the immunohistochemical results. We observe an immunophenotypical difference in the NMI and MI components in 96/251 UC patients (38.25%): half of tumors (44/96 cases) have a transition to basal, 36.46% (35/96 cases) to neu-like, 12.5% (12/96 cases) to mixed, and 5.2% (5/96 cases) to luminal phenotypes. Mixed tumors in the NMI component are more likely to change phenotype than other groups, particularly compared with basal tumors, which demonstrate greater stability (only 8/96 cases, p < 0.00001). The transition of luminal tumors to basal display a better OS compared with the transition toward neu-like tumors (p = 0.027). Overall, the phenotypical switch does not affect lymphovascular invasion, pT, DFS, or OS compared with non-switched cases. In the MI component, the presence of CD44 expression, irrespective of score-related phenotype, shows a protective effect in papillary-type UC (OS p = 0.008, HR 0.453, PFS p = 0.07, HR 0.599), and in UC naïve for CT (p = 0.0479). Piescore immunophenotyping reveals an intratumoral phenotypical transition between the NMI and MI components of the same tumor. The molecular change is a common event in the mixed and luminal categories, but not in basal tumors, which show better phenotypical stability. This phenomenon could partially explain the sensitivity of a subset of luminal UC to chemotherapy: good responders could be “non-real” luminal UC, which acquire nasal markers, such as CD44.
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Affiliation(s)
- Camilla De Carlo
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.D.C.); (M.V.); (N.R.); (M.C.); (G.M.E.); (A.B.); (L.M.T.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (P.A.Z.); (F.D.); (G.G.)
| | - Marina Valeri
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.D.C.); (M.V.); (N.R.); (M.C.); (G.M.E.); (A.B.); (L.M.T.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (P.A.Z.); (F.D.); (G.G.)
| | - Noemi Rudini
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.D.C.); (M.V.); (N.R.); (M.C.); (G.M.E.); (A.B.); (L.M.T.)
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (P.A.Z.); (F.D.); (G.G.)
- Department of Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Miriam Cieri
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.D.C.); (M.V.); (N.R.); (M.C.); (G.M.E.); (A.B.); (L.M.T.)
| | - Grazia Maria Elefante
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.D.C.); (M.V.); (N.R.); (M.C.); (G.M.E.); (A.B.); (L.M.T.)
| | - Federica D’antonio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (P.A.Z.); (F.D.); (G.G.)
- Department of Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (R.H.); (M.L.)
| | - Laura Giordano
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandra Bressan
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.D.C.); (M.V.); (N.R.); (M.C.); (G.M.E.); (A.B.); (L.M.T.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (P.A.Z.); (F.D.); (G.G.)
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (R.H.); (M.L.)
| | - Matteo Perrino
- Department of Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (P.A.Z.); (F.D.); (G.G.)
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (R.H.); (M.L.)
| | - Luigi Maria Terracciano
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.D.C.); (M.V.); (N.R.); (M.C.); (G.M.E.); (A.B.); (L.M.T.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (P.A.Z.); (F.D.); (G.G.)
| | - Piergiuseppe Colombo
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.D.C.); (M.V.); (N.R.); (M.C.); (G.M.E.); (A.B.); (L.M.T.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (P.A.Z.); (F.D.); (G.G.)
- Correspondence: ; Tel.: +39-0282244707
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Contieri R, Lughezzani G, Buffi NM, Taverna G, Giacobbe A, Micheli E, Barra S, Colombo P, Vanni E, Guazzoni G, Lazzeri M, Hurle R. Could We Safely Avoid a Second Resection in Selected Patients With T1 Non-Muscle-Invasive Bladder Cancer? Preliminary Results of Cost-Effectiveness Study From HUmanitas New Indications for ReTUR (HuNIRe) Multicenter Prospective Trial. Front Oncol 2022; 12:879399. [PMID: 35664755 PMCID: PMC9157494 DOI: 10.3389/fonc.2022.879399] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this study is to assess whether restaging transurethral resection (ReTUR) could be safely replaced with urine cytology (UC) and in-office fiexible cystoscopy in selected T1 non-muscle-invasive bladder cancer (NMIBC). Materials and Methods This is an ongoing prospective multicenter trial enrolling patients diagnosed with T1 BC from 5 Italian centers. Patients with a macroscopically incomplete initial resection or absence of detrusor muscle were subjected to ReTUR according to European Association of Urology (EAU) guidelines. Conversely, those with a complete tumor resection at initial TUR underwent UC at 3-4 weeks and in-office fiexible white-light and narrow-band cystoscopy at 4-6 weeks. In case of positive UC, or evidence of recurrence at cystoscopy, ReTUR was performed within 2 weeks. Otherwise, patients started Bacillus Calmette-Guérin (BCG) induction course without ReTUR. The primary endpoint was to determine the feasibility and the clinical utility of not performing ReTUR in selected T1 NMIBC patients. The secondary endpoint was to perform a cost-benefit analysis of this alternative approach. Results Since May 2020, among 87 patients presenting with T1, 76 patients were enrolled. Nineteen (25%) patients underwent standard ReTUR after initial resection, 10 (13.2%) due to the absence of the detrusor muscle and 9 (11.8%) due to a macroscopically incomplete initial TUR. Overall, 57 (75%) patients initially avoided immediate ReTUR and underwent UC plus in-office flexible cystoscopy. Among them, 38 (66.7%) had no evidence of residual disease and immediately started the BCG induction course. Nineteen patients (33.3%) underwent "salvage" ReTUR due to either positive UC (7; 12.3%) or suspicious cystoscopy (12; 21%). Considering only the patients who initially avoided the ReTUR, disease recurrence was observed in 10/57. The saving of resource for each safely avoided ReTUR was estimated to be 1,759 €. Considering the entire sample, we estimated a saving of 855 € per patient if compared with the EAU guideline approach. Conclusion The preliminary results of our trial suggested that ReTUR might be safely avoided in highly selected T1 BC patients with a complete resection at first TUR. Longer follow-up and larger sample size are needed to investigate the long-term oncological outcomes of this alternative approach.
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Affiliation(s)
- Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gianluigi Taverna
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy,Urology Unit, Humanitas Mater Domini, Varese, Italy
| | - Alessandro Giacobbe
- Struttura Complessa (SC) Urology and Reconstructive Andrology, Humanitas Gradenigo Hospital, Turin, Italy
| | | | - Sabato Barra
- Department of Urology, Azienda Socio Sanitarie Territoriali (ASST) Melegnano-Martesana, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Vanni
- Business Operations Office, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy,*Correspondence: Massimo Lazzeri,
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
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Valeri M, Contieri R, Fasulo V, Cieri M, Elefante GM, Lazzeri M, Taverna G, Terracciano LM, Hurle R, Colombo P. MP23-19 PROSPECTIVE VALIDATION OF THE ROL SYSTEM IN SUBSTAGING PT1 HIGH-GRADE BLADDER CANCER: A CONFIRMATORY PROGRESSION RISK ANALYSIS TO EASE DECISION MAKING. J Urol 2022. [DOI: 10.1097/ju.0000000000002562.19] [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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