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Leni R, Roscigno M, Barzaghi P, La Croce G, Catellani M, Saccà A, de Angelis M, Montorsi F, Briganti A, Da Pozzo LF. Medium-term follow up of active surveillance for early prostate cancer at a non-academic institution. BJU Int 2024; 133:614-621. [PMID: 38093673 DOI: 10.1111/bju.16259] [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] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To report oncological outcomes of active surveillance (AS) at a single non-academic institution adopting the standardised Prostate Cancer Research International Active Surveillance (PRIAS) protocol. PATIENTS AND METHODS Competing risk analyses estimated the incidence of overall mortality, metastases, conversion to treatment, and grade reclassification. The incidence of reclassification and adverse pathological findings at radical prostatectomy were compared between patients fulfilling all PRIAS inclusion criteria vs those not fulfilling at least one. RESULTS We analysed 341 men with Grade Group 1 prostate cancer (PCa) followed on AS between 2010 and 2022. There were no PCa deaths, two patients developed distant metastases and were alive at the end of the study period. The 10-year cumulative incidence of metastases was 1.9% (95% confidence interval [CI] 0.33-6.4%). A total of 111 men were reclassified, and 127 underwent definitive treatment. Men not fulfilling at least one PRIAS inclusion criteria (n = 43) had a higher incidence of reclassification (subdistribution hazards ratio 1.73, 95% CI 1.07-2.81; P = 0.03), but similar rates of adverse pathological findings at radical prostatectomy. CONCLUSION Metastases in men on AS at a non-academic institution are as rare as those reported in established international cohorts. Men followed without stringent inclusion criteria should be counselled about the higher incidence of reclassification and reassured they can expect rates of adverse pathological findings comparable to those fulfilling all criteria. Therefore, AS should be proposed to all men with low-grade PCa regardless of whether they are followed at academic institutions or smaller community hospitals.
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Affiliation(s)
- Riccardo Leni
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Roscigno
- University of Milano-Bicocca, Milan, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Barzaghi
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Antonino Saccà
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mario de Angelis
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Filippo Da Pozzo
- University of Milano-Bicocca, Milan, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Pellegrino F, Leni R, Basile G, Rosiello G, Re C, Scilipoti P, De Angelis M, Longoni M, Avesani G, Quarta L, Zaurito P, Cattafi F, Burgio G, Gandaglia G, Montorsi F, Briganti A, Moschini M. Peri- and post-operative outcomes of robot-assisted radical cystectomy after the implementation of the EAU guidelines recommendations for collecting and reporting complications at a high-volume referral center. World J Urol 2024; 42:270. [PMID: 38679650 DOI: 10.1007/s00345-024-04970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE No studies relied on a standardized methodology to collect postoperative complications after robot-assisted radical cystectomy (RARC). The aim of our study was to evaluate peri- and post-operative outcomes of patients undergoing RARC adhering to the European Association of Urology (EAU) recommendations for reporting surgical outcomes and using a long postoperative follow-up. MATERIALS AND METHODS 246 patients who underwent RARC with intracorporal urinary diversion at a single tertiary referral center with a postoperative follow-up ≥ 1 year for survivors. Postoperative outcomes were collected prospectively by interviews done by medical doctors. Complications were scored using the Clavien-Dindo classification (CD), grouped by type and severity (severe: CD score ≥ 3). We described peri- and post-operative outcomes and complication chronological distribution. RESULTS Overall, 16 (6.5%) and 225 patients (91%) experienced intraoperative and postoperative complications, respectively. Moreover, 139 (57%) experienced severe complications. The most common any-grade and severe complications were infectious (72%) and genitourinary (35%), respectively. Overall, 52% of complications (358/682) occurred within 10 days from surgery, and 51% of severe complications (106/207) occurred within 35 days. However, 13% of complications (90/682) and 28% of severe complications (59/207) occurred 3 months after surgery. The earliest complications were fever of unknown origins and paralytic ileus (median time-to-complication [mTTC]: 4 days), the latest complications were urinary tract infection (mTTC: 40 days) and hydronephrosis/ureteral obstruction (mTTC: 70 days). CONCLUSIONS The rate of postoperative complications after RARC is > 90% when a standardized collection method and a long follow-up is implemented. These results should be used to identify potential areas of improvement and for preoperative patient counseling.
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Affiliation(s)
- Franceso Pellegrino
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Riccardo Leni
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Re
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Scilipoti
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario De Angelis
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mattia Longoni
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Avesani
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Quarta
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Zaurito
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Cattafi
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giusy Burgio
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Urology and Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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3
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Pellegrino F, Stabile A, Sorce G, Mazzone E, Cannoletta D, Cirulli GO, Quarta L, Leni R, Robesti D, Brembilla G, Gandaglia G, De Cobelli F, Montorsi F, Briganti A. Variability of mpMRI diagnostic performance according to the upfront individual patient risk of having clinically significant prostate cancer. Prostate 2024; 84:473-478. [PMID: 38149793 DOI: 10.1002/pros.24665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND To assess the variation of multiparametric magnetic resonance imaging (mpMRI) positive predictive value (PPV) according to each patient's risk of clinically significant prostate cancer (csPCa) based exclusively on clinical factors. METHODS We evaluated 999 patients with positive mpMRI (PI-RADS ≥ 3) receiving targeted (TBx) plus systematic prostate biopsy. We built a multivariable logistic regression analysis (MVA) using clinical risk factors to calculate the individual patients' risk of harboring csPCa at TBx. A second MVA tested the association between individual patients' clinical risk and mpMRI PPV accounting for the PI-RADS score. Finally, we plotted the PPV of each PI-RADS score by the individual patient pretest probability of csPCa using a LOWESS approach. RESULTS Overall, TBx found csPCa in 21%, 51%, and 80% of patients with PI-RADS 3, 4, and 5 lesions, respectively. At MVA, age, PSA, digital rectal examination (DRE), and prostate volume were significantly associated with the risk of csPCa at biopsy. DRE yielded the highest odds ratio (OR: 2.88; p < 0.001). The individual patient's clinical risk was significantly associated with mpMRI PPV (OR: 2.49; p < 0.001) using MVA. Plotting the mpMRI PPV according to the predicted clinical risks, we observed that for patients with clinical risk close to 0 versus patients with risk higher than 90%, the mpMRI PPV of PI-RADS 3, 4, and 5 ranged from 0% to 75%, from 0% to 96%, and from 45% to 100%, respectively. CONCLUSION mpMRI PPV varies according to the individual pretest patient's risk based on clinical factors. These findings should be considered in the decision-making process for patients with suspect MRI findings referred for a prostate biopsy. Moreover, our data support the need for further studies to create an individualized risk prediction tool.
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Affiliation(s)
- Francesco Pellegrino
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Sorce
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Donato Cannoletta
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Leonardo Quarta
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Leni
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Robesti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Zattoni F, Pereira LJP, Marra G, Valerio M, Olivier J, Puche-Sanz I, Rajwa P, Maggi M, Campi R, Amparore D, De Cillis S, Junlong Z, Guo H, La Bombarda G, Fuschi A, Veccia A, Ditonno F, Marquis A, Barletta F, Leni R, Serni S, Kasivisvanathan V, Antonelli A, Dal Moro F, Rivas JG, van den Bergh RCN, Briganti A, Gandaglia G, Novara G. The impact of a second MRI and re-biopsy in patients with initial negative mpMRI-targeted and systematic biopsy for PIRADS ≥ 3 lesions. World J Urol 2023; 41:3357-3366. [PMID: 37755520 PMCID: PMC10632220 DOI: 10.1007/s00345-023-04578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/10/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE To evaluate the proportions of detected prostate cancer (PCa) and clinically significant PCa (csPCa), as well as identify clinical predictors of PCa, in patients with PI-RADS > = 3 lesion at mpMRI and initial negative targeted and systematic biopsy (initial biopsy) who underwent a second MRI and a re-biopsy. METHODS A total of 290 patients from 10 tertiary referral centers were included. The primary outcome measures were the presence of PCa and csPCa at re-biopsy. Logistic regression analyses were performed to evaluate predictors of PCa and csPCa, adjusting for relevant covariates. RESULTS Forty-two percentage of patients exhibited the presence of a new lesion. Furthermore, at the second MRI, patients showed stable, upgrading, and downgrading PI-RADS lesions in 42%, 39%, and 19%, respectively. The interval from the initial to repeated mpMRI and from the initial to repeated biopsy was 16 mo (IQR 12-20) and 18 mo (IQR 12-21), respectively. One hundred and eight patients (37.2%) were diagnosed with PCa and 74 (25.5%) with csPCa at re-biopsy. The presence of ASAP on the initial biopsy strongly predicted the presence of PCa and csPCa at re-biopsy. Furthermore, PI-RADS scores at the first and second MRI and a higher number of systematic biopsy cores at first and second biopsy were independent predictors of the presence of PCa and csPCa. Selection bias cannot be ruled out. CONCLUSIONS Persistent PI-RADS ≥ 3 at the second MRI is suggestive of the presence of a not negligible proportion of csPca. These findings contribute to the refinement of risk stratification for men with initial negative MRI-TBx.
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Affiliation(s)
- Fabio Zattoni
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy.
| | | | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126, Turin, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | | | - Ignacio Puche-Sanz
- Department of Urology, Instituto de Investigación Biosanitaria Ibs.Granada, Hospital Universitario Virgen de Las Nieves (HUVN), Granada, Spain
| | - Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
- Urology Unit, Department of Medico, Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
- School of Medicine, Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Sabrina De Cillis
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
- School of Medicine, Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Zhuang Junlong
- Institute of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
- Department of Urology, Nanjing University, Nanjing, China
| | - Hongqian Guo
- Institute of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
- Department of Urology, Nanjing University, Nanjing, China
| | - Giulia La Bombarda
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Andrea Fuschi
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
- Urology Unit, Department of Medico, Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alessandro Veccia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Francesco Ditonno
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126, Turin, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Leni
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fabrizio Dal Moro
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Juan Gomez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giacomo Novara
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
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Leni R, Gandaglia G, Stabile A, Mazzone E, Pellegrino F, Scuderi S, Robesti D, Barletta F, Cirulli GO, Cucchiara V, Zaffuto E, Dehò F, Montorsi F, Briganti A. Is Active Surveillance an Option for the Management of Men with Low-grade Prostate Cancer and a Positive Family History? Results from a Large, Single-institution Series. Eur Urol Oncol 2023; 6:493-500. [PMID: 37005213 DOI: 10.1016/j.euo.2023.02.014] [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: 07/27/2022] [Revised: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Family history (FH) of prostate cancer (PCa) is associated with an increased risk of PCa and adverse disease features. However, whether patients with localized PCa and FH could be considered for active surveillance (AS) remains controversial. OBJECTIVE To assess the association between FH and reclassification of AS candidates, and to define predictors of adverse outcomes in men with positive FH. DESIGN, SETTING, AND PARTICIPANTS Overall, 656 patients with grade group (GG) 1 PCa included in an AS protocol at a single institution were identified. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier analyses assessed the time to reclassification (GG ≥2 and GG ≥3 at follow-up biopsies) overall and according to FH status. Multivariable Cox regression tested the impact of FH on reclassification and identified the predictors among men with FH. Men treated with delayed radical prostatectomy (n = 197) or external-beam radiation therapy (n = 64) were identified, and the impact of FH on oncologic outcomes was assessed. RESULTS AND LIMITATIONS Overall, 119 men (18%) had FH. The median follow-up was 54 mo (interquartile range 29-84 mo), and 264 patients experienced reclassification. The 5-yr reclassification-free survival rate was 39% versus 57% for FH versus no FH (p = 0.006), and FH was associated with reclassification to GG ≥2 (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.19-2.15, p = 0.002). In men with FH, the strongest predictors of reclassification were prostate-specific antigen (PSA) density (PSAD), high-volume GG 1 (≥33% of cores involved or ≥50% of any core involved), and suspicious magnetic resonance imaging (MRI) of the prostate (HRs 2.87, 3.04, and 3.87, respectively; all p < 0.05). No association between FH, adverse pathologic features, and biochemical recurrence was observed (all p > 0.05). CONCLUSIONS Patients with FH on AS are at an increased risk of reclassification. Negative MRI, low disease volume, and low PSAD identify men with FH and a low risk of reclassification. Nonetheless, sample size and wide CIs entail caution in drawing conclusions based on these results. PATIENT SUMMARY We tested the impact of family history in men on active surveillance for localized prostate cancer. A significant risk of reclassification, but not adverse oncologic outcomes after deferred treatment, prompts the need for cautious discussion with these patients, without precluding initial expectant management.
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Affiliation(s)
- Riccardo Leni
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Armando Stabile
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Pellegrino
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scuderi
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Robesti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuele Zaffuto
- Department of Urology, Circolo and Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy; University of Insubria, Varese, Italy
| | - Federico Dehò
- Department of Urology, Circolo and Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy; University of Insubria, Varese, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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6
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Gandaglia G, Leni R, Plagakis S, Stabile A, Montorsi F, Briganti A. Active surveillance should not be routinely considered in ISUP grade group 2 prostate cancer. BMC Urol 2023; 23:153. [PMID: 37777767 PMCID: PMC10542696 DOI: 10.1186/s12894-023-01315-5] [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: 07/19/2023] [Accepted: 09/03/2023] [Indexed: 10/02/2023] Open
Abstract
Active surveillance has been proposed as a therapeutic option in selected intermediate risk patients with biopsy grade group 2 prostate cancer. However, its oncologic safety in this setting is debated. Therefore, we conducted a non-systematic literature research of contemporary surveillance protocols including patients with grade group 2 disease to collect the most recent evidence in this setting. Although no randomized controlled trial compared curative-intent treatments, namely radical prostatectomy and radiotherapy vs. active surveillance in patients with grade group 2 disease, surgery is associated with a benefit in terms of disease control and survival when compared to expectant management in the intermediate risk setting. Patients with grade group 2 on active surveillance were at higher risk of disease progression and treatment compared to their grade group 1 counterparts. Up to 50% of those patients were eventually treated at 5 years, and the metastases-free survival rate was as low as 85% at 15-years. When considering low- and intermediate risk patients treated with radical prostatectomy, grade group 2 was one of the strongest predictors of grade upgrading and adverse features. Available data is insufficient to support the oncologic safety of active surveillance in all men with grade group 2 prostate cancer. Therefore, those patients should be counselled regarding the oncologic efficacy of upfront active treatment modalities and the lack of robust long-term data supporting the safety of active surveillance in this setting.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Riccardo Leni
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Armando Stabile
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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7
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Pellegrino A, Gandaglia G, de Angelis M, Fallara G, Mazzone E, Stabile A, Pellegrino F, Robesti D, Leni R, Scuderi S, Cucchiara V, Cirulli GO, Barletta F, Montorsi F, Briganti A. Oncological and perioperative outcomes of surgery with or without metastasis-directed therapy as part of a multimodal treatment in men with de-novo oligometastatic prostate cancer. World J Urol 2023; 41:2069-2076. [PMID: 37326656 DOI: 10.1007/s00345-023-04460-6] [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: 01/16/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE To investigate the feasibility, safety, and oncological outcomes of Radical Prostatectomy (RP; either Robot-Assisted [RARP] or Open RP [ORP]) in oligometastatic prostate cancer (omPCa). Additionally, we assessed whether there was an added benefit of metastasis-directed therapy (MDT) in these patients in the adjuvant setting. METHODS Overall, 68 patients with omPCa (≤ 5 skeletal lesions at conventional imaging) treated with RP and pelvic lymph node dissection between 2006 and 2022 were included. Additional therapies (androgen deprivation therapy [ADT] and MDT) were administered according to the treating physicians' judgment. MDT was defined as metastasis surgery/radiotherapy within 6 months of RP. We assessed Clinical Progression (CP), Biochemical Recurrence (BCR), post-operative complications and overall mortality (OM) of RP and the impact of adjuvant MDT + ADT versus RP + ADT alone. RESULTS Median follow-up was 73 months (IQR 62-89). RARP reduced the risk of severe complications after adjusting for age and CCI (OR 0.15; p = 0.02). After RP, 68% patients were continent. Median 90-days PSA after RP was 0.12 ng/dL. CP and OM-free survival at 7 years were 50% and 79%, respectively. The 7-years OM-free survival rates were 93 vs. 75% for men treated with vs. without MDT (p = 0.04). At regression analyses, MDT after surgery was associated with a 70% decreased mortality rate (HR 0.27, p = 0.04). CONCLUSIONS RP appeared to represent a safe and feasible option in omPCa. RARP reduced the risk of severe complications. Integrating MDT with surgery in the context of a multimodal treatment might improve survival in selected omPCa patients.
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Affiliation(s)
- Antony Pellegrino
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Mario de Angelis
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Fallara
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Pellegrino
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Robesti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Leni
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scuderi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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8
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Basile G, de Angelis M, Leni R, Re C, Longoni M, Mari A, Soria F, Pradere B, Del Giudice F, Laukhtina E, D'Andrea D, Mori K, Krajewski W, Albisinni S, Gallioli A, Breda A, Esperto F, Briganti A, Montorsi F, Moschini M, Carando R. Implications for diagnosis and treatment strategies in non-muscle invasive bladder cancer with variant histology: a systematic review. Minerva Urol Nephrol 2023; 75:278-288. [PMID: 36946716 DOI: 10.23736/s2724-6051.23.05091-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION The identification of variant histology (VH) has been recognized as a critical element in the diagnostic pathway of bladder cancer (BCa), both for prognostic and therapeutic implications. However, the current evidence on the oncological outcomes of patients harboring VH BCa mostly derives from studies including muscle-invasive disease. Consequently, the correct management of patients with non-muscle invasive bladder cancer (NMIBC) and VH is limited and conflicting, and the optimal therapeutic approach remains therefore controversial. EVIDENCE ACQUISITION In this review, we aimed at reporting the current evidence on NMIBC with VH. EVIDENCE SYNTHESIS Despite a constant increase in VH reporting at transurethral resection of bladder tumor (TURBT) specimens as compared to previous decades, we found that the incidence of VH is still sparse among studies. Furthermore, the agreement between TURBT and radical cystectomy (RC) specimens in VH identification is another matter of debate. Currently, most of the included studies report a poor overall concordance, especially for the micropapillary variant. Finally, while squamous and micropapillary variants are those associated with the worst survival outcomes, immediate RC is mostly considered for micropapillary tumors. Conversely, the survival benefit of immediate RC as compared to bladder-sparing approaches (i.e., BCG immunotherapy) for the other types of VH BCa is still an open question owing to the paucity of data available. CONCLUSIONS Thus, in these patients, BCG treatment could be proposed considering the need for more intensive oncological surveillance.
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Affiliation(s)
- Giuseppe Basile
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Mario de Angelis
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Leni
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Re
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Mattia Longoni
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Oncologic Minimally Invasive Urology and Andrology Unit, Careggi Hospital, Florence, Italy
| | - Francesco Soria
- Department of Urology, School of Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Ekaterina Laukhtina
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Simone Albisinni
- Department of Urology, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University, Rome, Italy
| | - Andrea Gallioli
- Department of Urology, Puigvert Foundation, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Barcelona, Spain
| | - Francesco Esperto
- Department of Urology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Moschini
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy -
| | - Roberto Carando
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
- Clinica Luganese Moncucco, Lugano, Switzerland
- Sant'Anna Clinic, Swiss Medical Group, Sorengo, Switzerland
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9
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Leni R, Robesti D, Lucianò R, Gandaglia G, Stabile A, Mazzone E, Cucchiara V, Quarta L, Zaurito P, Tenace N, De Angelis M, Pellegrino A, Zaffuto E, Dehò F, De Cobelli F, Salonia A, Montorsi F, Capitanio U, Briganti A. Oncologic outcomes of patients with incidental prostate cancer: Can we rely on multiparametric mri to exclude aggressive prostate cancer? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00339-1] [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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10
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Basile G, Leni R, Re C, Pellegrino F, Scilipoti P, Longoni M, Cannoletta D, Necchi A, Gandaglia G, Salonia A, Briganti A, Montorsi F, Moschini M. The black box of intraoperative adverse incident reporting during radical cystectomy: Not only post-operative complications matter. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00205-1] [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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11
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Robesti D, Tenace N, Re C, Leni R, De Angelis M, Gandaglia G, Mazzone E, Stabile A, Fossati N, Gallina A, Doglioni C, Colecchia M, Montorsi F, Briganti A, Moschini M, Lucianò R. Assessing the impact of TURBT specimens review by a dedicated uropathologist on clinical decision making process: Results from a single tertiary referral center. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01097-7] [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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12
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Mazzone E, Gandaglia G, Stabile A, Cucchiara V, Rosiello G, Sorce G, Pellegrino F, Scuderi S, Barletta F, Robesti D, Leni R, De Angelis M, Pellegrino A, Longoni M, Scilipoti P, Brembilla G, De Cobelli F, Samanes Gajate A, Picchio M, Gianolli L, Van Leeuwen F, Van Oosterom M, Montorsi F, Briganti A. Defining the optimal target-to-background count rate to identify positive lymph nodes in patients undergoing robot-assisted 99mtc-PSMA-radioguided surgery for prostate cancer: A per-region analysis of a prospective, phase II study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00694-2] [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: 02/12/2023]
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13
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Pellegrino F, Stabile A, Gandaglia G, Cucchiara V, Mazzone E, Leni R, Sorce G, Scuderi S, Barletta F, Robesti D, Pellegrino A, De Angelis M, Quarta L, Zaurito P, Brembilla G, Zaffuto E, Esposito A, De Cobelli F, Montorsi F, Briganti A. Impact of radiologist expertise on PI-RADS distribution and detection of clinically significant prostate cancer: Results from a single, high volume center. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01023-0] [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: 02/12/2023]
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14
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Stabile A, Leni R, Gandaglia G, Mazzone E, Cucchiara V, Pellegrino F, Rosiello G, Nocera L, Cirulli G, Robesti D, Cannoletta D, Longoni M, Scilipoti P, De Angelis M, Pellegrino A, Larcher A, Capitanio U, Montorsi F, Briganti A. A patient tailored follow-up protocol for men with prostate cancer managed with active surveillance with the use of multiparametric magnetic resonance imaging: Identifying predictors of early and late reclassification in a large single institution cohort. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00994-6] [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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15
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Gianazza S, Belladelli F, Leni R, Masci F, Rossi P, Gianesini G, Maggio P, Zaffuto E, Salonia A, Carcano G, Dehò F, Capogrosso P. Peyronie's disease development and management in diabetic men. Andrology 2023; 11:372-378. [PMID: 35771713 DOI: 10.1111/andr.13224] [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: 03/31/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Peyronie's disease (PD) is a fibrosing disorder of the penis resulting in plaque formation and penile deformity that negatively affect sexual and psychosocial function of patients. A multifactorial etiology of PD is assumed with diabetes mellitus (DM) being a potential risk factor. OBJECTIVES The aim of this narrative review was to investigate diabetes role in PD pathophysiology, diagnosis, and treatment. MATERIALS AND METHODS A non-systematic narrative review of original articles, meta-analyses, and randomized trials was conducted, including articles in the pre-clinical setting to support relevant findings. RESULTS Diabetes is one of the most common comorbidity observed in PD patients, with a prevalence of about 11% and a strong association with erectile dysfunction (ED). DM is associated with both a higher risk of developing PD and has also an impact on the outcomes of PD's treatments. DISCUSSION Evidence from literature underlines that metabolic alterations typical of DM are pivotal factors in the development of PD and resistance to its medical treatment. CONCLUSION The role of DM in development of PD is still debated, while its role in PD development is not completely clear, there is a clear impact of DM on PD treatment outcomes.
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Affiliation(s)
- Simone Gianazza
- Department of Urology, University of Insubria, Varese, Italy.,Department of Surgery, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Leni
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Federica Masci
- Department of Urology, University of Insubria, Varese, Italy.,Department of Surgery, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Piercarlo Rossi
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Giuseppe Gianesini
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Paolo Maggio
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Emanuele Zaffuto
- Department of Urology, University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Carcano
- Department of Urology, University of Insubria, Varese, Italy.,Department of Surgery, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Federico Dehò
- Department of Urology, University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
| | - Paolo Capogrosso
- Department of Urology, University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese, Italy
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Avesani G, Pellegrino F, Re C, Leni R, Basile G, Scilipoti P, Longoni M, Cannoletta D, Gandaglia G, Capitanio U, Colombo R, Necchi A, Raggi D, Salonia A, Briganti A, Montorsi F, Moschini M. Impact of neoadjuvant immune-checkpoint inhibitor on intra and post operative outcomes in patients with muscle-invasive bladder cancer treated with radical cystectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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17
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Leni R, Belladelli F, Baldini S, Scroppo FI, Zaffuto E, Antonini G, Montorsi F, Salonia A, Carcano G, Capogrosso P, Dehò F. The Complex Interplay between Serum Testosterone and the Clinical Course of Coronavirus Disease 19 Pandemic: A Systematic Review of Clinical and Preclinical Evidence. World J Mens Health 2023:41.e15. [PMID: 36649920 DOI: 10.5534/wjmh.220143] [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: 07/13/2022] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 01/18/2023] Open
Abstract
Since the beginning of the coronavirus disease 19 (COVID-19) pandemic, efforts in defining risk factors and associations between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), clinical, and molecular features have initiated. After three years of pandemic, it became evident that men have higher risk of adverse outcomes. Such evidence provided the impetus for defining the biological fundaments of such a gender disparity. Our objective was to analyze the most recent literature with the aim of defining the relationship between COVID-19 and fertility, in particular, we assessed the interplay between SARS-CoV-2 and testosterone in a systematic review of literature from December 2019 (first evidence of a novel coronavirus in the Hubei province) until March 2022. As a fundamental basis for understanding, articles pertaining preclinical aspects explaining the gender disparity (n=9) were included. The main review categories analyzed the risk of being infected with SARS-CoV-2 according to testosterone levels (n=5), the impact of serum testosterone on outcomes of COVID-19 (n=23), and the impact SARS-CoV-2 on testosterone levels after infection (n=19). Preclinical studies mainly evaluated the relation between angiotensin-converting enzyme 2 (ACE2) and its androgen-mediated regulation, articles exploring the risk of COVID-19 according to testosterone levels were few. Although most publications evaluating the effect of COVID-19 on fertility found low testosterone levels after the infection, follow-up was short, with some also suggesting no alterations during recovery. More conclusive findings were observed in men with low testosterone levels, that were generally at higher risk of experiencing worse outcomes (i.e., admission to intensive care units, longer hospitalization, and death). Interestingly, an inverse relationship was observed in women, where higher levels of testosterone were associated to worse outcomes. Our finding may provide meaningful insights to better patient counselling and individualization of care pathways in men with testosterone levels suggesting hypogonadism.
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Affiliation(s)
- Riccardo Leni
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Belladelli
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Emanuele Zaffuto
- University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Gabriele Antonini
- Department of Urology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Carcano
- University of Insubria, Varese, Italy.,Department of Surgery, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Paolo Capogrosso
- University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy.
| | - Federico Dehò
- University of Insubria, Varese, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
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Sorce G, Mazzone E, Stabile A, Robesti D, Bravi C, Scuderi S, Leni R, Balestrazzi E, Fanti S, Farolfi A, Bianchi L, Schiavina R, Montorsi F, Briganti A. Reliability of 68Ga-PSMA PET/CT in assessing real nodal burden in men with cN1 disease: clinical implications for patient counselling and multi-modal treatments. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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19
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Nocera L, Basile G, Leni R, de Angelis M, Martini A, Avesani G, Scuderi S, Gandaglia G, Dehò F, Gallina A, Raggi D, Marandino L, Necchi A, Montorsi F, Briganti A, Moschini M. The impact of variant histology on the probability of lymph node involvement at imaging: CT scan vs FDG PET. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01023-0] [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: 11/07/2022] Open
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20
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Cucchiara V, Mazzone E, Robesti D, Gandaglia G, Stabile A, Scuderi S, Leni R, Barletta F, Nocera L, Necchi A, Raggi D, Marandino L, Balestrazzi E, Fanti S, Farolfi A, Bianchi L, Schiavina R, Montorsi F, Briganti A. Optimizing timing and indications for 68Ga-PSMA PET/CT in patients with biochemical recurrent prostate cancer after radical prostatectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cirulli G, Rosiello G, Mazzone E, Fossati N, Barletta F, Scuderi S, Robesti D, Gandaglia G, Toneatto L, Colandrea G, Leni R, D’Ambrosio L, Pellegrino A, Quarta L, Gallina A, Cucchiara V, Martini A, Comana S, Stabile A, Camisassa E, Dehò F, Montorsi F, Briganti A. Increased awareness of surgical outcomes improves long-term functional outcomes after robot-assisted radical prostatectomy. A prospective assessment following implementation of prospective data collection. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01250-2] [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: 11/05/2022] Open
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Giuseppe R, Scuderi S, Gandaglia G, Mazzone E, Stabile A, Barletta F, Pellegrino A, Toneatto L, Cannoletta D, Quarta L, Colandrea G, Leni R, Robesti D, Capitanio U, Larcher A, Salonia A, Dehò F, Karakiewicz P, Montorsi F, Briganti A. The impact of frailty status on surgical outcomes after robot-assisted radical prostatectomy - a prospective assessment using a standardized collection system for perioperative outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01210-1] [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: 11/07/2022] Open
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Gandaglia G, Mazzone E, Stabile A, Pellegrino A, Vitale L, Cucchiara V, Barletta F, Scuderi S, Leni R, Montorsi F, Briganti A. 99m-Technetium-PSMA radio-guided surgery to detect nodal metastases in prostate cancer patients undergoing with radical prostatectomy and extended pelvic lymph node dissection. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02221-2] [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: 11/05/2022] Open
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Martini A, Leni R, Pellegrino F, Basile G, Avesani G, Scuderi S, Nocera L, Rosiello G, Gandaglia G, Montorsi F, Briganti A, Gallina A, Moschini M. Acute kidney injury and its duration in patients treated with radical cystectomy in the enhanced recovery after surgery era: optimizing the selection of patients for restrictive fluid therapy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01126-0] [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: 11/07/2022] Open
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Gandaglia G, Mazzone E, Stabile A, Pellegrino A, Cucchiara V, Barletta F, Scuderi S, Robesti D, Leni R, Samanes Gajate AM, Picchio M, Gianolli L, Brembilla G, De Cobelli F, van Oosterom MN, van Leeuwen FWB, Montorsi F, Briganti A. Prostate-specific membrane antigen Radioguided Surgery to Detect Nodal Metastases in Primary Prostate Cancer Patients Undergoing Robot-assisted Radical Prostatectomy and Extended Pelvic Lymph Node Dissection: Results of a Planned Interim Analysis of a Prospective Phase 2 Study. Eur Urol 2022; 82:411-418. [PMID: 35879127 DOI: 10.1016/j.eururo.2022.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 03/29/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extended pelvic nodal dissection (ePLND) represents the gold standard for nodal staging in prostate cancer (PCa). Prostate-specific membrane antigen (PSMA) radioguided surgery (RGS) could identify lymph node invasion (LNI) during robot-assisted radical prostatectomy (RARP). OBJECTIVE To report the planned interim analyses of a phase 2 prospective study (NCT04832958) aimed at describing PSMA-RGS during RARP. DESIGN, SETTING, AND PARTICIPANTS A phase 2 trial aimed at enrolling 100 patients with intermediate- or high-risk cN0cM0 PCa at conventional imaging with a risk of LNI of >5% was conducted. Overall, 18 patients were enrolled between June 2021 and March 2022. Among them, 12 patients underwent PSMA-RGS and represented the study cohort. SURGICAL PROCEDURE All patients received 68Ga-PSMA positron emission tomography (PET)/magnetic resonance imaging; 99mTc-PSMA-I&S was synthesised and administered intravenously the day before surgery, followed by single-photon emission computed tomography/computed tomography. A Drop-In gamma probe was used for in vivo measurements. All positive lesions (count rate ≥2 compared with background) were excised and ePLND was performed. MEASUREMENTS Side effects, perioperative outcomes, and performance characteristics of robot-assisted PSMA-RGS for LNI were measured. RESULTS AND LIMITATIONS Overall, four (33%), six (50%), and two (17%) patients had intermediate-risk, high-risk, and locally advanced PCa. Overall, two (17%) patients had pathologic nodal uptake at PSMA PET. The median operative time, blood loss, and length of stay were 230 min, 100 ml, and 5 d, respectively. No adverse events and intraoperative complications were recorded. One patient experienced a 30-d complication (Clavien-Dindo 2; 8.3%). Overall, three (25%) patients had LNI at ePLND. At per-region analyses on 96 nodal areas, sensitivity, specificity, positive predictive value, and negative predictive value of PSMA-RGS were 63%, 99%, 83%, and 96%, respectively. On a per-patient level, sensitivity, specificity, positive predictive value, and negative predictive values of PSMA-RGS were 67%, 100%, 100%, and 90%, respectively. CONCLUSIONS Robot-assisted PSMA-RGS in primary staging is a safe and feasible procedure characterised by acceptable specificity but suboptimal sensitivity, missing micrometastatic nodal disease. PATIENT SUMMARY Prostate-specific membrane antigen radioguided robot-assisted surgery is a safe and feasible procedure for the intraoperative identification of nodal metastases in cN0cM0 prostate cancer patients undergoing robot-assisted radical prostatectomy with extended pelvic lymph node dissection. However, this approach might still miss micrometastatic nodal dissemination.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antony Pellegrino
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Robesti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Leni
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Maria Picchio
- Vita-Salute San Raffaele University, Milan, Italy; Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Brembilla
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Rosiello G, Scuderi S, Gandaglia G, Mazzone E, Barletta F, Robesti D, Leni R, Toneatto L, Pellegrino A, Quarta L, Stabile A, Cucchiara V, Colandrea G, Comana S, Camisassa E, Fossati N, Dehò F, Montorsi F, Briganti A. PD27-12 ASSESSING THE ROLE OF FRAILTY STATUS ON ONCOLOGIC AND FUNCTIONAL OUTCOMES IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER. J Urol 2022. [DOI: 10.1097/ju.0000000000002575.12] [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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Robesti D, Mazzone E, Gandaglia G, Stabile A, Rosiello G, Martini A, Bravi CA, Cirulli G, Pellegrino A, Leni R, Barletta F, De Angelis M, Scuderi S, Nocera L, Raggi D, Cucchiara V, Suardi N, Necchi A, Shariat SF, Montorsi F, Briganti A. MP48-13 THE KEY ROLE OF CONCOMITANT ANDROGEN-DEPRIVATION THERAPY ON THE EFFICACY OF IMAGING GUIDED TREATMENTS IN MEN WITH BIOCHEMICAL RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY AND POSITIVE 68GA-PSMA PET/CT SCAN. J Urol 2022. [DOI: 10.1097/ju.0000000000002619.13] [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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Robesti D, Mazzone E, Gandaglia G, Stabile A, Scuderi S, Barletta F, Nocera L, Leni R, Marandino L, Raggi D, Necchi A, Balestrazzi E, Fanti S, Farolfi A, Bianchi L, Schiavina R, Montorsi F, Briganti A. Optimizing timing and indications for 68Ga-PSMA PET/CT in patients with biochemical recurrent prostate cancer after radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00277-9] [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: 11/04/2022]
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Mazzone E, Gandaglia G, Stabile A, Chcchiara V, Zaffuto E, Mirone V, Pellegrino F, Nocera L, Barletta F, Toneatto L, Scuderi S, Cirulli G, Robesti D, Leni R, Pellegrino A, Montorsi F, Briganti A. A timely administration of metastasis-directed therapy can reduce the risk of disease progression in men with positive 68Ga-PSMA PET/CT for biochemical recurrence after radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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De Angelis M, Mazzone E, Gandaglia G, Stabile A, Scuderi S, Barletta F, Robesti D, Nocera L, Leni R, Cucchiara V, Necchi A, Zaffuto E, Suardi N, Shariat S, Montorsi F, Briganti A. Delaying post-operative radiation therapy after radical prostatectomy is associated with increased functional outcomes: Results from a large single, referral center series. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00912-5] [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: 11/30/2022]
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Sorce G, Rosiello G, Gandaglia G, Stabile A, Robesti D, Scuderi S, Mazzone E, Pellegrino A, Martini A, Leni R, Dambrosio L, Picozzi M, Tutolo M, Gallina A, Fossati N, Bianchi L, Schiavina R, Vansevenant B, Devos G, Karnes J, Joniau S, Montorsi F, Briganti A. The risk of recurrence in cN1 prostate cancer patients treated with radical prostatectomy varies according to preoperative staging. A comparison between 68Ga-PSMA-PET versus conventional imaging in a large, multi-institutional study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00903-4] [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: 11/16/2022]
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Mazzone E, Gandaglia G, Stabile A, Fossati N, Gallina A, Zaffuto E, Picozzi M, Barletta F, Scuderi S, Leni R, Nocera L, Sorce G, Pellegrino F, Rosiello G, Capitanio U, Larcher A, Lucianò R, Montironi R, Cimadamore A, Karakiewicz P, Shariat S, Montorsi F, Briganti A. Not all adverse pathology features are equal: Identifying optimal candidates for adjuvant radiotherapy among patients with adverse pathology at radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pellegrino F, Scuderi S, Lucianò R, Tenace N, Paparesta F, Pepi L, Quarta L, Toneatto L, Stabile A, Mazzone E, Barletta F, De Angelis M, Robesti D, Cannoletta D, Pellegrino A, Cucchiara V, Leni R, Gandaglia G, Cimadamore A, Montironi R, Montorsi F, Briganti A. Histological variants of prostate cancer are under-reported in prostate biopsies assessed outside tertiary referral centers: A plea for biopsy review for optimal patient management. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00697-2] [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: 11/04/2022]
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Nocera L, Leni R, Stabile A, Gandaglia G, Cucchiara V, Rosiello G, Sorce G, Pellegrino F, Scuderi S, Barletta F, Gallina A, Fossati N, Zaffuto E, Moschini M, Suardi N, Shariat S, Montorsi F, Briganti A. Drop-out rates from active surveillance for disease progression remain consistent and not negligible over time. A plea for long-term assessment based on a large, prospectively collected active surveillance cohort. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00371-2] [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: 11/04/2022]
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Nocera L, Basile G, Leni R, De Angelis M, Martini A, Scuderi S, Gandaglia G, Mottrie A, Gallina A, Raggi D, Marandino L, Necchi A, Montorsi F, Briganti A, Moschini M. The role of FDG PET in the staging of bladder cancer patients candidate for radical cystectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00976-9] [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: 11/04/2022]
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Martini A, De Angelis M, Lonati C, Fallara G, Nocera L, Basile G, Leni R, Rosiello G, Scuderi S, Bandini M, Gandaglia G, Mottrie A, Gallina A, Montorsi F, Briganti A, Shahrokh S, Moschini M. Oncologic surveillance for variant histology upper tract urothelial carcinoma. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00391-8] [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: 11/28/2022]
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Rosiello G, Scuderi S, Gandaglia G, Mazzone E, Barletta F, Leni R, Toneatto L, Quarta L, Cannoletta D, Pellegrino A, Colandrea G, Robesti D, Stabile A, Dehò F, Capitanio U, Larcher A, Salonia A, Karakiewicz P, Montorsi F, Briganti A. Assessing the role of frailty status on surgical, oncologic and functional outcomes in patients treated with robot-assisted radical prostatectomy for prostate cancer. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01232-5] [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: 11/26/2022]
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Cirulli G, Rosiello G, Scuderi S, Gandaglia G, Fossati N, Mazzone E, Barletta F, Cucchiara V, Robesti D, Leni R, Toneatto L, Quarta L, Dambrosio L, Gallina A, Pellegrino A, Camisassa E, Comana S, Dehò F, Fossati N, Martini A, Colandrea G, Stabile A, Montorsi F, Briganti A. Increased awareness of surgical outcomes improves long-term functional outcomes after robot-assisted radical prostatectomy. A prospective assessment following implementation of prospective data collection. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01239-8] [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: 11/04/2022]
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Cirulli G, Robesti D, Gandaglia G, Cucchiara V, Karnes R, Devos G, Berghen C, Evaraerts W, Joniau S, Pellegrino A, Rosiello G, Leni R, Tutolo M, De Angelis M, Gallina A, Fossati N, Dehò F, Van Poppel H, Montorsi F, Briganti A. Oncological outcomes, patterns of recurrence and impact of competing causes of mortality in clinically node-positive prostate cancer patients treated with radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00902-2] [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: 11/04/2022]
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Leni R, Scuderi S, Gandaglia G, Lucianò R, Tenace N, Paparesta F, Pepi L, Nocera L, Robesti D, Quarta L, Toneatto L, Stabile A, Mazzone E, Barletta F, Cimadamore A, Montironi R, Karakiewicz P, Shariat S, Dehò F, Montorsi F, Briganti A. Does centralized revision of prostate biopsy impact on active surveillance outcomes? Results from a single, high-volume institution series. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00364-5] [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: 11/27/2022]
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Gandaglia G, Mazzone E, Pellegrino A, Fossati N, Stabile A, Scuderi S, Barletta F, Leni R, Robesti D, D'Ambrosio L, Vitale L, Samanes Gajate A, Picchio M, Gianolli L, Montorsi F, Briganti A. 99m-technetium-psma radio-guided surgery to detect nodal metastases in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection: A phase 2 prospective, single-institution study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01297-0] [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: 11/04/2022]
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Bandini M, Ahmed M, Basile G, Watkin N, Master V, Zhu Y, Prakash G, Rodriguez A, Ssebakumba MK, Leni R, Cirulli GO, Ayres B, Compitello R, Pederzoli F, Joshi PM, Kulkarni SB, Montorsi F, Sonpavde G, Necchi A, Spiess PE. A global approach to improving penile cancer care. Nat Rev Urol 2022; 19:231-239. [PMID: 34937881 PMCID: PMC8693593 DOI: 10.1038/s41585-021-00557-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 02/06/2023]
Abstract
Rare tumours such as penile carcinoma have been largely neglected by the urology scientific community in favour of more common - and, therefore, more easily fundable - diseases. Nevertheless, penile cancer represents a rising burden for health-care systems around the world, because a lack of widespread expertise, ineffective centralization of care and absence of research funds have hampered our ability to improve the global care of these patients. Moreover, a dichotomy has arisen in the field of penile cancer, further impeding care: the countries that are mainly supporting research on this topic through the development of epidemiological studies and design of clinical trials are not the countries that have the highest prevalence of the disease. This situation means that randomized controlled trials in developed countries often do not meet the minimum accrual and are intended to close before reaching their end points, whereas trials are almost completely absent in those areas with the highest disease prevalence and probability of successful recruitment, such as Africa, South America and South Asia. The scientific and organizational inaction that arises owing to this mismatch translates into a burdensome cost for our patients. A global effort to gather experts and pull together scientific data from around the world may be the best way to boost clinical research, to change clinical practice and, ultimately, to improve care for patients and their families.
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Affiliation(s)
- Marco Bandini
- Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Mohamed Ahmed
- grid.66875.3a0000 0004 0459 167XDepartment of Urology, Mayo Clinic, Rochester, MN USA
| | - Giuseppe Basile
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicholas Watkin
- grid.451349.eSt George’s University Hospitals, NHS Foundation Trust, London, UK
| | - Viraj Master
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Department of Urology, Atlanta, GA USA
| | - Yao Zhu
- grid.452404.30000 0004 1808 0942Fudan University Shanghai Cancer Center, Shanghai, China
| | - Gagan Prakash
- grid.450257.10000 0004 1775 9822Department of Urosurgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Alejandro Rodriguez
- grid.416016.40000 0004 0456 3003Urology Associates of Rochester, Rochester General Hospital, Rochester, NY USA
| | | | - Riccardo Leni
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Ben Ayres
- grid.451349.eSt George’s University Hospitals, NHS Foundation Trust, London, UK
| | - Rachel Compitello
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Filippo Pederzoli
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Pankaj M. Joshi
- grid.512719.9Kulkarni Reconstructive Urology Center, Pune, India
| | | | - Francesco Montorsi
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Guru Sonpavde
- grid.38142.3c000000041936754XDana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | - Andrea Necchi
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Philippe E. Spiess
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center and Research Institute, Tampa, FL USA
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Gandaglia G, Leni R, Bray F, Fleshner N, Freedland SJ, Kibel A, Stattin P, Van Poppel H, La Vecchia C. Epidemiology and Prevention of Prostate Cancer. Eur Urol Oncol 2021; 4:877-892. [PMID: 34716119 DOI: 10.1016/j.euo.2021.09.006] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023]
Abstract
CONTEXT Worldwide, prostate cancer (PCa) represents the second most common solid tumor in men. OBJECTIVE To assess the geographical distribution of PCa, epidemiological differences, and the most relevant risk factors for the disease. EVIDENCE ACQUISITION Estimated incidence, mortality, and prevalence of PCa for the year 2020 in 185 countries were derived from the IARC GLOBOCAN database. A review of English-language articles published between 2010 and 2020 was conducted using MEDLINE, EMBASE, and Scopus to identify risk factors for PCa. EVIDENCE SYNTHESIS In the year 2020, there were over 1414000 estimated new cases of PCa worldwide, with an age-standardized rate (ASR) incidence of 31 per 100000 (lifetime cumulative risk: 3.9%). Northern Europe has the highest all-age incidence ASR (83), while the lowest ASR was in South-Central Asia (6.3). In the year 2020, there were over 375000 estimated deaths worldwide, and the overall mortality ASR was 7.7 per 100000, with the highest ASR in the Caribbean (28) and the lowest in South-Central Asia (3.1). Family history, hereditary syndromes, and race are the strongest risk factors for PCa. Metabolic syndrome was associated with the risk of developing PCa, high-grade disease, and adverse pathology. Diabetes and exposure to ultraviolet rays were found to be inversely associated to PCa incidence. Cigarette smoking and obesity may increase PCa-specific mortality, while regular physical activity may reduce disease progression. Although 5-alpha reductase inhibitors are known to be associated with a reduced incidence of PCa, available studies failed to show an effect on overall mortality. CONCLUSIONS Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality. PATIENT SUMMARY Prostate cancer (PCa) rates vary profoundly worldwide, with incidence and mortality rates being highest in Northern Europe and Caribbean, respectively. South-Central Asia has the lowest epidemiological burden. Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease itself, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Riccardo Leni
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Neil Fleshner
- Division or Urology, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Freedland
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Section of Urology, Durham VA Medical Center, Durham, NC, USA
| | - Adam Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hendrick Van Poppel
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Gabriele S, Gandaglia G, Fossati N, Mazzone E, Pellegrino F, Rosiello G, Basile G, Cirulli G, Barletta F, Leni R, Robesti D, Scuderi S, Cannoletta D, Dehò F, Esposito A, Brembilla G, Stabile A, De Cobelli F, Montorsi F, Briganti A. The learning curve of mpMRI targeted biopsy for the detection of clinically significant prostate cancer is related to the characteristics of the index lesion. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00917-4] [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: 10/20/2022] Open
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Cirulli G, Martini A, Gandaglia G, Fossati N, Necchi A, Raggi D, Stabile A, Cucchiara V, Leni R, Robesti D, Pellegrino F, Nocera L, Scuderi S, Karakiewicz P, Galsky M, Oh W, Sfakianos J, Parikh A, Tsao C, Montorsi F, Briganti A. The obesity paradox in metastatic castration resistant prostate cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00897-1] [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: 11/15/2022] Open
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Pellegrino F, Mazzone E, Stabile A, Sorce G, Scuderi S, Basile G, Colandrea G, Leni R, Cannoletta D, De Angelis M, Antony P, Sciacqua L, Comana S, Camisassa E, De Cobelli F, Montorsi F, Briganti A. Assessing the need for systematic biopsies in addition to targeted biopsies according to the volume of the index lesion diagnosed at mpMRI. results from a large, multi-institutional database. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Nocera L, Leni R, Gandaglia G, Fossati N, Stabile A, Bravi C, Giuseppe R, Toneatto L, Cirulli G, Brembilla G, De Cobelli F, Montorsi F, Briganti A. The detection of a PI-RADS 4–5 lesion at multiparametric MRI before confirmatory biopsy is the strongest predictor of disease progression among men with low-risk prostate cancer included in an active surveillance prospective protocol. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00958-7] [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: 11/24/2022] Open
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Leni R, Basile G, Bandini M, Pederzoli F, Martini A, Scuderi S, Alfano M, Barletta F, Toneatto L, Zaffuto E, Pellegrino F, Burgio G, Marandino L, Raggi D, Moschini M, Capitanio U, Salonia A, Briganti A, Montorsi F, Necchi A, Colombo R, Gallina A. Temporal trend analyses of stage, surgical technique, oncological treatment, and post-operative outcomes in a large cohort of patients undergoing radical cystectomy at a referral institution. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Scuderi S, Mazzone E, Heidenreich A, Gandaglia G, Pfister D, Shariat S, Bernhard G, Fossati N, Fallara G, Pellegrino A, Karnes R, Cucchiara V, Bravi C, Scuderi S, Robesti D, Leni R, Cannoletta D, Gallina A, Moschini M, Suardi N, Stabile A, Necchi A, Montorsi F, Briganti A. Which patients with oligometastatic prostate cancer should be considered for cytoreductive radical prostatectomy as part of a multimodal treatment? Results from a large, multi-institutional collaboration. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gandaglia G, Robesti D, Fossati N, Stabile A, Camisassa E, Cucchiara V, Moschini M, Necchi A, Rosiello G, Leni R, Colombo R, Karakiewicz PI, Montorsi F, Briganti A. MP15-19 68Ga-PSMA PET/CT For RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY: WHAT IS NEXT? J Urol 2021. [DOI: 10.1097/ju.0000000000001996.19] [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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