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Kwak L, Ravi P, Armstrong JG, Beckendorf V, Chin JL, D'Amico AV, Dearnaley DP, Di Stasi SM, Gillessen S, Lukka H, Mottet N, Pommier P, Seiferheld W, Sydes MR, Tombal B, Zapatero A, Regan MM, Xie W, Sweeney CJ. Prognostic Impact of Prostate-Specific Antigen at 6 Months After Radiotherapy in Localized Prostate Cancer: An Individual Patient Data Analysis of Randomized Trials. J Clin Oncol 2024:JCO2300762. [PMID: 38471051 DOI: 10.1200/jco.23.00762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE We sought to evaluate the prognostic impact of prostate-specific antigen (PSA) at 6 months after completion of radiotherapy (RT) in patients treated with RT alone, RT plus short-term (st; 3-6 months), and RT plus long-term (lt; 24-36 months) androgen-deprivation therapy (ADT). PATIENTS AND METHODS Individual patient data were obtained from 16 randomized trials evaluating RT ± ADT for localized prostate cancer (PCa) between 1987 and 2011. The lowest PSA recorded within 6 months after RT completion was identified and categorized as < or ≥0.1 ng/mL. The primary outcomes were metastasis-free survival (MFS), PCa-specific mortality (PCSM), and overall survival (OS), from 12 months after random assignment. RESULTS Ninety-eight percent (n = 2,339/2,376) of patients allocated to RT alone, 84% (n = 4,756/5,658) allocated to RT + stADT, and 77% (n = 1,258/1,626) allocated to RT + ltADT had PSA ≥0.1 ng/mL within 6 months after completing RT. PSA ≥0.1 ng/mL was associated with lower MFS and OS and higher PCSM among patients allocated to RT ± ADT (RT - MFS: hazard ratio [HR], 2.24 [95% CI, 1.21 to 4.16]; PCSM: subdistribution hazard ratio [sHR], 1.82 [0.51 to 6.49]; OS: HR, 1.72 [0.97 to 3.05]; RT + stADT - MFS: HR, 1.27 [1.12 to 1.44]; PCSM: sHR, 2.10 [1.52 to 2.92]; OS: HR, 1.26 [1.11 to 1.44]; RT + ltADT - MFS: HR, 1.58 [1.27 to 1.96]; PCSM: sHR, 1.97 [1.11 to 3.49]; OS: HR, 1.59 [1.27 to 1.99]). Five-year MFS rates among patients allocated to RT, RT + stADT, and RT + ltADT were 91% versus 79%, 83% versus 76%, and 87% versus 74%, respectively, based on PSA < or ≥0.1 ng/mL. CONCLUSION PSA ≥0.1 ng/mL within 6 months after RT completion was prognostic for lt outcomes in patients treated with RT ± ADT for localized PCa. This can be used to counsel patients treated with RT ± ADT and in guiding clinical trial design evaluating novel systemic therapies with RT + ADT as well as (de)intensification strategies.
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Affiliation(s)
- Lucia Kwak
- Department of Urology, Catholic University, Rome, Italy
| | - Praful Ravi
- Department of Urology, Catholic University, Rome, Italy
| | - John G Armstrong
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | | | | | | | | | | | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Himanshu Lukka
- McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | | | | | | | | | - Almudena Zapatero
- Department of Radiation Oncology, La Princesa University Hospital, Health Research Institute, Madrid, Spain
| | | | - Wanling Xie
- Department of Urology, Catholic University, Rome, Italy
| | - Christopher J Sweeney
- 6South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, SA, Australia
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Ferro M, Del Giudice F, Carrieri G, Busetto GM, Cormio L, Hurle R, Contieri R, Arcaniolo D, Sciarra A, Maggi M, Porpiglia F, Manfredi M, Fiori C, Antonelli A, Tafuri A, Bove P, Terrone C, Borghesi M, Costantini E, Iliano E, Montanari E, Boeri L, Russo GI, Madonia M, Tedde A, Veccia A, Simeone C, Liguori G, Trombetta C, Brunocilla E, Schiavina R, Dal Moro F, Racioppi M, Vartolomei MD, Longo N, Spirito L, Crocetto F, Cantiello F, Damiano R, Di Stasi SM, Marchioni M, Schips L, Parma P, Carmignani L, Conti A, Soria F, Gontero P, Barone B, Deho F, Zaffuto E, Papalia R, Scarpa RM, Pagliarulo V, Lucarelli G, Ditonno P, Botticelli FMG, Musi G, Catellani M, de Cobelli O. The Impact of SARS-CoV-2 Pandemic on Time to Primary, Secondary Resection and Adjuvant Intravesical Therapy in Patients with High-Risk Non-Muscle Invasive Bladder Cancer: A Retrospective Multi-Institutional Cohort Analysis. Cancers (Basel) 2021; 13:cancers13215276. [PMID: 34771440 PMCID: PMC8582553 DOI: 10.3390/cancers13215276] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary The worldwide COVID-19 emergency has had an important impact on healthcare systems with the need to assist infected patients and also treat non-deferrable oncological conditions. In urology, the main concern has been for patients with bladder cancer, the tenth most common malignancy, where the quality and the alacrity of treatment has a clear well-demonstrated impact on the survivor. The aim of our Italian multi-institutional retrospective study was to assess the impact of the COVID-19 outbreak on diagnosis and treatment of non-muscle invasive bladder cancer. We observed a significant delay between diagnosis and surgical treatment, with a lower adherence to the standard therapeutic scheme such as BCG intravesical instillation and urological guidelines. We also recorded a different attitude in treatment depending on the patients’ location in Italy. Further investigation could show the impact of the pandemic on the survival of these patients. Abstract Background: To investigate the impact of COVID-19 outbreak on the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). Methods: A retrospective analysis was performed using an Italian multi-institutional database of TURBT patients with high-risk urothelial NMIBC between January 2019 and February 2021, followed by Re-TURBT and/or adjuvant intravesical BCG. Results: A total of 2591 patients from 27 institutions with primary TURBT were included. Of these, 1534 (59.2%) and 1056 (40.8%) underwent TURBT before and during the COVID-19 outbreak, respectively. Time between diagnosis and TURBT was significantly longer during the COVID-19 period (65 vs. 52 days, p = 0.002). One thousand and sixty-six patients (41.1%) received Re-TURBT, 604 (56.7%) during the pre-COVID-19. The median time to secondary resection was significantly longer during the COVID-19 period (55 vs. 48 days, p < 0.0001). A total of 977 patients underwent adjuvant intravesical therapy after primary or secondary resection, with a similar distribution across the two groups (n = 453, 86% vs. n = 388, 86.2%). However, the proportion of the patients who underwent maintenance significantly differed (79.5% vs. 60.4%, p < 0.0001). Conclusions: The COVID-19 pandemic represented an unprecedented challenge to our health system. Our study did not show significant differences in TURBT quality. However, a delay in treatment schedule and disease management was observed. Investigation of the oncological impacts of those differences should be advocated.
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Affiliation(s)
- Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
| | - Francesco Del Giudice
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Gian Maria Busetto
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Rodolfo Hurle
- Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy; (R.H.); (R.C.)
| | - Roberto Contieri
- Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy; (R.H.); (R.C.)
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, 80138 Naples, Italy;
| | - Alessandro Sciarra
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Martina Maggi
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Alessandro Antonelli
- Department of Urology, Ospedale Civile Maggiore, Polo Chirurgico Confortini, University of Verona, 37126 Verona, Italy; (A.A.); (A.T.)
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Ospedale Civile Maggiore, Polo Chirurgico Confortini, University of Verona, 37126 Verona, Italy; (A.A.); (A.T.)
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165 Rome, Italy;
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genova, Italy; (C.T.); (M.B.)
| | - Marco Borghesi
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genova, Italy; (C.T.); (M.B.)
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy; (E.C.); (E.I.)
| | - Ester Iliano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy; (E.C.); (E.I.)
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (L.B.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Luca Boeri
- Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (L.B.)
| | | | - Massimo Madonia
- Urologic Clinic, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (M.M.); (A.T.)
| | - Alessandro Tedde
- Urologic Clinic, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (M.M.); (A.T.)
| | - Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA 23298, USA;
- Urology Unit, ASST Spedali Civili Hospital, 25133 Brescia, Italy
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Giovanni Liguori
- Department of Urology, ASUITS, University of Trieste, 34149 Trieste, Italy; (G.L.); (C.T.)
| | - Carlo Trombetta
- Department of Urology, ASUITS, University of Trieste, 34149 Trieste, Italy; (G.L.); (C.T.)
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (E.B.); (R.S.)
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (E.B.); (R.S.)
| | - Fabrizio Dal Moro
- Urology Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35128 Padua, Italy;
| | - Marco Racioppi
- Urology Clinic, A. Gemelli Hospital Foundation, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Mihai Dorin Vartolomei
- Urology Department, Medical University of Vienna, A-1090 Vienna, Austria;
- IOSUD, Universitatea de Medicina Farmacie Stiinte si Tehnologie “George Emil Palade” din Targu Mures, 540142 Mureș, Romania
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Lorenzo Spirito
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Felice Crocetto
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Francesco Cantiello
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Savino M. Di Stasi
- Department of Surgery and Experimental Medicine, Tor Vergata University, 00133 Rome, Italy;
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, “SS. Annunziata” Hospital, G. d’Annunzio University of Chieti, 66100 Chieti, Italy; (M.M.); (L.S.)
- Department of Urology, ASL Abruzzo 2, 65017 Chieti, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, “SS. Annunziata” Hospital, G. d’Annunzio University of Chieti, 66100 Chieti, Italy; (M.M.); (L.S.)
- Department of Urology, ASL Abruzzo 2, 65017 Chieti, Italy
| | - Paolo Parma
- Urology Unit, Ospedale San Carlo Poma, 46100 Mantova, Italy;
| | - Luca Carmignani
- Department of Urology, San Donato Policlinic Hospital, 20094 Milan, Italy; (L.C.); (A.C.)
| | - Andrea Conti
- Department of Urology, San Donato Policlinic Hospital, 20094 Milan, Italy; (L.C.); (A.C.)
| | - Francesco Soria
- Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, 10121 Turin, Italy; (F.S.); (P.G.)
| | - Paolo Gontero
- Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, 10121 Turin, Italy; (F.S.); (P.G.)
| | - Biagio Barone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Federico Deho
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy; (F.D.); (E.Z.)
| | - Emanuele Zaffuto
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy; (F.D.); (E.Z.)
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University Hospital, 00198 Rome, Italy; (R.P.); (R.M.S.)
| | - Roberto M. Scarpa
- Department of Urology, Campus Biomedico University Hospital, 00198 Rome, Italy; (R.P.); (R.M.S.)
| | | | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (P.D.)
| | - Pasquale Ditonno
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (P.D.)
| | - Francesco Maria Gerardo Botticelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Michele Catellani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Gubbiotti M, Conte A, Di Stasi SM, Tambasco N, Giannantoni A. Feasibility of mirabegron in the treatment of overactive bladder in patients affected by Parkinson's disease: A pilot study. Ther Adv Neurol Disord 2019; 12:1756286419843458. [PMID: 31156718 PMCID: PMC6515844 DOI: 10.1177/1756286419843458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/19/2019] [Indexed: 12/23/2022] Open
Abstract
Background: We investigated the effectiveness and safety of mirabegron oral treatment in a group of patients with Parkinson’s disease (PD) and overactive bladder (OAB), refractory to antimuscarinics. Materials and methods: Thirty patients with PD and refractory OAB were prospectively included in the study. At baseline, motor symptoms, severity of disease and cognitive status were assessed with the Hoehn–Yahr Scale, the Unified Parkinson’s disease Rating Scale, the Mini Mental State examination and the Montreal Cognitive Assessment. At baseline, urinary symptoms, satisfaction with treatment and the impact of urinary incontinence on quality of life (QoL) were assessed with the 3-day voiding diary, the Visual Analogue Scale (VAS), the Incontinence–QoL questionnaire and urodynamics. Patients started assuming mirabegron 50 mg tablets once daily. Evaluation of urinary symptoms and related questionnaires, motor symptoms, severity of PD and uroflowmetry with postvoid residual volume measurement were then repeated at the 3- and 6-month follow up. Side effects were also noted. Results: At baseline, the most frequently reported urinary symptoms were: urinary urgency (present in all the patients), urge urinary incontinence in 28/30 (93.3%) and increased daytime urinary frequency in 25 (83.3%) patients. At the 3-month follow up, 7 out of the 30 patients achieved a complete urinary continence. Significant improvements in VAS and Incontinence–QoL scores were observed in 24 patients. These benefits were maintained for the whole observation period. Four patients discontinued treatment due to poor efficacy, and two due to the cost of the drug. Conclusions: Mirabegron is a safe and effective treatment in patients with PD and OAB refractory to anticholinergics in the short-term follow up.
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Affiliation(s)
- Marilena Gubbiotti
- Serafico Institute of Assisi, Research Centre 'InVita', Assisi (Perugia), Italy
| | - Antonella Conte
- IRCCS Neuromed Institute, Pozzilli, Province of Isernia, Italy Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Savino M Di Stasi
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | | | - Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
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Bielli P, Di Stasi SM, Sette C. The emerging role of PTBP1 in human cancer: novel prognostic factor in non-muscle invasive bladder cancer. Transl Androl Urol 2019; 7:S765-S767. [PMID: 30688932 PMCID: PMC6323271 DOI: 10.21037/tau.2018.12.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pamela Bielli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Savino M Di Stasi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Sette
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Institute of Human Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
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Bielli P, Panzeri V, Lattanzio R, Mutascio S, Pieraccioli M, Volpe E, Pagliarulo V, Piantelli M, Giannantoni A, Di Stasi SM, Sette C. The Splicing Factor PTBP1 Promotes Expression of Oncogenic Splice Variants and Predicts Poor Prognosis in Patients with Non-muscle-Invasive Bladder Cancer. Clin Cancer Res 2018; 24:5422-5432. [PMID: 30012566 DOI: 10.1158/1078-0432.ccr-17-3850] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/02/2018] [Accepted: 07/10/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Non-muscle-invasive bladder cancer (NMIBC) is a malignant disease characterized by high heterogeneity, which corresponds to dysregulated gene expression and alternative splicing (AS) profiles. Bioinformatics analyses of splicing factors potentially linked to bladder cancer progression identified the heterogeneous nuclear ribonucleoprotein I (i.e., PTBP1) as candidate. This study aimed at investigating whether PTBP1 expression associates with clinical outcome in patients with NMIBC.Experimental Design: A cohort of 152 patients presenting with primary NMIBC (pTa-pT1) was enrolled. Primary NMIBCs were assessed for PTBP1 expression by IHC, and the results were correlated with clinical data using Kaplan-Meier curves and Cox regression analyses. Cell proliferation and survival assays were performed to assess the function of PTBP1. Furthermore, the impact of PTBP1 on the AS pattern of specific bladder cancer-related genes was investigated in cancer cell lines and in patients' specimens.Results: Public datasets querying highlighted a positive correlation between PTBP1 expression and NMIBC progression, which was then confirmed by IHC analysis. High PTBP1 expression was associated with worse clinical outcome in terms of incidence of tumor relapse and survival in patients with NMIBC. Interestingly, downregulation of PTBP1 in bladder cancer cell lines affected prosurvival features. Accordingly, PTBP1 modulated AS of bladder cancer-related genes in cell lines and patient's specimens.Conclusions: PTBP1 expression correlates with disease progression, poor prognosis, and worse survival in patients with NMIBC. Downregulation of PTBP1 expression affects prosurvival features of bladder cancer cells and modulates AS of genes with relevance for bladder cancer, suggesting its role as an outcome-predictor in this disease. Clin Cancer Res; 24(21); 5422-32. ©2018 AACR.
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Affiliation(s)
- Pamela Bielli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Valentina Panzeri
- Fondazione Santa Lucia IRCCS, Rome, Italy.,Department of Science Medical/Chirurgic and Translational Medicine, University of Rome "Sapienza", Rome, Italy.,Institute of Human Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rossano Lattanzio
- Department of Medical, Oral & Biotechnological Sciences, G. d'Annunzio University, Chieti, Italy.,Center of Excellence on Aging and Translational Medicine (CeSi-Met), G. d'Annunzio University, Chieti, Italy
| | - Simona Mutascio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marco Pieraccioli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | | | - Vincenzo Pagliarulo
- Department of Emergency and Organ Transplantation, University Aldo Moro, Bari, Italy
| | - Mauro Piantelli
- Department of Medical, Oral & Biotechnological Sciences, G. d'Annunzio University, Chieti, Italy
| | - Antonella Giannantoni
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Savino M Di Stasi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Claudio Sette
- Fondazione Santa Lucia IRCCS, Rome, Italy. .,Institute of Human Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
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Cantiello F, Russo GI, Vartolomei MD, Farhan ARA, Terracciano D, Musi G, Lucarelli G, Di Stasi SM, Hurle R, Serretta V, Busetto GM, Scafuro C, Perdonà S, Borghesi M, Schiavina R, Cioffi A, De Berardinis E, Almeida GL, Bove P, Lima E, Ucciero G, Matei DV, Crisan N, Verze P, Battaglia M, Guazzoni G, Autorino R, Morgia G, Damiano R, de Cobelli O, Mirone V, Shariat SF, Ferro M. Systemic Inflammatory Markers and Oncologic Outcomes in Patients with High-risk Non-muscle-invasive Urothelial Bladder Cancer. Eur Urol Oncol 2018; 1:403-410. [PMID: 31158079 DOI: 10.1016/j.euo.2018.06.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/02/2018] [Accepted: 06/12/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Serum levels of neutrophils, platelets, and lymphocytes have been recognized as factors related to poor prognosis for many solid tumors, including bladder cancer (BC). OBJECTIVE To evaluate the prognostic role of the combination of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) in patients with high-risk non-muscle-invasive urothelial BC (NIMBC). DESIGN, SETTING, AND PARTICIPANTS A total of 1151 NMIBC patients who underwent first transurethral resection of the bladder tumor (TURBT) at 13 academic institutions between January 1, 2002 and December 31, 2012 were included in this analysis. The median follow-up was 48 mo. INTERVENTION TURBT with intravesical chemotherapy or immunotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable Cox regression analysis was performed to identify factors predictive of recurrence, progression, cancer-specific mortality, and overall mortality. A systemic inflammatory marker (SIM) score was calculated based on cutoffs for NLR, PLR, and LMR. RESULTS AND LIMITATIONS The 48-mo recurrence-free survival was 80.8%, 47.35%, 20.67%, and 17.06% for patients with an SIM score of 0, 1, 2, and 3, respectively (p<0.01, log-rank test) while the corresponding 48-mo progression free-survival was 92.0%, 75.67%, 72.85%, and 63.1% (p<0.01, log-rank test). SIM scores of 1, 2, and 3 were associated with recurrence (hazard ratio [HR] 3.73, 7.06, and 7.88) and progression (HR 3.15, 4.41, and 5.83). Limitations include the lack of external validation and comparison to other clinical risk models. CONCLUSIONS Patients with high-grade T1 stage NMIBC with high SIM scores have worse oncologic outcomes in terms of recurrence and progression. Further studies should be conducted to stratify patients according to SIM scores to identify individuals who might benefit from early cystectomy. PATIENT SUMMARY In this study, we defined a risk score (the SIM score) based on the measurement of routine systemic inflammatory markers. This score can identify patients with high-grade bladder cancer not invading the muscular layer who are more likely to suffer from tumor recurrence and progression. Therefore, the score could be used to select patients who might benefit from early bladder removal.
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Affiliation(s)
- Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giorgio I Russo
- Department of Urology, University of Catania, Catania, Italy.
| | - Mihai Dorin Vartolomei
- Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
| | | | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Savino M Di Stasi
- Department of Surgery and Experimental Medicine, University Tor Vergata, Rome, Italy
| | - Rodolfo Hurle
- Department of Urology, Humanitas Hospital, Milan, Italy
| | | | | | - Chiara Scafuro
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS, Naples, Italy
| | - Marco Borghesi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Antonio Cioffi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Ettore De Berardinis
- Department of Gynecological-Obstetrics Sciences and Urological Sciences, Sapienza Rome University Policlinico Umberto I, Rome, Italy
| | | | | | - Estevao Lima
- Department of CUF Urology and Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Giuseppe Ucciero
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Deliu Victor Matei
- Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | - Paolo Verze
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, Italy
| | - Michele Battaglia
- Department of Surgery and Experimental Medicine, University Tor Vergata, Rome, Italy
| | | | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Giuseppe Morgia
- Department of Urology, University of Catania, Catania, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Vincenzo Mirone
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, Italy
| | - Shahrokh F Shariat
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
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Ferro M, Vartolomei MD, Cantiello F, Lucarelli G, Di Stasi SM, Hurle R, Guazzoni G, Busetto GM, De Berardinis E, Damiano R, Perdonà S, Borghesi M, Schiavina R, Almeida GL, Bove P, Lima E, Grimaldi G, Autorino R, Crisan N, Abu Farhan AR, Verze P, Battaglia M, Serretta V, Russo GI, Morgia G, Musi G, de Cobelli O, Mirone V, Shariat SF. High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study. Urol Int 2018; 101:7-15. [PMID: 29975950 DOI: 10.1159/000490765] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 04/17/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC). PATIENTS AND METHODS The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death. RESULTS A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses. CONCLUSIONS Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.
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Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Mihai Dorin Vartolomei
- Division of Urology, European Institute of Oncology, Milan, Italy.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Savino M Di Stasi
- Department of Experimental Medicine and Surgery, Tor Vegata University, Rome, Italy
| | - Rodolfo Hurle
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Humanitas University, Department of Biomedical Science, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Humanitas University, Department of Biomedical Science, Milan, Italy
| | | | | | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale"-IRCCS, Naples, Italy
| | - Marco Borghesi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | | | - Pierluigi Bove
- UOC of Urology Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Estevao Lima
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Giovanni Grimaldi
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nicolae Crisan
- Department of Urology, University of Medicine and Pharmacy "Iuliu Hațeganu", Cluj-Napoca, Romania
| | | | - Paolo Verze
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Vincenzo Serretta
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Giorgio Ivan Russo
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Giuseppe Morgia
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology, Milan, Italy.,Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Urology, Weill Cornell Medical College, New York, New York, USA
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8
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Di Stasi SM, De Carlo F, Pagliarulo V, Masedu F, Verri C, Celestino F, Riedl C. Hexaminolevulinate hydrochloride in the detection of nonmuscle invasive cancer of the bladder. Ther Adv Urol 2015; 7:339-50. [PMID: 26622319 DOI: 10.1177/1756287215603274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Clinical trials have shown that hexaminolevulinate (HAL) fluorescence cystoscopy improves the detection of bladder tumors compared with standard white-light cystoscopy, resulting in more efficacious treatment. However, some recent meta-analyses report controversially on recurrence-free rates with this procedure. A systematic review of literature was performed from December 2014 to January 2015 using the PubMed, Embase and Cochrane databases for controlled trials on photodynamic diagnosis (PDD) with HAL. A total of 154 publications were found up to January 2015. Three of the authors separately reviewed the records to evaluate eligibility and methodological quality of clinical trials. A total of 16 publications were considered eligible for analysis. HAL-PDD-guided cystoscopy increased overall tumor detection rate (proportion difference 19%, 95% confidence interval [CI] 0.152-0.236) although the benefit was particularly significant in patients with carcinoma in situ (CIS) lesion (proportion difference 15.7%, 95% CI 0.069-0.245) and was reduced in papillary lesions (Ta proportion difference 5.9%, 95% CI 0.014-0.103 and T1 proportion difference 1.2%, 95% CI 0.033-0.057). Moreover, there were 15% of patients (95% CI 0.098-0.211) with at least one additional tumor seen with PDD. With regard to recurrence rates, the data sample was insufficient for a statistical analysis, although the evaluation of raw data showed a trend in favor of HAL-PDD. This meta-analysis confirms the increased tumor detection rate by HAL-PDD with a most pronounced benefit for CIS lesion.
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Affiliation(s)
- Savino M Di Stasi
- Department of Experimental Medicine and Surgery, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - Francesco De Carlo
- Department of Experimental, Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Vincenzo Pagliarulo
- Department of Emergency and Organs Transplantation, 'Aldo Moro' University, Bari, Italy
| | - Francesco Masedu
- Department of Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
| | - Cristian Verri
- Department of Experimental, Medicine and Surgery, Tor Vergata University, Rome, Italy
| | | | - Claus Riedl
- Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria
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9
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Ciocca G, Limoncin E, Cellerino A, Fisher AD, Gravina GL, Carosa E, Mollaioli D, Valenzano DR, Mennucci A, Bandini E, Di Stasi SM, Maggi M, Lenzi A, Jannini EA. Gender Identity Rather Than Sexual Orientation Impacts on Facial Preferences. J Sex Med 2014; 11:2500-7. [DOI: 10.1111/jsm.12633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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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10
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Bielli P, Busà R, Di Stasi SM, Munoz MJ, Botti F, Kornblihtt AR, Sette C. The transcription factor FBI-1 inhibits SAM68-mediated BCL-X alternative splicing and apoptosis. EMBO Rep 2014; 15:419-27. [PMID: 24514149 DOI: 10.1002/embr.201338241] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Alternative splicing (AS) is tightly coupled to transcription for the majority of human genes. However, how these two processes are linked is not well understood. Here, we unveil a direct role for the transcription factor FBI-1 in the regulation of AS. FBI-1 interacts with the splicing factor SAM68 and reduces its binding to BCL-X mRNA. This, in turn, results in the selection of the proximal 5' splice site in BCL-X exon 2, thereby favoring the anti-apoptotic BCL-XL variant and counteracting SAM68-mediated apoptosis. Conversely, depletion of FBI-1, or expression of a SAM68 mutant lacking the FBI-1 binding region, restores the ability of SAM68 to induce BCL-XS splicing and apoptosis. FBI-1's role in splicing requires the activity of histone deacetylases, whose pharmacological inhibition recapitulates the effects of FBI-1 knockdown. Our study reveals an unexpected function for FBI-1 in splicing modulation with a direct impact on cell survival.
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Affiliation(s)
- Pamela Bielli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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11
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Giannantoni A, Porena M, Gubbiotti M, Maddonni S, Di Stasi SM. The efficacy and safety of duloxetine in a multidrug regimen for chronic prostatitis/chronic pelvic pain syndrome. Urology 2013; 83:400-5. [PMID: 24231216 DOI: 10.1016/j.urology.2013.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/30/2013] [Accepted: 09/11/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of duloxetine hydrochloride in the treatment of patients affected by chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS Thirty-eight CP/CPPS patients completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Index of Erectile Function-Erectile Function-5 (IIEF-5) questionnaires, uroflowmetry, and evaluation of psychologic status using Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). Patients were randomly assigned to 2 treatments groups. Treatment in group 1 consisted of a simultaneous oral administration of tamsulosin (0.4 mg/d, 60 mg/d), saw palmetto (320 mg/d), and duloxetine (60 mg/d). Treatment in group 2 consisted of tamsulosin (0.4 mg/d) and saw palmetto (320 mg/d). NIH-CPSI and IIEF-5 questionnaires, uroflowmetry, and evaluation of the psychological status were repeated at 16 weeks of follow-up. RESULTS At 16 weeks, a significant improvement in NIH-CPSI pain subscore, NIH-CPSI quality of life subscore, and NIH-CPSI total score were observed in group 1 patients compared with those in group 2 (P <.01, respectively), together with a significant improvement in HAM-A and HAM-D scores (P <.01, respectively). Patients in group 2 showed a significant improvement in NIH-CPSI total score, in the urinary symptoms subscore, and in the HAM-A total score. No significant differences were observed in IIEF-5 scores in the 2 groups. Maximum flow rate significantly increased in both groups. In group 1, 20% of patients stopped the study due to adverse effects. CONCLUSION The use of duloxetine in a multimodal treatment with an α-blocker medication and a saw palmetto extract allowed better results in controlling clinical symptoms, psychologic status and quality of life patients affected by CP/CPPS.
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Affiliation(s)
- Antonella Giannantoni
- Department of Urology and Andrology, University of Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy.
| | - Massimo Porena
- Department of Urology and Andrology, University of Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Marilena Gubbiotti
- Department of Urology and Andrology, University of Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Stefania Maddonni
- Department of Urology and Andrology, University of Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
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Di Stasi SM, Valenti M, Verri C, Liberati E, Giurioli A, Leprini G, Masedu F, Ricci AR, Micali F, Vespasiani G. Electromotive instillation of mitomycin immediately before transurethral resection for patients with primary urothelial non-muscle invasive bladder cancer: a randomised controlled trial. Lancet Oncol 2011; 12:871-9. [DOI: 10.1016/s1470-2045(11)70190-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Di Stasi SM, Verri C, Capelli G, Brausi M, Leprini G, Zampa G, Stephen RL. 1346 SIGLE PREOPERATIVE INTRAVESICAL INSTILLATION OF ELECTROMOTIVE MITOMYCIN-C FOR PRIMARY NON-MUSCLE INVASIVE BLADDER CANCER: A RANDOMIZED TRIAL. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Malmström PU, Sylvester RJ, Crawford DE, Friedrich M, Krege S, Rintala E, Solsona E, Di Stasi SM, Witjes JA. An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guérin for non-muscle-invasive bladder cancer. Eur Urol 2009; 56:247-56. [PMID: 19409692 DOI: 10.1016/j.eururo.2009.04.038] [Citation(s) in RCA: 427] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 04/16/2009] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with non-muscle-invasive bladder cancer with an intermediate or high risk need adjuvant intravesical therapy after surgery. Based largely on meta-analyses of previously published results, guidelines recommend using either bacillus Calmette-Guérin (BCG) or mitomycin C (MMC) in these patients. Individual patient data (IPD) meta-analyses, however, are the gold standard. OBJECTIVE To compare the efficacy of BCG and MMC based on an IPD meta-analysis of randomised trials. DESIGN, SETTING, AND PARTICIPANTS Trials were searched through Medline and review articles. The relevant trial investigators were contacted to provide IPD. MEASUREMENTS The drugs were compared with respect to time to recurrence, progression, and overall and cancer-specific death. RESULTS AND LIMITATIONS Nine trials that included 2820 patients were identified, and IPD were obtained from all of them. Patient characteristics were 71% primary, 54% Ta, 43% T1, 25% G1, 58% G2, and 16% G3, and 7% had prior intravesical chemotherapy. Based on a median follow-up of 4.4 yr, 43% recurred. Overall, there was no difference in the time to first recurrence (p=0.09) between BCG and MMC. In the trials with BCG maintenance, a 32% reduction in risk of recurrence on BCG compared to MMC was found (p<0.0001), while there was a 28% risk increase (p=0.006) for BCG in the trials without maintenance. BCG with maintenance was more effective than MMC in both patients previously treated and those not previously treated with chemotherapy. In the subset of 1880 patients for whom data on progression, survival, and cause of death were available, 12% progressed and 24% died, and, of those, 30% of the deaths were due to bladder cancer. No statistically significant differences were found for these long-term end points. CONCLUSIONS For prophylaxis of recurrence, maintenance BCG is required to demonstrate superiority to MMC. Prior intravesical chemotherapy was not a confounder. There were no statistically significant differences regarding progression, overall survival, and cancer-specific survival between the two treatments.
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Affiliation(s)
- Per-Uno Malmström
- Uppsala University Hospital, Department of Urology, Uppsala, Sweden.
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Di Stasi SM, Liberati E, Dutto L, Verri C. Intravesical electromotive drug administration of mitomycin-C for non-muscle invasive bladder cancer. Arch Ital Urol Androl 2008; 80:157-161. [PMID: 19235432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
This article reviews intravesical application of electromotive drug administration (EMDA) for the treatment of bladder cancer and the evidence in support of intravesical passive diffusion chemotherapy in the management of non-muscle invasive bladder cancer. Two recently published randomised trials adopting protocols that use EMDA to enhance urothelial transport of intravesical mitomycin-C showed it provided a therapeutical advantage and suggested that intravesical passive diffusion administration of chemotherapeutic drugs may be suboptimal. Further studies are required to demonstrate feasibility and advantage of intravesical EMDA of mitomycin-C in the wider uro-oncological community.
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Di Stasi SM, Storti L, Giurioli A, Brausi M, Capelli G, Zampa G, Stephen RL. SINGLE IMMEDIATE PREOPERATIVE INSTILLATION OF ELECTROMOTIVE MITOMYCIN-C PLUS TRANSURETHRAL RESECTION VERSUS TRANSURETHAL RESECTION ALONE VERSUS TRANSURETHRAL RESECTION PLUS IMMEDIATE MITOMYCIN-C FOR pTa BLADDER TUMORS: LONG TERM RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61715-2] [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: 11/16/2022]
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Di Stasi SM, Storti L, Giurioli A, Liberati E, Dutto L, Iorio B, Stephen RL. LONG-TERM FOLLOWUP ANALYSIS OF A RANDOMIZED PROSPECTIVE STUDY COMPARING INTRAVESICAL ELECTROMOTIVE MITOMYCIN-C, PASSIVE DIFFUSION MITOMYCIN-C AND BACILLUS CALMETTE-GUERIN IN PATIENTS WITH CARCINOMA IN SITU OF THE BLADDER. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61717-6] [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: 10/22/2022]
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Gravina GL, Brandetti F, Martini P, Carosa E, Di Stasi SM, Morano S, Lenzi A, Jannini EA. Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm. J Sex Med 2008; 5:610-8. [PMID: 18221286 DOI: 10.1111/j.1743-6109.2007.00739.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The physiology and anatomy of female sexual function are poorly understood. The differences in sexual function among women may be partly attributed to anatomical factors. AIM The purpose of this study was to use ultrasonography to evaluate the anatomical variability of the urethrovaginal space in women with and without vaginal orgasm. METHODS Twenty healthy, neurologically intact volunteers were recruited from a population of women who were a part of a previous published study. All women underwent a complete urodynamic evaluation and those with clinical and urodynamic urinary incontinence, idiopathic detrusor overactivity, or micturition disorders, as well as postmenopausal women and those with sexual dysfunction were excluded. The reported experience of vaginal orgasm was investigated. MAIN OUTCOME MEASURE The urethrovaginal space thickness as measured by ultrasound was chosen as the indicator of urogenital anatomical variability. Designated evaluators carried out the measurements in a blinded fashion. RESULTS The urethrovaginal space and distal, middle, and proximal urethrovaginal segments were thinner in women without vaginal orgasm. A direct correlation between the presence of vaginal orgasm and the thickness of urethrovaginal space was found. Women with a thicker urethrovaginal space were more likely to experience vaginal orgasm (r = 0.884; P = 0.015). A direct and significant correlation between the thickness of each urethrovaginal segment and the presence of vaginal orgasm was found, with the best correlation observed for the distal segment (r = 0.863; P < 0.0001). Interobserver agreement between the designated evaluators was excellent (r = 0.87; P < 0.001). CONCLUSIONS The measurement of the space within the anterior vaginal wall by ultrasonography is a simple tool to explore anatomical variability of the human clitoris-urethrovaginal complex, also known as the G-spot, which can be correlated to the ability to experience the vaginally activated orgasm.
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Giannantoni A, Di Stasi SM, Chancellor MB, Costantini E, Porena M. New Frontiers in Intravesical Therapies and Drug Delivery. Eur Urol 2006; 50:1183-93; discussion 1193. [PMID: 16963179 DOI: 10.1016/j.eururo.2006.08.025] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 08/16/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The intravesical route permits site-specific delivery of drugs with a reduced side-effect profile as compared to oral delivery systems, either by avoiding first-pass metabolism or by obtaining a local effect. We investigated mechanisms related to urothelium permeability and new physical and chemical developments in intravesical drug delivery that potentially permit successful treatment of several bladder dysfunction. METHODS A literature review. RESULTS Pharmacologic agents increasing urothelial permeability and useful for clinical purposes have been described, such as dimethylsulfoxide, protamine sulphate, chitosan, and nystatin. Among physical approaches, electromotive drug administration appears to be more effective than intravesical passive diffusion in delivering drugs through the urothelium into deeper layers of the bladder. Experimental and clinical reports demonstrated that electric current significantly increases the transport of local anaesthetics, mytomicin C, oxybutynin, resiniferatoxin, epinephrine, and dexamethasone. Among new chemical approaches, cell-penetrating peptides posses the ability to translocate macromolecular drugs across membranes of urothelial cells. The therapeutic benefits of sustained delivery afforded by thermosensitive hydrogel, which forms a depot for hydrophilic and hydrophobic drugs, have been demonstrated by delivering anti-inflammatory drugs. Liposomes improve the aqueous solubility of several hydrophobic drugs such as taxol, amphotericin, and capsaicin. CONCLUSIONS Electromotive drug administration, new in situ delivery systems, and bioadhesive liposomes may make it possible to extend intravesical therapy and drug administration to many bladder diseases. Research to expand knowledge of the chemical and physical properties of the bladder and processes regulating drug transport across biologic membranes is needed to make this a reality.
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Giannantoni A, Di Stasi SM, Nardicchi V, Zucchi A, Macchioni L, Bini V, Goracci G, Porena M. Botulinum-A toxin injections into the detrusor muscle decrease nerve growth factor bladder tissue levels in patients with neurogenic detrusor overactivity. J Urol 2006; 175:2341-4. [PMID: 16697870 DOI: 10.1016/s0022-5347(06)00258-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE We investigated the effects of BTX-A on visceral afferent nerve transmission by measuring bladder tissue NGF levels in patients with neurogenic detrusor overactivity before and after intravesical treatment with BTX-A. We also compared the bladder tissue NGF content with clinical and urodynamic data. MATERIALS AND METHODS A total of 23 patients underwent clinical evaluation and urodynamics with detection of the UDC threshold, maximum pressure and maximum cystometric capacity before, and at the 1 and 3-month followups. Endoscopic bladder wall biopsies were also obtained at the same time points. NGF levels were measured in tissue homogenate by enzyme-linked immunosorbent assay (Promega, Madison, Wisconsin). RESULTS At 1 and 3 months mean catheterization and incontinent episodes were significantly decreased (p <0.05 and <0.001, respectively). On urodynamics we detected a significant increase in the UDC threshold and maximum cystometric capacity, and a significant decrease in UDC maximum pressure at the 1 and 3-month follow-ups compared to baseline (each p <0.001). At the same time points we detected a significant decrease in NGF bladder tissue content (each p <0.02). CONCLUSIONS BTX-A intravesical treatment induces a state of NGF deprivation in bladder tissue that persists at least up to 3 months. As caused by BTX-A, the decrease in acetylcholine release at the presynaptic level may induce a decrease in detrusor contractility and in NGF production by the detrusor muscle. Alternatively BTX-A can decrease the bladder level of neurotransmitters that normally modulate NGF production and release.
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Di Stasi SM, Giannantoni A, Giurioli A, Vespasiani G, Zampa G, Storti L, Attisani F, De Carolis A, Valenti M, Stephen RL. 830: Sequential Bacillus Calmette-Guèrin and Electromotive Mitomycin-C Versus Bacillus Calmette Guèrin Alone for High Risk Superficial Bladder Cancer: Long-Term Follow-Up Results of a Prospective Controlled Study. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33066-0] [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: 10/17/2022]
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Giannantoni A, Costantini E, Di Stasi SM, Tascini MC, Bini V, Porena M. Botulinum A Toxin Intravesical Injections in the Treatment of Painful Bladder Syndrome: A Pilot Study. Eur Urol 2006; 49:704-9. [PMID: 16417964 DOI: 10.1016/j.eururo.2005.12.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Revised: 12/04/2005] [Accepted: 12/05/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We evaluated the efficacy and tolerability of botulinum A toxin (BTX-A) intravesical injections in patients affected by painful bladder syndrome with increased urinary frequency, refractory to conventional treatment modalities. METHODS Twelve women and two men were prospectively included in the study. Under short general anaesthesia patients were given injections of 200 U of commercially available BTX-A diluted in 20 ml 0.9% NaCl. Injections were performed submucosally in the trigone and bladder floor under cystoscopic control. Voiding chart, the Visual Analog Scale (VAS) for pain, and urodynamics were performed before treatment and 1 and 3 mo afterward. RESULTS Overall, 12 patients (85.7%) reported subjective improvement at 1 and 3 mo follow-up. The mean VAS score was significantly reduced at 1 and 3 mo after treatment (p<0.05 for both); at the same time points daytime and nighttime urinary frequency significantly decreased (p<0.01 and p<0.05, respectively), and bladder cystometric capacity significantly increased (p<0.01). Two patients reported incomplete bladder emptying. We did not detect any systemic side effects during or after treatment. CONCLUSIONS The results of this pilot study indicate that BTX-A intravesical injections are effective in the short-term management of painful bladder syndrome. By modulating afferent C-fiber activity within the bladder walls, BTX-A significantly improves urodynamic parameters and reduces bladder pain and urinary frequency.
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Di Stasi SM, Giannantoni A, Giurioli A, Valenti M, Zampa G, Storti L, Attisani F, De Carolis A, Capelli G, Vespasiani G, Stephen RL. Sequential BCG and electromotive mitomycin versus BCG alone for high-risk superficial bladder cancer: a randomised controlled trial. Lancet Oncol 2006; 7:43-51. [PMID: 16389183 DOI: 10.1016/s1470-2045(05)70472-1] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The rationale for combining anticancer drugs has not been applied consistently to use of intravesical agents for treatment of superficial bladder cancer, for which immunotherapeutic BCG and chemotherapeutic mitomycin seem to be a potentially effective combination. We aimed to do a prospective, randomised comparison of BCG alone with that of sequential BCG and electromotive mitomycin in patients with stage pT1 bladder cancer. METHODS After transurethral resection and multiple biopsies, 212 patients with stage pT1 bladder cancer were randomly assigned to: 81 mg BCG infused over 120 min once a week for 6 weeks (n=105); or to 81 mg BCG infused over 120 min once a week for 2 weeks, followed by 40 mg electromotive mitomycin (intravesical electric current 20 mA for 30 min) once a week as one cycle for three cycles (n=107). Complete responders underwent maintenance treatment: those assigned BCG alone had one infusion of 81 mg BCG once a month for 10 months, and those assigned BCG and mitomycin had 40 mg electromotive mitomycin once a month for 2 months, followed by 81 mg BCG once a month as one cycle for three cycles. The primary endpoint was disease-free interval; secondary endpoints were time to progression; overall survival; and disease-specific survival. Analyses were done by intention to treat. This trial has been submitted for registration at the US National Cancer Institute website . FINDINGS Median follow-up was 88 months (IQR 63-110). Patients assigned sequential BCG and electromotive mitomycin had higher disease-free interval than did those assigned BCG alone (69 months [95% CI 55-86] vs 21 months [15-54]; difference between groups 48 months [42-54], log-rank p=0.0012). Patients assigned sequential BCG and electromotive mitomycin also had lower recurrence (41.9% [32.7-51.5] vs 57.9% [48.7-67.5]; difference between groups 16.0% [2.7-29.3], log-rank p=0.0012); progression (9.3% [3.8-14.8] vs 21.9% [17.9-25.9]; difference between groups 12.6% [3.0-22.2], log-rank p=0.004); overall mortality (21.5% [13.5-29.5] vs 32.4% [23.4-41.4], difference between groups 10.9% [0.6-21.2], log-rank p=0.045); and disease-specific mortality (5.6% [1.2-10.0] vs 16.2% [6.1-23.3], difference between groups 10.6% [2.5-18.7], log-rank p=0.01). Side-effects were mainly localised to the bladder. INTERPRETATION BCG-induced inflammation might increase the permeability of the bladder mucosa such that mitomycin can reach the target tissue more easily and exert its anticancer effect.
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Di Stasi SM, Giannantoni A, Stephen RL, Storti L, Attisani F, Sansalone S, Virgili G. Percutaneous sequential bacillus Calmette-Guèrin and mitomycin C for panurothelial carcinomatosis. Can J Urol 2005; 12:2895-8. [PMID: 16401376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 59 year old male presented with a 4 month history of lower urinary tract symptoms. Exhaustive urological investigations revealed papillary tumors and carcinoma in situ extending from the prostatic urethra, throughout the bladder, up both ureters and into the renal pelves. Tumors were resected where possible and then bacillus Calmette-Guèrin (BCG) and mitomycin C (MMC) were infused sequentially through bilateral nephrostomy tubes for a total of six BCG and three MMC instillations. Follow up 1 month post treatment demonstrated a complete response which persisted for 2 years. Then there appeared a solitary papillomatous recurrence in the bladder which was successfully resected. Side effects were the occasional fever and BCG induced granulomatous prostatitis which slowly resolved. In conclusion, sequential BCG/MMC instillations were effective treatment for widespread panurothelial carcinomatosis.
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Carosa E, Radico C, Giansante N, Rossi S, D'Adamo F, Di Stasi SM, Lenzi A, Jannini EA. Ontogenetic profile and thyroid hormone regulation of type-1 and type-8 glucose transporters in rat Sertoli cells. ACTA ACUST UNITED AC 2005; 28:99-106. [PMID: 15811071 DOI: 10.1111/j.1365-2605.2005.00516.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The glucose transporters (GLUTs) gene encode glycoproteins responsible for facilitating transfer of glucose across plasma membrane. In testis, different members of this family are present. In particular the main GLUT mRNA expression within the adult testis is the type 8, while type 1 is more expressed in prepubertal testis. Thyroid hormone, which receptors and function have been characterized in the testis, plays a crucial role in the cellular energetic metabolism. In fact, in the immature Sertoli cells, GLUT1 is up regulated by l-triiodothyronine (T(3)). The aim of this paper is to investigate the expression profile of GLUT1 and GLUT8 in the testis during development and in adulthood and analyse the role of T(3) on their expression. To analyse the expression of GLUT8 and GLUT1 we performed Northern blot and RT-PCR experiments in the whole testis and in Sertoli cells from rats of different ages. Treatments in vivo and in vitro with T(3) were used to study the effect of thyroid hormones on GLUT1 and GLUT8 expression. The activity of the rat GLUT1 promoter and its regulation by T(3) was studied with transient transfections in gonadal and non-gonadal cell lines and in primary Sertoli cell cultures. GLUT8 is expressed at a low level in the prepubertal testis and Sertoli cells and does not appear to be under T(3) control. GLUT1 is the predominant form in immature Sertoli cells. The effect of T(3) on its mRNA accumulation was quantified and confirmed by RT-PCR (control: 0.65 +/- 0.17; T(3): 1.23 +/- 0.04, arbitrary units, p < 0.05). However, transfection experiments showed that T(3) does not directly regulate GLUT1 promoter in any cell line tested. This is confirmed by the evidence that, upon extensive analysis, the rat GLUT1 promoter and the first intron sequence do not shows any thyroid responsive elements. Our data demonstrate that GLUT1 and GLUT8 are both expressed in prepubertal testis, but only GLUT1 is regulated by T(3). In addition, we found that the effect of T(3) cannot be attributed to its action on GLUT1 promoter.
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Affiliation(s)
- Eleonora Carosa
- Course of Endocrinology and Medical Sexology, Department of Experimental Medicine, University of L'Aquila, 67100 L'Aquila, Italy
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Carosa E, Martini P, Brandetti F, Di Stasi SM, Lombardo F, Lenzi A, Jannini EA. Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels. Clin Endocrinol (Oxf) 2004; 61:382-6. [PMID: 15355456 DOI: 10.1111/j.1365-2265.2004.02108.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Lack of sexual activity due to erectile dysfunction (ED) decreases testosterone (T) levels through a central effect on the hypothalamic-pituitary axis. In this paper we studied the effect of different type V phosphodiesterase (PDE5) inhibitor treatments for ED on the reversibility of this endocrine pattern. DESIGN Open-label, retrospective study. PATIENTS Seventy-four consecutive patients were treated on demand with sildenafil (Sild) (50 mg) and tadalafil (Tad) 20 mg. MEASUREMENTS The success in sexual intercourse was recorded and total (tT) and free testosterone (fT) levels were studied before and after 3 months of treatment. RESULTS Basal level of tT and fT were at the bottom of the normal range and LH levels were at the top of the high normal range. After treatments, this endocrine pattern was reversed in both groups. However, the T increase in Sild-treated patients was significantly lower than in those treated with Tad (4.7 +/- 2.7 vs. 5.1 +/- 0.9, P < 0.001). fT levels followed a directly proportional pattern, while the inverse was found when LH production was studied. The intercourse rate reflected this effect: in fact, the Sild group showed a 4.9 +/- 2.9/month full sexual intercourse rate while in the Tad group a significantly higher rate of sexual intercourse was found (6.9 +/- 4.6/month, P = 0.04). However, drug consumption was comparable between the groups (Sild 4.9 +/- 2.9 vs. Tad 4.4 +/- 2.8 pills/month, P = 0.72). CONCLUSIONS As it is unlikely that the two drugs have a different direct effect on the pituitary-testis axis, this effect is probably due to the higher frequency of full sexual intercourse in the Tad-treated group, because of the drug's longer half-life.
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Affiliation(s)
- Eleonora Carosa
- Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
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Giannantoni A, Di Stasi SM, Stephen RL, Bini V, Costantini E, Porena M. Intravesical resiniferatoxin versus botulinum-A toxin injections for neurogenic detrusor overactivity: a prospective randomized study. J Urol 2004; 172:240-3. [PMID: 15201783 DOI: 10.1097/01.ju.0000132152.53532.5d] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We investigated the effectiveness and safety of intravesical resiniferatoxin (Sigma Chemical Co., St. Louis, Missouri) and botulinum-A toxin injections into the detrusor muscle in a group of spinal cord injured patients with neurogenic detrusor overactivity unresponsive to conventional anticholinergic therapy. MATERIALS AND METHODS A total of 25 patients were randomly assigned to receive intravesically 0.6 microM resiniferatoxin in 50 ml of 0.9% NaCl or injections into the detrusor muscle of 300 units botulinum A-toxin diluted in 30 ml 0.9% NaCl. Clinical evaluation and urodynamics were performed at baseline, and at 6, 12 and 18 months after treatment. RESULTS In both arms there was a significant decrease in catheterization and incontinent episodes, and a significant increase in first detrusor contraction and maximum bladder capacity at 6, 12 and 18-month followup. There were no local side effects with either treatment. Botulinum-A toxin induced a significant decrease in the frequency of daily incontinence episodes (p <0.05), a significant increase in first uninhibited detrusor contraction (p <0.01) in maximum bladder capacity (p <0.01), and a significant decrease in maximum pressure of uninhibited detrusor contractions (p <0.01) compared to resiniferatoxin at 6, 12 and 18-month followup. CONCLUSIONS In spinal cord injured patients with refractory neurogenic detrusor overactivity, intravesical resiniferatoxin and botulinum-A toxin injections into the detrusor muscle provided beneficial clinical and urodynamic results with decreases in detrusor overactivity and restoration of urinary continence in a large proportion of patients. Botulinum-A toxin injections provided superior clinical and urodynamic benefits compared to those of intravesical resiniferatoxin.
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Di Stasi SM, Giannantoni A, Stephen RL, Capelli G, Giurioli A, Jannini EA, Vespasiani G. A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. J Urol 2004; 171:1605-8. [PMID: 15017231 DOI: 10.1097/01.ju.0000116450.82816.2c] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Uncontrolled studies with intraplaque electromotive administration of verapamil and dexamethasone have demonstrated objective improvements in Peyronie's disease. We performed a prospective controlled study to assess the efficacy of intraplaque electromotive verapamil/dexamethasone vs electromotive lidocaine. MATERIALS AND METHODS Patients with Peyronie's disease were randomized into a study group (47 patients) and a control group (49 patients). For each treatment session an electrode receptacle was sited over the plaque and filled with either 5 mg verapamil and 8 mg dexamethasone (study group) or 2% lidocaine (control group), and a 2.4 mA electric current was applied for 20 minutes. All patients were scheduled for 4 sessions per week for 6 weeks. Assessment before and after treatment included measurements of plaque volume and penile curvature, and pain on erection (from questionnaire). RESULTS A total of 37 patients in the study group and 36 in the control group completed treatment courses. In the study group there were significant decreases in median plaque volume from 824 to 348 mm, and in penile curvature from 43 to 21 degrees. In the control group median volume and curvature were unchanged. The difference in results after treatment between the 2 groups was also significant. Significant pain relief occurred in both groups, transient in the control group and permanent in the study group. All patients experienced temporary erythema at the electrode site. There were no other side effects. CONCLUSIONS Intraplaque electromotive verapamil and dexamethasone induce substantial objective improvement in Peyronie's disease compared to electromotive lidocaine administration.
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Giannantoni A, Mearini E, Di Stasi SM, Mearini L, Bini V, Pizzirusso G, Porena M. Assessment of bladder and urethral sphincter function before and after radical retropubic prostatectomy. J Urol 2004; 171:1563-6. [PMID: 15017221 DOI: 10.1097/01.ju.0000118957.24390.66] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In a prospective study we analyzed the effects of radical retropubic prostatectomy (RRP) on detrusor and urethral sphincter function by comparing urodynamic status preoperatively with that during longitudinal followup. MATERIALS AND METHODS A total of 49 consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3 to 7 days before RRP (baseline), and then 1 and 8 months after surgery. We assessed bladder compliance, detrusor overactivity, detrusor contractility and intrinsic sphincter deficiency (ISD). RESULTS There was no significant change in detrusor overactivity at 1 and 8 months of followup. Decreased bladder compliance was observed in 20.4% of patients at baseline, and in 38.7% and 30.6% at 1 and 8 months, respectively. De novo decreased compliance was detected in 18.4% and 10.2% of patients at the same points. Impaired bladder compliance was comparable to that before surgery in 20% of cases. Impaired detrusor contractility was detected in 42.8% of patients at baseline, and in 61.2% (p <0.05) and 42.8% at 1 and 8 months, respectively. De novo hypocontractility was observed in 28.6% and 10.2% of patients at 1 and 8 months, respectively. A strong association between detrusor overactivity and ISD was observed at 1 and 8 months (p <0.01). CONCLUSIONS Following RRP detrusor hypocontractility and decreased bladder compliance represent de novo transient dysfunction probably due to bladder denervation and an established condition not influenced by the operation. The strong association between overactivity and ISD suggests that stress urinary incontinence increases urethral afferent nerve activity and induces involuntary detrusor contractions.
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Affiliation(s)
- Antonella Giannantoni
- Department of Urology, University of Perugia, Perugia and "Tor Vergata" University, Rome, Italy.
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Giannantoni A, Di Stasi SM, Stephen RL, Pizzirusso G, Mearini E, Bini V, Porena M. 532: Intravesical Resiniferatoxin Versus Botulinum-A Toxin Injections in Patients with Neurogenic Detrusor Overactivity: A Prospective Randomized Study. J Urol 2004. [DOI: 10.1016/s0022-5347(18)37794-2] [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: 10/17/2022]
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Di Stasi SM, Giannantoni A, Stephen RL, Capelli G, Navarra P, Massoud R, Vespasiani G. Intravesical electromotive mitomycin C versus passive transport mitomycin C for high risk superficial bladder cancer: a prospective randomized study. J Urol 2003; 170:777-82. [PMID: 12913696 DOI: 10.1097/01.ju.0000080568.91703.18] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE In laboratory studies electromotive mitomycin C (MMC) demonstrated markedly increased transport rates compared with passive transport. We performed a prospective study in patients with high risk superficial bladder cancer to assess the efficacy of intravesical electromotive vs passive MMC using bacillus Calmette-Guerin (BCG) as a comparative treatment. MATERIALS AND METHODS Following transurethral resection and multiple biopsies 108 patients with multifocal Tis, including 98 with T1 tumors, were randomized into 3 equal groups of 36 each who underwent 40 mg electromotive MMC instillation with 20 mA electric current for 30 minutes, 40 mg passive MMC with a dwell time of 60 minutes or 81 mg BCG with a dwell time of 120 minutes. Patients were scheduled for an initial 6 weekly treatments, a further 6 weekly treatments for nonresponders and a followup 10 monthly treatments for responders. Primary end points were the complete response rate at 3 and 6 months. MMC pharmacokinetics were assessed. RESULTS The complete response for electromotive vs passive MMC at 3 and 6 months was 53% versus 28% (p = 0.036) and 58% versus 31% (p = 0.012). For BCG the responses were 56% and 64%. Median time to recurrence was 35 vs 19.5 months (p = 0.013) and for BCG it was 26 months. Peak plasma MMC was significantly higher following electromotive MMC than after MMC (43 vs 8 ng/ml), consistent with bladder content absorption. CONCLUSIONS Intravesical electromotive administration increases bladder uptake of MMC, resulting in an improved response rate in cases of high risk superficial bladder cancer.
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Affiliation(s)
- Savino M Di Stasi
- Departments of Urology and Clinical Biochemistry, Tor Vergata University, Via Torrice n. 4, 00189 Rome, Italy.
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Giannantoni A, Di Stasi SM, Cucchi A, Mearini E, Bini V, Porena M. Pelvic floor muscle behavior during Valsalva leak point pressure measurement in males and females affected by stress urinary incontinence. J Urol 2003; 170:485-9. [PMID: 12853805 DOI: 10.1097/01.ju.0000074553.38914.c7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated pelvic floor muscle (PFM) behavior during Valsalva leak point pressure (VLPP) measurement in males and females affected by stress urinary incontinence and investigated whether VLPP results are influenced by PFM contraction. MATERIALS AND METHODS A total of 25 females and 14 males underwent surface electromyographic (EMG) recording of PFM activity while performing VLPP. We investigated 2 conditions, VLPP during spontaneous strain (test A), and with simultaneous relaxation of the pelvic floor (test B). We analyzed average EMG activity (microV) at rest and during VLPP in tests A and B, the increasing EMG activity during tests A and B (the difference between average EMG activity during tests A and B and at rest), and the mean duration (seconds) of EMG activity during tests A and B. RESULTS We detected a significant increase in EMG activity during tests A and B as compared to activity at rest (p <0.0001). Increasing EMG activity during test B was significantly reduced in females (p <0.05) but not in males. During test A patients reporting urinary incontinence showed a significantly lower EMG activity than that of continent patients (p <0.05). A significant reduction in maximum abdominal pressure was detected in test B compared to test A, but there was no difference in VLPP values between tests A and B. CONCLUSIONS PFM activity significantly increases during VLPP measurement. Eliminating muscular contraction of the pelvic floor does not significantly alter VLPP results.
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Di Stasi SM, Giannantoni A, Navarra P, Massoud R, Zavaglia D, Bertucci P, Vespasiani G, Stephen RL. The stability of lidocaine and epinephrine solutions exposed to electric current and comparative administration rates of the two drugs into pig bladder wall. Urol Res 2003; 31:169-76. [PMID: 12736765 DOI: 10.1007/s00240-003-0310-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2002] [Accepted: 03/20/2003] [Indexed: 10/26/2022]
Abstract
Intravesical electromotive administration of local anesthetics is clinically successful but electrochemistry, cost and effectiveness limit the choice of drugs to diluted lidocaine HCl 4% mixed with epinephrine. These studies address the stability of lidocaine and epinephrine both over time and when exposed to electric current, i.e. transport rates with passive diffusion and electromotive administration. The drug mixture used was 50 ml lidocaine 4%, 50 ml H2O and 1 ml epinephrine 1/1000. For stability, the solution was placed either in bowls for 7 days or in a two chamber cell with the donor compartment (drugs) separated from the receptor compartment (NaCl solution) by a viable pig bladder wall. This was subjected to 30 mA for 45 min. Stability was measured with mass spectrometry. The cell was also used to determine transport rates with passive diffusion and currents of 20 mA and 30 mA, over 20, 30 and 45 min. Drug measurements in both compartments and bladder were made with HPLC. Lidocaine remained stable throughout the 7 days, epinephrine on day 1 only and both drugs were stable with 30 mA for 45 min. Comparing 20 mA and 30 mA with passive diffusion, there were significant differences in 6/6 donor compartment lidocaine levels, 4/6 receptor compartment levels and 6/6 bladder tissue levels and also in 6/6 epinephrine donor levels and 6/6 tissue levels. The combination lidocaine and epinephrine remains stable for 1 day and when exposed to 30 mA for 45 min. Electric current accelerates the transport of lidocaine and epinephrine.
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Affiliation(s)
- Savino M Di Stasi
- Department of Urology, Tor Vergata University, Via Torrice no 4, 00189 Rome, Italy.
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Giannantoni A, Di Stasi SM, Stephen RL, Navarra P, Scivoletto G, Mearini E, Porena M. Intravesical Capsaicin Versus Resiniferatoxin In Patients With Detrusor Hyperreflexia: A Prospective Randomized Study. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65183-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Antonella Giannantoni
- From the Department of Urology, University of Perugia, Perugia, Department of Urology “Tor Vergata,” University of Rome, Institute of Pharmacology Catholic University of Rome and IRCCS S. Lucia Rehabilitation Hospital, Rome and Physion Laboratories, Medolla, Italy
| | - Savino M. Di Stasi
- From the Department of Urology, University of Perugia, Perugia, Department of Urology “Tor Vergata,” University of Rome, Institute of Pharmacology Catholic University of Rome and IRCCS S. Lucia Rehabilitation Hospital, Rome and Physion Laboratories, Medolla, Italy
| | - Robert L. Stephen
- From the Department of Urology, University of Perugia, Perugia, Department of Urology “Tor Vergata,” University of Rome, Institute of Pharmacology Catholic University of Rome and IRCCS S. Lucia Rehabilitation Hospital, Rome and Physion Laboratories, Medolla, Italy
| | - Pierluigi Navarra
- From the Department of Urology, University of Perugia, Perugia, Department of Urology “Tor Vergata,” University of Rome, Institute of Pharmacology Catholic University of Rome and IRCCS S. Lucia Rehabilitation Hospital, Rome and Physion Laboratories, Medolla, Italy
| | - Giorgio Scivoletto
- From the Department of Urology, University of Perugia, Perugia, Department of Urology “Tor Vergata,” University of Rome, Institute of Pharmacology Catholic University of Rome and IRCCS S. Lucia Rehabilitation Hospital, Rome and Physion Laboratories, Medolla, Italy
| | - Ettore Mearini
- From the Department of Urology, University of Perugia, Perugia, Department of Urology “Tor Vergata,” University of Rome, Institute of Pharmacology Catholic University of Rome and IRCCS S. Lucia Rehabilitation Hospital, Rome and Physion Laboratories, Medolla, Italy
| | - Massimo Porena
- From the Department of Urology, University of Perugia, Perugia, Department of Urology “Tor Vergata,” University of Rome, Institute of Pharmacology Catholic University of Rome and IRCCS S. Lucia Rehabilitation Hospital, Rome and Physion Laboratories, Medolla, Italy
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Giannantoni A, Di Stasi SM, Stephen RL, Navarra P, Scivoletto G, Mearini E, Porena M. Intravesical capsaicin versus resiniferatoxin in patients with detrusor hyperreflexia: a prospective randomized study. J Urol 2002; 167:1710-4. [PMID: 11912393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE Capsaicin and resiniferatoxin (Sigma Chemical Co., St. Louis, Missouri) administered intravesically are attractive options for treating detrusor hyperreflexia. Because the 2 agents differ in chemical structure and relative potency, possible differences in their clinical and urodynamic effects were investigated in this prospective comparative study. MATERIALS AND METHODS A group of 24 spinal cord injured patients with refractory detrusor hyperreflexia were randomly assigned to receive a single dose of 2 mM. capsaicin in 30 ml. ethanol plus 70 ml. 0.9% sodium chloride or 100 nM. resiniferatoxin in 100 ml. 0.9% sodium chloride. Dwell time was 40 minutes with urodynamic monitoring. Urodynamics were performed at baseline before treatment, and after followups of 30 and 60 days. The frequency of daily catheterizations, incontinence episodes and side effects was recorded. RESULTS There was no significant urodynamic or clinical improvement in the capsaicin arm at 30 and 60 days of followup. In the resiniferatoxin arm the mean uninhibited detrusor contraction threshold plus or minus standard deviation increased from 176 +/- 54 to 250 +/- 107 ml. at 30 days (p <0.05) and to 275 +/- 98 ml. at 60 days (p <0.01). Mean maximum bladder capacity increased from 196 +/- 75 to 365 +/- 113 ml. at 30 days (p <0.001) and to 357 +/- 101 ml. at 60 days (p <0.001). Daily catheterizations and incontinent episodes were significantly decreased at 30 and 60 days of followup. Autonomic dysreflexia, limb spasms, suprapubic discomfort and hematuria developed in most patients who received capsaicin but in none who received resiniferatoxin. CONCLUSIONS Intravesical administration of resiniferatoxin is superior to that of capsaicin in terms of urodynamic results and clinical benefits in spinal cord injured patients and it does not cause the inflammatory side effects associated with capsaicin.
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