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Cirulli GO, Corsi N, Rakic I, Stephens A, Chiarelli G, Finati M, Davis M, Tinsley S, Sood A, Buffi N, Lughezzani G, Carrieri G, Salonia A, Briganti A, Montorsi F, Rogers C, Abdollah F. Impact of lymphovascular invasion on survival in surgically treated upper tract urothelial carcinoma: a nationwide analysis. BJU Int 2024; 133:555-563. [PMID: 38097533 DOI: 10.1111/bju.16258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES To assess the prognostic ability of lymphovascular invasion (LVI) in upper tract urothelial carcinoma (UTUC) as a predictor of overall survival (OS) using a large North American cohort. PATIENTS AND METHODS Our cohort included 5940 patients with clinical M0 UTUC who underwent a radical nephroureterectomy (RNU), between 2010 and 2016, within the National Cancer Database. The main variable of interest was LVI status, and its interaction with pathological nodal (pN) status. Kaplan-Meier curves were used to depict the OS also stratifying patients on LVI status. Cox regression analysis tested the impact of LVI status on OS after accounting for the available covariates. RESULTS The median (interquartile range [IQR]) age at diagnosis was 71 (63-78) years and most patients had pathological T1 stage disease (48.6%). Nodal status was pN0, pN1 and pNx in 45.8%, 6.3% and 47.9%, respectively. Overall, 22.1% had LVI. The median (IQR) follow-up time was 32.6 (16.0-53.3) months. At the 5-year postoperative follow-up, the estimated OS rate was 28% in patients with LVI vs 66% in those without LVI (P < 0.001). When patients were stratified based on nodal status those rates were 32% vs 68% in pN0 patients (P < 0.001), 23% vs 30% in pN1 patients (P = 0.8), and 28% vs 65% in pNx patients (P < 0.001). On multivariable analysis, the presence of LVI was associated with less favourable OS (hazard ratio 1.79, 95% confidence interval 1.60-1.99; P < 0.001). CONCLUSION Our study assessed the impact of LVI on OS in patients with UTUC in a large North American nationwide cohort. Our series, as the largest to date, indicate that LVI is associated with less favourable survival outcomes in patients with UTUC after RNU, and this variable could be used in counselling patients about their prognosis and might be a useful tool for future trials to risk-stratify patients.
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Affiliation(s)
- Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicholas Corsi
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Ivan Rakic
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Matthew Davis
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Shane Tinsley
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Akshay Sood
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Andrea Salonia
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA
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Frego N, Contieri R, Fasulo V, Maffei D, Avolio PP, Arena P, Beatrici E, Sordelli F, De Carne F, Lazzeri M, Saita A, Hurle R, Buffi NM, Casale P, Lughezzani G. Development of a microultrasound-based nomogram to predict extra-prostatic extension in patients with prostate cancer undergoing robot-assisted radical prostatectomy. Urol Oncol 2024; 42:159.e9-159.e16. [PMID: 38423852 DOI: 10.1016/j.urolonc.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To develop a microultrasound-based nomogram including clinicopathological parameters and microultrasound findings to predict the presence of extra-prostatic extension and guide the grade of nerve-sparing. MATERIAL AND METHODS All patients underwent microultrasound the day before robot-assisted radical prostatectomy. Variables significantly associated with extra-prostatic extension at univariable analysis were used to build the multivariable logistic model, and the regression coefficients were used to develop the nomogram. The model was subjected to 1000 bootstrap resamples for internal validation. The performance of the microultrasound-based model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA). RESULTS Overall, 122/295 (41.4%) patients had a diagnosis of extra-prostatic extension on definitive pathology. Microultrasound correctly identify extra-prostatic extension in 84/122 (68.9%) cases showing a sensitivity and a specificity of 68.9% and 84.4%, with an AUC of 76.6%. After 1000 bootstrap resamples, the predictive accuracy of the microultrasound-based model was 85.9%. The calibration plot showed a satisfactory concordance between predicted probabilities and observed frequencies of extra-prostatic extension. The DCA showed a higher clinical net-benefit compared to the model including only clinical parameters. Considering a 4% cut-off, nerve-sparing was recommended in 173 (58.6%) patients and extra-prostatic extension was detected in 32 (18.5%) of them. CONCLUSION We developed a microultrasound-based nomogram for the prediction of extra-prostatic extension that could aid in the decision whether to preserve or not neurovascular bundles. External validation and a direct comparison with mpMRI-based nomogram is crucial to corroborate our results.
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Affiliation(s)
- Nicola Frego
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Roberto Contieri
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Vittorio Fasulo
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Davide Maffei
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Pier Paolo Avolio
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Paola Arena
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Edoardo Beatrici
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Federica Sordelli
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Fabio De Carne
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy.
| | - Paolo Casale
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
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Chiarelli G, Davis M, Stephens A, Cirulli GO, Finati M, Corsi NJ, Sood A, Tinsley S, Carrieri G, Briganti A, Montorsi F, Lughezzani G, Buffi N, Rogers C, Abdollah F. Comparison of patient background between a real-world North American cohort and the Göteborg-2 trial. Int J Urol 2024; 31:562-567. [PMID: 38334296 DOI: 10.1111/iju.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To analyze the generalizability of the Göteborg-2 findings to a North American cohort. METHODS We replicated the Göteborg-2 inclusion criteria in our Henry Ford Health (HFH) cohort, by identifying all patients 50-60 years old who had a PSA test from 2013 to 2018. The first PSA within the study period was considered PSA at entry, and included in the analysis. Chi-square test was used to compare categorical variables between the Göteborg-2 and HFH cohort, with a particular focus on Black men, who were also analyzed separately. RESULTS The HFH patients included in the cohort were 49 456, of which 8562 were Black. In patients within the entire HFH cohort, HFH Black cohort, Göteborg Reference cohort, and Göteborg Experimental cohort, the rate of PSA ≥3 ng/mL was, respectively, 6.8%, 10.2%, 6.8%, and 6.6%. The rate of biopsy performed was, respectively, 1.8%, 4.1%, 5.8%, and 2.5%. PCa was found in, respectively, 1.4%, 3.0%, 2.3%, and 1.5%; Gleason score 3 + 3 in, respectively, 0.5%, 0.8%, 1.2%, and 0.6%; Gleason score > 3 + 3 in, respectively, 0.9%, 2.2%, 1.1%, and 0.9%. CONCLUSIONS Our cohort had a lower biopsy rate and a lower incidence of non-csPCa diagnosis than both Göteborg cohorts, while still maintaining the same incidence of csPCa. This implies that the benefits of reducing non-csPCa diagnosis, as observed in the Experimental Göteborg cohort, are not necessarily replicable in U.S. "real-world practice" patients. Also noteworthy, we had a significantly higher percentage of Black men, who showed more aggressive disease.
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Affiliation(s)
- Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Matthew Davis
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Nicholas J Corsi
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Shane Tinsley
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA
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Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
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5
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Chiarelli G, Stephens A, Finati M, Cirulli GO, Beatrici E, Filipas DK, Arora S, Tinsley S, Bhandari M, Carrieri G, Trinh QD, Briganti A, Montorsi F, Lughezzani G, Buffi N, Rogers C, Abdollah F. Adequacy of prostate cancer prevention and screening recommendations provided by an artificial intelligence-powered large language model. Int Urol Nephrol 2024:10.1007/s11255-024-04009-5. [PMID: 38564079 DOI: 10.1007/s11255-024-04009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE We aimed to assess the appropriateness of ChatGPT in providing answers related to prostate cancer (PCa) screening, comparing GPT-3.5 and GPT-4. METHODS A committee of five reviewers designed 30 questions related to PCa screening, categorized into three difficulty levels. The questions were formulated identically for both GPTs three times, varying the prompts. Each reviewer assigned a score for accuracy, clarity, and conciseness. The readability was assessed by the Flesch Kincaid Grade (FKG) and Flesch Reading Ease (FRE). The mean scores were extracted and compared using the Wilcoxon test. We compared the readability across the three different prompts by ANOVA. RESULTS In GPT-3.5 the mean score (SD) for accuracy, clarity, and conciseness was 1.5 (0.59), 1.7 (0.45), 1.7 (0.49), respectively for easy questions; 1.3 (0.67), 1.6 (0.69), 1.3 (0.65) for medium; 1.3 (0.62), 1.6 (0.56), 1.4 (0.56) for hard. In GPT-4 was 2.0 (0), 2.0 (0), 2.0 (0.14), respectively for easy questions; 1.7 (0.66), 1.8 (0.61), 1.7 (0.64) for medium; 2.0 (0.24), 1.8 (0.37), 1.9 (0.27) for hard. GPT-4 performed better for all three qualities and difficulty levels than GPT-3.5. The FKG mean for GPT-3.5 and GPT-4 answers were 12.8 (1.75) and 10.8 (1.72), respectively; the FRE for GPT-3.5 and GPT-4 was 37.3 (9.65) and 47.6 (9.88), respectively. The 2nd prompt has achieved better results in terms of clarity (all p < 0.05). CONCLUSIONS GPT-4 displayed superior accuracy, clarity, conciseness, and readability than GPT-3.5. Though prompts influenced the quality response in both GPTs, their impact was significant only for clarity.
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Affiliation(s)
- Giuseppe Chiarelli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Alex Stephens
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Marco Finati
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Ottone Cirulli
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Edoardo Beatrici
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sohrab Arora
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Shane Tinsley
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Mahendra Bhandari
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Craig Rogers
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
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6
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Cocci A, Pezzoli M, Bianco F, Blefari F, Bove P, Cornud F, De Rienzo G, Destefanis P, Di Trapani D, Giacobbe A, Giovanessi L, Laganà A, Lughezzani G, Manenti G, Muto G, Patelli G, Pinzi N, Regusci S, Russo GI, Salamanca JI, Salvi M, Silvestri L, Verweij F, Walser E, Bertolo RG, Iacovelli V, Bertaccini A, Marchiori D, Davila H, Ditonno P, Gontero P, Iapicca G, M De Reijke T, Ricapito V, Pellegrini P, Minervini A, Serni S, Sessa F. Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project. Asian J Urol 2024; 11:271-279. [PMID: 38680587 PMCID: PMC11053328 DOI: 10.1016/j.ajur.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2024] Open
Abstract
Objective To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method. Methods Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized. Results Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations. Conclusion Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.
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Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marta Pezzoli
- Urology Section, University of Florence, Florence, Italy
| | | | | | - Pierluigi Bove
- Torvergata Oncoscience Research Centre of Excellence, TOR, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Francois Cornud
- Department of Radiology, Hôpital Cochin, Paris Descartes University, Paris, France
| | - Gaetano De Rienzo
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Paolo Destefanis
- Unit of Urology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Danilo Di Trapani
- Urology Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | | | - Luca Giovanessi
- Urology Unit, Surgical Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Antonino Laganà
- Departement of Urology, “S.Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Giovanni Lughezzani
- Humanitas Clinical and Research Center–IRCCS, Department of Urology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome “Tor Vergata”, Rome, Italy
| | - Gianluca Muto
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianluigi Patelli
- Department of Interventional Radiology, Pesenti-Fenaroli Hospital-ASST Bergamo Est, Alzano Lombardo, Italy
| | - Novello Pinzi
- Department of Urology, University of Siena, Siena, Italy
| | - Stefano Regusci
- Swiss International Prostate Center, Geneva, Switzerland
- Clinique Générale Beaulieu, Geneva, Switzerland
| | | | - Juan I.M. Salamanca
- Department of Urology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
- Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
| | - Matteo Salvi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luigi Silvestri
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy
| | - Fabrizio Verweij
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Eric Walser
- Department of Radiology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Riccardo G. Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Alessandro Bertaccini
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Debora Marchiori
- Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Hugo Davila
- Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, Florida Cancer Specialist and Research Institute, Vero Beach, FL, USA
- Department of Surgery, Division of Urology and Gynecology, Sebastian River Medical Center, Sebastian, FL, USA
| | - Pasquale Ditonno
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Paolo Gontero
- Department of Urology, Molinette Hospital, University of Torino School of Medicine, Turin, Italy
| | | | - Theo M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Vito Ricapito
- Department of Urology, Policlinico di Bari, Bari, Italy
| | - Pierluca Pellegrini
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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7
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Beatrici E, Frego N, Chiarelli G, Sordelli F, Mancon S, Saitta C, De Carne F, Garofano G, Arena P, Avolio PP, Gobbo A, Uleri A, Contieri R, Paciotti M, Lazzeri M, Hurle R, Casale P, Buffi NM, Lughezzani G. A Comparative Evaluation of Multiparametric Magnetic Resonance Imaging and Micro-Ultrasound for the Detection of Clinically Significant Prostate Cancer in Patients with Prior Negative Biopsies. Diagnostics (Basel) 2024; 14:525. [PMID: 38472997 DOI: 10.3390/diagnostics14050525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The diagnostic process for prostate cancer after a negative biopsy is challenging. This study compares the diagnostic accuracy of micro-ultrasound (mUS) with multiparametric magnetic resonance imaging (mpMRI) for such cases. METHODS A retrospective cohort study was performed, targeting men with previous negative biopsies and using mUS and mpMRI to detect prostate cancer and clinically significant prostate cancer (csPCa). RESULTS In our cohort of 1397 men, 304 had a history of negative biopsies. mUS was more sensitive than mpMRI, with better predictive value for negative results. Importantly, mUS was significantly associated with csPCa detection (adjusted odds ratio [aOR]: 6.58; 95% confidence interval [CI]: 1.15-37.8; p = 0.035). CONCLUSIONS mUS may be preferable for diagnosing prostate cancer in previously biopsy-negative patients. However, the retrospective design of this study at a single institution suggests that further research across multiple centers is warranted.
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Affiliation(s)
- Edoardo Beatrici
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giuseppe Chiarelli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Federica Sordelli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Stefano Mancon
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Fabio De Carne
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giuseppe Garofano
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Paola Arena
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
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Lughezzani G, Casale P, Evangelista L. Re: Giuseppe Basile, Giuseppe Fallara, Paolo Verri, et al. The Role of 99mTc-Sestamibi Single-photon Emission Computed Tomography/Computed Tomography in the Diagnostic Pathway for Renal Masses: A Systematic Review and Meta-analysis. Eur Urol. 2024;85:63-71. Eur Urol 2024; 85:e76. [PMID: 38092612 DOI: 10.1016/j.eururo.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy.
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Italy
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9
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Beatrici E, Labban M, Filipas DK, Stone BV, Reis LO, Dagnino F, Lughezzani G, Buffi NM, Lipsitz SR, Clinton TN, Matulewicz RS, Trinh QD, Cole AP. Smoking characteristics and years since quitting smoking of US adults diagnosed with lung and bladder cancer: A national health and nutrition examination survey analysis. Int Braz J Urol 2024; 50:199-208. [PMID: 38386790 PMCID: PMC10953605 DOI: 10.1590/s1677-5538.ibju.2023.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE Smoking is a recognized risk factor for bladder BC and lung cancer LC. We investigated the enduring risk of BC after smoking cessation using U.S. national survey data. Our analysis focused on comparing characteristics of LC and BC patients, emphasizing smoking status and the latency period from smoking cessation to cancer diagnosis in former smokers. MATERIALS AND METHODS We analyzed data from the National Health and Examination Survey (2003-2016), identifying adults with LC or BC history. Smoking status (never, active, former) and the interval between quitting smoking and cancer diagnosis for former smokers were assessed. We reported descriptive statistics using frequencies and percentages for categorical variables and median with interquartile ranges (IQR) for continuous variables. RESULTS Among LC patients, 8.9% never smoked, 18.9% active smokers, and 72.2% former smokers. Former smokers had a median interval of 8 years (IQR 2-12) between quitting and LC diagnosis, with 88.3% quitting within 0-19 years before diagnosis. For BC patients, 26.8% never smoked, 22.4% were active smokers, and 50.8% former smokers. Former smokers had a median interval of 21 years (IQR 14-33) between quitting and BC diagnosis, with 49.3% quitting within 0-19 years before diagnosis. CONCLUSIONS BC patients exhibit a prolonged latency period between smoking cessation and cancer diagnosis compared to LC patients. Despite smoking status evaluation in microhematuria, current risk stratification models for urothelial cancer do not incorporate it. Our findings emphasize the significance of long-term post-smoking cessation surveillance and advocate for integrating smoking history into future risk stratification guidelines.
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Affiliation(s)
- Edoardo Beatrici
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
- Humanitas Research HospitalDepartment of UrologyMilanItalyDepartment of Urology, Humanitas Research Hospital – IRCCS, Milan, Italy;
| | - Muhieddine Labban
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
| | - Dejan K. Filipas
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
- University Medical Center Hamburg-EppendorfDepartment of UrologyHamburgGermanyDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Benjamin V. Stone
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
| | - Leonardo O. Reis
- Universidade Estadual de CampinasFaculdade de Ciências MédicasCampinasSPBrasilUroScience, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, UNICAMP, Campinas, SP, Brasil;
- Pontifícia Universidade Católica de CampinasFaculdade de Ciências da VidaDivisão de Imuno-OncologiaCampinasSPBrasilDivisão de Imuno-Oncologia, Faculdade de Ciências da Vida, Pontifícia Universidade Católica de Campinas, PUC-Campinas, Campinas, SP, Brasil;
| | - Filippo Dagnino
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
- Humanitas Research HospitalDepartment of UrologyMilanItalyDepartment of Urology, Humanitas Research Hospital – IRCCS, Milan, Italy;
| | - Giovanni Lughezzani
- Humanitas Research HospitalDepartment of UrologyMilanItalyDepartment of Urology, Humanitas Research Hospital – IRCCS, Milan, Italy;
| | - Nicolò M. Buffi
- Humanitas Research HospitalDepartment of UrologyMilanItalyDepartment of Urology, Humanitas Research Hospital – IRCCS, Milan, Italy;
| | - Stuart R. Lipsitz
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
- Brigham and Women's HospitalHarvard Medical SchoolDepartment of MedicineBostonMAUnited StatesDepartment of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
| | - Timothy N. Clinton
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
| | - Richard S. Matulewicz
- Memorial Sloan Kettering Cancer CenterDepartment of Surgery and Department of UrologyNew YorkNYUnited StatesDepartment of Surgery and Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Quoc-Dien Trinh
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
| | - Alexander P. Cole
- Brigham and Women's HospitalHarvard Medical SchoolDivision of Urological Surgery and Center for Surgery and Public HealthBostonMAUnited StatesDivision of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States;
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Avolio PP, Lazzeri M, Maffei D, Fasulo V, Frego N, Saitta C, de Carne F, Paciotti M, Saita A, Hurle R, Guazzoni G, Casale P, Buffi NM, Lughezzani G. Is multiparametric MRI always needed in biopsy-naïve patients with abnormal digital rectal examination? A single-institutional experience combining clinical and micro-ultrasonography-based factors to optimize prostate cancer detection. World J Urol 2024; 42:9. [PMID: 38183489 DOI: 10.1007/s00345-023-04722-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/16/2023] [Indexed: 01/08/2024] Open
Abstract
PURPOSE To assess the diagnostic performance of microultrasound-targeted biopsy (microUSTBx) and systematic biopsy (SBx) in detecting clinically significant prostate cancer (csPCa) among men with abnormal digital rectal examination (DRE) and suspicious lesions at multiparametric magnetic resonance imaging (mpMRI), and to compare the diagnostic performance of this approach with a mpMRI-guided targeted biopsy (MTBx) plus SBx-based strategy. METHODS Biopsy-naïve men with suspicious lesions at mpMRI and abnormal DRE were prospectively evaluated between October 2017 and January 2023. csPCa detection rate by microUSTBx plus SBx and MTBx plus SBx was assessed and then compared by McNemar's test. The added value of prostate-specific antigen density (PSAd) was also evaluated. RESULTS Overall, 182 biopsy naïve men were included. MicroUSTBx plus SBx achieved comparable detection rate to MTBx plus SBx in diagnosis of ciPCa and csPCa (ciPCa: 9.3% [17/182] vs 10% [19/182]; csPCa: 63% [114/182] vs 62% [113/182]). MicroUSTBx outperformed MTBx (ciPCa: 5.5% [10/182] vs 6.0% [11/182]; csPCa: 57% [103/182] vs 54% [99/182]). Using microUSTBx plus SBx would have avoided 68/182 (37%) unnecessary mpMRI, while missing only 2/116 (1.7%) csPCa. The decision curve analysis of suspicious microUS plus PSAd ≥ 0.15 ng/ml showed higher net benefit in the ability to identify true positives and reduce the number of unnecessary prostate biopsy in this subcategory of patients. CONCLUSIONS The combination of microUSTBx and SBx showed equal diagnostic performance to an mpMRI-based approach in biopsy-naïve patients with an abnormal DRE. The combination of this approach with PSAd maximize the diagnostic accuracy while lowering the need for unnecessary biopsies.
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Affiliation(s)
- Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Fabio de Carne
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Rozzano, 20090, Milan, Italy.
- Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy.
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Frego N, Beatrici E, Labban M, Stone BV, Filipas DK, Koelker M, Lughezzani G, Buffi NM, Osman NY, Lipsitz SR, Sammon JD, Kibel AS, Trinh QD, Cole AP. Racial Disparities in Prostate Cancer Screening: The Role of Shared Decision Making. Am J Prev Med 2024; 66:27-36. [PMID: 37567369 DOI: 10.1016/j.amepre.2023.08.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION The 2018 U.S. Preventive Services Task Force recommendations endorsed shared decision making for men aged 55-69 years, encouraging consideration of patient race/ethnicity for prostate-specific antigen screening. This study aimed to assess whether a proxy shared decision-making variable modified the impact of race/ethnicity on the likelihood of prostate-specific antigen screening. METHODS A cross-sectional analysis of men aged between 55 and 69 years, who responded to the prostate-specific antigen screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System survey, was performed between September and December 2022. Complex sample multivariable logistic regression models with an interaction term combining race and estimated shared decision making were used to test whether shared decision making modified the impact of race/ethnicity on screening. RESULTS Of a weighted sample of 26.8 million men eligible for prostate-specific antigen screening, 25.7% (6.9 million) reported for prostate-specific antigen screening. In adjusted analysis, estimated shared decision making was a significant predictor of prostate-specific antigen screening (AOR=2.65, 95% CI=2.36, 2.98, p<0.001). The interaction between race/ethnicity and estimated shared decision making on the receipt of prostate-specific antigen screening was significant (pint=0.001). Among those who did not report estimated shared decision making, both non-Hispanic Black (OR=0.77, 95% CI=0.61, 0.97, p=0.026) and Hispanic (OR=0.51, 95% CI=0.39, 0.68, p<0.001) men were significantly less likely to undergo prostate-specific antigen screening than non-Hispanic White men. On the contrary, among respondents who reported estimated shared decision making, no race-based differences in prostate-specific antigen screening were found. CONCLUSIONS Although much disparities research focuses on race-based differences in prostate-specific antigen screening, research on strategies to mitigate these disparities is needed. Shared decision making might attenuate the impact of race/ethnic disparities on the likelihood of prostate-specific antigen screening.
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Affiliation(s)
- Nicola Frego
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Humanitas Research Hospital - IRSSC, Milan, Italy
| | - Edoardo Beatrici
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Humanitas Research Hospital - IRSSC, Milan, Italy
| | - Muhieddine Labban
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin V Stone
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dejan K Filipas
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mara Koelker
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nicolò M Buffi
- Department of Urology, Humanitas Research Hospital - IRSSC, Milan, Italy
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R Lipsitz
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse D Sammon
- Division of Urology, Maine Medical Center, Portland, Maine; Center for Outcomes Research & Evaluation (CORE), Maine Medical Center, Portland, Maine
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P Cole
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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12
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Ebm C, Paciotti M, Diana P, Lughezzani G, Casale P, Buffi N. A cost analysis in implementing simulation-based training into a novel urology curriculum. Minerva Urol Nephrol 2023; 75:791-793. [PMID: 37539671 DOI: 10.23736/s2724-6051.23.05481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Claudia Ebm
- Simulation Center, Humanitas University, Pieve Emanuele, Milan, Italy -
| | - Marco Paciotti
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pietro Diana
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Nicolò Buffi
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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13
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Beatrici E, Filipas DK, Stone BV, Labban M, Qian Z, Lipsitz SR, Lughezzani G, Buffi NM, Cole AP, Trinh QD. Clinical stage and grade migration of localized prostate cancer at diagnosis during the past decade. Urol Oncol 2023; 41:483.e11-483.e19. [PMID: 37852818 DOI: 10.1016/j.urolonc.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Early 2010s data suggest a reverse stage and grade migration towards more aggressive prostate cancer (PCa) at diagnosis, accelerated by the 2012 US Preventive Services Task Force recommendation against PSA screening. Using the National Cancer Database, we investigated the impact of the 2018 USPSTF recommendation and the COVID-19 outbreak on this shift. We hypothesized that the COVID-19 outbreak would further contribute to a stage and grade migration towards more aggressive disease. MATERIAL AND METHODS We identified men with localized PCa diagnosed between 2010 and 2020. We analyzed the shift in the proportion of PCa stratified according to D'Amico risk classification. We used multivariable logistic regression models to assess the association between year of diagnosis and dichotomous variables related to clinical stage and grade of PCa. Predicted probabilities with 95% CI were computed through marginal effect analyses. RESULTS We identified 910,898 men with localized PCa. The proportion of low-risk PCa almost halved from 34.9% in 2010 to 17.7% in 2020 (P < 0.001). Compared to 2010, we found in each year increased odds of: PSA≥10 ng/dL starting from 2012 (aOR2012 1.05; 95% CI, 1.02-1.08); cT3-T4 starting from 2015 (aOR2015 1.10; 95% CI, 1.03-1.17); ISUP GG 3-5 starting from 2011 (aOR2011 1.06; 95% CI, 1.03-1.08); and consequently, D'Amico intermediate/high-risk class starting from 2011 (aOR2011 1.03; 95% CI, 1.01-1.05). Fluctuations in the probabilities of PSA≥10 ng/dL and cT3-T4 at diagnosis were observed over time (all P < 0.001). The probability of PSA≥10 ng/dL peaked at 29.0% (95% CI, 28.0%-29.0%) in 2018, while the probability of cT3-T4 peaked at 3.7% (95% CI, 3.6%-3.8%) in 2020. All other outcome variables demonstrated a consistent upward shift (all P < 0.001), with the highest probabilities in 2020 for ISUP GG 3-5 (42.3%, 95% CI, 41.9%-42.6%) and D'Amico intermediate/high-risk (81.3%, 95% CI, 81.0%-81.6%). CONCLUSIONS Our study confirms an enduring shift towards a higher proportion of aggressive PCa at diagnosis, likely influenced by the COVID-19 pandemic. The impact of the 2018 USPSTF PCa screening recommendation on the proportion of aggressive PCa seems restricted and likely affected by the pandemic outbreak. Future investigations should evaluate the long-term effects of the 2018 USPSTF recommendations in the postpandemic setting.
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Affiliation(s)
- Edoardo Beatrici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin V Stone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Muhieddine Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Zhiyu Qian
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Nicolò M Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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14
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Uleri A, Baboudjian M, Tedde A, Gallioli A, Long-Depaquit T, Palou J, Basile G, Gaya JM, Sanguedolce F, Lughezzani G, Rajwa P, Pradere B, Roupret M, Briganti A, Ploussard G, Breda A. Is There an Impact of Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsy in Clinically Significant Prostate Cancer Detection Rate? A Systematic Review and Meta-analysis. Eur Urol Oncol 2023; 6:621-628. [PMID: 37634971 DOI: 10.1016/j.euo.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023]
Abstract
CONTEXT It is unclear whether a magnetic resonance imaging (MRI)-targeted transperineal (TP) biopsy can improve the detection of clinically significant prostate cancer (csPCa). OBJECTIVE To compare the MRI-targeted TP and transrectal (TR) approaches for csPCa detection. EVIDENCE ACQUISITION A literature search was conducted using the PubMed/Medline, Embase, and Web of Science databases to identify reports published until February 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was the detection of csPCa (Gleason grade group ≥2). Sensitivity analyses were performed to investigate csPCa detection rates according to tumor location, Prostate Imaging Reporting and Data System (PI-RADS) score, and type of fusion (cognitive or software based). EVIDENCE SYNTHESIS Eleven studies met our inclusion criteria, and data from 3522 and 5140 patients who underwent, respectively, TR and TP MRI-targeted biopsies were reviewed. No statistically significant difference in the detection of csPCa was observed between the TR and TP approaches (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.98-1.25; p = 0.1). When stratifying patients according to lesion location, the TP approach was associated with higher csPCa detection in case of anterior (OR 2.17, 95% CI 1.46-3.22; p < 0.001) and apical (OR 1.86, 95% CI 1.14-3.03; p = 0.01) lesions. In the subgroup analysis based on PI-RADS score, the TP approach was associated with higher csPCa detection (OR 1.57, 95% CI 1.07-2.29; p = 0.02) in PI-RADS 4 lesions. Conversely, no difference was found in PI-RADS 3 and 5 lesions (p > 0.05). The main limitation was the retrospective design of most included studies. CONCLUSIONS No significant association was found between the prostate biopsy approach and csPCa detection rate when we considered all biopsy indications. The TP approach provides a detection advantage in anterior and apical tumors, arguing for a preferred use of the TP approach in these lesion locations. PATIENT SUMMARY The transperineal magnetic resonance imaging-targeted prostate biopsy approach appears to be more effective only for selected lesions. No clear benefit was seen for the transperineal approach in the overall population.
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Affiliation(s)
- Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | | | - Alessandro Tedde
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | | | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology IRCCS Humanitas Research Hospital Rozzano Milan Italy
| | - Pawel Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Morgan Roupret
- GRC 5 Predictive Onco-Uro, Department of Urology, AP-HP, Pitié Salpétrière Hospital, Sorbonne University, Paris, France
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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15
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Saitta C, Afari JA, Autorino R, Capitanio U, Porpiglia F, Amparore D, Piramide F, Cerrato C, Meagher MF, Noyes SL, Pandolfo SD, Buffi NM, Larcher A, Hakimi K, Nguyen MV, Puri D, Diana P, Fasulo V, Saita A, Lughezzani G, Casale P, Antonelli A, Montorsi F, Lane BR, Derweesh IH. Development of a novel score (RENSAFE) to determine probability of acute kidney injury and renal functional decline post surgery: A multicenter analysis. Urol Oncol 2023; 41:487.e15-487.e23. [PMID: 37880003 DOI: 10.1016/j.urolonc.2023.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To create and validate 2 models called RENSAFE (RENalSAFEty) to predict postoperative acute kidney injury (AKI) and development of chronic kidney disease (CKD) stage 3b in patients undergoing partial (PN) or radical nephrectomy (RN) for kidney cancer. METHODS Primary objective was to develop a predictive model for AKI (reduction >25% of preoperative eGFR) and de novo CKD≥3b (<45 ml/min/1.73m2), through stepwise logistic regression. Secondary outcomes include elucidation of the relationship between AKI and de novo CKD≥3a (<60 ml/min/1.73m2). Accuracy was tested with receiver operator characteristic area under the curve (AUC). RESULTS AKI occurred in 452/1,517 patients (29.8%) and CKD≥3b in 116/903 patients (12.8%). Logistic regression demonstrated male sex (OR = 1.3, P = 0.02), ASA score (OR = 1.3, P < 0.01), hypertension (OR = 1.6, P < 0.001), R.E.N.A.L. score (OR = 1.2, P < 0.001), preoperative eGFR<60 (OR = 1.8, P = 0.009), and RN (OR = 10.4, P < 0.0001) as predictors for AKI. Age (OR 1.0, P < 0.001), diabetes mellitus (OR 2.5, P < 0.001), preoperative eGFR <60 (OR 3.6, P < 0.001) and RN (OR 2.2, P < 0.01) were predictors for CKD≥3b. AUC for RENSAFE AKI was 0.80 and 0.76 for CKD≥3b. AKI was predictive for CKD≥3a (OR = 2.2, P < 0.001), but not CKD≥3b (P = 0.1). Using 21% threshold probability for AKI achieved sensitivity: 80.3%, specificity: 61.7% and negative predictive value (NPV): 88.1%. Using 8% cutoff for CKD≥3b achieved sensitivity: 75%, specificity: 65.7%, and NPV: 96%. CONCLUSION RENSAFE models utilizing perioperative variables that can predict AKI and CKD may help guide shared decision making. Impact of postsurgical AKI was limited to less severe CKD (eGFR<60 ml/min 71.73m2). Confirmatory studies are requisite.
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Affiliation(s)
- Cesare Saitta
- University of California: San Diego Health System, San Diego, CA; Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Jonathan A Afari
- University of California: San Diego Health System, San Diego, CA
| | | | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Clara Cerrato
- University of California: San Diego Health System, San Diego, CA; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Sabrina L Noyes
- Spectrum Health, Grand Rapids, Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | - Nicolò M Buffi
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Kevin Hakimi
- University of California: San Diego Health System, San Diego, CA
| | - Mimi V Nguyen
- University of California: San Diego Health System, San Diego, CA
| | - Dhruv Puri
- University of California: San Diego Health System, San Diego, CA
| | - Pietro Diana
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Brian R Lane
- Spectrum Health, Grand Rapids, Michigan State University College of Human Medicine, Grand Rapids, MI
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Beatrici E, Labban M, Stone BV, Filipas DK, Reis LO, Lughezzani G, Buffi NM, Kibel AS, Cole AP, Trinh QD. Uncovering the Changing Treatment Landscape for Low-risk Prostate Cancer in the USA from 2010 to 2020: Insights from the National Cancer Data Base. Eur Urol 2023; 84:527-530. [PMID: 37758573 DOI: 10.1016/j.eururo.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/19/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
The management of prostate cancer (PCa) has evolved from a paradigm of "treat when caught early" to "treat only when necessary". Despite inconsistency in its use, active surveillance has evolved over the past two decades into the gold standard for management of low-risk PCa. Our objective was to investigate whether the use of expectant management (active surveillance, watchful waiting, no treatment) as a first-line approach for low-risk PCa has increased over the past decade. We queried the US National Cancer Data Base for men diagnosed with localized PCa between 2010 and 2020. Two multivariable logistic regression models with different two-way interaction terms (year of diagnosis × D'Amico risk classification, and year of diagnosis × International Society of Urological Pathology [ISUP] grade group) were fitted to predict the probability of undergoing expectant management versus active treatment. The predicted probability of expectant management increased from 13.7% in 2010 to 64.4% in 2020 for men with low-risk PCa, and from 12.9% in 2010 to 61.6% in 2020 for ISUP grade group 1 PCa (both pinteraction < 0.001). The frequency of expectant management for low-risk PCa has increased dramatically during the past decade. We expect this trend to further increase owing to the growing awareness of the harms of overtreatment of indolent disease. PATIENT SUMMARY: We examined the use of expectant management for prostate cancer between 2010 and 2020 in a large hospital-based registry from the USA. We found that the proportion of men receiving expectant management for low-risk prostate cancer is increasing. We conclude that growing awareness of the harms of overtreatment has profoundly affected trends for prostate cancer treatment in the USA.
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Affiliation(s)
- Edoardo Beatrici
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Humanitas Research Hospital IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Muhieddine Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin V Stone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leonardo O Reis
- UroScience, School of Medical Sciences, University of Campinas, Campinas, Brazil; Uro-Oncology Division, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Research Hospital IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Nicolò M Buffi
- Department of Urology, Humanitas Research Hospital IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Adam S Kibel
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Tan WS, Contieri R, Buffi NM, Lughezzani G, Grajales V, Soloway M, Casale P, Hurle R, Kamat AM. Reply by Authors. J Urol 2023; 210:770. [PMID: 37622536 DOI: 10.1097/ju.0000000000003639.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Soloway
- Division of Urology, Memorial Cancer Institute, Memorial Hospital, Hollywood, Florida
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Avolio PP, Lughezzani G, Anidjar M, Hassan T, Rompré-Brodeur A, Buffi NM, Lazzeri M, Sanchez-Salas R. The diagnostic accuracy of micro-ultrasound for prostate cancer diagnosis: a review. World J Urol 2023; 41:3267-3276. [PMID: 37555985 DOI: 10.1007/s00345-023-04521-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE Micro-UltraSound (microUS) is a new imaging modality capable of identifying and targeting suspicious areas, which might further increase the diagnostic yield of prostate biopsy (PBx). Aim of this review is to provide insights into the usefulness of microUS for the sub-stratification of prostate cancer (PCa), clinically significant PCa (i.e., any Gleason score ≥ 7 PCa; csPCa) along with non-organ-confined disease in patients undergoing PBx. METHODS A PubMed literature search was performed using keywords: prostate cancer diagnosis, prostate cancer diagnosis surveillance, systematic biopsy, target biopsy, micro-ultrasound, and prostate risk identification using micro-ultrasound. RESULTS MicroUS could significantly improve multiparametric magnetic resonance imaging (mpMRI) findings by adding valuable anatomical and pathological information provided by real-time examination. Furthermore, microUS target biopsy could replace systematic biopsy in clinical practice by reducing the detection of clinically insignificant (ciPCa) and increasing that of csPCa. Finally, microUS may be useful in predicting the presence of non-organ confined PCa before radical prostatectomy and it could also be an effective add-on tool for patient monitoring within the active surveillance program. CONCLUSION MicroUS may represent an attractive step forward for the management of csPCa as a complementary or alternative tool to mpMRI. Nevertheless, further longitudinal studies are warranted, and the strength of the evidence is still suboptimal to provide clear recommendations for daily clinical practice.
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Affiliation(s)
- Pier Paolo Avolio
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Toufic Hassan
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Alexis Rompré-Brodeur
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Nicolò Maria Buffi
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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Fasulo V, Buffi N, Chiarelli G, Lughezzani G, Zuradelli M, Ripamonti CB, Barile M, Bianchi P, Benetti A, Paciotti M, Uleri A, Avolio PP, Saita A, Hurle R, Maura F, Germagnoli L, Asselta R, Soldà G, Casale P, Lazzeri M. Male awareness of prostate cancer risk remains poor in relatives of women with germline variants in DNA-repair genes. BJUI Compass 2023; 4:738-745. [PMID: 37818031 PMCID: PMC10560622 DOI: 10.1002/bco2.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/25/2023] [Accepted: 05/07/2023] [Indexed: 10/12/2023] Open
Abstract
Abstract. Objective The aim of this study is to evaluate male awareness of developing prostate cancer (PCa) in families with germline DNA-repair genes (DRG) variants. Materials and methods Data were collected from a prospective, monocentric cohort study. The study was conducted in a university hospital with a multidisciplinary approach to the patient (collaboration of the Departments of Oncology, Urology, Pathology, Radiology, and Medical Genetics Laboratory). We recruited healthy males, relatives of families of women with breast or ovarian cancer who tested positive for pathogenic variants (PVs) or likely pathogenic variants (LPVs) in DRGs. A dedicated PCa screening was designed and offered to men aged 35 to 69 years, based on early visits with digital rectal examination (DRE), prostate health index (PHI) measurement, multiparametric magnetic resonance imaging (mpMRI) and, if necessary, targeted/systematic prostate biopsies. The primary endpoint was to evaluate the willingness of healthy men from families with a DRG variants detected in female relatives affected with breast and/or ovarian cancer to be tested for the presence of familial PVs. The secondary endpoints were the acceptance to participate if resulted positive and compliance with the screening programme. Results Over 1256 families, of which 139 resulted positive for PVs in DRGs, we identified 378 'healthy' men aged between 35 and 69 years old. Two hundred sixty-one (69.0%) refused to be tested for DRG variants, 66 (17.5%) declared to have been previously tested, and 51 (13.5%) males were interested to be tested. Between those previously tested and those who accepted to be tested, 62 (53.0%) were positive for a DRG variant, and all of them accepted to participate in the subsequent surveillance steps. The main limitation is that is a single-centre study and a short follow-up. Conclusions All men tested positive for a DRG variants agreed to go under the surveillance scheme. However, only 31% of 'men at risk' (i.e., relative of a DRG variant carrier) expressed their willingness to be tested for the familial DRG variant. This observation strongly supports the urgent need to implement awareness of genetic risk for PCa within the male population.
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Affiliation(s)
- Vittorio Fasulo
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - NicolòMaria Buffi
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giuseppe Chiarelli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giovanni Lughezzani
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Monica Zuradelli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Medical Oncology and Hematology UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | | | - Monica Barile
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Paolo Bianchi
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alessio Benetti
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Marco Paciotti
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alessandro Uleri
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Pier Paolo Avolio
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alberto Saita
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Rodolfo Hurle
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Federica Maura
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Luca Germagnoli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Rosanna Asselta
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giulia Soldà
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Paolo Casale
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Massimo Lazzeri
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
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20
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Tan WS, Contieri R, Buffi NM, Lughezzani G, Grajales V, Soloway M, Casale P, Hurle R, Kamat AM. International Bladder Cancer Group Intermediate-risk Nonmuscle-invasive Bladder Cancer Scoring System Predicts Outcomes of Patients on Active Surveillance. J Urol 2023; 210:763-770. [PMID: 37535836 DOI: 10.1097/ju.0000000000003639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE We sought to determine if the International Bladder Cancer Group IR-NMIBC (Intermediate-risk Nonmuscle-invasive Bladder Cancer) scoring system can predict the requirement of delayed transurethral resection of bladder tumor in low-grade nonmuscle-invasive bladder cancer managed by active surveillance. MATERIALS AND METHODS We prospectively studied recurrent low-grade Ta/T1 nonmuscle-invasive bladder cancer patients managed with active surveillance with the following characteristics: low-grade papillary nonmuscle-invasive bladder cancer, ≤5 apparent low-grade nonmuscle-invasive bladder tumors, tumor diameter ≤1 cm, absence of gross hematuria, and negative urinary cytology. Subsequent transurethral resection of bladder tumor was offered to patients who no longer met the inclusion criteria or patient choice. The ability of the International Bladder Cancer Group IR-NMIBC scoring system to predict receipt of subsequent transurethral resection of bladder tumor was determined. Multivariable Cox proportional hazards analysis was used to determine factors associated with subsequent transurethral resection of bladder tumor. RESULTS A total of 163 patients with low-grade Ta/T1 nonmuscle-invasive bladder cancer were included for analysis. After a median follow-up of 33 months (IQR: 21-46), transurethral resection of bladder tumor was performed on 109 patients. At landmark time point of 24 months, patients with 0 risk factors were over 2-fold more likely to continue active surveillance compared to patients with ≥3 risk factors (59% vs 24%). Multivariable Cox regression suggested that the International Bladder Cancer Group IR-NMIBC scoring system was associated with subsequent transurethral resection of bladder tumor (1-2 risk factors [HR: 1.66, 95% CI: 0.96-2.90, P = .072], ≥3 risk factors [HR: 3.21, 95% CI: 1.70-6.09, P < .001]) after adjusting for age, T stage, and sex. CONCLUSIONS The International Bladder Cancer Group IR-NMIBC scoring system can predict the risk of subsequent transurethral resection of bladder tumor in patients with low-grade nonmuscle-invasive bladder cancer on active surveillance.
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Affiliation(s)
- Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Soloway
- Division of Urology, Memorial Cancer Institute, Memorial Hospital, Hollywood, Florida
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
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21
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Avolio PP, Fasulo V, Sanchez-Salas R, Maffei D, Frego N, Lazzeri M, Paciotti M, Saita A, Hurle R, Guazzoni G, Casale P, Buffi NM, Lughezzani G. Diagnostic accuracy of multiparametric MRI- and microultrasound-targeted biopsy in biopsy-naïve patients with a PI-RADS 5 lesion: a single-institutional study. World J Urol 2023; 41:2335-2342. [PMID: 37418017 DOI: 10.1007/s00345-023-04480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (MRI)- and microultrasound (microUS)-guided targeted biopsy (TBx) in detecting prostate cancer (PCa) and clinically significant (cs) PCa among men with Prostate Imaging Reporting and Data System (PI-RADS 5) lesions and to compare this combined TBx (CTBx) strategy with CTBx plus systemic biopsy (SBx). METHODS One hundred and thirty-six biopsy-naïve patients with PI-RADS 5 lesion at multiparametric MRI undergoing CTBx plus SBx were retrospectively evaluated. Analysis of diagnostic performance of microUS-TBx, MRI-TBx, CTBx, SBx and combined CTBx plus SBx was performed. Cost (downgrade, upgrade and biopsy core) to effectiveness (detection rate) was compared. RESULTS CTBx achieved a comparable detection rate to CTBx plus SBx in diagnosis of PCa and csPCa (PCa: 78.7% [107/136] vs 79.4% [108/136]; csPCa: 67.6% [92/136] vs 67.6% [92/136]; p > 0.05) and outperformed SBx (PCa: 58.8% [80/136]; csPCa: 47.8% [65/136]; p < 0.001). Using CTB would have avoided 41.1% (56/136) unnecessary SBx, without missing any csPCa. The rate of any upgrading or csPCa upgrading was significantly higher by SBx than by CTBx [33/65 (50.8%) vs 17/65 (26.1%) and 20/65 (30.8%) vs 4/65 (6.15%), respectively, p < 0.05]. Considering csPCa detection rate, microUS showed high sensitivity and positive predictive value (94.6%, 87.9%, respectively), with lower specificity and negative predictive value (25.0% and 44.4%, respectively). At multivariable logistic regression models, positive microUS was identified as an independent predictor of csPCa (p = 0.024). CONCLUSIONS A combined microUS/MRI-TBx approach could be the ideal imaging tool for characterizing primary disease in PI-RADS five patients, allowing SBx to be avoided.
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Affiliation(s)
- Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- , Via Rita Levi Montalcini, 4, 20090, Rozzano, MI, Italy.
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22
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Gobbo A, Fasulo V, Contieri R, Uleri A, Avolio PP, Frego N, Lughezzani G, Saitta C, Taverna G, Zanoni M, Mancon S, Colombo P, Valeri M, Saita A, Lazzeri M, Buffi NM, Hurle R, Casale P. Clinical and pathological predictors of persistent T1 HG at second resection. Urologia 2023:3915603231181619. [PMID: 37341094 DOI: 10.1177/03915603231181619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND T1 high-grade (HG) non-muscle invasive bladder cancer (NMIBC) has a significant risk of recurrence and progression, and the European Association of Urology recommends a second transurethral resection of the bladder (ReTUR). Stage at ReTUR has been shown to be a reliable predictor of survival, therefore, we sought to assess clinical and pathological predictors associated with the persistence of T1 at ReTUR in our retrospective multicentric cohort. METHODS This is a retrospective multicentric study of T1 HG patients at transurethral resection of the bladder (TURB) who underwent subsequent ReTUR. All histological samples were sub-classified according to Rete Oncologica Lombarda (ROL) T1 sub-staging system. RESULTS One hundred and sixty-six patients were enrolled. Forty-four (26.5%) had T1 HG tumor at ReTUR while 93 (56%) had residual tumor of any stage. Lesion size was significantly greater in T1 HG patients at ReTUR, as well as the prevalence of multifocality. The multivariable logistic regression model showed lesion dimension and multifocality as predictors of T1 HG at ReTUR, after adjusting for significant covariables (CIS and detrusor muscle presence). ROL sub-staging system was not a significant predictor, but ROL2 prevalence was higher in the T1 HG at ReTUR group. CONCLUSIONS Lesion size and multifocality were independent predictors of T1 HG persistence at ReTUR, and patients at risk should be promptly identified and treated accordingly. Our results could help physicians make patient-tailored decisions by identifying those most likely to benefit from a second resection.
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Affiliation(s)
- Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianluigi Taverna
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Matteo Zanoni
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Stefano Mancon
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italia
| | - Marina Valeri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italia
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicolò M Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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23
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Chiancone F, Persico F, Fabiano M, Meccariello C, Giannella R, Fedelini M, Lughezzani G, Fedelini P. Comparison of laparoscopic versus open simple nephrectomy in patients with xanthogranulomatous pyelonephritis: A singlecenter analysis of outcomes and predictors of surgical approaches and complications. Curr Urol 2023; 17:135-140. [PMID: 37691987 PMCID: PMC10489480 DOI: 10.1097/cu9.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to compare the outcomes of open simple nephrectomy and laparoscopic simple nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) in a single-institutional retrospective study and to identify predictive factors of surgical approaches and complications. Materials and methods We retrospectively analyzed the data of 67 consecutive patients with a histopathological diagnosis of XGP who underwent either open simple nephrectomy (ON) or laparoscopic simple nephrectomy (LN) from January 2014 to April 2020. The primary endpoint was the evaluation of perioperative outcomes and complications. Secondary endpoints were to define factors influencing the surgical approach and the likelihood of postoperative complications. Results Overall, 44 out of 67 patients (65.67%) underwent ON, while 23 (34.33%) underwent LN. Patients in the ON group experienced more postoperative pain according to the visual analogic scale (p = 0.032). Moreover, time to deambulation and time to return to full daily activities, assessed according to the 12-Item Short Form Survey physical and mental component summary scores questionnaires, were significantly shorter in the LN group (p = 0.021, p < 0.001, and p < 0.001, respectively). Of note, there were no significant differences in intraoperative and postoperative complication rates among the groups (p = 0.258 and p = 0.317, respectively). No conversion to open surgery was described. Logistic regression analysis demonstrated that urgency (p = 0.025) was the only predictor associated with a higher risk of intraoperative complications. However, no independent factors associated with postoperative complications or with the surgical approach of choice were found. Conclusions Based on our results, laparoscopic treatment of XGP represents a feasible alternative to ON, resulting in less postoperative pain and faster recovery. In skilled hands, LN should be considered as the treatment of choice for XGP.
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Affiliation(s)
| | - Francesco Persico
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Marco Fabiano
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
| | | | | | | | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Paolo Fedelini
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
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24
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Saitta C, De Simone I, Fasulo V, Corbetta M, Duga S, Chiereghin C, Colombo FS, Benetti A, Contieri R, Avolio PP, Uleri A, Saita A, Guazzoni GF, Hurle R, Colombo P, Buffi NM, Casale P, Lughezzani G, Asselta R, Soldà G, Lazzeri M. Evaluation of Semen Self-Sampling Yield Predictors and CTC Isolation by Multi-Color Flow Cytometry for Liquid Biopsy of Localized Prostate Cancer. Cancers (Basel) 2023; 15:2666. [PMID: 37345004 DOI: 10.3390/cancers15102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 06/23/2023] Open
Abstract
Liquid biopsy (LB) for prostate cancer (PCa) detection could represent an alternative to biopsy. Seminal fluid (SF) is a source of PCa-specific biomarkers, as 40% of ejaculate derives from the prostate. We tested the feasibility of an SF-based LB by evaluating the yield of semen self-sampling in a cohort of >750 patients with clinically localized PCa. The overall SF collection yield was 18.2% (39% when considering only compliant patients), with about a half of the patients (53.15%) not consenting to SF donation. Independent favorable predictors for SF collection were younger age and lower prostate volume. We implemented a protocol to enrich prostate-derived cells by multi-color flow cytometry and applied it on SF and urine samples from 100 patients. The number of prostate-enriched cells (SYTO-16+ PSMA+ CD45-) was variable, with higher numbers of cells isolated from SF than urine (p value < 0.001). Putative cancer cells (EpCAMhigh) were 2% of isolated cells in both specimens. The fraction of EpCAMhigh cells over prostate-enriched cells (PSMA+) significantly correlated with patient age in both semen and urine, but not with other clinical parameters, such as Gleason Score, ISUP, or TNM stage. Hence, enumeration of prostate-derived cells is not sufficient to guide PCa diagnosis; additional molecular analyses to detect patient-specific cancer lesions will be needed.
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Affiliation(s)
- Cesare Saitta
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Ilaria De Simone
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Marinella Corbetta
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Flow Cytometry Core, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Chiara Chiereghin
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | | | - Alessio Benetti
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Roberto Contieri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Pier Paolo Avolio
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Alessandro Uleri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giorgio Ferruccio Guazzoni
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Nicolò Maria Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Flow Cytometry Core, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giulia Soldà
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Flow Cytometry Core, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
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25
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Frego N, Labban M, Stone BV, Koelker M, Alkhatib K, Lughezzani G, Buffi NM, Lipsitz SR, Weissman JS, Fletcher SA, Kibel AS, Trinh QD, Cole AP. Effect of type of definitive treatment on race-based differences in prostate cancer-specific survival. Prostate 2023. [PMID: 37150867 DOI: 10.1002/pros.24552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Racial and ethnic disparities in prostate cancer (PCa) mortality are partially mediated by inequities in quality of care. Intermediate- and high-risk PCa can be treated with either surgery or radiation, therefore we designed a study to assess the magnitude of race-based differences in cancer-specific survival between these two treatment modalities. METHODS Non-Hispanic Black (NHB) and non-Hispanic White (NHW) men with localized intermediate- and high-risk PCa, treated with surgery or radiation between 2004 and 2015 in the Surveillance, Epidemiology and End Results database were included in the study and followed until December 2018. Unadjusted and adjusted survival analyses were employed to compare cancer-specific survival by race and treatment modality. A model with an interaction term between race and treatment was used to assess whether the type of treatment amplified or attenuated the effect of race/ethnicity on prostate cancer-specific mortality (PCSM). RESULTS 15,178 (20.1%) NHB and 60,225 (79.9%) NHW men were included in the study. NHB men had a higher cumulative incidence of PCSM (p = 0.005) and were significantly more likely to be treated with radiation than NHW men (aOR: 1.89, 95% CI: 1.81-1.97, p < 0.001). In the adjusted models, NHB men were significantly more likely to die from PCa compared with NHW men (aHR: 1.18, 95% CI: 1.03-1.35, p = 0.014), and radiation was associated with a significantly higher odds of PCSM (aHR: 2.10, 95% CI: 1.85-2.38, p < 0.001) compared with surgery. Finally, the interaction between race and treatment on PCSM was not significant, meaning that no race-based differences in PCSM were found within each treatment modality. CONCLUSIONS NHB men with intermediate- and high-risk PCa had a higher rate of PCSM than NWH men in a large national cancer registry, though NHB and NHW men managed with the same treatment achieved similar PCa survival outcomes. The higher tendency for NHB men to receive radiation was similar in magnitude to the difference in cancer survival between racial and ethnic groups.
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Affiliation(s)
- Nicola Frego
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Muhieddine Labban
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin V Stone
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mara Koelker
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Khalid Alkhatib
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicolò M Buffi
- Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sean A Fletcher
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander P Cole
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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26
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Maffei D, Fasulo V, Avolio PP, Saitta C, Paciotti M, De Carne F, Colombo P, Pasini L, De Zorzi SZ, Saita A, Hurle R, Lazzeri M, Guazzoni GF, Casale P, Buffi NM, Lughezzani G. Diagnostic performance of Micro-Ultrasound at MRI-guided confirmatory biopsy in patients under active surveillance for low-risk prostate cancer. Prostate 2023; 83:886-895. [PMID: 36960788 DOI: 10.1002/pros.24532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/22/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Active surveillance (AS) represents a standard of care of low-risk prostate cancer (PCa). However, identification and monitoring of AS candidates remains challenging. Micro-ultrasound (microUS) is a novel high-resolution imaging modality for transrectal ultrasonography (TRUS). We explored the impact of microUS TRUS and targeted biopsies in mpMRI-guided confirmatory biopsies. METHODS Between October 2017 and September 2021 we prospectively enrolled 100 patients scheduled for MRI-guided confirmatory biopsy at 1 year from diagnosis of ISUP 1 PCa. TRUS was performed using the ExactVu microUS system; PRI-MUS protocol was applied to identify suspicious lesions (i.e. PRIMUS score ≥3). All patients received targeted biopsies of any identified microUS and mpMRI lesions and complementary systematic biopsies. The proportion of patients upgraded to clinically significant PCa (defined as ISUP≥2 cancer; csPCa) at confirmatory biopsies was determined, and the diagnostic performance of microUS and mpMRI were compared. RESULTS 92 patients had a suspicious MRI lesion classified PI-RADS 3, 4 and 5 in respectively 28, 16 and 18 patients. MicroUS identified 82 patients with suspicious lesions, classified as PRI-MUS 3, 4 and 5 in respectively 20, 50 and 12 patients, while 18 individuals had no lesions. 34 patients were upgraded to ISUP≥2 cancer and excluded from AS. MicroUS and mpMRI showed a sensitivity of 94.1% and 100% and a NPV of 88.9% and 100% respectively in detecting ISUP≥2 patients. A microUS-mandated protocol would have avoided confirmatory biopsies in 18 patients with no PRI-MUS ≥3 lesions at the cost of missing 4 upgraded patients. CONCLUSIONS MicroUS and mpMRI represent valuable imaging modalities showing high sensitivity and NPV in detecting csPCa, thus allowing their use for event-triggered confirmatory biopsies in AS patients. MicroUS offers an alternative imaging modality to mpMRI for the identification and real-time targeting of suspicious lesions in AS patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Cesare Saitta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Fabio De Carne
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Pathology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Luisa Pasini
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | | | - Alberto Saita
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Rodolfo Hurle
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Massimo Lazzeri
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Giorgio Ferruccio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Paolo Casale
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- IRCCS Humanitas Research Hospital, Department of Urology, via Manzoni 56, 20089, Rozzano, Mi, Italy
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27
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Buffi N, Uleri A, Paciotti M, Lughezzani G, Casale P, Diana P, DE Groote R, Sarchi L, Mottaran A, Bravi C, DE Backer P, Amparore D, Fiori C, Porpiglia F, Mottrie A. Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses. Minerva Urol Nephrol 2023; 75:223-230. [PMID: 36847584 DOI: 10.23736/s2724-6051.23.05161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Patients with multiple ipsilateral renal masses have an augmented risk of metachronous contralateral lesions and are likely to undergo repeated surgeries. We report our experience with the technologies currently available and the surgical techniques to preserve healthy parenchyma while guaranteeing oncological radicality during robot-assisted partial nephrectomy (RAPN). METHODS The data were collected at three tertiary-care centers, where 61 patients with multiple ipsilateral renal masses were treated with RAPN between 2012 and 2021. RAPN was performed with da Vinci Si or Xi surgical system using TilePro (Life360; San Francisco, CA, USA), indocyanine green fluorescence and intraoperative ultrasound. Three-dimensional reconstructions were built in some cases preoperatively. Different techniques were employed for hilum management. The primary endpoint is to report intra- and postoperative complications. Secondary endpoints were the estimated blood loss (EBL), warm ischemia time (WIT) and positive surgical margins (PSM) rate. RESULTS Median preoperative size of the largest mass was 37.5 mm (24-51) with a median PADUA and R.E.N.A.L. score of 8 (7-9) and 7 (6-9). One hundred forty-two tumors were excised, with a mean number of 2.32. The median WIT was 17 (12-24) minutes, and the median EBL was 200 (100-400) mL. Intraoperative ultrasound was employed in 40 (67.8%) patients. The rate of early unclamping, selective clamping and zero-ischemia were respectively 13 (21.3%), 6 (9.8%) and 13 (21.3%). ICG fluorescence was employed in 21 (34.42%) patients and three-dimensional reconstructions were built in 7 (11.47%) patients. Three (4.8%) intraoperative complications occurred, all classified as grade-1 according to EAUiaiC. Postoperative complications were reported in 14 (22.9%) cases with 2 Clavien-Dindo grade >2 complications. Four (6.56%) patients had PSM. Mean period of follow-up was 21 months. CONCLUSIONS In experienced hands, with the employment of the currently available technologies and surgical techniques, RAPN can guarantee optimal outcomes in patients with multiple ipsilateral renal masses.
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Affiliation(s)
- Nicolomaria Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy - .,IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Clinic, Rozzano, Milan, Italy.,Orsi Academy, Ghent, Belgium
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pietro Diana
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Ruben DE Groote
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Luca Sarchi
- Orsi Academy, Ghent, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Angelo Mottaran
- Orsi Academy, Ghent, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Carlo Bravi
- Orsi Academy, Ghent, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | | | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alex Mottrie
- Orsi Academy, Ghent, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
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28
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Paciotti M, Alkhatib KY, Nguyen DD, Yim K, Lipsitz SR, Mossanen M, Casale P, Pierorazio PM, Kibel AS, Trinh QD, Buffi NM, Lughezzani G, Cole AP. Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy? Cancers (Basel) 2023; 15:cancers15051373. [PMID: 36900166 PMCID: PMC10000204 DOI: 10.3390/cancers15051373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75-0.88; p < 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88; p = 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86; p < 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38; p = 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04; p = 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (p < 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.
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Affiliation(s)
- Marco Paciotti
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Khalid Y. Alkhatib
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Urology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
| | - Kendrick Yim
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
| | - Matthew Mossanen
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | | | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nicoló Maria Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Correspondence: ; Tel.: +39-(028)-224-7356
| | - Alexander P. Cole
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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29
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Lazzeri M, Fasulo V, Buffi N, Lughezzani G, Casale P, Benetti A, Saita A, Hurle R, Guazzoni GF, Chiarelli G, Asselta R, Soldà G. Awareness of genetic risk for prostate cancer (PCa) in men from families with germline mutations in DNA-repair genes. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
328 Background: Although one of the most important risk factors for prostate cancer (PCa) is a family history of the disease, there is a poor awareness of genetic risk. The aim of the current study is to investigate the awareness of genetic risk for PCa in men belonging to female families with germline variants in DNA-repair genes (DRGs). Methods: Data were extracted by a prospective observational study designed to select men with germline pathogenic variants (PVs) and offer them a dedicated PCa screening. The selection of probands was performed by genetic counseling and testing of male grade I relatives of female patients with a PVs. Male candidates were identified after reviewing the genealogical trees of all women who had received the diagnosis of breast and/or ovarian cancer and tested positive for a PVs. All the probands, 35-69 yrs old, who resulted positive for PVs were offered to participate to a specific PCa screening based on annually digital rectal examination (DRE), detection of PHI, which is a blood test including total PSA, free PSA, free/total PSA and -2proPSA, and multiparametric MRI. The primary outcome was the “willing to be tested”, defined as a proxy for male awareness of PCa risk. The secondary endpoint was the acceptance rate to be screened. Results: We reviewed the genealogical trees of breast/ovarian cancer female patients from January 2017 to December 2021 and we identified, over 1256 families, 139 positive cases for PVs in DRGs. Among 139 families, we identified 378 “healthy” 35-69 yrs old men, who were offered a genetic counseling, and if they agree a genetic testing. Overall 117/378 (31%) healthy males declared to be interested to be tested. Out of the 51 new tests (66 men already tested out of the study), we found 30 (58.8%) positive men. All the new positive tested men accepted to attend the PCa screening. Living in Northern Italy, having at least one child and higher (degree) level of education were the strongest predictors of willing for testing (p<0.01). Conclusions: Our data reveals a limited will to be tested, but all men tested positive for PVs accepted to participate to the PCa screening. These findings strongly support the urgent need to implement awareness of genetic risk for PCa.
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Affiliation(s)
| | | | | | | | - Paolo Casale
- IRCCS Humanitas Research Hospital, Rozzano, Italy
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30
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Lazzeri M, Rescigno M, Guazzoni GF, Casale P, Buffi N, Lughezzani G, Mancon S, Fasulo V, Saita A, Hurle R. Randomized phase III clinical trial of neoadjuvant intravesical mitomycin C (MMC) treatment in patients with primary treatment-naïve non-muscle invasive bladder cancer (NMIBC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.tps578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
TPS578 Background: Approximately 75-85% of vesical urothelial carcinomas are non-muscle invasive bladder cancers (NMIBC). The primary treatment is transurethral resection (TUR) followed by adjuvant intravesical therapies with immunotherapy (BCG) and/or chemotherapy agents (i.e. mitomycin C - MMC). Unfortunately, the response to intravesical treatments is variable and incomplete and there is a un-met clinical need to improve its efficacy for reducing the recurrence rate and progression to muscle invasive BC (MIBC). Recently, has been showed that MMC induces immunogenic cell death (ICD), determining the expression of specific damage signals, like HMGB1 molecule, that favors the phagocytosis of dying tumor cells, the activation of innate immune cells and the presentation of tumor antigens to T lymphocytes [1]. The identification of ICD as a novel immune-related mechanism of action of MMC could provide opportunities to optimize bladder cancer management by proposing the use of MMC in a “neoadjuvant” setting. The aim of current clinical trial is to test the hypothesis that the neoadjuvant instillation of MMC in patients with NMIBC may reduce the recurrence rate and/or progression to MIBC. Methods: This is a prospective phase III randomized clinical trial in patients with primary treatment-naïve NMIBC recruiting since March 2022 (EudraCT 2021-003751-42_studio ICH-013-MMC). Patients are randomized 1:1 to neo-adjuvant MMC or standard of care. Patients enrolled in the neo-MMC group receive two intravesical instillations of MMC (40 mg/40 ml saline) in the 2 weeks before (days: -14 and -7) the scheduled TUR (day: 0). After TUR, as for clinical practice, both controls and neoMMC subjects, undergo adjuvant treatment, if required, based on the histological evaluation of the tumor and following EAU/PMID: 33040478 guidelines. The primary endpoint of the study is to evaluate the efficacy of MMC neoadjuvant treatment in reducing the recurrence rate of BC calculated as the proportion of patients who achieve a complete response (no evidence of BC after 3, 6, 12 and 24 mo.). The secondary clinical endpoint will be the analysis of the rate of grade and stage progression to MIBC in case of recurrence and the correlation with specific biomarker (i.e. expression of HMGB1). Consider that the primary aim of the study is to see a reduction of relapse, leading to an HR of 0.6, estimating on the control group a 30% relapse free at 12 months. With equal-sized group, a two-sided significance level test (α =0.05) with power 80% power (β=0.2), and assume that recruitment was to be terminated after 12 months, with a 2-year follow up, the required sample size is approximate 160 patient, 80 in each group (control / neoMMC). References: 1. Oresta B, et al Sci Transl Med. Jan 6;13(575):eaba6110 Clinical trial information: EudraCT 2021-003751-42_studio ICH-013 (MMC) .
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Affiliation(s)
| | | | | | - Paolo Casale
- IRCCS Humanitas Research Hospital, Rozzano, Italy
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Arena P, Fasulo V, Chiarelli G, Frego N, De Carne F, Maffei D, Jandric J, Gelardi F, Garofano G, Saitta C, Mancon S, Sordelli F, Beatrici E, Hurle R, Saita A, Lazzeri M, Guazzoni G, Buffi N, Lughezzani G, Casale P. Prospective evaluation of the diagnostic accuracy of different PSMA PET/CT tracers for the nodal staging of radical prostatectomy candidates: A single institutional analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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32
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Pandini M, Carriero R, Buffi N, Carvetta M, Iovino M, Casale P, Lughezzani G, Hurle R, Alberto S, Fasulo V, Guazzoni G, Elefante G, Colombo P, Basso G, Marchini S, Kunderfranco P, Di Mitri D, Lazzeri M. Single cell-based immune profiling of the tumor and its immune microenvironment revealed differences between non-muscle invasive and muscle invasive bladder cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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33
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Frego N, Maffei D, Fasulo V, Paciotti M, Diana P, Avolio P, Chiarelli G, Arena P, Beatrici E, De Carne F, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Is micro-ultrasound a reliable tool for prostate cancer diagnosis? results from a single-institution cohort of over 1,000 men. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Contieri R, Martini A, Beatrici E, Frego N, Diana P, Paciotti M, Mancon S, Lazzeri M, Saita A, Lughezzani G, Buffi N, Casale P, Kamat A, Hurle R. Implementing the Active Surveillance (AS) follow-up schedule for low-grade Non- Muscle-Invasive Bladder Cancer (NMIBC) tumors. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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35
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Avolio P, Fasulo V, Maffei D, Saitta C, Frego N, Paciotti M, Contieri R, De Carne F, Lazzeri M, Saita A, Hurle R, Casale P, Buffi N, Lughezzani G. Clinical and high-resolution micro-ultrasound risk factors for detecting clinically significant prostate cancer in men with PI-RADS 3 lesions: Update from a large single center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Paciotti M, Diana P, Gaglioli A, De Groote R, Farinha R, Ficarra V, Gaston R, Gontero P, Hurle R, Martínez-Piñeiro L, Minervini A, Pansadoro V, Van Cleynenbreugel B, Wiklund P, Casale P, Lughezzani G, Mancon S, Uleri A, Mottrie A, Palou J, Gallagher A, Breda A, Buffi N. International experts consensus on performance metrics for a transurethral resection of bladder (TURB). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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37
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Zanoni M, Chiarelli G, Arena P, Clementi M, Mazzieri C, Vota P, Toia G, Casale P, Lughezzani G, Buffi N, Taverna G. Thulium laser enucleation (ThuLEP) versus transurethral prostate resection (TURP): Impact on erectile function. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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38
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Frego N, De Carne F, Fasulo V, Maffei D, Avolio P, Arena P, Chiarelli G, Beatrici E, Paciotti M, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Head-to-head comparison between microUS, the partin tables and memorial sloan kettering cancer center nomogram in predicting extraprostatic disease in patients undergoing robot-assisted radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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39
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Chiarelli G, Fasulo V, Zuradelli M, Arena P, Beatrici E, Gobbo A, Saitta C, Hurle R, Saita A, Maura F, Asselta R, Soldà G, Casale P, Guazzoni G, Lughezzani G, Buffi N, Lazzeri M. A dedicated screening for early detection of prostate cancer in men with germline mutations in DNA-repair genes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Avolio P, Fasulo V, Maffei D, Frego N, Paciotti M, Lazzeri M, Saita A, Hurle R, Casale P, Buffi N, Lughezzani G. Impact of a structured rehabilitation program on the functional outcomes of patients undergoing robot-assisted radical prostatectomy: A single tertiary-care center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00540-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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41
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Frego N, Chiarelli G, Fasulo V, Maffei D, Arena P, Avolio P, Beatrici E, Paciotti M, De Carne F, Saita A, Hurle R, Lazzeri M, Casale P, Buffi N, Lughezzani G. Comparison of the diagnostic performance between multiparametric MRI and microUS in the detection of clinically significance prostate cancer among patients with previous negative biopsy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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42
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Buffi N, Paciotti M, Gallagher AG, Diana P, De Groote R, Lughezzani G, Gallioli A, Casale P, Palou J, Mottrie A, Breda A. European training in urology (ENTRY): quality-assured training for European urology residents. BJU Int 2023; 131:177-178. [PMID: 36337002 PMCID: PMC10099734 DOI: 10.1111/bju.15928] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicolò Buffi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Paciotti
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Anthony G Gallagher
- ORSI Academy, Ghent, Belgium.,Faculty of Medicine, KU Leuven, Leuven, Belgium.,School of Medicine, Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Pietro Diana
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ruben De Groote
- ORSI Academy, Ghent, Belgium.,Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Giovanni Lughezzani
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Paolo Casale
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain.,Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Alexandre Mottrie
- ORSI Academy, Ghent, Belgium.,Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain.,Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
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Fasulo V, Arena P, Chiarelli G, De Carne F, Garofano G, Maffei D, Gelardi F, Jandric J, Sordelli F, Frego N, Mancon S, Avolio P, Saitta C, Saita A, Hurle R, Casale P, Lazzeri M, Buffi N, Lughezzani G. Comparison of the diagnostic accuracy of PSMA PET/CT scan and Briganti nomogram to predict lymph node invasion in candidates to robot-assisted radical prostatectomy: A single institutional analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lopci E, Lazzeri M, Disconzi L, Maffei D, Fasulo V, Avolio P, Paciotti M, Pasini L, Benetti A, Hurle R, Saita A, Colombo P, Marzo K, Leonardi L, Balzarini L, Chiti A, Guazzoni G, Casale P, Buffi N, Lughezzani G. Prospective comparison of PSMA PET/CT vs. mpMRI in patients with a high suspicion of prostate cancer and previously negative biopsy: Preliminary data from PROSPET-BX trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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45
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Lopci E, Lazzeri M, Colombo P, Casale P, Buffi NM, Saita A, Peschechera R, Hurle R, Marzo K, Leonardi L, Morenghi E, Balzarini L, Disconzi L, Guazzoni G, Chiti A, Lughezzani G. Diagnostic Performance and Clinical Impact of PSMA PET/CT versus mpMRI in Patients with a High Suspicion of Prostate Cancer and Previously Negative Biopsy: A Prospective Trial (PROSPET-BX). Urol Int 2023; 107:433-439. [PMID: 36724746 DOI: 10.1159/000528720] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND This prospective single-arm study is designed to compare in parallel 68Ga-PSMA PET/TRUS (transrectal or transperineal) fusion biopsy ("experimental test") with multiparametric MRI (mpMRI)/TRUS fusion prostate biopsy ("standard test") in men with a high suspicion of prostate cancer (PCa) after at least one negative biopsy. The primary objective was to evaluate the diagnostic performance of 68Ga-PSMA PET/TRUS fusion prostate biopsy in comparison to mpMRI/TRUS fusion prostate biopsy analyzed in parallel. Secondarily, we aimed to determine the relationship between the "experimental test" and the histopathological characteristics of the specimen, along with the clinical utility of the "experimental test" compared to the "standard test." SUMMARY To test the superiority of 68Ga-PSMA PET/CT compared to mpMRI, we will enroll a minimum cohort of 128 patients. Inclusion criteria comprise: age >18 years; blood PSA level >4.0 ng/mL; free-to-total PSA ratio <20%; progressive rise of PSA levels in two consecutive blood samples despite antibiotics; serum blood tests suspicious for PCa; at least one previous negative biopsy; ASAP and/or high-grade PIN; negative digital rectal examination. All eligible patients will undergo 68Ga-PSMA PET/CT and mpMRI scans within 1 month's distance from each other, followed by biopsy session to be completed within 1 month's distance. Targeted TRUS fusion needle biopsy will be performed for all lesions detected with PET and mpMRI. The total duration of the study is 36 months. KEY MESSAGES By comparing the "experimental test" and the "standard test" in parallel, we will be able to determine the superior diagnostic performance of 68Ga-PSMA PET/CT over mpMRI in detecting PCa, and in particular clinically significant PCa, in the specific cohort of patients with a high suspicion of PCa who are candidates to re-biopsy. The clinical impact of the "experimental test" will be subsequently analyzed in terms of the number of prostate biopsies that could be spared, time-consuming, patient friendliness, and cost-effectiveness.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Nicolo M Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Katia Marzo
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Lorenzo Leonardi
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Luca Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Luca Disconzi
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giorgio Guazzoni
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Arturo Chiti
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Giovanni Lughezzani
- Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Avolio PP, Lazzeri M, Buffi NM, Lughezzani G. Micro-ultrasound may significantly reduce the proportion of unnecessary prostate biopsies in patients with PI-RADS 3 lesions. Cancer 2023; 129:320-321. [PMID: 36427000 DOI: 10.1002/cncr.34549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
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Uleri A, Diana P, Lughezzani G, Casale P, Saita A, Hurle R, Lazzeri M, Porpiglia F, Fiori C, Amparore D, Verri P, Rosiello G, Mottrie A, DE Naeyer G, DE Groote R, Porter J, Buffi N. Are nephrometry scores accurate for the prediction of outcomes in patients with renal angiomyolipoma treated with robot-assisted partial nephrectomy? A multi-institutional analysis. Minerva Urol Nephrol 2022; 74:730-737. [PMID: 35622350 DOI: 10.23736/s2724-6051.22.04848-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prediction of complications and surgical outcomes is of outmost importance even in patients with benign renal masses. The aim of our study is to test the PADUA, SPARE and R.E.N.A.L. scores to predict nephron sparing surgery (NSS) outcomes in patients presenting with renal angiomyolipoma (RAML). METHODS We retrospectively analyzed the clinical and pathological data of 93 patients with AML treated with robot-assisted partial nephrectomy (RAPN) at three tertiary care referral centers. Renal masses were classified according to the PADUA, SPARE and R.E.N.A.L. nephrometry scores. Surgical success was defined according to the novel Trifecta Score. Logistic regression models (LRM) were fitted to predict the achievement of novel Trifecta and the risk of high-grade Clavien-Dindo (CD) complication. The receiver operating characteristics (ROC) curve analysis was used to estimate the accuracy of LRMs. RESULTS Of 93 patients, 66 (69.9%) were females; median tumor size was 42 (36-48) mm. Novel Trifecta was achieved in 79 patients (84.9%) and postoperative complications classified as CD>2 occurred in 7 (7.5%) patients. At univariate and multivariate LRMs all three nephrometry scores were significantly associated with novel Trifecta achievement. Similar findings were observed for the prediction of CD>2 complications. The AUCs to predict optimal surgical outcomes and CD>2 complications were 0.791 and 0.912 for PADUA, 0.767 and 0.836 for SPARE and 0.756 and 0.842 for RENAL Score, respectively. CONCLUSIONS RAPN appears to be a feasible and safe surgical technique for the treatment of RAML. PADUA, SPARE and RENAL scores can be safely adopted to predict surgical outcomes, with the first one showing a higher accuracy.
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Affiliation(s)
- Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy - .,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Pietro Diana
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Casale
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alberto Saita
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rodolfo Hurle
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giuseppe Rosiello
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Alex Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Geert DE Naeyer
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Ruben DE Groote
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - James Porter
- Department of Urology, Swedish Urology Group, Seattle, WA, USA
| | - Nicolomaria Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Chiarelli G, Fasulo V, Zuradelli M, Ripamonti C, Bianchi P, Buffi N, Casale P, Lughezzani G, Saita A, Hurle R, Santoro A, Lazzeri M. Male awareness of prostate cancer risk remains poor in families with germline DNA-repair genes mutations. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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49
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Garofano G, Diana P, Saitta C, Uleri A, Lughezzani G, Beatrici E, Chiarelli G, Frego N, Contieri R, Paciotti M, Fasulo V, Lazzeri M, Saita A, Hurle R, Casale P, Guazzoni G, Buffi N. The role of Mayo Adhesive Probability score in operative outcomes: A single center prospective analysis. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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50
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Diana P, Garofano G, Uleri A, Lughezzani G, Beatrici E, Saitta C, Chiarelli G, Frego N, Paciotti M, Fasulo V, Lazzeri M, Saita A, Hurle R, Casale P, Guazzoni G, Buffi N. Adherent perinephric fat as predictor of post-operative functional recovery after robot-assisted partial nephrectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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