Purpose: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwi... more Purpose: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. Methods: The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). Results: The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS 65 (4 + 3) and positive cancer cores 65 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. Conclusions: PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa
Journal of nuclear biology and medicine (Turin, Italy : 1991), 1993
The success of radioimmunoguided surgery (RIGS) is dependent on the performance parameters of the... more The success of radioimmunoguided surgery (RIGS) is dependent on the performance parameters of the apparatus, its correct handling, and the employment of a suitable radioactive compound. In the present study the authors examined the performance of the Neoprobe 1000 device with respect to the radioisotope 99mTc. Detecting efficiency was evaluated experimentally using a phantom containing a radioactive point source which could be moved both vertically and horizontally with respect to the central axis of the probe. In this way curves representing the variations in efficiency as a function of the vertical and horizontal distances of the source from the probe were constructed. Furthermore, values of minimum detectable activity as a function of source depth, counting time and background radioactivity were calculated. These results were compared to those previously obtained using 125I, the radioisotope most frequently employed in RIGS. The graphs and tables included could serve as a practic...
Thermal ablation of renal tumors is achieved by the delivery of extreme heat or extreme cold dire... more Thermal ablation of renal tumors is achieved by the delivery of extreme heat or extreme cold directly to the lesion in order to obtain in situ destruction of the malignant cells without having to remove the entire organ. Cryotherapy and radiofrequency ablation are becoming more and more attractive for the treatment of small lesions in select cases. Other types of energy such as microwave, laser and high intensity ultrasound have also been used to destroy kidney lesions but must still be considered in the experimental stage. Cryotherapy and radiofrequency ablation are minimally invasive and have been shown to be safe and effective in treating tumors up to 3-4 cm in diameter. However, the number of case series is rather limited and follow-up, especially for radiofrequency ablation, is short. Only now are workers beginning to present outcomes after 5 years for cryoablation. Therefore, the long-term oncological efficacy of these ablation techniques remains to be seen. As longer follow-up and greater patient numbers are reported we will get a clearer picture of the true potential of these modalities. Randomized prospective trials would be auspicable. For now, CA and RFA should be limited to few select patients-i.e. patients with comorbidities which render them at high risk for a surgical procedure and possibly patients with genetic conditions such as Von Hippel Lindau disease who will probably develop multiple tumors.
T1G3 superficial bladder cancer is considered to be at high risk for progression, and in some ins... more T1G3 superficial bladder cancer is considered to be at high risk for progression, and in some institutions early cystectomy is advocated. Other authors and personal experience suggest that conservative treatment, such as TURBT followed by intravesical prophylaxis, may be adequate in the majority of cases. The purpose of the present phase II study was to assess the tolerability and efficacy of sequential intravesical administration of a chemotherapeutic agent, epirubicin, followed by BCG, after TURBT. 81 patients with primary T1G3 superficial bladder cancer, without evidence of Tis or upper tract tumor, underwent TURBT and intravesical prophylaxis with weekly epirubicin 50 mg for 8 weeks followed by weekly BCG Connaught 120 mg for 6 weeks. A control cystoscopy with bladder mapping and/or TUR of suspicious areas was performed at 15-17 weeks. Then patients were followed-up with 3-month urinary cytology and cystoscopy. The sequential chemo-immunoprophylaxis was generally well tolerated. After a mean follow-up of 48 months recurrent tumors were found in 19 patients (23.4%) and progressive disease in 6 cases (7.4%). Of 6 progressions, 4 patients died (5%) of the disease. Sequential chemo-immunoprophylaxis with epirubicin followed by BCG is well tolerated and seems to be efficacious in primary T1G3 bladder cancer. The recurrence progression and disease-specific mortality rates were acceptable so that this study seems to confirm previous data which show that TURBT and intravesical prophylaxis are appropriate treatment for the majority T1G3 tumors.
localization of somatostatin receptor subtypes in prostate tissue from patients with bladder outl... more localization of somatostatin receptor subtypes in prostate tissue from patients with bladder outlet obstruction
Jon A. J. Lovisolo Divisione di Urologia Ospedale di Circolo e Fondazione Macchi Viale Borri 57, ... more Jon A. J. Lovisolo Divisione di Urologia Ospedale di Circolo e Fondazione Macchi Viale Borri 57, 21100 Varese Gli antagonisti dei recettori adrenergici alfa-1 (alfa-litici) sono ormai considerati di prima scelta nel trattamento dell’iperplasia prostatica benigna (IPB) sintomatica. Gli adrenocettori α 1 sono coinvolti nella regolazione di molti processi fisiologici: diversi studi hanno mostrato che tali recettori sono particolarmente rappresentati nello stroma prostatico, nel collo vescicale e nell’uretra prostatica di molte specie, compreso l’uomo. Tutti i farmaci alfa-litici attualmente impiegati per il trattamento dell’IPB sono selettivi per i recettori α 1 ma variano nella loro selettività per i sottotipi recettoriali α 1 . Il problema maggiore è legato agli effetti collaterali extraprostatici, quali ipotensione ortostatica, vertigini, cefalea e congestione nasale. E’ nato quindi il concetto di uroselettività per descrivere la caratteristica ideale di un farmaco capace di agire i...
204 THE JOURNAL OF UROLOGY® immunoprecipitation with specific antibodies. To reveal the intensity... more 204 THE JOURNAL OF UROLOGY® immunoprecipitation with specific antibodies. To reveal the intensity of cell-cell adhesion of cadherin, spheroid-blocking assay using specific antibody against each cadherin was performed on spheroid culture plate (Sumiron). The expression of cadherin and catenin was also stained in RCC specimens. RESULTS: Various cadherins were expressed at cellular membrane in RCC cell lines, and immunoprecipitation with anti-alpha-catenin antibody showed that CDH6 or NCD attended in the cell adhesion complex with three catenins. The spheroid-blocking assay showed that CDH6 was playing a role as cell-cell adhesion molecule, but not NCD. NCD functioned for cell attachment only when ECD and CDH6 were absent. RCC specimens expressed NCD normally in spite of elevation of tumor grade, and no correlation was observed beween NCD expression pattern and patients prognosis. CONCLUSIONS: It was confirmed that CDH6 was playing an important role for cell-cell adhesion in RCC. Expression of NCD in RCC altered independently of tumor grade or tumor aggressiveness. The function of NCD only acted as a cell adhesion molecule under impaired function of ECD and CDH6, suggesting that NCD might facilitate invasion of RCC cells by attaching other cells, e.g. mesenchymal cells, which expressed NCD as reported previously.
This retrospective study evaluates the outcome of patients with T1G3 bladder cancer treated by tr... more This retrospective study evaluates the outcome of patients with T1G3 bladder cancer treated by transurethral resection (TUR) and intravesical doxorubicin prophylaxis and identifies clinically useful prognostic factors. Methods. One hundred twenty-eight consecutive patients with primary T1 G3 bladder cancer were treated by TUR followed by 1-year intravesical prophylaxis with doxorubicin. Sex, age, number, size, and morphology of the tumors, exfoliative cytology, presence of dysplasia at first observation, pathologic findings of the first recurrence, and number of recurrences were the parameters considered in a multivariate analysis whose object was to identify specific risk factors for recurrence and progression. Results. The recurrence rate was 56.3% and progression of disease was seen in 23.4% of cases with a disease-specific mortality rate of 7.8%. The disease-free survival in patients who had cystectomy was 37.7 months and the disease-specific mortality rate for this group was 35.7%. The recurrence rate was found to be significantly higher for multiple tumors, solid morphology, size greater than 3 cm, positive exfoliative cytology, and concurrent dysplasia. The reappearance of Stage 1, grade 3 tumor on first recurrence was the only factor found to be correlated with progression. Conclusions. Up front therapy consisting of TUR and intravesical doxorubicin prophylaxis is appropriate for T1 G3 bladder cancer. Patients with unfavorable prognostic factors should be kept under strict control; and if a T1 G3 tumor is identified on first recurrence, immediate cystectomy should be considered.
Aging clinical and experimental research, Jan 24, 2017
The Pros-IT CNR project aims to monitor a sample of Italian males ≥18 years of age who have been ... more The Pros-IT CNR project aims to monitor a sample of Italian males ≥18 years of age who have been diagnosed in the participating centers with incident prostate cancer, by analyzing their clinical features, treatment protocols and outcome results in relation to quality of life. Pros-IT CNR is an observational, prospective, multicenter study. The National Research Council (CNR), Neuroscience Institute, Aging Branch (Padua) is the promoting center. Ninety-seven Italian centers located throughout Italy were involved. The field study began in September 1, 2014. Subjects eligible were diagnosed with biopsy-verified prostate cancer, naïve. A sample size of 1500 patients was contemplated. A baseline assessment including anamnestic data, clinical history, risk factors, the initial diagnosis, cancer staging information and quality of life (Italian UCLA Prostate Cancer Index; SF-12 Scale) was completed. Six months after the initial diagnosis, a second assessment evaluating the patient's hea...
Background: The aim of this study was to determine the learning curve for thulium laser enucleati... more Background: The aim of this study was to determine the learning curve for thulium laser enucleation of the prostate (ThuLEP) for two surgeons with different levels of urological endoscopic experience. Methods: From June 2012 to August 2013, ThuLEP was performed on 100 patients in our institution. We present the results of a prospective evaluation during which we analyzed data related to the learning curves for two surgeons of different levels of experience. Results: The prostatic adenoma volumes ranged from 30 to 130 mL (average 61.2 mL). Surgeons A and B performed 48 and 52 operations, respectively. Six months after surgery, all patients were evaluated with the International Prostate Symptom Score questionnaire, uroflowmetry, and prostate-specific antigen test. Introduced in 2010, ThuLEP consists of blunt enucleation of the prostatic apex and lobes using the sheath of the resectoscope. This maneuver allows clearer visualization of the enucleation plane and precise identification of the prostatic capsule. These conditions permit total resection of the prostatic adenoma and coagulation of small penetrating vessels, thereby reducing the laser emission time. Most of the complications in this series were encountered during morcellation, which in some cases was performed under poor vision because of venous bleeding due to surgical perforation of the capsule during enucleation. Conclusions: Based on this analysis, we concluded that it is feasible for laser-naive urologists with endoscopic experience to learn to perform ThuLEP without tutoring. Those statements still require further validation in larger multicentric study cohort by several surgeon. The main novelty during the learning process was the use of a simulator that faithfully reproduced all of the surgical steps in prostates of various shapes and volumes.
Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia, 2003
The objective of this study was to evaluate the feasibility of applying a case finding programme ... more The objective of this study was to evaluate the feasibility of applying a case finding programme for prostate carcinoma based on a questionnaire which was sent by post to the male population of a Northern Italian region. In November 2000 a questionnaire containing prostate related questions was sent to all men aged 55 or older residing in the area served by our hospital. Information provided by the answers was included in a specific data base. Subjects considered at risk for prostate carcinoma were invited for clinical consultation and prostate biopsy when appropriate. 41,627 questionnaires were sent and 7,732 were completed and returned. 960 subjects (12.4%) were considered at risk. Presently, 816 patients have been examined and 116 were biopsied. Thirty-six cases of prostate cancer were found (4.4%). The value of mass screening programmes for prostate carcinoma is still under debate and mature data from controlled screening trials must be obtained before definitive conclusions can...
The object of this study was to evaluate the results of a comprehensive clinical care pathway (CC... more The object of this study was to evaluate the results of a comprehensive clinical care pathway (CCP) aimed at reducing the length of hospitalization and overall cost for patients undergoing radical prostatectomy in a setting including both academic and private physicians. The clinical records of 1,129 consecutive patients who underwent radical prostatectomy by 24 urologists between July 1, 1990, and December 31, 1996, were reviewed. The factors considered were length of stay, morbidity and mortality, readmission rates, and average cost. The CCP was implemented on January 1, 1994. Its scope was to minimize preoperative evaluation, eliminate the preoperative hospital stay, standardize postoperative care and provide intensive patient education. The average length of stay decreased significantly after implementation of the CCP (8.1 vs. 4.9 days, p = 0.0001). In 1990, there was a large difference in length of stay between academic and private physicians (8.3 vs. 12.6 days) (p = 0. 02) but by 1 year after implementation of the CCP there was virtually no difference (4.69 vs. 4.71 days) (p > 0.05). Complication rates were similar before and after implementation of the CCP. Using the average 1993 cost/case as the baseline preCCP figure, the average cost of radical prostatectomy decreased by 16% in 1994 and by 22% in 1995. It is possible to successfully implement a CCP in a multi-physician system to reduce length of stay and cost of radical prostatectomy without subjecting the patient to a greater risk of complication.
The purpose of this analysis was to obtain clinical experience on the possible antitumoral prophy... more The purpose of this analysis was to obtain clinical experience on the possible antitumoral prophylactic activity of the fluoroquinolone pefloxacin against transitional cell carcinoma of the bladder. This inhibitory effect has been observed in vitro. During 1993, a controlled trial to test the antibacterial prophylactic activity of pefloxacin was conducted on 40 patients with superficial bladder cancer who underwent transurethral resection and various adjuvant intravesical treatments. Recurrence rate, interval between first observation and first recurrence, and disease progression were retrospectively compared with those of a group of 44 patients treated with cefotetan during 1992. The two groups were comparable in terms of age, disease characteristics, and adjuvant intravesical antitumoral prophylaxis. After a follow-up of more than 30 months, recurrences were observed in 43.2% and in 22.5% of patients treated with cefotetan and pefloxacin, respectively, and the disease-free interval was 13.5 months for cefotetan and 20.2 months for pefloxacin. These differences were both statistically significant. Clinical observations, although not collected within a prospective controlled study, suggest that the fluoroquinolone pefloxacin may have some antitumoral prophylactic activity against superficial bladder cancer, thus indirectly supporting experimental data. Controlled clinical trials should be performed.
The authors update the current status of diagnostic and staging work-up and therapy of renal cell... more The authors update the current status of diagnostic and staging work-up and therapy of renal cell carcinoma (RCC). They first point out that the disease is increasingly discovered incidentally (about 30% of cases) when symptoms are absent. This, on average, has not led to a clear variation in stage distribution at first observation. It is not rare, however, to find very small lesions, for which differential diagnosis and particular therapeutic strategy are needed, because in some instances small lesions can give distant metastases. Hematuria remains the onset symptom in about 60% of cases where in about 20% of cases systemic symptoms or paraneoplastic syndromes are present. Distant metastases at presentation are still not rare, being observed in about 6-15% of patients. A review of diagnostic tools is then made, concluding that CT scan should be considered the most sensitive examination. The differential diagnosis with oncocytoma, angiomyolipoma and the so-called 'pseudo-tumors' is discussed in detail because these are the most frequently observed renal lesions out of RCC. Special attention is reserved for the diagnostic problems of renal cysts, suggesting that the Bosniak classification should be generally followed, and to the indications for fine-needle aspiration and biopsy which should be performed only in very selected cases. Minimal requirements for staging are indicated after a survey of the most common diagnostic methods. In treatment issues, the efficacy of lymph node dissection and adrenalectomy are discussed, concluding that the present body of data is still unable to clearly indicate that there is an absolute indication for extensive lymph node dissection whereas in selected cases partial nephrectomy may be a valid therapeutic option. Results of immunotherapy, cytotoxic therapy and their association are finally summarized as well as future prospects.
Purpose: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwi... more Purpose: Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. Methods: The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). Results: The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS 65 (4 + 3) and positive cancer cores 65 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. Conclusions: PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa
Journal of nuclear biology and medicine (Turin, Italy : 1991), 1993
The success of radioimmunoguided surgery (RIGS) is dependent on the performance parameters of the... more The success of radioimmunoguided surgery (RIGS) is dependent on the performance parameters of the apparatus, its correct handling, and the employment of a suitable radioactive compound. In the present study the authors examined the performance of the Neoprobe 1000 device with respect to the radioisotope 99mTc. Detecting efficiency was evaluated experimentally using a phantom containing a radioactive point source which could be moved both vertically and horizontally with respect to the central axis of the probe. In this way curves representing the variations in efficiency as a function of the vertical and horizontal distances of the source from the probe were constructed. Furthermore, values of minimum detectable activity as a function of source depth, counting time and background radioactivity were calculated. These results were compared to those previously obtained using 125I, the radioisotope most frequently employed in RIGS. The graphs and tables included could serve as a practic...
Thermal ablation of renal tumors is achieved by the delivery of extreme heat or extreme cold dire... more Thermal ablation of renal tumors is achieved by the delivery of extreme heat or extreme cold directly to the lesion in order to obtain in situ destruction of the malignant cells without having to remove the entire organ. Cryotherapy and radiofrequency ablation are becoming more and more attractive for the treatment of small lesions in select cases. Other types of energy such as microwave, laser and high intensity ultrasound have also been used to destroy kidney lesions but must still be considered in the experimental stage. Cryotherapy and radiofrequency ablation are minimally invasive and have been shown to be safe and effective in treating tumors up to 3-4 cm in diameter. However, the number of case series is rather limited and follow-up, especially for radiofrequency ablation, is short. Only now are workers beginning to present outcomes after 5 years for cryoablation. Therefore, the long-term oncological efficacy of these ablation techniques remains to be seen. As longer follow-up and greater patient numbers are reported we will get a clearer picture of the true potential of these modalities. Randomized prospective trials would be auspicable. For now, CA and RFA should be limited to few select patients-i.e. patients with comorbidities which render them at high risk for a surgical procedure and possibly patients with genetic conditions such as Von Hippel Lindau disease who will probably develop multiple tumors.
T1G3 superficial bladder cancer is considered to be at high risk for progression, and in some ins... more T1G3 superficial bladder cancer is considered to be at high risk for progression, and in some institutions early cystectomy is advocated. Other authors and personal experience suggest that conservative treatment, such as TURBT followed by intravesical prophylaxis, may be adequate in the majority of cases. The purpose of the present phase II study was to assess the tolerability and efficacy of sequential intravesical administration of a chemotherapeutic agent, epirubicin, followed by BCG, after TURBT. 81 patients with primary T1G3 superficial bladder cancer, without evidence of Tis or upper tract tumor, underwent TURBT and intravesical prophylaxis with weekly epirubicin 50 mg for 8 weeks followed by weekly BCG Connaught 120 mg for 6 weeks. A control cystoscopy with bladder mapping and/or TUR of suspicious areas was performed at 15-17 weeks. Then patients were followed-up with 3-month urinary cytology and cystoscopy. The sequential chemo-immunoprophylaxis was generally well tolerated. After a mean follow-up of 48 months recurrent tumors were found in 19 patients (23.4%) and progressive disease in 6 cases (7.4%). Of 6 progressions, 4 patients died (5%) of the disease. Sequential chemo-immunoprophylaxis with epirubicin followed by BCG is well tolerated and seems to be efficacious in primary T1G3 bladder cancer. The recurrence progression and disease-specific mortality rates were acceptable so that this study seems to confirm previous data which show that TURBT and intravesical prophylaxis are appropriate treatment for the majority T1G3 tumors.
localization of somatostatin receptor subtypes in prostate tissue from patients with bladder outl... more localization of somatostatin receptor subtypes in prostate tissue from patients with bladder outlet obstruction
Jon A. J. Lovisolo Divisione di Urologia Ospedale di Circolo e Fondazione Macchi Viale Borri 57, ... more Jon A. J. Lovisolo Divisione di Urologia Ospedale di Circolo e Fondazione Macchi Viale Borri 57, 21100 Varese Gli antagonisti dei recettori adrenergici alfa-1 (alfa-litici) sono ormai considerati di prima scelta nel trattamento dell’iperplasia prostatica benigna (IPB) sintomatica. Gli adrenocettori α 1 sono coinvolti nella regolazione di molti processi fisiologici: diversi studi hanno mostrato che tali recettori sono particolarmente rappresentati nello stroma prostatico, nel collo vescicale e nell’uretra prostatica di molte specie, compreso l’uomo. Tutti i farmaci alfa-litici attualmente impiegati per il trattamento dell’IPB sono selettivi per i recettori α 1 ma variano nella loro selettività per i sottotipi recettoriali α 1 . Il problema maggiore è legato agli effetti collaterali extraprostatici, quali ipotensione ortostatica, vertigini, cefalea e congestione nasale. E’ nato quindi il concetto di uroselettività per descrivere la caratteristica ideale di un farmaco capace di agire i...
204 THE JOURNAL OF UROLOGY® immunoprecipitation with specific antibodies. To reveal the intensity... more 204 THE JOURNAL OF UROLOGY® immunoprecipitation with specific antibodies. To reveal the intensity of cell-cell adhesion of cadherin, spheroid-blocking assay using specific antibody against each cadherin was performed on spheroid culture plate (Sumiron). The expression of cadherin and catenin was also stained in RCC specimens. RESULTS: Various cadherins were expressed at cellular membrane in RCC cell lines, and immunoprecipitation with anti-alpha-catenin antibody showed that CDH6 or NCD attended in the cell adhesion complex with three catenins. The spheroid-blocking assay showed that CDH6 was playing a role as cell-cell adhesion molecule, but not NCD. NCD functioned for cell attachment only when ECD and CDH6 were absent. RCC specimens expressed NCD normally in spite of elevation of tumor grade, and no correlation was observed beween NCD expression pattern and patients prognosis. CONCLUSIONS: It was confirmed that CDH6 was playing an important role for cell-cell adhesion in RCC. Expression of NCD in RCC altered independently of tumor grade or tumor aggressiveness. The function of NCD only acted as a cell adhesion molecule under impaired function of ECD and CDH6, suggesting that NCD might facilitate invasion of RCC cells by attaching other cells, e.g. mesenchymal cells, which expressed NCD as reported previously.
This retrospective study evaluates the outcome of patients with T1G3 bladder cancer treated by tr... more This retrospective study evaluates the outcome of patients with T1G3 bladder cancer treated by transurethral resection (TUR) and intravesical doxorubicin prophylaxis and identifies clinically useful prognostic factors. Methods. One hundred twenty-eight consecutive patients with primary T1 G3 bladder cancer were treated by TUR followed by 1-year intravesical prophylaxis with doxorubicin. Sex, age, number, size, and morphology of the tumors, exfoliative cytology, presence of dysplasia at first observation, pathologic findings of the first recurrence, and number of recurrences were the parameters considered in a multivariate analysis whose object was to identify specific risk factors for recurrence and progression. Results. The recurrence rate was 56.3% and progression of disease was seen in 23.4% of cases with a disease-specific mortality rate of 7.8%. The disease-free survival in patients who had cystectomy was 37.7 months and the disease-specific mortality rate for this group was 35.7%. The recurrence rate was found to be significantly higher for multiple tumors, solid morphology, size greater than 3 cm, positive exfoliative cytology, and concurrent dysplasia. The reappearance of Stage 1, grade 3 tumor on first recurrence was the only factor found to be correlated with progression. Conclusions. Up front therapy consisting of TUR and intravesical doxorubicin prophylaxis is appropriate for T1 G3 bladder cancer. Patients with unfavorable prognostic factors should be kept under strict control; and if a T1 G3 tumor is identified on first recurrence, immediate cystectomy should be considered.
Aging clinical and experimental research, Jan 24, 2017
The Pros-IT CNR project aims to monitor a sample of Italian males ≥18 years of age who have been ... more The Pros-IT CNR project aims to monitor a sample of Italian males ≥18 years of age who have been diagnosed in the participating centers with incident prostate cancer, by analyzing their clinical features, treatment protocols and outcome results in relation to quality of life. Pros-IT CNR is an observational, prospective, multicenter study. The National Research Council (CNR), Neuroscience Institute, Aging Branch (Padua) is the promoting center. Ninety-seven Italian centers located throughout Italy were involved. The field study began in September 1, 2014. Subjects eligible were diagnosed with biopsy-verified prostate cancer, naïve. A sample size of 1500 patients was contemplated. A baseline assessment including anamnestic data, clinical history, risk factors, the initial diagnosis, cancer staging information and quality of life (Italian UCLA Prostate Cancer Index; SF-12 Scale) was completed. Six months after the initial diagnosis, a second assessment evaluating the patient's hea...
Background: The aim of this study was to determine the learning curve for thulium laser enucleati... more Background: The aim of this study was to determine the learning curve for thulium laser enucleation of the prostate (ThuLEP) for two surgeons with different levels of urological endoscopic experience. Methods: From June 2012 to August 2013, ThuLEP was performed on 100 patients in our institution. We present the results of a prospective evaluation during which we analyzed data related to the learning curves for two surgeons of different levels of experience. Results: The prostatic adenoma volumes ranged from 30 to 130 mL (average 61.2 mL). Surgeons A and B performed 48 and 52 operations, respectively. Six months after surgery, all patients were evaluated with the International Prostate Symptom Score questionnaire, uroflowmetry, and prostate-specific antigen test. Introduced in 2010, ThuLEP consists of blunt enucleation of the prostatic apex and lobes using the sheath of the resectoscope. This maneuver allows clearer visualization of the enucleation plane and precise identification of the prostatic capsule. These conditions permit total resection of the prostatic adenoma and coagulation of small penetrating vessels, thereby reducing the laser emission time. Most of the complications in this series were encountered during morcellation, which in some cases was performed under poor vision because of venous bleeding due to surgical perforation of the capsule during enucleation. Conclusions: Based on this analysis, we concluded that it is feasible for laser-naive urologists with endoscopic experience to learn to perform ThuLEP without tutoring. Those statements still require further validation in larger multicentric study cohort by several surgeon. The main novelty during the learning process was the use of a simulator that faithfully reproduced all of the surgical steps in prostates of various shapes and volumes.
Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia, 2003
The objective of this study was to evaluate the feasibility of applying a case finding programme ... more The objective of this study was to evaluate the feasibility of applying a case finding programme for prostate carcinoma based on a questionnaire which was sent by post to the male population of a Northern Italian region. In November 2000 a questionnaire containing prostate related questions was sent to all men aged 55 or older residing in the area served by our hospital. Information provided by the answers was included in a specific data base. Subjects considered at risk for prostate carcinoma were invited for clinical consultation and prostate biopsy when appropriate. 41,627 questionnaires were sent and 7,732 were completed and returned. 960 subjects (12.4%) were considered at risk. Presently, 816 patients have been examined and 116 were biopsied. Thirty-six cases of prostate cancer were found (4.4%). The value of mass screening programmes for prostate carcinoma is still under debate and mature data from controlled screening trials must be obtained before definitive conclusions can...
The object of this study was to evaluate the results of a comprehensive clinical care pathway (CC... more The object of this study was to evaluate the results of a comprehensive clinical care pathway (CCP) aimed at reducing the length of hospitalization and overall cost for patients undergoing radical prostatectomy in a setting including both academic and private physicians. The clinical records of 1,129 consecutive patients who underwent radical prostatectomy by 24 urologists between July 1, 1990, and December 31, 1996, were reviewed. The factors considered were length of stay, morbidity and mortality, readmission rates, and average cost. The CCP was implemented on January 1, 1994. Its scope was to minimize preoperative evaluation, eliminate the preoperative hospital stay, standardize postoperative care and provide intensive patient education. The average length of stay decreased significantly after implementation of the CCP (8.1 vs. 4.9 days, p = 0.0001). In 1990, there was a large difference in length of stay between academic and private physicians (8.3 vs. 12.6 days) (p = 0. 02) but by 1 year after implementation of the CCP there was virtually no difference (4.69 vs. 4.71 days) (p > 0.05). Complication rates were similar before and after implementation of the CCP. Using the average 1993 cost/case as the baseline preCCP figure, the average cost of radical prostatectomy decreased by 16% in 1994 and by 22% in 1995. It is possible to successfully implement a CCP in a multi-physician system to reduce length of stay and cost of radical prostatectomy without subjecting the patient to a greater risk of complication.
The purpose of this analysis was to obtain clinical experience on the possible antitumoral prophy... more The purpose of this analysis was to obtain clinical experience on the possible antitumoral prophylactic activity of the fluoroquinolone pefloxacin against transitional cell carcinoma of the bladder. This inhibitory effect has been observed in vitro. During 1993, a controlled trial to test the antibacterial prophylactic activity of pefloxacin was conducted on 40 patients with superficial bladder cancer who underwent transurethral resection and various adjuvant intravesical treatments. Recurrence rate, interval between first observation and first recurrence, and disease progression were retrospectively compared with those of a group of 44 patients treated with cefotetan during 1992. The two groups were comparable in terms of age, disease characteristics, and adjuvant intravesical antitumoral prophylaxis. After a follow-up of more than 30 months, recurrences were observed in 43.2% and in 22.5% of patients treated with cefotetan and pefloxacin, respectively, and the disease-free interval was 13.5 months for cefotetan and 20.2 months for pefloxacin. These differences were both statistically significant. Clinical observations, although not collected within a prospective controlled study, suggest that the fluoroquinolone pefloxacin may have some antitumoral prophylactic activity against superficial bladder cancer, thus indirectly supporting experimental data. Controlled clinical trials should be performed.
The authors update the current status of diagnostic and staging work-up and therapy of renal cell... more The authors update the current status of diagnostic and staging work-up and therapy of renal cell carcinoma (RCC). They first point out that the disease is increasingly discovered incidentally (about 30% of cases) when symptoms are absent. This, on average, has not led to a clear variation in stage distribution at first observation. It is not rare, however, to find very small lesions, for which differential diagnosis and particular therapeutic strategy are needed, because in some instances small lesions can give distant metastases. Hematuria remains the onset symptom in about 60% of cases where in about 20% of cases systemic symptoms or paraneoplastic syndromes are present. Distant metastases at presentation are still not rare, being observed in about 6-15% of patients. A review of diagnostic tools is then made, concluding that CT scan should be considered the most sensitive examination. The differential diagnosis with oncocytoma, angiomyolipoma and the so-called 'pseudo-tumors' is discussed in detail because these are the most frequently observed renal lesions out of RCC. Special attention is reserved for the diagnostic problems of renal cysts, suggesting that the Bosniak classification should be generally followed, and to the indications for fine-needle aspiration and biopsy which should be performed only in very selected cases. Minimal requirements for staging are indicated after a survey of the most common diagnostic methods. In treatment issues, the efficacy of lymph node dissection and adrenalectomy are discussed, concluding that the present body of data is still unable to clearly indicate that there is an absolute indication for extensive lymph node dissection whereas in selected cases partial nephrectomy may be a valid therapeutic option. Results of immunotherapy, cytotoxic therapy and their association are finally summarized as well as future prospects.
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