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Marra G, Tappero S, Barletta F, Marquis A, Allasia M, Oderda M, Dariane C, Timsit MO, Branchereau J, Mesnard B, Tilki D, Olsburgh J, Kulkarni M, Kasivisvanathan V, Lebacle C, Breda A, Galfano A, Gandaglia G, Briganti A, Montorsi F, Biancone L, Gontero P. Radical Prostatectomy for Nonmetastatic Prostate Cancer in Renal Transplant Recipients: Outcomes for a Large Contemporary Cohort and a Matched Comparison to Patients Without a Transplant. Eur Urol Focus 2024:S2405-4569(24)00042-7. [PMID: 38453584 DOI: 10.1016/j.euf.2024.02.008] [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: 12/04/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND OBJECTIVE It is unknown whether renal transplant receipt (RTR) status can affect perioperative and oncological outcomes of radical prostatectomy (RP). Our aim was to evaluate oncological and functional outcomes of RTR patients treated with RP for cN0M0 prostate cancer (PCa) via comparison with a no-RTR cohort. METHODS RTR patients who had undergone RP at seven European institutions during 2001-2022 were identified. A multi-institutional cohort of no-RTR patients treated with RP during 2004-2022 served as the comparator group. Propensity score matching (PSM) at a ratio of 1:4 was used to match no-RTR patients to the RTR cohort according to age, prostate-specific antigen, and final pathology features. We used Kaplan-Meier plots and multivariable Cox, logistic, and Poisson log-linear regression models to test the outcomes of interest. KEY FINDINGS AND LIMITATIONS After PSM, we analyzed data for 102 RTR and 408 no-RTR patients. RTR patients experienced higher estimated blood loss (EBL), longer length of hospital stay (LOS) and time to catheter removal, higher postoperative complication rates, and a lower continence recovery rate (all p < 0.001). On multivariable analyses, RTR independently predicted unfavorable operative time (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.18-1.25), LOS (OR 1.57, 95% CI 1.32-1.86), EBL (OR 2.24, 95% CI 2.18-2.30), and time to catheter removal (OR 1.93, 95% CI 1.68-2.21), but not complications or continence recovery. There were no significant differences for any oncological outcomes (biochemical recurrence, local or systemic progression) between the RTR and no-RTR groups. While no PCa deaths were recorded, the overall mortality rate was significantly higher in the RTR group (17% vs 0.5%, p < 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS Although RP is feasible for RTR patients, the procedure poses non-negligible surgical challenges, with longer operative time and LOS and higher EBL, but no major differences in terms of complications and continence recovery. The RTR group had similar oncological outcomes to the no-RTR group but significantly higher overall mortality related to causes other than PCa. Therefore, careful selection for RP is required among candidates with previous RTR. PATIENT SUMMARY Removal of the prostate for prostate cancer is possible in patients who have had a kidney transplant, and cancer control outcomes are comparable to those for the general population. However, transplant patients have a higher risk of death from causes other than prostate cancer and the prostate surgery is likely to be more challenging.
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Affiliation(s)
- Giancarlo Marra
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy.
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Marquis
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Allasia
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Benoit Mesnard
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Derya Tilki
- Department of Urology, Martini Klinik, Hamburg, Germany
| | | | | | | | - Cedric Lebacle
- Department of Urology, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, Paris, France
| | - Alberto Breda
- Department of Urology, Fundacio Puigvert, Barcelona, Spain
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Biancone
- Department of Nephrology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
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Martini A, Wever L, Soeterik TFW, Rakauskas A, Fankhauser CD, Grogg JB, Checcucci E, Amparore D, Haiquel L, Rodriguez-Sanchez L, Ploussard G, Qiang P, Affentranger A, Marquis A, Marra G, Ettala O, Zattoni F, Falagario UG, De Angelis M, Kesch C, Apfelbeck M, Al-Hammouri T, Kretschmer A, Kasivisvanathan V, Preisser F, Lefebvre E, Olivier J, Radtke JP, Carrieri G, Moro FD, Boström P, Jambor I, Gontero P, Chiu PK, John H, Macek P, Porpiglia F, Hermanns T, van den Bergh RCN, van Basten JPA, Gandaglia G, Valerio M. An updated model for predicting side-specific extraprostatic extension in the era of MRI-targeted biopsy. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00776-x. [PMID: 38182804 DOI: 10.1038/s41391-023-00776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Accurate prediction of extraprostatic extension (EPE) is pivotal for surgical planning. Herein, we aimed to provide an updated model for predicting EPE among patients diagnosed with MRI-targeted biopsy. MATERIALS AND METHODS We analyzed a multi-institutional dataset of men with clinically localized prostate cancer diagnosed by MRI-targeted biopsy and subsequently underwent prostatectomy. To develop a side-specific predictive model, we considered the prostatic lobes separately. A multivariable logistic regression analysis was fitted to predict side-specific EPE. The decision curve analysis was used to evaluate the net clinical benefit. Finally, a regression tree was employed to identify three risk categories to assist urologists in selecting candidates for nerve-sparing, incremental nerve sparing and non-nerve-sparing surgery. RESULTS Overall, data from 3169 hemi-prostates were considered, after the exclusion of prostatic lobes with no biopsy-documented tumor. EPE was present on final pathology in 1,094 (34%) cases. Among these, MRI was able to predict EPE correctly in 568 (52%) cases. A model including PSA, maximum diameter of the index lesion, presence of EPE on MRI, highest ISUP grade in the ipsilateral hemi-prostate, and percentage of positive cores in the ipsilateral hemi-prostate achieved an AUC of 81% after internal validation. Overall, 566, 577, and 2,026 observations fell in the low-, intermediate- and high-risk groups for EPE, as identified by the regression tree. The EPE rate across the groups was: 5.1%, 14.9%, and 48% for the low-, intermediate- and high-risk group, respectively. CONCLUSION In this study we present an update of the first side-specific MRI-based nomogram for the prediction of extraprostatic extension together with updated risk categories to help clinicians in deciding on the best approach to nerve-preservation.
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Affiliation(s)
- Alberto Martini
- Department of Urology, La Croix du Sud Hospital, Toulouse, France.
| | - Lieke Wever
- St. Antonius ziekenhuis, Nieuwegein, the Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Arnas Rakauskas
- Department of Urology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Josias Bastian Grogg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Luciano Haiquel
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Peng Qiang
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Otto Ettala
- Department of Urology, Turku University, Turku, Finland
| | - Fabio Zattoni
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | | | - Mario De Angelis
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Tarek Al-Hammouri
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Veeru Kasivisvanathan
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Fabrizio Dal Moro
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Peter Boström
- Department of Urology, Turku University, Turku, Finland
| | - Ivan Jambor
- Department of Urology, Turku University, Turku, Finland
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Peter K Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jean-Paul A van Basten
- St. Antonius ziekenhuis, Nieuwegein, the Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, Geneva, Switzerland.
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Calleris G, Marquis A, Zhuang J, Beltrami M, Zhao X, Kan Y, Oderda M, Huang H, Faletti R, Zhang Q, Molinaro L, Wang W, Guo H, Gontero P, Marra G. Impact of operator expertise on transperineal free-hand mpMRI-fusion-targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicenter prospective learning curve. World J Urol 2023; 41:3867-3876. [PMID: 37823940 PMCID: PMC10693515 DOI: 10.1007/s00345-023-04642-2] [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: 06/30/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Transperineal mpMRI-targeted fusion prostate biopsies (TPFBx) are recommended for prostate cancer diagnosis, but little is known about their learning curve (LC), especially when performed under local anaesthesia (LA). We investigated how operators' and institutions' experience might affect biopsy results. METHODS Baseline, procedure and pathology data of consecutive TPFBx under LA were prospectively collected at two academic Institutions, from Sep 2016 to May 2019. Main inclusion criterion was a positive MRI. Endpoints were biopsy duration, clinically significant prostate cancer detection rate on targeted cores (csCDR-T), complications, pain and urinary function. Data were analysed per-centre and per-operator (with ≥ 50 procedures), comparing groups of consecutive patient, and subsequently through regression and CUSUM analyses. Learning curves were plotted using an adjusted lowess smoothing function. RESULTS We included 1014 patients, with 27.3% csCDR-T and a median duration was 15 min (IQR 12-18). A LC for biopsy duration was detected, with the steeper phase ending after around 50 procedures, in most operators. No reproducible evidence in favour of an impact of experience on csPCa detection was found at operator's level, whilst a possible gentle LC of limited clinical relevance emerged at Institutional level; complications, pain and IPSS variations were not related to operator experience. CONCLUSION The implementation of TPFBx under LA was feasible, safe and efficient since early phases with a relatively short learning curve for procedure time.
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Affiliation(s)
- Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, C.so Bramante 88/90, 10126, Turin, Italy.
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, C.so Bramante 88/90, 10126, Turin, Italy
| | - Junlong Zhuang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Mattia Beltrami
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, C.so Bramante 88/90, 10126, Turin, Italy
| | - Xiaozhi Zhao
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Yansheng Kan
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, C.so Bramante 88/90, 10126, Turin, Italy
| | - Haifeng Huang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Riccardo Faletti
- Department of Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Qing Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Luca Molinaro
- Department of Pathology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wei Wang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, C.so Bramante 88/90, 10126, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, C.so Bramante 88/90, 10126, Turin, Italy
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Oderda M, Grimaldi S, Rovera G, Delsedime L, D'Agate D, Lavagno F, Marquis A, Marra G, Molinaro L, Deandreis D, Gontero P. Robot-assisted PSMA-radioguided Surgery to Assess Surgical Margins and Nodal Metastases in Prostate Cancer Patients: Report on Three Cases Using an Intraoperative PET-CT Specimen Imager. Urology 2023; 182:e257-e261. [PMID: 37669707 DOI: 10.1016/j.urology.2023.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The aim of this feasibility study was to test the intraoperative use of this brand-new specimen PET/CT to guide robot-assisted radical prostatectomy and pelvic lymph node dissection. MATERIALS AND METHODS Three cases of robot-assisted radical prostatectomy and pelvic lymph node dissection were performed with intraoperative use of the specimen imager. Surgeries were performed with Da Vinci Xi robot. An intravenous injection of 68Ga-PSMA-11 was performed in the OR and after complete excision, the specimens were analyzed with the imager. RESULTS The average nodal yield was 17.3 (5.8 SD) nodes per patient. Specimen PET/CT images showed a focal uptake in a metastatic node (TBR 13.6), and no uptake or diffuse, faint uptake in negative nodes (TBR range: 1-5.3). The specimen imager provided intraoperative PET/CT images that clearly showed negative surgical margins in two patients, whereas the results were uncertain in a locally advanced case. CONCLUSION The intraoperative use of the specimen PET/CT imager is safe and feasible and could improve the evaluation of prostate surgical margins and lymph node status.
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Affiliation(s)
- Marco Oderda
- Department of Surgical Sciences, Urology Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
| | - Serena Grimaldi
- Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Guido Rovera
- Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Luisa Delsedime
- Department of Pathology, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Daniele D'Agate
- Department of Surgical Sciences, Urology Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Federico Lavagno
- Department of Surgical Sciences, Urology Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Alessandro Marquis
- Department of Surgical Sciences, Urology Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Department of Surgical Sciences, Urology Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Luca Molinaro
- Department of Pathology, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
| | - Desireé Deandreis
- Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Urology Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy
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Zattoni F, Pereira LJP, Marra G, Valerio M, Olivier J, Puche-Sanz I, Rajwa P, Maggi M, Campi R, Amparore D, De Cillis S, Junlong Z, Guo H, La Bombarda G, Fuschi A, Veccia A, Ditonno F, Marquis A, Barletta F, Leni R, Serni S, Kasivisvanathan V, Antonelli A, Dal Moro F, Rivas JG, van den Bergh RCN, Briganti A, Gandaglia G, Novara G. The impact of a second MRI and re-biopsy in patients with initial negative mpMRI-targeted and systematic biopsy for PIRADS ≥ 3 lesions. World J Urol 2023; 41:3357-3366. [PMID: 37755520 PMCID: PMC10632220 DOI: 10.1007/s00345-023-04578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/10/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE To evaluate the proportions of detected prostate cancer (PCa) and clinically significant PCa (csPCa), as well as identify clinical predictors of PCa, in patients with PI-RADS > = 3 lesion at mpMRI and initial negative targeted and systematic biopsy (initial biopsy) who underwent a second MRI and a re-biopsy. METHODS A total of 290 patients from 10 tertiary referral centers were included. The primary outcome measures were the presence of PCa and csPCa at re-biopsy. Logistic regression analyses were performed to evaluate predictors of PCa and csPCa, adjusting for relevant covariates. RESULTS Forty-two percentage of patients exhibited the presence of a new lesion. Furthermore, at the second MRI, patients showed stable, upgrading, and downgrading PI-RADS lesions in 42%, 39%, and 19%, respectively. The interval from the initial to repeated mpMRI and from the initial to repeated biopsy was 16 mo (IQR 12-20) and 18 mo (IQR 12-21), respectively. One hundred and eight patients (37.2%) were diagnosed with PCa and 74 (25.5%) with csPCa at re-biopsy. The presence of ASAP on the initial biopsy strongly predicted the presence of PCa and csPCa at re-biopsy. Furthermore, PI-RADS scores at the first and second MRI and a higher number of systematic biopsy cores at first and second biopsy were independent predictors of the presence of PCa and csPCa. Selection bias cannot be ruled out. CONCLUSIONS Persistent PI-RADS ≥ 3 at the second MRI is suggestive of the presence of a not negligible proportion of csPca. These findings contribute to the refinement of risk stratification for men with initial negative MRI-TBx.
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Affiliation(s)
- Fabio Zattoni
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy.
| | | | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126, Turin, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | | | - Ignacio Puche-Sanz
- Department of Urology, Instituto de Investigación Biosanitaria Ibs.Granada, Hospital Universitario Virgen de Las Nieves (HUVN), Granada, Spain
| | - Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
- Urology Unit, Department of Medico, Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
- School of Medicine, Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Sabrina De Cillis
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
- School of Medicine, Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Zhuang Junlong
- Institute of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
- Department of Urology, Nanjing University, Nanjing, China
| | - Hongqian Guo
- Institute of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, People's Republic of China
- Department of Urology, Nanjing University, Nanjing, China
| | - Giulia La Bombarda
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Andrea Fuschi
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
- Urology Unit, Department of Medico, Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alessandro Veccia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Francesco Ditonno
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126, Turin, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Leni
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fabrizio Dal Moro
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Juan Gomez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giacomo Novara
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
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Martini A, Wever L, Soeterik TFW, Rakauskas A, Fankhauser CD, Grogg JB, Checcucci E, Amparore D, Haiquel L, Rodriguez-Sanchez L, Ploussard G, Qiang P, Affentranger A, Marquis A, Marra G, Ettala O, Zattoni F, Falagario UG, De Angelis M, Kesch C, Apfelbeck M, Al-Hammouri T, Kretschmer A, Kasivisvanathan V, Preisser F, Lefebvre E, Olivier J, Radtke JP, Briganti A, Montorsi F, Carrieri G, Moro FD, Boström P, Jambor I, Gontero P, Chiu PK, John H, Macek P, Porpiglia F, Hermanns T, van den Bergh RCN, van Basten JPA, Gandaglia G, Valerio M. Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Study That Challenges the Dogma. J Urol 2023; 210:117-127. [PMID: 37052480 DOI: 10.1097/ju.0000000000003442] [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: 08/27/2022] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Bilateral extended pelvic lymph node dissection at the time of radical prostatectomy is the current standard of care if pelvic lymph node dissection is indicated; often, however, pelvic lymph node dissection is performed in pN0 disease. With the more accurate staging achieved with magnetic resonance imaging-targeted biopsies for prostate cancer diagnosis, the indication for bilateral extended pelvic lymph node dissection may be revised. We aimed to assess the feasibility of unilateral extended pelvic lymph node dissection in the era of modern prostate cancer imaging. MATERIALS AND METHODS We analyzed a multi-institutional data set of men with cN0 disease diagnosed by magnetic resonance imaging-targeted biopsy who underwent prostatectomy and bilateral extended pelvic lymph node dissection. The outcome of the study was lymph node invasion contralateral to the prostatic lobe with worse disease features, ie, dominant lobe. Logistic regression to predict lymph node invasion contralateral to the dominant lobe was generated and internally validated. RESULTS Overall, data from 2,253 patients were considered. Lymph node invasion was documented in 302 (13%) patients; 83 (4%) patients had lymph node invasion contralateral to the dominant prostatic lobe. A model including prostate-specific antigen, maximum diameter of the index lesion, seminal vesicle invasion on magnetic resonance imaging, International Society of Urological Pathology grade in the nondominant side, and percentage of positive cores in the nondominant side achieved an area under the curve of 84% after internal validation. With a cutoff of contralateral lymph node invasion of 1%, 602 (27%) contralateral pelvic lymph node dissections would be omitted with only 1 (1.2%) lymph node invasion missed. CONCLUSIONS Pelvic lymph node dissection could be omitted contralateral to the prostate lobe with worse disease features in selected patients. We propose a model that can help avoid contralateral pelvic lymph node dissection in almost one-third of cases.
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Affiliation(s)
- Alberto Martini
- Department of Urology, La Croix du Sud Hospital, Toulouse, France
| | - Lieke Wever
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Arnas Rakauskas
- Department of Urology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Josias Bastian Grogg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Luciano Haiquel
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Peng Qiang
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Otto Ettala
- Department of Urology, Turku University, Turku, Finland
| | - Fabio Zattoni
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | | | - Mario De Angelis
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Tarek Al-Hammouri
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Veeru Kasivisvanathan
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Fabrizio Dal Moro
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Peter Boström
- Department of Urology, Turku University, Turku, Finland
| | - Ivan Jambor
- Department of Urology, Turku University, Turku, Finland
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Peter K Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jean-Paul A van Basten
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Oderda M, Dematteis A, Calleris G, Conti A, D'Agate D, Falcone M, Marquis A, Montefusco G, Marra G, Gontero P. Predictors of Prostate Cancer at Fusion Biopsy: The Role of Positive Family History, Hypertension, Diabetes, and Body Mass Index. Curr Oncol 2023; 30:4957-4965. [PMID: 37232832 DOI: 10.3390/curroncol30050374] [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: 03/25/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND PSA density and an elevated PI-RADS score are among the strongest predictors of prostate cancer (PCa) in a fusion biopsy. Positive family history, hypertension, diabetes, and obesity have also been associated with the risk of developing PCa. We aim to identify predictors of the prostate cancer detection rate (CDR) in a series of patients undergoing a fusion biopsy. METHODS We retrospectively evaluated 736 consecutive patients who underwent an elastic fusion biopsy from 2020 to 2022. Targeted biopsies (2-4 cores per MRI target) were followed by systematic mapping (10-12 cores). Clinically significant PCa (csPCa) was defined as ISUP score ≥ 2. Uni- and multi-variable logistic regression analyses were performed to identify predictors of CDR among age, body mass index (BMI), hypertension, diabetes, positive family history, PSA, a positive digital rectal examination (DRE), PSA density ≥ 0.15, previous negative biopsy status, PI-RADS score, and size of MRI lesion. RESULTS The median patients' age was 71 years, and median PSA was 6.6 ng/mL. A total of 20% of patients had a positive digital rectal examination. Suspicious lesions in mpMRI were scored as 3, 4, and 5 in 14.9%, 55.0%, and 17.5% of cases, respectively. The CDR was 63.2% for all cancers and 58.7% for csPCa. Only age (OR 1.04, p < 0.001), a positive DRE (OR 1.75, p = 0.04), PSA density (OR 2.68, p < 0.001), and elevated PI-RADS score (OR 4.02, p = 0.003) were significant predictors of the CDR in the multivariable analysis for overall PCa. The same associations were found for csPCa. The size of an MRI lesion was associated with the CDR only in uni-variable analysis (OR 1.07, p < 0.001). BMI, hypertension, diabetes, and a positive family history were not predictors of PCa. CONCLUSIONS In a series of patients selected for a fusion biopsy, positive family history, hypertension, diabetes, or BMI are not predictors of PCa detection. PSA-density and PI-RADS score are confirmed to be strong predictors of the CDR.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Alessandro Dematteis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Adriana Conti
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Daniele D'Agate
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Marco Falcone
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Gabriele Montefusco
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Turin, Italy
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Martini A, Wever L, Soeterik TFW, Rakauskas A, Fankhauser CD, Grogg JB, Checcucci E, Amparore D, Haiquel L, Rodriguez-Sanchez L, Ploussard G, Qiang P, Affentranger A, Marquis A, Marra G, Ettala O, Zattoni F, Falagario UG, De Angelis M, Kesch C, Apfelbeck M, Al-Hammouri T, Kretschmer A, Kasivisvanathan V, Preisser F, Lefebvre E, Olivier J, Radtke JP, Briganti A, Montorsi F, Carrieri G, Moro FD, Boström P, Jambor I, Gontero P, Chiu PK, John H, Macek P, Porpiglia F, Hermanns T, van den Bergh RCN, van Basten JPA, Gandaglia G, Valerio M. Reply by Authors. J Urol 2023:101097JU000000000000344202. [PMID: 37052482 DOI: 10.1097/ju.0000000000003442.02] [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] [Indexed: 04/14/2023]
Affiliation(s)
- Alberto Martini
- Department of Urology, La Croix du Sud Hospital, Toulouse, France
| | - Lieke Wever
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Arnas Rakauskas
- Department of Urology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Josias Bastian Grogg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Luciano Haiquel
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Peng Qiang
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Otto Ettala
- Department of Urology, Turku University, Turku, Finland
| | - Fabio Zattoni
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | | | - Mario De Angelis
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Tarek Al-Hammouri
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Veeru Kasivisvanathan
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Fabrizio Dal Moro
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Peter Boström
- Department of Urology, Turku University, Turku, Finland
| | - Ivan Jambor
- Department of Urology, Turku University, Turku, Finland
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Peter K Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jean-Paul A van Basten
- St Antonius Ziekenhuis, Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Marra G, Marquis A, Yanagisawa T, Shariat SF, Touijer K, Gontero P. Salvage Radical Prostatectomy for Recurrent Prostate Cancer After Primary Nonsurgical Treatment: An Updated Systematic Review. Eur Urol Focus 2023; 9:251-257. [PMID: 36822924 DOI: 10.1016/j.euf.2023.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/13/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 02/24/2023]
Abstract
Salvage radical prostatectomy (sRP) has historically been associated with high morbidity, whilst recently published multicentre series suggested a trend towards improved outcomes. Hence, we performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria to investigate the oncological and functional results and morbidity of sRP. We included 20 retrospective articles comprising 4175 men. Robotic procedures were performed in 40% and nerve sparing in up to 36% of men. Postoperative continence was preserved in 40.4% of patients and erectile function in <16%. High-grade complications were described in 6.6% of patients (rectal injuries 0.9%). At final sRP pathology, surgical margins were positive in 26.1%, 32.8% had seminal vesicle invasion, and International Society of Urological Pathology grade was >3 in 26.6%. Ten-year metastasis-free survival ranged from 72% to 77% and 5-yr cancer-specific survival ranged from 86.6% to 97.7%. Salvage radical prostatectomy shows durable oncological control and morbidity improved over recent years, despite remaining significant compared to and higher than that of primary radical prostatectomy. PATIENT SUMMARY: Salvage radical prostatectomy (sRP) shows improving oncological control and morbidity over time. The complications associated with sRP and its functional results seem to be acceptable and are continuously improving.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy.
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Karim Touijer
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
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Stabile A, Gandaglia G, Pellegrino F, Afferi L, Zhuang J, Guo H, Gontero P, Minervini A, Ploussard G, Mazzone E, Valerio M, Cucchiara V, Fossati N, Moschini M, Mattei A, Serni S, Rahota R, Beauval J, Marquis A, Rakauskas A, Van Den Bergh R, Soeterik T, Montorsi F, Briganti A. mpMRI of the prostate in patients carrying a high clinical risk of prostate cancer diagnosis: Is this imaging test necessary for diagnostic purposes in this subset of patients? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00146-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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Stabile A, Gandaglia G, Pellegrino F, Mazzone E, Cucchiara V, Fossati N, Moschini M, Mattei A, Afferi L, Serni S, Minervini A, Rahota RG, Ploussard G, Valerio M, Beauval J, Marquis A, Rakauskas A, Gontero P, Guo H, Zhuang J, Van Den Bergh R, Soeterik T, Montorsi F, Briganti A. Integrating index lesion volume to better classify men with indolent prostate cancer among patients with intermediate risk disease. Results from a large, multi-institutional series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00147-1] [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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Sorce G, Gandaglia G, Stabile A, Cucchiara V, Mazzone E, Fossati N, Moschini M, Mattei A, Afferi L, Serni S, Minervini A, Rahota RG, Ploussard G, Valerio M, Beavaul J, Marquis A, Rakauskas A, Gontero P, Guo H, Zhuang J, Van Den Bergh R, Soeterik T, Montorsi F, Briganti A. Has the introduction of multiparametric magnetic resonance imaging of the prostate and targeted biopsies led to a risk of overgrading of high risk prostate cancer? Results from a contemporary, large multi-institutional series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01271-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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Oderda M, Marquis A, Calleris G, D’Agate D, Dematteis A, Falcone M, Marra G, Sasia A, Anceschi U, Simone G, Gontero P. Surgery in advanced prostate cancer scenarios: Do benefits outweigh the risks? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Oderda M, Bertero L, Marquis A, Vissio E, Gatti M, Calleris G, D’Agate D, Montefusco G, Dematteis A, Marra G, Faletti R, Cassoni P, Gontero P. Clinical, radiological, pathological and genomic evaluation of MRI-invisible prostate cancers. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01027-8] [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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Marquis A, Soria F, Oderda M, Allasia M, Destefanis P, Livoti S, Rosazza M, Dutto D, Lillaz B, Gontero P. Feasibility and safety of full retroperitoneoscopic radical nephroureterectomy: A single-center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01453-7] [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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Oderda M, Marquis A, Calleris G, D’Agate D, Dematteis A, Faletti R, Gatti M, Marra G, Gontero P. Transperineal targeted microwave ablation for low to intermediate-risk prostate cancer: Results of a phase I-II study (NCT04627896). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01009-6] [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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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes JL, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Roumeguere T, Faletti R, Gontero P. Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy. Prostate 2023; 83:162-168. [PMID: 36259316 DOI: 10.1002/pros.24449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION When performing targeted biopsy (TBx), the need to add systematic biopsies (SBx) is often debated. Aim of the study is to evaluate the added value of SBx in addition to TBx in terms of prostate cancer (PCa) detection rates (CDR), and to test the concordance between multiparametric magnetic resonance imaging (mpMRI) findings and fusion biopsy results in terms of cancer location. METHODS We performed a retrospective, multicentric study that gathered data on 1992 consecutive patients who underwent elastic fusion biopsy between 2011 and 2020. A standardized approach was used, with TBx (2-4 cores per target) followed by SBx (12-14 cores). We assessed CDR of TBx, of SBx, and TBx+SBx for all cancers and clinically significant PCa (csPCa), defined as ISUP score ≥2. CDR was evaluated according to radiological and clinical parameters, with a particular focus on PI-RADS 3 lesions. In a subgroup of 1254 patients we tested the discordance between mpMRI findings and fusion biopsy results in terms of cancer location. Uni- and multivariable logistic regression analyses were performed to identify predictors of CDR. RESULTS CDR of TBx+SBx was 63.0% for all cancers and 38.8% of csPCa. Per-patient analysis showed that SBx in addition to TBx improved CDR by 4.5% for all cancers and 3.4% for csPCa. Patients with lesions scored as PI-RADS 3, 4, and 5 were diagnosed with PCa in 27.9%, 72.8%, and 92.3%, and csPCa in 10.7%, 43.6%, and 69.3%, respectively. When positive, PI-RADS 3 lesions were ISUP grade 1 in 61.1% of cases. Per-lesion analysis showed that discordance between mpMRI and biopsy was found in 56.6% of cases, with 710 patients having positive SBx outside mpMRI targets, of which 414 (58.0%) were clinically significant. PSA density ≥0.15 was a strong predictor of CDR. CONCLUSIONS The addition of systematic mapping to TBx contributes to a minority of per-patient diagnoses but detects a high number of PCa foci outside mpMRI targets, increasing biopsy accuracy for the assessment of cancer burden within the prostate. High PSA-density significantly increases the risk of PCa, both in the whole cohort and in PI-RADS 3 cases.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Simone Albisinni
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Ciccariello
- Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Dematteis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Romain Diamand
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Descotes
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Valerio Forte
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Aurel Messas
- Department of Urology, Hopitaux de Paris, Paris, France
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Alexandre Peltier
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Leire Rius
- Department of Urology, Galdakao Hospital, Bilbao, Spain
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Thierry Roumeguere
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Riccardo Faletti
- Division of Radiology, Molinette Hospital, University of Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
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Oderda M, Bertetto O, Barbera G, Calleris G, Falcone M, Filippini C, Marquis A, Marra G, Montefusco G, Peretti F, Gontero P. Appropriateness and complications of androgen deprivation therapy for prostate cancer: Can we do better? A retrospective observational analysis from a referral center. Urologia 2023; 90:100-108. [PMID: 36703243 DOI: 10.1177/03915603221149502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) is the key of medical treatment for advanced prostate cancer (PCa), especially in elderly patients. However, the adherence of ADT prescription to current guidelines is not optimal and must be balanced against possible side effects. Aim of this study was to evaluate the prescriptive appropriateness of ADT and ADT-related adverse events in a referral center for PCa. METHODS Five hundred fifty six patients who received an outpatient prescription for ADT from 2014 to 2018 were retrospectively identified from an administrative database. Only standard ADT was considered, including GnRH agonists, GnRH antagonists, and antiandrogens. Prescriptive appropriateness was defined according to the last European Association of Urology (EAU) guidelines. Our cohort was stratified according to age categories and patient follow-up was updated. RESULTS Four hundred twenty five patients were available for analysis. Mean age was 80 years; 96.3% of our patients fell in the "elderly" category. There was a predominance of GnRH agonists over the antagonists (84.9% vs 13%). 15.5% of ADTs did not have an appropriate indication according to guidelines. Patient compliance to ADT was evaluated as good in 372 (87.5%) cases. ADT-related complications were detected in 166 (39%) patients: bone, cardiovascular, and other complications were reported in 7.3%, 8.9%, and 19% of patients. Progression of disease was noted in 165 (38.8%) cases during ADT. At last follow-up, 124 (30.1%) patients were deceased. CONCLUSIONS In a referral center, most ADT prescriptions followed EAU guidelines, but a non-negligible proportion still did not fall within these indications, exposing patients to unnecessary side effects. Compliance to ADT was generally good with a predominant use of GnRH agonists. Tolerance to ADT was fair, even if standardized reports were lacking.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Oscar Bertetto
- Rete Oncologica del Piemonte e della Valle d'Aosta, Torino, Italy
| | - Giulia Barbera
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Giorgio Calleris
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Marco Falcone
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | | | - Alessandro Marquis
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Gabriele Montefusco
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Federica Peretti
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
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Kesch C, Pantea V, Soeterik T, Marquis A, la Bombarda G, Morlacco A, Barletta F, Radtke JP, Darr C, Preisser F, Zattoni F, Marra G, van den Bergh RCN, Hadaschik B, Gandaglia G. Risk and predictors of adverse pathology after radical prostatectomy in patients diagnosed with IUSP 1-2 prostate cancer at MRI-targeted biopsy: a multicenter analysis. World J Urol 2023; 41:427-434. [PMID: 36534151 PMCID: PMC9947075 DOI: 10.1007/s00345-022-04236-4] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Although active surveillance (AS) is recommended for low- to favorable intermediate-risk prostate cancer (PCa), risk of upgrading at radical prostatectomy (RP) is not negligible. Available studies based on systematic transrectal ultrasound biopsy might not be applicable to contemporary cohorts diagnosed with MRI-targeted biopsy (TB). The aim of the present study is to explore rates and risk factors for adverse outcomes (AO) at RP in patients with ISUP ≤ 2 PCa detected at TB with concomitant systematic biopsy (SB). METHODS Multicenter, retrospective analysis of 475 consecutive patients with ISUP ≤ 2 PCa at MRI-TB + SB is treated with RP. AO were defined as ISUP upgrading, adverse pathology (upgrading to ISUP ≥ 3 and/or ≥ pT3 at RP, and/or pN1) (AP) or biochemical recurrence (BCR) in men with follow-up (n = 327). RESULTS The rate of ISUP upgrading, upgrading ≥ 3, and AP were 39%, 21%, and 43%. Compared to ISUP2, men with ISUP1 PCa had a higher rate of overall upgrading (27 vs. 67%, p < 0.001), but less upgrading to ≥ 3 (27 vs. 10%, p < 0.001). AP was more common when ISUP2 was detected with a combined MRI-TB + SB approach compared to considering TB (p = 0.02) or SB (p = 0.01) alone. PSA, PSA density, PI-RADS, ISUP at TB, overall biopsy ISUP and EAU classification were predictors of upgrading to ISUP ≥ 3 and AP. The 1 year BCR-free survival was 94% with no differences in BCR rates between subgroups. CONCLUSION Upgrading in ISUP ≤ 2 PCa remains prevalent even in men diagnosed in the MRI era. The use of MRI-TB with concomitant SB allows for the accurate identification of ISUP2 PCa and predicts the risk of AO at RP.
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Affiliation(s)
- Claudia Kesch
- Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Vlad Pantea
- Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Timo Soeterik
- Department of Urology, St. Antonius Hospital, Nieuwegein-Utrecht, The Netherlands
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Giulia la Bombarda
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padova, Padua, Italy
| | - Allesandro Morlacco
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padova, Padua, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Christopher Darr
- Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padova, Padua, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | | | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Oderda M, Calleris G, D’Agate D, Falcone M, Faletti R, Gatti M, Marra G, Marquis A, Gontero P. Intraoperative 3D-US-mpMRI Elastic Fusion Imaging-Guided Robotic Radical Prostatectomy: A Pilot Study. Curr Oncol 2022; 30:110-117. [PMID: 36661658 PMCID: PMC9858363 DOI: 10.3390/curroncol30010009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION When performing a nerve-sparing (NS) robotic radical prostatectomy (RARP), cancer location based on multiparametric MRI (mpMRI) is essential, as well as the location of positive biopsy cores outside mpMRI targets. The aim of this pilot study was to assess the feasibility of intraoperative 3D-TRUS-mpMRI elastic fusion imaging to guide RARP and to evaluate its impact on the surgical strategy. METHODS We prospectively enrolled 11 patients with organ-confined mpMRI-visible prostate cancer (PCa), histologically confirmed at transperineal fusion biopsy using Koelis Trinity. Before surgery, the 3D model of the prostate generated at biopsy was updated, showing both mpMRI lesions and positive biopsy cores, and was displayed on the Da Vinci robotic console using TilePro™ function. RESULTS Intraoperative 3D modeling was feasible in all patients (median of 6 min). The use of 3D models led to a major change in surgical strategy in six cases (54%), allowing bilateral instead of monolateral NS, or monolateral NS instead of non-NS, to be performed. At pathologic examination, no positive surgical margins (PSMs) were reported. Bilateral PCa presence was detected in one (9%), four (36%), and nine (81%) patients after mpMRI, biopsy, and RARP, respectively. Extracapsular extension was found in two patients (18%) even if it was not suspected at MRI. CONCLUSIONS Intraoperative 3D-TRUS-mpMRI modeling with Koelis Trinity is feasible and reliable, helping the surgeon to maximize functional outcomes without increasing the risk of positive surgical margins. The location of positive biopsy cores must be registered in 3D models, given the rates of bilateral involvement not seen at mpMRI.
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Affiliation(s)
- Marco Oderda
- Department of Surgical Sciences-Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
| | - Giorgio Calleris
- Department of Surgical Sciences-Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
| | - Daniele D’Agate
- Department of Surgical Sciences-Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
| | - Marco Falcone
- Department of Surgical Sciences-Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
| | - Riccardo Faletti
- Department of Radiology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
| | - Marco Gatti
- Department of Radiology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
| | - Giancarlo Marra
- Department of Surgical Sciences-Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
| | - Alessandro Marquis
- Department of Surgical Sciences-Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
| | - Paolo Gontero
- Department of Surgical Sciences-Urology, Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, 10126 Torino, Italy
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Oderda M, Marquis A, Calleris G, D'Agate D, Faletti R, Gatti M, Marra G, Gontero P. Safety and Feasibility of Transperineal Targeted Microwave Ablation for Low- to Intermediate-risk Prostate Cancer. EUR UROL SUPPL 2022; 46:3-7. [PMID: 36304751 PMCID: PMC9594111 DOI: 10.1016/j.euros.2022.10.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Background Focal therapy has emerged as an interesting option for localized low- to intermediate-risk prostate cancer (PCa). Targeted microwave ablation (TMA) is a novel FT modality involving targeted delivery of microwave energy under multiparametric magnetic resonance imaging (MRI)/ultrasound guidance. Objective To describe the step-by-step procedure for TMA and report early functional outcomes. Design, setting, and participants This was an experimental phase 1–2 trial in 11 patients diagnosed with a single, MRI-visible PCa lesion of up to 12 mm, scored as International Society of Urological Pathology grade group (GG) 1 or 2. Surgical procedure Transperineal TMA under MRI/ultrasound image fusion guidance. Measurements We recorded patient and PCa features; intraoperative and postoperative parameters; pain (Visual Analog Scale [VAS]) and adverse events (Common Terminology Criteria for Adverse Events v5.0); and prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) scores at 1 wk and 1, 3, and 6 mo. Results and limitations The median patient age was 67 yr (interquartile range [IQR] 18). Median PSA was 5.4 ng/ml (IQR 1.8), median prostate volume was 51 cm3 (IQR 35), and median lesion size on MRI was 10 mm (IQR 4). Ten patients had GG 2 PCa and one had GG 1 disease. The median procedure time was 40 min (IQR 30). No intraoperative complications were reported. All treatments were performed on a day-case basis and no patients were discharged with a urinary catheter. Postoperatively, no grade ≥2 complications were reported. No significant changes in PSA (p = 0.46), IPSS (p = 0.39), or IIEF-5 scores (p = 0.18) scores were reported. The postoperative VAS score at 24 h was 0 for all patients. Conclusions TMA is safe, feasible, and well tolerated in patients with low- to intermediate-risk PCa. Oncological outcomes are still awaited. Patient summary Targeted microwave therapy is safe and feasible for selected patients with low- to intermediate-risk prostate cancer. The procedure is well tolerated and does not require a urinary catheter after the procedure. Cancer control outcomes are still awaited.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy,Corresponding author. Department of Surgical Sciences-Urology, University of Turin, Turin, Italy. Tel. +39 34 7938 3465.
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Daniele D'Agate
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Division of Radiology, Molinette Hospital, University of Turin, Turin, Italy
| | - Marco Gatti
- Division of Radiology, Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
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Gandaglia G, Mazzone E, Ploussard G, Marra G, Valerio M, Campi R, Mari A, Minervini A, Serni S, Moschini M, Marquis A, Beauval J, Rakauskas A, Sessa F, van den Bergh R, Rahota R, Soeterik T, Roumiguiè M, Afferi L, Zhuang J, Guo H, Mattei A, Gontero P, Cucchiara V, Stabile A, Fossati N, Montorsi F, Briganti A. Outcomes of prostate cancer patients with seminal vesicle invasion at multiparametric MRI managed with radical prostatectomy. Do all patients really need for a multi-modal approach? EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Marquis A, Marra G, Calleris G, Oderda M, Montefusco G, D'Agate D, Sotelo R, Sooriakumaran P, Walz J, Gontero P. Nightmares in Salvage Robot-assisted Radical Prostatectomy After Primary Radiation Therapy for Prostate Cancer: A Step by Step Tutorial. EUR UROL SUPPL 2022; 43:62-67. [PMID: 35942231 PMCID: PMC9356262 DOI: 10.1016/j.euros.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
Salvage radical prostatectomy after primary radiotherapy (sRP) is considered a challenging procedure. We highlight the complications of sRP and detail critical surgical steps to help prevent them. A nonsystematic literature review in PubMed using the term “salvage radical prostatectomy” was performed on December 1, 2021. Salvage robot-assisted RP (sRARP) cases and imaging materials were used to create an educational video providing practical examples. Owing to radiation-induced changes in the prostate and surrounding tissues after radiotherapy, sRP is typically more challenging than primary RP. Among its critical steps are incision of the endopelvic fascia, bladder neck dissection with attempts at sparing the neck, development of posterior planes between the prostate and rectum, and dissection of the prostatic apex. Complication rates are significant, in particular for bladder neck contracture (0–16%) and anastomotic leakage (10–33%). Rectal injury is now rare (<2%) but still feared; careful adherence to surgical principles is required to avoid this complication. Functional outcomes are nonoptimal, with a high risk of urinary incontinence (severe incontinence in ∼25% of men). sRARP is a challenging urological procedure and should be performed by experienced surgeons. Thorough knowledge of the surgical anatomy and a meticulous technique for the most difficult surgical steps are crucial to minimise complications and to improve patient outcomes. Patient summary In patients with prostate cancer, removal of the prostate because of cancer recurrence after primary treatment with radiotherapy can be difficult because of radiation-induced tissue damage. This challenging procedure should be performed by experienced surgeons to minimise the risk of complications.
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Marra G, Oderda M, Calleris G, Marquis A, Peretti F, Zitella A, Moschini M, Sanchez-Salas R, Karnes RJ, Kneitz B, Spahn M, Pacchioni D, Gontero P. Ki-67, topoisomerase IIα and miR-221 have a limited prostate cancer risk stratification ability on a medium-term follow-up: results of a high-risk radical prostatectomy cohort. Transl Androl Urol 2022; 11:1271-1281. [PMID: 36217395 PMCID: PMC9547160 DOI: 10.21037/tau-21-628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Currently, no biomarkers are able to differentiate lethal from relatively indolent prostate cancer (PCa) within high-risk diseases. Nonetheless, several molecules are under investigation. Amongst them, topoisomerase-II-alpha (TOPIIA), Ki67 and miR-221 showed promising results. Our aim was to investigate their prognostic role in the context of biochemical recurrence (BCR), clinical recurrence (CR) and PCa-related death (PcD). Methods We included 64 consecutive cM0 high-risk PCa [prostate specific antigen (PSA) >20 ng/mL or Gleason Score (GS) >7 or cT >2] undergoing radical prostatectomy (RP). Changes in miR-221 expression and alternative splicing were determined using microarrays. Immunohistochemical determination of Ki67 and TOPIIa were performed using monoclonal antibody MIB-1 and 3F6 respectively. Cox proportional-hazards regression models were used to predict BCR and CR as multivariate analysis. BCR and CR were defined as three consecutive rises in PSA and PSA >0.2 ng/mL and histologically-proven local recurrence or imaging positive for distant metastasis respectively. Results We included 64 men. Mean pre-operative PSA was 26.53 (range, 1.3–135); all GSs were ≥7 and pT was ≥ T3 in 78.13%. Positive margins and lymph-nodes were present in 42.19% and 32.81% respectively. At a mean follow-up of 5.7 years (range, 1.8–12.5), 42.18% experienced BCR (n=27), 29.68% CR (n=19) and 7.81% PcD (n=5). On univariate analysis positive nodes (<0.01), seminal vesicle invasion (0.02) and miR-221 downregulation (P=0.03), but not Ki67 and TOPIIA (both P>0.5) were associated with BCR whereas only PSA (P<0.01), seminal vesicle invasion (P<0.01) and positive nodes (both P<0.01) were linked to CR. No parameters predicted PcD (all P>0.05) or BCR and CR on multivariate analysis (all P>0.05 - miR-221 HR 0.776; 95% CI: 0.503–1.196 for BCR and HR 0.673; 95% CI: 0.412–1.099 for CR). Limitation of the study include its small sample size and limited follow-up. Conclusions TOPIIA, Ki-67 and miR-221 may not predict BCR, CR or PcD in high-risk PCa patients who underwent RP at a medium-term follow-up. Longer follow-up and larger cohorts are needed to confirm our findings.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology and Department of Pathology, Institut Mutualiste Montsouris, Paris, France
- Department of Surgical Sciences, University of Turin and San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences, University of Turin and San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Calleris
- Department of Surgical Sciences, University of Turin and San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Marquis
- Department of Surgical Sciences, University of Turin and San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Federica Peretti
- Department of Surgical Sciences, University of Turin and San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Zitella
- Department of Surgical Sciences, University of Turin and San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Marco Moschini
- Department of Urology and Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology and Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | | | - Burkhard Kneitz
- Department of Urology and Paediatric Urology, University Hospital Würzburg, Würzburg, Germany
| | - Martin Spahn
- Department of Urology and Paediatric Urology, University Hospital Würzburg, Würzburg, Germany
| | - Donatella Pacchioni
- Department of Pathology, University of Turin and San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, University of Turin and San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin, Italy
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Marra G, Shah TT, D’Agate D, Marquis A, Calleris G, Lunelli L, Filippini C, Oderda M, Gatti M, Valerio M, Sanchez-Salas R, Bossi A, Gomez-Rivas J, Conte F, Deandreis D, Cussenot O, Ricardi U, Gontero P. The SAFE Pilot Trial—SAlvage Focal Irreversible Electroporation—For Recurrent Localized Prostate Cancer: Rationale and Study Protocol. Front Surg 2022; 9:900528. [PMID: 35747441 PMCID: PMC9209638 DOI: 10.3389/fsurg.2022.900528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionCurrently, the majority of prostate cancer (PCa) recurrences after non-surgical first-line treatment are managed with androgen-deprivation therapy (ADT). Salvage radical prostatectomy (sRP) is a curative alternative to ADT but yields significant morbidity. Preliminary evidence from focal salvage treatments shows similar oncological control but lower morbidity compared to sRP. Among available ablative focal energies, irreversible electroporation (IRE) is a treatment modality that proved promising, especially in treating apical lesions, where PCa most often recurs. Our aim is to test the safety of salvage IRE for recurrent PCa.MethodsWe performed a single-arm pilot feasibility study (IDEAL stage 2a): SAFE, SAlvage Focal irreversible Electroporation for recurrent localized PCa. Twenty patients with biopsy-proven PCa recurrence after primary non-surgical (radiation or ablation) treatment were included. All men will undergo mpMRI ± targeted biopsies, pre-operative PSMA-PET staging before inclusion and sIRE. Outcomes will be evaluated through internationally validated questionnaires and morbidity scales. All men will undergo a control biopsy at one year.ResultsPrimary objectives were the evaluation of the safety of sIRE (and patients’ quality of life) after treatment. Secondary objectives were the evaluation of functional outcomes, namely, continence and erectile function changes and evaluation of short-term oncological efficacy.ConclusionsSAFE is the second pilot study to evaluate sIRE and the first one performed according to the most recent diagnostic and staging imaging standards. sIRE may provide a curative option for recurrent PCa together with lower comorbidities compared to sRP.
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Affiliation(s)
- Giancarlo Marra
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
- Department of Urology and Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University Paris, Paris, France
- Correspondence: Giancarlo Marra
| | - Taimur T. Shah
- Department of Urology, Imperial College, London, United Kingdom
| | - Daniele D’Agate
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Marquis
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Calleris
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Luca Lunelli
- Department of Urology and Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University Paris, Paris, France
| | - Claudia Filippini
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences and Radiology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier-Universitaire Vaudois, CHUV, Lausanne, Switzerland
| | | | - Alberto Bossi
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - Juan Gomez-Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Francesca Conte
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Desiree Deandreis
- Department of Nuclear Medicine, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Olivier Cussenot
- Department of Urology and Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University Paris, Paris, France
| | - Umberto Ricardi
- Division of Radiotherapy and Department of Oncology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
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Zhuang J, Kan Y, Wang Y, Marquis A, Qiu X, Oderda M, Huang H, Gatti M, Zhang F, Gontero P, Xu L, Calleris G, Fu Y, Zhang B, Marra G, Guo H. Machine Learning-Based Prediction of Pathological Upgrade From Combined Transperineal Systematic and MRI-Targeted Prostate Biopsy to Final Pathology: A Multicenter Retrospective Study. Front Oncol 2022; 12:785684. [PMID: 35463339 PMCID: PMC9021959 DOI: 10.3389/fonc.2022.785684] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to evaluate the pathological concordance from combined systematic and MRI-targeted prostate biopsy to final pathology and to verify the effectiveness of a machine learning-based model with targeted biopsy (TB) features in predicting pathological upgrade. Materials and Methods All patients in this study underwent prostate multiparametric MRI (mpMRI), transperineal systematic plus transperineal targeted prostate biopsy under local anesthesia, and robot-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer (PCa) sequentially from October 2016 to February 2020 in two referral centers. For cores with cancer, grade group (GG) and Gleason score were determined by using the 2014 International Society of Urological Pathology (ISUP) guidelines. Four supervised machine learning methods were employed, including two base classifiers and two ensemble learning-based classifiers. In all classifiers, the training set was 395 of 565 (70%) patients, and the test set was the remaining 170 patients. The prediction performance of each model was evaluated by area under the receiver operating characteristic curve (AUC). The Gini index was used to evaluate the importance of all features and to figure out the most contributed features. A nomogram was established to visually predict the risk of upgrading. Predicted probability was a prevalence rate calculated by a proposed nomogram. Results A total of 515 patients were included in our cohort. The combined biopsy had a better concordance of postoperative histopathology than a systematic biopsy (SB) only (48.15% vs. 40.19%, p = 0.012). The combined biopsy could significantly reduce the upgrading rate of postoperative pathology, in comparison to SB only (23.30% vs. 39.61%, p < 0.0001) or TB only (23.30% vs. 40.19%, p < 0.0001). The most common pathological upgrade occurred in ISUP GG1 and GG2, accounting for 53.28% and 20.42%, respectively. All machine learning methods had satisfactory predictive efficacy. The overall accuracy was 0.703, 0.768, 0.794, and 0.761 for logistic regression, random forest, eXtreme Gradient Boosting, and support vector machine, respectively. TB-related features were among the most contributed features of a prediction model for upgrade prediction. Conclusion The combined effect of SB plus TB led to a better pathological concordance rate and less upgrading from biopsy to RP. Machine learning models with features of TB to predict PCa GG upgrading have a satisfactory predictive efficacy.
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Affiliation(s)
- Junlong Zhuang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Yansheng Kan
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuwen Wang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China.,Medical School of Southeast University, Nanjing Drum Tower Hospital, Nanjing, China
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Xuefeng Qiu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Haifeng Huang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Marco Gatti
- Department of Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Fan Zhang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Linfeng Xu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Yao Fu
- Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy.,Department of Urology and Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University, Paris, France
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
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Kesch C, Pantea V, Soeterik T, Marquis A, La Bombarda G, Morlacco A, Barletta F, Preisser F, Zattoni F, Marra G, Van Den Bergh R, Radtke J, Hadaschik B, Gandaglia G. Risk of adverse outcomes after prostatectomy in patients diagnosed with IUSP <= 2 prostate cancer on MRI/TRUS fusion biopsy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00369-4] [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: 11/04/2022]
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Gandaglia G, Mazzone E, Ploussard G, Marra G, Valerio M, Campi R, Mari A, Minervini A, Serni S, Moschini M, Marquis A, Beauval JB, Rakauskas A, Sessa F, Van Den Bergh R, Rahota RG, Soeterik T, Roumiguié M, Afferi L, Zhuang J, Guo H, Mattei A, Gontero P, Montorsi F, Briganti A. Definition and predictors of upgrading at final pathology in prostate cancer patients undergoing mri-targeted and systematic biopsies: Results from a large, multi-institutional series. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00700-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Soria F, Allasia M, Marquis A, Calleris G, Agnello M, Giordano A, Mazzoli S, De Bellis M, Rosazza M, Livoti S, Lillaz B, Gontero P. Radical cystectomy in renal transplant recipients: The advantages of the robotic approach. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01343-4] [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: 11/17/2022]
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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes J, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Roumeguere T, Gontero P. Improved cancer detection with targeted biopsies only: results from a multicenter series using Koelis fusion system. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00914-9] [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: 10/20/2022] Open
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Gandaglia G, Mazzone E, Stabile A, Barletta F, Bravi C, Cirulli G, Scuderi S, Afferi L, Moschini M, Campi R, Mari A, Rahota R, Ploussard G, Valerio M, Marra G, Marquis A, Beauval J, Roumiguié M, Gontero P, Zhuang J, Tuo H, Fossati N, Montorsi F, Briganti A. Added value of radiological tumor stage in predicting early oncological outcomes in prostate cancer patients undergoing radical prostatectomy within clinical stage: a stage-by-stage analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mazzone E, Stabile A, Barletta F, Scuderi S, Cirulli G, Robesti D, Ploussard G, Rahota R, Valerio M, Campi R, Mari A, Marra G, Marquis A, Beavaul J, Roumiguié M, Afferi L, Moschini M, Gontero P, Zhuang J, Tuo H, Gandaglia G, Fossati N, Montorsi F, Briganti A. Individualized risk stratification of patients candidate to radical prostatectomy based on clinical and multi-parametric MRI parameters: beyond the conventional clinical risk models. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00967-8] [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: 10/20/2022] Open
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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes J, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Thierry R, Gontero P. Correlation between MRI and biopsy for cancer location definition: results from a multicentric study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Oderda M, Calleris G, Falcone M, Marquis A, Montefusco G, Peretti F, Gontero P. 3D MRI-TRUS elastic fusion imaging guiding robot-assisted radical prostatectomy: a feasibility study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)01011-9] [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: 10/20/2022] Open
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Marra G, Calleris G, Marquis A, Oderda M, Zhuang J, Guo H, Gontero P. Reply to letter by Montorsi et al. Re: Marra et al. 'Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases'. BJU Int 2021; 128:524. [PMID: 34581482 DOI: 10.1111/bju.15525] [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: 11/28/2022]
Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy.,Department of Urology, Institut Mutualiste Montsouris, Paris, France.,Department of Urology, Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University, Paris, France
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Junlong Zhuang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
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Oderda M, Soria F, Rosi F, Calleris G, Mazzoli S, Giordano A, Pizzuto G, Marquis A, De Bellis M, Vitiello F, Vercelli E, Peretti F, Montefusco G, Gontero P. COVID-19 pandemic impact on uro-oncological disease outcomes at an Italian tertiary referral center. World J Urol 2021; 40:263-269. [PMID: 34562122 PMCID: PMC8475474 DOI: 10.1007/s00345-021-03842-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/15/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose To assess differences in referral and pathologic outcomes for uro-oncology cases prior to and during the COVID pandemic, comparing clinical and pathological data of cancer surgeries performed at an academic referral center between 2019 and 2020. Methods We collected data of 880 prostate biopsies, 393 robot-assisted radical prostatectomies (RARP) for prostate cancer (PCa), 767 trans-urethral resections of bladder tumor (TURB) and 134 radical cystectomies (RC) for bladder cancer (BCa), 29 radical nephro-ureterectomies (RNU) for upper tract urothelial carcinoma, 130 partial nephrectomies (PN) and 12 radical nephrectomies (RN) for renal cancer, and 41 orchifunicolectomies for testicular cancer. Data of patients treated in 2019 (before COVID-19 pandemic) were compared to patients treated in 2020 (during pandemic). Results No significant decline in uro-oncological surgical activity was seen between 2019 and 2020. No significant increase in time between diagnosis and surgery was observed for all considered cancers. No differences in terms of main pathologic features were observed in patients undergoing RARP, TURB, RNU, RN/PN, or orchifunicolectomy. A higher proportion of ISUP grade 3 and 4 PCa were diagnosed in 2020 at biopsy (p = 0.001), but this did not translate into worse pathological grade/stage at RARP. In 2020, more advanced disease features were seen after RC, including lymph node involvement (p = 0.01) and non-organ confined disease (p = 0.02). Conclusion Neither decline in uro-oncologic activity nor delay between diagnosis and treatment was observed at our institution during the first year of COVID-19 pandemic. No significant worsening of cancer disease features was found in 2020 except for muscle-invasive BCa. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03842-y.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy.
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Francesco Rosi
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Simone Mazzoli
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Andrea Giordano
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Giuseppe Pizzuto
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Matteo De Bellis
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Federico Vitiello
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Eugenia Vercelli
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Federica Peretti
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Gabriele Montefusco
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences - Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Turin, Turin, Italy
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Mazzone E, Gandaglia G, Ploussard G, Marra G, Valerio M, Campi R, Mari A, Minervini A, Serni S, Moschini M, Marquis A, Beauval JB, van den Bergh R, Rahota RG, Soeterik T, Roumiguiè M, Afferi L, Zhuang J, Tuo H, Mattei A, Gontero P, Cucchiara V, Stabile A, Fossati N, Montorsi F, Briganti A. Risk Stratification of Patients Candidate to Radical Prostatectomy Based on Clinical and Multiparametric Magnetic Resonance Imaging Parameters: Development and External Validation of Novel Risk Groups. Eur Urol 2021; 81:193-203. [PMID: 34399996 DOI: 10.1016/j.eururo.2021.07.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 05/08/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the key importance of magnetic resonance imaging (MRI) parameters, risk classification systems for biochemical recurrence (BCR) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) are still based on clinical variables alone. OBJECTIVE We aimed at developing and validating a novel classification integrating clinical and radiological parameters. DESIGN, SETTING, AND PARTICIPANTS A retrospective multicenter cohort study was conducted between 2014 and 2020 across seven academic international referral centers. A total of 2565 patients treated with RP for PCa were identified. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Early BCR was defined as two prostate-specific antigen (PSA) values of ≥0.2 ng/ml within 3 yr after RP. Kaplan-Meier and Cox regressions tested time and predictors of BCR. Development and validation cohorts were generated from the overall patient sample. A model predicting early BCR based on Cox-derived coefficients represented the basis for a nomogram that was validated externally. Predictors consisted of PSA, biopsy grade group, MRI stage, and the maximum diameter of lesion at MRI. Novel risk categories were then identified. The Harrel's concordance index (c-index) compared the accuracy of our risk stratification with the European Association of Urology (EAU), Cancer of the Prostate Risk Assessment (CAPRA), and International Staging Collaboration for Cancer of the Prostate (STAR-CAP) risk groups in predicting early BCR. RESULTS AND LIMITATIONS Overall, 200 (8%), 1834 (71%), and 531 (21%) had low-, intermediate-, and high-risk disease according to the EAU risk groups. The 3-yr overall BCR-free survival rate was 84%. No differences were observed in the 3-yr BCR-free survival between EAU low- and intermediate-risk groups (88% vs 87%; p = 0.1). The novel nomogram depicted optimal discrimination at external validation (c-index 78%). Four new risk categories were identified based on the predictors included in the Cox-based nomogram. This new risk classification had higher accuracy in predicting early BCR (c-index 70%) than the EAU, CAPRA, and STAR-CAP risk classifications (c-index 64%, 63%, and 67%, respectively). CONCLUSIONS We developed and externally validated four novel categories based on clinical and radiological parameters to predict early BCR. This novel classification exhibited higher accuracy than the available tools. PATIENT SUMMARY Our novel and straightforward risk classification outperformed currently available preoperative risk tools and should, therefore, assist physicians in preoperative counseling of men candidate to radical treatment for prostate cancer.
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Affiliation(s)
- Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Guillame Ploussard
- La Croix du Sud Hospital, Quint Fonsegrives, France; Institut Universitaire du Cancer-Toulouse, Oncopole, Toulouse, France
| | - Giancarlo Marra
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Massimo Valerio
- Urology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mari
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Minervini
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Moschini
- Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Alessandro Marquis
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jean Baptiste Beauval
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | | | - Razvan-George Rahota
- La Croix du Sud Hospital, Quint Fonsegrives, France; Institut Universitaire du Cancer-Toulouse, Oncopole, Toulouse, France
| | - Timo Soeterik
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Urology, St. Antonius Hospital, Santeon-group, The Netherlands
| | - Mathieu Roumiguiè
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - Luca Afferi
- Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Junlong Zhuang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, People's Republic of China
| | - Hongqian Tuo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, People's Republic of China
| | - Agostino Mattei
- Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Vito Cucchiara
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Armando Stabile
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Gandaglia G, Mazzone E, Barletta F, Cirulli G, Scuderi S, Afferi L, Moschini M, Gacci M, Campi R, Mari A, Berni A, Serni S, Rahota R, Ploussard G, Valerio M, Marra G, Marquis A, Beauval J, Roumiguié M, Gontero P, Zhuang J, Tuo H, Fossati N, Montorsi F, Briganti A. Added value of radiological tumor stage in predicting early oncological outcomes in prostate cancer patients undergoing radical prostatectomy within clinical stage: A stage-by-stage analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01292-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Martini A, Soeterik T, Haverdings H, Rahota RG, Checcucci E, De Cillis S, Cirulli G, Hermanns T, Fankhauser C, Afferi L, Mattei A, Kesch C, Heidegger I, Preisser F, Zattoni F, Marquis A, Marra G, Briganti A, Porpiglia F, Van Basten J, Van Den Bergh R, Van Melick H, Ploussard G, Gandaglia G, Valerio M. An algorithm to personalize nerve sparing in men with unilateral high-risk prostate cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes J, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Roumeguere T, Gontero P. Accuracy of Koelis fusion biopsy: Improved cancer detection with targeted biopsies only. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gandaglia G, Mazzone E, Stabile A, Scuderi S, Barletta F, Robesti D, Ploussard G, Rahota R, Valerio M, Campi R, Mari A, Marra G, Marquis A, Beavaul J, Roumiguié M, Afferi L, Moschini M, Gontero P, Tuo H, Fossati N, Montorsi F, Briganti A. What is the definition of misclassification in patients with grade group 2 prostate cancer eligible for active surveillance and diagnosed with MRI targeted biopsy? A multi-institutional analysis with pathological confirmation. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oderda M, Calleris G, Falcone M, Marquis A, Montefusco G, Peretti F, Gontero P. Intraoperative 3D elastic fusion imaging guided robotic radical prostatectomy: A pilot study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01470-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oderda M, Rosazza M, Agnello M, Barale M, Calleris G, Daniele L, Delsedime L, Falcone M, Faletti R, Filippini C, Giordano A, Marquis A, Marra G, Pacchioni D, Gontero P. Natural history of widespread high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: should we rebiopsy them all? Scand J Urol 2021; 55:129-134. [PMID: 33410348 DOI: 10.1080/21681805.2020.1866659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the premalignant potential of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). METHODS Patients diagnosed with monofocal HGPIN (mHGPIN), widespread HGPIN (≥4 cores, wHGPIN) and/or ASAP who underwent at least one rebiopsy during their follow-up, were enrolled. All enrollment biopsies underwent central pathologic revision. Risks for PCa were estimated using Fine and Gray method for competing risk. RESULTS Pathologic revision changed the original diagnosis in 32.3% of cases. Among 336 cases enrolled, PCa was diagnosed in 164 (48.8%), and more specifically in 20 (30.3%) mHGPIN, 10 (34.5%) wHGPIN, 101 (54.0%) ASAP, and 33 (61.1%) HGPIN + ASAP (mean follow-up 124 months). Most PCa were Gleason score 6(3 + 3) (51.0%) and 7(3 + 4) (34.3%). On multivariate analysis, HGPIN + ASAP (HR 2.76, p < 0.001) and ASAP alone (HR 2.41, p < 0.001) were the only lesions significantly associated with PCa development. Of all cancers detected, 64.3% were at first rebiopsy. A rebiopsy performed within 3 months after ASAP diagnosis had a 45% chance of finding PCa. At Kaplan-Meier survival curves, median PCa-free survival was 48.1 months for HGPIN + ASAP and 64.9 months for ASAP (p 0.0005 at Log-rank test). At 1 year, 70% of HGPIN + ASAP, 73% of ASAP, 89% of wHGPIN, and 84% of mHGPIN were PCa-free. CONCLUSION The diagnosis of ASAP and HGPIN strongly relies on the expertise of dedicated uro-pathologists. Finding of ASAP is a strong risk factor for a subsequent PCa diagnosis, advising a rebiopsy, possibly within 3 months. m/wHGPIN should not be routinely rebiopsied.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Matteo Rosazza
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Marco Agnello
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Maurizio Barale
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Giorgio Calleris
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Lorenzo Daniele
- Division of Pathology, Città della Salute e della Scienza - Molinette Hospital, Turin, Italy
| | - Luisa Delsedime
- Division of Pathology, Città della Salute e della Scienza - Molinette Hospital, Turin, Italy
| | - Marco Falcone
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Division of Radiology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | | | - Andrea Giordano
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Alessandro Marquis
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Donatella Pacchioni
- Division of Pathology, Città della Salute e della Scienza - Molinette Hospital, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
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Marquis A, Zhuang J, Marra G, Zhao X, Calleris G, Kan Y, Beltrami M, Huang H, Oderda M, Zhang Q, Faletti R, Wang W, Molinaro L, Bergamasco L, Guo H, Gontero P. Outcomes and predictors of pain in transperineal free-hand mpMRI fusion-targeted biopsies under local anesthesia: A multicenter study of 1,008 patients. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Oderda M, Diamand R, Albisinni S, Calleris G, Carbone A, Falcone M, Fiard G, Gandaglia G, Marquis A, Marra G, Parola C, Pastore A, Peltier A, Ploussard G, Roumeguère T, Sanchez-Salas R, Simone G, Smelzo S, Witt JH, Gontero P. Indications for and complications of pelvic lymph node dissection in prostate cancer: accuracy of available nomograms for the prediction of lymph node invasion. BJU Int 2020; 127:318-325. [PMID: 32869940 DOI: 10.1111/bju.15220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To externally validate the currently available nomograms for predicting lymph node invasion (LNI) in patients with prostate cancer (PCa) and to assess the potential risk of complications of extended pelvic lymph node dissection (ePLND) when using the recommended threshold. METHODS A total of 14 921 patients, who underwent radical prostatectomy with ePLND at eight European tertiary referral centres, were retrospectively identified. After exclusion of patients with incomplete biopsy or pathological data, 12 009 were included. Of these, 609 had undergone multiparametic magnetic resonance imaging-targeted biopsies. Among ePLND-related complications we included lymphocele, lymphoedema, haemorrhage, infection and sepsis. The performances of the Memorial Sloan Kettering Cancer Centre (MSKCC), Briganti 2012, Briganti 2017, Briganti 2019, Partin 2016 and Yale models were evaluated using receiver-operating characteristic curve analysis (area under the curve [AUC]), calibration plots, and decision-curve analysis. RESULTS Overall, 1158 patients (9.6%) had LNI, with a mean of 17.7 and 3.2 resected and positive nodes, respectively. No significant differences in AUCs were observed between the MSKCC (0.79), Briganti 2012 (0.79), Partin 2016 (0.78), Yale (0.80), Briganti 2017 (0.81) and Briganti 2019 (0.76) models. A direct comparison of older models showed that better discrimination was achieved with the MSKCC and Briganti 2012 nomograms. A tendency for underestimation was seen for all the older models, whereas the Briganti 2017 and 2019 nomograms tended to overestimate LNI risk. Decision-curve analysis showed a net benefit for all models, with a lower net benefit for the Partin 2016 and Briganti 2019 models. ePLND-related complications were experienced by 1027 patients (8.9%), and 12.6% of patients with pN1 disease. CONCLUSIONS The currently available nomograms have similar performances and limitations in the prediction of LNI. Miscalibration was present, however, for all nomograms showing a net benefit. In patients with only systematic biopsy, the MSKCC and Briganti 2012 nomograms were superior in the prediction of LNI.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Torino, Italy
| | - Romain Diamand
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Giorgio Calleris
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Torino, Italy
| | - Antonio Carbone
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Marco Falcone
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Torino, Italy
| | - Gaelle Fiard
- Urology Department, CHU de Grenoble, Grenoble, France
| | - Giorgio Gandaglia
- Unit of Urology/Department of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Marquis
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Torino, Italy
| | - Giancarlo Marra
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Torino, Italy.,Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Cinzia Parola
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Torino, Italy
| | - Antonio Pastore
- Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Alexandre Peltier
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | - Guillaume Ploussard
- Quint Fonsegrives and Institut Universitaire du Cancer, La Croix du Sud Hospital, Toulouse, France
| | - Thierry Roumeguère
- Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Giuseppe Simone
- Urology Department, Regina Elena National Cancer Institute, Rome, Italy
| | | | - John H Witt
- Department of Urology, St Antonius Hospital Gronau, Gronau, Germany
| | - Paolo Gontero
- Division of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Torino, Italy
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Marra G, Zhuang J, Beltrami M, Calleris G, Zhao X, Marquis A, Kan Y, Oderda M, Huang H, Faletti R, Zhang Q, Molinaro L, Wang W, Bergamasco L, Guo H, Gontero P. Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases. BJU Int 2020; 127:122-130. [PMID: 32455504 DOI: 10.1111/bju.15121] [Citation(s) in RCA: 20] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the outcomes of multiparametric magnetic resonance imaging (mpMRI) transperineal targeted fusion biopsy (TPFBx) under local anaesthesia. PATIENTS AND METHODS We prospectively screened 1327 patients with a positive mpMRI undergoing TPFBx (targeted cores and systematic cores) under local anaesthesia, at two tertiary referral institutions, between September 2016 and May 2019, for inclusion in the present study. Primary outcomes were detection of clinically significant prostate cancer (csPCa) defined as (1) International Society of Urological Pathologists (ISUP) grade >1 or ISUP grade 1 with >50% involvement of prostate cancer (PCa) in a single core or in >2 cores (D1) and (2) ISUP grade >1 PCa (D2). Secondary outcomes were: assessment of peri-procedural pain (numerical rating scale [NRS]) and procedure timings; erectile (International Index of Erectile Function) and urinary (International Prostate Symptom Score) function changes; and complications. We also investigated the value of systematic sampling and concordance with radical prostatectomy (RP). RESULTS A total of 1014 patients were included, of whom csPCa was diagnosed in 39.4% (n = 400). The procedure was tolerable (NRS pain score 3.1 ± 2.3), with no impact on erectile (P = 0.45) or urinary (P = 0.58) function, and a low rate of complications (Clavien-Dindo grades 1 or 2, n = 8; grade >2, n = 0). No post-biopsy sepsis was recorded. Twenty-two men (95% confidence interval [CI] 17-29) needed to undergo additional systematic biopsy to diagnose one csPCa missed by targeted biopsies (D1). ISUP grade concordance of biopsies with RP was as follows: k = 0.40 (95% CI 0.31-0.49) for targeted cores alone and k = 0.65 (95% CI 0.57-0.72; P < 0.05) overall. CONCLUSIONS The use of TPFBx under local anaesthesia yielded good csPCa detection and was feasible, quick, well tolerated and safe. Infectious risk was negligible. Addition of systematic to targeted cores may not be needed in all men, although it improves csPCa detection and concordance with RP.
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Affiliation(s)
- Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Junlong Zhuang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Mattia Beltrami
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Giorgio Calleris
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Xiaozhi Zhao
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Yansheng Kan
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Marco Oderda
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Haifeng Huang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Riccardo Faletti
- Department of, Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Qing Zhang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Luca Molinaro
- Department of, Pathology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Wei Wang
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Laura Bergamasco
- Department of, Radiology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Hongqian Guo
- Department of, Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing University, Nanjing, Jiangsu, China
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
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Marra G, Zhuang J, Beltrami M, Marquis A, Zhao X, Calleris G, Kan Y, Oderda G, Huang H, Faletti R, Zhang Q, Molinaro L, Wang W, Bergamasco L, Guo H, Gontero P. Outcomes and predictors of pain in men undergoing transperineal free-hand mpMRI fusion-targeted biopsies under local anesthesia: A multicenter prospective study of 1008 patients. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gandaglia G, Ploussard G, Valerio M, Mattei A, Marra G, Beauval J, Malavaud B, Roumiguié M, Marquis A, Fossati N, Scalvi F, Robesti D, Rizzo A, Stabile A, Afferi L, Moschini M, Rakauskas A, Van Den Bergh R, De Cobelli F, Fiori C, Porpiglia F, Gontero P, Montorsi F, Briganti A. The added value of concomitant systematic biopsy in predicting biochemical recurrence after radical prostatectomy in patients with prostate cancer diagnosed by MRI-targeted biopsy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33882-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Calleris G, Marra G, Zhuang J, Beltrami M, Zhao X, Marquis A, Kan Y, Oderda M, Greco A, Zitella A, Bisconti A, Huang H, Faletti R, Zhang Q, Molinaro L, Falcone M, Cappuccelli S, Wang W, Barale M, Giordano A, Agnello M, Guo H, Gontero P. Transperineal free-hand mpMRI targeted prostate biopsies under local anesthesia: A preliminary analysis of learning curves. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Marra G, Zhuang J, Beltrami M, Calleris G, Zhao X, Marquis A, Kan Y, Oderda M, Huang H, Faletti R, Zhang Q, Molinaro L, Tappero S, D’Agate D, Wang W, Bergamasco L, Guo H, Gontero P. Do we need addition of systematic cores when performing transperineal mpMRI targeted biopsy under local anesthesia? Results of a multicenter prospective study of 1,014 cases. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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