Background:Lower urinary tract symptoms (LUTS) and pain are clinically relevant problems after transurethral resection (TURBT) of nonmuscle-invasive bladder cancer. Although intravesical instillation of hyaluronic acid has already been proven to be a valid treatment for storage LUTS and pain in patients with inflammatory bladder syndrome, its efficacy in patients who undergo TURBT is unknown. This study aimed to present the results of a prospective, randomized, controlled, clinical pilot study on the safety and clinical performance of HydealCyst (Fidia Farmaceutici S.p.A., Italy), a device formulated to provide progressive, long-lasting intravesical release of hyaluronic acid. Materials and methods:Adults diagnosed with nonmuscle-invasive bladder cancer and scheduled for TURBT were included and underwent 4 visits up to 25 days after TURBT. Of the 47 patients who completed the investigation, 25 participants received 2 postoperative intravesical instillations with HydealCyst. The efficacy of HydealCyst on storage LUTS, pain, urinary symptoms, and patients' quality of life was evaluated using validated questionnaires. Results:Although the overall LUTS were similar in the 2 experimental groups, lower micturition frequency and fewer daytime micturitions were observed in patients treated with HydealCyst. These patients also showed a significant reduction in pain (p = 0.03) 3 days after catheter removal and better quality of life at the end of the study. The device was well tolerated, with no treatment-emergent adverse events of severe intensity. Conclusion:The results from this pilot study indicate a clinically meaningful improvement of symptoms after 2 instillations of HydealCyst, supporting this intervention as a potentially effective treatment for LUTS and pain after TURBT.

This prospective imaging trial was designed to compare [68Ga]PSMA-11 PET/CT with multiparametric MRI (mpMRI) in parallel in men with suspicion of prostate cancer (PCa) after at least one previous negative biopsy (ClinicalTrials.gov: NCT05297162; GR-2018-12366240). Between April 2022 and June 2025, we enrolled 130 patients who met the inclusion criteria and completed protocol investigations. Target lesions were defined based on PI-RADS v2.1 for mpMRI and PRIMARY Score, SUVmax and SUVratio for [68Ga]PSMA-11 PET/CT. Findings were statistically correlated with pathology results. Subsequently, we developed a nomogram to predict clinically significant PCa (csPCa), defined as International Society of Urological Pathology [ISUP] grade ≥ 2, using Boruta’s algorithm for variable selection. Median age in our cohort was 65.5 years (range, 50.5–82.2) and median PSA 9.7 ng/ml (range, 4–35). According to pathology, 20 patients (15.4

288 Background: The current study is designed to evaluate the role of PSMA PET/CT for response prediction in prostate cancer (PCa) patients who are candidates for High-Intensity Focused Ultrasound (HIFU) focal therapy (FT). Methods: BetweenOctober 2020 and June 2023, overall 65 patients have been enrolled in our prospective, single-center study. Inclusion criteria were: PSA<20ng/mL, radiological stage ≤T2bN0M0, ISUP grade 1-3, PSMA PET/CT at baseline and at response evaluation 6-12 months post-treatment. Follow up included: PSA at 3, 6 and 12 months. Post-treatment biopsies were scheduled per-protocol at 12 months or earlier if imaging suspicious. Biochemical response and treatment failure were correlated to mpMRI and PSMA PET data, comprising PI-RADS, Primary score, SUVmax, SUVratio, and their variations after HIFU FT. Results: Median age was 67 years (range 53-80), initial PSA (iPSA) was 6.56ng/mL (range 2.25-13.25) and prostate volume was 45mL (range 20-160). The majority of the patients presented with ISUP 1 (66%). mpMRI results were: 14 patients with PI-RADS 1-2 (21.5%) and 51 with PI-RADS 3-4. Baseline Primary scores were: 30 score 1-2 (45%), and 35 score 3-5. Median baseline SUVmax and SUVratio resulted 5.4 (range 1.5-33.2) and 1.43 (range 0.86-9.39), respectively. At 3 months post-HIFU, 23% of the patients obtained a PSA response ≥50%; whereas at 6 months and 12 months, PSA responses were 26% and 45%, respectively. Post-treatment PSMA PET/CT was available in 40 patients. Median SUVmax and SUVratio post-treatment resulted 3.4 (range 1.4-28.4) and 1.1 (range 0.64-10), respectively, with a median ΔSUVmax of 39% and ΔSUVratio of 42%. There was a moderate negative correlation between post-treatment SUVmax and SUVratio with PSA response at 12 months (rho=-0.504, p=0.0280, and rho=-0.521, p=0.0231, respectively), while a positive moderate correlation was confirmed for ΔSUVmax (rho=0.475, p=0.0383). PET parameters were also statistically significantly correlated to treatment failure at 12months (p=0.020, p=0.048 and p=0,04, respectively for SUVmax, SUVratio and Primary), with Primary scores confirmed as predictive on logistic regression (OR=10.5; 95%CI 1.12-98.9). Conclusions: PSMA PET/CT provides useful information for treatment monitoring in PCa patients undergoing HIFU FT. Baseline and post-treatment SUV parameters and Primary score can predict biochemical response and treatment failure at 12 months post-completion.

This record contains raw data related to article "Diagnostic performance of microUltrasound at MRI-guided confirmatory biopsy in patients under active surveillance for low-risk prostate cancer" Abstract Background: Active surveillance (AS) represents a standard of care of low-risk prostate cancer (PCa). However, the identification and monitoring of AS candidates remains challenging. Microultrasound (microUS) is a novel high-resolution imaging modality for transrectal ultrasonography (TRUS). We explored the impact of microUS TRUS and targeted biopsies in mpMRI-guided confirmatory biopsies. Methods: Between October 2017 and September 2021, we prospectively enrolled 100 patients scheduled for MRI-guided confirmatory biopsy at 1 year from diagnosis of ISUP 1 PCa. TRUS was performed using the ExactVu microUS system; PRI-MUS protocol was applied to identify suspicious lesions (i.e., PRIMUS score ≥ 3). All patients received targeted biopsies of any identified microUS and mpMRI lesions and complementary systematic biopsies. The proportion of patients upgraded to clinically significant PCa (defined as ISUP ≥ 2 cancer; csPCa) at confirmatory biopsies was determined, and the diagnostic performance of microUS and mpMRI were compared. Results: Ninety-two patients had a suspicious MRI lesion classified PI-RADS 3, 4, and 5 in respectively 28, 16, and 18 patients. MicroUS identified 82 patients with suspicious lesions, classified as PRI-MUS 3, 4, and 5 in respectively 20, 50, and 12 patients, while 18 individuals had no lesions. Thirty-four patients were upgraded to ISUP ≥ 2 cancer and excluded from AS. MicroUS and mpMRI showed a sensitivity of 94.1% and 100%, and an NPV of 88.9% and 100%, respectively, in detecting ISUP ≥ 2 patients. A microUS-mandated protocol would have avoided confirmatory biopsies in 18 patients with no PRI-MUS ≥ 3 lesions at the cost of missing four upgraded patients. Conclusions: MicroUS and mpMRI represent valuable imaging modalities showing high sensitivity and NPV in detecting csPCa, thus allowing their use for event-triggered confirmatory biopsies in AS patients. MicroUS offers an alternative imaging modality to mpMRI for the identification and real-time targeting of suspicious lesions in AS patients.

You have accessJournal of UrologyCME1 Apr 2023MP73-16 SUV VARIATION ON PSMA PET/CT CORRELATES WITH BIOCHEMICAL RESPONSE IN PATIENTS WITH PROSTATE CANCER UNDERGOING HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU) FOCAL THERAPY Egesta Lopci, Giovanni Lughezzani, Vittorio Fasulo, Davide Maffei, Emmanuella Nana Yaa Dede Adjaye, Alberto Saita, Piergiuseppe Colombo, Rodolfo Hurle, Marzo Katia, Roberto Peschechera, Alessio Benetti, Silvia Zandegiacono, Luisa Pasini, Paolo Casale, Luca Balzarini, Arturo Chiti, Giorgio Guazzoni, Nicolò Maria Buffi, and Massimo Lazzeri Egesta LopciEgesta Lopci More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Emmanuella Nana Yaa Dede AdjayeEmmanuella Nana Yaa Dede Adjaye More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Piergiuseppe ColomboPiergiuseppe Colombo More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Marzo KatiaMarzo Katia More articles by this author , Roberto PeschecheraRoberto Peschechera More articles by this author , Alessio BenettiAlessio Benetti More articles by this author , Silvia ZandegiaconoSilvia Zandegiacono More articles by this author , Luisa PasiniLuisa Pasini More articles by this author , Paolo CasalePaolo Casale More articles by this author , Luca BalzariniLuca Balzarini More articles by this author , Arturo ChitiArturo Chiti More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , and Massimo LazzeriMassimo Lazzeri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy (FT) for localized prostate cancer (PCa) offers minimally invasive localized ablative treatment while minimizing treatment-related toxicity compared to standard radical options. Recent advances in PCa imaging with PSMA PET/CT offer new opportunities to detect PCa foci and monitor response to treatment. The current study is designed to evaluate the role of PSMA PET/CT for response assessment in PCa patients candidate to High-Intensity Focused Ultrasound (HIFU) focal therapy. METHODS: The present analyses was conducted in patients enrolled in an ongoing, prospective, single-center cohort study of patients treated with HIFU FT for localized PCa. Inclusion criteria: PSA<20 ng/mL, radiological stage≤T2bN0M0, ISUP grade 1-3, PSMA PET/CT at baseline and at response evaluation. Follow up included: PSA at 3, 6 and 12 months; PSMA PET/CT between 6-12 months post treatment. Biochemical response and PET response were statistically correlated: SUVmax and SUVratio to background of the target lesions were used as semi-quantitative parameters for PSMA PET/CT, together with their variations before and after HIFU FT (i.e. ΔSUVmax and ΔSUVratio). RESULTS: Overall, 23 patients met inclusion criteria for the analysis. Median age was 67 years (IQR 63-72), initial PSA (iPSA) was 5.9 ng/mL (IQR 5.2-8.7) and prostate volume was 40 mL (IQR 35.8-50.8). ISUP score was 1 in 16 (70%) patients and 2 in the remaining 7 (30%). Median SUVmax and SUVratio before treatment resulted 3.4 (IQR 2.6-6.3) and 1.4 (IQR 1.1-1.8), respectively. At 3 months post-HIFU, 35% of the patients obtained a PSA response≥50%; whereas at 6 months and 12 months, PSA responses were 35% and 36%, respectively. Median SUVmax and SUVratio post-treatment resulted 2.5 (IQR 1.7-3.4) and 0.9 (IQR 0.7-1.0), respectively, proving a statistically significant reduction compared to baseline values (p=0.048 and 0.0051, respectively). Median ΔSUVmax -22% and ΔSUVratio resulted-30%. There was a statistically significant correlation of ΔSUVmax and PSA response at 12 months post-HIFU (p=0.021) (Figure). CONCLUSIONS: PSMA-PET may be a useful tool for monitoring response in PCa patients undergoing HIFU FT. Moreover, the SUV variation can predict biochemical response at 12 months post-treatment completion. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1041 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Egesta Lopci More articles by this author Giovanni Lughezzani More articles by this author Vittorio Fasulo More articles by this author Davide Maffei More articles by this author Emmanuella Nana Yaa Dede Adjaye More articles by this author Alberto Saita More articles by this author Piergiuseppe Colombo More articles by this author Rodolfo Hurle More articles by this author Marzo Katia More articles by this author Roberto Peschechera More articles by this author Alessio Benetti More articles by this author Silvia Zandegiacono More articles by this author Luisa Pasini More articles by this author Paolo Casale More articles by this author Luca Balzarini More articles by this author Arturo Chiti More articles by this author Giorgio Guazzoni More articles by this author Nicolò Maria Buffi More articles by this author Massimo Lazzeri More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND:The aim of this study was to identify the predictive factors for progression defined as any event that shifted the management of the disease from a bladder sparing approach, by comparing patients with pure versus non-pure carcinoma in situ (CIS) of the bladder.METHODS:A retrospective analysis was carried out in consecutive patients affected by newly-diagnosed pure CIS and non-pure CIS (excluding cases with concomitant muscle invasive cancer). All patients were enrolled a in our institution from 1998 to 2010. Data was prospectively collected. Main end point was progression-free survival.RESULTS:Overall, 149 patients with CIS were identified for the analysis. A total of 98 patients had pure CIS (66%). Median follow-up was 103 months (range: 40-206 months). Progression occurred in 29 patients (19%). A total of 30 patients died during the follow-up (20%). In 13 cases (9%), the death was cancer specific. Progression-free survival estimate was 181 months (95% CI: 169-193 months) and 154 months (95% CI: 133-176 months) respectively for pure and non-pure CIS population (P=0.03). Among examined variables (age, gender, symptoms, smoking habit, ASA score, number of bacillus Calmette-Guérin [BCG] instillations), multivariate analysis disclosed that only CIS type was an independent predictor of progression (P=0.03) with a relative risk of 0.37 in favor of pure CIS.CONCLUSIONS:Pure and non-pure CIS are efficiently treated by BCG therapy combined with trans-urethral resection and/or radical cystectomy, with relatively low rate of progression. CIS type was the only significant predictor of progression.

Background: Positron emission tomography (PET)/computed tomography (CT) with Ga-68-labeled prostate-specific membrane antigen ligand (Ga-68-PSMA) may represent the most promising alternative to multiparametric magnetic resonance imaging (mpMRI) for prostate cancer (PCa) diagnosis. Objective: To test the diagnostic performance of Ga-68-PSMA PET/CT in this clinical context. Design, setting, and participants: From January 2017 to December 2018 we prospectively enrolled 97 patients with persistently elevated prostate-specific antigen and/or Prostate Health Index score, negative digital rectal examination, and previous negative biopsy. We also included patients with either negative mpMRI or contraindications to or positive mpMRI but previous negative biopsy. Intervention: Patients underwent 68Ga-PSMA PET/CT with additional pelvic reconstruction. Outcome measurements and statistical analysis: The primary endpoint of the study was the diagnostic performance of Ga-68-PSMA PET/CT in detecting malignant lesions and clinically significant PCa (Gleason score [GS] >= 7). Results and limitations: Ga-68-PSMA PET/transrectal ultrasound fusion biopsy was performed in 64 of 97 patients (66%) for 114 regions of interest (ROIs). Forty patients (41%) had already undergone mpMRI with either a negative result for PCa (n = 15; 22 ROIs) or a positive mpMRI result but a previous negative biopsy. According to pathology, 23 patients (36%) had evidence of PCa: eight (16 ROIs) with GS 6. 13 (21 ROIs) with GS 7 (3 + 4 or 4+ 3), one (2 ROIs) with GS 8, and one (2 ROIs) with GS 10. Clinically significant PCa was identified in four patients with previous negative mpMRI (25%). PET/CT demonstrated PCa in seven patients (14 ROls) with previous positive mpMRI and negative biopsy. The median maximum standardized uptake value (SUVmax) and median SUV ratio were significantly higher for PCa lesions than for benign lesions (p < 0.001). Optimal cutoff points obtained for SUVmax (>5.4) and SUV ratio (>2.2) could identify clinically significant PCa with accuracy of 81% and 90%, respectively. Conclusions: In our cohort of patients with high suspicion of cancer, Ga-68-PSMA PET/CT was capable of detecting malignancy and accurately identifying clinically relevant PCa. Patient summary: Positron emission tomography/computed tomography with a Ga-68-labeled ligand for prostate-specific membrane antigen is capable of detecting prostate cancer in patients with a high suspicion of cancer and a previous negative biopsy. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Objectives: Stereotactic body radiation treatment represents an intriguing therapeutic option for patients with early-stage prostate cancer. In this phase II study, stereotactic body radiation treatment was delivered by volumetric modulated arc therapy with flattening filter free beams and was gated using real-time electromagnetic transponder system to maximize precision of radiotherapy and, potentially, to reduce toxicities. Materials and Methods: Patients affected by histologically proven prostate adenocarcinoma and National Comprehensive Cancer Network (NCCN) intermediate class of risk were enrolled in this phase II study. Beacon transponders were positioned transrectally within the prostate parenchyma 7 to 10 days before simulation computed tomography scan. The radiotherapy schedule was 38 Gy in 4 fractions delivered every other day. Toxicity assessment was performed according to Common Terminology Criteria for Adverse Events (CTCAE), v4.0. Results: Thirty-six patients were enrolled in this study. Median initial prostate-specific antigen was 7.0 ng/mL (range: 2.3 to 14.0 ng/mL). Median nadir–prostate-specific antigen after treatment was 0.2 ng/mL (range: 0.006 to 4.8 ng/mL). A genitourinary acute toxicity was observed in 21 patients (dysuria grade [G] 1: 41.7%, G2: 16.7%). Gastrointestinal acute toxicity was found in 9 patients (proctitis G1: 19.4%, G2: 5.6%). Late toxicity was mild (genitourinary toxicity G1: 30.6%; G2: 8.3%; gastrointestinal toxicity G1: 13.9%; G2: 19.4%). At a median follow-up time of 41 months, 3 biochemical recurrences were observed (2 local recurrences, 1 distant metastasis). Three-year biochemical recurrence-free survival was 89.8% (International Society of Urologic Pathology Grade Group 2: 100%, Grade Group 3: 77.1%, P=0.042). Conclusion: Ultrahypofractionated radiotherapy, delivered with flattening filter free-volumetric modulated arc therapy and gated by electromagnetic transponders, is a valid option for intermediate-risk prostate cancer.

This record contains raw data related to article "Long-term outcomes of high-grade T1 bladder cancer treated with intravesical bacillus Calmette-Guérin: experience of a single center" BACKGROUND: To assess the outcomes of patients with high-grade (HG) pT1 bladder cancer (BC) treated with intravesical BCG therapy. METHODS: The study population consisted of 185 patients with HG pT1 BC treated between 1998 and 2010. We aimed to determine recurrence-free (RFS) and progression-free survival (PFS), as well as the predictors of RFS and PFS. RESULTS: Overall, 143 (77.3%) patients were males. Median age was 72 years (IQR: 66-78). Tumor size was ≥3 cm in 100 (54.1%) individuals. Most patients had single tumors (125; 67.6%). Primary, progressive and recurrent patterns of presentation were observed in 146 (78.9%), 21 (11.4%), and 18 (9.7%) cases, respectively. After 2nd-look TURB, 127 (68.6%) patients had no residual disease, 44 (23.8%) had Ta/CIS, and 14 (7.6%) had T1 HG BC. Twenty-two (11.9%) patients experience early recurrence after BCG. Of these, 12 patients (54.5%) were diagnosed with Ta/CIS, while 10 (45.5%) were diagnosed with HG pT1 BC. The median follow-up was 93 months (IQR: 63-147). Ten-year RFS and PFS rates were 69.6 and 79.2%. In multivariable Cox regression models, female gender (HR=2.41; P=0.001), progressive (HR=2.03; P=0.030) and recurrent (HR=3.87; P<0.001) pattern of presentation emerged as independent predictors of RFS, while age ≥70 years (HR=2.13; P=0.027), presence of multiple tumors (HR=2.06; P=0.019), and early recurrence (HR=3.88; P<0.001) emerged as independent predictors of PFS. CONCLUSIONS: Intravesical BCG appears to be an effective treatment for HG pT1 BC. Caution should be used in patients aged ≥70 years, with multiple tumors or experiencing early recurrence.

You have accessJournal of UrologyBladder Cancer: Non-invasive II (PD18)1 Apr 2019Bladder Cancer: Non-invasive II (PD18) View All Author Informationhttps://doi.org/10.1097/01.JU.0000558561.73805.83AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyBladder Cancer: Non-invasive II (PD18)1 Apr 2019PD18-05 XPERTBLADDER MONITOR TEST FOR FAILURE DEFINITION OF PATIENTS UNDER ACTIVE SURVEILLANCE FOR RECURRENT LOW-RISK NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) WITH NEGATIVE CITOLOGY Rodolfo Hurle*, Alberto Saita, Massimo Lazzeri, Paolo Casale, NicoloMaria Buffi, Giovanni Lughezzani, Vittorio Fasulo, Giulio Bevilacqua, Marco Paciotti, Luigi Domanico, Davide Maffei, Luisa Pasini, and Giorgio Guazzoni Rodolfo Hurle*Rodolfo Hurle* More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Paolo CasalePaolo Casale More articles by this author , NicoloMaria BuffiNicoloMaria Buffi More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Giulio BevilacquaGiulio Bevilacqua More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Luigi DomanicoLuigi Domanico More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Luisa PasiniLuisa Pasini More articles by this author , and Giorgio GuazzoniGiorgio Guazzoni More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555577.46578.24AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Active surveillance (AS) has been showed to be feasible and effective in a sub-set of patients with recurrent low-grade non-muscle invasive bladder cancer (LG-NMIBC). Xpert BC Monitor is a new mRNA-marker test for BC follow-up, which measures the levels of five target mRNAs from a voided urine sample by real-time RT- PCR. The aim of this study was to test the hypothesis that Xpert Bladder monitor test may improve the diagnosis of failure and avoid unnecessary TURBT in patients under AS. METHODS: This is a prospective observational cohort study of patients with a previous pathologically confirmed NMIBC, who experienced recurrence during follow-up and accepted to undergo AS according to the Bladder Cancer Italian Active Surveillance project (BIAS_ICH_V1.2_27.01.2018). in addition to urine cytology, urinary samples were analysed using Xpert BC Monitor (Cepheid, Sunnyvale, CA, USA) at each follow-up or at entry in case of a new episode of AS, measuring the gene expression levels of five targets (ABL1, CRH, IGF2, UPK1B, ANXA10) by RT-PCR according to the manufacturer's protocol. The primary end point was to compare Xpert BC Monitor results, with urine cytology, cystoscopy imaging and pathological assessment in case of active treatment (TURBT) for AS failure. Data were complemented by descriptive statistical analysis and the sensitivity, specificity, PPVs and NPVs were calculated. RESULTS: Of 63 patients (mean age 73.3 yrs ± 9.6; male/female 45/18) who were tested with Xpert BC Monitor, 42 were positive, 19 negative and 2 tests resulted invalid. Forty-three patients were deemed to have malignant lesions and 18 patients were suspected benign according to cystoscopic imaging. No patient of the whole cohort had a positive urine cytology. Xpert BC Monitor was positive in 40 patients with malignant lesions and in 2 suspected benign patients (11.%), resulting in a sensitivity of 93% and a specificity of 89%. Twelve (19%) patients of these 63 patients required treatment because the lesions had grown or progressed. In this subset the sensitivity of Xpert BC Monitor was 91%. Forty-nine patients remained under AS. As two patients had invalid Xpert BC Monitor results, in the remaining 47 patients, Xpert BC Monitor had a sensitivity of 86.2% with a specificity of 72.2%, PPV of 83.3% and NPV of 76.4%. CONCLUSIONS: Xpert BC Monitor correctly identified most patients in AS with LG malignant lesions and negative urine cytology. Negative Xpert BC monitor could avoid unnecessary TURBT and its combination with other tools might improve accuracy of decision making. Source of Funding: None Rozzano, Italy© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e313-e313 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rodolfo Hurle* More articles by this author Alberto Saita More articles by this author Massimo Lazzeri More articles by this author Paolo Casale More articles by this author NicoloMaria Buffi More articles by this author Giovanni Lughezzani More articles by this author Vittorio Fasulo More articles by this author Giulio Bevilacqua More articles by this author Marco Paciotti More articles by this author Luigi Domanico More articles by this author Davide Maffei More articles by this author Luisa Pasini More articles by this author Giorgio Guazzoni More articles by this author Expand All Advertisement PDF downloadLoading ...

IRIS è la soluzione IT che facilita la raccolta e la gestione dei dati relativi alle attività e ai prodotti della ricerca. Fornisce a ricercatori, amministratori e valutatori gli strumenti per monitorare i risultati della ricerca, aumentarne la visibilità e allocare in modo efficace le risorse disponibili … SIUrO PRIAS ITA WORKING GROUP: 9-YEAR EXPERIENCE OF ACTIVE SURVEILLANCE / Badenchini F; Zollo F; Altieri V; Barbaresi U; Battaglia M; Enrico B; Borghesi M; Cicchetti G; Colombo P; Colecchia M; Da Pozzo L; Ditonno P; Fabiano M; Fiorentino M; Frizzi J; Frego E; Gallucci M; Grimaldi G; Guazzoni G; Hurle R; Lapini A; Maiorino F; Minisola F; Montironi R; Napodano G; Paganelli A; Paolini B; Pasini L; Patriarca C; Pili A; Ranieri A; Raspollini MR; Roscigno M; Sanseverino R; Sentinelli S; Tanello M; Turci A; Rancati T; Magnani T; Luiting H; Conti G; Valdagni R. - 39:3(2019), pp. 1596-1598 … Non ci sono file associati a questo prodotto.

You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2018MP55-17 NEW CONCEPTION FOR FLEXOR VUE DEFLECTING ENDOSCOPIC SYSTEM USE, IN ORDER TO IMPROVE STONE FREE RATE (SFR) AFTER RIRS: PRELIMINARY RESULTS FROM A SINGLE CENTRE STAGE 2A STUDY Alberto Saita, Paolo Casale, Massimo Lazzeri, NicolòMaria Buffi, Rodolfo Hurle, Roberto Peschechera, Giovanni Lughezzani, Alessio Benetti, Luisa Pasini, Silvia Zandegiacomo, Giuliana Lista, Pasquale Cardone, and Giorgio Guazzoni Alberto SaitaAlberto Saita More articles by this author , Paolo CasalePaolo Casale More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , NicolòMaria BuffiNicolòMaria Buffi More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Roberto PeschecheraRoberto Peschechera More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Alessio BenettiAlessio Benetti More articles by this author , Luisa PasiniLuisa Pasini More articles by this author , Silvia ZandegiacomoSilvia Zandegiacomo More articles by this author , Giuliana ListaGiuliana Lista More articles by this author , Pasquale CardonePasquale Cardone More articles by this author , and Giorgio GuazzoniGiorgio Guazzoni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1788AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stone extraction devices have become a routine tool after RIRS. Perforation and avulsion of the ureter wall, due to excessive force on the extraction device, are serious complications of basketing. Furthermore timing of basketing may have a significant impact on procedure total time. We tested the hypothesis that the use of Flexor Vue Deflecting Endoscopic System used as ureteral access sheath (UAS) may increase the SFR after RIRS thanks to the Bernulli's principle. METHODS This is a prospective, observational, single-center stage 2a study with data collected on consecutive patients treated for renal stones. Patients 18 year-old or older, candidates for RIRS of medium size (1.5-2.5 cm) renal stones as primary treatment or after failed previous treatment were cases of interest. Patients with multiple stones were excluded from study. All the procedures were performed using a 200 μm holmium fiber using a flexible ureterorenoscope and standard UAS. The Flexor Vue Deflecting Endoscopic System was positioned at the end of procedure in order to avoid basketing and improve SFR. The outcomes of interest are feasibility, safety and efficacy. Feasibility was defined as the capacity of positioning and favouring fragment removal according to the Bernulli's principle by the Flexor device. Safety was defined by complication analysis. Efficacy outcomes measured operative time, SFR, hospital stay, re-treatment and rehospitalization. SFR was defined as fragments less than 4 mm assessed by ultrasound and CT. Descriptive statistical analysis was applied. RESULTS 11 patients (M/F ratio: 7/4, mean age 63.5 ± 8.3) were treated. The stones were located in the lower calyces, and the renal pelvis in 3 and 8 patients, respectively. Medium stone size was 1.8 mm ± 3.2. The procedure with Flexor Vue Deflecting Endoscopic System was feasible in all the patients. Eight patients underwent preoperative ureteral stent. Mean operative time was 82 min ± 13.7 and median hospital stay was of 1.5 day. During the procedure the video channel was used as irrigating channel in order to favour fragment evacuation according to Bernoulli's principle. The SFR after 30 days was 81% (9/11). Post-operatively we had no significant bleeding, 1 patient with fever, who required antibiotic treatment for 5 days and no sepsis. No cost/effectiveness study was performed CONCLUSIONS The use of Flexor Vue Deflecting Endoscopic System seems to be feasible, safe and effective for patients with medium size (1.5 to 2.5 cm) renal stones. The technique we described could allow an easy non-invasive procedure for fragments evacuation. Further studies with larger population and under randomised setting, comparing with traditional flexible RIRS, are mandatory before the introduction of this technique in our clinical practice. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e754 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Alberto Saita More articles by this author Paolo Casale More articles by this author Massimo Lazzeri More articles by this author NicolòMaria Buffi More articles by this author Rodolfo Hurle More articles by this author Roberto Peschechera More articles by this author Giovanni Lughezzani More articles by this author Alessio Benetti More articles by this author Luisa Pasini More articles by this author Silvia Zandegiacomo More articles by this author Giuliana Lista More articles by this author Pasquale Cardone More articles by this author Giorgio Guazzoni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2018MP20-14 POSITIVE PROSTATE 68GAPSMA-PET/CT CORRELATES WITH DETECTION OF CD45-/PSMA+ NON-SPERM EPITHELIAL CELLS OBTAINED BY LIQUID BIOPSY OF SEMINAL FLUID IN PATIENTS WITH PROSTATE CANCER (PCA). Massimo Lazzeri, Egesta Lopci, Giovanni Lughezzani, Paolo Casale, Rodolfo Hurle, Alberto Saita, Roberto Peschechera, Alessio Benetti, Luisa Pasini, Silvia Zandegiacomo, Giuliana Lista, Pasquale Cardone, Arturo Chiti, Giorgio Guazzoni, Federico Colombo, Chiara Chiereghin, Rosanna Asselta, Piergiuseppe Colombo, Simona Monterisi, Giulia Soldà, Giulia Veronesi, and Stefano Duga Massimo LazzeriMassimo Lazzeri More articles by this author , Egesta LopciEgesta Lopci More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Paolo CasalePaolo Casale More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Roberto PeschecheraRoberto Peschechera More articles by this author , Alessio BenettiAlessio Benetti More articles by this author , Luisa PasiniLuisa Pasini More articles by this author , Silvia ZandegiacomoSilvia Zandegiacomo More articles by this author , Giuliana ListaGiuliana Lista More articles by this author , Pasquale CardonePasquale Cardone More articles by this author , Arturo ChitiArturo Chiti More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Federico ColomboFederico Colombo More articles by this author , Chiara ChiereghinChiara Chiereghin More articles by this author , Rosanna AsseltaRosanna Asselta More articles by this author , Piergiuseppe ColomboPiergiuseppe Colombo More articles by this author , Simona MonterisiSimona Monterisi More articles by this author , Giulia SoldàGiulia Soldà More articles by this author , Giulia VeronesiGiulia Veronesi More articles by this author , and Stefano DugaStefano Duga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.684AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate Specific Membrane Antigen (PSMA) presents high expression in PCa cells and has been considered an attractive target for molecular imaging. 68GaPSMA-PET/CT showed high detection rate of nodal and bone metastases and, recently, was tested for diagnosis of primary PCa. Seminal fluid (SF) might contain prostate-derived PSMA positive tumour cells in men with PCa and serve as diagnosis. In order to investigate the clinical reliability of 68GaPSMA-PET/CT for identification of primary PCa we tested the hypothesis that it correlates with detection of CD45-/PSMA+ non-sperm epithelial cells obtained by liquid biopsy of SF in patients with PCa. METHODS This is a nested analysis combining data from two observational, longitudinal, prospective studies. Patients with primary PCa detected by 68GaPSMA-PET/CT software assisted fusion biopsy (Protocol ICH/382/2016), who received an indication to radical prostatectomy (RP), had a sample of SF one month after the biopsy and just before the RP (Protocol ICH/1791/2017). The prostate-derived cells from semen (non sperm epithelial cells) were sorted using the fluorescence-activated cell sorting (FACSAria III - BD Biosciences, San Jose, USA) and the CD45 negative/PSMA positive (CD45-/PSMA+) served as markers of interest. The primary endpoint was to determine the relationship between 68GaPSMA-PET/CT results and detection of CD45-/PSMA+ non-sperm epithelial cells in SF. RESULTS Seven patients over 59, who had received a diagnosis of PCa by 68GaPSMA-PET/CT software assisted fusion biopsy and were scheduled for radical prostatectomy (RP), collected SF. The FACS procedure sorted non-sperm epithelial cells and CD45-/PSMA+ cell, as well, in SF of all the patients with positive imaging, but not in negative ones. Figure 1 presents the SF cytology of CD45-/PSMA+ sorted cells (arrow) and CD45+/PSMA- ones (*). CONCLUSIONS Our findings, by the first, showed a potential correlation between the 68GaPSMA-PET/CT, PCa and cancer-specific markers detected by SF liquid biopsy. These findings may represent the proof-of-concept to improve the role of 68GaPSMA-PET/CT for primary PCa diagnosis in a selected population and to further investigate the prostate cancer tumor elements by liquid biopsy of the SF. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e258 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Massimo Lazzeri More articles by this author Egesta Lopci More articles by this author Giovanni Lughezzani More articles by this author Paolo Casale More articles by this author Rodolfo Hurle More articles by this author Alberto Saita More articles by this author Roberto Peschechera More articles by this author Alessio Benetti More articles by this author Luisa Pasini More articles by this author Silvia Zandegiacomo More articles by this author Giuliana Lista More articles by this author Pasquale Cardone More articles by this author Arturo Chiti More articles by this author Giorgio Guazzoni More articles by this author Federico Colombo More articles by this author Chiara Chiereghin More articles by this author Rosanna Asselta More articles by this author Piergiuseppe Colombo More articles by this author Simona Monterisi More articles by this author Giulia Soldà More articles by this author Giulia Veronesi More articles by this author Stefano Duga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Purpose: We investigated predictive factors of failure and performed a resource consumption analysis in patients who underwent active surveillance for nonmuscle invasive bladder cancer. Materials and Methods: This prospective observational study monitored patients with a history of pathologically confirmed stage pTa (grade 1-2) or pT1a (grade 2) nonmuscle invasive bladder cancer, and recurrent small size and number of tumors without hematuria and positive urine cytology. The primary end point was the failure rate of active surveillance. Assessment of failure predictive variables and per year direct hospital resource consumption analysis were secondary outcomes. Descriptive statistical analysis and Cox regression with univariable and multivariable analysis were done. Results: Of 625 patients with nonmuscle invasive bladder cancer 122 with a total of 146 active surveillance events were included in the protocol. Of the events 59 (40.4%) were deemed to require treatment after entering active surveillance. Median time on active surveillance was 11 months (IQR 5-26). Currently 76 patients (62.3%) remain under observation. On univariable analysis only time from the first transurethral resection to the start of active surveillance seemed to be inversely associated with recurrence-free survival (HR 0.99, 95% CI 0.98e1.00, p = 0.027). Multivariable analysis also revealed an association with age at active surveillance start (HR 0.97, 95% CI 0.94-1.00, p = 0.031) and the size of the lesion at the first transurethral resection (HR 1.55, 95% CI 1.06-2.27, p = 0.025). The average specific annual resource consumption savings for each avoided transurethral bladder tumor resection was V1,378 for each intervention avoided. Conclusions: Active surveillance might be a reasonable clinical and cost-effective strategy in patients who present with small, low grade pTa/pT1a recurrent papillary bladder tumors.

This record contains raw data related to article 68Ga-PSMA Positron Emission Tomography/Computerized Tomography for Primary Diagnosis of Prostate Cancer in Men with Contraindications to or Negative Multiparametric Magnetic Resonance Imaging: A Prospective Observational Study PURPOSE: 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography may represent the most promising imaging modality to identify and risk stratify prostate cancer in patients with contraindications to or negative multiparametric magnetic resonance imaging. MATERIALS AND METHODS: In this prospective observational study we analyzed 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography in a select group of patients with persistently elevated prostate specific antigen and/or Prostate Health Index suspicious for prostate cancer, negative digital rectal examination and at least 1 negative biopsy. The cohort comprised men with equivocal multiparametric magnetic resonance imaging (Prostate Imaging-Reporting and Data System, version 2 score of 2 or less), or an absolute or relative contraindication to multiparametric magnetic resonance imaging. Sensitivity, specificity and CIs were calculated compared to histopathology findings. ROC analysis was applied to determine the optimal cutoff values of 68Ga labeled prostate specific membrane antigen uptake to identify clinically significant prostate cancer (Gleason score 7 or greater). RESULTS: A total of 45 patients with a median age of 64 years were referred for 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography between January and August 2017. The 25 patients (55.5%) considered to have positive positron emission tomography results underwent software assisted fusion biopsy. We determined the uptake values of regions of interest, including a median maximum standardized uptake value of 5.34 (range 2.25 to 30.41) and a maximum-to-background standardized uptake value ratio of 1.99 (range 1.06 to 14.42). Mean and median uptake values on 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography (ie the maximum standardized uptake value or the maximum-to-background standardized uptake value ratio) were significantly higher for Gleason score 7 lesions than for Gleason score 6 or benign lesions (p <0.001). On ROC analysis a maximum standardized uptake value of 5.4 and a maximum-to-background standardized uptake value ratio of 2 discriminated clinically relevant prostate cancer with 100% overall sensitivity in each case, and 76% and 88% specificity, respectively. CONCLUSIONS: Our findings support the use of 68Ga labeled prostate specific membrane antigen positron emission tomography/computerized tomography for primary detection of prostate cancer in a specific subset of men.

portions of this surgery is overlooked and to date has not been reported.This study aimed to quantify fluoroscopic radiation exposure during renal tract dilation for patients undergoing PCNL at a high-volume stone center.METHODS: From October 2015 to October 2017, consecutive patients who underwent PCNL at the University of California San Francisco (UCSF) with two surgeons had total fluoroscopic time and cumulative radiation dose during PCNL recorded for this prospective cohort study.As part of the Registry for Stones of the Kidney and Ureter (ReSKU), intraoperative characteristics are recorded.Patients who underwent PCNL with only ultrasound (US) for renal tract access and dilation, US for renal tract access and fluoroscopy for dilation (US-FL), and fluoroscopy only (FL) for renal tract access and dilation were compared.Multivariate linear regression analysis was performed to examine factors associated with increased cumulative dosage.RESULTS: A total of 243 patients underwent 274 PCNL operations during the study period.Of these, 152 were US, 74 FL, and 48 US-FL.There were no statistically significant differences in mean patient age, BMI, stone burden, or stone free rates across the 3 groups.While the US group received no radiation exposure, the FL and US-FL groups were exposed to means of 181.5 vs 88.4 seconds total fluoroscopy time and 41.8 vs 17.7 mGy cumulative radiation dose respectively (p<0.01).Multivariate linear regression revealed a statistically significant association of higher cumulative radiation dose with both BMI and operative time in all groups (p<0.01).CONCLUSIONS: Nearly half of intraoperative radiation exposure during PCNL occurs during renal tract dilation compared to access.Adopting ultrasound or alternative approaches to fluoroscopy to guide tract dilation can have a significant impact on reducing total radiation exposure for patients and providers.Efforts to try and limit the amount of radiation exposure after gaining access during PCNL warrant further study.