In the era of risk-based prostate cancer (PCa) screening, overcoming the limitations of prostate-specific antigen (PSA) testing and stratifying men by individual risk is crucial. Our study aims to integrate anamnestic and lifestyle data with circulating biomarkers to minimize unnecessary second-level investigations (SLIs) for patients with suspected PCa, while improving the detection of clinically significant PCa (ISUP > 1). We collected plasma samples, recent clinical history, family cancer history, PSA levels, and lifestyle information from 904 men: 421 undergoing PSA testing, 421 with suspected and 62 with confirmed PCa. Univariable logistic regression was applied to identify ananmestic and lifestyle variables mostly associated with PCa. Penalized logistic regression models predictive of PCa or ISUP > 1 PCa were built both using the 814 subjects with complete information for such variables, applying a 10-fold cross validation approach, and dividing the dataset into a training (n = 445: 132 PCa, 313 non-PCa) and a test (n = 369: 147 PCa, 222 non-PCa) set. The concentration of 50 sphingolipids was analysed on the latter set of 369 subjects by mass-spectrometry, and multivariable penalized regression with 10-fold cross-validation was applied to integrate anamnestic, lifestyle, sphingolipid data. ROC-AUCs on the test sets were compared with PSA ROC-AUCs. Age, cardiovascular disease (CVD), number of medications, and sedentariness were significantly associated with PCa detection and their combination with PSA improved its performance (ROC-AUC from 0.85 to 0.89). In the SLI subgroup (n = 437), adding age improved PSA predictive power (ROC-AUC from 0.60 to 0.70), but performance was still poor. Penalized regression with 10-fold cross-validation on the sphingolipid dataset identified hypertension, CVD, PSA, age, and five sphingolipids (HexCer-20, Cer-20, HexCer-24.1, GM3-24.1, DHCer-24) as key variables for accurate PCa classification (average ROC-AUC: 0.92). Cer-20 and CVD were consistently selected by models predicting ISUP > 1 PCa. In the SLI subgroup, PSA, age, CVD, SM-16, HexCer-20, HexCer-24.1, DHS1P, and DHCer-24 were selected in all 10 models (average ROC-AUC: 0.83). Circulating sphingolipids are promising biomarkers that, when combined with PSA, anamnestic, and lifestyle data, may enhance PCa screening precision and reduce the need for invasive, costly examinations.

Introduction The aim of this study was to assess the safety of elective urological surgery performed during the pandemic by estimating the prevalence of COVID-19-like symptoms in the postoperative period and its correlation with perioperative and clinical factors. Material and methods In this multicenter, observational study we recorded clinical, surgical and postoperative data of consecutive patients undergoing elective urological surgery in 28 different institutions across Italy during initial stage of the COVID-19 pandemic (between February 24 and March 30, 2020, inclusive). Results A total of 1943 patients were enrolled. In 12%, 7.1%, 21.3%, 56.7% and 2.6% of cases an open, laparoscopic, robotic, endoscopic or percutaneous surgical approach was performed, respectively. Overall, 166 (8.5%) postoperative complications were registered, 77 (3.9%) surgical and 89 (4.6%) medical. Twenty-eight (1.4%) patients were readmitted to hospital after discharge and 13 (0.7%) died. In the 30 days following discharge, fever and respiratory symptoms were recorded in 101 (5.2%) and 60 (3.1%) patients. At multivariable analysis, not performing nasopharyngeal swab at hospital admission (HR 2.3; CI 95% 1.01–5.19; p = 0.04) was independently associated with risk of developing postoperative medical complications. Number of patients in the facility was confirmed as an independent predictor of experiencing postoperative respiratory symptoms (p = 0.047, HR:1.12; CI95% 1.00–1.05), while COVID-19-free type of hospitalization facility was a strong independent protective factor (p = 0.02, HR:0.23, CI95% 0.07–0.79). Conclusions Performing elective surgery during the COVID-19 pandemic does not seem to affect perioperative outcomes as long as proper preventive measures are adopted, including nasopharyngeal swab before hospital admission and hospitalization in dedicated COVID-19-free facilities.

Positive surgical margin status after minimally invasive radical prostatectomy: a multicenter study Aim: The aim of our study is to evaluate the status of positive margins (PSMs) comparing their incidence between aparoscopic radical prostatectomy (LRP) and robot assisted radical prostatectomy (RARP) in centers with medium case-load (50-150 cases/year). We also analyzed the correlations between surgical technique, nerve-sparing approach (NS), and incidence of PSMs, stratifying our results by pathological stage. Materials and methods: We analyzed 1992 patients who underwent RP in various urologic centers. We evaluated the incidence of PSMs, and then we compared the stage-related incidence of PSMs, for both the techniques. Results: We did not find a statistically significant difference between the two surgical modalities in the study regarding the overall incidence of PSMs. Conclusions: In our retrospective study, we did not find any difference in terms of PSMs in RARP versus LRP. Our PSMs were not negligible, particularly in pT3 stages, compared with high-volume centers; surgical experience and patients’ selection can be a possible explanation.

Introduction: Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer.Materials and methods: A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis.Results: Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35-89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or It (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type >= IIIa (p = 0.03). A longer operative time was an independent risk factor of CCS >= III (OR: 1.005; CI: 1.002-1.007 per minute; p = 0.0001).Conclusions: In our study, RC is associated with a significant morbidity (65%) and a reduced mortality (1.7%) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way. (C) 2013 Elsevier Ltd. All rights reserved.