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Open Access journal
ISSN (Print) 2279-9419 - ISSN (Online) 2279-9419
Published by Auro.it - Associazione Urologi Italiani [1 journal]
- Prostate cancer screening: Is there something new '
Authors: Matteo Spagni
Abstract: Single measure of Prostate Specific Antigen (PSA) at or before age 50, could predict significant prostate cancer diagnosed 20 to 30 years later.This is the conclusion of a large cohort nested case-control study, concluded in Sweden.In that country, as the national local guidelines say, PSA testing in uncommon, with most prostate cancers being diagnosed clinically.The
Authors evaluated PSA values in patients of the Malmo Preventive Project, from 1974 to 1986, aged 33-50, and a nested case-control study designed was used, matching with clinical prostate cancer diagnosis after 20 to 30 years.After the statistical analysis they could reveal a strong correlation between PSA measured at ages 44-50 and prostate cancer clinically diagnosed many years later. Moreover they estimated the probability of prostate cancer diagnosis based on PSA measurement at ages 44-50. The risk of subsequent clinically diagnosed prostate cancer was low for men with PSA < 0.5 ng/ml (1-5% risk), was close to population mean for those with PSA 0.75-1.25 ng/ml (8-18% risk) and was higher for men with PSA values above 1.5ng/ml.A distinctive feature of the study is that the diagnosis was done in a population were PSA is not recommended as routine test, with the subsequent exclusion of early prostate cancer diagnosis: findings are not restricted to cancers of questionable clinical significance but apply to cancers that are palpable and to those locally advanced or metastatic at diagnosis.A limitation of the study is of course the only evaluation of prostate cancer diagnosis, rather than morbidity or mortality from cancer.The clinical implication of the study is important and could change strategies in prostate cancer screening, for example with screening frequency be determined by individual risk assessed from an early PSA test. In fact, if low early PSA values are related to low risk of late prostate cancer diagnosis, annual PSA could be exaggerated in this group of patients. Conversely, patients with early PSA values of 1 ng/ml or more have high risk of prostate cancer diagnosis in the 20 to 30 years later and probably this is the group of patients that could have major benefits from PSA screening.Original Article:“Prediction of Significant Prostate Cancer Diagnosed 20 to 30 Years Later With a Single Measure of Prostate-Specific Antigen at or Before Age 50”Hans Lilja, MD PhD; Angel M. Cronin, MSc; Anders Dahlin, MD; Jonas Manjer, MD PhD; Peter M. Nilsson, MD; James A. Eastham, MD; Anders S. Bjartell, MD, PhD; Peter T. Scardino, MD; David Ulmert, MD, PhD and Andrew J. Vickers, PhDCancer, Volume 117, Issue 6, pages 1210–1219, 15 March 2011
- A rare case of hydronephrosis in a 77 years old woman.
Authors: Michele Potenzoni, Andrea Prati, Annamaria Pieri, Luigi Benecchi, Domenico Potenzoni, Antonio Savino, Daniel Maetens, Nicoletta Uliano, Carmelo Destro Pastizzaro, Roberto Arnaudi, Erico Maria Silini, Salvatore Bellafiore
Abstract: Abstract We report the case of a77 year-old woman complaining of a recent episode of left back pain right pelvic mass associated with hydronephrosis. The patient underwent abdominal laparotomy with removal of a pelvic mass (9x7,5 cm) and obturatory, ipogastric, internal and external iliac lymphadenectomy showing a Sertoli cell tumor. A karyotypic analysis was performed that revealed a 46 XY chromosomal profile. A diagnosis of androgen insensitivity syndrome (AIS) was suggested. The patient did not received any adjuvant therapy and at 6 months, the oncological follow up was negative for recurrence.
- Standardized reporting system of perioperative complications for radical
cystectomy in octogenarians: a multicentric study
Authors: Umberto Anceschi, Crescenzo Garzilli, Antonio De Vico, Tommaso Riga, Giorgio Federico, Marco Gaffi, Carlo Molinari, Marcello Perrone, Claudio Anceschi
Abstract: Objective To detail and analyze the early and late postoperative complications of radical cystectomy (RC) in a multicentric series of 184 patients of ≥80 yrs according to the Clavien standardized reporting system (CSRS) and the type of urinary diversion Methods From September 1998 to November 2012, 184 consecutive RCs were performed in patients of ≥80 yrs in two different institutions with an yearly-mean performance rate of 20 procedures (range 20-26). Full data on perioperative morbidity (POM) of patients were prospectively assessed using a multi-institutional database. Perioperative early (<90 days) and late (>90 days) complications of RC were reported and compared according to CSRS and the type of urinary diversion used (continent: group A; incontinent: group B). Results The overall early and late complications rate in the A group were 61,5 % ( Clavien: I 13,4%; II 28,8%; III 11,4%; IV 3,8%; V 3,8%) and 36% (II 4%; III 28%; IV 6%; V 2% ) , respectively. The overall early and late complications rate in the B group were 48,4 % (I 8,3%; II 28,7%; III 9,8%; IV 0,7%; V 0,7%) and 17,5% (II 3,8%; III 11,4%; IV 1,5%; V 0,76%), respectively. Overall early , late complication and reoperation rates were all significantly higher in patients receiving a bladder substitution (p=0,02; p=0,006; p=0,0001). Conclusions RC in octogenarians remains a morbidity-prone surgery using a standardized methodology. Since the perioperative complications of a continent urinary diversion are signficantly increased in the elderly, the chance of an orthotopic neobladder in octogenarians should be evaluated individually in highly-specialized centers.
- Laparoscopic Adrenalectomy for isolated adrenal metastasis
Authors: Rocco Papalia, Giuseppe Simone, Mariaconsiglia Ferriero, Salvatore Guaglianone, Michele Gallucci
Abstract: Purpose: To report oncological outcome of laparoscopic treatment of metastases to the adrenal glandPatients and Methods: We retrospectively reviewed a prospectively maintained database to evaluate the outcome of 16 patients undergone laparoscopic adrenalectomy (LA) for adrenal metastasis. Preoperative data, perioperative results and follow-up were evaluated.Results: Nineteen LAs were performed in 17 patients. Pathologic analysis revealed renal cell carcinoma metastases in 11 patients and transitional cell carcinoma metastases in 2 men who underwent bilateral laparoscopic adrenalectomy. Metastasis from papillary renal cell carcinoma, poorly differentiate lung carcinoma, colorectal carcinoma and melanoma were respectively detected in the other four patients. Surgical margins were negative in all patients and local recurrence occurred in one patient. At a median follow-up of 21 months 12 patients were alive and 5 were disease free. Five out of 11 patients with metastatic renal cell carcinoma were recurrence free and 10 alive. Indeed no patients with primary tumor histology different by renal cell carcinoma was recurrence free and 4 out of those 5 five patients died of disease.Conclusion: Laparoscopic removal of adrenal metastasis is minimally invasive and oncologically effective. The final outcome of patients mainly depends on the primary tumor histology and on the chances of treatment of metastases subsequently developed.
- RAPID COMMUNICATION: “Does multiparametric MRI 3D fusion biopsy
biopsy improve detection rate ' Preliminary experience”
Authors: Franco Bertolotto, Angelo Naselli, Paolo Puppo
Abstract: Multiparametric MR of the prostate has shown a great accuracy in the detection of prostate cancer foci. 3D TRUS of prostate indeed lets the operator to know exactly where the needle is positioned in the gland. The "fusion" of the 2 technologies is possible by means of dedicated workstation. In our preliminary experience the “per single” core analysis showed that 31 cores out of 116 (31%) obtained from target zones had prostate cancer whereas 75 out of 432 (14%) obtained outside targeted zone were positive. The odds ratio was 1.763 (95% CI 1.043 – 2.882, p 0.033) confirming that multiparametric MR 3D fusion prostate biopsy is a promising technology.
- Three-port extraperitoneal nerve-sparing laparoscopic radical
prostatectomy: a novel simplified approach
Authors: Umberto Anceschi, Marco Gaffi, Carlo Molinari, Claudio Anceschi
Abstract: Objective To detail the technique and to report outcomes of a simplified three-port approach to extraperitoneal nerve-sparing laparoscopic radical prostatectomy (3p-NSLRP) in a consecutive series of 102 patients. Methods From October 2007 to December 2010, 102 patients underwent 3p-NSLRP for organ-confined PCa. The control group comprised 150 patients who underwent conventional (5-port) NSLRP with the same technique. Mean operative time (MOT), estimated blood loss (EBL), mean catheterization time (MCT), mean hospital stay (MHS), % of positive surgical margins (PSMs) and % of perioperative complications were compared between groups. Functional outcomes were prospectively assessed by validated questionnaires and were compared at 3, 6, 12, 18 and 24 month follow-up. The technique was considered a failure if an additional fourth port was required. Cosmetic effects of the scar were also compared between the groups. Results There was no significant difference between the groups in terms of EBL, MOT, EBL, MCT or MHS. 3p-NSLRP resulted in PSMs, continence, and potency rate comparable to standard NSLRP at all follow-ups. Overall, the early complication rate for 3pNSLRP was 5.8%, including 1.9% Clavien I and 3.9 % Clavien III. The late complication rate was 3.9%. Only 5% of cases required a fourth port positioning. In the control group, the early complication rate was 7,3% including 2,6% Clavien I and 4.6 % Clavien III. The late complication rate was 3.3%. 3pNSLRP showed an increased cosmetic outcomes with a lower rate of patient’s dissatisfaction. Conclusions 3p-NSLRP is technically feasible, has a low failure rate and an acceptable complication rate with promising functional results. The early oncological and cosmetic outcomes, together with the high scar satisfaction confirmed the safety of LRP using a limited number of ports.