Evaluación de la biopsia de fusión elástica vs. biopsia sistemática para la detección del cáncer de próstata: resultados de un estudio multicéntrico en 1.119 pacientes / Elastic fusion biopsy versus systematic biopsy for prostate cancer detection: Results of a multicentric study on 1.119 patients

Objetivos: Evaluar la precisión de las biopsias guiada y sistemática para la detección del cáncer de próstata (CP) y CP clínicamente significativo (CPCS) en la práctica diaria, analizando el requerimiento de biopsias sistemáticas adicionales en el momento de la biopsia guiada. Pacientes y métodos: De nuestra base de datos multicéntrica que incluye 2.115 pacientes sometidos a biopsia de fusión con el sistema Koelis(TM) entre 2010 y 2017, seleccionamos 1.119 pacientes que recibieron biopsias guiadas (una mediana de 3 por cada lesión), con posterior muestreo sistemático (12 a 14 núcleos). Se evaluó la tasa de detección de cáncer (TDC) global y clínicamente significativa de las biopsias de fusión de Koelis(TM), comparando la biopsia guiada con la sistemática. Como objetivo secundario, está la identificación de los predictores de detección de CP. Resultados: La TDC de la biopsia guiada fue del 48% para todos los tipos de cáncer y del 33% para el CPCS. El muestreo de próstata sistemático adicional mejoró la TDC global en un 15% y en un 12% para CPCS. Se detectó CP en el 35, 69 y 92% de los pacientes con lesiones calificadas como PI-RADS 3, 4 y 5, respectivamente. Una puntuación elevada de PI-RADS y un examen rectal digital positivo fueron factores predictores de CP, y la condición «biopsia naïve» se asoció con CPCS. Conclusión: En la práctica diaria, la biopsia guiada con Koelis(TM) logra una buena TDC para todos los CP y CPCS, y mejora significativamente con el muestreo sistemático posterior de la próstata. Los excelentes resultados de la biopsia por fusión se confirman también en pacientes naïve. La puntuación PI-RADS elevada y el examen rectal digital positivo están altamente asociados con la presencia de CP

Objectives: To assess the accuracy of targeted and systematic biopsies for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in the everyday practice, evaluating the need for additional systematic biopsies at the time of targeted biopsy. Patients and methods: From our multicentric database gathering data on 2,115 patients who underwent fusion biopsy with Koelis(TM) system between 2010 and 2017, we selected 1,119 patients who received targeted biopsies (a median of 3 for each target), followed by systematic sampling of the prostate (12 to 14 cores). Overall and clinically significant cancer detection rate (CDR) of Koelis(TM) fusion biopsies were assessed, comparing target and systematic biopsies. Secondary endpoint was the identification of predictors of PCa detection. Results: The CDR of targeted biopsies only was 48% for all cancers and 33% for csPCa. The performance of additional, systematic prostate sampling improved the CDR of 15% for all cancers and of 12% for csPCa. PCa was detected in 35%, 69%, and 92% of patients with lesions scored as PI-RADS 3, 4 and 5, respectively. Elevated PI-RADS score and positive digital rectal examination were predictors of PCa, whereas biopsy-naïve status was associated with csPCa. Conclusion: In the everyday practice target biopsy with Koelis(TM) achieves a good CDR for all PCa and csPCa, which is significantly improved by subsequent systematic sampling of the prostate. The outstanding outcomes of fusion biopsy are confirmed also in biopsy-naïve patients. Elevated PI-RADS score and positive digital rectal examination are strongly associated with presence of PCa

Elastic fusion biopsy versus systematic biopsy for prostate cancer detection: Results of a multicentric study on 1,119 patients. / Evaluación de la biopsia de fusión elástica vs. biopsia sistemática para la detección del cáncer de próstata: resultados de un estudio multicéntrico en 1.119 pacientes.

OBJECTIVES: To assess the accuracy of targeted and systematic biopsies for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in the everyday practice, evaluating the need for additional systematic biopsies at the time of targeted biopsy. PATIENTS AND METHODS: From our multicentric database gathering data on 2,115 patients who underwent fusion biopsy with Koelis™ system between 2010 and 2017, we selected 1,119 patients who received targeted biopsies (a median of 3 for each target), followed by systematic sampling of the prostate (12 to 14 cores). Overall and clinically significant cancer detection rate (CDR) of Koelis™ fusion biopsies were assessed, comparing target and systematic biopsies. Secondary endpoint was the identification of predictors of PCa detection. RESULTS: The CDR of targeted biopsies only was 48% for all cancers and 33% for csPCa. The performance of additional, systematic prostate sampling improved the CDR of 15% for all cancers and of 12% for csPCa. PCa was detected in 35%, 69%, and 92% of patients with lesions scored as PI-RADS 3, 4 and 5, respectively. Elevated PI-RADS score and positive digital rectal examination were predictors of PCa, whereas biopsy-naïve status was associated with csPCa. CONCLUSION: In the everyday practice target biopsy with Koelis™ achieves a good CDR for all PCa and csPCa, which is significantly improved by subsequent systematic sampling of the prostate. The outstanding outcomes of fusion biopsy are confirmed also in biopsy-naïve patients. Elevated PI-RADS score and positive digital rectal examination are strongly associated with presence of PCa.

Italian prostate biopsies group: 2016 updated guidelines insights

AIM: To present a summary of the updated guidelines of the Italian Prostate Biopsies Group following the best recent evidence of the literature. MATERIALS AND METHODS: A systematic review of the new data emerging from 2012-2015 was performed by a panel of 14 selected Italian experts in urology, pathology and radiology. The experts collected articles published in the English-language literature by performing a search using Medline, EMBASE and the Cochrane Library database. The articles were evaluated using a systematic weighting and grading of the level of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation framework system. RESULTS: An initial prostate biopsy is strongly recommended when i) prostate specific antigen (PSA) >10 ng/ml, ii) digital rectal examination is abnormal, iii) multiparametric magnetic resonance imaging (mpMRI) has a Prostate Imaging Reporting and Data System (PIRADS) ≥4, even if it is not recommended. The use of mpMRI is strongly recommended only in patients with previous negative biopsy. At least 12 cores should be taken in each patient plus targeted (fusion or cognitive) biopsies of suspicious area (at mpMRI or transrectal ultrasound). Saturation biopsies are optional in all settings. The optimal strategy for reducing infection complications is still a controversial topic and the instruments to reduce them are actually weak. The adoption of Gleason grade groups in adjunction to the Gleason score when reporting prostate biopsy results is advisable. CONCLUSION: These updated guidelines and recommendations are intended to assist physicians and patients in the decision-making regarding when and how to perform a prostatic biopsy.

[Hemo-rheologic changes following treatment with human recombinant erythropoietin in chronic hemodialysis patients]. / Alterazioni emoreologiche in seguito a trattamento con eritropoietina umana ricombinante in pazienti emodializzati cronici.

Human recombinant erythropoietin constitutes a remarkable improvement in the treatment of uraemic anemia. Nevertheless, it causes haemorheological changes, which in turn may affect smaller blood vessel circulation. Our study was conducted on a pool of chronic uraemic patients under hemodialytic treatment who were given erythropoietin therapy. Substantial increases in overall blood viscosity and red cell aggregation were recorded, with no change in erythrocyte deformation. An increase in cardiovascular morbidity might occur in these patients who are already liable to this condition. Several years will have to elapse and thorough studies will have to be conducted on a large number of patients, to have conclusive evidence on this point.

Low ureteral obstruction caused by umbilical ligament in a 37 year old man: a case report.

Arterial vascular anomalies rarely cause extrinsic ureteral obstruction and only 11 cases have been reported so far. This paper deals with an unusual extrinsic obstruction of the left ureter caused by a residue of the umbilical artery in a 37 years old man. The patient had left flank pain due to serious hydronephrosis on the same side. At operation a fibrous cord, a residue of the left umbilical artery, partially obstructed the distal left ureter. Partial left terminal ureterectomy with ureteroneocystostomy was performed. In the differential diagnosis of low extrinsic ureteral obstructions also the uncommon vascular anomalies of the umbilical artery should be taken into consideration.

[Nephrogenic adenoma. Presentation of 7 cases]. / Adenoma nefrogenico. Presentazione di sette casi.

Nephrogenic adenoma is a vesical lesion of uncertain pathogenesis. Histologically it is characterised by glandular-like aspects that take on the form of tiny tubules consisting of a single layer of cuboidal or columnar epithelium. The lesion was first described by Davis in 1949 and a year later Friedman and Kuhlembeck coined the term nephrogenic adenoma. Personal experience with seven cases of this lesion is reported here. Six of the seven cases occurred in the bladder, the remaining one in the prostatic urethra. Four patients reported prior surgery of the urinary ways, three suffered from recurrent cystitis, one had bladder stones while three were being followed up in our department for urothelial carcinoma. Diagnosis of nephrogenic adenoma was based on histopathological examination carried out on biopsy samples taken during urethrocystoscopy. The urothelial lesions were subjected to transurethral resection or endoscopic diathermocoagulation. All patients are being followed up and no recurrences have yet been reported.

Verrucous carcinoma in situ of the bladder, not associated with urinary schistosomiasis.

Verrucous carcinoma is a variant of well differentiated squamous cell carcinoma that rarely affects the bladder. The bladder localization of this carcinoma is usually associated with urinary schistosomiasis. In this work we report on a rare case of verrucous carcinoma of the bladder not associated with urinary schistosomiasis. To complete this study, analysis of DNA was carried out on the histologic sections of the tumour.

[Treatment of advanced prostatic carcinoma with a depot LH-RH analog (ICI 118630)]. / Trattamento del carcinoma prostatico in fase avanzata con LH-RH analogo in forma depot (ICI 118630).

Twenty-two patients with newly diagnosed advanced prostatic cancer treated with once-monthly subcutaneous injection of a long acting depot preparation of a new luteinizing hormone-releasing hormone superagonist (ICI 118,630) with a minimum follow-up duration of 6 months are reported. The partial regression rate was 45.4% while 36.4% of the patients had stable disease and only 18.2% have progressed by P.O.N.CA.P. criteria. Patient acceptance was excellent and side effects occurring during treatment (hot flashes, gynecomastia, etc.) were minimal. The depot preparation of the LH-RH analogue was well tolerated and no side effects required dose modifications or removal from the study. Depot LH-RH analogue may become an alternative treatment for patients with advanced prostatic cancer if further clinical evolutions will confirm that the response rate with LH-RH analogue is comparable to the conventional endocrine therapies.

[Nosocomial infections of the urinary tract in urology patients]. / Le infezioni nosocomiali delle vie urinarie nei pazienti urologici.

Researches effected in different nations have revealed that 5-12% of all hospitalized patients was affected with a nosocomial infection and that almost 1/3 of these were urinary tract infections. The hospitalized urological patients have a considerable proneness to contract a nosocomial urinary tract infection, because they are subjected to transurethral or suprapubic bladder catheterisms, to transurethral surgery and to the endoscopies, that are promoting maneuvers the urinary tract infections. Generally the Gram negative bacilli are the cause of hospital-acquired urinary tract infections, even if lately Gram positive bacilli (especially Streptococcus Faecalis or Enterococcus), "Gram negative Facultative pathogens" (Klebsiella, Providencia, Citrobacter, Serratia) and Fungi are very important. Considering the importance of these infections we have examined the incidence of the urinary tract infections of the hospitalized patients between January 1, 1986 and December 31, 1986 in our Urologic Institute. During the 12-month study interval there were 450 hospital admissions, and 45 patients were affected with a nosocomial urinary tract infection (10%). The females were affected at the rate of 6.7% of them, with an incidence of 4.7% among all patients with a positive urine culture; on the contrary the males were affected at the rate of 11.4% of them, equal to 19.0% of patients with a positive urine culture. We have noticed that among the responsible microorganisms for the nosocomial urinary tract infections, the group of the "Gram negative Facultative pathogens" was more frequent (40%), followed by Pseudomonas Aeruginosa and Candida species. So also in our Urologic Institute the modification of the responsible agents for the nosocomial urinary tract infections happened. The nosocomial infections after the discovery of the antibiotics were considered wiped out, on the contrary these infections are still an important problem of public health, so that efficaciously must be tackled.