Endorectal multiparametric 3-tesla magnetic resonance imaging associated with systematic cognitive biopsies does not increase prostate cancer detection rate: a randomized prospective trial.

PURPOSE: To investigate prostate cancer (PC) detection rate, employing endorectal multiparametric 3-tesla magnetic resonance imaging (MRI) driving subsequent cognitive systematic prostatic biopsy (CSPB) versus a homogenous group of patients who did not undergo endorectal MRI. MATERIALS AND METHODS: A series of patients with a first negative biopsy were enrolled in the study. Patients were randomized into two groups: Group A: patients underwent MRI and subsequent CSPB; Group B: patients that did not undergo MRI. Each patient underwent a 13-core sampling. Patients from Group A had four cores more for each MRI suspected lesion. The cancer detection rate was calculated for each group with regard to possible matches or mismatches between MRI evidence and pathological reports. RESULTS: Two hundred consecutive patients were investigated. Fifty out of 200 (25 %) patients had a diagnosis of PC, 24 in Group A and 26 in Group B. In Group A, 67 patients (67 %) were positive for suspected lesions at the MRI. The mismatch between MRI findings and the CSPB outcome was 61 % with an MRI-driven detection rate of 15 %. Group B detection rate was 26 % with no significant differences versus Group A (P = NS). Patient discomfort was higher in Group A (82 %). The accuracy of CSPB was 41 % with a positive predictive value of 22.3 %. This rate is lower in high-grade cancers (11.9 %). The cost-effectiveness was higher in Group A. CONCLUSIONS: Prostate cancer detection rate does not improve by CSPB. The accuracy of CSPB was lower in high-grade PC, and a higher cost was found with CSPB.

An observational study of the use of beclomethasone dipropionate suppositories in the treatment of lower urinary tract inflammation in men.

BACKGROUND: Nonbacterial prostatitis, together with chronic pelvic pain syndrome, accounts for 90-95 % of prostatitis cases. Anti-inflammatory medications are commonly used to reduce storage/inflammatory symptoms that can deteriorate quality of life. The purpose of this study was to observe the efficacy and safety of beclomethasone dipropionate rectal suppositories (Topster®) in inflammations of the lower urinary tract in men. METHODS: Patients underwent diagnostic and therapeutic protocols according to current evidence-based practice. Efficacy assessments: voiding parameters, perineal pain, International Prostate Symptom Score (IPSS), digital rectal examination (DRE). Adverse events and patient compliance were recorded throughout the study. RESULTS: One hundred eighty patients were enrolled, mean age 52 ± 14.97. Most frequent diagnosis: nonbacterial prostatitis (85 %). All patients completed visits 1 and 2. All patients were treated with beclomethasone dipropionate (BDP) suppositories, 136/180 also with Serenoa repens (SR) extract. Antibiotics were rarely required. 162/180 patients presented clinically significant improvements and terminated treatment. Mean change vs. baseline in voiding frequency: -3.55 ± 2.70 n/day in patients taking only BDP and -3.68 ± 2.81 n/day in those taking both BDP and SR (P<.0001 in both groups). Uroflowmetry improved significantly; change from baseline 3.26 ± 5.35 ml/s in BDP only group and 5.61 ± 7.32 ml/s in BDP + SR group (P = 0.0002 for BDP, P<.0001 for BDP + SR). Urine stream normal in 35 % of patients at visit 1 and 57.22 % of patients at visit 2. Mean change in perineal pain, on 0-10 VAS, -0.66 ± 2.24 for BDP only group (P = 0.0699) and -1.37 ± 2.40 for BDP + SR group (P<.0001). IPSS increased at visit 2. No adverse events were reported. For all parameters, none of the comparisons between groups was found to be statistically significant. CONCLUSION: This study confirmed the drug's good safety profile. We also observed an improvement in the main storage symptoms and clinical findings associated with lower urinary tract inflammation in patients treated with beclomethasone dipropionate suppositories.

Application and Uses of Electronic Noses for Clinical Diagnosis on Urine Samples: A Review.

The electronic nose is able to provide useful information through the analysis of the volatile organic compounds in body fluids, such as exhaled breath, urine and blood. This paper focuses on the review of electronic nose studies and applications in the specific field of medical diagnostics based on the analysis of the gaseous headspace of human urine, in order to provide a broad overview of the state of the art and thus enhance future developments in this field. The research in this field is rather recent and still in progress, and there are several aspects that need to be investigated more into depth, not only to develop and improve specific electronic noses for different diseases, but also with the aim to discover and analyse the connections between specific diseases and the body fluids odour. Further research is needed to improve the results obtained up to now; the development of new sensors and data processing methods should lead to greater diagnostic accuracy thus making the electronic nose an effective tool for early detection of different kinds of diseases, ranging from infections to tumours or exposure to toxic agents.

Olfactory system of highly trained dogs detects prostate cancer in urine samples.

PURPOSE: We established diagnostic accuracy in terms of the sensitivity and specificity with which a rigorously trained canine olfactory system could recognize specific volatile organic compounds of prostate cancer in urine samples. MATERIALS AND METHODS: Two 3-year-old female German Shepherd Explosion Detection Dogs were trained to identify prostate cancer specific volatile organic compounds in urine samples. They were tested on 362 patients with prostate cancer (range low risk to metastatic) and on 540 healthy controls with no nonneoplastic disease or nonprostatic tumor. This cross-sectional design for diagnostic accuracy was performed at a single Italian teaching hospital and at the Italian Ministry of Defense Military Veterinary Center. RESULTS: For dog 1 sensitivity was 100% (95% CI 99.0-100.0) and specificity was 98.7% (95% CI 97.3-99.5). For dog 2 sensitivity was 98.6% (95% CI 96.8-99.6) and specificity was 97.6% (95% CI 95.9-98.7). When considering only men older than 45 years in the control group, dog 1 achieved 100% sensitivity and 98% specificity (95% CI 96-99.2), and dog 2 achieved 98.6% sensitivity (95% CI 96.8-99.6) and 96.4% specificity (95% CI 93.9-98.1). Analysis of false-positive cases revealed no consistent pattern in participant demographics or tumor characteristics. CONCLUSIONS: A trained canine olfactory system can detect prostate cancer specific volatile organic compounds in urine samples with high estimated sensitivity and specificity. Further studies are needed to investigate the potential predictive value of this procedure to identify prostate cancer.

Colour Doppler and microbubble contrast agent ultrasonography do not improve cancer detection rate in transrectal systematic prostate biopsy sampling.

UNLABELLED: What's known on the subject? and What does the study add? Transrectal gray-scale ultrasonography guided prostate biopsy sampling is the method for diagnosing prostate cancer (PC) in patients with an increased prostate specific antigen level and/or abnormal digital rectal examination. Several imaging strategies have been proposed to optimize the diagnostic value of biopsy sampling, although at the first biopsy nearly 10-30% of PC still remains undiagnosed. This study compares the PC detection rate when employing Colour Doppler ultransongraphy with or without the injection of SonoVue™ microbubble contrast agent, versus the transrectal ultrasongraphy-guided systematic biopsy sampling. The limited accuracy, sensitivity, specificity and the additional cost of using the contrast agent do not justify its routine application in PC detection. OBJECTIVE: • To compare prostate cancer (PC) detection rate employing colour Doppler ultrasonography with or without SonoVue™ contrast agent with transrectal ultrasonography-guided systematic biopsy sampling. PATIENTS AND METHODS: • A total of 300 patients with negative digital rectal examination and transrectal grey-scale ultrasonography, with PSA values ranging between 2.5 and 9.9 ng/mL, were randomized into three groups: 100 patients (group A) underwent transrectal ultrasonography-guided systematic bioptic sampling; 100 patients (group B) underwent colour Doppler ultrasonography, and 100 patients (group C) underwent colour Doppler ultrasonography before and during the injection of SonoVue™. • Contrast-enhanced targeted biopsies were sampled into hypervascularized areas of peripheral, transitional, apical or anterior prostate zones. • All the patients included in Groups B and C underwent a further 13 systematic prostate biopsies. The cancer detection rate was calculated for each group. RESULTS: • In 88 (29.3%) patients a histological diagnosis of PC was made, whereas 22 (7.4%) patients were diagnosed with high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. • No significant differences were found among the three groups for cancer detection rate (P= 0.329). • Additionally, low sensitivity, specificity and accuracy of colour Doppler with or without SonoVue™ contrast agent were found. CONCLUSIONS: • Prostate cancer detection rate does not significantly improve with the use of colour Doppler ultrasonography with or without SonoVue™. • Although no collateral effects have been highlighted, the combined use of colour Doppler ultrasonography and SonoVue™ determines adjunctive costs and increases the mean time for taking a single prostate biopsy.

Corporoplasty by plication: out patient surgery for the correction of penile curvature.

OBJECTIVE: Corporoplasty using plication of the albuginea is a simple technique but considered by many Authors at high risk for recurrence in respect to other corrective techniques using excision of the albuginea tunica. The aim of this study was to assess long-term functional and cosmetic results of this approach done in an outpatient environment. MATERIAL AND METHODS: From January 1997 to December 2008 we submitted 217 patients presenting induratio penis plastica (183) or congenital curvature (34) to corporoplasty with albuginea plication. All patients were assessed preoperatively with history, physical examination and photographic documention of the erectile penis. These patients, all with vaginal penetration problems, were submitted to corporoplication with 2-4 sutures 2/0 (polyglycolic) contralateral to the curvature, using local anaesthesia on outpatient basis. Follow-up included functional and cosmetic results, eventual complications and level of patient satisfaction. RESULTS: Median follow-up of our study was 44 months (range 2-58). Complete correction of curvature was achieved in 206 patients (95%) whereas 87% reported good erectile function (IIEF-5 > 21). 145 patients (67%) reported penis shortening and 41% complained of palpating the sutures. Two patients required reoperation for recurring curvature. No perioperative complications or altered sensitivity of the glans were reported. CONCLUSIONS: Simple plication of the corpora cavernosa can be done on an outpatient basis using local anaesthesia with optimal functional and cosmetic results. The success of this minimally invasive approach makes it a valid alternative to standard excision of the tunica albuginea procedure. Detailed preoperative information concerning procedure expectations and treatment course are extremely important in obtaining complete functional and cosmetic patient satisfaction.

Is there a clinical role for frozen section analysis during partial nephrectomy? A multicenter experience over 10 years.

BACKGROUND: Frozen section analysis (FSA) is frequently performed during partial nephrectomy (PN). We investigate the utility of intraoperative FSA by evaluating its impact on final surgical margin (SM) status. METHODS: Between January 1995 and December 2005, a series of patients who were treated with open PN for renal cell carcinoma was prospectively analyzed. During PN, each patient underwent a FSA on renal parenchyma distal margin. If FSA was positive for infiltration a deeper excision was performed till obtaining a negative FSA. SM outcome of the FSA was compared with the final pathology report. Recurrence-free survival (RFS) and cost analysis on the FSA performed were analyzed. RESULTS: A total number of 373 patients were enrolled. FSA was performed in all the patients considered for PN. Fifteen patients had a conversion to radical nephrectomy. Positive SMs at the definitive pathological outcome were found in 36 patients (9.6%). FSA was positive in eight patients (2.1%). In that eight cases after a deeper excision the definitive pathological outcome on SM was still positive in two cases. FSA revealed just 14.3% of the positive SM. Patients with positive SM had a worse follow up considering RFS (P<0.05). Kaplan-Meier analysis revealed that FSA did not considerably contribute to prevent recurrence (P=0.35). 1438 euros was the mean cost of performing a FSA during PN. CONCLUSIONS: FSA during PN does not reduce the risk of positive SMs. The use of FSA has also a higher cost related to the procedure.

PSA repeatedly fluctuating levels are reassuring enough to avoid biopsy?

INTRODUCTION: Prostate-specific antigen (PSA) levels can show wide fluctuations when repeatedly measured. Here we investigatewd if: (a) biopsy timing influences the prostate cancer (PC) detection rate in patients with fluctuating PSA (flu-PSA) in comparison with patients with steadily increasing PSA (si-PSA); (b) PSA slope estimated in patients with flu-PSA predicts a different risk of cancer detection; (c) flu-PSA and si-PSA patients develop PC in topographically different sites; (d) the behaviour of pre-operative PSA is an expression of a disease with defferent characteristics to the following radical prostatectomy. METHODS: The study involved 211 patients who underwent at least a second biopsy after a first negative prostate biopsy. PSA Slope, PSA velocity (PSAV) and PSA doubling time (PSADT) were estimated. Flu-PSA level was defined as a PSA series with at least one PSA value lower than the one immediately preceding it. RESULTS: 82 patients had flu-PSA levels and 129 si-PSA levels. There were no significant differences between the two groups in terms of cancer detection, clinical or pathological stage, but the si-PSA group with cancer had a higher Gleason score. No difference was found for PSA Slope between flu-PSA patients with cancer and those without. CONCLUSIONS: Our study demonstrates no difference in PC detection rate at repeat biopsy between patients with flu or si-PSA levels. PSA Slope, PSAV and PSADT were not found helpful tools in cancer detection.

Nephron sparing surgery of parenchymal kidney tumours in solitary kidney.

INTRODUCTION: The aim of this study is to assess the therapeutic efficacy of nephron sparing surgery (NSS) in our experience applied to patients with either bilateral renal cancer or patients with cancer in a solitary functioning kidney, from an oncological viewpoint as well as renal function. MATERIALS AND METHODS: From January 1997 to March 2006 we submitted 185 patients to NSS. Twenty-seven presented absolute indications with disease in functionally or anatomically solitary kidney. All but six patients presented with preoperative creatinine levels lower than 2 mg/dL. Access was always lombotomic. Nineteen patients underwent renal artery clamping and cold ischemia. Lesions were between 2 and 14 cm in size. In six cases the collecting system was formally opened. RESULTS: Follow-up was between 2 and 108 months. Final histology showed 17 patients with clear cell renal carcinoma, six papillary cell carcinomas, one chromophobe carcinoma, one oncocytoma and two angiomyolipomas. No major perioperative complications were recorded. Two patients died of lung metastases. Two patients present secondary tumours (lung and liver), whereas one patient is being treated with chemotherapy for colon cancer Twenty-two patients are disease-free. None of the 10 patients discharged with creatinine levels >2 mg/dL, were submitted to dialytic therapy during follow-up. None of the patients discharged with normal renal function developed kidney failure. CONCLUSIONS: Conservative surgery for patients with absolute indications, is a valid alternative to radical surgery that obviously commits patients to long-term dialysis or renal transplantation. Our cases showed minimal surgical complications, brief hospital stay and limited invasiveness for patients with small incidence of kidney failure associated to the all important cancer control.

Single small focus of prostate adenocarcinoma (< or = 1 mm and too small for grading) and clinical significant disease after radical prostatectomy.

OBJECTIVES: To determine whether a clinical significant adenocarcinoma of the cinoma (defined as a lesion < or =1 mm. and too small for grading) at needle biopsy, even repeated, and through prostate specific antigen (PSA), PSA density (PSAD) and free-to-total PSA ratio (f/t ratio). METHODS: Retrospectively 79/1610 consecutive patients undergoing prostatic needle biopsies presented one small focus of prostatic adenocarcinoma < or =1 mm and too small for grading. All patients underwent PSA, PSAD and f/t ratio to evaluate positive predictive value for clinically significant disease. All patients were submitted to radical retropubic prostatectomy (RRP) and were divided into three groups: group A (28/79 patients, 35.4%) submitted to RRP after diagnosis of just one small focus of adenocarcinoma at first biopsy; group B (26/79 patients, 32.9%) submitted to RRP after two successive diagnoses of small focus of adenocarcinoma; group C (25/79 patients, 31.6%) submitted to RRP after diagnosis of adenocarcinoma larger than 1 mm at successive biopsy in which Gleason score had been applied. RESULTS: The three groups resulted comparable for age, PSA, f/t ratio and PSAD. Clinically significant disease was found in 48 of 79 patients (60.7%); 16 patients of group A (33.3%), 15 patients of group B (31.2%) and 17 patients of group C (35.4%) respectively. Finally, PSA, f/t ratio, and PSAD showed no predictive value neither globally nor in the single groups. CONCLUSIONS: No selective criteria with consolidated predictive values emerge from our study and this is in agreement with data in the literature, where the risk to find no significant clinical disease is 9-48% approximately. The aim of this retrospective study is to analyze the correlation between a single small focus of adenocarcinoma by prostatic biopsy, even repeated, and the clinical significant disease on the following radical retropubic prostatectomy. Furthermore, we verified whether some preoperative parameters could be helpful to identify the subgroups of patients which could need a more or less aggressive and/or timely treatment. Our data show that 30-40% of patients did not harbor a clinically significant disease at the following RRP. Furthermore, the assumed predictive value of repeat biopsies has not been confirmed in these patients and no other preoperative predictive values can be helpful.

"En Bloc" Resection of Nonmuscle Invasive Bladder Cancer: A Prospective Single-center Study.

OBJECTIVE: To describe our "en bloc" technique for nonmuscle invasive bladder cancer (NMIBC), assess the quality of resection, and report the midterm oncological outcome. MATERIALS AND METHODS: This is an observational prospective longitudinal study, from June 2010 to February 2014, enrolling patients with clinically NMIBC, having tumors of ≤3 cm and ≤4 lesions who underwent electrical en bloc bladder resection. The primary study end point was recurrence-free survival. Secondary outcomes were feasibility, safety, the presence of detrusor muscle, and the recurrence rate at the first follow-up cystoscopy (3 months). Statistical analysis was complemented with multivariable analysis. RESULTS: Of 87 enrolled patients, 2 showed a nonurothelial carcinoma and 11 showed muscle invasive bladder carcinoma at the definitive pathology. The study cohort consisted of 74 transitional cell carcinoma NMIBC cases, mean age 71 years ± 8, presenting with a mean tumor diameter of 1.98 ± 0.59 cm and a median number of resected tumors per patients of 1 (range 1-4). The 2-year recurrence-free survival was 85.59%. All the en bloc resection of bladder tumor samples showed the presence of detrusor muscle and the recurrence rate at the first follow-up cystoscopy (3 months) was 5.4% (4/74). An extraperitoneal bladder perforation occurred in only one patient. At multivariable analysis, only gender and the presence of carcinoma in situ were independent predictors of recurrence. The midterm follow-up and the absence of a control group are the main limitations. CONCLUSION: Our findings confirmed the feasibility and safety of en bloc resection of bladder tumor, with a recurrence-free survival of 85% after 2 years.

Incidence and treatment of complications in nephron sparing surgery.

UNLABELLED: Conservative renal surgery (enucleation or segmentary resection) has become the gold standard treatment for small and peripheral malignant kidney lesions or in cases of reduced renal function or bilateral lesions. The aim of this study is to evaluate the incidence and treatment of complications of this technique in our experience. MATERIALS AND METHODS: Between March 1997 and March 2005, 159 patients aged from 23 to 77 years (median 66 years) underwent conservative renal surgery. In 123 patients the indication was elective and in 36 imperative. In 92 patients lesions were located in the upper pole, 41 in the lower pole and 24 were meso-renal . Two patients suffered from von Hippel-Lindau (VHL) disease and therefore presented multicentric lesions. Mean lesion diameter was 3 cm ( range 1 to 9 cm). Retroperitoneal access with flank incision was the approach used in all patients. In 124 patients the technique consisted of enucleation with hypothermia from contact with sterile ice. Time to ischaemia was between 12 - 40 minutes. The collecting system was opened in 23 patients. RESULTS: Twelve cases of perioperative complications were encountered in this group of patients. Major complications were: two massive hemorrhage, two arteriovenous fistula, one lesion of the ureter, five cases of acute kidney failure. The two massive bleedings occurred within the first eight hours after surgery and necessitated surgical intervention to check a bleeding perinephric vessel. The arteriovenous fistulas, which occurred on the seventh and tenth postoperative day, were treated with selective percutaneous sclero-embolisation. The five acute kidney failures involved patients with functional or anatomical solitary kidney. No patient required dialysis in the post-operative period. Ureter lesion characterised the post-operative course of one solitary kidney patient affected by voluminous angiomyolipoma. Anuria and urine emission from drainage lead to exploratory lumbotomy which evidenced an iatrogenic lesion of the lumbar ureter that was treated with termino-terminal anastomosis. No other major complications were noted, with the exception of delay in intestinal canalization occurring in a 74 year old patient, and a wound infection in a patient with previous renal abscess associated to infundibular lithiasis and caliceal exclusion. There were no postoperative deaths. CONCLUSIONS: Conservative renal surgery is a valid alternative to radical surgery. In our study, as already reported in literature, surgical complications were slight in incidence and conservatively treatable. Therefore, nephron sparing surgery (NSS) can be performed with safety and maximum preservation of renal function.

Retropubic nerve and seminal sparing radical prostatectomy for recurrent bladder neck-prostatic urethra strictures.

OBJECTIVES: To verify if nerve and seminal sparing radical prostatectomy could represent surgical solution for iatrogenic bladder neck prostatic urethra contracture without external sphincter involvement. MATERIAL AND METHODS: At our institution 4 patients have been submitted to nerve and seminal sparing radical prostatectomy for recurrent bladder neck-prostatic urethra contracture following TURP for middle size adenoma. In all cases bladder neck was reconstructed and a 20F silicon catheter was left in place for two weeks to stint the vesico-urethral anastomosis. RESULTS: In all cases no significant perioperative complications were experienced. A normal voiding urethrogram preceded removal of the catheter 14 days postoperatively. Urinary continence was recovered by all of the patients. Uroflowmetry was persistently normal at periodic controls. With a mean follow-up of 36.3 months, no patient complained of symptomatic recurrence of urinary obstruction. In three previously potent patients, sexual activity with satisfactory intercourse was maintained. CONCLUSION: Even though our experience is very limited in terms of number of patients and length of follow-up, we think that nerve and seminal sparing radical prostatectomy, because of the limited risk of major complications and the good result in terms of preservation of both urinary continence and erectile function, can be a reasonable solution for iatrogenic bladder neck-prostatic contracture after prostatic surgery for BPH.

Retrograde endopyelotomy using the holmium laser: technical aspects and functional results.

INTRODUCTION: Endopyelotomy is considered standard treatment for primary and secondary ureteropelvic junction obstruction. The aim of this study is to report our initial experience with the retrograde endopyelotomy technique. MATERIALS AND METHODS: Between January 2000 and April 2003 we submitted to retrograde ureteroscopic holmium laser endopyelotomy 16 patients (9 males and 7 females) aged between 22 and 64 years. Obstruction was primary in 10 cases and secondary due to unsuccessful open pyeloplasty in the remaining six. No patient was affected by coexisting urinary lithiasis. Excretory urography and diuretic renal scintigraphy were performed preoperatively in all patients. Endopyelotomy was carried out using the holmium laser which delivered an energy level of 1.2 Joule at 10-15 Hertz. A double J ureteral stent remained indwelling postoperatively for 6 weeks and a vesical catheter for 24 hours. Average operative time was 75 minutes (range 50-90 minutes). Patients were assessed on follow-up by echotomography of the urinary tract and diuretic renal scintigraphy after 3 months and then at 6-month intervals. RESULTS: Patients were assessed on a mean follow-up of 18 months (range 6-41). Outcome was considered successful when symptoms were resolved and renal function improved. Success was obtained in 13 patients. Two patients were submitted to pyeloplasty with positive results and the procedure on one patient was converted to pyeloplasty due to intraoperative haemorrhage. Average postoperative stay was three days (range 1-4). No patient required blood transfusion with postoperative reduction in haematocrit of 0-9%, (mean 3%). Normal daily activity resumed after 3-4 days from discharge. CONCLUSIONS: Retrograde endopyelotomy in our initial experience is a safe and efficient technique that gives an excellent percentage of success with reduced complications and good patient compliance. The retrograde compared with the anterograde approach has the advantage of being less invasive, does not require nephrostomal derivation and further reduces hospital stay.

Open partial nephrectomy: ancient art or currently available technique?

Renal cell carcinoma (RCC) accounts for 3 % of adult solid tumors, with the highest incidence between 50 and 70 years of age. Nephron-sparing surgery was initially reserved to patients with small renal masses detected in anatomically or functionally solitary kidney or in the presence of multiple bilateral tumors or hereditary forms of RCC, which posed a high risk of developing a tumor in the contralateral kidney. Nowadays, partial nephrectomy (PN) has grown up to an established approach for the treatment of small renal masses. In patients with T1a-staged RCCs, PN has proven to be associated with better survival, long-term renal function preservation with lower dialysis need or renal transplantation. Currently, most of the kidney masses are incidentally detected, up to 40 %, with smaller size due to the widespread use of imaging modalities such as ultrasound, computed tomography and magnetic resonance. Here we review the role of open PN in the management of small renal masses particularly focusing on indications, oncological outcomes and comparison with laparoscopic and robotic PN. Recent studies demonstrate that PN confers better survival, oncologic equivalence and lower risk of severe chronic kidney disease compared to radical nephrectomy becoming then the gold-standard surgical technique, even if increasingly challenged by laparoscopic and/or robot-assisted partial nephrectomy which in the hands of experts seems to achieve comparable outcome results albeit with slightly higher complication rate.

Two-dimensional neovascular complexity is significantly higher in nontumor prostate tissue than in low-risk prostate cancer.

PURPOSE: Prostate cancer is the most frequent cancer in men in Europe. A major focus in urology is the identification of new biomarkers with improved accuracy in patients with low-risk prostate cancer. Here, we evaluated two-dimensional neovascular complexity in prostate tumor and nontumor biopsy cores by use of a computer-aided image analysis system and assessed the correlations between the results and selected clinical and pathological parameters of prostate carcinoma. MATERIALS AND METHODS: A total of 280 prostate biopsy sections from a homogeneous series of 70 patients with low-risk prostate cancer (Gleason score 3+3, prostate-specific antigen [PSA]<10 ng/mL, and clinical stage T1c) who underwent systematic biopsy sampling and subsequent radical prostatectomy were analyzed. For each biopsy, 2-µm sections were treated with CD34 antibodies and were digitized by using an image analysis system that automatically estimates the surface fractal dimension. RESULTS: Our results showed that biopsy sections without cancer were significantly more vascularized than were tumors. No correlations were found between the vascular surface fractal dimension and patient's age, PSA and free-to-total PSA ratios, pathological stage, Gleason score, tumor volume, vascular invasion, capsular penetration, surgical margins, and biochemical recurrence. CONCLUSIONS: The value of angiogenesis in prostate cancer is still controversial. Our findings suggest that low-risk prostate cancer tissues are less vascularized than are nontumor tissues. Further studies are necessary to understand whether angiogenesis is a hallmark of intermediate- and high-risk prostate cancer.

[Nephron-sparing surgery. Reproducibility of results, personal cases, and comparison with the international literature]. / Chirurgia nephron sparing. Riproducibilitá dei risultati, casistica personale e confronto con la letteratura internazionale.

PURPOSE: Partial nephrectomy is an effective method of treatment for renal cell carcinoma. The aim of this study is to compare our experience with international literature data METHODS: Between January 1997 and December 2000 a total of 50 renal units in 30 males and 18 women, 27 to 77 years old (mean age 60.6) with renal solid lesion of < 4 cm diameter were treated at our institution with nephron sparing surgery (NSS). The indications for NSS was elective in 43 case, imperative in 5. So far no local metastases, or vascular involvement have been encountered. The procedure was performed by 4 surgeons alternatively. RESULTS: In 25 patients histology revealed with clear renal cell carcinoma, one case of the chromophobe cell type, 6 papillary renal cell carcinoma, 8 oncocytomas, 8 angiomyolipomas, 1 multicystic and 1 simple cyst renal carcinoma. The complications were 1 acute reversible renal failure and 1 arteriovenous fistula. At the follow-up of 23 months no local or distant metastases were encountered. No significant differences in results were noted in regard to surgeon. CONCLUSIONS: Our results suggest that nephron sparing surgery is as effective as radical nephrectomy for treatment of localised RCC. The reduced incidence of complications associated with a minimum complexity of the procedure and the results make this technique approachable by surgeons of different technical experience.

Senescent remodeling of the innate and adaptive immune system in the elderly men with prostate cancer.

Despite years of intensive investigation that has been made in understanding prostate cancer, it remains a major cause of death in men worldwide. Prostate cancer emerges from multiple alterations that induce changes in expression patterns of genes and proteins that function in networks controlling critical cellular events. Based on the exponential aging of the population and the increasing life expectancy in industrialized Western countries, prostate cancer in the elderly men is becoming a disease of increasing significance. Aging is a progressive degenerative process strictly integrated with inflammation. Several theories have been proposed that attempt to define the role of chronic inflammation in aging including redox stress, mitochondrial damage, immunosenescence, and epigenetic modifications. Here, we review the innate and adaptive immune systems and their senescent remodeling in elderly men with prostate cancer.