Publications by authors named "Fabio Crocerossa"

17 Publications

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Management of Bladder Neck Contracture in the Age of Robotic Prostatectomy: An Evidence-based Guide.

Eur Urol Focus 2021 Jan 30. Epub 2021 Jan 30.

Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA. Electronic address:

The incidence of bladder neck contracture (BNC), or postprostatectomy vesicourethral anastomosis, has declined since the advent of robotic surgery. However, men with peripheral vascular comorbidities, among other factors, still have a high risk of developing this complication after any surgery that involves manipulation of the prostate. The best strategy for BNC management remains uncertain because of inconsistency in success for different approaches across studies. We reviewed the available evidence on BNC, including the results for endoscopic treatments, scar modulation therapies, and open and robotic bladder neck reconstruction. On the basis of these data, we propose a management flowchart. Patient baseline status and subjective goals and preferences remain crucial in management choices. PATIENT SUMMARY: Contracture of the bladder neck can occur as a complication after surgery to the prostate. We reviewed the evidence for various treatment approaches and propose a flowchart for management of this condition.
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http://dx.doi.org/10.1016/j.euf.2021.01.007DOI Listing
January 2021

Nomogram predicting 30-day mortality after nephrectomy in the contemporary era: Results from the SEER database.

Int J Urol 2021 Mar 14;28(3):309-314. Epub 2020 Dec 14.

Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA.

Objectives: To assess contemporary 30-day mortality rates after partial and radical nephrectomy in USA, and to develop a predictive model of 30-day mortality.

Methods: We relied on the National Cancer Institute Surveillance, Epidemiology and End Results database. A multivariable logistic regression analysis was fitted to predict 30-day mortality. A nomogram was built based on the coefficients of the logit function. Internal validation was carried out using the leave-one-out cross-validation. Calibration was graphically investigated.

Results: A total of 102 146 patients who underwent partial nephrectomy (n = 36 425; 35.7%) or radical nephrectomy (n = 65 721; 64.3%) between 2005 and 2015 were included in the analysis. The median age at diagnosis was 62 years. A total of 11 921 (11.7%) patients were African American. The clinical stage was T1-T2 in 79 452 (77.8%), T3 in 16 141 (15.8%) and T4/T1-4-M1 in 6553 (6.4%) patients. Overall, 497 deaths occurred during the initial 30 days after nephrectomy (0.49% 30-day mortality rate). Stratified by type of surgery, the 30-day mortality rate was 0.16% for partial nephrectomy and 0.67% for radical nephrectomy. At univariate analyses, age, tumor size, stage and surgical procedure emerged as predictors of 30-day mortality (all P < 0.001). All of these covariates were included in the multivariable logistic regression model. The area under the curve after leave-one-out cross-validation was 0.808 (95% confidence interval 0.788-0.828), and the model showed good calibration in the range of predicted probability <10%.

Conclusions: Contemporary rates of 30-day mortality in patients undergoing radical or partial nephrectomy are very low. Age and tumor stage are key determinants of 30-day mortality. We present a predictive model that provides individual probabilities of 30-day mortality after nephrectomy, and it can be used for patient counseling prior surgery.
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http://dx.doi.org/10.1111/iju.14461DOI Listing
March 2021

New robotic surgical systems in urology: an update.

Curr Opin Urol 2021 Jan;31(1):37-42

Division of Urology, Virginia Commonwealth University Health System, Richmond, Virginia, USA.

Purpose Of Review: The landscape of robotic surgical systems in urology is changing. Several new instruments have been introduced internationally into clinical practice, and others are in development. In this review, we provide an update and summary of recent surgical systems and their clinical applications in urology.

Recent Findings: Robotic-assisted laparoscopic surgery is increasingly becoming a standard skillset in the urologist's technical armamentarium. The current state of the robotic surgery market is monopolized because of a number of regulatory and technical factors but there are several robotic surgical systems approved for clinical use across the world and numerous others in development. Next-generation surgical systems commonly include a modular design, open access consoles, haptic feedback, smaller instruments, and machine learning.

Summary: Numerous robotic surgical systems are in development, and several have recently been introduced into clinical practice. These new technologies are changing the landscape of robotic surgery in urology and will likely transform the marketplace of robotic surgery across surgical subspecialties within the next 10--20 years.
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http://dx.doi.org/10.1097/MOU.0000000000000833DOI Listing
January 2021

Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies.

Eur Urol 2020 Nov 17. Epub 2020 Nov 17.

Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA. Electronic address:

Context: Radical nephrectomy (RN) is the gold standard treatment for large and locally advanced renal tumors. Although robot-assisted radical nephrectomy (RRN) is being increasingly adopted, it remains unclear whether it offers benefits over standard laparoscopic radical nephrectomy (LRN) or open radical nephrectomy (ORN).

Objective: To compare the outcomes of robotic surgery to those of laparoscopic and open surgery in patients undergoing RN for renal cell carcinoma (RCC).

Evidence Acquisition: A systematic search was performed across MEDLINE, EMBASE, and Web of Science for retrospective and prospective studies comparing RRN to LRN or ORN. A meta-analysis evaluated perioperative safety, effectiveness, survival, and cost-effectiveness outcomes. The weighted mean difference (WMD) and odds ratio (OR) were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale. Sensitivity analyses were performed to assess the robustness of the estimates.

Evidence Synthesis: Twelve studies involving 64 221 patients were identified and included in the analysis. Compared to LRN, RRN was associated with statistically significant longer operative time (WMD 37.44 min; p =  0.03), shorter length of stay (WMD -0.84 days; p =  0.02) and higher total costs (WMD US$4700; p < 0.001). Compared to ORN, RRN was associated with shorter length of stay (WMD -3.06 days; p =  0.002), fewer overall complications (OR 0.56; p <  0.001), lower estimated blood loss (WMD -702 ml; p =  0.01), and higher total hospital costs (WMD US$4520; p =  0.004). There was high heterogeneity across all analyses.

Conclusions: In patients undergoing RN for RCC, RRN seems to offer some key advantages compared to ORN, including shorter hospitalization and fewer complications. Compared to LRN, RRN provides similar surgical outcomes but at higher total costs. These findings should be interpreted within the limitations of this type of analysis, given high heterogeneity between studies and poor robustness for most outcomes. Randomized clinical studies with long-term follow-up are needed to obtain more definitive results.

Patient Summary: In patients with renal cell carcinoma, robot-assisted radical nephrectomy shows perioperative advantages compared to open radical nephrectomy, but not compared to laparoscopic radical nephrectomy.
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http://dx.doi.org/10.1016/j.eururo.2020.10.034DOI Listing
November 2020

Robot-assisted partial nephrectomy: 7-year outcomes.

Minerva Urol Nefrol 2020 Nov 17. Epub 2020 Nov 17.

Division of Urology, VCU Health, Richmond, VA, USA -

Background: The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7-yr, the longest follow-up to date.

Methods: A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-yr follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis.

Results: Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88mo. Median clinical tumor size was 3cm, with mostly (74.1%) clinical stage T1a, and median R.E.N.A.L. score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in 7 patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7, 97.7, and 91.7% at 84mo, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort.

Conclusions: Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.
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http://dx.doi.org/10.23736/S0393-2249.20.04151-XDOI Listing
November 2020

Single overnight stay after robot-assisted partial nephrectomy: a bi-center experience.

Minerva Urol Nefrol 2020 Nov 17. Epub 2020 Nov 17.

Division of Urology, VCU Health, Richmond, VA, USA -

Background: Despite hospital length of stay (LOS) being shorter for robot-assisted partial nephrectomy (RAPN) compared to its open counterpart, several series in the literature report on average a LOS of 2-3 days or more. We aimed to assess factors predicting a prolonged length of stay (beyond a single overnight stay) in patients undergoing RAPN.

Methods: Patients who underwent RAPN between 2010 and 2019 at two U.S. Centers were included and divided into two groups according to LOS: the study group included all patients who were discharged on POD1, whereas the control group included patients with LOS≥2 days. Demographics, surgical and perioperative outcomes were compared between the groups. Multivariable logistic regression analyses were used to identify independent predictors of LOS≥2.

Results: Overall, 173 (60.5%) patients discharged on POD1, and 113 (39.5%) discharged on POD≥2. Patients in the study group presented a lower mean BMI (29 vs. 32, p=0.02). Retroperitoneal approach was performed in 13.3% patients with shorter LOS (p<0.001). There was a statistically significant difference in median OT (144 vs. 168min, p=0.005) and WIT (19 vs. 23min, p=0.001). We observed six postoperative complications (3.6%) in patients discharged on POD1 and 35 (30.5%) in control group (p<0.001). Major complications (Clavien-Dindo grade≥III) were observed in 3 of POD1 patients (1.8 vs. 6.1%, p<0.001). There was no difference in hospital readmission rate. On logistic regression analysis, independent predictors of prolonged LOS were OT (OR 1.01, 95%C.I.: 1.0-1.2, p=0.001), and occurrence of a postoperative complication (OR 2.2, 95%C.I. 2.0-2.5, p<0.001).

Conclusions: Our findings confirm that a single overnight stay after RAPN is feasible and safe. In our experience, and within the limitations of the present analysis, prolonged operative time and occurrence of immediate postoperative complications translate into higher risk of prolonged hospital stay. Besides adopting a minimally invasive approach, surgeons should also implement perioperative care pathways facilitating early discharge without increasing the risk of readmission.
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http://dx.doi.org/10.23736/S0393-2249.20.04054-0DOI Listing
November 2020

Robotic-assisted Partial Nephrectomy for "Very Small" (<2 cm) Renal Mass: Results of a Multicenter Contemporary Cohort.

Eur Urol Focus 2020 Nov 3. Epub 2020 Nov 3.

Division of Urology, VCU Health, Richmond, VA, USA. Electronic address:

Background: Patient with "very small" (<2 cm) renal mass can be offered active surveillance, thermal ablation, or partial nephrectomy. The management strategy will consider patient preferences and prioritize potential harms associated with each of these options. To date, outcomes of robot-assisted partial nephrectomy (RAPN) in patients with "very small" renal masses have not been reported.

Objective: To assess the outcomes of RAPN among patients with "very small" renal masses.

Design, Setting, And Participants: This was a retrospective analysis of a multi-institutional database including RAPN cases performed at eight high-volume US and European centers between 2009 and 2019. Patients were stratified into two groups according to clinical tumor size: <2 cm ("very small" renal mass, study group) and 2-4 cm (control group).

Intervention: RAPN for renal masses.

Outcome Measurements And Statistical Analysis: Baseline characteristics and intraoperative, pathological, and postoperative data were compared between the study and the control group. A "trifecta" was used as surrogate of "surgical quality."

Results And Limitations: Overall, a total of 1019 patients were included in the analysis. Of these, 352 had a renal mass of <2 cm (34.5%) and 667 (65.5%) had a renal mass of 2-4 cm. At baseline, the study group presented a lower rate of chronic kidney disease ≥stage III (p < 0.001), a lower RENAL score (p = 0.001), and lower rates of hilar (p = 0.04) and endophytic (p = 0.02) masses. Warm ischemia time was shorter for the study group (median 14 vs 18 min, p < 0.001), which also showed a lower rate of overall postoperative complications (9.6% vs 14.7%, p < 0.001) and no major complications. In terms of oncological outcomes, three and ten patients developed a local recurrence in the study and the control group, respectively (p = 0.1). In the study group, higher estimated glomerular filtration rates were found at discharge (p = 0.001) and at the last follow-up (p = 0.007), which showed a "trifecta" achievement of 90.6%. The retrospective design may limit the generalizability of the findings.

Conclusions: Whenever an active treatment is indicated or warranted, RAPN represents a minimally invasive management option for "very small" renal masses, as it carries minimal risk of complications and has minimal impact on renal function. While both active surveillance and kidney ablation remain valid management options in these cases, RAPN can be offered and discussed with patients as it provides excellent outcomes with low morbidity.

Patient Summary: In this report, we observed that robot-assisted partial nephrectomy represents a true minimally invasive active treatment for "very small" renal masses (<2 cm), as it carries minimal risk of complications and has minimal impact on renal function.
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http://dx.doi.org/10.1016/j.euf.2020.10.001DOI Listing
November 2020

Robot-assisted simple prostatectomy for giant benign prostatic hyperplasia.

Cent European J Urol 2020 24;73(3):383-384. Epub 2020 Jul 24.

Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA.

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http://dx.doi.org/10.5173/ceju.2020.0207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587478PMC
July 2020

Detection Rate of Prostate Specific Membrane Antigen Tracers for Positron Emission Tomography/Computerized Tomography in Prostate Cancer Biochemical Recurrence: A Systematic Review and Network Meta-Analysis.

J Urol 2021 02 16;205(2):356-369. Epub 2020 Sep 16.

Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Purpose: Restaging of prostate cancer in patients with biochemical recurrence after radical treatment remains a challenging clinical scenario as current imaging modalities are suboptimal. To date, prostate specific membrane antigen positron emission tomography/computerized tomography seems to represent a very promising diagnostic tool in this setting. Therefore, we evaluated the detection rate of several positron emission tomography/computerized tomography prostate specific membrane antigen based tracers in the restaging of prostate cancer in patients with biochemical recurrence.

Materials And Methods: According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, a systematic search was performed across MEDLINE®, Embase® and Web of Science™. PICOS (Patient, Intervention, Comparator, Outcome, Study Type), criteria consisted of P: patients with biochemical recurrence after radical prostatectomy and/or radiation therapy as primary treatment; I: studies using gallium-68-prostate specific membrane antigen-11, gallium-68-prostate specific membrane antigen inhibitor for imaging and therapy, gallium-68-trishydroxypyridinone-prostate specific membrane antigen, copper-64-prostate specific membrane antigen-617, fluorine-18-DCFPyL or fluorine-18-prostate specific membrane antigen-1007; C: no control group or positron emission tomography/computerized tomography comparative studies; O: patient specific overall detection rate; and S: retrospective/prospective studies. A meta-analysis of proportions and a network meta-analysis were performed. Heterogeneity was assessed using Cochran Q and I statistics. Quality was assessed by QUADAS-2 (University of Bristol, Bristol, United Kingdom). Funnel plots and Egger test were used for publication biases.

Results: A total of 43 studies including 5,832 patients were identified and included in the analysis. An overall detection rate of 74.1% (95% CI 69.2%-78.5%) was found, with no differences between tracers. The overall detection rates were 33.7%, 50.0%, 62.8%, 73.1% and 91.7% % in prostate specific antigen subgroups of less than 0.2 ng/ml, 0.2 to 0.49 ng/ml, 0.50 to 0.99 ng/ml, 1.0 to 1.99 ng/ml, and 2.0 ng/ml or greater, respectively. No difference between tracers was found according to prostate specific antigen doubling time or prostate specific antigen velocity. No tracer proved superior to the others through network meta-analysis. High heterogeneity and inconsistency were found across all analyses. Included studies showed a low risk of bias.

Conclusions: Prostate specific membrane antigen positron emission tomography/computerized tomography for prostate cancer restaging in patients with biochemical recurrence achieves best detection rates (over 70%) if prostate specific antigen is below 1 ng/ml. At lower prostate specific antigen levels the detection rate of prostate specific membrane antigen positron emission tomography/computerized tomography is lower (33.7% for levels below 0.2 ng/ml and 50% for levels 0.2 to 0.49 ng/ml), despite being better than "older" tracers such as choline based positron emission tomography or computerized tomography/bone scintigraphy. Furthermore, no prostate specific membrane antigen tracer can be currently considered superior to others. Further studies are needed to better define the diagnostic performance and role of these imaging techniques.
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http://dx.doi.org/10.1097/JU.0000000000001369DOI Listing
February 2021

Outcomes of robot-assisted partial nephrectomy for completely endophytic renal tumors: A multicenter analysis.

Eur J Surg Oncol 2020 Aug 16. Epub 2020 Aug 16.

Division of Urology, VCU Health, Richmond, VA, USA. Electronic address:

Introduction: Multicenter retrospective analysis of robotic partial nephrectomy for completely endophytic renal tumors (i.e. 3 points for the 'E' domain of the R.E.N.A.L. nephrometry score) was performed.

Materials And Methods: Patients' demographics, tumor characteristics, perioperative, functional, pathological and oncological data were analyzed and compared with those of patients with exophytic and mesophytic masses (i.e. 1 and 2 points for the 'E' domain, respectively). Multivariable logistic regression analysis was used to assess variables for trifecta achievement (negative margin, no postoperative complications, and 90% estimated glomerular filtration rate [eGFR] recovery).

Results: Overall, 147 patients were included in the study group. Patients with a completely endophytic mass had bigger tumors (mean 4.2 vs. 4.1 vs. 3.2 cm; p < 0.001) on preoperative imaging and higher overall R.E.N.A.L. score. There was no difference in mean operative time. Estimated blood loss was higher in the endophytic group (mean 177.75 vs. 185.5 vs. 130 ml; p = 0.001). Warm ischemia time was shorter for the exophytic group (median 16 vs. 21 vs. 22 min; p < 0.001). Postoperative complications were more frequent in patients with endophytic tumor (24.8% vs. 19.5% vs. 14.8%; p < 0.001). Six (4.5%) patients had positive surgical margins, there was no difference between groups. Trifecta was achieved in 44 patients in endophytic group (45.4 vs. 68.8 and 50.9%, p < 0.001). Multivariable analysis for trifecta revealed that clinical tumor size (odds ratio: 0.667, 95% confidence interval: 0.56-0.79, p < 0.001) was only significant predictor for trifecta achievement.

Conclusions: Our findings confirm that RAPN in case of completely endophytic renal masses can be performed with acceptable outcomes in centers with significant robotic expertise.
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http://dx.doi.org/10.1016/j.ejso.2020.08.012DOI Listing
August 2020

Urinary and sexual function after treatment with temporary implantable nitinol device (iTind) in men with LUTS: 6-month interim results of the MT-06-study.

World J Urol 2020 Aug 26. Epub 2020 Aug 26.

San Luigi Gonzaga di Orbassano University Hospital, Orbassano, Italy.

Purpose: To evaluate the functional outcomes as they relate to the preservation of urinary continence and sexual function after treatment with the temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Israel); a novel minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Methods: Men with symptomatic BPH (IPSS ≥ 10, Q < 12 ml/s, and prostate volume (PV) < 120 ml) were invited to participate in this single-arm, prospective multicenter study (MT06). Patients were not washed out of BPH medications before the procedure. The iTind was implanted through a 22F rigid cystoscope under intravenous sedation and was removed 5-7 days later through a 22F Foley catheter under local anesthesia. Post-operative VAS and complications (Clavien Dindo-Grading System) were recorded. Preservation of urinary continence and erectile and ejaculatory function were assessed according to ISI, MSHQ-EjD and SHIM questionnaires. Post-operative IPSS, QoL, Q and PVR were also assessed at 1, 3, and 6 months post-operatively.

Results: This interim report includes data out to 6 months on the first 70 patients enrolled in the study. The median age was 62.31 years, and the mean prostate volume was 37.68 ml (15-80 ml). Baseline and follow-up data are reported in Table 1. No intraoperative complications were observed, the average post-operative VAS score was 3.24 ± 2.56. On average patients returned to daily life after 4.3 days following the retrieval procedure. Sexual function and urinary continence were preserved in all subjects according to the ISI, SHIM and MSHQ-EjD questionnaires and significant improvements (p < 0.0001) from baseline levels were recorded in IPSS, QoL and peak flow.

Conclusion: iTind is a well-tolerated, minimally invasive treatment for BPH-related LUTS which preserves sexual function and urinary continence, offers a rapid recovery and return to daily life, and a significant improvement of symptoms and urinary flow at 6-month follow-up.
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http://dx.doi.org/10.1007/s00345-020-03418-2DOI Listing
August 2020

Circulating preoperative testosterone level predicts unfavourable disease at radical prostatectomy in men with International Society of Urological Pathology Grade Group 1 prostate cancer diagnosed with systematic biopsies.

World J Urol 2020 Jul 18. Epub 2020 Jul 18.

Department of Translational Medical Sciences, University of Naples "Federico II", 8031, Naples, Italy.

Purpose: The association between circulating total testosterone (T) levels and clinically significant PCa is still a matter of debate. In this study, we evaluated whether serum testosterone levels may have a role in predicting unfavorable disease (UD) and biochemical recurrence (BCR) in patients with clinically localized (≤ cT2c) ISUP grade group 1 PCa at biopsy.

Methods: 408 patients with ISUP grade group 1 prostate cancer, undergone to radical prostatectomy and T measurement were included. The outcome of interest was the presence of unfavourable disease (UD) defined as ISUP grade group [Formula: see text] 3 and/or pT [Formula: see text] 3a.

Results: Statistically significant differences resulted between serum testosterone values and ISUP grade groups (P < 0.0001). Significant correlation was found analyzing testosterone values versus age (P < 0.0001), and versus PSA (P = 0.008). BCR-free survival was significantly decreased in patients with low levels of testosterone (P = 0.005). These findings were confirmed also in the ISUP 1-2 subgroups (P = 0.01). ROC curve analysis showed that T outperformed PSA in predicting UD (AUC 0.718 vs AUC 0.525; P < 0.001) and was and independent risk factor for BCR.

Conclusion: Our findings suggested that circulating total T was a significant predictor of UD at RP in patients with preoperative low- to intermediate-risk diseases, confirming the potential role of circulating androgens in preoperative risk assessment of PCa patients.
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http://dx.doi.org/10.1007/s00345-020-03368-9DOI Listing
July 2020

64CuCl2 PET/CT as a potential new imaging method in prostate cancer: illusion or reality?

Minerva Urol Nefrol 2020 Mar 16. Epub 2020 Mar 16.

Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Copper (Cu) is an essential element for many cellular functions, including proliferation and angiogenesis. High serum Cu levels have been demonstrated in patients with neoplasia as well as high intra-tumoral Cu levels have been reported. Preclinical and clinical evidences suggest its use, in the form of 64Copper chloride (64CuCl2), as metabolic PET tracer in cancer diagnosis and therapy. Specifically, the use of 64CuCl2 in human Prostate Cancer (PCa) evidenced a high uptake of 64CuCl2 in tumoral prostate and involved regional lymph nodes in a staging setting and high sensitivity for local recurrence and lymph nodes detection in restaging, indicating its great potential. However, further and more solid clinical evidences are needed. On the other hand, 64CuCl2 seems to be a promising radiometabolic drug with great cytotoxic abilities on PCa cells. We have collected the most recent and relevant findings on its potential uses and limitations for the study and treatment of PCa, together with its possible translation in daily clinical practice.
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http://dx.doi.org/10.23736/S0393-2249.20.03615-2DOI Listing
March 2020

Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis.

Prostate Cancer Prostatic Dis 2019 05 28;22(2):206-220. Epub 2018 Nov 28.

Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.

Background: The use of multiparametric magnetic resonance imaging (mpMRI) in the setting of patients under active surveillance (AS) is promising. In this systematic-review we aimed to analyse the role of mpMRI in patients under AS.

Methods: A comprehensive literature research for English-language original and review articles, recently published, was carried out using Medline, Scopus and Web of sciences databases until 30 October 2017. The following MeSH terms were used: 'active surveillance', 'prostate cancer', 'multiparametric magnetic resonance imaging'. A diagnostic meta-analysis was performed for 3.0 T mpMRI in predicting disease re-classification.

Results: In total, 226 studies were selected after research and after removal of duplicates. After analysis on inclusion criteria, 43 studies were identified as eligible for this systematic review with a total of 6,605 patients. The timing of MRI during follow-up of AS differed from all studies like criteria for inclusion in the AS protocol. Overall, there was a low risk of bias across all studies. The diagnostic meta-analysis for 1.5 tesla showed a sensitivity of 0.60, negative predictive value (NPV) of 0.75 and a hierarchical summary receiving operating curve (HSROC) of 0.74 while for 3.0 tesla mpMRI a sensitivity of 0.81, a NPV of 0.78 and a HSROC of 0.83.

Conclusions: Overall, the available evidence suggests that both 1.5 or 3.0 Tesla mpMRI are a valid tool to monitor progression during AS follow-up, showing good accuracy capabilities in detecting PCa re-classification. However, the modality to better define what means 'disease progression' on mpMRI must be further evaluated.
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http://dx.doi.org/10.1038/s41391-018-0113-2DOI Listing
May 2019

High-throughput detection of low abundance sialylated glycoproteins in human serum by TiO enrichment and targeted LC-MS/MS analysis: application to a prostate cancer sample set.

Anal Bioanal Chem 2019 Jan 28;411(3):755-763. Epub 2018 Nov 28.

Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Campus "S. Venuta", Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy.

Glycopeptide enrichment can be a strategy to allow the detection of peptides belonging to low abundance proteins in complex matrixes such as blood serum or plasma. Though several glycopeptide enrichment protocols have shown excellent sensitivities in this respect, few reports have demonstrated the applicability of these methods to relatively large sample cohorts. In this work, a fast protocol based on TiO enrichment and highly sensitive mass spectrometric analysis by Selected Reaction Monitoring (SRM) has been applied to a cohort of serum samples from prostate cancer and benign prostatic hyperplasia patients in order to detect low abundance proteins in a single LC-MS/MS analysis in nanoscale format, without immunodepletion or peptide fractionation. A peptide library of over 700 formerly N-glycosylated peptides was created by data dependent analysis. Then, 16 medium to low abundance proteins were selected for detection by single injection LC-MS/MS based on selected-reaction monitoring. Results demonstrated the consistent detection of the low-level proteins under investigation. Following label-free quantification, four proteins (Adipocyte plasma membrane-associated protein, Periostin, Cathepsin D and Lysosome-associated membrane glycoprotein 2) were found significantly increased in prostate cancer sera compared to the control group. Graphical abstract ᅟ.
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http://dx.doi.org/10.1007/s00216-018-1497-5DOI Listing
January 2019

Comparison Between Cu-PSMA-617 PET/CT and F-Choline PET/CT Imaging in Early Diagnosis of Prostate Cancer Biochemical Recurrence.

Clin Genitourin Cancer 2018 10 4;16(5):385-391. Epub 2018 Jun 4.

Diagnostic Imaging, Nuclear Medicine Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Purpose: To evaluate the diagnostic performance of Cu-PSMA-617 positron emission tomography (PET) with computed tomography (CT) for restaging prostate cancer after biochemical recurrence (BCR) and to compare it with F-choline PET/CT in a per-patient analysis.

Patients And Methods: An observational study was performed of 43 patients with BCR after laparoscopic radical prostatectomy who underwent Cu-PSMA-617 PET/CT and subsequently F-choline PET/CT for restaging. The detection rates (DR) of Cu-PSMA-617 PET/CT and of F-choline PET/CT were calculated by standardized maximum uptake value (SUV) at 4 hours and SUV at 1 hour as reference, respectively. Furthermore, univariate logistic regression analysis was carried out to identify independent predictive factors of positivity with Cu-PSMA-617 PET/CT.

Results: An overall positivity with Cu-PSMA-617 PET/CT was found in 32 patients (74.4%) versus 19 (44.2%) with F-choline PET/CT. Specifically, after stratifying for prostate-specific antigen (PSA) values, we found a good performance of Cu-PSMA-617 PET/CT at low PSA levels compared to F-choline PET/CT, with a DR of 57.1% versus 14.3% for PSA 0.2-0.5 ng/mL (P = .031), and of 60% versus 30% with PSA 0.5-1 ng/mL. At univariate binary logistic regression analysis, PSA level was the only independent predictor of Cu-PSMA-617 PET/CT positivity. No significant difference in terms of DR for both Cu-PSMA-617 PET/CT and F-choline PET/CT was found according to different Gleason score subgroups.

Conclusion: In our study cohort, a better performance was observed for Cu-PSMA-617 PET/CT compared to F-choline PET/CT in restaging after BCR, especially in patients with low PSA values.
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http://dx.doi.org/10.1016/j.clgc.2018.05.014DOI Listing
October 2018