Publications by authors named "Jamil Ghahhari"

4 Publications

  • Page 1 of 1

Radical penectomy, a compromise for life: results from the PECAD study.

Transl Androl Urol 2020 Jun;9(3):1306-1313

Department of Urology, ASL 2 Abruzzo, Hospital "S. Pio da Pietrelcina", Vasto, Italy.

Background: The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15-20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients.

Methods: Data from a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 13 European and American urological centers (Hospital "Sant'Andrea", Sapienza University, Roma, Italy; "G.D'Annunzio" University, Chieti and ASL 2 Abruzzo, Hospital "S. Pio da Pietrelcina", Vasto, Italy; Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Hospital of Budapest, Hungary; Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Italy; Hospital "Spedali Civili", Brescia, Italy; Istituto Europeo di Oncologia, University of Milan, Milan, Italy; University of Modena & Reggio Emilia, Modena, Italy; Hospital Universitario La Paz, Madrid, Spain; Ceara Cancer Institute, Fortaleza, Brazil; Virginia Commonwealth University, Richmond, VA, USA; Aristotle University of Thessaloniki, Thessaloniki, Greece; Maria Skłodowska-Curie Memorial Cancer Center, Warsaw, Poland) between 2010 and 2016 were used. Medical records of patients who specifically underwent radical penectomy were reviewed to identify main clinical and pathological variables. Kaplan-Meier method was used to estimate 1- and 5-year OS and DFS.

Results: Of the entire cohort of 425 patients, 72 patients (16.9%) treated with radical penectomy were extracted and were considered for the analysis. The median age was 64.5 (IQR, 57.5-73.2) years. Of all, 41 (56.9%) patients had pT3/pT4 and 31 (43.1%) pT1/pT2. Moreover, 36 (50.0%) were classified as pN1-3 and 5 (6.9%) M1. Furthermore, 61 (84.7%) had a high grade (G2-G3) with 6 (8.3%) positive surgical margins. The 1- and 5-year OS rates were respectively 73.3% and 59.9%, while the 1- and 5-year DFS rates were respectively 67.3% and 35.1%.

Conclusions: PC is an aggressive cancer particularly in more advanced stage. Overall, more than a third of patients do not survive at 5 years and more than 60% report a disease recurrence, despite the use of a radical treatment.
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June 2020

Managing lines of therapy in castration-resistant prostate cancer: real-life snapshot from a multicenter cohort.

World J Urol 2020 Jul 12;38(7):1757-1764. Epub 2019 Oct 12.

Department of Urology, "Regina Elena" National Cancer Institute of Rome, Via Elio Chianesi 53, 00154, Rome, Italy.

Purpose: To provide a snapshot of toxicities and oncologic outcomes of Abiraterone (AA) and Enzalutamide (EZ) in a chemo-naïve metastatic castration-resistant prostate cancer (mCPRC) population from a longitudinal real-life multicenter cohort.

Methods: We prospectively collected data on chemo-naïve mCRPC patients treated with AA or EZ. Primary outcomes were PSA response, oncologic outcomes and toxicity profile. The Kaplan-Meier method was used to compare differences in terms of progression-free survival (PFS) between AA vs EZ and high- vs low-volume disease cohorts. Univariable and multivariable Cox regression analyses were performed to identify predictors of PFS. Toxicity, PSA response rates and oncologic outcomes on second line were compared with those observed on first line.

Results: Out of 137 patients, 88 received AA, and 49 EZ. On first line, patients receiving EZ had significantly higher PSA response compared with AA (95.9% vs 67%, p < 0.001), comparable toxicity rate (10.2% vs 16.3%, p = 0.437) and PFS probabilities (p = 0.145). Baseline PSA and high-volume disease were predictors of lower PFS probabilities at univariable analysis (p = 0.027 and p = 0.007, respectively). Overall, 28 patients shifted to a second-line therapy (EZ or radiometabolic therapy). Toxicity and PSA response rates on second line were comparable to those observed on first line (11.1% vs 12.4%, p = 0.77; 73.1% vs 77.4%, p = 0.62, respectively); 2-year PFS, cancer-specific and overall survival probabilities were comparable to those displayed in first-line cohort (12.1% vs 16.2%, p = 0.07; 85.7% vs 86.4%, p = 0.98; 71% vs 80.3%, p = 0.66, respectively).

Conclusions: Toxicity profile, PSA response rate and oncological outcomes were comparable between first-line and second-line courses in patients treated with either AA or EZ for mCRPC. Our findings showed the tolerability and oncological effectiveness, when feasible, of two lines of therapy other than chemotherapy.
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July 2020

The Surgical Experience Influences the Safety and Efficacy of Photovaporization of Prostate with 180-W XPS GreenLight Laser: Comparison Between Novices vs Expert Surgeons Learning Curves.

J Endourol 2018 11 20;32(11):1071-1077. Epub 2018 Oct 20.

1 Department of Urology, ASL02 Abruzzo , Chieti, Italy .

Purpose: To assess the extent to which surgical experience can affect perioperative and functional outcomes after photoselective vaporization of the prostate (PVP) with 180W XPX GreenLight laser in patients with lower urinary tract symptoms secondary to benign prostatic obstruction (BPO).

Materials And Methods: Data from 291 consecutive patients with symptomatic BPO (median follow-up 12 m) were collected and analyzed. Patients were treated at 2 different institutions by 2 expert (G1, n = 182) and 2 novice (G2, n = 109) transurethral prostate surgeons (February 2013 - March 2017) and underwent standard or anatomical PVP depending on surgeons' preferences. Patients' characteristics, perioperative and functional outcomes were compared using the chi-square and Mann-Whitney U tests. Patients' satisfaction was measured using the Patient Global Impression of Improvement (PGI-I) score. Learning curves were analyzed based on changes in quantitative parameters: surgery time, lasing/operative time, and energy delivered (kJ).

Results: Patients' baseline characteristics, perioperative data and PGI-I score were similar. Overall the complication rates showed better trends for G1. Serum prostate-specific antigen levels, maximum flow rate, and International Prostatic Symptoms Score improved in both groups, with perceived improvements greater in G2 (p < 0.006). Lasing time/operative time ratio showed greater evolution for G1 than G2 (0.50:IQR 0.38-0.60 vs 0.46:IQR 0.34-0.58, respectively)(p = 0.201). A major increase in energy delivery for G2 was achieved within the first 50 procedures, whereas more than 100 iterations were needed for G1 to reach LT/OT >60%.

Conclusion: Surgeons' background and expertise appear to affect outcomes over the learning curve, with roughly similar perioperative and functional results.
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November 2018

Monocenter Experience with 532 Nm-Laser Photoselective-Vaporization of the Prostate by GreenLight XPS™ Laser: Is It Really an Endourological Joker Card?

Surg Technol Int 2018 06;32:164-172

Department of Urology, SS. Annunziata Hospital , "G.D'Annunzio" University of Chieti, Chieti, Italy.

Introduction: In our study, we reported on our monocenter experience with GreenLight (GL) Xcelerated Performance System (XPS)™ /MoXy™ laser fiber (American Medical Systems Inc., Minnetonka, Minnesota), examining its efficacy, safety, and its ability to effectively treat lower urinary tract symptoms (LUTS) in benign prostate obstruction (BPO). We also explored and compared the three different endoscopic approaches used for GL treatment of benign prostatic hyperplasia (BPH), standard photovaporization (PVP), anatomical PVP, and GreenLight XPS™ enucleation of the prostate.

Materials And Methods: Between February 2013 and April 2017, 140 patients, with an average age of 67.7 years (range 47-85), were treated using the XPS™/MoXy™ system in a single-operative urologic center. The data were retrospectively analyzed with an assessment of the main intra- and postoperative outcomes at three, six, 12, and 18 months comparing both subjective (international prostate symptom score [IPSS]) and objective (uroflow [Qmax] parameters and prostate volume) parameters to the preoperative data. Patients underwent standard PVP, anatomical PVP, or prostate photo-selective en-bloc enucleation (PEBE) according to surgeon preferences.

Results: Median prostate volume (MPV) and prostate-specific antigen (PSA) were 69cc and 3.24 ng/dl, respectively. An indwelling catheter, at the time of surgery, was observed in 15% of men. Median operative-laser time and energy applied were 56.4 minutes, 26.5 minutes, and 245813 kJ. Outpatient surgery was feasible with median length of stay at 48 hours. Significant improvement in IPSS and Qmax are observed at all endpoints. No significant intraoperative complications were reported. When stratifying postoperative complications according to the Cavien-Dindo classification, only two cases of high-degree emerged (grades III-IV).

Conclusion: Our data confirm that in treating men with symptomatic benign prostate disease, the GreenLight XPS™/MoXy™ laser fiber is safe and able to achieve challenging results in terms of clinical outcomes and prostate volume reduction. Balance between functional outcomes and complications was great without statistically significant differences, in terms of outcomes, between the different surgical techniques.
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June 2018