Publications by authors named "Sebastiano Cimino"

85 Publications

Effects of dutasteride on sex hormones and cerebrospinal steroids in patients treated for benign prostatic hyperplasia.

Endocrine 2021 Mar 9. Epub 2021 Mar 9.

Department of Surgery, Urology Section, University of Catania, 95123, Catania, Italy.

Purpose: Neuroactive steroids may have a role in regulating sexual function. This case-control study assessed whether dutasteride, a 5α-reductase inhibitor used for treatment of patients with benign prostate hyperplasia (BPH), impacts on the levels of neuroactive steroids, leading to erectile dysfunction (ED) and/or hypoactive sexual desire (HSD).

Methods: Forty patients with BPH and moderate-to-severe lower urinary tract symptoms (LUTS), pre-scheduled for prostate transurethral resection or open prostatectomy were enrolled. Twenty of these patients with prostate volume ≤40 mL were treated with α-blockers (Group A) and the remaining 20, with prostate volume >40 mL, with dutasteride plus α-blockers (Group B) for at least 6 months before surgery. Serum sex steroids and gonadotropin levels were measured the day before surgery, and the neuroactive steroid levels were assessed in the cerebrospinal fluid (CSF) collected during spinal anesthesia, at the day of surgery.

Results: Before surgery, the International Index of Erectile Function 5-item score was higher in Group A that Group B (18.8 ± 4.8 vs. 15.1 ± 5.4, p < 0.01). Group A showed lower total testosterone (TT) (4.5 vs.6.4 ng/ml, p < 0.01) and 17β-estradiol (E) (24.3 vs.30.7 pg/ml, p < 0.05) serum levels than Group B. CSF levels of TT (1446.6 vs. 19.9 pg/ml, p < 0.05) and dihydrotestosterone (7.9 vs. 1.4 pg/ml, p < 0.05) were higher and CSF E levels were lower (26.0 vs.36.0 pg/ml, p < 0.01) in Group A than Group B.

Conclusions: A decrease of neuroactive steroids in the CSF of patients treated with dutasteride occurs. This may be one of the mechanisms by which dutasteride may cause ED and HSD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12020-021-02675-4DOI Listing
March 2021

Systemic combining inflammatory score (SCIS): a new score for prediction of oncologic outcomes in patients with high-risk non-muscle-invasive urothelial bladder cancer.

Transl Androl Urol 2021 Feb;10(2):626-635

Urology Section, Department of Surgery, University of Catania, Catania, Italy.

Background: An accurate and early diagnosis of bladder cancer (BC) is essential to offer patients the most appropriate treatment and the highest cure rate. For this reason, patients need to be best stratified by class and risk factors. We aimed to develop a score able to better predict cancer outcomes, using serum variables of inflammation.

Methods: A total of 1,510 high-risk non-muscle invasive bladder cancer (NMIBC) patients were included in this retrospective observational study. Patients with pathologically proven T1 HG/G3 at first TURBT were included. Systemic combined inflammatory score (SCIS) was calculated according to systemic inflammatory markers (SIM), modified Glasgow prognostic score (mGPS), and prognostic nutritional index (PNI) dichotomized (final score from 0 to 3).

Results: After 48 months of follow-up (IQR 40.0-73.0), 727 patients recurred (48.1%), 485 progressed (32.1%), 81 died for cancer (7.0%), and 163 died for overall causes (10.8%). Overall, 231 (15.3%) patients had concomitant Cis, 669 (44.3%) patients had multifocal pathology, 967 (64.1%) patients had tumor size >3 cm. Overall, 357 (23.6%) patients received immediate-intravesical therapy, 1,356 (89.8%) received adjuvant intravesical therapy, of which 1,382 (91.5%) received BCG, 266 (17.6%) patients received mitomycin C, 4 (0.5%) patients received others intravesical therapy. Higher SCIS was independently predictive of recurrence (hazard ratio HR 1.5, 1.3 and 2.2) and cancer specific mortality for SCIS 0 and 3 (HR: 1.61 and 2.3), and overall mortality for SCIS 0 and 3 (HR: 2.4 and 3.2). Conversely, SCIS was not associated with a higher probability of progression.

Conclusions: The inclusion of the SCIS in clinical practice is simple to apply and can help improve the prediction of cancer outcomes. It can identify patients with high-grade BC who are more likely to experience disease mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/tau-20-1272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947442PMC
February 2021

How Can the COVID-19 Pandemic Lead to Positive Changes in Urology Residency?

Front Surg 2020 24;7:563006. Epub 2020 Nov 24.

Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy.

The COVID-19 outbreak, in a few weeks, overloaded Italian hospitals, and the majority of medical procedures were postponed. During the pandemic, with hospital reorganization, clinical and learning activities performed by residents suffered a forced remodulation. The objective of this study is to investigate how urology training in Italy has been affected during the COVID-19 era. In this multi-academic study, we compared residents' training during the highest outbreak level with their previous activity. Overall 387 (67.1%) of the 577 Italian Urology residents participated in a 72-h anonymous online survey with 36 items sent via email. The main outcomes were clinical/surgical activities, social distancing, distance learning, and telemedicine. Clinical and learning activity was significantly reduced for the overall group, and after categorizing residents as those working only in COVID hospitals, both "junior" and "senior" residents, and those working in any of three geographical areas created (Italian regions were clustered in three major zones according to the prevalence of COVID-19). A significant decrease in outpatient activity, invasive diagnostic procedures, and endoscopic and major surgeries was reported. Through multivariate analysis, the specific year of residency has been found to be an independent predictor for all response modification. Being in zone 3 and zone 2 and having "senior" resident status were independent predictors associated with a lower reduction of the clinical and learning activity. Working in a COVID hospital and having "senior" resident status were independent predictors associated with higher reduction of the outpatient activity. Working in zone 3 and having "senior" resident status were independent predictors of lower and higher outpatient surgical activity, respectively. Working in a COVID hospital was an independent predictor associated with robotic surgical activity. The majority of residents reported that distance teaching and multidisciplinary virtual meetings are still not used, and 44.8% reported that their relationships with colleagues decreased. The COVID-19 pandemic presents an unprecedented challenge, including changes in the training and education of urology residents. The COVID era can offer an opportunity to balance and implement innovative solutions that can bridge the educational gap and can be part of future urology training.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fsurg.2020.563006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732553PMC
November 2020

Holmium laser for RIRS. Watts are we doing?

Arch Esp Urol 2020 Oct;73(8):735-744

European Training Center in Endourology at Department of Urology. IRCCS San Raffaele Hospital. Ville Turro Division. Milan. Italy.

Objective: To review recent and relevant information regarding the use of high-power (HPL) and low-power (LPL) Holmium:YAG lasers (Ho:YAG) in retrograde intrarenal surgery (RIRS) for lithotripsy. METHODS: A PubMed/Embase search was conducted and recent and relevant papers on Ho:YAG for RIRS were reviewed.

Results: Settings for Ho:YAG are pulse energy (PE), pulse frequency (PF), and pulse width. Currently, the majority of LPL can also adjust pulse-width but cannot reach PF as high as HPL, however, the higher energy outputs reached by HPL are rarely useful in lithotripsy. Higher PE might enhance ablation but generates larger fragments and higher retropulsion. Pulse width does not affect energy output but delivers energy for a longer time-length. Dusting and basketing are complementary techniques. Dusting seeks to pulverize stones into particles ≤250 μm avoiding the use of instruments for stone retrieval, whereas in fragmenting, the stones are break into smaller pieces which are then retrieved. Dusting can prevent the use of supplies such as access sheaths and baskets and also prevent the complications related to their use. However, is not always feasible in clinical practice to fully ablate a stone into dust, then the use of this supplies and popcorn technique are helpful for rendering a patient stonefree. The energy gap between HPL and LPL is wide and leaves room for a mid-power laser classification, which can overcome the main drawback of LPL, the expenses of HPL, and still holding its versatility for other procedures beyond stones.

Conclusions: HPL and LPL have similar effectiveness, but long-term cost-effectiveness comparisons are underexplored. Newer HPL would need to be compared to emerging technologies as the thulium fiber, and prove superiority to mid-power laser to determine how powerful is enough for Ho:YAG in the years to come.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2020

Pharmacotherapeutic management of lower urinary tract symptoms in Multiple Sclerosis patients.

Expert Opin Pharmacother 2020 Aug 26;21(12):1449-1454. Epub 2020 May 26.

Department G.F.Ingrassia, University of Catania , Catania, Italy.

Introduction: Multiple Sclerosis (MS) manifests with a plethora of signs and symptoms affecting brain structures and spinal pathways. The multitude of lesions in MS patients makes difficult to establish the relative role of each of them to lower urinary tract symptoms (LUTS). Generally, the subcortical white-matter lesions result in detrusor overactivity, whilst lesions of the spinal cord result in the combined occurrence of detrusor overactivity and detrusor-sphincter dyssynergia (DSD). It has been estimated that 80-90% of patients with MS will suffer from some form of LUTS over the course of the disease. Among LUTS, the most reported is detrusor overactivity which includes urinary urgency, frequent urination, nocturia, and urge urinary incontinence.

Areas Covered: The authors review the management of lower urinary tract symptoms in MS patients providing their expert opinions on the subject matter.

Expert Opinion: LUTS affect the quality of life substantially and are associated with a significantly increased mortality. The adequate management is an important challenge for both patients and caregivers with a multidisciplinary approach likely necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14656566.2020.1767068DOI Listing
August 2020

Evaluation of the "Teaching Guide for Basic Laparoscopic Skills" as a stand-alone educational tool for hands-on training sessions: a pilot study.

World J Urol 2021 Jan 21;39(1):281-287. Epub 2020 Mar 21.

Department of Urology and Kidney Transplant, Grande Ospedale Metropolitano, Reggio Calabria, Italy.

Introduction And Objectives: Standardization of hands-on training (HoT) has profoundly impacted the educational field in the last decade. To provide quality training sessions on a global scale, the European School of Urology Training group developed a teaching guide for tutors in 2015. Our study aims to understand whether this guide alone can provide information enough to match the performance improvement guaranteed by an expert tutor.

Material And Methods: 4 randomized groups of participants underwent HoT sessions with different teaching modalities: an expert surgeon (group 1), an expert E-BLUS tutor (group 2), E-BLUS guide alone (group 3), no tutor (group 4). Groups 1 and 2 were respectively provided with two different tutors to avoid biases related to personal tutor ability. Along the training session, each participant could perform five trials on two E-BLUS tasks: Peg transfer and Knot tying. During trials 1 and 5, completion time and number of errors were recorded for analysis with Pi-score algorithm. The average per-group Pi-scores were then compared to measure different performance improvement results.

Results: 60 participants from Italy were enrolled and randomized into four groups of 15. Pi-scores recorded on Peg transfer task were 24,6 (group 1), 26,4 (group 2), 42,2 (group 3), 11,7 (group 4). Pi-scores recorded on Knot tying task were 33,2 (group 1), 31,3 (group 2), 37,5 (group 3), 18,6 (group 4).

Conclusion: Compared to a human tutor, standardized teaching with the EBLUS guide may produce similar performance improvement. This evidence opens doors to automated teaching and to several novelties in hands-on training.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00345-020-03161-8DOI Listing
January 2021

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0393-2249.20.03615-2DOI Listing
March 2020

Clinical Efficacy of Serenoa repens Versus Placebo Versus Alpha-blockers for the Treatment of Lower Urinary Tract Symptoms/Benign Prostatic Enlargement: A Systematic Review and Network Meta-analysis of Randomized Placebo-controlled Clinical Trials.

Eur Urol Focus 2021 Mar 15;7(2):420-431. Epub 2020 Jan 15.

Department of Urology, University of Florence, Florence, Italy.

Context: International guidelines do not make any specific recommendations on Serenoa repens (SeR) for the treatment of male lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE), due to product heterogeneity and methodological limitations of the published trials and meta-analyses.

Objective: We aimed to compare the clinical efficacy of hexanic extract of SeR (HESr) versus non-HESr (nHESr) versus placebo versus alpha-blockers (ABs) in patients affected by LUTS secondary to BPE through a network meta-analysis method.

Evidence Acquisition: The search was conducted until December 31, 2018 using Medline, Scopus, and Web of Science databases without restriction. We included randomized controlled trials (RCTs) with at least one comparison between SeR, ABs, or placebo for the treatment of LUTS/BPE. Outcomes of the study were the mean change in the International Prostate Symptom Score (IPSS) and peak flow (PF). This systematic review has been registered on PROSPERO (CRD42018084360).

Evidence Synthesis: In total, 2115 articles were identified. After the global assessment, 22 RCTs matched with the inclusion criteria, including 8564 patients. For IPSS, the mean efficacies against placebo were +0.48 and -1.69 for HESr and nHESr, respectively, at 3 mo; 0.59 for nHESr at 6 mo; and -1.31 and -3.30 for nHESr and HESr, respectively, at 12 mo. For PF, the mean efficacies against placebo were +0.53 and +2.82 for HESr and nHESr, respectively, at 3 mo; +1.85 for nHESr at 6 mo; and +4.05 and +5.52 for HESr and nHESr, respectively, at 12 mo. Based on the surface under the cumulative ranking curve rankograms, terazosin showed the highest score (99.6%), while alfuzosin, tamsulosin, silodosin, HESr, and nHESr showed scores of 53.7%, 42.3%, 68.5%, 36.7%, and 47.3%, respectively.

Conclusions: In this network meta-analysis, we demonstrated that SeR did not show clinically meaningful improvement in LUTS and PF.

Patient Summary: In the present study, we found no clinically meaningful improvement of Serenoa repens for the treatment of lower urinary tract symptoms/benign prostatic enlargement. The analysis showed that the benefit over placebo was minimal and may not justify its clinical use before higher level of evidence will be available.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.euf.2020.01.002DOI Listing
March 2021

Clinical and psychological outcomes of patients undergoing Retrograde Intrarenal Surgery and Miniaturised Percutaneous Nephrolithotomy for kidney stones. A preliminary study.

Arch Ital Urol Androl 2020 Jan 14;91(4):256-260. Epub 2020 Jan 14.

Department of Urology, University of Catania.

Purpose: To assess disease-specific and health-related QoL, anxiety and depression as well as satisfaction regarding retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) intervention for kidney stones up to 2.5 cm. Secondarily, pain as well as perioperative and postoperative patient outcomes were evaluated.

Methods: 60 consecutive patients with kidney stones of dimensions not exceeding 2.5 cm were enrolled in the study of which 30 underwent RIRS and 30 mPCNL. Perioperative characteristics (age, gender, body mass index (BMI), stone side and size, previous interventions for kidney stones and duration of hospitalization) and surgical outcomes (hemoglobin drop, stone-free rate, visual analogue scale (VAS), stenting time, size of ureteral access sheath (UAS) deployment, and postoperative complications) of patients were collected. Quality of life and psychological outcomes were evaluated using validated questionnaires.

Results: No significant differences were found between the two groups in terms of age, gender, BMI, stone side and size (p > 0.05). Significant differences between the mPCNL and the RIRS groups were found regarding stenting time (p = 0.032) and duration of hospital stay (p < 0.001). The stone-free rates of mPCNL vs RIRS were not significantly different between the two groups (73.3% vs 66.7%, p > 0.05). Peri- and postoperative complications were not statistically different between the two groups (p > 0.05). RIRS group reported higher anxiety and depression scores compared with the mPCNL group (3 [range 0-15] vs 15 [range 6-24], p < 0.01). We found significant differences between the two groups in social (p < 0.05) and vitality (p < 0.01) scores. VAS pain score was significantly lower in the mPCNL group than in the RIRS one (p < 0.05).

Conclusions: These results open new scenarios in the treatment of kidney stones up to 2.5 cm when RIRS and mPCNL have interchangeable indications. Since in our experience complications and success rate are similar, the surgical choice of switching from RIRS to mPCNL in real-time and viceversa may be proposed to the patient in the preoperative counseling.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4081/aiua.2019.4.256DOI Listing
January 2020

Intratumoral Heterogeneity Determines the Expression of mTOR-pathway Proteins in Prostate Cancer.

Dis Markers 2019 11;2019:1296865. Epub 2019 Dec 11.

Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany.

The aim of this study was to evaluate the expression of mammalian target of rapamycin (mTOR), phosphorylated-mTOR (p-mTOR), and eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1) in prostate cancer (PCa) in order to assess intratumoral heterogeneity and correlation with clinicopathological parameters. Tissue samples from 115 patients undergoing radical prostatectomy were included in a tissue microarray comprising (A) tissue from the tumor center, (B) malignant border of the tumor, (C) tumor-adjacent benign tissue, and (D) tumor-distant benign prostatic tissue. Immune reactive scores 0-12 were correlated with clinical data in reference to localization. A meta-analysis of studies investigating the association between biochemical recurrence (BCR) and parameters of the mTOR pathway was conducted. Regardless of the location within the tumor, cancer tissue showed higher expression of mTOR, p-mTOR, and 4EB-P1 compared to benign tissue ( < 0.01). Significant differences in expression between tissue samples from groups C and D were observed for mTOR and p-mTOR. When considering expression according to the pathological stage, we observed lower p-mTOR expression in pT3 vs. pT2 (7.9 and 6.3; = 0.01). After a median follow-up of 74.5 months (IQR 65.0-84.0), 27 patients (23.47%) developed BCR. Weak staining of mTOR was associated with shorter time to BCR (HR: 2.0; = 0.049) after correcting for PSA and T stage. However, a significant association of mTOR expression with BCR was found for specimens from the malignant border of the tumor (B) but not the tumor center (A) ( = 0.0034 log rank). In a meta-analysis, we found that the expressions of mTOR ((RR) = 0.70; 95% CI 0.43-1.12; = 0.13) and 4E-BP1 ((RR) = 0.86; = 0.53) were not statistically associated with BCR, while strong staining of p-mTOR was associated with a lower risk of BCR ((RR) = 0.57; = 0.002). All 3 markers showed stronger expression in PCa and exhibited local gradients in relation to the border of tumor and healthy tissue. Our results suggest an important role of intratumor heterogeneity for the use of mTOR parameters as biomarkers in PCa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/1296865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927025PMC
May 2020

Use of 3D printing in andrological surgery: what are the new perspectives.

Int J Impot Res 2020 Jul 13;32(4):369-370. Epub 2019 Dec 13.

Urology Section, Department of Surgery, University of Catania, Catania, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41443-019-0221-0DOI Listing
July 2020

Consulting "Dr Google" for sexual dysfunction: a contemporary worldwide trend analysis.

Int J Impot Res 2020 Jul 7;32(4):455-461. Epub 2019 Oct 7.

Department of Urology, University of Naples Federico II, Naples, Italy.

Google Trends (GT) is a free, easily accessible search tool which can be used to analyze worldwide "big data" on the relative popularity of search terms over a specific period of time. To determine worldwide public interest in Peyronie' disease (PD), erectile dysfunction (ED), premature ejaculation (PE) treatments, their penetrance, variation, and how they compare over time. Worldwide search-engine trends analysis included electronic Google queries from people who searched PD, ED, and PE treatments options from January 2004 to October 2018, worldwide. Join-point regression (JPR) has been performed. Comparison annual relative search volume (ARSV), average annual percentage change (AAPC) and temporal patterns were analyzed to assess loss or gain of interest. Our results showed that for PD it has been a decreased interest for Drug (AAPC: -3.1%, p < 0.01), ESWT (AAPC: -3.1%, p < 0.01), and vacuum therapy (AAPC: -1.2%, p < 0.01). In the field of ED, we observed trends toward an increased interest in prosthetic surgical treatment (AAPC: +1.7%, p = 0.4), for prostaglandins (AAPC: +0.7%, p = 0.7), for traction (AAPC: +0.6%, p = 0.1) and for ESWT (AAPC: +1.8%, p = 0.4), but without statistical significance. On the contrary, we observed a slight reduction of search for Vacuum device (AAPC: -1 %, p < 0.01). The interest in PE decreased from 2004 to today (AAPC: -1%, p < 0.01), for surgical treatment (AAPC: -3.1%, p < 0.01), drug treatment (AAPC: -3.1%, p < 0.01), and for psychotherapy (AAPC: -6.7%, p < 0.01). On the contrary, the interest in spray drugs has increased significantly (AAPC: +5.1%, p < 0.01). Patients are searching the web for sexual diseases treatment options. Understanding people inquisitiveness together with degree of knowledge could be supportive to guide counseling in the decision-making-process and put effort in certifying patient information, avoiding them to fall in the pernicious trap of 'fake-news'.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41443-019-0203-2DOI Listing
July 2020

"Aquabeam® System" for benign prostatic hyperplasia and LUTS: birth of a new era. A systematic review of functional and sexual outcome and adverse events of the technique.

Int J Impot Res 2019 Nov 7;31(6):392-399. Epub 2019 Jun 7.

Department of Surgery, Urology Section, University of Catania, Catania, Italy.

Purpose: Aim of this systematic review is to evaluate functional outcomes (Qmax, QoL, IPSS, PVR), sexual outcome (erectile dysfunction and anejaculation rate), and adverse events evaluated according to the Clavien-Dindo classification.

Methods: The bibliographic search with the included terms (prostate, benign prostatic hyperplasia, benign prostatic enlargement, lower urinary tract symptoms, water jet dissection, aquablation, Aquabeam®) produced a literature of 32 articles altogether. After removing papers of not interest or articles which the outcomes could not be deduced, nine studies were examined for a total of 664 patients screened.

Results: The functional outcomes, evaluated after water jet dissection, have shown improvement with respect to the baseline in all the selected articles. In the comparison papers with the TURP, the Aquablation has been statistically not inferior regarding functional outcomes. The sexual outcomes have highlighted a better ejaculation rate for water jet dissection than TURP. Regarding the adverse events, water jet dissection documented low rates of adverse events and, in comparison studies, were not statistically superior than TURP.

Conclusions: In our systematic review, the Aquabeam® System for the treatment of LUTS/BPH has proven to be a safe technique that provides functional outcomes comparable to TURP. About sexual outcomes, the most important data is certainly the low rate of retrograde ejaculation. However, other multicenter randomized trials with larger cohorts and longer follow-up are still needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41443-019-0158-3DOI Listing
November 2019

Extracorporeal Shock Wave Therapy in Peyronie's Disease: Clinical Efficacy and Safety from a Single-Arm Observational Study.

World J Mens Health 2019 Sep 26;37(3):339-346. Epub 2019 Mar 26.

Department of Urology, University of Florence, Florence, Italy.

Purpose: In this study, we aimed to determine the role of extracorporeal shockwave therapy (ESWT) in the management of Peyronie's disease (PD).

Materials And Methods: A total of 325 patients suffering from PD were enrolled in this single-arm clinical study. All patients were received ESWT using a schedule of 1 treatment/wk. Penile curvature was measured by a goniometer after intracavernosal drug-induced erection using Alprostadil. Plaque size was measured with a ruler and sexual function assessed by the international index of erectile function (IIEF)-15 score. Severity of erectile dysfunction was classified as severe (IIEF-15 ≤10), moderate (IIEF-15 between 11 and 16), or mild (IIEF-15 between 17 and 25). Results were evaluated at baseline and 3 months after the treatment.

Results: All the patients completed the study protocol. Median age was 59.0 years (55.0-64.0 years). After treatment, the median (interquartile range, IQR) plaque size reduced from 1.78 cm² (1.43-2.17 cm²) to 1.53 cm² (1.31-1.96 cm²) (p<0.001); the median (IQR) penile length in erection increased from 13.0 cm (12.0-14.0 cm) to 14 cm (13.0-15.0 cm) (p<0.001) and the median (IQR) penile curvature from 30.4° (22.2°-35.4°) to 25.0° (20.2°-30.4°) (p<0.001). We also observed a decrease in pain assessed by visual analogue scale (7 . 3; p<0.001), an improvement in each of the IIEF sub-domains (p<0.001) and an improvement in all three PD questionnaire domains (p<0.001).

Conclusions: Based on our findings, ESWT could be considered a safe and efficient minimally invasive option for the management of the patients suffering from PD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5534/wjmh.180100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704308PMC
September 2019

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41391-018-0113-2DOI Listing
May 2019

Adherence to Mediterranean diet and prostate cancer risk in Sicily: population-based case-control study.

Int J Impot Res 2019 Jul 18;31(4):269-275. Epub 2018 Oct 18.

Urology Section, University of Catania, Catania, Italy.

Prostate cancer (PCa) is the second most frequently diagnosed cancer and the sixth leading cause of death from cancer worldwide. Countries following a Mediterranean-type dietary pattern, has been reported to have lower PCa incidence and mortality compared with other European regions. A population-based case-control study has been conducted from January 2015 to December 2016 in a single institution of the municipality of Catania, southern Italy. A total of 118 PCa and 238 population-based controls were collected. Controls had significantly higher adherence to the Mediterranean diet, which was evident for several subgroups (including age groups, overweight and obese men, current smokers, alcohol intake, low and medium physical activity levels). PCa cases were found to consume lower amount of vegetables (223 g/d vs. 261 g/d; p = 0.001), legumes (34.26 g/d vs. 53.55 g/d; p = 0.003), and fish (47.75 g/d vs. 58.3 g/d) than controls; other differences emerged were related to alcohol intake (12.37 g/d vs 5.07 g/d; p < 0.01), cereals (254.06 g/d vs.235.94 g/d; p < 0.001), dairy (196 g/d vs. 166 g/d; p < 0.001), and meat consumption (98.09 g/d vs. 70.15 g/d; p < 0.001). However, no statistically significant differences between cases and controls were found regarding fruit, legumes, and olive oil consumption. The Mediterranean diet score was inversely associated with lower likelihood of having PCa in a linear manner (odds ratio [OR]: 0.86 [95% CI 0.77-0.96]). Specifically, individuals in the highest group of adherence had 78% less likelihood of have PCa and 14% less likelihood for each point increase of the score. The model adjusted for total polyphenol intake showed still a significant inverse association between adherence to the Mediterranean diet and PCa, but the relation was no more linear and not significant for one-point increase of the score (OR: 0.88 [95% CI 0.77-1.01]). In our cohorts of Italian men, we observed that high adherence to the Mediterranean diet was inversely associated with likelihood of having PCa cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41443-018-0088-5DOI Listing
July 2019

Association between dietary flavonoids intake and prostate cancer risk: A case-control study in Sicily.

Complement Ther Med 2018 Aug 15;39:14-18. Epub 2018 May 15.

Urology section - University of Catania, Catania, Italy.

Objectives: The aim of this study is to test the association between dietary flavonoids intake and prostate cancer (PCa) in a sample of southern Italian individuals.

Design: A population-based case-control study on the association between PCa and dietary factors was conducted from January 2015 to December 2016, in a single institution.

Setting: Patients with elevated PSA (Prostate Specific Antigen) and/or suspicion of PCa underwent transperineal prostate biopsy (≥12 cores). A total of 118 histopathological-verified PCa cases were collected and matched with controls, which were selected from a sample of 2044 individuals randomly recruited among the same reference population. Finally, a total of 222 controls were selected.

Main Outcome Measures: Prevalence of PCa.

Results: Consumption of certain groups of flavonoids significantly differed between controls and cases, in particular: flavonols (63.36 vs 37.14 mg/d, P < 0.001), flavanols (107.61 vs. 74.24 mg/d, P = .016), flavanones (40.92 vs. 81.32 mg/d, P < 0.001), catechins (63.36 vs. 36.18 mg/d, P = .006). In the multivariate model, flavanols and flavones were associated with reduced risk of PCa, despite not in the highest quartile of intake. Higher flavonol and catechin intake was consistently associated with reduced risk of PCa (Odds Ratio (OR) = 0.19, 95% CI: 0.06-0.56 and OR = 0.12, 95% CI: 0.04-0.36). In contrast, the highest intake of flavanones was positively associated with PCa.

Conclusion: Flavonols and catechins have proved to be the most promising molecules for a potential protective role against PCa. Nevertheless, further research on flavanones is needed to better establish whether they are associated with PCa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctim.2018.05.002DOI Listing
August 2018

Complication Rate After Antibiotic Prophylaxis with Fosfomycin Versus Fluorochinolones or β-lactam Antibiotics in Patients Undergoing Prostate Biopsy: A Propensity Score-adjusted Analysis.

Eur Urol Focus 2020 03 13;6(2):370-375. Epub 2018 Jul 13.

Urology Section, Department of Urology, University of Catania, Catania, Italy; Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.

Background: Transrectal ultrasound-guided prostate biopsy (TRBx) or transperineal Bx (TPBx) are considered alternative approaches for the diagnosis of prostate cancer (PCa). However, urinary tract infection (UTI) or other complications could be more frequent in the TRBx approach.

Objective: To determine the complication rate following different antimicrobial prophylaxis (AMP; fosfomycin trometamol [FT] vs ß-lactame or fluorochinolones [FQ]) in patients undergoing TRBx or TPBx.

Design, Setting, And Participants: The analyses were based on prospectively collected data of a cohort of patients who underwent TRBx or TPBx for elevated prostate-specific antigen (PSA; ≥4ng/ml) or clinical suspicion of PCa, between September 2016 and March 2017. Patients received a single dose of 3g oral FT (group A) or, alternatively, FQ or ß-lactame (group B).

Intervention: TRBx versus TPBx.

Outcome Measurements And Statistical Analysis: Adjustment variables consisted of age, PSA, biopsy technique (TPBx vs TRBx), and antibiotic prophylaxis (FT vs ß-lactame or FQ) using 1:1 propensity-score matching. Overall, 526 patients were considered, of whom 258 received FT (group A) and the other 258 received ß-lactame or FQ (group B).

Results And Limitations: Overall complications occurred in 390 (75.58%) and major complications in 67/516 (12.98%). Lower prevalence of UTIs was detected in group A (34.1%) compared with that in group B (43.4%; p=0.03), while similar rates of haematuria (54.7% vs 55.4%), haemospermia (39.5% vs 33.0%), and acute urinary retention (11.6% vs 9.3%) were detected in groups A and B. We found that group B (odds ratio [OR]: 1.54; p=0.03), I grade haematuria (OR: 6.17; p<0.01), and II grade haematuria (OR: 5.13; p<0.01) were significantly associated with increased risk of UTIs.

Conclusions: AMP with fluoroquinoles or ß-lactam antibiotics increased the rate of UTIs, when compared with FT, in patients undergoing TRBx or TPBx. The appearance of haematuria or haemospermia is associated with UTIs, suggesting the possibility of tailoring the strategy for prophylaxis in this category of patients.

Patient Summary: In this study, comparing complications after transrectal ultrasound-guided prostate biopsy versus transperineal biopsy, prophylaxis with fluoroquinoles or ß-lactam antibiotics increased the rate of urinary tract infections when compared with fosfomycin trometamol, regardless of the type of biopsy approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.euf.2018.06.014DOI Listing
March 2020

Active Surveillance for Low-risk Prostate Cancer: Are All Criteria Similar?

Anticancer Agents Med Chem 2018 ;18(7):958-963

Department of Surgery, Urology Section, University of Catania, Catania, Italy.

Background: Active Surveillance (AS) is a therapeutic strategy for early-stage Prostate Cancer (PCa) conceived to balance early detection of aggressive disease and overtreatment of indolent tumor. Several active surveillance protocols have been published over the years, however the risk of misclassification still exist. In this review, we revised the current criteria of AS and evaluated the characteristics of potential risk factors of misclassification or deferred treatment.

Methods: We did a systematic search of the MEDLINE database, from 1993 to May 2015, according to Preferred Reporting Items for Systematic Reviews and Meta-analysis statement guidelines and limited to the English language. The search terms used included "prostate cancer" and "active surveillance" and "criteria. We have excluded from the study reviews and editorial comments as well as multiple papers from the same data sets.

Results: Although the follow-up of reported studies was a quite short compared to the duration of the disease, the data are sufficient to conclude that active surveillance should be offered to men with low-risk disease and to men with intermediate risk and poor life expectancy. The present challenge, in fact, is to differentiate the clinically silent disease from the unfavorable course by identifying the right timing for any deferred treatment. This is made particularly difficult by the absence of randomized controlled trials directly comparing different AS monitoring methods.

Conclusion: As summarized in this review, it is still difficult to select patients eligible for active surveillance and differentiate them from those that should move to active treatment. From the data, currently available in the literature, however, it is possible to recommend active surveillance to men with low-risk disease and to men with intermediate-risk disease but with short life expectancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871520618666180425121617DOI Listing
June 2019

Metabolic syndrome is not associated with greater evidences of proliferative inflammatory atrophy and inflammation in patients with suspected prostate cancer.

Urol Oncol 2018 May 9;36(5):240.e21-240.e26. Epub 2018 Feb 9.

Urology section, Department of Surgery, University of Catania, Catania, Italy.

Introduction And Objectives: To evaluate the association between metabolic syndrome (MetS) and proliferative inflammatory atrophy (PIA) in patients with suspected prostate cancer (PCa).

Patients And Methods: From June 2015 to July 2016, we conducted the FIERY (Flogosis Increased Events of pRostatic biopsY) study at the Urology section, Department of Surgery of the University of Catania (Local registration number: #131/2015). A total of 205 patients with elevated prostate-specific antigen (≥ 4 ng/ml) or clinical suspicion of PCa who underwent primary transperineal prostate biopsy were included in this cross-sectional study. The assessment of PIA, HGPIN, and PCa were performed by 2 experienced pathologists and samples were investigated for the presence of an inflammatory infiltrate, according to the Irani score. Primary and secondary Gleason grade of tumor in positive biopsies were evaluated according to the 2016 ISUP Modified Gleason System.

Results: In the entire cohort, median age was 68.0 (interquartile range: 62.0-74.5), median prostate-specific antigen was 6.5 (interquartile range: 5.51-9.57). The prevalence of MetS was 34.1%, the detection rate of PCa was 32.7%, the rate of PIA was 28.3%, the rate of HGPIN was 32.2%, whereas the rate of severe intraprostatic inflammation (Irani-score ≥4) was 28.8%. When comparing clinical and histological variables in patients without and with PIA, metabolic aberrations where not significantly different in both groups. We did not find statistical association in detection rate of PCa (29.3% vs. 34.0%; P = 0.07) and HGPIN (27.6% vs. 34.0%; P = 0.37) in patients with and without PIA, respectively. When considering metabolic aberrations, MetS was not associated with Irani-score ≥4 (28.6% vs. 28.4%; P = 0.96) and none of each component was statistically predictive of severe inflammation. At the multivariable logistic regression analysis, PIA, HGPIN, and MetS were not associated with greater risk of PCa.

Conclusion: In this study, we did not show an association between MetS and PIA and PCa. Although the small sample size and the cross-sectional nature of the study, we do not suppose that MetS could be associated with greater evidence of PIA. Further studies should be conducted to evaluate the exact nature of this pathological lesion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urolonc.2018.01.012DOI Listing
May 2018

Latest Evidence on the Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Insignificant Prostate Cancer: A Systematic Review.

Anticancer Agents Med Chem 2018 ;18(7):925-930

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

Objective: Multiparametric Magnetic Resonance Imaging (mpMRI) has become a very useful tool in the management of PCa. Particularly, there is a great interest in using mpMRI for men on Active Surveillance (AS) for low risk PCa. The aim of this systematic review was to critically review the latest literature concerning the role of mpMRI in this clinical setting, underlying current strengths and weakness.

Evidence Acquisition: A comprehensive literature research for English-language original and review articles was carried out using the National Center for Biotechnology Information PubMed database with the aim to identify studies pertaining to mpMRI for AS in low risk PCa patients. The following search terms were used: active surveillance, prostate cancer and multiparametric magnetic resonance imaging.

Evidence Synthesis: Data from 28 recent original studies and reviews were reviewed. We only considered studies on the use of mpMRI in selecting AS patients and during AS follow-up, in order to solve two important questions: -Can mpMRI have a role in improving the detection of clinically significant disease, better selecting AS patients? -Can mpMRI identify the progression of disease and, consequently, be used during AS follow-up?

Conclusions: mpMRI is useful to better select the ideal candidates to AS and to monitor them during follow-up. However, despite many advantages, there are yet important limitations to detect all clinically significant PCa and to better define mpMRI-radiological progression during AS. Further larger prospective studies are needed to definitively solve these important problems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871520618666180105105413DOI Listing
June 2019

Impact of Preoperative Patient Characteristics and Flow Rate on Failure, Early Complications, and Voiding Dysfunction After a Transobturator Tape Procedure: A Multicentre Study.

Int Neurourol J 2017 12 31;21(4):282-288. Epub 2017 Dec 31.

Department of Urology, University of Florence, Florence, Italy.

Purpose: To evaluate the impact of preoperative patient characteristics and flow rate on failure, early postoperative complications, and voiding in patients who underwent transvaginal tension-free vaginal tape-obturator (TVT-O) treatment for uncomplicated stress urinary incontinence (SUI).

Methods: We retrospectively reviewed patients who underwent TVT-O for SUI at 3 Italian centres. The exclusion criteria were predominant voiding and storage symptoms suggestive of detrusor overactivity, the presence of grade >1 urogenital prolapse, previous pelvic radiotherapy or other clinical contraindications for surgical procedures, neurogenic bladder dysfunction, and collagen diseases. Multivariate logistic regression models were constructed to identify predictors of early voiding dysfunction after TVT-O.

Results: A total of 219 patients underwent TVT-O between January 2010 and December 2015. All patients received follow-up at 3, 6, and 12 months, and underwent a stress test, uroflowmetry, and bladder ultrasound to evaluate the postvoid residual volume. They also responded to the Urogenital Distress Inventory (UDI-6) questionnaire. The rates of persistent incontinence after TVT-O, postoperative complications, and satisfaction were 16.4% (36 of 219), 24.2% (53 of 219), and 86.3% (189 of 219), respectively. Nineteen patients (9.5%) experienced early voiding dysfunction. Based on an analysis of baseline characteristics, we determined that a cutoff value of 9.0 on the UDI-6 predicted postoperative SUI with 62% specificity, 72% sensitivity, and 66% accuracy. In the multivariate logistic regression analysis, a preoperative UDI-6≥9.0 was an independent predictor of postoperative SUI. The predictors of complications were menopause (P = 0.04) and the preoperative UDI-6 score (P = 0.01).

Conclusions: Menopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5213/inj.1734910.455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756816PMC
December 2017

Dietary Consumption of Phenolic Acids and Prostate Cancer: A Case-Control Study in Sicily, Southern Italy.

Molecules 2017 Dec 5;22(12). Epub 2017 Dec 5.

Urology Section, University of Catania, 95124 Catania, Italy.

Dietary polyphenols gained the interest of the scientific community due to their wide content in a variety of plant-derived foods and beverages commonly consumed, such as fruits, vegetables, coffee, tea, and cocoa We aimed to investigate whether there was an association between dietary phenolic acid consumption and prostate cancer (PCa) in South Italy. We conducted a population-based case-control study from January 2015 to December 2016 in a single institution of the municipality of Catania, southern Italy (Registration number: 41/2015). Patients with elevated PSA and/or suspicious PCa underwent transperineal prostate biopsy. A total of 118 histopathological-verified PCa cases were collected and a total of 222 controls were selected from a sample of 2044 individuals. Dietary data were collected by using two food frequency questionnaires and data on the phenolic acids content in foods was obtained from the Phenol-Explorer database (www.phenol-explorer.eu). Association between dietary intake of phenolic acids and PCa was calculated through logistic regression analysis. We found lower levels of caffeic acid (2.28 mg/day vs. 2.76 mg/day; < 0.05) and ferulic acid (2.80 mg/day vs. 4.04 mg/day; < 0.01) in PCa when compared to controls. The multivariate logistic regression showed that both caffeic acid (OR = 0.32; < 0.05) and ferulic acid (OR = 0.30; < 0.05) were associated with reduced risk of PCa. Higher intake of hydroxybenzoic acids and caffeic acids were associated with lower risk of advanced PCa. High intake of caffeic acid and ferulic acid may be associated with reduced risk of PCa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/molecules22122159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149996PMC
December 2017

Association between metabolic syndrome and intravesical prostatic protrusion in patients with benign prostatic enlargement and lower urinary tract symptoms (MIPS Study).

BJU Int 2018 05 28;121(5):799-804. Epub 2017 Sep 28.

Urology Section, Department of Surgery, University of Catania, Catania, Italy.

Objective: To investigate the association between metabolic syndrome (MetS) and morphological features of benign prostatic enlargement (BPE), including total prostate volume (TPV), transitional zone volume (TZV) and intravesical prostatic protrusion (IPP).

Patients And Methods: Between January 2015 and January 2017, 224 consecutive men aged >50 years presenting with lower urinary tract symptoms (LUTS) suggestive of BPE were recruited to this multicentre cross-sectional study. MetS was defined according to International Diabetes Federation criteria. Multivariate linear and logistic regression models were performed to verify factors associated with IPP, TZV and TPV.

Results: Patients with MetS were observed to have a significant increase in IPP (P < 0.01), TPV (P < 0.01) and TZV (P = 0.02). On linear regression analysis, adjusted for age and metabolic factors of MetS, we found that high-density lipoprotein (HDL) cholesterol was negatively associated with IPP (r = -0.17), TPV (r = -0.19) and TZV (r = -0.17), while hypertension was positively associated with IPP (r = 0.16), TPV (r = 0.19) and TZV (r = 0.16). On multivariate logistic regression analysis adjusted for age and factors of MetS, hypertension (categorical; odds ratio [OR] 2.95), HDL cholesterol (OR 0.94) and triglycerides (OR 1.01) were independent predictors of TPV ≥ 40 mL. We also found that HDL cholesterol (OR 0.86), hypertension (OR 2.0) and waist circumference (OR 1.09) were significantly associated with TZV ≥ 20 mL. On age-adjusted logistic regression analysis, MetS was significantly associated with IPP ≥ 10 mm (OR 34.0; P < 0.01), TZV ≥ 20 mL (OR 4.40; P < 0.01) and TPV ≥ 40 mL (OR 5.89; P = 0.03).

Conclusion: We found an association between MetS and BPE, demonstrating a relationship with IPP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bju.14007DOI Listing
May 2018

Association between dietary phytoestrogens intakes and prostate cancer risk in Sicily.

Aging Male 2018 Mar 17;21(1):48-54. Epub 2017 Aug 17.

a Urology Section , University of Catania , Catania , Italy.

Objective: In this study we aimed to investigate the association between dietary phytoestrogen consumption and prostate cancer in a sample of southern Italian individuals.

Methods: A population-based case-control study on the association between prostate cancer and dietary factors was conducted from January 2015 to December 2016 in a single institution of the municipality of Catania, southern Italy (Registration number: 41/2015). A total of 118 histopathological-verified prostate cancer (PCa) cases and a total of 222 controls were collected. Dietary data was collected by using two food frequency questionnaires.

Results: Patients with PCa consumed significantly higher levels of phytoestrogens. Multivariate logistic regression showed that lignans (Q[quartile]4 vs. Q1, OR [odds ratio] = 4.72; p < .05) and specifically, lariciresinol (Q4 vs. Q1, OR = 4.60; p < .05), pinoresinol (Q4 vs. Q1, OR = 5.62; p < .05), matairesinol (Q4 vs. Q1, OR = 3.63; p < .05), secoisolariciresinol (Q4 vs. Q1, OR = 4.10; p < .05) were associated with increased risk of PCa. Furthermore, we found that isoflavones (Q3 vs. Q1, OR = 0.28; p < .05) and specifically, genistein (Q4 vs. Q1, OR = 0.40; p < .05) were associated with reduced risk of PCa.

Conclusion: We found of an inverse association between dietary isoflavone intake and PCa, while a positive association was found with lignans intake.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13685538.2017.1365834DOI Listing
March 2018

A phase II, randomized, single-blinded, placebo-controlled clinical trial on the efficacy of Curcumina and Calendula suppositories for the treatment of patients with chronic prostatitis/chronic pelvic pain syndrome type III.

Arch Ital Urol Androl 2017 Jun 30;89(2):110-113. Epub 2017 Jun 30.

Urology section, Department of Surgery, University of Catania.

Objective: The management of chronic prostatitis/ chronic pelvic pain syndrome type III (CP/CPPS) has been always considered complex due to several biopsychological factors underling the disease. In this clinical study, we aimed to evaluate the efficacy of the treatment with Curcumin and Calendula extract in patients with CP/CPPS III.

Material And Methods: From June 2015 to January 2016 we enrolled 60 consecutive patients affected by CP/CPPS III in our institution. Patients between 20 and 50 year of age with symptoms of pelvic pain for 3 months or more before study, a total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score ≥ 15 point and diagnosed with NIH category III. Patients were then allocated to receive placebo (Group A) or treatment (Group B). Treatment consisted of rectal suppositories of Curcumin extract 350 mg (95%) and Calendula extract 80 mg (1 suppository/die for 1 month). Patients of Group B received 1 suppository/die for 1 month of placebo. The primary endpoint of the study was the reduction of NIH-CPSI. The secondary outcomes were the change of peak flow, IIEF-5, VAS score and of premature ejaculation diagnostic tool (PEDT).

Results: A total of 48 patients concluded the study protocol. The median age of the all cohort was 32.0 years, the median NIH-CPSI was 20.5, the median IIEF-5 was 18.5, the median PEDT was 11.0, the median VAS score was 7.5 and the median peak flow was 14.0. After 3 months of therapy in group A we observed a significant improvement of NIH-CPSI (-5.5; p < 0.01), IIEF-5 (+ 3.5; p < 0.01), PEDT (-6.5; p < 0.01), peak flow (+2.8; p < 0.01) and VAS (-6.5; p < 0.01) with significant differences over placebo group (all p-value significant).

Conclusions: In this phase II clinical trial we showed the clinical efficacy of the treatment with Curcumin and Calendula in patients with CP/CPPS III. The benefits of this treatment could be related to the reduction of inflammatory cytokines and of inflammatory cells. These results should be confirmed in further studies with greater sample size.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4081/aiua.2017.2.110DOI Listing
June 2017

Comparison between Briganti, Partin and MSKCC tools in predicting positive lymph nodes in prostate cancer: a systematic review and meta-analysis.

Scand J Urol 2017 Oct 23;51(5):345-350. Epub 2017 Jun 23.

a Urology Section, Department of Urology , University of Catania , Catania , Italy.

Objective: The aim of this study was to analyze the discriminative capabilities of Briganti, Partin and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms in predicting lymph-node invasion (LNI) and to perform a meta-analysis to yield pooled area under the receiver operating characteristics curves (AUCs) for model comparison.

Materials And Methods: An electronic search of the MEDLINE and Embase databases up to October 2016 was undertaken. The AUC value, total number of patients and rate of LNI were extracted from the included references. After excluding redundant literature, 19 studies were identified including 86,338 patients. The Briganti, Partin and MSKCC nomograms were validated in 6629, 69,681 and 10,028 patients, respectively.

Results: The pooled AUCs for Briganti, Partin, and MSKCC nomograms were 0.793, 0.778 and 0.780, respectively. The Mantel-Haenszel-derived comparison of AUC values revealed no statistical differences of predictive capabilities for Briganti vs Partin (p = 0.23), Briganti vs MSKCC (p = 0.83) and Partin vs MSKCC (p = 0.26). The accuracy of Briganti, Partin and MSKCC models is statistically similar in predicting the presence of LNI. International guidelines could consider these findings by reporting similarities in the accuracy of these models.

Conclusions: The accuracy of Briganti, Partin and MSKCC was similar in predicting the presence of LNI. Based on these results, patients and clinicians may use any of these nomograms without significant advantages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/21681805.2017.1332680DOI Listing
October 2017

Confirmatory biopsy of men under active surveillance: extended versus saturation versus multiparametric magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy.

Scand J Urol 2017 Aug 17;51(4):260-263. Epub 2017 May 17.

b Urology Section, Department of Surgery , University of Catania , Catania , Italy.

Objective: The aim of this study was to evaluate the detection rate for clinically significant prostate cancer (PCa) after multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound (TRUS) fusion biopsy versus extended biopsy or saturation prostate biopsy (SPBx) in men enrolled on active surveillance (AS).

Materials And Methods: From May 2013 to January 2016, 100 men with very low-risk PCa were enrolled on AS. Eligible criteria were: life expectancy greater than 10 years, cT1c, prostate-specific antigen (PSA) below 10 ng/ml, PSA density less than 0.20 ng/ml², three or fewer unilateral positive biopsy cores, Gleason score (GS) equal to 6 and greatest percentage of cancer in a core 50% or lower. All patients underwent 3.0 T pelvic mpMRI before confirmatory transperineal extended biopsy (20 cores) and SPBx (median 30 cores) combined with mpMRI/TRUS fusion targeted biopsy (median four cores) of suspicious lesions [Prostate Imaging Reporting and Data System (PI-RADS) 3-5]. Clinically significant PCa was defined as the presence of at least one core with a GS of 4 or higher.

Results: After confirmatory biopsy, 16 out of 60 (26.6%) patients showed significant PCa. Targeted biopsy of PI-RADS 4-5 versus PI-RADS 3-5 lesions diagnosed six out of 16 (37.5%) and 12 out of 16 (87.5%) significant PCa, respectively, with two false positives (5%). The detection rate for significant PCa was equal to 68.8% on mpMRI/TRUS fusion biopsy, 75% on extended biopsy and 100% on SPBx. mpMRI/TRUS targeted biopsy and extended biopsy missed five out of 16 (31.2%) and four out of 16 (25%) PCa, respectively.

Conclusions: Although mpMRI may improve the diagnosis of significant PCa in men under AS, SPBx had a higher detection rate for clinically significant PCa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/21681805.2017.1313310DOI Listing
August 2017