Publications by authors named "Stefano DE Luca"

80 Publications

New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes.

Eur Urol Open Sci 2021 Nov 22;33:28-41. Epub 2021 Sep 22.

Department of Oncology, Division of Urology, University of Turin, Turin, Italy.

Context: Benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is diagnosed in up to 80% of men during their lifetime. Several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have become available over the past 5 yr.

Objective: To evaluate the perioperative and functional outcomes of recently introduced uMISTs for BPH/BPO, including Urolift, Rezūm, temporary implantable nitinol device, prostatic artery embolization (PAE), and intraprostatic injection.

Evidence Acquisition: A systematic literature search was conducted in December 2020 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42021225014). The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Pooled and cumulative analyses were performed to compare perioperative and functional outcomes between study groups. A random-effects model using the DerSimonian and Laird method was used to evaluate heterogeneity. Stata version 15.0 software was used for all statistical analyses.

Evidence Synthesis: The initial electronic search identified 3978 papers, of which 48 ultimately met the inclusion criteria and were included in the analysis. Pooled analysis revealed a uMIST benefit in terms of International Prostate Symptom Score (IPSS; -9.81 points, 95% confidence interval [CI] -11.37 to -8.25 at 1 mo; -13.13 points, 95% CI -14.98 to -11.64 at 12 mo), maximum flow rate (from +3.66 ml/s, 95% CI 2.8-4.5 to +4.14 ml/s, 95% CI 0.72-7.56 at 12 mo), and postvoid residual volume (-10.10 ml, 95% CI -27.90 to 7.71 at 12 mo). No negative impact was observed on scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, 95% CI 1.34-2.42 at the start of follow-up; and 1.04, 95% CI 0.28-1.8 after 1 yr), or the IPSS-Quality of Life questionnaire.

Conclusions: Novel uMISTs can yield fast and effective relief of LUTS without affecting patient quality of life. Only Rezūm, UroLift, and PAE had a minimal impact on patients' sexual function with respect to baseline, especially regarding preservation of ejaculation.

Patient Summary: We reviewed outcomes for recently introduced ultra-minimally invasive surgical treatments for patients with lower urinary tract symptoms caused by benign prostate enlargement or obstruction. The evidence suggests that these novel techniques are beneficial in terms of controlling symptoms while preserving sexual function.

Take Home  Message: Novel ultra-minimally invasive treatments can yield fast and effective relief of lower urinary tract symptoms without affecting a patient's quality of life.
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http://dx.doi.org/10.1016/j.euros.2021.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473553PMC
November 2021

Artificial intelligence for target prostate biopsy outcomes prediction the potential application of fuzzy logic.

Prostate Cancer Prostatic Dis 2021 Sep 3. Epub 2021 Sep 3.

Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Background: In current precision prostate cancer (PCa) surgery era the identification of the best patients candidate for prostate biopsy still remains an open issue. The aim of this study was to evaluate if the prostate target biopsy (TB) outcomes could be predicted by using artificial intelligence approach based on a set of clinical pre-biopsy.

Methods: Pre-biopsy characteristics in terms of PSA, PSA density, digital rectal examination (DRE), previous prostate biopsies, number of suspicious lesions at mp-MRI, lesion volume, lesion location, and Pi-Rads score were extracted from our prospectively maintained TB database from March 2014 to December 2019. Our approach is based on Fuzzy logic and associative rules mining, with the aim to predict TB outcomes.

Results: A total of 1448 patients were included. Using the Frequent-Pattern growth algorithm we extracted 875 rules and used to build the fuzzy classifier. 963 subjects were classified whereas for the remaining 484 subjects were not classified since no rules matched with their input variables. Analyzing the classified subjects we obtained a specificity of 59.2% and sensitivity of 90.8% with a negative and the positive predictive values of 81.3% and 76.6%, respectively. In particular, focusing on ISUP ≥ 3 PCa, our model is able to correctly predict the biopsy outcomes in 98.1% of the cases.

Conclusions: In this study we demonstrated that the possibility to look at several pre-biopsy variables simultaneously with artificial intelligence algorithms can improve the prediction of TB outcomes, outclassing the performance of PSA, its derivates and MRI alone.
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http://dx.doi.org/10.1038/s41391-021-00441-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413110PMC
September 2021

Comparison of the third molar maturity index (I) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample.

Int J Legal Med 2021 Nov 6;135(6):2423-2436. Epub 2021 Jul 6.

AgEstimation Project, Macerata, Italy.

The diagnostic accuracy of the I to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (IL and IR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for IL and IR, respectively. In addition, all these quantities were high when only the IR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both IL and IR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.
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http://dx.doi.org/10.1007/s00414-021-02656-2DOI Listing
November 2021

The real-time intraoperative guidance of the new HIFU Focal-One platform allows to minimize the perioperative adverse events in salvage setting.

J Ultrasound 2021 May 24. Epub 2021 May 24.

Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

Purpose: To assess the use of the new Focal-One HIFU platform in salvage setting to evaluate the occurrence of postoperative complications.

Methods: Patients who underwent salvage HIFU (sHIFU) with Focal-One platform were enrolled prospectively (Candiolo cancer institute-FPO IRCCS; registry number: 258/2018). Perioperative and postoperative outcomes (in terms of oncological and functional ones) were recorded during the first year of follow-up. In particular postoperative complications were classified according to Clavien-Dindo system.

Results: 20 patients were enrolled. No grade 3 complications were recorded. Referring to grade 2 complications, eight patients reported urgency after 3 months of follow-up, and in 4 cases, a low urinary tract infection occurred. Evaluating the impact of sHIFU on patients' sexual potency, micturition and quality of life, no significant deterioration was recorded during the follow-up as proven using the ANOVA analysis for repeated measurements. Only two patient had a biochemical failure after 12 months of follow-up.

Conclusions: The real-time intraoperative guidance with Focal-One platform, allows a continuous monitoring and tailoring of the treatment, with a minimization of the adverse events even in a salvage setting.
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http://dx.doi.org/10.1007/s40477-021-00594-8DOI Listing
May 2021

Study of the ethnicity's influence on the third molar maturity index (I) for estimating age of majority in living juveniles and young adults.

Int J Legal Med 2021 Sep 23;135(5):1945-1952. Epub 2021 May 23.

Centre of Epidemiology, Biostatistics and Information Technology, Polytechnic University of Marche, Ancona, Italy.

Estimation of age of majority has important applications in the forensic daily practice because of the increasing demand for age estimates of unaccompanied minors. Diagnostic accuracy of I to assess legal adult age of 18 years has been already tested in several specific population samples. The aim of this work was to compare the available data about sensitivity and specificity of the third molar maturity index (I) from five different regional groups' radiographic samples to study possible ethnical difference. For this purpose, a sample of 6157 orthopantomograms (OPGs), coming from 15 countries, was analysed. Data about sensitivity and specificity were pooled using a bivariate modelling approach. The one-way MANOVA analysis was applied to assess the likelihood that sensitivity and specificity of the five regional groups are sampled from the same population. The result of the one-way MANOVA showed that both sensitivity and specificity did not depend from the regional groups. The obtained sensitivity was 84% (95% CI: 82% and 85%), and its specificity was 94% (95% CI: 93% and 95%). Based on these results, the I was a useful statistical tool to identify whether a subject has reached the legal age of 18 years old, regardless of his or her ethnicity.
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http://dx.doi.org/10.1007/s00414-021-02622-yDOI Listing
September 2021

Diagnostic Accuracy of Single-plane Biparametric and Multiparametric Magnetic Resonance Imaging in Prostate Cancer: A Randomized Noninferiority Trial in Biopsy-naïve Men.

Eur Urol Oncol 2021 Dec 21;4(6):855-862. Epub 2021 Apr 21.

Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Background: Urological guidelines recommend multiparametric magnetic resonance imaging (mpMRI) in men with a suspicion of prostate cancer (PCa). The resulting increase in MRI demand might place health care systems under substantial stress.

Objective: To determine whether single-plane biparametric MRI (fast MRI) workup could represent an alternative to mpMRI in the detection of clinically significant (cs) PCa.

Design, Setting, And Participants: Between April 2018 and February 2020, 311 biopsy-naïve men aged ≤75 yr with PSA ≤15 ng/ml and negative digital rectal examination were randomly assigned to 1.5-T fast MRI (n = 213) or mpMRI (n = 98).

Intervention: All MRI examinations were classified according to Prostate Imaging-Reporting and Data System (PI-RADS) version 2. Men scored PI-RADS 1-2 underwent 12-core standard biopsy (SBx) and those with PI-RADS 4-5 on fast MRI or PI-RADS 3-5 on mpMRI underwent targeted biopsy in combination with SBx. Equivocal cases on fast MRI (PI-RADS 3) underwent mpMRI and then biopsy according to the findings.

Outcome Measurements And Statistical Analysis: The primary outcome was to compare the detection rate of csPCa in both study arms, setting a 10% difference for noninferiority. The secondary outcome was to assess the role of prostate-specific antigen density (PSAD) in ruling out men who could avoid biopsy among those with equivocal findings on fast MRI.

Results And Limitations: The overall MRI detection rate for csPCa was 23.5% (50/213; 95% confidence interval [CI] 18.0-29.8%) with fast MRI and 32.7% (32/98; 95% CI 23.6-42.9%) with mpMRI (difference 9.2%; p = 0.09). The reproducibility of the study could have been affected by its single-center nature.

Conclusions: Fast MRI followed by mpMRI in equivocal cases is not inferior to mpMRI in the detection of csPCa among biopsy-naïve men aged ≤75 yr with PSA ≤15 ng/ml and negative digital rectal examination. These findings could pave the way to broader use of MRI for PCa diagnosis.

Patient Summary: A faster MRI (magnetic resonance imaging) protocol with no contrast agent and fewer scan sequences for examination of the prostate is not inferior to the typical MRI approach in the detection of clinically significant prostate cancer. If our findings are confirmed in other studies, fast MRI could represent a time-saving and less invasive examination for men with suspicion of prostate cancer. This trial is registered at ClinicalTrials.gov as NCT03693703.
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http://dx.doi.org/10.1016/j.euo.2021.03.007DOI Listing
December 2021

An Overview on Anodes for Magnesium Batteries: Challenges towards a Promising Storage Solution for Renewables.

Nanomaterials (Basel) 2021 Mar 22;11(3). Epub 2021 Mar 22.

Department of Applied Science and Technology, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy.

Magnesium-based batteries represent one of the successfully emerging electrochemical energy storage chemistries, mainly due to the high theoretical volumetric capacity of metallic magnesium (i.e., 3833 mAh cm vs. 2046 mAh cm for lithium), its low reduction potential (-2.37 V vs. SHE), abundance in the Earth's crust (10 times higher than that of lithium) and dendrite-free behaviour when used as an anode during cycling. However, Mg deposition and dissolution processes in polar organic electrolytes lead to the formation of a passivation film bearing an insulating effect towards Mg ions. Several strategies to overcome this drawback have been recently proposed, keeping as a main goal that of reducing the formation of such passivation layers and improving the magnesium-related kinetics. This manuscript offers a literature analysis on this topic, starting with a rapid overview on magnesium batteries as a feasible strategy for storing electricity coming from renewables, and then addressing the most relevant outcomes in the field of anodic materials (i.e., metallic magnesium, bismuth-, titanium- and tin-based electrodes, biphasic alloys, nanostructured metal oxides, boron clusters, graphene-based electrodes, etc.).
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http://dx.doi.org/10.3390/nano11030810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004101PMC
March 2021

Multiparametric magnetic resonance imaging-targeted prostate biopsy: present and future of the prostate cancer diagnostic pathway.

Minerva Urol Nephrol 2021 02;73(1):128-129

Department of Radiology, IRCCS Candiolo Cancer Institute - FPO, Candiolo, Turin, Italy.

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http://dx.doi.org/10.23736/S2724-6051.21.04341-1DOI Listing
February 2021

Implementing telemedicine for the management of benign urologic conditions: a single centre experience in Italy.

World J Urol 2021 Aug 1;39(8):3109-3115. Epub 2021 Jan 1.

Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.

Purpose: To assess the use of telemedicine with phone-call visits as a practical tool to follow-up with patients affected by urological benign diseases, whose clinic visits had been cancelled during the acute phase of the COVID-19 pandemic.

Methods: Patients were contacted via phone-call and a specific questionnaire was administered to evaluate the health status of these patients and to identify those who needed an "in-person" ambulatory visit due to the worsening of their condition. Secondarily, the patients' perception of a potential shift towards a "telemedicine" approach to the management of their condition and to indirectly evaluate their desire to return to "in-person" clinic visits.

Results: 607 were contacted by phone-call. 87.5% (531/607) of the cases showed stability of the symptoms so no clinic in-person or emergency visits were needed. 81.5% (495/607) of patients were more concerned about the risk of contagion than their urological condition. The median score for phone visit comprehensibility and ease of communication of exams was 5/5; whilst patients' perception of phone visits' usefulness was scored 4/5. 53% (322/607) of the interviewees didn't own the basic supports required to be able to perform a real telemedicine consult according to the required standards.

Conclusion: Telemedicine approach limits the number of unnecessary accesses to medical facilities and represents an important tool for the limitation of the risk of transmission of infectious diseases, such as COVID-19. However, infrastructures, health workers and patients should reach out to a computerization process to allow a wider diffusion of more advanced forms of telemedicine, such as televisit.
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http://dx.doi.org/10.1007/s00345-020-03536-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775638PMC
August 2021

A full Bayesian calibration model for assessing age in adults by means of pulp/tooth area ratio in periapical radiography.

Int J Legal Med 2021 Mar 5;135(2):677-685. Epub 2020 Oct 5.

Centre of Epidemiology, Biostatistics and Information Technology, Polytechnic University of Marche, Ancona, Italy.

The Bayesian approach is being a fundamental tool in forensic and legal field where inferences and decisions are made. In this study, a full Bayesian calibration model was developed to make probabilistic inferences about age estimation in a reference sample of 891 periapical X-rays of upper and lower canines. These teeth belonged to both deceased and living adult subjects, aged between 20 and 86 years, coming from five different countries (Turkey, Italy, Portugal, Japan and Mexico). For this purpose, the narrowing of pulp chamber due to the apposition of secondary dentine was analysed by means of the pulp/tooth area ratio. To determine the agreement of the method, intra- and inter-observer differences for measuring process were calculated by means of the intraclass correlation coefficient (ICC) analysis. Observer error tests showed excellent agreement between observers and between repeated assessments. According to the results of the ANCOVA, neither nationality nor sex was associated to the secondary dentine apposition while it is associated with individual's age. The results of the present study indicated that the concept of probability is intrinsically linked to the assessment of age in a forensic context, and the Bayesian approach could be considered a robust tool to overtake the bias generated by traditional regression models, thus helping the decision-making process in a legal framework.
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http://dx.doi.org/10.1007/s00414-020-02438-2DOI Listing
March 2021

Assessment of bullet holes through the analysis of mushroom-shaped morphology in synthetic fibres: analysis of six cases.

Int J Legal Med 2021 May 31;135(3):885-892. Epub 2020 Jul 31.

Departamento de Antropología Física, Facultad de Ciencias Sociales, Universidad de Chile, Ignacio Carrera Pinto 1045, Ñuñoa, Santiago, Chile.

Textiles damage analysis is a very valuable tool in forensic investigations. However, to date, very little research has been carried out to understand the impact of bullet causing damages to clothing. According to the review of the most recent scientific papers, the frictional heating and crushing action of a bullet passing through synthetic fibres cause a unique transformation in their ends called mushroom-shaped morphology. In this study, the textile remains of six individuals executed during the first decade of the Chilean military dictatorship period (1973-1990) were analysed. The purpose was to examine their clothing in order to describe the fibre defects in the bullet holes. The fibres were directly observed using two different models of stereomicroscopy (MZ16A and EZ4D, Leica Microsystem Ltd., Wetzlar, Germany) and through a combination of transmitted, oblique and co-axial illumination (with Leica DFC500 Digital Camera), at × 230 and at a resolution of up to 840 Lp/mm. The mushroom-shaped morphology, along with rupturing of yarns, fibrillation or splitting of fibres, was observed in the bullet holes. Although the mushroom-shaped is a useful pattern for bullet hole identification in synthetic fibres, further research needs to be performed for developing a sounder interpretational framework of this type of forensic evidence.
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http://dx.doi.org/10.1007/s00414-020-02383-0DOI Listing
May 2021

Assessment of the Stability of the Palatal Rugae in a 3D-3D Superimposition Technique Following Slow Maxillary Expansion (SME).

Sci Rep 2020 02 14;10(1):2676. Epub 2020 Feb 14.

Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy.

The Palatal Rugae are considered a useful human identification marker for both orthodontists and forensic personnel. The principal aim of the present study was to evaluate the stability of palatal rugae with a 3D-3D superimposition procedure following Slow Maxillary Expansion (SME), in order to assess whether they kept their uniqueness and validity for human identification, even after a specific dental treatment. For this purpose, a sample of 27 digital dental models - belonging to growing patients (13 males and 14 females), aged between 8.5 and 15 years, who underwent SME therapy - was retrospectively studied and compared with a control group of 27 untreated subjects - (13 males and 14 females). Digital dental models were obtained pre-treatment and at device removal; both were processed by means of an intraoral scanner. A superimposition procedure was thus performed to reach the minimum point-to-point distance between two models of palatal rugae. Intra- and inter-observer differences were statistically analyzed by paired Wilcoxon test and Intra-class Correlation coefficient (ICC), showing values larger than 0.93. There was no difference in Root-Mean-Square (RMS) values between untreated control subjects and subjects treated with Leaf Expander (p = 0.062). A RMS value of 0.43 was the threshold to distinguish the pooled group ("Untreated" and "Leaf") from any mismatch. According to the obtained results, this study failed to reject the null hypothesis and presented no differences between the RMS values of the Test group and the RMS values of the untreated control group. This work highlighted the usefulness of 3D superimposition procedure for purposes of human identification, in subjects undergoing dental treatment. However, keeping in sight the forensic use of this technique as a helpful probation element in court, further studies should be performed to confirm these findings.
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http://dx.doi.org/10.1038/s41598-020-59637-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021754PMC
February 2020

Prospective evaluation of urinary steroids and prostate carcinoma-induced deviation: preliminary results.

Minerva Urol Nephrol 2021 02 11;73(1):98-106. Epub 2019 Dec 11.

Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

Background: The serum prostate-specific antigen is the most widespread biomarker for prostate disease. Its low specificity for prostatic malignancies is a matter of concern and the reason why new biomarkers for screening purposes are needed. The correlation between altered production of the main steroids and prostate carcinoma (PCa) occurrence is historically known. The purpose of this study is to evaluate the modifications of a comprehensive urinary endogenous steroidal profile (USP) induced by PCa, by multivariate statistical methods.

Methods: A total of 283 Italian subjects were included in the study, 139 controls and 144 PCa-affected patients. The USP, including 17 steroids and five urinary steroidal ratios, was quantitatively evaluated using gas chromatography coupled with single quadrupole mass spectrometry (GC-MS). The data were interpreted using a chemometric, multivariate approach (intrinsically more sensible to alterations with respect to traditional statistics) and a model for the discrimination of cancer-affected profiles was built.

Results: Two multivariate classification models were calculated, the former including three steroids with the highest statistical significance (e.g. testosterone, etiocholanolone and 7β-OH-DHEA) and PSA values, the latter considering the three steroids' levels only. Both models yielded high sensitivity and specificity scores near to 70%, resulting significantly higher than PSA alone.

Conclusions: Three USP steroids resulted significantly altered in our PCa population. These preliminary results, combined with the simplicity and low-cost of the analysis, open to further investigation of the potential role of this restricted USP in PCa diagnosis.
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http://dx.doi.org/10.23736/S2724-6051.19.03529-XDOI Listing
February 2021

Laparoscopic simple prostatectomy: complications and functional results after five years of follow-up.

Minerva Urol Nefrol 2020 Aug 10;72(4):498-504. Epub 2019 Oct 10.

Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

Background: The aim of this study was to investigate complications and functional results in a cohort of patients who underwent extraperitoneoscopic transcapsular laparoscopic simple prostatectomy (LSP) for large prostate adenomas with a minimum follow-up of 5 years.

Methods: We retrospectively reviewed data obtained from our prospectively maintained database of patients treated with LSP at our institution between January 2004 and June 2012, with at least 5 years of reported follow-up data. Demographics, perioperative results, early and late complications, and functional results were evaluated. The various impacts of the independent variables on the development of complications was evaluated performing logistic regression models. Follow-up was planned at 1, 3, 6 and 12 months, then yearly up to a minimum of 5 years.

Results: One-hundred patients were included in our analysis. Median follow-up was 135 (IQR 24) months (11 years and 3 months). Grade III complications were recorded in 2 cases. Five cases of late postoperative complications were recorded. Logistic regression models showed a statistically significant correlation between the adenoma volume and the risk of developing early postoperative complications (OR 1.014). International Prostate Symptom Score (I-PSS), I-PSS quality of life (QoL) index, and maximum urine flow (Qmax) significantly improved when comparing preoperative and postoperative results. No significant differences were recorded in the I-PSS and I-PSS QoL index during follow-up. A low but significant worsening in Qmax was observed starting the 48th month after surgery.

Conclusions: The present findings confirm that LSP carries a low rate of early and late complications, and it offers good functional outcomes at 5 years.
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http://dx.doi.org/10.23736/S0393-2249.19.03526-4DOI Listing
August 2020

Risk of Gleason Score 3+4=7 prostate cancer upgrading at radical prostatectomy is significantly reduced by targeted versus standard biopsy.

Minerva Urol Nefrol 2020 Jun 10;72(3):360-368. Epub 2019 Oct 10.

Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -

Background: The aim of this study is to evaluate if multiparametric magnetic resonance (mpMRI)-transrectal ultrasound (TRUS) fusion targeted biopsy (TBx) versus untargeted standard biopsy (SBx) may decrease the rate of pathological upgrading of Gleason Score (GS) 3+4 prostate cancer (PCa) at radical prostatectomy (RP). We also evaluated the impact of percent pattern 4 and cribriform glands at biopsy in the risk of GS 3+4=7 upgrading.

Methods: A total of 301 patients with GS 3+4 PCa on biopsy (159 SBx and 142 TBx) who underwent laparoscopic robot-assisted RP were sequentially enrolled. Histological data from RP sections were used as reference standard. The concordance of biopsy with pathological GS, as well as the GS 3+4 upgrading at RP were evaluated in different univariate and multivariate binary logistic regression models, testing age, PSA, fPSA%, tumor volume, PI-RADS, clinical stage, percentage of Gleason pattern 4 (GP) and/or presence of cribriform sub-type at biopsy.

Results: Of the 301 biopsies, the median of GP 4 was 16% of the tissue. Minimal GP 4 (≤16%) cancers had a significant lower median volume (1.7 mL) than those with GP4 >16% (2.9 mL), (P<0.001). Pathological GS 3+4 was confirmed for 58.8% and 82.2% for SBx and TBx patients, respectively. The rate of upgraded and downgraded GS on SBx versus TBx was 38.8% vis. 16.7% and 1.8% and 2.1%, respectively. The rate of upgrading was significantly associated with the presence of GP4 >16% versus ≤16% (OR 4.4, 95% CI 1.4-12.0; P=0.021) and with the presence of cribriform sub-type at biopsy specimens (OR 6.2, 95% CI 2.2-18.7; P<0.001).

Conclusions: We demonstrated that TBx technique significantly reduced the risk of GS 3+4 upgrading at RP, compared to SBx one. The rate of upgrading was significantly associated with GP4>16%, mostly when cribriform sub-type was present at biopsy specimens.
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http://dx.doi.org/10.23736/S0393-2249.19.03367-8DOI Listing
June 2020

Prostate cancer management at an Italian tertiary referral center: does multidisciplinary team meeting influence diagnostic and therapeutic decision-making process? A snapshot of the everyday clinical practice.

Minerva Urol Nefrol 2019 Dec 4;71(6):576-582. Epub 2019 Sep 4.

Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Background: Multidisciplinary team (MDT) management decision-making process appears as an interesting tool to answer most aspects of prostate cancer (PCa) diagnosis and treatment, allowing a fairer choice of therapies. The aim of this study to prospectively investigate the impact on prostate cancer clinical management of the uro-oncology MDT meeting at an Italian tertiary referral center.

Methods: All cases discussed over an 18-months period at San Luigi Hospital uro-oncology MDT were prospectively evaluated for the impact of the MDT discussion on PCa clinical decision-making. Dilemma and management plan in the monodisciplinary visit before and/or after primary treatment were recorded. Subsequently, the MDT discussed the case and reached a consensus decision, which was also recorded. Changes in diagnostic assessment and patient management from pre- to post-MDT meeting were evaluated by a consultant urologist.

Results: Overall, 201 patients, of which 99, 81 and 21 with local, advanced and metastatic disease respectively, were selected for MDT evaluation. The most frequent reasons for MDT approach after either PCa diagnosis or primary treatment were metastatic disease or locally advanced disease/positive surgical margins/biochemical recurrence, respectively. Patients with local, advanced and metastatic disease had a significative change of diagnostic/therapeutic management in 23.2%, 46.9% and 33.4%, respectively (P<0.001). Multimodal treatment was recommended in 25.3%.

Conclusions: The uro-oncology MDT meeting alters management plans in at least one-quarter of patients reaching almost 50% of cases in locally advanced disease.
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http://dx.doi.org/10.23736/S0393-2249.19.03231-4DOI Listing
December 2019

Hydrocephalus of King Charles II of Spain, the Bewitched King.

Eur Neurol 2019 21;81(1-2):76-78. Epub 2019 May 21.

Department of Ophthalmology, "Grigore. T. Popa" University of Medicine and Pharmacy, Iasi, Romania.

King of the Spanish Habsburg dynasty and sovereign of the overseas Spanish Empire, Charles II of Spain, was physically disabled, disfigured, mentally retarded, and he proved impotent. He is known in history as El Hechizado (the Bewitched) because both him and the people believed that his mental and physical incapacity were due to a "witchcraft act." Although several authors speculated about different diseases, most of them genetic such as pituitary hormone deficiency, distal renal tubular acidosis, Klinefelter syndrome, fragile X syndrome, or male XX hermaphroditism, the hypothesis of hydrocephalus was not taken into account. We don't have clear elements to hypothesize a certain etiology of Charles II' hydrocephalus; however, we think the herpetic infection he suffered of after his birth should not be ignored.
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http://dx.doi.org/10.1159/000500719DOI Listing
June 2020

Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures.

BJU Int 2019 09 15;124(3):477-486. Epub 2019 Mar 15.

Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Objectives: To present the functional and oncological outcomes after ≥1 year of follow-up, following an experience of >1000 robot-assisted radical prostatectomies (RARPs) with our standardised total anatomical reconstruction (TAR) technique. To evaluate which factors influence postoperative continence recovery in order to obtain a nomogram to predict the risk of postoperative urinary incontinence (UI).

Patients And Methods: The enrolment phase began in June 2013 and ended in May 2017. Patients were prospectively included in the study with the following inclusion criteria: (i) localised prostate cancer (clinical stages cT1-3, cN0, cM0); (ii) indication for RP; and (iii) preoperative multiparametric prostate magnetic resonance imaging. All patients underwent RARP with the TAR technique done at the end of the demolitive phase. The continence rates were assessed at 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal. Patients were defined as continent if they answered 'zero pad' or 'one safety pad' per day. A logistic regression model was used to evaluate the potential impact of some pre- and intraoperative factors on postoperative urinary continence recovery. Model discrimination was assessed using an area under (AUC) the receiver operating characteristic (ROC) curve. A nomogram to predict the risk of postoperative UI after RARP with the TAR technique was generated based on the logistic model.

Results: In all, 1008 patients were enrolled in our study. At 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal, 621 (61.61%), 594 (58.93%), 803 (79.66%), 912 (90.48%), 950 (94.25%) and 956 (94.84%) patients were continent, respectively. In the logistic regression model, the variables analysed had a higher impact on continence recovery at 4 and 12 weeks. At 4 weeks, the postoperative odds of urinary continence recovery increased with the absence of diabetes [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.41-5.41] and D'Amico low vs high risk (OR 2.01, 95% CI 1.01-3.99). At 12 weeks, urinary continence increased with the absence of diabetes (OR 3.01, 95% CI 1.23-7.35), D'Amico low vs high risk (OR 4.04, 95% CI 1.56-10.47), and D'Amico intermediate vs high risk (OR 3.33, 95% CI 1.66-6.70). ROC curves were drawn and an AUC value of 61.9% (95% CI 57.49-66.36) at 4 weeks and 63.8% (95% CI 58.03-69.65) at 12 weeks were computed. Based on these parameters, two nomograms (at 4 and 12 weeks postoperatively) were generated.

Conclusion: The TAR technique conferred excellent results in the early recovery of urinary continence. Two nomograms were created, to predict preoperatively the postoperative odds of urinary continence recovery at 4 and 12 weeks after RARP by integrating the presence of diabetes and D'Amico risk classification.
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http://dx.doi.org/10.1111/bju.14716DOI Listing
September 2019

Precision prostate cancer surgery: an overview of new technologies and techniques.

Minerva Urol Nefrol 2019 Oct 28;71(5):487-501. Epub 2019 Jan 28.

Department of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Over the past few years several new technologies have become available for the management of PCa. The implementation of robotic surgery allowed an unprecedented refinement of surgical techniques, and the RARP procedure is constantly evolving. Nowadays research is mainly focused towards a "tailored" case-specific surgical approach that might allow to achieve PCa control while preserving urinary continence and erectile function. Therefore, in contemporary urology era, several new tools have been introduced to optimize surgical planning, to aid surgical navigation, and to refine surgical execution. In this non-systematic review emerges that a better imaging technique in the preoperative setting can facilitate surgical planning. Moreover, in the intraoperative setting, new tools for image-guided surgical navigation are promising and will allow real time understanding of surgical anatomy. In the next future, a more personalized approach for the minimally invasive surgical treatment of PCa will be available, and the achievement of the best oncological and functional outcomes will be obtained.
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http://dx.doi.org/10.23736/S0393-2249.19.03365-4DOI Listing
October 2019

Radiological Wheeler staging system: a retrospective cohort analysis to improve the local staging of prostate cancer with multiparametric MRI.

Minerva Urol Nefrol 2019 Jun 17;71(3):264-272. Epub 2019 Jan 17.

Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.

Background: The knowledge of tumor location and extension can allow a modulated radical prostatectomy in order to minimize positive surgical margins and reduce functional morbidity after surgery in patients with prostate cancer (PCa). Multiparametric (mp) magnetic resonance imaging (MRI) could allow the assessment of tumor extension and of its relationship with external structures. Aim of this study is to propose a new radiological Wheeler (rW) staging system applied to mp-MRI, based on the pathologic staging system (pW) for the local assessment of PCa.

Methods: This retrospective single-center multi-reader study included consecutive patients with PCa and preoperative mp-MRI, who underwent non-nerve sparing radical prostatectomy. Three radiologists reported on all examinations and classified each selected lesion according to imaging criteria following rW. Whole-mount histological sections were used as the reference standard. An experienced pathologist classified the extent of prostatic capsular invasion of each PCa according to the pW. Each histological section was scanned for comparison with mp-MRI findings. The rate of PCa correctly classified by radiologists using the pW was assessed. To evaluate the accuracy of mp-MRI in the discrimination between T2 and T3 PCa, the AUC was computed.

Results: One-hundred and five patients with a total of 195 PCa foci were included in the study. 130/195 tumors with a clear overlap between mp-MRI and surgical specimens were selected. The sensitivity of the most experienced reader was lower than that of the other two readers (48.6% vs. 68.6% and 62.9%, P>0.09) while specificity and PPV were higher (95.8% vs. 79.0% and 57.9%, P<0.001; 81.0% vs. 54.6% and 35.5%, P<0.041; respectively). The AUC values for the most and the intermediate experienced readers in the detection of extracapsular extension were in the range 0.72-0.74.

Conclusions: The rW staging system has low accuracy in predicting each single pW class, while accuracy was over 80% for experienced readers in the identification of organ-confined (T2 stage class) tumors and non-organ confined cases (T3 stage class).
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http://dx.doi.org/10.23736/S0393-2249.19.03248-XDOI Listing
June 2019

The role of side-specific biopsy and dominant tumor location at radical prostatectomy in predicting the side of nodal metastases in organ confined prostate cancer: is lymphatic spread really unpredictable?

Minerva Urol Nefrol 2019 Apr 7;71(2):146-153. Epub 2018 Nov 7.

Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -

Background: The aim of this study was to evaluate the correlation between the location of prostate cancer (PCa) either at biopsy or at radical prostatectomy (RP) specimens and the side of positive lymph nodes (LNs). Furthermore, we assessed the risk of contralateral LN metastasis (LNMs) in patients with unilateral positive biopsy and/or dominant lesion at RP.

Methods: We reviewed retrospectively our prospectively maintained database of patients with LNM treated with robot-assisted RP and bilateral robot-assisted extended pelvic lymph node dissection (EPLND) for PCa from January 2014 to May 2018 at a surgical high-volume center. All men with a suspicion for PCa underwent a 12-cores prostate biopsy. In case of a first negative biopsy but the persistence of suspicion, all the patients underwent prostate multiparametric magnetic resonance imaging (mpMRI) and subsequently either fusion targeted biopsy (TBx) or systematic standard biopsy (SBx), in case of positive or negative mpMRI, respectively. All patients underwent a robot-assisted RP. Whole-mount histological sections resected from the RP specimens were used as reference standards.

Results: Eighty-seven patients were enrolled for the study. Median number of LNs retrieved per patient was 26, specifically 13 and 12, on the left and right side, respectively. Seven of 24 (29.1%) right lobe positive biopsy showed positive LNs on the left side (one exclusively left, 6 bilateral LNMs). Again, 12 of 26 (46.1%) left lobe positive biopsy showed positive LNs on the right side (one exclusively right, 11 bilateral LNMs). No significant differences of performance to predict the side of LNMs were recorded in the SBx and TBx groups. Concerning RP specimens, only five of 22 (22.7%) right lobe dominant cases showed positive LNs on the left side (two exclusively left, 3 bilateral LN metastases). Again, none of 16 left lobe dominant cases showed positive LNs on the contralateral side (15 exclusively right, 1 bilateral LNMs).

Conclusions: Our results suggest confirmed that a unilateral LN dissection limited to the tumor-bearing side of the gland evaluated by biopsy specimens should not be recommended due to the substantial risk of missing contralateral LNMs.
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http://dx.doi.org/10.23736/S0393-2249.18.03286-1DOI Listing
April 2019

Use of chitosan membranes after nerve-sparing radical prostatectomy improves early recovery of sexual potency: results of a comparative study.

BJU Int 2019 03 1;123(3):465-473. Epub 2018 Nov 1.

Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy.

Objectives: To evaluate the 1-year efficacy of chitosan membrane (ChiMe) application on the neurovascular bundles (NVBs) after nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) in potency recovery rate. To compare the results with those of a contemporary cohort of patients who did not benefit from chitosan use.

Patients And Methods: Patients in the ChiMe group were enrolled at our institution from July 2015 to September 2016 in a preliminary phase II study. All of them underwent NS-RARP with ChiMe applied on the NVBs and were followed over time to complete a 1-year follow-up. The control group was composed of patients who underwent NS-RARP at our institution without the application of ChiMe from January 2015. The patients were further classified into two groups based on the amount of nerves spared: Group A, comprised patients who underwent a monolateral or bilateral full NS; Group B, comprised patients in which a full NS was not performed. The demographics, peri- and postoperative data, and complications were recorded and compared. Potency recovery was recorded for Group A vs Group B in both the ChiMe and the control groups.

Results: In all, 136 patients were enrolled in the ChiMe group and 334 patients in the control group. There were no differences between groups in terms of baseline variables. Based on the amount of nerves preserved, 183 patients were included in Group A and 287 in Group B. Odds ratios at different time points showed that the only two factors influencing potency recovery were the amount of nerves preserved (Group A vs Group B) and the application or not of ChiMe on the NVBs spared. Comparing the ChiMe vs control groups at different time points, we found a statistically significant improvement in the potency recovery rate in the ChiMe group at 1 month (36.76% vs 25.88%; P = 0.02) and 2 months (52.2% vs 39.22%; P = 0.01) after surgery, showing a favourable trend at every time point of the entire follow-up period, even if not significant after the second postoperative month. In Group A, the log-rank test showed a statistically significant difference between the ChiMe vs control groups (P = 0.02), in particular at 1 and 2 months after surgery (P = 0.02 and P = 0.01, respectively).

Conclusion: The application of ChiMe on the NVBs resulted in a higher potency recovery rate at 1 and 2 months after a bilateral or monolateral full NS-RARP. A trend of a higher and shorter potency recovery rate showed it to be favourable to use ChiMe, even in the cohort of patients who did not undergo a full NS procedure.
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http://dx.doi.org/10.1111/bju.14583DOI Listing
March 2019

Is the third molar maturity index (I) useful for a genetic isolate population? Study of a Sardinian sample of children and young adults.

Int J Legal Med 2018 Nov 19;132(6):1787-1794. Epub 2018 Sep 19.

AgEstimation Project, Institute of Legal Medicine, University of Macerata, Macerata, Italy.

This work aims to assess the validity of the cut-off value (0.08) of the third molar maturity index (I) for discriminating minors from adults in Sardinian population. A sample of 336 digital panoramic radiographs of healthy Sardinian children and young minors (165 females and 171 males), aged between 15 and 23 years (mean age, 19.35 years in females and 18.80 years in males), was retrospectively evaluated. The left lower third molars were analysed by applying a specific cut-off value of 0.08 determined by Cameriere et al. in 2008. The reliability and reproducibility of the test was also studied: the intra-class correlation coefficients (ICC) were 0.91 (95% CI, 0.89-0.93) and 0.88 (95% CI, 0.86-0.90), for the intra- and inter-observer reliability, respectively. The I gradually decreased as the real age gradually increased in both sexes. According to the pooled results of the diagnostic test, the accuracy (ACC) was 0.86 (95% CI, 0.82-0.89); the proportion of correctly classified subjects (Se = sensitivity) was 0.82 (95% CI: 0.76-0.86); and specificity (Sp = specificity) was 0.95 (95% CI, 0.89-0.97). The positive predictive values (PPV) and the negative predictive values (NPVs) were 0.97 (95% CI, 0.94-0.99) and 0.70 (95% CI, 0.62-0.77). The LR+ and the LR- were 17.12 (95% CI, 7.27 to 40.36) and 0.19 (95% CI, 0.14 to 0.25). In spite of this, significant differences in the early mineralisation of the third molar were found between sexes as well as in the results of the diagnostic test, showing a better sensitivity in males than in females. The results showed that, although the third molar teeth are highly variable in development, and with differences between females and males as compare to other teeth, the I is a reliable method to distinguish between minors and adults even in such a genetic isolate population.
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http://dx.doi.org/10.1007/s00414-018-1933-2DOI Listing
November 2018

Correlation between chronological and physiological age of males from their multivariate urinary endogenous steroid profile and prostatic carcinoma-induced deviation.

Steroids 2018 11 16;139:10-17. Epub 2018 Sep 16.

Divisione di Urologia, Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Ospedale San Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.

The biosynthesis of endogenous androgenic anabolic steroids (EAAS) in males varies with age. Knowledge of the general urinary EAAS profile's dependence from aging - not reported up to now - may represents a prerequisite for its exploitation in the screening and diagnostic support for several pathologies. Extended urinary EAAS profiles were obtained from healthy and pathological individuals, using a GC-MS method which was fully validated by a stepwise, analyst-independent scheme. Seventeen EAAS and five of their concentration ratios were determined and investigated using multivariate statistical methods. A regression model based on Kernel partial least squares algorithm was built to correlate the chronological age of healthy male individuals with their "physiological age" as determined from their urinary EAAS profile. Strong correlation (R = 0.75; slope = 0.747) and good prediction ability of the real chronological age was inferred from EAAS data. In contrast, patients with recent diagnosis (not pharmacologically treated) of prostatic carcinoma (PCa) exhibited a comprehensive EAAS profile with strong negative deviation from the model, corresponding a younger predicted age. This result is possibly related to the activation of anomalous steroid biosynthesis induced from PCa. Over a restricted 60-80 years-old population, PLS-discriminant analysis (DA) was used to distinguish healthy subjects from patients with untreated PCa. PLS-DA yielded excellent discrimination (sensitivity and specificity >90%) between healthy and pathological individuals. This proof-of-concept study provides a preliminary evaluation of multivariate DA on wide EAAS profiles as a screening method to distinguish PCa from non-pathological conditions, overcoming the potentially interfering effect of ageing.
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http://dx.doi.org/10.1016/j.steroids.2018.09.007DOI Listing
November 2018

Comparing Image-guided targeted Biopsies to Radical Prostatectomy Specimens for Accurate Characterization of the Index Tumor in Prostate Cancer.

Anticancer Res 2018 05;38(5):3043-3047

Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.

Aim: To evaluate the accuracy of multiparametric magnetic resonance-transrectal ultrasound fusion targeted biopsy (TBx) in the characterization of the index tumor, as confirmed by association with radical prostatectomy (RP) specimens.

Patients And Methods: A total of 152 patients with TBx-confirmed prostate cancer (PCa) underwent robot-assisted RP. Stained whole-mount histological sections were used as the reference standard. All lesions with a volume >0.5 ml and/or pathological Gleason score (GS) >6 were defined as clinically significant PCa. The index lesion was defined as the largest tumor focus within the prostate gland.

Results: The pathological index tumours included: 147 lesions (96.7%) with a volume >0.5 ml and five (3.3%) with a volume ≤0.5 ml, but with a pathological GS ≥7; 135 (88.8%) were located in the peripheral zone. TBx accuracy in the detection of the correct site of the index lesion by reference standard was 82.2%. Sensitivity, specificity, positive and negative predictive value were: 82.3%, 50.4%, 82.8% and 49.7%, respectively. The primary/secondary Gleason grade and GS of the 152 index tumors were properly estimated in 130 (85.5%), 115 (75.6%) and 127 (83.6%) cases, respectively. The concordance of TBx with pathological GS was 83.6%. The rate of up-grading and down-grading of TBx Gleason sum was 12.2% and 4.2%, respectively.

Conclusion: TBx has a high sensitivity for characterization of index lesions, with a good concordance for topographic and Gleason grading accuracy between biopsy and surgical specimens.
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http://dx.doi.org/10.21873/anticanres.12560DOI Listing
May 2018

Indication to pelvic lymph nodes dissection for prostate cancer: the role of multiparametric magnetic resonance imaging when the risk of lymph nodes invasion according to Briganti updated nomogram is <5.

Prostate Cancer Prostatic Dis 2018 04 22;21(1):85-91. Epub 2018 Feb 22.

Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy.

Background: The Briganti updated nomogram (BN) is the most popular predictive model aiming to predict the presence of lymph node invasion (LNI) in patients with prostate cancer (PCa), but it lacks information obtained by preoperative imaging. The primary aim of the study was to evaluate the role of multiparametric prostate magnetic resonance imaging (mp-MRI) in the indication to perform pelvic lymph nodes dissection (PLND) or not in patients with risk of LNI according to BN below 5%.

Methods: Since March 2012 and September 2016, 310 patients who underwent a preoperative mp-MRI for staging purpose and subsequent robot-assisted extended PLND (RAEPLND) were retrospectively evaluated. Mp-MRIs were prospectively analyzed by two experienced radiologists. The imaging parameters analyzed were the presence of extracapsular extension (ECE), seminal vesicles invasion (SVI) and predominant Gleason pattern 4 (pG4). All patients underwent RAEPLND by two experienced surgeons with a standardized technique. A dedicated uropathologist performed all pathological analysis. Univariate analysis and multivariate logistic regression analysis were used in order to identify the predictors of LNI in patients with PCa.

Results: In the overall population, 57 (18.4%) patients had histologically proven pN1 disease. 48/250 patients (19.2%) with a risk of LNI ≥5% as calculated by the BN were staged pN1 at final histopathological analysis. 9/60 patients (15.0%) with a risk of LNI <5% as calculated by BN, who underwent RAEPLND anyway according to the findings at mp-MRI, were staged pN1 at final histopathological analysis. At multivariate logistic regression analysis, all the three mp-MRI parameters were significant independent predictors of LNI after RAEPLND.

Conclusions: The role of mp-MRI seemed to be crucial in patients with a risk of LNI <5% as calculated by the BN. The presence of ECE, SVI, or pG4 at mp-MRI was found to be an independent predictor of LNI by itself.
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http://dx.doi.org/10.1038/s41391-017-0026-5DOI Listing
April 2018

Editorial Comment.

J Urol 2018 05 10;199(5):1186-1187. Epub 2018 Feb 10.

Division of Urology, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Italy.

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http://dx.doi.org/10.1016/j.juro.2017.11.143DOI Listing
May 2018

3-Year follow-up of temporary implantable nitinol device implantation for the treatment of benign prostatic obstruction.

BJU Int 2018 07 14;122(1):106-112. Epub 2018 Feb 14.

Division of Urology, Department of Oncology - School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy.

Objectives: To report 3-year follow-up results of the first implantations with a temporary implantable nitinol device (TIND ; Medi-Tate Ltd., Or Akiva, Israel) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Patients And Methods: In all, 32 patients with LUTS were enrolled in this prospective study. The study was approved by the local Ethics Committee. Inclusion criteria were: age >50 years, International Prostate Symptom Score (IPSS) ≥10, peak urinary flow (Q ) <12 mL/s, and prostate volume <60 mL. The TIND was implanted within the bladder neck and the prostatic urethra under light sedation, and removed 5 days later in an outpatient setting. Demographics, perioperative results, complications (according to Clavien-Dindo classification), functional results, and quality of life (QoL) were evaluated. Follow-up assessments were made at 3 and 6 weeks, and 3, 6, 12, 24 and 36 months after the implantation. The Student's t-test, one-way analysis of variance and Kruskal-Wallis tests were used for statistical analyses.

Results: At baseline, the mean (standard deviation, sd) patient age was 69.4 (8.2) years, prostate volume was 29.5 (7.4) mL, and Q was 7.6 (2.2) mL/s. The median (interquartile range, IQR) IPSS was 19 (14-23) and the QoL score was 3 (3-4). All the implantations were successful, with a mean total operative time of 5.8 min. No intraoperative complications were recorded. The change from baseline in IPSS, QoL score and Q was significant at every follow-up time point. After 36 months of follow-up, a 41% rise in Q was achieved (mean 10.1 mL/s), the median (IQR) IPSS was 12 (6-24) and the IPSS QoL was 2 (1-4). Four early complications (12.5%) were recorded, including one case of urinary retention (3.1%), one case of transient incontinence due to device displacement (3.1%), and two cases of infection (6.2%). No further complications were recorded during the 36-month follow-up.

Conclusions: The extended follow-up period corroborated our previous findings and suggests that TIND implantation is safe, effective and well-tolerated, for at least 36 months after treatment.
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http://dx.doi.org/10.1111/bju.14141DOI Listing
July 2018

Prostate cancer biomarkers: new scenarios in the multi-parametric magnetic resonance imaging era.

BJU Int 2017 12;120(6):745-746

Division of Urology, San Luigi Gonzaga Hospital and University of Torino, Orbassano, Italy.

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http://dx.doi.org/10.1111/bju.13803DOI Listing
December 2017
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