Alberto Trucchi

Sapienza University of Rome, Roma, Latium, Italy

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Publications (35)57.58 Total impact

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    ABSTRACT: BACKGROUND: To evaluate the association between metabolic syndrome (MS) and prostate cancer diagnosis and grade in patients undergoing prostate biopsy. METHODS: From 2009 onwards, a consecutive series of patients undergoing 12-core prostate biopsy for PSA value ≥4 ng/ml and/or positive digital rectal examination (DRE) were prospectively enrolled. Body mass index (BMI), waist circumferences, and blood pressure were measured before the biopsy. Blood samples were tested for: PSA, fasting glucose, triglycerides, and cholesterol HDL. MS presence was defined according to Adult Treatment Panel III criteria. RESULTS: One hundred ninety five patients were enrolled with a median age and PSA of 69 years and 5.6 ng/ml respectively. Median BMI was 27.6 kg/m(2) with 64 patients (33%) being classified as obese (BMI ≥ 30 kg/m(2) ). Eighty-six patients (44%) had MS. Eighty-three patients (43%) had cancer on biopsy; 37 (45%) with MS and 46 (55%) without (P = 0.48). PSA was independently associated with higher risk of cancer (OR 1.12/1 U PSA, P = 0.01). Out of 83 patients with prostate cancer, 42 (51%) had Gleason score 6 (12 (28.5%) presented a MS) and 41 (49%) a Gleason score ≥7 (25 (61%) presented a MS). The presence of MS was not associated with an increased risk prostate cancer (OR: 0.97, P = 0.94) but with an increased risk of Gleason ≥7 (OR: 3.82; P = 0.013). CONCLUSIONS: In our single center study, MS is associated with an increased risk of high grade Gleason score when prostate cancer is diagnosed on biopsy. However, these results should be confirmed in a larger multicenter study. Prostate © 2011 Wiley-Liss, Inc.
    The Prostate 02/2011; · 3.84 Impact Factor
  • European Urology Supplements - EUR UROL SUPPL. 01/2011; 10(2):205-205.
  • European Urology Supplements - EUR UROL SUPPL. 01/2011; 10(2):116-116.
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    ABSTRACT: To investigate the relationship between androgens and prostate cancer in patients scheduled for radical prostatectomy. Patients scheduled for open radical prostatectomy were enrolled. Blood samples were collected before prostate biopsy and 12 months later to evaluate testosterone, free testosterone, sex hormone-binding globulin (SHBG), PSA, calculated free and bioavailable testosterone. 44 patients were consecutively enrolled. 15 patients (34%) presented a Gleason score (GS) of 6, 24 patients GS 7 (54%), 1 patient (2%) GS 8, and 4 patients GS 9 (9%). Mean prostate cancer volume was 4.3 ± 5.7 cm(3). 24 patients presented a pT2 stage, 16 a pT3a stage, and 4 a pT3b stage. Positive surgical margins were detected in 12 patients (27.3%). No significant change of testosterone (4.21 ± 1.49 vs. 4.00 ± 1.48 ng/ml, p = 0.46), free testosterone (9.01 ± 3.64 vs. 8.85 ± 3.04 pg/ml, p = 0.83), SHBG (38 ± 14.39 vs. 38.5 ± 17.23 nmol/l, p = 0.71), calculated free testosterone (0.091 ± 0.13 vs. 0.067 ± 0.026, p = 0.563), and bioavailable testosterone (1.89 ± 0.722 vs. 1.88 ± 0.53, p = 0.912) was observed. In our single-center study, prostate cancer does not impact on serum androgen levels, however our results should be confirmed in a larger study.
    Urologia Internationalis 01/2011; 86(2):161-6. · 1.07 Impact Factor
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    ABSTRACT: To evaluate the effect of tamsulosin on reducing the serum levels of prostate-specific antigen (PSA) in patients with lower urinary tract symptoms and an elevated PSA level. From June 2004 to July 2006, patients with lower urinary tract symptoms, a PSA level of >or=4 ng/mL, and a maximal flow rate of <15 mL/s received tamsulosin 0.4 mg daily for 2 months. They were then scheduled for 12-core prostate biopsy. PSA determination and a uroflow study were performed before biopsy. A total of 80 patients completed the present study. The mean patient age was 66.3 years, and the mean PSA level was 7.8 +/- 8.4 ng/mL at baseline and 7.1 +/- 9.1 ng/mL after treatment (P < .001). A total of 29 patients (36.25%) were diagnosed with prostate cancer from the biopsy findings. A significant increment in the PSA level was observed in patients with prostate cancer (6.7 versus 7.9 ng/mL; P = .002). A significant decrease in the PSA level was observed in patients with negative biopsy findings (6.9 versus 5.1 ng/mL, P = .000). Of the 38 patients with a decrease in the PSA level, 1 (2.6%) was diagnosed with prostate cancer and 37 (97.4%) with an benign prostatic hyperplasia/prostatitis. Of the 42 patients with no change in the PSA level, 28 (66.7%) had prostate cancer and 14 (33.3%) had negative findings. A change in PSA level after treatment gave a sensitivity of 96.6%, specificity of 72.5%, and diagnostic accuracy of 81% for prostate cancer. Treatment with tamsulosin seemed to reduce the PSA levels and identified patients at high risk of prostate cancer.
    Urology 08/2010; 76(2):436-41. · 2.42 Impact Factor
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    ABSTRACT: We evaluated voiding and storage symptom evolution in patients treated with prostate photoselective vaporization by a KTP laser. Enrolled in the study were 150 consecutive patients with lower urinary tract symptoms due to benign prostatic hyperplasia and a diagnosis of bladder outlet obstruction. Patients underwent prostate photoselective vaporization with the 80 W KTP laser. Baseline parameters included prostate volume, International Prostate Symptom Score with voiding and storage symptom subscores, uroflowmetry, pressure flow study and serum prostate specific antigen. Patients were followed 1, 3, 6 and 12 months after surgery. Mean +/- SD patient age was 69.6 +/- 10 years. Mean prostate volume was 52 +/- 18 ml. Mean International Prostate Symptom Score was 22.3 +/- 4, mean maximum urine flow was 9 +/- 2.9 ml per second and mean Schäfer obstruction class was 3.6 +/- 1. An average of 190 +/- 44 kJ were delivered in a mean of 68 +/- 24 minutes with an average of 3.6 kJ/ml prostate. The mean number of fibers was 1.2 +/- 0.4. Mean catheterization time was 20 +/- 8 hours. Retrograde ejaculation was reported in 67% of patients. Prostate specific antigen was significantly decreased at 12 months (2.6 +/- 2.3 vs 0.9 +/- 0.7 ng/ml, p = 0.001). Storage symptoms decreased by 54.5%, 63.6%, 72.7% and 81.8% at 1, 3, 6 and 12 months, respectively (p <0.001). Voiding symptoms decreased 63.6%, 72.7%, 81.8% and 90.9% at 1, 3, 6 and 12 months, respectively (p <0.001). As shown by a prostate specific antigen significant decrease, proper prostate debulking may be achieved by prostate photoselective vaporization. Significant continuous improvement in storage and voiding symptoms was observed at up to 12-month followup.
    The Journal of urology 03/2010; 183(3):1098-103. · 4.02 Impact Factor
  • Journal of Urology - J UROL. 01/2010; 183(4).
  • Journal of Urology - J UROL. 01/2010; 183(4).
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    ABSTRACT: We evaluated the association between the number of biopsy cores revealing high grade prostatic intraepithelial neoplasia and prostate cancer in an era of extended biopsy protocol. From December 2004 to September 2007 patients referred to our clinic with a prostate specific antigen of 4 ng/ml or greater or an abnormal digital rectal examination were scheduled for transrectal ultrasound prostatic biopsy with a 12-core template. In patients with high grade prostatic intraepithelial neoplasia we proposed a second prostate specific antigen evaluation and a new 12-core biopsy after 6 months independent of prostate specific antigen. Nonparametric tests were applied for statistical analysis. We evaluated 650 patients. Of the 147 patients (22%) with high grade prostatic intraepithelial neoplasia 117 underwent a second biopsy 6 months later. Patient characteristics (age, prostate specific antigen, free-to-total prostate specific antigen ratio, prostate volume, prostate specific antigen density) were similar at initial and repeat biopsy. On second biopsy 22 patients (18.8%) presented with prostate cancer (14 with Gleason score 6, 7 with Gleason score 7 and 1 with a Gleason score 8), 75 showed isolated high grade prostatic intraepithelial neoplasia (64.2%) and 20 (17%) had chronic prostatitis. The number of cores (4 or more) involved with high grade prostatic intraepithelial neoplasia on the first biopsy was significantly associated with prostate cancer on the second biopsy (p = 0.001). Prostate specific antigen could not be used to distinguish prostate cancer from benign disease or high grade prostatic intraepithelial neoplasia. The number of cores with high grade prostatic intraepithelial neoplasia seems to be associated with the presence of cancer on second biopsy. A 6-month biopsy is recommended in patients with high grade prostatic intraepithelial neoplasia when 4 or more cores with high grade prostatic intraepithelial neoplasia are detected in the initial biopsy sample independent of prostate specific antigen.
    The Journal of urology 02/2009; 181(3):1069-74; discussion 1074-5. · 4.02 Impact Factor
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    ABSTRACT: The development and introduction in clinical practice of finasteride, the first potent inhibitor of steroid 5-alpha-reductase that inhibits the conversion of testosterone to its active form dihydroxytestosterone, has created the possibility to prevent and treat prostatic disorder by manipulating and lowering the androgens levels in the prostate. Randomised and placebo-controlled trials have demonstrated the benefit of finasteride in men with enlarged prostatic gland owing to benign prostatic hyperplasia in terms of symptoms and urinary flow rate improvements. The Prostate Cancer Prevention Trial has clearly stated the chemopreventive properties of finasteride for prostate cancer but the necessity to provide such preventive therapy to a specific group of men with a higher risk to develop a clinically significant disease is under discussion. Finasteride is administered orally as a single daily dose. We recommend a 5 mg dose.
    Expert Opinion on Drug Metabolism &amp Toxicology 01/2009; 4(12):1561-8. · 2.94 Impact Factor
  • Journal of Urology - J UROL. 01/2009; 181(4):815-815.
  • European Urology Supplements - EUR UROL SUPPL. 01/2009; 8(4):266-266.
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    ABSTRACT: To evaluate the accuracy of the TRIMprob in the diagnosis of prostate neoplasm. Consecutive patients referred for prostate biopsy were prospectively enrolled. Patients had history taken, physical examination by digital rectal examination (DRE) of the prostate, assessment of total and free serum prostate-specific antigen (PSA) levels, prostate transrectal ultrasonography (TRUS), and TRIMprob test. Indications for prostate biopsy included one or more of the following conditions: total serum PSA levels of 4.0 ng/mL or more, free/total serum PSA ratio of 0.18 or less, positive results on DRE, and suspicious findings on TRUS. Twelve-core, TRUS-guided biopsies were performed with local anesthesia. A blinded investigator performed the TRIMprob test; the lowest value of the signal at 465 MHz was looked for and recorded, although data of the electromagnetic signal at 930 and 1295 MHz were also recorded. One hundred eleven patients (aged 64.9 +/- 8.1 years, mean +/- standard deviation), enrolled between November 2004 and August 2005, were analyzed. Total serum PSA level was 8.4 +/- 3.6 ng/mL, and free/total serum PSA ratio was 0.15 +/- 0.7. TRIMprob sensitivity for the diagnosis of prostate cancer was 0.86%; specificity and positive and negative predictive values were 0.60 and 0.88; accuracy was 72%. TRIMprob accuracy outperformed any other diagnostic parameter considered, including the rule of chance. The association of TRIMprob and DRE offered a sensitivity and a negative predictive value of 0.86% or greater. TRIMprob had the highest accuracy rate, among all other tests, for the diagnosis of prostate cancer. Electromagnetic detection with the TRIMprob test seems to be a promising technology and a useful additional tool for the early detection of prostate cancer.
    Urology 04/2008; 72(2):340-4. · 2.42 Impact Factor
  • European Urology Supplements - EUR UROL SUPPL. 01/2008; 7(3):224-224.
  • European Urology Supplements - EUR UROL SUPPL. 01/2008; 7(3):212-212.
  • European Urology Supplements - EUR UROL SUPPL. 01/2006; 5(2):277-277.
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    ABSTRACT: To test the hypothesis that periprostatic block could completely relief prostatic biopsy-associated pain. Patients scheduled for transrectal ultrasound guided prostate biopsy were randomized (1:1:1 ratio) to no analgesia (group A), endorectal enema of 1% lidocaine gel (group B) or transrectal periprostatic block (group C). All patients underwent 10 core TRUS-guided biopsy. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. The study design included interim analysis of pain score after the first 60 patients were enrolled. Kruskal-Wallis test for unpaired data was used for statistical analysis. Data are presented as mean, median (range). Sixty patients were enrolled between May 2003 and December 2003 and all patients were evaluable. Mean and median age was 68.5 and 69 (range 53-82) years, respectively. Mean and median PSA was 86.8 and 9 ng/ml (range 0.58-4.111), respectively. No major side effects were observed. Patients in group A scored at VAS a median 4, mean 5.5 +/- 2.3 (range 3-10). Patients in group B scored a median 4, mean 5.5 +/- 2.7 (range 3-10) (p = 0.237). Patients receiving periprostatic injections of carbocaine (group C) scored a median 0, mean 0.5 +/- 0.8 (range 0-2). The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostatic biopsy without anesthesia or with intrarectal anesthetic jelly (p = 0.00001). In the periprostatic block group 65% of patients referred no pain after the procedure (VAS = 0) while all patients in the other groups experience some degree of pain. The use of bilateral periprostatic block is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostatic biopsy procedure.
    Urologia Internationalis 02/2005; 74(3):209-13. · 1.07 Impact Factor
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    ABSTRACT: Detrusor hypertrophy associated with bladder outlet obstruction can be imaged on suprapubic ultrasound, and bladder mass can be quantified from the evaluation of bladder wall thickness and bladder volume. Bladder wall hypertrophy has been found to be correlated with detrusor function. Independent studies have shown that surgical treatment of benign prostatic obstruction results in a significant decrease of bladder mass. Preliminary data suggest the possibility that medical treatment with alpha-adrenergic antagonists might also produce a reduction of bladder wall hypertrophy, although confirmation is still awaited. The development of dedicated automated ultrasound systems for the evaluation of bladder mass might result in the use of such parameters in clinical trials of treatment for benign prostatic hyperplasia and ultimately in daily urologic practice.
    Reviews in urology 02/2005; 7 Suppl 6:S35-42.
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    ABSTRACT: To analyse the clinical and 24-hour urinary flow efficacy of alfuzosin 10mg once daily (OD), by means of the International Prostate Symptom Score (I-PSS) and home-based uroflowmetry (P-Flow) measurement, in patients with lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. In this open-label trial, 12 male patients (median age 67 years) with an I-PSS >15 (median 16) and maximum urinary flow (Q(max)) <15 mL/sec were evaluated. Patients underwent two days of P-Flow evaluation, and then received alfuzosin 10mg OD from day 3 to day 9. On days 7 and 8 they underwent further P-Flow evaluation. A second post-baseline evaluation I-PSS was recorded on day 9. Overall, 328 urinary flows were recorded and evaluated, an average of 27 flows per patient. A statistically significant improvement in mean maximum flow: (Q(max)) [10.8 +/- 2.8 vs 12.4 +/- 3 mL/sec; p = 0.02] and urinary voiding volume (219 +/- 70 vs 233 +/- 55mL; p = 0.04) were observed after treatment compared with baseline. No differences in the number of urinary flows were observed between baseline and after treatment (13 +/- 2.9 vs 14 +/- 1.8 flows; p = 0.199). A statistically significant difference between the two evaluations was noted for I-PSS (15.7 +/- 0.8 and 9.5 +/- 2; p = 0.02). Mean Q(max) recorded during treatment was always higher than baseline at different daytime evaluations. The alfuzosin 10mg OD formulation showed a significant improvement in I-PSS as well as a significant improvement in urinary flow parameters (Q(max)and urinary voiding volume) lasting for 24 hours in patients with LUTS.
    Clinical Drug Investigation 01/2005; 25(6):359-65. · 1.92 Impact Factor
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    ABSTRACT: A significant change has occurred in the management of symptomatic benign prostatic hyperplasia (BPH) since effective pharmacological treatment became available and led to a significant decrease in the number of surgical procedures in many Western countries. The hypothesis of a causative role of benign prostatic enlargement and bladder outflow obstruction (BOO) in lower urinary tract symptoms (LUTS) was based on the association between prostate growth and symptoms of prostatism in elderly men and on the dramatic reduction of LUTS upon relief of obstruction. Careful investigation into the epidemiology of LUTS and BPH failed to confirm such an association and opened new perspectives in the pathophysiology of lower urinary tract dysfunction and symptoms. The observation that LUTS were equally distributed in male and female cohorts, when matched for age, moved attention away from the prostate and towards the urinary bladder and its aging-related disorders. When BPH surgery was developed, the management of the disease was aimed at preventing death from chronic renal failure, but the picture has changed and modern medical treatment is now aimed at improving the patient's quality of life. The increasing size of elderly populations in the Western world and the consequent financial constraints of national healthcare systems have raised the question of when pharmacological treatment of symptomatic BPH should be initiated. Retrospective and prospective analysis of various BPH populations and clinical studies has clearly defined the capacity of pharmacological treatment to reduce the incidence of complications of BPH, such as acute urinary retention and the need for surgery, but the cost/benefit ratio is unclear. Notwithstanding the limitations inherent in the experimental models, there is evidence from various animal models, investigating the pathophysiology of the urinary bladder in the presence of outflow obstruction, to indicate that a cause and effect relationship between BOO and bladder decompensation has been established and to support the hypothesis that permanent bladder damage may occur when the obstruction is not relieved early enough. Preliminary experimental evidence also suggests that alpha(1)-adrenoceptor antagonists may have a role in reducing the damaging effects of BOO on the urinary bladder. At present, there is no evidence to support the need for early pharmacological treatment of symptomatic BPH with no BOO beyond the obvious target of improving the patient's quality of life. The evidence for early treatment of BOO and the need to preserve bladder function is clear. Further experimental and clinical research is required to identify markers of early bladder damage and decompensation which can be used to select patients for early pharmacological treatment of BPH.
    Drugs & Aging 02/2003; 20(3):185-95. · 2.65 Impact Factor

Publication Stats

251 Citations
57.58 Total Impact Points

Institutions

  • 1988–2011
    • Sapienza University of Rome
      • • Department of Medicine
      • • Department of Psychology
      Roma, Latium, Italy
  • 2010
    • University of Rome Tor Vergata
      Roma, Latium, Italy
  • 1993
    • Università degli Studi dell'Aquila
      Aquila, Abruzzo, Italy