Francesco Montorsi

Università Vita-Salute San Raffaele, Milano, Lombardy, Italy

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Publications (887)4764.04 Total impact

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    ABSTRACT: The impact of cardiopulmonary bypass (CPB) usage in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We sought to determine the impact of cardiopulmonary bypass (CPB) on overall and cancer specific survival, as well as surgical complication rates, and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without CPB. We retrospectively analyzed 362 patients with RCC and with level III or IV tumor thrombus from 1992 to 2012 in 22 US and European centers. Cox proportional hazards models were used to compare overall and cancer-specific survival between patients with and without CPB. Perioperative mortality and complications rates were assessed using logistic regression analyses. The median overall survival was 24.6 months in non-CPB patients and 26.6 months in CPB patients. Overall survival and cancer-specific survival (CSS) did not differ significantly in both groups, neither in univariate analysis nor when adjusting for known risk factors. In multivariate analysis, no significant differences were seen in hospital LOS, Clavien 1-4 complication rate, intraoperative or 30 day mortality, and CSS between both groups. Limitations include the retrospective nature of the study. In our multi-institutional analysis, the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality in the multivariate analysis. Higher surgical complications were not independently associated with the use of CPB. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of urology 03/2015; DOI:10.1016/j.juro.2015.02.2948 · 3.75 Impact Factor
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    ABSTRACT: To evaluate the role of prostate volume assessed at final pathology in the risk of biochemical recurrence in patients with clinically localized prostate cancer treated with radical prostatectomy. Overall, 5637 patients treated with radical prostatectomy between January 1993 and August 2013 were identified. Multivariable Cox regression analyses tested the association between prostate volume and biochemical recurrence in the overall population and after stratifying patients according to the D'Amico risk groups. Mean (median) prostate volume was 50.61 mL (46 mL). When patients were stratified according to D'Amico risk groups, mean (median) prostate volume was 51.7 mL (48 mL), 49.8 mL (45 mL) and 50.6 mL (46 mL) in low-, intermediate-, and high-risk prostate cancer, respectively (P = 0.04). Overall, the 5-year biochemical recurrence-free survival rate was 87.9%. In multivariable Cox regression analyses, prostate volume was associated with a lower risk of biochemical recurrence (hazard ratio 0.99, 95% confidence interval 0.99-1.00), after accounting for disease characteristics. However, when patients were stratified according to D'Amico risk groups, prostate volume represented an independent predictor of biochemical recurrence only in individuals with intermediate-risk disease (hazard ratio 0.99, 95% confidence interval 0.99-1.00). Conversely, prostate volume was not associated with the risk of experiencing biochemical recurrence in patients with low- and high-risk disease. Smaller prostates are associated with increased risk of biochemical recurrence after surgery only in men with intermediate-risk disease. In this category, the preoperative assessment of prostate volume might be helpful in order to identify patients at higher risk of biochemical recurrence after surgery. Additionally, prostate volume might be used to individualize follow-up schedules after radical prostatectomy. © 2015 The Japanese Urological Association.
    International Journal of Urology 03/2015; DOI:10.1111/iju.12748 · 1.80 Impact Factor
  • Stacy Loeb, Francesco Montorsi, James W Catto
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    ABSTRACT: At the 2014 International Society of Urological Pathology meeting, changes to prostate cancer grading were discussed including new prognostic Gleason grade groups 1-5 representing Gleason scores of 3+3, 3+4, 4+3, 8, and 9-10, respectively. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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    ABSTRACT: OBJECTIVE. The purpose of this study is to test the association between diffusion-weighted MRI and prostate cancer Gleason score at both biopsy and final pathologic analysis after radical prostatectomy. SUBJECTS AND METHODS. Patients with prostate cancer (n = 72) underwent diffusion-weighted MRI (b values, 0, 800, and 1600 s/mm(2)) with an endorectal coil. Apparent diffusion coefficient (ADC) and ADC ratio were obtained in normal and pathologic tissue and were correlated with transrectal ultrasound-guided biopsy (n = 72) and histopathologic (n = 39) Gleason scores using the ANOVA test. ADC accuracy was estimated using ROC curves. RESULTS. Lesions suspicious for prostate cancer were detected in 65 patients. The mean ADC was 1.47 and 0.87 × 10(-3) mm(2)/s for normal and pathologic tissue, respectively (p < 0.001). When we divided the population into four groups (normal tissue and biopsy Gleason scores of 6, 7, and 8-10), then the mean ADC value was 1.47, 0.96, 0.80, and 0.78 × 10(-3) mm(2)/s, respectively (p < 0.001). The ADC ratio decreased along with an increase in biopsy Gleason score (66.9%, 56.7%, and 51.5% for Gleason scores of 6, 7 and 8-10, respectively) (ANOVA, p = 0.003) and pathologic Gleason score (ANOVA, p < 0.001). ROC curves had an AUC of 0.94 and 0.86 for ADC and ADC ratio, respectively (p = 0.012 and 0.042, respectively). CONCLUSION. Decreasing ADC values may represent a strong risk factor of harboring a poorly differentiated prostate cancer, independently of biopsy characteristics.
  • Firas Abdollah, Francesco Montorsi, Alberto Briganti
    European Urology 02/2015; DOI:10.1016/j.eururo.2014.08.026 · 12.48 Impact Factor
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    ABSTRACT: Over the last decade, PET/CT with radiolabelled choline has been shown to be useful for restaging patients with prostate cancer (PCa) who develop biochemical failure. The limitations of most clinical studies have been poor validation of [(11)C]choline PET/CT-positive findings and lack of survival analysis. The aim of this study was to assess whether [(11)C]choline PET/CT can predict survival in hormone-naive PCa patients with biochemical failure. This retrospective study included 302 hormone-naive PCa patients treated with radical prostatectomy who underwent [(11)C]choline PET/CT from 1 December 2004 to 31 July 2007 because of biochemical failure (prostate-specific antigen, PSA, >0.2 ng/mL). Median PSA was 1.02 ng/mL. PCa-specific survival was estimated using Kaplan-Meier curves. Cox regression analysis was used to evaluate the association between clinicopathological variables and PCa-specific survival. The coefficients of the covariates included in the Cox regression analysis were used to develop a novel nomogram. Median follow-up was 7.2 years (1.4 - 18.9 years). [(11)C]Choline PET/CT was positive in 101 of 302 patients (33 %). Median PCa-specific survival after prostatectomy was 14.9 years (95 % CI 9.7 - 20.1 years) in patients with positive [(11)C]choline PET/CT. Median survival was not achieved in patients with negative [(11)C]choline PET/CT. The 15-year PCa-specific survival probability was 42.4 % (95 % CI 31.7 - 53.1 %) in patients with positive [(11)C]choline PET/CT and 95.5 % (95 % CI 93.5 - 97.5 %) in patients with negative [(11)C]choline PET/CT. In multivariate analysis, [(11)C]choline PET/CT (hazard ratio 6.36, 95 % CI 2.14 - 18.94, P < 0.001) and Gleason score >7 (hazard ratio 3.11, 95 % CI 1.11 - 8.66, P = 0.030) predicted PCa-specific survival. An internally validated nomogram predicted 15-year PCa-specific survival probability with an accuracy of 80 %. Positive [(11)C]choline PET/CT after biochemical failure predicts PCa-specific survival in hormone-naive PCa patients. Prospective studies are warranted to confirm our results before more extensive use of [(11)C]choline PET/CT for prognostic stratification of PCa patients.
    European journal of nuclear medicine and molecular imaging 02/2015; DOI:10.1007/s00259-015-3015-8 · 5.22 Impact Factor
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    ABSTRACT: A recent study reported a detrimental effect of phosphodiesterase type 5 inhibitors (PDE5-Is) on biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer (PCa). We tested the association between PDE5-I use, PDE5-I therapy scheme, number of PDE5-I pills taken, and BCR in 2579 patients treated with bilateral nerve-sparing RP for PCa between 2004 and 2013 at a single center. Patients were categorized according to PDE5-I use within 2 yr after surgery as on demand, rehabilitation schedule (daily PDE5-I use for at least 3 mo), and no PDE5-I use. Multivariable (MVA) Cox regression models tested the association between PDE5-I and BCR. The same analyses were repeated using the number of PDE5-I pills taken by each patient. Overall, 674 patients (26.1%) received PDE5-Is. At MVA analysis, PDE5-I use, type of administration schedule, and number of PDE5-I pills were not significantly associated with higher risk of BCR (all p ≥ 0.2) after accounting for multiple confounders including time from RP to PDE5-I use. While awaiting further studies, patients should not be denied PDE5-I treatment after RP. Among patients treated with radical prostatectomy, phosphodiesterase type 5 inhibitor use was not associated with an increased risk of biochemical recurrence, regardless of the therapeutic regimen used. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 02/2015; DOI:10.1016/j.eururo.2015.02.002 · 12.48 Impact Factor
  • Oncology (Williston Park, N.Y.) 02/2015; 29(2). · 2.98 Impact Factor
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    ABSTRACT: No data exist on the patterns of biochemical recurrence (BCR) and their effect on survival in patients with high-risk prostate cancer (PCa) treated with surgery. The aim of our investigation was to evaluate the natural history of PCa in patients treated with radical prostatectomy (RP) alone. Overall, 2,065 patients with high-risk PCa treated with RP at 7 tertiary referral centers between 1991 and 2011 were identified. First, we calculated the probability of experiencing BCR after surgery. Particularly, we relied on conditional survival estimates for BCR after RP. Competing-risks regression analyses were then used to evaluate the effect of time to BCR on the risk of cancer-specific mortality (CSM). Median follow-up was 70 months. Overall, the 5-year BCR-free survival rate was 55.2%. Given the BCR-free survivorship at 1, 2, 3, 4, and 5 years, the BCR-free survival rates improved by+7.6%,+4.1%,+4.8%,+3.2%, and+3.7%, respectively. Overall, the 10-year CSM rate was 14.8%. When patients were stratified according to time to BCR, patients experiencing BCR within 36 months from surgery had higher 10-year CSM rates compared with those experiencing late BCR (19.1% vs. 4.4%; P<0.001). At multivariate analyses, time to BCR represented an independent predictor of CSM (P<0.001). Increasing time from surgery is associated with a reduction of the risk of subsequent BCR. Additionally, time to BCR represents a predictor of CSM in these patients. These results might help provide clinicians with better follow-up strategies and more aggressive treatments for early BCR. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urologic Oncology 02/2015; DOI:10.1016/j.urolonc.2014.11.018 · 3.36 Impact Factor
  • Francesco Montorsi, Giorgio Gandaglia
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    ABSTRACT: IntroductionAlthough heavily investigated over the last decades, Peyronie's disease (PD) pathogenesis remains unclear.AimWe sought to investigate the association between PD and autoimmune diseases (ADs) in men seeking medical help for sexual dysfunction in the real-life setting.Methods Complete sociodemographic and clinical data from a homogenous cohort of 1,140 consecutive Caucasian–European men were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index and ADs were stratified according to International Classification of Diseases, Ninth Revision classification.Main Outcome MeasuresDescriptive statistics and multivariate logistic regression models tested the association between ADs and PD.ResultsPD was diagnosed in 148 (13%) of the 1,140 men; of PD patients, 14 (9.5%) had a comorbid AD; conversely, the rate of ADs in non-PD patients was significantly lower (χ2 = 24.7; P < 0.01). Both patient age and AD comorbidity achieved multivariable independent predictor status for PD (odds ratio [OR]: 1.05; P < 0.01 and OR: 4.90; P < 0.01, respectively).Conclusions Our observational findings showed that ADs are highly comorbid with PD in a large cohort of same-race individuals seeking medical help for sexual dysfunction in the real-life setting. Ventimiglia E, Capogrosso P, Colicchia M, Boeri L, Serino A, La Croce G, Russo A, Capitanio U, Briganti A, Cantiello F, Mirone V, Damiano R, Montorsi F, and Salonia A. Peyronie's disease and autoimmunity—A real-life clinical study and comprehensive review. J Sex Med **;**:**–**.
    Journal of Sexual Medicine 02/2015; DOI:10.1111/jsm.12825 · 3.15 Impact Factor
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    ABSTRACT: The risk of unfavorable prostate cancer in active surveillance (AS) candidates is nonnegligible. However, what represents an adverse pathologic outcome in this setting is unknown. We aimed at assessing the optimal definition of misclassification and its effect on recurrence in AS candidates treated with radical prostatectomy (RP). Overall, 1,710 patients eligible for AS according to Prostate Cancer Research International: Active Surveillance criteria treated with RP between 2000 and 2013 at 3 centers were evaluated. Patients were stratified according to pathology results at RP: organ-confined disease and pathologic Gleason score ≤6 (group 1); organ-confined disease and Gleason score 3+4 (group 2); and non-organ-confined disease, Gleason score ≥4+3, and nodal invasion (group 3). Biochemical recurrence (BCR) was defined as 2 consecutive prostate-specific antigen (PSA)≥0.2ng/ml. Kaplan-Meier curves assessed time to BCR. Multivariable Cox regression analyses tested the association between pathologic features and BCR. Multivariable logistic regression analyses identified the predictors of adverse pathologic characteristics. Overall, 926 (54.2%), 653 (33.0%), and 220 (12.9%) patients were categorized in groups 1, 2, and 3, respectively. Median follow-up was 32.2 months. The 5-year BCR-free survival rate was 94.2%. Patients in group 3 had lower BCR-free survival rates compared with those in group 1 (79.1% vs. 97.0%, P<0.001). No differences were observed between patients included in group 1 vs. group 2 (97.0% vs. 94.7%, P = 0.1). These results were confirmed at multivariable analyses and after stratification according to margin status. Older age and PSA density≥10ng/ml/ml were associated with higher risk of unfavorable pathologic characteristics (i.e., inclusion in group 3; all P<0.001). Among patients eligible for AS treated with RP, only men with Gleason score≥4+3 or non-organ-confined disease at final pathology were at increased risk of BCR. These individuals represent the real misclassified AS patients, who can be predicted based on older age and higher PSA density. Copyright © 2015 Elsevier Inc. All rights reserved.
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    ABSTRACT: Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes. A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference. A systematic review of the literature was performed in agreement with the PRISMA statement. Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques. RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference. Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 01/2015; 67(3). DOI:10.1016/j.eururo.2014.12.009 · 12.48 Impact Factor
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    ABSTRACT: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed. To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC. Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted. The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-25% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC. Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-29% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 67-76%, 68-83%, and 61-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. Oncologic and functional data from RARC remain immature, and longer-term prospective studies are needed. Cumulative analyses demonstrated that lymph node yields and PSM rates were similar between RARC and ORC. Conclusive long-term survival outcomes for RARC were limited, although oncologic outcomes up to 5 yr were similar to those reported for ORC. Although open radical cystectomy (RC) is still regarded as the standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RCs are becoming more popular. Templates of lymph node dissection, lymph node yields, and positive surgical margin rates are acceptable with robot-assisted RC. Although definitive comparisons with open RC with respect to oncologic or functional outcomes are lacking, early results appear comparable. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 01/2015; DOI:10.1016/j.eururo.2014.12.008 · 12.48 Impact Factor
  • Asian Journal of Andrology 01/2015; DOI:10.4103/1008-682X.149180 · 2.53 Impact Factor
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    ABSTRACT: To develop two nomograms predicting disease-free survival (DFS) and cancer-specific survival (CSS) and to externally validate them in multiple series. Prospectively collected data from a single-centre series of 818 consecutive patients who underwent RC and PLND were used to build the nomogram. External validation was performed in 3,173 patients from 7 centres worldwide. Time to recurrence and to cancer-specific death were addressed with univariable and multivariable analyses. Nomograms were built to predict 2-, 5- and 8-year DFS and CSS probabilities. Predictive accuracy was quantified using the concordance index. Age, pathologic T stage, lymph-node density and extent of PLND were independent predictors of DFS and CSS (p < 0.05). Discrimination accuracies for DFS and CSS at 2, 5 and 8 years were 0.81, 0.8, 0.79 and 0.82, 0.81, 0.8, respectively, with a slight overestimation at calibration plots beyond 24 months. In the external series, predictive accuracies for DFS and CSS at 2, 5 and 8 years were 0.83, 0.82, 0.82 and 0.85, 0.85, 0.83 for European centres; 0.73, 0.72, 0.71 and 0.80, 0.74, 0.68 for African series; 0.76, 0.74, 0.71 and 0.79, 0.76, 0.73 for American series. These nomograms developed from a contemporary series are simple clinical tools and provide optimal oncologic outcome prediction in all external cohorts.
    World Journal of Urology 12/2014; 191(4). DOI:10.1007/s00345-014-1465-4 · 3.42 Impact Factor
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    ABSTRACT: The aim of our study was to reexamine the prevalence of baseline cardiovascular (CV) morbidity and the rates of CV mortality in a contemporary cohort of patients with prostate cancer (PCa) exposed to androgen deprivation therapy (ADT). Records of patients aged 65 years and older with metastatic PCa who received ADT were abstracted from the Surveillance, Epidemiology, and End Results-Medicare database between 1991 and 2009. The primary end points comprised 5-year CV mortality rates. Survival rates were stratified according to age and Charlson comorbidity index (CCI). Competing-risks Poisson regression methodologies were performed. Overall, 9596 patients with metastatic PCa treated with ADT were identified. At baseline, 3049 patients (31.8%) had preexisting CV disease. The 5-year CV mortality rates were 9.8% and 14.8% in the overall population and in patients with preexisting CV disease, respectively. The 5-year CV mortality rates increased with advanced age and higher CCI score. In multivariate competing-risks regression analyses, age, year of diagnosis, CV comorbidities, CCI, and marital status represented independent predictors of CV mortality, after accounting for the risk of dying from other causes (all P ≤ .04). Of those, preexisting CV disease contributed to the highest risk of CV mortality. Our study is limited by its retrospective nature. CV mortality represents a common event in patients with metastatic PCa treated with ADT. Preexisting CV disease represented the strongest risk factor. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinical Genitourinary Cancer 12/2014; DOI:10.1016/j.clgc.2014.12.003 · 1.69 Impact Factor
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    ABSTRACT: The process of care for patients with prostate cancer is subject to different degrees of uncertainty. Patients and clinicians could, therefore, greatly benefit from improved prognostic instruments. One emerging tool is the cell cycle progression (CCP) score. This systematic review assesses evidence on the value of the CCP instrument in prostate cancer treatment by reviewing current publications and integrating the results via a meta-analysis. We performed a review of Medline and Embase in April 2014, according to Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). Unpublished studies were retrieved from the 2013-2014 proceedings of major conferences in the field. Sixteen publications were selected for inclusion. The results show that use of the CCP score is better than existing assessments at elucidating the aggressive potential of prostate cancer in an individual. The pooled hazard ratio for biochemical recurrence per 1-unit increase in the CCP score was 1.88 in a univariate model and 1.63 in a multivariate model. Four studies showed that CCP testing can impact the decisions of physicians regarding treatment, and potentially lead to a decrease in surgical interventions for low-risk patients. This review offers a comprehensive overview of existing evidence on CCP testing, and provides clinicians, patients, and policy makers with a strong summary measure of its prognostic validity and clinical utility. It will be important to develop economic studies to measure the impact of such technology on health care systems. In this paper, we review current evidence related to the cell cycle progression (CCP) score for patients with prostate cancer. We found good evidence suggesting that use of the CCP score improves prognosis, and can be a valuable tool for clinicians in treating patients. The economic benefits are yet to be studied. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 12/2014; DOI:10.1016/j.eururo.2014.11.038 · 12.48 Impact Factor
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    ABSTRACT: Lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) are associated with erectile dysfunction. Alpha-1-adrenoceptor antagonists are effective drugs for treating symptomatic BPH. Clinical data show improvements in LUTS by phosphodiesterase 5 inhibitors. This study aimed to evaluate effects of silodosin, a highly selective α1A-adrenoceptor antagonist, alone or in combination with the phosphodiesterase 5 inhibitor tadalafil on contractions of isolated human and rat prostates. In organbath studies, effects of increasing concentrations of silodosin (1 nM–1 µM) and tadalafil (100 nM–100 µM) on contractions by electrical field stimulation or phenylephrine of human and rat prostate strip preparations were investigated. The combination silodosin and tadalafil reduced electrically-induced contractions of human prostate preparations better than single drugs alone. At any frequencies (1–32 Hz), inhibitory effects of combined therapy (P-values vs single drug) in human tissue were 26–42% (1 nM silodosin+100 nM tadalafil; P<0.05), 40–58% (10 nM silodosin+1 µM tadalafil; P<0.001–0.05), 56–67% (100 nM silodosin+10 µM tadalafil; P<0.01–0.05), and 33–55% (1 µM silodosin+100 µM tadalafil P<0.01–0.05). Similar findings were obtained in rat prostate preparations. In human and rat prostate tissue, the drug combination exerted similar inhibitory effect on phenylephrine contractions as silodosin alone. Silodosin plus tadalafil had greater potency than each drug alone to inhibit prostate contractions to electrical field stimulation but not to phenylephrine. This study supports the clinical application of a combination of an α1A-adrenoceptor antagonist and a phosphodiesterase 5 inhibitor for symptomatic BPH and suggests that the drug combination requires endogenous nerve-activity for optimal effect.
    European Journal of Pharmacology 12/2014; 744. DOI:10.1016/j.ejphar.2014.09.030 · 2.68 Impact Factor
  • Giorgio Gandaglia, Andrea Salonia, Francesco Montorsi
    Annals of Pharmacotherapy 12/2014; 48(12):1665-6. DOI:10.1177/1060028014553833 · 2.92 Impact Factor

Publication Stats

15k Citations
4,764.04 Total Impact Points


  • 2001–2015
    • Università Vita-Salute San Raffaele
      Milano, Lombardy, Italy
  • 2014
    • Thomas Jefferson University
      Filadelfia, Pennsylvania, United States
    • University of Rhode Island
      Кингстон, Rhode Island, United States
  • 2013–2014
    • Universita' degli Studi "Magna Græcia" di Catanzaro
      Catanzaro, Calabria, Italy
    • Lund University
      • Department of Clinical Pharmacology
      Lund, Skåne, Sweden
    • Middlesex University, UK
      Londinium, England, United Kingdom
    • The University of Sheffield
      • Academic Urology Unit
      Sheffield, England, United Kingdom
  • 1994–2014
    • San Raffaele Scientific Institute
      Milano, Lombardy, Italy
    • Ospedale di San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico
      • Dipartimento di Urologia
      Milano, Lombardy, Italy
  • 2012–2013
    • Weill Cornell Medical College
      • Department of Urology
      New York City, New York, United States
    • Sheffield Teaching Hospitals NHS Foundation Trust
      Sheffield, England, United Kingdom
    • Sant'Anna Hospital
      Torino, Piedmont, Italy
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
  • 2008–2013
    • Università Politecnica delle Marche
      • Institute of Pathological Anatomy
      Ancona, The Marches, Italy
    • New York Presbyterian Hospital
      • Department of Urology
      New York City, New York, United States
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, Texas, United States
    • Indiana University-Purdue University Indianapolis
      • Department of Pathology and Laboratory Medicine
      Indianapolis, Indiana, United States
    • Johns Hopkins Medicine
      • Department of Urology
      Baltimore, Maryland, United States
  • 2011–2012
    • Henry Ford Health System
      Detroit, Michigan, United States
    • Ludwig-Maximilian-University of Munich
      • Department of Urology
      München, Bavaria, Germany
    • Queen's University
      Kingston, Ontario, Canada
    • Universitair Ziekenhuis Ghent
      • Department of Radiotherapy
      Gent, VLG, Belgium
    • Kitasato University
      • Department of Urology
      Edo, Tōkyō, Japan
  • 2010–2012
    • Università Telematica San Raffaele
      Milano, Lombardy, Italy
    • University of Michigan
      • Department of Urology
      Ann Arbor, Michigan, United States
    • Research Triangle Park Laboratories, Inc.
      Raleigh, North Carolina, United States
    • Washington University in St. Louis
      • Division of Urologic Surgery
      San Luis, Missouri, United States
  • 2009–2012
    • University of Florence
      • Dipartimento di Scienze Biomediche, Sperimentali e Cliniche
      Florens, Tuscany, Italy
    • University of Padova
      Padua, Veneto, Italy
    • Université de Rennes 2
      Roazhon, Brittany, France
    • University of Toronto
      • Division of Urology
      Toronto, Ontario, Canada
    • University of Texas MD Anderson Cancer Center
      • Department of Urology
      Houston, Texas, United States
  • 2006–2012
    • University of Hamburg
      • Department of Urology
      Hamburg, Hamburg, Germany
    • Università degli Studi di Milano-Bicocca
      Milano, Lombardy, Italy
    • University of Cordoba (Spain)
      Cordoue, Andalusia, Spain
    • Robert Wood Johnson University Hospital
      New Brunswick, New Jersey, United States
  • 2008–2011
    • Medical University of Vienna
      • Department of Urology
      Wien, Vienna, Austria
  • 2007–2011
    • Université de Montréal
      • Department of Surgery
      Montréal, Quebec, Canada
    • University Medical Center Hamburg - Eppendorf
      • Department of Urology
      Hamburg, Hamburg, Germany
  • 2006–2011
    • Cornell University
      Итак, New York, United States
  • 1991–2011
    • University of Milan
      • • Department of Internal Medicine
      • • Department of Biology and Genetics for Medical Sciences
      Milano, Lombardy, Italy
  • 2008–2010
    • Virginia Mason Medical Center
      Seattle, Washington, United States
  • 2004–2009
    • Centro Cardiologico Monzino
      Milano, Lombardy, Italy
    • Marmara University
      İstanbul, Istanbul, Turkey
  • 2007–2008
    • University of Texas at Dallas
      Richardson, Texas, United States