Francesco Montorsi

Elsevier B.V., Philadelphia, Pennsylvania, United States

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Publications (778)4467.72 Total impact

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    ABSTRACT: A non-negligible proportion of prostate cancer (PCa) patients undergoing radical prostatectomy (RP) harbors aggressive disease. These individuals are at higher risk of experiencing recurrence after surgery. Results from prospective, randomized trials support the efficacy of adjuvant radiotherapy (aRT) on cancer control in selected patients with adverse disease features at RP. However, only one of these randomized trials found a significant benefit of aRT on survival. Although such a level of evidence is not currently available for salvage RT, retrospective studies demonstrated that this approach leads to excellent outcomes if administered at the earliest sign of PSA recurrence. Prognostic models might help clinicians in identifying patients who would benefit the most from adjuvant and/or salvage RT. This individualized approach would allow sparing the risk of short- and long-term toxicity in a substantial proportion of patients. Nonetheless, results from randomized trials are still awaited to compare the efficacy of (early) salvage and aRT.
    Current Oncology Reports 12/2015; 17(12). DOI:10.1007/s11912-015-0478-5 · 2.89 Impact Factor
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    ABSTRACT: INTRODUCTION - Published series of transurethral resection of bladder tumour (TURBT) show high rates (18-52%) of procedures resulting in no detrusor muscle (DM) layer being present in the pathological specimen. This is of clinical importance since DM inclusion in surgical specimens is invariably associated with better oncological results and is considered a surrogate marker of surgical quality. We sought to assess rates and predictors of DM absence (DM-) at final pathology report in a series of consecutive TURBTs performed at a single tertiary-referral academic centre. MATERIALS AND METHODS - We retrospectively collected data from 437 TURBT performed over one year. Complete endoscopic peri-operative data were available for all patients; surgeons were categorized as either staff physicians or residents. Likewise, pathological data including tumour grade and stage, and DM status (present vs. absent) were recorded. Only procedures with bladder cancer (BCa) at final pathology were included in the analyses. Logistic regression analyses tested potential predictors of DM-. Kaplan-Meier analyses were applied to assess the impact of DM- on postoperative tumour recurrence. RESULTS - Overall, BCa was found in 302 (69.1%) specimens at final pathology; DM- occurred in 29 (9.6%) cases. A comparable rate of DM- was observed for procedures conducted by staff physicians and residents [9% (23/232) vs. 12.8% (6/41), respectively; p=0.6]. Flat morphology emerged as the most informative predictor of DM- after adjusting for tumour size, number of lesions, tumour stage and grade, surgeon experience and resection modality. At Kaplan-Meier analysis DM- was not associated with worse outcomes in terms of postoperative recurrence-free survival. CONCLUSIONS - Current findings showed a rate of roughly 10% of DM- at TURBT. Flat morphology emerged as the most significant predictor of DM-, whereas surgeon experience was not associated with DM-.
    Journal of Endourology 11/2015; DOI:10.1089/end.2015.0591 · 1.71 Impact Factor
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    ABSTRACT: The transient receptor potential (TRP) melastin 8 ion channel (TRPM8) is implicated in bladder sensing but limited information on TRPM8 antagonists in bladder overactivity (BO) is available. This study characterizes a new TRPM8-selective antagonist (DFL23448) and evaluates it in cold-induced behavioral tests and on bladder function and experimental BO in vivo in rats. DFL23448 displayed IC50 values of 10 and 21nM in hTRPM8 HEK-293 cells activated by Cooling Agent 10 or cold, but had limited activity (IC50 > 10μM) at TRPV1, TRPA1, TRPV4, or at various G-protein-coupled receptors. In rats, DFL23448 had a half-life of 37 minutes (intravenous; i.v.) or 4.9 hours (oral). DLF23448 (10mg/kg, i.v) reduced icilin-induced wet-dog shakes in rats. Intravesical (i.ves.) DFL23448 (10mg/L) but not vehicle increased micturition intervals (MI), micturition volumes (MV) and bladder capacity (BC). During BO by i.ves. PGE2, vehicle controls exhibited reductions of MI, MV and BC by 37-39%, whereas the same parameters only decreased by 12-15% (p<0.05-0.01 vs. vehicle) in DFL23448-treated rats. In vehicle-treated rats but not in DFL23448-treated rats, i.ves. PGE2 increased bladder pressures. Intravenous DFL23448 at 10mg/kg, but not 1mg/kg DFL23448 or vehicle, increased MI, MV, and BC. During BO by i.ves. PGE2, MI, MV, and BC decreased in vehicle- and in DFL23448 1mg/kg-treated rats, but not in DFL23448 10mg/kg-treated rats. Bladder pressures increased less in rats treated with DFL23448 10mg/kg than in vehicle- or DFL23448 1mg/kg- treated rats. DFL23448 (10mg/kg, i.v.), but not vehicle, prevented cold-stress BO. Our results support a role for bladder TRPM8-mediated signals in experimental BO.
    Journal of Pharmacology and Experimental Therapeutics 11/2015; DOI:10.1124/jpet.115.228684 · 3.97 Impact Factor
  • Giorgio Gandaglia · Alberto Briganti · Andrea Salonia · Francesco Montorsi ·

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    ABSTRACT: Patient summary: Orgasmic modifications such as climacturia and painful orgasm (PO) are frequently reported after radical prostatectomy. Robotic surgery was associated with a lower rate of postoperative PO and with greater and faster recovery from climacturia.
    European Urology 11/2015; DOI:10.1016/j.eururo.2015.10.046 · 13.94 Impact Factor
  • Luca Villa · Andrea Salonia · Francesco Montorsi ·

    The Lancet 11/2015; 386(10006):1822-1823. DOI:10.1016/S0140-6736(15)00763-1 · 45.22 Impact Factor
  • Guido Barbagli · Francesco Montorsi · Salvatore Sansalone · Massimo Lazzeri ·

    European Urology Supplements 11/2015; DOI:10.1016/j.eursup.2015.10.003 · 3.37 Impact Factor
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    ABSTRACT: Background: Early salvage radiation therapy (eSRT) represents a treatment option for patients who experience a prostate-specific antigen (PSA) rise after radical prostatectomy (RP); however, the optimal PSA level for eSRT administration is still unclear. Objective: To test the impact of PSA level on cancer control after eSRT according to pathologic tumour characteristics. Design, setting, and participants: The study included 716 node-negative patients with undetectable postoperative PSA who experienced a PSA rise after RP. All patients received eSRT, defined as local radiation to the prostate and seminal vesicle bed, delivered at PSA ≤0.5 ng/ml. Biochemical recurrence (BCR) after eSRT was defined as two consecutive PSA values ≥0.2 ng/ml. Outcome measurements and statistical analysis: Multivariable Cox regression analysis tested the association between pre-eSRT PSA level and BCR after eSRT. Covariates consisted of pathologic stage (pT2 vs pT3a vs pT3b or higher), pathologic Gleason score (≤6, 7, or ≥8), and surgical margin status (negative vs positive). We tested an interaction with PSA level and baseline pathologic risk for the hypothesis that BCR-free survival differed by pre-eSRT PSA level. Three pathologic risk factors were identified: pathologic stage pT3b or higher, pathologic Gleason score ≥8, and negative surgical margins. Results and limitations: Median follow-up among patients who did not experience BCR after eSRT was 57 mo (interquartile range: 27-105). At 5 yr after eSRT, BCR-free survival rate was 82% (95% confidence interval [CI], 78-85). At multivariable Cox regression analysis, pre-eSRT PSA level was significantly associated with BCR after eSRT (hazard ratio: 4.89; 95% CI, 1.40-22.9; p<0.0001). When patients were stratified according to the number of risk factors at final pathology, patients with at least two pathologic risk factors showed an increased risk of 5-yr BCR as high as 10% per 0.1 ng/ml of PSA level compared with only 1.5% in patients with one or no pathologic risk factors. Conclusions: In this retrospective study, cancer control after eSRT greatly depended on pretreatment PSA. The absolute PSA level had a different prognostic value depending on the pathologic characteristics of the tumour. In patients with more adverse pathologic features, eSRT conferred better cancer control when administered at the very first sign of PSA rise. Conversely, the benefit of eSRT was less evident in men with favourable disease at RP. Patient summary: In this retrospective study, cancer control after early salvage radiation therapy (eSRT) was influenced by pretreatment prostate-specific antigen (PSA) level. This effect was highest in men with at least two of the following pathologic features: pT3b/pT4 disease, pathologic Gleason score ≥8, and negative surgical margins. In these patients, eSRT conferred better cancer control when administered at the very first sign of PSA rise.
    European Urology 10/2015; DOI:10.1016/j.eururo.2015.10.009 · 13.94 Impact Factor
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    ABSTRACT: Background: Despite several studies, the adequate management of positive distal ureter margins at the time of radical cystectomy (RC) remains controversial. Particularly, it is not clear whether the achievement of negative distal ureter margins at the intraoperative frozen sections (IFS) affects postoperative cancer-specific mortality (CSM). Methods: In all, 1,447 consecutive patients treated with RC at a single center between January 1987 and August 2014 were considered. Multivariable (MVA) logistic regression analyses were used to determine predictors of positive IFS. MVA Cox regression analyses were used to test the effect on CSM of intraoperative conversion to negative margins. Results: At IFS, 368 patients (25%) experienced at least 1 positive margin. Of these, a negative conversion of the margin at IFS occurred in 178 (48%) whereas 190 (52%) had a positive final ureteral margin. The mean follow-up was 95 months (median = 102). At MVA, history of carcinoma in situ (odds ratio = 6.40, P<0.001) was predictors of positive margin at IFS. At MVA, ureteral margins that were not converted to negative (hazard ratio = 1.92, P = 0.01) were associated with CSM but only in patients with negative soft tissue margin and without node metastases. Conclusions: Achieving negative IFS margins may be associated with survival benefit in patients without residual bladder cancer after RC. Patients who recorded a history of carcinoma in situ before RC are at higher risk to incur positive ureteral margin at IFS and should be investigated during RC.
    Urologic Oncology 10/2015; DOI:10.1016/j.urolonc.2015.09.001 · 2.77 Impact Factor
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    ABSTRACT: PURPOSE To describe our initial experience with confocal laser endomiscroscopy (CLE) for the evaluation and treatment of patients with upper urinary tract transitional cell carcinoma (UUT-TCC). MATERIALS AND METHODS Preliminary data were analyzed from 11 patients with suspicion of UUT-TCC scheduled for flexible ureteroscopy (f-URS) and consensual holmium-YAG laser tumour ablation. CLE was performed prior to endoscopic biopsy and laser photoablation of the suspected lesion using a 3 Fr-diameter flexible probe UroFlexTM B (Cellvizio® system, Mauna Kea Technologies, Paris France), which allows to obtain microscopic resolution imaging (3.5 μm), with a field of view of 325 μm and a depth of tissue imaging of 40-70 um. Video sequences were analyzed off-line and thereafter compared with histopathological findings. RESULTS CLE technique was feasible and showed good quality imaging in all patients. Overall, Cellvizio® system provided reliable images of healthy urothelium when the probe was pointed towards normal tissue, showing umbrella cells on the surface and vessels in the lamina propria. Moreover, CLE displayed the characteristics features of high-density cellular aggregates and fibrovascular stalks in four patients with pathologically-confirmed low-grade UUT-TCC. In the patient with pathologically-confirmed high-grade UUT-TCC, more distorted microarchitecture and tortuous vessels were clearly recognized with CLE. CONCLUSIONS These preliminary data showed the feasibility of CLE technique when applied to the diagnosis of UUT-TCC. Further clinical studies are required to confirm CLE accuracy in distinguishing healthy urothelial tissue from malignant lesions, thus helping clinicians in targeting ureteroscopic biopsy and improving the conservative management of UUT-TCC patients.
    Journal of endourology / Endourological Society 10/2015; DOI:10.1089/end.2015.0644 · 1.71 Impact Factor
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    ABSTRACT: Background: The learning process for one-stage anterior urethroplasty has never been addressed before. Objective: To evaluate the surgical learning curve for one-stage anterior urethroplasty. Design, setting, and participants: Data from 641 consecutive patients treated with one-stage urethroplasty for urethral stricture were collected prospectively. All the procedures were performed by a single surgeon between 1994 and 2014. Intervention: One-stage anterior urethroplasty using substitute tissues. Outcome measurements and statistical analysis: The outcome was treatment failure, defined as any postoperative instrumentation needed including dilation. Surgeon experience was coded as the total number of one-stage urethroplasties performed by the surgeon before the operation. Multivariable Cox regression analysis was used to evaluate the association between surgeon experience and treatment failure. Covariates consisted of age, body mass index, smoking history (no, yes, ex-smoker), diabetes history (no or yes), previous surgical treatments (no or yes), stricture length, and stricture site (bulbar, penile, panurethral). Results and limitations: Overall, 546 patients (85%) were treated with one-stage oral mucosa urethroplasty; penile skin or skin flap was used in 95 patients (15%). Median follow-up among patients who did not experience surgical failure was 69 mo (interquartile range: 35-118). The failure-free survival at 5 yr was 77% (95% confidence interval [CI], 74-81). At multivariable analysis, surgeon experience was significantly associated with a lower probability of treatment failure (hazard ratio per 20 procedures: 0.98; 95% CI, 0.97-0.99; p=0.008). The surgical learning curve appeared lengthened, without reaching a plateau even after 600 procedures. Conclusions: In this single-surgeon analysis, surgical experience has a significant impact on the probability of treatment success for one-stage urethroplasty. Better results are achieved only after a long learning curve that may not be justifiable for late-career and low-volume surgeons. Patient summary: The probability of surgical success after one-stage urethroplasty is importantly influenced by surgeon experience. Better results are achieved only after a very long learning process.
    European Urology 10/2015; DOI:10.1016/j.eururo.2015.09.023 · 13.94 Impact Factor
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    ABSTRACT: Objectives: Recent studies showed that robot-assisted radical prostatectomy (RARP) represents an oncologically safe procedure in patients with prostate cancer (PCa), where the rate of positive surgical margins (PSMs) might be lower in patients treated with RARP as compared with that of those undergoing the open approach (open RP [ORP]). The aim of this study is to analyze the rate of PSMs according to preoperative risk groups in a large cohort of patients treated with RARP and ORP in a single institution with standardized surgical technique and pathological examination. Materials and methods: We evaluated 6,194 consecutive patients with PCa undergoing either ORP (71.1%) or RARP (28.9%) between 1992 and 2014. Logistic regression analyses were used to test the association between type of surgery and PSMs in each preoperative risk group (low vs. intermediate vs. high) after adjusting for confounders. Results: Overall, 21.6% patients had PSMs. RARP was associated with a lower rate of PSMs in low-risk (11.5 vs. 15.4%, P = 0.01), intermediate-risk (18.9 vs. 23.5%, P = 0.008), and high-risk patients (19.7 vs. 30.1%, P<0.001). In multivariable analyses, after stratification according to risk group categories, no difference in PSMs between RARP and ORP was observed for low-risk (odds ratio [OR] = 0.87, P = 0.46) and intermediate-risk patients (OR = 0.84, P = 0.19). Conversely, RARP was associated with lower odds of PSMs in high-risk patients (OR = 0.69, P = 0.04). Similar results were observed when our analyses were repeated after accounting for pathological characteristics, in patients treated between 2006 and 2014 and in a cohort of men treated by high-volume surgeons (all P≤ 0.03). Conclusions: The introduction of RARP at our institution led to a significant reduction in the risk of PSMs in patients with PCa with high-risk disease.
    Urologic Oncology 10/2015; DOI:10.1016/j.urolonc.2015.08.019 · 2.77 Impact Factor
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    European Urology 10/2015; 68(4):736-7. DOI:10.1016/j.eururo.2015.06.031 · 13.94 Impact Factor
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    European Urology 10/2015; DOI:10.1016/j.eururo.2015.09.022 · 12.48 Impact Factor

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    ABSTRACT: Objective: The impact of positive surgical margin (SM) on cancer control outcomes in prostate cancer (PCa) patients is a subject of continuous debate. We test the hypothesis that the impact of SM on clinical recurrence (CR) rate may vary based on the other clinical/pathological characteristics of the tumor. Methods: We focused on 5,290 patients treated with robotic-assisted radical prostatectomy and pelvic node dissection, between 2002 and 2013, at three tertiary care centers. Regression tree analysis stratified patients into risk-groups based on their tumor characteristics and the corresponding CR rate. Kaplan-Meier log-rank and multivariable Cox regression models tested the relationship between SM status and CR rate in each tree-generated risk group. Results: Mean (median) follow-up time was 47.7 (39.0) months. Regression tree analysis that considered all available covariates, except SM status, divided patients based on their CR risk into the following risk groups: 1) high-risk (any pT3b/pT4 disease); 2) intermediate-risk (≤pT3a disease and pGS 8-10); 3) low risk (≤pT3a, pGS≤7, and PSA >9 ng/ml); 4) very low-risk (≤pT3a, pGS≤7, and PSA ≤9 ng/ml). Positive SM had a significant detrimental impact on CR risk only in 2 groups: intermediate-risk (p<0.001) and high-risk (p=0.01). These observations were confirmed at the multivariable analyses. Conclusions Our findings show that positive SM had a detrimental impact on CR only in a minority of patients (15%), specifically in those with very advanced pathological stage, and/or pathologically poorly differentiated tumor. For all the remaining patients (85%), positive SM by itself did not increase the risk of CR.
    Journal of endourology / Endourological Society 09/2015; DOI:10.1089/end.2015.0465 · 1.71 Impact Factor
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    ABSTRACT: Background and purpose: The aim of our study was to assess the oncologic outcomes of robot-assisted radical cystectomy (RARC) in patients with bladder cancer (BCa) treated in a high-volume robotic center. Materials and methods: We retrospectively collected data of 155 consecutive patients who received RARC for urothelial BCa from January 2004 to May 2014. Kaplan-Meier analyses were used to assess time to recurrence, cancer-specific mortality (CSM) rate, and overall mortality rate. Uni- and multivariable Cox regression models addressed the predictors of recurrence and CSM. Results: Median follow-up for survivors was 42 months. Overall, 43%, 34%, 55%, and 18% of the patients had pT ≤1, pT2, pT3/4, and pN1-3 disease, respectively. Overall, 76% of the patients had high-grade disease at final pathology. The positive surgical margin rate was 9%. The 5-year recurrence-free, CSM-free, and overall survival estimates were 53.7%, 73.5%, and 65.2%, respectively. Among patients who experienced recurrence, 12.0%, 4.0%, and 84.0% had local, peritoneal, and distant recurrence, respectively. In multivariable Cox regression analyses, pathologic stage and nodal status represented independent predictors of recurrence and CSM (all p ≤ 0.04). Conclusions: In a high-volume robotic center, RARC provides acceptable oncologic outcomes in patients with urothelial BCa. Tumor stage and nodal status represent independent predictors of recurrence and CSM in this setting.
    Journal of endourology / Endourological Society 09/2015; DOI:10.1089/end.2015.0482 · 1.71 Impact Factor
  • Giorgio Gandaglia · Francesco Montorsi · Pierre I Karakiewicz · Maxine Sun ·
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    ABSTRACT: Since its introduction in the year 2000, robot-assisted radical prostatectomy (RARP) rapidly diffused, and nowadays roughly 70% of all the radical prostatectomies in the USA are performed using this approach. Interestingly, the broad dissemination of RARP occurred in the absence of comprehensive data coming from prospective randomized trials supporting the superiority of RARP versus the conventional open RP (ORP). Only observations originating from retrospective institutional or large population-based cohorts exist with respect to the comparative effectiveness of the two surgical techniques. What we have learned is that, given an adequate learning curve, RARP leads to better perioperative and long-term functional outcomes compared with ORP, without any compromise to cancer control outcomes. That being said, the substantially higher costs associated with the use of robotics cannot be ignored.
    Future Oncology 09/2015; 11(20). DOI:10.2217/fon.15.169 · 2.48 Impact Factor
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    Journal of the National Cancer Institute 09/2015; 107(9). DOI:10.1093/jnci/djv200 · 12.58 Impact Factor
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    ABSTRACT: Objectives To examine the potential difference in cancer specific mortality that could distinguish between local tumour ablation (LTA) and observation (OBS) for patients with kidney cancer using competing risks regression.Patients and methodsThe study focused on 1860 patients with cT1a kidney cancer treated with either LTA or OBS between 2000 and 2009 in the Surveillance Epidemiology and End Results-Medicare database. Propensity-score matching was used. Cancer specific mortality (CSM) represented the study outcome. Multivariable competing risks regression analyses adjusting for other-cause mortality as well as patient (including comorbidities) and tumour characteristics were fitted.ResultsOverall, fewer patients had LTA vs. OBS (30% vs. 70%; n=553 vs. n=1307). Compared to OBS patients, LTA patients were younger (median age 77 vs. 78 years; p<0.001), more frequently Caucasian (84 vs. 78%; p=0.005), more frequently married (59 vs. 52%; p=0.02) and more frequently of high socio-economic status (54 vs. 45%; p=0.001). After propensity-score matching, 553 LTA and 553 OBS patients remained for subsequent analyses. The mean standardized differences of patient characteristics between the two groups were <10%, indicating a high degree of similarity. After LTA or OBS, the 5-year CSM estimates from Poisson regression derived smoothed plots were 3.5 and 9.1%, respectively. In multivariable competing risks regression analyses, LTA use resulted in a protective effect on CSM (Hazard ratio 0.47; 95% 95% Confidence interval 0.25-0.89; p=0.02).Conclusions After adjustment for comorbidity and tumour characteristics in elderly patients with kidney cancer, LTA resulted associated with a clinically and statistically significant protective effect on CSM, compared to OBS. This advantage of LTA deserves consideration at informed consentThis article is protected by copyright. All rights reserved.
    BJU International 09/2015; DOI:10.1111/bju.13326 · 3.53 Impact Factor

Publication Stats

12k Citations
4,467.72 Total Impact Points


  • 2015
    • Elsevier B.V.
      Philadelphia, Pennsylvania, United States
  • 2001-2015
    • Università Vita-Salute San Raffaele
      • Faculty of Psychology
      Milano, Lombardy, Italy
  • 1994-2015
    • 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
    • Università Telematica San Raffaele
      Milano, Lombardy, Italy
    • Cornell University
      Итак, New York, United States
  • 2010
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, TX, United States
    • Research Triangle Park Laboratories, Inc.
      Raleigh, North Carolina, United States
  • 2008
    • Keio University
      Edo, Tōkyō, Japan
    • Johns Hopkins Medicine
      • Department of Urology
      Baltimore, Maryland, United States
  • 1989-1998
    • University of Milan
      • Department of Biology and Genetics for Medical Sciences
      Milano, Lombardy, Italy