Francesco Montorsi

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

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Publications (743)3779.58 Total impact

  • CancerSpectrum Knowledge Environment 09/2015; 107(9). DOI:10.1093/jnci/djv200 · 15.16 Impact Factor
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    ABSTRACT: Abstract Clinical lymphadenopathy (cN+) from prostate cancer (PCa) identified on imaging remains a contraindication to radical prostatectomy (RP) according to guidelines. We tested the hypothesis that there would be no difference in survival between patients with and without cN+ on preoperative imaging who underwent RP and pelvic lymph node dissection with detection of pelvic lymph node metastasis (LNM). A total of 302 patients with LNM were retrospectively reviewed (1988-2003) and stratified according to cN status on the basis of preoperative imaging. Univariable and multivariable Cox regression analyses were performed to evaluate cN+ as a predictor of survival. Of the 302 patients, 50 (17%) had cN+; the 252 (83%) patients with negative preoperative imaging comprised the cN0 group. During median follow-up of 17.4 yr, 161 deaths were recorded, 70 of which were from PCa. Among the entire LNM cohort, the number of positive lymph nodes (hazard ratio [HR] 1.10; p=0.02) and pathologic Gleason score 8-10 versus ≤6 (HR 2.37; p=0.04) were significant predictors of cancer-specific mortality (CSM). cN+ was not a significant predictor of CSM (p=0.6). Selected patients with cN+ have similar clinical outcomes to those with normal preoperative imaging in the setting of LNM. PATIENT SUMMARY: Clinical lymph node metastases are not a factor in determining survival after radical prostatectomy and pelvic lymph node dissection in patients with prostate cancer. Thus, the presence of clinical lymph node metastases should not be considered as an absolute contraindication to treatment with curative intent. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 08/2015; DOI:10.1016/j.eururo.2015.07.047 · 12.48 Impact Factor
  • Umberto Capitanio · Francesco Montorsi
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    ABSTRACT: The diagnosis and management of renal cell carcinoma have changed remarkably rapidly. Although the incidence of renal cell carcinoma has been increasing, survival has improved substantially. As incidental diagnosis of small indolent cancers has become more frequent, active surveillance, robot-assisted nephron-sparing surgical techniques, and minimally invasive procedures, such as thermal ablation, have gained popularity. Despite progression in cancer control and survival, locally advanced disease and distant metastases are still diagnosed in a notable proportion of patients. An integrated management strategy that includes surgical debulking and systemic treatment with well established targeted biological drugs has improved the care of patients. Nevertheless, uncertainties, controversies, and research questions remain. Further advances are expected from translational and clinical studies. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet 08/2015; DOI:10.1016/S0140-6736(15)00046-X · 45.22 Impact Factor
  • Giorgio Gandaglia · Nicola Fossati · Francesco Montorsi · Alberto Briganti
    Journal of Clinical Oncology 07/2015; DOI:10.1200/JCO.2015.61.0964 · 18.43 Impact Factor
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    European Urology 07/2015; DOI:10.1016/j.eururo.2015.07.011 · 12.48 Impact Factor
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    ABSTRACT: Despite the increasing number of studies confirming the importance of neoadjuvant chemotherapy (NC) in patients before radical cystectomy (RC) for bladder cancer (BCa), NC remains underused. The aim of our study was to develop a nomogram predicting the cancer-specific mortality (CSM) of patients who underwent RC for transitional BCa, evaluating the available clinical information and the NC. We identified 423 patients who underwent RC and pelvic lymph node dissection, treated or not with NC, in two European high-volume centers between 2007 and 2013. Chi-square and Student's t tests were used to evaluate differences between groups. Kaplan-Meier curves were used to assess time to cancer-specific (CSS) and overall survival (OS). Uni- (UVA) and multivariable (MVA) Cox regression analyses were developed to address predictors of CSS and OS. A nomogram based on the Cox regression coefficient was developed to show the impact of NC on CSM. Mean follow-up was 20.3 months. Our population had mainly pT2 disease (77.1 %), and 19.4 % had preoperative cisplatinum-based NC. NC showed better CSS at UVA (p = 0.014) and MVA (odds ratio: 0.44; p = 0.043). Overall, the 3-year OS and the CSS rate were 69.3 and 79 %, respectively. The nomogram developed to predict the 36-month CSM showed predictive accuracy of 67 %. We developed the first nomogram predicting the 36-month CSM rate in patients with high-risk BCa according to the clinical data. Moreover, we demonstrate that preoperative cisplatinum-based chemotherapy is associated with better CSS.
    World Journal of Urology 07/2015; DOI:10.1007/s00345-015-1640-2 · 3.42 Impact Factor
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    ABSTRACT: Current guidelines recommend local tumour ablation (LTA) over partial nephrectomy (PN) in nonsurgical candidates; however, objective definitions of these candidates are lacking. To identify specific patients who would benefit from LTA more than PN. A population-based assessment was performed of 2476 patients in the Surveillance Epidemiology and End Results-Medicare database who had cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009. The outcome of the study was the relevant perioperative complications rate. A multivariable logistic regression model was fitted to predict the risk of complications after PN. Model-derived coefficients were used to calculate the risk of complication in case of PN among patients treated with LTA. Locally weighted scatterplot smoothing method was used to plot the observed complication rate against the predicted risk of complication in case of PN. At multivariable logistic regression, age (odds ratio [OR]: 1.04; p<0.001), Charlson comorbidity index (OR: 1.14; p<0.001), acute kidney injury (OR: 1.91; p=0.04), or chronic kidney disease (OR: 2.16; p=0.002), tumour size (OR: 1.02; p=0.01), and minimally invasive approach (OR: 0.77; p<0.03) emerged as significant predictors of complications. When LTA was chosen over PN, the reduction in the risk of complications was greatest in high-risk patients, intermediate in intermediate-risk patients, and least in low-risk patients. When postoperative complications are evaluated, the benefit of choosing LTA is not the same in all patients diagnosed with T1a kidney cancer. Specifically, patients at high risk of complications in case of PN may benefit the most from LTA and represent ideal LTA candidates. Elderly patients at high risk of complications in case of surgical treatment with partial nephrectomy for kidney cancer should be instructed that local tumour ablation might decrease their perioperative morbidity. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 07/2015; DOI:10.1016/j.eururo.2015.07.003 · 12.48 Impact Factor
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    ABSTRACT: To determine if an inhibition of the endocannabinoid-degrading enzyme fatty acid amide hydrolase (FAAH) can counteract the changes in urodynamic parameters and bladder afferent activities induced by intravesical prostaglandin E2 (PGE2 )-instillation, we studied effects of URB937, a peripherally-restricted FAAH inhibitor, on single-unit afferent activity (SAA) during PGE2 -induced bladder overactivity in rats. Female Sprague-Dawley rats were used. In SAA measurements during urethane anesthesia, SAAs of Aδ- and C-fibers were identified by electrical stimulation of the pelvic nerve and by bladder distention. Cystometry in conscious animals and SAA measurements were performed during intravesical instillation of PGE2 (50 or 100 μM) after intravenous administration of URB937 (0.1 and 1 mg/kg) or vehicle. In separate experiments, comparative expressions of FAAH and cannabinoid receptors, CB1 and CB2, in microsurgically-removed L6 dorsal root ganglion (DRG) were studied by immunofluorescence. During cystometry, 1mg/kg of URB937, but not vehicle or 0.1 mg/kg URB937, counteracted PGE2 -induced changes in urodynamic parameters. In SAA measurements, PGE2 increased SAAs of C-fibers, but not Aδ-fibers. URB937 (1 mg/kg) depressed Aδ-fiber SAAs and abolished the facilitated C-fiber SAAs induced by PGE2 . DRG nerve cells showed strong staining for FAAH, CB1 and CB2, with 77 ± 2% and 87 ± 3% of FAAH-positive nerve cell bodies co-expressing CB1 or CB2-immunofluorescence. The present results demonstrate that URB937, a peripherally-restricted FAAH inhibitor, reduces bladder overactivity and C-fiber hyperactivity of the rat bladder provoked by PGE2 , suggesting an important role of the peripheral endocannabinoid system in bladder overactivity and hypersensitivity. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    BJU International 07/2015; DOI:10.1111/bju.13223 · 3.13 Impact Factor
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    ABSTRACT: To validate Caveolin-1 as an independent prognostic marker of biochemical recurrence (BCR) in a large multi-institutional cohort of patients treated with radical prostatectomy (RP). Caveolin-1 expression was evaluated by immunochemistry on a tissue microarray from 3117 patients treated with RP for prostate cancer (PCa) at five institutions. Univariable and multivariable Cox proportional hazards regression models assessed the association of Caveolin-1 status with BCR. Harrell's C-index quantified prognostic accuracy (PA). Overexpression of Caveolin-1 was observed in 644 (20.6%) patients and was associated with higher pathological Gleason sum (p=0.002) and lymph node metastases (p=0.05). Within a median follow-up of 38 months (IQR 21-66), 617 (19.8%) patients experienced BCR. Patients with overexpression of Caveolin-1 had worse BCR free survival compared to patients with normal expression (log rank test, p=0.004). Caveolin-1 was an independent predictor of BCR in multivariable analyses that adjusted for the effects of standard clinicopathologic features (HR=1.21, p=0.037). Addition of Caveolin-1 in a model for prediction of BCR based on these standard prognosticators did not significantly improve predictive accuracy of the model. In subgroup analyses, Caveolin-1 was associated with BCR in patients with favorable pathologic features (pT2pN0 and Gleason score = 6) (p=0.021). We confirmed that the overexpression of Caveolin-1 is associated with adverse pathologic features in PCa and independently predicts BCR after RP, especially in patients with favorable pathologic features. However, it did not add prognostically relevant information to established predictors of BCR, limiting its use in clinical practice. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    BJU International 07/2015; DOI:10.1111/bju.13224 · 3.13 Impact Factor
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    ABSTRACT: Intermediate-risk prostate cancer (PCa) represents a heterogeneous disease, where a non-negligible proportion of patients harbor favorable pathologic characteristics and are potentially eligible for active surveillance (AS). We aimed at developing a model for the identification of pathologically favorable PCa at radical prostatectomy (RP) among intermediate-risk patients. Overall, 3,821 intermediate-risk patients treated with RP at two centers between 2005 and 2013 were identified. Pathologically favorable PCa was defined as low-grade organ-confined disease. Age, biopsy Gleason, PSA density (PSAD), and the percentage of positive cores were included in multivariable logistic regression analyses predicting favorable PCa and formed the basis for a logistic regression-based risk calculator. The internally validated discrimination and calibration of the risk calculator were quantified using 200 bootstrap resamples. Decision curve analysis (DCA) provided an estimate of the net benefit obtained using this model versus treating no one and treating everyone. Overall, 10.0% of all intermediate risk patients had favorable disease. In multivariable analyses, patients with biopsy Gleason score ≤6 had higher probability of favorable disease compared to those with higher-grade disease (P < 0.001). Similarly, age, PSAD, and percentage of positive cores were associated with the probability of favorable disease (all P ≤ 0.01). The risk calculator achieved a validated accuracy of 82.5%. The DCA showed that our prediction model is better than both treating no one and treating everyone. One out of ten intermediate-risk patients harbors favorable disease at RP. Our novel, pre-operative, validated risk calculator may help clinicians identifying patients who could be considered for conservative therapy approaches such as AS. Prostate 9999: XX-XX, 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    The Prostate 07/2015; DOI:10.1002/pros.23040 · 3.57 Impact Factor
  • 06/2015; 2(2):14. DOI:10.14440/bladder.2015.55
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    ABSTRACT: Long-term cancer control outcomes in clinically high-risk prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP) remain unknown. To report on long-term biochemical recurrence (BCR)-free survival, clinical recurrence (CR)-free survival, and salvage therapy rates in these patients. Given the heterogeneity of high-risk patients, a second objective was to stratify them according to their BCR risk (using preoperative parameters), in an effort to counsel them better preoperatively regarding their cancer control outcomes. We evaluated 1100 D'Amico high-risk PCa patients who underwent RARP between 2002 and 2013 at three tertiary care centers. Outcomes consisted of BCR-free survival, CR-free survival, and salvage therapy rates. Regression tree analysis stratified patients into novel risk groups based on preoperative characteristics and corresponding BCR risk. Kaplan-Meier curves estimated BCR-free survival, CR-free survival, and salvage therapy rates in the entire cohort and after stratification according to the novel risk groups (RGs). Median age and prostate-specific antigen (PSA) were 63 yr and 6.5 ng/ml, respectively. Biopsy Gleason score (GS) was ≥8 in 57.7%. Mean follow-up was 53 mo (median: 49 mo). At 10 yr, BCR-free survival, CR-free survival, and salvage therapy rates were 50%, 87%, and 37%, respectively. Regression tree analysis stratified patients into five novel RGs): RG1, very low risk (GS ≤6); RG2, low risk (PSA ≤10 ng/ml; GS: 7); RG3, intermediate risk (PSA ≤10 ng/ml; GS ≥8); RG4, high risk (PSA >10 ng/ml; GS: 7); RG5, very high risk (PSA >10 ng/ml; GS ≥8). In these RGs, the 10-yr BCR-free survival rates were 86%, 70%, 36%, 31%, and 26% (p<0.001), respectively; the 10-yr CR-free survival rates were 99%, 96%, 85%, 67%, and 55% (p<0.001), respectively; and the 10-yr salvage therapy rates were 9.8%, 16%, 42%, 47%, and 64% (p<0.001), respectively. Most patients with clinically high-risk PCa treated with RARP alone remain CR free at long term. Nonetheless, almost 37% of the patients at 10 yr require salvage therapy. Our novel tool allows accurate stratification of these heterogeneous patients according to their BCR, CR, and salvage therapy risks. This may help inform patients preoperatively about their cancer control outcomes postoperatively. Robot-assisted radical prostatectomy confers lasting long-term oncologic control in most high-risk prostate cancer patients. Our novel risk grouping might serve as a useful tool for setting expectations and counseling patients regarding their cancer control outcomes. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 06/2015; DOI:10.1016/j.eururo.2015.06.020 · 12.48 Impact Factor
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    ABSTRACT: Testicular cancer (TC) is the most common solid cancer in men between the third and fourth decade of life. Due to successful treatment approaches, TC survivors (TCSs) have long life expectancy, but with numerous potential long-term sequelae, including sexual dysfunction. We investigated predictors of long-term normal sexual function (SF) recovery in TCSs. Sociodemographic, medical, and psychometric data were analyzed in 143 Caucasian-European TCSs, who underwent orchiectomy at a single institution. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF). Statistical models tested the association between predictors (including age at surgery, body mass index, CCI, and adjuvant therapy: radiotherapy [RT], chemotherapy [CT], CT followed by retroperitoneal lymph node dissection [RPLND] and RPLND alone) and the long-term recovery of normal SF (defined as IIEF-erectile function [EF] ≥26, and sexual desire [SD], intercourse satisfaction [IS] orgasmic function [OF], and overall satisfaction [OS] domain scores in the upper tertiles). At a mean follow-up of 86 months, 35 (25.5%) TCSs had erectile dysfunction (ED), with 16 (11.2%) experiencing severe ED. Median time of EF recovery was 60, 60, and 70 months after CT, RT, and RPLND, respectively. Only adjuvant RT emerged as an independent predictor of nonrecovery of normal EF (HR: 0.55, P= 0.01). Neither adjuvant CT nor CT plus RPLND or RPLND alone significantly impaired the recovery of normal erections. Adjuvant therapy was not associated with impaired recovery of normal sexuality as a whole, considering the IIEF-SD, -OF, -IS, and OS domains.
    Asian Journal of Andrology 06/2015; DOI:10.4103/1008-682X.149180 · 2.53 Impact Factor
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    ABSTRACT: Data on TMPRSS2-ERG and AR-V7 may pave the way for personalised therapy for prostate cancer (PCa) patients. Comprehensive molecular profiling can help identify multiple PCa subtypes and driving alterations. Translating these findings into clinical practice is still challenging. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 06/2015; DOI:10.1016/j.eururo.2015.05.041 · 12.48 Impact Factor
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    ABSTRACT: Multiparametric magnetic resonance imaging-informed prostate biopsy is attracting increasing interest among practicing urologists. Whether this will become the new gold standard in prostate cancer diagnosis and supplant systematic transrectal ultrasound-guided sampling remains to be determined. Here we present the main open questions and current concerns regarding this new approach. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European Urology 06/2015; DOI:10.1016/j.eururo.2015.05.049 · 12.48 Impact Factor
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    ABSTRACT: The prognostic role of perioperative blood transfusion (PBT) in patients who underwent radical cystectomy (RC) for bladder cancer (BCa), although supported by clinical evidence, still remains to be assessed definitively.
    06/2015; DOI:10.1016/j.euf.2015.03.002
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    ABSTRACT: Postoperative follow-up is considered the standard of care for nonmetastatic renal cell carcinoma (RCC). However, level 1 evidence regarding a proper follow-up protocol for RCC is still lacking, making clinical practice extremely heterogeneous.
    06/2015; DOI:10.1016/j.euf.2015.04.001
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    ABSTRACT: Current trials are investigating radical intervention in men with metastatic prostate cancer. However, there is a lack of safety data for radical prostatectomy as therapy in this setting. To examine perioperative outcomes and short-term complications after radical prostatectomy for locally resectable, distant metastatic prostate cancer. A retrospective case series from 2007 to 2014 comprising 106 patients with newly diagnosed metastatic (M1) prostate cancer from the USA, Germany, Italy, and Sweden. Radical prostatectomy and extended pelvic lymphadenectomy. Descriptive statistics were used to present margin status, continence, and readmission, reoperation, and overall complication rates at 90 d, as well as for 21 specific complications. Kaplan-Meier plots were used to estimate survival function. Intercenter variability and M1a/ M1b subgroups were examined. Some 79.2% of patients did not suffer any complications; positive-margin (53.8%), lymphocele (8.5%), and wound infection (4.7%) rates were higher in our cohort than in a meta-analysis of open radical prostatectomy performed for standard indications. At a median follow-up of 22.8 mo, 94/106 (88.7%) men were still alive. The study is limited by its retrospective design, differing selection criteria, and short follow-up. Radical prostatectomy for men with locally resectable, distant metastatic prostate cancer appears safe in expert hands for meticulously selected patients. Overall and specific complication rates related to the surgical extirpation are not more frequent than when radical prostatectomy is performed for standard indications, and the use of extended pelvic lymphadenectomy in all of this cohort compared to its selective use in localized/locally advanced prostate cancer accounts for any extra morbidity. Men presenting with advanced prostate cancer that has spread beyond the prostate are increasingly being considered for treatments directed at the prostate itself. On the basis of results for our international series of 106 men, surgery appears reasonably safe in this setting for certain patients. Copyright © 2015. Published by Elsevier B.V.
    European Urology 05/2015; DOI:10.1016/j.eururo.2015.05.023 · 12.48 Impact Factor
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    ABSTRACT: To evaluate the prevalence, and clinical and seminal impact of comorbidities in white European men presenting for couple infertility. Cross-sectional study. Academic reproductive medicine outpatient clinic. Cohort of 2,100 consecutive infertile men (noninterracial infertile couples). Obtaining complete demographic, clinical, and laboratory data from 2,100 consecutive infertile men with health-significant comorbidities scored via the Charlson comorbidity index (CCI; categorized 0 vs. 1 vs. ≥2) and semen analysis values assessed based on 2010 World Health Organization reference criteria. Assessment of the rate of comorbidities by means of CCI scores and possible associations between CCI, semen and hormonal parameters. Descriptive statistics and regression models tested the associations among semen parameters, clinical characteristics, and CCI. When assessing general comorbidity prevalence, CCI 0, CCI 1, and CCI ≥2 was found in 1,921 (91.5%), 102 (4.9%), and 77 (3.6%) patients, respectively. Patient age and follicle-stimulating hormone levels increased as the general health status decreased. Conversely, the total testosterone levels and sperm concentration decreased as CCI scores increased. A higher rate of oligozoospermia and nonobstructive azoospermia was observed in patients with CCI ≥1. No differences were observed among the considered comorbidity groups in terms of testicular volume or further hormonal or seminal parameters. Both continuously coded and categorized sperm concentrations were independent predictors of CCI ≥1. Patients with sperm concentration <45.6 million/mL (most informative cutoff value) had a 2.74-fold increased risk of having a CCI ≥1. Decreased general health status appears to be associated with impaired male reproductive health, including lower sperm concentration, lower total testosterone levels, and higher follicle-stimulating hormone values. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
    Fertility and sterility 05/2015; 104(1). DOI:10.1016/j.fertnstert.2015.04.020 · 4.59 Impact Factor
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    ABSTRACT: Multimodal treatment for men with locally advanced prostate cancer (PCa) using neoadjuvant/adjuvant systemic therapy, surgery, and radiation therapy is being increasingly explored. There is also interest in the oncologic benefit of treating the primary tumor in the setting of metastatic PCa (mPCa). To perform a review of the literature regarding the treatment of the primary tumor in the setting of mPCa. Medline, PubMed, and Scopus electronic databases were queried for English language articles from January 1990 to September 2014. Prospective and retrospective studies were included. There is no published randomized controlled trial (RCT) comparing local therapy and systemic therapy to systemic therapy alone in the treatment of mPCa. Prospective studies of men with locally advanced PCa and retrospective studies of occult node-positive PCa have consistently shown the addition of local therapy to a multimodal treatment regimen improves outcomes. Molecular and genomic evidence further suggests the primary tumor may have an active role in mPCa. Treatment of the primary tumor in mPCa is being increasingly explored. While preclinical, translational, and retrospective evidence supports local therapy in advanced disease, further prospective studies are under way to evaluate this multimodal approach and identify the patients most likely to benefit from the inclusion of local therapy in the setting of metastatic disease. In this review we explored preclinical and clinical evidence for treatment of the primary tumor in metastatic prostate cancer (mPCa). We found evidence to support clinical trials investigating mPCa therapy that includes local treatment of the primary tumor. Currently, treating the primary tumor in mPCa is controversial and lacks high-level evidence sufficient for routine recommendation. Copyright © 2015. Published by Elsevier B.V.
    European Urology 05/2015; DOI:10.1016/j.eururo.2015.04.036 · 12.48 Impact Factor

Publication Stats

9k Citations
3,779.58 Total Impact Points

Institutions

  • 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
  • 2010–2013
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, Texas, United States
    • Research Triangle Park Laboratories, Inc.
      Raleigh, North Carolina, United States
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
  • 2012
    • Henry Ford Health System
      Detroit, Michigan, United States
  • 2011–2012
    • Cornell University
      Итак, New York, United States
    • Indiana University-Purdue University Indianapolis
      • Department of Urology
      Indianapolis, Indiana, United States
  • 2009–2010
    • Université de Montréal
      • Department of Surgery
      Montréal, Quebec, Canada
    • Memorial Sloan-Kettering Cancer Center
      New York, New York, United States
  • 1991–2009
    • University of Milan
      • Department of Biology and Genetics for Medical Sciences
      Milano, Lombardy, Italy
  • 2008
    • Keio University
      Edo, Tōkyō, Japan
    • Johns Hopkins Medicine
      • Department of Urology
      Baltimore, Maryland, United States
  • 2007
    • University of Hamburg
      Hamburg, Hamburg, Germany