Publications (38)37.01 Total impact
Article: [Focal therapy and prostate cancer].[show abstract] [hide abstract]
ABSTRACT: The International Task Force on Prostate Cancer defines focal therapy (FT) for prostate cancer (PCa) as the therapy that "selectively ablates known disease and preserves existing functions, with the overall objective of minimizing lifetime morbidity without compromising life expectancy". FT for the treatment of PCa has been called the "male lumpectomy", an analogue to women's breast lumpectomy for the treatment of breast cancer. Radical prostatectomy continues to be the most frequently performed treatment for localized PCa, as anatomic knowledge and several technical advances, i.e. the introduction of robotic assisted surgery, have led to successful oncological outcome and lower rates of post-treatment morbidity. However, a proportion of patients still experiences a no negligible sexual, urinary, and bowel morbidity. Although the rationale of active surveillance for low-risk PCa (PSA <10 ng/mL, Gleason grade 6 or less, and clinical stage T1c-T2a) is sound, only few of newly diagnosed patients elect this approach. Thus, in the recent years the concept of a "subtotal therapy" gained the interest of some urological schools. The aim of this paper is to review the existing literature in order to provide the status of art on FT for PCa. The manuscript will focus on the characteristics of the target population, on the pre-operative evaluation to localise disease, as well as on perioperative, functional, and disease-control following focal therapy. L'International Task Force on Prostate Cancer definisce la terapia focale (TF) per il carcinoma prostatico (CP) una terapia che selettivamente distrugge la neoplasia precedentemente individuata e preserva le funzioni dell'organo, con l'obiettivo di minimizzare la morbilità senza compromettere la radicalità oncologica. La TF per il CP è stata paragonata alla quadrantectomia per il tumore della mammella. Sebbene, grazie ad una maggiore conoscenza anatomica e all'innovazione tecnologica, rappresentata in primis all'introduzione della piattaforma robotica, la prostatectomia radicale continua ad essere il trattamento radicale più diffuso per la cura del CP localizzato, l'impatto delle complicazioni urinarie, sessuali ed intestinali sulla qualità di vita non è trascurabile. La sorveglianza attiva è stata considerata un'alternativa ai trattamenti radicali per pazienti con basso rischio (PSA <10 ng/mL, Gleason score 6, stadio clinico T1c-T2a). Sfortunatamente una significativa percentuale di pazienti in sorveglianza attiva viene successivamente avviata a terapia radicale sia per riclassificazione bioptica o per motivi psicologici. Negli ultimi anni ha quindi preso campo la possibilità di una terapia sub totale o focale. L'obiettivo di questo lavoro è quello di rivedere la letteratura recente sul tema cercando di identificare quali siano le caratteristiche del paziente candidabile, gli strumenti impiegati per l'esatta localizzazione della neoplasia, le principali tecniche usate e le strategie di follow-up.Urologia 12/2013; 80(4):283-9.
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ABSTRACT: OBJECTIVE: To assess the complication rates and quality of life in patients eligible for focal therapy who underwent template-assisted transperineal prostate biopsy (TTPB). MATERIALS AND METHODS: Eighty-seven patients with low-risk prostate cancer (clinical stage T1c-T2a, prostate-specific antigen level ≤10 ng/mL, biopsy Gleason score ≤6), who were candidates for focal therapy, underwent TTPB. The study details are available from http://clinicaltrials.gov (NCT00928603). The primary outcomes were the complication rates, according to the Clavien-Dindo classification, and changes in the quality of life, evaluated using the International Prostate Symptom Score, International Index of Erectile Function, and Functional Assessment of Cancer Therapy-Prostate questionnaires, before and 1 month after TTPB. RESULTS: The median patient age was 63.9 years (range 46-78), with a median Charlson comorbidity index of 2.2 (range 0-4). No statistically significant differences were observed when comparing the general and/or specific domains of the International Prostate Symptom Score, International Index of Erectile Function, and Functional Assessment of Cancer Therapy-Prostate results before and 1 month after TTPB (P >.05 for all). Using the Clavien-Dindo classification, we observed 37 cases of grade 1 complications, including 5 (6.1%) cases of macrohematuria, 13 (16%) of hemospermia, 11 (13.5%) of perineal hematoma, 3 (3.7%) of perineal hematoma and hemospermia, and 5 (6.1%) of macrohematuria and hemospermia. Three patients (3.7%) developed a grade II complication (ie, acute urinary retention). Prostate cancer was detected in 54 patients (62.1%). Of 57 patients, 16 (29.6%) were upgraded from Gleason score 3+3/atypical small acinar proliferation to Gleason score 7. Of the 54 patients with positive TTPB findings, 18 (25.3%) showed an anatomic correspondence between the results of previous biopsies and TTPB. CONCLUSION: TTPB did not appear to have a significant effect on the quality of life of candidates for focal therapy, and the Clavien-Dindo complication rate was negligible.Urology 03/2013; · 2.42 Impact Factor
- European Urology Supplements - EUR UROL SUPPL. 01/2011; 10(2):66-66.
- European Urology Supplements - EUR UROL SUPPL. 01/2011; 10(2):206-206.
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ABSTRACT: Magnetic Resonance Angiography for NeuroVascular Bundle Dosimetry after Prostate Brachytherapy Paola Mangili1, Gianpiero Cardone2, Andrei Fodor3, Luciano Nava4, Andrea Losa4, Barbara Longobardi1, Riccardo Calandrino1, Giorgio Guazzoni4, Giuseppe Balconi2, Nadia Di Muzio3 1Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy; 2 Department of Radiology, San Raffaele Turro H, Milan, Italy; 3 Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy; 4 Department of Urology, San Raffaele Turro H, Milan, Italy. Objective: With prostate brachytherapy (PB) the erectile function preservation rate is high, but a gradual decline occurs during the follow-up. The role of radiation dose to the Neurovascular Bundles (NVBs) in brachytherapy-related impotence is controversial, because of localisation difficulties. We investigated whether the use of Magnetic Resonance Angiography (MRA) improves the ability to localize NVBs with precision and to evaluate the administered dose to these structures. Materials and Methods: 10 patients, treated with prostate brachytherapy in monotherapy for cT1-T2 prostate cancer, underwent both conventional morphologic and angiographic MR examination after implantation. A “radiographic localization” of the NVBs was compared with the MRA localization while the NVBs dosimetry based on morphologic MR images was compared with that based on fused transverse T1w, T2w and MRA images. Results: MRA 2D-TOF sequence performed with the endorectal coil allowed an accurate evaluation of NVBs. The real locations of the bundles with respect of the prostate gland were found patient dependent. The differences between radiographic and MRA localization of NVBs were up to 3.3 cm (mean 0.6 cm). The NVBs doses evaluated on MRA images were found different from those derived from “radiographic localization” up to 189%. Conclusion: Conventional MR imaging cannot adequately visualize NVBs leading to unreliable dosimetric results. This study demonstrated that merging morphologic and angiographic MR images can lead to an accurate dosimetry of the NVBs. Key words: Magnetic Resonance Angiography, Prostate Brachytherapy, NeuroVascular Bundle imaging, Potency.Journal of Radiotherapy&Medical Oncology. 06/2010; vol XVI(2):68-75.
- European Urology Supplements - EUR UROL SUPPL. 01/2010; 9(2):246-246.
- European Urology Supplements - EUR UROL SUPPL. 01/2010; 9(2):266-267.
- Journal of Radiotherapy&Medical Oncology. 01/2010; vol XVI(2).
- European Urology Supplements - EUR UROL SUPPL. 01/2009; 8(4):334-334.
- European Urology Supplements - EUR UROL SUPPL. 01/2009; 8(4):306-306.
- European Urology Supplements - EUR UROL SUPPL. 01/2009; 8(4):310-310.
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ABSTRACT: A prospective study to evaluate the reliability of cystoscopy was performed with fluorescence (photodynamic diagnosis, PDD) compared with standard white light (WL) cystoscopy in patients with solitary carcinoma in situ (CIS), undergoing BCG treatment. Between February 2004 and March 2006, 49 patients suffering from CIS were enrolled in the study. Patients age was 68.5 ± 13.5 years (mean ± SD) and all presented CIS alone at inclusion. All suspicious areas were biopsied either under white light or blue light. Urine cytology was peformed on each patient before endoscopy. Out of 49 patients enrolled, 15 (30.6%) presented with positive urinary cytology. Out of 18 patients positive to CIS at biopsy, 14 (77.7%) could be diagnosed exclusively by means of PDD cystoscopy and transurethral bladder resection and 4 (22.3%) during both standard and PDD cystoscopy. No additional CIS could be diagnosed by standard WL cystoscopy alone. The overall false positive rate for PDD accounted for 33.3% compared with 7.1% for WL cytoscopy. A statistical correlation was documented between the number of CIS findings and PDD (r = 0.6976, p = 0.0002) while WL cystoscopy (r = 0.1870, p = 0.3816) and urinary cytology (r = 0.4965, p = 0.0136) correlated only weakly with CIS. The overall side effects related to the drugs were negligible overall. These data show that PDD cystoscopy is more reliable than WL cytoscopy for the follow-up of CIS patients during BCG treatment. Long-term data and multicenter, prospective data are needed to assess the true impact on tumor recurrence and progression.Therapeutics and Clinical Risk Management 01/2008; 3(6):1003-7.
- European Urology Supplements - EUR UROL SUPPL. 01/2007; 6(2):189-189.
- European Urology Supplements - EUR UROL SUPPL. 01/2007; 6(2):90-90.
- European Urology Supplements - EUR UROL SUPPL. 01/2007; 6(2):124-124.
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ABSTRACT: To evaluate the morphological changes induced by a 3-month course of neoadjuvant bicalutamide 150 mg/day before radical prostatectomy (RP) on prostatic adenocarcinoma and high-grade prostatic intraepithelial neoplasia (HGPIN). In all, 90 patients with cT1-T2 prostate cancer and HGPIN on prostatic biopsy were randomized to receive bicalutamide (150 mg/day for 3 months) before RP, or to have immediate surgery. Surgical specimens were assessed for the histopathological features of cancer, HGPIN and benign epithelium in a blinded manner. The volumes of prostate cancer and HGPIN were evaluated using a stereological (i.e. grid) method. Compared with the bicalutamide-treated group, the ratio of stroma to epithelium, evaluated by visual microscopic assessment in the normal epithelium of the three prostate zones, was significantly lower in the control group, at 2.27 (sd 1.13), than in the treated group, at 1.87 (sd 0.72) (P = 0.048). The mean (sd) tumour volume was significantly lower in the bicalutamide-treated than in the control group, at 0.914 (0.13) vs 1.47 (0.24) mL (P = 0.044). Similarly, the mean (sd) volume of HGPIN was significantly lower in the bicalutamide-treated than in the control group, at 0.34 (0.06) vs 0.62 (0.07) mL (P = 0.003). At RP, specimen Gleason scores in the bicalutamide-treated group were similar to those in the control group, and were no different from the biopsy Gleason scores. Involution and epithelial shrinkage of prostate cancer and HGPIN were evident after neoadjuvant treatment with bicalutamide 150 mg. There was no evidence of the emergence of higher-grade cancer after treatment.BJU International 08/2006; 98(1):54-8. · 3.05 Impact Factor
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ABSTRACT: Five European centres (France, Finland, Italy, Spain and the UK) have pooled data to generate a large patient series involving 1175 patients treated with prostate brachytherapy. This paper reports preliminary data on PSA outcome up to 4 years. Out of 1175 in the database, 1050 patients with localised prostate cancer who had received transperineal seed implantation as monotherapy between May 1998 and August 2003 were stage T1-T2. A total of 668 (63.6%) patients met the low-risk group definition, 297 (28.3%) as intermediate-risk definition and 66 (6.3%) the high-risk group definition. The majority of patients were Gleason score 6 or less (n=951) and disease stage was T1c in 557 patients. Of the 1050 patients, PSA data up to 4 years were available for 210 patients, while 364 patients with PSA values up to 36 months were evaluable by the Kaplan-Meier method for freedom from biochemical failure. The biochemical progression-free rate at 3 years was estimated to be 91%, with a 93% and 88% rate for low- and intermediate-risk groups, respectively, versus 80% for the high-risk group. PSA kinetics provide encouraging evidence of treatment efficacy. These data on 4-year PSA follow-up on patients treated with prostate brachytherapy reflect those previously reported in the literature. This patient series will be followed to provide long-term outcome in the future.Radiotherapy and Oncology 08/2006; 80(1):57-61. · 4.52 Impact Factor
- European Urology Supplements - EUR UROL SUPPL. 01/2006; 5(2):312-312.
- European Urology Supplements - EUR UROL SUPPL. 01/2006; 5(2):149-149.
- European Urology Supplements - EUR UROL SUPPL. 01/2005; 4(3):3-3.
Università Vita-Salute San RaffaeleMilano, Lombardy, Italy
San Raffaele Scientific InstituteMilano, Lombardy, Italy