The role of anti-3-18F-FACBC pet for staging of high-risk prostate cancer and for restaging in patients radically treated and with biochemical relapse

Obiettivi: Valutare l’accuratezza diagnostica del PET/TC con 18F-FACBC e con 11C-choline nella stadiazione dei pazienti affetti da carcinoma prostatico (PCa) e nella ristadiazione dei pazienti con ripresa biochimica dopo trattamento radicale. Metodi: Questo studio prospettico è stato condotto in due fasi. Nella “Fase I” abbiamo arruolato 100 pazienti consecutivi con ripresa biochimica dopo trattamento radicale. Sono stati esclusi 11 pazienti. I criteri di inclusione erano: a)ripresa biochimica(BCR); b)nessuna terapia ormonale in corso. Nella “Fase II” abbiamo arruolato 94 pazienti affetti da PCa, dei quali sono stati esclusi 14. I criteri di inclusione erano; a)PCa ad alto rischio; b)assenza di metastasi ossee; c)nessuna terapia in corso. Tutti i pazienti inclusi sono stati sottoposti a prostatectomia radicale con linfadenectomia. Abbiamo calcolato per ogni radiotracciante la sensibilità, specificità, PPV,NPB, accuratezza considerando come standard di riferimento l’istologia per la fase II e il follow-up per la fase I (storia clinica, andamento del PSA, imaging convenzionale istologia ove disponibile). Risultati: Nelle analisi per paziente nella fase I abbiamo ottenuto i seguenti risultati in termini di sensibilità, specificità, PPV,NPB, accuratezza: 32%vs37%, 40%vs67%, 90%vs97%, 3%vs4%, 32%vs38% rispettivamente. Categorizzando i pazienti per valori di PSA la PET con 18F-FACBC ha dimostrato una sensibilità maggiore rispetto alla Colina con un numero superiore di TP. Dalle analisi eseguite in stadiazione (fase II) abbiamo ottenuto i seguenti risultati in termini di sensibilità, specificità, PPV,NPB, accuratezza: 57.9%vs52.6%, 68.9%vs85.2%, 36.7%vs52.6%, 84%vs85.2%, 66.2%vs77.5% rispettivamente. Conclusioni: La PET con 18F-FACBC può essere considerata una alternativa alla 11C-choline sia nella fase di staging che di restaging nel carcinoma prostatico, soprattutto nei Centri PET non dotati di ciclotrone grazie alla emivita più lunga di questo radiotracciante.Purpose: To compare the accuracy of 18F-FACBC and 11C-choline PET/CT in pre-operative staging of patients affected by prostate cancer and in patients radically treated for prostate cancer presenting with biochemical relapse. Methods: This prospective study was divided in two phases. In the “Phase I” we enrolled 100 consecutive patient radically treated for prostate cancer(PCa) and presenting with rising PSA. Of these 100 patients, 89 were included in the analysis with the following inclusion criteria: a)biochemical relapse; b)no hormonal therapy at the time of the scans. In the “Phase II” we enrolled 94 consecutive patients affected by PCa. Of these 94 patients, 80 were included in the analysis with the following inclusion criteria: a)High-risk PCa; b)no bone metastases c)no hormonal therapy. All patients underwent radical prostatectomy with lymphadenectomy. Sensitivity, specificity, PPV, NPV and accuracy were calculated for both the tracers. For phase I patients the standard of reference was follow-up at 1 year (including correlative imaging, PSA trend and pathology when available),for phase II patients was the histology. Results: In patients-based analysis sensitivity, specificity, PPV, NPV and accuracy for 11C-choline and 18F-FACBC PET/CT in restaging (phaseI) were: 32%vs37%, 40%vs67%, 90%vs97%, 3%vs4%, 32%vs38% respectively. Categorizing patients by PSA level (<1 ng/ml 28 patients, 1-2 ng/ml 28 patients, 2–3 ng/ml 11 patients, ≥3 ng/ml 22 patients) the number of patients with TP findings were generally higher with 18F-FACBC than with 11C-choline. In patients-based analysis sensitivity, specificity, PPV, NPV and accuracy for 11C-choline and 18F-FACBC PET/CT in staging (phaseII) were: 57.9%vs52.6%, 68.9%vs85.2%, 36.7%vs52.6%, 84%vs85.2%, 66.2%vs77.5% respectively. Conclusion: 18F-FACBC can be considered an alternative tracer to 11C-choline in the setting of patients with biochemical relapse after radical prostatectomy and in PCa staging. Last but not least thanks to its long half-life this radiotracer can be used also in PET Centers without cyclotron

Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence

Objective: We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy (RRP) and present our preliminary clinical results. Materials and methods: The first steps of the prostatectomy reflect the standard RRP, while for the final phases the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prostate. At this level, the inner circular muscle of the bladder neck forms a sphincteric ring of smooth muscle that covers the longitudinally oriented smooth muscle component of the urethral musculature that extends distally to the verumontanum. These two proximal structures represent the internal sphincter that envelops and locks the proximal urethra. A blunt dissection is continued until the ring shaped vesical sphincter is separated from the prostate and the longitudinally oriented smooth muscle component of the urethral musculature is identified. The base of the prostate is then gently separated from the urethra and from the bladder until the maximal length of the urethral musculature is isolated and preserved. Results: After 30 initial set-up procedures, 40 consecutive patients with organ confined prostate cancer were submitted to radical retropubic prostatectomy with the preservation of muscular internal sphincter and the proximal urethra and compared to 40 patients submitted to standard procedure who served as control group. The group of patients submitted to our technical modification had a faster recovery of early continence than control group at 3 and 7 days. Conclusions: The described technique is a feasible and safe method for preservation of the internal urethral sphincter and allows improving the early recovery of urinary continence. The technique does not increase the rate of positive margins and the duration of the procedure

Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up

The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n\uc2&nbsp;=\uc2&nbsp;36) and robotic (n\uc2&nbsp;=\uc2&nbsp;26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center\ue2\u80\u99s protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2\uc2&nbsp;\uc2\ub1\uc2&nbsp;71.9\uc2&nbsp;cc for the laparoscopic and 47.2\uc2&nbsp;\uc2\ub1\uc2&nbsp;32.3\uc2&nbsp;cc for the robotic, respectively (p\uc2&nbsp;=\uc2&nbsp;0.004). Mean days of hospitalization were 5.9\uc2&nbsp;\uc2\ub1\uc2&nbsp;2.4 for the laparoscopic group and 7.6\uc2&nbsp;\uc2\ub1\uc2&nbsp;3.4 for the robotic group (p\uc2&nbsp;=\uc2&nbsp;0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27\uc2&nbsp;months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p\uc2&nbsp;=\uc2&nbsp;0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence

Tubercular disease caused by bacillus of Calmette-Guerin administered as a local adjuvant treatment of relapsing bladder carcinoma. Pathogenetic, diagnostic and therapeutic issues, and literature review

Two exemplary case reports of respiratory granulomatous infection caused by bacillus of Calmette-Gu&eacute;rin (BCG) in patients who were repeatedly treated with local, intravesical adjuvant BCG therapy for a relapsing transitional bladder carcinoma, are outlined and discussed, on the ground of the cumbersome diagnostic and differential diagnostic process (especially when a prior tuberculosis and a concurrent chronic obstructive pulmonary disease are of concern), and an updated literature revision. Only four cases of respiratory BCG-itis (pulmonary tuberculosis-like forms), have been reporteduntil now to the best of our knowledge (two of them following bladder instillation of BCG). One episode of ours represents the first described case with a dual, concomitant granulomatous localization of BCG-itis, also involving the genitourinary tract

Metabolic Imaging in Prostate Cancer: Where We Are

In recent years, the development of diagnostic methods based on metabolic imaging has been aimed at improving diagnosis of prostate cancer (PCa) and perhaps at improving therapy. Molecular imaging methods can detect specific biological processes that are different when detected within cancer cells relative to those taking place in surrounding normal tissues. Many methods are sensitive to tissue metabolism, among them Positron Emission Tomography (PET) and Magnetic Resonance Spectroscopic Imaging (MRSI) which are widely used in clinical practice and clinical research. There is a rich literature that establishes the role of these metabolic imaging techniques as valid tools for the diagnosis, staging and monitoring of prostate cancer. Until recently, European guidelines for prostate cancer detection still considered both MRSI/MRI and PET/CT to be under evaluation, even though they had demonstrated their value in the staging of high risk prostate cancer, and in the restaging of patients presenting elevated PSA levels following radical treatment of PCa, respectively. Very recently, advanced methods for metabolic imaging have been proposed in the literature: mpMRI (multiparametric MRI), hyperpolarized MRSI, PET/CT with the use of new tracers and finally PET/MRI. Their detection capabilities are currently under evaluation, as is the feasibility of using such techniques in clinical studies

Renal leiomyoma: Case report and literature review

Renal leiomyomas are rare benign tumours of the kidney originating from muscle cells. They are usually found by an autopsy, whether the patient is asymptomatic or has symptoms (i.e., abdominal/flank pain, hematuria, palpable mass). Today the widespread use of ultrasonography and computed tomography has increased the detection of clinically asymptomatic renal leiomyomas. The differential diagnosis between leiomyomas and other malignant lesions (above all renal cell carcinoma or leiomyosarcoma) is still possible by histological examination. Radiological examinations are not sufficient for the differential diagnosis. Renal leiomyomas have no aggressive behaviour and they usually do not metastasize. The prognosis, after surgery, is excellent without recurrence. We report a case of leiomyoma in a 31-year-old man who presented hematuria and flank pain. We also review the literature and provide a summary of clinical, radiological and histological features of renal leiomyomas

Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence

Objective: We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy (RRP) and present our preliminary clinical results. Materials and methods: The first steps of the prostatectomy reflect the standard RRP, while for the final phases the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prostate. At this level, the inner circular muscle of the bladder neck forms a sphincteric ring of smooth muscle that covers the longitudinally oriented smooth muscle component of the urethral musculature that extends distally to the verumontanum. These two proximal structures represent the internal sphincter that envelops and locks the proximal urethra. A blunt dissection is continued until the ring shaped vesical sphincter is separated from the prostate and the longitudinally oriented smooth muscle component of the urethral musculature is identified. The base of the prostate is then gently separated from the urethra and from the bladder until the maximal length of the urethral musculature is isolated and preserved. Results: After 30 initial set-up procedures, 40 consecutive patients with organ confined prostate cancer were submitted to radical retropubic prostatectomy with the preservation of muscular internal sphincter and the proximal urethra and compared to 40 patients submitted to standard procedure who served as control group. The group of patients submitted to our technical modification had a faster recovery of early continence than control group at 3 and 7 days. Conclusions: The described technique is a feasible and safe method for preservation of the internal urethral sphincter and allows improving the early recovery of urinary continence. The technique does not increase the rate of positive margins and the duration of the procedure

A review discussing fluciclovine (18F) PET/CT imaging in the detection of recurrent prostate cancer

A significant number of patients radically treated for prostate cancer (PCa) will develop prostate-specific antigen recurrence (27-53%). Localizing the anatomical site of relapse is critical, in order to achieve the optimal treatment management. To date the diagnostic accuracy of standard imaging is low. Several desirable features have been identified for the amino-acid-based PET agent, fluciclovine (18F) including: long 18F half-life which allows more practical use in centers without a cyclotron onsite; acting as a substrate for amino acid transporters upregulated in PCa or associated with malignant phenotype; lacking of incorporation into protein; and limited urinary excretion. Fluciclovine (18F) is currently approved both in USA and Europe with specific indication in adult men with suspected recurrent PCa based on elevated prostate-specific antigen following prior treatment

OTTIMIZZAZIONE DELLA SENSIBILITÀ NEOCLITORIDEA NEL TRANSESSUALISMO ANDROGINOIDE: MODIFICHE DI TECNICA E RISULTATI A DISTANZA

OTTIMIZZAZIONE DELLA SENSIBILITÀ NEOCLITORIDEA NEL TRANSESSUALISMO ANDROGINOIDE: MODIFICHE DI TECNICA E RISULTATI A DISTANZ

Holmium laser prostatectomy in a tertiary Italian center: A prospective cost analysis in comparison with bipolar TURP and open prostatectomy

Objective: To assess the economic impact of Holmium laser enucleation of prostate (HoLEP) in comparison with transurethral resection of prostate (TURP) and open prostatectomy (OP). Methods: Between January 2017 and January 2018, we prospectively enrolled 151 men who underwent HoLEP, TURP or OP at tertiary Italian center, due to bladder outflow obstruction symptoms. Patients with prostate volume ≤ 70 cc and those with prostate volume > 70 cc were scheduled for TURP or HoLEP and OP or HoLEP, respectively. Intraoperative and early post-operative functional outcomes were recorded up to 6 months follow up. Cost analysis was carried out considering direct costs (operating room [OR] utilization costs, nurse, surgeons and anesthesiologists' costs, OR disposable products costs and OR products sterilization costs), indirect costs (hospital stay costs and diagnostics costs) and global costs as sum of both direct and indirect plus general costs related to hospitalization. Cost analysis was performed comparing patients referred to TURP and HoLEP with prostate volume ≤ 70 cc and men underwent OP and HoLEP with prostate volume > 70 cc respectively. Results: Overall, 53 (35.1%), 51 (33.7%) and 47 (31.1%) were scheduled to HoLEP, TURP and OP, respectively. Both TURP, HoLEP and OP proved to effectively improve urinary symptoms related to BPE. Considering patients with prostate volume ≤ 70 cc, median global cost of HoLEP was similar to median global cost of TURP (2151.69 € vs. 2185.61 €, respectively; p = 0.61). Considering patients with prostate volume > 70 cc, median global cost of HoLEP was found to be significantly lower than median global cost of OP (2174.15 € vs. 4064.97 €, respectively; p ≤ 0.001). Conclusions: Global costs of HoLEP are comparable to those of TURP, offering a cost saving of only 11.4 € in favor of HoLEP. Conversely, HoLEP proved to be a strong competitor of OP because of significant global cost sparing amounting to 1890.82 € in favor of HoLEP