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

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

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

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

Uretero-caval fistula after radical cystectomy with bricker ileal conduit: A case report

Uretero-caval fistula after radical cystectomy with bricker ileal conduit: a case repor

Androgen deprivation therapy influences the uptake of 11C-choline in patients with recurrent prostate cancer: results of a sequential PET/CT study in 22 patients

The influence of androgen deprivation therapy (ADT) on 11C-choline uptake in patients with recurrent prostate cancer (PC) has not yet been clarified and there are no recommendations in the literature about the question of whether ADT should be discontinued before 11C-choline PET/CT The aim of our study was to investigate this issue by means of sequential 11Ccholine positron emission tomography (PET)/CT in patients with recurrent PC

The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy

Aim: The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a “4 hours-proficiency”. However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program. Methods: A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases. Results: All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases. Conclusions: Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery