Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy versus systematic transrectal Ultrasound Biopsy in the diagnosis of clinically significant prostate cancer: a prospective study.

Obiettivo Valutare la performance diagnostica di una nuova piattaforma biotica per metodica Fusion (Ecografia e Risonanza Magnetica) in una coorte di pazienti con sospetto clinico di neoplasia prostatica (PCa). Materiali e Metodi Sono stati arruolati pazienti con sospetto PCa o con diagnosi di PCa indolente (in Sorveglianza Attiva). I pazienti, sottoposti a Risonanza Magnetica multiparametrica (RMmp), in caso di riscontro di lesione/i sospetta/e, secondo un punteggio standardizzato, sono stati poi sottoposti a Biopsia Prostatica eco-guidata e contestuale biopsia mirata Fusion con almeno 2 prelievi per lesione. Il criterio per definire la presenza di tumore clinicamente significativo (csPCa) era la presenza di un punteggio di Gleason score ≥7 negli specimen bioptici. Risultati Dei 305 pazienti arruolati, 279 (91.4%) hanno eseguito una biopsia Fusion. Complessivamente, la detection rate (DR) globale della biopsia Fusion è risultata del 61.3% mentre è risultata del 51.3% per csCaP. La Fusion Biopsy ha mostrato delle DR progressivamente più alte al crescere del PIRADS Score (p<.001); le lesioni risultate positive alla Fusion Biopsy sono risultate di maggior diametro rispetto a quelle negative (mediana: 12 mm vs 10.5 mm; p= 0.0005). L’analisi relativa al numero dei prelievi ha mostrato una percentuale di prelievi positivi per neoplasia significativamente maggiore nei prelievi con metodica Fusion rispetto a quelli eseguiti con metodica random (p<.0001); inoltre, il numero di prelievi indicativi di csPCa è risultato rispettivamente significativamente maggiore con metodica Fusion (p<.0001). In termini di efficacia, il numero mediano di prelievi mirati per diagnosticare un csPCa è risultato 4 contro 11 necessari in corso di biopsia tradizionale (p<.0001) Conclusioni La biopsia mirata con tecnica Fusion ha dimostrato una DR globale complessivamente simile alla biopsia eco-guidata tradizionale sebbene l'incidenza di PCa sia aumentata nei prelievi mirati. Inoltre, nelle re-biopsie, la performance diagnostica della Fusion biopsy è risultata migliore per la diagnosi di csPCa.Aims To evaluate the diagnostic performance of a new bioptic platform for Ultrasound-Magnetic resonance Fusion Prostate Biopsy in a cohort of patients with suspicion of Prostate Cancer (PCa). Materials and methods Men with suspicion of PCa or with an established diagnosis of indolent PCa (in Active Surveillance protocol) were enrolled. All patients underwent multiparametric Magnetic resonance of the Prostate (mpMR) and, in case of a suspected lesion (s) for PCa, according to a standardized score, were submitted to standard random Biopsy and contextual targeted biopsy with at least 2 samples for lesion, exploiting the "real-time" fusion of mpMR images with ultrasound images. The criterion for defining the presence of csPCa was Gleason score score ≥7 in the biopsy specimen. Results Of the 305 patients enrolled, 279 (91.4%) subsequently performed a Fusion biopsy. Overall, the global detection rate (DR) of Fusion biopsy was 61.3% (171/279) while in 51.3% of cases a csPCa was diagnosed (143/279). Fusion biopsy showed progressively higher DRs as the PIRADS Score increased with a strong statistically significant difference (p <.001); the lesions that were positive at the targeted biopsy were significantly larger than the negative ones (median: 12 mm vs. 10.5 mm; p = 0.0005). The analysis of the number of cores showed a significantly higher percentage of positive ones with the Fusion method and a simultaneous higher percentage for csPCa compared to those performed with random biopsy ( all p < .0001). In terms of efficacy, the median number of targeted cores to diagnose a csPCa was 4 against 11 needed with random biopsy (p <.0001) Conclusions Fusion biopsy showed similar global rates of PCa diagnosis compared to random biopsy although the incidence of PCa was higher increased in targeted cores. Furthermore, Fusion biopsy showed better performance in terms of csPCa in re-biopsy patients

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

First case of 18F-FACBC PET/CT-guided salvage radiotherapy for local relapse after radical prostatectomy with negative 11C-Choline PET/CT and multiparametric MRI: New imaging techniques may improve patient selection.

We present the first case of salvage radiotherapy based on the results of 18F-FACBC PET/CT performed for a PSA relapse after radical prostatectomy. The patients underwent 11CCholine PET/CT and multiparametric MRI that were negative while 18F-FACBC PET/CT visualized a suspected local relapse confirmed by transrectal ultrasound-guided biopsy. No distant relapse was detected. Thus the patient was submitted to salvage radiotherapy in the prostatic fossa. After 20 months of follow-up, the PSA was undetectable and 18F-FACBC PET/CT was negative. Salvage radiotherapy after surgery, provided that it is administered at the earliest evidence of the biochemical relapse, may improve cancer control and favourably influence the course of disease as well as the adjuvant approach. New imaging techniques may increase the efficacy of the salvage radiotherapy thus helping in the selection of the patients. Preliminary clinical reports showed an improvement in the detection rate of 20-40% of 18F-FACBC in comparison with 11C-Choline for the detection of disease relapse after radical prostatecomy, rendering the 18F-FACBC the potential radiotracer of the future for prostate cancer

Italian experiences in the management of andrological patients at the time of Coronavirus pandemic.

The SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) was first reported in December 2019, then its rapid spread around the world caused a global pandemic in March 2020 recording a high death rate. The epicenter of the victims moved from Asia to Europe and then to the United States. In this Pandemic, the different governance mechanisms adopted by local health regional authorities made the difference in terms of contagiousness and mortality together with a community strong solidarity. This document analyzes the andrological urgencies management in public hospitals and in private practice observed in Italy and in particular in the most affected Italian Regions: Emilia-Romagna and Marche

Testis Sparing Surgery of Small Testicular Masses: Retrospective Analysis of a Multicenter Cohort

PURPOSE: We evaluated possible factors predicting testicular cancer in patients undergoing testis sparing surgery. MATERIALS AND METHODS: We retrospectively analyzed the records of all patients who underwent testis sparing surgery for a small testicular mass at a total of 5 centers. All patients with 1 solitary lesion 2 cm or less on preoperative ultrasound were enrolled in the study. Testis sparing surgery consisted of tumor enucleation for frozen section examination. Immediate radical orchiectomy was performed in all cases of malignancy at frozen section examination but otherwise the testes were spared. Univariate and multivariate analysis were performed and ROC curves were produced to evaluate preoperative factors predicting testicular cancer. RESULTS: Overall 147 patients were included in the study. No patient had elevated serum tumor markers. Overall 21 of the 147 men (14%) presented with testicular cancer. On multivariate analysis the preoperative ultrasound diameter of the lesion was a predictor of malignancy (OR 6.62, 95% CI 2.26-19.39, p=0.01). On ROC analysis lesion diameter had an AUC of 0.75 (95% CI 0.63-0.86, p=0.01) to predict testicular cancer. At the best cutoff of 0.85 the diameter of the lesion had 81% sensitivity, 58% specificity, 24% positive predictive value and 95% negative predictive value. CONCLUSIONS: Our study confirms that small testicular masses are often benign and do not always require radical orchiectomy. Preoperative ultrasound can assess lesion size and the smaller the nodule, the less likely that it is malignant. Therefore, we suggest a stepwise approach to small testicular masses, including tumorectomy, frozen section examination and radical orchiectomy or testis sparing surgery according to frozen section examination results

Les droits disciplinaires des fonctions publiques : « unification », « harmonisation » ou « distanciation ». A propos de la loi du 26 avril 2016 relative à la déontologie et aux droits et obligations des fonctionnaires

The production of tt‾ , W+bb‾ and W+cc‾ is studied in the forward region of proton–proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98±0.02 fb−1 . The W bosons are reconstructed in the decays W→ℓν , where ℓ denotes muon or electron, while the b and c quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions.The production of $t\overline{t}$, $W+b\overline{b}$ and $W+c\overline{c}$ is studied in the forward region of proton-proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98 $\pm$ 0.02 \mbox{fb}^{-1}. The $W$ bosons are reconstructed in the decays $W\rightarrow\ell\nu$, where $\ell$ denotes muon or electron, while the $b$ and $c$ quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions

Observation of the B0 → ρ0ρ0 decay from an amplitude analysis of B0 → (π+π−)(π+π−) decays

Proton–proton collision data recorded in 2011 and 2012 by the LHCb experiment, corresponding to an integrated luminosity of 3.0 fb−1 , are analysed to search for the charmless B0→ρ0ρ0 decay. More than 600 B0→(π+π−)(π+π−) signal decays are selected and used to perform an amplitude analysis, under the assumption of no CP violation in the decay, from which the B0→ρ0ρ0 decay is observed for the first time with 7.1 standard deviations significance. The fraction of B0→ρ0ρ0 decays yielding a longitudinally polarised final state is measured to be fL=0.745−0.058+0.048(stat)±0.034(syst) . The B0→ρ0ρ0 branching fraction, using the B0→ϕK⁎(892)0 decay as reference, is also reported as B(B0→ρ0ρ0)=(0.94±0.17(stat)±0.09(syst)±0.06(BF))×10−6

A study of CP violation in B-+/- -&gt; DK +/- and B-+/- -&gt; D pi(+/-) decays with D -&gt; (KSK +/-)-K-0 pi(-/+) final states

A first study of CP violation in the decay modes $B^\pm\to [K^0_{\rm S} K^\pm \pi^\mp]_D h^\pm$ and $B^\pm\to [K^0_{\rm S} K^\mp \pi^\pm]_D h^\pm$, where $h$ labels a $K$ or $\pi$ meson and $D$ labels a $D^0$ or $\overline{D}^0$ meson, is performed. The analysis uses the LHCb data set collected in $pp$ collisions, corresponding to an integrated luminosity of 3 fb$^{-1}$. The analysis is sensitive to the CP-violating CKM phase $\gamma$ through seven observables: one charge asymmetry in each of the four modes and three ratios of the charge-integrated yields. The results are consistent with measurements of $\gamma$ using other decay modes