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The Prostate Cancer Specific Quality of Life Instrument (PROSQOLI) is a measure of health-related quality of life (HRQoL) in advanced hormone-resistant prostate cancer. In this study, we aimed at performing a cross-cultural adaptation and validation of the Italian version of the PROSQOLI.The original version of the PROSQOLI underwent several turnarounds of translations. A total of 472 patients treated with radical prostatectomy, radiotherapy or medical therapy were enrolled for the validation of the questionnaire. The PROSQOLI was administered together with the SF-12. Reliability indexes were calculated by using Cronbach alpha. To evaluate the validity of the construct, relationships between PROSQOLI and SF12 were assessed. The ANOVA test was used to evaluate the differences between groups of patients who had received different treatments.The reliability coefficient was 0.91. Item-to-total correlation indices were in most cases0.70. The correlation between the scores of the PROSQOLI and those of the SF-12 questionnaire was high (r=0.8139, p0.0001). The ANOVA test showed significant differences between groups (p0.01) based on age, recurrence risk and treatment.The adaptation process showed that the PROSQOLI Italian version has high reliability and presents both convergent and discriminant validity. This version of the tool can be used to assess HRQoL in Italian men who underwent radical treatment for advanced prostate cancer.

Objective: To assess the feasibility and safety of two novel methods for intravesical chemotherapy administration in patients suffering from superficial bladder carcinomas. To draw

— Thirty patients with benign prostatic hyperplasia and PSA levels > 10.0 ng/ml were submitted to open prostatectomy after a precise evaluation with transrectal ultrasound and prostatic biopsies. In the surgical specimen 7 prostatic carcinoma (23%) were found incidentally. In the remaining 23 patients the presence of active histological prostatitis was correlated with the PSA and PSA density values but was not directly due to an asymptomatic urinary infection or indwelling catheter. PIN and other pathological findings were not found to be correlated with PSA values.

— We report the results of a retrospective study of two groups of patients affected by locally advanced bladder cancer: the first group was submitted to adjuvant chemotherapy with Cisplatin and Methotrexate after cystectomy and the second group was submitted to neoadjuvant chemotherapy with the same scheme following radical cystectomy. The validity of the study is given by the homogeneity of the two groups for period of recruitment, number of patients, patient's age, stage of disease and treatment. The overall survival of 5 years in the first group was 30%, while the 5-year survival rate of the second group was 38%, 63% and 17% for all the patients, the responders and the nonresponders respectively. No significant difference in terms of survival was found between the two groups, but the results of the neoadjuvant approach may be influenced by clinical staging errors. The chemosensitivity, that can be assessed only with the neoadjuvant treatment, is the main prognostic factor.

The increasing incidence of prostate cancer is manly due to the improvement of systematic transrectal ultrasound-guided prostate biopsy techniques. The objective of this review is to analyze the different approaches and the most common schemes used to perform prostate biopsy, the role of the anesthetic procedures, of the complementary imaging methods and the histological evaluation of the biopsy results. The actual indications to perform prostate biopsy have been also critically reviewed. We performed a review of the literature by searching Medline Database with the following key words: prostate cancer, diagnosis, trans-rectal ultrasound (TRUS), prostate biopsy, anaesthesia and prognosis. Prostate biopsy is always performed under transrectal ultrasound guidance with both transrectal and transperineal approach, with a minimal core number of 10. The extended protocols include lateral peripheral zone cores and cores from lesions found on palpation or imaging. Saturation biopsies should be performed only in case of repeat biopsies. The refinement of effective local anesthesia has allowed to increase the number of biopsies without important side effects. Complementary imaging methods might be adopted in order to reduce the number of unnecessary procedures .The histological issues related to the number and the location of cores are still matter of debate as important prognostic factors. According to international guidelines, the factors most involved in performing prostate biopsy still include suspicious digital rectal examination and PSA. Both the transrectal and the transperineal approach in prostatic biopsy are valid in term of detection rate and low incidence of side effects. The initial biopsy scheme in mainly extended, saturation biopsy has to be considered only in the repeat setting, with the eventual help of the complementary imaging methods. The histological issues has to be considered about patient's prognosis.

The widespread acceptance of prostate-specific antigen (PSA) measurement as an early detection method for prostate cancer (Pca), coupled with the recent heightened public awareness of Pca as a common disease, has led to an increase in the detection of Pca. It has been established that digital rectal examination (DRE) and PSA are the most useful front-line methods for assessing an individual's risk of Pca. In addition to an elevated PSA above 4 ng/mL and an abnormal DRE, the decision to proceed with TRUS-guided biopsy may also be supported by other factors. Determining the presence of a significant rise in PSA between tests, whether the degree of PSA is concordant with the size of the prostate, and age appropriate PSA may aid in the interpretation of this risk. Grayscale transrectal ultrasound (TRUS) has been established as the first choice imaging technique making it possible to take biopsies, measure the volume and obtain a general overview of the prostate. To improve, however, the TRUS detection rate of Pca, many ultrasonographic technique improvements have been introduced and continuously evaluated. As for prostate biopsy, in the prostate with visible lesions, lesion-guided biopsies only play a role in combination with systematic biopsies, while the systematic prostate biopsy scheme should at the present time include 10 or 12 cores according to prostatic weight. The other imaging techniques actually play a marginal role in Pca detection, but may be useful for staging newly diagnosed Pca or in patient re-staging in case of biochemical failure after radical treatment.

The screening programs for prostate cancer will affect a number increasing of patients over 50 years with consequence rising the bioptic demand. Nevertheless the istopathologic results are negatives for carcinoma in the most part of patients. It's evident that a part of carcinomas are lost at biopsy. Two hundred four patients where submitted at second bioptic session after a maximum of 12 months. Our results show a percent probability of positive findings in 12%. In 75% cancer diagnosed in that second session had clinically significance. Prostate specific antigen (PSA) value, in our study, is the most positive predictive parameter for prostate cancer at second biopsy. Patients with PSA10 ng/ml have a risk 7 times greater of having a prostatic cancer respect to patients with PSA10 ng/ml. PSA density, PSA velocity and the presence of ipoecoic areas previously biopsied, aren't risk factors for detection of prostate cancer at second bioptic session.

The screening programs for prostate cancer will affect a number increasing of patients over 50 years with consequence rising the bioptic demand. For these reason it's important to know the real morbidity correlate with these widespread diagnostic method that will know a larger use in the future. Our study involve 1.467 patients with median age of 66.7 years (range 45-93). Forty-five were diabetics, 80 took a chronic anti-aggregant salicylic therapy, 25 took a chronic coumarolic anticoagulation therapy, 54 had a recent history of prostatitis. Our major complication rate was 0.7% of patients requesting hospital admission and care. An intermediate category of complications was considered, with complication rate of 6.9% and indication for out-patient treatment. Minor complication rate was 76% without need of therapy. In spite of high number of biopsies per patient, our major complication rate is similar of that demonstrate from other authors. In conclusion, whole complication rate is high, but the incidence of major complications is very low. The complications that need out-patient treatment are limited and acceptable.

Nowadays, the minimally invasive treatment of symptomatic renal cyst has been progressively gaining wide acceptance while classic open surgery has been almost abandoned. It is a still controversial which minimally invasive approach provides the major advantages and results. Fifty-two patients with symptomatic simple renal cyst underwent ultrasound guided percutaneous drainage and sclerotherapy (ethanol 95 degrees) and 20 patients underwent laparoscopic unroofing of simple renal cysts in our department. No major complication was recorded with both the techniques. Even if we reported a higher recurrence rate (82%) with sclerotherapy than that with laparoscopic treatment (5%) we consider the percutaneous drainage a valid approach because it is a safe, easy and at low cost procedure.

The treatment of T1 G3 bladder cancer is still an issue surrounded by much conflict. TUR of the bladder tumor as single treatment is considered not valid to be successful. TUR associated with intravescical chemotherapy or, even better, local immunotherapy may be the treatment of first choice in monocentric cancer, while radical cystectomy is, at the moment, the treatment of first choice in pluricentric or Cis associated T1 G3 bladder cancer. Since 1980, 25 patients with transitional T1 G3 bladder cancer have been observed in our department. Thirteen patients had a pluricentric disease while the remaining 12 cases had a monocentric bladder cancer. 92% of the patients (12/13) with a monocentric lesion and treated with TUR and local chemotherapy (Doxorubicin or BCG) are disease free after an average follow up of 34 Months (range 12-60 months). While 100% patients with a pluricentric cancer and treated with cystectomy are disease free after an average follow-up of 37 months (range 12-122 months); the 4 remaining cases with a pluricentric bladder lesion who refused cystectomy experienced a relapse of the disease after a follow-up of 19 months (range 9-27 months) and, despite surgery, they died within 12 months.

The angiomyolipoma is a rare tumor of the kidney with benign clinical evolution which can be found in more than half of the female patients with tuberous sclerosis. An uncommon case of renal angiomyolipoma with extracapsular extension, inter-aortocaval lymph node involvement and pulmonary lymphangiomyomatosis with a clinical history of spontaneous recurrent pneumothorax but without the neurological signs of the tuberous sclerosis, is described. The natural history of this disease which has various clinical forms of presentations is still unclear. The role of the lymph-node dissection in the surgical treatment of this tumor is discussed.

Aim In men with a negative first biopsy but persistent suspicion of PCa, the AUA and EAU recommend to repeat a biopsy. Repeat biopsies are negative in approximately 80% of men and they may be associated with economic costs, anxiety, discomfort, and sometime severe complications. The aim of this study was to determine the performance characteristics and clinical utility of the isoform [-2]proPSA and its derivates in detecting PCa in men scheduled for repeat biopsy . Material & Methods: This study was an observational prospective evaluation of a cohort of men with one or two previous negative prostate biopsies, with persistent suspicion of PCa (suspected DRE, elevated tPSA and or low %fPSA) who were scheduled for repeat biopsy. Men receiving medical therapy known to affect serum PSA (dutasteride and finasteride), suffering from prostatitis and having had invasive treatment for benign prostatic hyperplasia (BPH), such as TURP or HoLEP, were excluded. The primary endpoint was to determine the diagnostic accuracy of %p2PSA ⎨[(p2PSA pg/mL)/(fPSA ng/ml x 1000)]x100⎬ and Beckman-Coulter PHI [(p2PSA/fPSA) x √tPSA)] (index tests), and to compare it with the accuracy of established PCa serum tests (tPSA, fPSA and %fPSA) (reference standard tests). Multivariable logistic regression models, fitted for the prediction of the presence of PCa, were complemented by predictive accuracy analysis (ROC curves). All the patients underwent ambulatory repeated TRUS-guided prostate biopsies (18-22 cores). .

Impotence following transurethral prostatectomy is one of the main complications that still has a controversial origin. Many authors, reporting their experience, have demonstrated that this complication is due both to psychological problems and to organic causes. We review retrospectively 68 patients submitted to TURP. All patients (53 to 65 years old) were asked about their sexual efficiency before and after TURP, 6-12 months after surgery. Those who complained of erectile failure have been studied using this diagnostic protocol: plasmatic dosage of FSH, LH, Testosterone and Prolactin; penile Doppler ultrasound, polysomnographic recording of nocturnal tumescence test (NPT Test); angiography of the pudenda arteries has been performed in only one patient with pathological penile Doppler ultrasound (IPP0.7). The examinations demonstrated an organic impotence not secondary to vascular damage in 10 patients following surgery (incidence 15.6%). Our high incidence of this complication is, according to us, significant even if it should be considered in excess since in our study we used anamnestic criteria alone in the evaluation of sexual efficiency before surgery. In 1984 T. Lue demonstrated, through accurate histological preparations, that cavernous nerves run contiguously to the prostatic capsule at 5 and 7 hours in correspondence of the glandular apex. He suggested that impotence following TURP is due to iatrogenic lesions of these nervous structures during endoscopic resection. Similarly, we have conducted an anatomopathological study on prostate specimens taken from autopsies. We demonstrated the presence of nervous structure contiguously to the prostatic capsule in correspondence with the glandular apex. Thus, impotence following TURP probably occurs after an iatrogenic heat lesion of the periprostatic plexus caused by resection.(ABSTRACT TRUNCATED AT 250 WORDS)

From June 1986 to December 1994 29 patients (pts) with metastatic bladder carcinoma were treated with CMV regimen as originally reported by Harker et al. , J Clin Oncol 1985. Eight out of 29 pts were treated with CBDCA instead of CDDP with dose ranging from 200 to 300 mg/m 2 because of a pre-existing nephropaty, primary or due to the neoplasm (e.g. from pelvic masses). We retrospectively evaluated responses rate, CR duration and survival from the beginning of treatment. Patient's characteristics in CDDP group were: median age 66 yr (48–79), PS ECOG 0–1, median follow-up 69 mos (6–107); in CBDCA group: median age 65yr (60–71), PS ECOG 0–1, median follow-up 38 mos (26–51). In CDDP group 10 pts (48%) achieved an objective response, with 6 CR (29%) and 4 PR (19%), while in CBDCA group 3 pts (37%) showed an objective response with 2 CR and 1 PR. The median duration of CR was 30.5 mos in CDDP pts and 19 mos in CBDCA group, while the median survivals from the beginning of CT were 12 and 10.5 mos respectively. Two pts who received CDDP are still alive and free front relapse at 67 and 69 months. Toxicities ≥3 WHO in CDDP group: neutropenia in 3, piastrinopenia in 2, anemia in 2 and gastroenteric toxicity in 4; in CBDCA group: neutropenia in 3, anemia in 1 and gastroenteric toxicity in 1; no piastrinopania G3–G4 was observed Conclusions Our results confirm the previous reports and the efficacy of CMV regimen in metastatic bladder cancer, the regimens containing CBDCA are slightly less effective.

The only available method to detect prostate cancer is prostate biopsy; however, to our knowledge, no evidence-based clinical practice guidelines have been established on this topic.A three-year project was elaborated in which experts in the field worked to define the controversies existing in clinical practice regarding prostatic biopsies and then to develop guidelines by means of a systematic search of all the English-language literature using online databases and a consensus conference.The guidelines were formulated to help practitioners in making clinical decisions regarding the appropriate time the patient should undergo prostate biopsy, the type of antibiotic prophylaxis and anaesthesia, the biopsy approach, the method for processing and reporting prostatic needle cores, the biopsy technique, when to repeat a biopsy after a prior negative biopsy, radiotherapy or radical prostatectomy and the accuracy of biopsies in staging prostate cancer.

11 C-CHOLINE-PET/CT FOR PREOPERATIVE N-STAGING IN HIGH RISK PROSTATE CANCER