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1. Transrectal Prostate Biopsy Approach in Men Undergoing Kidney Transplant: A Retrospective Cohort Study at Three Referral Academic Centers.

Author

Dell'Atti, Lucio, Slyusar, Viktoria, Ronchi, Piero, Manno, Stefano, and Cambise, Chiara

Subjects
*ENDORECTAL ultrasonography, *PROSTATE biopsy, *KIDNEY transplantation, *COHORT analysis, *RETENTION of urine, *RETROSPECTIVE studies
Abstract

Background: Currently, there are no studies evaluating the feasibility of a prostate biopsy approach in men undergoing a kidney transplant (KT). Owing to this evidence, we planned a retrospective population-based study to evaluate our experience of a transrectal prostate biopsy (TR-PB) approach and studied the impact on the complication rate and outcomes in patients undergoing KT with suspected prostate cancer (PCa). Methods: We collected data from KT patients who underwent PB with a transrectal approach. One week and two weeks after the PB, patients' information was collected regarding possible complications during the post-biopsy period. Results: A total of 121 patients were included in this study. Among them, Group 1 was composed of 59 patients undergoing TR-PB with an ultrasound (US) standard technique, and Group 2 consisted of 62 patients undergoing TR-PB with an MRI-US cognitive technique. We observed a 28.9% Clavien–Dindo grade ≤ 2 of early side effect rates (mostly rectal bleeding and other minor hematuria), with a very low rate of hospital re-admission for acute urinary retention (3.3%); only one man required hospitalization for rectal bleeding, and there were no major complications. Conclusions: We can affirm that TR-PB can be a safe procedure with a low risk of severe complications when performed by skilled specialists with a standardized procedural pathway. [ABSTRACT FROM AUTHOR]

Published
2024
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4. The IDENTIFY Study: The Investigation and Detection of Urological Neoplasia in Patients Referred with Suspected Urinary Tract Cancer; A multicentre observational study

Author

Khadhouri, Sinan, Gallagher, Kevin M., MacKenzie, Kenneth R., Shah, Taimur T., Gao, Chuanyu, Moore, Sacha, Zimmermann, Eleanor F., Edison, Eric, Jefferies, Matthew, Nambiar, Arjun, Mannas, Miles P., Lee, Taeweon, Marra, Giancarlo, Lillaz, Beatrice, Gómez Rivas, Juan, Olivier, Jonathan, Assmus, Mark A., Uçar, Taha, Claps, Francesco, Boltri, Matteo, Burnhope, Tara, Nkwam, Nkwam, Tanasescu, George, Boxall, Nicholas E., Downey, Alison P., Lal, Asim A, Antón-Juanilla, Marta, Clarke, Holly, Lau, David H. W., Gillams, Kathryn, Crockett, Matthew, Nielsen, Matthew, Takwoingi, Yemisi, Chuchu, Naomi, O'Rourke, John, MacLennan, Graeme, McGrath, John S., Kasivisvanathan, Veeru, Chaudry, Aasem, Sharma, Abhishek, Bennett, Adam, Ahmad, Adnan, Abroaf, Ahmed, Suliman, Ahmed M, Lloyd, Aimee, McKay, Alastair, Wong, Albert, Silva, Alberto, Schneider, Alexandre, MacKay, Alison, Knight, Allen, Grigorakis, Alkiviadis, Bdesha, Amar, Nagle, Amy, Cebola, Ana, Dhanasekaran, Ananda Kumar, Kond?a, Andra?, Barcelos, André, Galosi, Andrea B, Ebur, Andrea, Minervini, Andrea, Russell, Andrew, Webb, Andrew, García de Jalón, Ángel, Desai, Ankit, Czech, Anna K, Mainwaring, Anna, Adimonye, Anthony, Das, Arighno, Figueiredo, Arnaldo, Villers, Arnauld, Leminski, Artur, Chippagiri, Arvinda, Y?ld?r?m, As?f, Voulgaris, Athanasios M, Uzan, Audrey, Oo, Aye Moh Moh, Younis, Ayman, Zelhof, Bachar, Mukhtar, Bashir, Ayres, Ben, Challacombe, Ben, Sherwood, Benedict, Ristau, Benjamin, Lai, Billy, Nellensteijn, Brechtje, Schreiter, Brielle, Trombetta, Carlo, Dowling, Catherine, Hobbs, Catherine, Benitez, Cayo Augusto Estigarribia, Lebacle, Cédric, Ho, Cherrie Wing Yin, Ng, ChiFai, Mount, Chloe, Lam, Chon Meng, Blick, Chris, Brown, Christian, Gallegos, Christopher, Higgs, Claire, Browne, Clíodhna, McCann, Conor, Alonso, Cristina Plaza, Beder, Daniel, Cohen, Daniel, Gordon, Daniel, Wilby, Daniel, Gordon, Danny, Lau, David Hua Wu, Hrouda, David, Karsza, Dávid, Mak, David, Martin-Way, David, Suthaharan, Denula, Patel, Dhruv, Carrion, Diego M, Nyanhongo, Donald, Bass, Edward, Mains, Edward, Chau, Edwin, Castillo, Elba Canelon, Day, Elizabeth, Desouky, Elsayed, Gaines, Emily, Papworth, Emma, Yuruk, Emrah, Kilic, Enes, Dinneen, Eoin, Palagonia, Erika, Xylinas, Evanguelos, Khawaja, Faizan, Cimarra, Fernando, Bardet, Florian, Kum, Francesca, Peters, Francesca, Kovács, Gábor, Tanasescu, Geroge, Hellawell, Giles, Tasso, Giovanni, Lam, Gitte, La Montagna, Giuseppe, Pizzuto, Giuseppe, Lenart, Gordan, Özgür, Günal, Bi, Hai, Lyons, Hannah, Warren, Hannah, Ahmed, Hashim, Simpson, Helen, Burden, Helena, Gresty, Helena, Pita, Hernado Rios, Serag, Hosam, Kynaston, Howard, Crawford-Smith, Hugh, Mostafid, Hugh, Otaola-Arca, Hugo, Fen Koo, Hui, Ibrahim, Ibrahim, Ouzaid, Idir, Puche-Sanz, Ignacio, Tomakovi, Igor, Tinay, Ilker, Sahibzada, Iqbal, Thangasamy, Isaac, Cadena, Iván Revelo, Irani, Jacques, Udzik, Jakub, Brittain, James, Catto, James, Green, James, Tweedle, James, Hernando, Jamie Borrego, Leask, Jamie, Kalsi, Jas, Frankel, Jason, Toniolo, Jason, Raman, Jay D, Courcier, Jean, Kumaradeevan, Jeevan, Clark, Jennifer, Jones, Jennifer, Teoh, Jeremy YuenChun, Iacovou, John, Kelly, John, Selph, John P, Aning, Jonathan, Deeks, Jon, Maw, Jonny, Herranz-Yagüe, José Antonio, Nolazco, Jose Ignacio, Cózar-Olmo, Jose Manuel, Bagley, Joseph, Jelski, Joseph, Norris, Joseph, Testa, Joseph, Meeks, Joshua, Hernandez, Juan, Vásquez, Juan Luis, Randhawa, Karen, Dhera, Karishma, Gronostaj, Katarzyna, Houlton, Kathleen, Lehman, Kathleen, Adasonla, Kelvin, Brown, Kevin, Murtagh, Kevin, Mistry, Kiki, Davenport, Kim, Kitamura, Kosuke, Derbyshire, Laura, Clarke, Laurence, Morton, Lawrie, Martinez, Levin, Goldsmith, Louise, Paramore, Louise, Cormier, Luc, Dell'Atti, Lucio, Simmons, Lucy, Martinez-Piñeiro, Luis, Rico, Luis, Chan, Luke, Forster, Luke, Ma, Lulin, Moore, Madeline, Gallego, Maria Camacho, Freire, Maria José, Emberton, Mark, Feneley, Mark, Rivero, Marta Viridiana Muñoz, Pira, Matea, Tallè, Matteo, Liew, Matthew, Trail, Matthew, Cooper, Meghan, Kulkarni, Meghana, Ager, Michael, He, Ming, Li, Mo, Omran Breish, Mohamed, Tarin, Mohamed, Aldiwani, Mohammed, Matanhelia, Mudit, Pasha, Muhammad, Akaln, Mustafa Kaan, Abdullah, Nasreen, Hale, Nathan, Gadiyar, Neha, Kocher, Neil, Bullock, Nicholas, Campain, Nicholas, Pavan, Nicola, Al?Ibraheem, Nihad, Bhatt, Nikita, Bedi, Nishant, Shrotri, Nitin, Lobo, Niyati, Balderas, Olga, Kouli, Omar, Capoun, Otakar, Manjavacas, Pablo Oteo, Gontero, Paolo, Mariappan, Paramananthan, Marchiñena, Patricio Garcia, Erotocritou, Paul, Sweeney, Paul, Planelles, Paula, Acher, Peter, Black, Peter C, Osei?Bonsu, Peter K, Østergren, Peter, Smith, Peter, Willemse, Peter-Paul Michiel, Chlosta, Piotr L, Ul Ain, Qurrat, Barratt, Rachel, Esler, Rachel, Khalid, Raihan, Hsu, Ray, Stamirowski, Remigiusz, Mangat, Reshma, Cruz, Ricardo, Ellis, Ricky, Adams, Robert, Hessell, Robert, Oomen, Robert J.A., McConkey, Robert, Ritchie, Robert, Jarimba, Roberto, Chahal, Rohit, Andres, Rosado Mario, Hawkins, Rosalyn, David, Rotimi, Manecksha, Rustom P, Agrawal, Sachin, Hamid, Syed Sami, Deem, Samuel, Goonewardene, Sanchia, Swami, Satchi Kuchibhotla, Hori, Satoshi, Khan, Shahid, Inder, Shakeel Mohammud, Sangaralingam, Shanthi, Marathe, Shekhar, Raveenthiran, Sheliyan, Horie, Shigeo, Sengupta, Shomik, Parson, Sian, Parker, Sidney, Hawlina, Simon, Williams, Simon, Mazzoli, Simone, Kata, Slawomir Grzegorz, Lopes, Sofia Pinheiro, Ramos, Sónia, Rai, Sonpreet, Rintoul-Hoad, Sophie, O'Meara, Sorcha, Morris, Steve, Turner, Stacey, Venturini, Stefano, Almpanis, Stephanos, Joniau, Steven, Jain, Sunjay, Mallett, Susan, Nikles, Sven, Yan, Shahzad Sylvia, Drake, Tamsin, Toma, Tarq, Plo, Teresa Cabañuz, Bonnin, Thierry, Muilwijk, Tim, Wollin, Tim, Chu, Timothy Shun Man, Appanna, Timson, Brophy, Tom, Ellul, Tom, Austin, Tomas, Smrkolj, Toma, Rowe, Tracey, Sukhu, Troy, Patel, Trushar, Garg, Tullika, Çakurlu, Turhan, Bele, Uros, Haroon, Usman, Crespo-Atín, Víctor, Cortes, Victor Parejo, Poves, Victoria Capapé, Gnanapragasam, Vincent, Gauhar, Vineet, During, Vinnie, Kumar, Vivek, Fiala, Vojtech, Mahmalji, Wasim, Lam, Wayne, Chin, Yew Fung, Filtekin, Yigit, Phan, Yih Chyn, Ibrahim, Youssed, Glaser, Zachary A, Adwin, Zainal, Qin, Zijian, Zotter, Zsuzsanna, Zainuddin, Zulkifli, Khadhouri, Sinan, Gallagher, Kevin M, Mackenzie, Kenneth R, Shah, Taimur T, Gao, Chuanyu, Moore, Sacha, Zimmermann, Eleanor F, Edison, Eric, Jefferies, Matthew, Nambiar, Arjun, Mannas, Miles P, Lee, Taeweon, Marra, Giancarlo, Lillaz, Beatrice, Gómez Rivas, Juan, Olivier, Jonathan, Assmus, Mark A, Uçar, Taha, Claps, Francesco, Boltri, Matteo, Burnhope, Tara, Nkwam, Nkwam, Tanasescu, George, Boxall, Nicholas E, Downey, Alison P, Lal, Asim Ahmed, Antón-Juanilla, Marta, Clarke, Holly, Hw Lau, David, Gillams, Kathryn, Crockett, Matthew, Nielsen, Matthew, Takwoingi, Yemisi, Chuchu, Naomi, O'Rourke, John, Maclennan, Graeme, Mcgrath, John S, Kasivisvanathan, Veeru, Khadhouri, Sinan [0000-0002-1836-8992], Moore, Sacha [0000-0002-0914-2051], Gómez Rivas, Juan [0000-0002-0556-3035], Olivier, Jonathan [0000-0002-5409-2911], Assmus, Mark A [0000-0003-3615-9251], Claps, Francesco [0000-0003-2812-5553], Nkwam, Nkwam [0000-0003-1086-6388], and Apollo - University of Cambridge Repository

Subjects
Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, Male, =+16+years%2C+referred+to+secondary+care+with+suspected+urinary+tract+cancer%2E+Patients+with+a+known+or+previous+urological+malignancy+were+excluded%2E+We+estimated+the+prevalence+of+bladder+cancer%2C+UTUC%2C+renal+cancer+and+prostate+cancer%22">Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged >= 16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer, stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05, P < 0.001), visible haematuria 3.47 (95% CI 2.90-4.15, P < 0.001), male sex 1.30 (95% CI 1.14-1.50, P < 0.001), and smoking 2.70 (95% CI 2.30-3.18, P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer, renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), bladder cancer, cancer prevalence, haematuria, hematuria, prostate cancer, renal cancer, upper tract urothelial cancer, urinary tract cancer, Adult, Aged, Female, Hematuria, Humans, Kidney Neoplasms, Middle Aged, Prospective Studies, Referral and Consultation, Ureteral Neoplasms, Urinary Bladder Neoplasms, Disease, urologic and male genital diseases, Prostate cancer, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, =+16+years%22">adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged >= 16 years, Medicine, bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, education.field_of_study, and smoking 2.70 (95% CI 2.30-3.18, stratified by age, female genital diseases and pregnancy complications, renal cancer and prostate cancer, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer, age 1.04 (95% CI 1.03-1.05 [stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were], UTUC (n = 128) 1.14% (95% CI 0.77-1.52), 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), visible haematuria 3.47 (95% CI 2.90-4.15, type of haematuria, P < 0.001), medicine.medical_specialty, Urology, Urinary system, Population, and countries. Results Of the 11 059 patients assessed for eligibility, Malignancy, smoking, UTUC, Internal medicine, sex, education, Bladder cancer, and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05, business.industry, Cancer, Odds ratio, medicine.disease, male sex 1.30 (95% CI 1.14-1.50, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, hospitals, business
Abstract

Funder: Action Bladder Cancer UK, Funder: Rosetrees Trust; Id: http://dx.doi.org/10.13039/501100000833, Funder: Urology Care Foundation; Id: http://dx.doi.org/10.13039/100006280, OBJECTIVE: To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. PATIENTS AND METHODS: This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. RESULTS: Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90-4.15; P < 0.001), male sex 1.30 (95% CI 1.14-1.50; P < 0.001), and smoking 2.70 (95% CI 2.30-3.18; P < 0.001). CONCLUSIONS: A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer.

Published
2021
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5. Detection of disease‐causing mutations in prostate cancer by NGS sequencing.

Author

Mangolini, Alessandra, Rocca, Christian, Bassi, Cristian, Ippolito, Carmelo, Negrini, Massimo, Dell'Atti, Lucio, Lanza, Giovanni, Gafà, Roberta, Bianchi, Nicoletta, Pinton, Paolo, and Aguiari, Gianluca

Subjects
SINGLE nucleotide polymorphisms, PROSTATE cancer, GENETIC mutation, WATCHFUL waiting, NUCLEOTIDE sequencing, DOCETAXEL
Abstract

Gene mutations may affect the fate of many tumors including prostate cancer (PCa); therefore, the research of specific mutations associated with tumor outcomes might help the urologist to identify the best therapy for PCa patients such as surgical resection, adjuvant therapy or active surveillance. Genomic DNA (gDNA) was extracted from 48 paraffin‐embedded PCa samples and normal paired tissues. Next, gDNA was amplified and analyzed by next‐generation sequencing (NGS) using a specific gene panel for PCa. Raw data were refined to exclude false‐positive mutations; thus, variants with coverage and frequency lower than 100× and 5%, respectively were removed. Mutation significance was processed by Genomic Evolutionary Rate Profiling, ClinVar, and Varsome tools. Most of 3000 mutations (80%) were single nucleotide variants and the remaining 20% indels. After raw data elaboration, 312 variants were selected. Most mutated genes were KMT2D (26.45%), FOXA1 (16.13%), ATM (15.81%), ZFHX3 (9.35%), TP53 (8.06%), and APC (5.48%). Hot spot mutations in FOXA1, ATM, ZFHX3, SPOP, and MED12 were also found. Truncating mutations of ATM, lesions lying in hot spot regions of SPOP and FOXA1 as well as mutations of TP53 correlated with poor prognosis. Importantly, we have also found some germline mutations associated with hereditary cancer‐predisposing syndrome. gDNA sequencing of 48 cancer tissues by NGS allowed to detect new tumor variants as well as confirmed lesions in genes linked to prostate cancer. Overall, somatic and germline mutations linked to good/poor prognosis could represent new prognostic tools to improve the management of PCa patients. [ABSTRACT FROM AUTHOR]

Published
2022
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6. Detection limits of significant prostate cancer using multiparametric MR and digital rectal examination in men with low serum PSA: Up-date of the Italian Society of Integrated Diagnostic in Urology.

Author

Galosi, Andrea B., Palagonia, Erika, Scarcella, Simone, Cimadamore, Alessia, Lacetera, Vito, Delle Fave, Rocco F., Antezza, Angelo, and Dell’Atti, Lucio

Subjects
DIGITAL rectal examination, PROSTATE-specific antigen, PROSTATE cancer, DETECTION limit, UROLOGY
Abstract

Reasons why significant prostate cancer is still missed in early stage were investigated at the 22nd National SIEUN (Italian Society of integrated diagnostic in Urology, Andrology, Nephrology) congress took place from 30th November to 1st December 2020, in virtual modality. Even if multiparametric magnetic resonance (MR) has been introduced in the clinical practice several, limitations are emerging in patient with regular digital rectal examination (DRE) and serum prostate specific antigen (PSA) levels approaching the normal limits. The present paper summarizes highlights observed in those cases where significant prostate cancer may be missed by PSA or imaging and DRE. The issue of multidisciplinary interest had been subdivided and deepened under four main topics: biochemical, clinical, pathological and radiological point of view with a focus on PI-RADS 3 lesions. [ABSTRACT FROM AUTHOR]

Published
2021
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7. The role of the serum testosterone levels as a predictor of prostate cancer in patients with atypical small acinar proliferation at the first prostate biopsy.

Author

Dell’Atti, Lucio and Galosi, Andrea B.

Abstract

The current literature does not support the usefulness of clinical markers on predicting which patients with atypical small acinar proliferation (ASAP) are more likely to progress to prostate cancer (PCa). Androgens have long been considered to be the potential risk factors for PCa. However, the role of testosterone is controversial. The present study aims to analyze the relationship between serum testosterone (TS) levels and the diagnosis of PCa after a first prostate biopsy in patients affected by ASAP. This retrospective study included 143 patients diagnosed with ASAP in an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa according to the European Association of Urology guidelines. Their TS levels, age, PSA, prostate volume, digital rectal examination, and prostate biopsy Gleason score (GS) were collected retrospectively for statistical analysis. All patients included in the study had a second biopsy and were suitable for further analysis. Re-biopsy was carried out 3-6 months after the first diagnosis of ASAP. Low and normal TS groups were composed of 29 (20.3%) and 114 (79.7%) patients, respectively. The diagnosis of the second biopsy was ASAP in 25.2% and PCa in 36.4% of patients. The comparison between patients with PCa and those with negative or an ASAP result in the second biopsy reported that men with cancer had significantly higher levels of TS (P < 0.001). However, there was no statistically significant association between GS postbiopsy and TS (P = 0.324). Our experience demonstrated that eugonadal patients may be a clinical risk factor for the diagnosis of PCa on re-biopsy after ASAP diagnosis than hypogonadal. [ABSTRACT FROM AUTHOR]

Published
2018
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8. Safety of transrectal ultrasound-guided prostate biopsy in patients affected by Crohn's disease.

Author

Dell'Atti, Lucio and Benedetto Galosi, Andrea

Subjects
*CROHN'S disease, *INFLAMMATION, *GASTROINTESTINAL system, *PROSTATE biopsy, *ENEMA
Abstract

Purpose: Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract. It is usually considered a contraindication to transrectal ultrasound-guided prostate biopsy (TRUSBx). The aim of this study was to investigate the safety of TRUSBx in a small cohort of patients with CD. Methods: We queried our institutional database clinical data of patients with a diagnosis of CD undergoing TRUSBx, and a retrospective prospective study of 5 patients was planned. All patients enrolled were in the remission phase of CD and asymptomatic. They received the same antibiotic prophylaxis and a povidone-iodine aqueous solution enema before the procedure. A standardized reproducible technique was used with using a ultrasound machine equipped with a 5-9 MHz multi-frequency convex probe "end-fire". The patients were treated under local anaesthesia, and a 14-core biopsy scheme was performed in each patient as first intention. After the procedure each patient was given a verbal numeric pain scale to evaluate tolerability of TRUSBx. Results: TRUSBx was successfully completed in all patients. The number of biopsy cores was 14 (12-16). Of the 5 biopsy procedures performed 40% revealed prostatic carcinoma (PCa) with a Gleason score 6 (3+3). No patients required catheterization or admission to the hospital for adverse events after the procedure. The most frequent adverse event was hematospermia (60%), while hematuria was present in 20% of patients and a minimal rectal bleeding in 20% of the patients. No patients reported severe or unbearable pain (score ≥ 8). Conclusions: This study suggests that CD may not be an absolute contraindication to TRUSBx for prostate cancer detection, but still requires a careful patients selection. [ABSTRACT FROM AUTHOR]

Published
2017
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9. Ultrasound analysis of seminal vesicles in prostate cancer invasion: monocentric experience of an extended prostate biopsy scheme.

Author

Dell'Atti, Lucio and Galosi, Andrea

Subjects
*ULTRASONIC imaging, *PROSTATE cancer, *SEMINAL vesicles, *BIOPSY, *ENDORECTAL ultrasonography
Abstract

Purpose: At present, uniformity does not exist with regard to the indication criteria of seminal vesicle (SV) biopsies. The aim of this study was to define the ultrasonographic (US) patterns observed in SV invaded by prostate cancer (PCa), and propose an extended prostate biopsy protocol when SV invasion (SVI) is suspected. Methods: We reviewed 1.252 patients who underwent an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa. We performed a 14-core biopsy scheme, as first intention, including 1 SV sample on each side when SVI is suspected: a nodule at the base of prostate (determined by digital rectal examination or US) and/or an US pattern that suggests a SVI. US patterns of SVs were classified as abnormal by a variation of the body anterior-posterior diameter, asymmetry of the volume, parietal thickness, distance between the SVs and the rectal surface, and altered echogenicity of SVs and the base of the prostate. Results: Of the 137 biopsies performed in SVs, the SVI by PCa was diagnosed in 66.5% of candidate patients. The overall prevalence of SVI was 28.5%. No significant difference was noted between the patients with SVI and without SVI, when comparing age, prostate volume, and total core length, except for preoperative PSA serum levels. The sensitivity of any abnormal finding on transrectal ultrasound for the presence of SVI by PCa is 90.8%, whereas the specificity is 96%. Conclusions: We believe that an extended prostate biopsy protocol to provide the possibility of taking one biopsy core of each SV when SVI is suspected should be considered a complementary procedure for PCa staging. [ABSTRACT FROM AUTHOR]

Published
2017
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10. Prostatic calculi detected in peripheral zone of the gland during a transrectal ultrasound biopsy can be significant predictors of prostate cancer.

Author

Dell'Atti, Lucio, Galosi, Andrea B., and Ippolito, Carmelo

Subjects
*CALCULI, *PROSTATE cancer, *INFLAMMATION, *DISEASE risk factors, *ENDORECTAL ultrasonography, *PROSTATE hypertrophy
Abstract

Purpose: Prostatic calculi (PC) are usually associated with benign prostatic hyperplasia or chronic inflammation. However, in several studies prostatic inflammation and calcification have been implicated in the pathogenesis of prostate cancer (CaP). We evaluated the prevalence of PC during transrectal ultrasound (TRUS) and correlate the ultrasonographic patterns with histological findings. Methods: A prospective study of 664 patients undergoing TRUS and prostate biopsy was planned. A standardized reproducible technique was used with using a GE Logiq 7 machine equipped with a 5-9MHz multi-frequency convex probe "end-fire". We defined marked presence of PC as multiple hyperechoic foci with significant area (≥ 3 mm in the largest diameter). PC were classified according to zone distribution into the gland: transitional zone (TZ), central zone (CZ), and peripheral zone (PZ). Results: No significant difference was noted between the patients with PC and without PC, when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for DRE findings. 168 patients (25.3%) had marked presence of PC on TRUS: 50.6% in TZ, 20.2% in CZ, and 29.2% in PZ. 31 patients (63.3%) with presence of PC in PZ had CaP on biopsy. The correlation observed between CaP and the presence of PC in PZ was statistically significant (p < 0.001). However, among patients in the CaP group there was no statistical association between PC and moderate or high Gleason grade. Conclusions: This study suggests that chronic prostatic inflammation and PC have a role in the biogenesis of cancer. CaP was more frequent in patients with PC in PZ of the gland, but was not associated with higher Gleason grade among these patients (p < 0.001). [ABSTRACT FROM AUTHOR]

Published
2016
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11. The impact of core length on prostate cancer diagnosis during a standard 14-core prostate biopsy scheme.

Author

Dell'Atti, Lucio and Ippolito, Carmelo

Subjects
*PROSTATE cancer, *DIAGNOSIS, *PROSTATE biopsy, *PROSTATE-specific antigen, *ENDORECTAL ultrasonography, *MEDICAL records, *COHORT analysis
Abstract

Introduction: Even if many studies in the literature purposed to evaluate the improvement of the prostate biopsy (PBx), few studies assessed the diagnostic value of core length in PBx. In this study, we evaluated the length of needle cores sampled during transrectal PBx (TRUSBx) and its impact on cancer diagnosis in a standard 14-core scheme. Methods: Medical records of 573 patients who underwent an initial TRUSBx with 14-cores scheme for suspicious prostate cancer (PCa) at our Department were reviewed. The PBx procedure and pathological evaluation were standardized. Cores lengths were compared in patients with versus without cancer, and were divided into group A and B, respectively. Statistical analysis was done to define an acceptable cut-off for biopsy length. Results: The mean age of the entire cohort was 62.1 ± 7.2 years, while median total prostate-specific antigen (PSA) and prostate volume were 4.2 ng/ml and 44.7 ml, respectively. PCa was showed in 33.3% of patients. Mean core length in group A versus B was 11.9 ± 3.9 versus 11.1 ± 3.2 mm (p = 0.016). Thus, core lengths were significantly longer in patients with cancer. There were no statistically significant differences when we considered the whole length of cores sampled from the right lobe (p = 0.58) and left lobe (p = 0.34). Conclusions: The cancer detection rates in cores may be increased by core length in PCa patients during a TRUSBx. Our results suggest a core length of greater than 11.8 mm as a cut-off for quality warranty. [ABSTRACT FROM AUTHOR]

Published
2016
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12. Relevance of prostate cancer in patients with synchronous invasive bladder urothelial carcinoma: A monocentric retrospective analysis.

Author

Dell'Atti, Lucio

Subjects
*PROSTATE cancer, *PROSTATECTOMY, *BLADDER cancer, *DISEASE incidence, *GLEASON grading system, *FOLLOW-up studies (Medicine), *PROGNOSIS
Abstract

Objectives: We retrospectively reviewed data of patients with incidental prostate cancer (PCa) who underwent radical cystoprostatectomy (RCP) for invasive bladder cancer and we analyzed their features with regard to incidence, pathologic characteristics, clinical significance, and implications for management. Material and Methods: Clinical data and pathological features of 64 patients who underwent standard RCP for bladder cancer were included in this study. Besides the urothelial carcinoma of the urinary bladder, the location and tumor volume of the PCa, prostate apex involvement, Gleason score, pathological staging and surgical margins were evaluated. Clinically significant PCa was defined as a tumor with a Gleason 4 or 5 pattern, stage ⩾ pT3, lymph node involvement, positive surgical margin or multifocality of three or more lesions. Postoperative follow-up was scheduled every 3 months in the first year, every 6 months in the second and third year, annually thereafter. Results: 11 out of 64 patients (17.2%) who underwent RCP had incidentally diagnosed PCa. 3 cases (27.3%) were diagnosed as significant PCa, while 8 cases (72.7%) were clinically insignificant. The positive surgical margin of PCa was detected in 1 patient with significant disease. The prostate apex involvement was present in 1 patient of the significant PCa group. Median follow-up period was 47.8 ± 29.2 (range 4-79). During the follow-up, biochemical recurrence occurred in 1 patient (9%). Concernig the cancer specific survival there was no statistical significance (P = 0.326) between the clinically significant and clinical insignificant cancer group. Conclusions: In line with published studies, incidental PCa does not impact on the prognosis of bladder cancer of patients undergoing RCP. [ABSTRACT FROM AUTHOR]

Published
2015
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13. Lidocaine spray administration in transrectal ultrasoundguided prostate biopsy: Five years of experience.

Author

Dell'Atti, Lucio

Subjects
*LIDOCAINE, *RECTUM, *ULTRASONIC imaging, *PROSTATE cancer, *BIOPSY, *ANESTHESIA, *THERAPEUTICS
Abstract

Objectives: We report in this single-center study our results of a five-year experience in the administration of lidocaine spray (LS) during ultrasound-guided prostate biopsy (TPB). Material and Methods: Between August 2008 and July 2013 a total of 1022 consecutive male patients scheduled for TPB with elevate PSA (⩾ 4 ng/ml) and (or) abnormal digital rectal and (or) suspect TRUS were considered eligible for the study. Each patient was treated under local anaesthesia with LS (10 gr/100 ml), applied two minutes before the procedure. TPB was performed with the patient in the left lateral decubitus using multi-frequency convex probe "end-fire". Two experienced urologists performed a 14-core biopsy, as first intention. After the procedure each patient was given a verbal numeric pain scale (VNS). The evaluation was differentiated in two scales VNS: VNS 1 for the insertion of the probe and the manoeuvres associated, while VNS 2 only for the pain during needle's insertion. Results: Pain scores were not statistically significant different with regard to the values of PSA and prostate gland volume. Pain score levels during probe insertion and biopsy were significantly different: the mean pain score according to VNS was 3.3 (2-8) in the first questionnaire (VNS1) (p < 0.001) and 2.1 (1-7) in the second one (VNS2) (p < 0.125). The 8.2% of cases referred severe or unbearable pain (score ⩾ 7), 74% of patients referred no pain at all. Only 21 patients would not ever repeat the biopsy or would request a different type of anaesthesia, while 82% of them would repeat it in the same way. In only eight patients we have not been able to insert TRUS probe. Conclusions: Our pain score data suggest that LS provides efficient patient comfort during TPB reducing pain both during insertion of the probe and the needle. This non-infiltrative anaesthesia is safe, easy to administer, psychologically well accepted by patients and of low cost. [ABSTRACT FROM AUTHOR]

Published
2014
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14. Production of Serum-free and Total Prostate-specific Antigen Due to Prostatic Intraepithelial Neoplasia.

Author

Minardi, Daniele, Galosi, Andrea B., Dell'Atti, Lucio, Hanitzsch, Herbert, Mario, Polito, and Muzzonigro, Giovanni

Subjects
PROSTATE-specific antigen, PROSTATE cancer
Abstract

Objective: High serum total prostate-specific antigen (PSA) levels have proven to be predictive of concurrent cancer but the role of prostatic intraepithelial neoplasia (PIN) in the production of total (t) and free (f) PSA is still the subject of research. In this study we wanted to discover whether variations in serum fPSA and tPSA levels are caused by PIN. Material and Methods: We reviewed the medical records of 87 patients: in 32 of them the diagnosis of isolated PIN was made from surgical samples (simple prostatectomy, n = 19; radical cystectomy, n = 13); in 30 patients a diagnosis of benign prostatic hyperplasia (BPH) without PIN or prostatic carcinoma was made after simple prostatectomy (n = 20) or radical cystectomy (n = 10); and in 25 patients a clinically significant prostatic cancer was diagnosed and these patients underwent radical prostatectomy. All patients underwent a standard preoperative evaluation, including serum fPSA and tPSA determinations and PSA density. Results: The frequency of isolated PIN in simple prostatectomy specimens was 6.3%. The mean f/t PSA ratios were 17.66% in the 32 patients with PIN, 19.2% in the 8 patients with low-grade PIN, 17.6% in the 24 patients with high-grade PIN, 24.2% in patients with BPH and 13% in patients who underwent radical prostatectomy. Conclusions: We believe that to make a definitive diagnosis of isolated PIN without carcinoma, study of the whole prostate gland is necessary, in order to definitively exclude the presence of concurrent neoplastic foci. Our data show that PIN does not contribute to tPSA levels and density; however, it may be responsible for a slight reduction in the f/t PSA ratio, with a significant reduction in cases with high-grade PIN (17.6%) compared to those with BPH (24.2%). [ABSTRACT FROM AUTHOR]

Published
2002
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15. Importance of an early diagnosis in primary adenocarcinoma of the seminal vesicle.

Author

Dell'Atti, Lucio

Subjects
*SEMINAL vesicles, *DYSURIA, *CARCINOEMBRYONIC antigen
Abstract

The prognosis of seminal vesicle (SV) adenocarcinoma is often poor due to delayed diagnosis. About 95% of the patients die in less than 3 years. Diagnosis is difficult due to the absence of early clinical signs as hematuria, hematospermia and/or dysuria. We present the case of a 61-year-old Caucasian man with a left SV mass detected by transrectal ultrasound. SV ultrasound-guided biopsy showed an adenocarcinoma. The tumor was uniformly strongly immunoreactive for cytokeratin-7 and carcinoembryonic antigen. There was no immunoreactivity for prostate-specific acid phosphatase (PSAP) and CK-20. These tumors have been reported to be also positive for CA- 125. Therefore a combination of positive staining for CK-7, CEA and CA-125; with negative staining for CK-20, PSA and PSAP is the pattern of immunohistochemical findings noted for this rare tumor. The computed tomography of the abdomen-pelvis and chest X-ray was negative for metastases. The patient underwent a radical prostatectomy and lymphadenectomy. The prostate, rectum, bladder and lymph nodes were free from tumor involvement. The patient did not receive any adjuvant chemotherapy or radiation; and remains free of disease 3 years post-surgery. [ABSTRACT FROM AUTHOR]

Published
2016
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16. Developing a Diagnostic Multivariable Prediction Model for Urinary Tract Cancer in Patients Referred with Haematuria: Results from the IDENTIFY Collaborative Study

Author

Sinan Khadhouri, Kevin M. Gallagher, Kenneth R. MacKenzie, Taimur T. Shah, Chuanyu Gao, Sacha Moore, Eleanor F. Zimmermann, Eric Edison, Matthew Jefferies, Arjun Nambiar, Thineskrishna Anbarasan, Miles P. Mannas, Taeweon Lee, Giancarlo Marra, Juan Gómez Rivas, Gautier Marcq, Mark A. Assmus, Taha Uçar, Francesco Claps, Matteo Boltri, Giuseppe La Montagna, Tara Burnhope, Nkwam Nkwam, Tomas Austin, Nicholas E. Boxall, Alison P. Downey, Troy A. Sukhu, Marta Antón-Juanilla, Sonpreet Rai, Yew-Fung Chin, Madeline Moore, Tamsin Drake, James S.A. Green, Beatriz Goulao, Graeme MacLennan, Matthew Nielsen, John S. McGrath, Veeru Kasivisvanathan, Aasem Chaudry, Abhishek Sharma, Adam Bennett, Adnan Ahmad, Ahmed Abroaf, Ahmed Musa Suliman, Aimee Lloyd, Alastair McKay, Albert Wong, Alberto Silva, Alexandre Schneider, Alison MacKay, Allen Knight, Alkiviadis Grigorakis, Amar Bdesha, Amy Nagle, Ana Cebola, Ananda Kumar Dhanasekaran, Andraž Kondža, André Barcelos, Andrea Benedetto Galosi, Andrea Ebur, Andrea Minervini, Andrew Russell, Andrew Webb, Ángel García de Jalón, Ankit Desai, Anna Katarzyna Czech, Anna Mainwaring, Anthony Adimonye, Arighno Das, Arnaldo Figueiredo, Arnauld Villers, Artur Leminski, Arvinda Chippagiri, Asim Ahmed Lal, Asıf Yıldırım, Athanasios Marios Voulgaris, Audrey Uzan, Aye Moh Moh Oo, Ayman Younis, Bachar Zelhof, Bashir Mukhtar, Ben Ayres, Ben Challacombe, Benedict Sherwood, Benjamin Ristau, Billy Lai, Brechtje Nellensteijn, Brielle Schreiter, Carlo Trombetta, Catherine Dowling, Catherine Hobbs, Cayo Augusto Estigarribia Benitez, Cédric Lebacle, Cherrie Wing Yin Ho, Chi-Fai Ng, Chloe Mount, Chon Meng Lam, Chris Blick, Christian Brown, Christopher Gallegos, Claire Higgs, Clíodhna Browne, Conor McCann, Cristina Plaza Alonso, Daniel Beder, Daniel Cohen, Daniel Gordon, Daniel Wilby, Danny Gordon, David Hrouda, David Hua Wu Lau, Dávid Karsza, David Mak, David Martin-Way, Denula Suthaharan, Dhruv Patel, Diego M Carrion, Donald Nyanhongo, Edward Bass, Edward Mains, Edwin Chau, Elba Canelon Castillo, Elizabeth Day, Elsayed Desouky, Emily Gaines, Emma Papworth, Emrah Yuruk, Enes Kilic, Eoin Dinneen, Erika Palagonia, Evanguelos Xylinas, Faizan Khawaja, Fernando Cimarra, Florian Bardet, Francesca Kum, Francesca Peters, Gábor Kovács, Geroge Tanasescu, Giles Hellawell, Giovanni Tasso, Gitte Lam, Giuseppe Pizzuto, Gordan Lenart, Günal Özgür, Hai Bi, Hannah Lyons, Hannah Warren, Hashim Ahmed, Helen Simpson, Helena Burden, Helena Gresty, Hernado Rios Pita, Holly Clarke, Hosam Serag, Howard Kynaston, Hugh Crawford-Smith, Hugh Mostafid, Hugo Otaola-Arca, Hui Fen Koo, Ibrahim Ibrahim, Idir Ouzaid, Ignacio Puche-Sanz, Igor Tomašković, Ilker Tinay, Iqbal Sahibzada, Isaac Thangasamy, Iván Revelo Cadena, Jacques Irani, Jakub Udzik, James Brittain, James Catto, James Green, James Tweedle, Jamie Borrego Hernando, Jamie Leask, Jas Kalsi, Jason Frankel, Jason Toniolo, Jay D. Raman, Jean Courcier, Jeevan Kumaradeevan, Jennifer Clark, Jennifer Jones, Jeremy Yuen-Chun Teoh, John Iacovou, John Kelly, John P. Selph, Jonathan Aning, Jon Deeks, Jonathan Cobley, Jonathan Olivier, Jonny Maw, José Antonio Herranz-Yagüe, Jose Ignacio Nolazco, Jose Manuel Cózar-Olmo, Joseph Bagley, Joseph Jelski, Joseph Norris, Joseph Testa, Joshua Meeks, Juan Hernandez, Juan Luis Vásquez, Karen Randhawa, Karishma Dhera, Katarzyna Gronostaj, Kathleen Houlton, Kathleen Lehman, Kathryn Gillams, Kelvin Adasonla, Kevin Brown, Kevin Murtagh, Kiki Mistry, Kim Davenport, Kosuke Kitamura, Laura Derbyshire, Laurence Clarke, Lawrie Morton, Levin Martinez, Louise Goldsmith, Louise Paramore, Luc Cormier, Lucio Dell'Atti, Lucy Simmons, Luis Martinez-Piñeiro, Luis Rico, Luke Chan, Luke Forster, Lulin Ma, Maria Camacho Gallego, Maria José Freire, Mark Emberton, Mark Feneley, Marta Viridiana Muñoz Rivero, Matea Pirša, Matteo Tallè, Matthew Crockett, Matthew Liew, Matthew Trail, Max Peters, Meghan Cooper, Meghana Kulkarni, Michael Ager, Ming He, Mo Li, Mohamed Omran Breish, Mohamed Tarin, Mohammed Aldiwani, Mudit Matanhelia, Muhammad Pasha, Mustafa Kaan Akalın, Nasreen Abdullah, Nathan Hale, Neha Gadiyar, Neil Kocher, Nicholas Bullock, Nicholas Campain, Nicola Pavan, Nihad Al-Ibraheem, Nikita Bhatt, Nishant Bedi, Nitin Shrotri, Niyati Lobo, Olga Balderas, Omar Kouli, Otakar Capoun, Pablo Oteo Manjavacas, Paolo Gontero, Paramananthan Mariappan, Patricio Garcia Marchiñena, Paul Erotocritou, Paul Sweeney, Paula Planelles, Peter Acher, Peter C. Black, Peter K Osei-Bonsu, Peter Østergren, Peter Smith, Peter-Paul Michiel Willemse, Piotr L. Chlosta, Qurrat Ul Ain, Rachel Barratt, Rachel Esler, Raihan Khalid, Ray Hsu, Remigiusz Stamirowski, Reshma Mangat, Ricardo Cruz, Ricky Ellis, Robert Adams, Robert Hessell, Robert J.A. Oomen, Robert McConkey, Robert Ritchie, Roberto Jarimba, Rohit Chahal, Rosado Mario Andres, Rosalyn Hawkins, Rotimi David, Rustom P. Manecksha, Sachin Agrawal, Syed Sami Hamid, Samuel Deem, Sanchia Goonewardene, Satchi Kuchibhotla Swami, Satoshi Hori, Shahid Khan, Shakeel Mohammud Inder, Shanthi Sangaralingam, Shekhar Marathe, Sheliyan Raveenthiran, Shigeo Horie, Shomik Sengupta, Sian Parson, Sidney Parker, Simon Hawlina, Simon Williams, Simone Mazzoli, Slawomir Grzegorz Kata, Sofia Pinheiro Lopes, Sónia Ramos, Sophie Rintoul-Hoad, Sorcha O'Meara, Steve Morris, Stacey Turner, Stefano Venturini, Stephanos Almpanis, Steven Joniau, Sunjay Jain, Susan Mallett, Sven Nikles, null Shahzad, Sylvia Yan, Tarq Toma, Teresa Cabañuz Plo, Thierry Bonnin, Tim Muilwijk, Tim Wollin, Timothy Shun Man Chu, Timson Appanna, Tom Brophy, Tom Ellul, Tomaž Smrkolj, Tracey Rowe, Troy Sukhu, Trushar Patel, Tullika Garg, Turhan Çaşkurlu, Uros Bele, Usman Haroon, Víctor Crespo-Atín, Victor Parejo Cortes, Victoria Capapé Poves, Vincent Gnanapragasam, Vineet Gauhar, Vinnie During, Vivek Kumar, Vojtech Fiala, Wasim Mahmalji, Wayne Lam, Yew Fung Chin, Yigit Filtekin, Yih Chyn Phan, Youssed Ibrahim, Zachary A Glaser, Zainal Adwin Abiddin, Zijian Qin, Zsuzsanna Zotter, Zulkifli Zainuddin, Khadhouri, Sinan, Gallagher, Kevin M., Mackenzie, Kenneth R., Shah, Taimur T., Gao, Chuanyu, Moore, Sacha, Zimmermann, Eleanor F., Edison, Eric, Jefferies, Matthew, Nambiar, Arjun, Anbarasan, Thineskrishna, Mannas, Miles P., Lee, Taeweon, Marra, Giancarlo, Gómez Rivas, Juan, Marcq, Gautier, Assmus, Mark A., Uçar, Taha, Claps, Francesco, Boltri, Matteo, La Montagna, Giuseppe, Burnhope, Tara, Nkwam, Nkwam, Austin, Toma, Boxall, Nicholas E., Downey, Alison P., Sukhu, Troy A., Antón-Juanilla, Marta, Rai, Sonpreet, Chin, Yew-Fung, Moore, Madeline, Drake, Tamsin, Green, James S. A., Goulao, Beatriz, Maclennan, Graeme, Nielsen, Matthew, Mcgrath, John S., Kasivisvanathan, Veeru, Chaudry, Aasem, Sharma, Abhishek, Bennett, Adam, Ahmad, Adnan, Abroaf, Ahmed, Suliman, Ahmed Musa, Lloyd, Aimee, Mckay, Alastair, Wong, Albert, Silva, Alberto, Schneider, Alexandre, Mackay, Alison, Knight, Allen, Grigorakis, Alkiviadi, Bdesha, Amar, Nagle, Amy, Cebola, Ana, Dhanasekaran, Ananda Kumar, Kondža, Andraž, Barcelos, André, Galosi, Andrea Benedetto, Ebur, Andrea, Minervini, Andrea, Russell, Andrew, Webb, Andrew, de Jalón, Ángel García, Desai, Ankit, Czech, Anna Katarzyna, Mainwaring, Anna, Adimonye, Anthony, Das, Arighno, Figueiredo, Arnaldo, Villers, Arnauld, Leminski, Artur, Chippagiri, Arvinda, Lal, Asim Ahmed, Yıldırım, Asıf, Voulgaris, Athanasios Mario, Uzan, Audrey, Oo, Aye Moh Moh, Younis, Ayman, Zelhof, Bachar, Mukhtar, Bashir, Ayres, Ben, Challacombe, Ben, Sherwood, Benedict, Ristau, Benjamin, Lai, Billy, Nellensteijn, Brechtje, Schreiter, Brielle, Trombetta, Carlo, Dowling, Catherine, Hobbs, Catherine, Benitez, Cayo Augusto Estigarribia, Lebacle, Cédric, Ho, Cherrie Wing Yin, Ng, Chi-Fai, Mount, Chloe, Lam, Chon Meng, Blick, Chri, Brown, Christian, Gallegos, Christopher, Higgs, Claire, Browne, Clíodhna, Mccann, Conor, Plaza Alonso, Cristina, Beder, Daniel, Cohen, Daniel, Gordon, Daniel, Wilby, Daniel, Gordon, Danny, Hrouda, David, Lau, David Hua Wu, Karsza, Dávid, Mak, David, Martin-Way, David, Suthaharan, Denula, Patel, Dhruv, Carrion, Diego M, Nyanhongo, Donald, Bass, Edward, Mains, Edward, Chau, Edwin, Canelon Castillo, Elba, Day, Elizabeth, Desouky, Elsayed, Gaines, Emily, Papworth, Emma, Yuruk, Emrah, Kilic, Ene, Dinneen, Eoin, Palagonia, Erika, Xylinas, Evanguelo, Khawaja, Faizan, Cimarra, Fernando, Bardet, Florian, Kum, Francesca, Peters, Francesca, Kovács, Gábor, Tanasescu, Geroge, Hellawell, Gile, Tasso, Giovanni, Lam, Gitte, Pizzuto, Giuseppe, Lenart, Gordan, Özgür, Günal, Bi, Hai, Lyons, Hannah, Warren, Hannah, Ahmed, Hashim, Simpson, Helen, Burden, Helena, Gresty, Helena, Rios Pita, Hernado, Clarke, Holly, Serag, Hosam, Kynaston, Howard, Crawford-Smith, Hugh, Mostafid, Hugh, Otaola-Arca, Hugo, Koo, Hui Fen, Ibrahim, Ibrahim, Ouzaid, Idir, Puche-Sanz, Ignacio, Tomašković, Igor, Tinay, Ilker, Sahibzada, Iqbal, Thangasamy, Isaac, Cadena, Iván Revelo, Irani, Jacque, Udzik, Jakub, Brittain, Jame, Catto, Jame, Green, Jame, Tweedle, Jame, Hernando, Jamie Borrego, Leask, Jamie, Kalsi, Ja, Frankel, Jason, Toniolo, Jason, Raman, Jay D., Courcier, Jean, Kumaradeevan, Jeevan, Clark, Jennifer, Jones, Jennifer, Teoh, Jeremy Yuen-Chun, Iacovou, John, Kelly, John, Selph, John P., Aning, Jonathan, Deeks, Jon, Cobley, Jonathan, Olivier, Jonathan, Maw, Jonny, Herranz-Yagüe, José Antonio, Nolazco, Jose Ignacio, Cózar-Olmo, Jose Manuel, Bagley, Joseph, Jelski, Joseph, Norris, Joseph, Testa, Joseph, Meeks, Joshua, Hernandez, Juan, Vásquez, Juan Lui, Randhawa, Karen, Dhera, Karishma, Gronostaj, Katarzyna, Houlton, Kathleen, Lehman, Kathleen, Gillams, Kathryn, Adasonla, Kelvin, Brown, Kevin, Murtagh, Kevin, Mistry, Kiki, Davenport, Kim, Kitamura, Kosuke, Derbyshire, Laura, Clarke, Laurence, Morton, Lawrie, Martinez, Levin, Goldsmith, Louise, Paramore, Louise, Cormier, Luc, Dell'Atti, Lucio, Simmons, Lucy, Martinez-Piñeiro, Lui, Rico, Lui, Chan, Luke, Forster, Luke, Ma, Lulin, Gallego, Maria Camacho, Freire, Maria José, Emberton, Mark, Feneley, Mark, Rivero, Marta Viridiana Muñoz, Pirša, Matea, Tallè, Matteo, Crockett, Matthew, Liew, Matthew, Trail, Matthew, Peters, Max, Cooper, Meghan, Kulkarni, Meghana, Ager, Michael, He, Ming, Li, Mo, Omran Breish, Mohamed, Tarin, Mohamed, Aldiwani, Mohammed, Matanhelia, Mudit, Pasha, Muhammad, Akalın, Mustafa Kaan, Abdullah, Nasreen, Hale, Nathan, Gadiyar, Neha, Kocher, Neil, Bullock, Nichola, Campain, Nichola, Pavan, Nicola, Al-Ibraheem, Nihad, Bhatt, Nikita, Bedi, Nishant, Shrotri, Nitin, Lobo, Niyati, Balderas, Olga, Kouli, Omar, Capoun, Otakar, Oteo Manjavacas, Pablo, Gontero, Paolo, Mariappan, Paramananthan, Marchiñena, Patricio Garcia, Erotocritou, Paul, Sweeney, Paul, Planelles, Paula, Acher, Peter, Black, Peter C., Osei-Bonsu, Peter K, Østergren, Peter, Smith, Peter, Willemse, Peter-Paul Michiel, Chlosta, Piotr L., Ul Ain, Qurrat, Barratt, Rachel, Esler, Rachel, Khalid, Raihan, Hsu, Ray, Stamirowski, Remigiusz, Mangat, Reshma, Cruz, Ricardo, Ellis, Ricky, Adams, Robert, Hessell, Robert, Oomen, Robert J. A., Mcconkey, Robert, Ritchie, Robert, Jarimba, Roberto, Chahal, Rohit, Andres, Rosado Mario, Hawkins, Rosalyn, David, Rotimi, Manecksha, Rustom P., Agrawal, Sachin, Hamid, Syed Sami, Deem, Samuel, Goonewardene, Sanchia, Swami, Satchi Kuchibhotla, Hori, Satoshi, Khan, Shahid, Mohammud Inder, Shakeel, Sangaralingam, Shanthi, Marathe, Shekhar, Raveenthiran, Sheliyan, Horie, Shigeo, Sengupta, Shomik, Parson, Sian, Parker, Sidney, Hawlina, Simon, Williams, Simon, Mazzoli, Simone, Grzegorz Kata, Slawomir, Pinheiro Lopes, Sofia, Ramos, Sónia, Rintoul-Hoad, Sophie, O'Meara, Sorcha, Morris, Steve, Turner, Stacey, Venturini, Stefano, Almpanis, Stephano, Joniau, Steven, Jain, Sunjay, Mallett, Susan, Nikles, Sven, Shahzad, Null, Yan, Sylvia, Toma, Tarq, Cabañuz Plo, Teresa, Bonnin, Thierry, Muilwijk, Tim, Wollin, Tim, Chu, Timothy Shun Man, Appanna, Timson, Brophy, Tom, Ellul, Tom, Smrkolj, Tomaž, Rowe, Tracey, Sukhu, Troy, Patel, Trushar, Garg, Tullika, Çaşkurlu, Turhan, Bele, Uro, Haroon, Usman, Crespo-Atín, Víctor, Parejo Cortes, Victor, Capapé Poves, Victoria, Gnanapragasam, Vincent, Gauhar, Vineet, During, Vinnie, Kumar, Vivek, Fiala, Vojtech, Mahmalji, Wasim, Lam, Wayne, Fung Chin, Yew, Filtekin, Yigit, Chyn Phan, Yih, Ibrahim, Youssed, Glaser, Zachary A, Abiddin, Zainal Adwin, Qin, Zijian, Zotter, Zsuzsanna, and Zainuddin, Zulkifli

Subjects
Renal cancer, Prostate cancer, Risk factors, Urology, Bladder cancer, Urothelial cancer, Risk factor, Urinary tract cancer, Haematuria, Risk Calculator
Abstract

Background: Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation. Objective: To develop a prediction model for urinary tract cancer in patients referred with haematuria. Design, setting, and participants: A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged ≥16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded. Outcome measurements and statistical analysis: The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism. Results and limitations: The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy. Conclusions: This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation. Patient summary: We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation.

Published
2022

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