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Purpose: To assess predictors of clinically significant (cs) prostate cancer (PCa) in men who had a non-malignant Multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy and persistent Prostate Imaging-Reporting Data System (PI-RADS) 3 to 5 lesions in subsequent mpMRI., Materials and Methods: We retrospectively analyzed MRI-targeted biopsy database in three centers., Inclusion Criteria: persistence of at least one PI-RADS ≥3 lesion found negative for cancer in a previous MRI-targeted plus systemic biopsy (baseline biopsy)., Exclusion Criteria: downgrading to PI-RADS 1-2. A logistic regression analysis was performed to estimate the predictors of csPCa., Results: Fifty-seven patients were included. Median interval between biopsies was 12.9(2.43) months. Median age was 68.0(12) years. Median PSA was 7.0(5.45) ng/ml. At follow-up, 24.6%, 54.4%, and 21% of patients had a PI-RADS score 3, 4, and 5 index lesion (IL), respectively. At re-biopsy, 28/57(49.1%) men were found to harbor PCa. Among these, 22(78.6%) had csPCa. csPCa was found outside the IL in only 2 patients. Eleven, 13, and 5 patients with PI-RADS 3, 4, and 5, respectively, had no cancer. Three patients with a PI-RADS 3 lesion had cancer (2 with Gleason score 3+3, 1 with Gleason score 3+4). 14/43 men with a PI-RADS 4/5 lesion harbored Gleason score ≥3+4 PCa. Logistic regression analysis found that PSA (HR 1.281, 95% CI: 1.013-1.619, P = 0.039) and IL size (HR 1.146, 95% CI: 1.018-1.268, P = 0.041) were the predictors of csPCa at re-biopsy., Conclusions: Patients with non-malignant pathology from PI-RADS ≥3 lesions targeted biopsy should be follow-up with mpMRI, and those with persistent PI-RADS 4 to 5 lesions should repeat MRI-targeted and systematic biopsy., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The index lesion (IL) is the largest cancer focus, usually harbors the highest grade, and might drive the history of prostate cancer (PCA). Multiparametric magnetic resonance imaging (mp-MRI) has a high negative predictive value in ruling out clinically significant (cs)PCA. We aimed evaluating the efficiency of mp-MRI and targeted biopsy in detecting csPCA and the concordance between the MRI index lesion (MRI-IL) and the presence of csPCA inside it., Materials and Methods: We retrospectively evaluated 158 men who underwent prostate biopsy after a positive pre-biopsy mp-MRI scan. All mp-MRI lesions were biopsied using a transrectal ultrasound elastic-fusion approach (2-4 targeted plus 10-12 random systematic biopsies). csPCA was defined as grading group ≥ 2 or > 3 cores with cancer or ≥ 50% of core involved by tumor., Results: mp-MRI detected 158 ILs and 46 non-ILs. One hundred were Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2) score 3, 84 score 4, and 20 score 5. csPCA was found in 63.9% of the MRI-ILs. Eighty percent of detected cancer using mp-MRI and targeted biopsy was clinically significant. Eighty-seven percent of the transitional zone lesions were clinically non-significant or negative for cancer. The probability of detecting csPCA increases with increasing size of MRI-IL, and every extra millimeter raises the odds of detecting csPCA of 12.2%. All PI-RADS v2 score lesions showed a strong association with csPCA. The risk of matching between MRI-IL and csPCA inside it increases by 36.2% as the total percentage of cancer in all cores increases., Conclusions: mp-MRI showed high sensitivity in detecting csPCA in the peripheral zone, with concordance between MRI-IL and csPCA., (Copyright © 2020 Elsevier Inc. All rights reserved.)

High-intensity focused ultrasound (HIFU) treatment has recently been pursued to reduce radical treatment-related morbidity in low-to-intermediate-risk localized prostate cancer (PCa), especially in older men. The aim of this study was to develop a dedicated framework for HIFU therapy. All clinical data, such as risk categories, magnetic resonance with functional parametric imaging, and histopathology, are essential for driving proper HIFU treatment. All needed data can be added to the framework to localize areas that need to be treated. Once PCa areas have been featured, quantified, and located, planning can be adapted to drive accurate HIFU treatment. Our planning framework may be useful for all ablative therapies in order to standardize treatment for both clinical and scientific purposes., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Aim: To present a summary of the updated guidelines of the Italian Prostate Biopsies Group following the best recent evidence of the literature., Materials and Methods: A systematic review of the new data emerging from 2012-2015 was performed by a panel of 14 selected Italian experts in urology, pathology and radiology. The experts collected articles published in the English-language literature by performing a search using Medline, EMBASE and the Cochrane Library database. The articles were evaluated using a systematic weighting and grading of the level of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation framework system., Results: An initial prostate biopsy is strongly recommended when i) prostate specific antigen (PSA) >10 ng/ml, ii) digital rectal examination is abnormal, iii) multiparametric magnetic resonance imaging (mpMRI) has a Prostate Imaging Reporting and Data System (PIRADS) ≥4, even if it is not recommended. The use of mpMRI is strongly recommended only in patients with previous negative biopsy. At least 12 cores should be taken in each patient plus targeted (fusion or cognitive) biopsies of suspicious area (at mpMRI or transrectal ultrasound). Saturation biopsies are optional in all settings. The optimal strategy for reducing infection complications is still a controversial topic and the instruments to reduce them are actually weak. The adoption of Gleason grade groups in adjunction to the Gleason score when reporting prostate biopsy results is advisable., Conclusion: These updated guidelines and recommendations are intended to assist physicians and patients in the decision-making regarding when and how to perform a prostatic biopsy., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective: Valute 3 TRUS to study the transitional zone of the prostate to calculate the PSA density Tz in patient with first negative biopsy, PSA Tot > 4 ng/ml and clinical suspicion of cancer., Methods: During a 12 months period we performed 429 biopsies. All patients had PSA = 4-10 ng/ml and/or suspected DRE. We repeated biopsy in 35 patients with PSA > 4 ng/ml, normal DRE but clinical suspicion of cancer. We used 3 TRUS to calculate the PSA density Tz and we performed standard sextant biopsies and additionally two biopsies of the transitional zone one on each side., Results: Of the 429 patients, 304 (70.8%) had IPB, 100 (23.3%) had cancer in peripherical and/or apex zone, 25 (5.9%) cancer in the transitional zone only., Conclusions: The use of 3 DUS is very important to study and estimate the volume of the transitional zone to calculate the PSA density Tz. The clear visualization of the Tz permit a careful execution of the biopsy. The biopsy of the TZ is not a method for the early detection to cancer prostate but only for specifics cases: negative first biopsy, negative DRE, PSA Tot > 4 ng/ml and clinical suspicion of cancer.

Human recombinant erythropoietin constitutes a remarkable improvement in the treatment of uraemic anemia. Nevertheless, it causes haemorheological changes, which in turn may affect smaller blood vessel circulation. Our study was conducted on a pool of chronic uraemic patients under hemodialytic treatment who were given erythropoietin therapy. Substantial increases in overall blood viscosity and red cell aggregation were recorded, with no change in erythrocyte deformation. An increase in cardiovascular morbidity might occur in these patients who are already liable to this condition. Several years will have to elapse and thorough studies will have to be conducted on a large number of patients, to have conclusive evidence on this point.

Twenty-two patients with newly diagnosed advanced prostatic cancer treated with once-monthly subcutaneous injection of a long acting depot preparation of a new luteinizing hormone-releasing hormone superagonist (ICI 118,630) with a minimum follow-up duration of 6 months are reported. The partial regression rate was 45.4% while 36.4% of the patients had stable disease and only 18.2% have progressed by P.O.N.CA.P. criteria. Patient acceptance was excellent and side effects occurring during treatment (hot flashes, gynecomastia, etc.) were minimal. The depot preparation of the LH-RH analogue was well tolerated and no side effects required dose modifications or removal from the study. Depot LH-RH analogue may become an alternative treatment for patients with advanced prostatic cancer if further clinical evolutions will confirm that the response rate with LH-RH analogue is comparable to the conventional endocrine therapies.

Researches effected in different nations have revealed that 5-12% of all hospitalized patients was affected with a nosocomial infection and that almost 1/3 of these were urinary tract infections. The hospitalized urological patients have a considerable proneness to contract a nosocomial urinary tract infection, because they are subjected to transurethral or suprapubic bladder catheterisms, to transurethral surgery and to the endoscopies, that are promoting maneuvers the urinary tract infections. Generally the Gram negative bacilli are the cause of hospital-acquired urinary tract infections, even if lately Gram positive bacilli (especially Streptococcus Faecalis or Enterococcus), "Gram negative Facultative pathogens" (Klebsiella, Providencia, Citrobacter, Serratia) and Fungi are very important. Considering the importance of these infections we have examined the incidence of the urinary tract infections of the hospitalized patients between January 1, 1986 and December 31, 1986 in our Urologic Institute. During the 12-month study interval there were 450 hospital admissions, and 45 patients were affected with a nosocomial urinary tract infection (10%). The females were affected at the rate of 6.7% of them, with an incidence of 4.7% among all patients with a positive urine culture; on the contrary the males were affected at the rate of 11.4% of them, equal to 19.0% of patients with a positive urine culture. We have noticed that among the responsible microorganisms for the nosocomial urinary tract infections, the group of the "Gram negative Facultative pathogens" was more frequent (40%), followed by Pseudomonas Aeruginosa and Candida species. So also in our Urologic Institute the modification of the responsible agents for the nosocomial urinary tract infections happened. The nosocomial infections after the discovery of the antibiotics were considered wiped out, on the contrary these infections are still an important problem of public health, so that efficaciously must be tackled.

Nephrogenic adenoma is a vesical lesion of uncertain pathogenesis. Histologically it is characterised by glandular-like aspects that take on the form of tiny tubules consisting of a single layer of cuboidal or columnar epithelium. The lesion was first described by Davis in 1949 and a year later Friedman and Kuhlembeck coined the term nephrogenic adenoma. Personal experience with seven cases of this lesion is reported here. Six of the seven cases occurred in the bladder, the remaining one in the prostatic urethra. Four patients reported prior surgery of the urinary ways, three suffered from recurrent cystitis, one had bladder stones while three were being followed up in our department for urothelial carcinoma. Diagnosis of nephrogenic adenoma was based on histopathological examination carried out on biopsy samples taken during urethrocystoscopy. The urothelial lesions were subjected to transurethral resection or endoscopic diathermocoagulation. All patients are being followed up and no recurrences have yet been reported.