B. Mangiarotti

Evaluation of Urinary Level of NMP22 as a Diagnostic Marker for Stage pTa-pT1 Bladder Cancer: Comparison with Urinary Cytology and BTA Test

Background: In the present study we compared the clinical value of two new specific tests for transitional cell carcinoma, urinary nuclear matrix protein (NMP22) levels and bladder tumor antigen (BTA) test, with that of urinary cytology in the follow-up of patients with superficial bladder cancer. Materials and Methods: Hundred and five bladder cancer patients were recruited: 30 stage pTa and 45 stage pT1 (group A), and 30 with a history of bladder cancer but no recurrence at the time of the study (group B). Urine samples were collected before any instrumental manipulation of the genitourinary tract. All patients were negative for urinary tract infections at conventional urine analysis. Results: NMP22 at a cutoff value of 6 U/ml showed a sensitivity of 83.3% in pTa cases and 97.7% in pT1 cases, with a false-positive rate of 23.3%. The BTA test was positive in 26.6% of patients with cancer stage pTa and in 66.6% of pT1 stage, with 30% false-positives in the non-neoplastic group. Urinary cytology, performed on three consecutive samples, was positive in 20% of patients with cancer stage pTa and in 64.4% of pT1 stage and did not show any false-positive cases. Stratifying the neoplastic patients according to lesion grade, NMP22 (at a cutoff value of 6 U/ml) was positive in 86.2% of G1, 97.2% of G2 and 90% of G3. BTA was positive in 37.9, 52.7 and 70% of G1, G2 and G3, respectively, while urinary cytology was positive in 37.9, 44.4 and 80%.

Rectal Culture-Guided Targeted Antimicrobial Prophylaxis Reduces the Incidence of Post-Operative Infectious Complications in Men at High Risk for Infections Submitted to Transrectal Ultrasound Prostate Biopsy – Results of a Cross-Sectional Study

The role of rectal culture-guided antimicrobial prophylaxis (TAP) in reducing infectious complications (IC) after transrectal-ultrasound prostate biopsy (TRUSPBx) is conflicting. We assessed the prevalence of IC in a cohort of men at high risk for IC submitted to TRUSPBx and treated with either TAP or empirical prophylaxis (EAP). Data from 53 patients at high risk for IC undergoing TRUSPBx were collected. Patients who did not receive a rectal swab (RS) were treated with EAP with fluoroquinolones (FQs). Of those who received the RS, patients with FQ-susceptible organisms received ciprofloxacin while those with FQ-resistant organisms received TAP. Office visits were scheduled to investigate the rate of complication at day 7 and 30 after TRUSPBx. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Descriptive statistics and logistic regression models detailed the association between clinical parameters and IC rate. Out of 53 men, 17 (32.1%) had RS while 36 (67.9%) did not. All RS cultures were positive for E. Coli and 4 (23.5%) reported FQ-resistant pathogens. Considering risk factors for IC, no difference was found in terms of CCI, rate of diabetes, UTIs or recent antibiotic utilization between groups. Overall, 12 (22.6%) men reported IC, with a greater proportion of them belonging to the group treated with EAP (30.6% vs 5.9%; p = 0.045). Of these, 9 (25.0%) patients, all treated with EAP, developed post biopsy UTIs. E. Coli sustained all UTIs and 7 (77.7%) were FQ resistant. At multivariable analysis, CCI≥1, a history of UTIs/prostatitis and recent antibiotic utilization (all p<0.04) were the most powerful predictors for ICs. In conclusion, we found that compared to EAP, TAP significantly reduces ICs, in men at high risk for post TRUSPBx IC. Patients at risk for IC, especially those with recent antibiotic utilization, CCI≥1 and a history of UTIs/prostatitis before biopsy, could benefit from TAP.

Microfocal Prostate Cancer

To determine whether microfocal prostate cancer on needle biopsy predicts clinically insignificant prostate cancer. Patients and Methods We reviewed the records of 257 patients who underwent radical retropubic prostatectomy between January 1999 to September 2003. 18 patients had preoperative diagnosis of microfocal prostate cancer defined as 1 positive core/8 cores, cancer length < 3 mm and Gleason score less than/equal to 6. Results Of the 18 patients with preoperative microfocal cancer, only 1 case had clinically insignificant disease. 15 pts had organ confined disease (pT2) and 3 pts had capsular penetration (pT3). The lesion was bioptic undergraded in 33% of cases. Conclusions Microfocal prostate cancer as determined by needle biopsy does not predict clinically insignificant disease.

596 Feasibility of transurethral resection of the bladder (TURB) done by narrow-band imaging (NBI)

MATERIAL & METHODS: 137 patients underwent to a TURB for a suspicious BC diagnosed by a WLI cystoscopy. We randomized these patients in two groups. 71 (52%) underwent to an NBI TURB and 66 (48%) to a WLI TURB. The TURBs was performed by the same surgeon by an Olympus resectoscope 26 Ch. using an Olympus Exera II endoscopical column. The characteristics of the groups are homogeneous in terms of age, lesions size, focality but not in terms of cancer history (primitive, recurrent): the recurrent tumours were significantly higher (p = 0,04 ) in NBI group (54%) respect WLI group ( 36%). The feasibility was studied evaluating the complication rate (CR) by Clavien-Dindo scale, mean surgery time (MST), mean time to catheter removal (MTCR), absence of muscular tissue in the specimen (AMT) and the false positive rate (FPR) in the two groups (NBI vs WLI). The statistical analysis was performed by Chisquare and T-test.