Gianna Mariotti

Distribution of inflammation, pre-malignant lesions, incidental carcinoma in histologically confirmed benign prostatic hyperplasia: A retrospective analysis

OBJECTIVES We analyze our experience on BPH through 20 years of histopathological examinations performed by the same pathologist. METHODS We retrospectively reviewed all histopathological examinations performed from January 1979 to December 1998 in patients undergoing surgery in our urological clinic who were diagnosed with BPH. We limited our evaluation to the following variables in each BPH case analyzed: inflammatory aspects associated with BPH, presence of focal acinar atrophy, atypical adenomatous hyperplasia (AAH), prostatic intraepithelial neoplasia (PIN), incidental prostate carcinoma (IC). These histological variables were analyzed according to some clinical parameters such as age, prostate volume and serum PSA. RESULTS The study population was comprised of 3942 cases with histological diagnosis of BPH. The mean patient age was 68.85+/-7.67 years. In particular, inflammatory aspects were associated with BPH in a high percentage of cases (43.1% =1700 cases), predominantly as chronic inflammation. Observation of focal acinar atrophy significantly increased according to patient decade of age (p=0.027). There was a significant trend to increase with age decades (p=0.036) for high grade PIN. A significant difference was found in IC (T1a, T1b) distribution in the different decades of age and especially in regards to both T1a and T1b tumors, there was a trend to increase with patient age (p=0.020 and p=0.025, respectively). On the contrary, the distribution of inflammatory aspects (p<0.001) and AAH (p=0.003) significantly varied according to prostate volume, and particularly in regards to chronic inflammation, there was a trend to increase depending on the prostate volume (p=0.002). Only the presence of T1b tumor but not of the other histological parameters associated to BPH, was able to significantly influence serum PSA. CONCLUSION In our analysis different histological variables associated to BPH are differently influenced by the age of patients and prostate volume, and they differently influence serum PSA levels.

Prostate growth and inflammation.

INTRODUCTION There is emerging evidence that prostatic inflammation may contribute to prostate growth either in terms of hyperplastic (BPH) or neoplastic (PC) changes. Inflammation is thought to incite carcinogenesis by causing cell and genome damage, promoting cellular turnover. METHODS We reviewed our personal experience and the international recent literature on the clinical data supporting a role of inflammation on BPH and PC growth and progression. RESULTS BPH: Among those patients with self-reported prostatitis, 57% had a history of BPH. MTOPS study showed that men with inflammation had a significantly higher risk of BPH progression and acute urinary retention. We showed that the use of a COX-2 inhibitor in combination with a 5 alpha reductase inhibitor could increase the apoptotic index in BPH tissue. Prostate cancer: A PCR-based analysis of bacterial colonization in PC specimens and normal prostate tissue showed highly suggestive correlation of bacterial colonization and chronic inflammation with a diagnosis of PC. Evidence from genetic studies support the hypothesis that prostate inflammation may be a cause of prostate cancer. De Marzo proposed that proliferative inflammatory atrophy (PIA) is a precursor to PIN and cancer. CONCLUSION The concept that inflammation can promote prostate growth either in terms of BPH and PC risk remains highly suggestive.

Early Recovery of Urinary Continence After Radical Prostatectomy Using Early Pelvic Floor Electrical Stimulation and Biofeedback Associated Treatment

PURPOSE We analyzed the benefit of the early combined use of functional pelvic floor electrical stimulation and biofeedback in terms of time to recovery and rate of continence after radical prostatectomy. MATERIALS AND METHODS A total of 60 consecutive patients who underwent radical prostatectomy were included in the study. Patients were prospectively randomized to a treatment group (group 1) vs a control group (group 2). In group 1 a program of pelvic floor electrical stimulation plus biofeedback began 7 days after catheter removal, twice a week for 6 weeks. Each of the 12 treatment sessions was composed of biofeedback (15 minutes) followed by pelvic floor electrical stimulation (20 minutes). The evaluation of continence was performed at time 0, at 2 and 4 weeks, and at 2, 3, 4, 5 and 6 months during followup. Evaluations were performed using the 24-hour pad test and the incontinence section of the International Continence Society questionnaire. RESULTS The mean leakage weight became significantly lower (p <0.05) in group 1 than in group 2 starting at 4 weeks until 6 months of followup. A significant difference (p <0.05) between groups 1 and 2 in terms of percentage of continent patients was achieved from 4 weeks (63.3% group 1 and 30.0% group 2) to 6 months (96.7% group 1 and 66.7% group 2). CONCLUSIONS Early, noninvasive physical treatment with biofeedback and pelvic floor electrical stimulation has a significant positive impact on the early recovery of urinary continence after radical prostatectomy.

Neuroendocrine differentiation in human prostate tissue: is it detectable and treatable?

which is present in the normal, hyperplastic and dysplastic prostate. NE cells are located in all regions of the human prostate at birth, but rapidly decrease in the peripheral prostate after birth and then reappear at puberty [4]. After puberty, the number of NE cells seems to increase until an apparently optimum level is reached, which persists from 25 to 54 years old [5]. The relationship of age beyond puberty to the number and distribution of these endocrine-paracrine cells has not been definitively assessed, but in the guinea pig these cells in the peripheral prostate increase markedly with adult age [6]. Studies on adult human prostates indicate that NE cells are more frequent in the periurethral ducts than in the peripheral parts of the gland [7]. Others [8,9] also described the presence of NE cells in the stroma of fetal and infantile prostates.

New perspective in the management of neuroendocrine differentiation in prostate adenocarcinoma

In this review, we will present some of the information that is known about neuroendocrine (NE) cells and differentiation in the prostate. We will then speculate on the potential role that NE differentiation in prostate carcinoma may play and how this differentiation may be clinically analysed and treated. The androgen‐independent growth of prostate cancer can be caused by different mechanisms; one of these is receptor‐specific paracrine or autocrine growth modulation of human prostatic cancer cells by neuropeptides secreted by NE cells. Our results affirm that different methods of androgen deprivation can influence the serum chromogranin A (CgA) levels to different extents in prostate cancer. In particular, bicalutamide produces a significantly lower increase in serum CgA compared with castration therapy. In the light of other evidence that supports a significant relationship between serum CgA levels, tissue CgA expression and NE activity, we hypothesise that bicalutamide may reduce the risk of NE cell hyperactivation in prostate cancer.

Comparative analysis of multiparametric magnetic resonance and PET-CT in the management of local recurrence after radical prostatectomy for prostate cancer

PURPOSE Our aim was to assess whether multiparametric magnetic resonance and PET-CT can have a role in detecting local recurrence in patients with biochemical recurrence after radical prostatectomy. METHODS We reviewed the recent international literature by carrying out a PUBMED search. RESULTS We critically reviewed 11 recent original studies about the use of PET-CT and 5 recent studies about the use of multiparametric magnetic resonance. PET-CT has not shown significant results in terms of detection rate for local recurrence in patients with low level of PSA. Multiparametric magnetic resonance showed encouraging results to detect local recurrence in patients with low PSA and with small diameter lesions. CONCLUSIONS Currently, most important urological societies do not consider multiparametric magnetic resonance and PET-CT in the follow-up of patients with suspected local recurrence after radical prostatectomy. We can assert that multiparametric magnetic resonance seems to have excellent results in detecting local recurrence in patients submitted to radical prostatectomy and PSA<1.5 ng/ml.

Modern role of magnetic resonance and spectroscopy in the imaging of prostate cancer

Recently, a large number of studies have shown that the addition of proton 1H-spectroscopic imaging (1H-MRSI) and dynamic contrast enhanced imaging (DCEMR) to magnetic resonance (MR) could represent a powerful tool for the management of prostate cancer (CaP) in most of its aspects. This combination of MR techniques can substantially sustain the clinical management of patients with CaP at different levels: in particular, (1) in the initial assessment, reducing the need for more extensive biopsies and directing targeted biopsies; (2) in the definition of a biochemical progression after primary therapies, distinguishing between fibrotic reaction and local recurrence from CaP.

The emerging role of targeted therapy in renal cell carcinoma (RCC): is it time for a neoadjuvant or an adjuvant approach?

PURPOSE We address whether rational and significant clinical data exist on using angiogenic targeted therapies as neoadjuvant or adjuvant options to nephrectomy in non-metastatic RCC. METHODS We reviewed the recent international literature by carrying out a PUBMED search. RESULTS Neoadjuvant: a possible indication for a neoadjuvant targeted therapy approach is to facilitate surgery, reducing risks for patients and increasing the possibility of removing the mass and improving oncological results. Adjuvant: three major phase III clinical trials are currently ongoing. The ASSURE trial (1 year on oral sunitinib, sorafenib or placebo), the SORCE trial (3 years on placebo versus 1 year on sorafenib, followed by 2 years on placebo versus 3 years on sorafenib), and the S-TRAC trial (1 year on sunitinib or placebo) analyze patients who are at high risk of relapse. CONCLUSIONS Rationale and needs for the neoadjuvant or adjuvant use of targeted therapies in RCC are relevant. Significant phase III trials on the adjuvant use of targeted therapy in RCC are ongoing.

Role of Radical Retropubic Prostatectomy in Patients with Locally Advanced Prostate Cancer: The Influence of Gleason Score 8–10

Background: To define whether in locally advanced prostate cancer submitted to radical retropubic prostatectomy (RRP) the presence of a Gleason score 8–10 represents an index of high risk for progression and cancer-specific death. Methods: Finally, a total of 130 men with pathologically confirmed T3 cancer were included in this analysis. On the basis of the histological grade obtained at RRP, patients were divided into two groups: patients with a Gleason score 8–10 (group 1) and patients with a Gleason score <8 (group 2). Postoperative follow-up ranged from 24 to 120 months (median 60). After RRP no patients received additional treatments until a biochemical or clinical disease progression was found. Kaplan-Meier projections were used in each group. Results: After RRP, 41 patients (31.5%) had a Gleason score 8–10 tumor. The incidence of positive lymph nodes was significantly higher (p = 0.0030) in group 1 (36.6%) when compared with group 2 (12.3%). Significant differences between the two groups were also found with respect to seminal vesicle involvement (p = 0.0045) and positive surgical margins (p = 0.0040). The actuarial cumulative disease-specific survival for group 1 and group 2 was, respectively, 69 and 82% at 10 years. A Kaplan-Meier analysis demonstrated a 100% disease-specific survival, a 92% clinical progression-free survival and a 38% biochemical progression-free survival 10 years postoperatively if patients in group 1 had negative surgical margins and negative lymph nodes (48.8%). Conclusions: Our data indicate a significant association between Gleason score 8–10 and disease-specific survival, only if patients in group 1 are stratified on the basis of surgical margins and/or lymph node involvement.

Histopathological aspects of transitional cell carcinoma of the bladder: Analysis of 20 years experience

Abstract  Background:  In this study we used histopathological examinations performed over a 20‐year period to describe the characteristics of newly diagnosed transitional cell carcinoma (TCC) of the bladder in relation to patient age, and to verify changes in the TCC over different periods of observation or in relation to patient age.