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Ferro M.,Italian National Cancer Institute | Lucarelli G.,Urology andrology and Kidney Transplantation Unit | Perdona S.,Urology Unit | Mazzarella C.,University of Naples Federico II | And 8 more authors.
Anticancer Research | Year: 2015

Background/Aim: Several efforts have been made to find biomarkers that could help clinicians to preoperatively determine prostate cancer (PCa) pathological characteristics and choose the best therapeutic approach, avoiding overtreatment. On this effort, prostate cancer antigen 3 (PCA3), prostate health index (phi) and sarcosine have been presented as promising tools. We evaluated the ability of these biomarkers to predict the pathologic PCa characteristics within a prospectively collected contemporary cohort of patients who underwent radical prostatectomy (RP) for clinically localized PCa at a single high-volume Institution. Materials and Methods: The prognostic performance of PCA3, phi and sarcosine were evaluated in 78 patients undergoing RP for biopsy-proven PCa. Receiver operating characteristic (ROC) curve analyses tested the accuracy (area under the curve (AUC)) in predicting PCa pathological characteristics. Decision curve analyses (DCA) were used to assess the clinical benefit of the three biomarkers. Results: We found that PCA3, phi and sarcosine levels were significantly higher in patients with tumor volume (TV) ≥0.5 ml, pathologic Gleason sum (GS) ≥7 and pT3 disease (all p-values ≤0.01). ROC curve analysis showed that phi is an accurate predictor of high-stage (AUC 0.85 [0.77-0.93]), high-grade (AUC 0.83 [0.73-0.93]) and high-volume disease (AUC 0.94 [0.88-0.99]). Sarcosine showed a comparable AUC (0.85 [0.76-0.94]) only for T3 stage prediction, whereas PCA3 score showed lower AUCs, ranging from 0.74 (for GS) to 0.86 (for TV). Conclusion: PCA3, phi and sarcosine are predictors of PCa characteristics at final pathology. Successful clinical translation of these findings would reduce the frequency of surveillance biopsies and may enhance acceptance of active surveillance (AS). © 2015, International Institute of Anticancer Research. All rights reserved.

Lucarelli G.,Urology andrology and Kidney Transplantation Unit | Bettocchi C.,Urology andrology and Kidney Transplantation Unit | Battaglia M.,Urology andrology and Kidney Transplantation Unit | Impedovo S.V.,Urology andrology and Kidney Transplantation Unit | And 6 more authors.
Transplantation Proceedings | Year: 2010

Introduction: Dual kidney transplantation (DKT), using extended criteria donor (ECD) grafts not suitable for single kidney transplantation (SKT), has been suggested to expand the kidney donor pool. Herein, we reviewed the long-term outcomes of DKT to assess its results versus a control group of 179 ECD SKTs. The allocation policy was based on a Remuzzi score obtained from a pretransplant biopsy. Materials and methods: We analyzed SKT in 179 (31.8%) and DKT in 41 (7.3%) of 563 cadaveric transplants from 2000 to 2008. Patients with DKT versus SKT showed mean recipient ages of 54 versus 51 years. We performed 17 ipsilateral and 24 bilateral DKT. The mean score was 2.78 for SKT and 4.3/4.6 for DKT. Results: Delayed graft function requiring dialysis occurred in 23 (56.1%) DKT and 70 (39.1%) SKT recipients. Primary nonfunction was observed in 1 (2.4%) DKT and 7 (3.9%) SKT recipients respectively. One DKT patient underwent monolateral transplantectomy. In the DKT versus SKT group, patient survivals were 92% versus 95%, 89% versus 93%, and 89 versus 91% at 12, 36, and 60 months, respectively (P = .3). Graft survivals were 100% versus 94%, 95% versus 90%, and 89% versus 78% at 12, 36, and 60 months, respectively (P < .001). We observed a lower incidence of chronic allograft nephropathy (P = .01) and a higher incidence of surgical adverse events (P = .04) in DKT. Conclusions: ECD graft survival using DKT provided better results compared with SKT, despite the use of organs from higher-risk donors. At 5 years follow-up, DKT was a safe strategy to face the organ shortage. To optimize the use of available kidneys, the criteria for DKT require further refinement and standardization. Preimplantation evaluation must maximize transplant success and protect recipients from receiving organs at increased risk of premature failure. © 2010 Elsevier Inc. All rights reserved.

Martino P.,Urology andrology and Kidney Transplantation Unit | Lucarelli G.,Urology andrology and Kidney Transplantation Unit | Palazzo S.,Urology andrology and Kidney Transplantation Unit | Tedeschi M.,Urology andrology and Kidney Transplantation Unit | And 5 more authors.
Archivio Italiano di Urologia e Andrologia | Year: 2010

Objective: Ultrasound is the principal imaging technique for the evaluation of a renal allograft; it is a safe imaging technique to assess the structure of the graft and its perfusion without the need for intravenous contrast or ionizing radiation. The evaluation of kidney transplant complications is easy due to its presence in the iliac fossa lying anterior to the external iliac vessels. Complications may be classified as medical and surgical; the latter are classified in urologic, vascular and general surgical complications. Materials and Methods: Our experience on surgical complications in kidney recipients from donors, on the role of ultrasound in the diagnosis of these complications and their impact on the graft and patient survival rates is reported. Results: Ultrasonoghaphy represents a safe imaging technique to assess the structure of the graft and its perfusion without the use of ionizing radiation and iodinated contrast medium, and a quick, accurate method for the evaluation of complications. Conclusions: Although it possesses limitations and is ultimately operator dependent, ultrasound is considered an excellent tool for the assessment of the kidney transplant and in our experience it represents the main imaging technique used in the evaluation of graft complications.

Lucarelli G.,Urology andrology and Kidney Transplantation Unit | Ditonno P.,Urology andrology and Kidney Transplantation Unit | Bettocchi C.,Urology andrology and Kidney Transplantation Unit | Spilotros M.,Urology andrology and Kidney Transplantation Unit | And 9 more authors.
Future Oncology | Year: 2013

Aim: Sarcosine has been identified as a differential metabolite that is greatly increased during progression from normal tissue to prostate cancer and metastatic disease. In this study we assessed the role of serum sarcosine in metastatic castration-resistant prostate cancer (mCRPC) patients. Patients & methods: Data from 52 mCRPC patients treated with docetaxel-based chemotherapy were retrospectively analyzed. Receiver operating characteristic curves, and Kaplan-Meier and Cox multivariate analyses were performed. Results: Median sarcosine values were significantly higher in mCRPC versus non-mCRPC patients (0.81 vs 0.52 nmol/μl; p < 0.0001). A significant correlation resulted between serum sarcosine levels and the duration of hormone sensitivity (Spearman's correlation coefficient:-0.51; p = 0.001). At multivariate analysis sarcosine was an independent prognostic factor of outcome in terms of overall and progression-free survival. Conclusion: Serum sarcosine values were significantly increased in patients with metastatic disease. Moreover, this biomarker is a risk factor for progression and survival in chemotherapy-treated mCRPC patients. © 2013 Future Medicine Ltd.

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