Genetic markers for the diagnosis of prostate cancer
Among the attendees of the European Association of Urology 2016 conference were: Professor Giorgio Guazzoni (Head of Urology), Dr. Massimo Lazzeri, Dr. Nicolo Buffi, Dr. Alberto Saita and Dr. Giovanni Lughezzani.
Dr. Lazzeri took part in a poster session and discussed the topic “Advances in Prostate Cancer Research Biomarkers”. It was an opportunity to present the latest developments related to the identification of new markers useful for the diagnosis and prognosis of neoplastic disease.
“PHI (Prostate Health Index) is characterized by greater precision in comparison to PSA. PSA is a very sensitive antigen through it is not specifically related to tumors. A study recently conducted in Humanitas has shown that this marker is able to predict the risk of recurrence in patients who have previously undergone prostatectomy. “The genetic markers represent advancement towards diagnostic accuracy, which is essential for introducing more targeted and effective therapies.”
PET-directed ultrasound for prostate biopsy
Dr. Lazzeri presented the results of research conducted on the possibility of using PET to perform prostate biopsy in individuals with claustrophobia. This research was done in collaboration with Prof. Arturo Chiti, Head of the Nuclear Medicine Department at Humanitas and Dr. Egesta Lopci. A study was conducted on patients with elevated PSA and negative results in previous prostate biopsy tests. “The biopsy merger – explains Dr. Lazzeri – is a technique that directly targets the tumor in the prostate and displays the results on ultrasound images and MRI. Humanitas is the first hospital in Lombardy and one of the first in Italy to make use of this diagnostic technique, which is available from April 2015.”
“The study presented at the EAU conference – says Dr. Lazzeri – introduces the possibility for individuals who are unable to undergo resonance, to perform a prostate biopsy with the PET-directed ultrasound.” The research is marked by strong innovation and opens the way to new diagnostic techniques.
Robotic Surgery: The Benefits of Pyeloplasty with the “Single Site” Platform
Dr. Buffi was chairman of the YAU (Young Academic Urologists) robotic surgery group and professor at the European School of Urology. He focused on robotics for renal lumpectomy and pyeloplasty with a single-site approach.
Pyeloplasty is a procedure that involves incision and removal of part of the ureter in order to treat uretero-pelvic junction obstruction. This procedure helps drain and decompress the kidney, allowing urine to pass through properly. The aim of this procedure is to eliminate symptoms and preserve organ function. An internal ureteral stent known as “Double J” is inserted through antegrade or retrograde approach and removed about one month after surgery. In the past, pyeloplasty was performed invasively (fully opening the patient). When the laparoscopic approach was introduced, it spread as a viable treatment option for uretero-pelvic junction obstruction.
The next step involved introduction of robotic instruments and minimally invasive techniques for the treatment of stenosis. In particular, the Robot Da Vinci was introduced. It ensured the same advantages as extremely precise surgery, resulting in decreased tissue trauma and reduced post-operative hospital stay. Surgery could also be performed through the “Single Site” platform. The Single Site platform is a system which, through a single incision in the naval, allows the introduction of surgical instruments into the abdomen.
During the EAU conference, Dr. Buffi presented the results of a multicenter study dedicated to this approach. The work showed that the results from the Single Site Laparoscopic Pyeloplasty were equivalent to those of laparoscopic surgery, but with an enhanced aesthetic effect.
Kidney cancer: “an algorithm” for predicting complications of partial nephrectomy
Dr. Buffi dedicated his second study to surgery on kidney disease. He saw this type of surgical intervention very successful when combined with robotic instruments.
Specifically, Dr. Buffi presented the results of a multicenter study that identified predictive values of complications and outcomes in patients undergoing partial nephrectomy with robotic approach.
In fact, if discovered at an early stage, the patient suffering from kidney cancer may benefit from conservative surgery. This type of surgery involves the removal of a tumor mass (and a margin of healthy tissue) and helps preserve renal function.
Among the parameters considered for determining these predictive values are:
- The presence or absence of margins of healthy tissue (following removal of the tumor)
- Duration of ischaemia (the amount of time the kidney can survive without oxygen supply and not be damaged)
Humanitas Urologists are experts in all surgical possibilities when it comes to kidney cancer (with particular reference to minimally invasive laparoscopic surgery). The ability to preserve the healthy renal parenchyma is a major advantage compared to nephrectomy.