Evaluación del valor predictivo negativo de la resonancia magnética multiparamétrica de próstata al combinar su puntuación con parámetros del antígeno prostático específico en pacientes con PSA en zona gris / The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients

Objetivo Calcular el valor predictivo negativo (VPN) de la resonancia magnética multiparamétrica (RMmp) de próstata negativa, definida como la ausencia de lesiones en las imágenes, cuando se combina con la densidad del PSA (DPSA) y el índice PSA libre/total (PSA l/t) en pacientes cuyo PSA se encuentra en la zona gris (4-10mg/ml). Métodos Se analizaron 191 pacientes con niveles de PSA entre 4 y 10mg/ml y RMmp negativa. El VPN de la RMmp negativa se calculó de acuerdo con un nivel de DPSA<0,15ng/ml/ml, un índice PSA l/t>0,15 y una combinación de ambos. Los pacientes se dividieron en 3 grupos de riesgo según estos dos parámetros, de la siguiente manera: • DPSA 0,01-0,07ng/ml/ml e índice PSA l/t≥25 en el grupo de bajo riesgo. • DPSA 0,08-0,15ng/ml/ml e índice PSA l/t 0,15-0,24 en el grupo de riesgo intermedio. • DPSA>0,15ng/ml/ml e índice PSA l/t<15 en el grupo de riesgo alto. Resultados El VPN de la RMmp negativa fue del 92,6% para el carcinoma de próstata clínicamente significativo (CPCS). El VPN aumentó al 97,5% en el grupo de riesgo bajo, y disminuyó al 33,3% en el de riesgo alto. El resultado al combinar la RMmp negativa con la DPSA<0,15ng/ml/ml fue muy similar al de su combinación con el PSA l/t>15. Conclusión el índice PSA l/t también podría utilizarse para aumentar el VPN de la RMmp, al igual que la DPSA. No recomendamos evitar la biopsia de próstata con una DPSA>0,15ng/ml/ml y un índice PSA l/t<0,15. Sin embargo, se requieren estudios controlados aleatorizados con más pacientes para confirmar los hallazgos de nuestro estudio. (AU)

Objective To calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. Methods One hundred ninety-one patients with PSA levels between 4-10mg/ml and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/ml/ml, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters: • PSAD 0.01-0.07 ng/ml/ml and f/t PSA ratio ≥25 in a low-risk group. • PSAD 0.08-0.15 ng/ml/ml, and f/t PSA ratio 0.15-0.24 in an intermediate-risk group and high-risk group. • PSAD>0.15 ng/ml/ml and f/t PSA ratio <15 in high-risk group, Results NPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD <0.15 ng/ml/ml and f/t PSA>15. Conclusion f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/ml/ml and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study. (AU)

El papel del antígeno prostático específico (PSA) y el estadio patológico antes de la radioterapia en la predicción de los resultados de la resonancia magnética multiparamétrica (RMmp) en pacientes con recidiva del cancer de próstata tras prostatectomía radical / Role of PSA levels and pathological stadiation before radiation therapy in predicting mp-MRI results in patients with prostate cancer recurrence after radical prostatectomy

Objetivo Evaluar el valor del antígeno prostático específico (PSA) en la predicción de los resultados de la resonancia magnética multiparamétrica (RMmp) en pacientes con cáncer de próstata (CaP) de alto (puntuación de Gleason≥8, pT≥3, pN1) y bajo grado (puntuación de Gleason<8, pT<3, pN0). Materiales y métodos Ciento ochenta y ocho pacientes se sometieron a una RMmp de 1,5-T después de la prostatectomía radical y antes de la radioterapia. Los pacientes se dividieron en 2 grupos: el grupo A incluía pacientes con recidiva bioquímica (RB) y el grupo B pacientes sin RB pero con alto riesgo de recidiva local. Teniendo en cuenta la puntuación de Gleason, pT y pN como variables de agrupación independientes, se realizaron análisis ROC de los niveles de PSA en el momento del diagnóstico del CaP primario y antes de la radioterapia con el fin de identificar el punto de corte óptimo para predecir el resultado de la RMmp. Resultados En los grupos A y B, el área bajo la curva del PSA antes de la radioterapia fue superior a la del PSA en el momento del diagnóstico del CaP, en tumores de bajo y alto grado. Para los tumores de bajo grado, la mejor área bajo la curva fue de 0,646 y 0,685 en el grupo A y B, respectivamente; para los tumores de alto grado, la mejor área bajo la curva fue de 0,705 y 1 en el grupo A y B, respectivamente. Para los tumores de bajo grado, el punto de corte óptimo del PSA fue de 0,565-0,58ng/ml en el grupo A (sensibilidad y especificidad: 70,5% y 66%), y de 0,11-0,13ng/ml en el B (sensibilidad y especificidad: 62,5% y 84,6%). Para los tumores de alto grado, el punto de corte de PSA óptimo fue de 0,265-0,305ng/ml en el grupo A (sensibilidad y especificidad: 95% y 42,1%), y de 0,13-0,15ng/ml en el grupo B (sensibilidad y especificidad: 100%). Conclusión La RMmp se debe realizar como herramienta diagnóstica complementaria siempre que se detecte una RB, especialmente en el CaP de alto grado... (AU)

Objective To evaluate prostate-specific antigen (PSA) value in multiparametric magnetic resonance imagin (mp-MRI) results prediction, analyzing patients with high (Gleason Score ≥8, pT≥3, pN1) and low grade (Gleason Score <8, pT<3, pN0) prostate cancer (PCa). Materials and methods One hundred eighty-eight patients underwent 1.5-T mp-MRI after radical prostatectomy and before radiotherapy. They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score, pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before radiotherapy were performed in order to identify the optimal cut-off to predict mp-MRI result. Results Group A and B showed higher area under the curve for PSA before radiotherapy than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best area under the curve was 0.646 and 0.685 in group A and B; for high grade the best area under the curve was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58ng/ml in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13ng/ml in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305ng/ml in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15ng/ml in B (sensitivity, specificity: 100%). Conclusion Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA>0.1-0.15ng/ml. (AU)

Predictive Value of Magnetic Resonance Imaging Radiomics Combined with Serum PSA for the Extracapsular Extension of Prostate Cancer Prediction

Objective: We aimed to investigate the value of magnetic resonance imaging (MRI) radiomics combined with serum prostate-specific antigen (PSA) in predicting the extracapsular extension (ECE) of prostate cancer. Methods: In total, 213 patients with prostate cancer admitted to our hospital from May 2021 to April 2023 were retrospectively enrolled as observation subjects. Based on the presence or absence of extracapsular extension, the patients were divided into occurrence (n = 70) and non-occurrence (n = 143) groups. The clinical data, PSA levels, Prostate Imaging Reporting and Data System (PI-RADS®), and MRI-ECE scores of the two groups were compared. Results: In total, 80 patients were included in the occurrence (n = 40) and non-occurrence groups (n = 40), and no statistical significance was observed in the baseline data of the two groups. Preoperative PSA levels were significantly higher in the occurrence group than in the non-occurrence group, and the PI-RADS and MRI-ECE scores of each group differed significantly (p < 0.05). The area under the curve (AUC) for the combined determination of PSA levels and PI-RADS and MRI-ECE scores was 0.900, which was significantly higher than the AUC for the individual determination of the mentioned indicators (p < 0.05). Conclusions: The combination of MRI radiomics and PSA can accurately predict the extracapsular extension of prostate cancer; Thus, it is a favorable reference for subsequent precise diagnosis and treatment. (AU)

Analysis of Factors Influencing Bone Metastasis in Prostate Cancer and Diagnostic Value of Serum PSA, CysC and D-D

Objective: This study aims to analyse factors influencing bone metastasis in prostate cancer and the diagnostic value of serum prostate-specific antigen (PSA), and D-dimer (D-D) combined with cystatin C (CysC) in bone metastasis of prostate cancer. Methods: Data of 116 patients with prostate cancer admitted to our hospital were retrospectively analysed. They were divided into two groups: Bone metastasis group (46 cases) and non-bone metastasis group (70 cases). Univariate and multivariate logistic regression analyses were used to determine factors influencing bone metastasis in prostate cancer. The values of serum PSA, D-D and CysC were identified using a receiver operating characteristic diagnostic curve. Results: Of the 116 patients, 46 had bone metastases and 70 had non-bone metastases. Among 46 patients with bone metastasis, 8 cases (17.39%) had single bone metastasis and 38 cases (82.61%) had multiple bone metastasis. Based on the univariate analysis, bone metastasis was associated with increases in Gleason score, clinical stage, lymph node metastasis, systemic inflammatory response index, fibrinogen to albumin ratio and alkaline phosphatase and fibrinogen levels. The Gleason score was higher than 8 points, the clinical stages ranged from T3 to T4 and the serum levels of PSA, D-D and CysC were higher in the bone metastasis group (p < 0.05). The combined value of serum PSA, D-D and CysC in the diagnosis of bone metastasis in prostate cancer was higher than the three indicators alone. Conclusions: Lymph node metastasis in T3–T4 clinical stages with Gleason score >8 was a risk factor for bone metastasis in prostate cancer (all p < 0.05). The risk of bone metastasis in patients with prostate cancer increases with increasing Gleason clinical stage and the occurrence of lymph node metastasis. Serum PSA, D-D and CysC have certain diagnostic value in the diagnosis of bone metastasis, and their combination has the highest value (AU)

Predictive Value of Preoperative Prostate Health Index and Serum Testosterone Testing for Biochemical Recurrence after Radical Prostatectomy for Non-Metastatic Prostate Cancer

Objective: To analyse the predictive value of prostate health index (PHI) combined with serum testosterone after radical prostatectomy(RP) for prostate cancer (PCa).Methods: A total of 132 PCa patients who received RP treatment from January 2016 to December 2019 were selected, retrospectively.And then these patients were divided into biochemical recurrence (BCR) group (n = 51) and non-biochemical recurrence(non-BCR) group (n = 81) based on whether BCR was present after RP. Basic data of PCa patients were collected, and preoperativeprostate health index (PHI) and serum testosterone levels were measured in both groups. Logistic regression analysiswas used to analyse the influencing factors of BCR after RP. The predictive value of PHI and serum testosterone on BCR afterRP was analysed using the receiver operating characteristic (ROC) curve. The Kaplan–Meier method was used to plot survivalcurves, and log rank test was used to analyse the differences between survival curves.Results: The BCR rate of patients in this study was 38.64% (51/132). Single-factor analysis showed that BCR after RP in PCapatients was associated with prostate-specific antigen (PSA), Gleason score, pathological stage, postoperative adjuvant therapy,testosterone and PHI (p < 0.05). Logistics regression analysis showed that PSA >20 ng/mL, Gleason score (8 scores), pathologicalstage pT3, increased PHI and increased testosterone were independent risk factors for BCR after RP. ROC curve analysisshowed that the area under curve (AUC) of PHI and serum testosterone predicting BCR after RP alone and in combination were0.769, 0.725 and 0.906, respectively. Kaplan–Meier survival analysis showed that preoperative high PHI and low testosteroneare negatively correlated with recurrence-free survival rate. (AU)

Intervenciones hacia la Prueba de Antígeno Prostático: Una revisión rápida de literatura / Interventions for Prostate-Specific Antigen Testing: A Rapid Literature Review

Objetivo: Identificar la mejor evidencia disponible relacionada a las intervenciones dirigidas hacia la aceptación de la prueba de antígeno prostático. Metodología: Revisión rápida de literatura, siguiendo los pasos establecidos por Tapia-Benavente, los cuales son: 1.- pregunta de investigación, para lo cual se utilizó la estructura PICO acotada a la definición del problema, intervención y resultado; 2.- búsqueda de bibliografía en bases de datos reconocidas; 3.- selección de estudios y extracción de datos; 4.- evaluación del riesgo de sesgo, para lo cual se utilizó la guía de comprobación de ensayos clínicos del grupo CONSORT; y 5.- la elaboración de la síntesis además de la conclusión de la evidencia encontrada. Resultados: La búsqueda rápida de literatura arrojó un total de 51 publicaciones de tres bases de datos, PubMed (27), EBSCO (13) y SCOPUS (11); de los cuales 11 cumplían con los criterios de inclusión. El 100% de los estudios indican un cambio significativo entre el grupo experimental y control (p < .05). Las estrategias más utilizadas incluyen la visita domiciliaria, conferencias, debates en grupo, lluvia de ideas, dinámicas de pregunta y respuesta con diapositivas, así como presentación de folletos educativos, mismos que se ejecutan en un periodo de un día, hasta seis meses. Conclusiones: Se hace evidente el vacío de conocimiento referente al desarrollo e implementación de estrategias para abordar la conducta de prevención relacionada al Cancer de Próstata hacia varones de pueblos originarios, así como la falta de modelos de intervención de enfermería enfocadas en este padecimiento. (AU)

Objective: To identify the best available evidence related to interventions for the acceptance of the prostate-specific antigen test. Methodology: Rapid literature review following the steps established by Tapia-Benavente, which are: 1.- research question, for which the PICO structure limited to the definition of the problem, intervention, and result was used; 2.- bibliography search in recognized databases; 3.- study selection and data extraction; 4.- bias risk assessment, for which the CONSORT group clinical trial verification guidelines were used; and 5.- preparation of a summary and conclusion of the evidence found. Results: The rapid literature search yielded a total of 51 publications from three databases, PubMed (27), EBSCO (13), and SCOPUS (11); 11 of which met the inclusion criteria. One hundred percent of the studies indicated a significant difference between the experimental and control groups (p < .05). The most frequently used strategies included home visits, conferences, group discussions, brainstorming, question-and-answer dynamics with slides, as well as the use of educational brochures, and were carried out in a period of one day and up to six months. Conclusions: There is an evident knowledge gap in the development and implementation of strategies for Prostate Cancer prevention behavior directed to indigenous men, as well as a lack of nursing intervention models focused on this disease. (AU)

The Value of Combined Detection of Serum PSA, MALAT1 and TMPRSS2-ETV1 in Evaluating the Progress and Prognosis of Prostate Cancer

Objective: To explore the prognostic value of combined detection of serum prostate specific antigen (PSA), lung cancer metastasis-associated transcript 1 (MALAT1), transmembrane serine protease 2 (TMPRSS2), and erythropoietin-specific transforming gene variant 1 (ETV1) in prostate cancer. Methods: Ninety patients with prostate cancer who were treated in hospital were divided into two groups according to tumor node metastasis stage: Stage I−II group (n = 34) and stage III−IV group (n = 56). The serum levels of PSA, MALAT1, and TMPRSS2-ETV1 were detected in both groups and correlated with prostate cancer status to determine their value as indicators of disease progression and prognosis. Results: Age, body mass index (BMI), and Gleason score differed significantly between the study group and the control group (p < 0.05). The expression levels of serum PSA and MALAT1 were higher in group III–IV than in group I–II, and the positive expression rate of TMPRSS2-ETV1 was significantly higher in group III–IV than in the control group (p < 0.05). Pearson’s correlation analysis showed that serum PSA, MALAT1, and TMPRSS2-ETV1 were significantly correlated with prostate cancer (p < 0.05). Differences in PSA levels correlated with differences in age, BMI, type of pathology, and Gleason score, whereas differences in serum MALAT1 levels correlated with differences in age, BMI, and type of pathology. Gleason scores differed significantly between patients with positive and negative TMPRSS2-ETV1 indicators (p < 0.05). Multivariate logistic regression analysis showed that serum PSA, MALAT1, and TMPRSS2-ETV1 were independent risk factors affecting the prognosis of prostate cancer (p < 0.05). The areas under the curve (AUCs) of serum PSA, MALAT1, and TMPRSS2-ETV1 as prognostic predictors in prostate cancer were 0.692, 0.731, and 0.709, respectively, whereas the AUC of the combination was 0.819 (AU)

Terapia de privación de andrógenos en el cáncer de próstata localizado. Situación actual y tendencias futuras / Androgen deprivation therapy in localized prostate cancer. Current status and future trends

Introducción El cáncer de próstata (CaP) se ha reconocido como una enfermedad sensible a los andrógenos desde las investigaciones de Huggins y Hodges en 1941, quienes, gracias a estos hallazgos, recibieron el Premio Nobel en 1966. Aquí se originó el desarrollo de la terapia de privación de andrógenos (TPA) como tratamiento para los pacientes con CaP. Objetivo Resumir las indicaciones actuales de la TPA en el CaP localizado. Adquisición de la evidencia Hemos realizado una investigación bibliográfica exhaustiva en inglés y español, centrada en las principales indicaciones de la TPA en el CaP localizado. Síntesis de la evidencia En la actualidad, las indicaciones de la TPA como monoterapia en el CaP localizado se han limitado a situaciones específicas, a pacientes que no desean o no pueden recibir ninguna forma de tratamiento local y que tienen un PSA-DT<12 meses y un PSA>50 ng/mL, un tumor poco diferenciado o síntomas locales molestos relacionados con la enfermedad. La TPA puede utilizarse en combinación con tratamiento local en diferentes escenarios. Aunque el tratamiento neoadyuvante con TPA antes de la cirugía con intención curativa no tiene un impacto oncológico claro, el CaP es una enfermedad heterogénea y en el futuro podría haber un grupo de pacientes con enfermedad localizada de alto riesgo que se beneficiaran de este tratamiento. Conclusiones Necesitamos optimizar el tratamiento con TPA en el CaP localizado, seleccionando a los pacientes en función de las características de su enfermedad. Dado que el arsenal terapéutico evoluciona día a día, es necesario el desarrollo de nuevos ensayos clínicos, así como el estudio molecular en los pacientes, para identificar a aquellos que podrían beneficiarse de un tratamiento multimodal temprano (AU)

Introduction Prostate cancer (PCa) has been recognized as an androgen-sensitive disease since the investigations from Huggins and Hodges in 1941. Thanks to these findings, they received the Nobel Prize in 1966. This was the beginning of the development of androgen deprivation therapy (ADT) as treatment for patients with PCa. Objective To summarize the current indications of ADT in localized PCa. Evidence acquisition We conducted a comprehensive English and Spanish language literature research, focused on the main indications for ADT in localized PCa. Evidence synthesis Nowadays, the indications for ADT as monotherapy in localized PCa have been limited to specific situations, to patients unwilling or unable to receive any form of local treatment if they have a PSA-DT<12 months, and either a PSA>50 ng/mL, a poorly differentiated tumor, or troublesome local disease-related symptoms. ADT can be used in combination with local treatment in different scenarios. Although neoadjuvant treatment with ADT prior to surgery with curative intent has no clear oncological impact, as a future sight, PCa is a heterogeneous disease, and there could be a group of patients with high-risk localized disease that could benefit. Conclusions We need to optimize the treatment with ADT in localized PCa, selecting the patients accordingly to their disease characteristics. Given that the therapeutic armamentarium evolves day by day, there is a need for the development of new clinical trials, as well as a molecular studies of patients to identify those who might benefit from an early multimodal treatment (AU)

Grupos de riesgo de recidiva bioquímica tras prostatectomía radical de la Asociación Europea de Urología: validación externa e identificación de factores de riesgo de progresión y mortalidad / European Association of Urology biochemical recurrence risk groups after radical prostatectomy: external validation and identification of independent risk factors for progression and death

Contexto La EAU propuso una clasificación del riesgo de progresión y muerte en pacientes con recidiva bioquímica tras prostatectomía radical (PR). Objetivo Validar la clasificación de riesgo de RB de la EAU en nuestro contexto e identificar los factores asociados con la progresión y la muerte. Material y métodos Estudio multicéntrico, retrospectivo y observacional que incluyó a 2140 pacientes sometidos a PR entre 2011 y 2015. Los pacientes con RB fueron identificados y estratificados en grupos de riesgo bajo (TD-PSA >1 año y pGS <8) o alto (TD-PSA <=1 año o pGS=>8). Se calcularon la supervivencia libre de progresión por PSA y supervivencia libre de metástasis (SLP-PSA, SLM), la supervivencia cáncer específica y la supervivencia global (curvas de Kaplan Meier y log-rank test). Se identificaron factores de riesgo independientes (regresión de Cox). Resultados Un total de 427 pacientes experimentaron RB (32,3% de bajo riesgo y 67,7% de alto riesgo). La mediana de SLP-PSA fue de 135,0 m (IC 95% 129,63-140,94) y 115,0 m (IC 95% 104,02-125,98) (p < 0,001) para los grupos de bajo y alto riesgo, respectivamente. Hubo diferencias significativas en la SLM y la supervivencia global entre ambos grupos. El grupo de riesgo de RB de la EAU fue un factor independiente de progresión del PSA (HR 2,55; p 0,009). El tiempo transcurrido entre la PR y la RB fue un factor independiente de aparición de metástasis (HR 0,43; IC 95%: 0,18-0,99; p 0,044) y muerte (HR 0,17; IC 95%: 0,26-0,96; 23 p 0,048). Se hallaron diferencias en la SLM (p 0,001) y la supervivencia cáncer específica (p 0,004) para <12, ≥ 12-<36 y ≥36 meses transcurridos entre la PR y la RB. Otros factores independientes fueron la radioterapia de rescate precoz y el PSA en el momento de aparición de la RB (AU)

Background The EAU proposed a progression and death risk classification in patients with biochemical recurrence after radical prostatectomy (PR). Objective To validate the EAU BCR-risk classification in our setting and to find factors related to progression and death. Material and methods Multicenter, retrospective, observational study including 2140 patients underwent RP between 2011 and 2015. Patients with BCR were identified and stratified in low risk (PSA-DT>1 yr and pGS <8) or high-risk (PSA-DT <=1 yr or pGS=>8) grouping. PSA and metastatic free survival (PSA-PFS, MFS), cancer specific survival and overall survival were calculated (Kaplan Meier curves and log-rank test). Independent risk factors were identified (Cox regression). Results 427 patients experienced BCR (32.3% low-risk and 67.7% high-risk). Median PSA-PFS was 135.0 mo (95% CI 129.63-140.94) and 115.0 mo (95% CI 104.02-125.98) (p < .001), for low and high-risk groups, respectively. There was also significant differences in MFS and overall survival. The EAU BCR risk grouping was independent factor for PSA-progression (HR 2.55, p 0.009). Time from PR to BCR, was an independent factor for metastasis onset (HR 0.43, 95% CI 0.18-0.99; p 0.044) and death (HR 0.17, 95% CI 0.26.0.96; 23 p 0.048). Differences in MFS (p 0.001) and cancer specific survival (p 0.004) were found for <12, ≥12-<36 and≥36 months from PR to BCR. Others independent factors were early salvage radiotherapy and PSA at BCR. Conclusions High-risk group is a prognostic factor for biochemical progression, but it has a limited accuracy on MP and death in our setting. The inclusion of other factors could increase its predictive power (AU)

Factores clínicos e histológicos predictores de reclasificación en pacientes incluidos en programa de vigilancia activa de cáncer de próstata / Clinical and histological predictive factors of reclassification of prostate cancer patients on active surveillance

Introducción y objetivo La vigilancia activa (VA) se ha establecido como estrategia terapéutica en pacientes con cáncer de próstata de bajo riesgo. Se han identificado factores demográficos y anatomopatológicos que aumentan la probabilidad de reclasificar a los enfermos. Materiales y métodos Se han recogido datos analíticos e histopatológicos de 116 pacientes incluidos en VA desde 2014. Se ha realizado un análisis univariante con X2, t de Student y Tau de Kendall, un análisis multivariante según regresión logística y se han calculado las curvas de Kaplan-Meier. Resultados De los 116 pacientes en VA, la mediana de edad al diagnóstico fue 66 años y la mediana de seguimiento fueron 13 meses (2-72). De todos ellos, 61 (52,6%) siguen en vigilancia mientras que 55 (47,4%) han salido del programa, la mayoría por progresión histológica (52 pacientes [45,2%]), realizándose prostatectomía radical en 27 (49,1%). El volumen prostático (Vp) ≤ 60cc y el número de cilindros positivos >1 en la biopsia diagnóstica (p = 0,05) se asociaron con mayor tasa de reclasificación en el análisis univariante (p < 0,05). En el análisis multivariante, estas dos variables se correlacionaron significativamente con una mayor tasa de reclasificación (Vp ≤ 60 cc: OR 4,39, p = 0,04; >1 cilindro positivo en la biopsia diagnóstica: OR 2,48, p = 0,03). Conclusiones Se ha objetivado que el volumen ecográfico inicial y el número de cilindros positivos en la biopsia diagnóstica son factores de riesgo independientes para la reclasificación. El antígeno prostático específico (PSA) inicial, la lateralidad de los cilindros afectos y la densidad de PSA no fueron elementos predictores de progresión en nuestra serie (AU)

Introduction and Objective Active surveillance (AS) has been established as a therapeutic strategy in patients with low-risk prostate cancer. Demographic and anatomopathological factors that increase the probability of reclassifying patients have been identified. Materials and Methods Laboratory and histopathological data were collected from 116 patients included on AS since 2014. Univariate analysis was performed with Chi-square, t-student and Kendall's Tau, multivariate analysis according to logistic regression and Kaplan-Meier curves were calculated. Results Of the 116 patients in AS, the median age at diagnosis was 66 years and the median follow-up was 13 months (2-72). Of these, 61 (52.6%) are still on surveillance, while 55 (47.4%) have left the program, mostly due to histological progression (52 patients (45.2%)); radical prostatectomy was performed in 27 (49.1%). Prostate volume (PV) ≤ 60cc and the number of positive cylinders > 1 in diagnostic biopsy (p = 0.05) were associated with higher reclassification rate in univariate analysis (p < 0.05). Multivariate analysis showed that these two variables significantly correlated with higher reclassification rate (PV 60 cc: OR 4.39, p = 0.04; > 1 positive cylinder at diagnostic biopsy: OR 2.48, p = 0.03). Conclusions It has been shown that initial ultrasound volume and the number of positive cylinders in the diagnostic biopsy are independent risk factors for reclassification. Initial PSA, laterality of the affected cylinders and PSA density were not predictive factors of progression in our series (AU)

Rendimiento de la PET/TC con 11C-colina en el seguimiento del cáncer de próstata / Effectiveness of 11C-choline PET/CT in prostate cancer surveillance

Objetivo Analizar el rendimiento diagnóstico de la PET/TC con 11C-colina en el seguimiento del cáncer de próstata (CaP), especialmente en pacientes con antígeno prostático específico (PSA)>1ng/ml. Material y métodos Se evaluaron retrospectivamente 329 exploraciones PET/TC con 11C-colina de 191 pacientes (68,2±7,2 años) con CaP con recaída bioquímica o en seguimiento (PSA en el momento de la PET/TC: 13,0±84,2ng/ml). El tratamiento inicial fue prostatectomía radical en 81 pacientes y otros tratamientos (radioterapia, quimioterapia, hormonoterapia) en 110. La PET/TC se adquirió 20min después de la inyección de 555-740MBq de 11C-colina. El seguimiento mínimo fue superior a 12 meses. Resultados Doscientas diecinueve (66,6%) de las 329 exploraciones PET/TC fueron positivas. El porcentaje de positivos fue significativamente mayor en los pacientes con otro tratamiento inicial diferente a la prostatectomía radical (85,6 frente a 43,6%, respectivamente). Ciento treinta PET/TC (59,4%) mostraron recidiva local, 48 (21,9%) a distancia y 41 (18,7%) local más a distancia. El abordaje terapéutico inicial se modificó en 139 casos (63,5%). De las 81 PET/TC con 11C-colina realizadas con PSA<1ng/ml, 23 (28,4%) fueron positivas. El abordaje terapéutico inicial se modificó en 9 (11,1%). Tres de 63 pacientes (4,8%) fallecieron por CaP. Conclusiones La PET/TC con 11C-colina demostró su eficacia en el seguimiento y la reestadificación del CaP, incluso en pacientes con PSA sérico<1ng/ml. El rendimiento diagnóstico fue diferente según el tratamiento inicial al que fueron sometidos los pacientes, siendo mayor en aquellos tratados inicialmente con otros tratamientos distintos de la PR prostatectomía radical (AU)

Aim Our aim was to analyse the performance of 11C-choline PET/CT in prostate cancer (PCa) surveillance, especially in patients with prostate specific antigen (PSA)<1ng/ml. Material and methods Three hundred and twenty-nine 11C-choline PET/CT examinations from 191 patients (68.2±7.2 years) submitted for PCa surveillance or biochemical recurrence were retrospectively evaluated (PSA at study was 13.0±84.2ng/ml). Main initial treatment was radical prostatectomy in 81 patients, and other treatments (radiotherapy, chemotherapy, hormonotherapy) in 110. PET/CT was acquired 20min after injection of 555-740MBq of 11C-choline. Minimum follow-up was 12 months. Results Two hundred and nineteen (66.6%) out of the 329 PET/CT examinations were positive. The percentage of positive examinations was significantly higher in patients with other initial treatment than radical prostatectomy compared to patients with radical prostatectomy (85.6 vs. 43.6%, respectively). One hundred and thirty PET/CT (59.4%) showed local recurrence, 48 (21.9%) distant recurrence, and 41 (18.7%) local plus distant recurrence. Initial therapeutic approach was changed in 139 cases (63.5%). In the subgroup of 81 11C-choline PET/CT scans performed with PSA<1ng/ml, 23 (28.4%) showed a positive result. Initial therapeutic approach was changed in 9 (11.1%). Three (4.8%) out of 63 patients died as per PCa. Conclusions 11C-choline PET/CT demonstrated its effectiveness in PCa surveillance and restaging, even in patients with serum PSA<1ng/ml. The diagnostic performance was different depending on the initial treatment, been higher in patients with non-surgical treatment (AU)

Urine-derived exosomal PSMA is a promising diagnostic biomarker for the detection of prostate cancer on initial biopsy

Purpose It is well-established that the lack of accurate diagnostic modalities for prostate cancer (PCa) leads to overdiagnosis and overtreatments. Accordingly, this study aimed to assess the value of urine-derived exosomal prostate-specific membrane antigen (PSMA) as a biomarker for the diagnosis of PCa and clinically significant prostate cancer (csPCa). Methods A total of 284 urine samples were collected from patients after the digital rectal examination (DRE). Urinary exosomes were extracted using commercial kits, and urine-derived exosomal PSMA was determined via enzyme-linked immunosorbent assay (ELISA). Evaluation of diagnostic accuracy of PSMA was performed via receiver operating characteristic (ROC) analysis, decision curve analysis (DCA), and waterfall plots. Results We found that urine-derived exosomal PSMA was significantly higher in PCa and csPCa than in benign prostatic hyperplasia (BPH) and BPH + non-aggressive prostate cancer (naPCa) groups (P < 0.001). Furthermore, the urine-derived exosome PSMA yielded area under the ROC curve (AUC) values of 0.876 and 0.826 for detecting PCa and csPCa, respectively, suggesting better performance than traditional clinical biomarkers. Besides, when the cutoff value used corresponded to a sensitivity of 95%, urine-derived exosomal PSMA could avoid unnecessary biopsies in 41.2% of cases and missed only 0.7% of csPCa cases. Conclusions Urine-derived exosomal PSMA exhibits a good diagnostic yield for detecting PCa and csPCa. Findings of the present study provide the foothold for future studies on cancer management and research in this patient population (AU)

Uso del antígeno prostático específico (PSA) para el cribado de cáncer de próstata en la población de 70 años o más de una zona de salud urbana, 2018-2020. Un estudio transversal / Prostate cancer screening with Prostate-Specific Antigen (PSA) to men over 70 years old in an urban health zone, 2018–2020: A cross-sectional study

Objetivos Cuantificar, describir el origen y estimar el coste de las solicitudes de antígeno prostático específico (PSA) con fines de cribado a varones de 70 años o más realizadas en una zona de salud urbana. Métodos Estudio transversal. Se obtuvieron todas las determinaciones de PSA a pacientes adscritos a una zona de salud entre los años 2018 y 2020. Se clasificaron retrospectivamente como cribado (PSAc) o no, de acuerdo a criterios preestablecidos revisando historiales clínicos. Se comparó la edad de los pacientes sometidos a cribado con aquellos que no lo fueron. Se calcularon tasas de solicitud por centros y solicitantes de acuerdo a la población de referencia provista por el padrón municipal (VM70). Se estimó el coste consultando las tarifas de facturación. Resultados Fueron estudiadas 2.036 PSA, de 888 hombres ≥ 70 años, y 350 clasificadas como cribado. Se diagnosticaron seis adenocarcinomas. Se estimaron 76,07 PSAc/1.000 VM70-año con origen en cualquier centro, 1,45 solicitudes por individuo cribado, y una prevalencia de 15,71%; población media de referencia de 1.534 hombres (DE 45,37). Los pacientes sometidos a cribado (edad media 75 años, DE 4,04) fueron más jóvenes que aquellos no cribados (media 76,5, DE 4,81). Se estimó un coste del cribado de 9.751 €. Conclusiones Se describe la epidemiología y estima el coste de los cribados con PSA a varones ≥ 70 años sin cáncer prostático en nuestra zona, en atención primaria y hospitalaria. Se trata de una práctica habitual, predominantemente en atención primaria, y en magnitud similar a la reportada en la bibliografía estatal. (AU)

Objectives To describe the epidemiology and estimate the cost of Prostate-Specific Antigen (PSA) screening tests to men ≥ 70 years old in an urban health zone. Methods A cross-sectional study was performed. We obtained every PSA test made in the health zone from 2018 to 2020, and classified them retrospectively as screening (PSAc) or not according to pre-established criteria, reviewing electronic health records. Testing rates were calculated by centres and clinical specialities. The standard population was provided by the city register of inhabitants (VM70). Cost estimation was made using our health system's price list. ResultsTwo thousand and thirty six PSA, of 888 men ≥ 70 years old were obtained, and 350 met screening classification criteria. Six adenocarcinomas were diagnosed from those tests. We estimated 76.07 PSAc/1000 VM70-year from any centre, 1.45 tests for each screened individual, and 15.71% prevalence. The standard population was 1534 men (mean 2018-2020, SD 45.37). Patients who were screened (median age 75, SD 4.04) were younger than those not screened. We estimated a total screening test cost of 9,751 €. Conclusions The epidemiology and cost of PSA screening tests to men ≥ 70 years old are reported, both in primary health care and in the hospital. PSA screening tests are common practice amongst professionals attending elderly men in our health zone, mostly in primary care. The screening testing rate of men without prostate cancer is similar to that reported in the literature. (AU)

¿Es el intervalo libre de docetaxel un factor predictivo para el cáncer de próstata resistente a la castración? / Is docetaxel-free interval a predictive factor for castration-resistant prostate cancer?

Objetivo: El cáncer de próstata (CaP) es el segundo tumor sólido más frecuente en los varones y la quinta causa de muerte relacionada con el cáncer. En los estadios avanzados de la enfermedad se administran tratamientos paliativos en lugar de terapias curativas, por lo que, conocer los posibles indicadores predictivos, parece importante. Se revisaron retrospectivamente los pacientes con cáncer de próstata resistente a la castración (CPRC) que recibieron quimioterapia con docetaxel (Dx). El objetivo de este estudio fue investigar si el intervalo libre de Dx podría tener un valor predictivo para el CaP e influir en las terapias secuenciales.Material y métodos: Este ensayo clínico se realizó en 104 pacientes en la Clínica de Oncología de la Universidad de Medeniyet en 2018-2020. Todos los pacientes con CPRC metastásico recibieron Dx como primer tratamiento y fueron sometidos a terapia dirigida al receptor de andrógenos (ARAT, por sus siglas en inglés) tras la progresión de la enfermedad. Se analizó el tiempo hasta la progresión de los pacientes después de la terapia con Dx y los efectos sobre el tratamiento secuencial.Resultados: Posterior al tratamiento con Dx, los pacientes recibieron ARAT (abiraterona [ABI] n: 49 [47,1%] y enzalutamida [ENZ] n: 54 [51,9%]) como tratamiento de segunda línea, excepto un paciente que recibió cabazitaxel. Hubo una relación estadísticamente significativa entre el intervalo libre de Dx y la duración de la respuesta al ARAT (p<0,001). El tiempo de respuesta al tratamiento con ARAT fue <10,5 meses en todos los pacientes con un período de intervalo libre de Dx<9 meses.Conclusiones: Nuestros resultados avalan la hipótesis de que el intervalo libre de Dx puede ser un factor predictivo para el CPRC. El CPRC podría clasificarse como enfermedad sensible al Dx o resistente al Dx en función del intervalo libre de Dx; y la decisión sobre los tratamientos posteriores podría tomarse con base en esta información. (AU)

Objective: Prostate cancer (PCa) is the second most common solid tumor in men and the fifth leading cause of cancer-related death. In advanced stage, palliative treatments are used instead of curative therapies. Therefore, finding predictive indicators seems crucial. Patients with castration-resistant prostate cancer (CRPC) that received Dx chemotherapy have been retrospectively reviewed. The aim of this study was to investigate whether docetaxel (Dx)-free interval could have a predictive value for PCa and influence other sequential therapies.Material and methods: This clinical trial study was performed on 104 patients at Medeniyet University Oncology Clinic in 2018-2020. All CRPC patients had metastases, received Dx as first-line treatment and underwent androgen receptor axis targeted (ARAT) therapy after disease progression. We analyzed patients’ progression time after Dx therapy and the effects on sequential treatment.Results: After Dx therapy, all patients received ARAT (abiraterone (ABI) n: 49 (47.1%) and enzalutamide (ENZ) n: 54 (51.9%)) as a second-line treatment, except for one patient who received cabazitaxel. There was a statistically significant relationship between the Dx-free interval and duration of response to ARAT (P<.001). The response time of ARAT treatment was <10.5 months in all patients whose Dx-free interval period was <9 months.Conclusions: Our findings support the theory that Dx-free interval can be a predictive factor for CRPC. CRPC disease can be classified as Dx-sensitive disease or Dx-resistance disease, based on the Dx-free interval. Decision on subsequent treatments could be made considering this information. (AU)

El papel de la resonancia magnética multiparamétrica en el diagnóstico de la recidiva local tras la prostatectomía radical y antes de la radioterapia de rescate / The role of multiparametric magnetic resonance imaging in the diagnosis of local recurrence after radical prostatectomy and before salvage radiotherapy

Objetivo Evaluar la precisión diagnóstica de la resonancia magnética multiparamétrica (RMmp) en la detección de la recidiva local del cáncer de próstata (CaP) después de la prostatectomía radical (PR) y antes de la radioterapia (RT). Materiales y métodos Un total de 188 pacientes se sometieron a una RMmp de 1,5T después de la PR y antes de la RT. Los pacientes se dividieron en 2 grupos: con recidiva bioquímica (grupo A) y sin recidiva bioquímica, pero con alto riesgo de recidiva local (grupo B). Las variables continuas se compararon entre los 2 grupos mediante la prueba t de Student; las variables categóricas se analizaron mediante chi-cuadrado de Pearson. El análisis ROC se realizó considerando como variables de agrupación el PSA antes de la RT, el grado ISUP, el pT y el pN. Resultados La recidiva del CaP (reducción de los niveles de PSA después de la RT) fue del 89,8% en el grupo A y del 80,3% en el grupo B. Al comparar los pacientes con y sin recidiva del CaP, hubo una diferencia significativa en los valores de PSA antes de la RT para el grupo A, y en los valores de PSA antes y después de la RT para el grupo B. En el grupo A hubo una correlación significativa entre el PSA antes de la RT y el diámetro de la recidiva, y entre el PSA antes de la RT y el tiempo transcurrido hasta la recidiva. La precisión diagnóstica de la RMmp en la detección de la recidiva local del CaP tras la RT es del 62,2% en el grupo A y del 38% en el grupo B. La imagen potenciada en difusión es la secuencia de RM más específica y la perfusión dinámica con contraste la más sensible. Para el PSA=0,5ng/ml, el AUC disminuye, mientras que la sensibilidad y la precisión aumentan para cada secuencia de RM. Para el PSA=0,9ng/ml, el AUC de la perfusión dinámica con contraste aumenta significativamente (AU)

Purpose Assess multiparametric-MRI (mp-MRI) diagnostic accuracy in the detection of local recurrence of prostate cancer (PCa) after radical prostatectomy (PR) and before radiation therapy (RT). Materials and methods A total of 188 patients underwent 1.5-T mp-MRI after RP before RT. Patients were divided into 2 groups: with biochemical recurrence (group A) and without but with high risk of local recurrence (group B). Continuous variables were compared between 2 groups using Student-t test; categoric variables were analyzed using Pearson chi-square. ROC analysis was performed considering PSA before RT, ISUP, pT and pN as grouping variables. Results PCa recurrence (reduction of PSA levels after RT) was 89.8% in group A and 80.3% in group B. Comparing patients with and without PCa recurrence, there was a significant difference in PSA values before RT for group A and for PSA values before RT and after RT for group B. In group A, there was a significant correlation between PSA before RT and diameter of recurrence and between PSA before RT and time spent before recurrence. The mp-MRI diagnostic accuracy in detecting PCa local recurrence after RP is of 62.2% in group A and 38% in group B. Diffusion weighted imaging is the most specific MRI-sequence and dynamic contrast enhanced the most sensitive. For PSA=0.5ng/ml, the AUC decreases while sensitivity and accuracy increase for each MRI-sequence. For PSA=0.9ng/ml, dynamic contrast enhanced-AUC increases significantly. Conclusion mp-MRI should always be performed before RT when a recurrence is suspected. New scenarios can be opened considering the role of diffusion weighted imaging for PSA≤0.5ng/ml (AU)

Unidades Hounsfield: una herramienta no invasiva prometedora para el diagnóstico de la hiperplasia benigna de próstata / Hounsfield units: A promising non-invasive tool for diagnosing benign prostatic hyperplasia

Objetivo Los síntomas clínicos en la hiperplasia benigna de próstata (HBP) son directamente proporcionales al volumen de la próstata. Nuestro objetivo es definir el tipo de paciente que debe ser intervenido de forma no invasiva, así como el momento idóneo para esta intervención, correlacionando los síntomas subjetivos del paciente con las herramientas objetivas de diagnóstico. Material y método Se utilizó el cuestionario International Prostate Symptom Score (IPSS) en los pacientes que acudieron por primera vez a la consulta externa de urología con síntomas del tracto urinario inferior (STUI). A continuación, se solicitaron niveles de PSA, urea, creatinina, análisis de orina completos, uroflujometría, ecografía del tracto urinario y tomografía computarizada (TC) abdominal inferior sin contraste. Se registraron los valores de las unidades Hounsfield (UH) de la zona central (zona de transición) y de la zona periférica de la próstata, la longitud de la uretra prostática y los valores de UH de la pared vesical mediante la TC. Se utilizó la fórmula del elipsoide para las mediciones ultrasonográficas y tomográficas del tamaño de la próstata (diámetro anteroposterior × diámetro transversal × diámetro longitudinal × 0,52). Resultados Se halló una correlación negativa estadísticamente significativa entre la proporción de UH de la zona periférica de la próstata/zona central y el flujo máximo medido en la uroflujometría. Conclusión Este es el primer estudio de la literatura en evaluar la correlación entre los parámetros miccionales, como las puntuaciones de Qmáx, Qave e IPSS, y las puntuaciones de UH de la próstata y la pared vesical obtenidas mediante TC en pacientes con HBP. Se ha detectado una relación significativa entre la proporción de UH de la zona periférica/zona central y Qmáx (AU)

Objective The clinical symptoms in benign prostatic hyperplasia (BPH) are directly proportional to prostate volume. We aimed to show whom and when to intervene in a noninvasive way, correlating the patient's subjective symptoms with objective diagnostic tools. Material and method International Prostate Symptom Score (IPSS) was evaluated in patients who consulted the urology outpatient clinic for the first time with lower urinary tract symptoms (LUTS). Subsequently, PSA, urea, creatinine, complete urinalysis, uroflowmetry, urinary tract ultrasound and non-contrast lower abdominal computed tomography (CT) examinations were requested. Prostate central (transitional zone) zone and peripheral zone HU scores, prostatic urethral length and bladder wall Hounsfield units (HU) scores were recorded by using computed tomography (CT). The ellipsoid formula was used for ultrasonographic and tomographic measurements of prostate size (anteroposterior diameter × transverse diameter × longitudinal diameter × 0.52). Results A statistically significant negative correlation was found between the prostate peripheral zone/central zone HU ratio and the maximum flow rate measured in the uroflowmetry test. Conclusion This is the first study in the literature to evaluate the correlation between voiding parameters such as Qmax, Qave and IPSS scores, and prostate and bladder wall HU scores obtained by computed tomography examination in BPH patients. A significant relationship has been detected between the peripheral zone/central zone HU ratio and Q max. Additional studies with larger patient populations could better clarify the contribution of HU in the diagnosis of BPH and treatment decision making of these patients (AU)

Fitoterapia para los síntomas del tracto urinario inferior en el varón: ¿qué ocurre después? Diez años de investigación / Phytotherapy for male luts: What happens then? 10-year research

Introducción y objetivos Nuestro objetivo es evaluar los resultados de la fitoterapia a largo plazo, centrándonos en el intervalo entre la fitoterapia y los tratamientos farmacológicos y los factores de riesgo que predisponen a dicho cambio en un seguimiento de 10 años. Material y métodos Se revisaron retrospectivamente los datos de los pacientes varones que tomaban fitoterapia para los síntomas del tracto urinario inferior (STUI) de leves a moderados entre enero y diciembre de 2010, a partir de una base de datos mantenida prospectivamente. Se realizó un seguimiento de los pacientes durante 10 años mediante consultas médicas presenciales y telefónicas. Resultados Ciento dos pacientes se sometieron al menos a un ciclo de fitoterapia para los STUI. Veinte (19,6%) pacientes resolvieron sus síntomas tras un ciclo fitoterápico y abandonaron el tratamiento, 27 (26,4%) continuaron con la fitoterapia y 52 (51%) cambiaron a bloqueadores alfa y/o inhibidores de la 5a-reductasa tras un intervalo medio de 24 meses. El motivo del cambio de tratamiento fue la sintomatología (n=45) o la progresión clínica (aumento del volumen residual n=15; retención urinaria, n=5). Los pacientes que cambiaron a fármacos sintéticos tenían una mediana de edad más alta (60 frente a 49), mayor volumen prostático (40 frente a 26cc) y antígeno prostático específico (1,9 frente a 0,9ng/ml), volumen residual más elevado (40 frente a 0cc) y una tasa de flujo máximo (Qmáx) más baja (12 frente a 15ml/s) en el momento de la presentación. Conclusiones El 46% de los pacientes con STUI leves o moderados sometidos a fitoterapia estarán libres de tratamiento o seguirán con la fitoterapia a los 10 años de la presentación de la enfermedad. Los pacientes de mayor edad, con próstatas más grandes, con volumen residual y antígeno protático específico más alto, deben ser informados sobre un mayor riesgo de progresión sintomática o clínica (AU)

Introduction and objectives Our objective is to assess the long-term results of phytotherapy, focusing on the interval between phytotherapy and pharmacological treatment and the predisposing risk factors to such switch on a 10-year follow-up. Material and methods The data of patients taking phytotherapy for mild to moderate male lower urinary tract symptoms (LUTS) from January to December 2010 were retrospectively reviewed from a prospectively maintained database. Patients were followed for 10 years through medical visits and telephone consultations. Results 102 patients underwent at least one cycle of phytotherapy for LUTS. Twenty (19.6%) patients resolved their symptoms after one phytotherapy cycle and stopped any treatment, 27 (26.4%) continued phytotherapy, and 52 (51%) switched to alpha-blockers and/or 5a-reductase inhibitors after a median interval of 24 months. The reasons for treatment switch were symptoms (n=45) or clinical progression (increased residual volume n=15; urinary retention, n=5). Patients switching to synthetic drugs had median higher age (60 vs 49), prostate volume (40 vs 26cc), prostate specific antigen (PSA) (1.9 vs 0.9ng/ml), residual volume (40 vs 0cc), and a lower maximum flow rate (Qmax) (12 vs 15ml/sec) at presentation. Conclusions 46% patients with mild to moderate LUTS undergoing phytotherapy will be either free of treatment or still on phytotherapy at 10 years from disease presentation. Older patients with larger prostates, increased residual volume and PSA, should be informed regarding their higher risk of symptomatic or clinical progression: the risk of a treatment switch to alpha-blockers or 5a-reductase inhibitors becomes an actual fact after an average span of 2 years (AU)

Salvage Radical Prostatectomy in Nonmetastatic Castration-Resistant Prostate Cancer

Objective: To analyze the perioperatory and short-oncological outcomes in 5 cases with CRPC M0 developed after pRT that underwent salvage laparoscopic RP (sLRP) and review the current evidence. Material and Methods: Perioperatory and oncological outcomes were prospectively analyzed. Inclusion criteria were patients that had received pRT and posteriorly presented with CRPC M0 in standard imagines and positron emission tomography MRI coline. Evidence was reviewed in PUBMED database. Results: No surgical complications and blood transfusion were reported. Two patients required an endoscopic urethrotomy due to bladder neck contracture (Clavien IIIb). Final pathological findings were T3 or more, multifocal with 3 positive surgical margins. Four patients reach undetectable PSA after surgery except one that continuous under ADT without disease progression. After 12 months follow-up, 4 patients persist with undetectable PSA and one with stable disease under ADT. Current evidence demonstrated that CRPC M0 treated with open, laparoscopic or robotic RP a biochemical recurrence of 68.7% as a hormone-sensitive PC; however, 17.4% were disease-free after 4 years of follow-up. Conclusion: Our serie, 4 cases are disease free after 12 months follow-up. Current evidence is a retrospective and multicenter experience with few cases and intermediate oncological follow-up. More cases with longer follow-up and better evidence are required to opt for this treatment as a first line (AU)

Role of 18F-Choline PET/CT in the Initial Staging of High Risk Prostate Cancer and Comparison with Conventional Imaging Techniques

Objective: To assess the diagnostic accuracy of 18F-Choline PET/CT in the initial staging of high-risk prostate cancer (PC), and to compare it with conventional imaging techniques and to assess the changes in therapeutic attitude derived from its results. Secondary Objectives: To assess the concordance between 18F-Choline PET/CT and conventional study and to find related prognostic factors. Material and Methods: Retrospective observational study of 78 patients with high-risk PC undergoing 18F-Choline PET/CT after conventional initial staging (CT + BS). Sensitivity, specificity and predictive values of 18F-Choline PET/CT and CT + BS were calculated. The golden standard was histological result or follow-up. Tumor characteristics were collected and univariate and multivariate analyzes were performed. Results: The median age was 67 years old and mean PSA was 42.39 ng/mL. The sensitivity, specificity and NPV in global initial staging for PET/CT 18F-Choline and conventional imaging were: 92.9% vs 38.5%, 83.3% vs 42.3%, and 90.9% vs 40.7%, respectively. Lymph node staging: sensitivity 96.3% vs 61.5% and specificity 80% vs 76%, respectively. Bone staging: sensitivity 91.7% vs 21.4% and specificity 97.4% vs 83.8%, respectively. There was agreement in 25 patients (32%) (p = 0.004), Kappa index 0.134 (p = 0.011). The treatment was modified in 47.4% patients. PSA, PSADT% positive cores and cT were related to PET results. PSA level <8.9 ng/mL was considered an independent protective factor for positive PET (OR 0.03) (95% CI: 0.002-0.435, p 0.010). Conclusions: 18F-Choline PET/CT seems to be superior to CT + BS for initial staging in high-risk PC. It could be considered because its results can change the treatment decision in almost half of the patients (AU)

The CAPRA-S Score and Immune Dysfunction as a Guide to Outcome in Men Treated with Prostatectomy Radical as Mono-Therapy for Prostate Cancer

Objective: Incorporate the immune function as determined by the absolute lymphocyte count (ALC) into the CAPRA-S risk stratification score to determine if predictive values could be improved. Materials and Methods: The clinical pathological findings in the surgical specimen and total PSA were used to define the three CAPRA-S risk groups. One month after surgery and at each follow up total PSA and the ALC were determined, until biochemical failure (BF) or the end of the study period. A cut off value of <1,000 lymphocytes/mm3 was used to define lymphocytopenia (LCP). Each CAPRA-S group was sub-divided based on the presence or absence of LCP. Kaplan-Meier biochemical failure free survival (BFFS) curves and restricted mean biochemical failure free survival times were calculated for each group. Results: 404 patients participated of whom 103 (25.5%) underwent BF. 270 men were CAPRA-S low risk (LR), 89 intermediate risk (IR) and 45 high risk (HR), of whom LCP was found in 22 (8%) of low risk, 24 (27%) of intermediate risk and 17 (38%) of high risk men. LCP was significantly associated with a higher PSA, higher Gleason and CAPRA-S scores and BF. HRs were 1.76 for IR, 2.49 for HR and 1.29 for LCP. Five-year BFFS for men without LCP, LR 93.5%, IR 61% and HR 36%, for those with LCP, LR 55%, IR 25% and HR 6%. All patients with LCP and IR or HR scores relapsed within 6 years. 10 year BFFS for men without LCP were 71% LR, 43% IR and 23% HR, LR with LCP 16%. Men with BF had increasing LCP approximately 18 months before BF. Conclusions: The incorporation of the ALC taken one month after surgery with the CAPRA-S improves risk stratification; decreases in the ALC suggest that BF is occuring. These results need to be confirmed with larger studies (AU)

Objetivo: Establecer el riesgo de recidiva bioquímica(RBQ) basado en la puntuación CAPRA-S (riesgo bajo(RB) , riesgo intermedio (RI) y riesgo alto (RA) y recuentoabsoluto de linfocitos (RAL) ≤1000 por mm3(definidiacomo linfocitipenia LCP).Material y Métodos: Entre 2005 y 2020, se realizaun estudio observacional prospectivo de sujetos con cáncerpróstatico tratado con cirugia. Se registran los hallazgos delespécimen quirúrgico y el PSA para definir la CAPRA-S.Un mes pos-cirugía y durante el seguimiento el PSA y RALfueron determinados hasta la RBQ o final del estudio. Seconstruye un modelo de supervivencia flexible paramétrico(FP) para predecir la RBQ a 5 años utilizando la puntuaciónCAPRA-S y la LCP. Se evalúan mediante regresión localponderada mediciones repetidas de los RAL y el tiempo aRBQ o fin del estudio.Resultados: De los 404 participantes observaron 103(25,5%) RBQ. Puntajes de la CAPRA-S: 270 RB, 89 RI y45 RA. La LCP estaba asociada con niveles elevados delPSA, puntuación Gleason, márgenes comprometidos, extensión extracapsular, invasión de vesículas seminales ynodos linfáticos. El modelo FP incorporo en forma independiente y significativa ( coeficiente con valor P<0,01) laLCP ( 1,29), RA (2,49), RI (1,76) y RB (1); mostrando unaC de Harrell de 0,81 con adecuada validez. la media restringida en años (MR) para ocurrencia de RBQ, como lasupervivencia predicha (SP) a 5 años fueron: sin LCP RA(MR: 3,63; SP 42,1%) RI (MR 4,3; SP 63,1%) RB (MR4,83; SP 91,7%) con LCP RA (MR 2,1; SP 4,34%) RI (MR3,14; SP 18,9%) y RB (MR 4,42; SP 73,1%). Los sujetoscon RBQ tuvieron LCP 18 meses previo a la RBQ. LCP más CAPRA-S predicen la RB en sujetos tratado con cirugia (AU)