Management of patients with localized prostate cancer and biochemical recurrence in Spain: A medical survey.

INTRODUCTION: The management of patients with prostate cancer (PCa) is established in clinical practice guidelines, which are based on randomized studies according to the level of evidence. In Spain, the degree of compliance with these guidelines in clinical practice is unknown. OBJECTIVES: To describe the profiles of PCa patients at the time of diagnosis and the management of patients with localized PCa and those with BCR in Spain. MATERIALS & METHODS: A medical survey was conducted in specialized care (85 urologists [UROs], 64 radiation oncologists [ROs], and 21 medical oncologists [MOs]). Three questionnaires were developed for this study with 22 (UROs and ROs) or 21 questions (MOs). RESULTS: The annual incidence of PCa was 24,057 in participating hospitals (N = 131). The extrapolated annual incidence in Spain is 40,531 cases. The estimated prevalence of PCa in Spain is 221,689. Of note, 79% and 80% of patients seen by UROs and ROs, respectively had localized PCa at diagnosis. Biopsy was the most used diagnostic test among the three specialties, followed by abdominopelvic computer tomography. More than 90% of patients with BCR underwent standard tests. Next generation imaging tests and PET-choline/PSMA are still used residually. Most patients with localized PCa are currently treated with either surgery or radiotherapy, while for BCR patients, UROs and ROs prefer radiotherapy and MOs androgen deprivation therapy alone or in combination. CONCLUSION: This study describes patient profiles at the time of diagnosis and provides an overview of the current therapeutic management of localized PCa and BCR in clinical practice in Spain.

Clinical drivers for imaging testing in non-metastatic castration-resistant prostate cancer in clinical practice: Results of the IDENTIFICA study. / Factores clínicos determinantes para la realización de pruebas de imagen en cáncer de próstata resistente a la castración no metastásico en la práctica clínica: resultados del estudio IDENTIFICA.

INTRODUCTION: The aim of the study was to describe the clinical drivers that lead physicians to perform imaging tests in search of metastasis in non-metastasic castration prostate resistant cancer (nmCRPC) patients. METHODS: Observational, cross-sectional study conducted at the Departments of Urology of 38 Spanish hospitals. The study included 188 patients diagnosed with nmCRPC who underwent an imaging test for the assessment of metástasis. In one study visit, physicians were requested to specify the clinical factors that led them to perform these tests. The results of the imaging tests and the clinical characteristics of the patients since the time of prostate cancer (PC) diagnosis, were reported. Regression analyses were used to determine predictors of imaging test results. RESULTS: Prostate-specific antigen (PSA) level was the most important driver to order imaging tests (57.1%), followed by regular follow-up (16.5%) and PSA doubling time (PSADT) (12.0%). Although these drivers were not associated to detection of metastasis, patients with PSA levels ≥20 ng/mL had a greater risk of metastasis than patients with PSA levels <4ng/mL (P=.004) and CRPC patients diagnosed with metastasis (mCRPC) had higher median PSA levels (20.9; interquartile range [IQR]: 6.7-38.6) than nmCRPC (9.1; IQR: 5.0-18.0) (P=.005). Sixty-six percent of the patients did not undergo any imaging test after CRPC diagnosis until the study visit (10.6, IQR: 4.0-19.5 months). Curative-intent treatment at PC diagnosis and Gleason score predicted longer time from PC to CRPC diagnosis. CONCLUSIONS: Physicians based their decisions to order imaging tests for metastasis detection in nmCRPC patients mainly on PSA and PSA kinetics, including the regular follow-up stated by guideline recommendations.

PREVALENCE OF FATIGUE AND IMPACT ON QUALITY OF LIFE IN CASTRATION-RESISTANT PROSTATE CANCER PATIENTS: the VITAL study.

BACKGROUND: Fatigue is one of the most prevalent symptoms among cancer patients. Specifically, in metastatic castration-resistant prostate cancer (mCRPC) patients, fatigue is the most common adverse event associated with current treatments. The purpose of this study is to describe the prevalence of fatigue and its impact on quality of life (QoL) in patients with CRPC in routine clinical practice. METHODS: This was a cross-sectional, multicentre study. Male chemo-naïve adults with high-risk non-metastatic (M0) CRPC and metastatic (M1) CRPC (mCRPC) were eligible. Fatigue was measured using the Brief Fatigue Inventory (BFI) and QoL was assessed using the Functional Assessment of Cancer Therapy questionnaire for patients with prostate cancer (FACT-P) and the FACT-General (FACT-G) questionnaire. Data were analysed using Mann-Whitney or Kruskal-Wallis tests (non-parametric distribution), a T-test or an ANOVA (parametric distribution) and the Fisher or chi-squared tests (categorical variables). RESULTS: A total of 235 eligible patients were included in the study (74 [31.5%] with M0; and 161 [68.5%] with M1). Fatigue was present in 74%, with 38.5% of patients reporting moderate-to-severe fatigue. Mean FACT-G and FACT-P overall scores were 77.6 ± 16.3 and 108.7 ± 21.4, respectively, with no differences between the CRPC M0 and CRPC M1 subgroups. Fatigue intensity was associated with decreased FACT-G/P scores, with no differences between groups. Among 151 mCRPC patients with available treatment data, those treated with abiraterone-prednisone ≥3 months showed a significant reduction in fatigue intensity (p = 0.043) and interference (p = 0.04) compared to those on traditional hormone therapy (HT). Patients on abiraterone-prednisone ≥3 months showed significantly better FACT-G/P scores than patients on HT (p = 0.046 and 0.018, respectively). CONCLUSION: Our data show a high prevalence and intensity of fatigue and its impact on QoL in chemo-naïve CRPC patients. There is an association between greater fatigue and less QoL, irrespective of the presence or absence of metastasis. Chemo-naïve mCRPC patients receiving more than 3 months of abiraterone acetate plus prednisone showed an improvement of fatigue and QoL when compared to those on traditional HT. TRIAL REGISTRATION: Not applicable since it is not an interventional study.

Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation. / Sobreutilización innecesaria. Estudio de los «no hacer¼ en pacientes con fibrilación auricular.

OBJECTIVE: To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation. METHOD: The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus. RESULTS: We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient. CONCLUSION: The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients.

Impact of chronic kidney disease on the risk of clinical outcomes in patients with cancer-associated venous thromboembolism during anticoagulant treatment.

BACKGROUND: Information on recurrent venous thromboembolic events (VTEs) and major bleeding risks during anticoagulant treatment in patients with cancer-associated VTEs and chronic kidney disease (CKD) is scarce, although it is of relevance in establishing better tailored management strategies in these patients. OBJECTIVES: We compared risks of recurrent VTEs and major bleeds in cancer-associated VTE patients with and without CKD. METHODS: A total of 1684 patients diagnosed with a cancer-associated VTE between 2001 and 2011 were followed for 180 days after VTE diagnosis. Patients were treated mainly with low-molecular-weight heparin (LMWH) or vitamin-K antagonists (VKA). Primary outcomes were recurrent VTE and major bleeding. Secondary outcome was fatal bleeding. RESULTS: Recurrent VTEs occurred in 15.9/100 patient years (py) in patients without CKD (eGFR > 60 mL min(-1) ), 19.5/100 py in those with CKD stage 3A (eGFR 45-60 mL min(-1) ), 14.9/100 py in those with CKD 3B (eGFR 30-45 mL min(-1) ), and 6.8/100 py in patients with CKD 4-5 (eGFR < 30 mL min(-1) ). Major bleeding occurred in 11.4/100 py in patients without CKD, 18.5/100 py in those with CKD stage 3A, 16.0/100 py in those with CKD 3B, and 40.8/100 py in patients with CKD 4-5. Fatal bleeding occurred in 1.1/100 py, 3.4/100 py, 6.3/100 py and 15.7/100 py, respectively. These increased bleeding risks in CKD patients were mainly observed in those on LMWH treatment, not VKA. CONCLUSIONS: The risk of major bleeding was increased in CKD patients with VTE and cancer, and was most prominent in those treated with LMWH and an eGFR < 30 mL min(-1) . These results indicate that LMWH should be used with caution in this specific population.

[Perilymph gush. A complication of stapedectomy]. / Chorro de perilinfa. Complicación de la estapedectomía.

Report of an unusual complication of stapes surgery, called "perilymph gush", resolved with improved hearing and no vertigo.

[Tonsillar angiofibroma]. / Angiofibroma amigdalar.

We report in this paper a case of a tonsillar angiofibroma, whose histopathological features did not differ from its nasopharyngeal counterpart. In an exhaustive review done we have only found another one reference, in the german literature of such location.

[Gushers. Perilymphatic leaks]. / Chorro de perilinfa. Complicación de la estapedectomía.

We report an unusual complication of stapedectomy called <>. It was resolved and the patient's hearing level improved without vertigo.

[Herpetic pseudotumor laryngitis]. / Laringitis herpética pseudotumoral.

The goal of this paper is to report an interesting case of laryngeal involvement by herpes virus, showing a morphological aspect very alike to an extense neoplasm of this region. Laryngeal involvement of herpes virus is a clinical infrequent entity, but as its wide onset forms range from a banal laryngitis until a severe airway obstruction, hoarseness or dysphagia, it seems mandatory an accurate differential diagnose to settle a treatment and the effective follow-up.

[Clinical and electronystagmographic manifestations in the elderly with vertigo]. / Manifestaciones clínicas y electronistagmográficas de los vértigos seniles.

The goal of the present work is to realize a review over the difference aspects of the alterations of the equilibrium and the vestibular system in the elderly patient. We also present a statistics about the symptomatology, the results of the vestibular tests and the diagnose, in a range of patients complaining of vertigo, aged over 65, studied in our ENT-Department.

[Surgical voice rehabilitation: influence of postoperative radiotherapy on tracheoesophageal fistulas. Long-term follow-up study]. / Rehabilitación quirúrgica de la voz: influencia de la radioterapia postoperatoria en las fístulas traqueoesofágicas. Seguimiento a largo plazo.

In an overall group of 270 patients who underwent total phonatory laryngectomy (TPL) with surgical restoration of alaryngeal voice by tracheoesophageal puncture (TEP) and prosthesis insertion, a subgroup of 152 consecutive patients who had undergone surgery at least 24 months earlier was selected (10 years follow-up). The frequency and type of effects of postoperative radiotherapy on TPL were studied. We analyzed postoperative complications, TEP closure and its causes, the tracheoesophageal voice achieved, and manometric results in the pharyngoesophageal segment. We conclude that postoperative radiotherapy at east a maximum dose of 65 Gy did not preclude phonatory surgery.

[Surgical voice rehabilitation: permanence of tracheoesophageal fistula after total phonatory laryngectomy. Long-term follow-up]. / Rehabilitación quirúrgica de la voz: permanencia de la fístula traqueoesofágica tras laringuectomía total fonatoria. Seguimiento a largo plazo.

A study of the 10-year follow-up of 152 patients who underwent total phonatory laryngectomy (TPL) for surgical alaryngeal voice rehabilitation by trachoesophageal puncture (TEP) and prosthesis insertion is reported. These patients belonged to a larger group of 270 patients who underwent TPL in our department in 1984-1995. Patients who had undergone surgery at least 24 months earlier were selected for the purpose of obtaining more reliable conclusions. TPL was a valid option for patients with primary or secondary laryngectomy. Tracheoesophageal voice conservation was achieved in 83.1% when technical surgical conditions and TEP follow-up improved, and dynamic tracheal and hypopharyngeal features were better understood.

[Videofluoroscopy of the pharyngoesophageal segment after total phonatory laryngectomy]. / Observaciones de videofluoroscopia del segmento faringoesofágico tras laringectomía total fonatoria.

Twenty-nine postoperative videofluoroscopic studies of the pharyngoesophageal segments, with phonation test, were compared with esophageal manometry findings. The group was drawn from an overall group of 220 patients who underwent total phonatory laryngectomy (1984-94) by tracheoesophageal puncture (TEP) and prosthesis insertion. Radiological videofluoroscopic features were defined (type I and type II) and found to correlate with patterns of esophageal manometry in 20 explorations. After surgery, these patients (type I VF) remained hypotonic, had fewer swallowing disorders and prosthesis fracture, and achieved a longer phonation time.

[Herpetic laryngeal involvement simulating neoplasm]. / Afectación laríngea por herpes: una lesión que simula neoplasia.

A case of laryngeal involvement by herpes virus is reported. Its appearance suggested an extensive neoplasm. Laryngeal herpes infection is uncommon, but the wide spectrum of forms of onset, from banal laryngitis to severe airway obstruction, hoarseness, or dysphagia, require accurate differential diagnosis to establish an effective treatment and follow-up.

[Tumoral collision: cancer metastases within a second neoplasm]. / Colisión tumoral. (Metástasis de cáncer en una segunda neoplasia).

A case report of epithelial carcinoma of the inferior lip which spread in cervical lymph nodes previously affected by a chronic lymphocitic leukaemia, is presented. The coexistence of both histological findings in some of the nodes (collision tumor) is remarked. We have made a review of the scanty literature about metastases on second tumors and compared and commented those features.

[Cervical dissection in laryngeal cancer: our experience of 15 years]. / Vaciamientos ganglionares cervicales en el cáncer de laringe. Nuestra experiencia de quince años.

A retrospective study was made of surgery with cervical dissection in 640 patients with laryngeal carcinoma treated from 1976 to 1991. Cervical dissection was carried out in 386 of 640 patients with laryngeal carcinoma treated surgically. Of a total of 496 cervical dissections performed, there were 173 unilateral functional, 88 bilateral functional, 67 unilateral block, 13 bilateral block, and 27 bilateral block dissections with contralateral functional dissection. The relations between tumor stage (T) and nodal involvement (N), type of dissection and T, type of dissection and N, laryngeal surgery and neck dissection, clinical and histological N, N+ and histologic type, extracapsular spread, number of recurrences, and their relation with T and N, and the relation between N+ and type of neck dissection were studied.

[The study of survival in the glottic cancer]. / Estudio de la supervivencia en el cáncer de origen glótico.

The survival rate for glottic carcinoma was analyzed in the cases treated in our service in 1978-88. All cases had a minimum of 5 years of follow-up. Clinical manifestations, tumor site, TNM and pTNM stages, histopathologic type, treatment, and five-year survival and recurrence rates were studied.