Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study.

INTRODUCTION: Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient's quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis. MATERIALS AND METHODS: PROSARC is a national (Spain) prospective observational study (May-2022-May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up. RESULTS: A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012). CONCLUSION: In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.

[Renal epithelioid angiomyolipoma]. / Angiomiolipoma epitelioide renal.

Epithelioid angiomyolipoma of renal origin are a very rare variant of the classic angiomyolipomas but with the peculiarity to present malignant potential. Its diagnosis is usually after surgery because the tumor simulates both clinical and radiological features of renal cell carcinoma. We report a case of a 14 year old patient who was diagnosed with this disease as an incidental finding, and that after she underwent partial nephrectomy for three years is currently asymptomatic with no signs of disease recurrence.

Leukocyte and platelet counts as prognostic values of testicular germ cell tumours. / Valor pronóstico del recuento de leucocitos y plaquetas, en tumores testiculares de células germinales.

INTRODUCTION: The immune system plays an essential role in the organism's response to cancer. Several haematological markers can influence prognosis and survival of patients. The objective of this study is to determine their prognostic value in testicular germ cell tumours. MATERIAL AND METHODS: Retrospective cohort study on 164 patients with germ cell tumours. Clinical, analytical, histological and evolutionary data were collected. The absolute neutrophil and absolute platelet counts, neutrophil-lymphocyte (NLR), platelet-lymphocyte and lymphocyte-monocyte ratios were estimated at diagnosis. The association that these markers can have with the classic prognostic factors, as well as their effect on prognosis and survival, have been analysed. RESULTS: 17.7% had NLR>4 and 14.6% ANC>8000/µL. These patients presented higher percentages of residual disease and stage II-III tumours. Patients with elevated absolute neutrophil showed also higher percentages of progression and exitus. 7.3% presented absolute platelet >400000/µL. These patients obtained higher rates of residual disease, nonseminomatous and stage III tumours. 28.4% showed platelet-lymphocyte values>150. This data was associated to higher percentages of residual disease, progression, stage II and III tumours and seminomatous tumours. 83.3% had an lymphocyte-monocyte >3. These patients presented: higher tumour markers in normal range, decreased residual disease rates and higher percentages of stage I and II tumours. The mean survival time was shorter in patients with NLR>4 and absolute neutrophil >8,000/µL. The ROC curves showed significance in the prediction of progression and values of lymphocyte-monocyte >3, and prediction of survival and values NLR>4. CONCLUSION: Our results indicate that the analysed haematological markers are associated with poor prognoses at diagnosis. Therefore, their use in daily clinical practice can be a valuable tool in the diagnosis and prognosis of patients with testicular germ cell tumours.

[Saturation biopsy in prostate cancer diagnosis]. / Biopsia por saturación en el diagnóstico de cáncer de próstata.

AIMS: To analyze the results obtained after doing saturation prostate biopsy to a series of patients with high level of PSA. SUBJECTS, MATERIAL AND METHOD: Among 2006 and 2007 saturation biopsies have been realized in our Service to 32 patients with high PSA, previous biopsies without diagnosis of prostate cancer and high suspicion of malignant disease. RESULTS: The mean age was 65.81 years, with an average of previous biopsies of 2.41 (range: 1 to 5). Mean of PSA was 15.45 ng/dl (range: 5.63 to 35.47 ng/ml). The mean number of cores obtained in the saturation biopsies was of 20.78 (range: 16-26). 13 were diagnosed prostate adenocarcinomas (40.63%), of which 10 had previous diagnosis of PIN or atipia. 8 patients underwent radical prostatectomy, 3 cases were treated with radiotherapy, 1 case was treated with hormonetherapy and the remaining one is kept in watchful waiting. Concordance of Gleason grade was in 6 of 8 patients treated surgically. CONCLUSIONS: Saturation biopsy is an effective method for the diagnosis of prostate cancer after several negative biopsies and a strong clinical suspicion of malignant pathology. Saturation biopsy is not a first choice procedure for the diagnosis of prostate cancer.

[Fracture of the penis: a case series]. / Fractura de cuerpos cavernosos. Serie de casos.

Penile fracture is an uncommon urological emergency with a typical presentation, which needs early surgery to avoid aesthetic and functional sequelaes. We have analyzed all the patients with a discharge diagnosis of fractures penis among 1997 to 2007, attended in the emergency service of Complejo Hospitalario Universitario de Albacete, showing its clinical features, attributed mechanism of injury, treatment and main complications.

VHL protein alterations in sporadic renal cell carcinoma.

AIMS: The vhl gene is a tumour suppressor gene implicated in renal tumorigenesis in both familial and sporadic renal cell carcinoma (RCC). Alterations in the gene may modify its suppressor function and allow the formation of renal tumours. The purpose of this study was to determine the existence of vhl gene mutations in renal tumour tissue among patients with sporadic RCC and to assess the effects on the structure of the VHL protein. MATERIALS AND METHODS: This was an observational, analytical and descriptive study of 96 patients who had undergone surgery for sporadic RCC. In surgical specimens of tumour tissue, the three exons of the vhl gene were amplified by polymerase chain reaction and subjected to automatic sequencing. The consequences of the mutations detected on the VHL protein were analysed, taking into account the physical and chemical properties of the amino acids changed by the mutations, the location of the alterations in the protein sequence, the degree of conservation throughout evolution, and prediction of the secondary structure of the protein. RESULTS: In total, 22 vhl gene mutations were detected in 21 (21.9%) patients; in particular, 13 exonic point mutations consisting of 11 sense mutations, one silent mutation and one missense mutation, plus five exon deletions and one insertion. The remaining three were intronic mutations. All changes occurred in protein functional domains and in regions that have been well conserved throughout evolution. Two-thirds of the intronic mutations were considered relevant for protein function. Among the mutations detected, 72.7% were considered capable of compromising the VHL protein suppressor function. CONCLUSIONS: Mutations in the vhl gene result in amino acid changes in the protein that usually occur at important functional sites that have been conserved throughout evolution and where the binding domains for other proteins are located and exert their suppressor function.

[Vesical schistosomiasis, case report and Spanish literature review]. / Esquistosomiasis vesical, aportación de un caso y revisión de la literatura española.

Urinary schistosomiasis is an infection caused by parasite, Schistosoma haematobium. Squistosomiasis is an endemic disease in Africa and Middle East. We are presenting a case of a young immigrant male from Mali that came to our clinic with hematuria and miccional irritative syndrome during a year. Parasitological study reported Schimosoma's eggs and ecography showed a possible vesical newformation. After RTU, anatomopatological study confirms the presence of a vesical esquistosomiasis. Now pacient is asyntomatic after he was treated with Praziquantel.

[Growing incidence in renal cell carcinoma]. / Incidencia creciente en el carcinoma de células renales.

OBJECTIVES: To analyze the change in the behavior of renal cell carcinoma for its presentation, treatment, histology and mortality during a 17 year period. MATERIAL AND METHOD: Retrospective study on 212 patients diagnosed with renal cell carcinoma in our Department from the year 1988 up to 2004, analyzing the clinical and demographic data and comparing them to each other according to two periods: 1988-1996 and 1997-2004. RESULTS: An increase has been appreciated in the incidence of renal tumors in the second period and in a same way an increase in the incidental diagnosis and in the practice of nephron sparing surgery. Clear cell type was the most frequent in both periods and tumoral size was higher in the first period than in second. TNM stage I was the most frequent, although in first period it was higher percentage of stage IV. Cause-specific mortality has increased in the last years. CONCLUSION: An increase is appreciated in the incidence of renal cell tumors. Although the diagnosis is in earlier stages, a descent in the mortality has not been found.

[Entero-neobladder ileal fistula: two cases report]. / Fístula entero-neovejiga ileal: a propósito de dos casos.

Fistulas between the orthotopic reservoir and the gastrointestinal tract have low incidence (1.5-2%). Simptomatology is variable, but it's frecuent to find fecaluria. Among 90 new intestinal bladders we show two fistule of new bladder to ileo, with nest postoperatory diagnosis, using retrograde cystografy; one was resolved with next postoperative treatment and the other with open surgery.

[Urachal pathology: an overview review and report of three clinical cases]. / Patología del uraco: revisión de conjunto y presentación de tres casos.

With the use of these two clinical cases (cyst and urachal adenocarcinoma) we did an overview of the urachal pathology. The urachus cyst is usually asyntomathic, it's detected randomly when we do other diagnostic tests or when we have any complications. The urachal adenocarcinoma is a rare pathology, it usually exhibit hematuria and we need to follow the same diagnostic tools as we use in vesical tumors (cystoscopy and transurethral vesical resection). Adenocarcinoma of the dome of the bladder is the main differential diagnosis. Partial cystectomy is the first choice treatment. Quimiotheraphy and radiotheraphy offer poor results.

[Problem-based learning in urology training. The Faculty of Medicine of the Universidad de Castilla-La Mancha model]. / El aprendizaje basado en problemas en la enseñanza de la urologia. Modelo de la Facultad de Medicina de la Universidad de Castilla-La Mancha.

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These "modern" strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes. At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a "real" case.

[Survival in patients treated with radical cystectomy for bladder carcinoma]. / Supervivencia en pacientes sometidos a cistectomía radical por carcinoma vesical.

AIM: To analyze survival among cystectomized bladder cancer patients. MATERIAL AND METHODS: A retrospective cohort study comprising data from 166 bladder cancer patients subjected to cystectomy between 1976 and 1998. Patient survival was considered the dependent variable, while sociodemographic data, renal function parameters, the existence of hydronephrosis, anaesthetic risk according to ASA status, the type of urinary diversion involved, the histopathological characteristics and postoperative complications were regarded as the independent variables. Survival was analyzed by the Kaplan-Meier method, comparing survival curves with the Mantel-Haennszel test, and developing a Cox proportional risk model. RESULTS: The mean survival was 81 months (median = 20 months); 82% of the patients died of causes related to the neoplastic process or surgical complications. The probability of survival 60 months after surgery was 35.2%--the figure being higher among patients aged < or = 65 years (p = 0.026), without prior hydronephrosis (p = 0.023), or with normal creatinine levels (p = 0.048). The principal influencing factor was tumor histological stage: for lesions in stage < or = pT2 survival at 60 months was 67.8%, versus 29.1% in stage pT3 and only 6% in pT4. In the presence of lymph node involvement, only 6.1% of the patients were still alive after 5 years. CONCLUSIONS: The local infiltration stage and pelvic node involvement are the two most decisive factors for patients prognosis. Hydronephrosis and increased creatinine levels before cystectomy are the two non-hystopatological parameters associated to a poorer prognosis.

[Pheochromocytoma of the organ of Zuckerkandl. Apropos of a case]. / Feocromocitoma del órgano de Zuckerkandl. A propósito de un caso.

INTRODUCTION: Extraadrenal pheochromocytomae represent 17-18% of pheochromocytomae, 85% of which are located infradiaphragmaticaly and generally wherever there is cromaffin tissue, as in this case, located at the organ of Zuckerkand. They can also appear in the context of family syndromes, i.e. phacomatosis and MEN (IIA and IIB). CLINICAL CASE: The authors present a case of pheochromocytoma located in the organ of Zuckerkand, diagnosed in the course of uncontroled HBP. Diagnosis was achieved by metanephrine determinations and radiological tests (ultrasound, CAT and MIBG). This patient was surgically treated by exeresis of the lession previous alpha and beta adrenergic blockade with phenoxybenzamine and propanolol. Currently this patient is asymptomatic with normal blood pressor and metanephrines blood levels. DISCUSSION: Extraadrenal pheochromocytomae are usually located in superior paraaortic infradiaphragmatic region. The grade of malignancy must be established by histopathological findings, local recidives and metastasis. After clinical suspicion and the finding of a retroperitoneal mass with ultrasound, CAT and/or MRI, MIBG must be performed to confirm the diagnosis as well as to leave out possible tumours at distance. Treatment is surgery previous blockade of cathecolamines secretion by the preoperative administration of alpha blockers, with or without beta blockers.

[Surgery of large residual mass after chemotherapy in advanced testicular germ cell tumor]. / Cirugía de gran masa residual tras quimioterapia en tumor germinal testicular avanzado.

Treatment for testicular tumours has progress in such a manner in the last years that high cure percentages can at present be achieved. After chemotherapy, in most cases, residual mass can appear. In this cases surgery is considered a viable therapeutic option although it implies an advanced surgical training since it is a complex technique and implies serious implications. We submit the case of a patient who presented a large residual mass from a testicular germ cell tumour after being treated with orquiectomía and chemotherapy. Surgery was performed resulting in total and radical extirpation of residual mass.

[Role of mitogen-activated protein kinase (MAPK) in the sporadic renal cell carcinoma]. / Papel de las proteínas quinasas activadas por mitógenos (MAPK) en el carcinoma de células renales esporádico.

CONTEXT: Only on the basis of the involvement of the vhl suppressor gene in the cases of renal cell carcinomas (RCC), the involvement of the signaling pathway between the pVHL and the Hypoxia inducible factor 1, alpha (HIF-1α) has been evaluated because of the need to find new diagnostic and prognostic and response to drugs markers. EVIDENCE SYNTHESIS: The overexpression of HIF-1α confers better prognosis in clear cell type RCC (ccRCC). Furthermore, HIF-1α regulates other genes, specifically that of the carbon anhydrase IX (CA-IX), whose overexpression is practically only of the ccRCC and its determination is useful for this subtype. However, the involvement of the CA-IX has not been demonstrated in the prognosis or in the response to immunomodulators or antiangiogenics. Therefore, it is necessary to make a global evaluation of all this pathway: pVHL → HIF-1α → CA-IX, and even the analysis of other proteins and signaling pathways that also control the HIF-1α activity. In the latter case, the MAPK are critical in the HIF-1α activation, there being evidence on the experimental level of the control on its activity. although its clinical role as a biomarkers has not been established. Although the role of the MAPK in the phenomena of resistance to conventional chemotherapy and radiotherapy has been demonstrated, it has not been demonstrated in response to sorafenib, an important piece of information if we consider that it is an inhibitor of several protein kinases. Recently, it has been observed that the MAPK may be involved in the responses to different therapies, included those based on tyrosine kinase inhibitors. CONCLUSIONS: The confirmation of these data would suppose an explanation of the variation observed between patients who, with the same functional alteration of the vhl gene, have a different biological, clinical behavior and better selection of non-surgical therapies.