Long responders to estramustine monophosphate. Report of two cases and literature review. / Repondedores a largo plazo a Estramustina monofosfato. A propósito de dos casos. Revisión bibliográfica.

OBJECTIVE: Estramustine is an stable estradiol and nitrogenated mustard conjugatewith antymicotic properties. Currently, with the appearance of chemotherapy and new molecules, estramustin acetate is not a drug of choice for castration resistant prostate cancer. METHODS: We describe two patients with castration resistant prostate cancer under treatment with estramustine acetate and complete biochemical response and stable disease. We review the literature to elucidate if the drug should be stopped and changed for the new molecules that have demonstrated survival increase. RESULTS: To our knowledge, there are not data in the literature to either solve the questions posed or shed light regarding cumulative toxicity due to prolongued use of estramustine acetate. CONCLUSIONS: We recognize that these clinical cases do not translate that estramustine acetate is a first line treatment for patients with CRPC. Nevertheless, they translate the heterogeneity of CRPC. It would be interesting to investigate the combination of new agents with estramustine acetate as well as the search of biomarkers that enable selection of candidates who could respond to estramustine acetate.

OBJETIVO: La estramustina es un conjugado estable de estradiol y una mostaza nitrogenada que tiene propiedades antimitóticas. Actualmente, con la aparición de la quimioterpia y las nuevas moléculas, el acetato de estramustina -no es un fármaco de elección en el cáncer de próstata resistente a castración.MÉTODO: Describimos dos pacientes con cáncer de próstata resistente a la castración en tratamiento con acetato de estramustina, y con una respuesta bioquímica completa y enfermedad estable. Revisamos la literatura para dilucidar si se debería retirar el acetato de estramustina y cambiar por las nuevas moléculas que han demostrado un aumento de supervivencia. RESULTADO: Hasta donde llega nuestro conocimiento, no hay datos en la literatura que resuelvan las dudas planteadas y tampoco que aporten luz en cuanto a la toxicidad acumulada por el uso prolongado del acetato de estramustina.CONCLUSIÓN: Somos conscientes de que estos casos clínicos no traducen que el acetato de estramustina sea un tratamiento de primera línea para los pacientes con cáncer de próstata resistente a la castración. Sin embargo, traducen la heterogeneidad del CPRC. Sería interesante investigar la combinación de los nuevos agentes con el acetato de estramustina así como la búsqueda de biomarcadores que permitan la selección de los candidatos que podrían responder al acetato de estramustina.

[Influence of learning curve in the diagnosis of prostate cancer by ultrasound guided biopsy]. / INFLUENCIA DE LA CURVA DE APRENDIZAJE EN EL DIAGNÓSTICO DEL CÁNCER DE PRÓSTATA MEDIANTE BIOPSIA ECODIRIGIDA.

OBJECTIVE: To analyze if there is a learning curve to get to perform high quality ultrasound guided prostate biopsies that enable to effectively perform the diagnosis of prostate cancer, taking the pathological result of the samples into consideration. METHODS: We retrospectively reviewed data from 790 ultrasound-guided biopsies performed consecutively in our center between May 2009 and December 2012 by four surgeons. We reviewed the following data: Surgeon, date of intervention, patient age, PSA, rectal digital examination (DRE), ultrasound, prostate volume, number of cores obtained, pathology result of the biopsy. The surgeons were residents in Urology in their first year in the department. For statistical analysis the biopsies were grouped in blocks of 25 and 75 cases performed by a surgeon, in a chronological order. To evaluate the influence of the learning curve on diagnosis we performed univariate and multivariate analysis between the different variables and pathological report. RESULTS: Median age was 67 years (42-90). 300 biopsies (38%) were positive for prostate cancer. On univariate analysis, regarding cancer detection rate, the variables surgeon, PSA, DRE, ultrasound result, prostate volume, number of cores and groups of 75 showed statistically significant differences, this latter showing 32% in the first 75 biopsies and 43.2% in the last group. The variables age (p=0.11) and groups of 25 patients (p=0.07) did not show differences. Nevertheless, on multivariate analysis only PSA, DRE, prostate volume and groups of 75 patients were statistically significant, this latter with an OR of 1.35 (95%CI 1.09-1.66). CONCLUSIONS: The results obtained in our study show that the number of procedures performed, namely surgeon experience, does have an influence to achieve an optimal diagnostic yield in ultrasound guided prostatic biopsies.

Cysticlean® a highly pac standardized content in the prevention of recurrent urinary tract infections: an observational, prospective cohort study.

BACKGROUND: The present study was aimed at determining the prophylactic efficacy of American cranberry (AC) extract (Cysticlean®) in women with recurrent symptomatic postcoital urinary tract infections (PCUTI), non-consumer of AC extract in the past 3 months before inclusion, and to determine changes in their quality of life (QoL). METHODS: This was a single center, observational, prospective study in a total of 20 women (mean age 35.2 years; 50.0% were married). Patients were followed up for 3 and 6 months during treatment. RESULTS: The number of PCUTIs in the previous 3 months prior to start the treatment with Cysticlean® was 2.8±1.3 and it was reduced to 0.2±0.5 at Month 6 (P<0.0001), which represent a 93% improvement. At baseline, the mean score on the VAS scale (range from 0 to 100) for assessing the QoL was 62.4±19.1, increasing to 78.2±12.4 at Month 6 (P=0.0002), which represents a 20% improvement. All patients had an infection with positive urine culture at baseline, after 6 months there were only 3 symptomatic infections (P<0.001). The most common bacterium was Escherichia coli. CONCLUSIONS: Prophylaxis with American cranberry extract (Cysticlean®) could be an alternative to classical therapies with antibiotics. Further studies are needed to confirm results obtained in this pilot study.