[Effectiveness and tolerability of zoledronic acid in the treatment of metastatic prostate cancer]. / Efectividad y tolerabilidad del acido zoledrónico en el tratamiento del cancer de próstata metastásico.

OBJECTIVES: To assess the effectiveness and tolerability of zoledronic acid in prostate cancer patients with bone metastases at the hormone-sensitive (HS) and hormone-independent (HI) stages. MATERIALS AND METHODS: A nationwide, observational, prospective, open and multi-centre trial was devised, with a total of 218 male patients diagnosed with prostate cancer at the HS stage (36%) or HI stage (64%) who were administered zoledronic acid (4 mg/IV/month for 6 months) in addition to their specific oncological treatment. Effectiveness was assessed by the following means: 1) Assessment of the improvement in pain and mobility; 2) Incidence and time to onset of skeletal-related events (SREs) and 3) Analysis of bone markers. Tolerability was assessed by means of registering the number and type of adverse effects. A satisfaction survey was carried out amongst the patients after the end of the trial. RESULTS: Out of the 218 patients, 170 (78%) were evaluable for effectiveness. A decrease in pain ratings at rest and during movement was observed in all patients, whether in the HS or HI groups (p < 0.0001). Improved mobility was observed likewise (p = 0.005), as was quality of life. The global incidence of skeletal events was 11.2%, with a time to onset of SREs of 10.7 months. There were no significant differences observed between HS vs. HI patients. Osteolysis markers (N-telopeptide) decreased significantly with the treatment across both the HS and HI groups. For safety reasons. 212 patients were evaluable (97.2%). The incidence of adverse drug reactions was 16% (34/212) and was found to be significantly higher in HS patients (22.4%) compared with HI patients (11.9%). Overall, the tolerability of zoledronic acid was good, with no significant morbidity in either group (HS and HI). 66% of the patients reported feeling satisfied or very satisfied. CONCLUSIONS: Zoledronic acid proved effective in the relief of pain, improving mobility and quality of life as well as reducing or delaying the occurrence of skeletal-related events in prostate cancer patients presenting metastatic bone disease, regardless of the phase, whether HS or HI, they found themselves in. Tolerability and patient satisfaction were rates as good.

[Biochemical control after external radiotherapy in localized prostatic cancer: results of a modern cohort]. / Control bioquímico tras radioterapia externa en el cáncer de próstata localizado: resultados de una cohorte moderna.

PURPOSE: The present study reports biochemical outcomes of a modern series of patients with localised prostate cancer treated with external beam radiation therapy, and analyses the implications of the nadir PSA levels in monitoring outcome after treatment. METHODS: From March 1993 to March 1997, eighty three patients with clinical stages T1-T3 NxM0 prostate cancer received definitive external radiation therapy, median dose 66 Gy (range 60 to 68 Gy). Adjuvant androgen deprivation was associated in 53 high risk patients. Initial response to treatment was defined as a decrease of serum PSA to levels of < or = 1.5 ng/ml, and biochemical failure as three consecutive PSA rises over post-treatment nadir PSA value. RESULTS: The 3-year actuarial BDFS was 78% +/- 7 for the whole series, 74% +/- 12 for patients treated with radiotherapy alone, and 71% +/- 10 for high risk patients treated with combination therapy (p = 0.27). Only nPSA emerged as a potential indicator of biochemical control. The probability of BDFS at 3 years was 82%, 83% and 40% for nPSA of < or = 1 ng/ml, 1-2 ng/ml and > 2 ng/ml respectively (p = 0.0409). In multivariate analysis, this correlation was independent on the effect of other variables and persisted after adjusting for the effect of hormonal therapy (p = 0.0540). CONCLUSION: Radiation therapy is a potentially curative treatment for prostate carcinoma. Our data indicate that the nadir PSA value after radiation can be an excellent early determinant of outcome.

[Prospective and randomized study comparing mitomycin C and interferon alpha 2b in the prevention of superficial tumors of the bladder]. / Estudio prospectivo y aleatorio comparando mitomicin C e interferon alfa 2b en la profilaxis de los tumores superficiales de vejiga.

Contribution of our experience in 66 patients included in a prospective randomized study to compare the efficacy of Mitomycin C (MMC) and Alpha 2B Interferon (IFN) in the prevention of relapse of vesical surface tumours. Thirty-five patients were included in the MMC arm, 29 of which completed the treatment. Thirty-one patients were included in the IFN arm, 26 of which are evaluable. MMC was given endovesically at a rate of 30 mg weekly for one month, and then monthly to complete one year. Through the same route, 50 million units of IFN were given weekly for 3 months, and then monthly to complete one year. Within the MMC arm, three patients (10.3%) showed progress, twelve patients (451.3%) relapsed, and seventeen (58.7%) are disease free. With regard to IFN treated patients, one patient (3.8%) showed progress, ten (38.4%) relapsed, and sixteen (61.6%) are disease free. We conclude that there are no significant differences between these two drugs.

[Role of autotransfusion of pre-stored blood in benign prostate hyperplasia. Our experience]. / Papel de la autotransfusión predepósito en la cirugía de la H.B.P. Nuestra experiencia.

The essence of self-transfusion is the extraction of a patient's own blood for subsequent infusion to the same patient. The practice of this strategy has become particularly important from the moment the likelihood of AIDS virus transmission through transfusion with homologous blood products became known. This article presents our experience in both open and endoscopic BPH surgery over the period ranging from January 93 to December 94, and analyzes the health care and socioeconomic aspects of that experience.

[Report of a new case of small-cell carcinoma of the bladder and review of the literature]. / Aportación de un nuevo caso de carcinoma de células pequeñas de localización vesical y revisión de la literatura.

We report a case of small cell carcinoma of the urinary bladder in 71-year-old male patient. Oat cell of the urinary bladder is extremely uncommon, and up to date only 135 cases have been reported in word literature. Histologic, microscopic, and immunohistochemical characteristics are similar to oat cell carcinoma of the lung and other extrapulmonary oat cell carcinomas. We conclude this report with immunohistochemical study with PGP 9.5, neuron-specific enolase a synaptophisine.

[Bladder schistosomiasis: report of 2 new cases with different anatomoclinical features and review of the literature]. / Esquistosomiasis vesical: aportación de dos nuevos casos con presentaciones anatomo-clínicas diferentes y revisión de la literatura.

This paper reports two cases of vesical schistosomiasis in two black patients treated in this Service over the last three years. A description is made of the different anatomo-clinical presentations of these two cases, commenting on the characteristics of this disease, its pathogenesis, diagnosis and treatment, and stressing the slight increase in its frequency in our environment as a consequence of the increased migratory movements of people from endemic regions into our country.

[Endometrial carcinoma of the prostate. Report of a case]. / Carcinoma endometroide de próstata. A propósito de un caso.

Endometrial Carcinoma is an uncommon intraductal prostatic tumour, the origin (either from prostatic epithelium or Müellerian) and management (traditional hormonal therapy vs. progestagens) of which has been the subject of vigorous debate. Currently and with the help of the immunohistochemical techniques its origin has finally been confirmed as being prostatic, thus justifying the use of the traditional hormonal therapy applied in prostate acinous carcinoma. The paper contributes one case of Endometrial Carcinoma confirmed by immunohistochemical techniques, as well as a review of the main landmarks in the study of these tumours.

[Left supraclavicular adenopathy with a neuroendocrine pattern of unknown cause: prostatic carcinoma metastasis]. / Adenopatía supraclavicular izquierda con patrón neuroendocrino de causa desconocida: metástasis por carcinoma de próstata.

Contribution of a case report of a male patient presenting with single left supraclavicular adenopathy of initially unknown origin and histologic pattern of neuroendocrine nature, finally traced to the prostate. It is believed that in any male over 45 diagnosed with carcinoma of unknown origin in the supradiaphragm lymph nodes, prostate carcinoma metastasis should also be ruled out using PSA immunostaining and by measuring serum PSA, serum alkaline phosphatase and DRE.

[Early diagnosis of prostate cancer in patients with prostate symptoms by DRE, PSA, TRU and DPSA]. / Diagnóstico precoz del cáncer de próstata en pacientes con sintomatología prostática mediante TR, PSA, ECOTR y DPSA.

Presentation of our experience in the early diagnosis of prostate cancer in patients with signs and symptoms of prostatism. Over a one year period (96-97), 316 patients underwent biopsy based on clearly defined criteria according to the diagnostic algorithm used in our centre: suspicious DRE and/or PSA > or = 10 ng/mL, and in patients with PSA between 4 and 10 ng/mL in the presence of suspicious TRU or when DPSA was > or = 0.15. The ratio of the 136 (43%) prostate cancer diagnosed relative to biopsy +/- was 1:1.32. It is concluded that early diagnosis in a selected population is useful and shows good diagnostic yield. The diagnostic algorithm used is more than acceptable with 43% positive biopsies and a good ratio between biopsy +/-. With a cutoff of 0.15 DPSA is a good method to improve PSA significance in patients in the difficult PSA range of 4 to 10 ng/mL.

[Prostate cancer in the Community of Madrid in the year 2000. III. Study of tumor extent]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. III--Estudio de extensión tumoral.

OBJECTIVE: To identify a potential relationship between two variables, risk of metastasis and use of imaging techniques, in an extension study in prostate cancer patients diagnosed in the Autonomous Community of Madrid in 2000. MATERIAL AND METHODS: 1,127 patients with available data on the tumour extension study were analysed. Performance and non performance of bone scans and CTs were correlated to risk variables for developing metastasis as described in the literature (PSA, Gleason and stage) and to therapy administered. RESULTS: The proportion of patients with risk variables for metastasis when bone scans were performed was between 7% to 14% greater than in patients with no variables. No differences were seen for CTs based on risk variables. With matching risk variables, more imaging techniques were used in patients receiving radiotherapy that in those managed with prostatectomy. CONCLUSION: Based on current recommendations imaging techniques were used in excess in the extension study in patients with no risk variables for metastasis. Conduct of a further study in the Autonomous Community seems advisable to confirm the likelihood of implementing such recommendations considering our prevalence of metastatic disease.

[Prostate cancer in the Community of Madrid in the year 2000. IV. Treatment]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. IV Tratamiento.

OBJECTIVE: To know the therapeutic options used in patients diagnosed with prostate cancer in the Autonomous Community of Madrid in 2000. MATERIAL AND METHODS: The study was conducted on 1,745 patients referred by hospitals taking part in the study. Data on treatment used was available for 1,104 (63%) patients. Treatment modality was correlated to clinical stage and patient age. RESULTS: Most frequent choice was hormone therapy (35%) followed by radical prostatectomy (34%) and radiotherapy (25%). Prostatectomy was most commonly used in patients with localised (42.3%) disease while hormone therapy was preferred for locally advanced (45.6%) or disseminated (94%) disease. There are significant differences in therapeutic indications between the various Health areas participating in the survey. Median age of patients with localised and locally advanced disease was lower in patients managed with prostatectomy (65 and 64 years, respectively) than in those managed with radiotherapy (70 and 69 years, respectively). CONCLUSION: The therapeutic modality indicated by urologists in the Madrid Autonomous Community for managing patients with prostate cancer generally meets with literature recommendations.

[The prostate cancer in the community of Madrid in 2000 I.- Incidence]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. I--Incidencia.

OBJECTIVE: To know the incidence in the year 2000 of prostate cancer in the Autonomous Community of Madrid and its breakdown by Health Areas. MATERIAL AND METHOD: Study of histologically confirmed prostate cancer case reports and retrospective data acquisition for 2000 in the Autonomous Community of Madrid, both from Public and Private Health Care hospitals. RESULTS: Gross incidence of prostate cancer in the Autonomous Community of Madrid was 100.4 cases per 100,000 males. The incidence adjusted for the Spanish, European and Worldwide population was 120.1, 103.5 and 68.6 cases per 100,000 males, respectively. Mean age at diagnosis was 70 +/- 7.8 (40-94) years, median of 70 years. The age group with higher incidence was 70 to 79 years. CONCLUSIONS: The incidence of prostate cancer in the Autonomous Community of Madrid is lower than that in the US but higher than in most countries or regions in the EU. The different way of using PSA testing in the Health Areas of the Autonomous Community may explain the differences seen in terms of incidence by Area.

[The prostate cancer in the community of Madrid in 2000. II Presentation and diagnosis]. / El cáncer de próstata en la Comunidad de Madrid en el año 2000. II--Presentación y diagnóstico.

OBJECTIVE: To know the presentation form, diagnostic method and clinical stage at the time of diagnosis in subjects with prostate cancer (PC) in the Autonomous Community of Madrid in 2000. MATERIAL AND METHOD: Data from 1745 patients with histologically confirmed prostate cancer obtained from 15 Hospitals participating in the study was analysed. The variables studied were: associated disease, reason for visiting the hospital, digital rectal examination (DRE), PSA, diagnostic method, graded Gleason score, tests performed in the tumoral extension study and tumour staging. The qualitative variables are given in percentages of the overall number and the quantitative variables are expressed as the median, standard deviation, maximum and minimum values and 25%, 50% (median) and 75% percentiles. RESULTS: 67% cases had an associated disease. In most (75%) patients the reason for visiting the hospital was prostatic syndrome. DRE revealed that 42.7% has no tumour. At the time of diagnosis half the patients had PSA levels lower than or equal to 11 ng/ml. Transrectal ultrasound-guided biopsy was used for diagnosis in 93% subjects. The most commonly reported Gleason scores were 6 (31.3%) and 7 (28.7%). In 75% subjects the disease was considered to be clinically limited to the prostate, in 12.5% locally advanced and in 12.5% metastatic. CONCLUSIONS: Most patients came to the hospital because of symptoms not related to PC. Transrectal ultrasound-guided biopsy is confirmed as the choice technique for PC diagnosis. When a comparison is made to historical series in our Autonomous Community a pattern of earlier diagnosis can be seen.

[Renal oncocytoma. Presentation of a case and review of the literature]. / Oncocitoma renal. Presentación de un caso y revisión de la literatura.

Renal oncocytoma is an uncommon, generally benign tumor of the renal parenchyma arising from tubular cells with typical gross, microscopic and ultrastructural features. We report another case of renal oncocytoma that had been treated conservatively on the basis of the pre- and intraoperative findings. The present case provides further insight into the biological behaviour of this tumor type. Its origin, pathological features, diagnostic and therapeutic difficulties, and prognosis are discussed.