Developing a Diagnostic Multivariable Prediction Model for Urinary Tract Cancer in Patients Referred with Haematuria: Results from the IDENTIFY Collaborative Study.

BACKGROUND: Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation. OBJECTIVE: To develop a prediction model for urinary tract cancer in patients referred with haematuria. DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged ≥16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism. RESULTS AND LIMITATIONS: The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy. CONCLUSIONS: This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation. PATIENT SUMMARY: We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation.

[Use of vascular prostheses in renal transplantation: series of 9 cases.] / Empleo de prótesis vasculares en el trasplante renal: serie de 9 casos.

OBJECTIVE: Calcification and atherosclerosis of the iliac arteries is very common in dialysis patients, making sometimes impossible the anastomosis of a kidney graft. The objective of this study is to present our kidney transplantation series using vascular prostheses for iliacartery reconstruction and to assess the results obtained in comparison to other published series. MATERIAL AND METHOD: In a single centre where 1090 kidney transplants were performed between January 2013 and December 2019, patients who required vascular reconstruction were identified for their descriptive analysis. RESULTS: In 9 patients (0.83%) arterial anastomosis was performed to a Gore-tex prosthesis (8) or using a bovine pericardium patch (1). Only in 1 case, the vascular bypass was prior to transplantation; in the other 8 the surgery was simultaneous. In 2 cases, an urgent transplantectomy was done because of acute rejection and prosthetic thrombosis. 6 patients had immediate graft function. 5 patients requireda new surgical or endovascular procedure to resolve complications. At 35 months of mean follow-up, 7 patients maintained renal graft function. CONCLUSION: Kidney transplantation with arterial anastomosis to a vascular prosthesis is very rare. Candidates should be carefully selected because of the high risk ofcomplications. Simultaneous vascular reconstruction is preferred.  The functional results are satisfactory.

OBJETIVO: La calcificación y arterioesclerosis de las arterias ilíacas es muy común en pacientes en diálisis llegando a poder imposibilitar la anastomosis de un injerto renal. El objetivo de este trabajo es presentar nuestra serie de trasplantes renales con uso de prótesis vasculares para reconstrucción arterial ilíaca y valorar los resultados obtenidos en comparación a otras series publicadas.MATERIAL Y MÉTODO: En un único centro donde se realizaron 1090 trasplantes renales entre enero 2013 y diciembre 2019, se identifica a los pacientes que precisaron reconstrucción vascular para su análisis descriptivo. RESULTADOS: En 9 receptores (0,83%) se realizó la anastomosis arterial a una prótesis de Gore-tex (8) o mediante un parche de pericardio bovino (1). Solo en 1 caso, el bypass vascular era previo al trasplante, en los 8 restantes la cirugía fue simultánea. En 2 casos se realizó trasplantectomía urgente por rechazo agudo y trombosis de la prótesis. 6 pacientes tuvieron una función inmediata del injerto. 5 pacientes precisaron un nuevo procedimiento quirúrgicoo endovascular para solucionar complicaciones. A los 35 meses de seguimiento medio, 7 pacientes mantuvieron un injerto renal funcionante.CONCLUSIÓN: El trasplante renal con anastomosis arterial a una prótesis vascular es muy infrecuente. Deben seleccionarse cuidadosamente los candidatos por el alto riesgo de complicaciones. Se prefiere la reconstrucción vascular simultánea al trasplante. Los resultados funcionales son satisfactorios.

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study.

OBJECTIVE: To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. PATIENTS AND METHODS: This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. RESULTS: Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90-4.15; P < 0.001), male sex 1.30 (95% CI 1.14-1.50; P < 0.001), and smoking 2.70 (95% CI 2.30-3.18; P < 0.001). CONCLUSIONS: A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer.

Prostate-specific membrane antigen theranostics in advanced prostate cancer: an evolving option.

OBJECTIVES: To review current data for the role of prostate specific membrane antigen (PSMA) radioligand therapy (RLT) for patients with advanced prostate cancer. This review provides an update for multidisciplinary teams on the current and potential future applications of theranostics in prostate cancer. METHODS: Narrative review focussing on PSMA as a target for RLT, and data using RESULTS: RLT with PSMA is an exciting therapeutic alternative to the existing management options already in use for patients with metastatic castrate-resistant prostate cancer (mCRPC). To date, most evidence exists regarding small-molecule PSMA inhibitors bound to beta-emitting radioisotopes such as 177Lu (Lu-PSMA). Prospective phase II data supports the safety and efficacy of Lu-PSMA in men with heavily pre-treated progressive mCRPC, and several late-phase randomised trials of Lu-PSMA are underway, with many more in the pipeline. Early results are encouraging, indicating that the theranostic approach may play a vital role in management of advanced prostate cancer and perhaps even in much earlier disease states. CONCLUSIONS: PSMA RLT is a promising new treatment option for men with mCPRC, and may also have utility in less advanced prostate cancer.

[Prostate cancer pathologic features in men ≤55 years treated with robot assisted radical prostatectomy.] / Características clínicopatológicas del cáncer de próstata en varones ≤55 años tratados mediante prostatectomía radical robótica.

OBJECTIVE: Among western males, prostate cancer is the most frequent oncological disease. Since the widespread of PSA, diagnoses in younger adults is increasing. The aim of this study is to analyze pathological features and biochemical recurrence event in patients ≤55 years who underwent robotic radical prostatectomy (RRP) surgery. MATERIAL AND METHODS: A study with a cohort of 510 patients operated between November 2012 and February 2017 in a tertiary centre is provided. A total of 460 are included in the analysis. Variables include PSA, biopsy Gleason score, prostate weight, final specimen Gleason score, pT and surgical margins. Biochemical recurrences during the follow-up are obtained. Statistical analysis with Chi2, Student's t test, Kaplan-Meier and log-rank (SPSS24.0) comparing the ≤55 years patients with older age group is performed. RESULTS: 8.3% (38) of the patients were ≤55 years. The mean PSA among the younger group was 8.54ng/ml while in the older was 8.18ng/ml (p=0.13). The biopsy Gleason scores showed similar distribution in both age groups. 52.6% (20) of the young group presented an upgrading in the final Gleason, vs 49.1% (207) among the elderly (p=0.79). The average prost at eweight was higher among elderly patients (54.29g vs.40.50g P=0.001). 84.2% (32) of prostate cancers in young group corresponded to pT2 stages compared to 81.3% (343) in the elder (p=0.66). The presence of positive surgical margins was similar in both groups. The mean follow-up time was 45 months regardless of age. In 21.1% (8) of the young group, biochemical recurrence was detected compared to 17.1% (72) among the elderly (p=0.53). There were no differences in the biochemical recurrence-free survival recorded in both groups (p=0.53). CONCLUSION: In our study population, patients  ≤55 years treated with RRP did not present differences in the pathologic features of prostate cancer or in biochemical recurrence rates in comparison to the group of older patients.

OBJETIVO: Entre los varones occidentales, el cáncer de próstata es la patología oncológica más frecuente. Con la difusión del PSA, los diagnósticos en adultos jóvenes han ido en aumento. El objetivo de este trabajo es analizar las características clínicopatológicas y la aparición de recidiva bioquímica en pacientes  ≤55años intervenidos mediante prostatectomía radical robótica (PRR).MATERIAL Y MÉTODOS: Se elabora un estudio con una cohorte de 510 pacientes operados entre noviembre 2012 y febrero 2017 en un centro terciario. Un total de 460 son incluidos en el análisis. Se registran variables que incluyen PSA, score Gleason de la biopsia, peso  de la próstata, score Gleason de la pieza, estadio patológico y márgenes quirúrgicos. Se obtienen las recidivas bioquímicas registradas durante el seguimiento. Se realiza un análisis estadístico con los test Chi2, T-Student, Kaplan-Meier y Log-Rank (SPSS24.0) comparando a los pacientes ≤55 años con el grupo de más edad. RESULTADOS: El 8,3% (38) de los pacientes eran ≤55años. El PSA medio entre los jóvenes fue 8,54 ng/ml mientras que en los mayores fue 8,18ng/ml (p=0,13). Los score Gleason descritos en las biopsias mostraron similar distribución en ambos grupos de edad. Tras el estudio anatomopatológico de la pieza quirúrgica, un 52,6% (20) de los jóvenes sufre upgrading en el Gleason, superior al 49,1% (207) registrado entre los mayores (p=0,79). El peso medio de la próstata fue mayor entre los pacientes añosos (54,29g vs. 40,50g P=0,001). El 84,2% (32) de los cánceres de próstata en jóvenes correspondían a estadios T2 frente al 81,3% (343) en los mayores (p=0,66). La presencia de márgenes quirúrgicos positivos fue similar en ambos grupos. El tiempo medio de seguimiento fue 45 meses con independencia de la edad. En el 21,1% (8) de los jóvenes se detectó recidiva bioquímica frente al 17,1%(72) presentado entre los mayores (p=0,53). No hubo diferencias en la supervivencia libre de recidiva bioquímica registrada en ambos grupos (p=0,53).CONCLUSIÓN: En nuestra población de estudio, los pacientes ≤55 años tratados con PRR no presentan diferencias en las características clinicopatológicas del cáncer de próstata ni en la aparición de recidiva bioquímica respecto al grupo de pacientes más mayores.