[Predictors of biochemical recurrence after radical prostatectomy at an oncology reference center in Colombia.] / Factores predictores de recaída bioquímica después de prostatectomía radical en un centro oncológico colombiano.

OBJECTIVE: To determine predictors of BCR in patients with localized PCa undergoing RP at an oncology reference center in Colombia. MATERIALS AND METHODS: A retrospective analytical study was conducted on patients with localized PCa undergoing RP and who at least had one adverse pathological factor for BCR. We consider BCR as two consecutive elevations of PSA after RP, greater than 0.2 ng/ml. For the bivariate analysis we used Kaplan-Meier, and Cox proportional risk analysis to estimate the hazard ratio as well as to determine variables independently associated with the outcome. RESULTS: 280 patients were included. The medianage was 65.3 years, with a median follow up of 52.2 months. BCR occurred in 39% of patients, with a median BCR time of 24.8 months. In the multivariate analysis, high risk [HR 2.07 (95% CI 1.11 - 3.86)], positive surgical margins [HR 2.79 (95% CI 1.66 - 4.69)] and tertiary Gleason pattern [HR 2.16 (95% CI 1.16 - 4.01)] were identified as independent variables associated significantly with BCR. Limitations include retrospective design and sample size. CONCLUSIONS: High risk, positive surgical margins and the presence of tertiary Gleason pattern are the predictive factors of BCR after RP in the Colombian population.

OBJETIVO: Determinar los predictores de recaída bioquímica en pacientes con cáncer de próstata localizado llevados a prostatectomía radical en un centro oncológico de referencia en Colombia.MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo analítico en pacientes con cáncer de próstata localizado que fueron llevados a prostatectomía radical y que tuvieran al menos un factor patológico adverso para recaída bioquímica. Las variables analizadas fueron la edad, el riesgo, el estadio pT, el estadio pN, la densidad ganglionar, los márgenes quirúrgicos, el grupo grado de Gleason y el patrón terciario del Gleason. Consideramos recaída bioquímica como 2 elevaciones consecutivas del PSA después de la prostatectomía radical, mayor a 0,2 ng/ml. Para el análisis bivariado usamos Kaplan-Meier y el análisis de riesgo proporcional de Cox para estimar el HR así como para determinarlas variables independientemente asociadas con el desenlace. RESULTADOS: Se incluyeron 280 pacientes. La edad promedio fue de 65,3 años, con una media de seguimiento de 52,2 meses. La recaída bioquímica ocurrió en el 39% de los pacientes, con una media de tiempo hasta la recaída bioquímica de 24,8 meses. En el análisis multivariado, el riesgo alto [HR 2,07 (IC95% 1,11­ 3,86)], los márgenes quirúrgicos positivos [HR 2,79 (IC95% 1,66 ­ 4,69)] y el patrón terciario del Gleason [HR 2,16 (IC 95% 1,16 ­ 4,01)] fueron identificados como variables independientes asociadas significativamente con recaída bioquímica. Las limitaciones incluyen el diseño retrospectivo del estudio y el tamaño de la muestra. CONCLUSIONES: El riesgo alto, los márgenes quirúrgicos positivos y la presencia de patrón terciario de Gleason son las variables predictoras de recaída bioquímica después de prostatectomía radical en la población colombiana.

Clinical and Histopathological Characteristics of Prostate Cancer Patients Taken to Palliative Transurethral Prostate Resection.

Introduction In prostate cancer (PCa) patients who have been treated with radiotherapy and/or androgen deprivation therapy (ADT), palliative transurethral resection of the prostate (TURP) is a management option in the presence of lower urinary tract symptoms (LUTS). The present work seeks to describe the clinical and histopathological characteristics of patients with PCa taken to palliative TURP. Methods An observational, descriptive and retrospective study of patients with PCa who underwent palliative TURP for the relief of obstructive urinary symptoms at an oncology reference center between January 2006 and June 2014 was performed. Among the included patients were those with localized PCa treated with radiotherapy and those with advanced PCa with or without metastasis who had previously received ADT. Results Sixty-six patients with a diagnosis of PCa taken to palliative RTUP were identified. Fifty patients (78.4%) were received some type of ADT, seven patients (10.7%) received curative radiotherapy along with adjuvant ADT, five patients (7.8%) were previously treated with only radiotherapy, and two patients (3.1 %) had received no prior management and thus were taken to bilateral orchiectomy along with palliative TURP in a single surgical act. With regard to the pathology reports, tumor tissue was found in 50 patients (76%), and no tumor was observed in the remaining 16 patients (24%). In one case (1.5%), the Gleason score (GS) could not be determined due to the effects of orchiectomy. Under-staging in the grade group was evidenced in 23 patients (46.9%), over-staging in three patients (6.3%), and no difference in 23 patients (46.9%), when compared to the initial GS at biopsy. The mortality rate and the incidence of TURP syndrome were low (3.1% and 1.5%, respectively). A 46% reduction in the mean serum prostate-specific antigen (PSA) value was documented when the preoperative and postoperative values were compared. Conclusion A decrease in the serum PSA levels was observed after palliative TURP, and despite having received ADT, it was possible to determine tumor pathology in the resected tissue, being able to identify a greater grade group compared the GS at the time of diagnosis. The palliative TURP proved to be a safe procedure to relieve LUTS in patients with advanced PCa, with a low morbidity and mortality rate.