[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.

[Screening of cancer of the prostate: study in a Spanish population]. / Screening del cáncer de próstata: estudio en una población española.

OBJECTIVES: A population of Spanish men aged over 49 years were screened for prostate cancer. The detection rate and the clinical features of the tumors found are analyzed. METHODS: The study comprised two phases: Phase I: Subjects were evaluated by digital rectal examination (DRE) and prostate-specific antigen (PSA) was determined. Phase II: Subjects with a positive DRE or PSA > 4 ng/ml were evaluated by transrectal US. If PSA was > 10 ng/ml or DRE or transrectal US were abnormal, a transrectal biopsy was performed; most of these were sextant. PSA density was used as a criterion for biopsy in subjects with PSA 4-10 ng/ml and normal DRE and transrectal US. From June, 1993 to August 1994, 1091 subjects have been evaluated. RESULTS: 1) The mean age was 59.32 years; 379 (34.7%) had low voiding symptoms. 2) 5.07% and 9.07% had abnormal DRE and PSA, respectively; 135 subjects (12.4%) with a questionable DRE and/or PSA were evaluated by transrectal US. 3) Of the 97 biopsies (8.8%) performed, prostate cancer was detected in only 11 (1%); 8.8 biopsies were required to detect one case of prostate cancer. 4) Clinically, 7 tumors (63.6%) were localized and 4 (36.3%) were in the advanced stages. CONCLUSIONS: 1) The participation rate was low (21%). 2) The PSA mean increased with age. Prostate volume was the factor that most influenced PSA changes. 3) PSA detected more tumors (10 cases; 90.9%) than DRE (8 cases; 72.7%). Approximately 27.27% of the lesions were detected by PSA and not by DRE, while 9.09% were detected by DRE alone. 4) The detection rate was low (1.008%); 0.91% for PSA, 0.73% for DRE and 51% (n = 135) for transrectal US. 5) We have detected more tumors in the clinically advanced stages (36.6%) than other series, perhaps because this is the first time this type of study has been performed in this population. In view of the foregoing results, we do not advocate performing these studies routinely. Perhaps in subsequent studies with a longer follow up, a higher detection rate can be achieved for localized tumors that are potentially curable.

[Primary mucinous adenocarcinoma of the prostate]. / Adenocarcinoma mucinoso prostático primario.

Contribution of a new case of prostatic mucinous adenocarcinoma of primary origin. Diagnosis was established by histochemical techniques alcian blue, PAS and alcian-PAS) processing the fragments from the prostate transurethral resection (PTUR). Neither the existence of extraprostatic tumoration, local infiltration, or metastasis was recognized. No correlation between preoperative prostatic acid phosphatase (PAP) (50) and prostatic specific antigen (PSA) values (3ng/m) was evidenced. After radical prostatectomy both markers remain undetected one year after surgery.

The value of transrectal ultrasonography in the diagnosis and treatment of partial obstruction of the seminal duct system.

We report a case of male subfertility with ejaculate volume less than 1 cc and moderate oligoasthenozoospermia. Partial obstruction of the seminal duct system was suspected and transrectal ultrasonography revealed a müllerian duct cyst. We confirmed the diagnosis with transperineal puncture and contrast filling of the cyst and seminal vesicles. This procedure allowed us to avoid scrotal vasostomy and perform conventional vasography as well as to measure the distance between the ceiling of the cyst and the urethra, which facilitated subsequent transurethral surgery.

[Tumors of the female urethra: difficulties in the early diagnosis]. / Tumores de uretra femenina: dificultad en el diagnóstico precoz.

There is no widespread agreement on the treatment of tumors of the female urethra due to their scant incidence. These are generally slowly growing tumors with no salient or specific symptoms and signs. They manifest late and can be misdiagnosed as urethral lesions mimicking a tumor, therefore a biopsy is warranted. For all the foregoing reasons, these tumors are diagnosed in the advanced stages, with a worse prognosis despite very aggressive therapies. Two such cases are described: one was a Grabstald stage C3 epidermoid carcinoma that was submitted to anterior pelvic exenteration and died at 6 months, and the other was a Grabstald stage D4 papillary adenocarcinoma that died a few days after a resection biopsy. Due to the lower incidence of urethral adenocarcinoma, we review the literature on this tumor type and highlight its greater predisposition to progression which carries a worse prognosis.

[Recurrent retroperitoneal malignant fibrous histiocytoma of myxoid type with mesocolon infiltration]. / Histiocitoma fibroso maligno retroperitoneal recidivante tipo mixoide con infiltración de mesocolon.

Malignant fibrous histiocytoma is an uncommon soft tissue sarcoma. If located in the retroperitoneum, abdominal pain is the predominant clinical feature. Like all primary tumors in this area, it is difficult to diagnosis early. A case of malignant myxoid retroperitoneal fibrous histiocytoma is described. Six years after it had been resected, the tumor recurred and infiltrated the mesocolon. The patient was submitted to intestinal resection. Although this tumor type carries a poor prognosis, patient survival is longer and there are less metastases.

[Value of preoperative autotransfusion in elective urologic surgery]. / Interés de la autotransfusión preoperatoria en cirugía urológica electiva.

Over a period of 5 months, 50 patients were entered into the preoperative autologous blood donation program of our Service. Two patients were excluded; one had previously had an acute myocardial infarction and the other had epilepsy. The remaining 48 patients, which accounted for one third of our elective surgery procedures, all accepted to enter the program. These patients were not more severely anemic than the other patients not in the program and who underwent the same surgical procedures. No patients required homologous blood transfusion and no complications ascribable to the procedure were observed. Although it is not utilized widely to date, predeposited autologous blood transfusion is a safe and efficient method, with no remarkable morbidity, even in patients aged over 65 years, the age group of one half of our patients. Autologous blood transfusion programs are necessary. The indications, the exclusion criteria for patients at high risk and the objective parameters for evaluating its success must be established.

[Eosinophilic cystitis]. / Cistitis eosinofílica.

We report two cases of eosinophilic cystitis that had been diagnosed anatomo-pathologically after TUR. These patients had a previous history of low grade and stage superficial bladder tumor that had been treated by intravesical interferon after surgery. The literature is reviewed highlighting the etiopathogenic aspects, the possible relationship with immune allergic factors, clinical aspects, diagnosis and treatment.

[Adrenal myelolipoma: a new case. Review]. / Mielolipoma adrenal: un nuevo caso. Revisión.

We report a case of symptomatic myelolipoma with a good evolution at three and a half years' follow up. The clinical features and the diagnosis of this tumor type are discussed. In this case, as in most cases, CT proved to be the most useful in making the diagnosis. Like most of the cases, the patient was middle aged, obese and hypertensive. The etiology, pathogenesis, clinical features and diagnosis of this disease entity are reviewed. The treatment modalities utilized according to the specific features of each case are discussed.