[Natural history of localized prostate cancer. Preliminary data on progression and mortality]. / Historia natural del cáncer de próstata localizado. Datos preliminares de progresión y mortalidad.

OBJECTIVE: To address the effect of therapy options and other factors on the natural history of localized prostate cancer (PCa). METHODS: Men with diagnosed clinically localized PCa who underwent radical prostatectomy (RP), radiotherapy (RT) or watchful waiting (WW). Rates of biochemical progression (BQP) and clinical progression (CLP) were calculated. The effects of therapy, initial PSA, presence of palpable tumor and Gleason score were assessed with Kaplan-Meier analysis and log-rank test. Similar methods were used to study overall and disease-specific survival. RESULTS: A total of 228 patients were studied (135 underwent RP, 46 RT, and 47 WW). Median followup time was 2.5 years. Forty patients presented with BQP. The probability of being free from BQP after 2 and 5 years was 76.8% and 57.9% respectively for the whole population, 70.9% and 57.6% for RP patients, 100% and 100% for RT, and 87.1% and 47.2% for WW (p = 0.031). Nineteen patients presented with CLP, with no significant differences with regard to therapy option. A poorly differentiated Gleason score favoured the probability of presenting with CLP (p = 0.022) and shift to metastatic disease (p < 0.001). No cancer-specific mortality was recorded in the studied population. CONCLUSIONS: Short and medium-term prognosis is excellent for localized prostate cancer in terms of survival. Nevertheless, some patients show a higher risk of progressing to metastatic disease (poorly differentiated Gleason score).

[Diet and prostate cancer]. / Dieta y cáncer de próstata.

Prostate cancer is the first neoplasia in the United States accounting the second in cancer deaths. With all the treatments strategies in debate because of their side effects, is very important try to elucidate prevention mechanisms that may be implicate in the development of this disease, between these, nutrients have been of mayor importance. In the present review we tried to study the most important nutritional factors implicated in the development and prevention of prostate carcinoma. We focus our attention over the polyphenols of the red wine, which influence over cellular proliferation and apoptosis in LNCaP cells have been studied in our Department.

[Epidemiologic analysis of clear cell and chromophilic carcinoma of the kidney]. / Análisis epidemiológico del carcinoma renal de células claras y cromofílico.

OBJECTIVE: Finding differences in the characteristics of the two most frequent variants of renal cancers: the clear-cell renal carcinoma, and the chromophilic one. MATERIAL AND METHODS: Retrospective analysis of epidemiological characteristics of patients diagnosed of renal carcinoma in our hospital between 1991 and 2001. Statistical differences were searched between patients' characteristics (age, sex, smoking habitus) and tumors' characteristics (size, focality, stage, side and grade). RESULTS: Sixty six renal tumors were diagnosed, of which 41 (62.1%) were clear-cell tumors and 9 (13%) were chromophilic. We only found statistical differences between both subpopulations' tumor size (p < 0.05), being greater for clear-cell tumors (7 +/- 3.92 cm) than for chromophilic ones (4.89 +/- 1.96 cm). We could also appreciate a bias towards a less advanced stage of the chromophilic type, although not statistically significant. CONCLUSIONS: Clear-cell renal carcinoma and chromophilic renal carcinoma are the two more frequent variants of renal tumors. The chromophilic type is smaller and is usually found in a less advanced stage, although this bias could not be demonstrated in our series.

[Detection of prostatic cancer in the PSA range between 3 and 3.9 ng/ml]. / Deteccion del cáncer de próstata en el rango de PSA entre 3 y 3,9 ng/ml.

OBJECTIVE: In our study, we analyze the benefit of lowering the PSA cutoff point for which a prostate biopsy is indicated from 4 to 3 ng/ml. MATERIALS AND METHODS: We have considered 4.278 individuals coming from a prostate cancer screening program. We studied 1.217 interventions in which PSA was determined, indicating the prostate biopsy with PSA > or = 3 ng/ml. Digital rectal examination was never the indication for the biopsy. All biopsies were sextant and assisted by transrectal ultrasound. We compared the performance of the biopsy using 4 and 3 ng/ml as cut points. RESULTS: Of the 1.217 interventions performed, 947 had PSA values lower than 3 ng/ml, 80 between 3 and 3.9 ng/ml and 190 over 4 ng/ml. A total of 189 patients (70% of these two last groups) underwent a prostate biopsy. With 4 ng/ml as the cut point, 134 biopsies were indicated, detecting 28 cancers (positive predictive value 20.9%). However 189 biopsies were indicated and 34 cancers detected by lowering the cut point to 3 ng/ml (positive predictive value 17.9%). The reduction in the biopsy performance was not statistically significant (OR = 0.89). None of the 6 additional cancers detected was palpable or ecographically visible (T1c), all of them had a Gleason score under 7 and half of them could be considered clinically relevant. CONCLUSIONS: Lowering PSA cutoff point from 4 to 3 ng/ml improved the detection rate in 21.4% not jeopardizing the biopsy performance. Therefore we think that the group of patients with PSA between 3 and 3.9 ng/ml as candidates for prostate biopsy, should be included in screening programs.

[Analysis of the use of prostate specific antigen (PSA) in a health area of the Community of Madrid]. / Análisis de la utilización del antígeno específico prostático (PSA) en un área sanitaria de la Comunidad de Madrid.

OBJECTIVES: To approach the local extent of PSA-use, and to check its yield in terms of prostate cancer (PC) detection. METHODS: All PSA-test records (1997-1999) were reviewed and testing rates calculated per 1000 person-years. Detection rate (PC) was also estimated and referred to our PC prevalence study using the odds ratio as instrument for comparison. RESULTS: Testing rate in the general population was 21.6/1000 person-years. PC detection rate was 1.76% (1.28 inside the prevalence study). For every CP detected in the general population with a PSA ranging 4-10 ng/ml, 2.39 (OR = 2.39) were detected in the prevalence study (OR = 4.48 for the PSA range > 10 ng/ml). CONCLUSIONS: PSA-testing in our setting is high. PC detection rates were lower than expected.

[Prostatic adenocarcinoma associated with incidental intestinal carcinoid]. / Asociación de adenocarcinoma prostático y carcinoide intestinal incidental.

The association of a carcinoid tumour with non-endocrine urologic neoplasms is an infrequent finding. This paper contributes one case of multiple primary neoplasm where a prostatic adenocarcinoma coexists with an intestinal carcinoid tumour in a 63-year old asymptomatic patient. Diagnosis of prostate cancer was achieved during a screening for this conditions whereas the intestinal carcinoid tumour was found in the extension study.

[A diagnostic algorithm based on transrectal echography in failure of surgery correcting stress urinary incontinence]. / Algoritmo diagnóstico basado en la ecografía transrectal en los fracasos de la cirugía correctora de la incontinencia urinaria de stress.

Transrectal ultrasound is a dynamic imaging diagnostic technique for the study of stress urinary incontinence (SUI). The highest efficiency is obtained in the study of failed corrective surgery of SUI. Our group studied 23 patients reporting clinical SUI after undergoing corrective surgery, 23.3% patients with transrectal ultrasound showed no condition that could justify it (bladder neck hypermobility, intrinsic sphincteral incompetence, calcification of suspension threads, urethra diverticulum...); 34.8% showed bladder neck hypermobility, indicative of failed corrective surgery; 34.8% showed presence of open urethra at rest, an echographic sign of intrinsic sphincteral incompetence; and in 4.3% cases the existence of intravesical calcifications of the suspension threads was diagnosed. Transrectal ultrasound can become the choice test to perform in this group of patients, leading to the performance of other diagnostic tests and offering an adequate customized solution for each patient's problem.

[Identification of factors conditioning urinary cytology in bladder cancer]. / Identificación de los factores que condicionan la citología urinaria en el cáncer vesical.

OBJECTIVES: To identify the clinical and tumoral aspects related with urinary cytology as a means of validating current criteria or determining the usefulness of this test in the diagnosis of bladder tumors. METHODS: 96 patients that were posteriorly diagnosed as having primary transitional cell carcinoma of the bladder were initially evaluated by urinary cytology. The diagnoses were positive, negative or inconclusive cytology. Any abnormality (for both inconclusive and positive cytologies) were considered as compatible with tumor. To determine the relationship between patient characteristics and tumors, and the results of cytology, standard univariate statistical analysis was performed. To eliminate the confounding factors, a multivariate analysis was performed. RESULTS: Cytology was positive on 44 (45.8%), inconclusive on 22 (23%) and negative on 30 (31.2%) occasions. Age > or = 55 years (p < 0.05), grade (p < 0.05), tumor aspect (p < 0.01) and size (p < 0.001) were associated with a higher frequency of cytologies compatible with tumor. Multiple regression analysis identified tumor size as the only independent variable related with the cytologies compatible with tumor [odds ratio = 8.68 (2.7-26.9)]. CONCLUSIONS: If, as the results of the present analysis suggest, the real effect of cytological analysis in the initial diagnosis of bladder tumors is the anticipation of different features of tumor grade and stage (as patient age, tumor size, aspect and number), its utility would be very limited since other more precise tests (US, cystoscopy...) that provide this information are available.

[Effect of cell differentiation in prostatic cancer on basal PSA]. / Influencia de la diferenciación celular del cáncer de próstata sobre el PSA basal.

The effect of cell differentiation on PSA production in patients with prostate cancer has been evaluated. With this intention 70 patients were included and were analyzed for age, T stage, cell differentiation, bone scan involvement and PSA level prior to therapy. In well-differentiated tumours mcan PSA was 31.3 ng/mL, 56.6 in those with moderate differentiation and 31.6 in poorly differentiated ones (p > 0.05). Multivariate analysis shows no significant differences between both variables, but and inverse relationship between cell differentiation and PSA production (r = -0.27, p > 0.05) can be seen. The most influential variable on PSA levels was de extent of bone scan involvement. Cell differentiation as confusion variable to interpret PSA values in poorly differentiated tumours deserves further study to know the exact role of this protein as a treatment response criterion in prostate cancer.

[Is it possible to do without bone gammagraphy in the staging of prostatic cancer?]. / Es posible prescindir de la gammagrafía ósea en el estadiaje del cáncer de próstata?

Since the discovery of the prostate specific antigen, and its use as tumoral marker, not only this has been shown to have a significant application for the diagnosis and evaluation of prostate cancer management, but also to be an eventual help to predict occurrence of bone metastasis. A retrospective study was conducted in 50 patient with prostate cancer, with mean age of 74 years (range 56-90), where PSA levels were analyzed and then correlated with the results obtained with bone scintigraphy. Our work results were that, given a 40% prevalence of the metastatic disease, no patient had PSA values under 10 ng/ml and, at the same time, bone dissemination, i.e., a 100% negative predictive value. Thus, we can state that in our group, we could have given a PSA cut-off value over 10 ng/ml to perform bone scintigraphy, without making any staging mistake.

[Ureteral resection of ureteral inflammatory polyp associated with lithiasis]. / Ureteroresección de un pólipo inflamatorio ureteral asociado a litiasis.

We report on a fibroepithelial polyp case with inflammatory characteristics located in the pelvian ureter, and related with an ureteral calculus, which was treated in a conservative way with ureteroscopic resection, after the pincer extraction of the stone. Our team found two fibroepithelial polyp cases in the bibliography reviewed treated with ureteroscopic resection. We consider that the polyp's reactive inflammatory nature is due to the urothelial chronic irritation caused by the calculus.

[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.