Competing risk analysis of mortality in prostate cancer treated with radical prostatectomy. / Análisis de riesgos competitivos de mortalidad en cáncer de próstata tratado mediante prostatectomía radical.

OBJECTIVE: To determine the risk of cancer-specific mortality (CSM) versus the competing risk of mortality by other causes (MOC) in patients with localised prostate cancer (LPC) treated with radical prostatectomy (RP). MATERIAL AND METHOD: An observational cohort study of 982 patients with LPC treated with RP selected from our department's PC registry database. A competing risk analysis was performed, calculating the probability of CSM in the presence of the competing risk of MOC. Cumulative incidence curves were constructed, and point estimates were performed at 5, 10 and 15 years. The analysis was stratified by age (≤65 vs. >65 years) and risk group: low (Gleason score ≤6 and pT2abc); intermediate (Gleason score of 7 and pT2abc) and high (Gleason score of 8-10 or pT3ab). RESULTS: With a median follow-up of 60 months, the overall probability of dying from PC was 3.5%, and the probability of dying from other causes was 9%. A competing effect for MOC was observed. The risk of MOC was almost 3 times greater than that of CSM. This effect remained for all risk groups, although its magnitude decreased progressively according to the risk group level. At 10 years, CSM was only 0%, 1% and 2% for the low, intermediate and high-risk groups, respectively, while the likelihood of MOC was 4%, 4% and 10%, respectively. The mortality risk was shown after 10years of follow-up and was higher for other causes not attributable to PC and for patients older than 65years. CONCLUSIONS: The benefit of RP might be overestimated, given that the risk of MOC is greater than that of CSM, regardless of the age group and risk group, especially after 10years of follow-up. The only parameter that varied was the magnitude of the CSM/MOC ratio. This information could help in choosing the active treatment for patients with LPC and short life expectancies.

Alternativas a la vía transuretral para la inyección de toxina botulínica en esfínter urinario / Botulinum toxin inyection in urinary sphincter: alternative approaches

Objetivo: Presentamos las vías transrectal en varones y transvaginal en mujeres como alternativas a la vía transuretral para la inyección de toxina botulínica (TB) en esfínter urinario, así como nuestros resultados. Material y Método: Se inyectó TB en esfínter urinario a 9 pacientes entre diciembre de 2008 y agosto de 2010para el tratamiento de distintas disfunciones de vaciado refractarias a tratamiento convencional. La vía utilizada fue transrectal en 7 varones y transvaginal en 2 mujeres. Las dosis utilizadas oscilaron entre 50 y200 U. Registramos resultados y complicaciones. Resultados: Obtuvimos resultados satisfactorios en 6pacientes (66 por ciento) según criterios clínicos. La duración del efecto osciló entre los 3 y 7 meses. No registramos complicaciones significativas relacionadas con la inyección y la tolerancia al dolor fue buena. Conclusiones: La vía transrectal en varones y transvaginal en mujeres son alternativas válidas y seguras para la inyección de TB en esfínter urinario.

Objective: To present our institution experience and outcomes with transrectal and transvaginal injection of botulinum toxin (TB) in urinary sphincter to treat voiding disfunction. Material and methods: We injected TB in 9 patients since December 2008 to august 2010 in order to treat different voiding disfunctions. We use the transrectal approach in 7 men and the transvaginal method in 2 women. The dose used ranged from 50 to 200 units. Outcomes and complications were registered. Results: Satisfactory outcomes were obtained in 6 patients (66 pert cent) according to clinical criteria. The duration of the effect was from 3 to 7 months. No major complications were registered and pain was well tolerated. Conclusions: Transrectal and transvaginal approaches are effective and safe for the injection of TB in urinary sphincter.