Asociación del síndrome de hipogonadismo tardío y síndrome metabólico con el cáncer de próstata y su agresividad / Association between late-onset hypogonadism syndrome plus metabolic syndrome and prostate cancer and its aggressiveness

Objetivo: Evaluar la relación entre el cáncer de próstata (CaP) y la presencia de síndrome metabólico (SM) y síndrome de hipogonadismo tardío (SHT). Material y método: Estudio retrospectivo de 686 pacientes sometidos a biopsia prostática. Analizamos: variables demográficas, datos clínicos y resultados de la biopsia. Para diagnosticar el SM se utilizaron los criterios de la American Heart Association. Para el diagnóstico de SHT se utilizó el cuestionario ADAM y los niveles de testosterona (TT). Evaluamos la relación de la testosterona libre (TL) y testosterona biodisponible (TB) con el CaP y su agresividad y la utilidad de la ratio TT/PSA en el diagnóstico de CaP. Resultados: Mediana de edad 65 años. El SM no se asoció al CaP (39,4% vs 35% p = 0,1) pero sí a un CaP Gleason > 7 (50,4% vs 29,44% p = 0,002). El SHT, TL baja y TB baja se asociaron a una mayor presencia de CaP (51% vs 35% p = 0,02; 44,86% vs 33,33%, p = 0,03; 46,46% vs 33,08%, p = 0,01 respectivamente) y a mayor probabilidad de CaP Gleason >7 (61,54% vs 37,5% p = 0,02; 54,17% vs 34,12%, p = 0,02; 54,35% vs 34,48% p = 0,02 respectivamente). Además, la mediana de la ratio de TT/PSA fue significativamente menor en los pacientes con BxP positiva (p = 0.022). Conclusiones: el SM no se asoció con la probabilidad de tener CaP, pero sí con el CaP Gleason > 7. Por otro lado, el SHT presentó un mayor porcentaje de CaP y una mayor presencia de CaP Gleason > 7, al igual que los niveles bajos de TL y los niveles bajos de TB

Objective: To assess the relationship between prostate cancer (PC) and the presence of metabolic syndrome and late-onset hypogonadism (LOH) syndrome. Material and method: A retrospective study was conducted on 686 patients who underwent prostate biopsy. We analysed the demographic variables, clinical data and biopsy results. To diagnose metabolic syndrome, we employed the criteria of the American Heart Association. For the diagnosis of LOH syndrome, we employed the Androgen Deficiency in the Aging Male questionnaire and testosterone levels (TT). We evaluated the relationship between free testosterone (FT) and bioavailable testosterone (BT) on one hand and PC and its aggressiveness on the other, as well as the usefulness of the TT to prostate specific antigen (TT/PSA) ratio in the PC diagnosis. :Results The patient's median age was 65 years. Metabolic syndrome is not associated with PC (39.4% vs. 35%; P = .1) but is associated with a PC Gleason score > 7 (50.4% vs. 29.44%; P = .002). LOH, low FT and low BT are associated with an increased presence of PC (51% vs. 35%, P = .02; 44.86% vs. 33.33%, P = .03; and 46.46% vs. 33.08%, P = .01, respectively) and with an increased probability of a PC Gleason score > 7 (61.54% vs. 37.5%, P = .02; 54.17% vs. 34.12%, P = .02; 54.35% vs. 34.48%, P = .02, respectively). Additionally, the median TT/PSA ratio was significantly lower in patients with positive biopsies (P = .022). Conclusions: Metabolic syndrome was not associated with the probability of having PC but was associated with a PC Gleason score > 7. Moreover, LOH syndrome had a higher percentage of PC and a greater presence of PC Gleason scores > 7, as did low levels of FT and low levels of BT

Association between late-onset hypogonadism syndrome plus metabolic syndrome and prostate cancer and its aggressiveness. / Asociación del síndrome de hipogonadismo tardío y síndrome metabólico con el cáncer de próstata y su agresividad.

OBJECTIVE: To assess the relationship between prostate cancer (PC) and the presence of metabolic syndrome and late-onset hypogonadism (LOH) syndrome. MATERIAL AND METHOD: A retrospective study was conducted on 686 patients who underwent prostate biopsy. We analysed the demographic variables, clinical data and biopsy results. To diagnose metabolic syndrome, we employed the criteria of the American Heart Association. For the diagnosis of LOH syndrome, we employed the Androgen Deficiency in the Aging Male questionnaire and testosterone levels (TT). We evaluated the relationship between free testosterone (FT) and bioavailable testosterone (BT) on one hand and PC and its aggressiveness on the other, as well as the usefulness of the TT to prostate specific antigen (TT/PSA) ratio in the PC diagnosis. RESULTS: The patient's median age was 65 years. Metabolic syndrome is not associated with PC (39.4% vs. 35%; P=.1) but is associated with a PC Gleason score >7 (50.4% vs. 29.44%; P=.002). LOH, low FT and low BT are associated with an increased presence of PC (51% vs. 35%, P=.02; 44.86% vs. 33.33%, P=.03; and 46.46% vs. 33.08%, P=.01, respectively) and with an increased probability of a PC Gleason score >7 (61.54% vs. 37.5%, P=.02; 54.17% vs. 34.12%, P=.02; 54.35% vs. 34.48%, P=.02, respectively). Additionally, the median TT/PSA ratio was significantly lower in patients with positive biopsies (P=.022). CONCLUSIONS: Metabolic syndrome was not associated with the probability of having PC but was associated with a PC Gleason score >7. Moreover, LOH syndrome had a higher percentage of PC and a greater presence of PC Gleason scores >7, as did low levels of FT and low levels of BT.

Síntomas del tracto urinario inferior y función eréctil en pacientes con sospecha de cáncer de próstata / Urinary tract symptoms and erectile function in patients at risk of prostate cancer

Introducción y objetivo: Estimamos que en España se llevan a acabo alrededor de 63.000 biopsias de próstata. No hay datos al respecto del estado funcional de los pacientes que acuden a realizarse dicha prueba, ni de si el resultado de la biopsia responde a un patrón funcional concreto. Planteamos un estudio que resuelva el anterior planteamiento. Material y método: Se incluyeron 1.128 biopsias. Los pacientes cumplimentaban, antes de la biopsia, los cuestionarios: IPSS, IIEF-5 y ICIQ-SF. Se recopilaron de forma prospectiva las variables clínicas, patológicas y los resultados de los cuestionarios. Se procedió a un análisis descriptivo de la muestra a estudio, incluyendo el resultado de los cuestionarios. Se comparó el resultado medio de los cuestionarios en función de la presencia de cáncer en la biopsia. Los síntomas del tracto urinario inferior (STUI) y de disfunción eréctil se categorizaron en grados de severidad, y se calculó la distribución de los mismos en función del resultado de la biopsia y, cuando la biopsia era positiva, del grupo de riesgo clínico. Resultados: La edad media de los pacientes era de 65 años. La tasa de biopsias positivas fue del 32,71%. El 52,2% refirió padecer síntomas del tracto urinario inferior (STUI) moderados y el 13,4% severos. En cuanto a la influencia de los STUI en la CV de los pacientes solo un 12,6% refería que su vida no estaba influenciada por los STUI. El 50,76% padecía algún grado de disfunción eréctil. Según los resultados del ICIQ-SF un 24% de la muestra refería padecer algún tipo de incontinencia urinaria, si bien es cierto que la mayor parte de ellos lo etiquetaba como escapes de escasa cuantía. Los pacientes con cáncer de próstata tenían un IPSS y un IIEF-5 medio menor. No se encontraron diferencias de la tasa diagnóstica de cáncer en función de la seriedad de los síntomas del tracto urinario. Conclusiones: Los pacientes a quienes indicamos una biopsia de próstata padecen con una alta probabilidad STUI, aproximadamente un 50% tiene cierto grado de disfunción eréctil y un 24% problemas de escapes urinarios

Introduction and objective: We estimate that more tan 63000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. Material and method: 1,128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. Results: The mean age of the sample was 65. Prostate cancer detection rate was 32,71%, 52,2% of the sample had mild lower urinary tract symptoms (LUTS) and 13,4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12,6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. Conclusions: Patients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage

Fístula rectovaginal y enterocutánea espontáneas: potenciales complicaciones durante la terapia con fármacos antiangiogénicos en cáncer renal / Spontaneous enterocutaneous and rectovaginal fistula: potential complications during therapy with anti-angiogenic drugs in renal cancer

Se presentan dos casos de fístula, enterovaginal y enterocutánea asociadas a tratamiento con pazopanib, un inhibidor de la angiogénesis para el tratamiento de cáncer renal metastásico. El tiempo entre el inicio del fármaco y la aparición de la fístula fue de 6 y 16 meses, respectivamente; en ninguno de los casos hubo antecedentes de radioterapia o cirugía previa en la zona donde surgió la complicación. Según lo reportado en la literatura, alrededor de un 70% de pacientes se benefician de un tratamiento conservador. Las fístulas enterovaginales y enterocutáneas, suponen menos del 1% de las complicaciones publicadas por el uso de fármacos antiangiogénicos; a pesar de eso, es una complicación que deberíamos tener presente, pues se reporta una mortalidad cercana al 30%. A través de este artículo, queremos trasmitir nuestra experiencia en este tipo de complicación, ya por su baja incidencia, es indudable, que esta por vía de información, nos podemos apoyar los diferentes especialistas que tratan a estos pacientes; tomando las precauciones necesarias y decidiendo un manejo adecuado

We present two cases of enterovaginal and enterocutaneous fistulae associated to treatment with pazopanib, which is an angiogenesis inhibitor for the treatment of metastatic renal cancer. The times from drug administration and the first appearance of a fistula were 6 and 16 months, respectively. None of the cases had a history of surgery or radiotherapy in the area where the complication was observed. Enterovaginal and enterocutaneous fistula represent less than 1% of all published complications caused by the use of antiangiogenic drugs. However, they must be taken into account as the reported mortality rate is close to 30%. Given its low incidence, we believe that sharing this data is a great way to help specialists who have to treat these patients to take the necessary precautions and decide on an adequate approach

Urinary tract symptoms and erectile function in patients at risk of prostate cancer.

INTRODUCTION AND OBJECTIVE: We estimate that more tan 63000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. MATERIAL AND METHOD: 1,128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. RESULTS: The mean age of the sample was 65. Prostate cancer detection rate was 32,71%, 52,2% of the sample had mild lower urinary tract symptoms (LUTS) and 13,4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12,6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. CONCLUSIONS: Patients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage.

Nefrometrías: reproducibilidad interobservador y predicción de factores perioperatorios / Nephrometry scores: Interobserver reproducibility and perioperative factors prediction

Objetivos: Validar la relación de las nefrometrías en una serie de pacientes a los que se les realizan nefrectomías parciales con parámetros perioperatorios. Demostrar la reproducibilidad urólogo-radiólogo en cuanto a los resultados de las nefrometrías. Material y métodos: Revisión retrospectiva de los pacientes intervenidos mediante nefrectomía parcial abierta y laparoscópica entre 2005 y junio de 2012 registrados en una base de datos de cumplimentación prospectiva. A un total de 86 pacientes se les calculan las nefrometrías RENAL, PADUA y C-index por parte de un urólogo y una radióloga. Procedimos a un estudio comparativo de los resultados mediante índices de correlación de Spearman y Pearson. Resultados: La distribución según la complejidad de los tumores al calcular RENAL fue: 42 (49%) baja, 35 (41%) moderada y 9 (11%) alta. Según PADUA: 35 (41%) de baja complejidad, 32 (37%) intermedia y 19 (22%) alta. No se encontró correlación estadísticamente significativa en cuanto a la aparición de complicaciones operatorias y el resultado anatomopatológico en el caso de RENAL y PADUA, encontrando correlación en el caso de PADUA en relación con el tiempo de isquemia caliente. Se encontró en todas una correlación positiva según el índice de Spearman en la valoración por el urólogo y la radióloga. Conclusiones: El cálculo de las nefrometrías previo a la cirugía de los tumores renales puede ayudar en la planificación quirúrgica, pero surgen dudas sobre la utilidad para la previsión de parámetros quirúrgicos y anatomopatológicos. La correlación entre urólogo y radiólogo parece suficente

Objectives: To validate the relation of the nephrometry scores in a series of patients who underwent partial nephrectomy with perioperative parameters and the urologist-radiologist reproducibility. Materials and methods: A retrospective study of open and laparoscopic partial nephrectomy patients performed between 2005 and 2012 registered in prospective filled out database. An urologist and a radiologist calculated the RENAL, PADUA and C-index for 86 patients. We carried out a comparative study of the results using the Spearman and Pearson correlation indexes. Results: Distribution according to the complexity of the tumors with the RENAL calculation was: 42 (49%) low, 35 (41%) moderated and 9 (11%) high complexity. According to PADUA: 35 (41%) low complexity, 32 (37%) intermediate and 19 (22%) high. No statistically significant correlation was found for the appearance of operative complications and the pathology results in case of RENAL and PADUA. A correlation was found in the case of PADUA in relation to the warm ischemia time. Positive correlation according to Spearman's index was found in RENAL, PADUA and C-index between urologist and radiologist evaluations. Conclusions: Nephrometry scores can be a useful tool to plan the surgical technique or approach. However, it is not clear if they are really predictors of surgical or pathologic parameters. The correlation between the urologist and radiologist seems to be sufficient to recommend their use by both specialties

Terapia focal en cáncer de próstata. Alternativas de tratamiento / Focal therapy for prostate cancer. Alternative treatment

Contexto: Los tratamientos radicales o de seguimiento activo son alternativas en el manejo del cáncer de próstata localizado, ambos no exentos de riesgos y efectos secundarios. El objetivo de este trabajo es analizar las diferentes posibilidades de la terapia focal en sus diferentes opciones para tratar el cáncer de próstata localizado. Adquisición de evidencia: Realizamos una revisión en Medline de las diferentes posibilidades de tratamiento focal desde el punto de vista técnico, desarrolladas en la actualidad con atención a los estudios prospectivos aleatorizados, así como las formas de seguimiento y evolución de resultados. Síntesis de evidencia: Diferentes técnicas en este momento están disponibles para realizar terapia focal, básicamente aquellas mínimamente invasivas -terapia vascular fotodinámica (TVF), crioterapia, braquiterapia, ultrasonido focalizado de alta intensidad (HIFU), láser intersticial- que permiten acceso directo y dirigido a la glándula. Los resultados preliminares de los estudios actuales demuestran una buena aceptabilidad de las técnicas con escasos efectos secundarios y buenos resultados oncológicos. La biopsia junto con la resonancia magnética nuclear (RMN) son las guías de seguimiento en estos pacientes, siendo el papel del antígeno prostático específico (PSA) menos definido. Conclusiones: La terapia focal es en la actualidad una alternativa con técnicas disponibles para una buena ejecución. Los datos actuales apuntan a una escasa morbilidad y buenos resultados oncológicos que hacen de la terapia focal una posible alternativa de tratamiento en los tumores localizados, a la espera de los resultados de más estudios aleatorizados

Context: The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection. Evidence acquisition: Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumor selection, characteristics and indications cited in MEDLINE search were reviewed. Summary of evidence: Focal therapy standardized criteria must be: low risk tumors, PSA < 10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3 + 4 or PSA > 15. Conclusions: Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy

Monográfico Vigilancia Activa en Cancer de Prostata / No disponible

No disponible

Factores que predicen el desarrollo de metástasis óseas por cáncer de próstata: recomendaciones de seguimiento y opciones terapéuticas / Factors that predict the development of bone metastases due to prostate cancer: Recommendations for follow-up and therapeutic options

Contexto: El cáncer de próstata representa un problema de salud pública en España y en el mundo occidental. En las fases avanzadas de la enfermedad la afectación ósea es prácticamente constante, asociada a una notable morbilidad. El objetivo de este trabajo es realizar una revisión de los factores pronósticos utilizados en la práctica clínica habitual que predicen el desarrollo de metástasis óseas y analizar las opciones de seguimiento y tratamiento en estos perfiles de pacientes. Adquisición de evidencia: Realizamos una revisión de la literatura sobre los factores útiles en el contexto de terapia de intención curativa; incluimos los valores clínicos clásicos al diagnóstico (PSA, estadio clínico, Gleason de la biopsia) factores patológicos (estadio pT, márgenes, invasión de vesículas, volumen tumoral, afectación ganglionar) y la cinética de PSA en sus diferentes contextos, así como parámetros histológicos y moleculares. Síntesis de evidencia: El grado de diferenciación tumoral «Gleason» y el PSA son los factores predictivos más importantes en la predicción de metástasis óseas en pacientes con intención curativa. Factores cinéticos como TDPSA < 8 meses o PSA > 10 ng/ml en la situación de CPRC son factores predictivos de desarrollo de metástasis. El ácido zoledrónico y el denosumab han demostrado su efectividad para el tratamiento de la enfermedad ósea en estudios aleatorizados. Conclusiones: Existen factores predictivos dentro de la práctica clínica habitual que permiten reconocer el «paciente riesgo» para el desarrollo de enfermedad metastásica ósea. Los tratamientos actualmente disponibles, ácido zoledrónico o denosumab, pueden ayudarnos en el manejo de paciente con riesgo de desarrollo de metástasis o metastásico, aumentando la calidad de vida y disminuyendo los eventos esqueléticos

Context: Prostate cancer is a public health problem in Spain and in the Western world. Bone involvement, associated to significant morbidity, is practically constant in the advanced stages of the disease. This work aims to review the prognostic factors used in the usual clinical practice that predict the development of bone metastases and to analyze the follow-up and treatment option in these patient profiles. Acquiring of evidence: We performed a review of the literature on the useful factors in the context of therapy with intention to cure. We included the classical clinical values in the diagnosis (PSA, clinical stage, Gleason score on the biopsy) pathological factors (pT stage, margins, bladder invasion, tumor volume, lymph node involvement) and PSA kinetics in their different contexts and the histological and molecular parameters. Synthesis of evidence: The tumor differentiation «Gleason» score and PSA are the most important predictive factors in the prediction of bone metastases in patients with intention to cure. Kinetic factors such as PSA doubling time (TDPSA) < 8 months or PSA > 10 ng/ml in the case of castration-resistant prostate cancer (CPRC), are predictive factors for the development of metastasis. Zoledronic acid and denosumab have demonstrated their effectiveness for the treatment of bone disease in randomized studies. Conclusions: There are predictive factors within the usual clinical practice that make it possible to recognize the «patient at risk» to develop bone metastatic disease. The currently available treatments, zoledronic acid or denosumab, can help us in the management of the patient at risk of developing metastasis or metastatic patient, increasing the quality of life and decreasing skeletal events

Nephrometry scores: interobserver reproducibility and perioperative factors prediction.

OBJECTIVES: To validate the relation of the nephrometry scores in a series of patients who underwent partial nephrectomy with perioperative parameters and the urologist-radiologist reproducibility. MATERIAL AND METHODS: A retrospective study of open and laparoscopic partial nephrectomy patients performed between 2005 and 2012 registered in prospective filled out database. An urologist and a radiologist calculated the R.E.N.A.L., PADUA and C-index for 86 patients. We carried out a comparative study of the results using the Spearman and Pearson correlation indexes. RESULTS: Distribution according to the complexity of the tumors with the RENAL calculation was: 42 (49%) low, 35 (41%) moderated and 9 (11%) high complexity. According to PADUA: 35 (41%) low complexity, 32 (37%) intermediate and 19 (22%) high. No statistically significant correlation was found for the appearance of operative complications and the pathology results in case of RENAL and PADUA. A correlation was found in the case of PADUA in relation to the warm ischemia time. Positive correlation according to Spearman's index was found in RENAL, PADUA and C-index between urologist and radiologist evaluations. CONCLUSIONS: Nephrometry scores can be a useful tool to plan the surgical technique or approach. However, it is not clear if they are really predictors of surgical or pathologic parameters. The correlation between the urologist and radiologist seems to be sufficient to recommend their use by both specialties.

Focal therapy for prostate cancer. Alternative treatment.

CONTEXT: The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection. EVIDENCE ACQUISITION: Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumour selection, characteristics and indications cited in MEDLINE search were reviewed. SUMMARY OF EVIDENCE: Focal therapy standardized criteria must be: low risk tumors, PSA<10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3+4 or PSA>15. CONCLUSIONS: Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy.

Factors that predict the development of bone metastases due to prostate cancer: Recommendations for follow-up and therapeutic options.

CONTEXT: Prostate cancer is a public health problem in Spain and in the Western world. Bone involvement, associated to significant morbidity, is practically constant in the advanced stages of the disease. This work aims to review the prognostic factors used in the usual clinical practice that predict the development of bone metastases and to analyze the follow-up and treatment option in these patient profiles. ACQUIRING OF EVIDENCE: We performed a review of the literature on the useful factors in the context of therapy with intention to cure. We included the classical clinical values in the diagnosis (PSA, clinical stage, Gleason score on the biopsy) pathological factors (pT stage, margins, bladder invasion, tumor volume, lymph node involvement) and PSA kinetics in their different contexts and the histological and molecular parameters. SYNTHESIS OF EVIDENCE: The tumor differentiation "Gleason" score and PSA are the most important predictive factors in the prediction of bone metastases in patients with intention to cure. Kinetic factors such as PSA doubling time (TDPSA) < 8 months or PSA > 10 ng/ml in the case of castration-resistant prostate cancer (CPRC), are predictive factors for the development of metastasis. Zoledronic acid and denosumab have demonstrated their effectiveness for the treatment of bone disease in randomized studies. CONCLUSIONS: There are predictive factors within the usual clinical practice that make it possible to recognize the "patient at risk" to develop bone metastatic disease. The currently available treatments, zoledronic acid or denosumab, can help us in the management of the patient at risk of developing metastasis or metastatic patient, increasing the quality of life and decreasing skeletal events.

El margen quirúrgico es el factor pronóstico de mayor relevancia en los pacientes con cáncer de próstata que infiltra las vesículas seminales / Margin Status is a very Important Prognostic Factor for Patients with pT3b Prostate Cancer

Objetivo: Pese al diagnóstico precoz del cáncer de próstata, la invasión de las vesículas seminales por este tumor es un escenario patológico, todavía presente en nuestra práctica clínica. El objetivo del presente trabajo es evaluar los factores pronósticos clínicos y patológicos en la evolución de este subgrupo de pacientes. Material y método: Previa autorización por el comité de investigación clínica de nuestro centro, procedimos a la selección en nuestra base de datos de los pacientes con estadio pT3b intervenidos durante el periodo comprendido entre los años 1987-2010. Excluimos los pacientes con tratamientos neoadyuvantes. Mediante el método de Kaplan-Meier se evaluó el periodo libre de recidiva bioquímica (SLRB) y el periodo libre de necesidad de tratamientos complementarios (SLTC) (adyuvante o rescate). El modelo de regresión de Cox se utilizó para determinar las variables clínicas y patológicas que se asociaban a las anteriores circunstancias. Resultados: De 1.470 procedimientos 101 pacientes fueron incluidos en el estudio. Con una mediana de seguimiento de 4 años y 4 meses, 28 pacientes (27,7%) fallecieron, 18 por el tumor y 74 (73,3%) presentaron progresión bioquímica. La SLRB a los 5 años fue del 30,2% (IC 95%: 20,2-40,1) mientras que la SLTC fue del 16,9% (IC 95%: 8,1-25,8%).En el estudio multivariante el estado de los márgenes quirúrgicos (R1) fue la variable que se asoció de manera independiente y significativa a la recidiva bioquímica y a la necesidad de rescate. El PSA preoperatorio se asoció a la recidiva bioquímica, y la presencia de adenopatías patológicas a la necesidad de tratamiento. El número de ganglios extraídos y la puntuación Gleason no alcanzaron la significación estadística. Conclusión: En el grupo de pacientes con infiltración de las vesículas seminales R1 es un factor de mal pronóstico común, tanto para la recidiva bioquímica como para la necesidad de rescate (AU)

Objective: Despite early diagnosis of prostate cancer, seminal vesicle invasion is still a common clinical scenario nowadays. The objective of this study is to evaluate clinical and pathological prognostic factors in that subgroup of patients. Material and methods: After approval of our Ethical Committee, we selected all pT3b prostate cancer patients operated between 1987 and 2010. Neoadjuvant treatment patients were excluded. The biochemical free survival periods BFS and the period free of complementary treatment were calculated with the Kaplan Meier method. Cox regression model was used to select those variables associated with biochemical failure and the need for complementary treatment. We considered complementary treatment when radiotherapy or hormone therapy in an adjuvant or salvage scheme was required. Results: 101 patients were selected from 1470 procedures. Among these, 28 patients died (27,7%), 18 due to tumor, and 74 showed biochemical relapse (73,3%). The median follow up was of 4 years and 4 months. The five years BFS was 30.2% (IC 95%: 20.2-40.1), whereas the 5 year period free of complementary treatment was 16.9% (IC 95%: 8.1-25.8%).In the multivariate analysis, margin status (R) was independently and significantly associated with biochemical relapse and the need for complementary treatment. Likewise, the preoperative PSA was associated to biochemical relapse and N1 tumours were clearly associated to complementary treatment. Conclusion: pT3b prostate cancer patients with R1 disease have a worse biochemical prognosis and higher probability of complementary treatment (AU)

Tratamiento del tumor vesical no músculo infiltrante frente al problema de disponibilidad de bacilo de Calmette-Guerin. Consenso de un panel de expertos españoles / Treatment of Non Muscle Invasive Bladder Tumor Related to the Problem of Bacillus Calmette-Guerin Availability. Consensus of a Spanish Expert’s Panel

Contexto: Desde junio de 2012 se ha producido una falta de disponibilidad de la cepa Connaught a nivel mundial. En diciembre de 2012 se reunió en la sede de la Asociación Española de Urología un grupo de expertos para analizar esta situación y plantear alternativas. Objetivo: Exponer el trabajo realizado por dicha comisión y las recomendaciones resultantes. Adquisición de la evidencia: Se ha realizado una actualización de las principales evidencias existentes en el tratamiento de los tumores de medio y alto riesgo, con especial referencia a las relacionadas con el empleo de BCG y sus posibles alternativas en virtud de la diferente disponibilidad de BCG. Síntesis de la evidencia: En tumores de alto riesgo de progresión debe considerarse la cistectomía inmediata cuando no se disponga de BCG, con reducción de dosis o alternancia con quimioterapia como medidas de ahorro cuando la disponibilidad sea reducida. En los tumores de medio riesgo de progresión puede emplearse quimioterapia, si bien cuando se asocia un alto riesgo de recidiva BCG estaría indicado si hubiera disponibilidad del mismo con las normas de ahorro citadas. El BCG requiere mantenimiento para preservar su efectividad, siendo necesario optimizar la aplicación de la quimioterapia endovesical y utilizar sistemas que incrementen su penetración en la pared vesical (EMDA) si estuvieran disponibles. Conclusiones: Ante la escasa disponibilidad de BCG ha sido preciso consensuar una serie de recomendaciones que han sido publicadas en la página Web de la Asociación Española de Urología (AU)

Context: Since June 2012, the has been a worldwide lack of available of the Connaught strain. In December 2012, a group of experts met in the Spanish Association of Urology to analyze this situation and propose alternatives. Objective: To present the work performed by said committee and the resulting recommendations. Acquisition of evidence: An update has been made of the principal existing evidence in the treatment of middle and high risk tumors. Special mention has been made regarding the those related with the use of BCG and their possible alternative due to the different availability of BCG. Evidence synthesis: In tumors with high risk of progression, immediate cystectomy should be considered when BCG is not available, with dose reduction or alternating with chemotherapy as methods to economize on the use of BCG when availability is reduced. In tumors having middle risk of progression, chemotherapy can be used, although when it is associated to a high risk of relapse, BCG would be indicated if available with the mentioned savings guidelines. BCG requires maintenance to maintain its effectiveness, it being necessary to optimize the application of endovesical chemotherapy and to use systems that increase its penetration into the bladder wall (EMDA) if they are available. Conclusions: Due to the scarcity of BCG, it has been necessary to agree on a series of recommendations that have been published on the web page of the Spanish Association of Urology (AU)

Treatment of non muscle invasive bladder tumor related to the problem of bacillus Calmette-Guerin availability. Consensus of a Spanish expert's panel. Spanish Association of Urology.

CONTEXT: Since June 2012, the has been a worldwide lack of available of the Connaught strain. In December 2012, a group of experts met in the Spanish Association of Urology to analyze this situation and propose alternatives. OBJECTIVE: To present the work performed by said committee and the resulting recommendations. ACQUISITION OF EVIDENCE: An update has been made of the principal existing evidence in the treatment of middle and high risk tumors. Special mention has been made regarding the those related with the use of BCG and their possible alternative due to the different availability of BCG. EVIDENCE SYNTHESIS: In tumors with high risk of progression, immediate cystectomy should be considered when BCG is not available, with dose reduction or alternating with chemotherapy as methods to economize on the use of BCG when availability is reduced. In tumors having middle risk of progression, chemotherapy can be used, although when it is associated to a high risk of relapse, BCG would be indicated if available with the mentioned savings guidelines. BCG requires maintenance to maintain its effectiveness, it being necessary to optimize the application of endovesical chemotherapy and to use systems that increase its penetration into the bladder wall (EMDA) if they are available. CONCLUSIONS: Due to the scarcity of BCG, it has been necessary to agree on a series of recommendations that have been published on the web page of the Spanish Association of Urology.

Margin status is a very important prognostic factor for patients with pT3b prostate cancer.

OBJECTIVE: Despite early diagnosis of prostate cancer, seminal vesicle invasion is still a common clinical scenario nowadays. The objective of this study is to evaluate clinical and pathological prognostic factors in that subgroup of patients. MATERIAL AND METHODS: After approval of our Ethical Committee, we selected all pT3b prostate cancer patients operated between 1987 and 2010. Neoadjuvant treatment patients were excluded. The biochemical free survival periods BFS and the period free of complementary treatment were calculated with the Kaplan Meier method. Cox regression model was used to select those variables associated with biochemical failure and the need for complementary treatment. We considered complementary treatment when radiotherapy or hormone therapy in an adjuvant or salvage scheme was required. RESULTS: 101 patients were selected from 1470 procedures. Among these, 28 patients died (27,7%), 18 due to tumor, and 74 showed biochemical relapse (73,3%). The median follow up was of 4 years and 4 months. The five years BFS was 30.2% (IC 95%: 20.2-40.1), whereas the 5 year period free of complementary treatment was 16.9% (IC 95%: 8.1-25.8%). In the multivariate analysis, margin status (R) was independently and significantly associated with biochemical relapse and the need for complementary treatment. Likewise, the preoperative PSA was associated to biochemical relapse and N1 tumours were clearly associated to complementary treatment. CONCLUSION: pT3b prostate cancer patients with R1 disease have a worse biochemical prognosis and higher probability of complementary treatment.

¿Está justificada la cistectomía radical en pacientes mayores de 75 años? / Is radical cystectomy justified in patients over 75 years old?

Introducción y objetivos: La cistectomía radical es el tratamiento de elección en el tumor vesical infiltrante. Los objetivos de este trabajo son evaluar las complicaciones intraoperatorias y postoperatorias de la cistectomía radical, así como el intervalo libre de enfermedad y supervivencia cáncer especifica en pacientes con edad superior a 75 años y compararlos con los resultados en pacientes de menor edad. Material y Métodos: Entre agosto de 1980 y octubre de 2004, se realizaron 495 cistectomías radicales. De ellas se excluyeron las cirugías realizadas con intención paliativa. Los pacientes fueron divididos en dos grupos: menores de 75 años (grupo control) y pacientes con edad igual o superior (grupo mayores de 75 años). En todos los casos se realizó cistectomía radical y linfadenectomía pélvica. Resultados: Se evaluaron 402 pacientes, de los cuales 39 fueron pacientes mayores de 75 años (edad media: 76 años) y 363 pacientes control (edad media: 62 años), con una media de seguimiento de 38 y 64 meses respectivamente. Treinta y un pacientes mayores de 75 años (80,4%) y 211 pacientes control (58,2%) tuvieron un tumor no-órgano confinado (pT3-pT4) (p=0,0096). Diez pacientes mayores de 75 años (28,6%) y 111 pacientes control (31,4%) tenían ganglios positivos (p=0,84). No hubo diferencias en la tasa de complicaciones quirúrgicas (p=0.08), reintervención (p=0,58) y mortalidad postoperatoria (p=0,28). Once pacientes mayores de 75 años (28%) y 50 pacientes control (13,8%) tuvieron alguna complicación médica postoperatoria (p=0,03). Catorce pacientes mayores de 75 años (35,9%) y 104 pacientes control (39,4%) murieron debido a su tumor (p=0,73), sin diferencias en la supervivencia cáncer específica ni en el tiempo hasta la progresión. Conclusiones: La cistectomía radical es un tratamiento adecuado en pacientes mayores de 75 años, sin diferencias con la población general en relación a las complicaciones quirúrgicas, intervalo libre de enfermedad y supervivencia cáncer específica. No obstante, es necesario evaluar la comorbilidad preoperatoria dado el aumento de complicaciones médicas postoperatorias (AU)

Introduction and objectives: Radical cystectomy is the standard treatment for invasive bladder cancer. The objectives are to evaluate intraoperative and postoperative complications and to determine overall disease-free interval and overall time to progression in patients over tha age of 75 and to compare these with younger patients. Material and methods: Between august 1980 and october 2004 , 495 patients underwent radical cistectomy. Patients with palliative surgery were excluded. Patients were divided in two groups according to age: control group (<75 years old) and elderly group (>=75 years old). Results: Four hundred and two patients were evaluated: 39 patients (35 male and 5 female) in the elderly group and 363 in the control group (321 males and 42 females). Mean age was 76 (range: 75-82) and 62 (range: 35-74) respectively. Mean followup was 38 months in the elderly group and 64 months in the control group. Thirty one patients (80.4%) in the elderly group and 211 patients (58.2%) in the control had non organ-confined tumour in cystectomy specimen (pT3-pT4) (p=0.0096) and ten patients (28.6%) in the elderly and 111 patients (31.4%) in the control group had positive nodes(p=0.84).There were no differences in postoperative surgical complications (p=0.08), postoperative reoperation rate (p=0.58) and postoperative mortality (p=0.28) in both groups. During postoperative time, 11 patients(28%) in the elderly group and 50 patients (13.8%) in the control had medical complications (p=0.03).Fourteen patients (35.9%) in the elderly group and 104 patients (39.4%) in the control group died due to tumour during follow-up(p=0.73). Kaplan-Meier survival curve revealed no differences between two groups in overall disease-free interval and overall time to progression. Conclusions: Radical cystectomy is a safe and effective treatment in elderly patients with invasive bladder cancer. It is necessary to evaluate co-morbidity in this group because there is an increase in postoperative medical complications. There were no differences between the two groups in overall disease-free interval and overall time to progression (AU)

[Molecular biology of the clear cell renal cell carcinoma: principles for a selective treatment]. / Biología molecular del carcinoma de células claras renales: principios para un tratamiento selectivo.

Renal cell carcinoma (RCC) and its most frequent subtype, the clear cell hystology type, has shown resistance to chemotherapy and radiotherapy treatment when disease was already spread in patients. Recently, a huge advance in the molecular biology of this tumor has been performed. This fact allowed a deeper and better knowledge of the disease and the development of new drugs that work against the growth factors involved in tumor origin. In this review article it is summarized the molecular milestones that are involved in the development of clear cell renal cell carcinomas.

Biología molecular del carcinoma de células claras renales: principios para un tratamiento selectivo / Molecular biology of the clear cell renal cell carcinoma: selective treatment

El cáncer de células renales (CCR) y más concretamente el subtipo más frecuente de células claras, se he mostrado resistente al tratamiento con quimioterapia y radioterapia cuando afecta a pacientes con metástasis a distancia. En los últimos años se han realizado grandes avances en el campo de la biología molecular que origina este tipo de tumores. Esto ha conducido a un mejor conocimiento del origen de la enfermedad y ha permitido el desarrollo de nuevos fármacos que actúan sobre los factores de crecimiento implicados en el desarrollo del tumor. En este artículo de revisión se resumen de manera concisa los hitos a nivel molecular que originan el desarrollo de los tumores renales de células claras

Renal cell carcinoma (RCC) and its most frequent subtype, the clear cell hystology type, has shown resistance to chemotherapy and radiotherapy treatment when disease was already spread in patients. Recently, a huge advance in the molecular biology of this tumor has been performed. This fact allowed a deeper and better knowledge of the disease and the development of new drugs that work against the growth factors involved in tumor origin. In this review article it is summarized the molecular milestones that are involved in the development of clear cell renal cell carcinomas

[Radical laparoscopic nephrectomy]. / Nefrectomía radical laparoscópica.

In this article, we review the different surgical approaches to carry out radical laparoscopic nephrectomy: transperitoneal approach, retroperitoneal approach and hand-assisted approach. We describe the advantages and drawbacks of each alternative and summarize the most important references in the medical literature. In spite of this being a relatively new surgical approach, less than 15 years old, it has become a standard treatment and, today, is considered as the elective surgical treatment for T1 and T2 renal tumours in many centres.