[Impact of predictive models and decision making in prostate cancer: An integral debate]. / Impacto de los modelos predictivos y la toma de decisiones en cáncer de próstata: un debate integral.

OBJECTIVES: To review the various methods to predict the risk of having prostate cancer, or that localized disease may be cured or progress after a given treatment. METHODS: We performed a review of the various mathematic models known for the probability analysis of the event, with a critical analysis of weaknesses and strengths of each method. In a Medline update we review the most relevant papers referred to diagnosis and management of localized prostate cancer in its diagnosis and management sides, as well as the probability of developing metastatic disease and to die. RESULTS: There are multiple methods and models to predict the various events in a patient candidate to diagnosis of prostate cancer, as well as to analyze the possibilities of success of a specific treatment, in many cases with an important exactness. We emphasize the heterogeneity in the methods, data and variables used for the analysis, basically about retrospective studies. Many of the most sophisticated methods, Neural Network or cart, do not present greater exactness than classic methods like logistic regression. CONCLUSIONS: Predictive models are an important element for decision making in usual clinical practice, favoring the decision of a diagnosis or certain treatment is not taken in a random manner and therefore it is taken following scientific criteria. Waiting for more precise methods, we have to know no method is perfect, and therefore it is an important tool, which should not by pass personal knowledge or the experience of a specific working group.

[Complementary tests in the diagnosis of erectile dysfunction. Which and when?]. / Pruebas complementarias en el diagnóstico de la disfunción eréctil: ¿cuáles y cuándo?

The introduction of PDE 5 inhibitors has widen the ambit of health care in erectile dysfunction (ED), which now includes family doctors, urologists, endocrinologists, neurologists, angio-cardiologists, psychiatrists, psychologists and other specialists. To make a proper diagnosis, it is convenient to know there are many diseases associated with ED. To evaluate ED we have to identify sexual problems and to use certain means, such as adequate questionnaires and symptom scores, a detailed sexual and clinical history, physical exam and elementary lab tests. In most cases of ED it is not necessary to perform invasive tests or refer the patient to a specialist, but the doctor needs to know there are cases that require such reference, and sometimes more studies and tests are required.

Giant cystic degeneration of the rete testis.

OBJECTIVES: We present a case of giant cyst of the rete-testis. METHODS/RESULTS: 85 year-old patient on follow -up for prostate cancer with maximum androgen blockade (MAB) treatment consults for a left hemiscrotum increase in size over a 2-month period. We performed bilateral orchiectomy confirming the histopathological diagnosis of cystic dilatation of the rete-testis sized 11 x 11 x 9 cm. CONCLUSIONS: This case of cystic degeneration of the rete-testis, with a size out of common (11 x 11 x 9 cm versus medium size in the literature: 3 x 3 x 3 cm), could be related with an androgen-estrogen misbalance caused by a MAB in a prostate cancer context.