Real-world prostate-specific antigen reduction and survival outcomes of metastatic hormone-sensitive prostate cancer patients treated with apalutamide: An observational, retrospective, and multicentre study.

Background: Metastatic hormone-sensitive prostate cancer (mHSPC) treatment has changed drastically during the last years with the emergence of androgen receptor-targeted agents (ARTAs). ARTA combined with androgen deprivation therapy has demonstrated better oncological and survival outcomes in these patients. However, the optimal choice among different ARTAs remains uncertain due to their analogous efficacy. Objectives: The objective of this study was to describe prostate-specific antigen (PSA) response and oncological outcomes of patients with mHSPC treated with apalutamide. Material and methods: Medical records from three different hospitals in Spain were used to conduct this study. Patients diagnosed with mHSPC and under apalutamide treatment were included between March 2021 and January 2023. Data regarding PSA response, overall survival (OS), and radiographic progression-free survival (rPFS) were collected and stratified by metastasis volume, timing, and stating. Results: 193 patients were included; 34.2% of patients were de novo mHSPC, and the majority was classified as m1b. The 18-month OS and rPFS were 92.5% and 88.9%, respectively. Patients with PSA levels ≤0.2 ng/ml showcased an 18-month OS rate of 98.7%, contrasting with 65.3% for those with PSA >0.2 ng/ml. Similar trends emerged for rPFS (97.4% and 53.7%, respectively). When differentiating between low-volume and high-volume metastasis, the OS rate stood at 98.4% and 80.7%, respectively, while the rPFS rates were 93% and 81.6%, respectively. No significant differences were found between groups stratified by metastasis timing. Conclusion: This real-world study on patients with mHSPC treated with apalutamide plus androgen deprivation therapy revealed robust oncological outcomes, aligning with the emerging evidence. The study's hallmark finding highlights the significance of rapid and deep PSA response as a predictor of improved oncological and survival outcomes.

Manual Therapy Intervention in Men With Chronic Pelvic Pain Syndrome or Chronic Prostatitis: An Exploratory Prospective Case-Series.

Purpose Chronic pelvic pain syndrome (CPPS) is permanent pelvic pain of unknown etiology. Current theories suggest a multifactorial origin for CPPS, including urinary pathologies, psychosocial factors, prostate inflammation, infection, central sensitization of the nervous system, and muscular contractures or fibrosis. As there are no defined treatment protocols for CPPS, a multimodal approach is recommended. The objective of this study was to evaluate the impact of a manual therapy treatment protocol on pain, urinary symptoms, and overall quality of life. Materials and Methods Twenty-three men aged 47.36 ± 10.11 years were recruited consecutively by urologists practicing at two hospitals. All men presented prostatic tenderness with no other positive clinical history, urine cultures, or echography studies. Patients underwent six manual therapy sessions (three during the first week and three every two weeks after that) performed by a single osteopath or physiotherapist. The intervention protocol addressed the treatment of muscle structures, fascial mechanics, vascularization, innervation, emotional factors, and the need for information. The questionnaires used to evaluate outcomes included the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptoms Score (IPSS), and a Visual Analog Scale (VAS) for pain, and the Hospital Anxiety and Depression Scale (HADS). Data were evaluated using Chi-squared or paired difference tests by an external researcher. Results The mean NIH-CPSI scores recorded for our study cohort decreased by 7.69 points (30.92%; p<0.0005; 95% CI 4.02-10.52). IPSS measurements decreased by 3.20 points (22.18%; p=0.009; 95% CI 1.00-6.09), although the item addressing quality of life decreased by 1.67 points only (31.99%; p<0.0005; 95% CI 0.94-2.33). The VAS score also decreased by 2.20 points (38.6%; p<0.0005; 95% CI 1.45-2.73). Changes in HADS scores were not statistically significant. Conclusions Based on patient responses, this case series revealed that manual therapy improved urinary symptoms, pain, and quality of life.

Hematuria por fístula arteriovenosa congénita tratada con embolización / Hematuria due to congenital arteriovenous fistula treated with embolization

OBJETIVO: Presentar un caso de una patología rara, como es una malformación arteriovenosa que causa hematuria, que puede suponer una urgencia urológica.MÉTODO: Describimos la historia clínica, la exploración física, las pruebas complementarias realizadas y sus resultados, así como el tratamiento aplicado a un paciente varón adolescente que acude a urgencias por hematuria anemizante sin patología conocida que la justificase.RESULTADOS: Se llega al diagnóstico de fístula arteriovenosa renal congénita y se realiza su embolización percutánea, cediendo la hematuria posteriormente.CONCLUSIONES: Las fístulas arteriovenosas de origen no-traumático son raras y más aún si debutan con macrohematuria. Este es un ejemplo que supuso una urgencia vital y fue posible tratarla mediante embolización percutánea, evitando otros procedimientos más invasivos(AU)

OBJECTIVE: To report a rare case that supposed an emergency. It is a case of hematuria caused by an arteriovenous fistula.METHODS: We describe the background, clinical exploration, complementary exams and their results, as well as the treatment applied in an adolescent with hematuria.RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization, with immediate stop of the hematuria.CONCLUSION: Non-traumatic renal arteriovenous fistulae are infrequent and even more if they appear with gross hematuria. We present the case of an emergency caused by one of them which was treated by percutaneous embolization, avoiding surgery(AU)

Hematuria por fístula arteriovenosa congénita tratada con embolización / Hematuria secondary to congenital arteriovenous fistula treated with embolization

OBJETIVO: Presentar un caso de una patología rara, como es una malformación arteriovenosa que causa hematuria, que puede suponer una urgencia urológica.MÉTODO: Describimos la historia clínica, la exploración física, las pruebas complementarias realizadas y sus resultados, así como el tratamiento aplicado a un paciente varón adolescente que acude a urgencias por hematuria anemizante sin patología conocida que la justificase. RESULTADOS: Se llega al diagnóstico de fístula arteriovenosa renal congénita y se realiza su embolización percutánea, cediendo la hematuria posteriormente.CONCLUSIONES: Las fístulas arteriovenosas de origen no-traumático son raras y más aún si debutan con macrohematuria. Este es un ejemplo que supuso una urgencia vital y fue posible tratarla mediante embolización percutánea, evitando otros procedimientos más invasivos(AU)

OBJECTIVE: To report a rare case of hematuria caused by an arteriovenous fistula which may be a urological emergency.METHODS: We describe the medical history, physical examination, complementary tests performed and their results, as well as the treatment applied in an adolescent with hematuria.RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization with immediate stop of hematuria.CONCLUSION: Non-traumatic renal arteriovenous fistulae are rare, even more if they present with gross hematuria. We present a case of a life-threatening emergency caused by one of them the treatment of which was possible by embolization, avoiding surgery(AU)

Hematuria secondary to congenital arteriovenous fistula treated with embolization.

OBJECTIVE: To report a rare case of hematuria caused by an arteriovenous fistula which may be a urological emergency. METHODS: We describe the medical history, physical examination, complementary tests performed and their results, as well as the treatment applied in an adolescent with hematuria. RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization with immediate stop of hematuria. CONCLUSION: Non-traumatic renal arteriovenous fistulae are rare, even more if they present with gross hematuria. We present a case of a life-threatening emergency caused by one of them the treatment of which was possible by embolization, avoiding surgery.

[Hand-assisted laparoscopic radical nephrectomy vs. open nephrectomy in the treatment of clinically localized renal cell carcinoma. Comparative study]. / Nefrectomía radical laparoscópica asistida por la mano frente a nefrectomía abierta en el tratamiento del carcinoma de células renales clínicamente localizado. Estudio comparativo.

INTRODUCTION: The description of the first laparoscopic nephrectomy made a revolution in the managing of the benign and malignant renal diseases. Hand-assisted laparoscopy (HAL) was developed with the aim of offering advantages to both patients and surgeons. The aim of the present work is to compare, in our experience, the results offered in the radical nephrectomy by HAL and open surgery, by analysis of surgical time, estimated blood loss during surgery and hospital stay. METHODS: Eleven Hand-assisted laparoscopic (HAL) radical nephrectomies and eight open radical nephrectomies were carried out at our institution during the same period (June 2001 to December 2002). All patients underwent computed tomography and were found to have a clinically localised functioning renal mass in all cases. The size of this renal mass was 4-7 cm (average 5.5 cm) in the HAL group and 4.5-15 cm (average 7.8 cm) in the open group. Patient age, body mass index, and American Society of Anaesthesiologists' score showed no significant difference between groups. RESULTS: The average surgical time in the HAL group was 156.72 minutes, the average blood loss during surgery was of 83.6 ml and the average hospital stay was of 3.09 days. Conversion to open surgery was not necessary in any patient. Average surgical time in the open surgery group was 178.25 minutes, the estimated blood loss during surgery was of 337.75 ml (p < 0.05) and the hospital stay was of 5.37 days (p < 0.05). The comparison of the means by two-tailed student's t test revealed significant differences in estimated blood loss and hospital stay, favoring HAL, and no significant differences in surgical time. CONCLUSIONS: HAL nephrectomy is feasible in almost all nephrectomies and is a safe, reproducible, and minimally invasive technique to perform extirpable renal surgery. HAL offer clear advantages over traditional open surgery, including decreased blood loss and hospital stay.

[Fatal evolution of a renal angiosarcoma]. / Evolución fatal de angiosarcoma renal.

OBJECTIVES: Report a new case of renal angiosarcoma treated by surgery and adjuvant chemotherapy with bad results. METHODS: 72-year-old male undergoing right nephrectomy for renal tumor. Pathology reports renal angiosarcoma. RESULTS: Three months after surgery patient refers lumbar pain and hemoptysis and CT scan reveals the existence of multiple bone and lung metastasis; a regimen of systemic chemotherapy with Doxorrubicine+ Ifosfamide was started without response; he died two months later. CONCLUSIONS: Primary renal angiosarcoma is very rare, with less than 10 cases in the literature before 1998, and it is always associated with bad prognosis. Diagnosis is based on immunohistochemical studies (antibodies against CD31, CD34 and factor VIII related antigen) to define the endothelial differentiation of the tumor. There is no experience to define the best therapeutic strategy against this entity.

Urograma en resonancia magnética como alternativa a la urografía I.V.A propósito de tres casos. Revisión de la literatura / MRI urography as an alternative to intravenous urography: report of three cases. Bibliographic review

OBJETIVOS: La urografía intravenosa ha sido considerada clásicamente como una exploración imprescindible en una gran mayoría de patologías urológicas debido a la mayor información que aporta tanto desde el punto de vista funcional como morfológico, sobretodo en alteraciones ureterales donde otras exploraciones no alcanzan suficiente definición. Sin embargo, existen casos en los que no es posible realizar una urografía intravenosa debido a procesos alérgicos al contraste yodado o insuficiencia renal con imposibilidad de eliminación del contraste. MÉTODOS: Se presentan tres casos, que representan el ejemplo de las indicaciones de urograma en RM como alternativa a la urografía i.v. en casos en los que ésta no se puede o no se debe realizar. RESULTADOS: El urograma en R.M.N. está totalmente aceptado como técnica de diagnóstico en patología urológica como procedimiento alternativo a la urografía I.V. Tienes ventajas, tales como, el obtener imágenes en múltiples planos, no usar radiación ionizante, no existen evidencias de que cause daño celular, no precisa de eliminación glomerular de ninguna sustancia por lo que puede ser usado en enfermos con insuficiencia renal y en alérgicos al contraste iodado. CONCLUSIONES: El uso del urograma en R.M.N. supone una ventaja en enfermos con insuficiencia renal, alergia al contraste iodado o mayor riesgo de nefrotoxicidad del mismo, como es el caso de los trasplantados renales (AU)

[Magnetic resonance urogram as alternative to i.v. urography. Report of 3 cases. Review of the literature]. / Urograma en resonancia magnética como alternativa a la urografia i.v. A propósito de tres casos. Revisión de la literatura.

OBJECTIVES: Intravenous urography (IVU) has been classically considered as an essential examination in the great majority of urologic diseases due to the great amount of information that supplies both functional and morphological, mainly for ureteral abnormalities where other exams do not reach enough definition. Nevertheless, there are cases in which it is not possible to perform an intravenous urography due to allergy to iodine contrasts or renal failure with impossibility of contrast excretion. METHODS: We report three cases which represent the example of the indications of MRI urography as an alternative to IVU in cases in which this latter cannot or should not be performed. RESULTS: MRI urography is completely accepted as a diagnostic technique for urologic diseases as an alternative to IVU. It has advantages, such as obtaining images in multiple planes, avoiding the use of ionizing radiation, that there is no evidence of it causing cell damage, that it does not require glomerular elimination of any substance so it can be used in patients with renal failure and allergy to iodine contrasts. CONCLUSIONS: The use of MRI urography results in an advantage for patients with renal failure, iodine contrasts allergy, or greater risk of contrast nephrotoxicity as it is the case of renal transplant patients.

[Controversies in the evaluation of asymptomatic microhematuria]. / Controversias en la evaluación de la microhematuria asintomática.

OBJECTIVE: Asymptomatic microhematuria continues to be a problem. It has a prevalence of 16% and numerous conditions can present this clinical manifestation. METHODS: A prospective study was carried out on all patients that consulted at the urological services during 2000 for asymptomatic hematuria. Patients presenting with irritative symptoms, urethral secretion, perineal or suprapubic pain, urinary tract infections, renal lithiasis or history of trauma were not included in the study. RESULTS: None of the patients presented tumors. Two patients presented renal lithiasis, 5 simple renal cysts, 8 hypercalciuria and 3 hyperuricosuria. None of the 11 patients with hypercalciuria or hyperuricosuria had a history of lithiasis. CONCLUSIONS: Although the size of the study is small, the incidence of tumors in patients with asymptomatic microhematuria appears to be far from the 12.5% incidence reported by some authors and might probably be closer to the 0.5% incidence reported by others. Furthermore, the significant pathology (renal lithiasis), which requires treatment, is also infrequent.

Controversias en la evaluación de la microhematuria asintomática / Controversies in the study of asymptomatic microhematuria

INTRODUCCIÓN: La hematuria microscópica sigue siendo en la actualidad un problema para el urólogo: se trata de una entidad que afecta hasta al 16 por ciento de la población general, siendo numerosas las enfermedades nefro y urológicas que pueden cursar con esta manifestación clínica.MÉTODOS: Hemos realizado un estudio prospectivo sobre los 98 pacientes que han acudido durante el año 2000 a nuestra consulta de urología, remitidos por presentar microhematuria asintomática. No hemos incluido a los pacientes que presentaban clínica irritativa, secreción uretral, dolor perineal o suprapúbico, infecciones urinarias, litiasis renal o antecedente de traumatismos.En todos ellos se ha practicado urocultivo, radiografía simple de abdomen, ecografía renovesical, citología urinaria (para filiar a la hematuria como glomerular o extraglomerular, así como para descartar la existencia de células sugerentes de tumoración urotelial), y se ha determinado calciuria y uricosuria en orina de 24 horas.En algunos pacientes, a juicio del facultativo, se ha practicado así mismo urografía intravenosa.RESULTADOS: Ninguno de los pacientes presentaba enfermedad tumoral. Dos pacientes presentaron litiasis renal, 5 pacientes quistes renales simples, 8 pacientes hipercalciuria y 3 hiperuricosuria (ninguno de estos 11 pacientes con hipercalciuria o hiperuricosuria presentaba antecedentes litiásicos) y en 8 pacientes el origen de la hematuria era glomerular, y fueron remitidos a estudio nefrológico.CONCLUSIONES: Aunque lo reducido de nuestra muestra no permite avanzar conclusiones relevantes, sí parece evidenciarse que la incidencia de patología tumoral en los pacientes con microhematuria no sintomática debe estar alejada de la cifra del 12,5 por ciento que indican algunos autores, estando probablemente más cerca del 0,5 por ciento que refieren otros. Por otra parte, la patología significativa, tributaria de tratamiento (litiasis renal) también es poco frecuente (AU)