ABSTRACT
PURPOSE: To assess the validity, reliability, and responsiveness of the Spanish version of the Expanded Prostate cancer Index Composite (EPIC) with 26 items. METHODS: Multicentric longitudinal study of patients diagnosed with localized or locally advanced prostate cancer (any T, any N, M0) treated with active surveillance, surgery, external radiotherapy, or brachytherapy. The EPIC-50 was administered initially to the cohort (n = 324 patients), until it was replaced in November 2019 by the EPIC-26 (n = 543), in both groups before treatment and 12 months after. We assessed confirmatory factor analysis (CFA), reliability with Cronbach's alpha coefficient, criterion validity with the intraclass correlation coefficient (ICC), and responsiveness by testing a priori hypotheses on deterioration effect size (ES). RESULTS: The CFA confirmed the five-domain structure of the EPIC-26 proposed by the original instrument (comparative fit index = 0.95). The agreement between EPIC-50 (gold standard) and EPIC-26 domains was excellent (ICC > 0.90). Cronbach's alpha was > 0.7 in almost all domains, and the floor effect was near zero, although ceiling effect was higher than 50% in urinary incontinence and bowel domains. Hypothesized changes between before and 12 months after treatment were confirmed: ES > 0.8 in both urinary incontinence and sexual domains among patients who underwent surgery; and ES ranging 0.44-0.48 for bowel and sexual domains in patients treated with external radiotherapy. CONCLUSION: The Spanish version of the EPIC-26 has demonstrated adequate metric properties, similar to those of the original version, with acceptable goodness-of-fit indices, good criterion validity, reliability, and responsiveness to detect changes after radical prostatectomy or external radiotherapy.
Subject(s)
Prostatic Neoplasms , Urinary Incontinence , Male , Humans , Longitudinal Studies , Quality of Life , Psychometrics , Surveys and Questionnaires , Reproducibility of Results , Prostatic Neoplasms/therapy , Prostatic Neoplasms/radiotherapyABSTRACT
To compare the effectiveness at ten years of follow-up of radical prostatectomy, brachytherapy and external radiotherapy, in terms of overall survival, prostate cancer-specific mortality and biochemical recurrence. Cohort of men diagnosed with localized prostate cancer (T1/T2 and low/intermediate risk) from ten Spanish hospitals, followed for 10 years. The treatment selection was decided jointly by patients and physicians. Of 704 participants, 192 were treated with open radical retropubic prostatectomy, 317 with 125I brachytherapy alone, and 195 with 3D external beam radiation. We evaluated overall survival, prostate cancer-specific mortality, and biochemical recurrence. Kaplan-Meier estimators were plotted, and Cox proportional-hazards regression models were constructed to estimate hazard ratios (HR), adjusted by propensity scores. Of the 704 participants, 542 patients were alive ten years after treatment, and a total of 13 patients have been lost during follow-up. After adjusting by propensity score and Gleason score, brachytherapy and external radiotherapy were not associated with decreased 10-year overall survival (aHR = 1.36, p = 0.292 and aHR = 1.44, p = 0.222), but presented higher biochemical recurrence (aHR = 1.93, p = 0.004 and aHR = 2.56, p < 0.001) than radical prostatectomy at ten years of follow-up. Higher prostate cancer-specific mortality was also observed in external radiotherapy (aHR = 9.37, p = 0.015). Novel long-term results are provided on the effectiveness of brachytherapy to control localized prostate cancer ten years after treatment, compared to radical prostatectomy and external radiotherapy, presenting high overall survival, similarly to radical prostatectomy, but higher risk of biochemical progression. These findings provide valuable information to facilitate shared clinical decision-making.Study identifier at ClinicalTrials.gov: NCT01492751.
Subject(s)
Brachytherapy , Prostatic Neoplasms , Brachytherapy/methods , Cohort Studies , Follow-Up Studies , Humans , Male , Prostate-Specific Antigen , Prostatectomy/adverse effects , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/surgeryABSTRACT
OBJECTIVES: We present a new case of small renal mass in which monitoring was chosen, no surgical intervention, and review of literature about this. METHODS AND RESULTS: We present a case of a female, 80 years of age, who was diagnosed of small renal mass (2 cms). We monitored the patient every 6 months through C.T. After more two years the renal mass is the same. CONCLUSIONS: In case of renal mass lower than 4 cm without local invasion we can choose the option of periodical monitoring with C.T. (6 monthly). It is important that the patient is assymptomatic. So therefore given the age (80 years), size of the tumor, and absence of symptoms, we can do monitoring without surgery.
Subject(s)
Kidney Neoplasms/pathology , Aged , Aged, 80 and over , Female , Humans , Incidental Findings , Kidney Neoplasms/diagnostic imaging , Radiography , Treatment Refusal , UltrasonographyABSTRACT
OBJETIVOS: Presentamos un nuevo caso de tumor renal pequeño en el que se decidió realizar monitorización sin intervención quirúrgica. Revisamos la literatura sobre esta situación. CONCLUSIONES: En el caso de tumores renales menores de 4 cm, sin invasión local, podemos elegir la opción de monitorización periódica con TAC (cada 6 meses). Es importante que el paciente esté asintomático. Por lo tanto, dada la edad de la paciente (80 años), el tamaño del tumor, y la ausencia de síntomas pudimos elegir la monitorización sin cirugía (AU)
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Subject(s)
Aged , Aged, 80 and over , Female , Humans , Treatment Refusal , Incidental Findings , Kidney NeoplasmsSubject(s)
Efficiency , Equity , Economics , Social Change , Socioeconomic Factors , Social SciencesSubject(s)
Economics , Efficiency , Equity , Socioeconomic Factors , Social Change , Social SciencesABSTRACT
Este trabajo analiza las implicaciones para las sociedades latinoamericanas del actual proceso de reestructuración de la economía mundial, el cual es conducido por la acelerada incorporación de la ciencia y la tecnología al proceso productivo. Luego de una breve revisión de los procesos que tienen lugar a nivel de América Latina en su conjunto, el análisis se concentra en los casos de México y Bolivia. La consideración de estos dos casos extremos, que incluyen desde industrias de alta tecnología en la frontera entre México y Estados Unidos hasta el desarrollo de una economía clandestina basada en la producción de coca y cocaína en el trópico del Chapare, permite analizar las nuevas formas de dependencia que están restringiendo los procesos de democratización y ajuste estructural en America Latina