ABSTRACT
Objetivos: Presentar un registro nacional de pacientes con cáncer de próstata seguidos mediante vigilancia activa, con la intención de testar la hipótesis de que la mortalidad cáncer específica en pacientes de muy bajo riesgo y riesgo bajo es menor del 5% a 15 años. Material y métodos: Estudio multicéntrico observacional (AEU-PIEM/2014/0001) promovido por la Asociación Española de Urología mediante su plataforma para estudios multicéntricos, en donde los criterios de inclusión clínico-patológicos son: cT1a-cT3a, PSA ≤ 20 ng/ml, biopsia (Bx) inicial mínima de 10 cilindros, número de cilindros afectos ≤ 3, Gleason 1.° = 3 y Gleason 2.° ≤ 4, y volumen prostático conocido (en cc). No se establece un seguimiento unificado para todos los centros reclutadores, y sí una encuesta en la que se reflejen las características del seguimiento en función de unos parámetros tangibles que permitan su comparabilidad. Con la misma filosofía de flexibilidad no se considera obligada la utilización de determinados biomarcadores o de RMN mutiparamétrica para su inclusión. Resultados: Se presentan las características y posibilidades del registro a modo descriptivo y los resultados preliminares de 324 pacientes incluidos en sus primeros 5 meses de funcionamiento por 15 centros reclutadores. De la misma forma se describen las variables clínico-patológicas, biomarcadores, técnicas de radiodiagnóstico y cuestionarios de calidad de vida contemplados por la base de datos, así como las posibilidades de seguimiento indefinido y abierto a cualquier tratamiento activo reconocido en guías clínicas. Conclusiones: La AEU-PIEM/2014/0001 constituye una herramienta extremadamente útil a todos los urólogos españoles para la investigación clínica multicéntrica, y sin duda permitirá la difusión de la vigilancia activa entre nuestros pacientes de una forma más coordinada, permitiendo mantener las ventajas del screeningoportunista optimizado en cáncer de próstata sin incurrir en el sobretratamiento
Objectives: To present a National Registry of patients with prostate cancer as monitored through active surveillance, with the intention of testing the hypothesis that cancer-specific mortality in very low-risk and low-risk patients is less than 5% at 15 years. Material and methods: A multicentre observational study (AEU-PIEM/2014/0001) sponsored by the Spanish Association of Urology was conducted using their platform for multicentre studies. The clinical-pathological inclusion criteria were as follows: cT1a-cT3a, PSA ≤ 20 ng/ml, initial minimum biopsy of 10 cores, number of affected cores ≤ 3, 1st Gleason score of 3 and 2nd Gleason score ≤ 4 and a known prostate volume (in cc). A unified follow-up was not established for all recruiting centres; however, a survey was conducted that reflects the follow-up characteristics based on a number of tangible parameters that allow for their comparison. With the same philosophy of flexibility, the use of certain biomarkers and multiparametric MRI was not considered necessary for inclusion. Results: We describe the Registry's characteristics and possibilities, as well as the preliminary results from the 324 patients included in its first 5 months of operation in the 15 recruiting centres. We also report the clinical-pathological variables, biomarkers, radiodiagnosis technique and quality-of-life questionnaires considered for the database, as well as the possibilities for indefinite follow-up, remaining open to any active treatment recognized in clinical guidelines. Conclusions: The AEU-PIEM/2014/0001 represents an extremely useful tool for all Spanish urologists for multicentre clinical research. The registry will undoubtedly enable the dissemination of active surveillance of our patients in a more coordinated manner, thus maintaining the advantages of optimised opportunistic screening for prostate cancer without resulting in overtreatment
Subject(s)
Humans , Male , Adult , Aged , Middle Aged , Watchful Waiting , Epidemiological Monitoring/organization & administration , Prostatic Neoplasms/therapy , Medical Records/standards , Prostatic Neoplasms/mortality , Spain , Societies, Medical/statistics & numerical data , Retrospective Studies , Time Factors , Prospective Studies , Survival RateABSTRACT
OBJECTIVES: To present a National Registry of patients with prostate cancer as monitored through active surveillance, with the intention of testing the hypothesis that cancer-specific mortality in very low-risk and low-risk patients is less than 5% at 15 years. MATERIAL AND METHODS: A multicentre observational study (AEU-PIEM/2014/0001) sponsored by the Spanish Association of Urology was conducted using their platform for multicentre studies. The clinical-pathological inclusion criteria were as follows: cT1a-cT3a, PSA ≤ 20 ng/ml, initial minimum biopsy of 10 cores, number of affected cores ≤ 3, 1st Gleason score of 3 and 2nd Gleason score ≤ 4 and a known prostate volume (in cc). A unified follow-up was not established for all recruiting centres; however, a survey was conducted that reflects the follow-up characteristics based on a number of tangible parameters that allow for their comparison. With the same philosophy of flexibility, the use of certain biomarkers and multiparametric MRI was not considered necessary for inclusion. RESULTS: We describe the Registry's characteristics and possibilities, as well as the preliminary results from the 324 patients included in its first 5 months of operation in the 15 recruiting centres. We also report the clinical-pathological variables, biomarkers, radiodiagnosis technique and quality-of-life questionnaires considered for the database, as well as the possibilities for indefinite follow-up, remaining open to any active treatment recognized in clinical guidelines. CONCLUSIONS: The AEU-PIEM/2014/0001 represents an extremely useful tool for all Spanish urologists for multicentre clinical research. The registry will undoubtedly enable the dissemination of active surveillance of our patients in a more coordinated manner, thus maintaining the advantages of optimised opportunistic screening for prostate cancer without resulting in overtreatment.
Subject(s)
Prostatic Neoplasms/therapy , Registries , Watchful Waiting , Adult , Aged , Humans , Male , Middle Aged , Prospective Studies , Prostatic Neoplasms/mortality , Retrospective Studies , Societies, Medical , Spain , Survival Rate , Time Factors , UrologyABSTRACT
The pathologic features of 16 nephrectomy specimens obtained from patients with a radiological diagnosis of reflux nephropathy were analyzed. Chronic pyelonephritis was diagnosed in 7 cases, renal dysplasia in 5 and segmental atrophy in 4. Clear correlations between pathologic pictures and pathogenic mechanisms involved in the development of renal lesions in kidneys with reflux are difficult to establish. These results show, however, that 'reflux nephropathy' is a broad term, which encompasses both congenital and acquired renal lesions.
Subject(s)
Kidney Diseases/pathology , Vesico-Ureteral Reflux/complications , Adolescent , Adult , Atrophy , Child , Child, Preschool , Chronic Disease , Female , Humans , Kidney/abnormalities , Kidney/pathology , Kidney Diseases/etiology , Male , Middle Aged , Pyelonephritis/etiology , Pyelonephritis/pathologyABSTRACT
Seventy-one patients with bladder tumors of stage Ta, T1 or T2 were studied by bladder mucosal biopsies. In 34 (48%) patients abnormal histology was found in at least one of the biopsies. The occurrence and severity of mucosal abnormalities were related to tumor grade and stage. Urinary cytology after complete tumor resection was positive in 18 of 19 patients with abnormal biopsies and in 6 of 12 patients with normal biopsies. Postoperative urinary cytology seems to be a good indicator for the presence of urothelial atypia.