Resultados patológicos y agresividad del cáncer de próstata de bajo riesgo en los hombres del norte de África / Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men

Antecedentes: Los hombres norteafricanos (NAF) presentan una alta incidencia de cáncer de próstata (CaP) avanzado en el momento del diagnóstico. Varios estudios han demostrado la existencia de diferencias étnicas en la agresividad del CaP y esto ha dado lugar a algunas preocupaciones relacionadas con la inclusión de algunos grupos étnicos en los protocolos de vigilancia activa. Objetivo: Evaluar los resultados patológicos y la agresividad del CaP de bajo riesgo tratado con prostatectomía radical en un grupo étnico NAF. Sujetos y métodos: Los datos de 147 NAF sometidos a prostatectomía radical por CaP de bajo riesgo diagnosticado por medio de una biopsia de 12 núcleos en 2 centros académicos entre 2011 y 2015 se revisaron retrospectivamente para evaluar las tasas de resultados patológicos peores definidas como: actualización de la puntuación de Gleason a por lo menos 3 + 4, eclipse a pT3a o superior o pN1, y márgenes quirúrgicos positivos. Resultados: El eclipse y/o actualización significativa global se produjo en el 20,2% y se produjeron márgenes quirúrgicos positivos en el 18,3%. En el análisis de regresión logística multivariante, las variables independientes que predijeron eclipse y/o actualización o márgenes quirúrgicos positivos en toda la cohorte fueron: grupo de riesgo NCCN (riesgo bajo > riesgo muy bajo), edad avanzada > 60 años, PSA > 6 ng/ml, densidad de PSA ≥ 0,15, más de 2 núcleos positivos en la biopsia, implicación del cáncer de más del 50% en los núcleos positivos, estadio clínico (T2a > T1c) y puntuación UCSF-CAPRA-S > 3. Conclusiones: Nuestro estudio encontró que, al menos patológicamente, los hombres NAF no tienen una enfermedad más agresiva que los caucásicos y afroamericanos, tanto en CaP de bajo como de muy bajo riesgo. Por lo tanto, creemos que la vigilancia activa es un enfoque adecuado para pacientes seleccionados ya que no hay datos definitivos que muestren una historia natural más agresiva de CaP en hombres NAF

Background: Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. Objective: To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. Subjects and methods: Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3 + 4, upstage to pT3a or higher or pN1, and positive surgical margins. Results: Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk > very low risk), advanced age > 60 years, PSA > 6 ng/ml, PSA density ≥ 0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a > T1c) and UCSF-CAPRA-S score > 3. Conclusions: Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men

Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men. / Resultados patológicos y agresividad del cáncer de próstata de bajo riesgo en los hombres del norte de África.

BACKGROUND: Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. OBJECTIVE: To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. SUBJECTS AND METHODS: Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3+4, upstage to pT3a or higher or pN1, and positive surgical margins. RESULTS: Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk>very low risk), advanced age>60 years, PSA>6ng/ml, PSA density≥0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a>T1c) and UCSF-CAPRA-S score>3. CONCLUSIONS: Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men.

Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml / Usefulness and Predictive Value of PSA Density, Adjusted by Transition Zone Volume, in Men With PSA Levels Between 2 and 4 ng/ml

Objetivo: Evaluar la significación diagnóstica del PSA, de su densidad (PSAD) y de la PSAD ajustada por el volumen de la zona de transición (PSATZD) en hombres con valores de PSA entre 2,0 y 4,0 ng/ml. Material y métodos: Entre los años 2000 y 2010, 138 hombres con niveles de PSA entre 2,0 y 4,0 ng/ml fueron sometidos a ultrasonografía transrectal (USTR) y biopsia prostática de 12 fragmentos. Se investigó la precisión diagnóstica de varios puntos de corte de la PSAD y de la PSATZD en rangos de PSA de 2,0 a 3,0ng/ml y de 3,1 a 4,0ng/ml. Resultados: La tasa de detección del cáncer de próstata fue del 23,9% (32/134). El porcentaje de pacientes con enfermedad extracapsular fue del 28,1% (10/32) y se obtuvieron primarios de grado Gleason 4 o 5 en 8 de 32 casos (25%). El volumen de la zona de transición y la PSATZD en los casos de cáncer fueron significativamente diferentes en comparación con los obtenidos en los casos sin cáncer. El área bajo la curva de la característica operativa del receptor (ROC) de la PSATZD fue significativamente mayor que la de la PSAD en los mismos rangos de subdivisión del PSA. La eficiencia diagnóstica de la PSATZD fue mayor que la de la PSAD. La eficiencia diagnóstica fue mayor en los niveles de corte de PSATZD de 0,23 y 0,28 en hombres con valores de PSA de 2,0 a 3,0ng/ml y de 3,1 a 4,0ng/ml, respectivamente. Conclusiones: El uso de puntos de corte de la PSATZD como indicación para biopsias evitaría muchas biopsias innecesarias sin pasar por alto la mayor parte de cánceres de próstata en el rango de PSA de 2,0 a 4,0ng/ml (AU)

Objective: To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0ng/ml. Material and methods: Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0ng/ml and 3.1 to 4.0ng/ml. Results: The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0ng/ml and 3.1 to 4.0ng/ml, respectively. Conclusions: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0ng/ml (AU)

[Usefulness and predictive value of PSA density, adjusted by transition zone volume, in men with PSA levels between 2 and 4 ng/ml]. / Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml.

OBJECTIVE: To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0 ng/ml. MATERIAL AND METHODS: Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0 ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml. RESULTS: The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively. CONCLUSIONS: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0 ng/ml.

Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia / Bone scan findings in a North African ethnic group and relation to PSA level and Gleason score of the biopsy

Objetivo: Numerosos estudios a gran escala realizados en países occidentales han demostrado una relación positiva entre el nivel sérico de antígeno prostático específico (APE) y la prevalencia de hallazgos positivos en la gammagrafía ósea en pacientes recientemente diagnosticados de cáncer de próstata. El objetivo de nuestro estudio es comprobar si esta tendencia aparece también en población norteafricana, así como determinar si se produce una relación entre los niveles de APE, los resultados de la gammagrafía ósea y la escala de Gleason. Material y método: Se revisaron de manera retrospectiva las historias clínicas de 348 pacientes diagnosticados de adenocarcinoma prostático, extrayendo los resultados de las gammagrafías óseas, los niveles de APE y la escala de Gleason. Se llevó a cabo un análisis estadístico mediante la prueba exacta de Fisher, utilizando el programa estadístico SPSS (Paquete Estadístico para las Ciencias Sociales, versión 11.5.1, Chicago), considerando significativa una p<0,05. Resultados: Mediante la gammagrafía ósea se demostró la existencia de metástasis óseas en 102 pacientes. Ninguno de estos pacientes tenía un nivel de APE menor de 10 ng/ml. Seis pacientes con metástasis tenían un nivel de APE entre 11 y 20 ng/ml. En 45 casos con metástasis se hallaron niveles de APE sérico entre 21 y 100. En relación con los niveles de APE superiores a 101 ng/ml, 51 hombres presentaban gammagrafía ósea positiva. Conclusión: Tomando como referencia los niveles de APE, se podría presuponer la probabilidad de un resultado positivo en la gammagrafía ósea. Según los niveles de APE, las investigaciones de estadificación pueden ser más selectivas en el caso de nuestros pacientes. En pacientes con un nivel de APE inferior a 10 ng/ml, el riesgo de presentar una gammagrafía ósea positiva es tan bajo que no sería necesario realizarla. Por otro lado, no se ha establecido una relación con significado estadístico entre la escala de Gleason y el nivel de APE o los resultados de la gammagrafía ósea(AU)

Objective: A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. Material and methods: Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences “SPSS”, version 11.5.1, Chicago, IL) with differences at P<0,05 considered significant. Results: Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan. Conclusion: Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established (AU)

Cambios en la densidad mineral ósea: comparación entre pacientes de cáncer de próstata con o sin metástasis y varones sanos (grupo étnico norteafricano) / Bone Mineral Density Change: Comparison Between Prostate Cancer Patients with or Without Metastases and Healthy Men (a North African Ethnic Group)

Objetivo: Evaluar la densidad mineral ósea total y la densidad mineral ósea regional en pacientes de cáncer de próstata con y sin metástasis, estableciendo una relación con los resultados de la escintigrafía ósea. Pacientes y métodos: La investigación se realizó sobre un grupo de 135 pacientes con carcinoma prostático y 50 pacientes sanos empleando escintigrafía ósea y absorciometría de rayos X de doble energía. Los resultados de la escintigrafía ósea se clasificaron como normales (puntuación 0: n=55), anómalos pero no típicos de metástasis (puntuación 1: n=45) y patrón típico de metástasis (puntuación 2: n=35). Resultados: Los pacientes de cáncer de próstata con metástasis ósea presentaban una densidad mineral ósea total y regional muy superior en el tronco y la pelvis que los sujetos control sanos, y que los pacientes de cáncer de próstata sin metástasis óseas. Se encontró una relación positiva significativa entre la puntuación obtenida en la exploración ósea y la densidad mineral ósea total y regional de tronco y pelvis (r=0,328, p<0,05, r=0,60, p<0,001, r=0,480, p<0,001, respectivamente). Conclusión: La metástasis ósea es una de las causas principales de morbilidad en el cáncer de próstata, y la pérdida ósea en el transcurso del tratamiento hormonal tiene eficacia en la actualidad. Nuestros resultados muestran que los pacientes de cáncer de próstata con metástasis ósea presentan una mayor densidad mineral ósea (DMO) en la pelvis y el tronco, lo cual es probable que se deba al predominio de las metástasis osteoblásticas sobre las osteolíticas, como demuestra la exploración ósea 99mTc MDP (AU)

Aim: To evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings. Patients and Methods: 135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n=55), abnormal but not typical for metastases (score 1: n=45), and typical pattern of metastases (score 2: n=35). Results: The patients with bone metastases prostate cancer had significantly higher total bone minera1 density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r=0.328; P<0.05; r=0.60; P<0.001; r=0.480; P<0.001, respectively). Conclusion: Bone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by 99mTc MDP bone scan (AU)

[Bone scan findings in a North African ethnic group and relation to PSA level and Gleason score of the biopsy]. / Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia.

OBJECTIVE: A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. MATERIAL AND METHODS: Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences "SPSS", version 11.5.1, Chicago, IL) with differences at P<0,05 considered significant. RESULTS: Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan. CONCLUSION: Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.

Terapia de oxígeno hiperbárico complementaria al desbridamiento en el control de la gangrena de Fournier: utilidad de la puntuación de un índice de severidad en la predicción de la gravedad de la enfermedad y la supervivencia del paciente / Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier’s gangrene: usefulness of a severity index score in predicting disease gravity and patient survival

Introducción: La terapia de oxígeno hiperbárico (TOHB) concomitante con la cirugía ha demostrado una mejora en la reducción de la mortalidad por gangrena de Fournier (GF) en comparación con la aplicación exclusiva de desbridamiento quirúrgico. La mayoría de los datos provienen de centros con un número relativamente reducido de pacientes, y en los que se emplea solamente un procedimiento quirúrgico. El objetivo planteado consistía en evaluar la eficiencia del desbridamiento agresivo con TOHB complementaria, así como evaluar el valor predictivo del índice de puntuación de gravedad de la gangrena de Fournier (IGGF). Material y métodos: 70 gangrenas de Fournier (GF) tratadas con desbridamiento quirúrgico y TOHB. Los datos evaluados fueron los resultados de las exploraciones físicas, los análisis de laboratorio tanto en el momento del ingreso como los finales, la extensión del desbridamiento quirúrgico y el antibiótico utilizado. Los pacientes recibieron TOHB complementaria. Se desarrolló un IGGF con el fin de adjudicar una puntuación que describiese la gravedad de la enfermedad. Este índice tiene en cuenta las constantes vitales de los pacientes, los parámetros metabólicos (niveles de sodio, potasio, creatinina y bicarbonato, así como recuento de linfocitos) y calcula una puntuación relativa a la gravedad de la enfermedad en ese momento. Se evaluaron los datos en función de la supervivencia o no del paciente. Todos los pacientes fueron sometidos a desbridamiento quirúrgico, realizándose el desbridamiento de la herida de forma periódica en el periodo postoperatorio. Resultados: De un total de 70 pacientes fallecieron 8 (el 11,4%) y sobrevivieron 62 (el 88,5%). La diferencia de edad entre los supervivientes (edad media 50,0 años) y no supervivientes (edad media 54,5 años) no fue significativa (p = 0,321). La extensión media del área del cuerpo afectada por el proceso de necrosis en los pacientes que sobrevivieron y en los que no sobrevivieron era del 2,4 y del 4,9%, respectivamente (p = 0,001). Excepto en lo referente a la albúmina, no se encontraron diferencias significativas entre supervivientes y no supervivientes. Las puntuaciones medias en el IGGF en el momento del ingreso de los supervivientes y de los no supervivientes fueron de 2,1±2,0 y de 4,2±3,8, (p = 0,331). Conclusión: La puntuación del IGGF no resultó ser un factor de predicción de la gravedad, de la enfermedad ni de la supervivencia del paciente. Sin embargo, tanto las alteraciones metabólicas como la extensión de la enfermedad aparecieron como factores significativos de riesgo en cuanto a predicción de la gravedad de la GF y la supervivencia del paciente (AU)

Introduction: Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier’s gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier’s gangrene severity score index (FGSI) predictive value. Material and methods: 70 Fournier’s gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed toa ssign a score describing the acuity of disease, was used. This index presents patients’ vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period. Results: Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p = 0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p = 0.001). Except for albumin, no significant differences were found between survivors and non survivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p = 0.331).Conclusion: FGSI score did not predict disease severity and the patient’s survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival (AU)

[Bone mineral density change: comparison between prostate cancer patients with or without metastases and healthy men (a North African ethnic group)]. / Cambios en la densidad mineral ósea: comparación entre pacientes de cáncer de próstata con o sin metástasis y varones sanos (grupo étnico norteafricano).

AIM: To evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings. PATIENTS AND METHODS: 135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n=55), abnormal but not typical for metastases (score 1: n=45), and typical pattern of metastases (score 2: n=35). RESULTS: : The patients with bone metastases prostate cancer had significantly higher total bone mineral density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r=0.328; P<0.05; r=0.60; P<0.001; r=0.480; P<0.001, respectively). CONCLUSION: Bone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by (99m)Tc MDP bone scan.

[Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier's gangrene: usefulness of a severity index score in predicting disease gravity and patient survival]. / Terapia de oxígeno hiperbárico complementaria al desbridamiento en el control de la gangrena de Fournier: utilidad de la puntuación de un índice de severidad en la predicción de la gravedad de la enfermedad y la supervivencia del paciente.

INTRODUCTION: Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier's gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier's gangrene severity score index (FGSI) predictive value. MATERIAL AND METHODS: 70 Fournier's gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed to assign a score describing the acuity of disease, was used. This index presents patients' vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period. RESULTS: Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p=0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p=0.001). Except for albumin, no significant differences were found between survivors and nonsurvivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p=0.331). CONCLUSION: FGSI score did not predict disease severity and the patient's survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival.

Evaluación de la sobreexpresión de proteína HER2 en cáncer vesical no músculo invasivo con énfasis en el grado tumoral y en la recurrencia / Evaluation of HER2 protein overexpression in non-muscle invasive bladder cancer with emphasis on tumour grade and recurrence

Objetivo: evaluar el valor pronóstico de la expresión de la HER2 en carcinoma vesical de células transicionales (CCT) no músculo invasivo, poniendo especial énfasis en la población con alto grado. Materiales y métodos (pacientes): se realizaron micromatrices de tejidos (TMA) con especímenes TUR-B representativos de 84 pacientes con CCT vesical no músculo invasivo (40 pT1GII y44 pT1GIII) a los que se trataba en nuestra institución. El mismo patólogo que había llevado a cabo la prueba ciega de análisis inmunohistoquímico con Hercep realizó el proceso de asignación de profundidades de invasión y grados de manera uniforme: se consideró el valor 3+ como signo altamente positivo de sobreexpresión de la HER2. También se evaluaron otras variables clínico-patológicas. Resultados: se detectó sobreexpresión de proteína HER2 en 30/ 44 (68,2%) lesiones pT1GIII, prediciendo recaídas en este subgrupo de CCT vesical (p < 0,01). Se detectó expresión negativa de la HER2 en 26/ 40 (65%) casos con CCT pT1GII, dándose esta situación con mayor frecuencia en tumores unifocales y sin angiogénesis, con baja tasa de recaída y sin evolución. La supervivencia libre de recidiva puede también preverse mediante la expresión de la HER 2 en los tumorespT1GII (p < 0,01). Conclusión: la expresión de la HER2 mediante test Hercep puede ser de utilidad en la predicción de recaídas en CCT vesical no músculo invasivo. El potencial de aplicación de este estudio, sobre todo en lo que se refiere a la predicción de la respuesta a BCG, debe confirmarse de forma prospectiva en ensayos multicéntricos (AU)

Objective: to evaluate the prognostic value of HER2 expression in non-muscle invasive bladder transitional cell carcinoma (TCC) with special emphasis in the high grade population. Materials and methods (patients): Tissue microarrays (TMA) were performed with representative TUR-B specimens from 84 patients with non-muscle invasive bladder TCC (40 pT1GII and 44 pT1GIII) treated in our institution. Depth of invasion and grade were uniformly assigned by the same pathologist who performed blind immunohistochemical analysis with Hercep test: 3+was considered strong positive HER2 over expression. Other clinico-pathological variables were also assessed. Results: HER2 protein over expression was detected in 30/44 (68.2%) pT1GIII lesions and predicted recurrence in this subgroup of bladder TCC (p < 0.01). Negative HER2 expression was detected in 26/40 (65%) cases with pT1GII TCC, and this condition was more frequent in unifocal tumours, without angiogenesis, with low recurrence rate and without progression. Recurrence-free survival can also be anticipated by HER 2 expression within pT1GII tumours (p < 0.01). Conclusion: HER2 expression using Hercep test may be useful to predict recurrence in non-muscle invasive bladder TCC. The potential application of this study, especially regarding prediction of response to BCG, should be prospectively confirmed in multi-institutional trials (AU)

[Evaluation of HER2 protein overexpression in non-muscle-invasive bladder cancer with emphasis on tumour grade and recurrence]. / Evaluación de la sobreexpresión de proteína HER2 en cáncer vesical no músculo invasivo con énfasis en el grado tumoral y en la recurrencia.

OBJECTIVE: To evaluate the prognostic value of HER2 expression in non-muscle invasive bladder transitional cell carcinoma (TCC) with special emphasis in the high grade population. MATERIALS AND METHODS (PATIENTS): Tissue microarrays (TMA) were performed with representative TUR-B specimens from 84 patients with non-muscle invasive bladder TCC (40 pT1GII and 44 pT1GIII) treated in our institution. Depth of invasion and grade were uniformly assigned by the same pathologist who performed blind immunohistochemical analysis with Hercep test: 3+ was considered strong positive HER2 overexpression. Other clinico-pathological variables were also assessed. RESULTS: HER2 protein overexpression was detected in 30/44 (68.2%) pT1GIII lesions and predicted recurrence in this subgroup of bladder TCC (p<0.01). Negative HER2 expression was detected in 26/40 (65%) cases with pT1GII TCC, and this condition was more frequent in unifocal tumours, without angiogenesis, with low recurrence rate and without progression. Recurrence-free survival can also be anticipated by HER 2 expression within pT1GII tumours (p<0.01). CONCLUSION: HER2 expression using Hercep test may be useful to predict recurrence in non-muscle invasive bladder TCC. The potential application of this study, especially regarding prediction of response to BCG, should be prospectively confirmed in multi-institutional trials.

[US-guided transrectal drainage of prostatic abscesses]. / Aspiration échoguidée transrectale des abcès prostatiques.

Prostatic abscess is rare and most commonly occurs as a complication of acute prostatitis. Because of the wider use of antibiotics, the clinical presentation is becoming less typical. Diagnosis is useful for diagnosis. Based on a review of 3 cases, the authors report their experience with US-guided transrectal drainage of prostatic abscesses and review other therapeutic options.

[Renocolic fistula following abdominal trauma: a case study]. / Les fistules rénocoliques post-traumatiques : à propos d'une observation.

The renocolic fistula is a rare entity, which has occurred exceptionally in a traumatic not iatrogenic context, we report a case of renocolic fistula complicating penetrating abdominal trauma from a gunshot.

[Three years results of transvaginal cystocele repair with polypropylene mesh using a tension-free technique]. / Resultados a los tres años de la reparación de un cistocele transvaginal con malla de propileno usando una técnica sin tensión.

OBJECTIVES: To evaluate the long term efficacy and safety of transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh) for the treatment of cystocele using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele between April 2004 and July 2007. A prolene mesh was cut to an appropriate size to cover the whole cystocele leaving two tabs on each side. The two tabs of the mesh were then placed in paravaginal spaces, tension free, without stitches. Mesh was used in 31 patients. All patients had a symptomatic cystocele >or= 2 according to Baden-Walker halfway classification. Patients were reviewed initially at 1 and 3 month and then every 6 months. RESULTS: The mean age of the patients was 58 years (range: 47-70 years). Mean parity was 5.8 (range 1-11), and mean weight was 75 kg (range 60-82Kg). All women were postmenopausal. The operation was combined with vaginal hysterectomy in 2 patients, Posterior colporraphy in 2 patients, Perineorrhaphy in 1 patient, Sacrospinous fixation in 2 patients, transobturator tape for stress urinary incontinence in 7 women. Average time of surgery was 23 minutes for cystocele. There were no major complications, such as trauma to the bladder, urethra, bowels, or large vessels in the patient group treated. There was no immediate postoperative complications (up to 7 days) recorded. No hematoma or infection was observed in the operative area. Mesh erosion was detected in one patient. It was treated by excision of the eroded part of the mesh. Mean follow-up was 36.4 months (18 to 52 months). Using our definition of success based on both anatomic and functional outcomes, the overall cure rate was 74.19% (asymptomatic with no or grade 1 cystocele). The improvement rate (asymptomatic with a grade 2 cystocele) was 19.35% and the overall failure rate (symptomatic or with a grade 3 or 4 cystocele) was only 6.4% (2 women). DISCUSSION AND CONCLUSIONS: The interposition of a sub-vesical transversal tension-free polypropylene mesh by the vaginal route seems to be an excellent procedure in the definitive surgical treatment of anterior vaginal wall prolapse. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance. The results seem to be stable after three years of follow up.

Resultados a los tres años de la reparación de un cistocele transvaginal con malla de propileno usando una técnica sin tensión / Three years results of transvaginal cystocele repair with polypropylene mesh using a tension-free technique

Objetivos: evaluar la eficacia y la seguridad a largo plazo de la implantación transvaginal de una prótesis sintética no absorbible (Gynemesh(R)) para el tratamiento del cistocele mediante una técnica vaginal sin tensión. Materiales y métodos: estudio prospectivo de pacientes sometidas a corrección de un cistocele entre abril de 2004 y julio de 2007. Se cortaba una malla de propileno al tamaño adecuado para cubrir todo el cistocele, dejando dos lengüetas a cada lado. Las dos lengüetas de la malla se colocaban después en los espacios paravaginales sin tensión ni suturas. Se utilizó la malla en 31 pacientes. Todas ellas tenían un cistocele sintomático de grado ≥ 2, según la clasificación del punto medio de Baden-Walker. Se les revisaba inicialmente al cabo de uno y tres meses, y después cada 6 meses. Resultados: la edad media de las pacientes era de 58 años (límites: 47-70 años). La paridad media era de 5,8 (límites: 1-11) y el peso medio de 75 kg (límites: 60-82 kg). Todas las mujeres eran posmenopáusicas. La operación se combinó con histerectomía vaginal en dos pacientes, colporrafia posterior en dos, perineorrafia en una, fijación sacroespinosa en dos y cinta transobturadora para incontinencia urinaria de esfuerzo en 7 mujeres. La duración media de la cirugía del cistocele fue de 23 minutos. En el grupo de pacientes tratadas no hubo complicaciones importantes como traumatismo de vejiga, uretra, intestino o grandes vasos. No se registraron complicaciones en el postoperatorio inmediato (hasta los 7 días). No se observó hematoma ni infección en la zona quirúrgica. En una paciente se detectó erosión de la malla, que se trató mediante extirpación de la parte erosionada de la misma. El seguimiento medio fue de 36,4 meses (de 18 a 52). Según nuestra definición de éxito, basada en los resultados anatómico y funcional, la tasa de curación global fue del 74,19% (asintomática sin cistocele o con cistocele de grado 1). La tasa de pacientes con mejoría (asintomáticas con cistocele de grado 2) fue del 19,35% y la de fracasos globales (sintomáticas o con cistocele de grado 3 o 4) de sólo el 6,4% (dos mujeres). Comentario y conclusiones: la interposición de una malla de polipropileno subvesical transversal, sin tensión, por la vía vaginal, parece ser un procedimiento excelente para el tratamiento quirúrgico definitivo del prolapso de la pared vaginal anterior. Se trata de un procedimiento simple, poco invasivo, reproducible y eficiente con baja morbilidad y bien tolerado. Los resultados parecen mantenerse estables a los tres años de seguimiento(AU)

Objectives: To evaluate the long term efficacy and safety of transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh(R)) for the treatment of cystocele using transvaginal free tension technique. Materials and methods: Prospective study of patients that have been submitted to correction of cystocele between April 2004 and July 2007. A prolene mesh was cut to an appropriate size to cover the whole cystocele leaving two tabs on each side. The two tabs of the mesh were then placed in paravaginal spaces, tension free, without stitches. Mesh was used in 31 patients. All patients had a symptomatic cystocele ≥ 2 according to Baden-Walker halfway classification. Patients were reviewed initially at 1and 3 month and then every 6 months. Results: The mean age of the patients was 58 years (range: 47–70 years). Mean parity was 5.8 (range 1-11), and mean weight was 75 kg (range 60-82Kg). All women were postmenopausal. The operation was combined with vaginal hysterectomy in 2 patients, Posterior colporraphy in 2 patients, Perineorrhaphy in 1 patient, Sacrospinous fixation in 2 patients, transobturator tape for stress urinary incontinence in 7 women. Average time of surgery was 23 minutes for cystocele. There were no major complications, such as trauma to the bladder, urethra, bowels, or large vessels in the patient group treated. There was no immediate postoperative complications (up to 7 days) recorded. No hematoma or infection was observed in the operative area. Mesh erosion was detected in one patient. It was treated by excision of the eroded part of the mesh. Mean follow-up was 36.4 months (18 to 52 months). Using our definition of success based on both anatomic and functional outcomes, the overall cure rate was 74.19% (asymptomatic with no or grade 1 cystocele). The improvement rate (asymptomatic with a grade 2 cystocele) was 19.35% and the overall failure rate (symptomatic or with a grade 3 or 4 cystocele) was only 6.4% (2 women). Discussion and conclusions: The interposition of a sub-vesical transversal tension-free polypropylene mesh by the vaginal route seems to be an excellent procedure in the definitive surgical treatment of anterior vaginalwall prolapse. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance. The results seem to be stable after three years of follow up(AU)

Synchronous Primary Tumors of the Kidney and Pancreas: Case Report

The simultaneous presence of primary carcinomas in the same patient is uncommon and synchronous primary tumors involving the kidney and pancreas are extremely rare. There are a few reports in the eng literature of synchronous primary malignancies of the kidney and pancreas. We present a 62-year-old man who had weight loss of 9 kg and epigastric pain. Findings showed a Furhman grade II renal papillary carcinoma confined to the kidney and a synchronous well differentiated pancreatic ductal adenocarcinoma

[Primitive neuroectodermal tumor (PNET) of the upper-urinary tract]. / Tumeur neuro-ectodermique primitive (TNEP) de la voie excrétrice supérieure.

Primitive neuroectodermal tumors (PNETs) are rare and aggressive malignant small round cell sarcomas. Primitive urogenital location of PNETs is rare and occurs most frequently in the kidney. PNETs of the upper-urinary tract are exceptional (only one case reported in the literature). Its diagnosis is almost postoperative within pathological study of the operatory specimen, supported by immunohistochemistry and cytogenetics. Treatment is similar in all to that of Ewing's sarcoma and involves surgery, chemotherapy and radiotherapy. We report a new case of upper-urinary tract PNET and discuss the diagnostic and therapeutic problems posed by this particular tumor.

Pseudotumoral malacoplakia of the bladder

Malacoplakia is a rare inflammatory condition most often affecting the genitourinary system. We report the case of a 24-year-old man who presented with gross hematuria; nocturia; frequency; dysuria and considerable weight loss during the preceding three months. Digital rectal examination showed a solid pelvic mass. Ultrasonography and computed tomography showed calyceal dilatation on the right side and a solid bladder mass 10 cm in diameter suspicious of bladder cancer. Transurethral resection of the tumor was incomplete; due to the large volume of the bladder mass. Histological examination of the resected specimen revealed malacoplakia of the bladder. The patient was treated with fluoroquinolone and vitamin C. Follow-up at 3 months showed marked regression of the bladder mass and complete resolution of the calyceal dilatation