Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study.

INTRODUCTION: Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient's quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis. MATERIALS AND METHODS: PROSARC is a national (Spain) prospective observational study (May-2022-May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up. RESULTS: A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012). CONCLUSION: In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.

[Preventing dependency in the elderly]. / Prevención de la dependencia en las personas mayores.

INTRODUCTION: Dependency, i.e. the need to depend on another person to perform activities of daily living, is the main concern and cause of suffering and poor quality of life in the elderly. The prevalence of dependency increases with age and is related to the presence of prior disease and fragility. Dependency is associated with increased morbidity, mortality and institutionalization, as well as with greater health and social resource utilization, all of which increases health costs. OBJECTIVE: To create a consensus document on the main health recommendations for the prevention of dependency in the elderly, based on the scientific evidence available to date, with the collaboration of scientific societies and public health administrations (the Spanish Ministry of Health, Autonomous Communities and Cities). METHODS: a) a preliminary consensus document was drafted by an expert group composed of representatives of various scientific societies and health administrations. This document was based on a review of the recommendations and guidelines published by the main organizations involved in health promotion and the prevention of disease, functional deterioration and dependency in the elderly; b) the consensus document was reviewed by the remaining experts assigned by the scientific societies and central and autonomous administrations; c) the final document was approved after a session in which the text was discussed and reviewed by all the experts participating in the working group (including the academic committee); d) the document was presented and discussed in the First National Conference on Prevention and Health Promotion in Clinical Practice in Spain. All participating experts signed a conflicts of interest statement. RESULTS: The document provides recommendations, with their grades of evidence, grouped in the following three categories: a) health promotion and disease prevention, with specific preventive activities for the elderly, including prevention of geriatric syndromes; b) prevention of functional deterioration, with clinical recommendations that can be applied in primary and specialized care; c) prevention of iatrogeny (drug prescription, inappropriate use of diagnostic and therapeutic modalities and healthcare). These recommendations were tailored to the characteristics of the older person (OP), categorized in five groups: healthy OP, OP with chronic disease, fragile or at risk OP, dependent OP, and OP at the end of life. CONCLUSION: These recommendations should be implemented by public health administrations to improve strategies for the prevention of dependency in the elderly in the xxi century.

Necesidad de la enseñanza de pregrado en geriatría: aportaciones de un nuevo modelo educativo / Need for undergraduate teaching in geriatrics: contribution of a new educational model

Introducción: analizar la adquisición de conocimientos en la especialidad de Geriatría en estudiantes de la Facultad de Medicina de la Universidad de Castilla-La Mancha (UCLM). Material y métodos: a 93 alumnos de quinto curso de la Facultad de Medicina de la UCLM se les realizó una encuesta antes y después de recibir la asignatura (6 semanas teoricoprácticas basadas en el aprendizaje por problemas). Resultados: después de recibir la asignatura de Geriatría, los alumnos mejoraron sus conocimientos sobre la especialidad, tanto en su utilidad como en la metodología y en la tipología de los principales beneficiarios. Al concluir, el 59,8% identificó al anciano con discapacidad reciente potencialmente recuperable como principal beneficiario de una unidad geriátrica de agudos. Los principales beneficiarios de una unidad de recuperación funcional fueron ancianos con ictus, fracturas de cadera y pérdida de funcionalidad. Las afecciones que más se benefician de la atención en consultas externas son el deterioro cognitivo, el síndrome confusional agudo, la pérdida funcional, las caídas y la pluripatología-polifarmacia. Tras la asignatura se produjo un cambio de opinión en los alumnos hacia que los geriatras son quienes deben abordar el síndrome confusional agudo, el trastorno depresivo, la incontinencia urinaria y las caídas. Tras la formación, hay una tendencia a que más ancianos en situación aguda, con buena función previa y con una enfermedad potencialmente recuperable, como el ictus, sean atendidos por un geriatra. Conclusiones: la enseñanza de pregrado de la Geriatría mejora el conocimiento de la especialidad, aclara cuál es el tipo de paciente que más se beneficia de su metodología de trabajo y prepara a los futuros médicos para prestar mayor calidad en la asistencia a pacientes ancianos

Introduction: to analyse knowledge of geriatrics among students of the Medical Faculty of Castilla-La Mancha University (UCLM) in Spain. Matherial and methods: we performed a survey of 93 fifth-year medical students at the UCLM Medical Faculty before and after they attended a 6-week problem-based training program in geriatrics. Results: after the learning period, the students had a better knowledge of geriatrics, including its utility, methods, and patient characteristics. At the end of the program, 59.8% were able to identify elderly individuals with potentially reversible, recent-onset disability as the principal users of acute geriatric units; those with stroke, hip fracture or functional decline as the main users of geriatric rehabilitation units and those with cognitive or functional decline, confusion, falls or multiple disorders/medications as the main users of outpatient clinics. Students changed their belief that confusion, depression, urinary incontinence and falls have to be managed by geriatricians. After the program students believed that geriatricians managed more elderly people with good functional status and acute, potentially treatable diseases such as stroke. Conclusions: education in geriatrics gives medical students a better understanding of the principal users of geriatric medicine and the methodology used, and prepares them to provide better care to the elderly

[Sensory demyelinating polyneuropathology as a manifestation of paraneoplastic encephalomyelitis associated to adenocarcinoma of the prostate]. / Polineuropatia sensitiva desmielinizante como manifestación de encefalomielitis paraneoplásica asociada al adenocarcinoma de próstata.

INTRODUCTION: Different neurological disorders affecting different levels of the nervous system, both central and peripheral, are included among the paraneoplastic symptomologies of cancers, although their incidence is not well defined and varies according to the type of tumour. CASE REPORT: We report the case of a 73 year old male patient who was admitted with a suspected polyneuropathy that had been developing for one month. The diagnosis was confirmed by electromyography. The only probable aetiology found in the course of a specific exploration was an adenocarcinoma of the prostate, with a widespread distribution throughout the central ganglionic chains and bone metastases, which were observed by computerised tomography of the abdomino pelvic region and bone gammography, and had not previously been diagnosed. CONCLUSIONS: We reviewed the literature on the relation between neurological paraneoplastic syndromes and neoplasias that are not of a pulmonary origin and we found a low rate of association between the two processes. The relation between adenocarcinoma of the prostate and neurological paraneoplastic processes receives very little attention. These syndromes vary greatly in their neurological expression, and there is a link with different antibodies that could explain an etiopathogenic mechanism of an immunitary nature. No effective treatment exists in spite of its usually being aggressive and varied. The disease often progresses quickly and leads to death after a few months.

Polineuropatía sensitiva desmielinizante como manifestación de encefalomielitis paraneoplásica asociada al adenocarcinoma de próstata / Sensory demyelinating polyneuropathology as a manifestation of paraneoplastic encephalomyelitis associated to adenocarcinoma of the prostate

Introducción. Dentro de la sintomatología paraneoplásica de los cánceres se incluye la afectación neurológica a distintos niveles del sistema nervioso, tanto central como periférico, sin que esté bien definida su incidencia, variando la misma según el tipo de tumor. Caso clínico. Presentamos el caso de un varón de 73 años que ingresa por sospecha de polineuropatía de un mes de evolución. El diagnóstico se confirmó por electromiografía. Al efectuarse el estudio específico se encontró como única probable etiología un adenocarcinoma de próstata, con una amplia extensión en las cadenas ganglionares centrales y metástasis óseas, objetivadas por una tomografía computarizada abdominopélvica y gammagrafía ósea, no diagnosticado previamente. Conclusiones. Realizamos una revisión bibliográfica sobre la relación existente entre los síndromes paraneoplásicos neurológicos y las neoplasias de origen no pulmonar, en la que se ha encontrado una baja frecuencia de asociación entre ambos procesos, con escasas reseñas en la literatura sobre la asociación entre el adenocarcinoma de próstata y los procesos paraneoplásicos neurológicos. Existe una gran diversidad de expresión neurológica de estos síndromes, así como una asociación a distintos anticuerpos que podrían explicar un mecanismo etiopatogénico de carácter inmunitario. No existe un tratamiento efectivo a pesar de que éste suele ser agresivo y variado. El curso es con frecuencia rápidamente progresivo y conduce a la muerte en pocos meses (AU)

Introduction. Different neurological disorders affecting different levels of the nervous system, both central and peripheral, are included among the paraneoplastic symptomologies of cancers, although their incidence is not well defined and varies according to the type of tumour. Case report. We report the case of a 73-year-old male patient who was admitted with a suspected polyneuropathy that had been developing for one month. The diagnosis was confirmed by electromyography. The only probable aetiology found in the course of a specific exploration was an adenocarcinoma of the prostate, with a widespread distribution throughout the central ganglionic chains and bone metastases, which were observed by computerised tomography of the abdomino-pelvic region and bone gammography, and had not previously been diagnosed. Conclusions. We reviewed the literature on the relation between neurological paraneoplastic syndromes and neoplasias that are not of a pulmonary origin and we found a low rate of association between the two processes. The relation between adenocarcinoma of the prostate and neurological paraneoplastic processes receives very little attention. These syndromes vary greatly in their neurological expression, and there is a link with different antibodies that could explain an etiopathogenic mechanism of an immunitary nature. No effective treatment exists in spite of its usually being aggressive and varied. The disease often progresses quickly and leads to death after a few months (AU)

Biloma por mínimo traumatismo en anciano / Biloma secondary to minor traumatism in the elderly

Presentamos el caso de una mujer de 77 años de edad sin antecedentes hepatobiliares de interés que presenta un biloma hepático secundario a traumatismo mínimo por caída accidental desde una silla al suelo, y que se resuelve sin complicaciones mediante drenaje percutáneo. No existen casos previos descritos, siendo las causas habituales de biloma la cirugía abdominal o laparoscópica o los grandes traumatismos (AU)