Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes.

OBJECTIVES: To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. METHODS: Six hundred eighty-five RPs were performed in our center between 2011-2018 (17,8% ORP, 22,2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs.1 comparisons (ORP vs. RARP and LRP vs. RARP). RESULTS: RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital stay (days) (OR 0,86; 95% CI: 0,80-0,94), hemoglobin loss (OR 0,38; 95% CI: 0,30-0,47), transfusion rate (OR 0,18; 95% CI: 0,09-0,34), early complications (p = 0,001), IQL (OR 0,82; 95% CI: 0,69-0,98), erectile function (OR 0,41; 95% CI: 0,21-0,79), pain control (OR 0,82; 95% CI: 0,75-0,89), postoperative recovery (p < 0,001) and choice of a different approach (OR 5,55; 95% CI: 3,14-9,80). RARP is superior to LRP in: urinary continence (OR 0,55; 95% CI: 0,37-0,82), IPSS (OR 0,96; 95% CI: 0,93-0,98), IQL (OR 0,76; 95% CI: 0,66-0,88), erectile function (OR 0,52; 95% CI: 0,29-0,93), postoperative recovery (p = 0,02 and 0,004), PS (p = 0,005; 0,002; and 0,03) and choice of a different approach (OR 7,79; 95% CI: 4,63-13,13). CONCLUSIONS: The findings of our study globally endorse a positive effectiveness of RARP over ORP and/or LRP, both on functional issues, postoperative recovery, QoL and PS. Oncologic results should still be improved.

Factores relacionados con la resistencia a la castración precoz en el cáncer de próstata metastásico. Resultados del Registro nacional de cáncer de próstata en España / Factors related to early castration resistance in metastatic prostate cancer. Results from the National Prostate Cancer Registry in Spain

Introducción: El objetivo del estudio fue establecer los factores que se relacionan de forma independiente con el desarrollo de resistencia a la castración (RC) a medio plazo en el cáncer de próstata (CP). Material y métodos: Ciento cincuenta y cinco pacientes con CP metastásicos al diagnóstico del registro nacional de CP con un seguimiento de hasta 39 meses. Las variables estudiadas fueron: edad, PSA, nadir de PSA, Gleason, invasión perineural, estadios T, N y M y tipo de bloqueo (intermitente/continuo). Resultados: Media de seguimiento 26,2 ± 13,4 meses. El 47,1% desarrolló RC precoz, con una media hasta el desarrollo de RC 12,2 ± 8,7 meses. Análisis univariante: se relacionaron con la RC la media de PSA (290 ± 905,1ng/ml en no RC, 519,1 ± 1437,2 ng/ml en RC, p < 0,001), media de edad (73,3 ± 8,3 años en no RC, 69,1 ± 9,3 en RC, p = 0,01), media de nadir de PSA (15,5 ± 57,3 ng/ml en no RC, 15,9 ± 23,7 ng/ml en RC, p < 0,001), Gleason (en ≥ 8, HR: 2,11; IC 95%: 1,22-3,65, p = 0,006) y estadio T (en T3-T4, HR: 2,85; IC 95%: 1,57-5,19, p < 0,001). Análisis multivariante: las variables independientes relacionadas con la RC son edad (HR: 0,96; IC 95%: 0,94-0,99, p = 0,01), nadir de PSA (HR: 1,65; IC 95%: 1,43-1,91, p < 0,001) y estadio T3-T4 (HR: 2,11; IC 95%: 1,10-4,04, p = 0,02). Conclusiones: El nadir de PSA y un estadio tumoral T3-T4 al diagnóstico se relacionan con un riesgo aumentado de desarrollar RC. Además, la edad al diagnóstico se muestra como una variable que disminuye el riesgo, de forma que, a más edad, menos riesgo de desarrollar RC a medio plazo

Introduction: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. Material and methods: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). Results: Mean follow-up 26,2 ± 13,4 months. 47.1% developed early CR, with mean time until onset of 12,2 ± 8,7 months. Univariate analysis the mean PSA was correlated with CR (290 ± 905,1 ng/mL in non CR, 519,1 ± 1437,2 ng/mL in CR, P < .001), mean age (73,3 ± 8,3 years in non CR, 69,1 ± 9,3 in CR P = .01), mean PSA nadir (15,5 ± 57,3 ng/mL in non CR, 15,9 ± 23,7 ng/mL in CR, p < 0,001), Gleason (in ≥ 8, HR: 2,11. 95% CI: 1.22-3.65, p = 0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P < .001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P = .01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P < .001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P = .02). Conclusions: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term

La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente / Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy

Introducción: Con el avance de la cirugía laparoscópica y robótica, la profilaxis tromboembólica en los procedimientos urológicos se han basado clásicamente en la experiencia de otras especialidades quirúrgicas. En este trabajo se realiza un análisis de la actualidad de las recomendaciones, basado en un estudio pormenorizado de las guías clínicas europeas y en la bibliografía, aplicando las recomendaciones de tromboprofilaxis a la práctica urológica diaria. Objetivos: Elaborar unas recomendaciones generales aplicables a los pacientes quirúrgicos en urología, evitando la aparición de eventos tromboembólicos en el periodo perioperatorio. Optimizar la medicación y el ajuste en pacientes crónicos y conocer qué pacientes son candidatos a terapias puente. Material y métodos: Se ha realizado una revisión de la literatura disponible y de las guías clínicas europeas. Se analizan los artículos de consenso más recientes realizando una revisión de la bibliografía disponible y los estudios y revisiones en los que se basan las guías europeas de tromboprofilaxis en urología. Resultados: La profilaxis tromboembólica se debe emplear en aquellas cirugías que requieran abordajes abdominales, encamamiento prolongado o enfermedades oncológicas. Las terapias puente con heparinas de bajo peso molecular deben ser reducidas. Los pacientes en tratamiento crónico se pueden beneficiar de terapias puente en casos concretos. Conclusiones: El empleo de heparinas, tan habitual en la práctica clínica, puede ser excesivo según las guías actuales. La aparición de nuevos fármacos anticoagulantes, los cuales poseen antagonistas directos, permiten la reducción de los tiempos de reintroducción de la medicación crónica y un control más eficaz del sangrado

Introduction: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. Objectives: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. Material and methods: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. Results: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases

Factors related to early castration resistance in metastatic prostate cancer. Results from the National Prostate Cancer Registry in Spain. / Factores relacionados con la resistencia a la castración precoz en el cáncer de próstata metastásico. Resultados del Registro nacional de cáncer de próstata en España.

INTRODUCTION: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. MATERIAL AND METHODS: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). RESULTS: Mean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P<.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p<0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P<.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P<.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02). CONCLUSIONS: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.

Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy. / La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente.

INTRODUCTION: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. OBJECTIVES: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. MATERIAL AND METHODS: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. RESULTS: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases. CONCLUSIONS: According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management.

Radio-223 en la secuencia terapéutica del cáncer de próstata resistente a la castración metastásico / Radium-223 in the therapeutic sequence of metastatic castration-resistant prostate cancer

Contexto: El radio-223 es un emisor de partículas □ con acción específica sobre las metástasis óseas. El estudio ALSYMPCA demostró que el radio-223 prolonga la supervivencia global y retrasa la aparición de eventos óseos en pacientes con cáncer de próstata resistente a la castración con metástasis óseas (CPRCm) sintomáticas y sin metástasis viscerales, con un buen perfil de seguridad. Objetivo: Revisión de la nueva evidencia científica de radio-223 a partir de análisis preespecificados y post hoc del estudio ALSYMPCA y de programas de acceso precoz posteriores a la publicación del estudio ALSYMPCA, con el fin de aportar nuevos datos en el manejo de pacientes con CPRCm. Adquisición de la evidencia: Búsqueda de evidencia en PubMed y en abstracts de congresos de urología y oncología internacionales, así como ensayos clínicos en marcha (ClinicalTrials.gov). Síntesis de la evidencia: Los resultados de los estudios revisados ofrecen resultados prometedores que ampliarían el beneficio terapéutico de radio-223 a pacientes con síntomas leves e incluso asintomáticos. También aportan evidencia preliminar acerca del beneficio del tratamiento con radio-223 tras el fracaso a docetaxel o a enzalutamida o abiraterona o la combinación de radio-223 con estos u otros agentes terapéuticos como los dirigidos al hueso o inmunoterapia. Conclusión: El radio-223 puede ser una opción de tratamiento en pacientes con síntomas leves y aportar un beneficio terapéutico tras el fracaso a tratamientos disponibles en la actualidad o en combinación con estos. Esta evidencia ha de ser corroborada en ensayos clínicos antes de ser incorporados en la práctica clínica

Context: Radium-223 is an -particle transmitter with specific action on bone metastases. The Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) study showed that radium-223 extended overall survival and delayed the onset of bone events in patients with symptomatic castration-resistant prostate cancer with bone metastases (mCRPC) and without visceral metastases, with a good safety profile. Objective: To review the new scientific evidence on radium-223 based on prespecified and post-hoc analyses of the ALSYMPCA study and on early-access programs after the publication of the ALSYMPCA study, thereby providing new data on the management of patients with mCRPC. Acquisition of evidence: We searched for evidence on PubMed and in the abstracts of international urology and oncology congresses, as well as ongoing clinical trials (ClinicalTrials.gov). Synthesis of the evidence: The results of the reviewed studies offer promising results that will broaden the therapeutic benefits of radium-223 to patients with mild symptoms and those with no symptoms. The results also provide preliminary evidence on the benefit of radium-223 treatment after the failure of docetaxel, enzalutamide or abiraterone or the combination of radium-223 with these agents or other therapeutic agents such as bone-targeted agents and immunotherapy. Conclusion: Radium-223 can be a treatment option for patients with mild symptoms and can provide a therapeutic benefit after failure of currently available treatments or in combination with these treatments. This evidence should be corroborated in clinical trials before being added to clinical practice

Eficacia y seguridad de distintas cepas de BCG en el tratamiento del tumor vesical en práctica clínica habitual / Safety and efficacy of various strains of bacille Calmette-Guérin in the treatment of bladder tumours in standard clinical practice

Introducción: La evolución natural del tumor vesical no músculo infiltrante (TVNMI) es la recidiva con elevado porcentaje de progresión. La BCG se ha demostrado eficaz para disminuir estos porcentajes, pero hay pocos estudios comparativos entre cepas. Material y métodos: Registro observacional, prospectivo y multicéntrico, estudiándose 433 pacientes con visita de seguimiento a 12 meses de 961 registrados y evaluado supervivencia libre de enfermedad (SLE), de progresión (SLP) cáncer-específica (SE) y efectos adversos. Se estudiaron las cepas Tice, Russian, Tokyo, Connaught y RIVM. Resultados: Los datos sociodemográficos, antecedentes de TVNMI, comorbilidades, tamaño, número, estadio, grado, CIS asociado y Re-RTU, están bien balanceados. SLE: 85 recidivas (19,6%). La mediana del tiempo de SLE fue 20 meses. Al comparar las diferentes cepas, no se detectaron diferencias estadísticamente significativas (Log-rank test, p = 0,93). SLP: 33 progresiones (7,62%). Al comparar las diferentes cepas, no se detectaron diferencias estadísticamente significativas (Log-rank test, p = 0,69). SE: fallecieron 7 pacientes (1,68%). Al comparar la SE entre las diferentes cepas, no se detectaron diferencias (Log-rank test, p = 0,93). En seguridad, el 33,3% habían presentado algún tipo de efecto adverso, mayoritariamente clínica urinaria baja no ITU < 48h, > 48h y hematuria. Según los Common Toxicity Criteria de la European Organisation for Research and Treatment of Cancer, el 92,7% eran grado 1. No se obtuvieron diferencias estadísticamente significativas relevantes entre cepas. Conclusiones: En este análisis intermedio, el riesgo de recidiva, progresión, muerte específica y seguridad es independiente de la cepa de BCG utilizada

Background: The natural progression of bladder tumours (nonmuscle-invasive bladder cancer [NMIBC]) is recurrence with a high rate of progression. Bacille Calmette-Guérin (BCG) has been shown effective in reducing these rates, but there are few comparative studies between strains. Material and methods: An observational, prospective and multicentre registry studied 433 patients with a 12-month follow-up visit from 961 registered patients, assessing disease-free survival (DFS), progression-free survival (PFS) cancer-specific survival (CSS) and adverse effects. We studied the Tice, Russian, Tokyo, Connaught and RIVM strains. Results: The sociodemographic data, NMIBC history, comorbidities, size, number, stage, grade, associated carcinoma in situ and transurethral resection were well balanced. DFS: There were 85 relapses (19.6%). The median DFS time was 20months. When comparing the various strains, we detected no statistically significant differences (log-rank test; P =.93). LPS: There were 33 cases of progression (7.62%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P = .69). CSS: Seven patients died (1.68%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P = .93). In terms of safety, 33.3% of the patients presented some type of adverse effect, mostly lower urinary symptoms (no urinary tract infections) < 48 h, > 48 h and haematuria. According to the Common Toxicity Criteria of the European Organisation for Research and Treatment of Cancer, 92.7% of the patients were grade 1. There were no statistically significant differences between the strains. Conclusions: In this intermediate analysis, the risk of recurrence, progression, specific death and safety were independent of the BCG strain employed

Seguimiento a largo plazo del cabestrillo AdVance(R)/AdVanceXP(R). ¿Qué piensa el cirujano?, ¿qué piensa el paciente? / Long-term follow-up of the AdVance(R)/AdVanceXP(R) sling. What are the surgeons' impressions? What are the patients'?

Objetivos: Analizar la seguridad, la eficacia y la calidad de vida del paciente con incontinencia urinaria de esfuerzo masculina tras una prostatectomía radical, tratados con el cabestrillo AdVance(R) y AdvanceXP(R). Pacientes y método: Se han incluido en el estudio 92 pacientes con incontinencia urinaria de esfuerzo tras una prostatectomía radical tratados mediante cabestrillo AdVance(R) y AdVanceXP(R) entre mayo de 2008 y diciembre de 2015. Se realizó en todos los casos test de reposición perineal con coaptación esfinteriana ≥ 1,5cm. Se definió incontinencia urinaria de esfuerzo leve como el uso de 1-2 absorbentes/24 h; moderada: 3-5 absorbentes/24 h, y grave más de 5 absorbentes/24 h. Como curación se definió la ausencia total de uso de absorbentes, mejoría cuando la reducción fue mayor del 50% en el número de estos y fracaso cuando la reducción fue menor del 50%, no se obtuvo mejoría o se produjo un empeoramiento de la incontinencia. Se realizaron controles a los 3, 12 y 36 meses tras la cirugía. El índice de calidad de vida utilizado fue el International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Las complicaciones se reflejaron según la clasificación de Clavien-Dindo. Resultados: El grado de incontinencia preoperatoria fue de tipo leve en el 23,9%, moderada en el 67,4% y grave en el 8,7%. El uso medio de absorbentes preoperatorio fue de 3,1 (rango 1-6, IC 95%). La puntuación media preoperatoria del test ICIQ-SF fue de 16,5 (15-20). La coaptación esfinteriana ≥ 1,5cm mediante el test de reposicionamiento perineal estaba presente en 87 pacientes (94,6%). El seguimiento medio desde la inserción del cabestrillo fue de 42,1 meses. El porcentaje de pacientes curados a los 3 meses fue del 89,1%, a los 12 meses del 70,7% y a los 36 meses del 70,4%. La puntuación del ICQ-SF a los 3, 12 y 36 meses mostró una mejoría significativa (p < 0,001) respecto a la puntuación preoperatoria. Conclusiones: Los sistemas Advance(R) y AdvanceXP(R) se muestran eficaces en el tiempo en cuanto a la continencia urinaria y la satisfacción del paciente

Objectives: To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance(R) and AdvanceXP(R) slings. Patients and method: The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVanc(R) and AdVanceXP(R) sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of ≥ 1.5 cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24 h; moderate was defined as 3-5 absorbers/24 h; and severe was defined as more than 5 absorbers/24 h. Healing was defined as the total absence of using pads; improvement was defined as a reduction > 50% in the number of pads; and failure was defined as a reduction < 50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. Results: The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation ≥ 1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P < .001) compared with the preoperative score. Conclusions: The Advance(R) and AdvanceXP(R) system are effective over time in terms of urinary continence and patient satisfaction

Nuevo escenario conceptual en el cáncer de próstata avanzado / New conceptual framework in advanced prostate cancer

No disponible

Safety and efficacy of various strains of bacille Calmette-Guérin in the treatment of bladder tumours in standard clinical practice. / Eficacia y seguridad de distintas cepas de BCG en el tratamiento del tumor vesical en práctica clínica habitual.

BACKGROUND: The natural progression of bladder tumours (nonmuscle-invasive bladder cancer [NMIBC]) is recurrence with a high rate of progression. Bacille Calmette-Guérin (BCG) has been shown effective in reducing these rates, but there are few comparative studies between strains. MATERIAL AND METHODS: An observational, prospective and multicentre registry studied 433 patients with a 12-month follow-up visit from 961 registered patients, assessing disease-free survival (DFS), progression-free survival (PFS) cancer-specific survival (CSS) and adverse effects. We studied the Tice, Russian, Tokyo, Connaught and RIVM strains. RESULTS: The sociodemographic data, NMIBC history, comorbidities, size, number, stage, grade, associated carcinoma in situ and transurethral resection were well balanced. DFS: There were 85 relapses (19.6%). The median DFS time was 20months. When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). LPS: There were 33 cases of progression (7.62%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.69). CSS: Seven patients died (1.68%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). In terms of safety, 33.3% of the patients presented some type of adverse effect, mostly lower urinary symptoms (no urinary tract infections) <48h, >48h and haematuria. According to the Common Toxicity Criteria of the European Organisation for Research and Treatment of Cancer, 92.7% of the patients were grade1. There were no statistically significant differences between the strains. CONCLUSIONS: In this intermediate analysis, the risk of recurrence, progression, specific death and safety were independent of the BCG strain employed.

Radium-223 in the therapeutic sequence of metastatic castration-resistant prostate cancer. / Radio-223 en la secuencia terapéutica del cáncer de próstata resistente a la castración metastásico.

CONTEXT: Radium-223 is an □ -particle transmitter with specific action on bone metastases. The Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) study showed that radium-223 extended overall survival and delayed the onset of bone events in patients with symptomatic castration-resistant prostate cancer with bone metastases (mCRPC) and without visceral metastases, with a good safety profile. OBJECTIVE: To review the new scientific evidence on radium-223 based on prespecified and post-hoc analyses of the ALSYMPCA study and on early-access programs after the publication of the ALSYMPCA study, thereby providing new data on the management of patients with mCRPC. ACQUISITION OF EVIDENCE: We searched for evidence on PubMed and in the abstracts of international urology and oncology congresses, as well as ongoing clinical trials (ClinicalTrials.gov). SYNTHESIS OF THE EVIDENCE: The results of the reviewed studies offer promising results that will broaden the therapeutic benefits of radium-223 to patients with mild symptoms and those with no symptoms. The results also provide preliminary evidence on the benefit of radium-223 treatment after the failure of docetaxel, enzalutamide or abiraterone or the combination of radium-223 with these agents or other therapeutic agents such as bone-targeted agents and immunotherapy. CONCLUSION: Radium-223 can be a treatment option for patients with mild symptoms and can provide a therapeutic benefit after failure of currently available treatments or in combination with these treatments. This evidence should be corroborated in clinical trials before being added to clinical practice.

Long-term follow-up of the AdVance®/AdVanceXP® sling. What are the surgeons' impressions? What are the patients'? / Seguimiento a largo plazo del cabestrillo AdVance®/AdVanceXP®. ¿Qué piensa el cirujano?, ¿qué piensa el paciente?

OBJECTIVES: To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdvanceXP® slings. PATIENTS AND METHOD: The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdVanceXP® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. RESULTS: The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. CONCLUSIONS: The Advance® and AdvanceXP® system are effective over time in terms of urinary continence and patient satisfaction.

La quimioterapia no debería todavía ser considerada en los pacientes con cáncer de próstata metastásico hormonosensible / Chemotherapy should not yet be considered in patients with hormono-sensitive metastatic prostate cáncer

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Documento de consenso sobre pautas de actuación y seguimiento del varón con síntomas del tracto urinario inferior secundarios a hiperplasia prostática benigna / Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia

La hiperplasia benigna de próstata (HBP) es una patología con una alta incidencia. Su diagnóstico y tratamiento son compartidos entre urólogos y médicos de atención primaria. Su manejo consume una enorme cantidad de recursos. La Sociedad Española de Médicos de Atención Primaria (SEMERGEN), la Sociedad Española de Médicos Generales y de Familia (SEMG), la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) y la Asociación Española de Urología (AEU) han elaborado un documento sobre pautas de actuación y seguimiento de la HBP, presentado aquí de manera resumida, en el que se pretende actualizar las guías anteriormente publicadas, en base a las últimas evidencias. Estas nuevas recomendaciones tienen como objetivo principal sensibilizar al médico de atención primaria y ayudarle en la evaluación diagnóstica, el tratamiento y el seguimiento, además de aportar criterios unificados y consensuados de derivación al segundo nivel asistencial (AU)

Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level (AU)

Influencia de las variables demográficas y tumorales en el tratamiento del cáncer de próstata con fines curativos en España. Resultados del Registro nacional de cáncer de próstata 2010 / Influence of demographic and tumour variables on prostate cancer treatment with curative intent in Spain. Results of the 2010 national prostate cancer registry

Objetivo: El objetivo del estudio es conocer qué criterios oncológicos y demográficos influyen en la indicación de cirugía (prostatectomía radical) o de radioterapia (externa o braquiterapia) en el tratamiento del cáncer de próstata. Material y métodos: Análisis de 2.714 pacientes del Registro nacional de cáncer de próstata de 2010 tratados con fines curativos. Las variables que se analizaron fueron la edad, el PSA, el volumen prostático, el número de cilindros biopsiados, el porcentaje de cilindros positivos, el estadio, la puntuación de Gleason, el tipo de patólogo, la existencia de invasión perineural y el centro de estudio. Analizamos la asociación de estas variables y el tipo de tratamiento (cirugía vs radioterapia/braquiterapia) mediante análisis univariante («t» de Student y Chi cuadrado) y una regresión logística múltiple binaria. Resultados: El 48,12% de los pacientes (1.306/2.714) fueron tratados con cirugía y el 51,88% (1.408/2.714) con radioterapia/braquiterapia. Se observaron diferencias entre los pacientes tratados mediante prostatectomía y con radioterapia/braquiterapia (p < 0,05) en la edad (63,50 ± 6,5 vs 69,0 ± 6,7), el PSA (8,76 ± 16,97 vs 13,21 ± 15,88), los cilindros biopsiados, el porcentaje de cilindros positivos (30,0 ± 22 vs 38,7 ± 29), el Gleason (G6: 53,9% vs 46,1%; G7: 45% vs 55% G8-10: 26,6%, 73,4%), el estadio (localizado: 50% vs 50%; localmente avanzado: 14,6% vs 85,4%), la invasión perineural y el centro hospitalario. En el análisis multivariante las variables independientes seleccionadas fueron edad, PSA, porcentaje de cilindros positivos, estadio, Gleason y centro hospitalario. Conclusión: Según nuestro estudio, en la elección del tratamiento curativo del cáncer de próstata parece influir la edad, la agresividad y estadio del tumor y el centro donde va a ser tratado el paciente

Objective: The aim of this study is to determine which cancer and demographic criteria influence the indication for surgery (radical prostatectomy) or radiation therapy (external or brachytherapy) in the treatment of prostate cancer. Material and methods: An analysis of the 2714 patients of the 2010 National Prostate Cancer Registry treated with curative intent. The analysed variables were age, prostate-specific antigen (PSA), prostate volume, the number of biopsy cores, the percentage of positive cores, the stage, Gleason score, the type of pathologist, the presence of perineural invasion and the study centre. We analysed the association among these variables and the type of treatment (surgery vs. radiation therapy/brachytherapy), using a univariate analysis (Student's t test and chi-squared) and a binary multiple logistic regression. Results: The 48.12% of the patients (1306/2714) were treated with surgery, and 51.88% (1,408/2,714) underwent radiation therapy/brachytherapy. Differences were observed between the patients treated with prostatectomy and those treated with radiation therapy/brachytherapy (p < .05) in age (63.50 ± 6.5 vs. 69.0 ± 6.7), PSA (8.76 ± 16.97 vs. 13.21 ± 15.88), biopsied cores, percentage of positives cores (30.0 ± 22 vs. 38.7 ± 29), Gleason score (G6: 53.9% vs. 46.1%; G7: 45% vs. 55% G8-10: 26.6%, 73.4%), stage (localised: 50% vs. 50%; locally advanced: 14.6% vs. 85.4%), perineural invasion and hospital centre. In the multivariate analysis, the selected independent variables were age, PSA, percentage of positives cores, stage, Gleason score and hospital centre. Conclusion: According to our study, age, tumour aggressiveness and stage and the centre where the patient will be treated affect the selection of curative treatment for prostate cancer

[Low and intermediate risk prostate cancer: Treatment options]. / Cáncer de próstata de bajo riesgo e intermedio: opciones de tratamiento.

Patients with low and intermediate risk prostate cancer are the most frequently diagnosed group currently. In those with a life expectancy inferior to 10 years it is highly likely that treatment is not necessary so that observation must be the most appropriate approach. In patients in whom active therapy, in any of its forms, is indicated, it is necessary to balance between risk of dying or developing metastases from the disease and adverse effects of commonly accepted radical treatments, such as radical prostatectomy and external beam or interstitial radiotherapy. The significant incidence of associated morbidity, mainly erectile dysfunction and urinary incontinence, with high impact on quality of life, demands this approach in the field of decisions shared with patients. The risk of overtreatment in this group of patients has generated the introduction of more conservative approaches such as active surveillance and focal therapy. The first one tries to differ radical treatments as far as there are not enough aggressiveness criteria on the tumor or the patient requests them. The second, called to have a place between active surveillance and radical treatments, involves the performance of a partial ablation of the prostate to avoid the adverse effects of radical treatments, trying to achieve the closest oncological control to the radical options. We perform a review of the therapeutic options and their results in this type of patients.

Influence of demographic and tumour variables on prostate cancer treatment with curative intent in Spain. Results of the 2010 national prostate cancer registry. / Influencia de las variables demográficas y tumorales en el tratamiento del cáncer de próstata con fines curativos en España. Resultados del Registro nacional de cáncer de próstata 2010.

OBJECTIVE: The aim of this study is to determine which cancer and demographic criteria influence the indication for surgery (radical prostatectomy) or radiation therapy (external or brachytherapy) in the treatment of prostate cancer. MATERIAL AND METHODS: An analysis of the 2714 patients of the 2010 National Prostate Cancer Registry treated with curative intent. The analysed variables were age, prostate-specific antigen (PSA), prostate volume, the number of biopsy cores, the percentage of positive cores, the stage, Gleason score, the type of pathologist, the presence of perineural invasion and the study centre. We analysed the association among these variables and the type of treatment (surgery vs. radiation therapy/brachytherapy), using a univariate analysis (Student's t test and chi-squared) and a binary multiple logistic regression. RESULTS: The 48.12% of the patients (1306/2714) were treated with surgery, and 51.88% (1,408/2,714) underwent radiation therapy/brachytherapy. Differences were observed between the patients treated with prostatectomy and those treated with radiation therapy/brachytherapy (p<.05) in age (63.50±6.5 vs. 69.0±6.7), PSA (8.76±16.97 vs. 13.21±15.88), biopsied cores, percentage of positives cores (30.0±22 vs. 38.7±29), Gleason score (G6: 53.9% vs. 46.1%; G7: 45% vs. 55% G8-10: 26.6%, 73.4%), stage (localised: 50% vs. 50%; locally advanced: 14.6% vs. 85.4%), perineural invasion and hospital centre. In the multivariate analysis, the selected independent variables were age, PSA, percentage of positives cores, stage, Gleason score and hospital centre. CONCLUSION: According to our study, age, tumour aggressiveness and stage and the centre where the patient will be treated affect the selection of curative treatment for prostate cancer.

Hiperplasia prostática benigna y síntomas del tracto urinario inferior. Revisión de las evidencias actuales / Benign prostatic hyperplasia and lower urinary tract symptoms. A review of current evidence

Contexto: El tratamiento de la hiperplasia benigna de próstata (HBP) está cambiando debido a un mayor conocimiento de la enfermedad y al desarrollo del concepto funcional de los síntomas del tracto urinario inferior (STUI). Objetivos: Exponer la situación actual en el ámbito de la HBP incluyendo el diagnóstico y tratamiento de los STUI. Adquisición de la evidencia: Se resumen los temas presentados y debatidos por un grupo de urólogos expertos durante el i Congreso UROVI, auspiciado por la Asociación Española de Urología. Los STUI engloban síntomas de llenado, de vaciado y posmiccionales que afectan a la calidad de vida de los pacientes. El diagnóstico etiológico es importante para poder iniciar el tratamiento más idóneo. Por este motivo, se hacen necesarias alternativas terapéuticas nuevas, tanto farmacológicas como quirúrgicas, que permitan abordar de manera individualizada la sintomatología en los diferentes perfiles de pacientes. Se dispone de una nueva combinación de fármacos, solifenacina 6 mg y TOCAS 0,4 mg, para el tratamiento de los síntomas de llenado de moderados a graves y de los síntomas de vaciado asociados a HBP en pacientes que no responden al tratamiento en monoterapia. Asimismo, las nuevas técnicas quirúrgicas, cada vez menos invasivas, permiten intervenir a pacientes de mayor edad y con elevada comorbilidad. Conclusiones: La disponibilidad de agentes farmacológicos capaces de actuar sobre los diferentes STUI permite integrar el paradigma anatomofisiopatológico con el funcional para proporcionar el tratamiento más adecuado a nuestros pacientes

Context: The treatment of benign prostatic hyperplasia (BPH) is changing due to a greater understanding of the disease and the development of the functional concept of lower urinary tract symptoms (LUTS). Objectives: To describe the current state of BPH and the diagnosis and treatment of LUTS. Acquisition of evidence: We summarise the issues presented and debated by a group of expert urologists during the First UROVI Congress, sponsored by the Spanish Urological Association. Summary of the evidence: LUTS encompasses filling, voiding and postvoiding symptoms that affect patients’ quality of life. The aetiological diagnosis is an important element in starting the most ideal treatment. For this reason, new alternative therapies (both pharmacological and surgical) are needed to help individually address the symptoms in the various patient profiles. There is now a new combination of drugs (6 mg of solifenacin and 0.4 mg of the tamsulosin oral controlled absorption system) for treating moderate to severe filling symptoms and emptying symptoms associated with BPH in patients who do not respond to monotherapy. Furthermore, new surgical techniques that are increasingly less invasive help provide surgical options for older patients and those with high comorbidity. Conclusions: The availability of drugs that can act on the various LUTS helps integrate the pathophysiological paradigm into the functional one, providing more appropriate treatment for our patients