SEOM clinical guidelines for treatment of prostate cancer

Prostate cancer (PC) is the most common cancer in men. Many patients have prolonged survival and die of other diseases, so treatment decisions are often influenced by age and coexisting comorbidities. The main procedure to diagnose PC is an ultrasound-guided core needle biopsy, which is indicated when a digital rectal examination (DRE) finds nodularity or when PSA is >10 ng/ml, but is also recommended with PSA between 4.0 and 10 ng/ml. Depending on age, PSA, Gleason score and characteristics of the tumour, treatment options for localised PC are active surveillance, radical prostatectomy and radiation therapy. Androgen deprivation treatment (ADT) should be added to radiotherapy for men with intermediate- or high-risk PC. ADT is the current standard first-line treatment for metastatic PC. Castration-resistant PC is a heterogeneous entity. Several treatments such as sipuleucel-T, docetaxel-based chemotherapy, radium 223, cabazitaxel or abiraterone plus prednisone, zoledronic and denosumab, are useful for this situation (AU)

[The clinico-mammographic follow-up of breast cancer after conservative treatment]. / Seguimiento clínico-mamográfico del cáncer de mama tras tratamiento conservador.

Clinical and mammographic follow-up of 149 patients diagnosed of stage I and II breast neoplasm and treated with conservative surgery and irradiation between January 1986 and December 1988 was reviewed to determine clinical and radiographic recurrence pattern. Follow-up controls included a clinical examination and a mammogram at 6-9 months, a second at 10-16, a third at 17-22, a fourth at 23-24 and a mammogram yearly and a clinical examination every 6 months thereafter. To December 1991 18 patients recurred. 12 had a metastatic spread, 3 a unique local recurrence and 3 a local recurrence with a metastasis spread. Clinical recurrence was as a carcinomatous mastitis in three patients and a solid nodule in two. Radiologic recurrence was as an augmented skin thickness in three patients. Mammogram was not performed in one patient because an associated poor prognostic metastatic spread. Mammographic skin thickness secondary to irradiation appeared in 93% of the patients at 6-9 first control, 62% at second, 50% at third and 35% at fourth. The number of recurrences is scarce to achieve any clinical, pathological or treatment factor associated with greater risk of recurrence. We suggest that first mammogram should be delayed after 12 months of treatment because we would not obtain any relevant clinical information before, once observed skin thickness persistence at 6 months and most frequent recurrence radiologic pattern.

Intensive chemotherapy in poor-prognosis nonseminomatous germ cell tumors of the testis.

Forty-one patients with poor-prognosis nonseminomatous germ cell tumors (NSGCT) of the testis were treated between 1980 and 1989. This group was defined by the presence of one of the following features: multiple large lung metastases, bone, liver or brain metastases, abdominal mass greater than 10 cm, abdominal mass greater than 5 cm with high serum concentration of the tumor markers [alpha-fetoprotein (alpha FP) greater than 500 kU/l or beta-subunit of human chorionic gonadotropin (beta HCG) greater than 1,000 IU/l) or very high serum tumor marker concentrations (alpha FP greater than 5,000 kU/l or beta HCG greater than 10,000 IU/l). The first 21 patients were treated with cisplatin, vinblastine, bleomycin (PVB) chemotherapy and the following 20 with an intense, alternating 6-drug chemotherapy consisting of cisplatin, bleomycin, vincristine, methotrexate, etoposide and ifosfamide (BOMP/EPI). Surgery of residual masses was performed when tumor markers were negative. Fifteen patients (71.4%) in the PVB group and 18 patients (85%) in the BOMP/EPI group remained disease-free at a median follow-up of 67 and 41 months, respectively. None of the resected masses in the BOMP/EPI group contained malignant disease whereas viable carcinoma was found in 5 of 14 (26.4%) patients in the PVB group. The toxicity of the BOMP/EPI regimen was severe but tolerable. Intensive chemotherapy regimen seems to be useful in this subset of patients, but randomised prospective trials comparing these with standard chemotherapy are necessary.

[Follow-up of patients with localized germinal testicular tumors: 6 years' experience at the "Santa Creu i Sant Pau" Hospital]. / Seguimiento en pacientes con tumores germinales de testículo localizado: seis años de experiencia del Hospital de la "Santa Creu i Sant Pau".

From 1984 to 1989, 89 patients with stage I testicular carcinoma had been treated and followed at the Oncology Unit of the "Santa Creu i Sant Pau" Hospital. The histologic diagnosis was that of seminoma in 53 and nonseminomatous tumor in 36 patients. Treatment considered of inguinal orchidectomy and close clinical surveillance. Eight of the patients that had been diagnosed as having seminoma received adjuvant radiotherapy since follow-up could not be possible. Recurrence was observed in 5 of the 45 (11 por 100) patients with seminoma and 11 of the 36 (31 por 100) with nonseminomatous tumor that could be followed. All recurrences received chemotherapy (cisplatin and etoposide) which achieved complete remission. All of the patients are currently tumor-free after a mean follow-up of 34 months for the patients with seminoma, 39 months for those with nonseminomatous tumor and no recurrence, and 20 months for the nonseminomatous tumors that had recurred. Surveillance following orchidectomy for stage I testicular tumors is a valid approach if the patient can be followed correctly and achieves the same results as other more aggressive therapeutic strategies.

[The modification of the toxicity produced by chemotherapy in testicular cancer by adapting its intensity to prognostic groups]. / Modificación de la toxicidad producida por la quimioterapia en el cáncer de testículo al adecuar su intensidad a los grupos pronósticos.

BACKGROUND: The reduction of iatrogenesis is fundamental in the treatment of germ-cell testicular tumors (GTT) because of the high incidence of cures achieved. On the other hand, the tumoral mass and the serum concentration of the beta fraction of the gonadotropin hormone (CGH) and of alphafetoprotein allow the differentiation of 2 clear prognostic groups; those for which the intensity of chemotherapy may be adapted to reduce its collateral effects and improve the results. METHODS: In the Oncology Department of the Hospital de la Santa Creu i Sant Pau 23 patients with GTT of good prognosis were treated between 1984-1990. These patients were given the combination of etoposide-cisplatin (EP) over the same period. Twenty patients with a bad prognosis received the alternative scheme of bleomycin-vincristine-methotrexate-cisplatin/etoposide-cisplatin- phosphamide (BOMP/EPI). RESULTS: In comparison to the classical treatment with cisplatin-vinblastine-bleomycin (PVB) the EP association demonstrated less iatrogenesis except in regards to the formation of granulocytopenia which was higher. The BOM/EPI combination conditioned greater hematological toxicity during the acute phase and the first observations suggested a diminution of chronic iatrogenesis. CONCLUSIONS: These results indicate that chemotherapy in testicular cancer may be adapted to the aggressiveness of the with the aim to thereby reduce global toxicity.