Clinical and histological predictive factors of reclassification of prostate cancer patients on active surveillance.

INTRODUCTION AND OBJECTIVE: Active surveillance (AS) has been established as a therapeutic strategy in patients with low-risk prostate cancer. Demographic and anatomopathological factors that increase the probability of reclassifying patients have been identified. MATERIALS AND METHODS: Laboratory and histopathological data were collected from 116 patients included on AS since 2014. Univariate analysis was performed with Chi-square, t-student and Kendall's Tau, multivariate analysis according to logistic regression and Kaplan-Meier curves were calculated. RESULTS: Of the 116 patients in AS, the median age at diagnosis was 66 years and the median follow-up was 13 months (2-72). Of these, 61 (52.6%) are still on surveillance, while 55 (47.4%) have left the program, mostly due to histological progression (52 patients (45.2%)); radical prostatectomy was performed in 27 (49.1%). Prostate volume (PV)≤60cc and the number of positive cylinders >1 in diagnostic biopsy (P=.05) were associated with higher reclassification rate in univariate analysis (P<.05). Multivariate analysis showed that these two variables significantly correlated with higher reclassification rate (PV 60 cc: OR 4.39, P=.04; >1 positive cylinder at diagnostic biopsy: OR 2.48, P=.03). CONCLUSIONS: It has been shown that initial ultrasound volume and the number of positive cylinders in the diagnostic biopsy are independent risk factors for reclassification. Initial PSA, laterality of the affected cylinders and PSA density were not predictive factors of progression in our series.

Factores clínicos e histológicos predictores de reclasificación en pacientes incluidos en programa de vigilancia activa de cáncer de próstata / Clinical and histological predictive factors of reclassification of prostate cancer patients on active surveillance

Introducción y objetivo La vigilancia activa (VA) se ha establecido como estrategia terapéutica en pacientes con cáncer de próstata de bajo riesgo. Se han identificado factores demográficos y anatomopatológicos que aumentan la probabilidad de reclasificar a los enfermos. Materiales y métodos Se han recogido datos analíticos e histopatológicos de 116 pacientes incluidos en VA desde 2014. Se ha realizado un análisis univariante con X2, t de Student y Tau de Kendall, un análisis multivariante según regresión logística y se han calculado las curvas de Kaplan-Meier. Resultados De los 116 pacientes en VA, la mediana de edad al diagnóstico fue 66 años y la mediana de seguimiento fueron 13 meses (2-72). De todos ellos, 61 (52,6%) siguen en vigilancia mientras que 55 (47,4%) han salido del programa, la mayoría por progresión histológica (52 pacientes [45,2%]), realizándose prostatectomía radical en 27 (49,1%). El volumen prostático (Vp) ≤ 60cc y el número de cilindros positivos >1 en la biopsia diagnóstica (p = 0,05) se asociaron con mayor tasa de reclasificación en el análisis univariante (p < 0,05). En el análisis multivariante, estas dos variables se correlacionaron significativamente con una mayor tasa de reclasificación (Vp ≤ 60 cc: OR 4,39, p = 0,04; >1 cilindro positivo en la biopsia diagnóstica: OR 2,48, p = 0,03). Conclusiones Se ha objetivado que el volumen ecográfico inicial y el número de cilindros positivos en la biopsia diagnóstica son factores de riesgo independientes para la reclasificación. El antígeno prostático específico (PSA) inicial, la lateralidad de los cilindros afectos y la densidad de PSA no fueron elementos predictores de progresión en nuestra serie (AU)

Introduction and Objective Active surveillance (AS) has been established as a therapeutic strategy in patients with low-risk prostate cancer. Demographic and anatomopathological factors that increase the probability of reclassifying patients have been identified. Materials and Methods Laboratory and histopathological data were collected from 116 patients included on AS since 2014. Univariate analysis was performed with Chi-square, t-student and Kendall's Tau, multivariate analysis according to logistic regression and Kaplan-Meier curves were calculated. Results Of the 116 patients in AS, the median age at diagnosis was 66 years and the median follow-up was 13 months (2-72). Of these, 61 (52.6%) are still on surveillance, while 55 (47.4%) have left the program, mostly due to histological progression (52 patients (45.2%)); radical prostatectomy was performed in 27 (49.1%). Prostate volume (PV) ≤ 60cc and the number of positive cylinders > 1 in diagnostic biopsy (p = 0.05) were associated with higher reclassification rate in univariate analysis (p < 0.05). Multivariate analysis showed that these two variables significantly correlated with higher reclassification rate (PV 60 cc: OR 4.39, p = 0.04; > 1 positive cylinder at diagnostic biopsy: OR 2.48, p = 0.03). Conclusions It has been shown that initial ultrasound volume and the number of positive cylinders in the diagnostic biopsy are independent risk factors for reclassification. Initial PSA, laterality of the affected cylinders and PSA density were not predictive factors of progression in our series (AU)

Efecto apoptótico como biomarcador de enfermedad, severidad y seguimiento en la cistitis intersticial / Apoptotic effect as biomarker of disease, severity and follow-up in interstitial cystitis

Objetivo: Estudiar si el test de efecto apoptótico podría servir como biomarcador de severidad en el síndrome de dolor vesical/cistitis intersticial. Material y métodos: Se realizó un estudio prospectivo entre enero de 2010 y enero de 2015, se incluyeron 57 pacientes diagnosticadas de cistitis intersticial y 49 de dolor pélvico crónico de origen ginecológico. Se expuso la orina a cultivos celulares y se analizó su capacidad para inducir apoptosis en ellos. Posteriormente se llevó acabó un análisis estadístico para valorar si el efecto apoptótico se asociaba con la sintomatología. Resultados: Al realizar un análisis de la asociación entre el grado del efecto apoptótico y la sintomatología de las pacientes con cistitis intersticial, se observó un aumento significativo de los porcentajes medios de apoptosis a medida que aumenta el grado de severidad sintomatológica. Al analizar la asociación entre el efecto apoptótico y la sintomatología, se obtuvo una correlación positiva en los pacientes con cistitis intersticial y una ausencia de correlación en los pacientes con dolor pélvico crónico de origen ginecológico. Los porcentajes de apoptosis aumentan de manera progresiva en las pacientes con cistitis intersticial a medida que presentan mayor sintomatología mientras que los pacientes con dolor pélvico crónico de origen ginecológico permanecen estables. Conclusiones: El efecto apoptótico de la orina de pacientes con cistitis intersticial podría ser un marcador de enfermedad, permitiendo diferenciar las pacientes afectas de cistitis intersticial de pacientes con dolor pélvico crónico y además poder tener una medida objetiva del grado de severidad de los síntomas

Objective: To determine whether the apoptotic effect test could serve as a biomarker of severity in bladder pain syndrome/interstitial cystitis. Material and methods: A prospective study was conducted between January 2010 and January 2015, which included 57 patients diagnosed with interstitial cystitis and 49 diagnosed with chronic pelvic pain of gynaecological origin. The urine was exposed to cell cultures, and the urine's capacity for inducing apoptosis in the cultures was analysed. A statistical analysis was then conducted to assess whether the apoptotic effect was associated with the symptoms. Results: After performing an analysis of the association between the degree of apoptotic effect and the symptoms of patients with interstitial cystitis, we observed a significant increase in the mean percentages of apoptosis as the degree of symptom severity increased. After analysing the association between the apoptotic effect and symptoms, we obtained a positive correlation in the patients with interstitial cystitis and a lack of correlation in the patients with chronic pelvic pain of gynaecological origin. The rates of apoptosis increased progressively in the patients with interstitial cystitis as the symptoms increased, while the patients with chronic pelvic pain of gynaecological origin remained stable. Conclusions: The apoptotic effect of the urine of patients with interstitial cystitis could be a marker of disease, thus differentiating patients with interstitial cystitis from patients with chronic pelvic pain. The effect could also provide an objective measure of symptom severity

Apoptotic effect as biomarker of disease, severity and follow-up in interstitial cystitis. / Efecto apoptótico como biomarcador de enfermedad, severidad y seguimiento en la cistitis intersticial.

OBJECTIVE: To determine whether the apoptotic effect test could serve as a biomarker of severity in bladder pain syndrome/interstitial cystitis. MATERIAL AND METHODS: A prospective study was conducted between January 2010 and January 2015, which included 57 patients diagnosed with interstitial cystitis and 49 diagnosed with chronic pelvic pain of gynaecological origin. The urine was exposed to cell cultures, and the urine's capacity for inducing apoptosis in the cultures was analysed. A statistical analysis was then conducted to assess whether the apoptotic effect was associated with the symptoms. RESULTS: After performing an analysis of the association between the degree of apoptotic effect and the symptoms of patients with interstitial cystitis, we observed a significant increase in the mean percentages of apoptosis as the degree of symptom severity increased. After analysing the association between the apoptotic effect and symptoms, we obtained a positive correlation in the patients with interstitial cystitis and a lack of correlation in the patients with chronic pelvic pain of gynaecological origin. The rates of apoptosis increased progressively in the patients with interstitial cystitis as the symptoms increased, while the patients with chronic pelvic pain of gynaecological origin remained stable. CONCLUSIONS: The apoptotic effect of the urine of patients with interstitial cystitis could be a marker of disease, thus differentiating patients with interstitial cystitis from patients with chronic pelvic pain. The effect could also provide an objective measure of symptom severity.

Study of the apoptotic effect of urine as a diagnostic biomarker in patients with interstitial cystitis. / Estudio del efecto apoptótico de la orina de pacientes con cistitis intersticial como biomarcador diagnóstico.

INTRODUCTION: The main objective of the study was to assess the apoptotic effect of urine from patients with interstitial cystitis (IC) in cell cultures and to study its value as a diagnostic biomarker for IC. MATERIAL AND METHODS: A prospective study was conducted between January 2010 and January 2015 and included 57 patients diagnosed with IC and 50 healthy patients from the Hospital Clinic of Barcelona and the La Paz University Hospital. The urine of these patients was exposed to cell cultures, and its ability to induce apoptosis in the cultures was analysed. Using flow cytometry, we then measured the degree of apoptosis, quantified by the percentage of cells of the cell cycle in phase sub G0. RESULTS: The cell cultures exposed to the urine of patients with IC had a sub G1 peak and a G2 phase, which was significantly greater than that of the control group, and a significantly lower percentage in the S phase than the control group. The mean apoptosis values in the urine cultures from patients with IC were significantly higher than those of the control group. Using a value >10% of the apoptosis test as a positive result, we observed a specificity of 96% and a positive predictive value of 92%. CONCLUSIONS: The urine of patients with IC exerts an apoptotic effect on tumour cell cultures that is significantly greater than that exerted by the urine of healthy control patients. A≥10% cutoff for the apoptosis test presented very low sensitivity (40%) but had a very high specificity (96%), thereby able to confirm the diagnosis of IC when positive.

Topical EMLA for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized, double-blind study.

Patient collaboration in external shock wave lithotripsy (ESWL) is critical for its correct application, making proper analgesic selection indispensable. The aim of this study was to evaluate the efficacy of combined application of EMLA and intravenous (i.v.) pethidine compared with pethidine plus placebo cream in patients undergoing ESWL for ureteral and/or renal lithiasis. Prospective, controlled, randomized, double-blind study was conducted in patients receiving ESWL for renal and/or ureterolithiasis. The patients were randomly assigned to receive i.v. pethidine plus either EMLA cream (group A) or placebo hydrating cream (group B). Evaluated were type, location, and size of lithiasis, patient's sex, age, body mass index, comorbidity, Visual Analogue Scale (VAS) score of pain, and degree of lithiasis fragmentation. EMLA cream provided significantly better pain relief and lithiasis fragmentation and more completed ESWL treatment. Topical application of EMLA cream combined with i.v. pethidine improved VAS scores and lithiasis fragmentation and decreased the rate of withdrawal from ESWL procedure versus i.v. pethidine plus placebo therapy.

Prognostic nomogram for disease-free survival in patients with renal adenocarcinoma.

OBJECTIVE: The aim of this study was to develop a postoperative prognostic nomogram for disease-free survival in patients with renal adenocarcinoma. MATERIALS AND METHODS: A total of 224 patients with organ-confined or locally advanced renal adenocarcinoma were treated with radical or partial nephrectomy. The variables included in the model were age, histological type, pathological stage, Fuhrman grade and DNA ploidy. Tumor recurrence was defined as any clinical evidence of recurrence. The probability of progression-free survival was calculated using the Kaplan-Meier estimate, and multivariate analysis was performed using a Cox regression. The nomogram was created using the data obtained from the Cox regression. RESULTS: Tumor recurrence was detected in 89 patients (39.74%). The median progression-free time in these patients was 9.55 months (range 0-133). Of these patients, 70.9% relapsed during the first 2 years, and only 15 patients (6.9%) were alive but ill at the end of the study. The probability of progression-free survival at 5 and 10 years was 66.64 and 61.97%, respectively. We performed a statistical validation of the model with accurate predictions that were discriminated with a confidence interval of 0.75 (comparing the predicted and actual probability). According to the nomogram obtained, patients with low-grade, diploid, organ-confined tumors would be candidates for follow-up not exceeding 5 years due to the low probability of recurrence (<40 points). CONCLUSION: The nomogram we developed is clinically relevant and can provide prognostic information for both patients and researchers. In addition, it can be used by researchers during the monitoring protocols that categorize patients based on their relative risk of disease progression.

In vivo aneuploidization during the expansion of renal adenocarcinoma.

BACKGROUND/AIMS: A correlation has been observed between DNA ploidy and other prognostic parameters such as tumor stage and grade. The present study evaluates tumor aneuploidization during renal adenocarcinoma expansion and growth. METHODS: A total of 252 renal tumors were analyzed between 1969 and 2001. Evaluated variables were age, TNM, Fuhrman classification, histology, size and DNA. A tumor was homogeneous when all the samples were diploid or aneuploid, and a heterogeneous tumor was the coexistence of aneuploid and diploid samples, or all-aneuploid with different aneuploid clones. RESULTS: A total of 224 tumors were included (coefficient of variation <8). The DNA study classified 129 (57.6%) as diploid and 95 (42.4%) as aneuploid. The percentage of aneuploid tumors increased significantly with the pathological stage. Both aneuploid patterns were also significantly more frequent in advanced pathological stages. Tumors with multiple aneuploid clones (n = 17) were significantly more frequent in tumors measuring `4 cm. Both aneuploid patterns showed no differences in survival (p = 0.83), indicating that the heterogeneous pattern probably represents an intermediate step between diploid and homogeneous aneuploid tumor status. CONCLUSIONS: The aneuploid pattern is more common in more advanced stages of the disease, with no clear correlation to primary tumor size. This suggests gradual aneuploidization with tumor expansion and growth.

[De novo urological neoplasms in kidney transplant patients: experience in 1,751 patients]. / Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes.

INTRODUCTION: Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. OBJECTIVE: To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. MATERIALS AND METHODS: A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. RESULTS: Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2-121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17-70) years, and median age at tumor diagnosis was 56.4 (19-79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. CONCLUSIONS: In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.

Características clínicas e histopatológicas del cáncer de próstata diagnosticado a partir de la tercera biopsia / Clinicla features and histopathology of prostate cancer diagnosed from the third biopsy

Objetivo: Estudiar las características histopatológicas y clínicas de los tumores diagnosticados a partir de terceras biopsias para valorar la relevancia clínica de éstos y descartar el sobre diagnóstico en el cáncer de próstata. Material y método: Revisamos las historias clínicas de 61 pacientes con al menos tres o más biopsias de próstata transrectales, sextantes o de saturación según el esquema preestablecido, desde el año 2000 al 2006. Las variables analizadas son: edad del paciente, PSA, cociente PSA libre/PSA total, PSA densidad, tacto rectal, volumen prostático, hallazgos ecográficos y lesión premaligna fuertemente asociadas a la presencia de tumor en biopsias previas. Y estudiamos la anatomía patológica de los tumores diagnosticados a partir de la tercera biopsia, abordaje terapéutico y su evolución con un seguimiento mínimo de 3 meses. Resultados: De 61 pacientes con más de tres biopsias, a 15 pacientes se les diagnostica cáncer (24,6%) en la tercera biopsia. A 14 se les realiza nueva biopsia (cuarta), encontrando tumor en 5 de ellos (35,7%). Se realiza quinta biopsia en2 pacientes siendo positiva en uno de ellos (50%). Según los resultados de la biopsia, 6 pacientes presentaban criterios de cáncer clínicamente no significativo (28,6%). En todos los pacientes se procedió a tratamiento curativo: 5 braquiterapia,6 radioterapia externa y a 10 se les realizó una prostatectomía radical, que evidenció tumores clínicamente significativos: 2 tumores pT2b y 7 tumores pT2c sin invasión de los márgenes quirúrgicos y con un excelente control de la enfermedad tras un seguimiento mínimo de 13 meses y un pT4 por invasión del cuello vesical. Conclusiones: En nuestro medio, la tercera, cuarta y quinta biopsia alcanza una positividad del 34,42% y se corresponde con tumores que se benefician de un tratamiento con intención curativa(AU)

Objective: To study of histological and clinical features of prostate cancer diagnosed after three or more prostate biopsies in order to assess its clinical relevance and to discard the over diagnosis of prostate cancer. Material and methods: We reviewed the clinical records of 61 patients who underwent three or more prostate biopsies between January 2000 and December 2006. The analyzed variables were: age, PSA level, free/total PSA ratio, PSA density, digital rectal examination, prostate volume, sonographic findings and previous malignant lesion strongly associated to the presence of tumor on previous biopsy. We studied the pathology of the tumors diagnosed from the third biopsy, therapeutical approach and its evolution with a minimum follow-up of 3 months. Results: Fifteen out of 61 patients with more than three biopsies had prostate cancer (24,59%) in the third biopsy, 5out of 14 patients with 4 biopsies (35,71%) and 1 of the 2 cases (50%) who underwent a fifth biopsy. According to the results of biopsy, 6 patients met the criteria of clinically insignificant cancer (28,57%). Curative treatment was performed in all patients: brachytherapy in 5, external beam radiotherapy in 6 and radical prostatectomy in 10. Clinically significant tumors were found in all cases: 2 pT2b tumors and 7 pT2c tumors with negative surgical margins and with an excellent control of the cancer after a minimum follow up of 13 months, and one pT4 tumor with bladder neck infiltration. Conclusion: In our practice, overall detection rate of the third, fourth and fifth biopsy is 34,42% corresponding with tumors that could benefit from curative treatment (AU)

[Pneumoscrotum secondary to bilateral tension pneumothorax]. / Neumoescroto secundario a un neumotórax a tensión bilateral.

We present a case of pneumoscrotum due to bilateral tension pneumothorax. Although the pneumoescrotum is an uncommon and light disease it can be a symptom of a life threatening pathology. The treatment of the pnemoescrotum is ethiological. It is necessary to treat the specific disease responsible of the pneumoescrotum.

Neumoescroto secundario a un neumotórax a tensión bilateral / Pneumoscrotum secondary to bilateral tension pneumothorax

Presentamos un caso clínico de neumoescroto secundario a un neumotórax a tensión bilateral de gran tamaño. A pesar de que el neumoescroto es una entidad clínica poco frecuente que generalmente se resuelve con tratamiento conservador, puede ser síntoma de un proceso grave y potencialmente mortal. El tratamiento del neumoescroto estará encaminado a tratar la causa que lo produjo (AU)

We present a case of pneumoscrotum due to bilateral tension pneumothorax. Although the pneumoescrotum is an uncommon and light disease it can be a symptom of a liFe threatening pathology. The treatment of the pnemoescrotum is ethiological. It is necessary to treat the specific disease responsible of the pneumoescrotum (AU)

[Clinical features and histopathology of prostate cancer diagnosed from the third biopsy]. / Características clínicas e histopatológicas del cáncer de próstata diagnosticado a partir de la tercera biopsia.

OBJECTIVE: To study of histological and clinical features of prostate cancer diagnosed after three or more prostate biopsies in order to assess its clinical relevance and to discard the overdiagnosis of prostate cancer. MATERIAL AND METHODS: We reviewed the clinical records of 61 patients who underwent three or more prostate biopsies between January 2000 and December 2006. The analyzed variables were: age, PSA level, free/total PSA ratio, PSA density, digital rectal examination, prostate volume, sonographic findings and previous malignant lesion strongly associated to the presence of tumor on previous biopsy. We studied the pathology of the tumors diagnosed from the third biopsy, therapeutical approach and its evolution with a minimum follow-up of 3 months. RESULTS: Fifteen out of 61 patients with more than three biopsies had prostate cancer (24,59%) in the third biopsy, 5 out of 14 patients with 4 biopsies (35,71%) and 1 of the 2 cases (50%) who underwent a fifth biopsy. According to the results of biopsy, 6 patients met the criteria of clinically insignificant cancer (28,57%). Curative treatment was performed in all patients: brachytherapy in 5, external beam radiotherapy in 6 and radical prostatectomy in 10. Clinically significant tumors were found in all cases: 2 pT2b tumors and 7 pT2c tumors with negative surgical margins and with an excellent control of the cancer after a minimum follow up of 13 months, and one pT4 tumor with bladder neck infiltration. CONCLUSION: In our practice, overall detection rate of the third, fourth and fifth biopsy is 34,42% corresponding with tumors that could benefit from curative treatment.