Value of Prostate-Specific Antigen Kinetics in Patients with Low-Risk Prostate Cancer under Active Surveillance.

INTRODUCTION: This study analyzes the value of PSA kinetics, PSA speed (vPSA), and PSA doubling time (PSAdt), in patients with low-risk prostate cancer who are in an active surveillance (AS) program. METHODS: An observational, retrospective, and longitudinal study of a sample of 86 patients included in AS program between January 2014 and October 2021 was conducted. A review of their medical records was performed, and PSA kinetics were calculated, analyzing the causes of discontinuation of the AS program and its relationship with PSA kinetics. RESULTS: The mean age was 63.39 years, and the median follow-up was 62.55 months. The mean PSA at diagnosis was 8.27 ng/mL. A median of PSAdt of 62.55 months and 1.3 ng/mL/year for vPSA was obtained. 35 patients left the program, with a higher percentage of patients leaving with a PSAdt less than 36 months (73.7 vs. 31.1%) and a vPSA greater than 2 ng/mL/year (68.2 vs. 31.3%). The probability of permanence and the time of permanence in AS were statistically significantly higher for those patients with favorable kinetic parameters. CONCLUSION: PSA kinetics is a parameter to take into account when making decisions to keep patients in an AS program.

Prognostic Value of the Neutrophil/Lymphocyte Ratio in Squamous Cell Carcinoma of the Penis.

INTRODUCTION: To determine the predictive role of the neutrophil/lymphocyte ratio (NLR) in the prognosis and survival of patients with squamous cell carcinoma of the penis. MATERIALS AND METHODS: A retrospective cohort study of 96 patients with squamous cell carcinoma of the penis (SCCP). Clinical and histological data, bloodwork and disease evolution information were collected. We determined neutrophil/lymphocyte ratios and analyzed their relationship to prognosis and survival. RESULTS: The mean age of patients was 72,1 years. The average follow-up time for the sample was 3,8 years (CI 95%: 3,0-4,6). Compared to patients with NLR <3, those with NLR >3 presented a higher proportion of cancers in stages cN1 (29.7% vs 6.8%; p = 0,004), stages pT3 and pT4 (24,3% vs 9,5%; p = 0,05), and stages TNM III and IV (32,4% vs 10,2%; p = 0,01); additionally, there were more cases of perineural invasion in the NLR >3 patients (29,7% vs 10,2%; p = 0,03). The mean overall survival (OS) was 7,9 years (CI 95%: 6,2-9,6) and the cancer-specific survival (CSS), 1,3 years (CI 95%: 0,7-1,9). There were no differences in OS, CSS or in progression-free survival (PFS) in patients with NLR >3 compared to those with NLR <3 . However, in the Cox regression analysis, a higher NLR was independently associated (along with metastasis and need for adjuvant treatment) with lower PFS, with an HR: 1,27 (CI 95%: 1,02-1,57; p = 0,02). CONCLUSIONS: The utilization of NLR in clinical practice can be considered an additional tool to aid in the diagnosis and prognosis of patients with squamous cell carcinoma of the penis.

Prognostic Value of the Neutrophil/Lymphocyte Ratio in Squamous Cell Carcinoma of the Penis

Introduction: To determine the predictive role of the neutrophil/lymphocyte ratio (NLR) in the prognosis and survival of patients with squamous cell carcinoma of the penis. Materials and Methods: A retrospective cohort study of 96 patients with squamous cell carcinoma of the penis (SCCP). Clinical and histological data, bloodwork and disease evolution information were collected. We determined neutrophil/lymphocyte ratios and analyzed their relationship to prognosis and survival. Results: The mean age of patients was 72,1 years. The average follow-up time for the sample was 3,8 years (CI 95%: 3,0–4,6). Compared to patients with NLR <3, those with NLR >3 presented a higher proportion of cancers in stages cN1 (29.7% vs 6.8%; p = 0,004), stages pT3 and pT4 (24,3% vs 9,5%; p = 0,05), and stages TNM III and IV (32,4% vs 10,2%; p = 0,01); additionally, there were more cases of perineural invasion in the NLR >3 patients (29,7% vs 10,2%; p = 0,03). The mean overall survival (OS) was 7,9 years (CI 95%: 6,2–9,6) and the cancer-specific survival (CSS), 1,3 years (CI 95%: 0,7–1,9). There were no differences in OS, CSS or in progression-free survival (PFS) in patients with NLR >3 compared to those with NLR <3 . However, in the Cox regression analysis, a higher NLR was independently associated (along with metastasis and need for adjuvant treatment) with lower PFS, with an HR: 1,27 (CI 95%: 1,02–1,57; p = 0,02). Conclusions: The utilization of NLR in clinical practice can be considered an additional tool to aid in the diagnosis and prognosis of patients with squamous cell carcinoma of the penis (AU)

[Biomarkers in renal cancer.] / Biomarcadores en cáncer renal.

The natural history of renal cell canceris unpredictable and despite the increased knowledgeof this disease, the incidence has been increasing in recent years. Renal cancer represents a tumor withsignificant mortality and efforts to understand its behaviorhavenot yet translated into a decrease in mortality.In the study of renal cell cancer, the knowledge ofmolecular pathways is very important, since they arethe basis for the development of new therapies. Thisknowledge has made it possible to reclassify these tumorsand the current challenge is the search for biomarkersthat allow to establish an adequate diagnosisand prognosis and predict the response to a certaintype of treatment.In the present manuscript we carry out a review ofthe main markers studied and their potential value inrenal cell cancer.

La historia natural del cáncer renal esimpredecible y a pesar del aumento del conocimientode esta enfermedad, la incidencia ha ido en aumentoen los últimos años. Representa un tumor con unamortalidad importante y los esfuerzos por conocer sucomportamiento todavía no se traducen en una disminuciónde su mortalidad.Dentro del estudio del cáncer renal es cada vezmás importante el conocimiento de su funcionamientomolecular, que por otra parte ha sido fundamentalpara la aparición de las nuevas terapias. Dicho conocimientoha permitido reclasificar estos tumores, siendoel desafío actual la búsqueda de biomarcadores quenos permitan establecer un adecuado diagnóstico ypronóstico y predecir la respuesta a un determinadotipo de tratamiento.En el presente trabajo realizamos una revisión delos principales marcadores estudiados y su potencialvalor en el cáncer renal.

Biomarcadores en cáncer renal / Biomarkers in renal cáncer

La historia natural del cáncer renal esimpredecible y a pesar del aumento del conocimientode esta enfermedad, la incidencia ha ido en aumento en los últimos años. Representa un tumor con unamortalidad importante y los esfuerzos por conocer sucomportamiento todavía no se traducen en una disminución de su mortalidad.Dentro del estudio del cáncer renal es cada vezmás importante el conocimiento de su funcionamiento molecular, que por otra parte ha sido fundamentalpara la aparición de las nuevas terapias. Dicho conocimiento ha permitido reclasificar estos tumores, siendo el desafío actual la búsqueda de biomarcadores quenos permitan establecer un adecuado diagnóstico ypronóstico y predecir la respuesta a un determinadotipo de tratamiento.En el presente trabajo realizamos una revisión delos principales marcadores estudiados y su potencialvalor en el cáncer renal. (AU)

The natural history of renal cell canceris unpredictable and despite the increased knowledge of this disease, the incidence has been increasing in recent years. Renal cancer represents a tumor withsignificant mortality and efforts to understand its behavior havenot yet translated into a decrease in mortality.In the study of renal cell cancer, the knowledge ofmolecular pathways is very important, since they arethe basis for the development of new therapies. Thisknowledge has made it possible to reclassify these tumors and the current challenge is the search for biomarkers that allow to establish an adequate diagnosisand prognosis and predict the response to a certaintype of treatment.In the present manuscript we carry out a review ofthe main markers studied and their potential value inrenal cell cancer. (AU)

Cost-Effectiveness of a Sublingual Bacterial Vaccine for the Prophylaxis of Recurrent Urinary Tract Infections.

INTRODUCTION: Recurrent urinary tract infections (rUTIs) affect 5-10% of women, resulting in an enormous healthcare and society burden. Uromune® is a polybacterial sublingual vaccine with an excellent clinical benefit in rUTI prophylaxis. This study assesses the impact of sublingual vaccination on healthcare resource use and expenditures associated with this pathology. METHODS: A quasi-experimental, pretest-posttest, single center study including women with rUTI and vaccinated with Uromune® in real-life clinical practice was performed. Variables were the need of healthcare resources, collected prospectively during two follow-up years, and the rUTI-associated expenditure, calculated using the micro-costing methodology; these were compared before and after vaccination. RESULTS: A total of 166 women {mean (standard deviation [SD]) urinary tract infection episodes/year 6.19 (2.15)} were included. After vaccination, annual consultations with a primary care physician (PCP) (43.9%), emergency room visits (71.8%), urinary analysis (90.0%), and ultrasound exams (35.6%) decreased compared to pre-vaccination (all p < 0.001). Per patient consumption in antibiotics, PCP consultations, emergency room visits, and complementary exams significantly decreased (all p < 0.02), resulting in a reduction in healthcare expenditure per patient/year from mean (SD) 1,001.1 (655.0) to 497.1 (444.4) EUR. CONCLUSION: Sublingual bacterial vaccination with Uromune® decreased healthcare resource use and associated expenditure in women with rUTI, representing an optimal strategy to reduce rUTI-associated healthcare and economic burden.

Clinical value of perioperative levels of DNA and mRNA in plasma of patients with renal cell carcinoma.

INTRODUCTION: The current challenge on renal cell carcinoma (RCC) is to finding a non-invasive biomarker for improving their diagnostic and therapeutic management. In the present study, we analyzed the clinical value of plasma levels of cell-free DNA (cfDNA) and RNA (cfRNA) of two genes: glyceraldehyde 3-phosphate-dehydrogenase (GAPDH) and human telomerase reverse transcriptase (hTERT). MATERIALS AND METHODS: We recruited 82 patients with RCC, and 20 healthy subjects. Using RT-PCR techniques, plasma levels of cfDNA and cfRNA from hTERT and GAPDH genes were quantified pre- and post-operatively, and one year after surgery. Relationships between such plasma levels and clinicopathological features and evolution of disease were analyzed. RESULTS: Levels of GAPDH cfDNA and cfRNA were significantly higher in patients than in healthy subjects. hTERT cfDNA was detected in plasma from 35% of RCC patients and in none healthy subject. At diagnosis, plasma levels of GAPDH cfDNA were higher in advanced pT and TNM stages, and hTERT cfDNA in patients with 3-4 Fuhrman grade and affected lymph nodes. Levels of cfNAs were not related to the presence of metastasis. Following nephrectomy, GAPDH cfDNA levels dropped, and patients with higher levels before and after nephrectomy, showed lower overall survival (OS). However, Cox's multivariate model did not prove any association of the cfNA levels with progression. CONCLUSION: Plasma levels of cfDNA from GADPH and hTERT genes were correlated to tumor diagnosis and progression and, thus, such analyses might help to diagnosis and prognosis of RCC patients.

[Urology clinics referral Patterns after initiation of a Primary Care BPH-LUTS protocol.] / Evolución de las derivaciones desde atención primaria a la consulta de urología tras la aplicación de un protocolo de pacientes con síntomas del tracto urinario inferior por hiperplasia benigna de próstata.

OBJECTIVE: In the Spanish health system, General Practitioners (GPs) play a key role in regulating the flow of patients to hospital care. Most of patients with BPH can be managed through out the evolution of the disease exclusively by the GPs.  METHODS: A pre-experimental study was carried outin two periods, before (pre-test) and after (post-test) of the dissemination of a management protocol for patients with BPH. The protocol was trialled in the health area of Villarrobledo and included all referrals to the urology clinic for BPH from Primary Care. We analyzed the appropriate referrals according with the criteria set for thin the protocol and compared the complementary tests through statistical study (descriptive, a bivariate, multivariate analysis and rate calculation) using version 21of the SPSS. RESULTS: Referral rate decreased after the application of the protocol but did not increase the rate of appropriated referrals. Patients referred after setting forth protocol by GPs that assisted to the education program were younger. There were referred less patients with elevated PSA and more patients with clinical progression. These GPs used less test to achieve diagnosis. The GPs whodid not attend were significantly younger, mainly women, with no previous specific training in BPH and without a full time GP position. CONCLUSIONS: The implementation of a protocol has reduced the referral rate, but it has not improved the appropriate referrals. More research is required to understand the determinants of inequalities in referral from primary care.

OBJETIVO: Los médicos de Atención Primaria (MAP) son fundamentales en la regulación del flujo de pacientes desde Atención Primaria (AP), por tanto,es esencial buscar métodos de adecuada gestión de la demanda asistencial y así optimizar recursos. En la hipertrofia benigna de próstata (HBP) se estima que 2/3 de los pacientes pueden ser manejados íntegramentedesd e AP a lo largo de todo el proceso de la HBP.MATERIAL Y MÉTODOS: Hemos realizado un estudio pre experimental en dos períodos, antes (pre-test) y después (post-test) de la creación de un protocolo de manejo y derivación de pacientes con HBP. Analizamos la adecuación a los criterios de derivación y el uso de los estudios complementarios para llevar a cabo el diagnóstico, realizando un análisis estadístico (descriptivo, bivariante, multivariante y cálculo de tasas) utilizando SPSS (versión 21). RESULTADOS: La tasa de derivación disminuyó tras la aplicación del protocolo, pero no logró mejorar la adecuación. Los pacientes derivados por los MAP que asistieron al programa educativo fueron más jóvenes. Se remitieron menos pacientes con PSA elevado y más pacientes con progresión clínica. Se utilizaron menos estudios complementarios. Los MAP que no acudieron a la formación eran más jóvenes, principalmente mujeres, sin formación especifica en HBP y con contrato temporal. CONCLUSIONES: A pesar de reducir la tasa de derivación no se consiguió mejorar la adecuación de la derivación de los pacientes. Consideramos necesario analizar la problemática de los MAP y valorar otras intervenciones que podrían mejorar la calidad en la transferencia de responsabilidades.

Evolución de las derivaciones desde atención primaria a la consulta de urología tras la aplicación de un protocolo de pacientes con síntomas del tracto urinario inferior por hiperplasia benigna de próstata / Urology clinics referral Patterns after initiation of a Primary Care BPH-LUTS protocol

OBJETIVO: Los médicos de Atención Primaria (MAP) son fundamentales en la regulación del flujo de pacientes desde Atención Primaria (AP), por tanto, es esencial buscar métodos de adecuada gestión de la demanda asistencial y así optimizar recursos. En la hipertrofia benigna de próstata (HBP) se estima que 2/3 de los pacientes pueden ser manejados íntegramente desde AP a lo largo de todo el proceso de la HBP. MATERIAL Y MÉTODOS: Hemos realizado un estudio pre experimental en dos períodos, antes (pre-test) y después (post-test) de la creación de un protocolo de manejo y derivación de pacientes con HBP. Analizamos la adecuación a los criterios de derivación y el uso de los estudios complementarios para llevar a cabo el diagnóstico, realizando un análisis estadístico (descriptivo, bivariante, multivariante y cálculo de tasas) utilizando SPSS (versión 21). RESULTADOS: La tasa de derivación disminuyó tras la aplicación del protocolo, pero no logró mejorar la adecuación. Los pacientes derivados por los MAP que asistieron al programa educativo fueron más jóvenes. Se remitieron menos pacientes con PSA elevado y más pacientes con progresión clínica. Se utilizaron menos estudios complementarios. Los MAP que no acudieron a la formación eran más jóvenes, principalmente mujeres, sin formación especifica en HBP y con contrato temporal. CONCLUSIONES: A pesar de reducir la tasa de derivación no se consiguió mejorar la adecuación de la derivación de los pacientes. Consideramos necesario analizar la problemática de los MAP y valorar otras intervenciones que podrían mejorar la calidad en la transferencia de responsabilidades

OBJECTIVE: In the Spanish health system, General Practitioners (GPs) play a key role in regulating the flow of patients to hospital care. Most of patients with BPH can be managed throughout the evolution of the disease exclusively by the GPs. METHODS: A pre-experimental study was carried out in two periods, before (pre-test) and after (post-test) of the dissemination of a management protocol for patients with BPH. The protocol was trialled in the health area of Villarrobledo and included all referrals to the urology clinic for BPH from Primary Care. We analyzed the appropriate referrals according with the criteria set forth in the protocol and compared the complementary tests through statistical study (descriptive, a bivariate, multivariate analysis and rate calculation) using version 21 of the SPSS. RESULTS: Referral rate decreased after the application of the protocol but did not increase the rate of appropriated referrals. Patients referred after setting forth protocol by GPs that assisted to the education program were younger. There were referred less patients with elevated PSA and more patients with clinical progression. These GPs used less test to achieve diagnosis. The GPs who did not attend were significantly younger, mainly women, with no previous specific training in BPH and without a full time GP position. CONCLUSIONS: The implementation of a protocol has reduced the referral rate, but it has not improved the appropriate referrals. More research is required to understand the determinants of inequalities in referral from primary care

Local and distant recurrence of the chromophobe renal cell carcinoma / Recidiva local y a distancia del carcinoma renal cromófobo

INTRODUCTION: There is still limited knowledge about surveillance and optimal management for patients with recurrent chromophobe renal cell carcinoma. OBJECTIVE: Describe our experience in the diagnosis and management in recurrent chromophobe renal cell carcinoma. MATERIAL AND METHOD: Review of medical records of patients with chromophobe renal cell carcinoma, selecting those cases that developed recurrence. RESULTS: Of the 23 patients, 4 developed recurrence and were the subjects of our analysis. The mean age was 61.5 years. Surgical treatment of primary renal tumor consisted of three radical nephrectomies and one partial nephrectomy. The mean time from nephrectomy to disease recurrence was 6.7 years. One patient had recurrence in the retrovesical area, another in bone, and the two others in the retroperitoneum. The treatment for retrovesical recurrence was an incomplete metastasectomy followed by temsirolimus and subsequent removal of the residual mass, staying stable. The other three cases were unresectable surgically and received sunitinib. One patient now has a stable diseaseand the two others died. CONCLUSIONS: Chromophobe renal cell carcinoma showed a greater tendency to metastasize, so requires a surveillance protocol based on the risk of recurrence

INTRODUCCIÓN: Existe un conocimiento limitado respecto al manejo óptimo y seguimiento del carcinoma renal cromófobo recidivante. OBJETIVO: Describir nuestra experiencia en el diagnóstico y tratamiento del carcinoma renal cromófobo recidivante. MATERIAL Y MÉTODO: Revisión de las historias clínicas de 23 pacientes diagnosticados de carcinoma renal cromófobo, seleccionando aquellos casos que desarrollaron recidiva. RESULTADOS: De los 23 pacientes, 4 desarrollaron recidiva y fueron los casos de nuestro análisis. La edad media fue de 61,5 años. La cirugía del tumor renal primario consistió en tres nefrectomías radicales y una parcial. La media del tiempo desde la nefrectomía hasta la recidiva fue de6,7 años. Un paciente tuvo recidiva retrovesical, otro ósea y los otros dos en retroperitoneo. El tratamiento para la recidiva retrovesical fue una metastasectomía parcial seguida de temsirolimus y posterior exéresis de la masa residual, manteniéndose estable. Los otros tres casos fueron irresecables quirúrgicamente y recibieron sunitinib, de los cuáles, un paciente está estable y los otros dos fallecieron. CONCLUSIONES: El carcinoma renal cromófobo presentó una mayor tendencia a metastatizar, por lo que requiere un protocolo de vigilancia basado en el riesgo de recidiva

Analysis of the Efficacy of a Sublingual Bacterial Vaccine in the Prophylaxis of Recurrent Urinary Tract Infection.

OBJECTIVES: Recurrent urinary tract infections (R-UTIs) are very common amongst women, and alternatives to antibacterial prophylaxis are necessary. This study evaluates the effectiveness of a sublingual bacterial vaccine for the prophylaxis of R-UTIs. METHODS: We conducted a quasi-experimental pretest-posttest study of 166 women diagnosed with R-UTIs. Both before and after the start of treatment with the vaccine, we analysed the total number of R-UTI episodes, the urine culture results, and the type and number of antibiotic packages consumed. Symptoms and urine cultures were evaluated 3, 6, 9, 12, 18, and 24 months after initiating treatment with the vaccine. RESULTS: The mean time of follow-up after vaccination was 1.7 years. After vaccination, there was a 54.6% reduction in episodes of UTI, and a 56.2% reduction in positive urine cultures. At 3 months, 74.4% of the patients had no R-UTI, the rate falling to 68.1% at 6 months, 52.4% at 12 months, and 44.5% at 24 months. The cumulative probability of maintaining negative urine cultures was 76% at 3 months, 37% at 12 months, and 18% at 2 years. CONCLUSIONS: The use of a sublingual bacterial vaccine for the prophylaxis of R-UTIs in women is an effective treatment that contributes to a reduction in the number of UTI episodes.

Local and distant recurrence of the chromophobe renal cell carcinoma. / Recidiva local y a distancia del carcinoma renal cromófobo.

INTRODUCTION: There is still limited knowledgeabout surveillance and optimal management for patientswith recurrent chromophobe renal cell carcinoma. OBJECTIVE: Describe our experience in the diagnosis andmanagement in recurrent chromophobe renal cell carcinoma. MATERIAL AND METHOD: Review of medical records ofpatients with chromophobe renal cell carcinoma, selectingthose cases that developed recurrence. RESULTS: Of the 23 patients, 4 developed recurrence andwere the subjects of our analysis. The mean age was 61.5years. Surgical treatment of primary renal tumor consistedof three radical nephrectomies and one partial nephrectomy.The mean time from nephrectomy to disease recurrencewas 6.7 years. One patient had recurrence in the retrovesicalarea, another in bone, and the two others in theretroperitoneum. The treatment for retrovesical recurrencewas an incomplete metastasectomy followed by temsirolimusand subsequent removal of the residual mass, stayingstable. The other three cases were unresectable surgicallyand received sunitinib. One patient now has a stable diseaseand the two others died. CONCLUSIONS: Chromophobe renal cell carcinomashowed a greater tendency to metastasize, so requires asurveillance protocol based on the risk of recurrence.

INTRODUCCIÓN: Existe un conocimientolimitado respecto al manejo óptimo y seguimiento del carcinomarenal cromófobo recidivante. OBJETIVO: Describir nuestra experiencia en el diagnósticoy tratamiento del carcinoma renal cromófobo recidivante. MATERIAL Y MÉTODO: Revisión de las historias clínicasde 23 pacientes diagnosticados de carcinoma renal cromófobo,seleccionando aquellos casos que desarrollaronrecidiva. RESULTADOS: De los 23 pacientes, 4 desarrollaron recidivay fueron los casos de nuestro análisis. La edad mediafue de 61,5 años. La cirugía del tumor renal primario consistióen tres nefrectomías radicales y una parcial. La mediadel tiempo desde la nefrectomía hasta la recidiva fue de6,7 años. Un paciente tuvo recidiva retrovesical, otro óseay los otros dos en retroperitoneo. El tratamiento para la recidivaretrovesical fue una metastasectomía parcial seguidade temsirolimus y posterior exéresis de la masa residual,manteniéndose estable. Los otros tres casos fueron irresecablesquirúrgicamente y recibieron sunitinib, de los cuáles,un paciente está estable y los otros dos fallecieron. CONCLUSIONES: El carcinoma renal cromófobo presentóuna mayor tendencia a metastatizar, por lo que requiereun protocolo de vigilancia basado en el riesgo de recidiva.

Leiomiomas vesicales / Bladder leiomyomas

Los leiomiomas vesicales son tumores benignos infrecuentes, causan sintomatología miccional y su tratamiento es quirúrgico. Objetivo: Presentar nuestra experiencia en el diagnóstico y tratamiento del leiomioma vesical. Material y metodo: Serie de 3 casos clínicos. Resultados: De los 3 casos, 2 fueron mujeres y 1 fue hombre. La edad media fue 33 años. Las dos mujeres presentaron síntomas miccionales irritativos y palpación de una masa pélvica, y el hombre cursó asintomático. La ecografía halló una masa anexial e hidronefrosis izquierdas en una paciente, tumoración vesical en otra paciente y masa pélvica de etiología no definida en el paciente varón. La tomografía y la resonancia magnética demostraron el origen vesical de la lesión. La biopsia confirmó el diagnóstico de leiomioma. Se realizó cistectomía parcial en todos los casos, con nefrectomía en uno de ellos. Durante el seguimiento no ocurrió recidiva tumoral. Conclusiones: Los estudios de imagen nos orientan al diagnóstico. La resección transuretral está indicada en lesiones menores de 3 cm. y la enucleación o cistectomía parcial en lesiones de mayor tamaño. Su pronóstico es bueno

Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection. Objective: To present our experience in the diagnosis and the treatment of bladder leiomyoma. Methods: A series of three clinical cases. Results: In our series, two patients were women and one was man. The mean age was 33 years. Two women presented with irritative urinary symptoms and palpation of a pelvic mass, and the man was asymptomatic. Ultrasound showed the presence of an adnexal mass with left hydronephrosis in a female patient, bladder tumor in another female patient and pelvic mass of unknown etiology in the male patient. CT scan and MRI demonstrated the bladder origin of the lesion. A biopsy confirmed a bladder leiomyoma. Surgical treatment was partial cystectomy in all patients, and in one of them, nephrectomy was performed. During follow-up, all patients were asymptomatic and without recurrence. Conclusions: Imaging studies guide to diagnosis. Transurethral resection is recommended in lesions smaller than 3 cm. and enucleation or partial cystectomy in larger lesions. Prognosis is good

[Bladder leiomyomas.] / Leiomiomas vesicales.

Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection. OBJECTIVE: To present our experience in the diagnosis and the treatment of bladder leiomyoma. METHODS: A series of three clinical cases. RESULTS: In our series, two patients were women and one was man. The mean age was 33 years. Two women presented with irritative urinary symptoms and palpation of a pelvic mass, and the man was asymptomatic. Ultrasound showed the presence of an adnexal mass with left hydronephrosis in a female patient, bladder tumor in another female patient and pelvic mass of unknown etiology in the male patient. CT scan and MRI demonstrated the bladder origin of the lesion. A biopsy confirmed a bladder leiomyoma. Surgical treatment was partial cystectomy in all patients, and in one of them, nephrectomy was performed. During follow-up, all patients were asymptomatic and without recurrence. CONCLUSIONS: Imaging studies guide to diagnosis. Transurethral resection is recommended in lesions smaller than 3 cm. and enucleation or partial cystectomy in larger lesions. Prognosis is good.

Los leiomiomas vesicales son tumores benignos infrecuentes, causan sintomatología miccional y su tratamiento es quirúrgico. OBJETIVO: Presentar nuestra experiencia en el diagnóstico y tratamiento del leiomioma vesical. MATERIAL Y METODO: Serie de 3 casos clínicos. RESULTADOS: De los 3 casos, 2 fueron mujeres y 1 fue hombre. La edad media fue 33 años. Las dos mujeres presentaron síntomas miccionales irritativos y palpación de una masa pélvica, y el hombre cursó asintomático. La ecografía halló una masa anexial e hidronefrosis izquierdas en una paciente, tumoración vesical en otra paciente y masa pélvica de etiología no definida en el paciente varón. La tomografía y la resonancia magnética demostraron el origen vesical de la lesión. La biopsia confirmó el diagnóstico de leiomioma. Se realizó cistectomía parcial en todos los casos, con nefrectomía en uno de ellos. Durante el seguimiento no ocurrió recidiva tumoral. CONCLUSIONES: Los estudios de imagen nos orientan al diagnóstico. La resección transuretral está indicada en lesiones menores de 3 cm. y la enucleación o cistectomía parcial en lesiones de mayor tamaño. Su pronóstico es bueno.

Diagnostic and prognostic value of the detection of hTERT mRNA in renal tumors.

INTRODUCTION: Elevated mRNA expression of human telomerase reverse transcriptase (hTERT mRNA) is common in many types of tumors, participating in tumor growth and progression. Such expression has not been sufficiently examined in renal cancer. The goal of the present study was to quantify it and analyze its possible clinical value in the management of this pathology. PATIENTS AND METHODS: The study included 111 patients who underwent surgery for renal cell carcinoma (RCC) between 2015 and 2017. Tumor samples were taken from all patients and, in 94 of them, healthy renal tissue adjacent to the tumor was also sampled. The 2 types of tissue were histologically confirmed, after which mRNA was extracted. Using real-time quantitative PCR, the expression of hTERT and glyceraldehyde-3-phosphate dehydrogenase (as endogenous control) were indirectly quantified using the crossing point (CP), which is inversely correlated with the number of sample replicates yielding positive results. These values were correlated with patient socio-demographic variables and clinical-pathological factors of the RCC. RESULTS: The majority of patients were males, with an average age of 60.5 years (SD: 14.02). Most tumors (69.4%) were clear cell carcinomas. The most frequent stages were pT2 or lower (73%), while 5% were pN1 and 12% pM1. The majority of tumors (58%) were Fuhrman grades 1 or 2 (low grade). All samples of tumor and nontumor tissue expressed glyceraldehyde-3-phosphate dehydrogenase mRNA, with the CP in the tumor sample significantly lower than in the nontumor tissue (P < 0.001). The expression of hTERT mRNA was detected in 68% of tumor tissues and significantly correlated with histopathology: 100% in sarcomatoid RCC and 77.9% in clear cell carcinomas (P < 0.0001). The CP was lower in pN1 (P = 0.018), pM1 (P = 0.046), and TNM IV stages (P = 0,041). A greater number of hTERT mRNA replicas were detected in M1 patients (P = 0.0005) and TNM IV stage (P = 0.017). There was no correlation of hTERT mRNA expression with Fuhrman grade. CONCLUSIONS: The quantitation of hTERT mRNA expression in RCC might be useful as a complementary diagnostic tool as well as for assessing aggressiveness of the tumor.

Increased Serine and One-Carbon Pathway Metabolism by PKCλ/ι Deficiency Promotes Neuroendocrine Prostate Cancer.

Increasingly effective therapies targeting the androgen receptor have paradoxically promoted the incidence of neuroendocrine prostate cancer (NEPC), the most lethal subtype of castration-resistant prostate cancer (PCa), for which there is no effective therapy. Here we report that protein kinase C (PKC)λ/ι is downregulated in de novo and during therapy-induced NEPC, which results in the upregulation of serine biosynthesis through an mTORC1/ATF4-driven pathway. This metabolic reprogramming supports cell proliferation and increases intracellular S-adenosyl methionine (SAM) levels to feed epigenetic changes that favor the development of NEPC characteristics. Altogether, we have uncovered a metabolic vulnerability triggered by PKCλ/ι deficiency in NEPC, which offers potentially actionable targets to prevent therapy resistance in PCa.

HIF1α Suppresses Tumor Cell Proliferation through Inhibition of Aspartate Biosynthesis.

Cellular aspartate drives cancer cell proliferation, but signaling pathways that rewire aspartate biosynthesis to control cell growth remain largely unknown. Hypoxia-inducible factor-1α (HIF1α) can suppress tumor cell proliferation. Here, we discovered that HIF1α acts as a direct repressor of aspartate biosynthesis involving the suppression of several key aspartate-producing proteins, including cytosolic glutamic-oxaloacetic transaminase-1 (GOT1) and mitochondrial GOT2. Accordingly, HIF1α suppresses aspartate production from both glutamine oxidation as well as the glutamine reductive pathway. Strikingly, the addition of aspartate to the culture medium is sufficient to relieve HIF1α-dependent repression of tumor cell proliferation. Furthermore, these key aspartate-producing players are specifically repressed in VHL-deficient human renal carcinomas, a paradigmatic tumor type in which HIF1α acts as a tumor suppressor, highlighting the in vivo relevance of these findings. In conclusion, we show that HIF1α inhibits cytosolic and mitochondrial aspartate biosynthesis and that this mechanism is the molecular basis for HIF1α tumor suppressor activity.

Testicular adrenal rest tumors.

We report a case of congenital adrenal hyperplasia in a 29 year old patient, who presented with testicular pain, bilateral testicular masses, and oligospermia. Ultrasonography confirmed, in both testis, the presence of heterogeneous and hypoechoic lesions with irregular borders and internal and peripheral vascularization. Seric tumor markers were negative. The patient was scheduled for perioperative testicular biopsy and bilateral orchiectomy. Perioperative biopsy was suggestive of testicular adrenal rest tumor and not additional procedure was performed. Treatment was initiated with high doses of glucocorticoids, decreasing the size of testicular masses and testicular pain was alleviated.

Testicular adrenal rest tumors / Tumores testiculares de restos adrenales

We report a case of congenital adrenal hyperplasia in a 29 year old patient, who presented with testicular pain, bilateral testicular masses, and oligospermia. Ultrasonography confirmed, in both testis, the presence of heterogeneous and hypoechoic lesions with irregular borders and internal and peripheral vascularization. Seric tumor markers were negative. The patient was scheduled for perioperative testicular biopsy and bilateral orchiectomy. Perioperative biopsy was suggestive of testicular adrenal rest tumor and not additional procedure was performed. Treatment was initiated with high doses of glucocorticoids, decreasing the size of testicular masses and testicular pain was alleviated

Presentamos el caso de un varón de 29 años diagnosticado de hiperplasia suprarrenal congénita, que fue derivado a nuestra consulta por dolor testicular, masas testiculares bilaterales y oligospermia. La ecografía confirmó la existencia de lesiones heterogéneas e hipoecoicas con bordes irregulares y vascularización interna y periférica en ambos testículos. Los marcadores tumorales séricos fueron negativos. El paciente fue programado para biopsia testicular perioperatoria y orquiectomía bilateral. La biopsia perioperatoria fue sugestiva de tumor testicular de restos suprarrenales y no se realizó ningún procedimiento adicional. Se inició tratamiento con altas dosis de glucocorticoides, disminuyó el tamaño de las masas testiculares y se alivió el dolor testicular