Impact of New Systemic Therapies in Overall Survival in Non-Metastatic Castration Resistant Prostate Cancer: Systematic Review and Meta-Analysis.

There was a high medical need for patients with non-metastatic castration-resistant prostate cancer (nmCRPC) when several next-generation anti-androgens (apalutamide, enzalutamide, and darolutamide) demonstrated clinically relevant delays in metastasis onset. However, to date, few publications have assessed the pooled effect of these treatments on overall survival (OS). We performed a systematic review and meta-analysis of all randomized, placebo-controlled studies investigating a systemic treatment in nmCRPC. Publications were identified by searching several databases on April 7, 2021. The primary objective of this analysis was to determine the OS benefit. Secondary outcomes included the relative risk (RR) of adverse events (AEs) and grade 3-4 AEs. A sensitivity analysis with simulated data was also conducted to examine the influence of the study designs on the results. Three randomized controlled studies (SPARTAN, PROSPER, ARAMIS) met our inclusion criteria. Pooled meta-analyses showed a significant benefit in OS with the active agents versus placebo (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.65-0.83), as well as increased risk of any grade (RR 1.09, 95% CI 1.01-1.17) and grade 3-4 AEs (RR 1.50, 95% CI 1.23-1.83). The sensitivity analysis with SPARTAN-like simulated populations demonstrated that when using ARAMIS statistical design, OS would be statistically significant in 98.1% of the cases, at a shorter follow-up and with lower number of events. First-line treatment of nmCRPC patients with anti-androgens increased OS with an acceptable safety profile. In light of the different study designs and follow-up, results should be interpreted separately.

Efficacy and safety of abiraterone acetate plus prednisone vs. cabazitaxel as a subsequent treatment after first-line docetaxel in metastatic castration-resistant prostate cancer: results from a prospective observational study (CAPRO).

BACKGROUND: To describe the patterns of second-line treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel treatment in a Spanish population, to identify the factors associated with those patterns, and to compare the efficacy and safety of the treatments most frequently administered. METHODS: Observational, prospective study conducted in patients with histologically or cytologically confirmed prostate adenocarcinoma; documented metastatic castration-resistant disease; progression after first-line, docetaxel-based chemotherapy with or without other agents. RESULTS: Of the 150 patients recruited into the study, 100 patients were prescribed abiraterone acetate plus prednisone (AAP), 44 patients received cabazitaxel plus prednisone (CP), and 6 patients received other treatments. Age (odds ratio [OR] 1.06, 95% [confidence interval] CI 1.01 to 1.11) and not elevated lactate dehydrogenase (LDH) levels (OR 0.33, 95% CI 0.14 to 0.76) were independently associated with the administration of AAP. Treatment with AAP was associated with significantly longer clinical/radiographic progression-free survival (hazard ratio [HR] 0.57, 95% CI 0.38 to 0.85) and overall survival (OS; HR 0.40, 95% CI 0.21 to 0.76) compared to CP, while no significant differences between the treatments were found regarding biochemical progression-free survival (PFS; HR 0.78 [95% CI 0.49 to 1.24]). However, in a post-hoc Cox regression analysis adjusted for potential confounders there were not differences between AAP and CP in any of the time-to-event outcomes, including overall survival. We observed no new safety signals related to either regimen. CONCLUSION: Second-line AAP for patients with mCRPC is the most common treatment strategy after progression with a docetaxel-based regimen. When controlling for potential confounders, patients receiving this treatment showed no differences in PFS and OS in comparison to those receiving CP, although these latter results should be confirmed in randomized controlled trials.

[Prostate carcinosarcoma.] / Carcinosarcoma de próstata.

OBJECTIVE: To report a new case of prostatic carcinosarcoma, an uncommon and locally and distance aggressive tumor. METHOD: We analyzed one case diagnosed in our Center, from clinical and pathological diagnosis to death, describing the treatments received. RESULT: Patient presented a huge pelvic mass and a pulmonary metastasis that was treated with cystoprostatectomy and bilateral cutaneous ureterostomy with the diagnosis of carcinosarcoma of the prostate. He received 8 cycles of Docetaxel with bone progression and then 3 cycles of doxorubicin, suspending treatment due to progression. The survival was 18 months. CONCLUSIONS: Prostate carcinosarcoma is a very aggressive neoplasia that does not respond to the usual treatments of prostate cancer.

Carcinosarcoma de próstata / Prostate carcinosarcoma

OBJETIVO: Reportar un nuevo caso de carcinosarcoma prostático, un tumor infrecuente y agresivo localmente y a distancia. MÉTODO: Se ha analizado un único caso diagnosticado en nuestro Centro, desde el diagnóstico clínico y anatomopatológico hasta el éxitus, describiéndose los tratamientos recibidos por el mismo. RESULTADO: Paciente que presenta gran masa pélvica y una metástasis pulmonar que es sometido a cistoprostatectomia y ureterostomía cutánea bilateral con el diagnóstico de carcinosarcoma de próstata. Recibió 8 ciclos de Docetaxel objetivándose progresión ósea y posteriormente 3 ciclos de Doxorrubicina suspendiéndose por progresión. La supervivencia fue de 18 meses. CONCLUSIONES: El carcinosarcoma prostático es una neoplasia muy agresiva que no responde a los tratamientos habituales del cáncer de próstata

OBJECTIVE: To report a new case of prostatic carcinosarcoma, an uncommon and locally and distance aggressive tumor. METHOD: We analyzed one case diagnosed in our Center, from clinical and pathological diagnosis to death, describing the treatments received. RESULT: Patient presented a huge pelvic mass and a pulmonary metastasis that was treated with cystoprostatectomy and bilateral cutaneous ureterostomy with the diagnosis of carcinosarcoma of the prostate. He received 8 cycles of Docetaxel with bone progression and then 3 cycles of doxorubicin, suspending treatment due to progression. The survival was 18 months. CONCLUSIONS: Prostate carcinosarcoma is a very aggressive neoplasia that does not respond to the usual treatments of prostate cancer

Nudo intrapiélico de la guía durante la colocación de un catéter doble J. A propósito de un caso / Guide wire knot during double J catherter insertion: Case report

OBJETIVO: Presentar un caso de formación de un bucle intrapiélico en una guía endourológica durante la colocación de un catéter doble J.MÉTODOS: Presentamos el caso de una paciente de 24 años diagnosticada de una masa pélvica que produce uropatía obstructiva, en la que se produjo un nudo en la guía del catéter doble J durante el proceso de colocación, situación que se resolvió finalmente sin recurrir a medidas agresivas. RESULTADOS: Presentamos el caso de una rara complicación de la cateterización de la vía urinaria y su solución, así como una revisión de la literatura al respecto de casos similares.CONCLUSIÓN: Los procesos de derivación endourológica de la vía urinaria no están exentos de complicaciones, de variado origen e importancia, y que pueden requerir medidas agresivas para su resolución(AU)

OBJECTIVE: To report one case of intrapyelic loop of a guide wire during double J catheter insertion.METHODS: We report the case of a 24 year-old female, with the diagnosis obstructive uropathy secondary to pelvic tumor who required double J catheter insertion for urinary diversion. A loop of the guide wire was formed during the procedure which was finally solved without aggressive measures.RESULTS: We report the case of a rare complication appeared during urinary catheter insertion procedure, as well as a review of the current literature.CONCLUSION: The use of guide wires and endourological catheters is not free of complications that may require aggressive measures to be solved(AU)