[Incidental prostatic cancer: T1a-T1b. Our experience after observation/radical surgery and literature review]. / Cáncer de próstata incidental: T1a-T1b. Nuestra experiencia tras observación/intervención radical y revisión de la literatura.

OBJECTIVES: To analyse the progress of T1a and T1b prostate cancer diagnosed in our hospital. MATERIAL AND METHODS: Retrospective study of 40 patients in T1a-T1b clinical stage diagnosed with prostate adenocarcinoma in our hospital, from 1986 to 1999. A restaging biopsy was performed on the 16 T1a patients after initial diagnosis and control. A radical prostatectomy was performed on the 24 T1b patients. They were all monitored every six months with rectal exam and PSA. We analysed biological and/or clinical progression, time to progression, mortality caused by the tumour and survival. RESULTS: None of the 16 patients with T1a clinical stage presented tumour progression, with a median follow-up of 90 months. 12,5% of the 24 T1b cases presented tumour progression, with a median follow-up of 70 months. Cancer-specific mortality was one patient (4,16 %) in the T1b group. CONCLUSIONS: Observation and follow-up with PSA and rectal exam appears to be a good option for T1a clinical stage, given the good prognosis. Our results show that patients with T1a clinical stage and good prognostic factors could be at a similar risk of suffering from a new prostate cancer as the normal population, although prospective studies are required to validate these results. T1b cases require active treatment and closer monitoring.

[The present time in handling of prostate abscesses: with regard to a case]. / Actualidad en manejo de abcesos prostáticos: a propósito de un caso.

The existence of prostate abscess as bad evolution of an acute protatitis is not very frequent due to the correct handling of the urinary infections by means of suitable antibiotics, in spite of the presence of inmunosupresion situations that can favor their appearance. It is our intention to review the performance in these situations because of a case that by means of minimal invasive therapy by transperineal percutaneous puncture obtained complete improvement.

Cáncer de próstata incidental: T1a-T1b. Nuestra experiencia tras observación/intervención radical y revisión de la literatura / Incidental prostatic cancer: T1a- T1b. Our experience after observational/radical surgery and literature review

Objetivos: Analizar el comportamiento del cáncer de próstata T1a y T1b diagnosticados en nuestro centro. Material y métodos: Estudio retrospectivo de 40 pacientes en estadio clínico T1a-T1b diagnosticados de adenocarcinoma de próstata en nuestro centro, entre los años 1986 y 1999. A los 16 pacientes T1a, se les realizó biopsia de reestadificación tras el diagnóstico inicial y control posterior. A los 24 T1b, se les realizó prostatectomía radical. Todos fueron seguidos mediante tacto rectal y PSA semestral. Analizamos progresión biológica y/o clínica, tiempo hasta la progresión, mortalidad por causa tumoral y supervivencia. Resultados: Ninguno de los 16 pacientes con estadio clínico T1a presentó progresión tumoral, con una mediana de seguimiento de 90 meses. El 12,5% de los 24 casos T1b presentaron progresión tumoral, con una mediana de seguimiento de 70 meses. La mortalidad cáncer específica fue de un paciente (4,16 %) que pertenecía al grupo T1b. Conclusiones: La observación y seguimiento mediante PSA y tacto rectal del estadio clínico T1a parece ser una buena opción dado el buen pronóstico. De nuestros resultados podría deducirse que los pacientes con estadio clínico T1a y buenos factores pronósticos podrían considerarse con un riesgo de padecer un nuevo cáncer de próstata clínico similar al de la población normal, si bien, son necesarios estudios prospectivos que validen estos resultados. Los casos T1b precisan un tratamiento activo y seguimiento más estricto

Objectives: To analyse the progress of T1a and T1b prostate cancer diagnosed in our hospital. Material and methods: Retrospective study of 40 patients in T1a-T1b clinical stage diagnosed with prostate adenocarcinoma in our hospital, from 1986 to 1999. A restaging biopsy was performed on the 16 T1a patients after initial diagnosis and control. A radical prostatectomy was performed on the 24 T1b patients. They were all monitored every six months with rectal exam and PSA. We analysed biological and/or clinical progression, time to progression, mortality caused by the tumour and survival. Results: None of the 16 patients with T1a clinical stage presented tumour progression, with a median follow-up of 90 months. 12,5% of the 24 T1b cases presented tumour progression, with a median follow-up of 70 months. Cancer-specific mortality was one patient (4,16 %) in the T1b group. Conclusions: Observation and follow-up with PSA and rectal exam appears to be a good option for T1a clinical stage, given the good prognosis. Our results show that patients with T1a clinical stage and good prognostic factors could be at a similar risk of suffering from a new prostate cancer as the normal population, although prospective studies are required to validate these results. T1b cases require active treatment and closer monitoring

Actualidad en manejo de abcesos prostáticos: a propósito de un caso / The present time in handling of prostate abscesses: with regard to case

La existencia de abscesos prostáticos como mala evolución de una prostatitis aguda no es muy frecuente dado al correcto manejo de las infecciones urinarias mediante antibioterapia adecuada, a pesar de ello existen situaciones de inmunosupresión que pueden favorecer su aparición. Es nuestro propósito revisar la actuación en estas situaciones a raíz de un caso que mediante un drenaje percutáneo mínimamente invasivo consiguió completa mejoría

The existence of prostate abscess as bad evolution of an acute protatitis is not very frequent due to the correct handling of the urinary infections by means of suitable antibiotics, in spite of the presence of inmunosupresion situations that can favor their appearance. It is our intention to review the performance in these situations because of a case that by means of minimal invasive therapy by transperineal percutaneous puncture obtained complete improvement

[Development of tissue microarray technology (TMA) for immunohistochemical study of molecular expression profiling in prostate cancer (part 1)]. / Desarrollo de un microarray tisular (TMA) para el estudio inmunohistoquímico del patrón de expresión molecular en el cáncer de próstata (parte 1).

Tissue microarray technology (TMA) is nowadays considered as a powerful tool for the high-throughput analysis of molecular expression pattern of cancer. In this manuscript we show the experience of both groups in the design and building of a TMA for the study of protein expression pattern of prostatecancer as well as a summary of the technical points to analyze the results obtained with this technology. Today, different data generated by the immunostained tissues are studied to achieve a molecular profile in different clinical scenarios.

Desarrollo de un microarray tisular (TMA) para el estudio inmunohistoquímico del patrón de expresión molecular en el cáncer de próstata (Parte 1) / Development of tissue microarray technology (TMA) for immunohistochemical study of molecular expression profiling in prostate cancer (Part 1)

El microarray tisular (TMA) es considerado hoy en día una potente herramienta para el análisis masivo del perfil molecular del cáncer. En este trabajo describimos la experiencia de ambos centros en el diseño y creación de un TMA para el estudio de la expresión molecular del cáncer de próstata así como una revisión de los diferentes aspectos técnicos necesarios para el análisis de los resultados obtenidos con esta técnica. En la actualidad, se están estudiando los datos generados por las distintas técnicas inmunohistoquímicas para la obtención de un patrón molecular en diferentes estadios clínicos

Tissue microarray technology (TMA) is nowadays considered as a powerful tool for the high-throughput analysis of molecular expression pattern of cancer. In this manuscript we show the experience of both groups in the design and building of a TMA for the study of protein expression pattern of prostate cancer as well as a summary of the technical points to analyze the results obtained with this technology. Today, different data generated by the immunostained tissues are studied to achieve a molecular profile in different clinical scenarios

[Which is the most appropriate diagnostic algorithm for prostate cancer screening?]. / Cuál es el algoritmo diagnóstico más apropiado para el cribado del cáncer de próstata?

Since the use of PSA to detect prostate cancer was generalised in the late 1980's, prostate cancer diagnosis has increased considerably. Although there is now indirect evidence pointing to the beneficial effect of screening, there are no data justifying PSA screening in the general population. There is also a controversy concerning the most appropriate algorithm, should screening be performed. Therefore, our aim was to review the literature and, based on our experience, attempt to define the best algorithm for prostate cancer screening. We have made a search on Medline using the following terms: prostate biopsy, screening, algorithms, radical prostatectomy, PSA and prostate cancer. After analysing the literature, we can confirm that there is no "definitive" algorithm, due to the rapid appearance and use of new technical and biological breakthroughs, although it appears that at this time, without ceasing to include a rectal examination, more value should be given to personal risk factors, including PSA, at ages under 50, with individual monitoring based on these factors. The algorithms applied to a population have first to be validated for the population concerned.

[Treatment of hemorrhagic cystitis secondary to cyclophosphamide. Literature review with regard to a case]. / Tratamiento de la cistitis hemorrágica por ciclofosfamida. Revisión de la literatura a propósito de un caso.

There are extreme situations in the clinical treatment of intractable hematuria (fortunately not a common disease nowadays), in which even benign process may represent a serious risk to the life of the patient and where certain aggressive procedures like cystectomy have to be considered. Our objective in this paper is to review the different existing therapeutic alternatives for the treatment of an intense type of hematuria which does not yield to continuous saline serum irrigation. This study is partly based on a recent real clinical case in which, after the administration of cyclophosphamide to a young patient with recurrent and intense hematuria, the excretion was controlled through intravesical alum irrigation of thus avoiding cystectomy, a very aggressive surgical procedure with many after-effects.

¿Cuál es el algoritmo diagnóstico más apropiado para el cribado del cáncer de próstata? / Which is the most appropriate diagnostic algorithm for prostate cancer screening?

Desde la generalización del uso del PSA para la detección del cáncer de próstata en los últimos años de la década de los 80, el diagnóstico del cáncer de próstata se ha incrementado de forma notable. Aunque hoy día existe evidencia indirecta que haría pensar en un efecto beneficioso del cribado, no hay datos que justifiquen el cribado con PSA en la población general. Así mismo, existe controversia sobre cual sería el algoritmo más apropiado en el caso de que el cribado se realice. Por todo ello, nuestro objetivo ha sido realizar una revisión de la literatura reflexionando en base a nuestra experiencia para intentar definir cual sería el mejor algoritmo para el cribado del cáncer de próstata. Para ello, hemos realizado una búsqueda en Medline cruzando los términos biopsia de próstata, cribado o screening, algoritmos, prostatectomía radical, PSA y cáncer de próstata. Después del análisis de la literatura, pensamos que no existe un algoritmo 'definitivo' debido al carácter dinámico de los mismos por la rápida aparición e incorporación de nuevos avances técnicos y biológicos, pero parecería que hoy por hoy, sin dejar de incorporar el tacto rectal, se debería dar más valor a los factores personales de riesgo, y entre ellos el PSA a edades inferiores a 50 años realizando un seguimiento individualizado en función de estos factores. Los algoritmos aplicados a una población deberían de ser validados previamente en dicha población (AU)

Since the use of PSA to detect prostate cancer was generalised in the late 1980’s, prostate cancer diagnosis has increased considerably. Although there is now indirect evidence pointing to the beneficial effect of screening, there are no data justifying PSA screening in the general population. There is also a controversy concerning the most appropriate algorithm, should screening be performed. Therefore, our aim was to review the literature and, based on our experience, attempt to define the best algorithm for prostate cancer screening. We have made a search on Medline using the following terms: prostate biopsy, screening, algorithms, radical prostatectomy, PSA and prostate cancer. After analysing the literature, we can confirm that there is no 'definitive' algorithm, due to the rapid appearance and use of new technical and biological breakthroughs, although it appears that at this time, without ceasing to include a rectal examination, more value should be given to personal risk factors, including PSA, at ages under 50, with individual monitoring based on these factors. The algorithms applied to a population have first to be validated for the population concerned (AU)

Tratamiento de la cistitis hemorrágica por ciclofosfamida. Revisión de la literatura a propósito de un caso / Treatment of hemorrhagic cystitis secondary to cyclophosphamide. Literature review with regard to a case

Existen situaciones límites en la práctica clínica de hematurias rebeldes a tratamiento, no muy frecuentes hoy en día afortunadamente, en la que por procesos incluso benignos corre serio riesgo la vida del paciente y se plantean actuaciones como la cistectomia. Es nuestro deseo hacer una revisión de las diversas opciones terapéuticas que existen ante una hematuria intensa que no cede con irrigación continua de suero salino. Recientemente se ha precisado el uso de diferentes técnicas en un paciente joven, que tras administración de ciclofosfamida se controlo la hematuria recurrente e intensa mediante irrigación intravesical de alumina, evitando así una cirugía tan agresiva y con tantas secuelas como la cistectomía (AU)

There are extreme situations in the clinical treatment of intractable hematuria (fortunately not a common disease nowadays), in which even benign process may represent a serious risk to the life of the patient and where certain aggressive procedures like cystectomy have to be considered. Our objective in this paper is to review the different existing therapeutic alternatives for the treatment of an intense type of hematuria which does not yield to continuous saline serum irrigation. This study is partly based on a recent real clinical case in which, after the administration of cyclophosphamide to a young patient with recurrent and intense hematuria, the excretion was controlled through intravesical alum irrigation of thus avoiding cystectomy, a very aggressive surgical procedure with many after-effects (AU)

[Secondary prostatic lymphoma in a kidney transplant patient]. / Linfoma de próstata secundario en paciente trasplantado renal.

Lymphoma involving the prostate is rare, both as a primary and as a secondary presenting. Usually the prognosis remains poor. The clinical presentation is similar to that of other lower urinary tract obstructions, in fact prostatic lymphoma must be considered in patients with these symptoms, particularly in patients with prior history of systemic lymphoma. We report a case of a kidney transplantation in a male patient, diagnosis of lymphoma non Hodgkin, with later recurrence in prostate.

Linfoma de próstata secundario en paciente trasplantado renal / Secondary prostatic lymphoma in renal with transplant recipient

La afectación prostática por linfomas, tanto de origen primario como secundario, es una entidad poco frecuente y que habitualmente conlleva mal pronóstico. Su forma de presentación no difiere de cualquier causa de obstrucción del tracto urinario inferior, Por lo que debe sospecharse en todo paciente con antecedentes de linfoma y sintomatología obstructiva de tracto urinario inferior.Presentamos un caso de un paciente trasplantado renal, con afectación posterior de linfoma no Hodgkin, con recidiva a nivel prostático (AU)

[Skin metastasis of long-course prostatic cancer]. / Metástasis cutáneas de cáncer de próstata de larga evolución.

OBJECTIVE: To present a case of prostate cancer of long evolution and follow up time, in the one which has been evidenced the appearance of skin metastases at hypogastrium level, inferior extremities root and inguinal zone. METHODS: Patient diagnosed of prostate cancer, treated with radical prostatectomy and followed in conferences during ten years by the neoplasica disease. RESULTS: Appearance of skin metastases of a prostate cancer, after ten years of a radical surgery, in the one which the pathological anatomy demonstrated the local infiltration at seminal bladders level. CONCLUSIONS: The skin metastases of a prostate cancer are extremely uncommon, appearing in most of the occasions in process of very long evolution and in those which the disease has not been able be controlled.

[Prostatic angiosarcoma: report of a new case]. / Angiosarcoma prostático: aportación de un nuevo caso.

We report the case of a 31 year old male, with lower urinary tract symptoms. We achieved the diagnosis of an prostate angiosarcoma. The treatment was a retropubic radical prostatectomy and partially resection of bladder neck, followed by chemotherapy with Ifosfamide and Adriamycin. At least 36 months up to surgery the patient is alive and free of symptoms and radiological signs of recurrence.

Metástasis cutáneas de cáncer de próstata de larga evolución / Sin metastases in a long follow-up prostatic cancer

OBJETIVO: Presentar un caso de cáncer de próstata de largo tiempo de evolución y seguimiento, en el cual se ha evidenciado la aparición de metástasis cutáneas a nivel de hipogastrio, raíz de extremidades inferiores y zona inguinal. MÉTODOS: Paciente diagnosticado de cáncer de próstata, tratado con prostatectomía radical y seguido en consultas de urología durante diez años de evolución de la enfermedad neoplásica. RESULTADOS: Aparición de metástasis cutáneas de un adenocarcinoma de próstata, tras diez años de una cirugía radical, en la cual la anatomía patológica demostró la infiltración local a nivel de vesículas seminales. CONCLUSIONES: Las metástasis cutáneas del adenocarcinoma de próstata son extremadamente infrecuentes, apareciendo en la mayoría de las ocasiones en procesos de muy larga evolución, y en los cuales la enfermedad neoplásica no ha podido ser controlada (AU)

Angiosarcoma prostático: aportación de un nuevo caso / Angiosarcoma of the prostate: new case report

Comunicamos el caso de un varón de 31 años, al que se le inició estudio por clínica inespecífica del tracto urinario inferior. Se llegó al diagnóstico anatomopatológico por punción de angioma prostático. El tratamiento consistió en la prostatectomía radical retropúbica, con resección parcial del cuello vesical, seguido de tratamiento citostático con Ifosfamida y Adriamicina. A los 36 meses de la cirugía el paciente está asintomático y libre de signos clínicos y radiológicos de recidiva (AU)

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[Prostatic rebiopsy. Prognosis factors of the anatomopathologic result]. / Rebiopsia de próstata. Factores pronósticos del resultado anatomopatológico.

The indications for repeat prostate needle biopsy after a previous biopsy are not defined. We examined 107 prostate biopsies (in 98 patients) without a diagnosis of malignancy, which we repeat. Carcinoma was detected in 31 patients (31.6%). We didn't find statistic relationship between the repeat biopsy's outcome and: interval between biopsy and repeat biopsy, PSA value, PSA density (biopsy), PSAD of the transitional area (PSAD ad., on repeat biopsy). We found relationship with: prostatic weight (p = 0.002 on the biopsy, p = 0.0002 on the repeat biopsy), volume of the transitional area (p = 0.02 on the biopsy, p = 0.0001 on the repeat biopsy), PSA value (p = 0.02, on the repeat biopsy), PSAD ad. (p = 0.002, on the repeat biopsy), and with PSA velocity (p = 0.008). We only found clinic usefulness for the PSA velocity: patients with PSA velocity greater than 1 ng/ml/year are at high risk for prostate carcinoma on the repeat biopsy, specially in small prostates.

[Stage pT3 prostatic cancer after radical prostatectomy. Results in progression and survival]. / Cáncer de próstata estadio pT3 tras prostatectomía radical. Resultados en progresión y supervivencia.

PURPOSE: To analyse progression and survival after radical prostatectomy in patients with stage pT3 carcinoma of the prostate. MATERIAL AND METHODS: Between 1986 and November 1998, we performed 372 radical prostatectomies, 74 of which were pT3N0 (19.8%), 43 pT3a and 31 pT3b (TNM 97). RESULTS: In patients with pathological stage pT3, we found any progression in 24 patients (32%), 8 in pT3a, and 16 in pT3b. In 10 of 24 pT3, there was local relapse or distant metastases. About the freedom from biochemical relapse survival rate, we found statistically differences between pT3a and pT3b (p < 0.0001). In pT3a patients, we found no differences between PSA levels > 20 ng/ml, versus < 20 (p = 0.415), and statistically differences between pathological Gleason 6 or greater, versus < 6 (p = 0.048). However, we found no differences when we used both criteria (PSA and Gleason) (p = 0.195). CONCLUSIONS: We support for early adjuvant hormonal therapy in pT3b patients. In pT3a, the hormonotherapy may be used if appears biochemical failure, specially with adverse prognostic factors (PSA and Gleason).