Efectividad de un programa de instilación de quimioterapia precoz en pacientes con cáncer de vejiga / Effectiveness of a program of early instillation single chemotherapy in patients with bladder cancer

Objetivo. Determinar la efectividad de un programa de tratamiento con quimioterapia precoz para pacientes con cáncer vesical no músculo infiltrante antes y después de un plan de formación y comunicación dirigido a los profesionales que intervienen en el mismo. Método. Estudio longitudinal prospectivo, no experimental, de una cohorte de 349 pacientes con diagnóstico endoscópico de tumor vesical no músculo infiltrante en el AGS norte de Cádiz, entre 2010 y 2013, subsidiarios de tratamiento con mitomicina C posoperatoria. Resultados. La tasa media de pacientes incluidos en el programa fue del 53,9%. Esta tasa aumentó un 79,3% a los 3 años. La reducción absoluta del riesgo de recidiva para los pacientes que recibieron QTp fue del 18,1% (IC 95%: 8,8-27,4, p < 0,001), y el número de pacientes necesario a tratar de 5,5 (IC 95%: 3,6-11,3, p < 0,001). Conclusiones. Un programa de quimioterapia precoz postoperatoria que contemple un plan de evaluación y difusión de resultados ha conseguido un adecuado nivel de adherencia entre los profesionales, obteniendo el impacto esperado en la disminución de la recidiva precoz del cáncer de vejiga no músculo infiltrante (AU)

Objective. To determine the effectiveness of early intravesical chemotherapy intervention for patients with non-muscle invasive bladder cancer, before and after a training and inter-professional communication plan. Method. Non-experimental prospective longitudinal study of a cohort of 349 patients with endoscopic diagnosis of a non-muscle invasive bladder tumour in Northern Area Health Management of Cadiz between 2010 and 2013 and amenable to postoperative treatment with mitomycin C. Results. The mean rate of patients included in the program was 53.9%. The inclusion rate rose by 79.3% at 3 years. The absolute risk reduction of recurrence for patients receiving treatment is 18.1% (95% CI; 8.81% - 27.48%, p<.001), and the number of patients needed to treat was 5.5 (95% CI; 3.6 - 11.3, p<.001). Conclusions. A program of early postoperative chemotherapy that includes a plan for evaluation and dissemination of results has achieved a good level of adherence among professionals, obtaining the expected impact on the reduction of early recurrence of non-muscle invasive bladder cancer (AU)

[Effectiveness of a program of early instillation single chemotherapy in patients with bladder cancer]. / Efectividad de un programa de instilación de quimioterapia precoz en pacientes con cáncer de vejiga.

OBJECTIVE: To determine the effectiveness of early intravesical chemotherapy intervention for patients with non-muscle invasive bladder cancer, before and after a training and inter-professional communication plan. METHOD: Non-experimental prospective longitudinal study of a cohort of 349 patients with endoscopic diagnosis of a non-muscle invasive bladder tumour in Northern Area Health Management of Cadiz between 2010 and 2013 and amenable to postoperative treatment with mitomycin C. RESULTS: The mean rate of patients included in the program was 53.9%. The inclusion rate rose by 79.3% at 3 years. The absolute risk reduction of recurrence for patients receiving treatment is 18.1% (95% CI; 8.81% - 27.48%, p<.001), and the number of patients needed to treat was 5.5 (95% CI; 3.6 - 11.3, p<.001). CONCLUSIONS: A program of early postoperative chemotherapy that includes a plan for evaluation and dissemination of results has achieved a good level of adherence among professionals, obtaining the expected impact on the reduction of early recurrence of non-muscle invasive bladder cancer.

Cistectomía radical, histerectomía con doble anexectomía y nefroureterectomía bilateral con extracción por vía transvaginal. Descripción y consideraciones específicas de la técnica quirúrgica / Radical cystectomy, hysterectomy with double adnexectomy and bilateral nephroureterectomy with transvaginal extraction

Objetivos: La aparición de carcinoma urotelial sincrónico en la vía urinaria superior e inferior es infrecuente, y lo es aún más la aparición de forma bilateral. El objetivo de este artículo es describir la técnica quirúrgica de exéresis completa del aparato urinario por vía laparoscópica y añadir diferentes variantes técnicas que permiten mejorar la hemodinámica del paciente durante la cirugía. Material y métodos: Presentamos la técnica de cistectomía con nefroureterectomía bilateral, histerectomía con doble anexectomía y linfadenectomía ilio-obturatriz bilateral por vía laparoscópica y extracción de piezas vía transvaginal en una paciente de 58 años con múltiples resecciones previas vesicales de carcinoma urotelial de alto grado, que en la actualidad presentaba recidiva vesical y tumoración ureteropiélica bilateral. La técnica consiste en primer lugar en la histerectomía y doble anexectomía junto con linfadenectomía y cistectomía, manteniendo la unión uretrovesical, uniones ureterovesicales y la unión útero-vaginal. Tras cambiar de posición a la paciente se realizan ambas nefroureterectomías y finalmente completamos la resección de los segmentos antes referidos para extraer las piezas por vía transvaginal. Resultados: El resultado histológico fue de carcinoma urotelial de alto grado que afecta a la vejiga y a ambas uniones ureteropiélicas, junto con carcinoma endometrial. Tras revisar la literatura hemos encontrado menos de 10 casos en los que se realice una exéresis completa del aparato urinario, y ninguna con la descripción técnica que presentamos en este artículo. En la mayoría de los casos descritos en la bibliografía se hace la cirugía en 2 tiempos y sin preservar la función renal hasta el final de exéresis completa. Conclusión: Esta técnica permite mantener la diuresis más tiempo durante la cirugía, y de ese modo facilitar la labor del anestesista y mejorar la dinámica circulatoria del paciente. Además, de este modo se previene cualquier tipo de manipulación de la vía urinaria evitando el paso de células tumorales a la cavidad peritoneal, puesto que se extrae de forma íntegra las piezas a través de la vagina

Objectives: The onset of synchronous urothelial carcinoma in the upper or lower urinary tract is uncommon. Even more uncommon is the onset the bilateral form. The aim of this article is to describe the surgical technique of complete laparoscopic exeresis of the urinary apparatus and to add several variants of the technique that improve the patient's hemodynamics during surgery. Material and methods: We present the technique of cystectomy with bilateral nephroureterectomy, hysterectomy with double adnexectomy and bilateral ilio-obturator lymphadenectomy by laparoscopy and transvaginal extraction of specimens from a 58-year-old patient with multiple prior vesical resections of high-grade urothelial carcinoma. The patient currently presents bladder recurrence and bilateral ureteropelvic tumor. The technique consists first of the hysterectomy and double adnexectomy along with the lymphadenectomy and cystectomy, maintaining the urethrovesical, ureterovesical and uterovaginal junctions. After changing the patient's position, both nephroureterectomies were performed. Lastly, we completed the resection of the previously mentioned segments to extract the specimens transvaginally. Results: The histological result was high-grade urothelial carcinoma that affected the bladder and both ureteropelvic junctions, along with endometrial carcinoma. After reviewing the literature, we found less than 10 cases in which complete exeresis of the urinary apparatus was performed and none with the technical description presented in this article. In most cases described in the literature, surgery was performed at 2 separate times and without preserving renal function until the end of the complete exeresis. Conclusion: This technique helps maintain diuresis for a longer time during surgery and thereby facilitates the work of the anesthesiologist and improves the patient's circulatory dynamics. Additionally, the technique prevents any type of handling of the urinary tract, thereby avoiding the passage of tumor cells to the peritoneal cavity, given that the specimens are extracted whole through the vagina

[Toxicity of intravesical gemcitabine in superficial bladder cancer treatment]. / Toxicidad de la gemcitabina intravesical en el tratamiento del cáncer de vejiga superficial.

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Toxicidad de la gemcitabina intravesical en el tratamiento del cáncer de vejiga superficial / Toxicity of intravesical gemcitabine in superficial bladder cancer treatment

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Acetato de abiraterona prequimioterapia. Propuesta de un algoritmo de tratamiento en el carcinoma de próstata resistente a castración / Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer

Contexto: El tratamiento del cáncer de próstata sigue siendo un reto para el urólogo. El control médico en el cáncer de próstata metastásico o localmente avanzado se realiza habitualmente con análogos LHRH y antiandrógenos. Cuando se produce la progresión bioquímica y clínica de la enfermedad diferentes tratamientos han sido propuestos y otros nuevos han cambiado la perspectiva y esperanza de vida de los pacientes. Objetivo: El objetivo de esta revisión es establecer el papel actual del acetato de abiraterona en el tratamiento del cáncer de próstata resistente a la castración y facilitar la toma de decisión del urólogo mediante un algoritmo de tratamiento. Adquisición de la evidencia: Se realiza una búsqueda de la evidencia actual del tratamiento con abiraterona en pacientes con cáncer de próstata metastásico resistente a castración en PubMed, analizando principalmente aquellos estudios diseñados como ensayos clínicos. Además se realiza una revisión y actualización del papel del tratamiento hormonal y de los receptores androgénicos en el cáncer de próstata. Síntesis de la evidencia: Existen en la actualidad fundamentalmente 2 ensayos clínicos que demuestran la eficacia de abiraterona en el cáncer de próstata metastásico con respecto a placebo. En el estudio COU AA-302 se observa un beneficio evidente con abiraterona previo a quimioterapia en pacientes con cáncer de próstata resistente a castración, lo que permite establecer un algoritmo de tratamiento inicial que facilita la toma de decisión por parte del urólogo. Conclusión: Abiraterona es una opción de tratamiento prequimioterapia en pacientes seleccionados con cáncer de próstata metastásico resistente a la castración, aunque debe mejorarse la oferta económica y diseñar más ensayos clínicos multicéntricos para optimizar la relación coste/beneficio

Context: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogs and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients’ perspective and life expectancy. Objective: This review has aimed to establish the current role of abiraterone acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. Acquisition of the evidence: A search of current evidence on Abiraterone treatment in patients with castration-resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. Evidence synthesis: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. Conclusion: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration-resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio

Experiencia inicial con acetato de abiraterona en pacientes con cáncer de próstata resistente a la castración / Initial experience with abiraterone acetate in patients with castration-resistant prostate cancer

Objetivo: Describir los resultados obtenidos de la experiencia en el tratamiento con acetato de abiraterona (AA) en 25 hombres con cáncer de próstata metastásico resistente a la castración (CPMRC). Realizamos el análisis comparativo de la eficacia y seguridad de este fármaco en relación con la literatura existente. Material y método: Estudio biinstitucional prospectivo de una cohorte de 25 pacientes consecutivos que reciben tratamiento con AA por CPMRC, con un seguimiento medio 7,9 (3-15) meses. Análisis de la seguridad y eficacia del tratamiento en relación con las características basales de los pacientes (edad, tratamientos previos, PSA basal, performance status, dolor, metástasis). Resultados: La supervivencia global es del 80% a los 13,6 meses de seguimiento (IC 95%: 11,8-15,4). La supervivencia libre de progresión clínico-radiológica de la serie es de 9,5 ± 1 meses (IC 95%: 7,7-11,3) y el de respuesta bioquímica de 6,8 ± 1 meses (IC 95%: 5-8,7). Solo el tratamiento previo con quimioterapia empeora significativamente el tiempo de respuesta a AA (supervivencia libre de progresión radiológica 6,4 meses [IC 95%: 4,2-8,6] y bioquímica de 4,3 meses [IC 95%: 2,6-6]). La incidencia de efectos adversos fue del 36%, todos grado 1-2/4, y en ningún caso requiere suspender o disminuir la dosis de AA. Conclusiones: El tratamiento con AA ha sido eficaz en nuestra serie, con una tolerabilidad considerablemente mayor a lo publicado en otros estudios

Objective: To describe the results obtained in 25 men with metastatic castration-resistant prostate cancer (MCRPC) treated with abiraterone (AA). A comparative analysis of abiraterone effectiveness and safety between our results and data published in the literature was conducted. Materials and method: Bi-institutional prospective analysis of 25 consecutive patients with MCRPC undergoing treatment with abiraterone, with a mean follow-up 7.9 (3-15) months was carried out. Treatment effectiveness and safety analyses regarding baseline characteristics of patients (age, prior treatments, basal PSA, performance status, pain, and metastasis) were conducted. Results: At 13.6 months of follow-up, the overall survival is 80% (CI 95%: 11.8-15.4). Clinical and radiological-free progression survival is 9.5 ± 1 months (CI 95%: 7.7-11.3) and biochemical response is 6.8 ± 1 months (CI 95%: 5-8.7). Only the treatment with chemotherapy impaired significantly the response time to AA [6.4 months for radiological-free progression survival (CI 95%: 4.2-8.6) and 4.3 months for biochemical-free progression survival (CI 95%: 2.6-6)]. The incidence of adverse drug events was 36%; all of them were of grade 1-2/4 and, in no case, suspension or reduction of the dose of AA was needed. Conclusions: The treatment with AA has been effective in our series, with a tolerability considerably higher than what other studies published

Radical cystectomy, hysterectomy with double adnexectomy and bilateral nephroureterectomy with transvaginal extraction.

OBJECTIVES: The onset of synchronous urothelial carcinoma in the upper or lower urinary tract is uncommon. Even more uncommon is the onset the bilateral form. The aim of this article is to describe the surgical technique of complete laparoscopic exeresis of the urinary apparatus and to add several variants of the technique that improve the patient's hemodynamics during surgery. MATERIAL AND METHODS: We present the technique of cystectomy with bilateral nephroureterectomy, hysterectomy with double adnexectomy and bilateral ilio-obturator lymphadenectomy by laparoscopy and transvaginal extraction of specimens from a 58-year-old patient with multiple prior vesical resections of high-grade urothelial carcinoma. The patient currently presents bladder recurrence and bilateral ureteropelvic tumor. The technique consists first of the hysterectomy and double adnexectomy along with the lymphadenectomy and cystectomy, maintaining the urethrovesical, ureterovesical and uterovaginal junctions. After changing the patient's position, both nephroureterectomies were performed. Lastly, we completed the resection of the previously mentioned segments to extract the specimens transvaginally. RESULTS: The histological result was high-grade urothelial carcinoma that affected the bladder and both ureteropelvic junctions, along with endometrial carcinoma. After reviewing the literature, we found less than 10 cases in which complete exeresis of the urinary apparatus was performed and none with the technical description presented in this article. In most cases described in the literature, surgery was performed at 2 separate times and without preserving renal function until the end of the complete exeresis. CONCLUSION: This technique helps maintain diuresis for a longer time during surgery and thereby facilitates the work of the anesthesiologist and improves the patient's circulatory dynamics. Additionally, the technique prevents any type of handling of the urinary tract, thereby avoiding the passage of tumor cells to the peritoneal cavity, given that the specimens are extracted whole through the vagina.

Initial experience with abiraterone acetate in patients with castration-resistant prostate cancer.

OBJECTIVE: To describe the results obtained in 25 males with metastatic castration-resistant prostate cancer (MCRPC) treated with abiraterone (AA). A comparative analysis of abiraterone effectiveness and safety between our results and data published in the literature was conducted. MATERIAL AND METHOD: Bi-institutional prospective analysis of 25 consecutive patients with MCRPC undergoing treatment with abiraterone, with a mean follow-up 7.9 (3-15) months was carried out. Treatment effectiveness and safety analyses regarding baseline characteristics of patients (age, prior treatments, basal PSA, performance status, pain, metastasis) were conducted. RESULTS: At 13.6 months of follow-up, the overall survival is 80% (CI 95%: 11.8-15.4). Clinical and radiological-free progression survival is 9.5 ± 1 months (CI 95%: 7.7-11.3) and biochemical response is 6.8 ± 1 months (CI 95%: 5-8.7). Only the treatment with chemotherapy impaired significantly the response time to AA [6.4 months for radiological-free progression survival (CI 95%: 4.2-8,6) and 4.3 months for biochemical-free progression survival (CI 95%: 2.6-6)]. The incidence of adverse drug events was 36%, all of them grade 1-2/4 and, in no case, suspension or reduction of the dose of AA was needed. CONCLUSIONS: The treatment with AA has been effective in our series, with a tolerability considerably higher than what other studies published.

Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer.

CONTEXT: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogues and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients' perspective and life expectancy. OBJECTIVE: This review has aimed to establish the current role of Abiraterone Acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. ACQUISITION OF THE EVIDENCE: A search of current evidence on Abiraterone treatment in patients with castration- resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. EVIDENCE SYNTHESIS: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. CONCLUSION: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio.

[Bilobular benign retroperitoneal schwannoma]. / Schwannoma retroperitoneal benigno bilobulado.

OBJECTIVE: To describe an additional case of retroperitoneal schwannoma. METHODS: A case of retroperitoneal neoplasm in a 29-year-old woman is presented. The clinical and therapeutic aspects are discussed. RESULTS: The anatomopathological study showed a benign schwannoma. CONCLUSIONS: Retroperitoneal schwannoma is an uncommon lesion that is difficult to diagnose preoperatively. Treatment is by surgical resection.

[High incidence of chromosome 8 monosomy and chromosome 7 trisomy in prostatic primary tumor and its related lymphatic metastasis. Preliminary results]. / Alta incidencia de la monosomia del cromosoma 8 y la trisomia del cromosoma 7 en el tumor primario prostático y su metástasis ganglionar asociada. Resultados preliminares.

INTRODUCTION: The research on tumoral aggressivity parameters in prostate cancer, such DNA ploidy detected by fluorescence in situ hybridization, has significant relevance to refine prognostic on an individualized patient. OBJECTIVES: To identify chromosome numeric alterations by FISH in primary prostate cancer focus and its corresponding lymph node metastases. b) To describe a cytogenetic tumoral progression pathway. METHODS: So far, we have retrospectively studies eight patients with prostate cancer and lymph node metastases performing FISH analysis on the primary prostate cancer focus and its metastatic lymph node. DNA probes for chromosomes 7, 8, 10 and 12 have been used for FISH analysis. RESULTS: a) Seven out of eight tumours (85%) were aneuploid when studied by FISH and the most frequent chromosome alterations found were monosomy 8 (100%) and trisomy 7 (85.7%). All the lymph nodes were aneuploid being monosomy 8 (87.5%) and trisomy 7 (62.5%) the most common chromosome alterations. b) Monosomy 8 and trisomy 7 appeared to be in the same cytogenetic tumoral progression pathway. CONCLUSION: Although we report about a preliminary study, monosomy of chromosome 8 and trisomy 7 are related with poor evolution, probably because of the loss of a suppressor gene or a proto-oncogen overexpression. The presence of any of them in a prostate cancer focus is related with poor prognosis.