Relationship between Mental Disorders, Smoking or Alcoholism and Benign Prostate Disease.

INTRODUCTION: Mental disorders, smoking, or alcoholism and benign prostate disease are highly prevalent in men. AIMS: To identify the relationship between mental disorders, smoking, or alcoholism and benign prostate disease. METHODOLOGY: A prospective multicenter study that evaluated prostate health status in 558 men from the community. Groups: GP-men who request a prostate health examination and whose medical history includes a mental disorder, smoking, or alcoholism prior to a diagnosis of benign prostate disease; GU-men who request a prostate health examination and whose medical history includes a benign prostate disease prior to a diagnosis of mental disorder, smoking, or alcoholism. VARIABLES: age, body mass index (BMI), prostate specific antigen (PSA), follow-up of the mental disorder, smoking or alcoholism, time elapsed between urological diagnosis and the mental disorder, smoking or alcoholism diagnosis, status of the urological disease (cured or not cured), concomitant diseases, surgical history, and concomitant treatments. Descriptive statistics, Student's t-test, Chi2, multivariate analysis. RESULTS: There were no mental disorders, smoking, or alcoholism in 51.97% of men. Anxiety, smoking, major depressive disorder, pathological insomnia, psychosis, and alcoholism were identified in 19.71%, 13.26%, 5.73%, 4.30%, 2.87%, and 2.15% of individuals, respectively. Nonbacterial prostatitis (31.54%), urinary tract infection (other than prostatitis, 24.37%), prostatic intraepithelial neoplasia (13.98%), and prostatodynia (1.43%) were prostate diseases. Unresolved symptomatic benign prostate disease was associated with anxiety, depression, and psychosis (p = 0.002). Smoking was the disorder that men managed to eliminate most frequently. The dominant disorder in patients with symptomatic benign prostatic disease was alcoholism (p = 0.006). CONCLUSIONS: Unresolved symptomatic benign prostatic disease is associated with anxiety, depression, and psychosis. Alcoholism is associated with a worse prognosis in the follow-up of symptomatic benign prostatic disease.

Type 2 Diabetes-Related Variants Influence the Risk of Developing Prostate Cancer: A Population-Based Case-Control Study and Meta-Analysis.

In this study, we have evaluated whether 57 genome-wide association studies (GWAS)-identified common variants for type 2 diabetes (T2D) influence the risk of developing prostate cancer (PCa) in a population of 304 Caucasian PCa patients and 686 controls. The association of selected single nucleotide polymorphisms (SNPs) with the risk of PCa was validated through meta-analysis of our data with those from the UKBiobank and FinnGen cohorts, but also previously published genetic studies. We also evaluated whether T2D SNPs associated with PCa risk could influence host immune responses by analysing their correlation with absolute numbers of 91 blood-derived cell populations and circulating levels of 103 immunological proteins and 7 steroid hormones. We also investigated the correlation of the most interesting SNPs with cytokine levels after in vitro stimulation of whole blood, peripheral mononuclear cells (PBMCs), and monocyte-derived macrophages with LPS, PHA, Pam3Cys, and Staphylococcus Aureus. The meta-analysis of our data with those from six large cohorts confirmed that each copy of the FTOrs9939609A, HNF1Brs7501939T, HNF1Brs757210T, HNF1Brs4430796G, and JAZF1rs10486567A alleles significantly decreased risk of developing PCa (p = 3.70 × 10-5, p = 9.39 × 10-54, p = 5.04 × 10-54, p = 1.19 × 10-71, and p = 1.66 × 10-18, respectively). Although it was not statistically significant after correction for multiple testing, we also found that the NOTCH2rs10923931T and RBMS1rs7593730 SNPs associated with the risk of developing PCa (p = 8.49 × 10-4 and 0.004). Interestingly, we found that the protective effect attributed to the HFN1B locus could be mediated by the SULT1A1 protein (p = 0.00030), an arylsulfotransferase that catalyzes the sulfate conjugation of many hormones, neurotransmitters, drugs, and xenobiotic compounds. In addition to these results, eQTL analysis revealed that the HNF1Brs7501939, HNF1Brs757210, HNF1Brs4430796, NOTCH2rs10923931, and RBMS1rs7593730 SNPs influence the risk of PCa through the modulation of mRNA levels of their respective genes in whole blood and/or liver. These results confirm that functional TD2-related variants influence the risk of developing PCa, but also highlight the need of additional experiments to validate our functional results in a tumoral tissue context.

[Editorial: El cáncer vesical, un tumor urológico.] / Editorial: El cáncer vesical, un tumor urológico.

Archivos Españoles de Urología finaliza el año 2020, un año difícil que todos recordaremos con tristeza como el año del Covid, editando un Número Monográfico que es pura Ciencia y Novedad ,y que también tendrá un largo recorrido en la Memoria de cuantos lo estudien o lo lean, titulado: NUEVOS PARADIGMAS EN EL CÁNCER VESICAL La importancia y relevancia del Tema seleccionado es y será notoria en tanto podemos afirmar con toda seguridad que durante 2021 y siguientes años, los artículos contenidos en el mismo, serán motivo de referencia, presentaciones, ponencias y debates en todos los foros nacionales e internacionales en los que se aborde el manejo y tratamiento del Cáncer Vesical...

Archivos Españoles de Urología finaliza el año 2020, un año difícil que todos recordaremos con tristeza como el año del Covid, editando un Número Monográfico que es pura Ciencia y Novedad ,y que también tendrá un largo recorrido en la Memoria de cuantos lo estudien o lo lean, titulado: NUEVOS PARADIGMAS EN EL CÁNCER VESICAL La importancia y relevancia del Tema seleccionado es y será notoria en tanto podemos afirmar con toda seguridad que durante 2021 y siguientes años, los artículos contenidos en el mismo, serán motivo de referencia, presentaciones, ponencias y debates en todos los foros nacionales e internacionales en los que se aborde el manejo y tratamiento del Cáncer Vesical...

El cáncer vesical, un tumor urológico / No disponible

No disponible

[Emergency surgery during COVID-19 pandemia.] / Cirugía de urgencia en urología durante la pandemia Covid-19.

INTRODUCTION: The crisis in the SARSCoV-2 coronavirus causing COVID-19 is putting health systems around the world to the test. In a great effort to standardize the management and treatment guidelines, the different health authorities and scientific associations have tried to issue recommendations on how to act in this new and complex scenario. OBJECTIVE: To synthesize the existing evidence and recommendations about urological emergency surgery during the COVID-19 pandemic situation. Furthermore, we propose a general action protocol for these patients. MATERIAL AND METHODS: The document is based ont he scarce evidence on SARS / Cov-2 and the experience of the authors in the management of COVID-19 in their institutions, including specialists from Andalusia, Cantabria, Madrid and the Basque Country. A web and PubMed search was performed using the keywords "SARS-CoV-2", "COVID19",  "COVID Urology", "COVID19 surgery" and "emergency care". A narrative review of the literature was carried out until April 30, 2020, including only articles and documents written in Spanish and English. After the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria. Finally, a definitive version was made, agreed by all the authors on May 12, 2020. RESULTS: General principles of action are set out, as well as specific recommendations for the most frequent urgent urological procedures. CONCLUSIONS: Given the exceptional nature of the situation, there is a lack of evidence regarding the optimal management of the patient with urgent urological pathology. The information is changing, as the epidemiological knowledge of the disease advances. The establishment of multidisciplinary surgical committees that develop and implement action protocols appropriate to the different resources and particular situations of each center is recommended. Likewise, these committees must individually assess each possible urological surgical emergency situation and ensure compliance with protective measures for the patient and other healthcare personnel.

INTRODUCCIÓN: La crisis del coronavirus SARS-CoV-2 causante del COVID-19 está poniendoa prueba los sistemas sanitarios de todo el mundo. En un gran esfuerzo por estandarizar las pautas de manejo y tratamiento, las distintas autoridades sanitarias y asociaciones científicas han tratado de dictar unas recomendaciones sobre como actuar en este nuevo y complejo escenario.OBJETIVO: Sintetizar la evidencia y recomendaciones existentes acerca de la cirugía de urgencia urológica durante la situación de pandemia COVID-19. Además, proponemos un protocolo de actuación general para estos pacientes. MATERIAL Y MÉTODOS: El documento se basa en la escasa evidencia sobre SARS/Cov-2 y la experiencia de los autores en el manejo de COVID-19 en sus instituciones incluyendo especialistas de Andalucía, Cantabria, Madrid y País Vasco. Se realizó una búsqueda web y en PubMed utilizando las palabras clave "SARSCoV-2", "COVID19", "COVID Urology", "COVID19 surgery" y "emergency care". Se realizó una revisión narrativa de la literatura hasta el día 30 de Abril de2020 incluyendo solo artículos y documentos escritos en lengua española e inglesa. Tras técnica de grupo nominal modificada debido a las restricciones extraordinarias se realizó un primer borrador para unificar criterios. Finalmente, se realizó una versión definitiva, consensuada por todos los autores el 12 Mayo 2020. RESULTADOS: Se exponen unos principios generales de actuación, así como unas recomendaciones específicas para los procedimientos urológicos urgentes más frecuentes.CONCLUSIONES: Dado el carácter excepcional de la situación, existe un déficit de evidencia respecto al óptimo manejo del paciente con patología urológica urgente. La información es cambiante, según avanza el conocimiento epidemiológico de la enfermedad. Es recomendable el establecimiento de comités multidisciplinares quirúrgicos que desarrollen e implementen protocolos de actuación adecuados a los distintos recursos y situaciones particulares de cada centro. Del mismo modo, estos comités deben evaluar de forma individualizada cada posible situación de urgencia quirúrgica urológica y velar por el cumplimiento de las medidas de protección para el paciente y resto del personal sanitario.

Cirugía de urgencia en urología durante la pandemia Covid-19 / Emergency surgery during COVID-19 pandemia

INTRODUCCIÓN: La crisis del coronavirus SARS-CoV-2 causante del COVID-19 está poniendoa prueba los sistemas sanitarios de todo el mundo. En un gran esfuerzo por estandarizar las pautas de manejo y tratamiento, las distintas autoridades sanitarias y asociaciones científicas han tratado de dictar unas recomendaciones sobre como actuar en este nuevo y complejo escenario. OBJETIVO: Sintetizar la evidencia y recomendaciones existentes acerca de la cirugía de urgencia urológica durante la situación de pandemia COVID-19. Además, proponemos un protocolo de actuación general para estos pacientes. MATERIAL Y MÉTODOS: El documento se basa en la escasa evidencia sobre SARS/Cov-2 y la experiencia de los autores en el manejo de COVID-19 en sus instituciones incluyendo especialistas de Andalucía, Cantabria, Madrid y País Vasco. Se realizó una búsqueda web y en PubMed utilizando las palabras clave "SARSCoV-2", "COVID19", "COVID Urology", "COVID19 surgery" y "emergency care". Se realizó una revisión narrativa de la literatura hasta el día 30 de Abril de2020 incluyendo solo artículos y documentos escritos en lengua española e inglesa. Tras técnica de grupo nominal modificada debido a las restricciones extraordinarias se realizó un primer borrador para unificar criterios. Finalmente, se realizó una versión definitiva, consensuada por todos los autores el 12 Mayo 2020. RESULTADOS: Se exponen unos principios generales de actuación, así como unas recomendaciones específicas para los procedimientos urológicos urgentes más frecuentes. CONCLUSIONES: Dado el carácter excepcional de la situación, existe un déficit de evidencia respecto al óptimo manejo del paciente con patología urológica urgente. La información es cambiante, según avanza el conocimiento epidemiológico de la enfermedad. Es recomendable el establecimiento de comités multidisciplinares quirúrgicos que desarrollen e implementen protocolos de actuación adecuados a los distintos recursos y situaciones particulares de cada centro. Del mismo modo, estos comités deben evaluar de forma individualizada cada posible situación de urgencia quirúrgica urológica y velar por el cumplimiento de las medidas de protección para el paciente y resto del personal sanitario

INTRODUCTION: The crisis in the SARSCoV-2 coronavirus causing COVID-19 is putting health systems around the world to the test. In a great effort to standardize the management and treatment guidelines, the different health authorities and scientific associations have tried to issue recommendations on how to act in this new and complex scenario. OBJECTIVE: To synthesize the existing evidence and recommendations about urological emergency surgery during the COVID-19 pandemic situation. Furthermore, we propose a general action protocol for these patients. MATERIAL AND METHODS: The document is based on the scarce evidence on SARS/Cov-2 and the experience of the authors in the management of COVID-19 in their institutions, including specialists from Andalusia, Cantabria, Madrid and the Basque Country. A web and PubMed search was performed using the keywords "SARS-CoV-2", "COVID19", "COVID Urology", "COVID19 surgery" and "emergency care". A narrative review of the literature was carried out until April 30, 2020, including only articles and documents written in Spanish and English. After the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria. Finally, a definitive version was made, agreed by all the authors on May 12, 2020. RESULTS: General principles of action are set out, as well as specific recommendations for the most frequent urgent urological procedures. CONCLUSIONS: Given the exceptional nature of the situation, there is a lack of evidence regarding the optimal management of the patient with urgent urological pathology. The information is changing, as the epidemiological knowledge of the disease advances. The establishment of multidisciplinary surgical committees that develop and implement action protocols appropriate to the different resources and particular situations of each center is recommended. Likewise, these committees must individually assess each possible urological surgical emergency situation and ensure compliance with rotective measures for the patient and other healthcare personnel

Utilidad de la PET/TC con 18F-fluorocolina en la recidiva bioquímica del cáncer de próstata: relevancia de la cinética del PSA y la terapia hormonal / Usefulness of 18F-fluorocoline PET/CT in prostate cancer patients with biochemical recurrence: Influence of PSA kinetics and hormone therapy

Objetivo: Evaluar la capacidad de la 18F-fluorometilcolina (FCH) tomografía por emisión de positrones/tomografía computarizada (PET/TC) en la detección de la enfermedad en la recidiva bioquímica del cáncer de próstata, su correlación con la cinética del antígeno prostático específico (PSA) y la influencia de la terapia hormonal antiandrogénica. Pacientes y métodos: Estudio observacional y retrospectivo, que incluyó a pacientes con cáncer de próstata y criterios de recidiva bioquímica y/o resistencia a la castración, según la Asociación Europea de Urología. Los resultados de la FCH PET/TC se categorizaron en dos grupos (positivo vs. negativo) utilizando como gold estándar la anatomía patológica, otras pruebas de imagen y/o seguimiento clínico. Se estudió la relación entre la FCH PET/TC y la cinética del PSA (PSA en el momento de la exploración [trigger-PSA], tiempo de duplicación [PSAdt] y velocidad de ascenso [PSAva]) y se analizó la influencia de la terapia hormonal. Resultados: Se incluyeron 203 pacientes. La tasa de detección global de la FCH PET/TC fue del 43,3%. El grupo de pacientes con FCH PET/TC positiva mostró una cinética de PSA más agresiva (PSAdt: 7,5±7,5meses y PSAva 8,37±14,8ng/ml/a) que el grupo FCH PET/TC negativa (PSAdt: 14,5±7,6meses y PSAva: 1,8±3,7ng/ml/a). La tasa de detección de la FCH-PET/TC en el subgrupo con resistencia a la castración fue del 89,1%, significativamente mayor a la tasa del 29,9% del grupo con tratamiento curativo, p <0,001. Conclusiones: La FCH PET/TC es útil en la detección de la enfermedad en la recidiva bioquímica del cáncer de próstata, especialmente en los pacientes con terapia hormonal o cinética del PSA más agresiva

Purpose: To evaluate the capacity of 18f-fluorocholine positron emission tomography/computed tomography (FCH PET/CT) to detect biochemical recurrence of prostate cancer and to determine the correlation with PSA kinetics and influence of antiandrogen hormone therapy. Patients and methods: Observational and retrospective study, which included patients with prostate cancer and criteria for biochemical recurrence and/or resistance to castration, according to the European Association of Urology. FCH PET/CT results were classified as positive or negative, using as gold standard the pathology report, findings of other imaging test, and/or clinical follow-up results. The correlation between FCH PET/CT and PSA kinetics (PSA at the time of exploration [PSA-trigger], doubling time [PSAdt] and velocity [PSAva]) was studied and the influence of hormone therapy was analysed. Results: The study included 203 patients. The FCH PET/CT detection rate was 43.3%. The group of patients with FCH PET/CT positive showed more aggressive PSA kinetics (PSAdt: 7.5 months and PSAva 8.37±14.8ng/ml/a) than the FCH PET/CT negative group (PSAdt: 14.5±7.6 months and PSAva: 1.8±3.7ng/ml/a). The detection rate of FCH PET/CT in the subgroup with castration resistance was 89.1%, significantly higher than in the group with radical treatment at 29.9%, p<.001. Conclusions: FCH PET/CT is useful to detect biochemical recurrence of prostate cancer, especially in patients who receive hormone therapy or more aggressive PSA kinetics

[Axitinib in real life, analysis of our results.] / Axitinib en el tratamiento del cáncer renal metastásico en la vida real, análisis de nuestros resultados.

OBJECTIVE: Following first-line treatment progression in metastatic renal carcinoma, different options for second-line treatment are available, with axitinib being one of them. The objective of this article is to evaluate the results of Axitinib in a real practice setting. METHODS: From December 2011 to October 2016, we treated 19 patients with CCRM with Axitinib, 3 patients in third line and 16 patients in second line after progression on Sunitinib or Pazopanib. We performed a retrospective study of the last 16 patients, analyzing the effectiveness and safety of the drug. RESULTS: The median progression-free survival (PFS) was 9 months and the median overall survival with 8 dead patients was 59 months. Overall, toxicity by Axitinib was very common, diarrhea 87.5%, asthenia 75%, dysphonia 56.25%, hypertension 37.5% and anorexia 37.5%, although most are grade 1-2 toxicities controlled with hygiene-diet measures and treatment recommendations. CONCLUSIONS: Axitinib is a drug that has been shown to increase PFS after 1st line progression, with a tolerable toxic profile. With the approval of nivolumab and cabozantinib, the place of Axitinib in sequential therapy is yet to be defined.

OBJETIVO: Tras progresión de primera línea de tratamiento en el carcinoma renal metastásico hay disponibles distintas opciones de tratamiento de segunda línea, siendo Axitinib una de ellas. MÉTODOS: Desde diciembre de 2011 hasta octubre de 2016, hemos tratado a 19 pacientes con CCRm con Axitinib, 3 pacientes en tercera línea y 16 en segunda línea tras progresión de Sunitinib o Pazopanib. Realizamos un estudio retrospectivo de los últimos 16 pacientes, analizando efectividad y seguridad del fármaco. RESULTADOS: La mediana de la supervivencia libre de progresión (SLP) fue de 9 meses y la mediana de supervivencia global con 8 pacientes fallecidos fue de 59 meses. La toxicidad global por Axitinib fue muy frecuente, diarrea 87,5%, astenia 75%, disfonía 56,25%, HTA 37,5% y anorexia 37,5%, aunque en su mayoría fueron toxicidades grado 1-2 controlados con medidas higiénico dietéticas y recomendaciones de tratamiento. CONCLUSIONES: Axitinib es un fármaco que ha demostrado aumentar la SLP tras progresión de 1ª línea, con un perfil toxico tolerable. Con la aprobación de nivolumab y cabozantinib, el lugar de Axitinib en la terapia secuencial está por definir.

Axitinib en el tratamiento del cáncer renal metastásico en la vida real, análisis de nuestros resultados / Axitinib in real life, analysis of our results

Objetivo: Tras progresión de primera línea de tratamiento en el carcinoma renal metastásico hay disponibles distintas opciones de tratamiento de segunda línea, siendo Axitinib una de ellas. Métodos: Desde diciembre de 2011 hasta octubre de 2016, hemos tratado a 19 pacientes con CCRm con Axitinib, 3 pacientes en tercera línea y 16 en segunda línea tras progresión de Sunitinib o Pazopanib. Realizamos un estudio retrospectivo de los últimos 16 pacientes, analizando efectividad y seguridad del fármaco. Resultados: La mediana de la supervivencia libre de progresión (SLP) fue de 9 meses y la mediana de supervivencia global con 8 pacientes fallecidos fue de 59 meses. La toxicidad global por Axitinib fue muy frecuente, diarrea 87,5%, astenia 75%, disfonía 56,25%, HTA 37,5% y anorexia 37,5%, aunque en su mayoría fueron toxicidades grado 1-2 controlados con medidas higiénico dietéticas y recomendaciones de tratamiento. Conclusiones: Axitinib es un fármaco que ha demostrado aumentar la SLP tras progresión de 1 línea, con un perfil toxico tolerable. Con la aprobación de nivolumab y cabozantinib, el lugar de Axitinib en la terapia secuencial está por definir

Objective: Following first-line treatment progression in metastatic renal carcinoma, different options for second-line treatment are available, with axitinib being one of them. The objective of this article is to evaluate the results of Axitinib in a real practice setting. Methods: From December 2011 to October 2016, we treated 19 patients with CCRM with Axitinib, 3 patients in third line and 16 patients in second line after progression on Sunitinib or Pazopanib. We performed a retrospective study of the last 16 patients, analyzing the effectiveness and safety of the drug. Results: The median progression-free survival (PFS) was 9 months and the median overall survival with 8 dead patients was 59 months. Overall, toxicity by Axitinib was very common, diarrhea 87.5%, asthenia 75%, dysphonia 56.25%, hypertension 37.5% and anorexia 37.5%, although most are grade 1-2 toxicities controlled with hygiene-diet measures and treatment recommendations. Conclusions: Axitinib is a drug that has been shown to increase PFS after 1st line progression, with a tolerable toxic profile. With the approval of nivolumab and cabozantinib, the place of Axitinib in sequential therapy is yet to be defined

A Combination of Positive Tumor HLA-I and Negative PD-L1 Expression Provides an Immune Rejection Mechanism in Bladder Cancer.

BACKGROUND: Tumor human leukocyte antigen class I (HLA-I) expression plays an important role in T cell-mediated tumor rejection. Loss of HLA-I is associated with cancer progression and resistance to immunotherapy, including antibodies blocking programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) signaling. Our objective was to analyze a correlation between HLA-I, tumor immune infiltration, and PD-L1/PD-1 axis in bladder cancer in association with the clinicopathologic features of patients. METHODS: We analyzed 85 cryopreserved bladder tumors by immunohistochemistry to investigate the expression of HLA-I, PD-L1, PD-1, CD3, CD8, and CXC chemokine receptor 4 (CXCR4). The results were correlated with tumor stage and other clinicopathologic variables of patients. RESULTS: We found a strong positive correlation between tumor HLA-I expression and infiltration with CD3+ and CD8 + T cells. PD-L1 expression was positive in 15.5% of tumors and heterogeneous in 40.5%, and was linked to a more advanced tumor stage. The majority of HLA-I-positive/heterogeneous tumors also expressed PD-L1 and PD-1, which were significantly correlated with each other and with lymphocyte infiltration. Interestingly, the analysis of the simultaneous expression of both markers revealed that 85.2% of tumors with a positive/heterogeneous HLA-I phenotype and negative for PD-L1 were mostly non-invasive, representing a 'tumor rejection' immune phenotype. CONCLUSIONS: High tumor HLA-I expression with absence of PD-L1 provides bladder cancer with an immune rejection mechanism. Evaluation of PD-L1 and HLA-I together should be considered in bladder cancer and may provide a new predictive biomarker of tumor invasiveness and of the response to 'immune checkpoint' therapy.

Usefulness of 18F-fluorocoline PET/CT in prostate cancer patients with biochemical recurrence: Influence of PSA kinetics and hormone therapy. / Utilidad de la PET/TC con 18F-fluorocolina en la recidiva bioquímica del cáncer de próstata: relevancia de la cinética del PSA y la terapia hormonal.

PURPOSE: To evaluate the capacity of 18f-fluorocholine positron emission tomography/computed tomography (FCH PET/CT) to detect biochemical recurrence of prostate cancer and to determine the correlation with PSA kinetics and influence of antiandrogen hormone therapy. PATIENTS AND METHODS: Observational and retrospective study, which included patients with prostate cancer and criteria for biochemical recurrence and/or resistance to castration, according to the European Association of Urology. FCH PET/CT results were classified as positive or negative, using as gold standard the pathology report, findings of other imaging test, and/or clinical follow-up results. The correlation between FCH PET/CT and PSA kinetics (PSA at the time of exploration [PSA-trigger], doubling time [PSAdt] and velocity [PSAva]) was studied and the influence of hormone therapy was analysed. RESULTS: The study included 203 patients. The FCH PET/CT detection rate was 43.3%. The group of patients with FCH PET/CT positive showed more aggressive PSA kinetics (PSAdt: 7.5 months and PSAva 8.37±14.8ng/ml/a) than the FCH PET/CT negative group (PSAdt: 14.5±7.6 months and PSAva: 1.8±3.7ng/ml/a). The detection rate of FCH PET/CT in the subgroup with castration resistance was 89.1%, significantly higher than in the group with radical treatment at 29.9%, p<.001. CONCLUSIONS: FCH PET/CT is useful to detect biochemical recurrence of prostate cancer, especially in patients who receive hormone therapy or more aggressive PSA kinetics.

The Effect of Anticholinergics for Prevention of Storage Symptoms After Prostate Photovaporization.

PURPOSE: To evaluate the efficacy of oral anticholinergics as a preventive strategy of storage symptoms and urinary incontinence associated with the early postoperative period after Greenlight laser photovaporization of the prostate (PVP). To analyze potential variables related to the onset of these symptoms. MATERIALS AND METHODS: Retrospective study of 105 patients who underwent PVP using a 180-W Greenlight laser (XPS). Patients were divided into two groups, depending on whether they were or weren´t prescribed anticholinergics when discharged (oral solifenacin 5 mg for 1 month after surgery). Differences between both groups were analyzed according to IPSS, ICIQ-SF and OABq-SF scores at 1 and 6 months. The potentially predictive variables of the symptomatology after undergoing PVP that we analyzed included age, prostate volume, PSA, IPSS, ICIQ-SF, OABq-SF, Qmax, previous use of a permanent urinary catheter, energy used, and laser application time. RESULTS: 58 patients in the group with anticholinergics and 47 in the group without anticholinergics were compared. No significant differences were observed between both groups in IPSS (p = .521), ICIQ-SF (p = .720) or OABq-SF (p = .851) at 1 and 6 months after surgery. Regardless of the use of anticholinergics, there was a significant score improvement between the first and second checkup in all the questionnaires: there was a significant decrease in the mean IPSS (p < .001) and the mean score of the eighth IPSS question on patient's quality of life (p = .026), ICIQ- SF (p = .010) and OAB-q related to symptoms (p = .001) as well as a significant increase in the mean OAB-q score regarding quality of life (p = .005). None of the variables analyzed showed a significant relation to the storage-symptom rate, rate of incontinence, or ICIQ-SF and OABq-SF scores. CONCLUSIONS: The use of solifenacin 5 mg after Greenlight laser PVP is not an effective preventive treatment for storage and incontinence symptoms associated with this procedure, which seem to self-limit over time.

[Recommendations for follow up in castration resistant prostate cancer.] / Recomendaciones para el seguimiento del cáncer de próstata resistente a la castración.

OBJECTIVES: There is no broad consensus about what diagnostic tests use for CRPC follow up as well as their frequency. Our objective is to review and analyze the most important CRPC follow up patterns described in the literature to date. METHODS: We performed a critical analysis of the recommendations for follow up most universally employed (PCWG3, RADAR, St Gallen consensus, NCCN guidelines, EAU guidelines) RESULTS: CT scan and bone scan are the routine recommended diagnostic tests, in front of other techniques such as PET/CT or MRI, that may improve the diagnostic efficacy but they have the problem of availability and lack of internal validity for follow up. CONCLUSIONS: Follow up is different for non metastatic and metastatic CRPC. For nm CRPC, it is recommended to perform monitoring that includes PSA and imaging tests, without consensus about periodicity. For mCRPC, it is recommendable to do follow up with periodic PSA and imaging tests, since it is possible to have radiological progression without PSA progression.

Variantes agresivas de cáncer de próstata resistente a la castracion (CPRC): cáncer de próstata neuroendocrino / Aggressive variants of castration resistant prostate cancer (crpc): neuroendocrine prostate cancer

OBJETIVO: No existe un consenso amplio sobre qué pruebas diagnósticas emplear en el seguimiento del CPRC, así como la periodicidad de las mismas. Nuestro objetivo es revisar y analizar las pautas de seguimiento en el CPRC más importantes descritas hasta la fecha en la literatura. MÉTODOS: Se realiza un análisis crítico de las recomendaciones de seguimiento más universalmente empleadas (PCWG3, RADAR, consenso de St Gallen, guías NCCN, Guías Europeas de Urología). RESULTADO: El TC y la gammagrafía ósea son las técnicas diagnósticas recomendadas rutinariamente, por delante de otras técnicas como el PET/TC o la RM, las cuales pueden mejorar la eficacia diagnóstica pero tienen el problema de la disponibilidad y la falta de validez interna para el seguimiento. CONCLUSIONES: El seguimiento es diferente entre CPRC no metastásico (nm) y metastásico(m). En el CPRCnm, se recomienda realizar una monitorización que incluya PSA y pruebas de imagen, no existiendo consenso en la periodicidad. En el CPRCm, es recomendable realizar el seguimiento con PSA y con pruebas de imagen periódicas, pues se puede dar una progresión radiológica sin progresión por PSA

OBJECTIVES: There is no broad consensus about what diagnostic tests use for CRPC follow up as well as their frequency. Our objective is to review and analyze the most important CRPC follow up patterns described in the literature to date. METHODS: We performed a critical analysis of the recommendations for follow up most universally employed (PCWG3, RADAR, St Gallen consensus, NCCN guidelines, EAU guidelines) RESULTS: CT scan and bone scan are the routine recommended diagnostic tests, in front of other techniques such as PET/CT or MRI, that may improve the diagnostic efficacy but they have the problem of availability and lack of internal validity for follow up. CONCLUSIONS: Follow up is different for non metastatic and metastatic CRPC. For nm CRPC, it is recommended to perform monitoring that includes PSA and imaging tests, without consensus about periodicity. For mCRPC, it is recommendable to do follow up with periodic PSA and imaging tests, since it is possible to have radiological progression without PSA progression

[Altered urinary calcium excretion in prostate cancer patients subjected to androgen deprivation. Preliminary pilot study results.] / Alteración de la excreción urinaria de calcio en pacientes sometidos a deprivación androgénica por cáncer de próstata. Resultados preliminares de un estudio piloto.

OBJECTIVES: Androgen deprivation therapy (ADT) in prostate cancer is associated with the appearance of different adverse effects. Among these effects, notable ones that may affect metabolism are osteoporosis and metabolic syndrome. The aim of this study is to analyse lithogenic risk markers three months after initiating treatment with LHRH analogue. METHODS: Pilot study encompassing 15 prostate cancer patients who were candidates for ADT, which they received in the form of quarterly doses of goserelin 10.8 mg. A blood and urine analyses for lithogenic risk, bone and metabolic markers were carried out, as was a study of metabolic syndrome criteria. Statistical analysis was performed with SPSS 17.0, taking P≤.05 to be statistically significant. RESULTS: Patients included in the study had a mean age of 72.46 ± 6.61 years. We observed a significant increase in the percentage of metabolic syndrome (20% versus 46.7%; P<.05) and insulin resistance index (1.87 versus 2.96; P=.01) at 3 months treatment. There was a notable increase in bone remodelling markers and significant increases in 24 h urinary calcium values (9.46 versus 14.57 mg/dl; P=.008), 24 h urinary calcium excretion index (0.10 versus 0.13 mg/dl GF [glomerular filtration]; P=.01) and the fasting calcium/ creatinine ratio (0.107 versus 0.195; P=.007), without any changes to other lithogenous risk markers. CONCLUSIONS: Androgen deprivation therapy can lead to the short-term appearance, primarily when fasting, of hypercalciuria in prostate cancer patients, possibly in association with bone metabolism.

Alteración de la excreción urinaria de calcio en pacientes sometidos a deprivación androgénica por cáncer de próstata. Resultados preliminares de un estudio piloto / Altered urinary calcium excretion in prostate cancer patients subjected to androgen deprivation. Preliminary pilot study results

OBJETIVOS: La terapia de deprivación androgénica en el cáncer de próstata se relaciona con la aparición de diferentes efectos adversos. En el ámbito metabólico destacan la aparición de osteoporosis y síndrome metabólico. El objetivo de este estudio es analizar los marcadores de riesgo litógeno a los 3 meses de haber iniciado tratamiento con análogo LHRH. MÉTODOS: Estudio piloto que incluye a 15 pacientes con cáncer de próstata subsidiarios de tratamiento con deprivación androgénica que se realiza con goserelina 10,8 mg trimestral. Se realiza estudio en sangre y orina de marcadores de riesgo litógeno, marcadores óseos y metabólicos, así como estudio de criterios de síndrome metabólico. Análisis estadístico con programa SPSS 17.0, considerando p≤0,05 como significación estadística. RESULTADOS: La edad media de los pacientes incluidos fue de 72,46 ± 6,61 años. Se observó un aumento significativo del porcentaje de síndrome metabólico a los 3 meses de tratamiento (20% versus 46,7%; p < 0,05), así como del índice de resistencia a la insulina (1,87 versus 2,96; p = 0,01). Destaca un aumento de los marcadores de remodelado óseo, así como un aumento significativo de la calciuria (9,46 versus 14,57 mg/dl; p = 0,008), del índice de excreción urinario de calcio (0,10 versus 0,13 mg/dl FG; p = 0,01) y del cociente calcio/creatinina de ayunas (0,107 versus 0,195; p = 0,007), sin modificaciones en otros marcadores de riesgo litógeno. CONCLUSIÓN: La terapia de deprivación androgénica puede inducir a corto plazo incremento de la calciuria, fundamentalmente de ayunas, en este tipo de pacientes en posible relación con alteración del metabolismo óseo

OBJECTIVES: Androgen deprivation therapy (ADT) in prostate cancer is associated with the appearance of different adverse effects. Among these effects, notable ones that may affect metabolism are osteoporosis and metabolic syndrome. The aim of this study is to analyse lithogenic risk markers three months after initiating treatment with LHRH analogue. METHODS: Pilot study encompassing 15 prostate cancer patients who were candidates for ADT, which they received in the form of quarterly doses of goserelin 10.8 mg. A blood and urine analyses for lithogenic risk, bone and metabolic markers were carried out, as was a study of metabolic syndrome criteria. Statistical analysis was performed with SPSS 17.0, taking P≤.05 to be statistically significant. RESULTS: Patients included in the study had a mean age of 72.46 ± 6.61 years. We observed a significant increase in the percentage of metabolic syndrome (20% versus 46.7%; P<.05) and insulin resistance index (1.87 versus 2.96; P=.01) at 3 months treatment. There was a notable increase in bone remodelling markers and significant increases in 24 h urinary calcium values (9.46 versus 14.57 mg/dl; P=.008), 24 h urinary calcium excretion index (0.10 versus 0.13 mg/dl GF [glomerular filtration]; P=.01) and the fasting calcium/ creatinine ratio (0.107 versus 0.195; P=.007), without any changes to other lithogenous risk markers. CONCLUSIONS: Androgen deprivation therapy can lead to the short-term appearance, primarily when fasting, of hypercalciuria in prostate cancer patients, possibly in association with bone metabolism

Evaluación de competencias en Urología. Esscolap® basic, como aproximación a la mejora de las capacidades de los urólogos / Evaluation of competencies in urology. Esscolap® basic, as aproximation to urologists skills improvement

Introducción: La Urología necesita de modelos de evaluación de capacidades, a pesar de que existe una variada oferta de herramientas que no están integradas en los programas de formación. Contexto: No existe un criterio universal para medir el nivel de competencia. Los programas de formación deben proporcionar conocimientos y destrezas, y deben considerar las habilidades cognitivas, la formación basada sobre simulación y modelo animal. La validez es un concepto complejo que hace referencia a la capacidad del instrumento de evaluación, por lo que es necesario establecer varios tipos de validación para asegurar la capacidad de un método, reforzarse con distintos test de fiabilidad y cálculo de consistencia interna entre evaluadores. Objetivo: A partir de un dossier estructurado de competencias quirúrgicas, clasificadas por grupos, se planteó el sistema ESSCOLAP® Basic con 5 ejercicios sobre simulador, para la evaluación de las competencias básicas en Laparoscopia. Una vez validado, en el CCMIJU, se planteó ampliar el alcance e implementación del mismo en otras localizaciones. Resultados: Nuestro sistema no ha demostrado aún su validez en el ámbito clínico real, porque no presenta una validez predictiva con datos clínicos de resultados en salud. Existe, además, un cierto rango de subjetividad, por lo que se requiere establecer criterios claros y definidos para cualquier situación. El número de evaluadores y de los ejercicios a evaluar, va a influir en los test de fiabilidad que miden el grado de acuerdo entre evaluadores, de modo que sólo obteniendo un elevado número de casos evaluados, podremos acercarnos a una mayor fiabilidad de nuestro sistema. Por último, asumimos que la incorporación de este tipo de herramientas implica un coste añadido a cargo de las instituciones públicas y privadas responsables, que sólo se considerará rentable cuando se demuestre su trazabilidad real y positiva en resultados sanitarios. Conclusiones: ESSCOLAP® Basic, con capacidad de implementación rápida y sencilla, ha sido validado y contrastado para la evaluación de las habilidades técnicas básicas en laparoscopia (AU)

Introduction: Urology needs models of competencies assessment, although there is a wide range of tools not yet integrated into the official training programs. Context: At present, there is no universal framework for measuring surgeons ́ level of competence. Urology training programs should provide and consider knowledge, pyschomotor/cognitive skills, and simulator, cadaver or animal models-based training. Validity is a complex concept that refers to the capacity of the evaluation tool, so it is necessary to demonstrate several types of validation to assure the capacity of a method, reinforced with different reliability tests and calculation of internal consistency between evaluators. Objective: Based on a structured dossier of surgical skills, classified by groups, the ESSCOLAP® Basic system was proposed with 5 simulator tasks to evaluate basic laparoscopic skills. Once validated in the JUMISC (Spain), the tool was proposed to extend its scope and implementation in other locations. Results: Our system has not yet demonstrated a full validity in the real clinical setting because a predictive validity needs to be demonstrated on the basis of clinical data. It also suffers from a certain range of subjectivity, thus implying clear and defined criteria for any situation. Factors like the number of evaluators and tasks to assess will influence the reliability tests that measure the degree of agreement between evaluators, so that a higher number of evaluated cases would imply a greater reliability of our system. Finally, we assume that the incorporation of this type of tools implies an added cost, charged to the public and private responsible institutions, which will only be considered cost-effective when it is demonstrated its real and positive traceability in health outcomes. Conclusions: ESSCOLAP® Basic, of quick and simple implementation capacity, has been validated and calibrated for the evaluation of basic technical skills in laparoscopy (AU)

Programa formativo en urología oncológica. Perspectivas de futuro / Training program in oncologic urology. Future prospectives

La urología es una especialidad médico-quirúrgica que se ocupa del estudio, diagnóstico y tratamiento de las afecciones médicas y quirúrgicas del aparato urinario y retroperitoneo en ambos sexos y del aparato genital masculino sin límite de edad, motivadas por padecimientos congénitos, traumáticos, sépticos, metabólicos, obstructivos y oncológicos. La oncologia- urológica es la parte de la Urología más amplia y donde la investigación y los nuevos avances hacen que sea imprescindible un aprendizaje continuo. En este capítulo abordamos todos los aspectos académicos relacionados con la formación en el campo de la uro-oncología (AU)

Urology is a medical-surgical specialty that deals with the study, diagnosis and treatment of the medical and surgical diseases of the urinary apparatus and retroperitoneum in both sexes and the male genital apparatus without age limit, due to congenital, traumatic, septic, metabolic, obstructive and oncological conditions. Urologic oncology is the broadest urological part, where research and new advances make continuous learning essential. In this chapter we treat all academic features related with training in the field of Urooncology (AU)