Cambios en el manejo ambulatorio de pacientes con cáncer de próstata durante la pandemia por SARS-CoV-2. Revisión bibliográfica y aporte de nuestro grupo en atención telemática / Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care

Introducción y objetivo: La pandemia por COVID-19ha supuesto un cambio en la atención a pacientes en el ámbito urológico, especialmente con cáncer de próstata.El objetivo de este trabajo es mostrar los cambios en el manejo a nivel ambulatorio individualizando para cada perfil de paciente la atención telemática.Materiales y métodosSe han revisado artículos publicados desde marzo del 2020 hasta enero del 2021. Se han seleccionado aquellos que aportaban los mayores niveles de evidencia en cuanto al riesgo en distintos aspectos: cribado, diagnóstico, tratamiento y seguimiento del cáncer de próstata.ResultadosDesarrollamos una clasificación según prioridades, en diferentes etapas de la enfermedad (cribado, diagnóstico, tratamiento y seguimiento) adaptando a esta el tipo de control: presencial o telefónico. Establecemos 4 opciones: prioridad A o baja, en la que la atención será telefónica en todos los casos; prioridad B o intermedia, en la que si el paciente valorado telefónicamente se considera subsidiario de visita presencial, esta se citará dentro de los 3 meses posteriores; prioridad C o alta, el paciente será visto presencial con un margen para la visita de 1 a 3 meses, y prioridad D o muy alta, la visita deberá ser siempre presencial con un margen de hasta 48 h y considerada muy preferente.ConclusionesLa atención telemática en cáncer de próstata representa una oportunidad para desarrollar nuevos protocolos de actuación y seguimiento que deberán ser analizados exhaustivamente en futuros trabajos con el fin de conformar un entorno seguro y garantizar resultados oncológicos para los pacientes. (AU)

Introduction and objective: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer.The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile.Materials and methodsArticles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer.ResultsWe developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48hours and considered very preferential.ConclusionsTelematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients. (AU)

Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer. The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS: Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS: We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 h and considered very preferential. CONCLUSIONS: Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.

[Changes in the ambulatory care of prostate cancer patients during the SARS-CoV-2 pandemic. Literature review and contribution of our group in telematic care]. / Cambios en el manejo ambulatorio de pacientes con cáncer de próstata durante la pandemia por SARS-CoV-2. Revisión bibliográfica y aporte de nuestro grupo en atención telemática.

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has brought about changes in the management of urology patients, especially those with prostate cancer.The aim of this work is to show the changes in the ambulatory care practices by individualized telematic care for each patient profile. MATERIALS AND METHODS: Articles published from March 2020 to January 2021 were reviewed. We selected those that provided the highest levels of evidence regarding risk in different aspects: screening, diagnosis, treatment and follow-up of prostate cancer. RESULTS: We developed a classification system based on priorities, at different stages of the disease (screening, diagnosis, treatment and follow-up) to which the type of care given, in-person or telephone visits, was adapted. We established 4 options, as follows: in priority A or low, care will be given by telephone in all cases; in priority B or intermediate, if patients are considered subsidiary of an in-person visit after telephone consultation, they will be scheduled within 3 months; in priority C or high, patients will be seen in person within a margin from 1 to 3 months and in priority D or very high, patients must always be seen in person within a margin of up to 48 hours and considered very preferential. CONCLUSIONS: Telematic care in prostate cancer offers an opportunity to develop new performance and follow-up protocols, which should be thoroughly analyzed in future studies, in order to create a safe environment and guarantee oncologic outcomes for patients.

Utilidad de la PET/TC 18-FDG en diagnóstico y seguimiento de tumores urológicos uroteliales y renales / Usefulness of PET/CT 18-FDG for the diagnosis and follow-up of urological, urothelial and kidney tumours

Introducción: En los últimos años han surgido nuevos estudios de imagen en diagnóstico y seguimiento de tumores urológicos metastásicos. Material y métodos: Se revisa a 41 pacientes con sospecha de recidiva de tumor urotelial o renal, analizando el rendimiento diagnóstico de las PET-TC realizadas entre 2013 y 2016. Resultados: Recopilamos 17 tumores uroteliales y 24 renales, con una mediana de seguimiento de 30 meses. Un 29,3% de los uroteliales corresponden a alto grado y un 29,3% de los renales a carcinoma de célula clara Furhman II. En conjunto, los estudios de imagen detectaron recidivas en 34 pacientes. La TC fue positiva en el 83% de los pacientes, mientas la PET lo fue en el 75,6%. La coincidencia TC/PET fue del 50%. La PET detectó más enfermedad en un 41% de los casos frente a un 5% con TC. Esto supuso un cambio en la estrategia terapéutica en el 40% de los pacientes. La sensibilidad, especificidad, valor predictivo positivo y negativo para la TC y la PET fueron de 92 y 92%; 57 y 100%; 92 y 100% y 57 y 70%, respectivamente. Conclusión: En tumores urológicos, la PET presenta una sensibilidad similar a las técnicas de imagen estándar, pero con una mayor especificidad, valor predictivo positivo y valor predictivo negativo. Esto supuso un cambio en la estrategia de tratamiento en el 40% de los pacientes de nuestra serie. La PET probablemente se convierta en la prueba de referencia en los estudios de extensión y seguimiento de la mayor parte de los tumores urológicos

Introduction: New imaging studies have appeared in recent years for the diagnosis and follow-up of metastatic urological tumours. Material and methods: A total of 41 patients were reviewed with suspected recurrence of a urothelial or kidney tumour, analysing the diagnostic performance of PET-CT scans undertaken between 2013 and 2016. Results: We collected 17 urothelial tumours and 24 renal tumours, with a median follow-up of 30 months. A total of 39.3% of the urothelial tumours were high grade and 29.3% of the kidney tumours were clear cell Fuhrman II. As a whole, the imaging studies detected recurrences in 34 patients. CT was positive in 83% of the patients, while the PET scan was positive in 75.6%, CT/PET coincidence was 50%. The PET scan detected further disease in 41% of the cases compared to 5% by CT. This resulted in a change of therapeutic strategy in 40% of the patients. Sensitivity, specificity, positive predictive value and negative predictive value for the CT and the PET scans were 92% and 92%, 57% and 100%, 92% and 100%, and 57% and 70% respectively. Conclusion: The PET scan showed similar sensitivity for urological tumours to the standard imaging techniques but with higher specificity, positive predictive value and negative predictive value. This led to a change in treatment strategy for 40% of the patients in our series. The PET scan will probably become the standard test in the extension and follow-up studies of most urological tumours

Usefulness of PET/CT 18-FDG for the diagnosis and follow-up of urological, urothelial and kidney tumours. / Utilidad de la PET/TC 18-FDG en diagnóstico y seguimiento de tumores urológicos uroteliales y renales.

INTRODUCTION: New imaging studies have appeared in recent years for the diagnosis and follow-up of metastatic urological tumours. MATERIAL AND METHODS: A total of 41 patients were reviewed with suspected recurrence of a urothelial or kidney tumour, analysing the diagnostic performance of PET-CT scans undertaken between 2013 and 2016. RESULTS: We collected 17 urothelial tumours and 24 renal tumours, with a median follow-up of 30 months. A total of 39.3% of the urothelial tumours were high grade and 29.3% of the kidney tumours were clear cell Fuhrman II. As a whole, the imaging studies detected recurrences in 34 patients. CT was positive in 83% of the patients, while the PET scan was positive in 75.6%, CT/PET coincidence was 50%. The PET scan detected further disease in 41% of the cases compared to 5% by CT. This resulted in a change of therapeutic strategy in 40% of the patients. Sensitivity, specificity, positive predictive value and negative predictive value for the CT and the PET scans were 92% and 92%, 57% and 100%, 92% and 100%, and 57% and 70% respectively. CONCLUSION: The PET scan showed similar sensitivity for urological tumours to the standard imaging techniques but with higher specificity, positive predictive value and negative predictive value. This led to a change in treatment strategy for 40% of the patients in our series. The PET scan will probably become the standard test in the extension and follow-up studies of most urological tumours.

Actualización en incontinencia urinaria femenina / Female urinary incontinence: an update

La incontinencia urinaria es un síntoma muy prevalente en la población adulta femenina. Genera importantes connotaciones psicosociales y económicas, repercutiendo en la calidad de vida de las pacientes que la padecen. Es un problema infradiagnosticado, ya que las pacientes no siempre consultan por ello, por lo que es importante tenerlo presente y hacer un cribado oportunista desde atención primaria. Es difícil conocer el gasto sanitario que genera, parece que puede llegar a ser hasta el 2% del presupuesto sanitario. Todo esto hace que sea de gran importancia saber diagnosticar esta enfermedad, conocer los diferentes tipos de incontinencia que existen, sus posibles causas y los tratamientos disponibles. Para ello se presenta esta revisión, con el fin de conocer las herramientas diagnósticas y terapéuticas de las que se dispone, ver cuál es el papel de atención primaria en esta enfermedad y cuándo se debe derivar al nivel asistencial correspondiente (AU)

The urinary incontinence is a highly prevalent symptom in the adult female population. It has important psychosocial and economic connotations, and affects the quality of life of these patients. As it is an under-diagnosed problem due to patients not always consulting for it, it is very important to keep this in mind and to provide an opportunistic screening from Primary Health Care. It is difficult to determine the costs of this, but it is estimated to be the 2% of the health budget. Because of all of this, it is very important to know how to make a correct diagnose of this condition, to determine the different types of incontinence, possible causes, and treatments available. The purpose of this review is to show the different diagnostic and therapeutic tools available, to show the Primary Health Care role in this condition, and when to refer to specialist care (AU)

Radioterapia para la oligorrecurrencia en cáncer de próstata. Resultados preliminares en nuestro centro / Radiation therapy for oligorecurrence in prostate cancer. Preliminary results of our centre

Introducción y objetivo: Existe un interés creciente por el uso de modalidades terapéuticas más agresivas en el cáncer de próstata metastásico. En el presente estudio abordamos el uso de la radioterapia estereotáctica (SBRT) en pacientes con cáncer de próstata oligorecurrente. Analizamos la respuesta bioquímica y la toxicidad de los pacientes a quienes se les administró en nuestro centro. Material y método: Se seleccionaron los pacientes que padecieron una oligorrecurrencia desde enero de 2015 hasta diciembre de 2016 y se administro?? SBRT. La asociación de privación androgénica (DA) quedo?? a decisión de cada caso en el comité de tumores. Describimos la situación clínica al diagnóstico de las oligorrecurrencias, el tratamiento administrado y la respuesta bioquímica. Consideramos respuesta bioquímica un descenso del 50% en las cifras absolutas del PSA. Resultados: Se administró SBRT a 11 pacientes con oligometástasis óseas (82%) y/o ganglionares (18%). El esquema de tratamiento en las óseas fue de 27 Gy repartidos en 3 sesiones, mientras que en las ganglionares se llegó a 70 Gy. Siete pacientes no tenían ningún tratamiento en el momento del diagnóstico, 2 estaban en fase de resistencia a la castración, un paciente estaba con DA intermitente fase OFF y un paciente con DA adyuvante por pN1. Siete pacientes presentaron una respuesta bioquímica con disminución de PSA entre el 75% y el 100%. En 4 pacientes la respuesta no fue valorable por persistir con DA adyuvante. Con un seguimiento medio de 10,5 meses solo han progresado 2 pacientes. Únicamente se detectó toxicidad gastrointestinal grado i en un paciente. Conclusión: Nuestros datos sugieren que el uso de la SBRT en pacientes cuidadosamente seleccionados oligorrecurrentes metastásicos de cáncer de próstata puede lograr respuesta bioquímica y potencialmente retrasar la progresión y el uso de tratamientos sistémicos

Introduction and objective: There is growing interest in the use of more aggressive therapeutic modalities for treating metastatic prostate cancer. In this study, we examine the use of stereotactic body radiation therapy (SBRT) for patients with oligorecurrent prostate cancer. We analysed the biochemical response and toxicity of patients who underwent this therapy at our centre. Material and method: We selected patients who experienced oligorecurrence between January 2015 to December 2016 and were administered SBRT. The association of androgen deprivation (AD) was left in each case to the decision of the tumour committee. We describe the clinical situation at diagnosis of oligorecurrence, the treatment administered and the biochemical response. We considered a biochemical response to be a 50% reduction in the absolute prostate-specific antigen (PSA) readings. Results: SBRT was administered to 11 patients with bone (82%) and/or lymph node oligometastasis (18%). The treatment regimen for bone oligometastasis was 27 Gy divided into 3 sessions, while the treatment for lymph node oligometastasis reached 70 Gy. Seven patients had no treatment at the time of diagnosis, 2 were in the castration-resistant phase, 1 patient was in the off phase of intermittent AD, and 1 patient had adjuvant AD for pN1. Seven patients presented a biochemical response with a PSA reduction of 75-100%. The response was not assessable in 4 patients due to the continuing adjuvant AD. With a mean follow-up of 10.5 months, only 2 patients had progressed. Grade 1 gastrointestinal toxicity was detected in only 1 patient. Conclusion: Our data suggest that the use of SBRT in carefully selected patients with metastatic oligorecurrence of prostate cancer can achieve biochemical response and potentially delay progression and the use of systemic treatments

Metaloproteinasa 11, potencial marcador y diana molecular en cáncer de próstata avanzado y resistente a la castración. Estudio en cultivo de fibroblastos peritumorales / Metalloproteinase 11, potential marker and molecular target in advanced and castration-resistant prostate cancer. Culture study of peritumoral fibroblasts

Objetivo: Analizar el comportamiento de la metaloprotesa 11 (MMP11) en fibroblastos cultivados procedentes de tumores prostáticos humanos con diferentes características clinicopatológicas. Material y métodos: Para este estudio se analizaron muestras de biopsias de próstata obtenidas por vía transrectal de tumores con diferentes características, tratados o no con privación androgénica (PA). Tras la optimización del método de cultivo, se aislaron y cultivaron los fibroblastos para realizar el estudio (PCR) del ARNm de MMP11. Resultados: Se estudiaron finalmente 37 casos: 5 muestras de hiperplasia benigna de próstata, 14 casos con neoplasias localizadas (7 de alto riesgo según la clasificación de D’Amico), 5 con tumores con metástasis óseas y 13 tratados con PA, de los que 6 cumplían los requisitos para ser definidos como resistentes a la castración. En los tumores sin PA, la expresión de MMP11 fue significativamente mayor (p = 0,001) en los fibroblastos de tumores de grados más altos. Se encontró una correlación significativa (p = 0,001) entre PSA y expresión de MMP11 fibroblástica y un aumento significativo de la expresión de MMP11 en los tumores metastásicos. En los tumores con PA se objetivó una expresión significativamente mayor de MMP11 en pacientes resistentes a la castración que en los sensibles a esta (p = 0,003). Conclusión: En tumores de próstata avanzados o en fases de mayor agresividad tumoral, la producción de MMP11 por los fibroblastos resulta significativamente mayor que en tumores no metastásicos o en fases de sensibilidad a la PA

Objective: To analyze the expression of metalloprotein 11 (MMP11) in cultured fibroblasts obtained from human prostate tumors with different clinical and pathological characteristics. Material and methods: For this study we analyzed samples of transrectal prostate biopsies from tumors with different characteristics, treated with or whithout androgen deprivation (AD). After optimization of the culture method, fibroblasts were isolated and cultured to perform the study (PCR) of MMP11 mRNA. Results: Finally, 37 cases were studied: 5 samples of benign prostatic hyperplasia, 14 cases with localized neoplasms (7 high-risk according to the D’Amico classification), 5 with metastasic tumors (bone metastases), and 13 treated with AD therapy, of which 6 fulfilled the requirements to be defined as resistant to castration. In tumors without AD therapy, MMP11 expression was significantly higher (P= .001) in fibroblasts of higher grade tumors. A significant (P= .001) correlation was found between PSA and expression of MMP11 in fibroblast s and a significant increase of MMP11 expression in metastatic tumors. In tumors with AD therapy, a significantly greater expression of MMP11 was observed in resistant to castration patients than in those sensitive to castration (P= .003). Conclusion: In advanced prostate tumors or in stages of increased tumor aggressiveness, the production of MMP11 by fibroblasts is significantly greater than in non-metastatic tumors or in AD sensitive tumors

Radiation therapy for oligorecurrence in prostate cancer. Preliminary results of our centre. / Radioterapia para la oligorrecurrencia en cáncer de próstata. Resultados preliminares en nuestro centro.

INTRODUCTION AND OBJECTIVE: There is growing interest in the use of more aggressive therapeutic modalities for treating metastatic prostate cancer. In this study, we examine the use of stereotactic body radiation therapy (SBRT) for patients with oligorecurrent prostate cancer. We analysed the biochemical response and toxicity of patients who underwent this therapy at our centre. MATERIAL AND METHOD: We selected patients who experienced oligorecurrence between January 2015 to December 2016 and were administered SBRT. The association of androgen deprivation (AD) was left in each case to the decision of the tumour committee. We describe the clinical situation at diagnosis of oligorecurrence, the treatment administered and the biochemical response. We considered a biochemical response to be a 50% reduction in the absolute prostate-specific antigen (PSA) readings. RESULTS: SBRT was administered to 11 patients with bone (82%) and/or lymph node oligometastasis (18%). The treatment regimen for bone oligometastasis was 27Gy divided into 3 sessions, while the treatment for lymph node oligometastasis reached 70Gy. Seven patients had no treatment at the time of diagnosis, 2 were in the castration-resistant phase, 1 patient was in the off phase of intermittent AD, and 1 patient had adjuvant AD for pN1. Seven patients presented a biochemical response with a PSA reduction of 75-100%. The response was not assessable in 4 patients due to the continuing adjuvant AD. With a mean follow-up of 10.5 months, only 2 patients had progressed. Grade 1 gastrointestinal toxicity was detected in only 1 patient. CONCLUSION: Our data suggest that the use of SBRT in carefully selected patients with metastatic oligorecurrence of prostate cancer can achieve biochemical response and potentially delay progression and the use of systemic treatments.

Beneficio de la nefrectomía en el tratamiento del carcinoma de células renales metastásico / Benefit of on nephrectomy for treating metastatic renal cell carcinoma

Introducción: El tratamiento sistémico del carcinoma de células renales metastásico (CCRm) ha cambiado con la aparición de nuevas terapias, planteándose la utilidad de la nefrectomía (NFT) en estos pacientes. Objetivo: Analizar si la NFT asociada a tratamiento sistémico prolonga el tiempo libre de progresión (TLP) y la supervivencia global (SG). Material y métodos: Estudio descriptivo restrospectivo de 45 pacientes con CCRm entre 2006-2014. Se descartaron casos avanzados con tratamiento paliativo o con metástasis únicas tratados exclusivamente con cirugía. Resultados: Finalmente 34 pacientes fueron tratados con tratamiento sistémico. En 26 se empleó además cirugía. El 70% presentaban riesgo intermedio en la clasificación de Motzer y un índice de Karnofsky > 80%. El TLP fue de 7 m, encontrándose diferencias significativas entre los grupos con y sin NFT (10 vs. 4 m). Hubo menor TLP en pacientes con Motzer alto (p < 0,0001). La SG fue de 11,5 m. Se encontró mayor SG en pacientes con índice de Karnofsky > 80 (13 vs. 5 m; p = 0,005), Motzer medio/bajo (14 vs. 3 m; p=0,0001), NFT (14 vs. 6m; p = 0,001) y tratamiento inhibidor mTOR en segunda línea (9 vs. 5 m; p = 0,003). En el análisis multivariable solo la NFT (p = 0,006; HR 4,5) y un Motzer medio/bajo demostraron una mayor supervivencia (p = 0,020; HR 8,9). Conclusiones: El TLP y la SG aumentaron significativamente en pacientes con NFT asociada, en CCRm de riesgo intermedio/bajo (Motzer). La SG además aumentó en pacientes tratados con mTOR de segunda línea y en pacientes con índice de Karnofsky > 80% en el análisis univariable, no pudiendo demostrarlo en el estudio multivariable

Introduction: Systemic treatment for metastatic renal cell carcinoma (mRCC) has changed with the new therapies, and it is not clear if nephrectomy (NEP) has a survival benefit in this kind of patients. Objective: To investigate if NEP associated to systemic treatment improves overall survival (OS) and progression-free survival (PFS). Material and methods: A retrospective, observational, descriptive study of 45 patients with diagnosis of mRCC between 2006-2014. Advanced cases with only palliative care were excluded, also patients with solitary metastasis who were managed with surgical resection. Results: Finally 34 patients were treated with systemic treatment. Twenty-six also with surgery associated. Seventy percent were intermediate/low risk at the Motzer classification and > 80% Karnofsky performance status. PFS was 7 m. NEP improves PFS (10 vs. 4 m). High risk Motzer decreased PFS (P < .001). The OS was 11.5m. Patients with Karnofsky performance status > 80, intermediate or low risk Motzer treated with NEP and mTOR as second line treatment, increased the OS (14 vs. 3 m, P = .0001; 14 vs. 6 m, P = .001; and 9 vs. 5m, P = .003, respectively). In the multivariate analysis only NEP (P = 0,006; HR 4.5) and intermediate/low risk at the Motzer classification(P = .020; HR 8.9) demonstrated significant improvement in OS. Conclusions: Patients treated with NEP associated to systemic treatment and with an intermediate/low risk in the Motzer classification had a better PFS and OS. The OS also improves in patients treated with mTOR in second line, and Karnofsky performance status > 80%in the univariate study, but not in the multivariable one

[Female urinary incontinence: An update]. / Actualización en incontinencia urinaria femenina.

The urinary incontinence is a highly prevalent symptom in the adult female population. It has important psychosocial and economic connotations, and affects the quality of life of these patients. As it is an under-diagnosed problem due to patients not always consulting for it, it is very important to keep this in mind and to provide an opportunistic screening from Primary Health Care. It is difficult to determine the costs of this, but it is estimated to be the 2% of the health budget. Because of all of this, it is very important to know how to make a correct diagnose of this condition, to determine the different types of incontinence, possible causes, and treatments available. The purpose of this review is to show the different diagnostic and therapeutic tools available, to show the Primary Health Care role in this condition, and when to refer to specialist care.

Metalloproteinase 11, potential marker and molecular target in advanced and castration-resistant prostate cancer. Culture study of peritumoral fibroblasts. / Metaloproteinasa 11, potencial marcador y diana molecular en cáncer de próstata avanzado y resistente a la castración. Estudio en cultivo de fibroblastos peritumorales.

OBJECTIVE: To analyze the expression of metalloprotein 11 (MMP11) in cultured fibroblasts obtained from human prostate tumors with different clinical and pathological characteristics. MATERIAL AND METHODS: For this study we analyzed samples of transrectal prostate biopsies from tumors with different characteristics, treated with or whithout androgen deprivation (AD). After optimization of the culture method, fibroblasts were isolated and cultured to perform the study (PCR) of MMP11 mRNA. RESULTS: Finally, 37 cases were studied: 5 samples of benign prostatic hyperplasia, 14 cases with localized neoplasms (7 high-risk according to the D'Amico classification), 5 with metastasic tumors (bone metastases), and 13 treated with AD therapy, of which 6 fulfilled the requirements to be defined as resistant to castration. In tumors without AD therapy, MMP11 expression was significantly higher (P=.001) in fibroblasts of higher grade tumors. A significant (P=.001) correlation was found between PSA and expression of MMP11 in fibroblast s and a significant increase of MMP11 expression in metastatic tumors. In tumors with AD therapy, a significantly greater expression of MMP11 was observed in resistant to castration patients than in those sensitive to castration (P=.003). CONCLUSION: In advanced prostate tumors or in stages of increased tumor aggressiveness, the production of MMP11 by fibroblasts is significantly greater than in non-metastatic tumors or in AD sensitive tumors.

Benefit of on nephrectomy for treating metastatic renal cell carcinoma. / Beneficio de la nefrectomía en el tratamiento del carcinoma de células renales metastásico.

INTRODUCTION: Systemic treatment for metastatic renal cell carcinoma (mRCC) has changed with the new therapies, and it is not clear if nephrectomy (NEP) has a survival benefit in this kind of patients. OBJECTIVE: To investigate if NEP associated to systemic treatment improves overall survival (OS) and progression-free survival (PFS). MATERIAL AND METHODS: A retrospective, observational, descriptive study of 45 patients with diagnosis of mRCC between 2006-2014. Advanced cases with only palliative care were excluded, also patients with solitary metastasis who were managed with surgical resection. RESULTS: Finally 34 patients were treated with systemic treatment. Twenty-six also with surgery associated. Seventy percent were intermediate/low risk at the Motzer classification and>80% Karnofsky performance status. PFS was 7m. NEP improves PFS (10 vs. 4m). High risk Motzer decreased PFS (P<.001). The OS was 11.5m. Patients with Karnofsky performance status>80, intermediate or low risk Motzer treated with NEP and mTOR as second line treatment, increased the OS (14 vs. 3m, P=.0001; 14 vs. 6m, P=.001; and 9 vs. 5m, P=.003, respectively). In the multivariate analysis only NEP (P=0,006; HR 4.5) and intermediate/low risk at the Motzer classification(P=.020; HR 8.9) demonstrated significant improvement in OS. CONCLUSIONS: Patients treated with NEP associated to systemic treatment and with an intermediate/low risk in the Motzer classification had a better PFS and OS. The OS also improves in patients treated with mTOR in second line, and Karnofsky performance status>80%in the univariate study, but not in the multivariable one.