Avances en Uro-Oncología «OncoUrology Forum Special Edition»: lo mejor del 2020 / Advances in Urologic Oncology “OncoUrology Forum Special Edition”: The best of 2020

Contexto y objetivo: Conocer las últimas evidencias sobre Urología oncológica de tumores de próstata, riñón y vejiga, analizando su impacto en la práctica clínica diaria, además de los esquemas futuros a medio y largo plazo.Materiales y métodos: Se revisan los resúmenes sobre Uro-Oncología presentados en los Congresos del año 2020 (EUA, AUA, ASCO, ESMO y ASTRO), las publicaciones de mayor impacto y especialmente las nuevas líneas de desarrollo y avance en Uro-Oncología valoradas por el comité de OncoForum.Resultados: El uso de los radioligandos de antígeno de membrana específico de próstata en el diagnóstico de cáncer de próstata puede tener gran cabida y utilidad en los próximos años gracias a su mejor sensibilidad y especificidad. La caracterización genética del tumor es importante tanto a nivel germinal como somático, dado que las mutaciones en BRCA2 son especialmente importantes por su significado en riesgo. El diseño de estudio más conveniente a nivel de cáncer genitourinario es el ensayo controlado aleatorizado múltiple de cohortes. La aplicación del big data traerá mejoras en procesos, ahorros en costes sanitarios y una potenciación de los estudios en vida real gracias a la facilidad de comparación, gestión y almacenamiento de datos.Conclusiones: El uso de las nuevas técnicas diagnósticas con ligandos de antígeno de membrana específico de próstata aportará una modalidad diagnóstica más completa y el aumento de los estudios del perfil genético del tumor y la calidad de los estudios realizados. La aplicación práctica de la inteligencia artificial mejorará el tratamiento del cáncer genitourinario. (AU)

Objective: To provide latest findings of Urologic Oncology on prostate, kidney, and bladder cancer, and analyze its impact on clinical practice as well as future schemes in the medium- and long-term.Methods:This document reviews the abstracts on Uro-Oncology presented at the 2020 Congresses (EUA, AUA, ASCO, ESMO and ASTRO), the publications with the highest impact and especially the new lines of development and progress in Uro-Oncology evaluated by the OncoForum committee.Results: The use of prostate-specific membrane antigen (PSMA) radioligands in the diagnosis of prostate cancer may have great potential and utility in the coming years due to their improved sensitivity and specificity. The genetic characterization of the tumor is important at both, germline and somatic levels, due to the significant role of BRCA2 mutations regarding risk. The cohort multiple randomised controlled trial is the most suitable study design at the genitourinary cancer level. The application of big data will lead to process improvements, savings in healthcare costs, and an empowerment of real-life studies through ease of data comparison, management, and storage.Conclusions:The use of new diagnostic techniques with PSMA ligands will provide a more comprehensive diagnostic modality, increase the number of studies about tumor genetic profiling, and enhance their quality. The practical application of artificial intelligence will improve the treatment genitourinary cancer. (AU)

Advances in urologic oncology "OncoUrology Forum Special Edition": The best of 2020.

OBJECTIVE: To provide latest findings of Urologic Oncology on prostate, kidney, and bladder cancer, and analyze its impact on clinical practice as well as future schemes in the medium- and long-term. METHODS: This document reviews the abstracts on Uro-Oncology presented at the 2020 Congresses (EUA, AUA, ASCO, ESMO and ASTRO), the publications with the highest impact and especially the new lines of development and progress in Uro-Oncology evaluated by the OncoForum committee. RESULTS: The use of prostate-specific membrane antigen (PSMA) radioligands in the diagnosis of prostate cancer may have great potential and utility in the coming years due to their improved sensitivity and specificity. The genetic characterization of the tumor is important at both, germline and somatic levels, due to the significant role of BRCA2 mutations regarding risk. The cohort multiple randomised controlled trial is the most suitable study design at the genitourinary cancer level. The application of big data will lead to process improvements, savings in healthcare costs, and an empowerment of real-life studies through ease of data comparison, management, and storage. CONCLUSIONS: The use of new diagnostic techniques with PSMA ligands will provide a more comprehensive diagnostic modality, increase the number of studies about tumor genetic profiling, and enhance their quality. The practical application of artificial intelligence will improve the treatment genitourinary cancer.

Avances en uro-oncología «OncoForum»: lo mejor del 2019 / Advances in urologic oncology "OncoForum": The best of 2019

OBJETIVO: Conocer las últimas evidencias sobre Urología oncológica de tumores de riñón, vejiga y próstata. MÉTODOS: Se revisan los resúmenes sobre cáncer renal, de vejiga y de próstata (CaP) presentados en los congresos del año 2019 (EAU, AUA, ASCO y ESMO) y las publicaciones de mayor impacto en este periodo con mayor valoración por parte del comité del OncoForum. RESULTADOS: En pacientes con cáncer renal metastásico, los regímenes que incluyen inmunoterapia (nivolumab + ipilimumab, pembrolizumab) han mostrado ser superiores a sunitinib en términos de supervivencia. En pacientes con cáncer de vejiga no músculo-invasivo, pembrolizumab ha demostrado ser una alternativa efectiva en aquellos refractarios al bacilo de Calmette-Guérin, mientras que, en pacientes con cáncer urotelial metastásico, enfortumab vedotin en tercera línea logró una tasa de respuesta considerable (44%). En pacientes con CaP localizado, la radioterapia externa ultrafraccionada no mostró mayor toxicidad aguda que la radioterapia fraccionada o hipofraccionada. Se ha confirmado el beneficio de enzalutamida y apalutamida asociados a la castración en pacientes con CaP M1, independientemente del volumen de la enfermedad. En los pacientes con CaP resistente a la castración (CPRC) M0, el tratamiento con enzalutamida, apalutamida o darolutamida se ha asociado con un retraso de la aparición de metástasis y la prolongación de la supervivencia. Cabazitaxel ha demostrado un beneficio en la supervivencia de pacientes con CPRC metastásico, mientras que olaparib mostró actividad antitumoral tras la quimioterapia en aquellos tumores con mutaciones en genes de reparación del ADN. CONCLUSIONES: Estos datos ponen de manifiesto la incorporación de la inmunoterapia como alternativa novedosa para combatir el cáncer renal y de vejiga. Cabe destacar la llegada de nuevos agentes para líneas avanzadas en el carcinoma urotelial y queda establecida la eficacia de enzalutamida y apalutamida en CaP metastásico de novo. En el CPRC metastásico, cabacitaxel y olaparib (dirigido a mutaciones) son opciones terapéuticas prometedoras

OBJECTIVE: Review the latest evidence on urologic oncology on kidney, bladder and prostate tumors. METHODS: Abstracts on kidney, bladder and prostate cancer presented at the 2019 congresses (EAU, AUA, ASCO and ESMO) and the publications with the greatest impact in this period, with the highest evaluation by the OncoForum committee, are reviewed. RESULTS: In patients with metastatic kidney cancer, regimens including immunotherapy (nivolumab + ipilimumab, pembrolizumab) have been shown to be superior to sunitinib in terms of survival. In patients with non-muscle invasive bladder cancer, pembrolizumab has been shown to be an effective alternative in those refractory to bacillus Calmette-Guérin, while in patients with metastatic urothelial cancer, third-line enfortumab vedotin achieved a significant response rate (44%). In patients with localized prostate cancer (PCa), ultrafractionated external radiotherapy did not show any greater acute toxicity than fractionated or hypofractionated radiotherapy. The benefit of enzalutamide and apalutamide associated with castration has been confirmed in M1 PCa patients, regardless of disease volume. In patients with castration-resistant M0 PCa, treatment with enzalutamide, apalutamide or darolutamide has been associated with a delay in the occurrence of metastasis and prolonged survival. Cabazitaxel has demonstrated a survival benefit in patients with metastatic CRPC, while olaparib showed anti-tumor activity after chemotherapy in those tumors with mutations in DNA repair genes. CONCLUSIONS: These data show the implementation of immunotherapy as a novel alternative against renal and bladder cancer. The arrival of new agents for advanced urothelial carcinoma should be highlighted, and the efficacy of enzalutamide and apalutamide in de novo metastatic prostate cancer is established. In metastatic CRPC, cabazitaxel and olaparib (targeting mutations) are promising therapeutic options

Advances in urologic oncology "OncoForum": The best of 2019. / Avances en uro-oncología «OncoForum¼: lo mejor del 2019.

OBJECTIVE: Review the latest evidence on urologic oncology on kidney, bladder and prostate tumors. METHODS: Abstracts on kidney, bladder and prostate cancer presented at the 2019 congresses (EAU, AUA, ASCO and ESMO) and the publications with the greatest impact in this period, with the highest evaluation by the OncoForum committee, are reviewed. RESULTS: In patients with metastatic kidney cancer, regimens including immunotherapy (nivolumab + ipilimumab, pembrolizumab) have been shown to be superior to sunitinib in terms of survival. In patients with non-muscle invasive bladder cancer, pembrolizumab has been shown to be an effective alternative in those refractory to bacillus Calmette-Guérin, while in patients with metastatic urothelial cancer, third-line enfortumab vedotin achieved a significant response rate (44%). In patients with localized prostate cancer (PCa), ultrafractionated external radiotherapy did not show any greater acute toxicity than fractionated or hypofractionated radiotherapy. The benefit of enzalutamide and apalutamide associated with castration has been confirmed in M1 PCa patients, regardless of disease volume. In patients with castration-resistant M0 PCa, treatment with enzalutamide, apalutamide or darolutamide has been associated with a delay in the occurrence of metastasis and prolonged survival. Cabazitaxel has demonstrated a survival benefit in patients with metastatic CRPC, while olaparib showed anti-tumor activity after chemotherapy in those tumors with mutations in DNA repair genes. CONCLUSIONS: These data show the implementation of immunotherapy as a novel alternative against renal and bladder cancer. The arrival of new agents for advanced urothelial carcinoma should be highlighted, and the efficacy of enzalutamide and apalutamide in de novo metastatic prostate cancer is established. In metastatic CRPC, cabazitaxel and olaparib (targeting mutations) are promising therapeutic options.

Terapia de privación de andrógenos en pacientes con enfermedad localizada: comparación de las opciones de tratamiento y tiempo hasta la resistencia a la castración. Resultados del Registro Español de Cáncer de Próstata / Androgen deprivation therapy in patients with localized disease: Comparison with curative intent treatments and time to castration resistance. Results of the Spanish Prostate Cancer Registry

ANTECEDENTES: El efecto del tratamiento primario de privación androgénica (TPA) en pacientes con cáncer de próstata (CP) localizado no está bien documentado. El objetivo del presente estudio fue analizar el resultado de los tumores tratados con TPA como terapia primaria en el Registro Español de Cáncer de Próstata (19,4% de la serie). PACIENTES Y MÉTODOS: Los pacientes se clasificaron en tres grupos: 1) con tumores clínicamente localizados de riesgo bajo/intermedio; 2) con tumores de alto riesgo y localmente avanzados (T3-4); 3) con tumores metastásicos. Se analizó el tiempo hasta la resistencia a la castración y la supervivencia general específica del cáncer. En tumores no metastásicos, las supervivencias en pacientes tratados con TPA se compararon con los datos de pacientes que recibieron tratamientos locales del Registro Español de Cáncer de Próstata. RESULTADOS: Se analizaron 703 casos. Hubo diferencias significativas en el tiempo de resistencia a la castración, que fue menor en el grupo de tumores metastásicos. Durante el seguimiento hubo 179 muertes (25,5%), de las cuales 89 (12,6%) se debieron a CP. Después de 3 años de TPA, solo el 14,6% de los pacientes en el grupo 1 fallecieron (1% debido a CP), el 20,5% en el grupo 2 y el 46,8% en el grupo 3 (9,2% y 31,3% debido a CP, respectivamente). La supervivencia específica del cáncer fue significativamente peor en el grupo 1 tratado con TPA que en el que recibió prostatectomía radical o radioterapia. En los tumores de alto riesgo y localmente avanzados, la TPA también tuvo una menor supervivencia específica al cáncer que los tratamientos locales. CONCLUSIÓN: Se observó un tiempo más largo hasta la resistencia a la castración en pacientes con tumores localizados de riesgo intermedio y bien tratados con TPA. Los pacientes con tumores metastásicos mostraron el menor tiempo hasta la resistencia a la castración

BACKGROUND: The effect of primary androgen deprivation therapy (ADT) in patients with localized prostate cancer (PCa) has not been well documented. The objective of the present study was to analyze the outcome of tumors treated with ADT as primary therapy in the Spanish Prostate Cancer Registry (19.4% of the series). PATIENTS AND METHODS: Patients were classified in three groups: 1) with low/intermediate risk clinically localized tumors; 2) with high risk and locally advanced (T3-4) tumors; 3) with metastatic tumors. Time to castration resistance and overall cancer-specific survival were analyzed. In non-metastatic tumors, survivals in patients treated with ADT were compared with data from patients who underwent local treatments from the Spanish Prostate Cancer Registry. RESULTS: 703 cases were analyzed. There were significant differences in the time to castration resistance, which was lower in the group of metastatic tumors. During follow-up, there were 179 deaths (25.5%) of which 89 (12.6%) were due to PCa. After 3 years of ADT, only 14.6% of patients in group 1 had died (1% due to PCa), 20.5% in group 2 and 46.8% in group 3 (9.2% and 31.3% due to PCa, respectively). Cancer-specific survival was significantly worse in group 1 using ADT than radical prostatectomy or radiotherapy. In high-risk and locally advanced tumors, ADT also had a lower cancer-specific survival than local treatments. CONCLUSIÓN: A longer time until the castration resistance was observed in patients with well- and intermediate-risk localized tumors treated with ADT. Patients with metastatic tumors showed the shortest time to castration resistance

Impacto del tiempo desde la biopsia a la prostatectomía radical en la infragradación del grado de Gleason y análisis de factores relacionados / The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors

INTRODUCCIÓN: La infragradación del grado de Gleason de la biopsia (IGGB) puede impactar en el manejo y pronóstico de los pacientes con cáncer de próstata. Se analiza el posible impacto del tiempo y otros factores clínico-analíticos y la aparición de IGBB en nuestra serie. PACIENTES Y MÉTODO: Estudio multicéntrico ambispectivo de 1.955 pacientes con cáncer de próstata localizado intervenidos mediante prostatectomía radical entre 2005 y 2018. Se utiliza estadística descriptiva y pruebas de contraste de hipótesis con análisis uni- y multivariado para comunicar los RESULTADOS: RESULTADOS: Edad media 63,69 años (44-80), mediana de PSA 8,70 ng/ml (1,23-99). Se observa IGGB en el 34,7% de toda la muestra. En el 72,8% de los casos la IGGB fue en un único punto consecutivo del grado de Gleason: el paso de 3 + 3 a 3 + 4 fue el más frecuente (289 pacientes, 47,6%). La realización de prostatectomía radical antes o después de 90-180 días desde la biopsia no impactó en su infragradación en ninguno de los grupos. En los análisis uni- y multivariante, la presencia de tumor o tacto rectal patológico en ambos lóbulos, la carga tumoral ≥ 50% de los cilindros totales y una DPSA ≥ 0,20 mostraron capacidad discriminativa independiente para seleccionar pacientes que presentaron IGGB. CONCLUSIONES: El tiempo desde la biopsia hasta la prostatectomía radical no mostró impacto en IGGB. El número de cilindros afectados, la DPSA y presentar tumor bilateral fueron parámetros de fácil acceso que pueden ayudarnos a seleccionar pacientes con mayor probabilidad de presentar IGGB

INTRODUCTION: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥ 50% of cylinders and a DPSA ≥ 0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU

Androgen deprivation therapy in patients with localized disease: Comparison with curative intent treatments and time to castration resistance. Results of the Spanish Prostate Cancer Registry. / Terapia de privación de andrógenos en pacientes con enfermedad localizada: comparación de las opciones de tratamiento y tiempo hasta la resistencia a la castración. Resultados del Registro Español de Cáncer de Próstata.

BACKGROUND: The effect of primary androgen deprivation therapy (ADT) in patients with localized prostate cancer (PCa) has not been well documented. The objective of the present study was to analyze the outcome of tumors treated with ADT as primary therapy in the Spanish Prostate Cancer Registry (19.4% of the series). PATIENTS AND METHODS: Patients were classified in three groups: 1) with low/intermediate risk clinically localized tumors; 2) with high risk and locally advanced (T3-4) tumors; 3) with metastatic tumors. Time to castration resistance and overall cancer-specific survival were analyzed. In non-metastatic tumors, survivals in patients treated with ADT were compared with data from patients who underwent local treatments from the Spanish Prostate Cancer Registry. RESULTS: 703 cases were analyzed. There were significant differences in the time to castration resistance, which was lower in the group of metastatic tumors. During follow-up, there were 179 deaths (25.5%) of which 89 (12.6%) were due to PCa. After 3 years of ADT, only 14.6% of patients in group 1 had died (1% due to PCa), 20.5% in group 2 and 46.8% in group 3 (9.2% and 31.3% due to PCa, respectively). Cancer-specific survival was significantly worse in group 1 using ADT than radical prostatectomy or radiotherapy. In high-risk and locally advanced tumors, ADT also had a lower cancer-specific survival than local treatments. CONCLUSION: A longer time until the castration resistance was observed in patients with well- and intermediate-risk localized tumors treated with ADT. Patients with metastatic tumors showed the shortest time to castration resistance.

The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors. / Impacto del tiempo desde la biopsia a la prostatectomía radical en la infragradación del grado de Gleason y análisis de factores relacionados.

INTRODUCTION: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU.

Factores relacionados con la resistencia a la castración precoz en el cáncer de próstata metastásico. Resultados del Registro nacional de cáncer de próstata en España / Factors related to early castration resistance in metastatic prostate cancer. Results from the National Prostate Cancer Registry in Spain

Introducción: El objetivo del estudio fue establecer los factores que se relacionan de forma independiente con el desarrollo de resistencia a la castración (RC) a medio plazo en el cáncer de próstata (CP). Material y métodos: Ciento cincuenta y cinco pacientes con CP metastásicos al diagnóstico del registro nacional de CP con un seguimiento de hasta 39 meses. Las variables estudiadas fueron: edad, PSA, nadir de PSA, Gleason, invasión perineural, estadios T, N y M y tipo de bloqueo (intermitente/continuo). Resultados: Media de seguimiento 26,2 ± 13,4 meses. El 47,1% desarrolló RC precoz, con una media hasta el desarrollo de RC 12,2 ± 8,7 meses. Análisis univariante: se relacionaron con la RC la media de PSA (290 ± 905,1ng/ml en no RC, 519,1 ± 1437,2 ng/ml en RC, p < 0,001), media de edad (73,3 ± 8,3 años en no RC, 69,1 ± 9,3 en RC, p = 0,01), media de nadir de PSA (15,5 ± 57,3 ng/ml en no RC, 15,9 ± 23,7 ng/ml en RC, p < 0,001), Gleason (en ≥ 8, HR: 2,11; IC 95%: 1,22-3,65, p = 0,006) y estadio T (en T3-T4, HR: 2,85; IC 95%: 1,57-5,19, p < 0,001). Análisis multivariante: las variables independientes relacionadas con la RC son edad (HR: 0,96; IC 95%: 0,94-0,99, p = 0,01), nadir de PSA (HR: 1,65; IC 95%: 1,43-1,91, p < 0,001) y estadio T3-T4 (HR: 2,11; IC 95%: 1,10-4,04, p = 0,02). Conclusiones: El nadir de PSA y un estadio tumoral T3-T4 al diagnóstico se relacionan con un riesgo aumentado de desarrollar RC. Además, la edad al diagnóstico se muestra como una variable que disminuye el riesgo, de forma que, a más edad, menos riesgo de desarrollar RC a medio plazo

Introduction: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. Material and methods: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). Results: Mean follow-up 26,2 ± 13,4 months. 47.1% developed early CR, with mean time until onset of 12,2 ± 8,7 months. Univariate analysis the mean PSA was correlated with CR (290 ± 905,1 ng/mL in non CR, 519,1 ± 1437,2 ng/mL in CR, P < .001), mean age (73,3 ± 8,3 years in non CR, 69,1 ± 9,3 in CR P = .01), mean PSA nadir (15,5 ± 57,3 ng/mL in non CR, 15,9 ± 23,7 ng/mL in CR, p < 0,001), Gleason (in ≥ 8, HR: 2,11. 95% CI: 1.22-3.65, p = 0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P < .001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P = .01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P < .001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P = .02). Conclusions: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term

PREVALENCE OF FATIGUE AND IMPACT ON QUALITY OF LIFE IN CASTRATION-RESISTANT PROSTATE CANCER PATIENTS: the VITAL study.

BACKGROUND: Fatigue is one of the most prevalent symptoms among cancer patients. Specifically, in metastatic castration-resistant prostate cancer (mCRPC) patients, fatigue is the most common adverse event associated with current treatments. The purpose of this study is to describe the prevalence of fatigue and its impact on quality of life (QoL) in patients with CRPC in routine clinical practice. METHODS: This was a cross-sectional, multicentre study. Male chemo-naïve adults with high-risk non-metastatic (M0) CRPC and metastatic (M1) CRPC (mCRPC) were eligible. Fatigue was measured using the Brief Fatigue Inventory (BFI) and QoL was assessed using the Functional Assessment of Cancer Therapy questionnaire for patients with prostate cancer (FACT-P) and the FACT-General (FACT-G) questionnaire. Data were analysed using Mann-Whitney or Kruskal-Wallis tests (non-parametric distribution), a T-test or an ANOVA (parametric distribution) and the Fisher or chi-squared tests (categorical variables). RESULTS: A total of 235 eligible patients were included in the study (74 [31.5%] with M0; and 161 [68.5%] with M1). Fatigue was present in 74%, with 38.5% of patients reporting moderate-to-severe fatigue. Mean FACT-G and FACT-P overall scores were 77.6 ± 16.3 and 108.7 ± 21.4, respectively, with no differences between the CRPC M0 and CRPC M1 subgroups. Fatigue intensity was associated with decreased FACT-G/P scores, with no differences between groups. Among 151 mCRPC patients with available treatment data, those treated with abiraterone-prednisone ≥3 months showed a significant reduction in fatigue intensity (p = 0.043) and interference (p = 0.04) compared to those on traditional hormone therapy (HT). Patients on abiraterone-prednisone ≥3 months showed significantly better FACT-G/P scores than patients on HT (p = 0.046 and 0.018, respectively). CONCLUSION: Our data show a high prevalence and intensity of fatigue and its impact on QoL in chemo-naïve CRPC patients. There is an association between greater fatigue and less QoL, irrespective of the presence or absence of metastasis. Chemo-naïve mCRPC patients receiving more than 3 months of abiraterone acetate plus prednisone showed an improvement of fatigue and QoL when compared to those on traditional HT. TRIAL REGISTRATION: Not applicable since it is not an interventional study.

Factors related to early castration resistance in metastatic prostate cancer. Results from the National Prostate Cancer Registry in Spain. / Factores relacionados con la resistencia a la castración precoz en el cáncer de próstata metastásico. Resultados del Registro nacional de cáncer de próstata en España.

INTRODUCTION: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. MATERIAL AND METHODS: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). RESULTS: Mean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P<.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p<0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P<.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P<.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02). CONCLUSIONS: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.

Resultados preliminares de supervivencia global y libre de progresión a tres años en una cohorte de pacientes diagnosticados de cáncer de próstata (grupo GESCAP) / Three-year interim results of overall and progression-free survival in a cohort of patients with prostate cancer (GESCAP group)

Objetivos: Describir la supervivencia libre de progresión (SLP), la supervivencia global (SG) y la mortalidad específica en la cohorte prospectiva GESCAP de cáncer de próstata de 3 años de seguimiento, así como la aparición de resistencia a la castración en aquellos pacientes en hormonoterapia. Material y métodos: Estudio epidemiológico, observacional, multicéntrico y prospectivo. De los 4.087 pacientes reclutados, 3.843 fueron evaluables. Las variables analizadas fueron el grupo de riesgo (localizado, localmente avanzado, afectación linfática, metastásico), edad, niveles de PSA, puntuación Gleason y tratamiento inicial. Se utilizaron el método de Kaplan-Meier, la comparación log-rank y el modelo de Cox para evaluar los datos de supervivencia. Resultados: La SLP a 3 años fue del 81,4% y la SG del 92,4%. Durante los 3 años de seguimiento, murieron 303 (7,9%) pacientes, 110 de ellos (36,3%) por causas relacionadas con la enfermedad. La probabilidad de resistencia a la castración para el global de pacientes en hormonoterapia (n = 715) fue del 14,2%: el 5, el 9,9, el 26,1 y el 44,4% en localizado, localmente avanzado, afectación linfática y metastásico, respectivamente (log-rank p < 0,0001). Los pacientes con metástasis tuvieron peores resultados respecto a SLP, SG, mortalidad específica y resistencia a la castración. En el análisis multivariante, la puntuación Gleason, el PSA y la presencia de metástasis estuvieron asociados a menores SG y SLP. Conclusiones: Se demuestra una estratificación del riesgo, con un pronóstico más desfavorable para pacientes metastásicos. Los pacientes con enfermedad localmente avanzada se diferencian respecto a los de enfermedad localizada por su mayor riesgo en cuanto a mortalidad específica. (Controlled-trials.com ISRCTN19893319)

Aims: To describe the 3-year progression-free survival (PFS), overall survival (OS) and disease-specific mortality in the prospective prostate cancer GESCAP cohort, as well as the progression to castration resistance in patients on hormone therapy. Material and methods: Prospective, observational, epidemiological, multicentre study. Of the 4087 patients recruited, 3843 were evaluable. The variables analysed were the risk group (localized, locally advanced, lymph involvement, metastatic), age, prostate-specific antigen (PSA) levels, Gleason score and initial treatment. Kaplan Meier survival analysis, the log-rank test and the Cox model were used to evaluate the survival data. Results: Three-year PFS was 81.4% and OS was 92.4%. During the 3 years of follow-up, 303 patients died (7.9%), 110 of them (36.3%) due to disease-related causes. The probability of castration resistance for all patients on hormone therapy (n = 715) was 14.2%: 5%, 9.9%, 26.1% and 44.4% in localized, locally advanced, lymph involvement and metastatic cancer, respectively (log-rank P < .0001). Patients with metastases had poorer outcomes with respect to PFS, OS, disease-specific mortality and castration resistance. In the multivariate analysis, the Gleason score, PSA and presence of metastases were associated with shorter OS and PFS. Conclusions: Our study showed stratification of risk, with a more unfavourable prognosis for patients with metastases. Patients with locally advanced disease differed with respect to those with localized disease due to their higher risk as regards disease-specific mortality. (Controlled-trials.com ISRCTN19893319)

Three-year interim results of overall and progression-free survival in a cohort of patients with prostate cancer (GESCAP group). / Resultados preliminares de supervivencia global y libre de progresión a tresaños en una cohorte de pacientes diagnosticados de cáncer de próstata (grupo GESCAP).

AIMS: To describe the 3-year progression-free survival (PFS), overall survival (OS) and disease-specific mortality in the prospective prostate cancer GESCAP cohort, as well as the progression to castration resistance in patients on hormone therapy. MATERIAL AND METHODS: Prospective, observational, epidemiological, multicentre study. Of the 4087 patients recruited, 3843 were evaluable. The variables analysed were the risk group (localized, locally advanced, lymph involvement, metastatic), age, prostate-specific antigen (PSA) levels, Gleason score and initial treatment. Kaplan Meier survival analysis, the log-rank test and the Cox model were used to evaluate the survival data. RESULTS: Three-year PFS was 81.4% and OS was 92.4%. During the 3 years of follow-up, 303 patients died (7.9%), 110 of them (36.3%) due to disease-related causes. The probability of castration resistance for all patients on hormone therapy (n=715) was 14.2%: 5%, 9.9%, 26.1% and 44.4% in localized, locally advanced, lymph involvement and metastatic cancer, respectively (log-rank P<.0001). Patients with metastases had poorer outcomes with respect to PFS, OS, disease-specific mortality and castration resistance. In the multivariate analysis, the Gleason score, PSA and presence of metastases were associated with shorter OS and PFS. CONCLUSIONS: Our study showed stratification of risk, with a more unfavourable prognosis for patients with metastases. Patients with locally advanced disease differed with respect to those with localized disease due to their higher risk as regards disease-specific mortality. (Controlled-trials.com ISRCTN19893319).

Radio-223 en el tratamiento del cáncer de próstata resistente a la castración metastásico: una ventana de oportunidad / Radium-223 for the treatment of metastatic castration-resistant prostate cancer: A window of opportunity

Contexto: Eliminar las metástasis óseas, restaurar/preservar la morfología ósea y prevenir/retrasar los eventos óseos constituyen un objetivo fundamental en el manejo del cáncer de próstata resistente a la castración metastásico (CPRCm). Radio-223 es la primera terapia alfa-dirigida con acción sobre el hueso que aumenta la supervivencia en estos pacientes, además de mostrar otros beneficios sobre los eventos óseos. Objetivo: Analizar el impacto de las metástasis óseas en el CPRCm, así como los beneficios y la ventana de oportunidad ofrecida por radio-223 en el tratamiento de pacientes con CPRCm en el contexto terapéutico actual. Adquisición de la evidencia: Búsqueda bibliográfica en PubMed y congresos nacionales/internacionales sobre radio-223 y otros tratamientos en primera línea para el CPRCm. Se consultaron guías y recomendaciones de expertos recientes. Resumen de la evidencia: La evidencia acerca del mecanismo de acción de radio-223 amplía su efecto al entorno óseo del tumor. La supervivencia en pacientes tratados con radio-223 es superior en aquellos con síntomas leves respecto a moderados-graves. La aparición de metástasis viscerales incluso en fases tempranas del CPRCm apoya comenzar el tratamiento con radio-223 antes incluso de que los síntomas sean clínicamente relevantes. Un estudio a 3 años ha confirmado su buen perfil de seguridad. Los cambios de tALP y LDH podrían constituir marcadores útiles para la monitorización, aunque no son predictores de la supervivencia global. Conclusión: Radio-223 ofrece un alternativa terapéutica valiosa en el tratamiento de pacientes con CPRCm en fases tempranas de la enfermedad, con buen perfil de seguridad. Su beneficio se extiende al entorno óseo

Context: The elimination of bone metastases, restoration and/or preservation of bone morphology and prevention and/or delay of skeletal events are a fundamental objective in the management of metastatic castration-resistant prostate cancer (mCRPC). Radium-223 is the first targeted alpha therapy with effects on bone that has been shown to increase survival in these patients, besides providing other bone-related benefits. Objective: To analyze the impact of bone metastasis on mCRPC, and the benefits and the window of opportunity provided by radium-223 in the treatment of patients with mCRPC in the current treatment era. Evidence acquisition: A bibliographic search of PubMed and Spanish and international congresses on radium-223 and other first-line treatments for mCRPC was performed. Recent guidelines and recommendations by experts were also consulted. Summary of the evidence. Evidence for the mechanism of action of radium-223 widen its effects to the tumor bone environment. Survival of patients treated with radium-223 is higher in those with mild symptoms as opposed to those with moderate-severe symptoms. The presence of visceral metastases even in the early stages of mCRPC supports starting radium-223 therapy before the symptoms become clinically relevant. A 3-year study has confirmed its good safety profile. Changes in tALP and LDH may be useful markers for monitoring the treatment with radium-223, but they are not predictors of overall survival. Conclusion: Radium-223 is a valuable therapeutic alternative in the treatment of patients with mCRPC in early stages of the disease, with a good safety profile. Its benefits extend to the bone environment

Incidencia real de cáncer de próstata en las áreas sanitarias de la comunidad autónoma de Castilla y León durante el año 2014. Datos del registro CAPCYL / Actual incidence of prostate cancer in healthcare areas of the autonomous community of Castilla-Leon during 2014. CAPCYL registry data

Objetivo: Conocer la incidencia real de cáncer de próstata (CP) en las áreas sanitarias de Castilla y León en el año 2014. Material y métodos: Estudio multicéntrico en el que participan 7 de las 9 áreas sanitarias de Castilla y León. Se recogen datos con carácter retrospectivo que incluyen el 87,8% de la población diana (varones diagnosticados de CP con confirmación histopatológica en el año 2014). Se calculan incidencias brutas e incidencias ajustadas por edad según el método directo. Los datos epidemiológicos comunitarios y nacionales son consultados en el Instituto Nacional de Estadística. Resultados: Se diagnosticaron 1.198 nuevos casos de CP. La tasa de incidencia bruta comunitaria es 109,54 casos por 100.000 varones. Las tasas ajustadas a población española y europea resultan en 115,41 y 110,07, respectivamente. El grupo etario de mayor concentración diagnóstica fue el de 60-70 años, con el 41,97% de los diagnósticos, y el que mostró mayor incidencia fue el comprendido entre 70 y 80años, con 438,87 casos por 100.000 habitantes. Se objetivan diferencias en las incidencias brutas y ajustadas por grupo de edad, así como en el factor edad al diagnóstico entre las diferentes áreas sanitarias incluidas. Conclusiones: La tasa de incidencia bruta comunitaria resultó ser mayor que la mayoría de datos existentes previamente. Se aprecian importantes diferencias entre las distintas áreas geográficas que pueden ser explicadas principalmente por la distribución del factor edad y las políticas de cribado oportunista en cada una de ellas

Objective: To determine the actual incidence of prostate cancer (PC) in the healthcare areas of Castilla-Leon in 2014. Material and methods: A multicentre study was conducted with the participation of 7 of the 9 healthcare areas of Castilla-Leon. We collected retrospective data that included 87.8% of the target population (men diagnosed with PC with histopathological confirmation in 2014). We calculated the raw and age-adjusted incidence rates based on the direct method and consulted the community and national epidemiological data in the Spanish National Institute of Statistics. Results: A total of 1198 new cases of PC were diagnosed, with a raw incidence rate in the community of 109.54 cases per 100,000 men. The adjusted rates for the Spanish and European populations were 115.41 and 110.07, respectively. The age group with the highest diagnostic concentration was the 60-70-year group, with 41.97% of the diagnoses. The group with the highest incidence was the 70-80-year group, with 438.87 cases per 100,000 inhabitants. There were differences in the raw and age-adjusted incidence rates and in the age at diagnosis among the various included healthcare areas. Conclusions: The community raw incidence rate was higher than most existing data. We observed significant differences among the various geographical areas, which could be explained mainly by the age distribution and the opportunistic screening policies for each area

Avances en uro-oncología "OncoForum": lo mejor del 2017 / Developments in urologic oncology "OncoForum": The best of 2017

Objetivo: Conocer las últimas evidencias sobre Urología oncológica de tumores de próstata, riñón y vejiga, analizando su impacto en la práctica clínica diaria, además de los esquemas futuros a medio y largo plazo. Métodos: Se revisan los resúmenes sobre cáncer de próstata, renal y vejiga presentados en los congresos del año 2017 (EAU, AUA, ASCO, ESMO y ASTRO) y las publicaciones de mayor impacto en este periodo que recibieron mayor valoración por parte del comité del OncoForum. Resultados: En pacientes con cáncer renal de alto riesgo de recurrencia tras nefrectomía, se observó beneficio de sunitinib adyuvante versus placebo en el subgrupo de mayor riesgo. En pacientes con cáncer uroterial avanzado inelegibles a cisplatino, pembrolizumab en primera línea dio lugar a respuestas duraderas clínicamente significativas. En pacientes con cáncer de próstata (CaP) localizado, el tratamiento por progresión de la enfermedad fue menos frecuente con prostatectomía radical (PR) que con observación (diferencia absoluta de 26,2%) y se asoció a mayor frecuencia de eventos adversos (EA). En pacientes con CaP M0, la adición de abiraterona más prednisona (ABI + P) a deprivación androgénica (TDA) supuso menos muertes y menos eventos por fallo de tratamiento (p < 0,001). En pacientes con cáncer de próstata resistente a castración metastásico (CPRCm) tratados previamente con abiraterona, la mediana de supervivencia libre de progresión radiográfica (SLPr) con enzalutamida fue de 8,1 meses y la de supervivencia global (SG) no se alcanzó. Conclusiones: En pacientes con cáncer renal de alto riesgo de recurrencia tras nefrectomía, sunitinib adyuvante otorgó beneficio en todos los subgrupos, incluidos aquellos de mayor riesgo. En pacientes con CaP localizado, la PR no se asoció significativamente con mortalidad por todas las causas o mortalidad cáncer específica en comparación con observación. En pacientes con CaP M0, TDA combinado con ABI + P se asoció significativamente con mayores tasas de SG y SLP que TDA solo. En pacientes con CPRCm tratados previamente con abiraterona en tratamiento con enzalutamida permaneció activo

Objective: To put forth new findings of urologic oncology with impact on clinical practice presented during 2017 in the main annual meetings. Methods: This document reviews abstracts on prostate, kidney and bladder cancer presented at the congresses of 2016 (EAU, AUA, ASCO, ESMO and ASTRO) and publications with the highest impact in this period valued with the highest scores by the OncoForum committee. Results: Among patients at high risk of recurrent renal cell carcinoma after nephrectomy, adjuvant sunitinib compared to placebo showed a benefit in patients at higher risk of recurrence. In cisplatin-ineligible advanced urothelial cancer, pembrolizumab elicits clinically meaningful, durable responses. Among patients with localized prostate cancer, treatment for disease progression was less frequent (absolute difference, 26.2 percentage pontis) and adverse events was more frequent with surgery than with observation. Among patients with locally advanced or merastatic prostate cancer, androgen-deprivation therapy plus abiraterone and prednisolone resulted in fewer deaths and fewer treatment-failure events (P < .001). Among patients with metastatic castration-resistant prostate cancer previously treated with abiraterone acetate, enzalutamide median radiographic progression free survival was 8,1 months and enzalutamide median overall survival was not reached. Conclusions: Among patients at high risk of recurrent renal cell carcinoma after nephrectomy, adjuvant sunitinib showed a benefit across subgroups including patients at higher risk of recurrence. Among patients with localized prostate cancer, surgery was not associated with significantly lower all-cause or porstate-cancer mortality than observation. Among patients with locally advanced or merastatic prostate cancer, androgen-deprivation therapy plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than androgen-deprivation therapy alone. In patients with metastatic castration-resistant prostate cancer previously treated with abiraterone enzalutamide remained active

Radium-223 for the treatment of metastatic castration-resistant prostate cancer: A window of opportunity. / Radio-223 en el tratamiento del cáncer de próstata resistente a la castración metastásico: una ventana de oportunidad.

CONTEXT: The elimination of bone metastases, restoration and/or preservation of bone morphology and prevention and/or delay of skeletal events are a fundamental objective in the management of metastatic castration-resistant prostate cancer (mCRPC). Radium-223 is the first targeted alpha therapy with effects on bone that has been shown to increase survival in these patients, besides providing other bone-related benefits. OBJECTIVE: To analyze the impact of bone metastasis on mCRPC, and the benefits and the window of opportunity provided by radium-223 in the treatment of patients with mCRPC in the current treatment era. EVIDENCE ACQUISITION: A bibliographic search of PubMed and Spanish and international congresses on radium-223 and other first-line treatments for mCRPC was performed. Recent guidelines and recommendations by experts were also consulted. SUMMARY OF THE EVIDENCE: Evidence for the mechanism of action of radium-223 widen its effects to the tumor bone environment. Survival of patients treated with radium-223 is higher in those with mild symptoms as opposed to those with moderate-severe symptoms. The presence of visceral metastases even in the early stages of mCRPC supports starting radium-223 therapy before the symptoms become clinically relevant. A 3-year study has confirmed its good safety profile. Changes in tALP and LDH may be useful markers for monitoring the treatment with radium-223, but they are not predictors of overall survival. CONCLUSION: Radium-223 is a valuable therapeutic alternative in the treatment of patients with mCRPC in early stages of the disease, with a good safety profile. Its benefits extend to the bone environment.

Developments in urologic oncology "OncoForum": The best of 2017. / Avances en uro-oncología «OncoForum¼: lo mejor del 2017.

OBJECTIVE: To put forth new findings of urologic oncology with impact on clinical practice presented during 2017 in the main annual meetings. METHODS: This document reviews abstracts on prostate, kidney and bladder cancer presented at the congresses of 2016 (EAU, AUA, ASCO, ESMO and ASTRO) and publications with the highest impact in this period valued with the highest scores by the OncoForum committee. RESULTS: Among patients at high risk of recurrent renal cell carcinoma after nephrectomy, adjuvant sunitinib compared to placebo showed a benefit in patients at higher risk of recurrence. In cisplatin-ineligible advanced urothelial cancer, pembrolizumab elicits clinically meaningful, durable responses. Among patients with localized prostate cancer, treatment for disease progression was less frequent (absolute difference, 26.2 percentage pontis) and adverse events was more frequent with surgery than with observation. Among patients with locally advanced or merastatic prostate cancer, androgen-deprivation therapy plus abiraterone and prednisolone resulted in fewer deaths and fewer treatment-failure events (P<.001). Among patients with metastatic castration-resistant prostate cancer previously treated with abiraterone acetate, enzalutamide median radiographic progression free survival was 8,1 months and enzalutamide median overall survival was not reached. CONCLUSIONS: Among patients at high risk of recurrent renal cell carcinoma after nephrectomy, adjuvant sunitinib showed a benefit across subgroups including patients at higher risk of recurrence. Among patients with localized prostate cancer, surgery was not associated with significantly lower all-cause or porstate-cancer mortality than observation. Among patients with locally advanced or merastatic prostate cancer, androgen-deprivation therapy plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than androgen-deprivation therapy alone. In patients with metastatic castration-resistant prostate cancer previously treated with abiraterone enzalutamide remained active.

Actual incidence of prostate cancer in healthcare areas of the autonomous community of Castilla-Leon during 2014. CAPCYL registry data. / Incidencia real de cáncer de próstata en las áreas sanitarias de la comunidad autónoma de Castilla y León durante el año 2014. Datos del registro CAPCYL.

OBJECTIVE: To determine the actual incidence of prostate cancer (PC) in the healthcare areas of Castilla-Leon in 2014. MATERIAL AND METHODS: A multicentre study was conducted with the participation of 7 of the 9 healthcare areas of Castilla-Leon. We collected retrospective data that included 87.8% of the target population (men diagnosed with PC with histopathological confirmation in 2014). We calculated the raw and age-adjusted incidence rates based on the direct method and consulted the community and national epidemiological data in the Spanish National Institute of Statistics. RESULTS: A total of 1198 new cases of PC were diagnosed, with a raw incidence rate in the community of 109.54 cases per 100,000 men. The adjusted rates for the Spanish and European populations were 115.41 and 110.07, respectively. The age group with the highest diagnostic concentration was the 60-70-year group, with 41.97% of the diagnoses. The group with the highest incidence was the 70-80-year group, with 438.87 cases per 100,000 inhabitants. There were differences in the raw and age-adjusted incidence rates and in the age at diagnosis among the various included healthcare areas. CONCLUSIONS: The community raw incidence rate was higher than most existing data. We observed significant differences among the various geographical areas, which could be explained mainly by the age distribution and the opportunistic screening policies for each area.

Avances en uroncología «OncoForum»: lo mejor de 2016 / Developments in urologic oncology «OncoForum»: The best of 2016

Objetivo: Conocer las últimas evidencias sobre urología oncológica de tumores de próstata, riñón y vejiga, analizando su impacto en la práctica clínica diaria, además de los esquemas futuros a medio y largo plazo. Adquisición de la evidencia: Se revisan los resúmenes sobre cáncer de próstata, renal y vejiga presentados en los congresos del año 2016 (EAU, AUA, ASCO, ESMO y ASTRO) y las publicaciones de mayor impacto en este periodo que recibieron mayor valoración por parte del comité del OncoForum. Síntesis de la evidencia: En pacientes con carcinoma renal localizado de alto riesgo tras nefrectomía la enfermedad libre de progresión fue significativamente mayor para sunitinib que para el grupo placebo, con eventos adversos más frecuentes. En pacientes con cáncer de vejiga localmente avanzado o metastásico aletozumab obtuvo tasas de repuesta global en todos los subgrupos de pacientes, incluidos aquellos con mal pronóstico. En pacientes con cáncer de próstata localizado la diferencia de mortalidad cáncer específica entre prostatectomía radical, radioterapia o seguimiento activo no fue significativa (p = 0,48). En el estudio TERRAIN, con pacientes con cáncer de próstata resistente a la castración, se comunicaron eventos adversos graves en el 31% y el 23% de los pacientes tratados con enzalutamida y bicalutamida, respectivamente. Además, enzalutamida mejoró significativamente la supervivencia libre de progresión (1,57 meses) en comparación con bicatulamida (5,8 meses) (p < 0,0001). En el estudio ESTRIVE enzalutamida redujo el riesgo de progresión o muerte en un 76% en comparación con bicalutamida (p = 0,001). Conclusiones: En pacientes con cáncer renal de alto riesgo tras nefrectomía se ha evaluado sunitinb como opción de tratamiento. En pacientes con cáncer de próstata localizado la mortalidad cáncer específica fue baja, independientemente del tratamiento asignado (prostatectomía radical, radioterapia o seguimiento activo). En cáncer de próstata resistente a la castración se han publicado nuevos resultados de la eficacia y seguridad de enzalutamida y abiraterona, que han mostrado efectos beneficiosos en pacientes metastásicos y no metastásicos

Objective: To put forth new findings of urologic oncology with impact on clinical practice presented during 2016 in the main annual meetings. Acquisition of evidence: This document reviews abstracts on prostate, kidney and bladder cancer presented at the congresses of 2016 (EAU, AUA, ASCO, ESMO and ASTRO) and publications with the highest impact in this period valued with the highest scores by the OncoForum committee. Synthesis of evidence: In High-Risk Renal-Cell carcinoma after nephrectomy, disease-free survival was significantly greater for sunitinib than placebo group, with adverse events more frequents. In locally advanced and metastatic urotherial carcinoma patients, aletozumab achieved overall response rate in all subgroups of patients, included poor prognostic. In localized prostate cancer, the difference of prostate-cancer-specific mortality among active monitoring, radical prostatectomy and external-beam radiotherapy was not significant (P = 0,48). In TERRAIN study, with castration-resistant prostate cancer patients, adverse events was reported in 31% and 23% of patients treated with enzalutamide and bicalutamide, respectively. Moreover, enzalutamide significantly improved median progression-free survival (15.7 months) compared bicalutamide (5.8 months) (P < .0001). In SRTIVE study, Enzalutamide reduced the risk of progression or death by 76% compared with bicalutamide (P < .001). Conclusions: In high-risk renal-cell carcinoma after nephrectomy, sunitinb has been considered as treatment choice. In localized prostate cancer, prostate-cancer-specific mortality was low irrespective of the treatment assigned (active monitoring, radical prostatectomy and external-beam radiotherapy). In metastatic castration-resistant prostate cancer new results of treatment with enzalutamide and abiraterone has been published, wich have been shown beneficial effects in metastatic and no metastatic patients