Diagnóstico incidental del cáncer de vejiga en España. Estudio observacional a nivel nacional / Incidental diagnosis of bladder cancer in a national observational study in Spain

Introducción El cáncer de vejiga (CV) es una neoplasia frecuente en España. Los objetivos de este estudio fueron: identificar la proporción de pacientes diagnosticados de CV de forma incidental o tras la presentación de síntomas en un periodo contemporáneo en España; comparar las características demográficas, clínicas y patológicas entre estos grupos. Métodos El presente fue un análisis retrospectivo de un estudio observacional multicéntrico realizado en 26 hospitales del Sistema Nacional de Salud español, incluyendo a todos los nuevos diagnósticos de CV en 2011. El estudio representó 21,5% de la población española y los hospitales fueron seleccionados de forma proporcional a las regiones españolas para asegurar una muestra representativa. Los pacientes fueron categorizados según el diagnóstico de cáncer incidental o tras la presentación sintomática y se analizaron las características demográficas, patológicas y clínicas basales. Resultados En los 26 hospitales españoles incluidos en el estudio, se diagnosticaron 2.472 casos de CV, de los cuales 308 (12,5%) fueron diagnosticados de forma incidental y 2.164 (87,5%) tras la presentación de síntomas. No se observaron diferencias entre los pacientes diagnosticados incidentalmente frente a los sintomáticos en términos demográficos o de comorbilidades evaluadas. En comparación con los tumores de vejiga con diagnostico posterior a la presentación de síntomas, los diagnósticos incidentales tenían más probabilidades de ser tumores papilares, significativamente más pequeños y de tener una citología positiva/sospechosa. Además, los tumores de vejiga diagnosticados incidentalmente tenían menos probabilidades de ser músculo-invasivos (11,7 vs. 25%, p < 0,01) y de ser agresivos en el estudio patológico, con 33,6% de grado 3 vs. 50,1% (p < 0,01). Conclusiones Identificamos un porcentaje significativo (12,5%) de nuevos diagnósticos de CV realizados de forma incidental en una muestra representativa de la población española (AU)

Introduction Bladder cancer (BC) is a common malignancy in Spain. The aims of this study were: to identify the proportion of patients diagnosed with BC incidentally or after symptomatic presentation in a contemporary period in Spain; to compare demographic, clinical, and pathologic characteristics between these groups. Methods This was a retrospective analysis of a multi-centre observational study of 26 hospitals in the Spanish National Health System of all BCs newly diagnosed in 2011. The study represented 21.5% of the Spanish population and hospitals were selected in proportion to Spain's regions to ensure a representative sample. Patients were categorized by whether the cancer was diagnosed incidentally or after symptomatic presentation and baseline demographic, pathologic, and clinical characteristics were analyzed. Results 2472 were newly diagnosed with BC at the 26 participating Spanish hospitals with 308 (12.5%) of cases diagnosed incidentally and 2164 (87.5%) diagnosed after symptomatic presentation. No differences were observed between patients diagnosed incidentally vs. symptomatically in terms of demographics or measured co-morbidities. Compared to symptomatically diagnosed bladder tumours, those diagnosed incidentally were more likely to have a papillary appearance, to be significantly smaller, and less likely to have positive/suspicious cytology. Additionally, incidentally diagnosed bladder tumours were less likely to be muscle-invasive (11.7% vs. 25.0%, P < .01) nor aggressive at pathology, with 33.6% Grade 3 compared to 50.1%, (P < .01). Conclusions We identified a significant percentage (12.5%) of new bladder cancer diagnosis made incidentally in a representative sample of the Spanish population. These tumours exhibited less aggressive pathologic characteristics than their symptomatic counterparts (AU)

Papel del antígeno prostático específico ante las nuevas evidencias científicas, una nueva actualización en 2020 / The role of prostate-specific antigen in light of new scientific evidence: An update in 2020

OBJETIVO: Revisar y actualizar las últimas evidencias científicas que se han producido en los últimos años con respecto al antígeno prostático específico (PSA) para su mejor aplicación en la práctica clínica habitual. ADQUISICIÓN DE EVIDENCIA: Análisis de la evidencia disponible acerca del papel actual del PSA, según la consideración de un panel de expertos que recoge su experiencia en el tema analizado. SÍNTESIS DE EVIDENCIA: Actualmente no puede considerarse el PSA únicamente un elemento orientativo en cuanto a la presencia o no de cáncer de próstata, sino que esta determinación ayuda al urólogo a indicar cuál es el tratamiento más conveniente ante un paciente con hipertrofia prostática benigna (HPB) como criterio de progresión de la enfermedad, así como a sospechar la existencia de un tumor prostático cuando la cifra de PSA se eleva > 0,3 ng/ml en pacientes bajo tratamiento con un inhibidor de la 5-alfa-reductasa sobre la cifra alcanzada a los 6 meses de haber iniciado dicho tratamiento. Sin embargo, los límites de este aumento del PSA con derivados de inhibidores de la 5-alfa-reductasa alternativos a la dutasterida están en controversia. Por otro lado, el PSA resulta clave para el seguimiento de pacientes tratados de un carcinoma prostático en cualquier estadio y con cualquier opción (cirugía, radioterapia o terapias focales u hormonoterapia), para definir recidiva bioquímica, sospechar la existencia de recidiva local o a distancia, así como para plantear o descartar tratamientos adyuvantes. Por último, recientemente se ha reforzado el papel del PSA como herramienta de cribado, demostrando unas tasas de aumento de mortalidad o de existencia de casos más agresivos de cáncer de próstata en aquellos países donde se ha disminuido el uso de esta herramienta. CONCLUSIONES: Ofrecemos nuevos datos acerca del papel actual del PSA en el manejo de pacientes tratados por HPB y/o cáncer de próstata que deben tenerse en cuenta en la práctica clínica habitual, haciendo especial hincapié en el papel relevante de este biomarcador en el cribado y seguimiento del cáncer de próstata, así como en la progresión de la HPB en tratamiento con dutasterida

OBJECTIVE: To review and update the latest scientific evidence gathered in recent years regarding prostate-specific antigen (PSA) for better implementation into routine clinical practice. EVIDENCE ACQUISITION: Analysis of the available evidence on the current role of PSA, based on the experience of an expert panel in the subject under analysis. EVIDENCE SYNTHESIS: Currently, PSA cannot be considered only as a guide for the presence or absence of prostate cancer. This determination can also help the urologist to decide on the most convenient treatment for a patient with benign prostatic hypertrophy (BPH) as a criterion for disease progression, and it can also suggest the suspicious existence of a prostatic tumor when there is PSA rise of > 0.3 ng/ml over the level reached 6 months after having initiated treatment with 5-alpha-reductase inhibitor. However, the limits of this PSA rise with derivatives of alternative 5-alpha-reductase (5-ARI) inhibitors to dutasteride are controversial. Moreover, PSA is a key factor for the follow-up of patients with prostate adenocarcinoma at any stage who have received treatment (surgery, radiotherapy or focal therapies, hormone therapy), it acts as a guide to identify biochemical recurrence, to suspect the existence of local or distant recurrence, as well as to propose or discard adjuvant treatments. Finally, the role of PSA as a screening tool has been recently reinforced, demonstrating increased mortality rates or the existence of more aggressive cases of prostate cancer in those countries where the use of this tool has declined. CONCLUSIONS: We present new data about the current role of PSA in the management of patients treated for BPH and/or prostate cancer that should be implemented into routine clinical practice, with special emphasis on the relevant role of this biomarker in the screening and follow-up of prostate cancer, as well as in the progression of BPH in dutasteride treatment

The role of prostate-specific antigen in light of new scientific evidence: An update in 2020. / Papel del antígeno prostático específico ante las nuevas evidencias científicas, una nueva actualización en 2020.

OBJECTIVE: To review and update the latest scientific evidence gathered in recent years regarding prostate-specific antigen (PSA) for better implementation into routine clinical practice. EVIDENCE ACQUISITION: Analysis of the available evidence on the current role of PSA, based on the experience of an expert panel in the subject under analysis. EVIDENCE SYNTHESIS: Currently, PSA cannot be considered only as a guide for the presence or absence of prostate cancer. This determination can also help the urologist to decide on the most convenient treatment for a patient with benign prostatic hypertrophy (BPH) as a criterion for disease progression, and it can also suggest the suspicious existence of a prostatic tumor when there is PSA rise of>0.3 ng/ml over the level reached 6 months after having initiated treatment with 5-alpha-reductase inhibitor. However, the limits of this PSA rise with derivatives of alternative 5-alpha-reductase (5-ARI) inhibitors to dutasteride are controversial. Moreover, PSA is a key factor for the follow-up of patients with prostate adenocarcinoma at any stage who have received treatment (surgery, radiotherapy or focal therapies, hormone therapy), it acts as a guide to identify biochemical recurrence, to suspect the existence of local or distant recurrence, as well as to propose or discard adjuvant treatments. Finally, the role of PSA as a screening tool has been recently reinforced, demonstrating increased mortality rates or the existence of more aggressive cases of prostate cancer in those countries where the use of this tool has declined. CONCLUSIONS: We present new data about the current role of PSA in the management of patients treated for BPH and/or prostate cancer that should be implemented into routine clinical practice, with special emphasis on the relevant role of this biomarker in the screening and follow-up of prostate cancer, as well as in the progression of BPH in dutasteride treatment.

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

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.

Análisis de cuestionario de salud y desarrollo de cuestionario de satisfacción en pacientes tratados con litotricia extracorpórea por ondas de choque (SATISLIT) / Health questionnaire analysis and development of satisfaction questionnaire for patients treated with extracorporeal shock wave lithotripsy (SATISLIT)

INTRODUCCIÓN: Debido a la ausencia de instrumentos específicos para estudiar la esfera psicosocial de los pacientes que reciben litotricia extracorpórea por ondas de choque (LEOC), el objetivo es desarrollar un cuestionario de satisfacción respecto al tratamiento recibido con LEOC a partir de un cuestionario de salud ya diseñado y validado previamente. MATERIAL Y MÉTODOS: El diseño del cuestionario de satisfacción se realizó en 5 fases a partir de una escala de salud en pacientes tratados con LEOC (ESPTL) ya validada previamente, utilizando una muestra total de 135 pacientes tratados en nuestro centro a los que se entrevistó por vía telefónica. En la fase 1 se realizó análisis descriptivo de la serie y de las puntuaciones de los 8 ítems de ESPTL. En la fase 2 se compararon las puntuaciones de ESPTL según sexo con U-Mann Whitney, estudiando la correlación con la edad mediante Rho de Spearman en la fase 3. En la fase 3 se compararon las puntuaciones de los factores de ESPTL según el sexo y se analizó la correlación con la edad al igual que en las fases 2 y 3 con la puntuación global. En la fase 5 se obtuvo la subescala de satisfacción-SATISLIT- y se realizó análisis descriptivo, comparación según sexo, correlación con la edad y modelo de regresión lineal con respecto a ESPTL. RESULTADOS: Ciento treinta y cinco pacientes, 85 (63%) hombres, 50 (37%) mujeres. Mediana (mínimo-máximo) de edad 56 (27-79) y puntuación ESPTL 31 (8-39). Diferencias en puntuación global ESPTL entre hombres y mujeres (p < 0,001), así como en los ítems 1 (p = 0,029), 3 (p = 0,002), 6 (p = 0,006), 7 (p = 0,005) y 8 (p = 0,025). Correlación no significativa de ESPTL con la edad. Significativa en ítems 2, 4, 5 y 8 pero correlación muy débil (< 0,2). Cuatrofactores con 2 ítems cada uno, con diferencias estadísticamente significativas según sexo en F2 (p = 0,001), F3 (p = 0,007) y F4 (p = 0,001). Correlación significativa con la edad únicamente en F1 y F3 pero muy débil (< 0,2). Mediana (mínimo-máximo) SATISLIT 18 (4-20). Diferencias estadísticamente significativas según sexo (p = 0,001). Correlación no significativa con la edad (p = 0,836). Regresión lineal de SATISLIT con respecto a ESPTL significativa (p < 0,001). CONCLUSIONES: El trabajo realizado a partir de un cuestionario validado de salud ha proporcionado un nuevo instrumento de evaluación de la satisfacción tras tratamiento con LEOC llamado SATISLIT. Serán necesarios futuros estudios de validación externa y validación temporal para contrastar su verdadera utilidad clínica

INTRODUCTION: Due to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. MATERIAL AND METHODS: The design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients' sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. RESULTS: 135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39). Differences in global ESPTL score between men and women (p < .001), as well as in items 1 (p =.029), 3 (p = .002), 6 (p = .006), 7 (p = .005) and 8 (p = .025). Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (< 0.2).4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p = .001), F3 (p =.007) and F4 (p = .001). Significant correlation with age only in F1 and F3, but very weak (< 0.2). Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients' sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p < .001). CONCLUSIONS: Based on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients' satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness

Health questionnaire analysis and development of satisfaction questionnaire for patients treated with extracorporeal shock wave lithotripsy (SATISLIT). / Análisis de cuestionario de salud y desarrollo de cuestionario de satisfacción en pacientes tratados con litotricia extracorpórea por ondas de choque (SATISLIT).

INTRODUCTION: Due to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. MATERIAL AND METHODS: The design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients' sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. RESULTS: 135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39). Differences in global ESPTL score between men and women (p <.001), as well as in items 1 (p =.029), 3 (p =.002), 6 (p =.006), 7 (p =.005) and 8 (p =.025). Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (<0.2). 4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p =.001), F3 (p =.007) and F4 (p =.001). Significant correlation with age only in F1 and F3, but very weak (<0.2). Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients' sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p <.001). CONCLUSIONS: Based on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients' satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness.

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).

Diagnóstico y tratamiento del cáncer de prostata clínicamente localizado. Adherencia a las guías clínicas en un estudio poblacional nacional - GESCAP / Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group

Objetivos: Evaluar la adherencia a las guías de la Asociación Europea de Urología (EAU) en el manejo del cáncer de próstata (CaP) en España. Pacientes y métodos: Estudio epidemiológico poblacional que incluyó una muestra representativa a nivel nacional formada por 3.918 pacientes con diagnóstico nuevo y confirmación histopatológica durante el año 2010; de estos pacientes, al 95% se les realizó un seguimiento mínimo de un año. Se registró el diagnóstico junto con las variables relacionadas con el tratamiento (para el CaP localizado de riesgo bajo, intermedio, alto o localmente avanzado, según la estratificación de riesgo de D’Amico). Las diferencias entre los grupos se evaluaron mediante pruebas de Chi-cuadrado y Kruskal-Wallis. Resultados: La media (DE) de la edad de los pacientes con CaP fue de 68,48 (8,18) años. En relación con los procedimientos diagnósticos, en el 64,56% de los pacientes se disponía de 8-12 cilindros en la primera biopsia y se realizó biopsia al 46,5% de los pacientes mayores de 75 años con PSA < 10ng/ml. Se utilizó tomografía computarizada o gammagrafía ósea para determinar la extensión tumoral en el 60,09% de los casos de alto riesgo; estas técnicas se aplicaron diferencialmente en función de la edad de los pacientes; 3.293 pacientes (84,05%) recibieron tratamiento para el CaP localizado. Se realizó prostatectomía radical a 1.277 pacientes; de ellos, 206 fueron también sometidos a linfadenectomía, siendo el 4,64% de los pacientes de bajo riesgo, el 22,81% de riesgo intermedio y el 36,00% de alto riesgo. El 86,08% de los 1.082 pacientes que recibieron radioterapia fueron tratados con 3D o RTIM y el 35,77% recibieron una dosis ≥ 75Gy; 419 pacientes fueron tratados con braquiterapia (BT), el 54,81% fueron pacientes de bajo riesgo, el 22,84% de riesgo intermedio y el 12,98% de alto riesgo. La terapia hormonal (TH, n = 521) se utilizó como monoterapia en el 9,46% de los pacientes de bajo riesgo y en el 17,92% de los pacientes de riesgo intermedio. Además, la TH se combinó con RT en el 14,34% de los pacientes con bajo riesgo y en el 58,26% con alto riesgo; el 67,19% de los pacientes de riesgo intermedio con RT y/o BT recibieron TH neoadyuvante/concomitante/adyuvante. Por último, el 83,75% de los pacientes de alto riesgo que recibieron RT y/o BT también recibieron TH. Conclusiones: Aunque las guías EAU para el manejo del CaP están disponibles en Europa, la adherencia a sus recomendaciones es baja; las mayores discrepancias se refieren a la necesidad de las biopsias de próstata y a los métodos diagnósticos. Una mayor información y programas educacionales podrían mejorar la adherencia a las guías y reducir la variabilidad en la práctica diaria. (Controlled-trials.com: ISRCTN19893319)

Objective: To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain. Patients and methods: Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D’Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests. Results: Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA < 10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients’ age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥ 75 Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n = 521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT. Conclusions: Although EAU guidelines for PCa management are easily available in Europe; the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319)

Cáncer de próstata resistente a la castración. Recomendaciones de consenso de la Asociación Española de Urología / Castrate resistant prostate cancer. Consensus recommendations of the Spanish Association of Urology

No disponible

Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group. / Diagnóstico y tratamiento del cáncer de prostata clínicamente localizado. Adherencia a las guías clínicas en un estudio poblacional nacional ­ GESCAP.

OBJECTIVE: To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain. PATIENTS AND METHODS: Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D'Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests. RESULTS: Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients' age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n=521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT. CONCLUSIONS: Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319).

Tendencias de tratamiento en el cáncer de próstata clínicamente localizado. Análisis poblacional a nivel nacional: grupo GESCAP / Treatment trends for clinically localised prostate cancer. National population analysis: GESCAP group

Objetivos: Describir las terapias establecidas para el cáncer de próstata (CaP) localizado en España y valorar el cumplimiento de las guías EAU 2010. Pacientes y métodos: Estudio epidemiológico, observacional, prospectivo y multicéntrico. De los 3.918 pacientes diagnosticados con CaP durante 2010, solo se incluyeron los pacientes con CaP localizado. Finalmente, se hizo el seguimiento durante un periodo mínimo de un año a partir del diagnóstico a 3.713 pacientes (94,77%). Los grupos de tratamiento evaluados fueron: prostatectomía radical, radioterapia, terapia hormonal, braquiterapia, vigilancia activa u observación y tratamiento local experimental (crioterapia u otro tratamiento). Se estudió el cumplimiento de las recomendaciones de las guías EAU describiendo los grupos de tratamiento según los criterios de estratificación de riesgo de D’Amico (localizado [bajo riesgo, riesgo intermedio y alto riesgo] y localmente avanzado), edad, PSA y puntuación Gleason. Resultados: Considerando los criterios D’Amico, se incluyó a 3.641 (92,93%) pacientes. Según las recomendaciones EAU: 1) se hizo prostatectomía radical al 68,87% de los pacientes de riesgo bajo-intermedio de ≤ 65 años; 2) se administró radioterapia y terapia hormonal al 34,51% de los pacientes con riesgo alto-enfermedad localmente avanzada > 65 años; 3) se trató solo con terapia hormonal al 30,36% de los pacientes con riesgo alto-enfermedad localmente avanzada; 4) recibieron solo braquiterapia el 15,20% de los pacientes con riesgo bajo; 5) se eligió la vigilancia activa u observación en el 2,44% de los pacientes ≤ 65 años y en el 10,63% de los pacientes de riesgo bajo-intermedio > 65 años. Por último, el 86,5% de los pacientes de bajo riesgo recibió un único tratamiento y el 43,62% de los pacientes con riesgo alto-enfermedad localmente avanzada recibió tratamientos combinados. Conclusiones: Este es el primer estudio europeo de ámbito nacional que evalúa el manejo terapéutico para el CaP localizado en función del grupo de riesgo al que pertenece el paciente. La mayor parte de los pacientes jóvenes (≤ 65 años) con CaP localizado de riesgo bajo e intermedio fueron tratados con cirugía, lo cual se adapta a las recomendaciones de las guías de la EAU de 2010. En los pacientes con tumores localizados de alto riesgo y localmente avanzados se han empleado distintas combinaciones terapéuticas, poniendo de manifiesto la necesidad de un abordaje multidisciplinar (número de Controlled-trials.com ISRCTN19893319)

Objectives: To describe the established therapies for localised prostate cancer (PC) in Spain and to assess compliance with the 2010 UAE guidelines. Patients and methods: This was an epidemiological, observational, prospective and multicentre study. Of the 3,918 patients diagnosed with PC during 2010, only those patients with localised PC were included. Follow-up was ultimately conducted for a minimum of one year from the diagnosis for 3,713 patients (94.77%). The treatment groups assessed were as follows: radical prostatectomy, radiation therapy, hormone therapy, brachytherapy, active surveillance or observation and experimental local treatment (cryotherapy or other treatment). Compliance with the recommendations of the EAU guidelines was studied, describing the treatment groups according to D’Amico risk stratification criteria (localised [low, intermediate and high risk] and locally advanced), age, PSA and Gleason score. Results: By applying the D’Amico criteria, we included 3,641 (92.93%) patients. Based on the UAE recommendations: 1) 68.87% of the patients at low-intermediate risk aged ≤ 65 years underwent radical prostatectomy; 2) 34.51% of the patients > 65 years at high risk with locally advanced disease were administered radiation therapy and hormone therapy; 3) 30.36% of the patients at high risk with locally advanced disease were only treated with hormone therapy; 4) 15.20% of the patients at low risk were only treated with brachytherapy; 5) active surveillance or observation was selected for 2.44% of the patients aged ≤ 65 years and for 10.63% of the patients at low-intermediate risk who were > 65 years. Lastly, 86.5% of the patients at low risk underwent a single treatment, and 43.62% of the patients at high risk with locally advanced disease underwent combined treatments. Conclusions: This is the first national European study to evaluate the therapeutic management of localised PC based on the risk group to which the patient belonged. Most young patients (≤ 65 years) with low-intermediate risk localised PC were treated with surgery, which adheres to the recommendations of the 2010 UAE guidelines. Various therapeutic combinations have been employed for patients with high-risk, locally advanced localised tumours, revealing the need for a multidisciplinary approach (Controlled-trials.com number: ISRCTN19893319)

Treatment trends for clinically localised prostate cancer. National population analysis: GESCAP group. / Tendencias de tratamiento en el cáncer de próstata clínicamente localizado. Análisis poblacional a nivel nacional: grupo GESCAP.

OBJECTIVES: To describe the established therapies for localised prostate cancer (PC) in Spain and to assess compliance with the 2010 UAE guidelines. PATIENTS AND METHODS: This was an epidemiological, observational, prospective and multicentre study. Of the 3,918 patients diagnosed with PC during 2010, only those patients with localised PC were included. Follow-up was ultimately conducted for a minimum of one year from the diagnosis for 3,713 patients (94.77%). The treatment groups assessed were as follows: radical prostatectomy, radiation therapy, hormone therapy, brachytherapy, active surveillance or observation and experimental local treatment (cryotherapy or other treatment). Compliance with the recommendations of the EAU guidelines was studied, describing the treatment groups according to D'Amico risk stratification criteria (localised [low, intermediate and high risk] and locally advanced), age, PSA and Gleason score. RESULTS: By applying the D'Amico criteria, we included 3,641 (92.93%) patients. Based on the UAE recommendations: 1) 68.87% of the patients at low-intermediate risk aged≤65 years underwent radical prostatectomy; 2) 34.51% of the patients>65 years at high risk with locally advanced disease were administered radiation therapy and hormone therapy; 3) 30.36% of the patients at high risk with locally advanced disease were only treated with hormone therapy; 4) 15.20% of the patients at low risk were only treated with brachytherapy; 5) active surveillance or observation was selected for 2.44% of the patients aged≤65 years and for 10.63% of the patients at low-intermediate risk who were>65 years. Lastly, 86.5% of the patients at low risk underwent a single treatment, and 43.62% of the patients at high risk with locally advanced disease underwent combined treatments. CONCLUSIONS: This is the first national European study to evaluate the therapeutic management of localised PC based on the risk group to which the patient belonged. Most young patients (≤65 years) with low-intermediate risk localised PC were treated with surgery, which adheres to the recommendations of the 2010 UAE guidelines. Various therapeutic combinations have been employed for patients with high-risk, locally advanced localised tumours, revealing the need for a multidisciplinary approach (Controlled-trials.com number: ISRCTN19893319).

Análisis comparativo de la incidencia de cáncer de vejiga en las comunidades de Andalucía, Cataluña y Comunidad de Madrid en el año 2011 / Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011

Objetivos: Estimar la incidencia del cáncer de vejiga (CAV) en las comunidades autónomas que incluyeron mayor número de casos en el registro nacional hospitalario de CAV (Andalucía, Cataluña y Comunidad de Madrid) y describir las diferencias y similitudes clínicas, patológicas y diagnósticas del CAV en estas regiones. Material y métodos: Estudio observacional epidemiológico realizado en el año 2011 en 12 hospitales públicos con área de población de referencia según el Sistema Nacional de Salud. Se recogieron variables sociodemográficas y clínicas de nuevos casos y recidivas con confirmación histopatológica de CAV. La tasa bruta de incidencia se calculó mediante el número de casos diagnosticados en todos los centros participantes respecto al total agregado de población adscrita de cada uno de ellos. Las tasas brutas por edad y sexo se obtuvieron ponderando la población adscrita con la distribución por edad y sexo del Instituto Nacional de Estadística (INE) 2011. Resultados: Las 3 comunidades autónomas registraron el 51% de los 4.285 casos incluidos en el registro nacional, correspondiendo el 42,8% de estos a recidivas. La tasa de incidencia bruta anual para los nuevos episodios fue de 22,6 (IC 95%: 20,7; 24,6) en Andalucía, de 23,5 (IC 95%: 20,9; 26,0) en Cataluña y de 22,0 (IC 95%: 19,9; 24,1) en la Comunidad de Madrid. Conclusiones: Salvo la mayor proporción de fumadores y el menor grado tumoral de las lesiones en Andalucía, las 3 comunidades autónomas estudiadas presentan similitudes en cuanto a características clínicas, comorbilidades, sintomatología de los pacientes y procesos diagnósticos del CAV

Objectives: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. Material and methods: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. Results: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. Conclusions: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC

Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011.

OBJECTIVES: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. MATERIAL AND METHODS: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. RESULTS: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. CONCLUSIONS: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC.

Salud ósea en pacientes con cáncer de próstata / Bone health in patients with prostate cancer

Contexto: La salud ósea se ve comprometida en los pacientes con cáncer de próstata por la avanzada edad media al diagnóstico, los tratamientos de supresión androgénica y el desarrollo de metástasis óseas. Revisamos la literatura con la finalidad de actualizar el estado del arte sobre su incidencia, prevención y manejo. Adquisición de la evidencia: Realizamos una revisión de la literatura sobre afectación ósea en los pacientes con cáncer de próstata en diferentes contextos clínicos. Síntesis de la evidencia: Los pacientes diagnosticados de cáncer de próstata experimentan una disminución de la densidad mineral ósea mayor que varones de la misma edad antes de iniciar el tratamiento. La supresión androgénica provoca una pérdida de masa ósea más intensa durante el primer año de tratamiento, y parece ralentizarse a partir de entonces, persistiendo a largo plazo. Conocer del punto de partida y de la dinámica de la pérdida de masa ósea es importante para prevenir su progresión. Los eventos relacionados con el esqueleto ejercen gran impacto en la calidad de vida de los pacientes, y tanto el denosumab como el ácido zoledrónico han demostrado ser eficaces en su reducción. Conclusiones: La prevención y el manejo de la afectación ósea en pacientes con cáncer de próstata es determinante para su calidad de vida y exige un abordaje individualizado. Antes de iniciar una supresión androgénica prolongada debe valorarse la situación de riesgo basal del hueso para adoptar las medidas protectoras apropiadas. En aquellos con metástasis debe considerarse precozmente el inicio de terapias que disminuyan el riesgo de eventos óseo

Context: In patients with prostate cancer, bone health is compromised by advanced age at diagnosis, androgen suppression treatments and the developmentofbone metastases. In this paper the medical literature is reviewed in order to update the state of the art on their incidence, prevention and management. Evidence acquisition: A literature review about bone involvement in patients with prostate cancer in different clinical settings is performed. Synthesis of the evidence: Decreased bone mineral density is higher in patients diagnosed of prostate cancer before starting treatment than in healthy men with the same age. During the first year of treatment, a severe loss bone density is reported due to androgen suppression therapy. From then on, loss bone density seems to slow down, persisting at long-term. It is important to know the starting point and the dynamics of loss bone in order to prevent its progression. The skeletal events have an important impact on quality of life in patients with prostate cancer. Both Denosumab and Zoledronic Acid have proven effective in reducing loss bone. Conclusions: The prevention and management of bone involvement in patients with prostate cancer is critical to quality of life in these patients and requires an individualized approach. Before starting a prolonged androgen deprivation, baseline risk of fracture should be evaluated in order to adopt the proper protective measures. In patients with metastases, early treatments reducing the risk of bone events should be taken into account

Bone health in patients with prostate cancer.

CONTEXT: In patients with prostate cancer, bone health is compromised by advanced age at diagnosis, androgen suppression treatments and the developmentofbone metastases. In this paper the medical literature is reviewed in order to update the state of the art on their incidence, prevention and management. EVIDENCE ACQUISITION: A literature review about bone involvement in patients with prostate cancer in different clinical settings is performed. SYNTHESIS OF THE EVIDENCE: Decreased bone mineral density is higher in patients diagnosed of prostate cancer before starting treatment than in healthy men with the same age. During the first year of treatment, a severe loss bone density is reported due to androgen suppression therapy. From then on, loss bone density seems to slow down, persisting at long-term. It is important to know the starting point and the dynamics of loss bone in order to prevent its progression. The skeletal events have an important impact on quality of life in patients with prostate cancer. Both Denosumab and Zoledronic Acid have proven effective in reducing loss bone. CONCLUSIONS: The prevention and management of bone involvement in patients with prostate cancer is critical to quality of life in these patients and requires an individualized approach. Before starting a prolonged androgen deprivation, baseline risk of fracture should be evaluated in order to adopt the proper protective measures. In patients with metastases, early treatments reducing the risk of bone events should be taken into account.