The role of negative magnetic resonance imaging: can we safely avoid biopsy in P.I.-R.A.D.S. 2 as in P.I.-R.A.D.S. 1?

Purpose: It remains unclear whether patients with prostate cancer suspicion and negative magnetic resonance imaging (M.R.I.) can safely obviate biopsy. The purpose of this study was to assess the clinical negative predictive value (N.P.V.) of M.R.I. in excluding prostate cancer. The secondary end-point was to compare N.P.V. to detect significant prostate cancer of M.R.I.The secondary end-point was to compare N.P.V. to detect significant prostate cancer in M.R.I. classified as P.I.-R.A.D.S.1 and as P.I.-R.A.D.S.2 Methods: From December 2012 to January 2017, 1128 M.R.I.s were performed consecutively due to prostate cancer clinical suspicion. The absence of suspicious and presence of low-risk areas were considered as negative M.R.I., P.I.-R.A.D.S.1 and 2. Biopsy results were compared according to P.I.-R.A.D.S. classification. The clinically significant disease was defined as International Society of Urological Pathology group higher than 1. Results: Two hundred and twenty-two (20%) M.R.I.s didn't highlight targetable imaging suspicious areas, which were recorded as negative tests: 130 (59%) P.I.-R.A.D.S.1 and 92 (41%) P.I.-R.A.D.S.2. Detection of clinically significant prostate cancer in at least one biopsy core was higher in the P.I.-R.A.D.S.2 group, 9% (8/92) vs 3% (4/130), p = 0.047. The N.P.V. in biopsy-naïve men and P.I.-R.A.D.S.1 was 95% for significant disease, while in patients subjected to repeated biopsies and P.I.-R.A.D.S.1, the N.P.V. found was 99%. Those rates differ from the P.I.-R.A.D.S.2 group: N.P.V. in biopsy-naïve patients was 84%, and 95% in repeated biopsy. Conclusions: P.I.-R.A.D.S.2 shouldn't be considered as a negative M.R.I. A biopsy cannot be routinely omitted in biopsy-naïve men with clinical suspicion of cancer and a low-suspicious area in M.R.I., giving the possibility of missing clinically significant tumors.

Serum Testosterone Levels in Prostate Cancer Patients Undergoing Luteinizing Hormone-Releasing Hormone Agonist Therapy.

BACKGROUND: Serum testosterone measurement is recommended to assess the efficacy of androgen deprivation therapy (ADT) and to diagnose castration resistance in patients with prostate cancer (PCa). Currently, the accepted castrate level of serum testosterone is 50 ng/dL. Liquid chromatography and tandem mass spectrometry (LC MSMS) is the appropriate method to measure testosterone, especially at low levels. However, worldwide, chemiluminescent assays (CLIAs) are used in clinical laboratories, despite their lack of accuracy and reproducibility, because they are automatable, fast, sensitive, and inexpensive. MATERIALS AND METHODS: We compared serum testosterone levels measured using LC MSMS and CLIAs in 126 patients with PCa undergoing luteinizing hormone-releasing hormone (LHRH) agonist therapy. RESULTS: The median serum testosterone level was 14.0 ng/dL (range, 2.0-67.0 ng/dL) with LC MSMS and 31.9 ng/dL (range, 10.0-91.6 ng/dL) with CLIA (P < .001). The serum testosterone levels, measured using LC MSMS, were < 20 ng/dL in 83 patients (65.9%), 20 to 50 ng/dL in 40 (31.7%), and > 50 ng/dL in 3 patients (2.4%). These ranges were found in 34 (27%), 72 (57.1%), and 20 (15.9%) patients when testosterone was measured using CLIA (P < .001). The castrate level of serum testosterone using LC MSMS and CLIA was 39.8 ng/dL (95% confidence interval [CI], 37.1-43.4 ng/dL) and 66.5 ng/dL (95% CI, 62.3-71.2 ng/dL), respectively. CONCLUSION: We found that CLIA overestimated the testosterone levels in PCa patients undergoing LHRH agonist therapy. Thus, the castration level was incorrectly considered inadequate with CLIA in almost 15% of patients. The true castration level of serum testosterone using an appropriate method is < 50 ng/dL.

Hormonal response recovery after long-term androgen deprivation therapy in patients with prostate cancer.

OBJECTIVE: The aim of this study was to evaluate hormonal recovery after cessation of androgen deprivation therapy (ADT) in a group of elderly prostate cancer patients. MATERIALS AND METHODS: Forty patients with locally advanced or metastatic prostate cancer, with a mean age of 71.5 years [95% confidence interval (CI) 69.1-73.9], were treated with ADT for a mean duration of 74.6 months (95% CI 59.7-89.5 months). Mean follow-up time after ADT cessation was 36.5 months (95% CI 30.6-42.3 months). Serum testosterone and luteinizing hormone (LH) were determined at 6 month intervals after ADT cessation. RESULTS: After 18 months of follow-up, all patients had recovered normal LH levels, while 38% of patients still presented castration levels of testosterone (< 50 ng/dl). A multivariate analysis was performed to find factors related to testosterone recovery (testosterone >50 ng/dl). Neither age at start of ADT nor clinical stage reached statistical significance. Only time under ADT was correlated with testosterone recovery (p = .031). Kaplan-Meier curves were obtained. Mean time for testosterone recovery was 14.5 months (95% CI 6.5-22.6 months) in patients treated with ADT for less than 60 months compared to 29.3 months (95% CI 19.6-39.1 months) in patients treated with ADT for more than 60 months (log-rank p = .029). CONCLUSIONS: Age did not correlate with testosterone recovery in a group of elderly prostate cancer patients in whom ADT was stopped. Testosterone recovery after ADT cessation was significantly correlated with time under ADT treatment. Significant implications related to economic aspects of the dosage schedule may be considered.

Clinical Significance of Proliferative Inflammatory Atrophy in Negative Prostatic Biopsies.

PURPOSE: To analyze the association between prostatic proliferative inflammatory atrophy finding in negative prostate biopsies and future detection of prostate cancer (PCa) and its aggressiveness in men subjected to repeat biopsies, due to persistent suspicion of PCa. MATERIALS AND METHODS: Prospective and observational study of 474 men scheduled to repeated PBs. Assessment of PIA and its extension in the previous biopsy. PCa detection rate and tumor aggressiveness. Age, serum total PSA, free PSA, percent free PSA (%fPSA), digital rectal exam (DRE), prostate volume (PV), PSA density (PSAD), PSA kinetics (PSAV and PSADT) findings of PIA and HGPIN, and number of affected cores in previous PBs were included in the univariate and multivariate analysis. Aggressive tumors were considered when any Gleason pattern 4 was found. RESULTS: PCa was detected in 133 men (28.1%). Age, serum total PSA, %fPSA, PV, PSAD, PSAV, PSADT, and PIA finding were significantly associated to PCa detection. However, only age, OR: 1.06 (95%CI: 1.03-1.10), P < 0.01; DRE, OR: 1.76 (95%CI: 1.05-2.92), P = 0.03; %fPSA, OR: 0.96 (95%CI: 0.93-0.99), P = 0.03; PV, OR: 0.98 (95%CI: 0.97-0.99) and PIA finding, OR: 0.49 (95%CI: 0.29-0.83), P < 0.01, were independent predictors of PCa detection. PCa was found in 18% of 159 men with previous PIA finding while in 33% of 315 men without previous PIA (P < 0.01). None of the studied parameters including PIA in the previous biopsy were related with subsequent PCa aggressiveness. CONCLUSIONS: PIA finding in negative biopsies correlates with a decreased frequency of detecting PCa in men with persistent suspicion of PCa. The aggressiveness of future detected tumors was not associated with previous PIA finding. Prostate 76:1501-1506, 2016. © 2016 Wiley Periodicals, Inc.

Clinical significance of proliferative inflammatory atrophy finding in prostatic biopsies.

BACKGROUND: Proliferative inflammatory atrophy (PIA) has been involved in prostatic carcinogenesis. However, little is known about the clinical significance of a PIA finding in prostatic biopsies (PBs). The aim of this study is to determine the incidence of prostate inflammatory atrophy (PIA) in prostate biopsies (PBs), its association to high-grade prostatic intraepithelial neoplasia (HGPIN), prostate cancer (PCa), and tumor aggressiveness. METHODS: Prospective and observational study of PIA lesion in 528 extended PBs and 200 radical prostatectomy specimens (RPS). OUTCOME MEASUREMENTS: PIA, HGPIN, PCa incidence, Gleason score, clinical and pathologic tumor stage and insignificant tumor rate. Univariate and multivariate analysis. RESULTS: Overall incidence of PIA and HGPIN was 30.3% and 54%. In RPS, the incidence was 30.5% and 72%, respectively. No significant association was found between PIA and HGPIN. Overall PCa detection rate in PBs was 38.1%. PCa was found in 27.5% PBs with PIA and 42.7% of those without PIA, P < 0.001. In contrast, PCa was detected in 50.9% of PBs with HGPIN and 23% of those without HGPIN, P = 0.001. Multivariate analysis revealed that PIA decreased the risk of PCa, OR:0.59 (95%CI:0.37-0.95), P = 0.029, while HGPIN increased OR:3.16 (95%CI:2.04-4.90), P = 0.001. PIA was not related to Gleason grade and clinical stage, however it was associated to an insignificant tumors increase, OR:3.08 (95%CI:1.09-8.7), P = 0.033. The information in RPS suggests that PIA is associated with less aggressive tumors and a higher probability of insignificant tumors. CONCLUSIONS: PIA is present in one third of PBs, HGPIN in one half of them, and no association exists between both lesions. Contrary to HGPIN, PIA finding is associated to lower risk of PCa detection. Tumors accompanying PIA seem to be less aggressive and have a greater probability of being insignificant.

Identification of somatic gene mutations in penile squamous cell carcinoma.

There is a lack of studies on somatic gene mutations and cell signaling driving penile carcinogenesis. Our objective was to analyze somatic mutations in genes downstream of EGFR in penile squamous cell carcinomas, especially the mTOR and RAS/MAPK pathways. We retrospectively analyzed somatic mutations in 10 in situ and 65 invasive penile squamous cell carcinomas by using Sequenom's Mass Spectrometry iPlex Technology and Oncocarta v1.0 Panel. The DNA was extracted from FFPE blocks and we identified somatic missense mutations in three in situ tumors and in 19 invasive tumors, mostly in PIK3CA, KRAS, HRAS, NRAS, and PDGFA genes. Somatic mutations in the PIK3CA gene or RAS family genes were neither associated with tumor grade, stage or outcome, and were equally often identified in hrHPV positive and in hrHPV negative tumors that showed no p53 expression. Mutations in PIK3CA, KRAS, and HRAS are frequent in penile squamous cell carcinoma and likely play a role in the development of p53-negative tumors. Although the presence of these mutations does not seem to correlate with tumoral behavior or outcome, they could be biomarkers of treatment failure with anti-EGFR mAb in patients with penile squamous cell carcinoma.

[Current role of protatic specific antigen (PSA) and its by-products in the diagnosis of prostate cancer]. / Papel actual del antígeno prostático específico (PSA) y sus derivados en el diagnóstico del cáncer de próstata.

Incorporation of prostatic specific antigen (PSA) to clinical practice was a revolution in the diagnosis and modified the epidemiology of prostate cancer (PCa). Although it lacks of many characteristics of an ideal tumor marker, it is the marker most used for diagnosis and follow up of any kind of cancer. It represents the best clinical tool we have available today for screening and staging of PCa. On the contrary, its greatest limitation is the lack of tumor specificity. The use of PSA by-products and molecular isoforms tries to solve, at least partially, its limitations. Indeed, the use of FreePSA ratio (%fPSA) ad PSA density (PSAD) increase significantly the specificity of the diagnostic test and, the use of derivatives that evaluate time kinetics of PSA (PSA velocity (PSAV) and PSA doubling time (PSADT) represents a very useful tool for prognosis estimation during treatment and follow up of the disease. The greatest advance over the last years comes from the analysis of the predecessor isoform (-2) pPSA and the phi Index. Both markers have demonstrated to improve the sensitivity and specificity results obtained to date, resulting in a decrease of unnecessary biopsies. Probably, with the ongoing development of new markers for PCa , the role of PSA on disease diagnosis and staging would be modified in a few years.

Urinary biomarkers for the detection of prostate cancer in patients with high-grade prostatic intraepithelial neoplasia.

INTRODUCTION: High-grade prostatic intraepithelial neoplasia (HGPIN) is a recognized precursor stage of PCa. Men who present HGPIN in a first prostate biopsy face years of active surveillance including repeat biopsies. This study aimed to identify non-invasive prognostic biomarkers that differentiate early on between indolent HGPIN cases and those that will transform into actual PCa. METHODS: We measured the expression of 21 candidate mRNA biomarkers using quantitative PCR in urine sediment samples from a cohort of 90 patients with initial diagnosis of HGPIN and a posterior follow up of at least two years. Uni- and multivariate statistical analyses were applied to analyze the candidate biomarkers and multiplex models using combinations of these biomarkers. RESULTS: PSMA, PCA3, PSGR, GOLM, KLK3, CDH1, and SPINK1 behaved as predictors for PCa presence in repeat biopsies. Multiplex models outperformed (AUC = 0.81-0.86) the predictive power of single genes, including the FDA-approved PCA3 (AUC = 0.70). With a fixed sensitivity of 95%, the specificity of our multiplex models was of 41-58%, compared to the 30% of PCA3. The PPV of our models (30-38%) was also higher than the PPV of PCA3 (27%), suggesting that benign cases could be more accurately identified. Applying statistical models, we estimated that 33% to 47% of repeat biopsies could be prevented with a multiplex PCR model, representing an easy applicable and significant advantage over the current gold standard in urine sediment. DISCUSSION: Using multiplex RTqPCR-based models in urine sediment it is possible to improve the current diagnostic method of choice (PCA3) to differentiate between benign HGPIN and PCa cases.

Papel actual del antígeno prostático específico (PSA) y sus derivados en el diagnóstico del cáncer de próstata / Current role of protatic specific antigen (PSA) and its by-products in the diagnosis of prostate cancer

La incorporación del antígeno prostático específico (PSA) a la clínica revolucionó el diagnóstico y modificó la epidemiología del cáncer de próstata (CaP). Aunque le faltan muchas de las características de un marcador tumoral ideal, es el marcador más usado para el diagnóstico y seguimiento de cualquier tipo cáncer. Representa la mejor herramienta clínica de las que disponemos en la actualidad para el cribado y estadificación del CaP. Por contra, la mayor limitación que presenta el PSA es su falta de especificidad tumoral. El empleo de los derivados y de las isoformas moleculares del PSA trata de solventar, al menos en parte, sus limitaciones. De hecho, la utilización del cociente del PSA libre (%fPSA) y de la densidad del PSA (PSAD) aumenta de forma significativa la especificidad del test en el diagnóstico y, el uso de los derivados que evalúan la cinética temporal del PSA (velocidad del PSA (PSAV) y tiempo de duplicación del PSA (PSADT)) representan herramientas de gran utilidad para estimar el pronóstico durante el tratamiento y seguimiento de la enfermedad. El mayor avance que se ha producido en los últimos años ha venido del análisis de la isoforma precursora (-2)pPSA y del índice phi. Ambos marcadores han demostrado mejorar los resultados de sensibilidad y especificidad obtenidos hasta ahora, ocasionando una disminución de biopsias innecesarias. Es probable que con el desarrollo de nuevos marcadores para el CaP que está habiendo, en pocos años se modifique el papel que el PSA tiene en el diagnóstico y en la estadificación de la enfermedad

Incorporation of prostatic specific antigen (PSA) to clinical practice was a revolution in the diagnosis and modified the epidemiology of prostate cancer (PCa). Although it lacks of many characteristics of an ideal tumor marker, it is the marker most used for diagnosis and follow up of any kind of cancer. It represents the best clinical tool we have available today for screening and staging of PCa. On the contrary, its greatest limitation is the lack of tumor specificity. The use of PSA by-products and molecular isoforms tries to solve, at least partially, its limitations. Indeed, the use of FreePSA ratio (%fPSA) ad PSA density (PSAD) increase significantly the specificity of the diagnostic test and, the use of derivatives that evaluate time kinetics of PSA (PSA velocity (PSAV) and PSA doubling time (PSADT)) represents a very useful tool for prognosis estimation during treatment and follow up of the disease. The greatest advance over the last years comes from the analysis of the predecessor isoform (-2) pPSA and the phi Index. Both markers have demonstrated to improve the sensitivity and specificity results obtained to date, resulting in a decrease of unnecessary biopsies. Probably, with the ongoing development of new markers for PCa , the role of PSA on disease diagnosis and staging would be modified in a few years

Effects of holmium laser enucleation of the prostate on sexual function.

OBJECTIVE: To evaluate the effects of holmium laser enucleation of the prostate (HoLEP) on sexual function. METHODS: A retrospective analysis of 202 sexually active patients who underwent HoLEP was performed. Patients were assessed at baseline and 3 and 12 months post-HoLEP. Evaluations included uroflowmetry and symptom questionnaires (five-item version of the International Index of Erectile Function [IIEF-5], ICIQ-male sexual matters associated with LUTS [ICIQ-MLUTSsex], American Urological Association symptom score [AUA-SS], and single-question quality of life [QoL] score). Nonparametric, Fisher's exact, and chi-squared tests were used to assess changes from baseline and to identify risk factors, if any, associated with deterioration of sexual function after surgery. RESULTS: No significant differences were found between the preoperative and postoperative scores on the questionnaires that evaluated erection quality. However, 6.9% and 12.4% of the patients reported an increase or a reduction, respectively, of greater than five points in total IIEF-5 score. The reduction in IIEF-5 score was statistically significant only in the subgroup of patients without preoperative erectile dysfunction (ED). No preoperative characteristics and no parameters related to the surgery or postoperative outcome were significantly associated with the impairment of erection quality after surgery. In fact, neither capsular perforation nor the total laser energy used during the procedure affected erections. Loss of antegrade ejaculation was found in 70.3% of patients, while 21% reported a reduction in semen quantity. However, concern regarding ED or ejaculatory dysfunctions decreased with surgery. CONCLUSIONS: Although erectile function was not altered in the vast majority of patients after HoLEP, patients without preoperative ED displayed a relatively small, but still significant, negative effect on erections. The overwhelming majority of patients suffered from retrograde ejaculation after surgery.

Role of serum cholesterol and statin use in the risk of prostate cancer detection and tumor aggressiveness.

The aim of this study was to analyze the relationship between statin use along with serum cholesterol levels and prostate cancer (PCa) detection and aggressiveness. Statin users of three years or more and serum cholesterol levels (SC) were assessed in 2408 men scheduled for prostate biopsy. SC was classified as normal (NSC: <200 mg/dL) or high (HSC: >200 mg/dL). High-grade PCa (HGPCa) was considered if the Gleason score was greater than 7. Statin users comprised 30.9% of those studied. The PCa detection rate was 31.2% of men on statins and 37% of non-statin users (p<0.006). The PCa detection rate was 26.3% in men with NSC and 40.6% in those with HSC (p<0.001). In the subset of NSC men, the PCa rate was 26.5% for statin users and 26.2% for non-users (p=0.939), while in men with HSC, the PCa rate was 36.4% for statin users and 42.0% for non-statin users (p=0.063). The HGPCa rate was 41.8% for statin users and 32.5% for non-users (p=0.012). NSC men had a 53.8% rate of HGPCa, while the rate was only 27.6% in HSC men (p<0.001). NSC men on statins had an HGPCa rate of 70.2%, while non-statin users had a rate of 41.2% (p<0.001). The HGPCa rate for HSC men on statins was 18.8%, while the rate was 30.0% (p=0.011) for non-users. Logistic regression analysis suggested that serum cholesterol levels could serve as an independent predictor of PCa risk, OR 1.87 (95% CI 1.56-2.24) and HGPCa risk, OR 0.31 (95% CI 0.23-0.44), while statin usage could not. Statin treatment may prevent PCa detection through serum cholesterol-mediated mechanisms. A disturbing increase in the HGPCa rate was observed in statin users who normalized their serum cholesterol.

Metabolic syndrome increases the risk of aggressive prostate cancer detection.

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Metabolic syndrome can identify patients at high risk of cardiovascular disease. The prevalence of metabolic syndrome is increasing worldwide and is associated with increased age, obesity and hypogonadism. The association between metabolic syndrome and prostate cancer development has not been studied comprehensively, and published studies report divergent results. This study indicates that tumours detected in men with metabolic syndrome are more aggressive than those detected in men without this condition. OBJECTIVE: To further examine the association between metabolic syndrome (MS), prostate cancer (PC) detection risk and tumour aggressiveness. PATIENTS AND METHODS: From 2006 to 2010, 2408 men not receiving 5α-reductase inhibitors were scheduled for prostatic biopsy due to PSA above 4 ng/mL and/or abnormal digital rectal examination. MS was evaluated according to the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III definition. Tumour aggressiveness was evaluated through biopsy Gleason score, clinical stage and risk of biochemical recurrence after primary treatment. RESULTS: The rates of PC detection were 34.5% and 36.4% respectively in men with and without MS, P = 0.185. High grade PC rates (Gleason score 8-10) were 35.9% and 23.9% respectively, P < 0.001. The advanced disease rates (cT3-4 N0-1 M0-1) were 17% and 12.7% respectively, P = 0.841. The high risk PC rates (cT2c-4 or Gleason score 8-10 or PSA > 20) were 38.5% and 33.0% respectively, P = 0.581. Multivariate analysis confirmed that MS was not associated with the risk of PC detection but it was associated with an increased risk of high grade tumours (odds ratio 1.75, 95% CI 1.26-2.41), P < 0.001. CONCLUSION: MS seems not be associated with an increased risk of PC detection but it is associated with an increased risk of more aggressive tumours.

Dhat syndrome, an emergent condition within urology in Spain.

BACKGROUND: Dhat syndrome (DS) consists of vague somatic symptoms and at times sexual dysfunction which the patient falsely attributes to involuntary emissions of semen outside of sexual relations. OBJECTIVE: Describe and analyse the occurrences of DS in patients attending the clinic and clarify the existence of this condition within the Spanish Urological service. MATERIALS AND METHODS: Patients reporting semen loss in urine or involuntarily outside of sexual relations were studied during a period from May 2006 to December 2007. Variables of age, nationality, marital status, family situation, medical history, reasons for the consultation, physical condition and additional tests were studied. All treatments and its effectiveness were also recorded. RESULTS: DS affected predominantly southern Asian continent citizens (n = 32). The average age was 35.44. Seventeen patients reported semen loss during urination; 20 at the end of urination; 11 spontaneously; 5 while sleeping; 4 during defecation; 1 while showering; 1 while eating meat; and 3 produced by noticing stained clothing. In 28 cases, the supposed loss of semen was linked to sex-related symptoms. All examinations and tests ruled out the existence of actual loss of semen. CONCLUSIONS: In urology consultations, we have been witnessing the unusual appearance of DS, a condition known by psychologists and psychiatrists and practically unheard of by urologists. A previously unknown condition in Spain, immigration from Asia, is causing the appearance of this syndrome. Its rapid identification will prevent patients from paying costly and unnecessary tests and provide alternative therapies, within a multidisciplinary approach involving psychologists and psychiatrists.

MYC copy number gains are associated with poor outcome in penile squamous cell carcinoma.

PURPOSE: We determined MYC gene numerical aberrations and protein expression at different stages of penile squamous cell carcinoma carcinogenesis. We correlated these findings with clinicopathological parameters and HPV infection. MATERIALS AND METHODS: We evaluated 79 cases of penile squamous cell carcinoma, including 11 in situ and 68 invasive carcinomas. The MYC cytogenetic profile was evaluated by fluorescence in situ hybridization. HPV was detected by polymerase chain reaction amplification. RESULTS: MYC gains were identified in 4 of 11 in situ carcinomas (36%) and 50 of 68 invasive penile squamous cell carcinomas (73%). A significant association between MYC gains, and tumor progression and poor outcome was demonstrated (p <0.05). HPV DNA was detected in 32 of 79 penile squamous cell carcinomas (39%). High risk type 16 was the most prevalent type. MYC numerical aberrations did not correlate with HPV status. A significant association between HPV and MYC protein over expression was noted. In HPV negative cases MYC gains correlated with MYC over expression. CONCLUSIONS: MYC gains progressively increased during penile squamous cell carcinoma progression from in situ samples to metastases. MYC gains were an independent factor for poor prognosis. These findings were independent of HPV infection. MYC expression was increased in samples with HPV infection, probably reflecting direct activation of MYC.

[Usefulness of prostatic specific antigen (PSA) for diagnosis and staging of patients with prostate cancer]. / Utilidad del antígeno prostático específico (PSA) para el diagnóstico y estadificación de los pacientes con cáncer de próstata.

The incorporation of prostatic specific antigen (PSA) to clinical practice revolutionized diagnosis and modified the epidemiology of prostate cancer(PCa). Although it lacks of many of the characteristics of an ideal tumor marker, it is the marker most used for diagnosis and follow up of any type of cancer. It represents the best clinical tool we currently have available for screening and staging of PCa. On the contrary, the greatest limitation PSA presents is its lack of tumor specificity. The use of PSA molecular derivatives and isoforms tries to solve, at least in part, its limitations. As a matter of fact, the use of % free PSA and PSAD significantly increases the test specificity for diagnosis and, the use of derivatives evaluating PSA temporary kinetics (PSAV and PSADT) represent very useful tools to estimate líquiprognosis during disease treatment and follow up. With the ongoing development of new markers for PCa, It is likely the role of PSA in diagnosis and staging of the disease will be modified.

Utilidad del antígeno prostático específico (PSA) para el diagnóstico y estadificación de los pacientes con cáncer de próstata / No disponible

La incorporación del antígeno prostático específico (PSA) a la clínica revolucionó el diagnóstico y modificó la epidemiología del cáncer de próstata (CaP). Aunque le faltan muchas de las características de un marcador tumoral ideal, es el marcador más usado para el diagnóstico y seguimiento de cualquier tipo de cáncer. Representa la mejor herramienta clínica de las que disponemos en la actualidad para el cribado y estadificación del CaP. Por contra, la mayor limitación que presenta el PSA es su falta de especificidad tumoral. El empleo de los derivados y de las isoformas moleculares del PSA trata de solventar, al menos en parte, sus limitaciones. De hecho, la utilización del %fPSA y de la PSAD aumenta de forma significativa la especificidad del test en el diagnóstico y, el uso de los derivados que evalúan la cinética temporal del PSA (PSAV y PSADT) representan herramientas de gran utilidad para estimar el pronóstico durante el tratamiento y seguimiento de la enfermedad. Es probable que con el desarrollo de nuevos marcadores para el CaP que está habiendo, en pocos años se modifique el papel que el PSA tiene en el diagnóstico y en la estadificación de la enfermedad(AU)

The incorporation of prostatic specific antigen (PSA) to clinical practice revolutionized diagnosis and modified the epidemiology of prostate cancer (PCa). Although it lacks of many of the characteristics of an ideal tumor marker, it is the marker most used for diagnosis and follow up of any type of cancer. It represents the best clinical tool we currently have available for screening and staging of PCa. On the contrary, the greatest limitation PSA presents is its lack of tumor specificity. The use of PSA molecular derivatives and isoforms tries to solve, at least in part, its limitations. As a matter of fact, the use of % free PSA and PSAD significantly increases the test specificity for diagnosis and, the use of derivatives evaluating PSA temporary kinetics (PSAV and PSADT) represent very useful tools to estimate líquiprognosisduring disease treatment and follow up. With the ongoing development of new markers for PCa, It is likely the role of PSA in diagnosis and staging of the disease will be modified(AU)

A multicolor fluorescence in situ hybridization assay: A monitoring tool in the surveillance of patients with a history of non-muscle-invasive urothelial cell carcinoma: A prospective study.

BACKGROUND: Non-muscle-invasive urothelial cell carcinoma (NMIUCC) has a high tendency to recur and affected patients must be monitored regularly using invasive cystoscopies. The aim of the current study was to compare a multicolor fluorescence in situ hybridization (FISH) assay (UroVysion) with routine follow-up (cystoscopy and cytology) in the monitoring of patients with a previous history of NMIUCC. METHODS: An unselected cohort of patients under surveillance for a previous history of NMIUCC was prospectively studied. A total of 248 examinations in 223 patients were analyzed. Each exploration was comprised of cytological and FISH microscopic examination of voided urine samples and cystoscopy. The sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for tumor recurrence of all 3 techniques were determined. RESULTS: The sensitivities of FISH and cystoscopy were not found to be significantly different (92.9% and 82.1%, respectively). The specificities of FISH and cystoscopy were 92.7% and 89.7%, respectively. The PPV and NPV of FISH were 53.5% and 97.2%, respectively, whereas those of cystoscopy were 63.4% and 98.9%, respectively. No significant differences were found between these 2 tests. In contrast, the sensitivity and specificity of cytology were 14.3% and 99.5%, respectively. CONCLUSIONS: Given the lack of statistically significant differences with regard to FISH and cystoscopy results, the authors propose that FISH could be a useful monitoring tool in the surveillance of patients with a previous history of NMIUCC.

[Holmium laser enucleation of the prostatic adenoma]. / Enucleación del adenoma prostático mediante el láser de Holmio (HOLEP).

Holmium laser enucleation of the prostatic adenoma (HoLEP) represents an innovative surgical option for the treatment of bladder outlet obstruction caused by benign prostatic hypertrophy. The results of numerous randomized prospective studies and clinical case series have confirmed that HoLEP is a procedure that attains immediate bladder outlet obstruction release, that improvement of symptomatic and uroflowmetry parameters is maintained in the midterm and, it is associated with less morbidity than conventional surgery. On the other hand, the shortage of urologists with experience in this procedure, and its technical difficulty have limited its spread in our environment. In this article we describe in detail the technique we use in our center for the performance of HoLEP, emphasizing the modifications we have introduced with time to make the operation easier and to avoid complications.

Enucleación del adenoma prostático mediante el láser de holmio (HOLEP) / No disponible

La enucleación del adenoma prostático mediante el láser de holmio (HoLEP) representa una novedosa alternativa quirúrgica para el tratamiento de la obstrucción infravesical ocasionada por el crecimiento prostático benigno. Los resultados de numerosos estudios prospectivos aleatorizados y de series de casos clínicos han confirmado que HoLEP es un procedimiento que logra una desobstrucción infravesical inmediata, que la mejoría de los parámetros sintomáticos y flujométricos que consigue se mantiene a medio plazo y que se asocia a menor morbilidad que la cirugía convencional. Por contra, la escasez de urólogos con experiencia en el procedimiento y su dificultad técnica han limitado su difusión en nuestro medio. En el presente trabajo describimos detalladamente la técnica que empleamos en nuestro centro para la realización de HoLEP, haciendo hincapié en las modificaciones que hemos ido realizando con el tiempo para facilitar la cirugía y evitar las complicaciones(AU)

Holmium laser enucleation of the prostatic adenoma (HoLEP) represents an innovative surgical option for the treatment of bladder outlet obstruction caused by benign prostatic hypertrophy. The results of numerous randomized prospective studies and clinical case series have confirmed that HoLEP is a procedure that attains immediate bladder outlet obstruction release, that improvement of symptomatic and uroflowmetry parameters is maintained in the midterm and, it is associated with less morbidity than conventional surgery. On the other hand, the shortage of urologists with experience in this procedure, and its technical difficulty have limited its spread in our environment. In this article we describe in detail the technique we use in our center for the performance of HoLEP, emphasizing the modifications we have introduced with time to make the operation easier and to avoid complications(AU)