Valoración de factores predictivos de positividad en PET con 68Ga-PSMA-11 en el cáncer de próstata / Assessment of 68Ga-PSMA-11 PET positivity predictive factors in prostate cancer

Objetivo: La tomografía por emisión de positrones (PET) con 68Ga-PSMA-11 (68Ga-HBED-CC-PSMA) se ha ganado la atención de los investigadores, gracias a que el PSMA se encuentra sobreexpresado en los tejidos tumorales del cáncer de próstata. El objetivo de este trabajo es analizar la rentabilidad diagnóstica de este radiotrazador en la recidiva del cáncer de próstata. Material y métodos: Estudio retrospectivo que cuenta con 53 estudios, realizados en 50 pacientes varones con cáncer de próstata remitidos por sospecha de recidiva bioquímica. Todos presentaban resultados negativos o dudosos en otras técnicas de imagen. Resultados: De los 53 estudios, 36 (68%) fueros positivos. Se encontraron diferencias significativas entre los estudios positivos y negativos en la escala de Gleason, los niveles de PSA, el PSAdt, el estudio tardío y el haber recibido durante el tratamiento un bloqueo hormonal androgénico (p<0,05). Respecto al valor del PSA, de los 21 pacientes con un PSA<1ng/ml, 10 (48%) obtuvieron una PET patológica. Cuando el PSAdt fue inferior a 6 meses, el 86,7% de los pacientes obtuvieron una PET anormal. En el análisis multivariante, solo la escala de Gleason se asoció de forma independiente con el hallazgo de una PET anormal. Conclusiones: Nuestro estudio encontró una alta tasa de detección de enfermedad en estudios PET con 68Ga-PSMA-11 en pacientes en los que otras técnicas presentaban imágenes dudosas o negativas. Casi un 50% de los pacientes con recurrencia bioquímica de cáncer de próstata y niveles bajos de PSA (<1ng/ml) tienen enfermedad activa en la PET con 68Ga-PSMA-11, precisamente un nivel donde otros radiotrazadores tienen un peor umbral de sensibilidad

Purpose: Positron emission tomography (PET) studies with 68Ga-PSMA-11 (68Ga-HBED-CC-PSMA) have earned the attention of researchers, due to overexpression of PSMA in the tumoral tissues of prostate cancer. Our aim was to analyse the potential benefit of this radiotracer in the biochemical relapse of prostate cancer. Material and methods: This retrospective analysis included 53 studies, performed on 50 male prostate cancer patients referred due to biochemical recurrence. In all cases, previous imaging techniques were negative or inconclusive. Results: Of the 53 studies, 36 (68%) were positive. Significant differences were found between the positive and negative PET groups in Gleason's scale, PSA levels, PSAdt, late acquisition and the administration of androgen deprivation therapy during treatment (P<.05). Regarding PSA levels, 10 (48%) of the 21 patients with PSA<1ng/ml, obtained a pathological PET result. When the PSAdt was below six months, 86.7% of the patients obtained an abnormal PET. In the multivariate analysis, only Gleason's scale was associated independently with an abnormal PET result. Conclusions: 68Ga-PSMA-11 PET shows a high disease detection rate in patients where other techniques showed negative or doubtful images. Almost 50% of patients with prostate cancer biochemical recurrence and low PSA levels (<1ng/ml) have active disease on 68Ga-PSMA-11 PET, precisely where other radiotracers lack sensitivity

Assessment of 68Ga-PSMA-11 PET positivity predictive factors in prostate cancer. / Valoración de factores predictivos de positividad en PET con 68Ga-PSMA-11 en el cáncer de próstata.

PURPOSE: Positron emission tomography (PET) studies with 68Ga-PSMA-11 (68Ga-HBED-CC-PSMA) have earned the attention of researchers, due to overexpression of PSMA in the tumoral tissues of prostate cancer. Our aim was to analyse the potential benefit of this radiotracer in the biochemical relapse of prostate cancer. MATERIAL AND METHODS: This retrospective analysis included 53 studies, performed on 50 male prostate cancer patients referred due to biochemical recurrence. In all cases, previous imaging techniques were negative or inconclusive. RESULTS: Of the 53 studies, 36 (68%) were positive. Significant differences were found between the positive and negative PET groups in Gleason's scale, PSA levels, PSAdt, late acquisition and the administration of androgen deprivation therapy during treatment (P<.05). Regarding PSA levels, 10 (48%) of the 21 patients with PSA<1ng/ml, obtained a pathological PET result. When the PSAdt was below six months, 86.7% of the patients obtained an abnormal PET. In the multivariate analysis, only Gleason's scale was associated independently with an abnormal PET result. CONCLUSIONS: 68Ga-PSMA-11 PET shows a high disease detection rate in patients where other techniques showed negative or doubtful images. Almost 50% of patients with prostate cancer biochemical recurrence and low PSA levels (<1ng/ml) have active disease on 68Ga-PSMA-11 PET, precisely where other radiotracers lack sensitivity.

[Abortion and rights. Legal thinking about abortion]. / El aborto y el derecho. Reflexiones juridicas sobre el aborto.

PIP: Analysis of abortion in Mexico from a juridical perspective requires recognition that Mexico as a national community participates in a double system of values. Politically it is defined as a liberal, democratic, and secular state, but culturally the Judeo-Christian ideology is dominant in all social strata. This duality complicates all juridical-penal decisions regarding abortion. Public opinion on abortion is influenced on the 1 hand by extremely conservative groups who condemn abortion as homicide, and on the other hand by groups who demand legislative reform in congruence with characteristics that define the state: an attitude of tolerance toward the different ideological-moral positions that coexist in the country. The discussion concerns the rights of women to voluntary maternity, protection of health, and to making their own decisions regarding their bodies vs. the rights of the fetus to life. The type of analysis is not objective, and conclusions depend on the ideology of the analyst. Other elements must be examined for an objective consideration of the social problem of abortion. For example, aspects related to maternal morbidity and mortality and the demographic, economic, and physical and mental health of the population would all seem to support the democratic juridical doctrine that sees the clandestine nature of abortion as the principal problem. It is also observed that the illegality of abortion does not guarantee its elimination. Desperate women will seek abortion under any circumstances. The illegality of abortion also impedes health and educational policies that would lower abortion mortality. There are various problems from a strictly juridical perspective. A correct definition of the term abortion is needed that would coincide with the medical definition. The discussion must be clearly centered on the protected juridical right and the definition of reproductive and health rights and rights to their own bodies of women. The experiences of other countries with decriminalization of abortion should also be assessed. Factors considered should include the true impunity of abortion, public health problems and socioeconomic problems generated by the state through criminalization of abortion, and the psychological and economic implications for women of the criminal status of abortion. Systems of decriminalization should be examined to decide which would be appropriate for Mexico. These systems include authorizing complete freedom of choice for the 1st trimester and permitting abortion only for specific indications. All penal codes in Mexico now use the system of abortion for specific indications. Few cases are accepted for legal pregnancy termination.^ieng