Prognostic value of p53, Ki-67, microstaging and microvessel density in pT1G3 bladder tumors: creation of risk groups for progression.

OBJECTIVE: New predictive factors for bladder tumor progression have been analyzed in many publications, often with contradictory results. Very few papers have referred specifically to T1G3 tumors. Our objective was to find new, clinically useful markers which either alone or in association with classical prognostic factors would allow the early selection of the correct therapeutic approach. MATERIAL AND METHODS: This was a retrospective study of 83 patients with T1G3 bladder tumors who were initially treated with transurethral resection + bacillus Calmette-Guérin therapy, with a minimum follow-up period of 3 years. We analyzed eight variables. New factors considered were: the level of submucosal invasion; microvessel density; and immunostaining for Ki-67 and p53. Independent prognostic variables for progression were established using logistic regression analysis, and risk groups were created from mathematical models. RESULTS: Five variables were determined as unfavorable: tumor multiplicity; tumor size >3 cm; carcinoma in situ; T1b substage; and p53 positivity. The first three factors predicted progression in only 32% of cases, while the addition of the new prognostic factors (T1b substage and p53 positivity) increased this rate to 65%. We established four risk groups, with rates of progression of 67% and 100% in the high-risk and very high-risk groups, respectively. For inclusion in these groups, both new predictive factors had to be unfavorable; if either one were absent then the three classical factors had to be present. CONCLUSIONS: Microstaging and p53 positivity have a prognostic value for predicting progression in T1G3 tumors, providing 33% more information than that obtained with classical prognostic factors alone. The application of mathematical models identifies risk groups and allows the use of an early and more aggressive treatment.

Relationship between the Saint Louis University ADAM questionnaire and sexual hormonal levels in a male outpatient population over 50 years of age.

OBJECTIVES: To determine the relationship between the ADAM questionnaire and the sexual hormonal levels in a male population older than 50 yr, and to know the predictive capacity of this questionnaire with regard to biochemical hypogonadism in the ageing male. METHODS: A prospective study was carried out on 230 Spanish men. Patients were evaluated by clinical history. The ADAM questionnaire and the Yesavage's Geriatric Depression Scale were completed by each patient. Blood tests were performed including total testosterone, SHBG, free testosterone (FT), dehidroepiandrosterone sulfate (DHEA-S), androstenedione, 17-beta-estradiol, FSH, LH, and prolactin. The relationship between positive ADAM questionnaire and age, clinical and sociodemographic backgrounds, and hormone levels was analysed by means of uni- and multivariate tests. The capacity of the ADAM questionnaire to predict biochemical hypogonadism was determined with a chi-square test. RESULTS: ADAM questionnaire (excluding men with positive Yesavage's Scale) was positive in 140 patients (67.9%). With respect to clinical backgrounds, diabetes mellitus and age had a significant relationship with an ADAM-positive questionnaire. With respect to hormones, FT and DHEA-S levels were significantly lower when the ADAM questionnaire was positive. In the multivariate analysis, age, FT, and diabetes were independently related to an ADAM-positive questionnaire. Prevalence of biochemical hypogonadism (FT<0.228 nmol/l) was 24.6%. The ADAM test had a sensitivity of 84.0% and a specificity of 36.6% to detect biochemical hypogonadism. CONCLUSIONS: FT is inversely related to the ADAM-positive questionnaire, independently of age. The ADAM questionnaire is a valid test to detect hypogonadism but has low specificity.

[Cystocele repair with a polypropylene mesh: our experience]. / Nuestra experiencia en la reparación del cistocele con malla de polipropileno.

OBJECTIVES: To evaluate the efficacy of the polypropilene mesh shaped in a T, with a circular area (to repair the cystocele) and an anterior extension (to function as a tension free sling), for the combined treatment of cystocele and urinary incontinence. METHODS: Retrospective study including 31 female patients with cystocele, with or without urinary incontinence, undergoing mesh repair. Mean age was 62.3 yr. (range 55-72). All patients were multiparous. Number of childbirths varied between 1 and 4. Mean follow-up was 23.5 months (range 12 to 29 months). 80% had grade III cystocele and 20% grade IV. 28 patients (90.3%) presented with urinary incontinence and 3 (9.67%) urgency without incontinence. 16 patients had previously undergone hysterectomy and another 6 surgery for urinary incontinence (2 Raz and 4 Burch operations). 11 patients (33.6%) needed a combination technique in the same operation: associated vaginal hysterectomy in 4 patients and posterior mesh colporrhaphy for grade III symptomatic rectocele in 7 patients. RESULTS: No patient had prolapse recurrence, 1 patient needed clean intermittent catheterizations for 3 months, and 3 suffered de novo urgency (with good response to anticolinergic drugs). The worsening of stress urinary incontinence (SUI) in one patient was solved by suburethral sling insertion; another patient who had prolonged postoperative vaginal bleeding requiring blood transfusions and subsequent mesh erosion of the vaginal wall (she underwent re-operation to cut off the mesh). 3 patients complained of intercourse discomfort which disappeared after an average of 3 months. No other remarkable intra or postoperative complications appeared. CONCLUSIONS: The polypropilene mesh associated with a sling is an effective treatment to repair cystocele with or without SUI, although long-term studies with a greater number of patients are required to validate the technique.

[Improvement of anemia and quality of life of patients with prostate cancer by treatment with human recombinant erythropoietin]. / Mejora de la anemia y calidad de vida de pacientes con cáncer de próstata mediante la administración de eritropoyetina humana recombinante.

OBJECTIVES: Anemia is a frequent finding in patients with prostate cancer. Reduction of erythropoiesis caused by androgenic blockade is among its etiologies. Therefore, quality of life of these patients results decreased, being origin of significant morbidity and mortality. Recombinant forms of human erythropoietin have demonstrated their effectiveness improving quality of life of patients with various solid tumors, but specific studies in prostate cancer are a few. Our objective is to evaluate the efficacy of human recombinant erythropoietin (EPO) correcting anemia and improving the quality of life of patients with prostate cancer. METHODS: Prospective study of patients with prostate cancer under combined androgenic blockade treatment having hemoglobin levels lower than 11 g/dl. We analyze clinical characteristics and quality of life prior to EPO dispense. We used the Triple Linear Analogical Scale for patients with cancer (CLAS) to evaluate quality of life. EPO was administered during 12 weeks (10.000 units subcutaneously, three times a week). We study the evolution of different parameters compared to baseline. RESULTS: We included a total of 17 patients. Average age was 75.5 +/- 5.9 yr. Average time of neoplasia evolution was 57.6 +/- 13.9 months. Eleven patients presented active disease (PSA > 1 ng/ml). Mean initial haemoglobin level was 10.3 +/- 0.4 mg/dl, reaching 12.2 +/ - 1.0 after treatment (p < 0.001). Patients with active disease and levels of initial haemoglobin smaller than 10.2 g/dl presented worse outcomes. There were not adverse events attributable to EPO. CONCLUSIONS: We consider that the administration of EPO increases significantly the levels of haemoglobin and the quality of life of patients with prostate adenocarcinoma, being the response worse in patients with low levels of baseline haemoglobin.

Mejora de la anemia y calidad de vida de pacientes con cáncer de próstata mediante la administración de eritropoyetina humana recombinante / Improvement of anemia and quality of life of patients with prostate cancer by treatment with human recombinant erythropoietin

OBJETIVOS: La anemia es un hecho frecuente en pacientes con carcinoma prostático. Entre sus causas está la reducción de la eritropoyesis provocada por el propio bloqueo androgénico. La calidad de vida de estos pacientes se siente por ello mermada, siendo origen de una importante morbimortalidad. Las formas recombinantes de eritropoyetina humana han demostrado, en diversos tumores sólidos, su eficacia en la mejora de la calidad de vida de estos pacientes; pero los estudios específicos en cáncer de próstata son muy escasos. Nuestro objetivo es evaluar la eficacia de la eritropoyetina humana recombinante (EPO) en la corrección de la anemia y mejora de la calidad de vida de los pacientes con carcinoma prostático. MÉTODOS: Estudio prospectivo de pacientes con adenocarcinoma prostático sometidos a bloqueo androgénico completo, con niveles de hemoglobina inferiores a 11 g/dL. Analizamos las características clínicas y calidad de vida previas a la administración de la EPO. Para evaluar la calidad de vida utilizamos la Triple Escala Analógica Lineal para pacientes con Cáncer (CLAS). Administramos EPO durante 12 semanas (10.000 Unidades, vía subcutánea, 3 veces por semana). Comparamos la evolución de los distintos parámetros analizados, respecto de la visita basal. RESULTADOS: Incluimos un total de 17 pacientes. La edad media fue de 75,5 +/- 5,9 años. El tiempo medio de evolución de la neoplasia ha sido de 57,6 +/- 13,9 meses. Presentaban enfermedad activa (PSA > 1 ng/mL) 11 pacientes. El nivel medio de hemoglobina (Hb) inicial fue de 10,3 +/- 0,4 mg/dL, alcanzando los 12,2 +/- 1,0 tras el tratamiento (p<0,001). En cuanto a la calidad de vida, pasamos de una puntuación inicial media de 6,5 +/- 2,2 a 14,4 +/- 3,3 (p<0,001). Presentaron peor respuesta aquellos pacientes con enfermedad activa y niveles de Hb inicial menores a 10,2 g/dL. No aparecieron efectos secundarios atribuibles a la EPO.CONCLUSIONES: Consideramos que la administración de EPO incrementa de forma significativa los niveles de hemoglobina y la calidad de vida de los pacientes con adenocarcinoma de próstata, presentando peor respuesta cuanto menor es el nivel de Hb inicial (AU)