Prospective study of diagnostic accuracy in the detection of high-grade prostate cancer in biopsy-naïve patients with clinical suspicion of prostate cancer who underwent the Select MDx test.

OBJECTIVES: This study aimed to externally validate the diagnostic accuracy of the Select MDx test for Significant prostate cancer (Sig PCa) (ISUP > 1), in a contemporaneous, prospective, multicenter cohort with a prostate-specific antigen (PSA) between 3 and 10 ng/ml and a non-suspicious digital rectal examination. METHODS AND PARTICIPANTS: For all enrolled patients, the Select Mdx test, the risk calculator ERSPC3 + DRE, and a prostatic magnetic resonance imaging (MRI) were carried out. Subsequently, a systematic 12-core trans-rectal biopsy and a targeted biopsy, in the case of a prostate imaging-reporting and data system (PIRADS) > 2 lesion (max three lesions), were performed. To assess the accuracy of the Select MDx test in the detection of clinically Sig PCa, the test sensitivity was evaluated. Secondary objectives were specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC). A direct comparison with the ERSPC + DRE risk calculator and MRI were also performed. We also studied the predictive ability to diagnose Sig PCa from the combination of the Select MDx test with MRI using clinical decision-curve analysis. RESULTS: There were 163 patients enrolled after meeting the inclusion criteria and study protocol. The Select MDx test showed a sensitivity of 76.9% (95% CI, 63.2-87.5), 49.6% specificity (95% CI, 39.9-59.2), 82.09% (95% CI, 70.8-90.4) NPV, and 41.67% (95% CI, 31.7-52.2) PPV for the diagnosis of Sig PCa. COR analysis was also performed, which showed an AUC of 0.63 (95% CI, 0.56-0.71). There were no differences in the accuracy of Select MDx, ERSPC + DRE, or MRI. The combination of Select MDX + MRI showed the highest impact in the decision-curve analysis, with an NPV of 93%. CONCLUSION: Our study showed a worse performance for the SelectMdx test than previously reported, within a cohort of patients with a PSA 3-10 ng/ml and a normal DRE, with results similar to those from ERSPC + DRE RC and MRI, but with an improvement in the usual PSA pathway. A combination of the Select Mdx test and MRI could improve accuracy, but studies specifically evaluating this scenario with a cost-effective analysis are needed.

Telomere-based risk models for the early diagnosis of clinically significant prostate cancer.

BACKGROUND: The objective of this study was to explore telomere-associated variables (TAV) as complementary biomarkers in the early diagnosis of prostate cancer (PCa), analyzing their application in risk models for significant PCa (Gleason score > 6). METHODS: As part of a larger prospective longitudinal study of patients with suspicion of PCa undergoing prostate biopsy according to clinical practice, a subgroup of patients (n = 401) with PSA 3-10 ng/ml and no prior biopsies was used to evaluate the contribution of TAV to discern non-significant PCa from significant PCa. The cohort was randomly split for training (2/3) and validation (1/3) of the models. High-throughput quantitative fluorescence in-situ hybridization was used to evaluate TAV in peripheral blood mononucleated cells. Models were generated following principal component analysis and random forest and their utility as risk predictors was evaluated by analyzing their predictive capacity and accuracy, summarized by ROC curves, and their clinical benefit with decision curves analysis. RESULTS: The median age of the patients was 63 years, with a median PSA of 5 ng/ml and a percentage of PCa diagnosis of 40.6% and significant PCa of 19.2%. Two TAV-based risk models were selected (TAV models 1 and 2) with an AUC ≥ 0.83 in the full study cohort, and AUC > 0.76 in the internal validation cohort. Both models showed an improvement in decision capacity when compared to the application of the PCPT-RC in the low-risk probabilities range. In the validation cohort, with TAV models 1 and 2, 33% /48% of biopsies would have been avoided losing 0/10.3% of significant PCa, respectively. The models were also tested and validated on an independent, retrospective, non contemporary cohort. CONCLUSIONS: Telomere analysis through TAV should be considered as a new risk-score biomarker with potential to increase the prediction capacity of significant PCa in patients with PSA between 3-10 ng/ml.

A Single-Center Experience With Third and Fourth Kidney Transplants and Second Kidney Transplant After Pancreas-Kidney Transplant: Surgical Aspects and Outcomes.

OBJECTIVES: Overall, 25% to 33% of patients on kidney transplant wait lists present with prior graft loss. In addition, the number of patients who require a retransplant seems to be increasing. Here, we describe our experience with patients who had a second kidney transplant after a previous pancreas-kidney transplant or a third or fourth kidney transplant. We focused specifically on the technical aspects and outcomes related to this patient group. MATERIALS AND METHODS: A single-center retrospective study was performed. The cohortincluded 15 patients > 18 years old who had received a second kidney graft after pancreas-kidney transplant or a second or greater kidney graft between 2013 and 2019. RESULTS: Median age of recipients was 45 years (range, 20-58 y). In 10 patients, the transperitoneal approach was selected. In 5 patients, the retroperitoneal heterotopic kidney retransplant technique was used. Early surgical complications (≤ 30 days posttransplant) were reported in 4 patients. Three patients had late ureteral stenosis (> 90 days posttransplant). All grafts were functioning at time of patient discharge. Mean creatinine level was 2.69 mg/dL (range, 1.23-6.26 mg/dL). The 1-year and 2-year graft survivalrates were 85% and 75%, respectively. No grafts were lost because of surgical complications. CONCLUSIONS: Retransplant of a second graft after pancreas-kidney transplant or retransplant of a third or fourth renal graft is challenging but feasible, with evidence of reasonably positive outcomes after retransplant.

Observational study comparing the accuracy/variability between the ERSPC and the PCPT risk calculators for the prediction of significant prostate cancer in patients with PSA <10 ng/mL.

INTRODUCTION: Risk calculators (RCs) are easy-to-use tools considering available clinical variables that could help to select those patients with risk of prostate cancer (PCa) who should undergo a prostate biopsy. OBJECTIVE: To perform a comparison for the prediction of significant PCa (SigPCa) between the European Randomised Study of Screening for PCa (ERSPC) and the PCa Prevention Trial (PCPT) RCs in patients with prostate-specific antigen (PSA) between 3 and 10 ng/mL through an evaluation of the accuracy/variability between two consecutive PSA values. SETTING: An observational study in a major university hospital in the south of Spain. METHODS AND PARTICIPANTS: An observational study was performed in patients who underwent a prostate biopsy. SigPCa probabilities were calculated with the two PSA measures using ERSPC3/4+digital rectal examination and PCPT v2+free PSA RCs. The prediction of SigPCa was determined by the area under the receiver operating characteristic curve (AUC). Calibration, discrimination and decision curve analysis were studied. The variability between both RCs' agreement was compared using Cohen's kappa coefficient. RESULTS: 510 patients were analysed (87 diagnosed with SigPCa). The median PSA values were 5.3 and 5 ng/mL for PSA1 and PSA2, respectively. Both RCs overestimated the risk in the case of high-risk probabilities. Discriminative ability for SigPCa was similar between models with an AUC=0.73 (0.68-0.79) for ERSPC-RC versus 0.73 (0.67-0.79) for PCPT-RC. ERSPC-RC showed less variability than PCPT-RC, with a constant agreement (k=0.7-0.8) for usual range of clinical decision-making. Remarkably, a higher number of biopsies would be avoided using the ERSPC-RC, but more SigPCa would be missed along all the risk probabilities. CONCLUSIONS: Both RCs performed similar in the prediction of SigPCa. However, ERSPC-RC seems to be more stable for intraindividual PSA variations.

CE-MS-based urinary biomarkers to distinguish non-significant from significant prostate cancer.

BACKGROUND: Prostate cancer progresses slowly when present in low risk forms but can be lethal when it progresses to metastatic disease. A non-invasive test that can detect significant prostate cancer is needed to guide patient management. METHODS: Capillary electrophoresis/mass spectrometry has been employed to identify urinary peptides that may accurately detect significant prostate cancer. Urine samples from 823 patients with PSA (<15 ng/ml) were collected prior to biopsy. A case-control comparison was performed in a training set of 543 patients (nSig = 98; nnon-Sig = 445) and a validation set of 280 patients (nSig = 48, nnon-Sig = 232). Totally, 19 significant peptides were subsequently combined by a support vector machine algorithm. RESULTS: Independent validation of the 19-biomarker model in 280 patients resulted in a 90% sensitivity and 59% specificity, with an AUC of 0.81, outperforming PSA (AUC = 0.58) and the ERSPC-3/4 risk calculator (AUC = 0.69) in the validation set. CONCLUSIONS: This multi-parametric model holds promise to improve the current diagnosis of significant prostate cancer. This test as a guide to biopsy could help to decrease the number of biopsies and guide intervention. Nevertheless, further prospective validation in an external clinical cohort is required to assess the exact performance characteristics.

Clinical association of metabolic syndrome, C-reactive protein and testosterone levels with clinically significant prostate cancer.

Recently, the influence that metabolic syndrome (MetS), hormonal alterations and inflammation might have on prostate cancer (PCa) risk has been a subject of controversial debate. Herein, we aimed to investigate the association between MetS-components, C-reactive protein (CRP) and testosterone levels, and the risk of clinically significant PCa (Sig-PCa) at the time of prostate biopsy. For that, men scheduled for transrectal ultrasound guided biopsy of the prostate were studied. Clinical, laboratory parameters and criteria for MetS characterization just before the biopsy were collected. A total of 524 patients were analysed, being 195 (37.2%) subsequently diagnosed with PCa and 240 (45.8%) meet the diagnostic criteria for MetS. Among patients with PCa, MetS-diagnosis was present in 94 (48.2%). Remarkably, a higher risk of Sig-PCa was associated to MetS, greater number of MetS-components and higher CRP levels (odds-ratio: 1.83, 1.30 and 2.00, respectively; P < 0.05). Moreover, higher circulating CRP levels were also associated with a more aggressive Gleason score in PCa patients. Altogether, our data reveal a clear association between the presence of MetS, a greater number of MetS-components or CRP levels >2.5 mg/L with an increased Sig-PCa diagnosis and/or with aggressive features, suggesting that MetS and/or CRP levels might influence PCa pathophysiology.

[Oligometastatic prostate cancer. concept and implications.] / Cáncer de próstata oligometastásico. Concepto e implicaciones.

Oligometastatic prostate cancer has been proposed as an intermediate stage between localized and extensively disseminated disease. Oligometastatic disease is being diagnosed more frequently due to the advances in imaging tests. Nevertheless, there is no consensus definition yet of oligometastatic prostate cancer. The importance of this entity is that several studies have pointed out that local and metastasis directed treatment may improve survival in selected patients. However, we need the results of well controlled prospective randomized clinical trials to help a better understanding and management of oligometastatic prostate cancer.

Cáncer de próstata oligometastásico. Concepto e implicaciones / Oligometastatic prostate cancer. concept and implications

El CaP oligometastásico se ha propuesto como un estadio intermedio entre la enfermedad localizada y la ampliamente diseminada. La enfermedad oligometastásica está siendo más frecuentemente diagnosticada debido a los avances en las pruebas de imagen. No obstante, aún no existe una definición de consenso en cuanto a qué se considera un CaP oligometastásico. La importancia de esta entidad radica en que varios trabajos han apuntado que el tratamiento local y el dirigido a la metástasis en pacientes seleccionados podría mejorar su supervivencia. Sin embargo, aún son necesarios los resultados de ensayos clínicos prospectivos bien controlados y aleatorizados que ayuden a un mejor entendimiento y manejo del CaP oligometastásico

Oligometastatic prostate cancer has been proposed as an intermediate stage between localized and extensively disseminated disease. Oligometastatic disease is being diagnosed more frequently due to the advances in imaging tests. Nevertheless, there is no consensus definition yet of oligometastatic prostate cancer. The importance of this entity is that several studies have pointed out that local and metastasis directed treatment may improve survival in selected patients. However, we need the results of well controlled prospective randomized clinical trials to help a better understanding and management of oligometastatic prostate cancer

New Approach to Guide Target Prostate Biopsy: Technique and Initial Experience.

OBJECTIVE: To describe the technique of transrectal biopsy with a new device that fuses multiparametric magnetic resonance (mpMRI) and ultrasound images in real time to guide target biopsies and to evaluate our initial experience. METHODS: Patients with persistent suspicion of prostate cancer despite a previous negative biopsy and who had an mpMRI before the biopsy were selected. All patients underwent target biopsy plus standard systematic biopsy. Significant prostate cancer (sig PCa) was defined according to the Epstein criteria for standard biopsy and Gleason grade of ≥7 and a positive core length of ≥5 mm for target biopsy. RESULTS: The first 40 patients were evaluated. The median age was 65 years old. In a sagittal isotropic sequence, the fusion process was started. The fusion can be improved by using different tools such as concordant points and Global Positioning System corrections tools. In the target biopsy, a median of 4 cores was taken, whereas in the standard biopsy, 12 cores were taken. Twenty-two patients were diagnosed with prostate cancer; of these patients, 17 were diagnosed with sig PCa. The fusion target biopsy diagnosed more sig PCa than the standard biopsy; however, it was not statistically significant (37.5% vs 25%, P=.08). The probability of being diagnosed with cancer increased in correlation with the Prostate Imaging Reporting and Data System score, without reaching statistical significance (k=0.45, P=.08). CONCLUSIONS: This new device is a useful tool to guide biopsy in patients with target lesions in an mpMRI to increase the detection of sig PCa. A larger cohort would be required to show significant differences.

Comorbilidad y factores sociodemográficos asociados a litiasis renal en personas de 40 a 65 años: estudio transversal / Comorbidity and socio-demographic factors associated with renal lithiasis in persons aged 40 to 65: A cross-sectional study

Fundamento y objetivo: La litiasis renal es una de las enfermedades urológicas más importantes. Parece estar relacionada con factores sociodemográficos y climáticos, estilos de vida y comorbilidad preexistente. El objetivo de este trabajo fue examinar la relación entre variables sociodemográficas, ciertos factores de riesgo y enfermedades crónicas, y la litiasis renal. Pacientes y método: Se realizó un estudio transversal, seleccionando a población española de 40 a 65 años, combinando 2 muestras aleatorias (PreLiRenA y PreLiRenE). Los datos fueron recogidos por encuestas telefónicas personales, recopilando información sobre variables sociodemográficas y la morbilidad percibida. También se recogieron datos sobre las temperaturas medias anuales en cada región española. Se realizó un análisis bivariado y multivariado. Resultados: Fueron encuestados 4.894 sujetos; el 51,3% eran mujeres; el 25% tenían entre 40 y 45 años; el 36% tenían educación primaria y el 31,4% eran de clase social baja. La prevalencia global de litiasis renal fue del 15,0% (intervalo de confianza al 95% [IC 95%] 14,5-15,5). Por medio del análisis multivariado, las variables que mostraron una fuerte relación estadística con la presencia de litiasis renal fueron: edad avanzada (61-65 años, OR=1,39; IC 95% 1,06-1,8), clase social alta (OR=1,98; IC 95% 1,29-2,62), antecedentes familiares de litiasis renal (OR=2,22; IC 95% 1,88-2,65), hipertensión arterial (OR=1,68; IC 95% 1,39-2,02) y sobrepeso/obesidad (OR=1,31; IC 95% 1,12-1,54). Se observó una correlación entre la litiasis renal y las temperaturas medias anuales en las regiones españolas (r=0,59; p=0,013). Conclusiones: Existe relación entre litiasis renal y edad avanzada, pertenecer a clases sociales altas, existencia de antecedentes familiares de urolitiasis, y tener hipertensión y sobrepeso/obesidad. La prevalencia de la litiasis renal es mayor en las zonas climáticas más cálidas (AU)

Background and objective: Renal lithiasis is one of the most important urological diseases. It seems to be related to different socio-demographic and climatic factors, lifestyle and pre-existing comorbidity. The aim of this study was to examine the relationship between socio-demographic variables, certain risk factors and chronic diseases and the renal lithiasis. Patients and method: A cross-sectional population-based study was carried out, selecting the Spanish population aged from 40 to 65 years, combining 2 random samples (PreLiRenA and PreLiRenE studies). Data were collected by personal telephone surveys, gathering information on socio-demographic variables and perceived morbidity. Data on annual average temperatures in each Spanish region were also collected. A bivariate and multivariate analysis was performed. Results: A total of 4,894 subjects were surveyed; 51.3% were women; 25% were aged 40-45 years, 36% had primary school education and 31.4% were of low social class. The overall prevalence of renal lithiasis was 15.0% (95% confidence interval [95% CI] 14.5-15.5). By means of multivariate analysis, the variables that showed a strong statistical relationship with the presence of renal lithiasis were: older age (61-65 years; OR=1.39; 95% CI 1.06-1.80), high social class (OR=1.98; 95% CI 1.29-2.62), family history of renal lithiasis (OR=2.22; 95% CI 1.88-2.65), high blood pressure (OR=1.68; 95% CI 1.39-2.02) and overweight/obesity (OR=1.31; 95% CI 1.12-1.54). A correlation was observed between renal lithiasis and average annual temperatures in the Spanish regions (r=0.59; P=.013). Conclusions: A relationship was observed between renal lithiasis and older age, belonging to higher social classes, the existence of a family history of urolithiasis, and hypertension and overweight or obesity. The prevalence of renal lithiasis is greater in warmer climate zones (AU)

Comorbidity and socio-demographic factors associated with renal lithiasis in persons aged 40 to 65: A cross-sectional study. / Comorbilidad y factores sociodemográficos asociados a litiasis renal en personas de 40 a 65 años: estudio transversal.

BACKGROUND AND OBJECTIVE: Renal lithiasis is one of the most important urological diseases. It seems to be related to different socio-demographic and climatic factors, lifestyle and pre-existing comorbidity. The aim of this study was to examine the relationship between socio-demographic variables, certain risk factors and chronic diseases and the renal lithiasis. PATIENTS AND METHOD: A cross-sectional population-based study was carried out, selecting the Spanish population aged from 40 to 65 years, combining 2 random samples (PreLiRenA and PreLiRenE studies). Data were collected by personal telephone surveys, gathering information on socio-demographic variables and perceived morbidity. Data on annual average temperatures in each Spanish region were also collected. A bivariate and multivariate analysis was performed. RESULTS: A total of 4,894 subjects were surveyed; 51.3% were women; 25% were aged 40-45 years, 36% had primary school education and 31.4% were of low social class. The overall prevalence of renal lithiasis was 15.0% (95% confidence interval [95% CI] 14.5-15.5). By means of multivariate analysis, the variables that showed a strong statistical relationship with the presence of renal lithiasis were: older age (61-65 years; OR=1.39; 95% CI 1.06-1.80), high social class (OR=1.98; 95% CI 1.29-2.62), family history of renal lithiasis (OR=2.22; 95% CI 1.88-2.65), high blood pressure (OR=1.68; 95% CI 1.39-2.02) and overweight/obesity (OR=1.31; 95% CI 1.12-1.54). A correlation was observed between renal lithiasis and average annual temperatures in the Spanish regions (r=0.59; P=.013). CONCLUSIONS: A relationship was observed between renal lithiasis and older age, belonging to higher social classes, the existence of a family history of urolithiasis, and hypertension and overweight or obesity. The prevalence of renal lithiasis is greater in warmer climate zones.

[Epidemiology of urinary lithiasis in Spain: New scenarios.] / Epidemiología de la litiasis en España: nuevos escenarios.

Renal lithiasis is one of the most common disorders in modern society, constituting an important health problem that associates a great economic burden. The nature of stone disease varies according to age and sex, being also influenced by dietary and lifestyle factors, and climatic variations among others. In spite of the advances made in the management of this pathology, it continues being a disease with a high recurrence rate. In recent years, several studies have pointed out that its prevalence is rising especially in developed countries. This increase seems to be fundamentally due to changes in dietary habits and lifestyle, although other factors such as migratory flows from rural areas to major cities, and a rise in global temperatures may also be involved. In the present article, we discuss the main factors that seem to influence today the epidemiology of urinary litiasis, as well as the aforementioned increase of prevalence.

Epidemiología de la litiasis en España: nuevos escenarios / Epidemiology of urinary lithiasis in Spain: New scenarios

La litiasis renal es una de las afecciones más comunes de la sociedad moderna, constituyendo un importante problema de salud que además asocia una gran carga económica. La naturaleza de la litiasis varía según la edad y el sexo, viéndose también influenciada por factores dietéticos, climáticos y de estilo de vida entre otros. A pesar de los avances que se han producido en el manejo de dicha patología, ésta continúa siendo una enfermedad con alta tasa de recurrencia. En los últimos años son varios los trabajos que hacen referencia a un aumento en su prevalencia sobre todo en países desarrollados. Dicho incremento parecer ser fundamentalmente debido a un cambio en los hábitos dietéticos y en el estilo de vida, si bien, otros factores tales como un aumento de las temperaturas o los flujos migratorios hacia grandes urbes podrían estar también relacionados. En el presente trabajo se discuten los principales factores que a día de hoy parecen influir en la epidemiología de la litiasis urinaria, así como en el citado aumento de su prevalencia

Renal lithiasis is one of the most common disorders in modern society, constituting an important health problem that associates a great economic burden. The nature of stone disease varies according to age and sex, being also influenced by dietary and lifestyle factors, and climatic variations among others. In spite of the advances made in the management of this pathology, it continues being a disease with a high recurrence rate. In recent years, several studies have pointed out that its prevalence is rising especially in developed countries. This increase seems to be fundamentally due to changes in dietary habits and lifestyle, although other factors such as migratory flows from rural areas to major cities, and a rise in global temperatures may also be involved. In the present article, we discuss the main factors that seem to influence today the epidemiology of urinary litiasis, as well as the aforementioned increase of prevalence

European Randomized Study of Screening for Prostate Cancer Risk Calculator: External Validation, Variability, and Clinical Significance.

OBJECTIVE: To externally validate the European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator (RC) and to evaluate its variability between 2 consecutive prostate-specific antigen (PSA) values. MATERIALS AND METHODS: We prospectively catalogued 1021 consecutive patients before prostate biopsy for suspicion of prostate cancer (PCa). The risk of PCa and significant PCa (Gleason score ≥7) from 749 patients was calculated according to ERSPC-RC (digital rectal examination-based version 3 of 4) for 2 consecutive PSA tests per patient. The calculators' predictions were analyzed using calibration plots and the area under the receiver operating characteristic curve (area under the curve). Cohen kappa coefficient was used to compare the ability and variability. RESULTS: Of 749 patients, PCa was detected in 251 (33.5%) and significant PCa was detected in 133 (17.8%). Calibration plots showed an acceptable parallelism and similar discrimination ability for both PSA levels with an area under the curve of 0.69 for PCa and 0.74 for significant PCa. The ERSPC showed 226 (30.2%) unnecessary biopsies with the loss of 10 significant PCa. The variability of the RC was 16% for PCa and 20% for significant PCa, and a higher variability was associated with a reduced risk of significant PCa. CONCLUSION: We can conclude that the performance of the ERSPC-RC in the present cohort shows a high similitude between the 2 PSA levels; however, the RC variability value is associated with a decreased risk of significant PCa. The use of the ERSPC in our cohort detects a high number of unnecessary biopsies. Thus, the incorporation of ERSPC-RC could help the clinical decision to carry out a prostate biopsy.

Prevalencia de la urolitiasis en la población española de 40 a 65 años: Estudio PreLiRenE / Prevalence of urolithiasis in the 40 to 65 year old Spanish population: The PreLiRenE study

Fundamento y objetivo: La urolitiasis constituye una afección frecuente, cuya prevalencia se ha incrementado a nivel mundial. En Andalucía (España) el estudio PreLiRenA mostró una elevada prevalencia (16,4%; intervalo de confianza al 95% [IC 95%] 14,8-17,8) en población de 40 a 65 años, lo cual nos hizo cuestionarnos cuál sería la situación a nivel nacional. El objetivo fue estimar la prevalencia de urolitiasis en la población española de entre 40 y 65 años. Pacientes y método: Estudio observacional, transversal, mediante muestreo estratificado según las regiones del país, sexo y edad. Se realizaron un total de 2.444 entrevistas telefónicas mediante un cuestionario que incluía variables sociodemográficas y clínicas. Se realizó una estadística descriptiva y bivariada, calculando las ratios de prevalencia (RP) con IC 95%. Resultados: De los 2.444 sujetos entrevistados, el 51,2% (n = 1.251) eran mujeres. La prevalencia de urolitiasis fue del 14,6% (IC 95% 13,1-15,9), y la incidencia, del 2,9% (IC 95% 2,2-3,6). Se observaron diferencias significativas respecto a la edad, con una mayor prevalencia en pacientes de 46-50 años (RP 1,58; IC 95% 1,12-2,21; p < 0,001) y 61-65 años (RP 1,47; IC 95% 1,02-2,13), así como de clase social elevada (RP 1,75; IC 95% 1,07-2,86; p = 0,024). Un 52,8% presentó más de un episodio de urolitiasis. El 46,9% expulsó el cálculo espontáneamente y el 51,1% fue diagnosticado en Urgencias. Conclusiones: Se observa una elevada prevalencia de urolitiasis entre la población española de 40 a 65 años, sobre todo entre los sujetos de clase social superior y mediana edad, así como una alta tasa de recurrencia (AU)

Background and objective: Urolithiasis is a common urologic condition with increasing incidence in the population worldwide. In Andalusia (Spain), the PreLiRenA study showed a high prevalence (16.4%; 95% confidence interval [95% CI] 14.8-17.8) of this condition in population aged between 40 and 65 years. The interesting results reported in that study encouraged us to further investigate the magnitude of this condition at a national level. We aimed to estimate the prevalence of urolithiasis in the Spanish population aged between 40 and 65 years. Patients and method: This is an observational, cross-sectional, prevalence, stratified sampling study by Spanish region, sex and age. A total of 2,444 telephone interviews were conducted using a questionnaire that covered several sociodemographic and clinical variables. Bivariate, descriptive statistical study was performed. The prevalence ratio (PR) with the 95% CI was calculated. Results: Of the 2,444 subjects interviewed, 51.2% (n = 1,251) were women. The prevalence and incidence of urolithiasis were 14.6% (95% CI 13.1-15.9) and 2.9% (95% CI 2.2-3.6), respectively. Significant differences were found by age, with a higher prevalence in 46-50 years (PR 1.58; 95% CI 1.12-2.21;P < .001) and 61-65 years (PR 1.47; 95% CI 1.02-2.13), and upper-class subjects (PR 1.75; 95% CI 1.07-2.86; P < .024). Of respondents, 52.8% had experienced more than one episode of urolithiasis. A total of 46.9% passed the calculus spontaneously, and 51.1% were diagnosed in the Emergency Unit. Conclusions: The prevalence of urolithiasis in the Spanish population aged between 40 and 65 years is high; especially among upper-class subjects and in middle-aged. A high recurrence rate is also observed (AU)

[Prevalence of urolithiasis in the 40 to 65 year old Spanish population: The PreLiRenE study]. / Prevalencia de la urolitiasis en la población española de 40 a 65 años: Estudio PreLiRenE.

BACKGROUND AND OBJECTIVE: Urolithiasis is a common urologic condition with increasing incidence in the population worldwide. In Andalusia (Spain), the PreLiRenA study showed a high prevalence (16.4%; 95% confidence interval [95% CI] 14.8-17.8) of this condition in population aged between 40 and 65 years. The interesting results reported in that study encouraged us to further investigate the magnitude of this condition at a national level. We aimed to estimate the prevalence of urolithiasis in the Spanish population aged between 40 and 65 years. PATIENTS AND METHOD: This is an observational, cross-sectional, prevalence, stratified sampling study by Spanish region, sex and age. A total of 2,444 telephone interviews were conducted using a questionnaire that covered several sociodemographic and clinical variables. Bivariate, descriptive statistical study was performed. The prevalence ratio (PR) with the 95% CI was calculated. RESULTS: Of the 2,444 subjects interviewed, 51.2% (n=1,251) were women. The prevalence and incidence of urolithiasis were 14.6% (95% CI 13.1-15.9) and 2.9% (95% CI 2.2-3.6), respectively. Significant differences were found by age, with a higher prevalence in 46-50 years (PR 1.58; 95% CI 1.12-2.21; P<.001) and 61-65 years (PR 1.47; 95% CI 1.02-2.13), and upper-class subjects (PR 1.75; 95% CI 1.07-2.86; P<.024). Of respondents, 52.8% had experienced more than one episode of urolithiasis. A total of 46.9% passed the calculus spontaneously, and 51.1% were diagnosed in the Emergency Unit. CONCLUSIONS: The prevalence of urolithiasis in the Spanish population aged between 40 and 65 years is high; especially among upper-class subjects and in middle-aged. A high recurrence rate is also observed.

[When should we perform a bone scintigraphy in patients with new diagnosis of asymptomatic prostate cancer in order to detect bone metastasis?]. / Cuándo debemos realizer un studio de extension en cáncer de próstata asintomático?

OBJECTIVE: To define, based on PSA value, Gleason score (GS), clinical stage and age, those patients diagnosed with asymptomatic prostate cancer whose cases warrant further study of bone metastasis (BMet). METHODS: From January 2006 to May 2010, we evaluated 263 patients diagnosed with prostate cancer who were chosen for further study of bone scintigraphy following the consensus protocol accepted by the Ministry of Health of Andalusia (Integrated Andalusian Process Prostate Cancer-BPH). All selected studies met the criteria defined in the test indications: PSA >10 or Gleason score (GS) ≥7 or positive biopsy of seminal vesicles, all without symptoms of bone pain. A multivariate analysis of potential predictive factors for positive bone scintigraphy was performed and cutoffs were determined by calculating the following diagnostic rates: sensitivity, specificity and positive and negative predictive values with their respective confidence intervals at 95% certainty. RESULTS: BMet were detected in 29 cases (11%). The average age of the patients with a positive bone scan was 65.5 and 68.4 years in those with a negative result (p=0.03). Multivariate analysis showed that GS OR: 2.08 [95% CI (1.34 - 3.18)] (p<0.001) and PSA level 21-200 ng/ml OR: 3.68 [95% CI (1.13-1.02)] (p<0.05) were independent predictive variables for positive bone scan. The cutoffs were estimated by ROC curve analysis, resulting in a cutoff of 16.18 ng/ml for PSA value and 7 for GS (larger area under the curve: 0.864 with a sensitivity of 94.5% and specificity of 47%). CONCLUSIONS: In the group of patients defined in our study, diagnosed with asymptomatic prostate cancer, the assessment of BMet using a bone scan should be carried out with a PSA level ≥ 16.18 ng/ml and GS ≥7 as reference points.

¿Cuándo debemos realizar un estudio de extensión en cáncer de próstata asintomático? / When should we perform a bone scintigraphy in patients with new diagnosis of asymptomatic prostate cancer in order to detect bone metastasis?

OBJETIVO: Definir en función del valor de PSA, grado Gleason (SG), estadio clínico y edad, el grupo de pacientes con diagnostico de cáncer de próstata (CaP) asintomático, en los cuales estaría indicado hacer estudio de extensión de metástasis óseas (MetO). MÉTODOS: Desde Enero 2006 a Mayo de 2010 se estudiaron 263 pacientes con diagnóstico de CaP en los que se solicito gammagrafía ósea como estudio de extensión, siguiendo el protocolo de consenso de Andalucía (Proceso Andaluz integrado HBP-Cáncer de Próstata). Todos los estudios seleccionados cumplían los criterios definidos para la indicación de la prueba: PSA >10 o gleason (SG) ≥7 o biopsia de vesículas seminales positiva, todos sin clínica de dolor óseo. Realizamos un análisis multivariante de los potenciales factores predictores de gammagrafía positiva y establecemos puntos de corte, calculándose los siguientes índices diagnósticos: sensibilidad, especificidad y valores predictivos positivos y negativos, con sus respectivos intervalos de confianza al 95% de seguridad. RESULTADOS: Se detectaron MetO en 29 casos (11%). La edad media de los pacientes con gammagrafía positiva fue 65,5 y 68,4 años en aquellos con resultado negativo (p = 0,03). El análisis multivariante mostró al SG OR: 2,08 [IC 95% (1,34 - 3,18)] (p < 0,001) y al valor de PSA 21-200 ng/ml OR: 3,68 [IC 95% (1,13-12,02)] (p < 0,05) como variables predictoras independientes de gammagrafía positiva. Al realizar las curvas ROC se obtuvo un punto de corte de 16,18 ng/ml para el valor PSA y 7 para el SG (mayor área bajo la curva: 0,864 con una sensibilidad de 94,5% y una especificad del 47 %). Concluisiones: En el grupo de pacientes de nuestro estudio, diagnosticados de CaP asintomático, la evaluación de MetO, mediante gammagrafía ósea, debería ser realizada con un PSA ≥ 16,18 (ng/ml) y un SG ≥ 7 como puntos de referencia

OBJECTIVE: To define, based on PSA value, Gleason score (GS), clinical stage and age, those patients diagnosed with asymptomatic prostate cancer whose cases warrant further study of bone metastasis (BMet). METHODS.- From January 2006 to May 2010, we valuated 263 patients diagnosed with prostate cancer who were chosen for further study of bone scintigraphy following the consensus protocol accepted by the Ministry of Health of Andalusia (Integrated Andalusian Process Prostate Cancer- BPH). All selected studies met the criteria defined in the test indications: PSA >10 or Gleason score (GS) ≥7 or positive biopsy of seminal vesicles, all without symptoms of bone pain. A multivariate analysis of potential predictive factors for positive bone scintigraphy was performed and cutoffs were determined by calculating the following diagnostic rates: sensitivity, specificity and positive and negative predictive values with their respective confidence intervals at 95% certainty. RESULTS- BMet were detected in 29 cases (11%). The average age of the patients with a positive bone scan was 65.5 and 68.4 years in those with a negative result (p = 0.03). Multivariate analysis showed that GS OR: 2.08 [95% CI (1.34 - 3.18)] (p < 0.001) and PSA level 21-200 ng/ml OR: 3.68 [95% CI (1.13-1.02)] (p < 0.05) were independent predictive variables for positive bone scan. The cutoffs were estimated by ROC curve analysis, resulting in a cutoff of 16.18 ng/ml for PSA value and 7 for GS (larger area under the curve: 0.864 with a sensitivity of 94.5% and specificity of 47%). Conclusions.- In the group of patients defined in our study, diagnosed with asymptomatic prostate cancer, the assessment of BMet using a bone scan should be carried out with a PSA level ≥ 16.18 ng/ ml and GS ≥ 7 as reference points

Palliative surgery for rare cases of anterior urethral metastasis in prostate cancer.

Penis metastasis from prostate cancer is very rare, and its management varies from case to case as there are very few cases reported in the literature. We describe a patient with prostate cancer treated with radiotherapy and androgen deprivation therapy who presented with urethral bleeding as a symptom of anterior urethral metastasis during followup. We propose a way to manage this and review the literature.

Importancia de la rehabilitación precoz de los cuerpos cavernosos tras prostatectomía radical / Importance of early rehabilitation of the corpus cavernosum after radical prostatectomy

Objetivos: Primario: evaluar la importancia de una rehabilitación precoz de los cuerpos cavernosos sobre la función eréctil tras prostatectomía radical. Secundario: analizar los factores asociados a una mejor respuesta. Material y método: Estudio retrospectivo en pacientes tratados con inyecciones intracavernosas tras prostatectomía radical entre el 1 de enero de 2006 y el 31 de diciembre de 2008. Se incluyeron enfermos sin antecedentes de disfunción eréctil previa a la cirugía, no respondedores a inhibidores de la 5-fosfodiesterasa. En todos se realizó ecodoppler color tras inyección de prostaglandina E1 10-20 mg. Se compararon 2 grupos en función de la precocidad del inicio de la rehabilitación tras la cirugía (precoz, < 6 meses, o tardía, > 6 meses). Resultados: Se incluyeron 82 pacientes. En el análisis multivariante, fueron factores predictores de buena respuesta al tratamiento: inicio precoz de la rehabilitación (OR: 0,06; IC 95%: 0,014- 0,26), mayor velocidad pico sistólica durante el test (OR: 1,01; IC 95%: 1,01-1,1) y estadio anatomopatológico favorable (OR: 0,15; IC 95%: 0,036-0,6). El ecodoppler color tras inyección de prostaglandina E1 presentó valores anormales con mayor frecuencia en el grupo de inicio tardío frente al precoz (89,5% [n = 34] vs. 65,9% [n = 29]; p = 0,01). El 40,2% (n = 33) de los sujetos presentaron fracaso del mecanismo corporovenooclusivo, presentando valores más elevados el grupo de inicio tardío (5,53 ± 1,4 cm/seg) frente al precoz (4,75 ±1,03 cm/seg) (p = 0,005). La presencia de erecciones funcionales a los 18 meses del seguimiento fue mayor en el grupo de inicio precoz (p < 0,001). Conclusiones: Según el presente estudio, en pacientes tras prostatectomía radical la rehabilitación farmacológica precoz de la erección presenta mejores resultados comparada con la tardía (AU)

Objectives: Primary: to evaluate the importance of early rehabilitation of the corpus cavernosum on erectile function after radical prostatectomy. Secondary: to analyse the factors associated with better response. Material and method: Retrospective study in patients treated with intracavernous injections after radical prostatectomy between 1 January 2006 and 31 December 2008. We included patients lacking a history of erectile dysfunction prior to surgery, not responding to phosphodiesterase-5 inhibitors. All patients underwent colour echo-doppler after injection of prostaglandin E1 10-20 mg. The outcomes of these 2 groups were then compared according to how early rehabilitation began after surgery (early, < 6 months, or late, > 6 months). Results: There were 82 patients included in the study. In the multivariate analysis, predictive factors of good response to treatment were: early onset of rehabilitation (OR: 0.06; 95% CI: 0.014-0.26), higher peak systolic velocity during the test (OR: 1.01; 95% CI: 1.01-1.1) and favourable histopathological stage (OR: 0.15; 95% CI 95%: 0.036-0.6). The colour echo-doppler procedure after prostaglandin E1 injection showed abnormal values more frequently in the lateonset than in the early group (89.5% [n = 34] vs. 65.9% [n = 29]; P = .01). Corporal veno-occlusive dysfunction was presented by 40.2% (n = 33) of subjects, with the late-onset group presenting higher values (5.53 ± 1.4 cm/sec) than the early group (4.75 ± 1.03 cm/sec) (P = .005). The presence of functional erections at 18 months’ follow-up was higher in the early onset group (P < .001). Conclusions: According to this study, early erectile dysfunction rehabilitation after radical prostatectomy achieves better results than late rehabilitation in patients (AU)