The role of multiparametric magnetic resonance in active surveillance of a low-risk prostate cancer cohort from clinical practice.

INTRODUCTION: Active surveillance (AS) is considered a suitable management practice for those patients with low-risk prostate cancer (PCa). At present, however, the role of multiparametric magnetic resonance imaging (mpMRI) in AS protocols has not yet been clearly established. OUTCOMES: To determine the role of mpMRI and its ability to detect significant prostate cancer (SigPCa) in PCa patients enrolled in AS protocols. MATERIALS AND METHODS: There were 229 patients enrolled in an AS protocol between 2011 and 2020 at Reina Sofía University Hospital. MRI interpretation was based on PIRADS v.1 or v.2/2.1 classification. Demographics, clinical, and analytical data were collected and analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for mpMRI in different scenarios. We defined SigPCa and reclassification/progression as a Gleason score (GS) ≥ 3 + 4, a clinical stage ≥T2b, or an increase in PCa volume. Kaplan-Meier and log-rank tests were used to estimate progression-free survival time. RESULTS: Median age was 69.02 (±7.73) at diagnosis, with a 0.15 (±0.08) PSA density (PSAD). Eighty-six patients were reclassified after confirmatory biopsy, with a suspicious mpMRI an indication for a clear reclassification and risk-predictor factor in disease progression (p < 0.05). During follow-up, 46 patients were changed from AS to active treatment mainly due to disease progression. Ninety patients underwent ≥2mpMRI during follow-up, with a median follow-up of 29 (15-49) months. Thirty-four patients had a baseline suspicious mpMRI (at diagnostic or confirmatory biopsy): 14 patients with a PIRADS 3 and 20 patients with ≥PIRADS 4. From 14 patients with a PIRADS 3 baseline mpMRI, 29% progressed radiologically, with a 50% progression rate versus 10% (1/10 patients) for those with similar or decreased mpMRI risk. Of the 56 patients with a non-suspicious baseline mpMRI (PIRADS < 2), 14 patients (25%) had an increased degree of radiological suspicion, with a detection rate of SigPCa of 29%. The mpMRI NPV during follow-up was 0.91. CONCLUSION: A suspicious mpMRI increases the reclassification and disease progression risk during follow-up and plays an important role in monitoring biopsies. In addition, a high NPV at mpMRI follow-up can help to decrease the need to monitor biopsies during AS.

Consumo de opioides en la Comunidad de Madrid (España) entre 2004 y 2014 / Opioid consumption in the Community of Madrid (Spain) between 2004 and 2014

Antecedentes y objetivo: El consumo de opioides es un indicador adecuado de cómo se trata el dolor. En España apenas existen estudios de la evolución del consumo y de su utilización pormenorizada en los distintos ámbitos. Materiales y métodos: Estudio analítico, observacional, retrospectivo de las prescripciones realizadas en la Comunidad de Madrid (CM) en toda la atención primaria (AP) y la atención especializada (AE) entre 2004 y 2014 y de tres grandes hospitales, para determinar la influencia de los distintos servicios en su prescripción. Resultados: El consumo de opioides en la CM entre 2004 y 2014 aumentó más de tres veces (DHD 2004: 2,67; 2014: 8,10). El tramadol fue el opioide globalmente más prescrito (DHD 2014: 4,12). Entre los de tercer escalón, el más utilizado fue el fentanilo (DHD 2014: 1,23). En AP los opioides más prescritos de tercer escalón fueron el fentanilo (DHD 2014: 0,92), seguido de la buprenorfina (DHD 2014: 0,31), la oxicodona (DHD 2014: 0,20) y el tapentadol (DHD 2014: 0,14). En AE los opioides más prescritos fueron el fentanilo (DHD 2014: 0,05), la oxicodona (DHD 2014: 0,03) y el tapentadol (DHD 2014: 0,02). En ambos casos la morfina representaba un porcentaje muy reducido (DHD 2014: AP 0,12 y AE 0,02). Por último, el opioide más utilizado en los hospitales fue la morfina (DHD 2014: 0,38), seguido del fentanilo (DHD 2014: 0,27) y la oxicodona (DHD 2014: 0,04). Los equipos de cuidados paliativos, tanto domiciliarios como hospitalarios, mostraron un consumo mayoritario de morfina (40-50% del total) y de metadona (35% del total). Conclusiones: El consumo global de opioides en la CM se triplicó entre 2004 y 2014. El tramadol y el fentanilo fueron los más prescritos del segundo y tercer escalón analgésico, respectivamente. La morfina está teniendo un papel residual en la prescripción de opioides

Background and objectives: Opioid consumption is an appropriate indicator of pain treatment. In Spain, there are scarcely any studies on the evolution of the consumption of opioids and their detailed use in the various settings. Material and methods: We conducted an analytical, observational, retrospective study of prescriptions performed in the Community of Madrid in all primary care and specialized care centres and the three major hospitals between 2004 and 2014 to determine the influence of the various departments on the prescription of opioids. Results: Opioid consumption in Madrid between 2004 and 2014 increased more than 3-fold (2.67 vs. 8.10 defined daily doses/1000 inhabitants/day [DIDs] for 2004 and 2014, respectively).Tramadol was the most widely prescribed opioid (4.12 DIDs in 2014).Among the stepIII opioids, the most widely employed was fentanyl (1.23 DIDs in 2014). In primary care, the most prescribed stepIII opioids were fentanyl (0.92 DIDs in 2014), buprenorphine (0.31 DIDs in 2014), oxycodone (0.20 DIDs in 2014) and tapentadol (0.14 DIDs in 2014). In specialized care, the most prescribed opioids were fentanyl (0.05 DIDs in 2014), oxycodone (0.03 DIDs in 2014) and tapentadol (0.02 DIDs in 2014). In both cases, morphine represented a tiny percentage (0.12 primary care and 0.02 specialized care DIDs in 2014). Lastly, the most widely used opioid in the hospitals was morphine (0.38 DIDs in 2014), fentanyl (0.27 DIDs in 2014) and oxycodone (0.04 DIDs in 2014). For the palliative care teams (both home and hospital), the most consumed opioids were morphine (40-50% of the total) and methadone (35% of the total). Conclusions: The overall consumption of opioids in Madrid tripled between 2004 and 2014. Tramadol and fentanyl were the most prescribed of the stepII andIII analgesics, respectively. The role of morphine is diminishing in the prescription of opioids

Opioid consumption in the Community of Madrid (Spain) between 2004 and 2014. / Consumo de opioides en la Comunidad de Madrid (España) entre 2004 y 2014.

BACKGROUND AND OBJECTIVES: Opioid consumption is an appropriate indicator of pain treatment. In Spain, there are scarcely any studies on the evolution of the consumption of opioids and their detailed use in the various settings. MATERIAL AND METHODS: We conducted an analytical, observational, retrospective study of prescriptions performed in the Community of Madrid in all primary care and specialized care centres and the three major hospitals between 2004 and 2014 to determine the influence of the various departments on the prescription of opioids. RESULTS: Opioid consumption in Madrid between 2004 and 2014 increased more than 3-fold (2.67 vs. 8.10 defined daily doses/1000 inhabitants/day [DIDs] for 2004 and 2014, respectively).Tramadol was the most widely prescribed opioid (4.12 DIDs in 2014).Among the stepIII opioids, the most widely employed was fentanyl (1.23 DIDs in 2014). In primary care, the most prescribed stepIII opioids were fentanyl (0.92 DIDs in 2014), buprenorphine (0.31 DIDs in 2014), oxycodone (0.20 DIDs in 2014) and tapentadol (0.14 DIDs in 2014). In specialized care, the most prescribed opioids were fentanyl (0.05 DIDs in 2014), oxycodone (0.03 DIDs in 2014) and tapentadol (0.02 DIDs in 2014). In both cases, morphine represented a tiny percentage (0.12 primary care and 0.02 specialized care DIDs in 2014). Lastly, the most widely used opioid in the hospitals was morphine (0.38 DIDs in 2014), fentanyl (0.27 DIDs in 2014) and oxycodone (0.04 DIDs in 2014). For the palliative care teams (both home and hospital), the most consumed opioids were morphine (40-50% of the total) and methadone (35% of the total). CONCLUSIONS: The overall consumption of opioids in Madrid tripled between 2004 and 2014. Tramadol and fentanyl were the most prescribed of the stepII andIII analgesics, respectively. The role of morphine is diminishing in the prescription of opioids.

Evolución del consumo de opiáceos en dos áreas sanitarias de Atención Primaria de la Comunidad de Madrid (España) y sus hospitales de referencia entre los años 2002 y 2006 / Evolution of opiate use in two Primary Health Care areas in the Community of Madrid (Spain) and their referral hospitals between 2002 and 2006

Fundamento y objetivo. Describir la evolución de laprescripción de opiáceos desde 2002 a 2006 enlas áreas 2 y 5 de Atención Primaria de laComunidad de Madrid y sus hospitales de referencia(Hospitales Universitarios de la Princesa y la Paz).Material y método. Estudio observacionalretrospectivo de prescripciones realizadas medianteel cálculo de dosis por habitante y día.Resultados. En Atención Primaria, el opiáceo másprescrito del tercer escalón analgésico de laOrganización Mundial de la Salud es el fentanilotransdérmico (78,39% del total en 2006 en el área2 y 76,69% en el área 5), seguido por labuprenofina (12,30% y 13,23%) y la morfina(6,94% y 8,45%). En cuanto al segundo escalón, eltramadol es el opiáceo más prescrito con un85,12% y un 83,56% del consumo total.Observamos un crecimiento del consumo del tercerescalón desde una dosis por habitante y día 897,67en 2003 en el área 5 y 1.056,42 en el área 2, hasta1.490,15 y 1.601,48, respectivamente, en 2006 ydel segundo escalón desde 1.545,25 y 1.629,94 en2003 hasta 1.904,70 y 1.730,66 en ambas áreasen 2006. En los hospitales analizados se apreciauna progresión similar con un incremento gradualen la utilización del fentanilo y una tendencia a lareducción del consumo de morfina.Conclusiones. Nuestros datos reflejan el aumentodel consumo de opiáceos a pesar del descenso de lamorfina. Es destacable que el fentanilo transdérmicoes el mayor opiáceo prescrito

Background and objective. Describe the evolutionof prescription opioids from 2002 to 2006 inPrimary Health Care Area 2 and 5 in the MadridCommunity and its referral hospitals (UniversityHospitals of la Princesa and La Paz).Materials and methods. A retrospectiveobservational study of prescriptions made bycalculating defined daily doses per millioninhabitants.Results. In Primary Care, transdermal fentanyl(78.39% of the total in 2006 in area 2 and 76.69%in the area 5) is the opioid prescribed most on thethird step on the WHO analgesic ladder. This isfollowed by buprenofin (12.30% and 13.23%) andmorphine (6.94% and 8.45%). As for the secondstep, tramadol is the most prescribed opioid with85.12% and 83.56% of total consumption. We see agrowth in consumption in the third step that goesfrom a defined daily doses per one millioninhabitants of 897.67 in 2003 in area 5 and1056.42 in area 2 to 1490.15 and 1601.48,respectively in 2006 and the second step goes from1545.25 and 1629.94 in 2003 to 1904.70 and1730.66 in both areas in 2006. In the hospitalsanalyzed, there is a similar progression, with agradual increase in the use of fentanyl and a trendtowards reduction in the consumption of morphine.Conclusions. Our data reflect the increase inconsumption of opioids, despite declining morphine.It is noteworthy that transdermal fentanyl is theopioid prescribed most

[Evolution of opiate use in two Primary Health Care Areas in the community of Madrid (Spain) and their referral hospitals between 2002 and 2006]. / Evolución del consumo de opiáceos en dos áreas sanitarias de Atención Primaria de la Comunidad de Madrid (España) y sus hospitales de referencia entre los años 2002 y 2006.

BACKGROUND AND OBJECTIVE: Describe the evolution of prescription opioids from 2002 to 2006 in Primary Health Care Area 2 and 5 in the Madrid Community and its referral hospitals (University Hospitals of la Princesa and La Paz). MATERIALS AND METHODS: A retrospective observational study of prescriptions made by calculating defined daily doses per million inhabitants. RESULTS: In Primary Care, transdermal fentanyl (78.39% of the total in 2006 in area 2 and 76.69% in the area 5) is the opioid prescribed most on the third step on the WHO analgesic ladder. This is followed by buprenofin (12.30% and 13.23%) and morphine (6.94% and 8.45%). As for the second step, tramadol is the most prescribed opioid with 85.12% and 83.56% of total consumption. We see a growth in consumption in the third step that goes from a defined daily doses per one million inhabitants of 897.67 in 2003 in area 5 and 1056.42 in area 2 to 1490.15 and 1601.48, respectively in 2006 and the second step goes from 1545.25 and 1629.94 in 2003 to 1904.70 and 1730.66 in both areas in 2006. In the hospitals analyzed, there is a similar progression, with a gradual increase in the use of fentanyl and a trend towards reduction in the consumption of morphine. CONCLUSIONS: Our data reflect the increase in consumption of opioids, despite declining morphine. It is noteworthy that transdermal fentanyl is the opioid prescribed most.

Síndrome constitucional, fiebre y dolor en flanco izquierdo en mujer de 41 años / 41-year-old female with constitutional syndrome, fever, and pain in left flank

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Adenoma hepático en relación con la toma de anticonceptivos orales / Hepatic adenoma related to taking oral contraceptives

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Pielonefritis xantogranulomatosa tras sospecha de cáncer de colon / Xanthogranulomatous pyelonephritis mimicking colonic cancer

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