Validación del índice de salud prostática en un modelo predictivo de cáncer de próstata / Validation of the prostate health index in a predictive model of prostate cancer

Objetivos: Validar y analizar la utilidad clínica de un modelo predictivo de cáncer de próstata que incorpora el biomarcador «[-2] proantígeno prostático específico» a través del índice de salud prostática (PHI) en la toma de decisión para realizar una biopsia de próstata. Material y métodos: Se aisló suero de 197 varones con indicación de biopsia de próstata para la determinación del antígeno prostático específico total (tPSA), fracción libre de PSA (fPSA) y [-2] proPSA (p2PSA); el PHI se calculó como p2PSA/fPSA × √tPSA. Se crearon 2 modelos predictivos que incorporaban variables clínicas junto a tPSA o a PHI. Se evaluó el rendimiento de PHI usando análisis de discriminación mediante curvas ROC, calibración interna y curvas de decisión. Resultados: Las áreas bajo la curva para el modelo tPSA y el modelo PHI fueron de 0,71 y 0,85, respectivamente. PHI mostró mejor capacidad de discriminación y mejor calibración para predecir cáncer de próstata, pero no para predecir un grado de Gleason en la biopsia ≥7. Las curvas de decisión mostraron un beneficio neto superior del modelo PHI para el diagnóstico de cáncer de próstata cuando el umbral de probabilidad está entre 15 y 35% y un mayor ahorro (20%) en el número de biopsias. Conclusiones: La incorporación de p2PSA a través de PHI a los modelos predictivos de cáncer de próstata mejora la exactitud en la estratificación del riesgo y ayuda en la toma de decisión sobre realizar una biopsia de próstata

Objectives: To validate and analyse the clinical usefulness of a predictive model of prostate cancer that incorporates the biomarker «[-2] pro prostate-specific antigen» using the prostate health index (PHI) in decision making for performing prostate biopsies. Material and methods: We isolated serum from 197 men with an indication for prostate biopsy to determine the total prostate-specific antigen (tPSA), the free PSA fraction (fPSA) and the [-2] proPSA (p2PSA). The PHI was calculated as p2PSA/fPSA × √tPSA. We created 2 predictive models that incorporated clinical variables along with tPSA or PHI. The performance of PHI was assessed with a discriminant analysis using receiver operating characteristic curves, internal calibration and decision curves. Results: The areas under the curve for the tPSA and PHI models were 0.71 and 0.85, respectively. The PHI model showed a better ability to discriminate and better calibration for predicting prostate cancer but not for predicting a Gleason score in the biopsy ≥7. The decision curves showed a greater net benefit with the PHI model for diagnosing prostate cancer when the probability threshold was 15-35% and greater savings (20%) in the number of biopsies. Conclusions: The incorporation of p2PSA through PHI in predictive models of prostate cancer improves the accuracy of the risk stratification and helps in the decision-making process for performing prostate biopsies

Validation of the prostate health index in a predictive model of prostate cancer. / Validación del índice de salud prostática en un modelo predictivo de cáncer de próstata.

OBJECTIVES: To validate and analyse the clinical usefulness of a predictive model of prostate cancer that incorporates the biomarker «[-2] pro prostate-specific antigen¼ using the prostate health index (PHI) in decision making for performing prostate biopsies. MATERIAL AND METHODS: We isolated serum from 197 men with an indication for prostate biopsy to determine the total prostate-specific antigen (tPSA), the free PSA fraction (fPSA) and the [-2] proPSA (p2PSA). The PHI was calculated as p2PSA/fPSA×√tPSA. We created 2 predictive models that incorporated clinical variables along with tPSA or PHI. The performance of PHI was assessed with a discriminant analysis using receiver operating characteristic curves, internal calibration and decision curves. RESULTS: The areas under the curve for the tPSA and PHI models were 0.71 and 0.85, respectively. The PHI model showed a better ability to discriminate and better calibration for predicting prostate cancer but not for predicting a Gleason score in the biopsy ≥7. The decision curves showed a greater net benefit with the PHI model for diagnosing prostate cancer when the probability threshold was 15-35% and greater savings (20%) in the number of biopsies. CONCLUSIONS: The incorporation of p2PSA through PHI in predictive models of prostate cancer improves the accuracy of the risk stratification and helps in the decision-making process for performing prostate biopsies.

Asociación entre síndrome metabólico y cáncer de próstata: efecto sobre su agresividad y progresión / The association between metabolic syndrome and prostate cancer: Effect on its aggressiveness and progression

Objetivos: Evaluar el impacto del síndrome metabólico y de sus componentes individuales en los hallazgos en la biopsia de próstata, la pieza de prostatectomía radical y en la recidiva bioquímica. Material y métodos: Estudio observacional de 1.319 varones sometidos a biopsia de próstata entre enero de 2007 y diciembre de 2011. El impacto en los hallazgos en la biopsia, en la pieza de prostatectomía radical y en la recidiva bioquímica se ha evaluado mediante regresión logística y regresión de Cox. Resultados: De los 1.319 pacientes 275 (21%) presentaban Síndrome metabólico y se diagnosticaron 517 cánceres de próstata. Se encontró un mayor porcentaje de síndrome metabólico entre pacientes con cáncer de próstata que entre pacientes sin cáncer de próstata (25% frente a 18%; p = 0,002). Se encontraron peores hallazgos en la pieza de prostatectomía radical (grado de Gleason ≥ 7, p < 0,001; estadio ≥ T2c, p < 0,001; márgenes quirúrgicos positivos, p < 0,001) y un mayor porcentaje de recidivas bioquímicas en pacientes con síndrome metabólico que sin síndrome metabólico (24% frente a 13%; p = 0,003). El síndrome metabólico se comportó como factor predictivo independiente de encontrar un grado de Gleason de la pieza ≥ 7, así como de encontrar un estadio de la pieza ≥ T2c, y fue capaz de predecir de forma independiente una mayor tasa de recidivas bioquímicas (p < 0,001, OR: 3,6; p < 0,001 OR: 3,2; p = 0,03 HR: 1,7, respectivamente). Conclusiones: El síndrome metabólico se asocia a peores hallazgos en la pieza de prostatectomía radical y es un factor pronóstico independiente de recidiva bioquímica

Objectives: To evaluate the impact of metabolic syndrome and its individual components on prostate biopsy findings, the radical prostatectomy specimen and on biochemical recurrence. Material and methods: An observational study was conducted of 1319 men who underwent prostate biopsy between January 2007 and December 2011. The impact on the biopsy findings, the radical prostatectomy specimen and biochemical recurrence was evaluated using logistic regression and Cox regression.Results: Of the 1319 patients, 275 (21%) had metabolic syndrome, and 517 prostate cancers were diagnosed. A greater percentage of metabolic syndrome was found among patients with prostate cancer than among patients without prostate cancer (25% vs. 18%; P = .002). Poorer results were found in the radical prostatectomy specimens (Gleason score ≥ 7, P < .001; stage ≥ T2c, P < .001; positive surgical margins, P < .001), and there was a greater percentage of biochemical recurrence in patients with metabolic syndrome than in those without metabolic syndrome (24% vs. 13%; P = .003). Metabolic syndrome behaved as an independent predictive factor of finding a Gleason score ≥ 7 for the specimen, as well as for finding a specimen stage ≥ T2c. Metabolic syndrome was also able to independently predict a greater rate of biochemical recurrence (OR: 3.6, P < .001; OR: 3.2, P = .03; HR: 1.7; respectively). Conclusions: Metabolic syndrome is associated with poorer findings in the radical prostatectomy specimens and is an independent prognostic factor of biochemical recurrence

Evolución de las características del paciente candidato a prostatectomía radical y de los resultados obtenidos con la técnica / Evolution of the patient characteristics of candidates for radical prostatectomy and the results obtained with the technique

Objetivos: Evaluar el perfil oncológico y el riesgo de recidiva bioquímica de pacientes con cáncer de próstata sometidos a prostatectomía radical en función del periodo en el que fueron intervenidos. Evaluar las diferencias en el PSA al diagnóstico de los pacientes con o sin recidiva bioquímica en función de dichos periodos. Material y métodos: Diseño observacional hacia delante de una cohorte de 972 prostatectomías radicales realizadas en 3 periodos (1994-2000, 2001-2006, 2007-2011). La importancia del PSA al diagnóstico en los periodos y en la recidiva bioquímica se evaluó mediante modelo lineal generalizado. El comportamiento predictivo independiente de recidiva bioquímica se analizó mediante regresión de Cox. Resultados: La mediana de seguimiento fue de 38 (16-76) meses. El PSA diagnóstico fue más alto en el periodo 1994-2000 (12,97 ng/ml, p < 0,001). Un 72% de los pacientes del periodo 2007-2011 frente al 55% de los del periodo 1994-2000 se diagnosticaron con estadio clínico T1c (p < 0,001). El porcentaje de extensión extracapsular en la pieza disminuyó del 27 al 18% del periodo 1994-2000 al periodo 2007-2011 (p < 0,001). El porcentaje de pacientes con recidiva bioquímica pasó del 38 al 14% del primer al tercer periodo (p > 0,001). La diferencia entre el PSA al diagnóstico de los pacientes con o sin recidiva bioquímica fue independiente del periodo (p = 0,84). El periodo en que se realiza la cirugía no es un factor predictivo independiente de recidiva bioquímica (p = 0,09). Conclusiones: Los pacientes del periodo 2007-2011 presentan menos enfermedad extracapsular en la prostatectomía radical. El periodo no es un factor predictivo independiente de recidiva bioquímica

Objectives: To evaluate the oncological profile and risk of biochemical recurrence of patients with prostate cancer who underwent radical prostatectomy based on the time period in which the patients were operated. To evaluate the differences in prostate-specific antigen (PSA) at diagnosis of patients with or without biochemical recurrence based on these time periods. Material and methods: Observation carried forward study of a cohort of 972 radical prostatectomies performed during 3 time periods (1994-2000, 2001-2006, 2007-2011). The importance of PSA at diagnosis on the time periods and on biochemical recurrence was assessed using a generalized linear model. The independent predictive behavior of biochemical recurrence was analyzed using Cox regression. Results: The median follow-up was 38 (16-76) months. PSA levels at diagnosis were higher in the period 1994-2000 (12.97 ng/mL, P < .001). Seventy-two percent of the patients from the period 2007-2011 were diagnosed as clinical stage T1c (P < .001), compared with 55% from the period 1994-2000. The percentage of extracapsular extension in the specimen decreased from 27% to 18% from the period 1994-2000 to the period 2007-2011 (p<.001). The percentage of patients with biochemical recurrence went from 38% to 14% from the first to the third period (P > .001). The difference between PSA levels at diagnosis for the patients with or without biochemical recurrence was independent of the period (P = .84). The period during which surgery was performed was not an independent predictive factor for biochemical recurrence (P = .09). Conclusions: Patients from the 2007-2011 period had less extracapsular disease in the radical prostatectomy. The period was not an independent predictive factor for biochemical recurrence

Evolution of the patient characteristics of candidates for radical prostatectomy and the results obtained with the technique.

OBJECTIVES: To evaluate the oncological profile and risk of biochemical recurrence of patients with prostate cancer who underwent radical prostatectomy based on the time period in which the patients were operated. To evaluate the differences in prostate-specific antigen (PSA) at diagnosis of patients with or without biochemical recurrence based on these time periods. MATERIAL AND METHODS: Observation carried forward study of a cohort of 972 radical prostatectomies performed during 3 time periods (1994-2000, 2001-2006, 2007-2011). The importance of PSA at diagnosis on the time periods and on biochemical recurrence was assessed using a generalized linear model. The independent predictive behavior of biochemical recurrence was analyzed using Cox regression. RESULTS: The median follow-up was 38 (16-76) months. PSA levels at diagnosis were higher in the period 1994-2000 (12.97ng/mL, P<.001). Seventy-two percent of the patients from the period 2007-2011 were diagnosed as clinical stage T1c (P<.001), compared with 55% from the period 1994-2000. The percentage of extracapsular extension in the specimen decreased from 27% to 18% from the period 1994-2000 to the period 2007-2011 (p<.001). The percentage of patients with biochemical recurrence went from 38% to 14% from the first to the third period (P>.001). The difference between PSA levels at diagnosis for the patients with or without biochemical recurrence was independent of the period (P=.84). The period during which surgery was performed was not an independent predictive factor for biochemical recurrence (P=.09). CONCLUSIONS: Patients from the 2007-2011 period had less extracapsular disease in the radical prostatectomy. The period was not an independent predictive factor for biochemical recurrence.

The association between metabolic syndrome and prostate cancer: Effect on its aggressiveness and progression.

OBJECTIVES: To evaluate the impact of metabolic syndrome and its individual components on prostate biopsy findings, the radical prostatectomy specimen and on biochemical recurrence. MATERIAL AND METHODS: An observational study was conducted of 1319 men who underwent prostate biopsy between January 2007 and December 2011. The impact on the biopsy findings, the radical prostatectomy specimen and biochemical recurrence was evaluated using logistic regression and Cox regression. RESULTS: Of the 1319 patients, 275 (21%) had metabolic syndrome, and 517 prostate cancers were diagnosed. A greater percentage of metabolic syndrome was found among patients with prostate cancer than among patients without prostate cancer (25% vs. 18%; P=.002). Poorer results were found in the radical prostatectomy specimens (Gleason score ≥ 7, P<.001; stage ≥ T2c, P<.001; positive surgical margins, P<.001), and there was a greater percentage of biochemical recurrence in patients with metabolic syndrome than in those without metabolic syndrome (24% vs. 13%; P=.003). Metabolic syndrome behaved as an independent predictive factor of finding a Gleason score ≥ 7 for the specimen, as well as for finding a specimen stage ≥ T2c. Metabolic syndrome was also able to independently predict a greater rate of biochemical recurrence (OR: 3.6, P<.001; OR: 3.2, P=.03; HR: 1.7; respectively). CONCLUSIONS: Metabolic syndrome is associated with poorer findings in the radical prostatectomy specimens and is an independent prognostic factor of biochemical recurrence.

[Staphylococcus aureus prostatic abscess and subdural empyema: a case report]. / Absceso prostático por Staphilococo aureus y empiema subdural: presentación de un caso.

INTRODUCTION AND OBJECTIVES: To report one case of prostatic abscess and subdural empyema by Staphylococcus aureus. METHODS: We describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physical exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confirmation methods. RESULTS: The clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversion. CONCLUSIONS: Prostatic abscess is an uncommon entity nowadays. Provided the great variety of symptoms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggressive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy.

Absceso prostático por Sthapilococo aureus y empiema subdural: presentación de un caso / Staphylococcus aureus prostatic abscess and subdural empyema: a case report

Introducción y objetivo: Presentamos el caso de un paciente con absceso prostático y empiema subdural por Staphilococo aureus. Material y método: Descripción de un caso de un paciente de 51 años de edad diagnosticado de absceso prostático y empiema subdural por Staphilococo aureus. Utilizamos como método de aproximación diagnóstica la sospecha clínica y la exploración física mediante tacto rectal. Como métodos de confirmación diagnóstica, pruebas de imagen, como la tomografía axial computerizada y la ecografía transrectal, que permite además el drenaje del material purulento. Resultados: El cuadro se resolvió con ecografía transrectal y punción-drenaje de la colección y con tratamiento conservador en base a antibioterapia y derivación urinaria. Conclusiones: El absceso prostático es en la actualidad una patología poco frecuente. Dada la gran variedad de presentación de esta entidad, hay que tener un alto grado de sospecha para su diagnóstico y una vez realizado comenzar un tratamiento inmediato agresivo. La ecografía transrectal permite, no sólo el diagnóstico, sino también la punción-drenaje del contenido purulento. El cultivo de las muestras obtenidas identifica el agente causante y la antibioterapia más adecuada

Introduction and objectives: To report one case of prostatic abscess and subdural empyema by Staphylococcus aureus. Methods: We describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physical exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confirmation methods. Results: The clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversion. Conclusions: Prostatic abscess is an uncommon entity nowadays. Provided the great variety of symptoms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggressive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy

[Primary adenocarcinoma of the urinary bladder: our experience]. / Adenocarcinoma vesical primario: nuestra experiencia.

Adenocarcinoma of the bladder is an uncommon neoplasm. Depending on its origin it is classified in: primary, secondary and urachal. Generally it grows to the density of the wall, so its clinical appearence is delayed, with the subsequent delayed diagnosis and although an agressive treatment is performed, it frequently has a very bad prognosis. Since there are very few publications of this kind of neoplasm in the literature the lines of actuation in this pathology are not well established. We report the eleven cases of adenocarcinoma neoplasm of the bladder treated in our centre and review the literature.

Adenocarcinoma vesical primario: nuestra experiencia / Primary adenocarcinoma of the urinary bladder: our experience

El adenocarcinoma vesical es un tumor infrecuente. Se clasifica según su origen en: primario, secundario y uracales. Generalmente se caracteriza por crecer hacia el espesor de la pared provocando manifestaciones clínicas tardías, esto demora el diagnóstico y así, pese a tratamiento agresivo, suele tener muy mal pronóstico. Existen pocas series amplias publicadas por lo que no están establecidas claras pautas de actuación con este tipo de tumores. Presentamos los once casos de adenocarcinoma vesical primario en nuestro centro entre el año 1986 y el 2003 y revisamos la bibliografía (AU)

Adenocarcinoma of the bladder is an uncommon neoplasm. Depending on its origin it is classified in: primary, secondary and urachal. Generally it grows to the density of the wall, so its clinical aparienceis delayed, with the subsequent delayed diagnosis and although an agressive treatment is performed, it frequently has a very bad prognosis. Since there are very few publications of this kind of neoplasm in the literature the lines of actuation in this pathology are not well established. We report the eleven cases of adenocarcinoma neoplasm of the bladder treated in our centre and review the literature (AU)