Outcomes of salvage radical prostatectomy after initial irreversible electroporation treatment for recurrent prostate cancer.

OBJECTIVE: To evaluate: (i) safety, (ii) feasibility, and medium-term (iii) oncological and (iv) functional outcomes of salvage radical prostatectomy (sRP) for recurrent localised prostate cancer (PCa) following initial focal therapy using irreversible electroporation (IRE). PATIENTS AND METHODS: An international, multicentre and retrospective analysis of prospectively collected data of patients that underwent sRP for recurrent localised PCa after initial primary IRE treatment. Data were reported on (i) surgical complications, (ii) feasibility of sRP reported by surgeons, (iii) time interval between IRE and sRP and pathology results, and (iv) urinary continence, erectile function, and quality of life. RESULTS: In four participating centres, a total of 39 patients with a median (interquartile range [IQR]) age 64 (60-67) years were identified. No serious adverse events occurred during or following sRP and surgery was deemed feasible without difficulties. The median (IQR) time to recurrence following IRE was 14.3 (9.1-38.8) months. Pathology results showed localised disease in 21 patients (53.8%) and locally-advanced disease in 18 (46.2%). Positive surgical margins (PSMs) were observed in 10 patients (25.6%), of which six (15.4%) had significant PSMs. A persistent detectable prostate-specific antigen level was found in one case after sRP, caused by metastatic disease. One patient had a biochemical recurrence 6 months after sRP. These two cases, together with a PSM case, required additional therapy after sRP. After a median (IQR) follow-up of 17.7 (11.8-26.4) months, urinary continence and erectile function were preserved in 34 (94.4%) and 18 patients (52.9%), respectively, while quality of life remained stable. CONCLUSIONS: Salvage RP is safe and feasible for patients with recurrent localised PCa following initial IRE treatment. The medium-term oncological and functional outcomes are similar to primary RP. Strict patient selection for focal therapy and standardised follow-up is needed as some patients developed high-grade disease.

Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice.

Prostate cancer (PCa) is the most commonly diagnosed cancer in men. The diagnosis is currently based on PSA levels, which are associated with overdiagnosis and overtreatment. Moreover, most PCas are localized tumours; hence, many patients with low-/very low-risk PCa could benefit from active surveillance (AS) programs instead of more aggressive, active treatments. Heterogeneity within inclusion criteria and follow-up strategies are the main controversial issues that AS presently faces. Many biomarkers are currently under investigation in this setting; however, none has yet demonstrated enough diagnostic ability as an independent predictor of pathological or clinical progression. This work aims to review the currently available literature on tissue, blood and urine biomarkers validated in clinical practice for the management of AS patients.

Ablation energies for focal treatment of prostate cancer.

CONTEXT: In recent years, focal therapy has emerged as a treatment option for a selected group of men with localized prostate cancer. Cryotherapy and high-intensity focused ultrasound (HIFU) are the most investigated types of focal treatment with other options currently under evaluation. OBJECTIVE: The objective of the study was to give a comprehensive overview of six available focal treatment options for prostate cancer with their rationale, delivery mechanism, and outcomes. INFORMATION ACQUISITION: The SIU ICUD chapter on available Energies to Treat Prostate Cancer was used as a guide to describe the different technologies. For outcomes, a literature search was conducted using PubMed key words including focal therapy, HIFU, cryotherapy, irreversible electroporation, vascular-targeted photodynamic therapy, laser interstitial therapy, radiofrequency ablation, microwave therapy, and their synonyms in MeSH terms. CONCLUSION: Focal therapy appears to have encouraging outcomes on quality of life and urinary and erectile function. For oncological outcomes, it is challenging to fully interpret the outcomes due to heterogeneity in patient selection and short-term follow-up.

Unlocking the Potential of Adequate Bacillus Calmette-Guérin Immunotherapy in Very-high-risk Non-muscle-invasive Bladder Carcinoma: A Multicenter Analysis of Oncological Outcomes and Risk Dynamics.

BACKGROUND: The European Association of Urology (EAU) recommends discussing upfront radical cystectomy for all patients with very high risk (VHR) non-muscle-invasive bladder carcinoma (NMIBC), but the role of bacillus Calmette-Guérin (BCG) treatment remains controversial. OBJECTIVE: To analyze oncological outcomes in VHR NMIBC patients (EAU risk groups) treated with adequate BCG. DESIGN, SETTING, AND PARTICIPANTS: A multi-institutional retrospective study involving patients with VHR NMIBC who received adequate BCG therapy from 2007 to 2020 was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A survival analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), and the cumulative incidence of cancer-specific mortality (CSM) after accounting for other causes of mortality as competing risk events and of the overall mortality (OM). Conditional survival probabilities for 0-4 yr without events were computed. Cox regression assessed the predictors of oncological outcomes. RESULTS AND LIMITATION: A total of 640 patients, with a median 47 (32-67) mo follow-up for event-free individuals, were analyzed. High-grade RFS and PFS at 5 yr were 53% (49-57%) and 78% (74-82%), respectively. The cumulative incidence of CSM and OM at 5 yr was 13% (10-16%) and 16% (13-19%), respectively. Conditional RFS, PFS, overall survival, and cancer-specific survival at 4 yr were 91%, 96%, 87%, and 94%, respectively. Cox regression identified tumor grade (hazard ratio [HR]: 1.54; 1.1-2) and size (HR: 1.3; 1.1-1.7) as RFS predictors. Tumor multiplicity predicted RFS (HR: 1.6; 1.3-2), PFS (HR: 2; 1.2-3.3), and CSM (HR: 2; 1.2-3.2), while age predicted OM (HR: 1.48; 1.1-2). CONCLUSIONS: Patients with VHR NMIBC who receive adequate BCG therapy have a more favorable prognosis than predicted by EAU risk groups, especially among those with a sustained response, in whom continuing maintenance therapy emerges as a viable alternative to radical cystectomy. PATIENT SUMMARY: Our research shows that a sustained response to bacillus Calmette-Guérin in patients can lead to favorable outcomes, serving as a viable alternative to cystectomy for select cases.

[Muscle invasive bladder cancer and bladder preservation protocols. Where are we?] / Cáncer vesical músculo invasivo y preservación vesical ¿dónde estamos?

Radical cystectomy remains as gold standard for treatment of muscle-invasive bladder cancer. Radical cystectomy has a high morbidity and mortalityas sociated even with the new anesthetic and surgical techniques. Some patients are still not candidates for this major surgery. Besides, some patients reject radical cystectomy. Bladder preservation strategies were develop aiming to decrease morbidity and mortality related to major surgery. Bladder preservation allow for improved quality of life and similar oncologic control rates. Radical cystectomy remains as gold standard for treatment of muscle-invasive bladder cancer. Radical cystectomy has a high morbidity and mortality associated even with the new anesthetic and surgical techniques. Some patients are still not candidates for this major surgery. Besides, some patients reject radical cystectomy. Bladder preservation strategies were develop aiming to decrease morbidity and mortality related to major surgery. Bladder preservation allow for improved quality of life and similar oncologic control rates.Bladder preservation has historically been used in 2clinical scenarios: 1) Patients unable to under go a radicalcystectomy due to comorbidities o patients that rejectradical cystectomy, and 2) patients that are offeredbladder preservation strategies with and oncologicalsafety and curative intent.This is the real scenario for bladder preservation, thefirst scenario belongs to palliation, not cure.In the current manuscript, we will review the bladderpreservation strategies for muscle invasive bladdercancer, specially focusing on trimodal therapy (recommendedby international guidelines) and tetramodaltherapy.

Mientras que la cistectomía radical continúa siendo el tratamiento estándar en el carcinoma urotelial músculo infiltrante (CVMI) y así está refrendada por todas las guías clínicas internacionales, esta cirugía conlleva una importante morbilidad y mortalidad, así pues, y pese a las mejoras en la técnica quirúrgica, anestésica y la optimización perioperatoria, esta cirugía aún no es posible en todos los pacientes. A esta limitación obvia, hay que añadir pacientes que, por cualquier motivo, rechazan la cistectomía. Por todo ello, y como ocurre en otros cánceres, debemos desarrollar estrategias de preservación vesical, encaminadas a disminuir la morbi-mortalidad de la cirugía radical. Estrategias que permitan una mejor calidad de vida, con un menor impacto en la esfera funcional, al tiempo que permiten un control oncológico seguro para el paciente. Tradicionalmente, la preservación vesical se ha aplicado en dos contextos clínicos bien distintos: 1) Pacientes no candidatos a CR por su comorbilidad o porque rechazaran la cirugía y 2) Pacientes a los que, siendo subsidiarios de cirugía radical, se les ofrece una estrategia de preservación vesical, como una alternativa oncológicamente segura y con intención curativa. Es este último, el contexto en el que debemos entender la preservación vesical, lo contrario es un mero ejercicio de paliación. En este artículo, revisaremos las distintas estrategias de preservación en el CVMI, centrándonos en las series más actuales, en particular, la terapia trimodal (TMT), recomendada por las guías internacionales y, la prometedora terapia tetramodal.

Ex-vivo confocal fluorescence microscopy for rapid evaluation of renal core biopsy.

Small renal mass incidentally diagnosed are common findings nowadays due to the widespread of imaging. Renal mass biopsy is still underutilized by urologists due to its non-diagnostic rates. Confocal microscopy allows for rapid imaging of fresh tissue samples. We report the feasibility of using confocal technology for determining the quality of the renal core at renal mass biopsy on 4 consecutive cases at our institution.

[ICG lymphography and fluorescence in pelvic lymphadenectomy for bladder and prostate cancer.] / Linfografía con ICG y fluorescencia en la linfadenectomía pélvica por cáncer vesical y prostático.

OBJECTIVE: ICG navigation in cancer surgery may help during pelvic lymphadenectomy. METHODS: We performed a systematic review combining the terms: bladder cancer or radical cystectomy and ICG, and prostate cancer or radical prostatectomy and ICG. We used the PRISMA guidelines recommendations. We describe the populations studied in each work, the pathological results, as well as the parameters specificity, sensitivity and predictive values. RESULTS: In muscle-invasive bladder cancer, 4 case series analyzed the performance of lymphography with ICG. The most accepted injection method is under endoscopic vision. Several punctures are done in the submucosa and the detrusor surrounding the scar. Sentinel nodes were found in up to 92% of patients with a technique sensitivity to find metastases of 88% in the series with largest casuistry. In prostate cancer, we collected data from 11 case series. Nine of them apply transrectal or transperineal dilution immediately before surgery. Sensitivity in the detection of all adenopathies ranged between 44% and 100%. The sensitivity of the technique to know the lymph node stage ranges between 67% and 100%. CONCLUSIONS: There is little experience of ICG-guided lymph node dissedction in bladder tumors. Endoscopic fluorophore injection allows us to find the nodes that drain the infiltrated area. However, the use of this technique is not widespread. In prostate cancer, it is a reproducible and efficient technique for staging patients with prostate cancer.

OBJETIVO: La principal aplicación del ICG en cirugía oncológica es la navegación intraoperatoria durante la linfadenectomía. Revisamos la literatura para conocer el uso de ICG durante la linfadenectomía pélvica en el cáncer de próstata y cáncer de vejiga.MATERIAL Y MÉTODO: Hacemos una revisión sistemática con los términos cáncer de vejiga o cistectomía radical, cáncer de próstata o prostatectomía radical. Utilizamos las recomendaciones de las guías PRISMA. Describimos las poblaciones a estudio en cada trabajo, los resultados patológicos así como los parámetros sensibilidad especificidad y valores predictivos. RESULTADOS: En tumor vesical musculo invasivo 4 series de casos analizan el rendimiento de la linfografia con ICG. El método de inyección más aceptado es la inyección de la dilución -bajo visión endoscópica- en la submucosa y en el detrusor, peri tumoral o pericicatrical. Se encontraron ganglios centinela hasta en el 92% de los pacientes con una sensibilidad de la técnica para encontrar las metástasis del 88% en la serie de mayor casuística. En cáncer de próstata recopilamos datos de 11 series. De entre ellas 9 aplican la dilución vía transrectal o transperineal inmediatamente antes de la cirugía. La sensibilidad en la detección de todas las adenopatías oscila entre el 44 y el 100%. En cuanto la sensibilidad de la técnica para conocer el estadio ganglionar oscila entre el 67% y el 100%. CONCLUSIONES: Existe poca experiencia de la linfadenectomía guiada por ICG en tumor de vejiga. La inyección endoscópica del fluoróforo permite encontrar los ganglios que drenan el área infiltrada, sin embargo no se populariza el uso de esta técnica. El cáncer de próstata es una técnica reproducible y eficiente para estadiar a los pacientes con cáncer de próstata.

Oncological Outcomes of Laparoscopic Nephroureterectomy Versus Open Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: An European Association of Urology Guidelines Systematic Review.

CONTEXT: Most series have suggested better perioperative outcomes of laparoscopic radical nephroureterectomy (RNU) over open RNU. However, the oncological safety of laparoscopic RNU remains controversial. OBJECTIVE: To systematically review all relevant literature comparing oncological outcomes of open versus laparoscopic RNU. EVIDENCE ACQUISITION: A systematic literature search using the Medline, Embase, and Cochrane databases and clinicaltrial.gov was performed in December 2014 and updated in August 2016. Randomised controlled trials (RCTs) and prospective or retrospective nonrandomised comparative studies comparing the oncological outcomes of any laparoscopic RNU with those of open RNU were included. The primary outcome was cancer-specific survival. The risk of bias (RoB) was assessed using Cochrane RoB tools. A narrative synthesis of the evidence is presented. EVIDENCE SYNTHESIS: Overall, 42 studies were included, which accounted for 7554 patients: 4925 in the open groups and 2629 in the laparoscopic groups. Most included studies were retrospective comparative series. Only one RCT was found. RoB and confounding were high in most studies. No study compared the oncological outcomes of robotic RNU with those of open RNU. Bladder cuff excision in laparoscopic groups was performed via an open approach in most studies, with only three studies reporting laparoscopic removal of the bladder cuff. Port-site metastasis rates ranged from 0% to 2.8%. No significant difference in oncological outcomes was reported in most series. However, three studies, including the only RCT, reported significantly poorer oncological outcomes in patients who underwent laparoscopic RNU, especially in the subgroups of patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinoma (UTUC), as well as in instances when the bladder cuff was excised laparoscopically. CONCLUSIONS: The current available evidence suggests that the oncological outcomes of laparoscopic RNU may be poorer than those of open RNU when bladder cuff is excised laparoscopically and in patients with locally advanced high-risk (pT3/pT4 and/or high-grade) UTUC. PATIENT SUMMARY: We reviewed the literature comparing the outcomes of two different surgical procedures for the treatment of upper tract urothelial carcinoma. Open radical nephroureterectomy is a surgical procedure in which the kidney is removed through a large incision in the abdomen, while in laparoscopic radical nephroureterectomy, the kidney is removed through a number of small incisions. Our findings suggest that the outcomes of laparoscopic radical nephroureterectomy may be poorer than those of open radical nephroureterectomy, particularly when the bladder cuff is also required to be removed. Laparoscopic radical nephroureterectomy may also be less effective in patients with locally advanced (pT3/pT4) or high-grade upper tract urothelial carcinomas.

Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer.

CONTEXT: The oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial. OBJECTIVE: To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients. EVIDENCE ACQUISITION: Embase, Medline, and Cochrane databases were searched for all studies comparing outcomes of patients undergoing RNU without LND versus any form of LND. We identified nine retrospective studies eligible for inclusion in this systematic review. We took cancer-specific survival (CSS) as the primary end point, and performed a narrative review and risk of bias assessment. EVIDENCE SYNTHESIS: Six studies compared outcomes of no LND versus LND. Three studies compared complete LND versus incomplete LND versus no LND. The incidence of pN+ in patients with high-stage (≥pT2) tumours ranged from 14.3% to 40%. Pre- and postoperative characteristics differed among the study groups, potentially biasing the results, as demonstrated by the risk of bias assessment, potentially favouring the LND group. Oncological outcomes such as cancer-specific, overall, recurrence-free, and metastasis-free survival were reviewed, demonstrating a survival benefit with LND in high-stage disease of the renal pelvis. CONCLUSIONS: Template-based and complete LND improves CSS in patients with high-stage (≥pT2) UTUC and reduces the risk of local recurrence. The impact of LND in ureteral tumours remains uncertain. PATIENT SUMMARY: Studies comparing radical nephroureterectomy with or without the removal of nodes (lymph node dissection [LND]) were analysed. LND improves survival in patients with high-stage disease of the renal pelvis, if it is performed according to an anatomical template-based approach.

[Homogeneity of the European training program. The role of the European Board of Urology.] / Homogeneidad en el programa de formación europeo. El papel del European Board of Urology.

From its origins and acting through its specific committees, the E.B.U. has been dedicated to the improvement and standardization of urological training across Europe. Identifying minimal requirements for urology training, publishing a European Curriculum and defining basic rules for accreditation of educational activities, hence, offering a systematic assessment for the recognition of quality. Working through different dedicated committees, the E.B.U. oversees every aspect on the urological training in Europe. The Accreditation Committee sets standards for the accreditation of educational/scientific activities and ensures the proper evaluation of submissions for CME/ CPD accreditation. The Certification Committee oversees the appropriate implementation of the EBU Certification programme and ensures a thorough quality assessment process that aims to standardise urological training across Europe. Finally, the Examination Committee, that is structured into two sub-committees one for the In Service Assessment (I.S.A.) and the written F.E.B.U. examination (Part 1) and a second for the oral F.E.B.U. examination (Part 2). The committee works to ensure that all EBU examinations and associated assessment activities are thoroughly prepared and conducted in accordance with EBU's criteria.

[Immediate post TURBT MMC instillation.] / Instilación inmediata de MMC post-RTU vesical.

Mitomycin C is an antitumor alkylating antibiotic agent that inhibits DNA synthesis extensively used as intravesical chemotherapy agent in the adjuvant treatment of urothelial carcinoma. Its clinical efficacy is the context of single early postoperative instillation was demonstrated by Toley et al. in 1988. Since then, multiple clinical trials and 4 metanalyses have endorsed its use with level 1a evidence. The objective of this chapter is to perform a comprehensive updated review on the use of MMC in the context of single early instillation at the time of TURBT, the available clinical evidence, most relevant recommendations in the international clinical guidelines, its complications and potential maneuvers for the optimization of its use.

Cognitive Function in Patients With Prostate Cancer Receiving Luteinizing Hormone-Releasing Hormone Analogues: A Prospective, Observational, Multicenter Study.

PURPOSE: The effect of androgen deprivation therapy (ADT) on cognitive performance (CP) in prostate cancer (PCa) patients is not well understood. We evaluated changes in CP after 6 months of medical castration with luteinizing hormone-releasing hormone (LHRH) analogues. METHODS AND MATERIALS: We performed a prospective, observational, multicenter, open-label study of PCa patients scheduled to receive LHRH analogues for ≥6 months. We assessed 4 domains of CP at baseline and after 6 months of ADT: (1) working memory, assessed with the Wechsler Adult Intelligence Scale III (WAIS III) Digit Span subtest; (2) visual memory, assessed with an ad hoc visual memory test; (3) visuospatial ability, assessed with the Judgment of Line Orientation test and Mental Rotation of Three-Dimensional Objects test; and (4) nonverbal analytical reasoning, assessed with the WAIS III Matrix Reasoning test. Changes outside the baseline 95% confidence intervals were considered significant. RESULTS: A total of 308 patients completed the study. Of these, 245 (79.6%) experienced no statistically significant changes on any test whereas 63 (20.4%) experienced significant changes on ≥1 test. Most of these patients showed a change on only 1 test, distributed evenly between improvement (58 patients, 18.8%) and worsening (56 patients, 18.2%). For individual tests, most patients (87.8%-91.8%) had no change from baseline; however, the significant changes (improvement vs deterioration) were as follows: WAIS III Digit Span subtest (6.3% vs 5.9%), visual memory (5.3% vs 5.7%), Judgment of Line Orientation test (5.3% vs 4.5%), Mental Rotation of Three-Dimensional Objects test (4.1% vs 4.1%), and WAIS III Matrix Reasoning test (4.8% vs 5.8%). CONCLUSIONS: CP in patients with PCa does not appear to be adversely affected by 6 months of LHRH analogue administration.

Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel.

CONTEXT: There is uncertainty regarding the oncologic effectiveness of kidney-sparing surgery (KSS) compared with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). OBJECTIVE: To systematically review the current literature comparing oncologic outcomes of KSS versus RNU for UTUC. EVIDENCE ACQUISITION: A computerised bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting comparative oncologic outcomes of KSS versus RNU. Approaches considered for KSS were segmental ureterectomy (SU) and ureteroscopic (URS) or percutaneous (PC) management. Using the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we identified 22 nonrandomised comparative retrospective studies published between 1999 and 2015 that were eligible for inclusion in this systematic review. A narrative review and risk-of-bias (RoB) assessment were performed using cancer-specific survival (CSS) as the primary end point. EVIDENCE SYNTHESIS: Seven studies compared KSS overall (n=547) versus RNU (n=1376). Information on the comparison of SU (n=586) versus RNU (n=3692), URS (n=162) versus RNU (n=367), and PC (n=66) versus RNU (n=114) was available in 10, 5, and 2 studies, respectively. No significant difference was found between SU and RNU in terms of CSS or any other oncologic outcomes. Only patients with low-grade and noninvasive tumours experienced similar CSS after URS or PC when compared with RNU, despite an increased risk of local recurrence following endoscopic management of UTUC. The RoB assessment revealed, however, that the analyses were subject to a selection bias favouring KSS. CONCLUSIONS: Our systematic review suggests similar survival after KSS versus RNU only for low-grade and noninvasive UTUC when using URS or PC. However, selected patients with high-grade and invasive UTUC could safely benefit from SU when feasible. These results should be interpreted with caution due to the risk of selection bias. PATIENT SUMMARY: We reviewed the studies that compared kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma. We found similar oncologic outcomes for favourable tumours when using ureteroscopic or percutaneous management, whereas indications for segmental ureterectomy could be extended to selected cases of aggressive tumours.

Linfografía con ICG y fluorescencia en la linfadenectomía pélvica por cáncer vesical y prostático / ICG lymphography and fluorescence in pelvic lymphadenectomy for bladder and prostate cancer

Objetivo: La principal aplicación del ICG en cirugía oncológica es la navegación intraoperatoria durante la linfadenectomía. Revisamos la literatura para conocer el uso de ICG durante la linfadenectomía pélvica en el cáncer de próstata y cáncer de vejiga. Material y método: Hacemos una revisión sistemática con los términos cáncer de vejiga o cistectomía radical, cáncer de próstata o prostatectomía radical. Utilizamos las recomendaciones de las guías PRISMA. Describimos las poblaciones a estudio en cada trabajo, los resultados patológicos así como los parámetros sensibilidad especificidad y valores predictivos. Resultados: En tumor vesical musculo invasivo 4 series de casos analizan el rendimiento de la linfografia con ICG. El método de inyección más aceptado es la inyección de la dilución -bajo visión endoscópica- en la submucosa y en el detrusor, peri tumoral o pericicatrical. Se encontraron ganglios centinela hasta en el 92% de los pacientes con una sensibilidad de la técnica para encontrar las metástasis del 88% en la serie de mayor casuística. En cáncer de próstata recopilamos datos de 11 series. De entre ellas 9 aplican la dilución vía transrectal o transperineal inmediatamente antes de la cirugía. La sensibilidad en la detección de todas las adenopatías oscila entre el 44 y el 100%. En cuanto la sensibilidad de la técnica para conocer el estadio ganglionar oscila entre el 67% y el 100%. Conclusiones: Existe poca experiencia de la linfadenectomía guiada por ICG en tumor de vejiga. La inyección endoscópica del fluoróforo permite encontrar los ganglios que drenan el área infiltrada, sin embargo no se populariza el uso de esta técnica. El cáncer de próstata es una técnica reproducible y eficiente para estudiar a los pacientes con cáncer de próstata

Objective: ICG navigation in cancer surgery may help during pelvic lymphadenectomy. Methods: We performed a systematic review combining the terms: bladder cancer or radical cystectomy and ICG, and prostate cancer or radical prostatectomyand ICG. We used the PRISMA guidelines recommendations. We describe the populations studied in each work, the pathological results, as well as the parameters specificity, sensitivity and predictive values. Results: In muscle-invasive bladder cancer, 4 case series analyzed the performance of lymphography with ICG. The most accepted injection method is under endoscopic vision. Several punctures are done in the submucosa and the detrusor surrounding the scar. Sentinel nodes were found in up to 92% of patients with a technique sensitivity to find metastases of 88% in the series with largest casuistry. In prostate cancer, we collected data from 11 case series. Nine of them apply transrectal or transperineal dilution immediately before surgery. Sensitivity in the detection of all adenopathies ranged between 44% and 100%. The sensitivity of the technique to know the lymph node stage ranges between 67% and 100%. Conclusions: There is little experience of ICG-guided lymph node dissedction in bladder tumors. Endoscopic fluorophore injection allows us to find the nodes that drain the infiltrated area. However, the use of this technique is not widespread. In prostate cancer, it is a reproducible and efficient technique for staging patients with prostate cancer

Instilación inmediata de MMC POST-RTU vesical / Immediate post TURBT MMC instillation

La Mitomicina C es un agente antibiótico antitumoral alquilante que inhibe la síntesis de ADN ampliamente utilizado como agente quimioterápico intravesical en el tratamiento adyuvante del carcinoma urotelial. Su eficacia clínica en el contexto de la instilación única precoz perioperatoria fue demostrada por Tolley et al. En 1988. Desde entonces, múltiples ensayos clínicos y 4 meta-análisis han avalado su utilización con un nivel de evidencia 1a. El objetivo de este capítulo será la revisión meticulosa y actualizada del uso de la MMC en el contexto de la instilación única precoz al tiempo de la RTU vesical, la evidencia clínica disponible, las recomendaciones de las guías clínicas internacionales más relevantes, sus complicaciones y las potenciales maniobras de optimización de su uso

Mitomycin C is an antitumor alkylating antibiotic agent that inhibits DNA synthesis extensively used as intravesical chemotherapy agent in the adjuvant treatment of urothelial carcinoma. Its clinical efficacy is the context of single early postoperative instillation was demonstrated by Toley et al. in 1988. Since then, multiple clinical trials and 4 metanalyseshave endorsed its use with level 1a evidence. The objective of this chapter is to perform a comprehensive updated review on the use of MMC in the context of single early instillation at the time of TURBT, the available clinical evidence, most relevant recommendations in the international clinical guidelines, its complications andpotential maneuvers for the optimization of its use

Ablación Focal con Láser y Terapia Vascular Fotodinámica con TOOKAD® soluble, en el tratamiento del cáncer de próstata de bajo riesgo / Focal Laser Ablation and Photodynamic Vascular Therapy with soluble TOOKAD® in the treatment of low risk prostate cancer

El incremento en el diagnóstico de Cáncer de Próstata (CaP) de bajo riesgo se traducen una nueva entidad clínica, para la cual, la vigilancia activa puede no ser siempre suficiente y para la que las terapias convencionales suponen un claro sobre-tratamiento. Ante la necesidad de dar una respuesta terapéutica a estos pacientes, y facilitado por los avances tecnológicos en el campo de la imagen y nuevas fuentes de energía, el interés se centra ahora en el desarrollo clínico de las terapias focales, como una alternativa de mínima comorbilidad y oncológicamente segura. Como parte de la revisión llevada a cabo por este monográfico, este artículo se centrará en aspectos referentes al desarrollo pre-clínico y clínico de la terapia ablativa con láser y de la novedosa terapia vascular fotodinámica con TOOKAD® Soluble. Con esta finalidad, se realizó una exhaustiva búsqueda bibliográfica, actualizada en Febrero de 2016, de las mayores bases reprográficas, incluyendo publicaciones originales y revisiones referentes al objeto de esta revisión, sin restricciones por año de publicación. Este artículo revisa el desarrollo pre- y clínico de estas novedosas técnicas ablativas en el campo de la terapia focal del CaP de bajo riesgo

The increase of the diagnosis of low risk prostate cancer translates into a new clinical entity, for which active surveillance may not be always enough and conventional therapies are clearly overtreatment. Faced with the necessity of giving a therapeutic answer to these patients, and facilitated by the technological advances in the imaging field and new energy sources, the interest is centered in the clinical development of focal therapies as an alternative with minimal morbidity and oncologically safe. As a part of the review carried out in this monographic issue, this article focus on the features relative to the preclinical and clinical development of laser ablative therapy and the innovative photodynamic vascular therapy with soluble TOOKAD®. With this aim we performed an exhaustive bibliographic search, updated to February 2016, in the greater databases, including original articles and reviews in reference to the object of this review, without restrictions for year of publication. This article reviews the preclinical and clinical development of these innovative ablative techniques in the field of focal therapy for low risk prostate cáncer