Las biopsias de próstata dirigidas ¿están listas para reemplazar las biopsias de próstata sistemáticas? / Are targeted prostate biopsies ready to replace systematic prostate biopsies?

Objetivos: Evaluar la eficacia y la eficiencia de la biopsia prostática sistemática (BPS) y la biopsia de próstata por fusión cognitiva (BPFC) para diagnosticar el cáncer de próstata (CaP) y el CaP significativo (CaPs) y analizar si la BPFC podría reemplazar con seguridad a la BPS. Material y métodos: Una cohorte de 314 hombres consecutivos que tenían PI-RADS ≥2 en una biopsia previa 3T resonancia magnética multiparamétrica se sometieron prospectivamente a BPFC ecográfica transrectal (dos núcleos por área sospechosa hasta un máximo de tres áreas) y una BPS de 12 núcleos periféricos. Se consideró CaPs cuando el grado de la OMS fue superior a 2 (Gleason 4 + 3 o superior). Resultados: Se diagnosticó CaP en 133 pacientes (42,4%), de los que 83 (62,4%) fueron CaPs. La BPS detectó CaP en 114 hombres (85,7%) y BPFC en 103 (77,4%), p < 0,001. La BPS detectó CaPs en 64 hombres (77,1%) y BPFC en 71 (85,5%), p < 0,001. En 52 de los 81 hombres (64,2%) se detectó CaPs en BPS y BPFC. En 19 hombres solo se detectó CaPs en BPFC (23,5%), mientras que en 10 solo se detectó en BPS (12,3%). Se necesitaron 33,1 núcleos para diagnosticar un CaP en BPS y 8,5 en BPFC, p < 0,001. 58,9 núcleos fueron necesarios para diagnosticar un CaPs en BPS y 12,4 en BPFC, p < 0,001. Conclusiones: Las BPFC son más efectivas y también más eficientes que las BPS para detectar CaPs. Sin embargo, las BPFC aún no pueden reemplazar las BPS de manera segura porque no pueden detectar hasta el 15% de los CaPs

Objectives: To evaluate the efficacy and efficiency of systematic prostatic biopsy (SPB) and cognitive fusion PB (CFPB) to diagnose prostate cancer (PCa) and significant PCa (SPCa), and to analyse if CFPB could safely replace SPB. Material and methods: A cohort of 314 consecutive men having PI-RADS ≥ 2 in a pre-biopsy 3T mp-MRI were prospectively subjected to trans-rectal ultrasound CFPB (two cores per suspicious area until a maximum of three areas) and a 12 peripheral core SPB. SPCa was considered when the WHO grade was higher than 2 (Gleason 4+3 or higher). Results: PCa was diagnosed in 133 patients (42.4%), being 83 (62.4%) SPCa. SPB detected PCa in 114 men (85.7%) while CFPB in 103 (77.4%), P < .001. SPB detected SPCa in 64 men (77.1%) while CFPB in 71 (85.5%), P < .001. In 52 of the 81 men (64.2%) SPCa was detected in SPB and CFPB. In 19 men SPCa was only detected in CFPB (23.5%) while in 10, it was only detected in SPB (12.3%). 33.1 cores were needed to diagnose one PCa in SPB while 8.5 in CFPB, P < .001. 58.9 cores were needed to diagnose one SPCa in SPB, while 12.4 in CFPB, P < .001. Conclusions: CFPB are more effective and also more efficient than SPBs in detecting SPCa. However, CFPBs still can’t safely replace SPBs because they are not able to detect up to 15% of SPCa

Maternal morbidity after implementation of a postpartum hemorrhage protocol including use of misoprostol

Objective: To compare maternal morbidity before and after implementation of a postpartum hemorrhage (PPH) protocol that included misoprostol. Methods: A retrospective analysis was performed using data from 34 631 deliveries recorded at a Spanish hospital between January 1, 2007, and December 31, 2014. The PPH protocol was implemented in 2009 and included use of misoprostol and the Bakri balloon. Results: The pre-implementation and post-implementation groups comprised 9394 and 25 237 women, respectively. Women in the pre-implementation group tended to have lower hemoglobin levels than did those in the post-implementation group: 811 (8.6%) versus 1349 (5.3%) for levels less than 90 g/L, and 272 (2.9%) versus 497 (2.0%) for levels less than 80 g/L (both P<0.001). Implementation of the PPH protocol was also associated with a decrease in the frequency of postpartum hysterectomies owing to uterine atony (0.11 cases per 1000 deliveries vs 0.53 cases per 1000 deliveries for the pre-implementation group; P=0.063). Pregnancy length, maternal age, neonatal weight at delivery, multiple pregnancy, previous cesarean delivery, parity, operative vaginal delivery, induced labor, cesarean delivery, and not using the PPH protocol were found to predict postpartum anemia in the multivariate analysis (all P<0.001). Conclusion: Implementation of the PPH protocol decreased rates of postpartum anemia and postpartum hysterectomy owing to uterine atony. (AU)

Programa de monitorización de la vigilancia activa en cáncer de próstata en España de la Sociedad Española de Urología; resultados preliminares / Preliminary results of the Spanish Association of Urology National Registry in Active Surveillance for prostate cancer

Objetivos: Presentar un registro nacional de pacientes con cáncer de próstata seguidos mediante vigilancia activa, con la intención de testar la hipótesis de que la mortalidad cáncer específica en pacientes de muy bajo riesgo y riesgo bajo es menor del 5% a 15 años. Material y métodos: Estudio multicéntrico observacional (AEU-PIEM/2014/0001) promovido por la Asociación Española de Urología mediante su plataforma para estudios multicéntricos, en donde los criterios de inclusión clínico-patológicos son: cT1a-cT3a, PSA ≤ 20 ng/ml, biopsia (Bx) inicial mínima de 10 cilindros, número de cilindros afectos ≤ 3, Gleason 1.° = 3 y Gleason 2.° ≤ 4, y volumen prostático conocido (en cc). No se establece un seguimiento unificado para todos los centros reclutadores, y sí una encuesta en la que se reflejen las características del seguimiento en función de unos parámetros tangibles que permitan su comparabilidad. Con la misma filosofía de flexibilidad no se considera obligada la utilización de determinados biomarcadores o de RMN mutiparamétrica para su inclusión. Resultados: Se presentan las características y posibilidades del registro a modo descriptivo y los resultados preliminares de 324 pacientes incluidos en sus primeros 5 meses de funcionamiento por 15 centros reclutadores. De la misma forma se describen las variables clínico-patológicas, biomarcadores, técnicas de radiodiagnóstico y cuestionarios de calidad de vida contemplados por la base de datos, así como las posibilidades de seguimiento indefinido y abierto a cualquier tratamiento activo reconocido en guías clínicas. Conclusiones: La AEU-PIEM/2014/0001 constituye una herramienta extremadamente útil a todos los urólogos españoles para la investigación clínica multicéntrica, y sin duda permitirá la difusión de la vigilancia activa entre nuestros pacientes de una forma más coordinada, permitiendo mantener las ventajas del screeningoportunista optimizado en cáncer de próstata sin incurrir en el sobretratamiento

Objectives: To present a National Registry of patients with prostate cancer as monitored through active surveillance, with the intention of testing the hypothesis that cancer-specific mortality in very low-risk and low-risk patients is less than 5% at 15 years. Material and methods: A multicentre observational study (AEU-PIEM/2014/0001) sponsored by the Spanish Association of Urology was conducted using their platform for multicentre studies. The clinical-pathological inclusion criteria were as follows: cT1a-cT3a, PSA ≤ 20 ng/ml, initial minimum biopsy of 10 cores, number of affected cores ≤ 3, 1st Gleason score of 3 and 2nd Gleason score ≤ 4 and a known prostate volume (in cc). A unified follow-up was not established for all recruiting centres; however, a survey was conducted that reflects the follow-up characteristics based on a number of tangible parameters that allow for their comparison. With the same philosophy of flexibility, the use of certain biomarkers and multiparametric MRI was not considered necessary for inclusion. Results: We describe the Registry's characteristics and possibilities, as well as the preliminary results from the 324 patients included in its first 5 months of operation in the 15 recruiting centres. We also report the clinical-pathological variables, biomarkers, radiodiagnosis technique and quality-of-life questionnaires considered for the database, as well as the possibilities for indefinite follow-up, remaining open to any active treatment recognized in clinical guidelines. Conclusions: The AEU-PIEM/2014/0001 represents an extremely useful tool for all Spanish urologists for multicentre clinical research. The registry will undoubtedly enable the dissemination of active surveillance of our patients in a more coordinated manner, thus maintaining the advantages of optimised opportunistic screening for prostate cancer without resulting in overtreatment

Urología y recursos predictivos en la Web / Urology and Web predictive resources

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