PSA levels in patients on hemodialysis treatment.

OBJECTIVES: Standardized prostate-specific antigen (PSA) levels are based upon the general population levels and, although a higher incidence of prostate cancer in patients on hemodialysis (HD)has not been demonstrated, some studies point at the possibility of observing higher PSA levels in this type of patients than in males with preserved renal function. The objective of the present study is to compare PSA levels in males on hemodialysis with those of the population with normal renal function. METHODS: Comparative, transversal study of the variables age, total PSA, free PSA and PSA index in 190 patients with chronic renal disease on hemodialysis treatment (group 1) and 237 subjects without renal disease ( group 2). We carried out a descriptive analysis and a comparative study of the above mentioned variables using the SPSS software. RESULTS: Median age of patients on HD was 55 in cases (47-61)and 59 in controls (54-63.5). Mean total PSA was 1.49 ng/mL [1.24-1.73] in cases and 1.62 ng/mL [1.29-1.95] in controls; mean free PSA was 1.40 ng/mL [0.89-1.91] in group 1 and 2.31 ng/mL [-0.83-5.45] in group 2; mean PSA index was 27.67% [19.91-35.63] in cases and 14.82%[12.79-16.85]] in controls. The comparative study showed differences between the two groups in free PSA (p ≤ 0.007), PSA index (p ≤ 0.000) and total PSA (p ≤ 0.000) in patients under 50 after an age-specific analysis. CONCLUSIONS: Total PSA is higher in patients on HD within the subgroup of patients under 50 with statistically significant but not clinically relevant difference. PSA index is remarkably higher in the group of patients on HD. These data could have clinical implications as far as indications for biopsy is concerned.

Low-dose-rate brachytherapy for prostate cancer in renal transplant recipients.

PURPOSE: Prostate cancer (PCa) is the most common malignancy among men and one of the most common neoplasms affecting renal transplant recipients (RTRs). The available treatments for localized PCa among the general population (GP), surgery and external beam radiotherapy, carry a risk of damage to the transplanted kidney, the ureters, and the bladder and therefore tend to be avoided by most groups. The objective of this study was to assess the efficacy and feasibility of low-dose-rate brachytherapy (LDR-BT) for PCa in RTRs. METHODS AND MATERIALS: We carried out a retrospective review on all RTRs diagnosed of PCa who had undergone LDR-BT at our institution between 2000 and 2015. Nine patients met these criteria, but 1 did not fulfill the followup. Hence, we analyzed 8 patients. We reviewed all clinical data for PCa and graft function in these patients and compared the results with the GP. RESULTS: Mean baseline prostate-specific antigen was 6.8 ± 1.9 ng/mL. All PCa had a Gleason score of 6 and were classified as low risk according the Europe Association of Urology guidelines. Mean followup after seed implantation was 48 ± 12.8 months. All 8 patients remain free of prostate-specific antigen failure. Five-year progression-free survival, cancer-specific survival, and overall survival rates were 100%, 100%, and 62.5%. There was no specific toxicity associated with LDR-BT, and there were no acute adverse events affecting the graft. CONCLUSIONS: LDR-BT is a feasible and acceptable treatment for localized PCa in RTRs. Oncological outcomes are similar to the GP, and there is minimal toxicity to the renal graft.

Learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. / Curva de aprendizaje en el manejo de los inhibidores de tirosina quinasa como primera línea de tratamiento en pacientes con cáncer renal metastásico.

OBJECTIVES: To analyse the learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. MATERIAL AND METHODS: We evaluated 32 consecutive patients treated in our department for metastatic renal cancer with tyrosine kinase inhibitors (pazopanib or sunitinib) as first-line treatment between September 2012 and November 2015. We retrospectively analysed this sample. We measured the time to the withdrawal of the first-line treatment, the time to progression and overall survival using Kaplan-Meier curves. The learning curve was analysed with the cumulative sum (CUSUM) methodology. RESULTS: In our series, the median time to the withdrawal of the first-line treatment was 11 months (95% CI 4.9-17.1). The mean time to progression was 30.4 months (95% CI 22.7-38.1), and the mean overall survival was 34.9 months (95% CI 27.8-42). By applying the CUSUM methodology, we obtained a graph for the CUSUM value of the time to withdrawal of the first-line treatment (CUSUM TW), observing 3 well-differentiated phases: phase 1 or initial learning phase (1-15), phase 2 (16-26) in which the management of the drug progressively improved and phase 3 (27-32) of maximum experience or mastery of the management of these drugs. The number of treated patients needed to achieve the proper management of these patients was estimated at 15. CONCLUSIONS: Despite the limitations of the sample size and follow-up time, we estimated (in 15 patients) the number needed to reach the necessary experience in the management of these patients with tyrosine kinase inhibitors. We observed no relationship between the time to the withdrawal of the first-line treatment for any cause and progression.

[Retroperitoneal malignant fibrous histiocytoma]. / Histiocitoma maligno fibroso retroperitoneal.

We report a new case of retroperitoneal tumor: a malignant fibrous histiocytoma, in its less aggressive histologic type, the mixoid variety. This is a recently isolated histologic presentation from other sarcomas, with a low incidence, non-specific clinic findings and poor prognosis due to its tendency to reappear and to produce metastasis.

[Retroperitoneal neurilemmona]. / Neurilemoma retroperitoneal.

Schwannoma is an uncommon tumor arising from neural sheath of peripheral nerves. Histological findings showing Antoni A and B zones are the main diagnostic features. We report a new case of a retroperitoneal located one, which is not its most usual place to appear, in a 60 year old male, presenting left flank pain. He received surgical treatment, having a satisfactory evolution.

[Analysis of renal neoplasms in adult patients under 40]. / Análisis de las neoplasias renales en adultos menores de 40 años.

OBJECTIVES: To analyze within our sample population the number of patients under 40 receiving surgery as a result of renal neoplasm; to describe the characteristics of these patients and compare them with those of adult patients over 40. PATIENTS AND METHODS: We have revised the clinical history of the 379 patients with renal neoplasm who have undergone surgery in our Service from January 1986 through June 2003. Patients were divided into two groups. Group I, formed by 36 subjects (9.5%) < or = 40. Group II includes 343 patients (90.5%) over 40. Data were included in a database created using the software programme Access and were subsequently analysed using the statistical package SPSS. A descriptive analysis was performed and life expectancy was calculated for both groups using the Kaplan-Meier survival curve. RESULTS: 7.3% of the total number of renal cell carcinomas included in our series occurs in patients of or under 40. No significant differences have been observed as regards the distribution per sexes, laterality, size, incidental occurrence, clinical symptoms, anatomopathology, staging or surgical technique employed. However, we have observed differences as regards cancer-specific survival rate after 5 years, being 94.74% in the case of group I and 68.64% in group II (log-rank 0.0338). CONCLUSIONS: The number of patients < or = 40 undergoing surgery as a result of renal cell carcinoma in the sample under study matches other series already published. No statistically significant difference has been observed as regards staging among patients under and over 40. Differences do exist as regards cancer-specific survival rate. In the case of our patients, irrespective of the age group to which they were ascribed, it is more common to diagnose a renal neoplasm incidentally than through the clinical manifestations.

[Paratesticular adenomatoid tumor: a report of nine cases]. / Tumor adenomatoide paratesticular: una serie de nueve casos.

INTRODUCTION: Paratesticular tumors are rare. Most of them are benign, and adenomatoid tumors are most common. These tumors sometimes infiltrate the testicular parenchyma and require differential diagnosis with malignant tumors. In such cases, intraoperative biopsy allows for performing conservative surgery. MATERIALS AND METHODS: A retrospective study of nine patients with paratesticular adenomatoid tumors seen during a nine-year period (2000-2008) is reported. RESULTS AND CONCLUSIONS: Patient age (mean, 49.6 years) and most common initial signs (tender nodule) are reported. The tumor most commonly occurred as a small, usually oval, nodule in the tail of epididymis. Our series included a case each of intraparenchymal tumor of the testis and tumor of the tunica vaginalis. Diagnosis was initially made based on a ultrasound scan and subsequently confirmed by histology. Differential diagnosis and surgical treatment, performed in all patients, are reported, and also the pathological features of surgical specimens.

Tumor adenomatoide paratesticular: una serie de nueve casos / Paratesticular adenomatoid tumor: a report of nine cases

Introducción: los tumores paratesticulares son raros. La mayoría son benignos, siendo el más frecuente el tumor adenomatoide. En ocasiones estos tumores infiltran el parénquima testicular y es necesario plantear un diagnóstico diferencial con tumores malignos, por lo que la biopsia intraoperatoria, en estos casos, permite realizar una cirugía conservadora. Material y métodos: presentamos de forma retrospectiva nuestra extraordinaria serie de 9 casos de tumores adenomatoides paratesticulares durante un periodo de 9 años (2000- 2008). Resultados y conclusiones: describimos la edad de los pacientes (media de 49,6 años) y la clínica de inicio (nódulo palpable doloroso). La localización de la lesión más frecuente fue en el epidídimo, que habitualmente se manifiesta como un nódulo de pequeño tamaño, generalmente oval en la cola del epidídimo. En nuestra serie tenemos un caso de lesión testicular intraparenquimatosa y otro en túnica vaginal; el resto se localizan en el epidídimo. El diagnóstico de sospecha fue por ecografía, con confirmación histológica posterior. Describimos el diagnóstico diferencial y el tratamiento quirúrgico, que se aplicó en el 100% de los casos, así como sus características anatomopatológicas(AU)

Introduction: Paratesticular tumors are rare. Most of them are benign, and adenomatoid tumors are most common. These tumors sometimes infiltrate the testicular parenchyma and require differential diagnosis with malignant tumors. In such cases, intraoperative biopsy allows for performing conservative surgery. Materials and methods: A retrospective study of nine patients with paratesticular adenomatoid tumors seen during a nine-year period (2000-2008) is reported. Results and conclusions: Patient age (mean, 49.6 years) and most common initial signs (tender nodule) are reported. The tumor most commonly occurred as a small, usually oval, nodule in the tail of epididymis. Our series included a case each of intraparenchymal tumor of the testis and tumor of the tunica vaginalis. Diagnosis was initially made based on a ultrasound scan and subsequently confirmed by histology. Differential diagnosis and surgical treatment, performed in all patients, are reported, and also the pathological features of surgical specimens(AU)

[Renal cancer: descriptive analysis of a series of 267 intervened cases]. / Cáncer renal: análisis descriptivo de una serie de 267 casos intervenidos.

OBJECTIVE: To present the results of a descriptive analysis of 267 surgically treated renal tumors. METHODS: From January 1986 to October 1999, 267 patients (153 males and 114 females) with renal tumor were treated in our department. All data were introduced into the Access data base program and analyzed using the SPSS software. Descriptive analysis was performed and life expectancy was calculated with the Kaplan-Meier survival curve. Mean follow-up was 42.72 months. RESULTS: 56.4% were in the right and 43.6% were in the left kidney. 41.2% of the cases were incidentally discovered. In the symptomatic patients, the most common presenting feature was hematuria (51.8%). Radical nephrectomy was performed in 94.2%, partial in 3.1% and tumor resection in 2.7%. The lumbar approach was used in 75.5% of the cases. In regard to the histology, 88.7% were carcinomas. Clear cell was the most frequent cell type (91.5%). By grade, 55.8% were GI, 32.9% GII and 11.3% were GIII. By stage (according to the 1992 TNM classification), 64.3% were stage I, 15.4% stage II, 17% stage III and 3.3% stage IV. 80.5% showed no vascular involvement. The 5-year overall survival was 71.93% (mean 114 months; median 167 months). Currently, 76% of the patients are alive. CONCLUSIONS: Distribution by sex in our series was different to that reported in most of the studies. The tumor was incidentally discovered in a high proportion of the cases. The lumbar access was the most widely used surgical approach. The overall survival is similar to that reported by other groups.