I. de Torres

Prediction of Prostate Volume Based on Total and Free Serum Prostate–Specific Antigen: Is It Reliable?

Objective: To analyze the utility of total/free prostate–specific antigen (PSA) and age as predictors of the prostate volume in men with symptomatic benign prostatic hyperplasia (BPH) and no evidence of prostate cancer.Patients and Methods: Total and free serum PSA were determined in 681 patients with normal digital rectal examination and symptomatic BPH using the Hybritech method. Prostate volume was measured by transrectal ultrasound (TRUS). TRUS–guided biopsy was performed in 459 (67.4%) of the patients with a serum PSA >4.0 ng/ml.Results: The relationship with prostate volume was best described in a log linear fashion by free PSA (R2 = 0.367), total PSA (R2 = 0.264) and age (R2 = 0.017). Multiple linear regression demonstrates no significant influence of age. Free PSA was able to predict the individual TRUS prostate volume ±10% in 67% of the patients and ±20% in 91.2% and total PSA in 63 and 90.9%, respectively.Conclusion: Prostate volume is strongly related with free and total PSA. Both determinations would be able to predict the TRUS prostate volume ±20% in more than 90% of the patients.

Use of Percent Free Prostate–Specific Antigen as a Predictor of the Pathological Features of Clinically Localized Prostate Cancer

Purpose: To evaluate the usefulness of percent free serum prostate–specific antigen (PSA) as a predictor of the pathological features of prostate cancer.Materials and Methods: Total and free serum PSA were measured preoperatively in 220 consecutive patients with clinically localized prostate cancer who underwent radical prostatectomy. Organ–confined disease and favorable pathology were considered as the outcomes for this study.Results: Percent free serum PSA was not able to predict these outcomes in the overall population. However, it could significantly predict favorable pathology in a subset of patients in whom digital rectal examination (DRE) was normal and total PSA ranged from 4.1 to 10 ng/ml. A 11% cutoff provided a significant distribution with an odds ratio of 2.8 (95% confidence interval 1.1–7.0), a positive predictive value of 63.3% and a negative predictive value of 46.3%.Conclusions: According to these results, we suggest that percent free PSA may provide additional information for the staging of clinically localized prostate cancer. However, the reference population for its usefulness would be those patients with normal DRE and total PSA between 4.1 and 10 ng/ml.

Simultaneous Treatment with Statins and Aspirin Reduces the Risk of Prostate Cancer Detection and Tumorigenic Properties in Prostate Cancer Cell Lines

Nowadays prostate cancer is the most common solid tumor in men from industrialized countries and the second leading cause of death. At the ages when PCa is usually diagnosed, mortality related to cardiovascular morbidity is high; therefore, men at risk for PCa frequently receive chronic lipid-lowering and antiplatelet treatment. The aim of this study was to analyze how chronic treatment with statins, aspirin, and their combination influenced the risk of PCa detection. The tumorigenic properties of these treatments were evaluated by proliferation, colony formation, invasion, and migration assays using different PCa cell lines, in order to assess how these treatments act at molecular level. The results showed that a combination of statins and aspirin enhances the effect of individual treatments and seems to reduce the risk of PCa detection (OR: 0.616 (95% CI: 0.467–0.812), P < 0.001). However, if treatments are maintained, aspirin (OR: 1.835 (95% CI: 1.068–3.155), P = 0.028) or the combination of both drugs (OR: 3.059 (95% CI: 1.894–4.939), P < 0.001) represents an increased risk of HGPCa. As observed at clinical level, these beneficial effects in vitro are enhanced when both treatments are administered simultaneously, suggesting that chronic, concomitant treatment with statins and aspirin has a protective effect on PCa incidence.

Significado clínico de la atrofia proliferativa inflamatoria en la biopsia prostática

INTRODUCTION Proliferative inflammatory atrophy (PIA) is a frequently observed lesion in prostate biopsies and some authors have postulated its involvement in prostate carcinogenesis. However, the mechanisms that would permit its neoplastic transformation and the clinical significance of its finding in a prostate biopsy is currently not well known. OBJECTIVE To analyze the characteristics of the PIA lesion, its possible role in prostate carcinogenesis and its relation with the tumor aggressiveness. MATERIAL AND METHOD A systematic review was made of the literature in PubMed with the terms «proliferative inflammatory atrophy» or «PIA» and «prostate.» The most important findings are summarized in accordance with the study objective. RESULTS PIA seems to be involved in prostate carcinogenesis. This hypothesis is based on its frequent association to cancer lesions (CaP) and on some genetic alterations that are common to the high grade prostatic intraepithelial neoplasia (HGPIN) and to the CaP, fundamentally deficit in GSTP1 expression and overexpression of AGR2. Currently, there are no epidemiological studies that evaluate the incidence of PIA or its association with HGPIN and CaP. Only one study, carried out by our group, has determined the global incidence of PIA in 30% of the prostate biopsies, a lower association to CaP than the HGPIN lesion and an association between PIA and tumors of lower and insignificant grade. CONCLUSIONS PIA shares genetic alterations with HGPIN and CaP. Currently, there is no epidemiologic evidence to consider that the PIA is associated to a greater incidence of CaP and the genetic and epidemiological data available suggest its association to not very aggressive tumors.

Carcinoma escamoso de pene

Penile squamous cell carcinoma (SCC) is uncommon in Europe, where it accounts for approximately 0.7% of all malignant tumors in men. The main risk factors are poor hygiene, lack of circumcision, human papillomavirus (HPV) infection, and certain chronic inflammatory skin diseases. HPV infection is detected in 70% to 100% of all penile in situ SCCs and in 30% to 50% of invasive forms of the disease, mainly basaloid and warty SCCs. In situ tumors can be treated conservatively, but close monitoring is essential as they become invasive in between 1% and 30% of cases. The treatment of choice for penile SCC is surgery. Inguinal lymph node irradiation is no longer recommended as a prophylactic measure, and it appears that selective lymph node biopsy might be useful for reducing the morbidity associated with prophylactic inguinal lymph node dissection. Survival is directly related to lymph node involvement. Improving our knowledge of underlying molecular changes and their associated genotypes will open up new therapeutic pathways.

Eficacia del índice de salud prostática para identificar cánceres de próstata agresivos. Una validación institucional

INTRODUCTION New generations of tumor markers used to detect prostate cancer (PCa) should be able to discriminate men with aggressive PCa of those without PCa or nonaggressive tumors. The objective of this study has been to validate Prostate Health Index (PHI) as a marker of aggressive PCa in one academic institution. METHODS PHI was assessed in 357 men scheduled to prostatic biopsy between June of 2013 and July 2014 in one academic institution. Thereafter a subset of 183 men younger than 75 years and total PSA (tPSA) between 3.0 and 10.0 ng/mL, scheduled to it first prostatic biopsy, was retrospectively selected for this study. Twelve cores TRUS guided biopsy, under local anaesthesia, was performed in all cases. Total PSA, free PSA (fPSA), and [-2] proPSA (p2PSA) and prostate volume were determined before the procedure and %fPSA, PSA density (PSAd) and PHI were calculated. Aggressive tumors were considered if any Gleason 4 pattern was found. PHI was compared to %fPSA and PSAd through their ROC curves. Thresholds to detect 90%, 95% of all tumors and 95% and 100% of aggressive tumors were estimated and rates of unnecessary avoided biopsies were calculated and compared. RESULTS The rate of PCa detection was 37.2% (68) and the rate of aggressive tumors was 24.6% (45). The PHI area under the curve was higher than those of %fPSA and PSAd to detect any PCa (0.749 vs 0.606 and 0.668 respectively) or to detect only aggressive tumors (0.786 vs 0.677 and 0.708 respectively), however, significant differences were not found. The avoided biopsy rates to detect 95% of aggressive tumors were 20.2% for PHI, 14.8% for %fPSA, and 23.5% for PSAd. Even more, to detect all aggressive tumors these rates dropped to 4.9% for PHI, 9.3% for %fPSA, and 7.9% for PSAd. CONCLUSIONS PHI seems a good marker to PCa diagnosis. However, PHI was not superior to %fPSA and PSAd to identify at least 95% of aggressive tumors.

Presentación de un nuevo caso de adenocarcinoma de células claras uretral y su manejo quirúrgico

OBJECTIVE: To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. MATERIAL AND METHODS: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. CONCLUSIONS: It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.PRESENTATION OF A NEW CASE OF PRIMARY CLEAR CELL ADENOCARCINOMA OF THE URETHRA AND ITS SURGICAL MANAGEMENT Objective: To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. Material and methods: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. Conclusions: It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.

Pseudotumor inflamatorio vesical

Resumen Pseudotumor Inflamatorio Vesical Objetivo Presentar un nuevo caso de pseudotumor inflamatorio vesical. Material y metodo Se describe la clinica, diagnostico y tratamiento de un caso de pseudotumor inflamatorio de localizacion vesical en un varon de 22 anos sin antecedentes urologicos de interes. Conclusiones El pseudotumor inflamatorio es una lesion benigna poco frecuente y de etiologia desconocida. El principal diagnostico diferencial morfologico es el rabdomiosarcoma vesical. El estudio inmunohistoquimico es fundamental en el diagnostico, caracterizacion y diferenciacion de ambas patologias. Su caracter benigno obliga a un tratamiento conservador siempre que sea posible.

Síndrome metabólico en pacientes con cáncer de próstata sometidos a supresión androgénica

OBJECTIVES Cardiovascular mortality is the leading cause of death in patients with prostate cancer (PC), metabolic syndrome (MS) being related to it. The main objective of this study was to determine the prevalence of MS in patients with CP undergoing androgen suppression (AS). MATERIAL AND METHODS We performed a retrospective study of cases and controls that included 159 patients. The study group was made up of 53 patients with PC undergoing SA for a period exceeding 12 months. The control group was formed by 53 patients with PC at the time of diagnosis and 53 patients with negative prostate biopsy. All patients were evaluated for presence of MS according to NCEP-ATPIII criteria. RESULTS Prevalence of MS in patients without PC was 32.1% and in those with non-treated PC 35.8%, P = .324. In patients with PC undergoing AS, prevalence of MS was 50.9%, P < .001. When AS duration was less than 36 months, prevalence of MS was 44.0% and when greater than 36 months 57.1%, P < .001. Waist circumference and hyperglycemia were the two MS components that significantly increased. AS and its duration were independent predictors factors for the development of MS. CONCLUSIONS Continuous AS therapy increases the prevalence of MS and especially waist circumference and hyperglycemia. Development of MS increases according to AS duration.

Carcinoma linfoepitelioma-like puro primario de vejiga

Resumen Objetivo Presentar un nuevo caso de carcinoma linfoepitelioma-like vesical puro. Material y metodos Se describe la clinica, diagnostico, tratamiento y evolucion de este tipo de tumor. Revision de la literatura. Conclusiones Se trata de un tumor vesical infrecuente que requiere de un analisis anatomopatologico cuidadoso y confirmacion mediante tecnicas de inmunohistoquimica. La forma focal se asocial a peor pronostico. La cistectomia radical es el gold estandar. Este tipo de tumor presenta sensibilidad a radioterapia y quimioterapia, pudiendose utilizar ambas como tratamiento adyuvante.