CONTEXTDespite being a validated source of biomarkers, liquid biopsy has not yet succeeded in becoming part of the standard clinical practice in prostate cancer patients. Few biomarkers undergo ...adequate validation, prospective and independent, of their predictive and/or prognostic value, which results in a lack of the different available tests in the clinical practice. OBJECTIVETo carry out a pragmatic synthesis of current scientific evidence on liquid biopsy for prostate cancer patients. EVIDENCE ACQUISITIONNon-systematic literature review, narrowing the search to papers on liquid biopsy from blood samples in prostate cancer patients. We mainly selected works evaluating clinical endpoints in prostate cancer. EVIDENCE SYNTHESISThe most clinically advanced forms of liquid biopsy are circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). Both CTCs and ctDNA have demonstrated their prognostic value in metastatic disease. ARV7 determination is the first predictive biomarker of the disease. Its implementation into routine clinical practice requires methodological standardization and adequate clinical validation of the different available ways to detect it. The detection of CTCs in the early stages of the disease still depends on the optimization of the diagnostic methods and on the development of the biological characterization of these cells. The biological information provided by CTCs and ctDNA is different; therefore, the study of its adequate combination is the object of cutting-edge research. CONCLUSIONSThe absence of protocols and methodological standards is the limiting factor when aiming to reach conclusions that could have a potential impact on clinical practice. Therefore, the real short-term challenge for liquid biopsy is the establishment of consensus and common criteria.
Summary
The literature on the treatment of painful varicocoele is limited, likely because of the short period since it was recognized as a clinical entity and the limitations posed by the ...subjectivity of pain. Our aim was to systematically analyse the results of percutaneous embolization as the chosen treatment for this condition. We conducted a retrospective study of patients undergoing percutaneous embolization as primary treatment for painful varicocoele from January 2007 to November 2013. Radiologic and ultrasonographic successes were evaluated according to the existence or absence of venous reflux on venography after embolization and on Echo Doppler control at 3–6 months. Clinical success was assessed by Visual Analog Scale pain questionnaires before surgery and at 3–6 months; in addition, at the time of the study, telephone interviews were conducted to update the clinical situation and development. A total of 154 patients received operations. The median pain before surgery, at 3–6 months and at the time of interview was 7, 1 and 0 points respectively (p < 0.001). The ultrasonographic success rate at 3–6 months was 68.6%. With a median follow‐up of 39 months, the success and relapse/clinical persistence rates were 86.9 and 13.1% respectively. By studying the degree of agreement between clinical success and ultrasonographic success, a kappa index = 0.443 was obtained. Patients with success recounted greater pre‐operative pain scores than those who relapsed or persisted (7.5 vs. 5.0; p = 0.004). In patients with painful varicocoele, the ultrasonographic recurrence of venous reflux does not imply the recurrence of pain; hence, the proper assessment of success in these patients should include a systematic assessment of their pain and grade of reflux. Percutaneous retrograde embolization as a primary treatment for painful varicocoele is a clinically effective option with a high success rate that can be maintained in the long term, especially in patients with high pre‐operative pain.
Abstract Context The treatment of benign prostatic hyperplasia (BPH) is changing due to a greater understanding of the disease and the development of the functional concept of lower urinary tract ...symptoms (LUTS). Objectives To describe the current state of BPH and the diagnosis and treatment of LUTS. Acquisition of evidence We summarize the issues presented and debated by a group of expert urologists during the First UROVI Congress, sponsored by the Spanish Urological Association. Summary of the evidence LUTS encompasses filling, voiding and postvoiding symptoms that affect patients’ quality of life. The aetiological diagnosis is an important element in starting the most ideal treatment. For this reason, new alternative therapies (both pharmacological and surgical) are needed to help individually address the symptoms in the various patient profiles. There is now a new combination of drugs (6 mg of solifenacin and 0.4 mg of the tamsulosin oral controlled absorption system) for treating moderate to severe filling symptoms and emptying symptoms associated with BPH in patients who do not respond to monotherapy. Furthermore, new surgical techniques that are increasingly less invasive help provide surgical options for older patients and those with high comorbidity. Conclusions The availability of drugs that can act on the various LUTS helps integrate the pathophysiological paradigm into the functional one, providing more appropriate treatment for our patients.
INTRODUCTIONThe aim of the study was to describe the clinical drivers that lead physicians to perform imaging tests in search of metastasis in non-metastasic castration prostate resistant cancer ...(nmCRPC) patients. METHODSObservational, cross-sectional study conducted at the Departments of Urology of 38 Spanish hospitals. The study included 188 patients diagnosed with nmCRPC who underwent an imaging test for the assessment of metástasis. In one study visit, physicians were requested to specify the clinical factors that led them to perform these tests. The results of the imaging tests and the clinical characteristics of the patients since the time of prostate cancer (PC) diagnosis, were reported. Regression analyses were used to determine predictors of imaging test results. RESULTSProstate-specific antigen (PSA) level was the most important driver to order imaging tests (57.1%), followed by regular follow-up (16.5%) and PSA doubling time (PSADT) (12.0%). Although these drivers were not associated to detection of metastasis, patients with PSA levels ≥20 ng/mL had a greater risk of metastasis than patients with PSA levels <4ng/mL (P=.004) and CRPC patients diagnosed with metastasis (mCRPC) had higher median PSA levels (20.9; interquartile range IQR: 6.7-38.6) than nmCRPC (9.1; IQR: 5.0-18.0) (P=.005). Sixty-six percent of the patients did not undergo any imaging test after CRPC diagnosis until the study visit (10.6, IQR: 4.0-19.5 months). Curative-intent treatment at PC diagnosis and Gleason score predicted longer time from PC to CRPC diagnosis. CONCLUSIONSPhysicians based their decisions to order imaging tests for metastasis detection in nmCRPC patients mainly on PSA and PSA kinetics, including the regular follow-up stated by guideline recommendations.
Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with ...prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis.
Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included.
37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time.
Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes.
La ansiedad específica del cáncer es la reacción psicológica más frecuentemente tras la prostatectomía radical (PR). Evaluamos la prevalencia de la patología psiquiátrica pretratamiento de cáncer de próstata mediante PR e identificamos la influencia de los diagnósticos psiquiátricos en la supervivencia y pronóstico en los pacientes.
Estudio retrospectivo multicéntrico observacional, 1.078 varones intervenidos mediante PR por cáncer de próstata órgano-confinado. Grupos: GP: pacientes con patología psiquiátrica previa a la PR; GNP: pacientes sin patología psiquiátrica previa a la PR, variables urológicas, oncológicas y psiquiátricas, estadística descriptiva y análisis multivariante.
El 37,94% presentó algún diagnóstico psiquiátrico. Fue necesario tratamiento adyuvante de radioterapia en 27,83% y hormonoterapia en 23,38%; más frecuentes en GP. La supervivencia cáncer-específica fue superior en GNP. La ansiedad, depresión, insomnio, tabaquismo, psicosis y alcoholismo fueron los más frecuentes. El bajo TNM y baja presencia de STUI e IUE aumentó la probabilidad de ausencia de patología psiquiátrica. En GP aumentó la fatiga, disfunción eréctil y deterioro cognitivo tras la PR junto con RT y/o HT. A mayor edad y mayor PSA al diagnóstico, aumentó el riesgo relativo de patología psiquiátrica y peor evolución. Los factores más relacionados fueron la PR, PSA, la edad y el tiempo de supervivencia.
La patología psiquiátrica está presente en pacientes tratados mediante prostatectomía radical debido a cáncer de próstata, teniendo alto impacto en los resultados de supervivencia y pronóstico.
OBJECTIVETo study the current status of the activity and academic training of residents and young urologists in Spain. MATERIAL AND METHODSFrom the working group of residents and young urologists of ...the Spanish Association of Urology (AEU), an anonymous survey of 32 questions was designed. Its aim was to evaluate the academic activity of residents, defined by: number of communications to congresses, publications in national and international journals, clinical rotations within Spain and abroad, master's degree, Doctorate (PhD), applications to the European Board of Urology exam and language competences. The survey was sent via email and disseminated through social networks. RESULTSNinety-one respondents were obtained; 66% affirmed not having publications in scientific journals, 67% did not perform rotations abroad. Only 21% claimed to have taken the EBU exam. Only 2% of the respondents had completed a Fellowship. Although most of them (82%) had not done so, they would be interested. However, 67% of respondents believed that the relevance of academic/research activity is from high to very high. CONCLUSIONSOur results indicate that academic activity, scientific production and publication of articles of the residents and young urologists in Spain is low. Moreover, participation in the EBU exam, the completion of a master's degree, PhD, rotations and fellowship is low. In contrast, the assessment of scientific activity is considered to be very relevant.
INTRODUCTIONThe objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. MATERIAL AND ...METHODS155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). RESULTSMean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P<.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p<0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P<.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P<.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02). CONCLUSIONSPSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.
Abstract Objective To translate into Spanish and validate the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) questionnaire, assessing its psychometric properties and ...determining its suitability for clinical use in our community. We also assessed the potential changes in ejaculatory function using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). Materials and methods A systematic translation of the British version was performed. Patients scheduled for anterior urethral stricture surgery between September 2014 and September 2015 were prospectively included in the study. All patients completed the questionnaire before and after the surgery. We conducted an in-depth psychometric study of the questionnaire. Results We assessed the responses of a total of 40 patients. The questionnaire showed its validity, presenting an excellent negative correlation between the voiding symptom scores and the maximum flow ( r = −0.6, P < .001), and also showed significant improvement in the EQ5D-VAS (visual analogue scale) and the time trade-off. For internal consistency, the Cronbach's alpha was 0.701. For the test–retest reliability, the overall intraclass correlation coefficient (ICC) was 0.974, and the ICC for each item separately ranged from 0.799 to 0.980. We observed significant improvement in all items regarding urinary symptoms and health-related quality of life ( P < .001), thereby demonstrating the response capacity to changing the questionnaire. There were no significant changes in the MSHQ-EjD. Conclusions The Spanish version of the USS-PROM questionnaire is a valid instrument for quantifying changes in voiding symptoms and the health-related quality of life of patients undergoing anterior urethral surgery.
To provide latest findings of Urologic Oncology on prostate, kidney, and bladder cancer, and analyze its impact on clinical practice as well as future schemes in the medium- and long-term.
This ...document reviews the abstracts on Uro-Oncology presented at the 2020 Congresses (EUA, AUA, ASCO, ESMO and ASTRO), the publications with the highest impact and especially the new lines of development and progress in Uro-Oncology evaluated by the OncoForum committee.
The use of prostate-specific membrane antigen (PSMA) radioligands in the diagnosis of prostate cancer may have great potential and utility in the coming years due to their improved sensitivity and specificity. The genetic characterization of the tumor is important at both, germline and somatic levels, due to the significant role of BRCA2 mutations regarding risk. The cohort multiple randomised controlled trial is the most suitable study design at the genitourinary cancer level. The application of big data will lead to process improvements, savings in healthcare costs, and an empowerment of real-life studies through ease of data comparison, management, and storage.
The use of new diagnostic techniques with PSMA ligands will provide a more comprehensive diagnostic modality, increase the number of studies about tumor genetic profiling, and enhance their quality. The practical application of artificial intelligence will improve the treatment genitourinary cancer.
Conocer las últimas evidencias sobre Urología oncológica de tumores de próstata, riñón y vejiga, analizando su impacto en la práctica clínica diaria, además de los esquemas futuros a medio y largo plazo.
Se revisan los resúmenes sobre Uro-Oncología presentados en los Congresos del año 2020 (EUA, AUA, ASCO, ESMO y ASTRO), las publicaciones de mayor impacto y especialmente las nuevas líneas de desarrollo y avance en Uro-Oncología valoradas por el comité de OncoForum.
El uso de los radioligandos de antígeno de membrana específico de próstata en el diagnóstico de cáncer de próstata puede tener gran cabida y utilidad en los próximos años gracias a su mejor sensibilidad y especificidad. La caracterización genética del tumor es importante tanto a nivel germinal como somático, dado que las mutaciones en BRCA2 son especialmente importantes por su significado en riesgo. El diseño de estudio más conveniente a nivel de cáncer genitourinario es el ensayo controlado aleatorizado múltiple de cohortes. La aplicación del big data traerá mejoras en procesos, ahorros en costes sanitarios y una potenciación de los estudios en vida real gracias a la facilidad de comparación, gestión y almacenamiento de datos.
El uso de las nuevas técnicas diagnósticas con ligandos de antígeno de membrana específico de próstata aportará una modalidad diagnóstica más completa y el aumento de los estudios del perfil genético del tumor y la calidad de los estudios realizados. La aplicación práctica de la inteligencia artificial mejorará el tratamiento del cáncer genitourinario.
