ABSTRACT
BACKGROUND: Androgen deprivation therapy (ADT) is a mainstay of prostate cancer in both adjuvant and palliative settings. Since androgens are crucial for functional status and psychological functions, we evaluated whether blood testosterone, androstenedione, or DHEA concentrations were associated with functional status and psychological alterations in patients with localised (PCa) or metastatic prostate cancer (mPCa) receiving ADT with analogues of luteinising hormone-releasing hormone (LHRH). METHODS: The five Fried criteria were considered to identify frailty syndrome. In addition, complementary evaluations were carried out to measure other variables of interest. Sleep quality was assessed using the Athens Insomnia Scale, cognitive functions were assessed using the Mini-Mental State Examination, and symptoms of depression were measured using the Yesavage Geriatric Depression Scale. Logistic regression analysis was performed to determine if the androgens level could be related to frailty syndrome, sleep impairment, depressive symptoms, and cognitive functions. RESULTS: The results of the multivariate analyses show that high concentrations of androstenedione were significantly associated with frailty syndrome in both groups (p = 0.018; odds ratio = 4.66, 95% confidence interval [1.30-16.6]). There were significant relationships between frailty syndrome and the systemic concentration of androstenedione (p = 0.01), but not the concentration of testosterone (p = 0.60) or DHEA (p = 0.42). In addition, the results of the non-parametric tests show significant results between a decreased gait speed in the two groups (metastatic and localised) and the concentration of androstenedione (p = 0.015). High androstenedione levels were associated with a slow walking speed in the mCaP group (p = 0.016), while high testosterone levels were associated with a better walking speed in the localised CaP group (p = 0.03). For the concentration of androstenedione in plasma, the area under the curve was 0.72, with a 95% CI of 0.55-0.88 with acceptable values, and with a cut-off point of 4.51 pg/mL, a sensitivity of 82.9%, and specificity of 53.8%. No relationships between the concentration of androgens in plasma and sleep quality, cognitive functions, or symptoms of depression suggest that the changes were specific to frailty syndrome. CONCLUSIONS: Further research into the role of androstenedione should be evaluated in follow-up studies in order to recommend its use as a suitable biomarker of frailty syndrome in prostate cancer patients.
Subject(s)
Frailty , Prostatic Neoplasms , Male , Aged , Humans , Prostatic Neoplasms/pathology , Androgens , Androstenedione , Androgen Antagonists , Frail Elderly , Testosterone , DehydroepiandrosteroneABSTRACT
BACKGROUND: Prostate cancer (PCa) is considered one of the most important medical problems in the male population, with a very high incidence after the age of 65. Frailty represents one of the most critical issues facing healthcare due to its inherent relationship with poor healthcare outcomes. The physical phenotype of frailty syndrome based on Fried criteria has been associated with poor outcomes, morbidity, and premature mortality. To date, there are few studies that have analyzed frailty syndrome in patients with localized and advanced (mPCa) disease under androgen-deprivation therapy. OBJECTIVE: Our goal was to assess whether there are differences in frailty criteria between mPCa and localized PCa. We also evaluated the role of other geriatric variables such as depressive and insomnia symptoms, which are frequently reported in cancer patients. METHODS: In this cross-sectional study, frailty syndrome was evaluated in both groups, as well as its possible relationship with cognitive functions, depressive and insomnia symptoms, and other clinical variables related to PCa and its treatment. Frailty was defined on Fried's criteria: low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed; prefrailty was defined as having one or two of those criteria and frailty as having three or more, depressive symptoms were defined by the Yesavage scale, cognitive functions with the Mini-Mental examination test, and insomnia symptoms by the Athens scale and self-reported health status. RESULTS: The prevalence of prefrailty/frailty was slightly higher in mPCa compared to localized PCa (81.5% versus 72.3%, respectively), however by analyzing each of the frailty criteria, two of them were significantly reduced in mPCa compared to localized PCa patients, e.g., gait speed (p = 0.001) and muscle strength (p = 0.04). The reduced gait speed and muscle strength in mPCa were not due to the increased age in mPCa group, or to an increase in comorbidities or shorter time under androgen-deprivation therapy. The symptoms of insomnia were significantly higher in mPCa patients compared to those with localized PCa (p < 0.05) whereas cognitive functions or depressive symptoms were not significantly different between the two groups. CONCLUSION: Patients with mPCa under androgen-deprivation therapy display higher alterations in gait speed and muscular strength and insomnia symptoms, thus interventions should be aimed to reduce these alterations in order to limit adverse outcomes related to them and to improve quality of life in these patients.
ABSTRACT
BACKGROUND: Abiraterone and enzalutamide, androgen receptor pathway inhibitors (ARPI) for the treatment of metastatic castration-resistant prostate cancer (mCRPC), are at high risk of potential drug interactions (PDIs). We aimed to describe PDIs and their management, and triggered adverse events (AEs) in clinical practice. METHODS: We conducted a cross-sectional study in mCRPC patients who started treatment with abiraterone or enzalutamide in a university hospital between August 1st, 2016 and July 31st, 2020. Lexicomp® was used to identify and analyze PDIs, and the clinical records to assess their management and the occurrence of AEs. RESULTS: We included 173 patients: 36.8% and 93.0% treated with abiraterone and enzalutamide, respectively, had at least 1 PDI. Globally, 6.3% of PDIs had X-risk (contraindication due to high probability of AE). Treatment was modified in 9.2% of patients and 9.8% suffered AEs due to PDIs. Factors associated with a higher risk of PDIs were polypharmacy (OR= 41.0, p 0.003) and treatment with enzalutamide (OR= 128.26, p < 0.001). CONCLUSIONS: At least two-thirds of patients treated with ARPI suffered a PDI. Overall, abiraterone would have a more favorable PDI profile. Knowing these interaction profiles may be helpful to develop a more efficient therapeutic follow-up and to select the safest treatment.
Subject(s)
Abiraterone Acetate , Prostatic Neoplasms, Castration-Resistant , Abiraterone Acetate/therapeutic use , Androstenes , Benzamides , Cross-Sectional Studies , Drug Interactions , Humans , Male , Nitriles/therapeutic use , Phenylthiohydantoin , Prostatic Neoplasms, Castration-Resistant/drug therapy , Prostatic Neoplasms, Castration-Resistant/pathology , Treatment OutcomeABSTRACT
OBJECTIVE: Report of a case of leukemic infiltration of the prostate as an incidental CT finding. METHODS: We describe a case of a 60-year-old male suffering from chronic lymphocytic leukemia. A routine-performed CT showed multiple lymphadenopathies and an hypodense area in the left prostatic lobe. The patient was sent to our department to carry out a transrectal ultrasound and prostatic biopsy. He didn't relate any urinary symptoms. RESULTS: By the prostate rectal examination the gland felt hard and with no well defined limits. The transrectal ultrasound showed heterogene parenchyma and several hyperechoic areas by a bad circumscribed prostate. The pathological analysis reported a diffuse infiltration of the gland by chronic lymphocytic leukemia cells. CONCLUSIONS: Although the relapse of hematological tumors to the prostate has been described previously, there is no published case to our knowledge of a leukemic prostate infiltration in an assymptomatic patient as an incidental finding by an imaging procedure.
Subject(s)
Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Leukemic Infiltration , Prostate/pathology , Humans , Male , Middle AgedABSTRACT
Objetivo: Presentar un caso de infiltración leucémica de la próstata como hallazgo incidental en una prueba de imagen. Métodos: Describimos el caso de un varón de 60 años en seguimiento por una leucemia linfática crónica, al que se realiza un TAC de rutina apreciando adenopatías múltiples y un nódulo hipodenso en el lóbulo prostático izquierdo. El paciente es remitido a nuestro servicio para la realización de ecografía transrectal y biopsias prostáticas. No refiere clínica urinaria. Resultados: Al tacto rectal la próstata está mal delimitada y con aumento difuso de consistencia. La ecografía transrectal muestra una glándula mal delimitada, con parénquima heterogéneo y varias áreas hiperecoicas. El informe anatomopatológico describe la infiltración difusa de la glándula por una leucemia linfática crónica. Conclusiones: Aunque la extensión de tumores hematológicos a la próstata ha sido descrita previamente, no existe en nuestro conocimiento ningún caso publicado de hallazgo incidental en una prueba de imagen de infiltración prostática por leucemia en un paciente asintomático (AU)
Objective: Report of a case of leukemic infiltration of the prostate as an incidental CT finding. Methods: We describe a case of a 60-year-old male suffering from chronic lymphocytic leukemia. A routine-performed CT showed multiple lymphadenopathies and an hypodense area in the left prostatic lobe. The patient was sent to our department to carry out a transrectal ultrasound and prostatic biopsy. He didnt relate any urinary symptoms. Results: By the prostate rectal examination the gland felt hard and with no well defined limits. The transrectal ultrasound showed heterogene parenchyma and several hyperechoic areas by a bad circumscribed prostate. The pathological analysis reported a diffuse infiltration of the gland by chronic lymphocytic leukemia cells. Conclusions: Although the relapse of hematological tumors to the prostate has been described previously, there is no published case to our knowledge of a leukemic prostate infiltration in an assymptomatic patient as an incidental finding by an imaging procedure (AU)
Subject(s)
Humans , Male , Middle Aged , Prostate/injuries , Leukemia, Lymphoid/pathology , Leukemic Infiltration/pathology , Tomography/instrumentationABSTRACT
OBJECTIVE: Report one case of ectopic spleen simulating a renal tumor. We performed a review of etiopathogenesis, diagnosis and treatment. METHODS: We present the case of a 54-year-old splenectomized female patient with the incidental diagnosis on ultrasound of a left kidney upper pole mass simulating a renal tumor. RESULTS: After the performance of CT scan, and with the suspicion of renal neoplasia, the patient underwent tumorectomy with the pathologic diagnosis of the specimen compatible with supernumerary spleen. CONCLUSIONS: We emphasize the importance of including pseudo masses of splenic origin in the differential diagnosis of left renal, adrenal and retroperitoneal tumors. We emphasize the importance of CT scan as the imaging test of choice, and gammagraphy as a complementary test. We point out conservative attitude as the most suitable in cases of asymptomatic pseudomass of splenic origin.
Subject(s)
Kidney Neoplasms/diagnosis , Spleen/abnormalities , Diagnosis, Differential , Female , Humans , Incidental Findings , Middle AgedABSTRACT
Objetivo: Presentar un caso de bazo ectópico simulando un tumor renal. Hacemos una revisión de la etiopatogenia, diagnóstico y del tratamiento. Método: Presentamos a una paciente de 54 años esplenectomizada que se le detecta incidentalmente mediante una ecografía una masa en polo superior del riñón izquierdo simulando un tumor renal. Resultados: Tras la realización de un TAC, y bajo la sospecha de neoplasia renal, se le practicó tumorectomía de la lesión observándose en el diagnóstico histológico posterior pieza compatible con bazo supernumerario. Conclusiones: Resaltamos la importancia de incluir las pseudomasas de origen esplénico dentro del diagnóstico diferencial de los tumores renales, suprarrenales y retroperitoneales izquierdos. Destacamos la importancia del TAC como técnica de elección y de la gammagrafía como estudio complementario. Apuntamos la actitud conservadora como la más idónea en los casos de pseudomasa de origen esplénico asintomática tumor (AU)
Objective: Report one case of ectopic spleen simulating a renal tumor. We performed a review of etiopathogenesis, diagnosis and treatment. Methods: We present the case of a 54-year-old splenectomized female patient with the incidental diagnosis on ultrasound of a left kidney upper pole mass simulating a renal tumor. Results: After the performance of CT scan, and with the suspicion of renal neoplasia, the patient underwent tumorectomy with the pathologic diagnosis of the specimen compatible with supernumerary spleen. Conclusions: We emphasize the importance of including pseudo masses of splenic origin in the differential diagnosis of left renal, adrenal and retroperitoneal tumors. We emphasize the importance of CT scan as the imaging test of choice, and gammagraphy as a complementary test. We point out conservative attitude as the most suitable in cases of asymptomatic pseudomass of splenic origin (AU)
Subject(s)
Female , Middle Aged , Humans , Splenic Diseases/diagnosis , Choristoma/diagnosis , Splenic Diseases/etiology , Splenic Diseases/surgery , Choristoma/etiology , Choristoma/surgery , Diagnosis, Differential , Kidney Neoplasms/diagnosisABSTRACT
OBJECTIVE: To report two cases of acute idiopathic scrotal edema. METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles. CONCLUSIONS: Acute idiopathic scrotal edema is a self-limited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions.
Subject(s)
Edema , Genital Diseases, Male , Scrotum , Child , Edema/diagnostic imaging , Edema/drug therapy , Genital Diseases, Male/diagnostic imaging , Genital Diseases, Male/drug therapy , Humans , Male , UltrasonographyABSTRACT
OBJETIVO: Presentar dos casos de edema de escroto agudo idiopático. MÉTODOS: Describimos los casos de dos varones de 12 años que acudieron al Servicio de Urgencias de nuestro hospital presentando dolor, edema y eritema en un hemiescroto sin recordar antecedente traumático previo. RESULTADOS: A la exploración de ambos pacientes se puede observar los hemiescrotos enrojecidos y aumentados de tamaño pero con testes y epidídimos normales. Con el diagnóstico de escroto agudo se les efectuaron unas ecografías en las que se pudo ver un edema heterogéneo en piel escrotal con flujo Doppler aumentado y testes ecográficamente normales. CONCLUSIONES: El edema de escroto agudo idiopático es una patología autolimitada que afecta básicamente a niños prepúberes que debe ser incluida en el diagnostico diferencial del escroto agudo para evitar intervenciones más agresivas innecesarias
OBJECTIVE: To report two cases of acute idiopathic scrotal edema. METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles. CONCLUSIONS: Acute idiopathic scrotal edema is a self-limited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions
Subject(s)
Male , Child , Humans , Scrotum/injuries , Genital Diseases, Male/diagnosis , Diagnosis, Differential , Laser-Doppler FlowmetryABSTRACT
OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci affecting both testicles. METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed. RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy. CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classic seminoma. The diagnosis and treatment are similar to unilateral testicular tumors except certain cases in which partial excision of the testicle may be considered.
Subject(s)
Neoplasms, Multiple Primary/pathology , Seminoma/pathology , Testicular Neoplasms/pathology , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Atrophy , Carboplatin/administration & dosage , Combined Modality Therapy , Humans , Male , Neoplasms, Multiple Primary/drug therapy , Neoplasms, Multiple Primary/surgery , Orchiectomy , Remission Induction , Seminoma/drug therapy , Seminoma/surgery , Testicular Neoplasms/drug therapy , Testicular Neoplasms/surgery , Testis/pathologyABSTRACT
OBJETIVOS: Presentar un caso de tumor testicular bilateral sincrónico con focos de Neoplasia Intratubular de Células Germinales (NICG) en ambos testículos. METODOS: Describimos el caso de un varón de 29 años que presenta tumoración indolora de un mes de evolución en teste izquierdo. Bajo la sospecha de tumor testicular se le realiza una ecografía escrotal, una determinación de marcadores tumorales y un estudio de extensión tumoral. RESULTADOS: En la ecografía se puede ver un teste izquierdo hipotrófico con lesión sospechosa de neoplasia e, incidentalmente, un testículo derecho con una lesión hipoecoica y aumento de flujo doppler. Se le practicó una orquiectomía bilateral con el diagnóstico de anatomía patológica de seminoma clásico con focos de Neoplasia Intratubular de Células Germinales (NICG) en ambos testículos y se completó el tratamiento con 2 ciclos de quimioterapia. CONCLUSIONES: Los tumores testiculares bilaterales sincrónicos son muy infrecuentes. El tipo histológico más frecuente es el seminoma clásico. El diagnóstico y tratamiento es similar al de los tumores testiculares unilaterales excepto en determinados casos en los que se puede plantear la resección parcial del testículo (AU)
OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci affecting both testicles. METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed. RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy. CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classic seminoma. The diagnosis and treatment are similar to unilateral testicular tumors except certain cases in which partial excision of the testicle may be considered
