Outcomes and patterns of use of Radium-223 in metastatic castration-resistant prostate cancer.

Introduction: Radium-223 dichloride (Ra-223) is recommended as a treatment option for metastatic castration-resistant prostate cancer (mCRPC) patients with symptomatic bone metastases and no visceral disease, after docetaxel failure, or in patients who are not candidates to receive it. In this study, we aimed to ambispectively analyze overall survival (OS) and prognostic features in mCRPC in patients receiving Ra-223 as per clinical routine practice and identify the most suitable treatment sequence. Patients and methods: This study is observational, multicentric, and ambispective. Eligibility criteria included mCRPC patients treated with Ra-223, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, without visceral metastases, and no more than three cm involved lymph nodes. Results: A total of 145 patients were included; the median age was 73.97 years, and a Gleason score of more than or equal to 7 in 61 (48%) patients; 73 (81%) had previously received docetaxel. The most important benefit was reached by those patients who received Ra-223 in the second-line setting, with a median OS of 17 months (95% CI, 12-21), and by patients who received six cycles of treatment, with a median OS of 19 months (95% CI, 14-21). An alkaline phosphatase (ALP) decrease was also identified as a prognosis marker. When performing the multivariate analysis, the time to develop castration-resistant disease longer than 24 months was the most important prognostic factor to predict the evolution of the patients receiving Ra-223. Ra-223 was well tolerated, with thrombocytopenia, anemia, and diarrhea being the main adverse events. Conclusion: There is a benefit for those patients who received Ra-223 in the second-line setting, regardless of prior use of docetaxel. In addition, a survival benefit for patients presenting with a decline in ALP was observed.

Análisis comparativo de la expresión de metaloproteasas (MMP-2, MMP-9, MMP-11 y MMP-13) y del inhibidor tisular de la metaloproteasa 3 (TIMP-3) entre las biopsias previas negativas y las prostatectomías radicales / Comparative analysis of the expression of metalloproteases (MMP-2, MMP-9, MMP-11 and MMP-13) and the tissue inhibitor of metalloprotease 3 (TIMP-3) between previous negative biopsies and radical prostatectomies

Las metaloproteasas (MMP) y el inhibidor tisular de metaloproteasas 3 (TIMP-3) se han relacionado con el riesgo de padecer cáncer y con la agresividad de varios tumores. En ocasiones, existen muchas dificultades para diagnosticar el cáncer de próstata y la expresión de MMP y del TIMP-3 en biopsias negativas nos podría ayudar a realizar una sospecha diagnóstica en estos casos. El objetivo es hacer un estudio comparativo de la expresión de MMP y TIMP-3 en las biopsias previas negativas y las prostatectomías radicales (PR). MATERIAL Y MÉTODOS: Análisis retrospectivo de una cohorte de base hospitalaria que incluye a 21 pacientes con sospecha de carcinoma prostático en los que se analizaron por técnica inmunohistoquímica las expresiones de MMP-2, 9, 11 y 13 y el TIMP-3 en la zona tumoral, tanto de las biopsias previas negativas como de las PR. RESULTADOS: Los valores de tinción inmunohistoquímicos (score) para las MMP (-11 y -13) y TIMP-3 no mostraron diferencias significativas al comparar las áreas de las biopsias negativas donde luego se desarrolló tumor con las de la PR. Sin embargo, sí que observamos una diferencia significativa aumentando la expresión de la MMP-2 (p = 0,002) y MMP-9 (p = 0,001) en la zona tumoral de la PR con respecto al área correspondiente de la biopsia previa negativa. CONCLUSIONES: Nuestros datos indican una mayor expresión global de la MMP-2 y la MMP-9 en la zona tumoral de la PR en comparación con las áreas correspondientes de la biopsia previa negativa, lo que parece estar en relación con el proceso de transformación maligna

Metalloproteases (MMPs) and tissue inhibitor of metalloprotease-3 (TIMP-3) have been associated to the risk of having cancer and tumor aggressiveness. When facing the difficulties of prostate cancer diagnosis, the expression of MMPs and TIMP-3 in negative biopsies could be helpful to evaluate a diagnostic suspicion. Our objective is to carry out a comparative study of the expression of MMPs and TIMP-3 in previous negative biopsies and radical prostatectomies (RP). MATERIAL AND METHODS: Retrospective analysis of a hospital-based cohort including 21 patients with suspicion of prostate carcinoma, whose expressions of MMP-2, 9, 11 and 13 and TIMP-3 were evaluated by immunohistochemistry in the tumor area from previous negative biopsies and RP. RESULTS: Immunohistochemical staining values (Score) for MMPs (-11 and -13) and TIMP-3 showed no significant differences when comparing the areas of negative biopsies where tumors subsequently developed with those of the RP. However, we did observe a significant difference in the increased expression of MMP-2 (P = .002) and MMP-9 (P = .001) in the tumor area of the RP with respect to the corresponding area of the previous negative biopsy. CONCLUSIONS: Our data indicate a higher overall expression of MMP-2 and MMP-9 in the tumor area of the RP compared to the corresponding areas of the negative previous biopsy, which seems to be associated to the process of malignant transformation

Impacto de los modelos predictivos y la toma de decisiones en cáncer de próstata: un debate integral / No disponible

OBJETIVO: Hacer una revisión de los diferentes métodos para predecir el riesgo de padecer un cáncer de próstata o que la enfermedad localizada pueda ser curada o progrese después de un tratamiento concreto. MÉTODOS: Realizamos una revisión de los diferentes modelos matemáticos conocidos para el análisis de probabilidad del evento, con un estudio crítico de debilidades y fortalezas de cada uno de estos métodos. En una actualización del Medline, revisamos los diferentes trabajos más relevantes referidos al diagnóstico y manejo del cáncer de próstata localizado en sus vertientes de diagnóstico y tratamiento, así como las posibilidades de desarrollar enfermedad metastásica o exitus. RESULTADOS: Existen múltiples métodos y modelos para predecir los diferentes eventos en pacientes candidatos a diagnóstico de cáncer de próstata, así como para analizar posibilidades de éxito de un tratamiento concreto, en muchos casos con una importante exactitud. Destaca la heterogeneidad en los métodos empleados, datos y variables utilizadas para los análisis, básicamente sobre estudios retrospectivos. Muchos de los métodos más sofisticados, Neural Network o Cart, no presentan exactitudes mayores que los métodos clásicos como la regresión logística. CONCLUSIONES: Los modelos predictivos son un elemento importante para la toma de decisiones en la práctica clínica habitual, favoreciendo que la decisión de un diagnóstico o un determinado tratamiento no se haga de forma aleatoria y por tanto siguiendo un criterio científico. En espera de desarrollo de métodos más precisos, hemos de saber que ningún modelo es perfecto y por tanto, es una herramienta importante, que no debe dejar de lado el conocimiento personal o la experiencia en un grupo de trabajo concreto(AU)

OBJECTIVES: To review the various methods to predict the risk of having prostate cancer, or that localized disease may be cured or progress after a given treatment. METHODS: We performed a review of the various mathematic models known for the probability analysis of the event, with a critical analysis of weaknesses and strengths of each method. In a Medline update were Arch view the most relevant papers referred to diagnosis and management of localized prostate cancer in its diagnosis and management sides, as well as the probability of developing metastatic disease and to die. RESULTS: There are multiple methods and models to predict the various events in a patient candidate to diagnosis of prostate cancer, as well as to analyze the possibilities of success of a specific treatment, in many cases with an important exactness. We emphasize the heterogeneity in the methods, data and variables used for the analysis, basically about retrospective studies. Many of the most sophisticated methods, Neural Network or cart, do not present greater exactness than classic methods like logistic regression. CONCLUSIONS: Predictive models are an important element for decision making in usual clinical practice, favoring the decision of a diagnosis or certain treatment is not taken in a random manner and therefore it is taken following scientific criteria. Waiting for more precise methods, we have to know no method is perfect, and therefore it is an important tool, which should not by pass personal knowledge or the experience of a specific working group(AU)

Hemorragia suprarrenal espontánea unilateral / Spontaneous unilateral adrenal hemorrhage

Hombre de 73 años que acude al servicio de urgencias por dolor abdominal. Al examen físico se palpa masa que ocupa hipocondrio derecho. Angio TAC muestra masa abdominal de 12 cm dependiente de glándula suprarrenal derecha. Analítica de orina muestra elevación de metanefrinas y normetanefrinas. La gamagrafía fue compatible con feocromocitoma. Se realiza extirpación quirúrgica de masa y la anatomía patológica describe hemorragia suprarrenal sin malignidad.

A 73 year old man, came to the emergency department referring abdominal pain. A palpable mass occupying right upper quadrant on physical examination was identified. CT angiography showed a 12 cm abdominal mass dependent of the right adrenal. Urinalysis showed elevation of metanephrines and normetanephrines. Gamagraphy scan was compatible with pheochromocytoma. Surgical resection of the mass was performed and pathology described an adrenal hemorrhage without malignancy.

[Inguinal ureteral hernia: a clinical case]. / Hernia ureteral inguinal: caso clínico.

SUMMARY OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic. METHODS: 80 year-old patient with, hypertension, left inguinal hernia surgery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen. RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided. CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy.

Hernia ureteral inguinal: caso clínico / Inguinal ureteral hernia: a clinical case

OBJETIVOS: Describir caso clínico de hernia ureteral inguinal y luego comentar brevemente tema.MÉTODOS: Paciente 80 años hipertenso con hernia inguinal izquierda operada, hemicolectomia derecha por adenocarcinoma de colon y colecistectomia. En urografía intravenosa como hallazgo se identifica uréter derecho en posición ectópica que sale de la cavidad abdominal por región inguinal derecha para luego volver al abdomen.RESULTADOS: Se realiza TAC que confirma diagnostico. Debido a la edad avanzada del paciente, comorbilidades y ausencia de síntomas, se decidió actitud expectante. CONCLUSIONES: Las hernias urterales a través del conducto inguinal son poco frecuentes. Existen 2 tipos: paraperitoneal y extraperitoneal. La más frecuente es la paraperitoneal (80%) donde se acompaña de saco herniario y pueden aparecer otros órganos intra abdominales. La extraperitoneal suele acompañarse de grasa retroperitoneal. Ambos tipos de hernias suelen se indirectas. El tratamiento suele ser la herniorrafia(AU)

OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic.METHODS: 80 year-old patient with, hypertension, left inguinal hernia sugery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen.RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided.CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy(AU)