Metastasic Prostate Cancer: Predictive Factors of Earlier Progression to Castration-Resistance.

INTRODUCTION: Prostate cancer (PCa) can progress to the lethal phenotype of metastatic castration resistance (mCRPC), either from initially localized disease or de novo metastatic cancer. New drugs improving overall survival are now the cornerstone of treatment. Nevertheless, there are no defined sequences or established timing to initiate or discontinue treatments; besides, not all patients end in CRPC or reach this stage at the same time. OBJECTIVE: To evaluate characteristics of patients who progress to mCRPC and establish an association with time to mCRPC diagnosis. MATERIAL AND METHODS: Retrospective, descriptive and observational study of 35 mCRPC patients, performed from 2013 to 2017. Variables analyzed were age, Gleason score and prostate-specific antigen (PSA) at diagnosis, initial stage, response time to androgen deprivation therapy (ADT), PSA nadir on ADT and time until mCRPC progression. Statistical analysis comparing variables with time to mCRPC diagnosis was performed. RESULTS: Average age at diagnosis was 68.9 years; PSA values were classified into 3 categories: <20 ng/ml, 20-50 and >50. Gleason score was 7 in 50%, and 8-9 in the rest. Tumor was initially localized in 46% of the patients and metastatic in the rest. PSA nadir on ADT was <1 ng/ml in 67%. Average time to androgen deprivation: 5.5 years, time to mCRPC diagnosis: 6.9 years. Significant associations between time to mCRPC and time of androgen deprivation, PSA nadir during ADT and stage at diagnosis were found. CONCLUSION: Response time to ADT <1 year, PSA nadir value >5 ng/ml during treatment and metastatic stage at diagnosis were associated with earlier progression to mCRPC.

Prostate cancer as incidental finding in transurethral resection.

UNLABELLED: Prostate adenocarcinoma is found in surgical samples without prior diagnosis in 4 to 15% of the patients. In some of them, there is previous suspicion but in others this finding is completely incidental. We present 7 cases of prostate cancer detected in 100 patients who underwent bipolar transurethral resection (TUR) of the prostate due to regular indications. The aim of this paper is to describe patient's characteristics, postoperative outcome, analyze TURP as a diagnostic tool and evaluate therapeutic options for prostate cancer (PCa). METHODS: One hundred patients with bladder outlet obstruction due to benign prostatic hyperplasia (BPH) underwent TURP in FUCDIM between June 2007 and August 2009. In 7 of them, prostate adenocarcinomas were detected. None of the patients underwent TURP only because of increased prostate-specific antigen (PSA). RESULTS: Mean preoperative PSA was 7.6 ng/ml (r= 0.72 -27 ng/ml), 39% of the patients had PSA < 4 ng/ml; 33 (40%) had undergone previous biopsies and 36% of them had 2 or more previous biopsies. Prostate cancer detection global rate was 7%, 3 cases were incidental findings (low PSA and low-risk tumors), 3 patients had increased PSA and several previous biopsies with negative results and 1 had low PSA and aggressive tumor (Gleason 4+3). CONCLUSIONS: TURP patients with prostate cancer are a heterogeneous group. TURP can be both diagnostic and therapeutic when facing patients with obstructive symptoms, high PSA and negative prostate biopsies. There are several therapeutic alternatives for TURP patients with cancer, taking into consideration tumor grade and stage, age, life expectancy and will of the patient. Bipolar TUR, in selected patients, allows to offer optional active surveillance (in these patients PSADT is very useful) and if cancer is not found, it eases the follow up of these patients. Active treatment (surgery or radiotherapy) is indicated in T1a patients with life expectancy longer than 10 years, and in the majority of T1b patients.

[Emphysematous pyelonephritis. Case report]. / Pielonefritis enfisematosa. Comunicación de un caso.

OBJECTIVE: To describe an unusual case of emphysematous pyelonephritis, a disease with high morbidity and mortality. METHODS: We present the case of a 62-year old diabetic female with history of kidney stones, who consulted for fever, left lower-back pain and impairment of the general condition. Abdominopelvic computed tomography revealed a perinephric collection of air reaching the abdominal wall. RESULTS: After initial medical management with antibiotics and general supportive measures, we performed an open incision and drainage. A week later, signs of sepsis reappeared and the left kidney was excised. The patient died two weeks later of septic shock. CONCLUSIONS: This disease must be suspected in diabetic females with renal lithiasis and pyelonephritis not responding to treatment, and impaired general condition. Early diagnosis (computed tomography is the gold-standard) and supportive measures are essential for initial management. Surgery can be open (drainage, initial or deferred nephrectomy), percutaneous (nephrostomy) or endoscopic (double-J stent). Conservative management is a choice in bilateral or mild cases. Mortality rate is high and worsens with delayed therapy.