Incidencia, prevalencia y patrones de tratamiento del cáncer de próstata metastásico hormonosensible en España: Estudio ECHOS / Incidence, prevalence, and treatment patterns in metastatic hormone-sensitive prostate cancer in Spain: ECHOS study

Introducción y objetivo: El manejo de los pacientes con cáncer de próstata hormonosensible metastásico (CPHSm) ha cambiado en los últimos años debido a la autorización de nuevos medicamentos. El objetivo fue caracterizar la prevalencia, incidencia y patrones de tratamiento para el CPHSm en España.Pacientes y métodos: Estudio multicéntrico, observacional, longitudinal, retrospectivo en condiciones de práctica clínica habitual con pacientes con CPHSm atendidos en hospitales españoles entre 2015 y 2019 (estudio ECHOS). Las historias clínicas se extrajeron de la base de datos BIG-PAC (geográficamente representativa).Resultados: Se incluyeron los datos de 379 hombres con CPHSm. La prevalencia varió entre 12,2-14,6%. Hubo de 671 a 824 nuevos casos anualmente, con una tendencia creciente. La incidencia media en el periodo del estudio fue de 2,5%, con valores anuales en el rango 2,2-3%. Los nuevos casos anuales de pacientes de novo y recurrentes osciló en el rango 7-11 y 77-104, respectivamente, sin tendencia observada. Mayoritariamente eran pacientes recurrentes (91%) y de alto volumen tumoral (68,6%). La primera línea de tratamiento fue la combinación de docetaxel y terapia de deprivación de andrógenos (TDA) (53%), seguida por TDA sola (23,8%), combinación de TDA y abiraterona (11,1%) y radioterapia (8,6%). En los 12 meses anteriores al diagnóstico de metástasis, la mayoría se sometieron a una prostatectomía (84,9%). El resto había recibido radioterapia (12%) o no recibieron tratamiento (3,8%).Conclusiones: El estudio ECHOS proporciona datos epidemiológicos y patrones de tratamiento actuales en la práctica clínica en pacientes con CPHSm en España. Los resultados obtenidos destacan la necesidad médica de terapias dirigidas. (AU)

Introduction and objective: The management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has changed in recent years due to the approval of new drugs. The aim of this study was to evaluate the prevalence, incidence, and treatment patterns in mHSPC in Spain.Patients and methods: Multicenter, observational, longitudinal, retrospective study in routine clinical practice of patients diagnosed with mHSPC treated in Spanish hospitals between 2015 and 2019 (ECHOS study). Electronic medical records were extracted from BIG-PAC database, which contains geographically representative Spanish centers.Results: Data from 379 men with mHSPC were included. The prevalence of mHSPC ranged between 12.2-14.6% per year, representing from 671 to 824 annual cases with an increasing trend. The mean incidence along the 4-year period was 2.5%, with annual incidence ranging 2.2-3.0%. New annual cases of de novo and recurrent disease ranged between 7-11 and 77-104, respectively, with no trend being observed. These patients were mostly recurrent (91%) with high-volume disease (68.6%). The most common first-line therapy was ADT combined with docetaxel (53%), followed by ADT alone (23.8%), combination of ADT and abiraterone (11.2%), and radiotherapy (8.6%). In the last 12 months before diagnosis of metastasis, most men had been submitted to radical prostatectomy (84.9%). The remaining patients had received radiotherapy (12%) or no treatment at all (3.8%).Conclusions: The ECHOS study provides epidemiologic data and current patterns of treatment in clinical practice of patients with mHSPC in Spain. These results emphasize the medical need of targeted treatments in these clinical settings. (AU)

Incidence, prevalence, and treatment patterns in metastatic hormone-sensitive prostate cancer in Spain: ECHOS study.

INTRODUCTION AND OBJECTIVE: The management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has changed in recent years due to the approval of new drugs. The aim of this study was to evaluate the prevalence, incidence, and treatment patterns in mHSPC in Spain. PATIENTS AND METHODS: Multicenter, observational, longitudinal, retrospective study in routine clinical practice of patients diagnosed with mHSPC treated in Spanish hospitals between 2015 and 2019 (ECHOS study). Electronic medical records were extracted from BIG-PAC database, which contains geographically representative Spanish centers. RESULTS: Data from 379 men with mHSPC were included. The prevalence of mHSPC ranged between 12.2-14.6% per year, representing from 671 to 824 annual cases with an increasing trend. The mean incidence along the 4-year period was 2.5%, with annual incidence ranging 2.2-3.0%. New annual cases of de novo and recurrent disease ranged between 7-11 and 77-104, respectively, with no trend being observed. These patients were mostly recurrent (91%) with high-volume disease (68.6%). The most common first-line therapy was ADT combined with docetaxel (53%), followed by ADT alone (23.8%), combination of ADT and abiraterone (11.2%), and radiotherapy (8.6%). In the last 12 months before diagnosis of metastasis, most men had been submitted to radical prostatectomy (84.9%). The remaining patients had received radiotherapy (12%) or no treatment at all (3.8%). CONCLUSIONS: The ECHOS study provides epidemiologic data and current patterns of treatment in clinical practice of patients with mHSPC in Spain. These results emphasize the medical need of targeted treatments in these clinical settings.

Change of concept about the regulation of angiotensin II-induced monocyte chemoattractant protein-1 production in human endothelial cells.

AIMS: Some intriguing clinical observations about the anti-inflammatory effects of angiotensin type 1 (AT1) receptor blockers and angiotensin converting enzyme inhibitors in cardiovascular patients brought us to study the signalling pathways which lead to angiotensin II (ANG)-induced monocyte chemoattractant protein-1 (MCP-1) production in human endothelial cells. METHODS: MCP-1 production in human umbilical vein endothelial cells (HUVECs) under treatments with ANG, AT1 and angiotensin type 2 (AT2) receptor blockers and pravastatin was measured by ELISA. The expression of AT1 and AT2 receptors and NADPH oxidase catalytic subunits (NOX 1-5) was analysed at mRNA and protein levels. Nuclear factor-kappa B (NF-κB) activation was studied by p65 subunit translocation to the cellular nucleus. Cell viability was tested by the MTT method. Nox4 subcellular distribution was analysed by subcellular protein fractionation and by immunoprecipitation followed by matrix-assisted laser desorption/ionization mass spectrometry analysis. RESULTS: ANG-induced MCP-1 production was mediated by AT2 receptor, but not AT1 receptor in HUVECs in culture, which in turn activated NF-κB, promoting p65 subunit translocation to the nucleus. Reactive oxygen species produced by NADPH oxidase participated in this activation, mainly by the Nox4 subunit, ubiquitously expressed in all the compartments of HUVECs. Pravastatin inhibited ANG-induced MCP-1 production. CONCLUSIONS: Our results support that ANG-induced MCP-1 production in HUVECs is mediated by AT2 instead AT1 receptor activation, which in turn activates NF-κB involving reactive oxygen species produced by the NADPH oxidase complex. Statins can also block ANG-induced MCP-1 production, probably by their inhibitory effects on NADPH oxidase activity.

[Pulmonary granulomatosis caused by lentil aspiration]. / Granulomatosis pulmonar por aspiración de lentejas.

Pulmonary nodular granulomatosis caused by aspirated lentils is a rare entity. We report the case of a healthy 8 years-old girl who suffered a choking life-threatening choking event during a meal, with cardiorespiratory arrest. After a delay of one month delay without symptoms, she developed respiratory distress with radiologic changes. Lung biopsy disclosed foreing body granulomas. Steroids were not used because of their uncertain effectiveness in these cases. One year later the patient's progress was satisfactory.

[Primary Mycobacterium avium respiratory infection in nonimmunocompromised children]. / Primoinfección respiratoria por Mycobacterium avium en niños no inmunocomprometidos.

Mycobacterium avium is a common pathogen in barnyards, where it infects poultry and pigs. In human beings M. avium is most often found to cause disease in immunocompromised individuals, although it is also described fairly often as affecting patients with tuberculosis or chronic obstructive pulmonary disease; in recent years lung infections by M. avium have even been reported in elderly women with no underlying disease. Respiratory infection by this mycobacterium is unusual, however, in healthy children. We describe the case of a previously healthy 2-year-old boy with pneumonia whose course was complicated. After 6 months of treatment with various broad spectrum antibiotics there was no clinically or radiologically observable improvement. Other underlying diseases were ruled out, including infection by germs that cause atypical pneumonia. When all tests were negative, we investigated the possibility of primary infection by an atypical mycobacterium. A skin test was positive for M. avium. Acid-alcohol resistant bacilli were isolated from lung biopsy samples and the presence of tuberculoid granulomas were confirmed. Our patient then responded favorably after tuberculostatic treatment with 3 drugs (isoniazid, rifampicin and pyrazinamide).