Correlation between the 1-hour and 24-hour pad test in the assessment of male patients with post-prostatectomy urinary incontinence.

INTRODUCTION: This study is aimed at studying the correlation between the 1-hour and 24-hour pad tests for urinary incontinence following prostatectomy; the second objective is to check whether the severity level established by both tests is adequate for male urinary incontinence. MATERIAL AND METHODS: The study population includes patients who had undergone prostatectomy at a single center between February 2015 and December 2016, using 159 measurements consisting of 24-hour and 1-hour pad tests, belonging 45 patients. Both tests have been performed according to the protocol standardized by the International Continence Society. Once all the data have been obtained, the levels marked by each of the pads have been established, and the statistical analysis has started. RESULTS: The relationship between the amounts recorded in grams by the two test is highly significant (P=0.000), however, when comparing the incontinence levels established by each test (mild, moderate and severe), discrepancies have been found. The median of the severe cases in the 24-hour pad test was 389.5 grams, and in the 1-hour pad test was 92 grams. So, patient's loss values are well above the cut-off point defined for severe urinary incontinence in both 24-hour (50 grams) and 1-hour pad test (75 grams). CONCLUSIONS: There is a diagnostic discrepancy between the 24-hour pad test and the 1-hour pad test in terms of defined urinary incontinence severity levels. In our opinion, these levels should be redefined for male urinary incontinence since the amount of urine loss is well above the threshold established for severe incontinence. LEVEL OF EVIDENCE: 4.

[Pathological prognostic indicators in renal cell carcinoma]. / Indicadores pronósticos anatomopatológicos del cáncer de riñón.

OBJECTIVE: To analyze histological factors not routinely assessed as potential prognostic factors in renal cell carcinoma, such as tumor necrosis, microscopic vascular invasion, and sinus fat invasion. MATERIALS AND METHODS: A retrospective, analytical study was conducted of surgical specimens from 139 patients with localized renal cell carcinoma who underwent nephrectomy from 1993 to 2005. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion were analyzed and compared to the classical factors: TNM classification, Fuhrman grade, and tumor size. For statistical analysis, variables analyzed were categorized as pT1, 2 vs pT3, 4; Fuhrman grade 1, 2 vs 3, 4; tumor size < 7 cm vs >or= 7cm; tumor necrosis vs no tumor necrosis; microvascular invasion of sinus fat vs no invasion. Cancer-specific survival probability and disease-free survival were calculated. A descriptive and analytical statistical analysis was performed using logistic regression for univariate and multivariate analyses. Dependent variables were used to analyze cancer-specific survival rates. Disease-free survival was estimated using a Cox regression model and Kaplan-Meier curves. RESULTS: In the univariate analysis, all variables analyzed had a significant influence on death for renal cell carcinoma. In the multivariate analysis, the variable having the greatest influence was Fuhrman grade (p = 0,032). The variables significantly influencing disease-free survival, estimated by the Cox method, were the pT stage (p = 0.038) and Fuhrman grade (p = 0.048). CONCLUSIONS: In patients with clinically localized renal cell carcinoma undergoing nephrectomy, pT stage and Fuhrman grade are the most important prognostic factors for survival and disease-free survival. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion are prognostic factors for death from renal carcinoma which are associated to TNM classification, Fuhrman grade, and tumor size.

Indicadores pronósticos anatomopatológicos del cáncer de riñón / Pathological prognostic indicators in renal cell carcinoma

Objetivo: analizar el valor pronóstico independiente de supervivencia de factores anatomopatológicos no valorados de modo rutinario, como necrosis tumoral, invasión microvascular e invasión del seno renal. Material y métodos: se realizó un estudio retrospectivo y analítico incluyendo las piezas de 139 cánceres renales, intervenidos entre enero de 1993 y diciembre de 2005, clínicamente localizados. Las variables analizadas fueron: necrosis tumoral, invasión microvascular e invasión del seno renal. Se compararon con los factores clásicos: clasificación TNM, gradación de Fuhrman y tamaño tumoral. Para el análisis estadístico las variables analizadas fueron categorizadas en: pT1,2 frente a pT3,4, Fuhrman 1,2 frente a 3,4, diámetro tumoral < 7 cm frente a diámetro tumoral ≥ 7, necrosis tumoral frente a no necrosis tumoral, invasión microvascular frente a no invasión microvascular e invasión del seno renal frente a no invasión del seno renal. Se calculó la probabilidad de supervivencia cáncer específica y el periodo libre de enfermedad. Se realizó el análisis estadístico descriptivo y analítico con el empleo de regresión logística para análisis univariante y multivariante. El periodo libre de enfermedad se estimó mediante el modelo de regresión de Cox y curvas de Kaplan-Meier. Resultados: en el análisis univariante todas las variables analizadas influyen de forma significativa en la muerte por cáncer de riñón. En el análisis multivariante la variable que más influye es el grado de Fuhrman (p = 0,032). En el periodo libre de enfermedad estimado por el método de Cox las variables que influyen de forma significativa son la categoría pT (p = 0,038) y el grado de Fuhrman (p = 0,048). Conclusión: en pacientes con cáncer renal clínicamente localizado la categoría pT y el grado de Fuhrman son los factores pronósticos anatomopatológicos más importantes en cuanto a la supervivencia y el periodo libre de enfermedad. La invasión microvascular, la necrosis tumoral y la invasión tumoral del seno renal son factores pronósticos de muerte por cáncer renal que se asocian con la categoría TNM, el grado de Fuhrman y tamaño tumoral(AU)

Objective: To analyze histological factors not routinely assessed as potential prognostic factors in renal cell carcinoma, such as tumor necrosis, microscopic vascular invasion, and sinus fat invasion. Materials and methods: a retrospective, analytical study was conducted of surgical specimens from 139 patients with localized renal cell carcinoma who underwent nephrectomy from 1993 to 2005. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion were analyzed and compared to the classical factors: TNM classification, Fuhrman grade, and tumor size. For statistical analysis, variables analyzed were categorized as pT1, 2 vs pT3, 4; Fuhrman grade 1, 2 vs 3, 4; tumor size < 7 cm vs ≥ 7cm; tumor necrosis vs no tumor necrosis; microvascular invasion of sinus fat vs no invasion. Cancer-specific survival probability and disease-free survival were calculated. A descriptive and analytical statistical analysis was performed using logistic regression for univariate and multivariate analyses. Dependent variables were used to analyze cancer-specific survival rates. Disease-free survival was estimated using a Cox regression model and Kaplan-Meier curves. Results: In the univariate analysis, all variables analyzed had a significant influence on death for renal cell carcinoma. In the multivariate analysis, the variable having the greatest influence was Fuhrman grade (p = 0,032). The variables significantly influencing disease-free survival, estimated by the Cox method, were the pT stage (p = 0.038) and Fuhrman grade (p = 0.048). Conclusions: In patients with clinically localized renal cell carcinoma undergoing nephrectomy, pT stage and Fuhrman grade are the most important prognostic factors for survival and disease-free survival. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion are prognostic factors for death from renal carcinoma which are associated to TNM classification, Fuhrman grade, and tumor size(AU)

[Do older men with localized prostate cancer Gleason 8-10 benefit from curative therapy?]. / Puede beneficiarse un hombre de avanzada edad con cancer de próstata Gleason 8-10 de un tratamiento con intención curativa?

OBJECTIVE: The aim is to analyse until which age a radical procedure could have an influence on life expectancy of patients with localized prostate cancer Gleason 8-10. METHODS: We analyse retrospectively 80 patients with localized prostate cancer T1-2N0-XM0 Gleason 8-10. The patients were stratified in 2 groups: group A 34 patients who received hormonal treatment and group B, 46 patients submitted to radical prostatectomy. The analysed variables are: cancer mortality and cancer specific survival. RESULTS: Patients characteristics: median age group A 75 years (66-84) and group B 64 years (56-75) (p = 0.033): median followup group A 54 months (20-180) and group B 37 months (12-140) (p = 0.016); median Gleason group A 8 (8-10) and group B 8 (8-10) (p = 0.144); percentage T1 group A 24% and group B 41% (p = 0.096); median PSA group A 10 (4-91) and group B 12 (4-71) (p = 0.269). The cancer specific mortality from group A is 24 (71%) and in group B 3 (7%) (p = 0.000). In the first 5 years, 20 (59%) patients died from prostate cancer in the group A and 1 (2%) in the group B. The Kaplan-Meier curves and Log-Rank test show significant differences in the survival cancer specific between the 2 groups. The Cox regression shows that the possibilities of dying from prostate cancer are higher in the group of patients who did not receive treatment with curative intention. The relative risk (HR 95% IC) in group A is 6.826 (2.032-22.931). CONCLUSIONS: More than half of the patients with localized prostate cancer Gleason 8-10 treated in a conservative way die from cancer within the next 5 years since the diagnosis. The patients with a life expectancy greater than 5 years can benefit with a curative treatment.

¿Puede beneficiarse un hombre de avanzada edad con cáncer de próstata Gleason 8-10 de un tratamiento con intención curativa? / Do older men with localized prostate cancer Gleason 8-10 benefit from curative therapy?

Objetivo: El objetivo es analizar hasta qué edad podría influir una actitud radical en la esperanza de vida de los pacientes con cánceres de próstata clínicamente localizados Gleason 8-10. Material y métodos: Se hace un estudio retrospectivo de 80 pacientes con cáncer de próstata localizado T1-2N0-XM0 Gleason 8-10. Los pacientes se estratificaron en 2 grupos: grupo A 34 pacientes que por diversos motivos, edad superior a 75 años, riesgo quirúrgico, elección del paciente u otros motivos, habían sido tratados con bloqueo androgénico y grupo B, 46 pacientes sometidos a prostatectomía radical. Las variables analizadas son: mortalidad por cáncer y supervivencia cáncer específica. Resultados: Características de los pacientes: mediana de edad grupo A 75 años (66-84) y grupo B 64 años (56-75) (p=0,033); mediana de tiempo de seguimiento grupo A 54 meses (20-180) y grupo B 37 meses (12-140) (p=0,016); mediana de Gleason grupo A 8 (8-10) y grupo B 8 (8-10) (p=0,144); porcentaje de T1 grupo A 24% y grupo B 41% (p=0,096); mediana de PSA grupo A 10 (4-91) y grupo B 12 (4-71) (p=0,269). La mortalidad cáncer específica del grupo A es de 24 (71%) y en el grupo B 3 (7%) (p=0.000). A los 5 años han fallecido 20 (59%) pacientes como consecuencia del cáncer en el grupo A y 1 (2%) de los pacientes en el grupo B. Las curvas de Kaplan-Meier y testde Log-Rank muestran diferencias significativas en la supervivencia cáncer específicas entre los 2 grupos. La regresión de Cox muestra que las posibilidades de morir por cáncer de próstata son superiores en el grupo de pacientes que no recibieron tratamiento con intención curativo, el riesgo relativo (HR 95% IC) en el grupo A es de 6.826 (2.032-22.931). Conclusiones: Algo más de la mitad de los pacientes con cáncer de próstata localizado Gleason 8-10 tratados de forma conservadora, mueren por cáncer dentro de los 5 años siguientes al diagnóstico. Los pacientes con una expectativa de vida superiora 5 años pueden beneficiarse de una actitud curativa (AU)

Objective: The aim is to analyse until which age a radical procedure could have an influence on life expectancy of patients with localized prostate cancer Gleason 8-10.Methods: We analyse retrospectively 80 patients with localized prostate cancer T1-2N0-XM0 Gleason 8-10. The patients were stratified in 2 groups: group A 34 patients who received hormonal treatment and group B, 46 patients submitted to radical prostatectomy. The analysed variables are: cancer mortality and cancer specific survival. Results: Patients characteristics: median age group A 75 years (66-84) and group B 64 years (56-75) (p=0.033); median followup group A 54 months (20-180) and group B 37 months (12-140) (p=0.016); median Gleason group A 8 (8-10) and group B 8 (8-10) (p=0.144); percentage T1 group A 24 % and group B 41% (p=0.096); median PSA group A 10 (4-91) and group B 12 (4-71) (p=0.269). The cancer specific mortality from group A is 24 (71%) and in group B 3 (7 %) (p=0.000). In the first 5 years, 20 (59%) patients died from prostate cancer in the group A and 1 (2%) in the group B. The Kaplan-Meier curves and Log-Rank test show significant differences in the survival cancer specific between the 2 groups. The Cox regression shows that the possibilities of dying from prostate cancer are higher in the group of patients who did not receive treatment with curative intention. The relative risk (HR 95 % IC) in group A is 6.826 (2.032-22.931). Conclusions: More than half of the patients with localized prostate cancer Gleason 8-10 treated in a conservative way die from cancer within the next 5 years since the diagnosis. The patients with a life expectancy greater than 5 years can benefit with a curative treatment (AU)

[Prognostic implications of positive margins in radical prostatectomy specimens]. / Implicaciones pronósticas de los márgenes positivos de las piezas de prostatectomía radical.

UNLABELLED: To evaluate the histopathologic implication of positive margins of prostatectomy specimens in the biochemical recurrence. MATERIAL AND METHODS: The study group consisted of 290 patients with clinically localized prostate cancer who were treated by radical retropubic prostatectomy. Patients with neoadjuvant hormonal therapy and positive lymph nodes were excluded. The mean age at the time of surgery was 63 years (range 47-73); 166 (57.2%) patients were T1c and 124 (42.8%) T2; the average time of folow-up was of 4 years (range 1-12). Positive surgical margins were defined as the presence of cancer cells at the surface inked of prostatectomy specimens. They were classified as: Margin for capsular incision (without extraprostatic extension evidence)/ margin for extraprostatic extension, margin with smooth rounded surface/margin with irregular surface, margin < or = 4 mm/margin > 4 mm, unifocal margin/multifocal margin. We define biochemical recurrence if the PSA exceeds 0.20 ng/ml in two consecutive determinations. RESULTS: The overall rate of positive margins was 65/290 (22.4%). The 5-year survival free of biochemical recurrence was as follows: Negative margins 71% vs positive margins 44% (p < 0.001); positive margins for capsular incision 84% vs positive margins for extraprostatic extension 33% (p < 0.01); positive margins with smooth rounded surface 58% vs positive margins with irregular surface 26% (p < 0.01); positive margins < or = 4 mm 57% vs positive margins > 4 mm 32% (p < 0.05); unifocal margins 53% vs multifocal margins 0% (p < 0.01). The multivariate analysis revealed that preoperative PSA, Gleason score and pathological classification were the best predictors of biochemical recurrence. CONCLUSIONS: Two groups are established of positive margin. The first group with high probability of biochemical recurrence: margin for extraprostatic. The second group with less probability of biochemical recurrence: margin for capsular incision, margin with smooth rounded surface, margin < or = 4 mm and unifocal margin.

Implicaciones pronósticas de los márgenes positivos de las piezas de prostatectomía radical / Prognostic implications of positive margins in radical prostatectomy specimens

Evaluar las implicaciones de los hallazgos histopatológicas de los márgenes positivos de las piezas de prostatectomía en la recidiva bioquímica. Material y métodos: Se analiza un grupo de 290 pacientes con cáncer de próstata clínicamente localizado que fueron tratados con prostatectomía radical retropúbica. Se desecharon todos los pacientes con tratamiento hormonal neoadyuvante y ganglios positivos. La media de edad en el momento de la cirugía era de 63 años (rango 47-73). 166 (57,2%) eran T1c y 129 (42,8%) T2. El tiempo medio de seguimiento fue de 4 años (rango 1-12). Se definió margen positivo como la presencia de células tumorales en contacto con la superficie tintada de la pieza quirúrgica. Fueron valorados desde diferentes puntos de vista: Margen por incisión capsular (sin evidencia de extensión extraprostática)/margen por extensión extraprostática, margen romo/margen espiculado, margen ≤4 mm/margen >4 mm, margen único/margen multifocal. Definimos recidiva bioquímica si el PSA supera 0,20 ng/ml en 2 determinaciones consecutivas. Resultados: El porcentaje global de márgenes positivos fue de 65/290 (22,4%). Las posibilidades de estar libres de recidiva a los 5 años son las siguientes: Márgenes negativos 71% vs márgenes positivos 44% (p4 mm 32% (p<0,05); márgenes únicos 53% vs márgenes multifocales 0% (p<0,01). El análisis multivariante demuestra que el PSA preoperatorio, el Gleason y el estadio anatomopatológico son los mejores predictores de recidivabioquímica. Conclusiones: Se establecen dos grupos de márgenes positivos. Un primer grupo con alta probabilidad de recidiva bioquímica: márgenes por extensión extraprostática, márgenes espiculados, márgenes de más de 4 mm y márgenes múltiples. Un segundo grupo con pronóstico más esperanzador en cuanto a la recidiva bioquímica: márgenes por incisión capsular, márgenes romos, márgenes ≤4 mm y márgenes únicos (AU)

To evaluate the histopathologic implication of positive margins of prostatectomy specimens in the biochemical recurrence. Matherial and methods: The study group consisted of 290 patients with clinically localized prostate cancer who were treated by radical retropubic prostatectomy. Patients with neoadjuvant hormonal therapy and positive lymph nodes were excluded. The mean age at the time of surgery was 63 years (range 47-73); 166 (57.2%) patients were T1c and 124 (42.8%) T2; the average time of folow-up was of 4 years (range 1-12). Positive surgical margins were defined as the presence of cancer cells at the surface inked of prostatectomy specimens. They were classified as: Margin for capsular incision (without extraprostatic extension evidence)/ margin for extraprostatic extension, margin with smooth rounded surface/margin with irregular surface, margin ≤4 mm/margin >4 mm, unifocal margin/multifocal margin. We define biochemical recurrence if the PSA exceeds 0.20 ng/ml in two consecutive determinations. Results: The overall rate of positive margins was 65/290 (22.4%). The 5-year survival free of biochemical recurrence was as follows: Negative margins 71% vs positive margins 44% (p4 mm 32% (p<0.05); unifocal margins 53% vs multifocal margins 0% (p<0.01). The multivariate analysis revealed that preoperative PSA, Gleason score and pathological classification were the best predictors of biochemical recurrence. Conclusions: Two groups are established of positive margin. The first group with high probability of biochemical recurrence: margin for extraprostatic. The second group with less probability of biochemical recurrence: margin for capsular incision, margin with smooth rounded surface, margin ≤4 mm and unifocal margin (AU)

Recidiva del cáncer de próstata después de la prostatectomía radical y radioterapia de rescate / Prostate cancer recurrence after radical prostatectomy and salvage radiotherapy

OBJETIVO: Evaluar la eficacia de la radioterapia en el lecho prostático en pacientes con cáncer de próstata y fracaso bioquímico después de la prostatectomía radical. MATERIAL Y MÉTODOS: Analizamos los resultados de 292 pacientes a los que se le practicó prostatectomía radical por cáncer de próstata localizado T1-T2, entre enero de 1992 y junio de 2003, con un seguimiento medio de 36 meses (rango 6 meses a 12 años). Se detecta fracaso bioquímico (PSA > 0,20 ng/ml) en 75 (26%) pacientes. De los 75 pacientes con fracaso bioquímico, 9 (12%) se diagnosticó de recidiva local siguiendo los siguientes criterios: a) Primer PSA obtenido a las 6 semanas de la intervención 6 meses. c) Tiempo de duplicación del PSA > 6 meses. d) Velocidad de PSA después de la prostatectomía radical <0,75/ng/ml/año. e) Nivel de PSA después de la prostatectomía radical <2,5 ng/ml. Los 9 pacientes diagnosticados de recidiva local reciben una dosis media de 56,42 Gy en el lecho prostático. RESULTADOS: De los 9 pacientes diagnosticados de recidiva local, en 7 (77,7%) se obtuvo una respuesta completa durante un tiempo medio de seguimiento de 25 meses (6-30 meses). El tiempo entre la radioterapia y la respuesta, en los pacientes con respuesta completa, siempre fue inferior a los 3 meses. No se observaron efectos adversos importantes secundarios a la radioterapia. CONCLUSIONES: La radioterapia de rescate puede ser beneficiosa en un seleccionado grupo de pacientes con recidiva local. La cinética del PSA después de la prostatectomía radical es útil para distinguir las recidivas locales de las metástasis a distancia

OBJETIVE: To evaluate the efficacy of the radiotherapy to prostatic bed in patients with biochemical recurrence for prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the results of 292 patients underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average folow-up of 36 months (range 6 months to 12 years). We detect biochemical recurrence (PSA >0.20 ng/ml) in 75 (26%) patients. Of 75 patients with biochemical recurrence, 9 (12 %) was diagnosed of local recurrence by the following criteria: a) The first PSA obtained 6 weeks after radical prostatectomy 6 months. c) The prostate specific antigen doubling time >6 months. d) The prostate specific antigen velocity after radical prostatectomy <0.75 ng/ml/year. e) The prostate specific antigen level after radical prostatectomy <2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy in the prostate bed. RESULTS: Of all 9 patients with local recurrence, 7 (77.7%) has complete response with an average time of followup of 25 months (6-30 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months. Were not observed significant adverse effects associated to radiotherapy. CONCLUSIONS: The salvage radiotherapy may be beneficial in select patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases

Utilidad de la expresión de Ki67 en las biopsias preoperatorias para predecir la recidiva bioquímica del cáncer de próstata después de la prostatectomía radical / The usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progresion of the prostate cancer after radical prostatectomy

OBJETIVO: Evaluar la utilidad de la expresión de Ki67 de las biopsias diagnósticas preoperatorias, para predecir la recidiva bioquímica del cáncer de próstata después de la prostatectomía radical. MATERIAL Y MÉTODOS: Analizamos la expresión de Ki67 en las biopsias ecodirigidas de 103 pacientes a los que se les practicó prostatectomía radical. El tiempo medio de seguimiento es de 3,4 años (1,3-8,8 años). Correlacionamos la recidiva bioquímica con los factores pronósticos clásicos como el PSA (>10/=7/3%/3%/3%/10/=7/<7) y clasificación pT (pT3/pT0-2), para predecir la progresión bioquímica del cáncer de próstata después de la prostatectomía radical

OBJETIVE: To evaluate the usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progression of the prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the Ki67 expression in the biopsy specimens of 103 patients treated with radical prostatectomy. The mean follow up is 3.4 years (1.3-8.8 years). We correlate the biochemical progression with traditional prognostic factors as the PSA (>10/=7/3%/3%/3%/10/=7/<7) and pT ification (pT3/pT0-2), to predict the biochemical progression of the prostate cancer after radical prostatectomy

[Prostate cancer recurrence after radical prostatectomy and salvage radiotherapy]. / Recidiva del cáncer de próstata después de la prostatectomía radical y radioterapia de rescate.

OBJECTIVE: To evaluate the efficacy of the radiotherapy to prostatic bed in patients with biochemical recurrence for prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the results of 292 patients underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average folow-up of 36 months (range 6 months to 12 years). We detect biochemical recurrence (PSA >0.20 ng/ml) in 75 (26%) patients. Of 75 patients with biochemical recurrence, 9 (12%) was diagnosed of local recurrence by the following criteria: a) The first PSA obtained 6 weeks after radical prostatectomy <0.20 ng/ml. b) The time to biochemical recurrence >6 months. c) The prostate specific antigen doubling time >6 months. d) The prostate specific antigen velocity after radical prostatectomy <0.75 ng/ml/year. e) The prostate specific antigen level after radical prostatectomy <2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy in the prostate bed. RESULTS: Of all 9 patients with local recurrence, 7 (77.7%) has complete response with an average time of follow-up of 25 months (6-30 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months. Were not observed significant adverse effects associated to radiotherapy. CONCLUSIONS: The salvage radiotherapy may be beneficial in select patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases.

[The usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progresion of the prostate cancer after radical prostatectomy]. / Utilidad de la expresión de Ki67 en las biopsias preoperatorias para predecir la recidiva bioquímica del cáncer de próstata después de la prostatectomía radical.

OBJECTIVE: To evaluate the usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progression of the prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the Ki67 expression in the biopsy specimens of 103 patients treated with radical prostatectomy. The mean follow up is 3.4 years (1.3-8.8 years). We correlate the biochemical progression with traditional prognostic factors as the PSA (> 10/< or = 10), Gleason (> or = 7/< 7), pT classification (pT3/pTO-2) and immunohistochemical factor Ki67 (> 3%/< or = 3%). RESULTS: Of all 103 patients, in 71 (69%) biochemical progression was not detected and in 32 (31%) biochemical progression was detected. The mean of preoperative PSA is 10.07 ng/ml in the patients without progression and 20.90 ng/ml in the patients with biochemical progression (p=0.0001). The mean of Gleason score in 6.03 in the patients without progression and 6.75 in the patients with biochemical progression (p=0.0001). The percentage of Ki67 expression is 3.95% in the patients without progression and 5.05% in the patients with biochemical progression (p=0.030). The tumors pT0-2 progressed 12/67 (17.9%) and the tumors pT3 progressed 20/36 (55.6%) (p=0.0001). Multivariant regression analysis indicate that it does not exist a statistically significant relation between Ki67 (> 3%/< or = 3%) expression in the biopsy specimens and the biochemical progression of the prostate cancer after radical prostatectomy (p=0.204). CONCLUSIONS: The immunohistochemical factor Ki67 (> 3%/< or = 3%) in the biopsy specimens, is less effective than the classic factors, PSA (> 10/< or = 10), Gleason (> or = 7/< 7) and pT classification (pT3/pT0-2), to predict the biochemical progression of the prostate cancer after radical prostatectomy.

[Cystitis folicular. A case report and review of the literature]. / Cistitis folicular. Aportación de un caso y revisión de la literatura.

OBJECT: We report a patient with cystitis follicularis and review the literature about it. CLINICAL CASE: A man 78 years old with prostate cancer, who need a permanent bladder catheter. We make a desobstructive TUR, prostate resection and many nodular lesions in the lateral walls and bladder down. The diagnostic was cystitis follicularis. CONCLUSIONS: The cystitis follycularis is a cystitis inespecific and chronic kind with a important inflammation made of lymphocytes and plasmatic cells. Its makes lymphocytes foliculos in the bladder subepithelial wall. The indefination its alive about cystitis follicularis etiopageny, treatment and prognostic. The histopathology study is neccessary.

[Clinical and biological progression of incidental prostatic cancer ( Stage T 1a)]. / Progresión biológica y clínica del cáncer de próstata incidental (estadío T1a).

OBJECTIVES: To analyze the biological and clinical progression of the prostate cancer stage T1a. MATERIAL AND METHODS: Retrospective study of 44 patients diagnosed of T1a prostate carcinoma between 1985 and 2001. We value biological and clinical progression, time up to the progression, mortality for tumour reason and survival, with the following stratification: patients without initial treatment and patients treated by means of external radiotherapy or radical prostatectomía. RESULTS: Of all 44 patients biological progression was observed in 5 (11.36%) and clinical progression in 4 (9.09%). The mortality to 5 years for tumour reason was of 2 (4.54%). Of all 38 patients without initial treatment biological progression was observed in 5 (13.15%), in an average time of 25.8 months and clinical progression in 4 (10.52%), in an average time of 34.5 months. The mortality to 5 years was of 2 (5.26%). In all 6 patients to whom radical treatment carried out them progression was not observed and they all live. There are no statistically significant differences between both groups of patients (p = NS). CONCLUSIONS: The biological and clinical progression of the T1a prostate cancer is low, 11.36% and 9.09%, respectively. The mortality to 5 years is of 4.54%. Differences of survival do not exist, statistically significant, between treated and not treated.

[Correlation of the anatomo-pathological staging of radical prostatectomy specimens with the amount of cancer in the preoperative sextant biopsy]. / Correlación del estadio anatomopatológico de la pieza de prostatectomía radical con la cantidad de cáncer en la biopsia sextante preoperatoria.

OBJECTIVE: We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropublic prostatectomy. MATERIAL AND METHODS: We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS: Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p = 0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p = 0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p = 0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p = 0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p = 0.972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p = 0.355). Univariate analysis demonstrated that the risk of extraprostatic extension is predicted by the number of cores positive (p = 0.003), the percent of cores positive (p = 0.006), the percent of cancer in all cores (p = 0.001), the Gleason score (p = 0.002), the clinical stage (p = 0.019) and initial PSA (p = 0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p = 0.971), vascular invasion and perineural invasion (p = 0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p = 0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS: The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy.

Cistitis folicular. Aportación de un caso y revisión de la literatura / Cystitis folicular. A case report and review of the literature

OBJETIVO: Aportar un caso clínico con el diagnóstico de cistitis folicular y revisar la literatura sobre el tema. CASO CLÍNICO: Paciente de 78 años de edad, diagnosticado de cáncer de próstata, portador de sonda de forma permanente por retención urinaria. Se indica resección transuretral desobstructiva de próstata, realizándose al mismo tiempo resección y estudio anatomopatológico de múltiples formaciones con aspecto nodular, situadas en el trígono y caras laterales de la vejiga. El diagnóstico fue cistitis folicular. CONCLUSIONES: La cistitis folicular es un tipo de cistitis crónica inespecífica que se caracteriza por un intenso infiltrado inflamatorio a expensas de linfocitos y células plasmáticas que se agrupan formando folículos en la submucosa vesical. Continúa vigente la indefinición en la etiopatogenia, tratamiento y pronóstico de esta patología. Tan sólo la certeza del diagnóstico histológico confirma su entidad (AU)

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Correlación del estadio anatomopatológico de la pieza de prostatectomía radical con la cantidad de cáncer en la biopsia sextante preoperatoria / The pathological correlation of radical prostatectomy specimen with the quantification of the amount of cancer on preoperative needle sextant biopsy

OBJETIVO: Analizamos la utilidad que tiene la estimación del porcentaje de cáncer en la biopsia sextante para predecir el riesgo de extensión extraprostática en la pieza de prostatectomía radical retropúbica. MATERIAL Y MÉTODOS: Revisamos los hallazgos en las biopsias preoperatorias de 97 pacientes con cáncer de próstata T1c-T2c a los que se le practicó prostatectomía radical retropúbica. En cada biopsia se evalúa el número de cilindros positivos, el porcentaje de cilindros positivos, el porcentaje de cáncer en todos los cilindros, el Gleason, la presencia de neoplasia intraepitelial, la invasión perineural y la invasión vascular. A los resultados de la biopsia se añade el PSA preoperatorio y el estadio clínico, para determinar que parámetros pueden determinar mejor el estadio anatomopatológico, con un análisis univariante y multivariante. RESULTADOS: De los 97 pacientes, 72 (74 por ciento) tenían cáncer organoconfinado y 25 (26 por ciento) presentaban extensión extraprostática del cáncer. El número medio de cilindros positivos en los cánceres organoconfinados fue de 4,2 (mediana 4) vs. 6,8 (mediana 6) para los cánceres con extensión extraprostática (p=0,001). El porcentaje medio de cilindros positivos en los cánceres organoconfinados fue de 34,9 por ciento (mediana 28) vs. 53,8 por ciento (mediana 46) para los cánceres con extensión extraprostática (p=0,013). El porcentaje medio de cáncer en todo el material de la biopsia del cáncer organoconfinado fue de 13,6 por ciento (mediana 6) vs. 30,5 por ciento (mediana 30) para los cánceres con extensión extraprostática (p=0,002). Los valores medios de la puntuación de Gleason eran de 5,9 (mediana 6) en las biopsias de los cánceres organoconfinados vs. 6,6 (mediana 7) en los que presentaban extensión extraprostática (p=0,007). Se observó neoplasia intraepitelial en 3 (4 por ciento) de los cánceres organoconfinados vs. 1 (4 por ciento) de los cánceres con extensión extraprostática (p=0,972). Se encontró invasión perineural en 6 (8,3 por ciento) de las biopsias de los cánceres organoconfinados vs. 4 (16 por ciento) de los cánceres con invasión extraprostática (p=0,355). El análisis univariante demuestra que el riesgo de extensión extraprostática está en relación con el número de cilindros positivos (p=0,003), porcentaje de cilindros positivos (p=0,006), el porcentaje de cáncer en toda la biopsia (p=0,001), el Gleason (p=0,002), el estadio clínico (p=0,019) y el PSA preoperatorio (p=0,032). La presencia de neoplasia intraepitelial (p=0,971), infiltración vascular o infiltración perineural (p=0,285), no predice la extensión extraprostática. En el análisis multivariante se demuestra que el porcentaje de cáncer en el material de la biopsia es la variable que mejor predice la extensión extraprostática del cáncer (p=0,035). Con un porcentaje de cáncer inferior al 3 por ciento en la biopsia, la probabilidad de extensión extraprostática es solamente del 11,5 por ciento. CONCLUSIONES: El porcentaje de cáncer en la biopsia sextante preoperatoria es la variable que mejor predice el estadio del cáncer de próstata, pero es poco práctica a la hora de admitir o desechar un paciente para prostatectomía radical (AU)

OBJETIVE: We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropubic prostatectomy. MATERIAL AND METHODS: We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS: Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p=0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p=0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p=0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p=0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p=0,972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p=0.355). Univariate analysis demostrated that the risk of extraprostatic extension is predicted by the number of cores positive (p=0.003), the percent of cores positive (p=0.006), the percent of cancer in all cores (p=0.001), the Gleason score (p=0.002), the clinical stage (p=0.019) and initial PSA (p=0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p=0.971), vascular invasion and perineural invasion (p=0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p=0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS: The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy (AU)

[Mucinous adenocarcinoma of the urachus]. / Adenocarcinoma mucinoso de uraco.

OBJECTIVE: The Adenocarcinoma of the Urachus is very rare tumor, with an incidence of 1/5,000,000 inhabitants, represents less than 0.001 of all types of bladder cancer. CASE REPORT: A 51 year old man with a chronic history of suprapubic pain and hematuria. Physical examination and excretory urography were normal. The cystoscopy demonstrated a oedematosa area in cupola of bladder wall. The transuretral biopsy was moderately differentiated adenocarcinoma, with positive antibody to CK7 and CK20, the carcinoembryonic antigen was 6.6 ng/ml. Extended partial cystectomy was done, followed for chemotherapy and radiotherapy. CONCLUSIONS: The treatment of adenocarcinoma of the urachus with a combination of extended partial cystectomy, chemotherapy and radiation, is a effective treatment.

Progresión biológica y clínica del cáncer de próstata incidental (Estadío T1a) / Clinical and biological progresion of incidental prostatic cancer (Stage T1a)

OBJETIVO: Analizar el comportamiento biológico y clínico del cáncer de próstata estadío T1a. MATERIAL Y MÉTODOS: Estudio retrospectivo de 44 pacientes diagnosticados de adenocarcinoma de próstata T1a entre 1985 y 2001. Valoramos progresión biológica y clínica, tiempo hasta la progresión, mortalidad por causa tumoral y supervivencia, con la siguiente estratificación: pacientes sin tratamiento inicial y pacientes tratados mediante radioterapia externa o prostatectomía radical. RESULTADOS: De los 44 pacientes se observó progresión biológica en 5 (11,36 por ciento) y progresión clínica en 4 (9,09 por ciento). La mortalidad a 5 años por causa tumoral fue de 2 (4,54 por ciento). De los 38 pacientes sin tratamiento inicial se observó progresión biológica en 5 (13,15 por ciento), en un tiempo medio de 25,8 meses y progresión clínica en 4 (10,52 por ciento), en un tiempo medio de 34,5 meses. La mortalidad a 5 años fue de 2 (5,26 por ciento). En los 6 pacientes a los que se les realizó tratamiento radical no se observó progresión y viven todos. No hay diferencias estadísticamente significativas entre los dos grupos de pacientes (p = NS). CONCLUSIONES: La progresión biológica y clínica del cáncer de próstata T1a es baja, 11,36 por ciento y 9,09 por ciento, respectivamente. La mortalidad a 5 años es del 4,54 por ciento. No existen diferencias de supervivencia, estadísticamente significativas, entre tratados y no tratados (AU)

Adenocarcinoma mucinoso de uraco / Mucinous adenocarcinoma of the urachus

OBJETIVO: El adenocarcinoma de uraco es un tumor extremadamente raro, con una incidencia de 1/5.000.000 de habitantes, lo que representa menos del 0,001 de todos los tumores de vejiga. CASO CLÍNICO: Varón de 51 años con historia de dolor suprapúbico y hematuria. La exploración física y la urografía intravenosa eran normales. La cistoscopia demostraba un área edematosa en la cúpula de la vejiga. La biopsia transuretral confirmó un adenocarcinoma moderadamente diferenciado, con anticuerpos positivos CK7 y CK20. El antígeno carcinoembrionario era de 6,6. Se practicó cistectomía parcial extensa, seguida de quimioterapia y radioterapia. CONCLUSIONES: El tratamiento del adenocarcinoma de uraco con una combinación de cistectomía parcial extensa, quimioterapia y radioterapia es eficaz. (AU)