ABSTRACT
Introducción La aparición de pruebas de imagen más específicas y sensibles, junto con el empleo cada vez más extendido de técnicas mínimamente invasivas, ha centrado el interés urológico sobre el cáncer de próstata oligometastásico. A pesar de esto, aún queda por determinar el manejo óptimo de esta patología. Objetivo Evaluar la eficacia y seguridad de la cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Adquisición de la evidencia Revisión sistemática de la literatura científica (01/01/2010-31/12/2021) en las bases de datos Medline, Embase, Cochrane Library, CINAHL, Scopus, Agencias de Evaluación de Tecnologías Sanitarias y ClinicalTrials.gov. Los descriptores utilizados han sido prostatectomy, prostatic neoplasm, radical prostatectomy, y los términos de búsqueda libre prostatectomy y oligomestastasicprostate. Los criterios de inclusión fueron estudios con pacientes con cáncer de próstata oligometastásico e intervenidos mediante prostatectomía radical citorreductora (CRP). Síntesis de la evidencia La revisión sistemática incluyó cuatro estudios observacionales, dos ensayos clínicos y dos series de casos, de calidad moderada. Los resultados observados sugieren un beneficio en cuanto a eficacia en aquellos pacientes oligometastásico sometidos a una cirugía de próstata citorreductora. Por otro lado, la mayoría de estos estudios revelan una reducción en el número de las complicaciones locales cuando se compara con los mejores tratamientos sistémicos. Conclusiones La cirugía citorreductora en este grupo de pacientes, es un procedimiento seguro que reduce las complicaciones locales, que ofrece resultados prometedores en cuanto a supervivencia. Hasta la fecha, la falta de ensayos prospectivos limita el papel de esta opción terapéutica a entornos experimentales (AU)
Introduction Interest in oligometastatic prostate cancer has spiked due to the emergence of new evidence regarding more specific and accurate imaging, and the wider use of minimally invasive techniques. Nevertheless, the optimal management of this pathology is yet to be determined. Objective Assess the efficacy and safety of cytoreductive surgery in patients suffering from oligometastatic prostate cancer. Evidence gathering Systematic review of the scientific literature (01/01/2010-31/12/2021) within the MedLine, Embase, Cochrane Library, Cinahl, Scopus, Spanish Healthcare Technology Assessment Agencies (AETS, Agencias de Evaluación de Tecnologías Sanitarias) and ClinicalTrials.gov databases. The keywords used were prostatectomy, prostatic neoplasm, radical prostatectomy; the free search terms were prostatectomy and oligometastaticprostate. The inclusion criteria comprised studies on patients with oligometastatic prostate cancer who had been operated on using radical cytoreductive prostatectomy. Evidence synthesis The systematic review included 4 observational studies, 2 clinical trials, and 2 case series, of moderate quality. The results observed suggest that oligometastatic prostate cancer patients who had undergone cytoreductive prostate surgery obtained a benefit in terms of efficacy. Conversely, the majority of these studies showed a reduction in the number of localized complications, when compared to the best systemic treatments. Conclusions Cytoreductive surgery in this group of patients is a safe procedure that reduces the incidence of localized complications and that presents promising results with regard to survival rates. To date, the lack of prospective trials limits the use of this therapeutic option to experimental environments (AU)
Subject(s)
Humans , Male , Cytoreduction Surgical Procedures/methods , Prostatic Neoplasms/surgery , Prostatectomy/methods , Survival AnalysisABSTRACT
INTRODUCTION: Interest in oligometastatic prostate cancer has spiked due to the emergence of new evidence regarding more specific and accurate imaging, and the wider use of minimally invasive techniques. Nevertheless, the optimal management of this pathology is yet to be determined. OBJECTIVE: Assess the efficacy and safety of cytoreductive surgery in patients suffering from oligometastatic prostate cancer. EVIDENCE GATHERING: Systematic review of the scientific literature (01/01/2010-31/12/2021) within the MedLine, Embase, Cochrane Library, Cinahl, Scopus, Spanish Healthcare Technology Assessment Agencies (AETS, Agencias de Evaluación de Tecnologías Sanitarias) and ClinicalTrials.gov databases. The keywords used were prostatectomy, prostatic neoplasm, radical prostatectomy; the free search terms were prostatectomy and oligometastatic prostate. The inclusion criteria comprised studies on patients with oligometastatic prostate cancer who had been operated on using radical cytoreductive prostatectomy. EVIDENCE SYNTHESIS: The systematic review included 4 observational studies, 2 clinical trials, and 2 case series, of moderate quality. The results observed suggest that oligometastatic prostate cancer patients who had undergone cytoreductive prostate surgery obtained a benefit in terms of efficacy. Conversely, the majority of these studies showed a reduction in the number of localized complications, when compared to the best systemic treatments. CONCLUSIONS: Cytoreductive surgery in this group of patients is a safe procedure that reduces the incidence of localized complications and that presents promising results with regard to survival rates. To date, the lack of prospective trials limits the use of this therapeutic option to experimental environments.
Subject(s)
Cytoreduction Surgical Procedures , Prostatic Neoplasms , Male , Humans , Cytoreduction Surgical Procedures/methods , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Prostate/pathology , Prostatectomy/methods , Survival RateABSTRACT
OBJECTIVE: Over the last decade, significant advances have been made in the development of therapies for patients with metastatic castration-resistant prostate cancer. Abiraterone and enzalutamide were approved as treatments based on data supporting improved overall survival compared to placebo. Radium-223 became the first approved radiopharmaceutical which decreased skeletal-related events, palliated pain, and showed improved overall survival in symptomatic patients with castration-resistant prostate cancer and bone metastasis only. MATERIALS AND METHODS: We present the case of an eighty-two year old man with metastatic castration-resistant prostate cancer who was treated with sequential therapy (abiraterone - enzalutamide - radium 223). The sequencing and treatment used for our patient was viable because of his clinical characteristics, which have allowed for longer survival time with an acceptable quality of life. These actions must be agreed on by the Multidisciplinary Tumour Board, in order to optimize the use of available courses of treatment. RESULTS: The treatment of these patients is changing rapidly, but many questions remain regarding the optimal sequencing of the available drugs. Sequential or concomitant use of the next generation hormonal agents - abiraterone and enzalutamide - cannot currently be recommended. Data regarding the safety of concomitant abiraterone, enzalutamide or denosumab with radium-223 is reassuring and timely. However, we cannot advocate the general use of combined radium-223 therapy at this time, irrespective of prior therapy. CONCLUSION: A better understanding of active mechanisms, the genetic characteristics of each metastatic castration-resistant prostate cancer and the development of new prognostic and predictive biomarkers will help determine sequencing or different combination treatments for each individual patient.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Prostatic Neoplasms/therapy , Radium/therapeutic use , Abiraterone Acetate/administration & dosage , Aged, 80 and over , Benzamides , Biomarkers, Tumor , Bone Neoplasms/diagnosis , Bone Neoplasms/secondary , Bone Neoplasms/therapy , Combined Modality Therapy , Humans , Male , Neoplasm Metastasis , Neoplasm Staging , Nitriles , Phenylthiohydantoin/administration & dosage , Phenylthiohydantoin/analogs & derivatives , Prostatic Neoplasms/diagnosis , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A nivel mundial, el 19% de todos los cánceres es atribuible al medio ambiente. Está demostrada la influencia de los factores medioambientales en el desarrollo del cáncer vesical. En los países occidentales, en el varón es el cuarto cáncer más frecuente y el octavo en mujeres. En este estudio trataremos de demostrar de qué modo influye tanto la cantidad ingerida de agua como el tipo de la misma (corriente, mineral o de pozo) en el desarrollo del cáncer vesical (CV). Para ello realizamos un estudio epidemiológico observacional y retrospectivo, caso-control: 500 casos (diagnóstico de CV previo) y 500 controles, habitantes de la provincia de Cádiz, los controles emparejados en edad y sexo a los casos. Del estudio original, mucho más amplio, extraemos los resultados obtenidos para un determinado factor: AGUA ingerida. Se compara la exposición relativa de cada grupo a dicha variable o factor. Analizamos estadísticamente su influencia en función de la cantidad y tipo de agua ingerida en el desarrollo de esta enfermedad. A la vista de los resultados pensamos que al aumentar el volumen de líquidos ingeridos y la frecuencia miccional disminuimos el tiempo de exposición de carcinógenos presentes en la orina sobre el urotelio. En cuanto al tipo de agua, parece problemática la ingesta de agua de pozo, aunque se necesitan más estudios. Concluimos que consumos por debajo de 1 litro suponen un factor de riesgo y por encima de 2 litros, un factor protector
Globally, 19% of all cancers are attributable to the environment. The influence of environmental factors on the development of bladder cancer has been demonstrated. In the western countries, in the male is the 4th most frequent cancer and the 8th in women. In this study, we will try to demonstrate how the amount of water ingested and its type (tape water, mineral water, or well water) influence the development of bladder cancer (CV). To do this, we performed an observational and retrospective epidemiological study, case-control: 500 cases (diagnosis of previous CV) and 500 controls, inhabitants of the province of Cádiz, controls matched in age and sex to the cases. From the original study, much more extensive we extract the results obtained for a certain factor: WATER ingested. The relative exposure of each group to that variable or factor is compared. We analyzed its influence statistically according to the amount and type of water ingested in the development of this disease. In view of the results, we believe that by increasing the volume of fluids ingested and the frequency of micturition we decrease the time of exposure of carcinogens present in the urine over the urothelium. Regarding the type of water, well water intake seems problematic, although more studies are needed. We conclude that: consumption below 1 liter is a risk factor and above 2 liters is a protective factor
