Cryotherapy for primary treatment of prostate cancer: intermediate term results of a prospective study from a single institution.

Purpose. Published data about cryotherapy for prostate cancer (PC) treatment are based on case series with a lack of clinical trials and the inexistence of a validated definition of biochemical failure. A prospective study with standardized followup protocol was conducted in our institution. Material and Methods. Prospective study of a series of cases including 108 patients diagnosed with localized PC at clinical stage T1c-T2c treated by primary cryoablation and median followup of 61 months. Criteria of biochemical recurrence were unified according to the American Society for Therapeutic Radiology and Oncology (ASTRO). End points were biochemical progression-free survival (BPFS), cancer-specific survival, and overall survival. Rate of complications was reported. Results. The BPFS for low-, medium-, and high-risk patients was 96.4%, 91.2%, and 62.2%, respectively. Cancer-specific survival was 98.1%. Overall survival reached 94.4%. Complications included incontinence in 5.6%, urinary tract obstruction in 1.9%, urethral sloughing in 5.6%, haematuria in 1.9%, perineal pain in 11.1%, and prostatorectal fistula in 0.9%. Erectile disfunction was found in 98.1%. Conclusions. Cryotherapy is an effective and minimally invasive treatment for primary PC in well-selected cases, with low surgical risk and good results in terms of BPFS, cancer-specific survival, and overall survival.

[Prognostic significance of PIN and Atypical Small Acinar Proliferation on transrectal ultrasound-guided prostate biopsy]. / Significación pronóstica del PIN y la atípia glandular focal en la Biopsia Transrectal Ecodirigida de Próstata.

OBJECTIVE: To review the incidence of PIN and Atypical Small Acinar Proliferation (ASAP) on first biopsy, the risk to find cancer on following biopsies and what is the importance given to this findings, analizing how frequently and how long after the initial finding this patients are rebiopsied. METHOD: We selected 6000 patients who underwent TRUS biopsy between 1994 and 2002. Patients with prior cancer diagnosis were not included. 861 of them underwent more than one biopsy, adding up to a total of 7127 biopsies. A descriptive study has been done including percentages and percentiles for qualitative variables, mean and median for continuous variables. RESULTS: Incidence of cancer on the first biopsy was 39,1%. PIN and ASAP are stable or slightly increase from 2 and 2,1% respectively on the first biopsy to more than 6% on the fourth and fifth ones. Mean time between biopsies when ASAP or PIN are the initial findings is 180 +/- 221,6 and 264 +/- 213,8 days respectively. Just 42 and 40% of patients with prior PIN or ASAP diagnose are rebiopsied. On subsequent biopsies 45 and 40% of cancers were respectively found. CONCLUSIONS: Presence of PIN or ASAP implies a higher cancer risk on subsequent biopsies; in spite of that, less than half of them are biopsied again. Performing two more biopsies or an amplified biopsy can find most of the tumors associated.

Significación pronóstica del PIN y la atípia glandular focal en la Biopsia Transrectal Ecodirigida de Próstata / Prognostic significance of pin and atypical small acinar proliferation on transrectal ultrasound guided prostate biopsy

Objetivo: Revisar la incidencia de Neoplasia Intraepitelial Prostática (PIN) y Atípia Glandular Focal (AGF) en primera biopsia, el riesgo de estos pacientes de padecer cáncer en biopsias sucesivas y qué importancia se concede a estos hallazgos analizando con qué frecuencia son rebiopsiados estos pacientes y cuánto tiempo después del hallazgo inicial. Método: Estudio retrospectivo sobre 6.000 pacientes biopsiados entre 1994 y 2002. No se han incluido pacientes con diagnóstico previo de cáncer. De los 6.000 pacientes 861 se han rebiopsiado en alguna ocasión sumando en conjunto 7.127 biopsias. Se ha realizado un estudio descriptivo que incluye los porcentajes y percentiles para variables cualitativas y medidas de tendencia central para las variables cuantitativas continuas. Resultados: La incidencia de cáncer en la primera biopsia fué del 39,1%. Las cifras de PIN o AGF se mantienen estables o aumentan progresivamente desde un 2 y 2,1% respectivamente en la primera biopsia hasta más del 6% en la cuarta y quinta biopsia. La media de tiempo entre biopsias en el caso de encontrar AGF o PIN en el diagnóstico inicial es de180 ± 221,6 y 264 ± 213,8 días respectivamente. Sólo el 42 y el 40% de pacientes con diagnóstico inicial de PIN o AGF se rebiopsian, encontrando finalmente un 45 y un 40% de tumores en las posteriores biopsias respectivamente. Conclusión: La presencia de PIN o AGF implica un mayor riesgo de cáncer en biopsias posteriores; a pesar de ello menos de la mitad vuelven a biopsiarse. La realización de dos biopsias posteriores o una biopsia ampliada localiza la mayoría de los tumores asociados

Objective: To review the incidence of PIN and Atypical Small Acinar Proliferation (ASAP) on first biopsy, the risk tofind cancer on following biopsies and what is the importance given to this findings, analizing how frequently and how long after the initial finding this patients are rebiopsied. Method: We selected 6000 patients who underwent TRUS biopsy between 1994 and 2002. Patients with prior cancer diagnosis were not included. 861 of them underwent more than one biopsy, adding up to a total of 7127 biopsies. A descriptive study h as been done including percentages and percentiles for qualitative variables, mean and median for continuous variables. Results: Incidence of cancer on the first biopsy was 39,1% .PIN and ASAP are stable or slightly increase from 2 and 2,1% respectively on the first biopsy to more than 6% on the fourth and fifth ones. Mean time between biopsies when ASAP or PIN are the initial findings is 180 ± 221,6 and 264 ± 213,8 days respectively. Just 42 and 40% of patients with prior PIN or ASAP diagnose are rebiopsied. On subsequent biopsies 45 and 40% of cancers were respectively found. Conclusions: Presence of PIN or ASAP implies a higher cancer risk on subsequent biopsies; in spite of that, less than half of them are biopsied again. Performing two more biopsies or an amplified biopsy can find most of the tumors associated

Recidiva tardía de carcinoma epidermoide de pene / Epidermoid pennis carcinoma recidive

OBJETIVO: Presentar un caso de recidiva de carcinoma epidermoide de pene a los 21 años de la cirugía. MÉTODO: Se trata de un paciente de 85 años con antecedentes de penectomía parcial por carcinoma epidermoide, que presenta lesión excrecente a nivel de glande de 1 mes de evolución. Se biopsia siendo el resultado carcinoma epidermoide por lo que se realiza penectomía total con uretrostomía cutánea. RESULTADO: El estudio histopatológico de la pieza confirmó un carcinoma epidermoide bien diferenciado (AU)

OBJETIVE: We report a recidive of pennis carcinoma after 21 years of surgery. METHODS: This is the case of a male of 85 years old, with parcial penectomy; by epidermoid carcinoma. In phisics exploration, that it displays excrecente lesion at level of glande of 1 month of evolution. Biopsy being the result of epidermoid carcinoma reason why is made. Total penectomy, a with cutaneus uretrostomy. RESULTS: The histopathological study of the piece, confirm a epidermoid carcinoma well differentiated (AU)

[Renal metastasis of hepatocellular carcinoma]. / Metástasis renal de hepatocarcinoma.

OBJECTIVE: To report the case of a solitary renal metastasis secondary to hepatocellular carcinoma. METHODS: We report the case of a 51 year old patient who on abdominal ultrasonography was revealed a left renal tumour and a hepatic mass incidentally. A TAC showed the left renal tumor measuring 17 cm in size, possible involvement of left renal vein and a tumour mass in the right lobe of the liver. A TAC guided fine needle punction aspiration biopsy demonstrated a malignant hepatic lesion compatible with hepatocarcinoma, and malignant renal cells compatible with renal or adrenal carcinoma. Left radical nephrectomy and right hepatectomy was performed. RESULTS: Histopathologic study confirmed the diagnosis of moderately differentiated trabecular hepatocarcinoma with lymph node and left renal metastasis.

[Meningitis caused by multiresistant E. coli after an echo-directed transrectal biopsy]. / Meningitis por E. coli multirresistente tras biopsia transrectal ecodirigida.

Transrectal prostate biopsy is the most accurate method for prostate cancer diagnosis. Although an antimicrobial prophylaxis is employed in most cases, infectious complications are among the most severe. We present a case of E. coli multirresistant meningitis after transrectal prostate biopsy despite quinolone prophylaxis.

Metástasis renal de hepatocarcinoma / Renal metastasis of hepatocellular carcinoma

OBJETIVO: Presentar el caso de una metástasis renal solitaria secundaria a hepatocarcinoma. MÉTODO: Describimos el caso de un paciente de 51 años que en ecografía abdominal se descubre incidentalmente una masa renal izquierda y una masa hepática. En el TAC se objetivó la masa renal izquierda de 17 cm de diámetro con posible afectación de vena renal izquierda y una masa hepática en lóbulo derecho. La PAAF guiada por TAC de ambas masas demostró en hígado celularidad maligna compatible con hepatocarcinoma, y en riñón celularidad maligna compatible con carcinoma renal o suprarrenal. Se indicó tratamiento quirúrgico con nefrectomía radical izquierda más hepatectomía derecha. RESULTADO: El análisis histopatológico de la pieza mostró hepatocarcinoma trabecular moderadamente diferenciado con metástasis ganglionar y renal izquierda (AU)

Meningitis por E. coli multirresistente tras biopsia transrectal ecodirigida / E. Coli multirresistant meningitis after transrectal prostate biopsy

La biopsia transrectal ecodirigida es actualmente el método más eficaz para el diagnóstico del carcinoma prostático. A pesar de que en la mayoría de los protocolos se emplea profilaxis antibiótica, las complicaciones infecciosas se encuentran entre las de mayor gravedad. Presentamos un caso de meningitis por E. coli multirresistente después de la realización de una biopsia transrectal de próstata a pesar de la profilaxis con quinolonas (AU)

Transrectal prostate biopsy is the most accurate method for prostate cancer diagnosis. Althoug an antimicrobial prophylaxis is employed in most cases, infectious complications are among the most severes. We present a case of E. coli multirresistant meningitis after transrectal prostate biopsy despite quinolone prophylaxis (AU)

[Late recurrence of penile epidermoid carcinoma]. / Recidiva tardía de carcinoma epidermoide de pene.

OBJECTIVE: We report a recidive of penis carcinoma after 21 years of surgery. METHODS: This is the case of a male of 85 years old, with partial penectomy; by epidermoid carcinoma. In physics exploration, that it displays excrecente lesion at level of gland of 1 month of evolution. Biopsy being the result of epidermoid carcinoma reason why is made. Total penectomy, a with cutaneus uretrostomy. RESULTS: The histopathological study of the piece, confirm a epidermoid carcinoma well differentiated.