Ictericia no obstructiva como síndrome paraneoplásico del carcinoma de próstata: revisión sistemática de casos publicados / Non-obstructive jaundice as paraneoplastic syndrome of prostate carcinoma: Systematic review of published cases

El síndrome de Stauffer es un síndrome paraneoplásico (SPN) en el que se produce una afectación hepática; clásicamente se ha relacionado con tumores renales, pero también con otros tumores como el adenocarcinoma de próstata (ACP). Nuestro objetivo es llevar a cabo una revisión sistemática de los casos publicados asociados al cáncer de próstata. El número de artículos cribados en la revisión bibliográfica fue de 357, de los cuales 25 cumplieron los criterios de inclusión. Todos los casos publicados de síndrome de Stauffer en pacientes con ACP estaban en estadio metastásico. El SPN se resolvió en 3 de cada 4 pacientes cuando se instauró el tratamiento dirigido al cáncer de próstata. La aparición del SPN en pacientes ya diagnosticados de ACP, niveles no elevados de bilirrubina total y la no resolución del SPN se presentaron como factores de mal pronóstico. (AU)

Stauffer syndrome is a paraneoplastic syndrome (PS) that involves liver disorders; it has been often related to renal tumors, but also to others such as adenocarcinoma of the prostate (ACP). Our objective was to carry out a systematic review of published cases associated with ACP. A total of 357 articles were accessed, 25 of which met the study's inclusion criteria. All published cases of Stauffer syndrome in patients diagnoses with ACP were in the metastatic stage. The PS resolved in 3 out of 4 patients when ACP-targeted therapy was implemented. The following were identified as poor prognosis factors: the diagnosis of ACP prior to that of SP, non-elevated levels of total bilirubin, and the non-resolution of SP at the start of treatment. (AU)

[Non-obstructive jaundice as paraneoplastic syndrome of prostate carcinoma: Systematic review of published cases]. / Ictericia no obstructiva como síndrome paraneoplásico del carcinoma de próstata: revisión sistemática de casos publicados.

Stauffer syndrome is a paraneoplastic syndrome (PS) that involves liver disorders; it has been often related to renal tumors, but also to others such as adenocarcinoma of the prostate (ACP). Our objective was to carry out a systematic review of published cases associated with ACP. A total of 357 articles were accessed, 25 of which met the study's inclusion criteria. All published cases of Stauffer syndrome in patients diagnoses with ACP were in the metastatic stage. The PS resolved in 3 out of 4 patients when ACP-targeted therapy was implemented. The following were identified as poor prognosis factors: the diagnosis of ACP prior to that of SP, non-elevated levels of total bilirubin, and the non-resolution of SP at the start of treatment.

Intraocular metastasis as a systemic presentation of neuroendocrine differentiation of prostate carcinoma.

A 68 year-old male was referred for assessment of an amelanotic lesion in the right eye (RE) that was associated with a gradual loss of visual acuity (VA), of 2 months onset, as the main symptom. It was noted in his medical history, that 6 years ago, he had prostate cancer treated with prostatectomy, lymphadenectomy, and coadjuvant local radiotherapy (RT). He was asymptomatic until 6 months ago, when a metastasis was discovered in the left femur, which was treated with radiotherapy. There were no findings of interest in the left eye (LE). His AV was very low in his RE, and in the eye fundus examination a mass without pigment was observed in the posterior pole with an adjacent exudative retinal detachment. Due to his personal history and results of the complementary tests such as ultrasound and magnetic resonance, the most likely diagnostic option was metastasis of prostate carcinoma, subsequently being confirmed with the histopathology results. Despite 4 cycles of chemotherapy, the patient did not show any clinical or radiological response, worsening until his death 3 months later.

Metástasis intraocular como presentación sistémica de un adenocarcinoma de próstata con diferenciación neuroendocrina / Intraocular metastasis as a systemic presentation of neuroendocrine differentiation of prostate carcinoma

Varón de 68 años derivado para valoración de una lesión amelanótica en el ojo derecho (OD) que asociaba como síntoma principal pérdida de agudeza visual (AV) progresiva de 2 meses de evolución. Entre sus antecedentes destaca un adenocarcinoma de próstata tratado con prostatectomía, linfadenectomía y radioterapia local (RT) coadyuvante hace 6 años. Asintomático hasta hace 6 meses, cuando se descubrió una metástasis en fémur izquierdo, tratada con radioterapia. La exploración del ojo izquierdo (OI) no tenía hallazgos de interés. En el OD su AV era muy baja y en el fondo de ojo (FO) se encontró una masa sin pigmento en polo posterior con un desprendimiento de retina (DdR) exudativo adyacente. Por sus antecedentes personales y características de las pruebas complementarias como ecografía o resonancia, la opción diagnóstica más probable era metástasis de adenocarcinoma de próstata, certificándose posteriormente con los resultados anatomopatológicos. A pesar de los 4 ciclos de quimioterapia (QT) recibidos, el paciente no obtuvo respuesta clínica ni radiológica, empeorando hasta su fallecimiento 3 meses después (AU)

A 68 year-old male was referred for assessment of an amelanotic lesion in the right eye (RE) that was associated with a gradual loss of visual acuity (VA), of 2 months onset, as the main symptom. It was noted in his medical history, that 6 years ago, he had prostate cancer treated with prostatectomy, lymphadenectomy, and coadjuvant local radiotherapy (RT). He was asymptomatic until 6 months ago, when a metastasis was discovered in the left femur, which was treated with radiotherapy. There were no findings of interest in the left eye (LE). His VA was very low in his RE, and in the eye fundus examination a mass without pigment was observed in the posterior pole with an adjacent exudative retinal detachment. Due to his personal history and results of the complementary tests such as ultrasound and magnetic resonance, the most likely diagnostic option was metastasis of prostate carcinoma, subsequently being confirmed with the histopathology results. Despite 4 cycles of chemotherapy, the patient did not show any clinical or radiological response, worsening until his death 3 months later (AU)

[New recommendations for prostate cancer screening with PSA]. / Nuevas recomendaciones en el screening de cáncer de próstata mediante PSA.

Prostate cancer is the most frequently diagnosed cancer in men and the second cause of death in those worldwide. The fact that is a tumor with a long latency period has led to a confusion in the convenience of its diagnosis and treatment in patients at an early stage. Classically, European and American societies have not recommended prostate cancer screening with PSA, allowing physicians take this decision. In 2012, after many years full of controversy, the American organization United States Preventive Task Force recommended to abandon its use. The results of these statements carried an increase in the incidence of the metastatic prostate cancer and, therefore, a rise in its mortality. In 2018, after these consequences, the European Association of Urology released new recommendations in favor of screening based on PSA for the first time. In 2019, guidelines were updated with no changes in its recommendations.

Gleason sum upgrading between biopsy and radical prostatectomy in Chinese population: Updated nomograms. / Infragradación de la biopsia de próstata respecto a la pieza de prostatectomía la población china: nomogramas actualizados.

INTRODUCTION: To assess the risk factors of Gleason sum upgrading between biopsy and radical prostatectomy (RP) and update the nomogram for the prediction of Gleason sum upgrading. METHODS: The study cohort consisted of 237 Chinese prostate adenocarcinoma patients who underwent 10-core prostate biopsy and subsequently received RP in Huashan Hospital from February 2011 to May 2015. The main outcome of our study was Gleason sum upgrading between biopsy and RP pathology. Univariate and multivariate logistic regression models were conducted to explore the potential predictors, and ultimately to build the nomograms. The prediction model was further evaluated for its ability to predict significant upgrading in patients with biopsy Gleason sum<8. RESULTS: In the main cohort of all the patients, Gleason sum upgrading was observed in 62 (26.16%) patients. The pre-operative prostate-specific antigen (PSA) level, biopsy Gleason sum, and digital rectal examination were used in building the nomogram, which was validated internally with a bootstrap-corrected concordance index of 0.787. In the sub-cohort of 115 patients with standardized biopsy details, Gleason sum upgrading was observed in 31 (26.96%) patients. The pre-operative PSA level, biopsy Gleason sum, and number of positive cores were used in the nomogram, which was also validated internally with a bootstrap-corrected concordance index of 0.833. These two nomograms both demonstrated satisfactory statistical performance for predicting significant upgrading. CONCLUSIONS: Updated nomograms to predict Gleason sum upgrading in Chinese population between biopsy and RP were developed, demonstrating good statistical performance upon internal validation.

Frecuencia de virus papiloma humano en tumores no ginecológicos de la Región de la Araucanía, Chile / Human papilloma virus frequency in non-gynecological tumors in the Araucanía Region, Chile

El Virus Papiloma Humano (HPV por sus siglas en inglés) es una de las infecciones de transmisión sexual más frecuentes del mundo y se encuentra presente en la mayoría de los cánceres de cuello uterino. Se ha descrito su presencia en otros tipos de cáncer no ginecológicos como lo son esófago y próstata. Sin embargo, las frecuencias de HPV descritas hasta el momento para estos tipos de cáncer son muy variables, y no hay artículos donde se muestren la presencia de HPV en estas neoplasias en Chile. El objetivo de este estudio fue determinar la frecuencia de HPV en muestras de biopsias de tumores no ginecológicos y tejido inflamatorio de pacientes de la región de La Araucanía. Se extrajo DNA desde un total de 47 biopsias de pacientes con esofagitis, 25 con carcinoma escamoso esofágico, 20 con hiperplasia nodular de la próstata y 39 con adenocarcinoma prostático. Estas fueron analizadas por PCR de la región L1 del virus y posterior genotipificación por reverse line blot. Se detectó HPV en el 53,2% de las muestras de esofagitis, 48% en muestras de carcinoma escamoso esofágico, 15% en hiperplasia nodular de la próstata y un 15,4% en los casos de adenocarcinoma prostático. Siendo los más frecuentes los genotipos de HPV 16 y 18, ya sea en infecciones simples o junto con otros genotipos, en lesiones preneoplásicas y neoplásicas de los tejidos estudiados. Existe una alta frecuencia de infección por HPV en biopsias de esofagitis y tejido inflamatorio esofágico de pacientes de la región de la Araucanía. En los casos de adenocarcinoma prostático e hiperplasia nodular de la próstata se observa una baja frecuencia de HPV.

Human Papilloma Virus (HPV) is the most common sexually transmitted disease in the world and it is present in practically all cervical cancers. Its presence was described in other types of non-gynecologic cancer such as esophageal and prostate. However, HPV frequency described for these cancers is highly variable, and there are no articles describing the presence of HPV in these tumors in Chile. To determine HPV frequency in samples from biopsies of non-gynecological tumors and inflammatory tissue from patients in the Araucanía region, DNA was extracted from a total of 47 biopsies from patients with esophagitis, 25 with esophageal squamous cell carcinoma, 20 with prostate nodular hyperplasia and 39 with prostate adenocarcinoma. These were analyzed by PCR of HPV L1 region and subsequent genotyping by reverse line blot. HPV was detected in 53.2% of esophagitis samples, 48% in esophageal squamous cell carcinoma, 15% in prostatitis and 15.4% in cases of prostatic adenocarcinoma. The most frequent HPV genotypes were 16 and 18, either single or in combination with other genotype infections, in inflammatory tissue and neoplastic lesions. In patients of the Araucanía region, there is a high rate of HPV infection in biopsies obtained in esophagitis and esophageal inflammatory tissue. In cases of prostatic adenocarcinoma and prostate nodular hyperplasia a low rate of HPV was observed.

Diagnostic usefulness of the cytological study of the transport buffer in transrectal prostate core biopsies.

BACKGROUND: To evaluate the diagnostic usefulness of the cytological study of the transport buffer in the diagnosis of prostate adenocarcinoma in transrectal core biopsies. METHODS: A total of 256 consecutively biopsied patients have been included in the analysis, 100 of them diagnosed of prostate adenocarcinoma. The procedure included the cytological analysis of the transport buffer and conventional histology. Cytological evaluation was performed in a blind way by the same pathologist. RESULTS: Overall sensitivity, specificity, and positive and negative predictive values to detect malignancy in the cytological slides were 54%, 98%, 94% and 76%, respectively. When restricted the analysis to cases with Gleason score higher than 8, sensitivity and negative predictive value increased to 85% and 97%, respectively. Similarly, when the analysis focused exclusively to cases with more than 5mm of cancer in the biopsy, sensitivity and positive predictive value increased to 66% and 96%, respectively. CONCLUSIONS: This study shows that whilst specificity was maintained in 98%, sensitivity, and positive and negative predictive values significantly improved in high grade and high volume adenocarcinomas. Our findings confirm that the cytological study of the transport buffer may complement the histology in the diagnosis of prostate adenocarcinoma.

Radical prostatectomy is a reasonable treatment for patients over 70 years of age.

OBJECTIVE: To compare the tumor nature and oncological course of patients operated on by radical prostatectomy in three age groups. MATERIAL AND METHOD: From the prospective completion of the data base of our department, we analyzed 1012 patients operated on between 1986 and December 2009. Patients with neo- or adjuvant treatment and those with pre-operative PSA over 50 were excluded. The sample was divided into three groups: younger than 60, 60 to 69 and over 70. The clinical, pathological variables, biochemical course and need for rescue treatment were analyzed. We consider biochemical relapse as when the PSA values reached values greater than 0.4 in two consecutive measurements. Rescue was defined as the need for hormone treatment or radiotherapy. We then made a comparative study, a univariate survival analysis by Kaplan and Meyer Curves and multivariate by Cox's regression. RESULTS: The median follow-up was 55.1 months. Of the 1012 patients included in the study, 317 patients (31.3%) had biochemical progression and 259 (25.6%) required rescue treatment. We observed that the groups with the older age had a significantly higher PSA and higher stages than the rest. No differences were observed in the Gleason score of the surgical specimen or in the state of the surgical margins. Biochemical relapse free survival at 5 years was 72.3% (CI 66.4-78.2) in patients under 60 years, 65.3% (CI 60.6-70.0) for patients under 70 and 62.2% (CI 53.2-71.1) for patients of 70 years or older; P<.05. In the univariate study, age was a factor that was significantly associated to biochemical relapse. However, it loses interest in the multivariate study and PSA, pathological state and Gleason score regain interest. Rescue treatment free survival did not differ by age groups. CONCLUSIONS: In the current study, worse biochemical evolution of patients over 70 was observed. However, this worse biochemical course was conditioned by clinically more aggressive tumors that, in our opinion, justifies the decision made in regards to the surgical approach taken with these patients.

Realidad actual del screening para cáncer de próstata: ¿se llevan a cabo las recomendaciones? / Current reality of the screening for prostate cancer: are we carrying out the recommendations?

INTRODUCCIÓN: El cáncer de próstata es la segunda causa de muerte por cáncer en hombres, al igual que en países desarrollados. A pesar de la alta prevalencia y mortalidad, no existen programas de amplia cobertura para detección precoz en la población masculina. OBJETIVO: Determinar la prevalencia del tamizaje para cáncer de próstata en hombres de diversos centros de salud de Santiago de Chile. METODOLOGÍA: Encuesta dirigida a hombres mayores o igual de 40 años que consultaron a centros de salud por causas no urológicas. Se preguntó respecto a edad, realización de exámenes de detección de cáncer de próstata e inicio de controles para pesquisa. RESULTADOS: Respondieron a la encuesta 517 hombres, con una edad promedio de 59 años. Un 50,3 por ciento de los encuestados refirieron haber tenido control para detección de cáncer de próstata alguna vez en su vida. Se observó una mayor proporción de pacientes controlados en un centro de alto nivel socioeconómico de la ciudad, y de un Hospital, en comparación a otros 3 centros. La mayor parte de los controlados tenían más de 60 años, y sólo un tercio inició los controles antes de los 50 años. Finalmente, sólo un 50 por ciento de los controlados se habían realizado tanto medición de antígeno prostático específico como el examen digital rectal. CONCLUSIÓN: La cobertura del screening para cáncer de próstata es baja en la población masculina de Santiago de Chile. Además, la mayor parte de los pacientes inician los controles a edades tardías.

BACKGROUND: In Chile, prostate cancer is the second leading cause of cancer death in men, similar to developed countries. Despite the high prevalence and mortality, there are no established screening programs for early detection. AIM: To evaluate the prevalence of the prostate cancer screening method in different centers of Santiago. MATERIALS AND METHODS: A questionnaire was applied to men 40 years or older to determine age, performing some prostate screening, age at first screening, and which type of screening has been performed. RESULTS: The questionnaire was answered by 517 men, mean age 59 years. 50,3 percent reported had control for detection of prostate cancer at least one time in their life. A higher proportion of patient controlled was observed in a high socioeconomic center of the city and a hospital, compared to other 3 centers. Most of the controlled were over 60 years, and only one third of the controlled started before 50 age. Finally, only 50 percent had done prostate specific antigen plus digital rectal examination. CONCLUSION: The screening for prostate cancer is low in the male population of Santiago de Chile. Furthermore, most patients stars controls at later ages.

Hiperplasia benigna da próstata / Benign prostatic hyperplasia

A hiperplasia benigna da próstata (HPB) e o adenocarcinoma da próstata (CaP) possuem elevada prevalência em homens acima dos 50 anos. As duas patologias possuem forte caráter hereditário, sendo que na HPB a intensidade dos sinais clínicos determina, na maioria das vezes, a necessidade e o tipo de tratamento a ser instituído. Já no CaP a detecção precoce é fundamental para a cura do paciente e a doença localizada, normalmente, não produza sintomas. Há várias opções de tratamento para ambas as patologias, dependendo do quadro clínico do paciente, a simples observação vigilante, o tratamento medicamentoso e os procedimentos cirúrgicos. O prognóstico da doença depende da fase em que é detectada, sendo necessária orientação para realização de exames periódicos.

Metástase cerebral como manifestação inicial de adenocarcinoma de próstata / Cerebral metastases as the first manifestation of prostatic adenocarcinoma

O acometimento do sistema nervoso central por neoplasia primária de próstata é raro. Cerca de 2% a 4% dos pacientes com adenocarcinoma de próstata disseminado apresentam metástases parenquimatosas para cérebro ou medula espinhal. A metástase cerebral por adenocarcinoma de próstata ocorre por disseminação hematogênica a distância, somenteapós comprometimento dos ossos e pulmões. Os autores descrevem dois casos de metástases cerebrais como manifestação inicial de adenocarcinoma de próstata, sem acometimento clínico de outros órgãos. Discutem sua via de disseminação e prognóstico. Sem dúvida, pode haver lesão em outros órgãos que não se manifestaram clinicamente e apresentam um péssimo prognóstico.

Intracranial metastases from adenocarcinoma of the prostate is rare. The incidence of metastatic prostatic cancer in the brain or spinal cord is approximately 2 to 4 percent in large series. Brain metastases tases from prostatic adenocarcinoma can be explained by distance hematogenic widespread after secundary focus in the bone or lung. The authors report two patients with intracranial metastases as the first manifestation of prostate cancer, with no symptoms in other sites.