Prostate Cancer in Latin America: Challenges and Recommendations.

Prostate cancer (PCa) is the most frequent tumor among Latin American (LATAM) men. The incidence of de novo metastatic PCa is higher in LATAM than other parts of the world, and demographic changes in the region have increased disease burden. However, region-specific information regarding prevalence, progression, and treatment effectiveness is not currently available for nonmetastatic, castration-resistant PCa (nmCRPC). Nonmetastatic, castration-resistant PCa is a heterogeneous disease with varying potential to develop metastasis with limited treatments available, until recently. New clinical trials with promising results have allowed second-generation antiandrogen drugs to be used as first-line treatments, rendering guidelines outdated. As a result, this panel of experts reviewed the current status and challenges and developed recommendations for nmCRPC diagnosis and management in LATAM. The Americas Health Foundation (AHF) conducted a literature review and identified LATAM scientists and clinicians who have published in the field of PCa since 2012. The AHF convened a panel of 7 chosen experts urologists and medical oncologists from the region. The AHF developed specific questions relating to nmCRPC, which were answered by the experts prior to the multiday meeting. Each narrative was discussed and edited by the panel, through numerous rounds of discussion until a consensus was reached in a final manuscript. The panel proposes specific and realistic recommendations for improving access to diagnosis and management of PCa in LATAM. No treatment has yet shown improvement in overall survival; however, when including metastasis-free survival as an end point, second-generation antiandrogen drugs have emerged as effective treatment options and are currently included as first-line treatment. Although nmCRPC is a specific disease that represents a small percentage of patients with PCa, effective diagnostic and treatment strategies can contribute toward increasing quality of life and survival rates of patients with PCa in LATAM.

Multilocular Cystic Renal Cell Carcinoma or Cystic Nephroma?

The incidence of Multilocular cystic renal cell carcinoma (MCRCC) in literature is very low and confounding MCRCC with cystic nephroma (CN) is even more unusual. The aim of this report is to present a case of MCRCC and emphasize the importance of the preoperative radiologic evaluation and immunohistochemical staining confirmation to obtain an accurate diagnosis. A 73-year-old woman presented with a history of 4-month right flank pain. CT showed a Bosniak type III renal mass. After laparoscopic partial nephrectomy the initial report was cystic nephroma. Immunohistochemical staining was performed being positive for Epithelial Membrane Antigen thus changing the diagnosis to MCRCC. Multilocular cystic renal cell carcinoma cannot reliably be distinguished from cystic nephroma neither by physical examination nor by radiologic evaluation; immunohistochemical staining assay is useful to differentiate between these conditions allowing an accurate diagnosis and proper follow-up.

The Psychological Impact of Prostate Biopsy: Anxiety and Depression Associated with a Positive Biopsy Result.

INTRODUCTION: We evaluated the psychological impact on patients caused by transrectal prostate biopsy and the emotional stress in those with a positive prostate cancer finding. METHODS: We performed a psychological evaluation of 328 men who underwent transrectal prostate biopsy using HADS (Hospital Anxiety and Depression Scale) at 3 time points. In addition we analyzed events related to the procedure, compared anxiety and depression levels in men with a negative result vs those diagnosed with prostate cancer, and evaluated anxiety and depression associated with events related to the procedure. RESULTS: Of the 328 men 99.08% completed the evaluation, including 51.2% with a biopsy positive for prostate cancer and 48.8% with a negative prostate cancer result. The group with a positive biopsy scored an average of 6.85 in the anxiety category and 3.48 for depressive symptoms with a 2.02 point difference in respect to the original evaluation (p = 0.01). Prostate cancer with prostate specific antigen greater than 20 ng/ml was associated with significant anxiety (p = 0.03). CONCLUSIONS: Biopsy positive for prostate cancer with prostate specific antigen greater than 20 ng/ml is associated with significant anxiety. However, events related to the procedure and marital status are not associated with significant anxiety.

Penile tuberculosis after intravesical bacille Calmette-Guérin immunotherapy.

Immunotherapy with bacille Calmette-Guérin (BCG) is widely used for treatment of superficial urothelial cancer. Complications associated with BCG treatment are common. The most common are minor reactions as cystitis, hematuria, fever, malaise. We report an unusual case of granulomatous balanoposthitis as a complication of intravesical BCG instillation therapy. To our knowledge, only a few reports of BCG-related penile or urethral granulomatous infection have been previously published in the literature.

Abiraterone acetate and castration resistant ductal adenocarcinoma of the prostate.

Ductal adenocarcinoma of the prostate is a rare histological variant that only represents <1% of prostate tumors. This histological variant has several important clinical implications with respect to their evolution, clinical prognosis, and treatment. We report the case of a 64-year-old patient with ductal adenocarcinoma of the prostate, which progresses to castration-resistant prostate cancer, that was treated with abiraterone acetate with good clinical response, to our knowledge, the first case of ductal adenocarcinoma of the prostate in treatment with abiraterone acetate.

Single Dose of Levofloxacin versus Three Dosages for Prophylaxis in Prostate Biopsy.

Transrectal ultrasound-guided core prostate biopsy is a key event in the diagnosis of prostate cancer, transient side events such as local pain, haematuria, haematospermia, dysuria, and rectal bleeding are reported in a large number of patients. Antimicrobial agents lower the incidence of postbiopsy infectious complications. The timing and duration of the regimen and the route of administration remain controversial. We developed a standard prophylactic regimen, in which safety and efficiency were maximized, while costs and variability were minimized. Accordingly we prospectively evaluated 425 consecutive patients, who underwent outpatient transrectal ultrasound-guided prostate biopsy after a single dose versus three doses of levofloxacin.

Association of urine oncofetal fibronectin levels with urology's most common disorders.

UNLABELLED: Urine oncofetal fibronectin (OnfFN) has proven useful in the assessment of malignant diseases such as transitional cell carcinoma (TCC) of the bladder. This study aimed to explore whether OnfFN may identify benign and common urinary diseases. METHODS: The urine OnfFN concentrations from patients who had bladder TCC (8 patients), benign urinary diseases (10 benign prostatic enlargement [BPE] patients, 10 urolithiasis patients), or controls (10 healthy individuals) were determined by ELISA and compared. RESULTS: The urine OnfFN concentration was significantly higher in patients with bladder TCC and lithiasis (mean ± SE 0.43 ± 0.18 and 0.45 ± 0.23 ug/mL) than in patients with BPE and in healthy individuals (0.15 ± 0.06 and 0.10 ± 0.02 ug/mL, p<0.05). The urine OnfFN level (cutoff value 0.038 µg/mL), was able to identify 75% of patients with bladder TCC, 60% of patients with BPE and 80% of patients with urolithiasis, achieving a sensitivity of 0.75 for the recognition of either cancer or a urinary disorder. The OnfFN level had a high sensitivity (0.9) for the identification of urolithiasis. CONCLUSION: The urine OnfFN level proved helpful in the identification of bladder TCC patients. However, it had a better performance for the identification of urolithiasis, highlighting the potential usefulness of OnfFN as a biomarker for urothelial inflammation and repair.