RESUMO
Castration resistant prostate cancer (CRPC) is characterized by an important molecular, pathological and clinical heterogeneity. Although most of them present androgen receptor (AR) signal dependence, there are independent phenotypes. Neuroendocrine prostate cancer (NEPC) is a rare histologic subtype with adverse prognosis due to late diagnosis, heterogeneous clinical features and lack of effective systemic treatments. Platinum based chemotherapy is the standard treatment, presenting short limited responses. There are pure forms or mixed with adenocarcinoma component. De novo diagnosis is unusual, being more frequent in advanced stages of prostate cancer, as a consequence of the inhibition of androgen receptor performed by various treatments. Thus, it could represent an aggressive evolution from carcinoma through a NEEpithelial transdifferentiation. Development of preclinical studies has permitted characterization of molecular and genomic alterations associated with this evolution and they may help to develop new therapeutic targets. Over the last years, there have been important advances in identification and characterization of clinical and pathological CRPC variants. NEPC is one of the most aggressive subtypes. A better knowledge of the disease biology is necessary to develop new treatments and biomarkers that help to manage this aggressive variant of PC.
Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias de Próstata Resistentes à Castração/classificação , Neoplasias de Próstata Resistentes à Castração/patologia , Carcinoma Neuroendócrino/genética , Carcinoma Neuroendócrino/terapia , Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/genética , Neoplasias de Próstata Resistentes à Castração/terapiaRESUMO
El cáncer de próstata resistente a la castración (CPRC) se caracteriza por una importante heterogeneidad molecular, patológica y clínica. Aunque la mayoría presentan dependencia a la señal del receptor androgénico (RA), existen fenotipos independientes a ésta. El cáncer de próstata neuroendocrino (CPNE) es un subtipo histológico poco frecuente y de pronóstico adverso debido al diagnóstico tardío, características clínicas heterogéneas y a la falta de tratamientos sistémicos efectivos. El tratamiento estándar es la quimioterapia (QT) basada en platino, presentando respuestas de escasa duración. Existen formas puras o mixtas con un componente de adenocarcinoma. Es raro su diagnóstico de novo, siendo más frecuente su aparición en estados avanzados del cáncer de próstata (CP), como consecuencia de la inhibición del receptor androgénico (RA) realizada por diversos tratamientos. Así, podría representar una evolución agresiva desde un adenocarcinoma (CPAD) a través de un mecanismo de transdiferenciación epitelio-NE. El desarrollo de estudios preclínicos han permitido la determinación de alteraciones moleculares y genómicas asociadas a esta evolución y que pueden ayudar al desarrollo de nuevas dianas terapéuticas. En los últimos años se han producido importantes avances en la identificación y caracterización de variantes clínicas y patológicas del CPRC. El CPNE es uno de los subtipos más agresivos. Un mayor conocimiento de la biología de la enfermedad es necesario para desarrollar nuevos tratamientos y biomarcadores que ayuden al manejo de esta variante agresiva del CP
Castration resistant prostate cancer (CRPC) is characterized by an important molecular, pathological and clinical heterogeneity. Although most of them present androgen receptor (AR) signal dependence, there are independent phenotypes. Neuroendocrine prostate cancer (NEPC) is a rare histologic subtype with adverse prognosis due to late diagnosis, heterogeneous clinical features and lack of effective systemic treatments. Platinum based chemotherapy is the standard treatment, presenting short limited responses. There are pure forms or mixed with adenocarcinoma component. De novo diagnosis is unusual, being more frequent in advanced stages of prostate cancer, as a consequence of the inhibition of androgen receptor performed by various treatments. Thus, it could represent an aggressive evolution from carcinoma through a NEEpithelial transdifferentiation. Development of preclinical studies has permitted characterization of molecular and genomic alterations associated with this evolution and they may help to develop new therapeutic targets. Over the last years, there have been important advances in identification and characterization of clinical and pathological CRPC variants. NEPC is one of the most aggressive subtypes. A better knowledge of the disease biology is necessary to develop new treatments and biomarkers that help to manage this aggressive variant of PC
Assuntos
Humanos , Masculino , Carcinoma Neuroendócrino/patologia , Neoplasias de Próstata Resistentes à Castração/classificação , Neoplasias de Próstata Resistentes à Castração/patologia , Carcinoma Neuroendócrino/genética , Carcinoma Neuroendócrino/terapia , Neoplasias de Próstata Resistentes à Castração/genética , Neoplasias de Próstata Resistentes à Castração/terapiaRESUMO
UNLABELLED: Patients with Benign Prostatic Obstruction (BPO) and Myasthenia Gravis (MG) treated with Transurethral Resection of the prostate (TURP) show a high incidence of urinary incontinence due to unnoticed damage to muscle fibres of the external sphincter. Photoselective laser vaporization could be an alternative treatment based on the hypothesis that using Laser as energy source in the treatment of BPH prevents sphincter damage because the energy is not transmitted outside the fiber tip. METHODS: We report the case of a man diagnosed of MG and symptomatic BPO treated satisfactorily with photoselective laser vaporization (GreenLight-XPS). RESULTS: Patient did not experienced postoperative secondary incontinence. CONCLUSIONS: Laser photoselective vaporization (GreenLight-XPS) could be the standard treatment for men with MG and BPO, whose prostate volume is less than 60 cc who are candidates for surgical treatment. Despite the extremely low incidence of these cases, further investigations are needed to confirm this affirmation.
Assuntos
Terapia a Laser , Miastenia Gravis/complicações , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Obstrução Uretral/etiologia , Obstrução Uretral/cirurgia , Idoso , Humanos , Masculino , Incontinência UrináriaRESUMO
OBJETIVOS: Los pacientes con miastenia gravis (MG) diagnosticados de sintomatología del tracto urinario inferior (STUI) secundaria a hiperplasia benigna de próstata (HBP), presentan una elevada incidencia de incontinencia urinaria al ser sometidos a resección transuretral de próstata (RTUp), secundaria a la lesión inadvertida de las fibras musculares del esfínter externo. La fotovaporización prostática con Láser podría ser una alternativa de tratamiento, ya que podría evitar el daño inadvertido del esfínter debido a que la energía no se transmite más allá de la punta de la fibra. MÉTODOS: Presentamos el caso de un varón con antecedente de MG y HBP sintomática tratado de forma satisfactoria mediante fotovaporiazación selectiva con Láser verde (GreenLight-XPS). RESULTADOS: El paciente no presentó incontinencia urinaria tras la cirugía. CONCLUSIONES: La fotovaporización prostática con Láser verde (GreenLight-XPS) podría ser el tratamiento estándar de aquellos varones con MG y HBP candidatos a tratamiento quirúrgico, con volumen prostático menor de 60 cc. A pesar de la baja incidencia de estos pacientes, futuros casos son necesarios para corroborar esta afirmación
Patients with Benign Prostatic Obstruction (BPO) and Myasthenia Gravis (MG) treated with Transurethral Resection of the prostate (TURP) show a high incidence of urinary incontinence due to unnoticed damage to muscle fibres of the external sphincter. Photoselective laser vaporization could be an alternative treatment based on the hypothesis that using Laser as energy source in the treatment of BPH prevents sphincter damage because the energy is not transmitted outside the fiber tip. METHODS: We report the case of a man diagnosed of MG and symptomatic BPO treated satisfactorily with photoselective laser vaporization (GreenLight-XPS). Results Patient did not experienced postoperative secondary incontinence. CONCLUSION: Laser photoselective vaporization (GreenLight-XPS) could be the standard treatment for men with MG and BPO, whose prostate volume is less than 60 cc who are candidates for surgical treatment. Despite the extremely low incidence of these cases, further investigations are needed to confirm this affirmation
