[Effect of complete androgen block before radical prostatectomy for cancer of the prostate]. / Efecto del bloqueo androgénico completo previo a la prostatectomía radical por cáncer de próstata.

OBJECTIVE: To evaluate the efficacy of complete androgen deprivation in downstaging advanced localized prostate cancer prior to radical prostatectomy. The study evaluated positive margins, prostate volume, PSA and histological changes. METHODS: We evaluated 22 patients with stage T2 (13 pts, 59%) and T3 (13 pts, 59%) prostate cancer treated with complete androgen deprivation for at least 3 months prior to radical prostatectomy. RESULTS: PSA levels dropped in 97% (51.1-1.4 ng/dl) after treatment (p < 0.001); 20 (90%) had PSA < 3 ng/dl, including 3 cases (14%) with positive nodes; 2 cases (9%) with pT2 tumor had PSA > 3 ng/ml. The mean prostate volume dropped 33% from 52.6 to 35.2 cc (p < 0.001). Of the 22 cases, only one T2 (4%) was staged down; 10 (45.5%) had positive margins versus 17 (53%) of the control group (p > 0.05). The Gleason score increased in 19 (86%) and 90% had cytoplasmic vacuolization and pyknosis with moderate nuclear lysis in 50%. CONCLUSION: Neoadjuvant treatment significantly reduces PSA levels and prostate volume. The decrease in PSA levels, however, does not appear to have a direct correlation with the final pathologic stage. Tumor stage changed slightly in patients with T2 tumors and no response was observed in those with T3. Patients receiving neoadjuvant therapy had a slight advantage with respect to positive margins. The histological findings were suggestive of cellular lysis.

[Urinary lithiasis in transplanted kidney]. / Litiasis urinaria en riñón trasplantado.

OBJECTIVE: We reviewed the records of patients submitted to renal transplantation at our institution to determine the incidence and risk factors for calculus formation in these patients. METHODS: Of 794 functioning renal grafts that had been transplanted from January, 1981 to May, 1996, 16 patients (2%), 9 males and 7 females, had upper urinary tract calculi post-transplantation. All 16 patients had received kidneys from cadaver donors. Three had donor graft lithiasis. The calculi were located predominantly in the calyces, at multiple sites in 7 patients and the mean size was 8.3 mm. The composition of the calculi was predominantly uric acid. Four patients who developed sudden obstructive anuria with elevated serum creatinine, underwent percutaneous drainage. RESULTS: All patients had one or more stone-predisposing factors, such as obstructive uropathy, recurrent urinary tract infection or metabolic abnormalities (predominantly hyperuricosuria). Five patients passed their stones spontaneously, 7 patients with uric acid stones were treated with urinary alkalinization, two patients underwent open pyelolithotomy, one underwent percutaneous nephrolithotomy and one patient with a small asymptomatic caliceal stone was managed conservatively (watchful waiting). During long-term follow-up (mean 69 months), 4 patients lost the real graft [only one case was related to urinary calculi (primary hyperoxaluria)] and 4 patients had recurrent calculi. CONCLUSION: Urinary lithiasis after renal transplantation is a relatively uncommon complication. A multifactorial etiology for calculus formation has been observed. The predisposing factors and composition of the calculi, but not frequency, are identical to those of non-transplant patients. A variety of methods are used to treat posttransplant calculi. The least invasive treatment available should be utilized according to the likelihood of recurrence and the need to preserve renal function. With adequate treatment and prophylaxis, posttransplant urolithiasis does not appear to affect graft function.

[Value of PSA and (pre- postoperative) Gleason in predicting the potential lymphatic involvement in patients with prostatic cancer]. / Valor del PSA y del Gleason (pre-postoperatorio) en la predicción de la posible afectación ganglionar en pacientes con cáncer de próstata.

OBJECTIVE: To determine the possibility of selecting patients at risk for lymph node involvement prior to radical prostatectomy utilizing PSA concentration and/or the Gleason score. METHODS: We reviewed the records of 52 patients with tumor stage T1 to T3, who had undergone lymphadenectomy; of these, 50 patients underwent radical prostatectomy. The predictive values for PSA and the Gleason score and their utility in predicting risk of lymph node involvement were analyzed. RESULTS: Of the 52 patients, 10 (19%) had lymph node involvement. Nine of 26 patients (35%) with PSA > 20 and 9 of 21 patients (42%) with a Gleason score > 7 had lymph node involvement. No patient with PSA < 15 or Gleason score < 5 and none of the 24 patients (57%) with PSA < 20 and Gleason score < 7 had lymph node involvement. The preoperative biopsy was understaged in 21 patients (41%); of these, 16% had a Gleason score of 5-6. Two of these patients with PSA > 20 micrograms/ml had lymph node involvement. CONCLUSION: PSA concentration and the Gleason score are useful in predicting the risk of lymph node involvement. Patients with PSA < 20 and a Gleason score of < 7 can be considered to be at no risk and staging lymphadenectomy could be unnecessary. Although the preoperative Gleason score appears to have a predictive value, the possibility of understaging should be taken into account. In this regard PSA can be useful in identifying those patients at risk.