Análisis de las recomendaciones en contra del cribado con antígeno prostático específico en cáncer de próstata / Analysis of recommendations against prostate cancer screening with prostate specific antigen

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Histo-morpho-biochemical findings of the residual prostate (III): (undetectable) PSA maintained after retropubic adenomectomy for BPH.

SUMMARY OBJECTIVES: To present 4 cases with "undetectable" PSA levels (PSA <0.15 ng/ml) long-term postoperative follow-up after retropubic adenomectomy for BPH METHODS: They come from a series of 70 consecutive cases of retropubic prostatic adenomectomies, monitored and controlled at the hospital in their biochemical, histological and morphometric analysis for 5 years following the intervention. RESULTS: Four patients have demonstrated PSA levels <0.15 in all controls after surgery. Mean follow-up of the global series: 45.25 months. There is correlation between this determination and histological and morphometric data, when they were achieved. CONCLUSIONS: "Undetectable" PSA after open prostatic adenomectomy could be an equivalent to the expression of "radical cure"of BPH, and a reliable marker for monitoring neo-hyperplasia.

Hallazgos bioquímicos –histo-morfométrico de la próstata residual (III): PSA “indetectable” mantenido tras adenomectomía retropúbica por HBP / Histo-morpho- biochemical findings of the residual prostate (III)

OBJETIVO: La presentación de 4 casos que, intervenidos de adenomectomía retropúbica por HBP, han presentado, en los controles postoperatorios de PSA, cifras “indetectables” del antígeno (PSA<0.15ng/ml), de forma mantenida a largo plazo. MÉTODO: Proceden de una serie de 70 casos consecutivos intervenidos por vía abierta de HBP que han venido siendo seguidos y controlados, a nivel hospitalario, en sus aspectos bioquímico, histológico y morfométrico durante los 5 años siguientes a la intervención. RESULTADOS: Cuatro pacientes han demostrado cifras de PSA < 0.15 en todos los controles que se han establecido a partir de la cirugía hasta el momento presente en el que, en conjunto, supone una media de seguimiento de 45,25 meses. Ha existido una concordancia de esta determinación con los datos morfométricos e histológicos, cuando se han conseguido. CONCLUSIÓN: La “indetectabilidad” del PSA después de adenomectomía prostática abierta podría suponer un fiable marcador de seguimiento para descartar la neohiperplasia equivalente a la expresión de “cura radical” de la HBP (AU)

OBJECTIVES: To present 4 cases with “undetectable” PSA levels (PSA <0.15ng/ml) on long-term postoperative follow-up after retropubic adenomectomy for BPHMETHODS: They come from a series of 70 consecutive cases of retropubic prostatic adenomectomies, monitored and controlled at the hospital in their biochemical, histological and morphometric analysis for 5 years following the intervention. RESULTS: Four patients have demonstrated PSA levels <0.15 in all controls after surgery. Mean follow-up of the global series: 45.25 months. There is correlation between this determination and histological and morphometric data, when they were achieved. CONCLUSIONS: “Undetectable” PSA after open prostatic adenomectomy could be an equivalent to the expression of “radical cure” of BPH, and a reliable marker for monitoring neo-hyperplasia (AU)

[Biochemical-histo-morphometric findings of the residual prostate (II): long-term PSA behavior after retropubic adenomectomy for BPH. Relationship with prostate volume, histology and its implications in the diagnosis of subsequent adenocarcinoma]. / Hallazgos bioquímico- histo- morfométricos de la próstata residual (II): comportamiento del PSA,A largo plazo, tras adenomectomía retropúbica por H.B.P. Interrrelaciones con el volumen e histología de la próstata residual y sus implicaciones en el diagnóstico ulterior de adenocarcinoma.

SUMMARY OBJECTIVES: To evaluate the changes experienced by the amount of PSA in patients diagnosed with BPH undergoing retropubic adenomectomy (with vesico-capsule plasty) in the short and long term, and the relationships between weight and /or prostate volume calculated preoperatively, volumes and histology of the surgical tissue and residual tissue remaining immediate and on the long term. METHODS: A consecutive series of 70 cases of BPH surgery and followed up beyond 5 years with preoperative PSA and transrectal ultrasound, histology of the piece, postoperative transrectal ultrasound, PSA annually until the fifth year and ultrasound. Within this group, residual prostate histology was obtained in 30 patients between 12 and 36 months after adenomectomy. RESULTS: In accordance to our own confirmed studies, the ATH (transcervical hemostatic adenomectomy) removes by enucleation 76% of the entire volume reported by preoperative ultrasound, including capsule. In our cases, PSA has dropped 83% at one year after surgery compared with the preoperative value, and in most cases that have already reached 5 years of follow-up, this percentage remains with little variation. Having being established a strong relationship between PSA and glandular volume, we must evaluate the need for new cut-off values giving more value to the PSA density in relation to the volume of residual prostate, attempting to improve early diagnosis of carcinoma in these particular cases, in which will be useful a new protocol design. CONCLUSIONS: PSA decline, histology of the prostate after adenomectomy and the morphometric changes after surgery and at mid-term, advise a more accurate value of PSA in patients who underwent open surgery, in order to detect a carcinoma in the residual prostate gland.

Hallazgos bioquímico-histomorfométricos de la prostata residual (II): Comportamiento del PSA,a largo plazo, tras adenomectomia retropubica por H.B.P. Interrrelaciones con el volumen e histología de la prostata residual y sus implicaciones en el diagnostico ulterior de adenocarcinoma / Biochemical–histo-morphometric findings of the residual prostate (II): Long-term PSA behavior after retropubic adenomectomy for BPH. Relationship with prostate volume, histology and its implications in the diagnosis of subsequent adenocarcinoma

OBJETIVO: Constatar las variaciones experimentadas por la cifra de PSA en pacientes diagnosticados de HBP y sometidos a adenomectomía retropúbica (A.T.H. con vesicocapsuloplastia) a corto y largo plazo y las relaciones existentes entre aquella, los pesos y/o volúmenes prostáticos calculados en el preoperatorio, los volúmenes e histología de la pieza quirúrgica y del tejido residual inmediatos y lejanos.MÉTODO: Lo constituyen una serie inical de 70 casos de HBP consecutivos sometidos a cirugía y seguidos hasta más allá de los 5 años con PSA y ecografías transrectales preoperatorias, histología de la pieza, ecografía transrectal postoperatoria , PSA anual hasta el quinto año, según los casos, y ecografía postoperatoria lejana discrecional. Dentro de este grupo, en 30 pacientes, se obtuvo histología de la próstata residual entre 12 y 36 meses post adenomectomía.RESULTADOS: Según estudios propios, ya confirmados, la ATH (adenomectomía transcervical hemostática) extirpa la hiperplasia por enucleación representando el 76% de todo el volumen preoperatorio que informa la ecografía, incluyendo cápsula. A su vez, en nuestros casos, el PSA ha descendido, al año de la cirugía, una media del 83% con relación al preoperatorio y, en la mayoría de los casos que ya han alcanzado los 5 años de seguimiento, ese porcentaje se mantiene sin apenas variación. Establecida una fuerte relación entre PSA y volumen glandular hay que plantearse la necesidad de redeterminar las cifras de “cut-off” dando más valor a la PSA density del mismo en relación con los volúmenes reducidos de la próstata residual en un intento por mejorar el diagnóstico precoz de un carcinoma de la misma para lo que será útil el diseño de un nuevo protocolo(AU)

CONCLUSIÓN: El descenso del PSA, la histología de la próstata tras la adenomectomía y los morfométricos cambios tras la cirugía y a medio plazo aconsejan una más adecuada definición del nivel de corte del PSA en estos pacientes en orden a detectar más precozmente un carcinoma en la próstata residual(AU)

OBJECTIVES: To evaluate the changes experienced by the amount of PSA in patients diagnosed with BPH undergoing retropubic adenomectomy (with vesico-capsule plasty) in the short and long term, and the relationships between weight and / or prostate volume calculated preoperatively, volumes and histology of the surgical tissue and residual tissue remaining immediate and on the long term.METHODS: A consecutive series of 70 cases of BPH surgery and followed up beyond 5 years with preoperative PSA and transrectal ultrasound, histology of the piece, postoperative transrectal ultrasound, PSA annually until the fifth year and ultrasound. Within this group, residual prostate histology was obtained in 30 patients between 12 and 36 months after adenomectomy.RESULTS: In accordance to our own confirmed studies, the ATH (transcervical hemostatic adenomectomy) removes by enucleation 76% of the entire volume reported by preoperative ultrasound, including capsule. In our cases, PSA has dropped 83% at one year after surgery compared with the preoperative value, and in most cases that have already reached 5 years of follow-up, this percentage remains with little variation. Having being established a strong relationship between PSA and glandular volume, we must evaluate the need for new cut-off values giving more value to the PSA density in relation to the volume of residual prostate, attempting to improve early diagnosis of carcinoma in these particular cases, in which will be useful a new protocol design.CONCLUSIONS: PSA decline, histology of the prostate after adenomectomy and the morphometric changes after surgery and at mid-term, advise a more accurate value of PSA in patients who underwent open surgery, in order to detect a carcinoma in the residual prostate gland(AU)

[The impact of statins use in clinically localized prostate cancer treated with radical prostatectomy]. / Influencia del empleo de estatinas en el cáncer de próstata clínicamente localizado tratado con prostatectomía radical.

INTRODUCTION: Use of statins has been associated with reduced risk, progression and mortality of some tumors, including prostate cancer (CaP). According to recent Studies, long-term treatment with statins significantly reduces the risk of PC and also confers a protective effect against advanced or aggressive CaP. However, there is no conclusive data regarding the potential effect on patients diagnosed with clinically localized CaP undergoing radical treatment. MATERIALS AND METHODS: A retrospective study was performed in a cohort of 250 patients that did not undergo screening and diagnosis in clinical practice of localized CaP (T1c-T2cNxM0). All patients were treated with radical prostatectomy between 2001 and 2008. Data about clinical and pathological findings, and also the existence of dyslipemia as well as treatment with statins for at least 5 years was collected and analyzed. A logistic regression analysis was performed to determine the independent predictive variables related with a more favorable pathology. RESULTS: In our study, we found a relationship, using a univariate analysis, between treatment with statins and the presence of insignificant carcinoma in the group with low or intermediate risk of recurrence. However, this relationship is not independent when we applied a multivariate analysis. DISCUSSION: Hypothesis about the potential effect of the statins preventing or inhibiting the development of high risk CaP needs to be proven applying specific clinical trials designed for this purpose. There isn't conclusive data that demonstrate that statins lower the risk of development of potentially lethal high grade CaP.

Influencia del empleo de estatinas en el cáncer de próstata clínicamente localizado tratado con prostatectomía radical / The impact of statins use in clinically localized prostate cancer treated with radical prostatectomy

Introducción: El empleo de estatinas se ha relacionado con la reducción del riesgo, progresión y mortalidad de algunos tumores, incluyendo el cáncer de próstata (CP). Según estudios recientes el tratamiento con estatinas a largo plazo no reduce significativamente el riesgo de padecer CP pero parece conferir un efecto protector frente al CP avanzado o agresivo. No existen datos concluyentes del efecto potencial en los pacientes diagnosticados de CP clínicamente localizado y sometidos a tratamiento radical. Material y métodos: Se realiza un análisis retrospectivo en una cohorte de 250 pacientes no sometidos a cribado y diagnosticados en la práctica clínica de CP localizado (T1c-T2cNxM0) tratados con prostatectomía radical desde el año 2001 a 2008. Se recogen las variables clínicas y patológicas además de la existencia de dislipemia y el tratamiento con estatinasdurante al menos 5 años. Se empleó un análisis de regresión logística para determinar las variables independientes predictoras de una patología más favorable. Resultados: En el análisis univariante hemos encontrado relación entre el tratamiento con estatinas, la presencia de carcinoma insignificante y el grupo de riesgo de recidiva bajo o intermedio. Sin embargo, está relación no es independiente en el análisis multivariante. Discusión: La hipótesis sobre el potencial efecto de las estatinas en la prevención o la inhibición del desarrollo del cáncer de alto riesgo necesita de ensayos clínicos diseñados para analizar este objetivo. Existen datos no concluyentes que parecen favorecer a los pacientes tratados con estatinas presentando un menor riesgo de CP de alto grado y probablemente letal (AU)

Introduction: Use of statins has been associated with reduced risk, progression and mortality of some tumors, including prostate cancer (CaP).According to recent Studies, long-term treatment with statins significantly reduces the risk of PC and also confers a protective effect against advanced or aggressive CaP. However, there is no conclusive data regarding the potential effect on patients diagnosed with clinically localized CaP undergoing radical treatment. Materials and methods: A retrospective study was performed in a cohort of 250 patients that did not undergo screening and diagnosis in clinical practice of localized CaP (T1c-T2cNxM0). All patients were treated with radical prostatectomy between 2001 and 2008. Data about clinical and pathological findings, and also the existence of dyslipemia as well as treatment with statins for at least 5 years was collected and analyzed. A logistic regression analysis was performed to determine the independent predictive variables related with a more favorable pathology. Results: In our study, we found a relationship, using a univariate analysis, between treatment with statins and the presence of insignificant carcinoma in the group with low or intermediate risk of recurrence. However, this relationship is not independent when we applied a multivariate analysis. Discussion: Hypothesis about the potential effect of the statins preventing or inhibiting the development of high risk CaP needs to be proven applying specific clinical trials designed for this purpose. There isn’t conclusive data that demonstrate that statins lower the risk of development of potentially lethal high grade CaP (AU)

Hernia vesical masiva / Massive bladder hernia

OBJETIVO: Presentamos el caso de una herniavesical masiva en bolsa escrotal que había condicionadola migración de prácticamente la globalidad de la vejiga.MÉTODOS Y RESULTADOS: Varón de 65 años en estudio por HBP que presenta una tumoración en bolsa escrotal, que resultó ser una hernia vesical masiva en bolsa escrotal derecha, del tipo paraperitoneal y acompañada de hernia inguinal, que fue tratada con resección de la porción herniadade la vejiga y corrección de la hernia inguinal con malla de Marlex. En un segundo tiempo se realizó RTU de próstata. Controlado a los seis meses el paciente está asintomático.CONCLUSIONES: La hernia vesical es una patología poco frecuente, que en la mayoría de los casos supone un mero hallazgo preoperatorio en el contexto de la reparaciónde una hernia inguinal. Puede ser del tipo intraperitoneal,extraperitoneal o paraperitoneal. Su diagnóstico es clínico y su confirmación puede ser por cistografía retrógrada,ecografía o TAC. El tratamiento es quirúrgico, ya sea mediante la reducción simple o con resección de la porción herniada

OBJECTIVES: We report a case of a huge bladder hernia conditioning the migration of almost all the bladder into the scrotum. ;;METHODS AND RESULTS: 65-year-old male being studied for BPH who presents a scrotal tumor, which turned out to be a huge inguinal bladder hernia in scrotum, paraperitoneal, accompanied by an inguinal hernia. The treatment consisted in bladder resection and repair of the inguinal hernia with a marlex mesh. Later on, a TURP was done. At a six month control, the patient was non-asymptomatic. ;;CONSLUSIONS: Bladder hernia is an uncommon pathology, and in most of the cases it is an incidental finding during the repair of an inguinal hernia. It can be intraperitoneal, extraperitoneal or paraperitoneal. The diagnosis is clinical, but comfirmation can be done by retrograde cystoghraphy, ultrasonography or CT. The treatment is surgical, repairing the herniation or adding the resection of the bladder herniation

[Massive bladder hernia]. / Hernia vesical masiva.

OBJECTIVES: We report a case of a huge bladder hernia conditioning the migration of almost all the bladder into the scrotum. METHODS AND RESULTS: 65-year-old male being studied for BPH who presents a scrotal tumor, which turned out to be a huge inguinal bladder hernia in scrotum, paraperitoneal, accompanied by an inguinal hernia. The treatment consisted in bladder resection and repair of the inguinal hernia with a marlex mesh. Later on, a TURP was done. At a six month control, the patient was non-asymptomatic. CONCLUSIONS: Bladder hernia is an uncommon pathology, and in most of the cases it is an incidental finding during the repair of an inguinal hernia. It can be intraperitoneal, extraperitoneal or paraperitoneal. The diagnosis is clinical, but comfirmation can be done by retrograde cystoghraphy, ultrasonography or CT The treatment is surgical, repairing the herniation or adding the resection of the bladder herniation.