Influencia de la localización y del número de metástasis en la supervivencia de los pacientes con cáncer de próstata metastásico / Influence of the location and number of metastases in the survival of metastatic prostatic cancer patients

Introducción: En los pacientes con cáncer de próstata metastásico el pronóstico de la enfermedad podría estar modulado por factores como son la localización y el número de metástasis. Nuestro objetivo es evaluar la supervivencia de los pacientes en función de estos factores en nuestra serie en los últimos 15 años. Material y métodos: Estudio retrospectivo de pacientes diagnosticados entre 1998 y 2014. Calculamos la supervivencia global y la supervivencia libre de progresión, en función del número de metástasis y la localización de las mismas. Analizamos otros posibles factores pronósticos: edad, estadio clínico, PSA, Gleason, PSA nadir, tiempo hasta PSA nadir y tratamientos de primera línea o segunda línea tras la progresión. Resultados: Evaluamos a 162 pacientes con una edad media de 72,7 años (DE: 8,5). La supervivencia global fue de 3,9 años (IC95%: 2,6-5,2) Según la localización de las metástasis la supervivencia global fue de 7 años (IC95%: 4,1-9,7) para los pacientes con metástasis ganglionares; 3,9 años (IC95%: 2,3-5,5) en caso de metástasis óseas; 2,5 años (IC95%: 2-2,9) para metástasis óseas y ganglionares; y 2,2 años (IC95%: 1,4-3) en pacientes con metástasis viscerales (p<0,001).En el análisis multivariante, la localización de las metástasis se asoció significativamente con la supervivencia global y libre de progresión. El número de metástasis no presentó impacto en la supervivencia.Conclusiones: La localización de las metástasis tiene una clara influencia tanto en la supervivencia global como en la supervivencia libre de progresión, siendo los pacientes con afectación exclusivamente ganglionar los que presentan mejor pronóstico. El número de metástasis no tiene un efecto significativo en la supervivencia de nuestra serie

Introduction: The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. Materials and methods: A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. Results: We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6-5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1-9.7), 3.9 (95%CI 2.3-5.5) in patients with only bone metastases, 2.5 yr (95% CI 2-2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4-3) in patients with visceral metastases (P<.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. Conclusions: The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series

Influence of the location and number of metastases in the survival of metastatic prostatic cancer patients. / Influencia de la localización y del número de metástasis en la supervivencia de los pacientes con cáncer de próstata metastásico.

INTRODUCTION: The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. MATERIALS AND METHODS: A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. RESULTS: We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6-5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1-9.7), 3.9 (95%CI 2.3-5.5) in patients with only bone metastases, 2.5 yr (95% CI 2-2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4-3) in patients with visceral metastases (P<.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. CONCLUSIONS: The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series.

Estudio de cohortes comparando fotovaporización prostática con láser XPS 180 W y HPS 120 W / Cohort study comparing prostate photovaporisation with XPS 180 W and HPS 120 W laser

Introducción y objetivo: La fotovaporización prostática con láser Greenlight, para el tratamiento quirúrgico de la hiperplasia benigna de próstata ha evolucionado rápidamente hasta el nuevo XPS 180 W. Demostramos anteriormente la eficacia y seguridad con el HPS 120 W. El objetivo de este estudio ha sido evaluar los resultados funcionales y de seguridad, con un año de seguimiento, de la fotovaporización mediante el XPS 180 W comparándolo con su predecesor. Material y métodos: Estudio de cohortes sobre una serie de 191 pacientes consecutivos sometidos a fotovaporización entre 01/2008 y 05/2013. Los criterios de inclusión fueron un IPSS >15 tras fracaso médico, un volumen prostático < 80cc y un flujo máximo <15 ml/s. Se evaluaron variables preoperatorias, intraoperatorias (energía empleada, tiempo de láser y tiempo total de la cirugía), complicaciones, horas de sonda, estancia y resultados funcionales (flujo máximo, IPSS, PSA y volumen prostático) a 3, 6 y 12 meses. Se analiza la homogeneidad en las características preoperatorias de los dos grupos mediante técnicas de análisis univariante. Los resultados funcionales postoperatorios se evalúan mediante análisis de la varianza de medidas repetidas con modelos mixtos. Resultados: Se realizaron 109 (57,1%) procedimientos mediante HPS 120 W y 82 (42,9%) mediante XPS. No se encontraron diferencias entre las características preoperatorias. Se observaron diferencias significativas tanto en el tiempo quirúrgico como en el tiempo efectivo de láser a favor del sistema XPS, siendo esta ventaja de un 11% (48 ± 15,7 vs. 53,8 ± 16,2, p < 0,05), y de un 9% (32,8 ± 11,7 vs. 36 ± 11,6, p < 0,05), respectivamente. En el resto de los parámetros analizados no se encontraron diferencias estadísticamente significativas. Conclusión: Las mejorías técnicas del sistema XPS 180 W permiten reducir el tiempo quirúrgico manteniendo el perfil de seguridad y eficacia que ofrecía el sistema HPS 120 W con unos resultados totalmente superponibles con un año de seguimiento

Introduction and objective: Prostate photovaporisation with Greenlight laser for the surgical treatment of benign prostate hyperplasia has rapidly evolve to the new XPS 180 W. We have previously demonstrated the safety and efficacy of the HPS 120 W. The aim of this study was to assess the functional and safety results, with a year of follow-up, of photovaporisation using the XPS 180 W laser compared with its predecessor. Material and methods: A cohort study was conducted with a series of 191 consecutive patients who underwent photovaporisation between 1/2008 and 5/2013. The inclusion criteria were an international prostate symptom score (IPSS) >15 after medical failure, a prostate volume < 80 cc and a maximum flow <15 mL/s. We assessed preoperative and intraoperative variables (energy used, laser time and total surgical time), complications, catheter hours, length of stay and functional results (maximum flow, IPSS, prostate-specific antigen and prostate volume) at 3, 6 and 12 months. We analysed the homogeneity in preoperative characteristics of the 2 groups through univariate analysis techniques. The postoperative functional results were assessed through an analysis of variance of repeated measures with mixed models. Results: A total of 109 (57.1%) procedures were performed using HPS 120 W, and 82 (42.9%) were performed using XPS. There were no differences between the preoperative characteristics. We observed significant differences both in the surgical time and effective laser time in favour of the XPS system. This advantage was 11% (48 ± 15.7 vs. 53.8 ± 16.2, p< .05) and 9% (32.8 ± 11.7 vs. 36 ± 11.6, p< .05), respectively. There were no statistically significant differences in the rest of the analysed parameters. Conclusion: The technical improvements in the XPS 180 W system help reduce surgical time, maintaining the safety and efficacy profile offered by the HPS 120 W system, with completely superimposable results at 1 year of follow-up

Cohort study comparing prostate photovaporisation with XPS 180W and HPS 120W laser.

INTRODUCTION AND OBJECTIVE: Prostate photovaporisation with Greenlight laser for the surgical treatment of benign prostate hyperplasia has rapidly evolve to the new XPS 180W. We have previously demonstrated the safety and efficacy of the HPS 120W. The aim of this study was to assess the functional and safety results, with a year of follow-up, of photovaporisation using the XPS 180W laser compared with its predecessor. MATERIAL AND METHODS: A cohort study was conducted with a series of 191 consecutive patients who underwent photovaporisation between 1/2008 and 5/2013. The inclusion criteria were an international prostate symptom score (IPSS) >15 after medical failure, a prostate volume <80 cm(3) and a maximum flow <15 mL/s. We assessed preoperative and intraoperative variables (energy used, laser time and total surgical time), complications, catheter hours, length of stay and functional results (maximum flow, IPSS, prostate-specific antigen and prostate volume) at 3, 6 and 12 months. We analysed the homogeneity in preoperative characteristics of the 2 groups through univariate analysis techniques. The postoperative functional results were assessed through an analysis of variance of repeated measures with mixed models. RESULTS: A total of 109 (57.1%) procedures were performed using HPS 120W, and 82 (42.9%) were performed using XPS. There were no differences between the preoperative characteristics. We observed significant differences both in the surgical time and effective laser time in favour of the XPS system. This advantage was 11% (48 ± 15.7 vs. 53.8 ± 16.2, p<.05) and 9% (32.8 ± 11.7 vs. 36 ± 11.6, p<.05), respectively. There were no statistically significant differences in the rest of the analysed parameters. CONCLUSION: The technical improvements in the XPS 180W system help reduce surgical time, maintaining the safety and efficacy profile offered by the HPS 120W system, with completely superimposable results at 1 year of follow-up.

Optimización de un programa de alta precoz tras prostatectomía radical laparoscópica / Optimization of an early discharge program after laparoscopic radical prostatectomy

Objetivo: Evaluar la seguridad del alta hospitalaria a las 24 h tras prostatectomía radical laparoscópica y determinar posibles factores asociados con estancias hospitalarias más prolongadas. Material y métodos: Estudio retrospectivo de pacientes con diagnóstico clínico de cáncer de próstata localizado, intervenidos consecutivamente entre mayo de 2007 y diciembre de 2010 mediante prostatectomía radical laparoscópica. Los pacientes fueron dados de alta en menos de 24 h en el caso de cumplir los siguientes requisitos: ausencia de complicaciones médicas, débito del drenaje menor de 50 cc, tolerancia oral normal, no hematuria significativa por sonda vesical y buena recuperación funcional del paciente. Realizamos un análisis de regresión logística para evaluar las posibles variables asociadas con ingreso mayor de 24 h. Resultados: Se analizaron un total de 266 pacientes. La mediana de seguimiento fue de 34 meses. Ochenta (30,1%) pacientes fueron dados de alta en menos de 24 h.La estancia media (DE) de la serie global fue de 2,9 días (3,08). En el análisis univariado solo las variables HTA, preservación de haces neurovasculares y la realización de linfadenectomía resultaron estadísticamente diferentes entre ambos grupos (alta < 24 h vs alta > 24 h). En el análisis multivariado solo la HTA con OR de 1,98 (IC 95%: 1,13-3,47) p = 0,016 y la realización de linfadenectomía con OR de 2,56 (IC 95%: 1,18-5,56) p = 0,017 resultaron ser variables predictivas independientes para estancias hospitalarias mayores de 24 h. Conclusiones: El alta temprana de los pacientes intervenidos mediante PRL es factible y seguro. En nuestra serie la realización de linfadenectomía y la HTA fueron factores asociados a una estancia hospitalaria más prolongada

Objective: To assess the safety of hospital discharge 24 h after laparoscopic radical prostatectomy and to identify possible factors associated with longer hospital stays. Materials and methods: Retrospective study of patients diagnosed with localized prostate cancer who underwent laparoscopic radical prostatectomy consecutively between May 2007 and December 2010. Those patients who met the following requirements were discharged in less than 24 h: absence of complications, drainage debit minor than 50 cc, normal oral tolerance, no significant bladder haematuria and good functional recovery. Logistic regression analysis was conducted in order to assess the possible associated variables with longer hospital stays. Results: A total of 266 patients were analyzed. The follow-up median was 34 months. Eighty patients (30.1%) were discharged in less than 24 h. Average stay (SD) of all series was 2.9 days (3.08). Solely HTA, neurovascular bundles sparing and the development of lymphadenectomy were statistically significant between both groups in univariate analysis (discharge < 24 h vs. discharge > 24 h). In multivariate analysis, only HTA (OR = 1.98 [CI 95%: 1.13-3.47], P = 0.016) and lymphadenectomy performance (OR = 2.56 [CI 95%: 1.18-5.56] P = 0.017) were independent predictive variables of hospital stays longer than 24 h. Conclusions: Early hospital discharge of patients who underwent LRP is feasible and safe. In our series, the lymphadenectomy performance and the HTA were associated factors for longer hospital stay

Optimization of an early discharge program after laparoscopic radical prostatectomy.

OBJECTIVE: To assess the safety of hospital discharge 24 hours after laparoscopic radical prostatectomy and to identify possible factors associated with longer hospital stays. MATERIAL AND METHODS: Retrospective study of patients diagnosed with localized prostate cancer underwent to laparoscopic radical prostatectomy consecutively between May of 2007 and December of 2010. Those patients who met the following requirements were discharged in less than 24 hours: absence of complications, drainage debit minor than 50 cc, normal oral tolerance, no significant bladder haematuria and good functional recovery. Logistic regression analysis was conducted in order to assess the possible associated variables with longer hospital stays. RESULTS: A total of 266 patients were analysed. The follow-up median was 34 months. Eighty patients (30.1%) were discharged in less than 24 hours. Average stay (SD) of all series was 2.9 days (3.08). Solely HTA, neurovascular bundles sparing and the development of lymphadenectomy were statistically significant between both groups in univariate analysis (discharge<24 hours vs. discharge>24 hours). In multivariate analysis, only HTA (OR=1.98 [CI 95%:1.13-3.47], P=.016) and lymphadenectomy performance (OR=2.56 [CI 95%:1.18-5.56] P=.017) were independent predictive variables of hospital stays longer than 24 hours. CONCLUSIONS: Early hospital discharge of patients underwent to LRP is feasible and safe. In our series, the lymphadenectomy performance and the HTA were associated factors to longer hospital stay.