RESUMO
OBJECTIVES: To move towards a more standardized approach in clinical practice to manage patients with castration-resistant prostate cancer (CRPC) in Spain. METHODS: A panel of 18 Spanish experts in Urology with expertise managing CRPC followed a modified Delphi process with two rounds and a final face-to-face consensus meeting. The panel considered a total of 106 clinical questions divided into the following 6 sections: definition of CRPC, diagnosis of metastases by imaging techniques, symptoms of CRPC, progression of CRPC, M0 and M1 management and therapeutic sequencing. RESULTS: A bone scan (BS) is recommended at diagnosis, at the onset of bone pain, and depending on PSA levels, but it is not sensitive enough to confirm or exclude bone metastases if there is bone pain. Whole-body MRI and axial MRI are more sensitive than BS and plain X-rays, but more expensive, so they have to be used in certain situations. There is CRPC progression when there is radiologic, clinical or confirmed PSA progression. Flare phenomenon appears in treatment with taxanes and abiraterone. It was agreed that in M0 CRPC patients no drug treatment is currently recommended, although in M1 CRPC patients the first-line therapy would be mainly enzalutamide/abiraterone and/or docetaxel, depending on the symptom burden. CONCLUSION: After the consensus, we provide a series of recommendations for Spanish physicians treating CRPC to address the disease characteristics,how to tailor patient management decisions, the use of imaging techniques, and how to handle disease progression appropriately to improve patients' quality of life.
Assuntos
Neoplasias de Próstata Resistentes à Castração/diagnóstico , Neoplasias de Próstata Resistentes à Castração/terapia , Humanos , Masculino , Guias de Prática Clínica como Assunto , EspanhaRESUMO
OBJETIVOS: Establecer recomendaciones sobre la práctica clínica habitual del manejo del cáncer de próstata resistente a la castración (CPRC) en España. MÉTODOS: Un panel de 18 expertos en Urología con experiencia en el manejo del CPRC participaron en un proceso Delphi modificado a dos rondas con una reunión final presencial. El panel consideró un total de 106 cuestiones clínicas divididas en las siguientes secciones: definición del CPRC, diagnóstico de metástasis por técnicas de imagen, síntomatología, progresión, manejo de M0 y M1 y secuenciación terapéutica. RESULTADOS: Se recomienda realizar una gammagrafía ósea (GO) en el diagnóstico, al comienzo del dolor óseo y dependiendo de los niveles de PSA. La resonancia magnética de cuerpo entero y la axial son más sensibles que la GO y la radiografía, pero más caras, por lo que se reservan para ciertas situaciones. Existe progresión del CPRC cuando se confirma la progresión radiológica, clínica o por PSA. El fenómeno "flare" aparece en el tratamiento con taxanos y abiraterona. En pacientes M0 no se recomienda tratamiento farmacológico actualmente, y el tratamiento en primera línea para los pacientes M1 incluiría principalmente enzalutamida/ abiraterona y/o docetaxel, según los síntomas. CONCLUSIÓN: Se proponen recomendaciones para personalizar la toma de decisiones ante cada paciente, el uso de técnicas de imagen y cómo abordar la progresión de la enfermedad para mejorar la calidad de vida de los pacientes
OBJECTIVES: To move towards a more standardized approach in clinical practice to manage patients with castration-resistant prostate cancer (CRPC) in Spain. METHODS: A panel of 18 Spanish experts in Urology with expertise managing CRPC followed a modified Delphi process with two rounds and a final face-to-face consensus meeting. The panel considered a total of 106 clinical questions divided into the following 6 sections: definition of CRPC, diagnosis of metastases by imaging techniques, symptoms of CRPC, progression of CRPC, M0 and M1 management and therapeutic sequencing. RESULTS: A bone scan (BS) is recommended at diagnosis, at the onset of bone pain, and depending on PSA levels, but it is not sensitive enough to confirm or exclude bone metastases if there is bone pain. Whole-body MRI and axial MRI are more sensitive than BS and plain X-rays, but more expensive, so they have to be used in certain situations. There is CRPC progression when there is radiologic, clinical or confirmed PSA progression. Flare phenomenon appears in treatment with taxanes and abiraterone. It was agreed that in M0 CRPC patients no drug treatment is currently recommended, although in M1 CRPC patients the first-line therapy would be mainly enzalutamide/abiraterone and/or docetaxel, depending on the symptom burden. CONCLUSION: After the consensus, we provide a series of recommendations for Spanish physicians treating CRPC to address the disease characteristics how to tailor patient management decisions, the use of imaging techniques, and how to handle disease progression appropriately to improve patients' quality of life
Assuntos
Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/terapia , Acetato de Abiraterona/uso terapêutico , Antígeno Prostático Específico/análise , Estadiamento de Neoplasias/métodos , Antineoplásicos/uso terapêutico , Antagonistas de Androgênios/uso terapêuticoRESUMO
Paratuberculosis is a chronic granulomatous enteritis caused by Mycobacterium avium subspecies paratuberculosis (Map), which affects wild and domestic ruminants. Map is shed in feces from infected animals. Transmission of the infection takes place by oral ingestion of the bacterium from contaminated food and water with feces. With the objective to establish a paratuberculosis diagnosis in ovine by nested-PCR from fecal samples, 204 fecal and serum ovine samples were studied. Feces were evaluated by nested-PCR and bacterial culture, serum samples were analyzed by agar gel immunodiffusion (AGID). Nested-PCR yielded a 210 bp amplification product that corresponds to Map-IS900, in 61 out of 204 samples. From these, 43 were from AGID positive animals and 18 from negative animals. Seventeen Map strains were isolated by bacterial culture and AGID detected 91 positive animals. Nested-PCR allowed to detect, sooner, greater number of animals shedding bacillus, even when they had resulted negative to the serological test. This result is considered important because generally these animals, while remaining in the farm, constitute the main source of infection for the herd. Nested-PCR should be considered as an alternative, when a prompt result is required to know the health status of the herd with respect to paratuberculosis.
La paratuberculosis es una enteritis granulomatosa de curso crónico ocasionada por Mycobacterium avium subespecie paratuberculosis (Map), afecta a rumiantes domésticos y silvestres. Map es excretada en las heces de animales que desarrollan la enfermedad, y la transmisión de la infección se da mediante la ingestión de alimentos y agua contaminados por heces de animales infectados. Con el objetivo de establecer el diagnóstico de paratuberculosis en ovinos por medio de la PCR-anidada a partir de muestras de heces, se trabajaron 204 muestras de heces y sueros de ovinos; las heces se evaluaron por PCR-anidada y cultivo bacteriológico, las muestras de sueros fueron analizadas por medio de inmunodifusión en agar gel (lDGA). Con la PCR-anidada se obtuvo un producto de amplificación 210 pb que corresponde a la IS900 de Map, en 61 de las 204 muestras. De éstas, 43 eran de animales positivos a IDGA y 18 negativos. Mediante cultivo bacteriológico se aislaron 17 cepas de Map; en este contexto, la IDGA detectó a 91 animales como positivos. La PCR-anidada permitió detectar en menor tiempo a mayor cantidad de animales que estaban eliminando al bacilo, aun cuando habían resultado negativos a la prueba serológica; este resultado se considera importante, ya que generalmente estos animales, al permanecer dentro de la granja, constituyen la principal fuente de infección para el rebaño. Se debe considerar a la PCR-anidada como alternativa, cuando se requiera el diagnóstico en breve tiempo, para conocer el estado sanitario del rebaño con respecto a paratuberculosis.
