[Cryosurgery in the management of prostate cancer]. / Criocirugía en el tratamiento del cáncer de próstata.

This article reviews the current status of the prostatic cryosurgery in the management of patients with prostate cancer. Recent advances in cryoablative technology have allowed to treat these patients successfully with decreased morbidity. Using transrectal high-resolution ultrasound imaging, prostate cryotherapy is delivered with multiple ultrathin (17-gauge) cryo-needles, via percutaneous transperineal approach. The extent of freezing can be precisely controlled and monitored with thermic devices, tissue destruction is monitored with real-time visualization of the prostate and surrounding structures, and urethral warming is used to avoid urethral sloughing. However, the results with the second and third-generation cryosurgical equipment will have to be confirmed by means of prospective and randomized trials, because up to now we only have data based on retrospective analyses, which are very heterogeneous. The ability of prostate-specific antigen (PSA) to predict long-term outcome after cryotherapy for localized prostate cancer is not well known because experience with this treatment modality is still limited; however, it seems that a PSA value of 0.5 ng/ml or less after 6 months or longer after cryotherapy would be associated with a high probability (greater than 95%) of negative post-treatment biopsy. Cryosurgery could also be an option of treatment for men with recurrent local disease who have undergone radiotherapy or radical prostatectomy. We have to keep in mind possible complications (incontinence, impotency, urethrorectal fistula or bladder outlet obstruction. The favorable side effect profile and preliminary oncologic and funtional results could suggest that cryosurgery will have a role in the minimally invasive management of selected patients with prostate cancer.

[Sarcomatoid renal carcinoma]. / Carcinoma renal sarcomatoide.

Study of 250 pieces from nephrectomies performed in our service due to renal carcinoma, 10 (4%) of which where of the sarcomatoid histological variant. In 2 of the 10 cases, tumour was confined within the renal capsule at the time of surgery. These were the only cases where no disease progression was seen after treatment. A survival study using the Kaplan-Meter method was conducted. Median survival of patients with sarcomatoid pattern was 6 months, showing a significant difference with that obtained in other histological patterns. DNA content of tumoral cells was assessed by flow cytometry, which displayed a diploid pattern in 7 patients and aneuploid in 3. The 2 cases with no disease progression were diploid. We conducted nuclear cytomorphometry studies which showed significant differences in the mean nuclear perimeter between progressive and non-progressive tumours.

[Risk of suffering from a second primary neoplasm in patients with bladder tumor]. / Riesgo de padecer una segunda neoplasia primaria en pacientes con tumor vesical.

An evaluation was made on the risk of having a second primary neoplasia following vesical tumor diagnosis. All patients attended the 'Hospital La Fe' and had been diagnosed between 1984 and 1993. A total of 238 vesical tumours were studied, 45 (15.9%) with associated second neoplasia; in 34 cases the vesical tumour was the first one to be diagnosed. The number of tumors seen was compared to expected figures, according to the appropriate incidence rates by age, sex and tumour type, taken out from the Spanish section of the 1987 edition of "Cancer Incidence in Five Continents". An increase over the expected values of second neoplasias for lung, prostate, kidney and bone cancer was found. Sixty percent developed concurrently (within 6 months from initial diagnosis). Most vesical tumours were infiltrant, thus conditioning both the prognosis and the second neoplasia. The likely factors implied in this phenomenon are discussed.

[Is radical surgery indicated in patients with infiltrating bladder carcinoma and involved regional lymph nodes?]. / Está indicada la cirugía radical en los pacientes con carcinoma vesical infiltrante y ganglios regionales afectos?

To evaluate the efficacy of radical vesical surgery in Infiltrant Vesical Carcinoma affecting the regional nodes, a retrospective study of a group of 75 patients who underwent radical cystectomy and lymphadenectomy was conducted. Based on the degree of node affectation patients were classified as follows: 49 pN(-) (65.3); 22 pN(+) (29.3); and 4 pN(x) (5.3) in which the pathological anatomy was inconclusive. In the pN(-) group, 8 (8.16%) died during the immediate postoperative due to surgical complications. Of the remaining 45, 5 cases were lost to follow-up; 31 (63.26%) died (all of them as a result of the tumour (M+)); whereas 9 (18.36%) are still alive and disease-free. Overall mean survival is 35.91% 10.3 months (4-65 months). Of them, 3 (13.6%) were lost while in poor performance status; 13 (59.09%) died for neoplasia-related causes (M+), and only one (4.5%) is alive and disease free. In this group, neoadjuvant chemotherapy was used in 10 cases, neoadjuvant radiotherapy in 4 and adjuvant radiotherapy in 5. Local relapse was seen in 8 (36.6%) cases. In our experience, a clear improvement in quality of live and mean survival at one year (up to 65 months) was noted in patients with Vesical Infiltrant Carcinoma and regional node affectation. Such situation encourages the use of radical surgery when faced, during surgical examination, with node infiltration by neoplastic cells.

Spontaneous rupture of a neobladder.

The spontaneous rupture of neobladder is an extremely rare entity of which there only exists one formerly reported case in the world literature. It is far more common after enterocystoplasty for augmentation (19 reported cases). We describe here the spontaneous rupture of a neobladder 8 months after performing cystectomy and bladder replacement by an enterocystoplasty in order to treat a bladder carcinoma. In this case the patient showed symptoms and signs of acute peritonitis. The diagnosis was carried out using a cystogram and the treatment consisted of a laparotomy with closure of the perforation and drainage of the peritoneal cavity.

[The risk of second primary neoplasm in prostatic cancer patients]. / Riesgo de padecer una segunda neoplasia primaria en pacientes con cáncer de próstata.

The risk of suffering a second primary neoplasia after bearing a prostate cancer has been evaluated. The study patients attended the Hospital La Fe and were diagnosed between 1984 and 1992. There was a total of 223 prostate neoplasias, 22 of which had associated a second neoplasia and in 12 cases, corresponding to seven tumoral locations, prostate cancer was the first pathology to be diagnosed. Tumours observed were compared to those expected, according to the incidence rates appropriate for each age group and tumoral type, taken from the Spanish section of "Cancer Incidence in Five Continents", 1987. An excess of second neoplasias for vesical, kidney, CNS, bone and lymphoma tumours was found. In most cases, the second tumour was diagnosed between 6 to 12 months after diagnosis of prostate cancer. The patient's prognosis is dependent of the second neoplasia. The possible mechanisms of these associations are discussed in the light of state-of-the-art knowledge.