OBJECTIVES: Serum prostate specific antigen and digital rectal examination are the tests used as screening tests to detect prostate cancer. However, only approximately 30% of men with suspicion of cancer have it confirmed on prostate biopsy, and not all of these need treatment. Detection of circulating tumor cells in localized prostate cancer has given variable results, but it could be a useful complementary screening tool to detect prostate cancer in men with abnormal screening tests before the evaluation with prostate biopsy. This may be more so in subsequent biopsies where serum PSA has a decreased diagnostic yield. To evaluate the diagnostic yield of the detection of CPCs as a complementary PC screening test in a population fulfilling criteria for an initial, second and third prostate biopsy for suspicion of PC.METHODS: A prospective screening study of consecutive patients aged 45-80 years presenting to the urologist for PC screening. Inclusion criteria were PSA >4.0ng/ml, PSA velocity >0.35ng/ml/year and/or DRE suspicious for cancer. Patients fulfilling inclusion criteria had blood taken for CPC detection and then underwent 12-core transrectal prostate biopsy. Double immune-his-tochemical staining with anti-PSA and anti-P504S was used to detect CPCs. Both cytologist and pathologist were blinded to the results of the biopsy, CPC results and clinical details. The diagnostic yield of the presen-ce or absence of CPC was evaluated; the prostate biopsy was classified as cancer or no-cancer.RESULTS: 282 men participated, 83 undergoing of these undergoing a second and 38 a third biopsy, with a mean age of 66.2 ± 8.9 years and a median serum PSA of 5.10ng/ml, 5.45ng/ml and 6.45ng/ml for first, second and third biopsies. Cancer was detected in 33,6%, 10.8% and 29.0% of first, second and third biopsies respectively, CPCs were detected in 36.9%, 21.7% and 36.8% of the patients. Sensibility, specificity and negative predictive value were 86%, 91% and 94% for the first biopsy, 89%, 87% and 99% for the second and 100%, 89% and 100% for third biopsy respectively. All the CPC determinations were interpretable. There were 11 false negative cases, all with small low grade tumors. Of the 29 men with a false positive CPC, 8/10 had cancer detected in the subsequent biopsy.CONCLUSIONS: The use of CPC detection could be useful as a complementary prostate cancer screening test, especially for excluding cancer, and including patients with indications for repeat biopsies. Men with a false positive CPC detection had a high risk of detecting cancer in the succeeding biopsy.
OBJECTIVES: Advances in diagnosis of prostate cancer (PCa) have led to an increased detection of these tumors, some of them with low-risk of progression, with the consequent risk of overdiagnosis and overt treatment. In consequence, there is a tendency to offer alternatives to active therapy, like active surveillance (AS); however, some patients under AS need definitive therapy and after surgery it becomes evident that they are not “low-risk” patients. We retrospectively reviewed the data of patients who met criteria for low-risk tumors treated with radical prostatectomy.METHODS: We selected 21 out of 190 patients treated with radical prostatectomy from January 2004 to December 2008 who met Epstein´s criteria for lowrisk tumors. We analyzed the number of organ-confined tumors, Gleason undergrading and understaging by biopsy, surgical margins and postoperative PSA.RESULTS: Mean age was 58.6 years; mean PSA was 6.6 ng/ml, predominant Gleason score was 6 (3+3), 76% were unilateral tumors and 90% were organconfined, 10% had extracapsular extension, none had involvement of the seminal vesicles, 15% of the patients had Gleason score >6 and surgical margins were positive in 30% of the specimens. Eighty five percent had their first postoperative PSA <0.10 ng/ml and 75% remain free of biochemical recurrence. According to the Johns Hopkins criteria for “incurable tumors”, our cohort had 28%.CONCLUSION: Patients with low-risk prostate cancer include cases that may have greater risk than estimated. In our series, we had 10% extracapsular disease, 15% understaging for Gleason score and 25% biochemical recurrence, which demonstrates that current criteria do not warrant good oncological results. Active surveillance offers good quality of life and acceptable oncological results, it can be proposed until definitive therapy, without seriously endangering the patient. Anyway, as a therapeutic tool, it still requires improvements. Technical advances are awaited so as to properly assess each patient´s risk and to define the best therapeutic option for every case
OBJECTIVES: Nephron-sparing surgery (NSS) has been considered throughout history for patients with solitary kidney, bilateral renal tumors, impaired renal function, and hereditary renal cancer. However, recently the indications for Partial Nephrectomy (PN) have extended and include patients with a healthy contralateral kidney. NSS has evolved in a great way during the last decade, specifically in terms of oncological indications, and in the renal ischemia time used with the goal to maintain as much renal function as possible.This change is secondary to a better understanding of renal cancer histology, the equivalence in oncological outcomes between radical and PN, and finally the impact of chronic kidney disease (CKD) as a cause of cardiovascular complications and mortality.The main purpose of our study is to review the role of ischemia in NSS.METHODS: A literature review was performed focusing on NSS, risk factors of renal damage, types of ischemia, as well as its effect on renal function, and ischemia time.CONCLUSIONS: Renal ischemia has been considered for a long time as the main factor related with postoperative Renal Function (RF) in patients with NSS. Furthermore it is one of the few modifiable factors that directly depend on the surgeon. The ischemia time limit, both in warm and cold, is not well established and is a controversial issue that is still on debate till now. At this moment, there is evidence that considers the impact of ischemia only in acute or early stages. Also other factors have emerged and seem to have greater effect on RF, mainly in the long-term, leaving ischemia in second place. These factors are the quantity and quality of the remaining renal parenchyma. More studies are needed to support this rising concept and to clarify the real part that ischemia plays.
OBJECTIVES: The study was conducted toassess the incidence of positive surgical margins (PSMs)in our series of laparoscopic radical prostatectomy (LRP)performed by a fellowship trained surgeon in indepen-dent practice.METHODS: In this series, 300 patients underwent LRPby the same surgeon at our institution. The prospectivelycreated records of all consecutive LRPs were reviewed.The patients were divided into three groups based onthe time of surgery: group I included the first 100 cases;group II included the second 100 cases; and group IIIthe last 100 cases. We compared the incidence rateand the location of PSMs among the groups. As additio-nal variables, prostate-specific antigen (PSA) level, biop-sy/specimen Gleason score, clinical/pathological sta-ge and pathologic tumor volume were also evaluated.RESULTS: Patient demographics and preoperative stagingvariables were comparable among the three groups,with no statistically significant differences among them.The PSM rates were 27%, 22% and 27% for groupsI, II and III, respectively. The difference in overall PSMrates in the three groups was statistically insignificant (p:0.966). PSM rates decreased specifically at the poste-rolateral region and in pT3b stage with non-significantdifference when comparing the first 100 patients to thelast 100 patients.CONCLUSION: Pathologic surgical margin safety canbe achieved with laparoscopic fellowship-training (LFT)from the initial cases in independent practice
OBJECTIVE: To report a case of aneuroendocrine differentiation in a prostate cancer patient,a rare subtype.METHODS: We describe the case of a patient diagnosedwith adenocarcinoma of the prostate initially, who presentedhematuria due to disease progression with neuroendocrinedifferentiation despite androgen-deprivation therapy (ADT).DISCUSSION: Prostate cancer is the most commontumor in men. Histologically they are diagnosed asadenocarcinomas, which followed by ADT for a long time,develop neuroendocrine differentiation (NED).CONCLUSIONS: The prognostic significance of NEDremains controversial. We must think in neuroendocrinedifferentiation in ADT-treated patient with diseaseprogression and low PSA
OBJECTIVE: To report a clinical case of testicular rupture and review of the published literature.METHODS: A 15 year old male with a testicular rupture after a sport injury was diagnosed by Doppler ultrasound.RESULTS: Surgical exploration was performed and the tear was repaired. He had a benign postoperative course. The patient presents a normal size testicle after a year of follow-up.CONCLUSIONS: Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and management to avoid orchiectomy
OBJECTIVE: We report one case of Castleman’s disease and review published literature.METHODS: We report the case of a 58 year old man who was referred to our institution because of lumbar pain. A computed tomography scan revealed a retroperitoneal mass. Open surgical exploration and excision were carried out. Finally pathological examination addressed the diagnosis.RESULTS: Pathological examination demonstrated findings characteristic of unicentric hyaline vascular type of Castleman’s disease. After surgical excision and 12 months follow-up there is no evidence of recurrence disease.CONCLUSIONS: Castleman’s disease is a rare lymphoproliferative disorder of uncertain etiology. Retroperitoneal localization is exceptional.
OBJECTIVE: The basaloid carcinoma of the prostate (BC) is a rare malignant neoplasm arising from the basal cells of prostatic ducts and acini. We report a case and review the literature.METHODS: A 76-year-old man presented with symptoms of lower obstructive uropathy, the IPSS score was 29 and prostate specific antigen (PSA) of 0,924 ng / ml. Transurethral resection of prostate (TURP) was performed in September 2008, histopathological diagnosis was BC. In February 2009 laparoscopic radical prostatectomy was performed.RESULTS: Histopathological examination revealed a BC with adenoid cystic growth pattern, perineural infiltration and focal involvement of the left seminal vesicle. Immunohistochemically, the cells were negative for PSA, stained and were strongly positive for specific monoclonal antibodies anti-cytokeratin 34βE12, p63 and BCL-2. The patient has 23 months of follow-up, with complete continence and no evidence of tumor recurrence.CONCLUSIONS: The BC is an extremely rare subtype of malignant tumors of the prostate, where immunohistochemistry plays a fundamental role in diagnosis.
OBJECTIVE: To report a case of a mesothelioma of the tunica vaginalis and to review the published literature.METHODS / RESULTS: A 61-year-old patient complained of one-month increase of right scrotum size with pain. An ultrasound showed a right hydrocele with a mass attached to the tunica vaginalis. He didn’t refer any urological history or known exposure to asbestos. Blood levels of tumor markers (alpha-fetoprotein and beta-HCG) were within normal limits. We performed a radical inguinal orchiectomy with an en-bloc resection of the tunica vaginalis. The pathology described a potentially malignant biphasic mesothelioma. The patient has remained asymptomatic with negative extension studies after 10 years of follow up.CONCLUSIONS: Paratesticular mesotheliomas are rare tumors (approximately 250 cases reported) with uncertain etiology (only 30-40% are associated with asbestos exposure). The age range is between 50-70 years. Its presentation is usually as a scrotal mass with recurrent reactive hydrocele, which may delay early diagnosis. During surgery, intraoperative biopsy is recommended. It is important to do a differential diagnosis with other benign diseases. Treatment is only curative in early stages with radical orchidectomy and resection in-block of the tunica vaginalis. Despite being multidisciplinary, it is not curative in most cases due to rapid local and distant spread.