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OBJECTIVES: Androgen deprivation therapy (ADT) in prostate cancer is associated with the appearance of different adverse effects. Among these effects, notable ones that may affect metabolism are osteoporosis and metabolic syndrome. The aim of this study is to analyse lithogenic risk markers three months after initiating treatment with LHRH analogue. METHODS: Pilot study encompassing 15 prostate cancer patients who were candidates for ADT, which they received in the form of quarterly doses of goserelin 10.8 mg. A blood and urine analyses for lithogenic risk, bone and metabolic markers were carried out, as was a study of metabolic syndrome criteria. Statistical analysis was performed with SPSS 17.0, taking P≤.05 to be statistically significant. RESULTS: Patients included in the study had a mean age of 72.46 ± 6.61 years. We observed a significant increase in the percentage of metabolic syndrome (20% versus 46.7%; P<.05) and insulin resistance index (1.87 versus 2.96; P=.01) at 3 months treatment. There was a notable increase in bone remodelling markers and significant increases in 24 h urinary calcium values (9.46 versus 14.57 mg/dl; P=.008), 24 h urinary calcium excretion index (0.10 versus 0.13 mg/dl GF [glomerular filtration]; P=.01) and the fasting calcium/ creatinine ratio (0.107 versus 0.195; P=.007), without any changes to other lithogenous risk markers. CONCLUSIONS: Androgen deprivation therapy can lead to the short-term appearance, primarily when fasting, of hypercalciuria in prostate cancer patients, possibly in association with bone metabolism.
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OBJECTIVE: Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Several experimental studies have demonstrated that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The objective of this study was to assess the relationship between AGD (as an indirect marker of prenatal hormonal environment) and severity of the surgical specimen and prostate cancer (PCa) prognosis.METHODS: We conducted a cross-sectional study with a total of 119 PCa patients with confirmed biopsy of the tumour. Every participant underwent a physical examination where two variants of the AGD were assessed, a) from the anus to the cephalad insertion of the penis (AGDAP) and b) to the posterior base of the scrotum (AGDAS). To assess the association between both AGD and severity and PCa prognosis multiple logistic regression analysis was used.RESULTS: Longer AGDAS was significantly associated with biochemical recurrence and affected margins of the surgical specimen (OR: 2.5; IC 95%:1.2-5.5, and 2.8; IC 95%: 1.1-7.5, respectively).CONCLUSIONS: Our findings suggest that a higher prenatal androgen exposure, resulting in a longer AGD, is associated with worse prognosis of PCa.
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OBJECTIVE: To determine the incidence and clinical and histopathological characteristics of patients with prostatic evanescent carcinoma in the Urology Department of the Hospital Universitario de Caracas. METHODS: We reviewed the medical records of 257 patients undergoing radical prostatectomy for a previous diagnosis of prostatic carcinoma in the period January 2010 to June 2016. RESULTS: Four patients had evanescent carcinoma corresponding to 1.55%, similar to documented studies, thus maintaining their percentage of appearance in time. Adenocarcinomas are usually associated with Gleason scores ≤6, but they can present in carcinomas with less differentiated histopathological pattern, like Gleason 7 (3 + 4). CONCLUSIONS: In the pathological study of the specimen of radical prostatectomy of patients with evanescent carcinoma, it is advisable to apply additional immunohistochemistry technique or seek for a second pathological opinion, to confirm this entity, and to rule out a technical or interpretation failure.
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OBJECTIVE: In patients with prostatecancer and high-risk pathological factors, adjuvantradiotherapy (ART) has been reported to be superior toobservation for local disease control and progressionfreesurvival. But more than 30% of the patients do notpresent biochemical relapse (BR) and therefore the ARTassociated with the toxicity can be avoided. It has notbeen determined whether close observation with earlysalvage radiotherapy provides a similar result to ART.METHODS: Patients with localized prostate cancertreated with radical prostatectomy (RP) at the Instituteof Cancerology (Medellín-Colombia), and those whohad adverse predictors of biochemical relapse wereincluded: extracapsular compromise, seminal vesicleinvolvement (pT3), and positive surgical margins (PSM)or not. Biochemical progression-free survival wascompared between ART group and the observationgroup.RESULTS: Of 171 patients treated with RP, 55 had atleast one adverse pathological factor. Of them, 33(60 %) were observed and 22 (40%) received ART.The median follow-up was 55 months (IQR: 37-89).Biochemical relapse occurred in 6 (18.2%) of the firstgroup and 3 (13.6%) of the second group (p>0.05).Biochemical progression-free survival was 24.2%(95%CI: 11.5%-39.6%) in the observation group and47.7% (95%CI: 26.3%-66.4%) in the ART.CONCLUSIONS: After radical prostatectomy, thebiochemical relapse in the patient with high-risk prostatecancer was similar in the observation group and in theART group.
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OBJECTIVE: To compare the cost-effectivenessof fixed dose combination of solifenacin 6 mgand tamsulosin 0.4 mg in a controlled absorption system(TOCAS) with free dose combination of tolterodine plustamsulosin, when used for the treatment of patients withmoderate to severe lower urinary tract symptoms (LUTS)associated with benign prostatic hyperplasia (BPH) whodo not respond adequately to monotherapy. The analysiswas conducted from the perspective of the SpanishNational Health System.METHODS: A Markov model was developed in Excel,with 1-year time horizon. The transition probabilities ofthe model were obtained from the NEPTUNE clinicaltrial and published literature. Unit costs were obtainedfrom Spanish sources. The use of healthcare resourceswas validated by Spanish clinical experts. Both deterministicand probabilistic analyses were performed todetermine the key drivers of the model.RESULTS: Treatment with fixed dose combination of solifenacinplus TOCAS was found to be dominant, as itresulted in lower annual costs (€ 1,349 vs. € 1,619)and greater quality-adjusted life years (QALY) gainedper patient (0.8406 vs. 0.8386) when compared withfree dose combination of tolterodine plus tamsulosin. Accordingto the probabilistic analyses, the probability ofthe fixed dose combination treatment being cost-effectiveat a willingness to pay threshold of € 20,000 or30,000 would be 100%.CONCLUSIONS: This analysis suggests that fixed dosecombination of solifenacin plus TOCAS represents acost-effective choice for the treatment of patients withmoderate to severe LUTS/BHP, compared to free dosecombination of tolterodine plus tamsulosin.
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OBJECTIVES: To assess the efficacy of a new anti-reflux intraureteral stent design in a swine model after minimally invasive treatment of ureteral stricture to reduce ureteral stent morbidity, previous to manufacture this design in a biodegradable fashion.METHODS: Twenty-eight female pigs were included. The study began with a cystoscopic, nephrosonographic and contrast fluoroscopic assessment. Afterwards, obstructive uropathy model in right ureter was created. Obstruction was confirmed 6 weeks later and animals were randomly distributed into 2 groups. Group I underwent laser endopyelotomy and Group-II laparoscopic pyeloplasty. A 3Fr anti-reflux intraureteral stent was placed 6 weeks. Follow-up evaluations were performed at 3-6 weeks. The final follow-up was completed at 5 months and included the aforementioned diagnostic methods and pathological study.RESULTS: None of the study animals showed any vesicoureteral reflux signs or ureteral orifice injury. There were no urinomas or ureteric fistulas. The dislodgement rate was 10.7%. After 6 weeks of stenting, 71.4% of ureters showed ureteral peristalsis below the stent, and 100% at the final follow-up. After pathological assessment, no differences were shown at UPJ and healing in the incised area was correct in both groups.CONCLUSIONS: The new stent design avoids vesicoureteral reflux and bladder trigone irritation, consequently might reduce morbidity associated with double pigtail ureteral stents. This study also shows that it is only necessary temporary scaffolding the incised ureteral segment and not the entire length of the ureter after minimally invasive surgery. It is also necessary to manufacture this design in a biodegradable material, thus avoiding its removal.
Case Report
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OBJECTIVE: To report a new case of prostatic carcinosarcoma, an uncommon and locally and distance aggressive tumor. METHOD: We analyzed one case diagnosed in our Center, from clinical and pathological diagnosis to death, describing the treatments received. RESULT: Patient presented a huge pelvic mass and a pulmonary metastasis that was treated with cystoprostatectomy and bilateral cutaneous ureterostomy with the diagnosis of carcinosarcoma of the prostate. He received 8 cycles of Docetaxel with bone progression and then 3 cycles of doxorubicin, suspending treatment due to progression. The survival was 18 months. CONCLUSIONS: Prostate carcinosarcoma is a very aggressive neoplasia that does not respond to the usual treatments of prostate cancer.
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OBJECTIVE: Purple urine bag syndrome is a rare entity that appears in elderly patients with long-term urinary catheters with chronic diseases.METHOD: We describe the cases of two patients admitted to our service, who serve as example to illustrate this pathology and which process should be followed in its diagnosis and treatment.CONCLUSION: Purple urine bag syndrome is a rare entity that occurs more frequently in elderly patients, women, with long-term urinary catheters, whose main factors are debilitating diseases, prolonged immobility and chronic constipation. It should be treated by avoiding the triggering factors, adequate hydration of the patient, antibiotics directly antibiogram therapy and the change of urinary catheter can be evaluated.
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