Terapia de privación de andrógenos en el cáncer de próstata localizado. Situación actual y tendencias futuras

IntroductionProstate cancer (PCa) has been recognized as an androgen-sensitive disease since the investigations from Huggins and Hodges in 1941. Thanks to these findings, they received the Nobel Prize in 1966. This was the beginning of the development of androgen deprivation therapy (ADT) as treatment for patients with PCa.ObjectiveTo summarize the current indications of ADT in localized PCa.Evidence acquisitionWe conducted a comprehensive English and Spanish language literature research, focused on the main indications for ADT in localized PCa.Evidence synthesisNowadays, the indications for ADT as monotherapy in localized PCa have been limited to specific situations, to patients unwilling or unable to receive any form of local treatment if they have a PSA-DT < 12 months, and either a PSA > 50 ng/mL, a poorly differentiated tumor, or troublesome local disease-related symptoms. ADT can be used in combination with local treatment in different scenarios. Although neoadjuvant treatment with ADT prior to surgery with curative intent has no clear oncological impact, as a future sight, PCa is a heterogeneous disease, and there could be a group of patients with high-risk localized disease that could benefit.ConclusionsWe need to optimize the treatment with ADT in localized PCa, selecting the patients accordingly to their disease characteristics. Given that the therapeutic armamentarium evolves day by day, there is a need for the development of new clinical trials, as well as a molecular studies of patients to identify those who might benefit from an early multimodal treatment.     

Relación del síndrome metabólico con el cáncer de mama posmenopáusico

IntroductionMetabolic syndrome is associated with an increased risk of diabetes mellitus (DM) and coronary heart disease. It may also be associated with a higher risk of some common cancers. The objective of this study was to determine the relationship between metabolic syndrome and breast cancer in postmenopausal women.MethodsWe present a prospective cohort study of postmenopausal women. This cohort was divided into two groups: the «benign diagnosis group», including women who were studied after breast cancer screening; and the «malignant tumor group», including patients with breast cancer that had been diagnosed by biopsy. Age, weight, height, body mass index (BMI), abdominal perimeter, serum glucose, LDL, HDL and insulin levels were analyzed as variables under study. The HOMA-IR homeostatic model formula was used to assess insulin resistance. The differences were considered statistically significant when P < .05.ResultsTwo hundred women with a mean age of 61.5 ± 9.6 (range: 37-93) were enrolled in the study, consisting of 150 (75%) patients with a benign diagnosis and 50 (25%) patients with a malignant tumor. BMI and abdominal perimeter were higher in the group with a malignant tumor (P < .05). The incidence of DM and metabolic syndrome was higher in the malignant tumor group (P < .005). In the malignant tumor group, much higher incidences correlated with fasting glycemic levels > 100 mg/dL, insulin levels > 10 mIU/L and HOMA-IR scores > 2.7 (P < .05).ConclusionsThere is a relationship between metabolic syndrome and postmenopausal breast cancer. More studies are needed to establish methods for the prevention of breast cancer in women with metabolic syndrome.     

La disfunción eréctil y su severidad están en relación con el número de factores de riesgo cardiovascular

AimErectile dysfunction (ED) is a very common condition in the general population. ED is closely related to Hypertension (HT), Diabetes Mellitus (DM), Dyslipidemia (DLP) and Metabolic Syndrome (MS). This study has aimed to clarify whether the presence and severity of ED are related to the presence and number of cardiovascular risk factors (CVRF).Material and methodsWe retrospectively analyzed the characteristics of 242 males referred to our center for a prostate biopsy from September 2007 to December 2009. The following variables were collected prospectively: age, height, weight, body mass index (BMI), AHT, DM, DLP and obesity (BMI < 30 kg/m²). The Erection Hardness Score Questionnaire was used to assess erectile function. We analyzed the relation between the presence and severity of ED and the presence of HT, DM, DLP and obesity. We analyzed the clinical variables based on the presence or absence of ED and in relationship to its severity.ResultsThe presence of ED was related to HT (OR: 1.805 [1.128-2.887]; p = 0.013), DM (OR 3.585 [1.613-7.966]; p = 0.001) and Dyslipidemia (OR: 1.928 [1.062-3.500]; p = 0.029). Erectile function was not related to Obesity (OR: 0.929 [0.522-1.632]; p = 0.795). Patients with ED were more likely to have more CVRF (p = 0.009) and the severity of ED was related to the presence of HT (p < 0.001), DM (p < 0.001), DLP (p = 0.001) and the number of CVRF (p < 0.001).ConclusionsThe presence and severity of ED correlate with the presence of HT, DM, Dyslipidemia and the number of DVRF.     

Disfunción eréctil,síndrome metabólico y arteriopatía. Relación clínico-patológica mediante ecografía carotídea

IntroductionDifferent studies have shown the relationship between erectile dysfunction, metabolic syndrome and cardiovascular disease. The objective of this study was to evaluate the presence of arteriopathy performing carotid ultrasound in patients with and without erectile dysfunction.Material and methodsWe conducted a case-control study with 44 patients consulting for erectile dysfunction and 20 controls. All subjects completed the IIEF-5 test and we studied the criteria for metabolic syndrome, and a carotid ultrasound to study the intima-media thickness and the presence of atherosclerotic plaques was performed.ResultsMean intima-media thickness was .71 mm ± .21 for the right and of .71 ± .17 for the left carotid in patients with erectile dysfunction. In the control group, the means were .54 ± 0.11 and 0.59 ± 0.15 mm respectively, statistically significant differences (P = .02 and P = .05 respectively). No plaque was found in any control, but in 25% of both carotid arteries of patients with erectile dysfunction (P = .01). As metabolic syndrome, according to the American Heart Association, were diagnosed 52.8% of patients with erectile dysfunction, and 16.7% of controls, and according to the International Diabetes Federation, 52.3% of patients with erectile dysfunction and 25% of controls met diagnostic criteria. In both cases there were significant differences (P < .01 and P = .02 respectively). We found a positive linear correlation between waist circumference and the intima-media thickness in both carotid (P < .05).ConclusionsPatients with erectile dysfunction may be at increased risk of cardiovascular disease, as determined by the presence of arterial disease in the carotid arteries, which indicates that we should made a more thorough and comprehensive study of patients with erectile dysfunction.     

Terapia de privación de andrógenos en pacientes con enfermedad localizada: comparación de las opciones de tratamiento y tiempo hasta la resistencia a la castración. Resultados del Registro Español de Cáncer de Próstata

BackgroundThe effect of primary androgen deprivation therapy (ADT) in patients with localized prostate cancer (PCa) has not been well documented. The objective of the present study was to analyze the outcome of tumors treated with ADT as primary therapy in the Spanish Prostate Cancer Registry (19.4% of the series).Patients and methodsPatients were classified in three groups: 1) with low/intermediate risk clinically localized tumors; 2) with high risk and locally advanced (T3-4) tumors; 3) with metastatic tumors. Time to castration resistance and overall cancer-specific survival were analyzed. In non-metastatic tumors, survivals in patients treated with ADT were compared with data from patients who underwent local treatments from the Spanish Prostate Cancer Registry.Results703 cases were analyzed. There were significant differences in the time to castration resistance, which was lower in the group of metastatic tumors. During follow-up, there were 179 deaths (25.5%) of which 89 (12.6%) were due to PCa. After 3 years of ADT, only 14.6% of patients in group 1 had died (1% due to PCa), 20.5% in group 2 and 46.8% in group 3 (9.2% and 31.3% due to PCa, respectively). Cancer-specific survival was significantly worse in group 1 using ADT than radical prostatectomy or radiotherapy. In high-risk and locally advanced tumors, ADT also had a lower cancer-specific survival than local treatments.ConclusionA longer time until the castration resistance was observed in patients with well- and intermediate-risk localized tumors treated with ADT. Patients with metastatic tumors showed the shortest time to castration resistance.     

Crisis epiléptica en el postoperatorio tardío de endarterectomía carotídea: ¿un caso de síndrome de hiperperfusión cerebral?

The so-called cerebral hyperperfusion syndrome is basically due to a lack of cerebral autoregulation, inability to control the restoring of flow after revascularisation surgery. It present clinically as intense migraine, epileptic seizures, or neurological focality. It may even progress to an intracerebral haemorrhage. It usually appears a few days after surgery. We present the case of a patient subjected to a carotid endarterectomy, who had an epileptic episode in the late post-operative period. We attributed a cerebral hyperperfusion syndrome as the most likely cause. Knowledge of this syndrome may help to correctly orientate and treat the neurological complications that appear after this type of surgery.     

Síndrome metabólico en pacientes con cáncer de próstata sometidos a supresión androgénica

ObjectivesCardiovascular mortality is the leading cause of death in patients with prostate cancer (PC), metabolic syndrome (MS) being related to it. The main objective of this study was to determine the prevalence of MS in patients with CP undergoing androgen suppression (AS).Material and methodsWe performed a retrospective study of cases and controls that included 159 patients. The study group was made up of 53 patients with PC undergoing SA for a period exceeding 12 months. The control group was formed by 53 patients with PC at the time of diagnosis and 53 patients with negative prostate biopsy. All patients were evaluated for presence of MS according to NCEP-ATPIII criteria.ResultsPrevalence of MS in patients without PC was 32.1% and in those with non-treated PC 35.8%, P = .324. In patients with PC undergoing AS, prevalence of MS was 50.9%, P < .001. When AS duration was less than 36 months, prevalence of MS was 44.0% and when greater than 36 months 57.1%, P < .001. Waist circumference and hyperglycemia were the two MS components that significantly increased. AS and its duration were independent predictors factors for the development of MS.ConclusionsContinuous AS therapy increases the prevalence of MS and especially waist circumference and hyperglycemia. Development of MS increases according to AS duration.     

Correlación entre el índice neutrófilo/linfocito y las puntuaciones de riesgo en el cáncer de vejiga no músculo-invasivo

ObjectivesAim of this study is to evaluate the correlation between European Organization for Research and Treatment of Cancer (EORTC) risk score and neutrophil-lymphocyte ratio (NLR) in patients with non-muscle invasive bladder cancer and the relationship between NLR and risk groups.MethodsWe retrospectively reviewed data of 212 patients with non-muscle invasive bladder cancer were included in the study. The tumors were graded according to the 1973 World Health Organization grading system and the tumor node metastasis (TNM) 2012 staging system. Patients were categorized low, intermediate and high risk for recurrence and progression, according to European Association of Urology guidelines. Serum values for the NLR were measured on the day before the operation to ascertain the baseline value for neutrophil and lymphocyte counts and statistically analyzed.ResultsOf the 212 patients, 193 were male and 19 were female. Mean age was 66.7. Mean NLR score was 3.04 ± 2.11. T1 tumors, G3 tumors, multiple tumors and > 3 cm tumors seen mostly in patients with NLR > 2.41. Low, intermediate and high risk groups compared and NLR rates were significantly higher in high risk group patients (P < .001). When the correlation between NLR and EORTC recurrence and progression scores was evaluated, it was observed that as NLR value increased, recurrence (r = 0.252, P < .001) and progression (r = 0.145, P = .034) scores increased significantly.ConclusionsThis study demonstrated the association of high NLR value with T1 tumor, high grade, multiple tumor, > 3 cm tumor and EORTC high risk group in non-muscle invasive bladder cancer patients. There was also a positive correlation between NLR and EORTC recurrence and progression scores.     

Tratamiento anestésico en el síndrome de Kearns-Sayre. Descripción de un caso

Kearns-Sayre syndrome is a mitochondrial myopathy characterized by ophthalmoplegia, pigmentary retinopathy and cardiac conduction abnormalities. This article describes the clinical management of a 50-year-old patient with Kearns-Sayre syndrome who underwent subarachnoid anesthesia for a traumatic femoral fracture surgery.     

¿Existen diferencias en las características y en el comportamiento del tumor vesical según edad de presentación? Nuestra experiencia

IntroductionOwing to the different results from the series that evaluate the behavior of the bladder cancer according to the age at the moment of the diagnosis, our objective is based on valuing the characteristics and behaviour according to age of appearance.MethodsA retrospective study of bladder cancer diagnosed in our area during decade 1993-2003, distributed in 3 intervals of age and some characteristics and behaviour are valued.ResultsElderly patients present greater tumors, non differentiated and with greater rate of progression to infiltrated. Moreover the age, the pathological stage and the tumorlike degree appear as independent significant factors in the multivariant study.ConclusionsIn our experience, the patients greater than 70 years present neoplasms of similar clinical characteristics, although pathologically more aggressive, with greater percentage of progression and worse survival.     

Síndrome metabólico en los cálculos de oxalato cálcico: ¿es tan importante en este tipo de litiasis?

Introduction and objectiveThe association of metabolic syndrome with lithogenesis has been described, especially in uric acid stones.The aim of the work was to analyze the role of the metabolic syndrome in oxalocalcic lithogenesis.Materials and methodsMetabolic evaluation of 151 patients including biochemical, hormonal and 24-urine urine parameters, as well as characteristics associated with metabolic syndrome.The relationship between characteristics associated with metabolic syndrome and those related to lithogenesis was evaluated using Spearman's correlation coefficient (SCC), Student's t test and Fisher's exact test.ResultsThe average body mass index (BMI) was 25.9 (SD 3.7). The median age was 51 years (18.6-84.8) and 64.9% were men.There were no statistically significant differences between hypertension and estradiol, testosterone, triglycerides, or cholesterol (P = .191, .969, .454, .345, respectively). Regarding glucose, mean value was 114.5 and 93.5 mg/dl in patients with and without hypertension (P = .000). Glucose, estradiol, testosterone, or cholesterol levels did not vary with proteinuria (P = .518, P = .227, P = .095, P = .218, respectively). Mean triglycerides were 185.6 and 108.2 mg/dl in patients with and without proteinuria (P = .001). Hypertension and proteinuria were not associated (P = .586). BMI correlated with serum and urinary uric acid and urinary creatinine.ConclusionsThere are few associations between the characteristics of metabolic syndrome and abnormalities related to lithogenesis. Metabolic syndrome does not seem to have a relevant role in the development of oxalocalcic stones.     

Desprendimiento de retina exudativo bilateral en paciente con presentación atípica de preeclampsia por síndrome de HELLP

Exudative retinal detachment (ERD) is a rare complication that occurring in 1% of patients with preeclampsia, its incidence is increased when it is associated with HELLP syndrome.Preeclampsia is defined by the development of arterial hypertension and proteinuira occurs after 20 weeks of gestation until postpartum. HELLP syndrome (low platelets, hemolysis and elevated liver enzymes) is a severe form of preeclampsia.ERD in preeclampsia is related to choroidal ischaemia, in the vast majority of the cases associated with hypertensive retinopathy. However, it has been proposed that the combination of hypertension with a microangiopathic hemolysis, hipercoagulability and hypoalbuminemia are the main factors contributing to the development of ERD.Its treatment includes a rapid resolution of labor to reverse ocular manifestations and prevent visual sequels.We describe the case of a pregnant woman with atypical preeclampsia who, in the postpartum of a cesarean, presented an ERD concomitantly with a HELLP syndrome.