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Los métodos de cribado y diagnóstico actuales en cáncer de próstata (CaP) son insuficientes, inespecíficos o invasivos, por lo que la búsqueda de nuevos biomarcadores y técnicas diagnósticas sigue siendo relevante clínicamente. En el presente estudio, la Espectroscopía Raman mejorada por superficies (SERS) de muestras de orina y el estudio quimiométrico mediante análisis de componentes principales (PCA) acoplado a análisis linear discriminante (LDA) permite crear un sistema diagnóstico de CaP rápido, no invasivo y de bajo coste, posibilitando la identificación eficaz de CaP con una sensibilidad del 77.78 % y una especificidad del 100 %. A su vez, se aborda la búsqueda de biomarcadores propios del CaP mediante cromatografía de gases acoplada a espectrometría de masas (GC-MS), en la que se sugiere que los metabolitos urinarios no son biomarcadores válidos para CaP.

To validate and analyse the clinical usefulness of a predictive model of prostate cancer that incorporates the biomarker «[-2] pro prostate-specific antigen» using the prostate health index (PHI) in decision making for performing prostate biopsies.We isolated serum from 197 men with an indication for prostate biopsy to determine the total prostate-specific antigen (tPSA), the free PSA fraction (fPSA) and the [-2] proPSA (p2PSA). The PHI was calculated as p2PSA/fPSA×√tPSA. We created 2 predictive models that incorporated clinical variables along with tPSA or PHI. The performance of PHI was assessed with a discriminant analysis using receiver operating characteristic curves, internal calibration and decision curves.The areas under the curve for the tPSA and PHI models were 0.71 and 0.85, respectively. The PHI model showed a better ability to discriminate and better calibration for predicting prostate cancer but not for predicting a Gleason score in the biopsy ≥7. The decision curves showed a greater net benefit with the PHI model for diagnosing prostate cancer when the probability threshold was 15-35% and greater savings (20%) in the number of biopsies.The incorporation of p2PSA through PHI in predictive models of prostate cancer improves the accuracy of the risk stratification and helps in the decision-making process for performing prostate biopsies.

To evaluate the impact of metabolic syndrome and its individual components on prostate biopsy findings, the radical prostatectomy specimen and on biochemical recurrence.An observational study was conducted of 1319 men who underwent prostate biopsy between January 2007 and December 2011. The impact on the biopsy findings, the radical prostatectomy specimen and biochemical recurrence was evaluated using logistic regression and Cox regression.Of the 1319 patients, 275 (21%) had metabolic syndrome, and 517 prostate cancers were diagnosed. A greater percentage of metabolic syndrome was found among patients with prostate cancer than among patients without prostate cancer (25% vs. 18%; P=.002). Poorer results were found in the radical prostatectomy specimens (Gleason score ≥ 7, P.001; stage ≥ T2c, P.001; positive surgical margins, P.001), and there was a greater percentage of biochemical recurrence in patients with metabolic syndrome than in those without metabolic syndrome (24% vs. 13%; P=.003). Metabolic syndrome behaved as an independent predictive factor of finding a Gleason score ≥ 7 for the specimen, as well as for finding a specimen stage ≥ T2c. Metabolic syndrome was also able to independently predict a greater rate of biochemical recurrence (OR: 3.6, P.001; OR: 3.2, P=.03; HR: 1.7; respectively).Metabolic syndrome is associated with poorer findings in the radical prostatectomy specimens and is an independent prognostic factor of biochemical recurrence.

To evaluate the oncological profile and risk of biochemical recurrence of patients with prostate cancer who underwent radical prostatectomy based on the time period in which the patients were operated. To evaluate the differences in prostate-specific antigen (PSA) at diagnosis of patients with or without biochemical recurrence based on these time periods.Observation carried forward study of a cohort of 972 radical prostatectomies performed during 3 time periods (1994-2000, 2001-2006, 2007-2011). The importance of PSA at diagnosis on the time periods and on biochemical recurrence was assessed using a generalized linear model. The independent predictive behavior of biochemical recurrence was analyzed using Cox regression.The median follow-up was 38 (16-76) months. PSA levels at diagnosis were higher in the period 1994-2000 (12.97ng/mL, P.001). Seventy-two percent of the patients from the period 2007-2011 were diagnosed as clinical stage T1c (P.001), compared with 55% from the period 1994-2000. The percentage of extracapsular extension in the specimen decreased from 27% to 18% from the period 1994-2000 to the period 2007-2011 (p.001). The percentage of patients with biochemical recurrence went from 38% to 14% from the first to the third period (P.001). The difference between PSA levels at diagnosis for the patients with or without biochemical recurrence was independent of the period (P=.84). The period during which surgery was performed was not an independent predictive factor for biochemical recurrence (P=.09).Patients from the 2007-2011 period had less extracapsular disease in the radical prostatectomy. The period was not an independent predictive factor for biochemical recurrence.

Premio Extraordinario de Doctorado de la UAH en 2015, Introducción De un 27-53% de pacientes que se someten a prostatectomía radical o radioterapia desarrollan recurrencia local o a distancia en los primeros años de seguimientos y entre un 16-35% de pacientes requieren un tratamiento de segunda línea en los 5 primeros años tras recibir un tratamiento con intención curativa1. La recidiva bioquímica se define como la elevación del antígeno prostático específico (PSA) tras tratamiento, basada en el estudio de Pound2, quien mostró que ningún paciente seguido durante más de 5 años desarrollaba una recurrencia sin aumento concomitante de PSA. Se han identificado distintos factores pronósticos de recidiva bioquímica3. Dentro de los factores preoperatorios se encuentran el estadiaje clínico, PSA al diagnóstico y Grado de Gleason de la biopsia. Entre los factores pronósticos de recidiva bioquímica en la pieza de prostatectomía radical se encuentran el Grado de Gleason de la pieza, el volumen tumoral, los márgenes quirúrgicos, la extensión extracapsular, la infiltración perineural, la invasión linfovascular y las metástasis ganglionares. Objetivos Objetivos principales 1. Establecer el valor pronóstico de recidiva bioquímica de las siguientes variables preoperatorias: PSA al diagnóstico, estadiaje clínico al diagnóstico y Grado de Gleason de la biopsia. 2. Establecer el valor pronóstico de recidiva bioquímica de las siguientes variables anatomopatológicas en la pieza de prostatectomía radical: estadiaje de la pieza, Grado de Gleason de la pieza, márgenes quirúrgicos, invasión linfovascular e infiltración perineural. Objetivos secundarios 1. Asociación entre variables clínicas, de laboratorio y anatomopatológicas previas a prostatectomía radical, variables anatomopatológicas de la pieza de prostatectomía radical y variables postoperatorias de interés como el primer PSA postoperatorio y el PSA a los 6 meses de la cirugía. Desarrollo teórico Para evaluar los objetivos propuestos se ha realizado un diseño de tipo observacional hacia delante de una cohorte de 972 prostatectomías radicales con diagnóstico anatomopatólogico de adenocarcinoma de próstata acinar. El análisis pronóstico para la variable resultado principal (recidiva bioquímica) se ha realizado mediante Regresión de Cox. Conclusiones ?PSA al diagnóstico, estadiaje de la pieza, márgenes quirúrgicos, infiltración perineural y primer PSA postoperatorio se comportan como factores predictores independientes de recidiva bioquímica. ?Los márgenes quirúrgicos son un factor predictor independiente de recidiva bioquímica tanto en enfermedad organoconfinada como en extracapsular ?La presencia de un Grado de Gleason de la pieza ? 8 y la presencia de un estadiaje de la pieza ? T3a actúan como modificadores del efecto en la asociación entre el PSA al diagnóstico y la recidiva bioquímica.

Retrospective review of 106 germ-cell testicular tumors treated in our center between 1992 and 2009.Description and analysis of several clinical-pathologic and prognostic variables and survival analysis.68% of our patients were diagnosed in the last 5 years. 54.7% presented seminoma histology. The mean age at diagnosis was 33.47 for the seminoma (S) and 27.63 for non seminoma (NS), p=0,001. The median tumoral size in mm was 45.99mm (globally). 44.3% presented elevation of at least one tumor marker; Alpha-fetoprotein (AFP) or Human chorionic gonadotropin (HCG) .29.3% in the S and 60.4% in NS; p=0.02. The percentage of patients with increased HCG in S was 29.3% and 52.1% in NS; p=0.017 and AFP was elevated in 5.2% of S and 45.8% of NS; P0.001. Accordingly to the classification of The Royal Marsden Hospital 96.5% of S and 83.2% of NS were diagnosed in stage I-II. Using the classification of the International Germ Cell Cancer Collaborative Group (IGCCG) for patients with advanced disease, 98.2% of S and 83.2% of NS belonged to the good prognostic group. Regarding the risk factors for relapse in stage I S (Rete testis invasion (RTI) and tumoral size (TS)4cm) 28% of our patients presented both risk factors. 18% of stage I NS presented vascular (VI) or lymphatic invasion (LI). Following the treatment protocols in consideration with the histology, stage and risk factors, 100% of stage I S with both risk factors and 100% of NS with vascular or lymphatic invasion received adjuvant therapy. Almost all the stage II-IV S and NS received different protocols of chemotherapy. In 2.8% of stage II NS a retroperitoneal lymph node dissection was performed. Residual tumor resection was documented in eight patients with stage II-IV NS. With a median follow-up of 60 months, the event free survival (EFS) was 93.3%.Our study has similar characteristics compared to other studies.

To report one case of prostatic abscess and subdural empyema by Staphylococcus aureus.We describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physical exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confirmation methods.The clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversion.Prostatic abscess is an uncommon entity nowadays. Provided the great variety of symptoms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggressive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy.

Introducción y objetivo: Presentamos el caso de un paciente con absceso prostático y empiema subdural por Staphilococo aureus. Material y método: Descripción de un caso de un paciente de 51 años de edad diagnosticado de absceso prostático y empiema subdural por Staphilococo aureus. Utilizamos como método de aproximación diagnóstica la sospecha clínica y la exploración física mediante tacto rectal. Como métodos de confirmación diagnóstica, pruebas de imagen, como la tomografía axial computerizada y la ecografía transrectal, que permite además el drenaje del material purulento. Resultados: El cuadro se resolvió con ecografía transrectal y punción-drenaje de la colección y con tratamiento conservador en base a antibioterapia y derivación urinaria. Conclusiones: El absceso prostático es en la actualidad una patología poco frecuente. Dada la gran variedad de presentación de esta entidad, hay que tener un alto grado de sospecha para su diagnóstico y una vez realizado comenzar un tratamiento inmediato agresivo. La ecografía transrectal permite, no sólo el diagnóstico, sino también la punción-drenaje del contenido purulento. El cultivo de las muestras obtenidas identifica el agente causante y la antibioterapia más adecuada. Introduction and objectives: To report one case of prostatic abscess and subdural empyema by Staphylococcus aureus. Methods: We describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physical exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confirmation methods. Results: The clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversion. Conclusions: Prostatic abscess is an uncommon entity nowadays. Provided the great variety of symptoms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggressive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy.

Adenocarcinoma of the bladder is an uncommon neoplasm. Depending on its origin it is classified in: primary, secondary and urachal. Generally it grows to the density of the wall, so its clinical appearence is delayed, with the subsequent delayed diagnosis and although an agressive treatment is performed, it frequently has a very bad prognosis. Since there are very few publications of this kind of neoplasm in the literature the lines of actuation in this pathology are not well established. We report the eleven cases of adenocarcinoma neoplasm of the bladder treated in our centre and review the literature.