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To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology.

Objectives To evaluate the utility of virtual cystoscopy (VC) performed with CT urography in patients being studied under gross hematuria or patients being followed-up after a previous bladder cancer and compare the results with those obtained with gold standard technique (optical cystoscopy). Methods Retrospective study of 117 patients who were referred for VC by the Urology Department between May 2014 and May 2015. Those patients presented with gross hematuria or they were previously treated patients from bladder cancer being followed up. These patients were evaluated with MDCT and virtual cystoscopy after distending the bladder with air. The results were compared with those obtained with optical cystoscopy which was performed no more than a week after. Results The global sensitivity and specificity of VC were 81.8 and 92.1 per cent. Additional findings detected in CT urography were an aortic dissection, urinary lithiasis and colonic metastasis. Conclusion VC seems an useful technique in the diagnosis and follow-up for bladder cancer with a good correlation with OC. The main limitations are the impossibility of biopsy during the procedure and the detection of erythematous lesions. Collateral findings can be detected performed with CT urography although the high radiation exposure does not recommend their combined use.

Fundamento. El tratamiento con bloqueo androgenico intermitente (BAI) pretende mejorar la calidad de vida de los pacientes con cancer de prostata con los mismos resultados oncologicos que el bloqueo androgenico continuo (BAC). El presente trabajo compara la calidad de vida mediante la aplicacion del cuestionario CAVIPRES entre dos grupos de pacientes, uno tratado con BAC y otro con BAI. Material y metodos. Se realizo un estudio longitudinal de 24 meses de duracion que incluyo 114 pacientes. Tras 6 meses se aleatorizaron a ambos grupos de tratamiento (49 pacientes a BAC y51 a BAI), controlandose posteriormente a los 6, 12 y 18 meses de aleatorizarlos. Se comparo la puntuacion de los bloques de items y la puntuacion global del cuestionario CAVIPRES entre ambos grupos de tratamiento y se estudio su variacion a lo largo del tiempo. Resultados. Los pacientes con BAI presentaron mejor calidad de vida global que los pacientes con BAC (p=0,002). De los 5 bloques en los que se divide el cuestionario, el grupo BAI presento mejor puntuacion que el BAC en “Aspectos psicologicos” (p=0,009) y “Apoyo social y pareja” (p=0,008). El BAI mejoro la calidad de vida global de los pacientes a los 18 meses respecto al momento de la aleatorizacion (p=0,000), y la puntuacion de “Vida Sexual” (p=0,000) y “Apoyo social y pareja” (p=0,002). El BAC no mejoro ni la calidad de vida global ni la puntuacion de los diferentes bloques a largo del estudio (p>0,05). Conclusion. El BAI mejora la calidad de vida global de los pacientes a los 18 meses de la suspension del tratamiento.

To evaluate the utility of virtual cystoscopy (VC) performed with CT urography in patients being studied under gross hematuria or patients being followed-up after a previous bladder cancer and compare the results with those obtained with gold standard technique (optical cystoscopy).Retrospective study of 117 patients who were referred for VC by the Urology Department between May 2014 and May 2015. Those patients presented with gross hematuria or they were previously treated patients from bladder cancer being followed up. These patients were evaluated with MDCT and virtual cystoscopy after distending the bladder with air. The results were compared with those obtained with optical cystoscopy which was performed no more than a week after.The global sensitivity and specificity of VC were 81,8 and 92,1%. Aditional findings detected in CT urography were an aortic dissection, urinary lithiasis and colonic metastasis.VC seems an useful technique in the diagnosis and follow-up for bladder cancer with a good correlation with OC. The main limitations are the impossibility of biopsy during the procedure and the detection of erythematous lesions. Collateral findings can be detected performed with CT urography although the high radiation exposure does not recommend their combined use.

Introducción: los tumores renales localmente avanzados presentan un alto porcentaje de progresión tras el tratamiento quirúrgico. El tratamiento quirúrgico de estos tumores renales presenta algunas peculiaridades en relación con la afectación de la glándula suprarrenal, de la vena cava o de la afectación de ganglios regionales. Objetivo: revisar el tratamiento actual de los carcinomas renales localmente avanzados. Material y métodos: se realiza una revisión de los distintos fármacos utilizados, así como de las distintas posibilidades terapéuticas en estos tumores. Resultados: el tratamiento sistémico con inhibidores de la angiogénesis puede mejorar la historia natural de estos pacientes. La pauta de tratamiento sistémico puede ser preoperatoria o adyuvante al tratamiento quirúrgico. Los primeros estudios realizados muestran una disminución de la masa tumoral cuando se realiza tratamiento preoperatorio, aunque no existen estudios prospectivos aleatorizados que nos den suficiente evidencia para recomendar la neoadyuvancia. Conclusiones: la aparición de los tratamientos sistémicos con inhibidores de la angiogénesis puede abrir un campo importante en el tratamiento de estos tumores, tanto en neoadyuvancia como en adyuvancia a la cirugía, pero en la actualidad no tenemos evidencias científicas suficientemente sólidas para recomendar su uso de forma indiscriminada. Probablemente serán los estudios aleatorizados con sunitinib y/o sorafenib los que marcarán la pauta a seguir cuando se completen los resultados definitivos. Introduction: Locally advanced renal tumors show a high progression rate after surgery. Surgical treatment of renal tumors has some unique characteristics related to involvement of the adrenal gland, vena cava, or regional lymph nodes. Objective: To review the current treatment of locally advanced renal tumors. Materials and methods: A review is made of both the different drugs used and the different therapeutic possibilities in these tumors. Results: Systemic treatment with angiogenesis inhibitors may improve the natural history of these patients. Systemic treatment may be administered before surgery or as an adjuvant to surgical treatment. Early studies showed a decrease in tumor mass when treatment is administered before surgery, but no prospective randomized studies providing adequate evidence for recommending neoadjuvant treatment are available. Conclusions: Availability of systemic treatment with angiogenesis inhibitors may open an important field in the treatment of these tumors in both the neoadjuvant setting and as adjuvants to surgery, but no sufficiently solid scientific evidence as to recommend their use is currently available. Randomized studies with sunitinib and sorafenib will probably suggest the adequate approach to be used when their final results are reported.

Treatment with intermittent androgen deprivation (IAD) seeks to improve the quality of life of patients with prosta-te cancer, with the same oncologic results as continuous androgen deprivation (CAD). The aim of this paper is to compare, using the CAVIPRES questionnaire, the quality of life between two groups of patients, one treated with CAD and the other with IAD.A longitudinal study was performed for 24 months involving 114 patients. After 6 months, patients were randomized to two treatment groups (49 patients in CAD and 51 patients in IAD), controlled at 6, 12 and 18 months from randomisation. The score of the items and the overall score of the CAVIPRES questionnaire between the two groups was compared and their variation over time was studied.Patients with IAD had a better overall score than patients with CAD (p=0.002). Of the 5 blocks of items into which the questionnaire was divided, the IAD group had a better score than CAD in "Psychological aspects" (p=0.009) and "Social and partner support" (p=0.008). At 18 months, IAD improved the overall quality of life of patients relative to the time of randomization (p=0.000), as well as the score for "Sexual Life" (p=0.000) and "Social and partner support" (p=0.002). CAD did not improve overall quality of life or the score for the different blocks throughout the study (p0.05).IAD improves overall quality of life of patients at 18 months of stopping treatment.

Resumen Objetivo Valorar las caracteristicas clinicas y patologicas de los tumores renales incidentales tratados en nuestro centro. Material y Metodos Se realiza una revision retrospectiva de 318 nefrectomias comparando las variables clinico-patologicas de los tumores diagnosticados de forma incidental con los tumores renales sintomaticos. Se analizan los diferentes factores influyentes en la supervivencia libre de enfermedad en ambos grupos. Resultados En nuestra experiencia, aunque los tumores renales incidentales presentan una mejor supervivencia que los sintomaticos por presentar mejor estadio patologico y mejor grado tumoral, el diagnostico incidental no se muestra como factor influyente independiente en el estudio multivariado. Solamente cuando se estudian aquellos pacientes que no presentaban metastasis al diagnostico, el diagnostico incidental se presenta como un factor influyente de forma muy proxima a la significacion estadistica. Conclusiones El diagnostico incidental no es un factor pronostico independiente.

Resumen Objetivo Valorar los distintos factores pronostico en relacion con la progresion de la enfermedad y con la supervivencia global. Realizacion de grupos de riesgo segun la agrupacion de factores de riesgo. Material y metodos 117 pacientes que presentaban estadio pT3 (TNM 1997) en la pieza de nefrectomia. Ochenta y ocho pacientes no presentaban enfermedad metastasica en el momento del diagnostico. La forma de presentacion mas frecuente fue el diagnostico casual de tumores asintomaticos. Ochenta pacientes fueron varones (69%) y 37 mujeres (31%). Edad media 59 anos (rango 24-82). Mediana de seguimiento 34 meses (media 44 ± 39 meses). Resultados Estadio patologico; pT3a 51 pacientes (43,6%), pT3b 63 pacientes (53,6%) y pT3c 3 pacientes. Variantes anatomo-patologicas; carcinoma de celulas claras (incluyendo variedad sarcomatoide) 106 pacientes (90,6%), papilar 5 pacientes (4,3%) y cromofobo 4 pacientes (3,4%). Siguiendo la clasificacion de Fuhrman, 13 pacientes presentaron grado 1, 45 pacientes grado 2, 32 pacientes grado 3 y 12 pacientes grado 4. El tamano, el grado, la afectacion ganglionar, y las metastasis se mantuvieron como factores independientes en la progresion en la supervivencia global de los pacientes pT3. Los pacientes no metastasicos con ningun o un factor de mal pronostico presentan mayor supervivencia global que los pacientes con dos o tres factores pronostico y que los pacientes metastasicos. Conclusiones El tamano, la diferenciacion celular, el estadio, la afectacion ganglionar y la presencia de metastasis son factores influyentes independientes en la aparicion de recidivas y en la supervivencia global de los pacientes pT3. El sub-estadio patologico no es factor independiente de progresion de la enfermedad en el estudio multivariado ni influye en la supervivencia global de estos pacientes.Los pacientes estadio pT3 con dos o tres factores de riesgo no presentan diferencias significativas en la supervivencia cuando se comparan con los pacientes metastasicos.

Resumen En la patologia tumoral de localizacion renal se ha producido en los ultimos anos cambios conceptuales relevantes. En esta revision de conjunto, los autores desde la perspectiva de una amplia experiencia institucional, describen los aspectos clinicos y diagnosticos mas actuales de la enfermedad. Destacan el estadiaje molecular y dos variables que presiden el pronostico de la enfermedad un aspecto decisivo para establecer el tratamiento y contribuir a modificar las tasas de supervivencia actual.

Resumen La cirugia radical constituye el tratamiento estandar en el carcinoma renal. En los casos de tumores unicos y menor de 4 cm y en los tumores renales en pacientes monorrenos, la nefrectomia parcial esta estandarizada como tratamiento de eleccion. La tasa de respuesta en el carcinoma renal metastasico con las diversas modalidades de tratamiento inmunoterapico varian de un 15 a un 35%, siendo respuestas de corta duracion.

Resumen Objetivos Valorar la capacidad pronostica de la sobre-expresion de p53, la expresion del factor de proliferacionnuclear Ki67 y de la perdida de expresion de la proteina del retinoblastoma (prot. Rb), valorados mediante inmunohistoquimica,en los tumores vesicales infiltrantes Material y metodos 47 pacientes diagnosticados de tumor vesical profundo. 42 varones y 5 mujeres. Edadmedia 63 anos. Mediana de seguimiento 10 meses. Recidiva en 19 pacientes (40%). Tiempo medio hasta la recidiva8,5 meses. Se valoro la expresion de p53 y Ki67 en 47 pacientes y la de la prot. Rb en 40 pacientes Resultados p53: La media de expresion fue del 41%. Existen diferencias significativas en la expresion de p53entre los pacientes que no presentaron recidiva y los que si lo hicieron (p = 0,03). Los pacientes con p53 > 20% tienenuna supervivencia libre de progresion significativamente menor que los pacientes con p53 Conclusiones La oncoproteina p53 es un buen marcador para el pronostico de recidivas y de supervivencialibre de enfermedad en los tumores vesicales profundos

Adenocarcinoma of the bladder is an uncommon neoplasm corresponding as usual to a metastases and with a lower frequency to a primary vesical tumour. We present the primary adenocarcinoma treated in our hospital in the last 10 years. The moment at the diagnosis is related to the prognosis because of its tendency to muscle infiltration. The most accepted treatment is the radical cistectomy and if recurrence occurs complementary proceedings must be consider.

Resumen Objetivos Estudio de la supervivencia en pacientes diagnosticados de adenocarcinoma de prostata, con afectacion de un ganglio linfatico en el estudio patologico intraoperatorio, valorando el tratamiento quirurgico radical y castracion precoz como tratamiento. Identificacion de los factores clinicos predictores de afectacion ganglionar. Metodo Se estudian 20 pacientes operados mediante prostatectomia radical entre 1988-1998. Todos diagnosticados clinicamente de adenocarcinoma de prostata T1-2N0Mx (T.N.M. 1992), afectacion metastasica ganglionar unica en el estudio patologico y orquiectomia subalbuginea precoz. Se compara este grupo a un grupo control de 200 pacientes con adenocarcinoma de prostata tambien T1-2N0Mx y sin afectacion ganglionar patologica. Estudio estadistico: Para comparar variables cualitativas; tablas de contingencia 2Xb (chi2 de Pearson o un exacto de Fisher), t de Student para comparacion de medias, Kaplan-Meier para el calculo de supervivencia actuarial y para la comparacion de curvas de supervivencia Log-rank. Para el estudio de las variantes clinicas influyentes en la afectacion ganglionar un modelo de regresion logistica. Resultados La edad media es 63 ± 0,8 anos. La mediana de seguimiento 56 meses. La media de P.S.A. es de 33 ± 4,4 ng/ml y el 55% tenian un Gleason 5-7. 16 pacientes fueron estadio pT3. La supervivencia especifica a los cinco anos fue de 90 ± 8% y la supervivencia libre de progresion bioquimica de 63 ± 12%. Las variables clinicas con significacion estadistica para la afectacion ganglionar son el P.S.A. precirugia mayor 20 ng/ml (RR = 4,6), y el Gleason mayor de 4 (RR = 3). El resto de variables no tenian diferencias estadisticamente significativas. Conclusiones El Gleason y el P.S.A. son los unicos valores clinicos predictores de afectacion ganglionar. El tratamiento realizado obtiene buenos resultados con una supervivencia comparable al grupo control.

Resumen Objetivo Valorar la influencia del tratamiento neoadyuvante hormonal, sobre el estadio patologico, margenes y supervivencia libre de enfermedad, en pacientes con cancer de prostata T1-T2 sometidos a prostatectomia radical. Material y metodos Se estudian 42 pacientes T1-T2 tratados de forma no aleatoria con bloqueo hormonal completo neoadyuvante y prostatectomia radical entre 1988-1998. Forman parte de 220 pacientes T1-T2 tratados con cirugia radical. El grupo se compara: a) con el resto de los pacientes (178) (Grupo I); y b) con un grupo escogido (54 pacientes) homogeneo en relacion con las variables clinicas (Grupo II). La media de seguimiento: 35 meses, mediana: 32 meses. Resultados El grupo de pacientes con tratamiento neoadyuvante en relacion con el Grupo I evidencia peor Gleason (p: 0,01), peor estadio clinico (p: 0,02), mayor proporcion de pacientes de alto riesgo clinico (p: 0,03) y mas alto PSA (aunque no estadisticamente diferente). No se objetivan diferencias en relacion con estado patologico o margenes. En relacion con el Grupo II (54 pacientes), no existen diferencias ni en las variables clinicas ni en las patologicas. En ningun caso hay diferencias en la supervivencia libre de progresion. Conclusiones La terapia neoadyuvante hormonal en pacientes T1-T2 de riesgo clinico alto, no supone mejoria en estadio patologico, margenes o supervivencia libre en progresion.

Resumen Fundamento La biopsia prostatica es el procedimiento diagnostico de eleccion para la identificacion del cancer de prostata. Se intenta definir el punto optimo de corte de PSA, indicacion de biopsia y las caracteristicas clinico-patologicas que sugieran la repeticion de la prueba en los casos de biopsia negativa. Metodos Estudiamos 344 biopsias realizadas en 292 pacientes durante 16 meses. Realizamos un estudio univariado y multivariado para identificar los factores influyentes en la aparicion de carcinoma prostatico, tanto en los pacientes sometidos a una sola biopsia como en los que se realizo una segunda. Resultados Pacientes sometidos a primera biopsia: Estudio univariado: De las variables estudiadas (PSA, indice de PSA, tacto rectal, y volumen prostatico) solo el PSA se revelo estadisticamente significativo. Estudio multivariado: Solo el PSA es factor de influencia independiente. Curva ROC: El punto de corte optimo es 10,5 ng/ml. Pacientes sometidos a segunda biopsia. Estudio univariado: Ningun factor se relaciono con la presencia de cancer. Comparacion de grupos: Realizamos una comparacion entre el grupo que se habia realizado una sola biopsia y el grupo que se habia realizado una segunda, no encontrando diferencias significativas entre los dos grupos. Conclusiones Los pacientes con PSA serico >4 ng\ml deben ser sometidos a biopsia de prostata especialmente aquellos cuyo PSA es >10 ng\ml. La utilidad de la fraccion de PSA libre es minima en nuestro caso. -La necesidad de repetir la biopsia no hemos podido fundamentarla en nada solido. Debido al alto riesgo de falsos negativos del metodo, todos los pacientes con biopsias negativas deben ser vigilados estrechamente y rebiopsiados si se producen alteraciones clinicas o elevacion del PSA.

Resumen Objetivos Se realiza un estudio de todos los pacientes tratados de estenosis de la union pieloureteral (EPU) en nuestro departamento, asi como una revision de esta patologia centrandonos en el diagnostico y en las pautas terapeuticas Material Y Metodos Se tratan 62 pacientes de edades comprendidas entre 7 semanas y 68 anos (media 29 ± 1,9 anos). La mitad de los pacientes fueron hombres y la otra mitad mujeres. En 30 casos la estenosis afectada a la pelvis derecha y en 32 a la pelvis izquierda resultados La clinica de presentacion mas frecuente fue el dolor lumbar sordo (46,8%). El diagnostico se confirmo por urografia intravenosa en el 61,3% de los pacientes y por ecografia en el 38,7% de los pacientes. El tratamiento realizado en la mayoria de los pacientes fue la pieloplastia de Anderson- Hynes (96,8% de los pacientes). En 33 pacientes (53,2%) se coloco cateter ureteral “doble J”. El porcentaje de reestenosis fue del 9,7%. En el 29% de los pacientes, aparecio algun tipo de complicacion post-operatoria conclusiones La cirugia abierta sigue siendo el tratamiento de eleccion para el tratamiento de la EPU en casos seleccionados, principalmente en pacientes pediatricos

Resumen Objetivos Valorar la eficacia de la cirugia en pacientes pT3c; saber si constituye un factor de influencia independiente en la supervivencia y los factores clinicos de prediccion diagnostica. Material Y Metodos Se estudian 45 pacientes pT3c (TNM 1982) de una serie de 220 pacientes con cancer de prostata T1-T2 sometidos a prostatectomia radical. Media y mediana de seguimiento: 42 y 36 meses respectivamente. Resultados El grupo pT3 constituye el 20% (45/220) de los pacientes. Tiene un PSA medio (25 ± 2 ng/ml) significativamente mas elevado (0,001), peor Gleason (0,0002) y estadio clinico (0,0003), mayor afectacion de margenes (0,0007), progresion bioquimica (0,02), local (0,05) y metastasica (0,001). Los factores de influencia independiente son: PSA > 20 ng/ml; T2bc y Gleason 7-10. Con ellos se forman tres grupos de riesgo: a) Grupo I (0-1 variable desfavorable): riesgo de afectacion de vesicula seminal 7%; Grupo II (2 variables desfavorables): riesgo 47%; Grupo III (3 variables desfavorables): riesgo 61%. Supervivencia Libre de progresion: es significativamente menor que la de los pT2 (58 ± 8% vs 66 ± 6% en 5 anos) (0,002), pero similar a la de los pT3ab (0,91). La afectacion de vesicula seminal no es un factor de influencia independiente (estudio multivariado de Cox). Los factores influyentes son PSA, Gleason y estadio clinico. Conclusiones Los pT3c no son un grupo de influencia independiente en la supervivencia libre de progresion. Evidencian peor supervivencia libre de progresion que los pT2 e igual que los pT3ab. Su mal pronostico depende de su asociacion a factores clinico-patologicos de influencia negativa.

Resumen Objetivos El presente trabajo estudia en cancer de prostata T1-T2:a) Si existe relacion entre expresion de Ki67 y p53, y las variables clinico-patologicas.b) Si dicha expresion influye en la supervivencia libre de progresion. Material y metodos Se estudian 68 pacientes diagnosticados de cancer de prostata T1-T2, sometidos a prostatectomia radical y estudio inmunohistoquimico de Ki67 y p53 en la pieza de prostatectomia, indicando en cada caso el porcentaje de celulas tenidas. El estudio se ha realizado:a) Comparando entre los grupos las medias del porcentaje de celulas tenidas.b) Agrupando a los pacientes de acuerdo con el porcentaje de expresion. En Ki67 se compara los que expresan 0-5%, con los que expresan > 5%. En p53, los que no expresan (0%) frente a los que expresan > 1%. Seguimiento medio: 20 meses; mediana: 16 meses. Resultados La expresion media de Ki67 es de 7,2% (57% de los casos > 5%). El 60% no sobreexpresa p53; la media es de 3,65 y solo el 15% es superior a 5%. Hay correlacion entre Ki67 y p53 (p: 0,002), pero no con PSA. La expresion de Ki67 se relaciona con peor estadio patologico (p: 0,07) y mayor progresion bioquimica (p: 0,07), e influye significativamente en la supervivencia libre de progresion en el estudio univariado (a tres anos 76% versus 48%; p: 0,04) y en el multivariado (RR: 5,7; p: 0,005). La sobreexpresion de p53 no se relaciona con ninguna variable clinico-patologica, ni influye en la supervivencia libre de progresion.

Resumen Material Y Metodos Estudio de las caracteristicas anatomo-patologicas y los factores influyentes en la supervivencia de 59 pacientes diagnosticados de tumor urotelial de vias altas tratados con cirugia radical. Resultados La edad media fue de 65 anos, el 83% eran varones y en el 64% el tumor se localizaba en pelvis renal. el 54% era pt1-2. el 73% g1-2. el 10% tenian afectacion ganglionar y el 15% metastasis. el 44% tenia tumor vesical concomitante. no hubo exitus atribuible a la cirugia. el 60% seguia vivo al finalizar el estudio. la supervivencia actuarial global fue del 60% ± 7 a los 5 anos. la supervivencia media fue de 134 meses con una mediana de 156 (101-168 meses. ic 95%). sexo, localizacion, morfologia, tipo tumoral, concomitancia de tumor vesical, numero y afectacion ganglionar no influyen significativamente en la supervivencia. solo el grado de diferenciacion tumoral (p = 0,006) y el estadio patologico (p = 0,005) son significativos en el estudio univariado. al realizar el estudio multivariado el unico factor influyente en la supervivencia es el estadio patologico. Conclusiones El factor independiente mas influyente en la supervivencia de los pacientes con tumor de urotelio de vias altas es el estadio patologico. El grado es influyente en el estudio univariado y probablemente es un factor subsidiario. Por el escaso numero de casos, no hemos podido descartar que la afectacion ganglionar y el tipo tumoral influyan en la supervivencia.

Resumen Material y metodos Se estudia la eficacia del diagnostico estadial, la forma de fundamentarlo en datos objetivos de caracter clinico y la descripcion de un modelo pronostico, analizando 160 pacientes diagnosticados de adenocarcinoma de prostata localizado y sometidos a prostatectomia radical en la Clinica Universitaria de Navarra entre 1988-1997. Estudio estadistico utilizado: pruebas de Fisher o de Pearson para comparacion de variables cualitativas. Estudio multivariado de regresion logistica para evitar los factores influyentes en el estadio patologico. Resultados H an sido correctamente estadiados 85/160 (53%). El estadiaje incorrecto se ha producido en pacientes con mayor estadio clinico (T1-T2a: 25%; T2bc: 65%). El estadio patologico, en el estudio univariado, esta relacionado significativamente a) con el valor del PSA serico (15 ng/ml en p2 frente a 25 ng/ml en p3-4), siendo el punto de corte mas apropiado 15 ng/ml. b) con el tacto rectal y el Gleason. En el estudio multivariado son factores influyentes negativamente: el PSA mayor de 15 ng/ml, el Gleason mayor de 5 y el estadio clinico T2bc. Grupos de riesgo: Con los factores indicados se forman 4 grupos de riesgo (ser incluido en el 1o supone un riesgo de p3 del 8%, del 30% en el 2o, del 56% en el 3o y del 84% en el 4o). Conclusiones Los factores clinicos influyentes en el estadio patologico son el PSA, Gleason y estadio clinico. Con ellos se puede establecer grupos de riesgo de notable fiabilidad.

A case of an infiltrating bladder tumor is reported. The pathology was treated by radical cistectomy and orthotopic neo-bladder. After treatment we identified disease in the upper urinary tract and inside the ileal neo-bladder. This case show us the high relapse index of this kind of tumours.

Locally advanced renal tumors show a high progression rate after surgery. Surgical treatment of renal tumors has some unique characteristics related to involvement of the adrenal gland, vena cava, or regional lymph nodes.To review the current treatment of locally advanced renal tumors.A review is made of both the different drugs used and the different therapeutic possibilities in these tumors.Systemic treatment with angiogenesis inhibitors may improve the natural history of these patients. Systemic treatment may be administered before surgery or as an adjuvant to surgical treatment. Early studies showed a decrease in tumor mass when treatment is administered before surgery, but no prospective randomized studies providing adequate evidence for recommending neoadjuvant treatment are available.Availability of systemic treatment with angiogenesis inhibitors may open an important field in the treatment of these tumors in both the neoadjuvant setting and as adjuvants to surgery, but no sufficiently solid scientific evidence as to recommend their use is currently available. Randomized studies with sunitinib and sorafenib will probably suggest the adequate approach to be used when their final results are reported.

Resumen Introduccion los tumores renales localmente avanzados presentan un alto porcentaje de progresion tras el tratamiento quirurgico. El tratamiento quirurgico de estos tumores renales presenta algunas peculiaridades en relacion con la afectacion de la glandula suprarrenal, de la vena cava o de la afectacion de ganglios regionales. Objetivo revisar el tratamiento actual de los carcinomas renales localmente avanzados. Material y metodos se realiza una revision de los distintos farmacos utilizados, asi como de las distintas posibilidades terapeuticas en estos tumores. Resultados el tratamiento sistemico con inhibidores de la angiogenesis puede mejorar la historia natural de estos pacientes. La pauta de tratamiento sistemico puede ser preoperatoria o adyuvante al tratamiento quirurgico. Los primeros estudios realizados muestran una disminucion de la masa tumoral cuando se realiza tratamiento preoperatorio, aunque no existen estudios prospectivos aleatorizados que nos den suficiente evidencia para recomendar la neoadyuvancia. Conclusiones la aparicion de los tratamientos sistemicos con inhibidores de la angiogenesis puede abrir un campo importante en el tratamiento de estos tumores, tanto en neoadyuvancia como en adyuvancia a la cirugia, pero en la actualidad no tenemos evidencias cientificas suficientemente solidas para recomendar su uso de forma indiscriminada. Probablemente seran los estudios aleatorizados con sunitinib y/o sorafenib los que marcaran la pauta a seguir cuando se completen los resultados definitivos.

To study the clinical and pathological characteristics of incidental renal tumors treated in our center.A retrospective review is conducted of 318 nephrectomies comparing the clinico-pathological variables of renal tumors diagnosed incidentally with those of symptomatic renal tumors. The factors influencing disease-free survival are analyzed in both groups.In our experience, although incidental renal tumors presented better survival than symptomatic ones owing to their better pathological state and tumor grade, incidental diagnosis was not an independent influencing factor in the multivariate study. Only when patients were studied who did not present metastases on diagnosis did incidental diagnosis become an influencing factor very close to statistical significance.Incidental diagnosis is not an independent prognostic factor.

Metastases in the kidney are rare, evenmore if primary source is thyroid. We report the tenth case of metastases in the kidney from thyroid, and it is the first to be follicular type and absolutely asymptom. Sonography and computerized tomography with suspicion of renal tumour are showed in a asymtom female 75 years old. Left partial nephrectomy was perfomed, initially it has been pathologically diagnosed as renal clear cells tumour, however the definitive pathologic report showed follicular tumour of thyroid. Local and systemic stage was discovered with complementary techniques. Sources of metastases in kidney and diagnoses techniques are discussed.

The aim of this study was to detect mutations in the human androgen receptor gene in radical prostatectomy specimens.The genomic sequence was realized in 67 radical prostatectomy specimens. The mean age was 64 years old. The PSA median was 15 ng/ml. TNM 1997: 34.3% were T1 and 65.7% T2. Genomic sequence: 1. Radical prostatectomy specimens desparaffitation. 2. Extraction of the DNA 3. DNA amplification. 4. Automatic genome sequence. 5. Comparison with Gene-Bank.16.7% of the specimens were mutated. The most frequent mutation was the punctual mutation. The exon most frequent mutated was exon 1.

Analysis in T1-T2 prostate cancer of the following: a) Whether there is a relationship between Ki67 and p53 over-expression, and clinico-pathological variables. b) Whether that expression influences on progression free survival.The study included 68 patients diagnosed with T1-T2 prostate cancer undergoing radical prostatectomy and immunohistochemical testing of Ki67 and p53 in the prostatectomy specimen, indicating in each case the percentage of stained cells. The study was carried out by: a) Comparison of means between percentage groups of stained cells. b) Grouping patients according to expression percentage. In Ki67, a comparison is made between those expressing 0-5% vs5%. In p53, those expressing (0%) vs1%. Mean follow-up: 20 months; median: 16 months.Mean expression of Ki67 is 7.2% (57% cases5%). 60% do not over-express p53; mean 3.65; only 15% is higher than 5%. There is a correlation between Ki67 and p53 (p: 0.002), but not to PSA. Ki67 expression is related with a poorer pathological stage (p: 0.07) and greater biochemical progression (p: 0.07), and it has a significant influence on progression free survival in both the univariate (at three years 76% vs 48%; p: 0.04) and the multivariate studies (RR: 5.7; p: 0.005). Over-expression of p53 is not related to any clinico-pathological variable, and does not influence progression free survival.

Primary tumors of extragonadal origin are rare, with fewer than 1000 cases described in the literature. Although the exact incidence of EGTs is unknown, clinical data suggest that roughly 3% to 5% of all germ cell tumors. We expose a case report of EGT with unusually clinic presentation. We present our diagnostic and therapeutic experience in this injuries.

Resumen Mutaciones del gen del receptor de androgenos en pacientes con adenocarcinoma de prostata clinicamente localizado Los objetivos del presente trabajo son el estudio de las mutaciones del gen del receptor de androgenos, tanto su frecuencia como su localizacion en pacientes sometidos a prostatectomia radical. Material y metodos Se realizo la secuenciacion genomica en 67 pacientes sometidos a prostatectomia radical. La edad media fue de 64 anos. La mediana de PSA fue de 15 ng/ml. El 34,3% de los pacientes presentaban un estadio T1 y el 65,7% un estadio T2. Secuenciacion genomica: 1. Desparafinacion de las muestras. 2. Extraccion del ADN genomico. 3. Amplificacion del ADN. 4. Secuenciacion. 5. Evaluacion de la secuenciacion con el GenBank. Resultados Un 16,7% de los pacientes presentaban mutaciones del gen del receptor de androgenos. La mutacion mas frecuente fue la mutacion puntual. El exon mas frecuentemente mutado fue el exon 1.

Resumen Masa renal asintomatica como primera manifestacion de carcinoma folicular de tiroides Las metastasis de carcinoma de tiroides en rinon son raras. Presentamos el 10o caso, que conocemos publicado, de metastasis tiroidea en rinon y el primero del tipo folicular y asintomatico. Se trata de una paciente de 75 anos asintomatica, que presenta una masa en el rinon derecho, que se decide realizar nefrectomia parcial derecha. El diagnostico provisional habla de tumor de celulas claras renales pero el definitivo es de metastasis de carcinoma folicular de tiroides, descubrimos un estado avanzado de la enfermedad tanto localmente como a distancia. Las fuentes de metastasis en el rinon asi como las tecnicas diagnosticas son discutidas en el caso.

Resumen El carcinoma de prostata es un tumor que cada vez se diagnostica en fases mas precoces de su evolucion pero que puede presentar un comportamiento caprichoso e impredecible. El tratamiento radical tanto prostatectomia como radioterapia es el tratamiento de eleccion en paciente con tumores clinicamente localizados, sin embargo el fracaso bioquimico a los 5 anos de la cirugia afecta al 20-50% de estos pacientes, la progresion a partir de los 5 anos de tratamiento es un hecho poco frecuente que puede deberse a factores pronosticos poco conocidos de la propia naturaleza biologica del tumor. Presentamos un caso clinico en que tras 10 anos del tratamiento radical sin evidenciar progresion bioquimica ni progresion clinica, aparece un nodulo pulmonar solitario junto con discreta elevacion de las cifras de psa

To identify independent predictors of progression and global survival in patients affected by pT3 renal cell carcinoma. To make risk groups by risk factors.We evaluated 117 patients with pT3 renal cell carcinoma. 88 was M0 and 29 M1. Most frequent clinical feature: asintomatic patients. 80 males (69%) and 37 females (31%). Mean age 59 (24-82). Median follow up 34 months (mean 44 +/- 39 months).Pathological stage (TNM 1997) was pT3a in 52 patients (43.6%), pT3b 63 patients (53.6%) and pT3c 2 patients.clear cell carcinoma 106 patients (90.6%), papillary 5 patients (4.3%) an dchromophobe 4 patients (3.4%). Nuclear grading according Fuhrman's classification: G1 13 patients, G2 45 patients, G3 32 and G4 12 patients. Size4 cm (p = 0.005/p = 0.0019), grade 3-4 (p = 0.006/p = 0.0007), N+ (p = 0.034/p = 0.009) and M+ (p = 0.035/p = 0.042) were independent prognosis factors for progression and global survival of the pT3 renal cell carcinoma. Patients M0 with 0 or 1 risk factor have better global survival tanh patients M0 with 3 or 4 risk factors and patients M1.Size, grade, N+ and M+ were independent prognosis factors for progression and global survival of the pT3 renal cell carcinoma. Tera are no differencies in global survival between patients M0 with 2 or 3 risk factors and patients M1.

The standard therapy for renal carcinoma is radical surgery. When dealing with single, under 4 cm tumors and in the case of renal tumors in single-kidney patients, the choice therapy is nephrectomy or partial nephrectomy. Response rates in metastatic renal carcinoma using the various immune therapy approaches available range from 15 to 35%, responses being short-lasting.

Significant conceptual changes have taken place in renal tumoral diseases over the last few years. As a result of the authors' broad institutional experience, this overall revision describes the most up-to-date clinical and diagnostic aspects of this condition. Emphasis is made on molecular staging and two variables that guide the prognosis of the disease, a decisive feature to establish treatment and to contribute to change current survival rates.

To determinate whether increased expression of the p53 and Ki67 and the of the tumour suppressor gene retinoblastoma (prot Rb), in an immunohistochemistry study, were associated with relapse in invasive bladder cancer.47 patients with invasive bladder cancer. 42 men and 5 women. Mean age 63 years old. Relapse in 19 patients (40%). Mean time until recurrence 8.5 months. p53 and Ki67 were study in 47 patients and prot Rb in 40 patients.p53: Mean expression 41%. There were significant differences in the increased expression of p53 between patients with and without relapse (p = 0.03). A statistically significant association was then observed between patients with p5320% (vs p5320%) and adverse outcome of the disease (p = 0.04). Ki67 and prot Rb: There were no significant differences in relapse and progression free survival between Ki6740% (vs Ki6740%) and prot Rb10% (vs prot Rb10%). p53 expression showed a statistically significant correlation with Ki67 and prot Rb.p53 is a good prognostic marker for the relapse and progression free survival in invasive bladder cancer.

A case of an infiltrating bladder tumor is reported. The pathology was treated by radical cistectomy and orthotopic neo-bladder. After treatment we identified disease in the upper urinary tract and inside the ileal neo-bladder. This case show us the high relapse index of this kind of tumours.

Adenocarcinoma of the bladder is an uncommon neoplasm corresponding as usual to a metastases and with a lower frequency to a primary vesical tumour. We present the primary adenocarcinoma treated in our hospital in the last 10 years. The moment at the diagnosis is related to the prognosis because of its tendency to muscle infiltration. The most accepted treatment is the radical cistectomy and if recurrence occurs complementary proceedings must be consider.

To report two cases of verrucous carcinoma of the penis, a rare tumor with a characteristic course and specific treatment that accounts for approximately 1% of tumors in the male.Two patients, aged 86 and 51 years, with verrucous carcinoma of the penis are described. Treatment was by partial penectomy and resection of the glans penis, respectively. The anatomopathological characteristics and prognostic aspects are reviewed.Verrucous carcinoma of the penis usually presents as an exophytic lesion in the glans penis or prepuce and should be distinguished from epidermoid carcinoma which carries a worse prognosis and requires a different therapeutic approach. The differential diagnosis is based on the biopsy findings. Verrucous carcinoma of the penis carries a good prognosis and can be managed by conservative surgery (partial penectomy).

Prostate biopsy is the diagnostic method to detect prostate carcinoma. We try to identify the optimal PSA cut-off, biopsy indication and the clinico-pathological characteristics in order to differentiate those patients with negative biopsy in which we should repeat the proceeding.We study 344 biopsies in 292 patients for 16 months. An univariate and multivariate study to identify the influent factors in the existence of prostate cancer in the first biopsy and in the patients with a second one was taken place.Patients in the first biopsy Univariate study: Out of these variables (PSA, PSA ratio, digital rectal examination and prostate volume) just the PSA has statistical significance. Multivariate study: Only the the PSA is an indepent influence factor. Receiving Operated Curve: The optimal cut-off is 10.5 ng/ml. Patients with a second biopsy Univariate study: None of the variables is related with the existence of prostate cancer. Groups comparison: A comparison between the patients in the first biopsy and the patients with a second biopsy is performance with no statistical differences in the variables already mentioned.The patient with a PSA greater than 4 ng/ml should be perform a prostate biopsy, mostly if his PSA is over 10 ng/ml. In our experience we do not related the need of a second biopsy with any factor in particular, therefore in our opinion and because of the high rate of negative false, all of the patients should be controlled and undergo a second biopsy if any change in PSA or clinics modification takes place.

To study the survival in patients with prostate adenocarcinoma, lymph nodes involvement in the intraoperative pathological examination, evaluating both radical surgery and early ablation as treatment. Identification of clinical factors that can predict node involvement.20 patients who underwent radical prostatectomy between 1988-1998 were included in the study. All patients clinically diagnosed with T1-2N0Mx prostate adenocarcinoma (T.N.M. 1992), single metastatic node involvement in the pathological study and early sub-albuginea orchidectomy. This group was compared to a 200-patient control group also with T1-2N0Mx prostate adenocarcinoma but with no pathologic nodular involvement. Statistical study: contingency 2Xb tables (Pearson's chi 2 or Fisher's exact test) to compare qualitative variables; Student's t test for means comparison; Kaplan-Meier for actuarial survival calculations and comparison of Log-rank survival curves. For the study of clinical variants with influence in node involvement a logistic regression model was used.Mean age was 63 +/- 0.8 years. Median follow up 56 months. Mean PSA 33 +/- 4.4 ng/mL and 55% had Gleason 5-7. 16 patients were stage pT3. Specific 5-year survival was 90 +/- 8% and biochemical progression free survival 63 +/- 12%. Clinical variables with statistical significance for node involvement are: pre-surgical PSA greater than 20 ng/mL (RR = 4.6), and Gleason higher than 4 (RR = 3). The remaining variables showed no statistical significance.Gleason and PSA are the only clinical values that predict node involvement. The procedure performed obtains good results and a survival comparable to that of the control group.

To assess the influence of neo-adjuvant hormone therapy on the pathologic stage, margins and disease-free survival in patients with T1-T2 prostate cancer after radical prostatectomy.Forty-two non-randomised, T1-T2 patients who underwent complete neo-adjuvant blockade and radical prostatectomy between 1988-1998 were included in the study. This group is part of a larger cohort of 220 T1-T2 patients treated with radical surgery. The group is compared to: a) the remaining patients (178) (Group I) and b) a selected group (54 patients) of consistent characteristics relative to clinical variables (Group II). Mean follow-up: 35 months; median: 32 months.Compared to Group I patients with neo-adjuvant therapy show worse Gleason (p: 0.01), worse clinical stage (p: 0.02), higher rate of patients with high clinical risk (p: 0.03), and higher PSA (though not statistically different). No differences were seen relative to pathological status or margins. Compared to Group II (54 patients) no differences are found in clinical or pathological variables. Groups are comparable in terms of progression-free survival.Neo-adjuvant hormone therapy in high clinical risk, T1-T2 patients does not involve improvement in pathological stage, margins or progression-free survival.

To assess the efficacy of surgery in pT3c patients; to discern whether this is an independent influential factor for survival and clinical factor for diagnostic prediction.Forty-five pT3c (TNM 1982) patients from a cohort of 220 subjects with T1-T2 prostate cancer who underwent radical prostatectomy. Mean and median follow-up: 42 and 36 months, respectively.pT3 stage accounts for 20% (45/220) patients. They display a significantly higher mean PSA (25 +/- 2 ng/ml) (0.001), worse Gleason (0.0002) and clinical stage (0.0003), greater margins involvement (0.0007), and biochemical (0.02), local (0.05) and metastatic (0.001) progression. Independent influential factors are: PSA20 ng/ml; T2bc and Gleason 7-10. From these values patients can be divided into 3 risk groups: a) Group I (0-1 unfavourable variables): risk of seminal vesicle involvement 7%; Group II (2 unfavourable variables): risk 47%; Group III (3 unfavourable variables): risk 61%. Progression-free survival: significantly lower than patients with pT2 (58 +/- 8% vs 66 +/- 6% at 5 years) (0.002), but similar to those with pT3ab (0.91). Seminal vesicle involvement is not an independent influential factor (Cox's multivariate study). Influential factors are PSA, Gleason and clinical stage.pT3c tumours are not an independently influential group in progression-free survival. Progression-free survival is lower than pT2 but similar to pT3ab. Their poor prognosis is dependent on association to negatively influential clinico-pathological factors.

To study patients with ureteropelvic junction obstruction treated in our department and a retrospective study of this pathology, focus our attention in the diagnosis and treatment.62 patients from 7 weeks to 68 years old (mean 29 +/- 1.9). Half of the patients were men and the other half women. In 30 patients the UPJ obstruction was on the right side and 32 patients was on the left side.The most frequent symptom was the flank pain (46.8%). To confirm the diagnosis, we had IVU in the 61.3% of the patients and ultrasound in the 38.7%. The treatment was the Anderson-Hynes pyeloplasty in the 96.8% of the patients. In 33 patients we used a ureteral catheter. The overall success rate was 90.3%. The 29% of the patients presented postoperative complications.Open pyeloplasty is the gold standard treatment of the UPJ obstruction in selected cases, mainly in children.

Margins involvement in T1-T2 patients undergoing radical prostatectomy is a negative prognostic factor. We aimed to: a) Study the clinical and pathological features of patients with surgical margins involvement; b) Elucidate the influence of margins involvement on the progression-free survival.The study included the group with "positive margins" out of a series of 160 patients with localised prostate adenocarcinoma who underwent radical prostatectomy at the Clínica Universitaria de Navarra between 1988-1997. statistics used: Fisher's or Pearson's test for qualitative variables. Kaplan-Meyer, Log-rank and Cox's multivariate tests for the survival study.The group accounts for 28% (45/158) of all patients undergoing radical prostatectomy. Mean PSA (22 +/- 14 ng/ml) is similar to the remaining group although there is greater significant rates of PSA15 ng/ml (p: 0.006), worse Gleason (p: 0.01), higher proportion of T2bc (p: 0.003) and node involvement (0.001). Progression-free survival (BPFS) is significantly lower in this group (32 +/- 12% vs 61 +/- 6% at 5 years). Margins are the single factor with higher influence (RR:5) in the multivariate study. Influence is clear in patients with Gleason5 (0% vs 87%) and PSA30 ng/ml (33 +/- 14 vs 70 +/- 7%), but has no influence on BPFS of patients with PSA30 ng/ml or Gleason 5-10.Positive margins in patients undergoing radical prostatectomy is associated to higher PSA, worse Gleason and higher stage. They are the most significant independent risk factor (except for PSA30 ng/ml) for biochemical progression-free survival as evidenced in the multivariate study, although it is likely this influence is diluted in patients with PSA30 ng/ml and/or Gleason 5-10.

Study on the efficacy of stage diagnosis, how to support it based on clinical objective data and description of a prognostic model. Analysis of 160 patients diagnosed with localized prostate adenocarcinoma undergoing radical prostatectomy in the Clínica Universitaria de Navarra between 1988-1997. The statistical study used Fisher's or Pearson's tests for the comparison of qualitative variables. A logistic regression multivariate analysis was run to avoid confounding factors in the pathological stage.85/160 (53%) were correctly staged. Incorrect staging occurred in patients with higher clinical stage (T1-T2a: 25%; T2bc: 65%). The univariate study shows that the pathological stage is significantly correlated to: a) serum PSA levels (15 ng/mL in P2 vr. 25 ng/mL in P3-4), the most suitable cutoff value being 15 ng/mL. b) digital rectal examination and Gleason. Negatively influencing factors in the multivariate study were: PSA greater than 15 ng/mL, Gleason greater than 5 and a T2bc clinical stage. Risk groups: 4 risk groups are established based on the above factors (inclusion in group 1 involves an 8% risk of having P3, 30% in group 2, 56% in group 3 and 84% in group 4).The clinical factors with influence in the pathological stage are PSA, Gleason and clinical stage. The reliability of the risk groups established based on these factors is remarkable.

Study of biochemical progression (PSA0.5 ng/ml) and biochemical progression-free survival in 160 patients diagnosed with clinically localized prostate adenocarcinoma who underwent radical prostatectomy at the University Clinic in Navarra between 1988-1997.At the end of the study, 120 patients (75%) are alive and free of progression, 33 (20%) are alive and in progression, 3 (1.9%) died of cancer, and 4 (2.5%) died for other causes. Biochemical progression occurred in 43/160 (27%) patients. Progression is related to previous PSA, both in absolute terms and divided into greater or smaller than 15 ng/ml; to Gleason grade greater or smaller than 7 or divided into 2-4, 5-7, 8-10; to pathological stage and to urethro-vesical junction stenosis. Biochemical progression-free survival (BPFS) in the univariate study is related to PSA (the ideal prognostic cut-off value being 15 ng/ml); to Gleason, specially when divided into 2-4, 5-7, 8-10; to the pathological stage and to margins. The multivariate study evidences that the single most influential factors are PSA (divided as greater or smaller than 15 ng/ml), Gleason grade (divided into: 2-4, 5-7, 8-10) and margins involvement. There are 3 highly reliable risk groups based on PSA, Gleason and clinical stage. When these are introduced as variables in the multivariate study, they appear as the strongest predictive variables.The influential factors on progression-free survival are PSA (15 ng/ml being the best prognostic cut-off value), Gleason grade (divided into 2-4, 5-7, 8-10) and margins' positivity, which are the single most significant pathological factor ahead of clinical stage. Serum PSA, clinical stage and Gleason grade allow to define three reliable risk groups.