Search

The etiology of prostate cancer (PCa) remains uncertain, and the role of diet is unclear. We aimed to evaluate the role of diet, through dietary patterns, on PCa, considering tumor aggressiveness and extension. The CAPLIFE study is a population-based case-control study including a total of 428 incident PCa cases and 393 controls aged 40–80 years. Dietary information was collected through a validated food frequency questionnaire. Three dietary patterns were identified through principal component analysis: “Mediterranean,” “Western,” and “Unhealthy,” which were categorized into tertiles according to the control group cutoff points. Tumor aggressiveness and extension was determined. Logistic regression models were used to assess the association between dietary patterns and PCa. High adherence to an unhealthy dietary pattern was associated with higher odds of PCa, ORT3vsT1 = 1.52 (95% CI 1.02–2.27), especially for cases with ISUP 1–2 and localized PCa tumors. This association was not observed with aWestern or Mediterranean pattern. In conclusion, adherence to an unhealthy diet appears to be associated with higher odds of PCa, especially for cases with ISUP 1–2 and localized PCa tumors., Regional Ministry of Health and Families, Junta de Andalucia/Consejeria de Salud y Familias, Junta de Andalucia PI-0514-2016

Resumen Contexto A pesar de ser una demostrada fuente de biomarcadores, la biopsia liquida aun no ha conseguido dar el paso a la practica clinica habitual en pacientes con cancer de prostata. Pocos biomarcadores se someten a una adecuada validacion, prospectiva e independiente, de su valor predictivo o pronostico y ello resulta en una falta de resultados con capacidad de traslacion real a la clinica de los diferentes test disponibles. Objetivo Realizar una sintesis, clinicamente pragmatica, de la evidencia cientifica actual sobre la biopsia liquida sanguinea en cancer de prostata. Adquisicion de la evidencia Revision no sistematica de la literatura, acotando la busqueda a trabajos sobre biopsia liquida de origen sanguineo en cancer de prostata. Se seleccionaron preferentemente aquellos trabajos en los cuales se estudian end-points clinicos aplicados al cancer de prostata. Sintesis de la evidencia Las formas de biopsia liquida mas avanzadas en terminos clinicos son las celulas tumorales circulantes (CTC) y el ADN tumoral circulante (ADNtc). Tanto CTC como ADNtc han demostrado su valor pronostico en enfermedad metastasica. La determinacion de ARV7 constituye el primer biomarcador predictivo de la enfermedad. Su traslacion a la practica clinica habitual pasa por la estandarizacion metodologica y la adecuada validacion clinica de las distintas formas de deteccion disponibles. La deteccion de CTC en estadios iniciales de la enfermedad depende aun de la optimizacion de los metodos de deteccion y del desarrollo de la caracterizacion biologica de estas celulas. La informacion biologica aportada por CTC y ADNtc es distinta; por ello, el estudio de su adecuada conjuncion es objeto de la investigacion mas actual. Conclusiones La ausencia de protocolos y estandares metodologicos es el factor limitante para llegar a conclusiones de impacto clinico. Por ello, el consenso y la unificacion de criterios constituyen el verdadero desafio a corto plazo para la biopsia liquida.

Context Despite being a validated source of biomarkers, liquid biopsy has not yet succeeded in becoming part of the standard clinical practice in prostate cancer patients. Few biomarkers undergo adequate validation, prospective and independent, of their predictive and/or prognostic value, which results in a lack of the different available tests in the clinical practice. Objective To carry out a pragmatic synthesis of current scientific evidence on liquid biopsy for prostate cancer patients. Evidence acquisition Non-systematic literature review, narrowing the search to papers on liquid biopsy from blood samples in prostate cancer patients. We mainly selected works evaluating clinical endpoints in prostate cancer. Evidence synthesis The most clinically advanced forms of liquid biopsy are circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). Both CTCs and ctDNA have demonstrated their prognostic value in metastatic disease. ARV7 determination is the first predictive biomarker of the disease. Its implementation into routine clinical practice requires methodological standardization and adequate clinical validation of the different available ways to detect it. The detection of CTCs in the early stages of the disease still depends on the optimization of the diagnostic methods and on the development of the biological characterization of these cells. The biological information provided by CTCs and ctDNA is different; therefore, the study of its adequate combination is the object of cutting-edge research. Conclusions The absence of protocols and methodological standards is the limiting factor when aiming to reach conclusions that could have a potential impact on clinical practice. Therefore, the real short-term challenge for liquid biopsy is the establishment of consensus and common criteria. Resumen Contexto A pesar de ser una demostrada fuente de biomarcadores, la biopsia liquida aun no ha conseguido dar el paso a la practica clinica habitual en pacientes con cancer de prostata. Pocos biomarcadores se someten a una adecuada validacion de su valor predictivo y/o pronostico, prospectiva e independiente,; y ello resulta en una falta de traslacion real a la clinica de los diferentes test disponibles. Objetivo Realizar una sintesis, clinicamente pragmatica, de la evidencia cientifica actual sobre la biopsia liquida sanguinea en cancer de prostata. Adquisicion de la evidencia revision no sistematica de la literatura acotando la busqueda a trabajos sobre biopsia liquida de origen sanguineo en cancer de prostata. Se seleccionan preferentemente aquellos trabajos en los cuales se estudian end-points clinicos aplicados al cancer de prostata. Sintesis de la evidencia Las formas de biopsia liquida mas avanzadas en terminos clinicos son las celulas tumorales circulantes (CTCs) y el ADN tumoral circulante (ctDNA). Tanto CTCs como ctDNA han demostrado su valor pronostico en enfermedad metastasica. La determinacion de ARV7 constituye el primer biomarcador predictivo de la enfermedad. Su traslacion a la practica clinica habitual pasa por la estandarizacion metodologica y la adecuada validacion clinica de las distintas formas de deteccion disponibles. La deteccion de CTCs en estadios iniciales de la enfermedad depende aun de la optimizacion de los metodos de deteccion y del desarrollo de la caracterizacion biologica de estas celulas. La informacion biologica aportada por CTCs y ctDNA es distinta; por ello, el estudio de su adecuada conjuncion es objeto de la investigacion mas actual. Conclusiones La ausencia de protocolos y estandares metodologicos es el factor limitante para llegar a conclusiones de impacto clinico. Por ello, el consenso y la unificacion de criterios constituyen el verdadero desafio a corto plazo para la biopsia liquida.

We analyzed the association between salivary melatonin rhythm and prostate cancer (PCa).A total of 40 PCa cases and 41 controls from the CAPLIFE study were analyzed to determine the salivary melatonin rhythm through 6 saliva samples. Amplitude (maximum melatonin peak) was categorized as low or high using the cutoff point median of the controls. Acrophase (time of maximum melatonin peak) was classified as early or late using the same criteria. In addition, the following data were collected: characteristics related to sleep habits, and clinical and sociodemographic information. Melatonin rhythms were represented for cases and controls and analyzed according to urinary symptoms, tumor aggressiveness and tumor extension. Variations in melatonin levels were estimated using generalized estimating equations on the ln-transformed values. To estimate the association between amplitude, acrophase and PCa, adjusted odds ratio (aOR) and 95% CI were calculated using logistic regression models.The mean age was 67.0 years (SD 7.3) for cases and 67.5 (SD 5.5) for controls. Melatonin levels were always lower in PCa cases than in controls. On average, melatonin levels in cases were -64.0% (95% CI -73.4, -51.4) than controls. PCa cases had lower amplitude, 26.0 pg/ml (SD 27.8) vs 46.3 pg/ml (SD 28.2; p0.001). A high amplitude was associated with a decreased risk of PCa, aOR=0.31 (95% CI 0.11, 0.86), while a late acrophase could be increased risk of PCa, aOR=2.36 (95% CI 0.88, 6.27).Patients with PCa always had lower melatonin levels than men without PCa, independent of urinary symptomatology or extension and aggressiveness of the tumor.

Background: Components of liquid biopsy are promising non-invasive biomarkers for monitoring the renal cell carcinoma (RCC) status. Present study tries to evaluate the role of exosomes and mitochondrial DNA (mtDNA) as promise, novel and stable biomarkers that could improve current ones in RCC. Methods: A total of 140 fractions obtained by ultracentrifugations of whole blood samples stored in EDTA anticoagulant from 28 (13 patients and 15 controls) were included in present study. An exosome collection protocol and exhaustive analysis of all phases obtained by ultracentrifugations (named from B to F) was performed. Subsequently, an analysis of dPCR (digital PCR) using the QuantStudio™ 3D Digital PCR platform and the quantification of mtDNA copy number using by QuantStudioTM 12K Flex Real-Time PCR System (qPCR) was developed. Moreover, Next Generation Sequencing (NGS) analyses were included using MiSeq system (Illumina, CA, USA). Results: F fraction, which contains all exosomes´ data and all mitochondrial markers (hypervariable region 1 (HV1) and apocytochrome b of complex III (MT-CYB)) were statistically identified in dPCR and qPCR (p values < 0.05) when a comparison between cases and controls was performed. Moreover, the studied mitochondrial genes shown a relevant significance in RCC aggressiveness analyses (metastasis and stages 4).Conclusions: To sum up, this is the first time a relation between mtDNA genetic markers in exosome and clinical management of RCC is suggested.

There is an urged need of non-invasive biomarkers for the implementation of precision medicine. These biomarkers are required to these days for improving prostate cancer (PCa) screening, treatment or stratification in current clinical strategies. There are several commercial kits (Oncotype DX genomic prostate score®, Prolaris®, among others) that use genomic changes, rearrangement or even non-coding RNA events. However, none of them are currently used in the routine clinical practice. Many recent studies indicate that miRNAs are relevant molecules (small single-stranded non-coding RNAs that regulate gene expression of more than 30% of human genes) to be implement non-invasive biomarkers. However, contrasting to others tumors, such as breast cancer where miR-21 seems to be consistently upregulated; PCa data are controversial. Here we reported an extended revision about the role of miRNAs in PCa including data of AR signaling, cell cycle, EMT process, CSCs regulation and even the role of miRNAs as PCa diagnostic, prognostic and predictive tool. It is known that current biomedical research uses big-data analysis like Next Generation Sequencing (NGS) analysis. We also conducted an extensive online search, including the main platforms and kits for miRNAs massive analysis (like MiSeq, Nextseq 550, or Ion S5™ systems) indicating their pros, cons and including pre-analytical and analytical issues of miRNA studies.

Prostate cancer (PC) is one of the most prevalent tumours in the world, however, the hereditary (Hereditary PC; HPC) form is a rare pathology, that does not exceed 6%. Despite its very low incidence, a family history of PC in a first-degree relative multiplies the risk of suffering from PC by approximately two-fold. Therefore, the search for genetic variables associated with the detection, monitoring and treatment of the condition is paramount. In this study, we conduct deep screening of exomes by next-generation sequencing (NGS) analysis in search of new biomarkers. We performed this analysis in a family with a high incidence of PC. Our data reveal that variants in some genes, such as HIBCH and DPP4, are present in all HPC patients. Moreover, high-risk patients have unique additional variants, such as FANK1, TUBA3FP and ALDH3B2. These results provide a new set of promising biomarkers in HCP.

The androgenic signalling pathway is essential for carcinogenesis and tumour development in prostate cancer (PC). The importance of that pathway makes it the main target of treatments against PC, among which androgen deprivation therapy (ADT) stands out. The heterogeneity of the response against the same treatment shows the importance of the search for molecular biomarkers, which enable the prediction of the response to the therapy in each case. This work focuses on the characterization of the response to treatment in several patients of PC through the analysis of different genetic variants (rs10877012 (CYP27B1); rs3768490 (GSTM5); rs1004446 (IGF2)). The statistical analysis revealed a certain tendency to resistance in A/G genotype carriers in rs1004446 (IGF2). Furthermore, a significant statistical relation between aggressive phenotypes was confirmed in single nucleotide polymorphism (SNP) rs10877012 (CYP27B1, p = 0.013).

Renal Cell Carcinoma (RCC) is the third most common urologic malignancy,remains one of the most lethal urological malignancies, preferably in developed countries. The incidence and mortality rates differ significantly according to sex, race, age and external factors such as smoking, obesity and hypertension increasing RCC risk. The use of novel predictive biomarkers is currently being increased as these improve the diagnosis, progression and prognosis of RCC. Since recent studies have demonstrated a promising association between mitocondrial DNA (mtDNA) copy number alteration in peripheral blood and risk of developing RCC, we conducted a case-control study to determine exosomes mtDNA content in plasma fractions as a potential novel non-invasive biomarker in liquid biopsy in order to monitor the RCC status in patients. In this way, plasma fractions highly purified in exosomes were obtained from blood samples from controls and RCC cases, and relative mtDNA content was measured by quantitative real-time polymerase chain reaction (qPCR). Our results show fragment size distribution profile and the copy numbers of nuclear regions and mitochondrial genes (in hypervariable and conserved regions) in each plasma fraction.

To analyze the association between prostate cancer (PCa) risk and night shift work, chronotype, and sleep duration in the context of a population-based case-control study of incident prostate cancer in Spain, a total of 465 PCa cases and 410 controls were analyzed. Selection criteria were: (i) age 40&ndash, 80 years, and (ii) residence in the coverage area of the reference hospitals for &ge, 6 months before recruitment. Exposure variables were: (i) night shift work (permanent or rotating), (ii) chronotype: morning, neither, or evening (Munich ChronoType Questionnaire) and (iii) sleep duration according to the recommendations of the American National Sleep Foundation. PCa aggressiveness was determined according to the International Society of Urology Pathology classification. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression models. Night shift work was associated with PCa, aOR = 1.47 (95% CI 1.02&ndash, 2.11), especially for rotating night shifts, aOR = 1.73 (95% CI 1.09&ndash, 2.75). The magnitude of the association between ever night work and PCa was higher in evening subjects with aOR = 3.14 (95% CI 0.91&ndash, 10.76) than in morning chronotypes with an aOR = 1.25 (95% CI 0.78&ndash, 2.00). Working night shifts, especially rotating night shifts, could increase PCa risk. This risk may be higher in people with an evening chronotype.

The crisis in the SARSCoV-2 coronavirus causing COVID-19 is putting health systems around the world to the test. In a great effort to standardize the management and treatment guidelines, the different health authorities and scientific associations have tried to issue recommendations on how to act in this new and complex scenario. OBJECTIVE: To synthesize the existing evidence and recommendations about urological emergency surgery during the COVID-19 pandemic situation. Furthermore, we propose a general action protocol for these patients.The document is based ont he scarce evidence on SARS / Cov-2 and the experience of the authors in the management of COVID-19 in their institutions, including specialists from Andalusia, Cantabria, Madrid and the Basque Country. A web and PubMed search was performed using the keywords "SARS-CoV-2", "COVID19", "COVID Urology", "COVID19 surgery" and "emergency care". A narrative review of the literature was carried out until April 30, 2020, including only articles and documents written in Spanish and English. After the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria. Finally, a definitive version was made, agreed by all the authors on May 12, 2020.General principles of action are set out, as well as specific recommendations for the most frequent urgent urological procedures.Given the exceptional nature of the situation, there is a lack of evidence regarding the optimal management of the patient with urgent urological pathology. The information is changing, as the epidemiological knowledge of the disease advances. The establishment of multidisciplinary surgical committees that develop and implement action protocols appropriate to the different resources and particular situations of each center is recommended. Likewise, these committees must individually assess each possible urological surgical emergency situation and ensure compliance with protective measures for the patient and other healthcare personnel.INTRODUCCIÓN: La crisis del coronavirus SARS-CoV-2 causante del COVID-19 está poniendoa prueba los sistemas sanitarios de todo el mundo. En un gran esfuerzo por estandarizar las pautas de manejo y tratamiento, las distintas autoridades sanitarias y asociaciones científicas han tratado de dictar unas recomendaciones sobre como actuar en este nuevo y complejo escenario.OBJETIVO: Sintetizar la evidencia y recomendaciones existentes acerca de la cirugía de urgencia urológica durante la situación de pandemia COVID-19. Además, proponemos un protocolo de actuación general para estos pacientes. MATERIAL Y MÉTODOS: El documento se basa en la escasa evidencia sobre SARS/Cov-2 y la experiencia de los autores en el manejo de COVID-19 en sus instituciones incluyendo especialistas de Andalucía, Cantabria, Madrid y País Vasco. Se realizó una búsqueda web y en PubMed utilizando las palabras clave “SARSCoV-2”, “COVID19”, “COVID Urology”, “COVID19 surgery” y “emergency care”. Se realizó una revisión narrativa de la literatura hasta el día 30 de Abril de2020 incluyendo solo artículos y documentos escritos en lengua española e inglesa. Tras técnica de grupo nominal modificada debido a las restricciones extraordinarias se realizó un primer borrador para unificar criterios. Finalmente, se realizó una versión definitiva, consensuada por todos los autores el 12 Mayo 2020. RESULTADOS: Se exponen unos principios generales de actuación, así como unas recomendaciones específicas para los procedimientos urológicos urgentes más frecuentes.CONCLUSIONES: Dado el carácter excepcional de la situación, existe un déficit de evidencia respecto al óptimo manejo del paciente con patología urológica urgente. La información es cambiante, según avanza el conocimiento epidemiológico de la enfermedad. Es recomendable el establecimiento de comités multidisciplinares quirúrgicos que desarrollen e implementen protocolos de actuación adecuados a los distintos recursos y situaciones particulares de cada centro. Del mismo modo, estos comités deben evaluar de forma individualizada cada posible situación de urgencia quirúrgica urológica y velar por el cumplimiento de las medidas de protección para el paciente y resto del personal sanitario.

The authors wish to thank all subjects who participated in the study as well as all CAPLIFE collaborators. The authors also thank Ingrid de Ruiter for English editing support., Dietary diversity (DD) is a key component of a high-quality diet, providing the adequate nutrient requirements. However, the role of DD on prostate cancer (PCa) is still uncertain. The aim of this study was to evaluate the relationship between DD, adequate nutrient intake and PCa, according to the aggressiveness of the tumor. The CAPLIFE (CAP: prostate cancer; LIFE: lifestyles) study is a population-based case-control study including a total of 402 incident PCa cases and 302 controls. The DD score (DDS), adjusted by total energy intake, was collected through a validated food frequency questionnaire. Nutrient adequacy was defined according to European Dietary Recommendation Intake for men. The aggressiveness of PCa was determined according to the International Society of Urology Pathology classification. The association between DDS, nutrient intake and PCa was assessed by logistic regression models with adjustment for potential confounding factors. DDS was similar for PCa cases and controls, independent of PCa aggressiveness. According to each food group DDS, the protein group showed the highest mean score in all the subgroups analyzed. However, no differences were observed for each of the DDS components. The DDS, the variety of the group’s food intake, and the adequate nutrient intake, were not associated with PCa., Regional Ministry of Health of Andalusia (Consejeria de Salud de la Junta de Andalucia) PI-0514-2016

Ureaplasma parvum is the most prevalent genital mycoplasma in women of childbearing age. There is debate around the relevance of its presence in male or female genitals for disease development and as a cofactor. The objective of this study was to determine the prevalence of colonization/infection by U. parvum and its possible relationship with reproductive tract infections. We retrospectively analyzed the presence of U. parvum in patients referred by specialist clinicians for suspicion of genitourinary tract infection. U. parvum was detected in 23.8% of samples, significantly more frequently in females (39.9%) than in males (6%). Among the males, U. parvum was found alone in 68.4% of episodes, with Ct

Cancer is considered a complex disease that in many cases results from the interaction between chemical exposures, either from environmental or dietary sources, and genetic polymorphisms of xenobiotic-metabolizing enzymes (XME) or antioxidant enzymatic defenses. This study explored associations and interactions between genetic and environmental risk factors on the risk of prostate cancer (PCa) in 323 subjects that underwent prostate biopsy due to prostate specific antigen (PSA) levels above 4 ng/ml (161 PCa and 162 non-PCa). Eleven genes involved directly or indirectly in xenobiotic detoxification, oxidative stress and estrogen signaling were studied (GSTM1, GPX1 (rs1050450 and rs17650792), NAT2 (rs1801280), TXNRD1 (rs7310505), PRDX3 (rs3740562), CYP17A1 (rs743572), PON1 (rs662), SOD1 (rs10432782), SOD2 (rs4880), CAT (rs1001179), and ESR1 (rs746432)). A structured questionnaire was administered to all individuals to assess environmental and dietary chemical exposures. Medical data was collected by urologists. GPX1 rs17650792 polymorphism was the only one showing a significant inverse association with PCa risk. PRDX3 and GPX1 (rs17650792) genetic polymorphisms were significantly associated with Gleason score and PSA levels, respectively. The intake of nuts and soya products was associated with a reduced risk of PCa, as well as the performance of physical activity. Moreover, a number of gene-environmental interactions were found to increase the risk of PCa, particularly exposure to pesticides and rs1801280 (NAT2) and tobacco smoking and rs1050450 (GPX1). These findings suggest that the association of genetic and environmental risk factors with PCa risk should be assessed jointly for a better understanding of this complex disease.

Resumen Objetivos La prostatitis cronica bacteriana (PCB) es la enfermedad urologica mas frecuente en menores de 50 anos, cuya clinica de larga evolucion puede estar relacionada con una inadecuada pauta terapeutica. El objetivo fue analizar la sensibilidad de los microorganismos aislados de pacientes con PCB y medir las concentraciones de antibiotico semanalmente en suero, semen y orina. Material y metodos Para el estudio de la sensibilidad antibiotica, entre enero de 2013 y diciembre de 2014 se incluyeron 60 aislados clinicos procedentes de muestras de semen de pacientes confirmados microbiologicamente con PCB, y se llevo a cabo por microdilucion en caldo. Para el estudio de las concentraciones de antibioticos, entre los meses de enero y mayo de 2014 se recogieron muestras de orina, sangre y semen, semanalmente, durante 4 semanas de tratamiento de 8 pacientes con cultivo positivo para PCB, y se midieron las concentraciones mediante cromatografia de liquidos de ultra alta eficacia acoplada a espectrometria de masas en tandem (UHPLC-MS/MS). Resultados Fosfomicina y nitrofurantoina fueron los antibioticos con mayor actividad (95,2% en ambos casos). Las concentraciones medias de antibiotico en semen durante las 4 semanas estudiadas fueron las siguientes: 1,68 mg/l; 8,30 mg/l; 2,61 mg/l; 0,33 mg/l y 2,90 mg/l, respectivamente para los pacientes 1 a 5, que recibieron levofloxacino; 1,625 mg/l para el paciente 6, que recibio ciprofloxacino 2,67 mg/l para el paciente 7, que fue tratado con ampicilina, y 1,05 mg/l para el paciente 8, que recibio doxiciclina. Se obtuvieron mayores concentraciones en las muestras de orina que en suero y semen, siendo comparables estas 2 ultimas. Conclusiones Fosfomicina se postula como principal alternativa al tratamiento empirico de la PCB por su elevada actividad in vitro. La concentracion de antibiotico en semen fue superior a la concentracion minima inhibitoria frente al agente etiologico, aunque no siempre se correlaciono la negativizacion microbiologica con la evolucion clinica favorable.

Objectives Chronic bacterial prostatitis (CBP) is the most common urological disease in patients younger than 50 years, whose long-standing symptoms could be related to an inappropriate therapeutic regimen. The objective was to analyze the sensitivity of microorganisms isolated from patients with CBP and measure the weekly antibiotic concentrations in serum, semen and urine. Material and methods For the antibiotic sensitivity study, 60 clinical isolates were included between January 2013 and December 2014 from semen samples from patients with microbiologically confirmed CBP. Broth microdilution was performed on the samples. For the antibiotic concentration study from January to May 2014, urine, blood and semen samples were collected weekly, over 4 weeks of treatment from 8 patients with positive cultures for CBP. The concentrations were measured using ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). Results The antibiotics fosfomycin and nitrofurantoin had the highest activity (95.2% in both cases). The mean antibiotic concentrations in semen during the 4 weeks studied were as follows: 1.68 mg/L, 8.30 mg/L, 2.61 mg/L, 0.33 mg/L and 2.90 mg/L, respectively, for patients 1 to 5, who were treated with levofloxacin; 1.625 mg/L for patient 6, who was treated with ciprofloxacin; 2.67 mg/L for patient 7, who was treated with ampicillin; and 1.05 mg/L for patient 8, who was treated with doxycycline. Higher concentrations were obtained in the urine samples than in serum and semen, the latter 2 of which were comparable. Conclusions Fosfomycin is proposed as the primary alternative to the empiric treatment of CBP due to its high in vitro activity. The antibiotic concentration in semen was higher than the minimal inhibitory concentration against the aetiological agent, although microbiological negativisation was not always correlated with a favorable clinical outcome.

Resumen Objetivos Analizar la capacidad de la PET-TC con 18 F-fluorocolina ( 18 F-FCH) para detectar enfermedad en el momento de la recidiva bioquimica tras tratamiento con intencion curativa. Determinar que variables clinicas serian capaces de optimizar la rentabilidad diagnostica de la prueba. Material y metodos Estudio retrospectivo de las PET-TC con 18 F-FCH realizadas a 61 pacientes con cancer de prostata sometidos a tratamiento con intencion curativa y que cumplian criterios de recidiva bioquimica. Los resultados del estudio PET-TC se categorizaron en positivos o negativos y fueron validados segun criterios preestablecidos. Se estudio la relacion entre el resultado de la PET-TC y el PSA inicial, PSA nadir, PSA trigger, velocidad de ascenso del PSA (PSAva) y PSA doubling time (PSAdt). Se analizo la relacion entre las localizaciones metastasicas en la PET-TC y el resto de variables. Resultados La tasa de deteccion de enfermedad fue del 34,4%. El PSA inicial, el PSA nadir, el PSA trigger y el PSAva demostraron diferencias estadisticamente significativas segun el resultado de la PET-TC. El mejor punto de corte discriminatorio entre una PET-TC positiva o negativa para el PSA trigger y la PSAva fue 3,5 ng/ml y 0,25 ng/ml/mes respectivamente. El PSAdt fue significativamente menor en los pacientes con enfermedad a distancia frente a los pacientes con enfermedad localizada (5.1 vs 16.8 meses, p = 0.01). La probabilidad de que la PET-TC detectara enfermedad a distancia vs localizada fue 3,2 veces mayor si el PSAdt era menor de 6 meses (80% vs 20%, OR: 3,2, p = 0,02). En el analisis multivariante solo el PSA inicial y el hecho de no haberse sometido a prostatectomia radical demostraron ser factores predictores independientes del resultado positivo de la PET-TC. Conclusiones La PET-TC con 18 F-FCH es capaz de detectar enfermedad en un alto porcentaje de pacientes con recidiva bioquimica, y proporciona informacion sobre la localizacion anatomica de la misma. La cinetica del PSA y el tratamiento previo del paciente son variables clave para aumentar el rendimiento diagnostico de la exploracion.

Objectives To analyze the ability of the PET-CT with 18F-fluorocholine (18F-FCH) to detect disease on biochemical recurrence after treatment with curative intent. To determine the clinical variables that would be able to optimize the test's diagnostic yield. Material and methods A retrospective study of PET-CTs with 18F-fluorocholine performed on 61 patients with prostate cancer who had undergone treatment with curative intent and met the criteria for biochemical recurrence. The results of the PET-CT were categorized into positive or negative and were validated using pre-established criteria. The relationship between the result of the PET-CT and the initial PSA nadir, PSA trigger, rising PSA velocity (PSAva) and PSA doubling time (PSAdt). The relationship between the metastatic sites on the PET-CT and the remaining variables was analyzed. Results There was a 34.4% detection rate of the disease. The initial PSA, PSA nadir, PSA trigger and PSAva showed statistically significant differences according to the result of the PET-CT. The best discriminatory cut-off point between a positive or negative PET-CT for PSA trigger and PSAva was 3.5 ng/ml and 0.25 ng/ml/month respectively. The PSAdt was significantly lower in patients with remote disease compared to patients with localized disease (5.1 vs 16.8 months, p = 0.01). The probability that the PET-CT would detect remote disease vs localized disease was 3.2 times higher if the PSAdt was under 6 months (80% vs 20%, OR: 3.2, p = 0.02). In the multivariate analysis, only the initial PSA and not having undergone radical prostatectomy were demonstrated as independent predictive factors of a positive PET-CT result. Conclusions The PET-CT with 18F-FCH can detect disease in a high percentage of patients with biochemical recurrence and provides information on its anatomical location. PSA kinetics and the patient's previous treatment are key variables in increasing the test's diagnostic.

Following first-line treatment progression in metastatic renal carcinoma, different options for second-line treatment are available, with axitinib being one of them. The objective of this article is to evaluate the results of Axitinib in a real practice setting. METHODS: From December 2011 to October 2016, we treated 19 patients with CCRM with Axitinib, 3 patients in third line and 16 patients in second line after progression on Sunitinib or Pazopanib. We performed a retrospective study of the last 16 patients, analyzing the effectiveness and safety of the drug. RESULTS: The median progression-free survival (PFS) was 9 months and the median overall survival with 8 dead patients was 59 months. Overall, toxicity by Axitinib was very common, diarrhea 87.5%, asthenia 75%, dysphonia 56.25%, hypertension 37.5% and anorexia 37.5%, although most are grade 1-2 toxicities controlled with hygiene-diet measures and treatment recommendations. CONCLUSIONS: Axitinib is a drug that has been shown to increase PFS after 1st line progression, with a tolerable toxic profile. With the approval of nivolumab and cabozantinib, the place of Axitinib in sequential therapy is yet to be defined.Tras progresión de primera línea de tratamiento en el carcinoma renal metastásico hay disponibles distintas opciones de tratamiento de segunda línea, siendo Axitinib una de ellas. MÉTODOS: Desde diciembre de 2011 hasta octubre de 2016, hemos tratado a 19 pacientes con CCRm con Axitinib, 3 pacientes en tercera línea y 16 en segunda línea tras progresión de Sunitinib o Pazopanib. Realizamos un estudio retrospectivo de los últimos 16 pacientes, analizando efectividad y seguridad del fármaco. RESULTADOS: La mediana de la supervivencia libre de progresión (SLP) fue de 9 meses y la mediana de supervivencia global con 8 pacientes fallecidos fue de 59 meses. La toxicidad global por Axitinib fue muy frecuente, diarrea 87,5%, astenia 75%, disfonía 56,25%, HTA 37,5% y anorexia 37,5%, aunque en su mayoría fueron toxicidades grado 1-2 controlados con medidas higiénico dietéticas y recomendaciones de tratamiento. CONCLUSIONES: Axitinib es un fármaco que ha demostrado aumentar la SLP tras progresión de 1ª línea, con un perfil toxico tolerable. Con la aprobación de nivolumab y cabozantinib, el lugar de Axitinib en la terapia secuencial está por definir.

There is no broad consensus about what diagnostic tests use for CRPC follow up as well as their frequency. Our objective is to review and analyze the most important CRPC follow up patterns described in the literature to date.We performed a critical analysis of the recommendations for follow up most universally employed (PCWG3, RADAR, St Gallen consensus, NCCN guidelines, EAU guidelines) RESULTS: CT scan and bone scan are the routine recommended diagnostic tests, in front of other techniques such as PET/CT or MRI, that may improve the diagnostic efficacy but they have the problem of availability and lack of internal validity for follow up.Follow up is different for non metastatic and metastatic CRPC. For nm CRPC, it is recommended to perform monitoring that includes PSA and imaging tests, without consensus about periodicity. For mCRPC, it is recommendable to do follow up with periodic PSA and imaging tests, since it is possible to have radiological progression without PSA progression.

Urothelial bladder tumors in children are an uncommon pathology, and they are not usually associated with exposure to carcinogenic fa ctors.

Introduction Prostate cancer is the most frequent solid malignant tumor in Western countries. Positron emission tomography/X-ray computed tomography imaging with radiolabeled choline analogs is a useful tool for restaging prostate cancer in patients with rising prostate-specific antigen after radical treatment (in whom conventional imaging techniques have important limitations) as well as in the initial assessment of a selected group of prostate cancer patients. For this reason a literature review is necessary in order to evaluate the usefulness of this imaging test for the diagnosis and treatment of prostate cancer. Evidence acquisition A MEDLINE (PubMed way) literature search was performed using the search parameters: «Prostate cancer» and «Choline-PET/CT». Other search terms were «Biochemical failure» and/or «Staging» and/or «PSA kinetics». English and Spanish papers were selected; original articles, reviews, systematic reviews and clinical guidelines were included. Conclusions According to available data, radiolabeled choline analogs plays an important role in the management of prostate cancer, especially in biochemical relapse because technique accuracy is properly correlated with prostate-specific antigen values and kinetics. Although is an emerging diagnostic technique useful in treatment planning of prostate cancer, final recommendations have not been submitted.

Resumen Introduccion El cancer de prostata es el tumor maligno solido mas frecuente en los paises occidentales. La tomografia por emision de positrones/tomografia computarizada con analogos radiomarcados de colina es una herramienta util en la re-estadificacion de pacientes con aumento del antigeno prostatico especifico despues de tratamiento radical —donde las tecnicas de imagen convencional tienen limitaciones importantes— asi como en un seleccionado grupo de pacientes en la valoracion inicial de esta neoplasia. Esta situacion nos lleva a plantear una revision de la literatura donde se evalue la utilidad de esta exploracion en la toma de decisiones diagnostico-terapeuticas en el cancer de prostata. Evidencia de adquisicion Realizamos una busqueda bibliografica a traves de la base de datos Medline (via Pubmed) utilizando los terminos Prostate cancer y Choline-PET/CT a los que anadimos los terminos Biochemical failure y/o Staging y/o PSA kinetics. Asi mismo, seleccionamos los trabajos en lengua inglesa y espanola e incluimos articulos originales, revisiones, revisiones sistematicas, metaanalisis y guias de practica clinica. Conclusiones De acuerdo con los datos disponibles los analogos radiomarcados de colina desempenan un papel importante en el manejo del cancer de prostata, especialmente en la recurrencia bioquimica, donde la exactitud de la tecnica se correlaciona bien con el valor del antigeno prostatico especifico y su cinetica. Aunque esta tecnica se perfila como una modalidad diagnostica de aplicacion en la planificacion del tratamiento del cancer de prostata, aun no se han realizado recomendaciones finales sobre su uso.

In 2006, sunitinib approval by the FDA was a real revolution for the treatment of metastatic renal cell carcinoma (mRCC). However, considerable rates of dose reductions and therapeutic suppressions with the standard regimen (4:2) have forced the search for new schedule proposals in order to optimize the balance between side effects and oncologic efficacy. Among these new proposals, the 2:1 scheme is the one that has generated more expectations.The objective of this paper is to make a review and critical discussion of current evidence about the new schedules of treatment with sunitinib.Unstructured review of the literature on the various therapeutic regimens with sunitinib, making a comparison in terms of progression-free survival (PFS), overall survival (OS) and toxicity.We summarize the data from all relevant studies published to date comparing the standard 4:2 schedule versus the new 2:1. Most patients treated with 2:1 scheme are grouped in three retrospective observational studies and mostly correspond to patients who were initially treated with a 4:2 scheme and then moved to 2:1. A phase II randomized clinical trial comparing 4:2 and 2:1 schemes from the beginning has also been conducted. None of these studies found significant differences between the two regimens in terms of PFS or OS. Regarding the toxicity profile, the 2:1 scheme has proved to be more advantageous than the 4:2.Despite the still limited amount of data, current evidence supports the use of a 2:1 schedule, as it provides patients substantial advantages because of its better tolerability profile, without a loss in oncological efficacy. Currently, the 2:1 scheme is an appropriate alternative therapeutic strategy, especially in patients with poor tolerance to the standard 4:2 regimen.

Summary The literature on the treatment of painful varicocoele is limited, likely because of the short period since it was recognized as a clinical entity and the limitations posed by the subjectivity of pain. Our aim was to systematically analyse the results of percutaneous embolization as the chosen treatment for this condition. We conducted a retrospective study of patients undergoing percutaneous embolization as primary treatment for painful varicocoele from January 2007 to November 2013. Radiologic and ultrasonographic successes were evaluated according to the existence or absence of venous reflux on venography after embolization and on Echo Doppler control at 3–6 months. Clinical success was assessed by Visual Analog Scale pain questionnaires before surgery and at 3–6 months; in addition, at the time of the study, telephone interviews were conducted to update the clinical situation and development. A total of 154 patients received operations. The median pain before surgery, at 3–6 months and at the time of interview was 7, 1 and 0 points respectively (p

Resumen Contexto y objetivo Analizar la influencia de las distintas alteraciones de las moleculas del antigeno leucocitario humano de clase i (HLA I ) en la promocion del cancer renal, vesical y prostatico. Tambien estudiaremos la correlacion entre la expresion de estas moleculas y la progresion de la enfermedad neoplasica, ademas de la respuesta al tratamiento. Adquisicion de evidencias Se ha podido constatar, experimentalmente, que el sistema inmunitario puede reconocer y destruir celulas tumorales. Mediante el analisis de la expresion de las moleculas HLA I , en la superficie de celulas tumorales, hemos podido estudiar este mecanismo de escape tumoral frente al sistema inmunitario. Sintesis de evidencias Una alteracion o dano irreversible en las moleculas HLA de clase i es utilizado por las celulas cancerigenas como mecanismo de escape frente al sistema inmunitario. La funcion de estas moleculas es reconocer peptidos endogenos y presentarlos a los linfocitos T del sistema inmunitario. Existe una clara relacion entre alteraciones reversibles de HLA I y el exito de la terapia, mientras que las lesiones irreversibles implican una falta de respuesta al tratamiento. La activacion del sistema inmunitario puede revertir la expresion de moleculas HLA I en aquellos tumores con lesiones reversibles, mientras que los tumores con lesiones irreversibles no responden a dicha activacion. Determinar el tipo de alteracion HLA I en los tumores es de vital importancia a la hora de elegir el tipo de tratamiento a seguir buscando el exito terapeutico. Aquellos tumores con lesiones reversibles pueden ser tratados con inmunoterapias clasicas, sin embargo, los tumores con alteraciones irreversibles deberian seguir protocolos alternativos, como el uso de vectores virales que trasporten los genes HLA danados para conseguir la reexpresion de la proteina. Conclusion A partir de los estudios realizados, en tumores urologicos, podemos concluir que las moleculas HLA de clase i tienen un papel fundamental en el escape de estos tumores frente al sistema inmunitario.

Context and objective To analyze the influence of different alterations in human leukocyte antigen class I molecules (HLA I ) in renal cell carcinoma, as well as in bladder and prostate cancer. We also study the correlation between HLA I expression and the progression of the disease and the response after immunotherapy protocols. Evidences acquisition It has been shown, experimentally, that the immune system can recognize and kill neoplastic cells. By analyzing the expression of HLA I molecules on the surface of cancer cells, we were able to study the tumor escape mechanisms against the immune system. Evidences synthesis Alteration or irreversible damage in HLA I molecules is used by the neoplastic cells to escape the immune system. The function of these molecules is to recognize endogenous peptides and present them to T cells of the immune system. There is a clear relationship between HLA I reversible alterations and success of therapy. Irreversible lesions also imply a lack of response to treatment. The immune system activation can reverse HLA I molecules expression in tumors with reversible lesions, whereas tumors with irreversible ones do not respond to such activation. Determining the type of altered HLA I molecules in tumors is of paramount importance when choosing the type of treatment to keep looking for therapeutic success. Those tumors with reversible lesions can be treated with traditional immunotherapy; however, tumor with irreversible alterations should follow alternative protocols, such as the use of viral vectors carrying the HLA genes to achieve damaged re-expression of the protein. Conclusion From studies in urologic tumors, we can conclude that the HLA I molecules play a key role in these tumors escape to the immune system.

Introduction A short right renal vein remains a challenge for renal transplant surgery, especially in the living donor. Our objective was to report on a new technique to solve this problem. Technical Considerations We describe our experience with the use of cryopreserved iliac artery grafts for right renal vein extension. Two renal grafts from living donors with a short right renal vein were subjected to an extension with a cryopreserved external iliac artery allograft. There were no perioperative or postoperative complications. There were also no changes in ischemia times. The renal implantation was performed easily and conveniently using our standard technique. For the first and second procedures, at 3 and 3.5 years after surgery, respectively, both vascular grafts maintain good patency, and the renal function of both recipients is optimal. Conclusion Tissue-banked cryopreserved cadaveric vessels can be a useful tool in renal transplant surgery. The use of a cryopreserved iliac artery for renal vein extension is a simple and effective new technique that can be added to the pool of surgical solutions for a short renal vein in living-donor kidney transplantation. To our knowledge, this is the first time that the use of such grafts for this purpose has been described.

To provide an updated epidemiological description of urinary lithiasis in a health area in the Western hemisphere over the past four decades.2704 urinary lithiases analysed in our institution between 1980 and 2015 were retrospectively reviewed. They were analyzed using polarized light microscopy, and in the case this method had questionable results we used X-ray diffraction. The variables collected were the lithiasis chemical composition (oxalates, phosphates, uric acid, infectious, cystine, mixed, other). Regarding the date of the analysis, the series of cases was grouped into four periods (1980-1989, 1990- 1999, 2000-2009, and 2010-2015), and also by sex and age of the patient.The mean age at diagnosis was 48.32 years (49.37 in men vs 46.53 in women, p=0.005). A male predominance was found (58.7%). Throughout the four decades, the involvement of women has progressively diminished compared to men. Of all the lithiases, the most frequent were those composed of oxalates (43.3%), followed by uric acid (16.9%) and infectious types (10.7%). The uric acid and oxalate lithiases were more common in men than in women (67.4% vs. 32.6% and 59.1% vs. 40.9%, respectively, p0.001), while the lithiasis of infectious origin was more frequent in women than in men (56.3% vs. 43.7%, p0.001). Throughout the time period, a trend of increasing oxalic lithiases and decreasing uric acid and phosphate lithiases was observed, as well as an increase of infectious lithiases over the past five years.In our setting, urinary lithiases appear more frequently in males at the end of the fourth decade of life. The most common lithiases are composed of oxalates, and their frequency has increased over time, while uric acid and phosphates lithiases have decreased.

To compare the characteristics, clinical course, and survival of pairs of renal grafts from the same donor, with special interest in cold ischemia times (CIT) as a risk factor for graft survival.We retrospectively reviewed paired grafts originating from the same cadaver donor from our prospectively recorded database of kidney transplants, from 1987 to 2015. We selected and divided them into two groups depending on whether they corresponded to the first or second graft.We studied a total of 860 paired kidneys. Mean CIT for the first and second groups were 15.12 and 19.16 hours, respectively. In the second group we observed higher incidences of acute tubular necrosis and initial delayed graft function (59.9% vs. 69.4% and 54.9% vs. 63.5%, respectively; p0.001). No significant differences in either creatinine clearance rate or the rate of dialysis were observed between the two groups. No difference was found between the first and second groups in terms of graft survival (18.4 vs. 18.1 years, respectively; log-rank, p=0.667), and no differences were found by dividing the grafts into different categories according to their CIT (14, 14-17, 17-20,20 hours). For the set of grafts studied, CIT did not act as a risk factor for graft survival (hazard ratio [HR]=1.014; p=0.312).The proportion of ATN and DGF were greater in second transplants. However, there were no differences in long-term graft survival. Furthermore, we found no evidence that a CIT for less than 24 hours acted as a risk factor to graft survival.

Background and objective Chronic bacterial prostatitis (CBP) is characterized by long-lasting symptoms, frequently associated with psychosomatic disorders. The objective of the study was to study PCB in our environment clinically and microbiologically. Methods Between January 2013 and December 2014 761 patients with suspected CBP were studied. Of these patients 332 (43.6%) underwent a complete microbiological study and the major clinical signs and symptoms were collected. Results Eighteen point four percent of patients were diagnosed microbiologically with CBP, Enterococcus faecalis being the main aetiologic agent (37.7%), followed by Escherichia coli (22.2%). Ninety-six point seven percent of the CBP had positive semen cultures, while only 22.9% had positive urine post-semen cultures. Data of sensitivity, specificity, positive predictive value and negative predictive value of semen were 96.7%, 95.9%, 84.3% and 99.3%, respectively and urine post-semen 22.9%, 99.3%, 87.5% and 85.1%, respectively. Testicular perineum pain (44.3%), ejaculatory discomfort (27.9%) and haemospermia (26.2%) were highlighted as the patients’ main clinical manifestations. Conclusions Fractionated culture for the microbiological diagnosis of CBP could be simplified by the culture of urine pre-semen and semen, without the need for the culture of urine post-semen. The main aetiologic agent of CBP in our media was E. faecalis , followed by E. coli .

Resumen Objetivo Valorar la situacion actual en el tratamiento del carcinoma renal con extension a vena cava inferior (VCI): Clasificacion, diagnostico, abordaje quirurgico, terapia adyuvante, factores de pronostico y supervivencia. Materiales y metodos Se revisan 19 casos de carcinomas renales con extension a VCI intervenidos entre enero de 1988 y agosto de 2008. Se valoran la edad, el sexo, lateralidad y funcion renal de los pacientes. Con respecto al tumor se valoran: estadio segun TNM y la clasificacion de Neves-Zincke. Se describe el abordaje quirurgico segun el nivel del trombo. Resultados Con una tasa de mortalidad perioperatoria del 10.5% y una media de seguimiento de 22,65 meses (rango 2- 79), sobreviven 5 pacientes; 11 han fallecido por la enfermedad; uno por otra causa y 2 se han perdido. Los pacientes metastasicos han recibido tratamiento adyuvante con Inmunoterapia o inhibidores de las kinasas. La supervivencia media es de 15,1 meses. Existen diferencias significativas a tres y cinco anos en la supervivencia de los pacientes estadiados como n0m0 vs resto (n+m0, n0m+, n+m+). no hay diferencias en funcion del nivel del trombo. Conclusiones El carcinoma renal con trombo en VCI es un tumor con alta mortalidad. El abordaje quirurgico del mismo es la opcion mas valida y precisa una correcta valoracion prequirurgica y el apoyo de un equipo multidisciplinar preparado y con experiencia. La supervivencia depende de la extension de la enfermedad.

Journal Article; Gout is a metabolic disease characterized by hyperuricemia and the deposition of monosodium urate crystals in different anatomical locations. We report the case of a 61-year-old man who received consultation for gouty tophi in the penis, which is an unusual location for this type of pathology, that was resolved with the surgical removal of the tophi. We provide a review on gout and its treatment as well as other locations where atypical gouty tophi have been described. Yes

Journal Article; Primary renal lymphoma (PRL) is a rare disease of which the etiology and pathogenesis remain controversial, and there is currently no standard treatment for it. We present the results of a long-term followup of two patients who were diagnosed with PRL and treated with cyclophosphamide, adriamycin, vincristine, prednisolone and rituximab (CHOP + R) regimen. Both patients reached a complete response, and there is no evidence of recurrence after 4.5- and 5-year followup periods. Based on our experience and other recently published studies, we recommend the combination of CHOP + rituximab as the elective treatment for this disease. To our knowledge, this is the longest followup period with a complete response that has been reported with this modality of treatment. Yes

There are reports of renal cell carcinoma (RCC) metastases in almost every part of the body. Skin metastases due to RCC are a rare condition. Only 3.4% of all RCCs give rise to metastases in the skin. We present a 73-year-old man who developed a solitary cutaneous metastasis 21 years after radical nephrectomy. A computed tomography scan also revealed two nodules in the lungs and a mid-pole mass in the right kidney. Complete local excision of the lesion was performed. The patient was started on oral treatment with sunitinib. At the 24-month review a control computed tomography revealed that the lung lesions had completely disappeared but the size of the renal mass had not changed. To our knowledge this is the only reported case of cutaneous metastasis appearing more than 20 years after radical treatment.

Circulating Tumor Cells (CTCs) are a valuable prognostic factor in several solid tumors. By understanding the biological characteristics of CTCs we could better understand the biology of metastasis. CTCs usually adopt a dormant state that is believed to be a strategy to survive in extreme conditions. To enter a dormant state, CTCs undergo numerous phenotypic, genetic and functional mutations that significantly affect the efficacy of the therapies used to kill dormant CTCs. Hence, understanding the biological events involved in the dormancy process of CTCs would allow the identification of new therapeutic targets. Some experimental studies or preclinical models have explored these biological events, as well as the molecular factors that contribute to the maintenance of and release from dormancy. However, few studies have assessed the effects of anticancer therapies on dormant cells. This study reviews current the data currently available on cell dormancy mechanisms in prostate cancer, with a special focus on the functional, genetic and phenotypic plasticity of CTCs and their potential implications in the clinical and therapeutic management of prostate cancer.

To analize the current role of target therapies in the treatment of small renal masses.We performed a bibliographic review on the effect of target therapies on primary renal tumor, including our initial experience with two cases of small renal tumor in single kidneys treated with sunitinib.There is very limited experience with target therapies, being possible to use them, as the reviewed literature shows, to increase safety in nephron sparing surgery or tissue ablation technique, or as the treatment for small renal tumors in patients with single kidney in whom nephron sparing surgery is not feasible. Of our two cases with small renal tumors in patients with single kidney, the first case has had complete response to sunitinib after 21 months of follow up, and the second has had tumor stabilization after 33 months of follow up, shifting from sunitinib to pazopanib due to intolerance.The indication of target therapies in the treatment of metastatic renal cancer could be expanded. These therapies could be useful in localized small renal cancer and, although experience with this indication is limited, results are promising.