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OBJECTIVES: To review current data for the role of prostate specific membrane antigen (PSMA) radioligand therapy (RLT) for patients with advanced prostate cancer. This review provides an update for multidisciplinary teams on the current and potential future applications of theranostics in prostate cancer. METHODS: Narrative review focussing on PSMA as a target for RLT, and data using RESULTS: RLT with PSMA is an exciting therapeutic alternative to the existing management options already in use for patients with metastatic castrate-resistant prostate cancer (mCRPC). To date, most evidence exists regarding small-molecule PSMA inhibitors bound to beta-emitting radioisotopes such as 177Lu (Lu-PSMA). Prospective phase II data supports the safety and efficacy of Lu-PSMA in men with heavily pre-treated progressive mCRPC, and several late-phase randomised trials of Lu-PSMA are underway, with many more in the pipeline. Early results are encouraging, indicating that the theranostic approach may play a vital role in management of advanced prostate cancer and perhaps even in much earlier disease states. CONCLUSIONS: PSMA RLT is a promising new treatment option for men with mCPRC, and may also have utility in less advanced prostate cancer.

Background: Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation. Objective: To develop a prediction model for urinary tract cancer in patients referred with haematuria. Design, setting, and participants: A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged ≥16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded. Outcome measurements and statistical analysis: The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism. Results and limitations: The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy. Conclusions: This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation. Patient summary: We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation.

To review current data for the role of prostate specific membrane antigen (PSMA) radioligand therapy (RLT) for patients with advanced prostate cancer. This review provides an update for multidisciplinary teams on the current and potential future applications of theranostics in prostate cancer.Narrative review focussing on PSMA as a target for RLT, and data using RESULTS: RLT with PSMA is an exciting therapeutic alternative to the existing management options already in use for patients with metastatic castrate-resistant prostate cancer (mCRPC). To date, most evidence exists regarding small-molecule PSMA inhibitors bound to beta-emitting radioisotopes such as 177Lu (Lu-PSMA). Prospective phase II data supports the safety and efficacy of Lu-PSMA in men with heavily pre-treated progressive mCRPC, and several late-phase randomised trials of Lu-PSMA are underway, with many more in the pipeline. Early results are encouraging, indicating that the theranostic approach may play a vital role in management of advanced prostate cancer and perhaps even in much earlier disease states.PSMA RLT is a promising new treatment option for men with mCPRC, and may also have utility in less advanced prostate cancer.

The COVID-19 pandemic has seriously disrupted the day-to-day running of hospitals, affecting the activity of all medical and surgical departments. It has also affected urology residents, depriving them of training at their usual workplaces and forcing them to support COVID units. This has implied not only the loss of daily activities, but also the uncertainty of job opportunities for the final year residents. In addition, the cancellation of numerous events such as congresses, exams,or courses has affected the annual planning of the specialty. A review of the current literature on the impact of the COVID-19 pandemic, as well as the de-escalation process, on resident training has been carried out using web search and PubMed. The situation of the residents has been analyzed, both through the information generated by recent literature and by the personal experience of the authors, from different areas: evaluation systems, educational and surgical aspects, as well as healthcare work. As a result of this review, the negative impact of the crisison urology resident training can be observed, especially in the surgical field, but new learning opportunities or new forms of communication with the patient can also be observed. These educational and healthcare resources invite the urology resident in particular, and the medical society in general, to reinvent themselves. The aim of this article is to analyse the training of the urology resident in the de-escalation phase. Similarly, the emerging educational resources during the pandemic are synthesized, inviting the reader, and especially the urology resident, to continue their training and learningin these times of uncertainty.La pandemia por COVID-19 ha irrumpido gravemente en el día a día de los hospitales, afectando a la actividad de todos los servicios médicos y quirúrgicos. Del mismo modo ha afectado a los residentes de urología, privándoles a los mismos de seguir la formación en sus puestos de trabajo habituales y viéndose obligados a dar apoyo a las unidades COVID. Esto ha implicado, no solamente la pérdida de las actividades diarias, si no también la incertidumbre en oportunidades laborales de los residentes de último año. Además, la cancelación de numerosos eventos como congresos, exámenes o cursos, ha afectado a la planificación anual de la especialidad. Se ha realizado una revisión de la literatura actual sobre el impacto de la pandemia por COVID-19, así como el proceso de desescalada, en la formación de los residentes mediante búsqueda web y en PubMed. Se ha analizado la situación de los residentes, tanto através de la información generada por la reciente literatura, como por la experiencia personal de los autores, desde distintos ámbitos: sistemas de evaluación, aspectos docentes y quirúrgicos, así como labor asistencial. Como resultado de esta revisión, se observa el impacto negativo de la crisis en la formación del residente en urología, especialmente, en el ámbito quirúrgico, pero también se observan nuevas oportunidades de aprendizaje o formas de comunicación con el paciente. Estos recursos educativos y asistenciales invitan al residente de urología en concreto, y a la sociedad médica en general, a reinventarse. El objetivo del presente artículo es analizar la formación del residente en urología en la fase de desescalada. Del mismo modo, se sintetizan los recursos educativos emergentes durante la pandemia, invitando al lector y, de manera especial al residente de urología, a continuar su formación y aprendizaje ante estos tiempos de incertidumbre.

Among western males, prostate cancer is the most frequent oncological disease. Since the widespread of PSA, diagnoses in younger adults is increasing. The aim of this study is to analyze pathological features and biochemical recurrence event in patients ≤55 years who underwent robotic radical prostatectomy (RRP) surgery.A study with a cohort of 510 patients operated between November 2012 and February 2017 in a tertiary centre is provided. A total of 460 are included in the analysis. Variables include PSA, biopsy Gleason score, prostate weight, final specimen Gleason score, pT and surgical margins. Biochemical recurrences during the follow-up are obtained. Statistical analysis with Chi2, Student's t test, Kaplan-Meier and log-rank (SPSS24.0) comparing the ≤55 years patients with older age group is performed.8.3% (38) of the patients were ≤55 years. The mean PSA among the younger group was 8.54ng/ml while in the older was 8.18ng/ml (p=0.13). The biopsy Gleason scores showed similar distribution in both age groups. 52.6% (20) of the young group presented an upgrading in the final Gleason, vs 49.1% (207) among the elderly (p=0.79). The average prost at eweight was higher among elderly patients (54.29g vs.40.50g P=0.001). 84.2% (32) of prostate cancers in young group corresponded to pT2 stages compared to 81.3% (343) in the elder (p=0.66). The presence of positive surgical margins was similar in both groups. The mean follow-up time was 45 months regardless of age. In 21.1% (8) of the young group, biochemical recurrence was detected compared to 17.1% (72) among the elderly (p=0.53). There were no differences in the biochemical recurrence-free survival recorded in both groups (p=0.53).In our study population, patients ≤55 years treated with RRP did not present differences in the pathologic features of prostate cancer or in biochemical recurrence rates in comparison to the group of older patients.Entre los varones occidentales, el cáncer de próstata es la patología oncológica más frecuente. Con la difusión del PSA, los diagnósticos en adultos jóvenes han ido en aumento. El objetivo de este trabajo es analizar las características clínicopatológicas y la aparición de recidiva bioquímica en pacientes ≤55años intervenidos mediante prostatectomía radical robótica (PRR).MATERIAL Y MÉTODOS: Se elabora un estudio con una cohorte de 510 pacientes operados entre noviembre 2012 y febrero 2017 en un centro terciario. Un total de 460 son incluidos en el análisis. Se registran variables que incluyen PSA, score Gleason de la biopsia, peso de la próstata, score Gleason de la pieza, estadio patológico y márgenes quirúrgicos. Se obtienen las recidivas bioquímicas registradas durante el seguimiento. Se realiza un análisis estadístico con los test Chi2, T-Student, Kaplan-Meier y Log-Rank (SPSS24.0) comparando a los pacientes ≤55 años con el grupo de más edad.El 8,3% (38) de los pacientes eran ≤55años. El PSA medio entre los jóvenes fue 8,54 ng/ml mientras que en los mayores fue 8,18ng/ml (p=0,13). Los score Gleason descritos en las biopsias mostraron similar distribución en ambos grupos de edad. Tras el estudio anatomopatológico de la pieza quirúrgica, un 52,6% (20) de los jóvenes sufre upgrading en el Gleason, superior al 49,1% (207) registrado entre los mayores (p=0,79). El peso medio de la próstata fue mayor entre los pacientes añosos (54,29g vs. 40,50g P=0,001). El 84,2% (32) de los cánceres de próstata en jóvenes correspondían a estadios T2 frente al 81,3% (343) en los mayores (p=0,66). La presencia de márgenes quirúrgicos positivos fue similar en ambos grupos. El tiempo medio de seguimiento fue 45 meses con independencia de la edad. En el 21,1% (8) de los jóvenes se detectó recidiva bioquímica frente al 17,1%(72) presentado entre los mayores (p=0,53). No hubo diferencias en la supervivencia libre de recidiva bioquímica registrada en ambos grupos (p=0,53).CONCLUSIÓN: En nuestra población de estudio, los pacientes ≤55 años tratados con PRR no presentan diferencias en las características clinicopatológicas del cáncer de próstata ni en la aparición de recidiva bioquímica respecto al grupo de pacientes más mayores.

ANTECEDENTES: Los trombos grasos en la vena renal son raros y el angiomiolipoma es la única tumoración benigna que puede asociarlos.CASOS CLÍNICOS: Caso 1: paciente femenina de 70 años, con hallazgo durante el seguimiento endocrino de un trombo graso en la vena renal izquierda, con extensión a la vena cava sin clara lesión renal asociada. Se trató de manera conservadora con anticoagulantes y estudios de control anual. Caso 2: paciente femenina de 43 años, con diagnóstico durante el embarazo de una masa en el seno renal derecho, con trombo graso en la vena renal y cava. Se le indicó un anticoagulante y en el posparto se le efectuó nefrectomía radical derecha con trombectomía. El diagnóstico anatomopatológico fue angiomiolipoma.CONCLUSIONES: La coexistencia de un trombo graso en la vena renal es poco común y suele estar ligada a un angiomiolipoma renal. Por el riesgo de embolismo pulmonar o diferenciación maligna está indicado el tratamiento quirúrgico con nefrectomía radical y trombectomía, incluso en pacientes asintomáticos. En el caso de un trombo graso aislado en pacientes con comorbilidades, el tratamiento conservador con anticoagulación es una opción válida.PALABRAS CLAVE: Trombo; vena renal; angiomiolipoma; anticoagulantes; vena cava; embolismo.