Epidemiology of Kidney Cancer

Some tumors are known to have a definite cause-effect etiology, but renal cell carcinoma (RCC) is not one of them precisely. With regard to RCC we can only try to identify some clinical and occupational factors as well as substances related to tumorigenesis. Smoking, chemical carcinogens like asbestos or organic solvents are some of these factors that increase the risk of the RCC. Viral infections and radiation therapy have also been described as risk factors. Some drugs can increase the incidence of RCC as well as other neoplasms. Of course, genetics plays an outstanding role in the development of some cases of kidney cancer. Chronic renal failure, hypertension, and dialysis need to be considered as special situations. Diet, obesity, lifestyle, and habits can also increase the risk of RCC. The aim of this review is to summarize the well-defined causes of renal cell carcinoma

Clinical and surgical assistance in prostate cancer during the COVID-19 Pandemic: Implementation of assistance protocols

Purpose: Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. Material and Methods: We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. Results: Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. Conclusions: Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged

A multistate model and its standalone tool to predict hospital and ICU occupancy by patients with COVID-19

Objective: This study aims to build a multistate model and describe a predictive tool for estimating the daily number of intensive care unit (ICU) and hospital beds occupied by patients with coronavirus 2019 disease (COVID-19). Material and methods: The estimation is based on the simulation of patient trajectories using a multistate model where the transition probabilities between states are estimated via competing risks and cure models. The input to the tool includes the dates of COVID-19 diagnosis, admission to hospital, admission to ICU, discharge from ICU and discharge from hospital or death of positive cases from a selected initial date to the current moment. Our tool is validated using 98,496 cases positive for severe acute respiratory coronavirus 2 extracted from the Aragón Healthcare Records Database from July 1, 2020 to February 28, 2021. Results: The tool demonstrates good performance for the 7- and 14-days forecasts using the actual positive cases, and shows good accuracy among three scenarios corresponding to different stages of the pandemic: 1) up-scenario, 2) peak-scenario and 3) down-scenario. Long term predictions (two months) also show good accuracy, while those using Holt-Winters positive case estimates revealed acceptable accuracy to day 14 onwards, with relative errors of 8.8%. Discussion: In the era of the COVID-19 pandemic, hospitals must evolve in a dynamic way. Our prediction tool is designed to predict hospital occupancy to improve healthcare resource management without information about clinical history of patients. Conclusions: Our easy-to-use and freely accessible tool (https://github.com/peterman65) shows good performance and accuracy for forecasting the daily number of hospital and ICU beds required for patients with COVID-19

Active surveillance in prostate cancer: role of available biomarkers in daily practice

Prostate cancer (PCa) is the most commonly diagnosed cancer in men. The diagnosis is currently based on PSA levels, which are associated with overdiagnosis and overtreatment. Moreover, most PCas are localized tumours; hence, many patients with low-/very low-risk PCa could benefit from active surveillance (AS) programs instead of more aggressive, active treatments. Heterogeneity within inclusion criteria and follow-up strategies are the main controversial issues that AS presently faces. Many biomarkers are currently under investigation in this setting; however, none has yet demonstrated enough diagnostic ability as an independent predictor of pathological or clinical progression. This work aims to review the currently available literature on tissue, blood and urine biomarkers validated in clinical practice for the management of AS patients

Processing reflectivity and Doppler velocity from EarthCARE's cloud-profiling radar: the C-FMR, C-CD and C-APC products

The Earth Clouds, Aerosols and Radiation (EarthCARE) satellite mission is a joint effort by the European Space Agency (ESA) and the Japanese Aerospace Exploration Agency (JAXA). The EarthCARE mission features the first spaceborne 94 GHz cloud-profiling radar (CPR) with Doppler capability. The raw CPR observations and auxiliary information are used as input to three Level-2 (L2) algorithms: (1) C-APC: Antenna Pointing Characterization; (2) C-FMR: CPR feature mask and reflectivity; (3) C-CD: Corrected CPR Doppler Measurements. These algorithms apply quality control and corrections to the CPR primary measurements and derive important geophysical variables, such as hydrometeor locations, and best estimates of particle sedimentation fall velocities. The C-APC algorithm uses natural targets to introduce any corrections needed to the CPR raw Doppler velocities due to the CPR antenna pointing. The C-FMR product provides the feature mask based on only-reflectivity CPR measurements and quality-controlled radar-reflectivity profiles corrected for gaseous attenuation at 94 GHz. In addition, C-FMR provides best estimates of the path-integrated attenuation (PIA) and flags identifying the presence of multiple scattering in the CPR observations. Finally, the C-CD product provides the quality-controlled, bias-corrected mean Doppler velocity estimates (Doppler measurements corrected for antenna mispointing, non-uniform beam filling and velocity folding). In addition, the best estimate of the particle sedimentation velocity is estimated using a novel technique.</p

Optimizing the clinical utility of PCA3 to diagnose prostate cancer in initial prostate biopsy

Background: PCA3 has been included in a nomogram outperforming previous clinical models for the prediction of any prostate cancer (PCa) and high grade PCa (HGPCa) at the initial prostate biopsy (IBx). Our objective is to validate such IBx-specific PCA3-based nomogram. We also aim to optimize the use of this nomogram in clinical practice through the definition of risk groups. Methods: Independent external validation. Clinical and biopsy data from a contemporary cohort of 401 men with the same inclusion criteria to those used to build up the reference’s nomogram in IBx. The predictive value of the nomogram was assessed by means of calibration curves and discrimination ability through the area under the curve (AUC). Clinical utility of the nomogram was analyzed by choosing thresholds points that minimize the overlapping between probability density functions (PDF) in PCa and no PCa and HGPCa and no HGPCa groups, and net benefit was assessed by decision curves. Results: We detect 28 % of PCa and 11 % of HGPCa in IBx, contrasting to the 46 and 20 % at the reference series. Due to this, there is an overestimation of the nomogram probabilities shown in the calibration curve for PCa. The AUC values are 0.736 for PCa (C.I.95 %:0.68–0.79) and 0.786 for HGPCa (C.I.95 %:0.71–0.87) showing an adequate discrimination ability. PDF show differences in the distributions of nomogram probabilities in PCa and not PCa patient groups. A minimization of the overlapping between these curves confirms the threshold probability of harboring PCa >30 % proposed by Hansen is useful to indicate a IBx, but a cut-off > 40 % could be better in series of opportunistic screening like ours. Similar results appear in HGPCa analysis. The decision curve also shows a net benefit of 6.31 % for the threshold probability of 40 %. Conclusions: PCA3 is an useful tool to select patients for IBx. Patients with a calculated probability of having PCa over 40 % should be counseled to undergo an IBx if opportunistic screening is required

Predictors Of Positivity Of [F-18]F-Choline PET-CT In Prostate Cancer Recurrence. Preliminary Results

EP-173 Aim/Introduction: To analyze the validity of [18F]F-Choline PET-CT results in prostate cancer recurrence in our daily practice, based on theoretical cut-off points of prostatespecific antigen (PSA), its kinetic, and PSA doubling time (PSADT), to identify predictors of positivity and modify the indication criteria. Materials and Methods: Prior to the validity analysis, a descriptive, prospective analysis of consecutive patients with prostate cancer treated with curative intent by radical prostatectomy (RP) or radiotherapy (RT), who underwent PET-CT scan with recurrence criteria: PSA =1 or PSA 0.4-1 with PSADT Nadir + 2 after RT, was performed. Results: From April to December 2019, 69 patients were included, 40 were treated with RP (58%) and 29 with RT (42%). In 45 patients (65%) PET-CT was able to identify recurrence of the disease (positive PET) and in 24 it was not (negative PET). Of patients treated with RP, 82, 5% (33/40) had PSA>1, and of those, 61% were positive PET. 17, 5% (7/40) had PSA6months (28/69), in 71% if PSADT6 months, in 61% and 92% if PSADT<6 months and in 77% and 100% if PSADT<3 months. Conclusion: Preliminarily and awaiting validation, it seems that PSA>1 after RP or Nadir +2 after RT is an indicator of PET-CT. There seems to be a tendency that shows that PSA<1 after RP is an indicator of PET-CT if PSADT<3 months. PSADT <3 or <6 months could be the best predictor of positivity of PET-CT with [18F]F-Choline in recurrent prostate cancer

Variabilidad dentro del Registro Nacional multicéntrico en Vigilancia Activa; cuestionario a urólogos

Introducción: Nuestro objetivo principal es describir la utilización actual en España de la vigilancia activa (VA) identificando áreas de potencial mejora. Métodos: Un cuestionario generado en AEU/PIEM/2014/0001 (NCT02865330) fue remitido a todos los investigadores asociados (IA) durante los meses de enero-marzo del 2016. Incluía 7 dominios diferentes cubriendo diferentes aspectos en VA. Resultados: Treinta y tres de cuarenta y un IA respondieron el cuestionario. La VA es principalmente controlada por los Servicios de Urología (87,9%). Hubo una gran heterogeneidad en las clásicas variables clínico-patológicas como criterios de selección. La densidad de antígeno prostático específico (PSAd) solo se usaba en el 36,4% IA. La RMmp era claramente infrautilizada como estadificación inicial (6%). Solo el 27,3% reconocía un alto nivel de experiencia en RMmp de sus colegas radiólogos. Con relación a la biopsia de confirmación, la mayoría de los centros utilizaban la vía transrectal y solo 2/33 la vía transperineal/software de fusión. La mitad de los IA entrevistados pasaron a tratamiento activo ante progresión patológica a Gleason 7 (3 + 4). No existió consenso en cuanto a cuándo pasar a estrategia de observación. Conclusiones: El estudio demostró la infrautilización del consentimiento informado y de los cuestionarios de calidad de vida. El PSAd no se incluía como elemento decisor en la estrategia inicial en la mayoría. Se plasmó una desconfianza en la experiencia de los urólogos con la RMmp y una infrautilización de la vía transperineal, así como la no existencia de consenso en los protocolos de seguimiento y en los criterios de tratamiento activo., confirmando la necesidad de estudios prospectivos analizando el papel de la RMmp y los biomarcadores. Background: Our main objective was to report the current use of active surveillance in Spain and to identify areas for potential improvement. Methods: A questionnaire generated by the Platform for Multicentre Studies of the Spanish Urology Association (AEU/PIEM/2014/0001, NCT02865330) was sent to all associate researchers from January to March 2016. The questionnaire included 7 domains covering various aspects of active surveillance. Results: Thirty-three of the 41 associate researchers responded to the questionnaire. Active surveillance is mainly controlled by the urology departments (87.9%). There was considerable heterogeneity in the classical clinical-pathological variables as selection criteria. Only 36.4% of the associate researchers used prostate-specific antigen density (PSAd). Multiparametric magnetic resonance imaging (mpMRI) was clearly underused as initial staging (6%). Only 27.3% of the researchers stated that their radiology colleagues had a high level of experience in mpMRI. In terms of the confirmation biopsy, most of the centres used the transrectal pathway, and only 2 out of 33 used the transperineal pathway or fusion software. Half of the researchers interviewed applied active treatment when faced with disease progression to Gleason 7 (3+4). There was no consensus on when to transition to an observation strategy. Conclusions: The study showed the underutilisation of informed consent and quality-of-life questionnaires. PSAd was not included as a decisive element in the initial strategy for most researchers. There was a lack of confidence in the urologists’ mpMRI experience and an underutilisation of the transperineal pathway. There was also no consensus on the follow-up protocols and active treatment criteria, confirming the need for prospective studies to analyse the role of mpMRI and biomarkers

Geodetic fault slip rates on active faults in the Baza sub-Basin (SE Spain): Insights for seismic hazard assessment

One of the most significant parameters for seismic hazard assessment analyses is the fault slip rate. The combination of both geological (long-term) and geodetic (short-term) data offers a more complete characterization of the seismic potential of active faults. Moreover, geodetic data are also a helpful tool for the analysis of geodynamic processes. In this work, we present the results of a local GPS network from the Baza sub-Basin (SE Spain). This network, which includes six sites, was established in 2008 and has been observed for seven years. For the first time, we obtain short-term slip rates for the two active faults in this area. For the normal Baza Fault, we estimate slip rates ranging between 0.3 ± 0.3 mm/yr and 1.3 ± 0.4 mm/yr. For the strike-slip Galera Fault, we quantify the slip rate as 0.5 ± 0.3 mm/yr. Our GPS study shows a discrepancy for the Baza Fault between the short-term slip rates and previously reported long-term rates. This discrepancy indicates that the fault could be presently in a period with a displacement rate higher than the mean of the magnitude 6 seismic cycle. Moreover, the velocity vectors that we obtained also show the regional tectonic significance of the Baza Fault, as this structure accommodates one-third of the regional extension of the Central Betic Cordillera. Our GPS-related slip rates form the basis for future seismic hazard analysis in this area. Our results have further implications, as they indicate that the Baza and Galera Faults are kinematically coherent and they divide the Baza sub-Basin into two tectonic blocks. This points to a likely physical link between the Baza and Galera Faults; hence, a potential complex rupture involving both faults should be considered in future seismic hazard assessment studies.We acknowledge the comments of Editor Prof. Irina M. Artemieva and two anonymous reviewers, which significantly improved the quality of this paper. This research was funded by the Spanish Ministry of Science, Innovation and University (Research Projects: RTI2018-100737-BI00 and CGL2016-80687-R), the University of Alicante (Research Project: VIGROB053), the University of Jaén (PAIUJA 2019-2020 and Programa Operativo FEDER Andalucía 2014-2020 - call made by UJA 2018), the University of Granada (B-RNM-301-UGR18) and the Junta de Andalucía regional government (RNM148, RNM282, and RNM370 and P18-RT-3275 research groups). We thank all observers who collected the data of survey-mode GPS measurements