PCUMex survey: Controversies in the management of prostate cancer among Mexican urologists

AbstractBackgroundProstate cancer is the first cause of mortality related to malignancy in Mexican men. Common clinical practice has to be evaluated in order to gain a picture of reality apart from the guidelines.AimTo analyze clinical practice among urologists in Mexico in relation to prostate cancer management and to compare the results with current recommendations and guidelines.MethodsWe collected the data from 600 urologists, members of the Sociedad Mexicana de Urología, who were invited by email to answer a survey on their usual decisions when managing controversial aspects of prostate cancer patients.ResultsQuinolones were the most common antibiotic used as prophylaxis in prostate biopsy (75.51%); 10–12 cores were taken in more than 65% of prostate biopsies; and 18.27% of the participants performed limited pelvic lymphadenectomy. Treatment results showed that 10.75% of the urologists surveyed preferred radical prostatectomy as monotherapy in high-risk patients with extraprostatic extension and 60.47% used complete androgen deprivation in metastatic prostate cancer.ConclusionsThere are many areas of opportunity for improvement in our current clinical practice for the management of patients with prostate cancer

Resultados oncológicos en enfermedad N1 posterior a la prostatectomía radical

ResumenAntecedentesLa prostatectomía radical+linfadenectomía pélvica puede mejorar la supervivencia libre de progresión y supervivencia cáncer-específica en la enfermedad ganglionar.ObjetivoAnalizar las características de los pacientes con enfermedad ganglionar en el análisis histopatológico de la prostatectomía radical.Material y métodosEstudio retrospectivo de pacientes sometidos a prostatectomía radical con enfermedad ganglionar metastásica de 1988 a 2015.ResultadosSe incluyeron 25 pacientes, de 66.5 años (DE±6.5); antígeno prostático específico medio de 20.17ng/dL (RIC: 18); con una mediana de seguimiento en 63 meses (RIC: 86). Clasificación de riesgo por D’Amico, 15 (60%) pacientes de alto, 8 (32%) intermedio y 2 (8%) de riesgo bajo. Se encontraron márgenes positivos en 15 casos (60%); estadio tumoral T2 en 4 (16%), T3A en 3 (12%), T3B en 17 (68%) y T4 en 1 (4%); cantidad de ganglios positivos, uno en 14 (56%), 2 en 3 (12%) y más de 2 en 8 (32%) casos. Recibieron radioterapia 3 pacientes (16%) y bloqueo hormonal 24 (96%). La supervivencia libre de progresión fue de 105 meses y la supervivencia cáncer-específica fue del 86 y 45% a 5 y 10 años respectivamente. El HR para progresión bioquímica fue significativo en márgenes positivos (HR: 9.5, IC95%: 0.99-91.5, p=0.50) y ≥2 ganglios positivos (HR: 8.5, IC95%: 1.1-61.9, p=0.34). La afectación≥2 ganglios predijo progresión con una OR de 7.2 (IC95% 1.06-48.6, p=0.043).ConclusionesLa supervivencia media a 5 años es superior al 80%. El número de ganglios positivos podría ser un factor predictor de progresión bioquímica.AbstractBackgroundRadical prostatectomy+pelvic lymph node dissection can improve progression-free survival and cancer-specific survival in lymph node disease.AimTo analyze the characteristics of patients with lymph node disease in the histopathologic findings of the radical prostatectomy and lymph node dissection.Material and methodsA retrospective study was carried out on patients that underwent radical prostatectomy with metastatic lymph node disease within the time frame of 1988 to 2015.ResultsThe study included 25 patients with a mean 66.5 years of age (SD±6.5), a mean prostate-specific antigen of 20.17ng/dl (IQR: 18), and a median follow-up period of 63 months (IQR: 86). According to the D’Amico classification, 15 (60%) patients were high-risk, 8 (32%) were intermediate-risk, and 2 (8%) were low-risk. Positive margins were found in 15 cases (60%); 4 (16%) patients had T2 tumor stage, 3 (12%) had T3A, 17 (68%) had T3B, and one patient (4%) had T4. Fourteen (56%) patients had one positive lymph node, 3 (12%) patients had 2 positive lymph nodes, and 8 (32%) patients had more than 2 positive lymph nodes. Three (16%) patients received radiotherapy and 24 (96%) underwent hormone blockade. Progression-free survival was 105 months and cancer-specific survival was 86% at 5 years and 45% at ten years. The HR for biochemical progression was significant in positive margins (HR: 9.5, 95% CI: 0.99-91.5, P=.50) and when there were≥2 positive lymph nodes (HR: 8.5, 95% CI: 1.1-61.9, P=0.34). Involvement of≥2 lymph nodes predicted progression with an odds ratio of 7.2 (95% CI: 1.06-48.6, P=.043).ConclusionsThe average 5-year survival was above 80%. The number of positive lymph nodes could be a predictive factor for biochemical progression

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

Carcinoma renal de células claras localmente avanzado con tuberculosis renal asociada

ResumenLa asociación de carcinoma de células renales (CCR) y tuberculosis(TB) renal es inusual. Mientras el descubrimiento incidental de CCR en riñones tuberculosos está bien descrito, el descubrimiento de lesiones tuberculosas después de una nefrectomía radical por cáncer es excepcional. El objetivo de este artículo es reportar un caso de CCR de células claras localmente avanzado cuyo examen histológico reveló TB asociada. Muy pocos son los casos de cáncer renal y TB que se han publicado. Se ha descrito un caso de carcinoma epidermoide de la pelvis renal en un riñón con TB y un caso de adenocarcinoma renal y TB. En este caso se trata de un CCR localmente avanzado, con gran carga tumoral y múltiples adenopatías en retroperitoneo, que apuntaban antes de la cirugía a enfermedad metastásica a ganglios; sin embargo, solo se encontraron cambios histopatológicos por TB. No se ha logrado encontrar una correlación clínica ni patológica clara entre estas 2 entidades; además, no existe ningún estudio clínico que estudie dicha correlación.AbstractThe association of renal cell carcinoma (RCC) and renal tuberculosis (TB) is uncommon. Whereas the incidental discovery of RCC in tuberculous kidneys is well described, the discovery of tuberculous lesions after radical nephrectomy for cancer is exceptional. The aim of this article was to report a case of locally advanced clear cell RCC whose histologic study revealed associated TB. There are very few published cases of kidney cancer and TB. A case of squamous cell carcinoma of the renal pelvis in a kidney with TB and a case of renal adenocarcinoma and TB have been reported. The present case describes locally advanced RCC with high tumor burden and retroperitoneal adenopathy that, before surgery, suggested metastatic disease to the lymph nodes. However, only histopathologic changes due to TB were found. No clinical or pathologic correlation has been found between these 2 entities, and clinical studies on the subject are lacking