Influencia del tratamiento médico en el pronóstico del cáncer de próstata intervenido quirúrgicamente

[ES]En una serie multicéntrica se encuentra que el 19.78% de los pacientes tratados de cáncer de próstata (CP) con intención curativa mediante prostatectomía radical (PR) precisan tratamiento médico coadyuvante. Interesa conocer los efectos de estos tratamientos. OBJETIVOS: Conocer la relación entre los diagnósticos secundarios (DDSS) de novo y el tratamiento médico adyuvante a la prostatectomía radical. MATERIAL Y MÉTODOS Estudio retrospectivo de 910 varones intervenidos quirúrgicamente de CP antes de diciembre de 2016. Grupos de estudio: Grupo A(GA, n=170): pacientes tratados de CP mediante prostatectomía radical (PR) más tratamiento médico. Grupo B(GB, n=740): pacientes tratados con PR sólo. La hormonoterapia (HT) se codificó: HT1(1.97%): Abiraterona + Leuprorelina. HT2(1.97%): Bicalutamida. HT3(0.98%): Goserelina + Bicalutamida. HT4(9.78%): Leuprorelina. HT5(0.98%): Leuprorelina + Bicalutamida. HT6(0.98%): Leuprorelina + Enzalutamida. HT7(1.97%): Triptorelina. HT8(1.09%): Triptorelina + Bicalutamida. Edad, PSA, pTNM, Gleason, antecedentes médico-quirúrgicos, tiempo de seguimiento, DDSS pre y post-tratamiento fueron analizados. Estadística descriptiva, análisis ANOVA, t de Student, test exacto de Fisher, test de correlación de Pearson, análisis multivariante, p<0.05 se considera significativo. RESULTADOS Edad media 64.50años (45-90). Hubo más depresión en HT6 , HT8 y HT4. No hubo diferencia en patología respiratoria entre subgrupos. Hubo más cardiopatía isquémica en HT2 y menos en la HT4. Hubo más HTA en HT3, DM en HT2, dislipemia en subgrupos HT1, HT5 y HT8; hepatopatía en HT1, HT2 y HT7 (y menos en HT4), hiperuricemia en HT1 y HT2. Entre GA y GB en post-tratamiento en GA fueron más frecuentes depresión, cardiopatía isquémica, hipertensión arterial, diabetes mellitus, dislipemia, hepatopatía, hiperuricemia. No hubo diferencias en patología respiratoria, incontinencia urinaria, síntomas del tracto urinario inferior y necesidad de tratamiento antiagregante. CONCLUSIONES Depresión, cardiopatía isquémica, HTA, DM, hepatopatía e hiperuricemia son más frecuentes en pacientes que reciben tratamiento médico. No aumenta la patología respiratoria, incontinencia urinaria, síntomas del tracto urinario inferior y necesidad de tratamiento antiagregante. Goserelina más bicalutamida (HT3) muestra mejoría de parámetros de depresión, patología respiratoria, hiperuricemia, síntomas del tracto urinario inferior respecto a otros protocolos. Leuprorelina más bicalutamida (HT5) muestra buen control evolutivo en la probabilidad de desarrollar cardiopatía isquémica, hipertensión arterial e hiperuricemia respecto a otros protocolos.[EN]In a multicentre trial, it is found that 19.78% of patients treated for prostate cancer (PC) with curative intention by radical prostatectomy (RP) require adjuvant medical treatment. It is interesting to know the effects of these treatments. OBJECTIVES: To know the relationship between de novo secondary diagnoses (DDSS) and adjuvant medical treatment to radical prostatectomy. MATERIAL AND METHODS Retrospective study of 910 men surgically treated with PC before December 2016. Study groups: Group A (GA, n = 170): patients treated for PC by radical prostatectomy (RP) plus medical treatment. Group B (GB, n = 740): patients treated with PR only. Hormone therapy (HT) was coded: HT1 (1.97%): Abiraterone + Leuprorelin. HT2 (1.97%): Bicalutamide. HT3 (0.98%): Goserelin + Bicalutamide. HT4 (9.78%): Leuprorelin. HT5 (0.98%): Leuprorelin + Bicalutamide. HT6 (0.98%): Leuprorelin + Enzalutamide. HT7 (1.97%): Triptorelin. HT8 (1.09%): Triptorelin + Bicalutamide. Age, PSA, pTNM, Gleason, medical-surgical background, follow-up time, DDSS pre and post-treatment were analyzed. Descriptive statistics, ANOVA analysis, Student's t test, Fisher's exact test, Pearson's correlation test, multivariate analysis, p <0.05 is considered significant. RESULTS Average age 64.50 years (45-90). There was more depression in HT6, HT8 and HT4. There was no difference in respiratory pathology between subgroups. There was more ischemic heart disease in HT2 and less in HT4. There was more HT in HT3, DM in HT2, dyslipidemia in subgroups HT1, HT5 and HT8; liver disease in HT1, HT2 and HT7 (and less in HT4), hyperuricemia in HT1 and HT2. Between GA and GB post-treatment, in GA were more frequent depression, ischemic heart disease, hypertension, diabetes mellitus, dyslipidemia, liver disease, hyperuricemia. There were no differences in respiratory pathology, urinary incontinence, lower urinary tract symptoms and the need for antiplatelet therapy. CONCLUSIONS Depression, ischemic heart disease, hypertension, DM, liver disease and hyperuricemia are more frequent in patients receiving medical treatment. It does not increase respiratory pathology, urinary incontinence, lower urinary tract symptoms and the need for antiplatelet therapy. Goserelin plus bicalutamide (HT3) shows improvement of depression parameters, respiratory pathology, hyperuricemia, lower urinary tract symptoms compared to other protocols. Leuprorelin plus bicalutamide (HT5) shows good control in the probability of developing ischemic heart disease, hypertension and hyperuricemia compared to other protocols

Relationship between Mental Disorders, Smoking or Alcoholism and Benign Prostate Disease

Introduction: Mental disorders, smoking, or alcoholism and benign prostate disease are highly prevalent in men. Aims: To identify the relationship between mental disorders, smoking, or alcoholism and benign prostate disease. Methodology: A prospective multicenter study that evaluated prostate health status in 558 men from the community. Groups: GP—men who request a prostate health examination and whose medical history includes a mental disorder, smoking, or alcoholism prior to a diagnosis of benign prostate disease; GU—men who request a prostate health examination and whose medical history includes a benign prostate disease prior to a diagnosis of mental disorder, smoking, or alcoholism. Variables: age, body mass index (BMI), prostate specific antigen (PSA), follow-up of the mental disorder, smoking or alcoholism, time elapsed between urological diagnosis and the mental disorder, smoking or alcoholism diagnosis, status of the urological disease (cured or not cured), concomitant diseases, surgical history, and concomitant treatments. Descriptive statistics, Student’s t-test, Chi2, multivariate analysis. Results: There were no mental disorders, smoking, or alcoholism in 51.97% of men. Anxiety, smoking, major depressive disorder, pathological insomnia, psychosis, and alcoholism were identified in 19.71%, 13.26%, 5.73%, 4.30%, 2.87%, and 2.15% of individuals, respectively. Nonbacterial prostatitis (31.54%), urinary tract infection (other than prostatitis, 24.37%), prostatic intraepithelial neoplasia (13.98%), and prostatodynia (1.43%) were prostate diseases. Unresolved symptomatic benign prostate disease was associated with anxiety, depression, and psychosis (p = 0.002). Smoking was the disorder that men managed to eliminate most frequently. The dominant disorder in patients with symptomatic benign prostatic disease was alcoholism (p = 0.006). Conclusions: Unresolved symptomatic benign prostatic disease is associated with anxiety, depression, and psychosis. Alcoholism is associated with a worse prognosis in the follow-up of symptomatic benign prostatic disease