mpMRI-US Fusion-Guided Targeted Cryotherapy in Patients with Primary Localized Prostate Cancer: A Prospective Analysis of Oncological and Functional Outcomes.

Targeted therapy (TT) for prostate cancer (PCa) aims to ablate the malignant lesion with an adequate margin of safety in order to obtain similar oncological outcomes, but with less toxicity than radical treatments. The main aim of this study was to evaluate the recurrence rate (RR) in patients with primary localized PCa undergoing mpMRI/US fusion targeted cryotherapy (FTC). A secondary objective was to evaluate prostate-specific antigen (PSA) as a predictor of recurrences. We designed a prospective single-center single-cohort study. Patients with primary localized PCa, mono or multifocal lesions, PSA 15 ng/mL, and a Gleason score (GS) 4 + 3 undergoing FTC were enrolled. RR was chosen as the primary outcome. Recurrence was defined as the presence of clinically significant prostate cancer in the treated areas. PSA values measured at different times were tested as predictors of recurrence. Continuous variables were assessed with the Bayesian t-test and categorical assessments with the chix-squared test. Univariate and logistic regression assessment were used for predictions. A total of 75 cases were included in the study. Ten subjects developed a recurrence (RR: 15.2%), while fifty-six (84.8%) patients showed a recurrence-free status. A %PSA drop of 31.5% during the first 12 months after treatment predicted a recurrence with a sensitivity of 53.8% and a specificity of 79.2%. A PSA drop of 55.3% 12 months after treatment predicted a recurrence with a sensitivity of 91.7% and a specificity of 51.9%. FTC for primary localized PCa seems to be associated with a low but not negligible percentage of recurrences. Serum PSA levels may have a role indicating RR.post-print644 K

Genetic testing for the clinician in prostate cancer

Introduction: Prostate cancer (PCa) is one of the most common cancers worldwide and a leading cause of cancer-related mortality. Although the diagnosis and treatment of prostate cancer has improved substantially in recent years, new molecular biomarkers are needed to further prolong survival and improve the quality of life in these patients. Areas covered: This review analyzes the current evidence for prognostic and predictive molecular biomarkers that can be applied across different clinical scenarios, ranging from localized disease to metastatic castration-resistant PCa, with a particular emphasis on the biomarkers likely to become available in routine clinical practice in the near future. Expert opinion: There is a growing need for molecular testing to identify the most indolent types of prostate cancer to help optimize treatment strategies and spare treatment in these patients when possible. Current trends in the treatment of prostate cancer underscore the unmet clinical need for biomarkers to improve decision-making in a challenging clinical setting.Sin financiación5.225 JCR (2020) Q1, 17/77 Pathology1.482 SJR (2020) Q1, 80/340 GeneticsNo data IDR 2020UE

The Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging in Primary and Recurrent Prostate Cancer: A Systematic Review of the Literature

Prostate-specific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) is a novel imaging technique with several potential applications in the prostate cancer (PCa) setting

Kinematic analysis of distributed strike-slip shear zone reveal significant geohazard by secondary faults in the Alboran basin

FLOWS : 6th Management Committee (MC) and Working Group (WG) Meeting, 16-18 November 2016, BarcelonaPeer Reviewe

Kinematic analysis of secondary faults within a distributed shear-zone reveals fault linkage and increased seismic hazard

Complex multifault earthquake ruptures involving secondary faults emphasize the necessity to characterize their seismogenic potential better and study their relationship with major faults to improve the seismic hazard assessment of a region. High-resolution geophysical data were interpreted to make a detailed characterization of the Averroes Fault and the North Averroes Faults, which are poorly known secondary right-lateral strike-slip faults located in the central part of the Alboran Sea (western Mediterranean). These faults appear to have evolved since the Pliocene as part of a distributed dextral strike-slip shear zone in response to local strain engendered by the diverging movement of the Carboneras Fault to the north, and the Yusuf and Alboran Ridge faults to the south. In addition, the architecture of these faults suggests that the Averroes Fault may eventually link with the Yusuf fault, thus leading to a higher seismogenic potential. Therefore, these secondary faults represent a hitherto unrecognized seismogenic hazard since they could produce earthquakes up to moment magnitude (Mw) 7.6. Our results highlight the importance of the role played by secondary faults in a specific kinematic framework. Their reciprocal linkage and their mechanical relationship with the main faults could lead to future complex fault ruptures. This information could improve fault source and earthquake models used in seismic and tsunami hazard assessment in this and similar regions

Prognostic Impact of the 2009 UICC/AJCC TNM Staging System for Renal Cell Carcinoma with Venous Extension

The prognostic significance of venous involvement and tumour thrombus level in renal cell carcinoma (RCC) remains highly controversial. In 2010, the American Joint Committee on Cancer (AJCC) and the Union International Centre le Cancer (UICC) revised the RCC staging system (7th edition) based on tumour thrombus level, differentiating the T stage of tumours limited to renal-vein-only involvement. We aimed to evaluate the impact of tumour thrombus extension in a multi-institutional cohort of patients. An international consortium of 11 institutions was established to retrospectively review a combined cohort of 1215 patients undergoing radical nephrectomy and tumour thrombectomy for RCC, including 585 patients with inferior vena cava (IVC) involvement or higher. Predictive factors of survival, including histology, tumour thrombus level, nodal status, Fuhrman grade, and tumour size, were analysed. A total of 1122 patients with complete data were reviewed. The median follow-up for all patients was 24.7 mo, with a median survival of 33.8 mo. The 5-yr survival was 43.2% (renal vein involvement), 37% (IVC below the diaphragm), and 22% with caval involvement above the diaphragm. On multivariate analysis, tumour size (hazard ratio [HR]: 1.64 [range: 1.03–2.59]; p=0.036), Fuhrman grade (HR: 2.26 [range: 1.65–3.1]; p=0.000), nodal metastasis (HR: 1.32 [range: 1.09–1.67]; p=0.005), and tumour thrombus level (HR: 2.10 [range: 1.53–3.0]; p=0.00) correlated independently with survival. Based on analysis of the largest known cohort of patients with RCC along with IVC and atrial thrombus involvement, tumour thrombus level is an independent predictor of survival. Our findings support the changes to the latest AJCC/UICC staging system. Our consortium set out to evaluate the newly revised TNM system by investigating the impact of renal vein versus inferior vena cava (IVC) involvement below the diaphragm (pT3a vs pT3b) as well as the impact of infradiaphragmatic versus supradiaphragmatic IVC involvement (pT3b vs pT3c). Our data demonstrate that patients with renal-vein-only involvement enjoy improved 5-yr cancer-specific survival compared to those with IVC extension below the diaphragm. At 10-yr follow-up, the survival differences are less marked but still persist. Based on these findings, we believe that the 2009 TNM changes are valid

Impact of Ga-PSMA PET/CT in the treatment of prostate cancer: Initial experience in Spain

AimTo evaluate whether positron-emission tomography/computed tomography with 68Ga-PSMA (68Ga-PSMA PET/CT) influences the therapeutic management of patients with primary or recurrent prostate cancer (PCa).BackgroundAlthough 68Ga-PSMA PET/CT is one of the best options for staging or restaging patients with PCa, its availability is still very limited in Spain. The present study reports the results of the first group of patients in Spain who underwent 68Ga-PSMA PET/CT imaging.Materials and methodsAll patients (n = 27) with a histological diagnosis of PCa who underwent 68Ga-PSMA PET/CT prior to the definitive treatment decision at the only centre with this technology in Spain during 2017–2018 were included. Two nuclear medicine physicians and a radiologist reviewed the imaging studies. The clinical impact was assessed from a theoretical perspective, based on the treatment that would have been applied if no data from the 68Ga-PSMA PET/CT were available.ResultsMost patients (n = 26; 96%) had persistent disease or biochemical recurrence after radical prostatectomy, radiotherapy, or combined treatment. One patient underwent 68Ga-PSMA PET/CT imaging to stage high-risk PCa. Overall, 68Ga-PSMA PET/CT was positive in 19 patients (70.4%). In 68.75% of these patients, none of the other imaging tests—MRI, CT, or bone scans—performed prior to the 68Ga-PSMA PET/CT were able to detect the presence of cancerous lesions. Overall, the findings of the 68Ga-PSMA PET/CT led to a modification of the therapeutic approach in 62.96% of the patients in the study.Conclusions68Ga-PSMA PET/CT alters the therapeutic approach in a substantial proportion of patients with PCa

Impact of 68Ga-PSMA PET/CT in the treatment of prostate cancer: initial experience in Spain

Aim To evaluate whether positron-emission tomography/computed tomography with 68Ga-PSMA (68Ga-PSMA PET/CT) influences the therapeutic management of patients with primary or recurrent prostate cancer (PCa). Background Although 68Ga-PSMA PET/CT is one of the best options for staging or restaging patients with PCa, its availability is still very limited in Spain. The present study reports the results of the first group of patients in Spain who underwent 68Ga-PSMA PET/CT imaging. Materials and methods All patients (n = 27) with a histological diagnosis of PCa who underwent 68Ga-PSMA PET/CT prior to the definitive treatment decision at the only centre with this technology in Spain during 2017–2018 were included. Two nuclear medicine physicians and a radiologist reviewed the imaging studies. The clinical impact was assessed from a theoretical perspective, based on the treatment that would have been applied if no data from the 68Ga-PSMA PET/CT were available. Results Most patients (n = 26; 96%) had persistent disease or biochemical recurrence after radical prostatectomy, radiotherapy, or combined treatment. One patient underwent 68Ga-PSMA PET/CT imaging to stage high-risk PCa. Overall, 68Ga-PSMA PET/CT was positive in 19 patients (70.4%). In 68.75% of these patients, none of the other imaging tests—MRI, CT, or bone scans—performed prior to the 68Ga-PSMA PET/CT were able to detect the presence of cancerous lesions. Overall, the findings of the 68Ga-PSMA PET/CT led to a modification of the therapeutic approach in 62.96% of the patients in the study. Conclusions 68Ga-PSMA PET/CT alters the therapeutic approach in a substantial proportion of patients with PCa.Sin financiaciónNo data JCR 20200.367 SJR (2020) Q3, 253/354 OncologyNo data IDR 2020UE