Apalutamide for prostate cancer: multicentre and multidisciplinary real-world study of 227 patients

Apalutamide; Metastatic hormone-sensitive prostate cancer; Prostate cancerApalutamida; Cáncer de próstata metastásico sensible a hormonas; Cáncer de prostataApalutamida; Càncer de pròstata metastàtic sensible a les hormones; Càncer de pròstataObjective: To evaluate the efficacy and safety of apalutamide prostate cancer compared to the pivotal trials patients and to identify the first subsequent therapy in a real-world setting. Methods: The study is prospective and observational based on real-world evidence, performed by different medical disciplines and eight academics centres around Barcelona, Spain. It included all patients with metastatic hormone-sensitive prostate cancer (mHSPC) and high-risk non-metastatic castration-resistant prostate cancer (nmCRPC) treated with apalutamide from June 2018 to December 2022. Results: Of 227 patients treated with apalutamide, 10% had ECOG-PS 2, and 41% were diagnosed with new-generation imaging. In the mHSPC group (209 patients), 75 years was the median age, 53% had synchronous metastases, and 22% were M1a. In the nmCRPC (18 patients), 82 years was the median age, and 81% ≤6 months had PSA doubling time. Patients achieved PSA90 in 92% of mHSPC and 50% of nmCRPC and PSA ≤0.2 in 71% of mHSPC and 39% of nmCRPC. Treatment-related adverse events occurred in 40.1% of mHSPC and 44.4% of nmCRPC. After discontinuation of apalutamide due to disease progression, 54.5% in mHSPC and 75% in nmCRPC started chemotherapy, while after discontinuation because of adverse events, 73.3% in mHSPC and 100% in nmCRPC continued with other hormonal-therapies.This study did not receive funding. Julián Córdoba and Meritxell Pérez have received sponsorship from Janssen for medical congresses and symposiums. Alejo Rodriguez- Vida, Jesús Muñoz Rodriguez, Antonio Alcaraz and Antoni Vilaseca have received honoraria from Janssen for advisory board meetings, symposiums and travel ex-penses. The other authors declare no conflict of interest. Approval of the research protocol by an Institutional Reviewer Board: HCB/2019/0919

A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies

Prostate biopsy concordance; Systematic biopsy; Targeted biopsyConcordancia de biopsia de próstata; Biopsia sistemática; Biopsia dirigidaConcordança de biòpsia de pròstata; Biòpsia sistemàtica; Biòpsia dirigidaThe primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721–0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed.This research was funded by the Instituto de Salut Carlos III (SP) and the European Union, grant number PI20/01666

Comparison of clinical outcomes between Maastricht-III kidney donors >65 years old and donors after brain death: a single center, matched-pair study

Introduction & Objectives: the inclusion of Maastricht Category-III (MIII) donors after circulatory death (DCD) has increased the donors' pool and, therefore, kidney transplants (KT). However, DCD have higher incidence of delayed graft function (DGF) compared to donors after brain death (DBD), being age one of its risk factors. Available data of using expanded criteria DCD is still controversial and conflicting in the current medical practice. The purpose of this study was to compare aged DCD outcomes to DBD regarding DGF, graft and patient's survival. Materials & Methods: We performed a retrospective observational matched-pair analysis of DCD >65 years old (yo) compared to DBD with minimum 1 year follow-up. Patients were matched according to donors' age (±2 years), receptors' age (±5 years), cold ischemia time (CIT) (±3 hours) and type of storage (cold vs perfusion machine). Stata14 program was used for statistical analysis: Tstudent, χ2 for descriptive analysis, logistic regression for DGF and Kaplan Meier survival curves

Multiple partial nephrectomy for multifocal synchronous renal cancer in a solitary kidney

Introduction & Objectives: multifocal synchronous renal cancer on a solitary kidney represent a challenging clinical scenario. The complexity of imperative nephron-sparring surgery in this setting resides in ensuring complete excision of cancer with the maximal preservation of renal function. We aim to present a case of multiple partial nephrectomy (MPN) for multifocal synchronous renal cancer in a patient with a solitary kidney and discuss our experience of imperative partial in this setting. Materials & Methods: We present a case of a 76 years old man with a past medical history of hypertension, chronic obstructive pulmonary disease, peripheral vascular disease, left radical nephrectomy for renal mass (2006) and a right renal artery stent placement for renal artery stenosis. During his surveillance, computerized axial tomography (CAT) scan showed 3 enhancing renal masses (2.2cm, 1.5cm and 1cm, respectively). Biopsy of the largest mass was consistent in clear cell renal cell carcinoma (ccRCC). Preoperative level of creatinine was 1.4mg/dL and estimated glomerular filtration rate (eGFR) 50ml/min/1,73m2. After ablative therapy was deemed unsafe, a MPN was planned