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Context and objective The increasingly early diagnosis of prostate cancer requires a search for therapeutic alternatives with good oncological results that in turn facilitate a good long-term quality of life. This review analyses 2 minimally invasive therapies for treating localized prostate cancer in terms of oncological and functional results, as well as the complications resulting from the therapies. Acquisition of evidence A systematic literature review was conducted of the treatment of localized prostate cancer with 2 ablative techniques as the primary therapy: cryosurgery or cryotherapy and high intensity focused ultrasound (HIFU). We included patients who underwent procedures that included the entire gland, with hemiablation or focal therapy, which were indicated for low to intermediate-risk prostate cancer according to the D’Amico criteria. We excluded patients with high-risk prostate cancer and those who underwent any prior treatment for prostate cancer. Synthesis of the evidence After conducting the literature search and excluding the studies that did not meet the protocol criteria, we reviewed a total of 14 studies, with a total of 350 patients treated using cryotherapy and 1107 treated with HIFU. All studies were either prospective or retrospective and were not randomized. The patients’ mean age was younger than 75 years. Overall, the rate of disease recurrence in the patients treated with cryotherapy varied between 13.2% and 26%, while the rate for those treated with HIFU varied between 7.3% and 67.9%. The overall demonstrated continence at 12 months was 97.6–100% for cryotherapy and 96–100% for HIFU. In terms of sexual potency rates, cryotherapy showed complete potency at 12 months for 86–100% of the patients treated with focal cryotherapy and slightly lower rates for hemiablation (76.9–100%) and total therapy (39%). HIFU showed potency rates of 89%, 52–80% and 33–78% for focal therapy, hemiablation and total therapy, respectively. Conclusions Both techniques have comparable functional results, although the somewhat poorer oncological results for HIFU reflect a steeper learning curve, which could lead to its use in centers with high volumes of patients.

Resumen Contexto y objetivo El diagnostico cada vez mas precoz del cancer de prostata obliga a buscar alternativas terapeuticas con buenos resultados oncologicos, que a su vez faciliten una buena calidad de vida a largo plazo. La presente revision analiza los resultados de 2 terapias minimamente invasivas en el tratamiento del cancer localizado de prostata en cuanto a resultados oncologicos y funcionales, asi como las complicaciones derivadas de los mismos. Adquisicion de la evidencia Revision sistematica de la literatura referida al tratamiento del cancer localizado de prostata con 2 tecnicas ablativas como terapia primaria: la criocirugia o crioterapia y el high intensity focused ultrasound (HIFU). Se incluyen pacientes con procedimientos que incluian la totalidad de la glandula, con hemiablacion o con terapia focal e indicados en cancer de prostata de bajo riesgo o riesgo intermedio segun criterios D’Amico. Se excluyen pacientes con cancer de prostata de alto riesgo, o aquellos que hayan recibido cualquier tratamiento previo para el cancer de prostata. Sintesis de la evidencia Tras la busqueda y exclusion de estudios que no cumplian los criterios del protocolo, se revisan un total de 14 estudios, con un total de 350 pacientes tratados mediante crioterapia, y un total de 1.107 pacientes tratados con HIFU. En todos los casos se trataron de estudios prospectivos o retrospectivos, no aleatorizados. La edad media de los pacientes fue de menos de 75 anos. En global la tasa de recidiva anatomopatologica en los pacientes tratados con crioterapia oscila entre el 13,2% y el 26%, mientras que en el HIFU oscilan entre el 7,3% y el 67,9%. La continencia global mostrada fue de un 97,6-100% en el caso de la crioterapia, y un 96-100% en el HIFU a los 12 meses. Respecto a las tasas de potencia sexual la crioterapia muestra una potencia completa del 86-100% a los 12 meses en pacientes tratados con crioterapia focal, y algo menores en la hemiablacion (76,9-100%) y en la terapia total (39%). El HIFU reporta tasas de potencia del 89% 52-80% y 33-78% en terapia focal, hemiablacion y terapia total respectivamente. Conclusiones Ambas tecnicas presentan unos resultados funcionales equiparables, si bien los resultados oncologicos algo mas pobres en el HIFU son reflejo de una curva de aprendizaje mas complicada, que puede abocar su uso a centros con alto volumen de pacientes.

Resumen Objetivo Analisis de los resultados obtenidos en el seguimiento de los pacientes intervenidos de carcinoma renal con invasion vascular en nuestro centro, evaluacion de los factores pronosticos y de las complicaciones. Material y metodos Estudio observacional retrospectivo de 37 pacientes diagnosticados de carcinoma renal con invasion vascular intervenidos entre mayo de 1999 y julio de 2013. Se emplean el metodo de Kaplan-Meier para el analisis de supervivencias y la prueba de Mantel-Haenszel (LogRank) y el modelo de riesgos proporcionales de Cox para el analisis de los factores de riesgo de mortalidad. Resultados La mediana de edad fue de 60 anos. El tiempo de seguimiento medio de 42,1 meses. Las medianas de supervivencia global y supervivencia libre de enfermedad fueron de 53,8 y 36,3 meses respectivamente. Existe asociacion estadistica entre supervivencia global y el ASA (p = 0,047), estadio tumoral (p = 0,003), la afectacion ganglionar (p = 0,024), la presencia de metastasis (p = 0,013), el nivel de trombo tumoral (p = 0,05) y el tipo histologico (p = 0,001). Catorce pacientes presentaron complicaciones grado IIIb o mayor segun la clasificacion de Clavien-Dindo, siendo la mas frecuente el sangrado. Conclusiones El carcinoma renal con invasion vascular es una enfermedad con alta tasa de mortalidad. La cirugia es una opcion terapeutica que puede resultar curativa. El numero de complicaciones es importante. La supervivencia esta condicionada por el ASA, el estadio tumoral, el nivel de trombo tumoral, la afectacion ganglionar, las metastasis y el tipo histologico.

Objective Analysis of the results of patients who had been operated of renal cell carcinoma with vascular invasion in our institution, evaluation of prognostic factors and complications. Methods Retrospective observational study of 37 patients diagnosed of renal cell carcinoma with vascular invasion operated between May 1999 and July 2013. We used the method of Kaplan–Meier survival analysis and the Mantel–Haenszel's test (log rank) and the Cox's proportional hazards analysis test to analyse the risk factors of mortality. Results The median age was 60 years. Mean follow-up period was 42.1 months. The median overall survival and disease-free survival were 53.8 and 36.3 months, respectively. There was statistical association between overall survival and American Society of Anesthesiologists Classification score ( p = 0.047), tumor stage ( p = 0.003), lymph node involvement ( p = 0.024), presence of metastases ( p = 0.013), level of tumor thrombus ( p = 0.05) and histological type ( p = 0.001). 14 patients had grade IIIb complications or higher according to the Clavien Dindo classification, the most frequent was bleeding. Conclusions Renal cell carcinoma with vascular invasion is a disease with high rate of mortality. Surgery is a therapeutic option that can be curative. The number of complications is important. Survival is conditioned by the American Society of Anesthesiologists Classification score, tumor stage, the level of tumor thrombus, lymph node involvement, metastasis and histological type.

The increasingly early diagnosis of prostate cancer requires a search for therapeutic alternatives with good oncological results that in turn facilitate a good long-term quality of life. This review analyses 2 minimally invasive therapies for treating localised prostate cancer in terms of oncological and functional results, as well as the complications resulting from the therapies.A systematic literature review was conducted of the treatment of localised prostate cancer with 2 ablative techniques as the primary therapy: cryosurgery or cryotherapy and high intensity focused ultrasound (HIFU). We included patients who underwent procedures that included the entire gland, with hemiablation or focal therapy, which were indicated for low to intermediate-risk prostate cancer according to the D'Amico criteria. We excluded patients with high-risk prostate cancer and those who underwent any prior treatment for prostate cancer.After conducting the literature search and excluding the studies that did not meet the protocol criteria, we reviewed a total of 14 studies, with a total of 350 patients treated using cryotherapy and 1107 treated with HIFU. All studies were either prospective or retrospective and were not randomised. The patients' mean age was younger than 75 years. Overall, the rate of disease recurrence in the patients treated with cryotherapy varied between 13.2% and 26%, while the rate for those treated with HIFU varied between 7.3% and 67.9%. The overall demonstrated continence at 12 months was 97.6-100% for cryotherapy and 96-100% for HIFU. In terms of sexual potency rates, cryotherapy showed complete potency at 12 months for 86-100% of the patients treated with focal cryotherapy and slightly lower rates for hemiablation (76.9-100%) and total therapy (39%). HIFU showed potency rates of 89%, 52-80% and 33-78% for focal therapy, hemiablation and total therapy, respectively.Both techniques have comparable functional results, although the somewhat poorer oncological results for HIFU reflect a steeper learning curve, which could lead to its use in centres with high volumes of patients.

Analysis of the results of patients who had been operated of renal cell carcinoma with vascular invasion in our institution, evaluation of prognostic factors and complications.Retrospective observational study of 37 patients diagnosed of renal cell carcinoma with vascular invasion operated between May 1999 and July 2013. We used the method of Kaplan-Meier survival analysis and the Mantel-Haenszel's test (log rank) and the Cox's proportional hazards analysis test to analyse the risk factors of mortality.The median age was 60 years. Mean follow-up period was 42.1 months. The median overall survival and disease-free survival were 53.8and 36.3 months, respectively. There was statistical association between overall survival and ASA (p=0.047), tumor stage (p=0.003), lymph node involvement (p=0.024), presence of metastases (p=0.013), level of tumor thrombus (p=0, 05) and histological type (p=0.001). 14 patients had grade IIIb complications or higher according to the Clavien Dindo classification, the most frequent was bleeding.Renal cell carcinoma with vascular invasion is a disease with high rate of mortality. Surgery is a therapeutic option that can be curative. The number of complications is important. Survival is conditioned by the ASA, tumor stage, the level of tumor thrombus, lymph node involvement, metastasis and histological type.