Objective: Thirty percent of patients with localized prostate cancer undergoing radical prostatectomy experience biochemical recurrence with rising serum prostate-specific antigen (PSA). More than 50% of these develop distant metastases. Methods: Presence of PSA mRNA in pathologically normal pelvic lymph nodes from 154 patients undergoing radical prostatectomy was investigated with non-quantitative PSA reverse transcriptase polymerase chain reaction (RT-PCR). In 135 of these patients preoperative serum PSA RT-PCR was also assessed. RT-PCR positivity was correlated with biochemical recurrence and compared with other clinical risk factors. Results: At a median follow-up of 58 months the biochemical failure-free survival of patients with positive versus negative lymph node RT-PCR was 68.4% and 76.7% respectively (p=0.2). Biochemical failure-free survival was not influenced by the serum PSA RT-PCR result either (72.3% versus 72.6%). Surgical margin status, preoperative serum PSA, pT category and Gleason score were independent prognostic risk factors for biochemical recurrence with a hazard ratio of 5.48, 2.56, 2.56 and 2.13 respectively. Conclusions: At 5 year follow-up after radical prostatectomy, both serum and lymph node RT-PCR are not correlated with biochemical failure-free survival. Established clinical risk factors have a much stronger impact on biochemical recurrence.

Objetivo: El 30% de los pacientes con cáncer de próstata localizado sometidos a prostatectomía radical sufren recurrencia bioquímica con aumento del antígeno prostático específico (PSA). Más del 50% de ellos desarrollan metástasis a distancia. Métodos: Utilizando la prueba de reacción en cadena de polimerasa con transcriptasa inversa (RT-PCR) se investigó en 154 pacientes sometidos a prostatectomía radical la presencia de mRMA de PSA en ganglios linfáticos normales según el análisis anatomopatológico. En 135 pacientes también se evaluó la RT-PCR de PSA preoperatoria en sangre periférica. Se correlacionó un resultado positivo de RT-PCR con recurrencia bioquímica y se comparó con otros factores de riesgo clínicos. Resultados: La supervivencia libre de recurrencia bioquímica en los pacientes con RT-PCR positiva y negativa en ganglios linfáticos fue de 68,4% y 76,7% respectivamente (p = 0,2), con una mediana de seguimiento de 58 meses. El resultado de RT-PCR en suero no influyó en la supervivencia libre de recurrencia bioquímica en ninguno de los grupos (72,3% frente a 72,6%). El estado de los márgenes quirúrgicos, el PSA sérico preoperatorio, la categoría pT y el escore de Gleason fueron factores de riesgo independientes para el pronóstico de recurrencia bioquímica con un riesgo relativo de 5,48, 2,56, y 2,13 respectivamente. Conclusiones: Ni la RT-PCR de PSA sérica ni la de ganglios linfáticos se correlacionan con supervivencia libre de recidiva bioquímica a los cinco años de seguimiento después de prostatectomía radical. Factores de riesgo clínico establecidos tienen un impacto mucho más fuerte sobre la recurrencia bioquímica.

OBJECTIVE: The literature lacks of studies on postoperative outcomes after urological ambulatory surgery. Our study aims to identify parameters associated with postoperative complications within 30 days after ambulatory urological surgery. MATERIALS AND METHODS: Adjusted and unadjusted comparisons between clinical features and postoperative outcome (complicated and uncomplicated). RESULTS: Postoperative course was complicated in 5% of the patients. Discharge schedule was not completed in 1.1% while unplanned visits resulted in admission in 0.5%. Multivariate analyses could only confirm the independent effect of type of anesthesia and diagnosis-related group (DRG) relative weight. CONCLUSIONS: Ambulatory urological surgery can be safe in terms of postoperative complications. In the present study surgery under general anesthesia, or a higher DRG relative weight procedure, increased the risk of complications compared to surgery under regional or local anesthesia or lower DRG relative weight operations. Patients scheduled for general anesthesia or undergoing complex urological procedures should be warned about an increased risk of postoperative incidents and/or readmission.