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Introducción: El antígeno prostático específico (APE) es el marcador en suero más utilizado para la patología prostática, y el único empleado para la detección del cáncer de próstata. Si bien el APE es sumamente específico para tejido prostático, un nivel elevado no lo es para cáncer de próstata, ya que se puede ver elevado también en la enfermedad prostática benigna. Existe la necesidad de un examen simple para definir la necesidad de una biopsia prostática en hombres con un APE alterado. El examen de detección de células prostáticas malignas en sangre (CPMs) puede ser un candidato para la detección precoz del cáncer de próstata (CP). Métodos y pacientes: Analizamos de manera prospectiva un grupo de pacientes que fueron sometidos a una biopsia inicial por sospecha de cáncer de próstata y también a una segunda biopsia en el seguimiento posterior. Los resultados de la biopsia fueron comparados con las células prostáticas malignas circulantes (CPMC), las cuales fueron identificadas en muestras de sangre tomadas antes de la realización de la biopsia utilizando inmunocitoquímica estándar. El objetivo fue determinar la capacidad diagnóstica de las CPMC antes de la primera, la segunda y la tercera biopsia prostática. Resultados: En total, 423 pacientes consecutivos participaron en el estudio, con una edad promedio de 65.3 ± 8.9 años y un APE (mediana) de 5.28 ng/ml (RIQ 4.36-7.94 ng/ml). De ellos, 138 (32.6%) tuvieron un cáncer detectado en la biopsia inicial. La prueba de la detección de CPCs tuvo una sensibilidad de 0.89 (IC 95%: 0.82 a 0.94) y una especificidad de 0.89 (IC 95%: 0.84 a 0.92). De los 423 pacientes, a 125 se les reallizó una segunda biopsia, y a 57, una tercera, las CPCs lograron una sensibilidad y especificidad de 0.89/0.87 y 0.88/0.96 en la segunda y tercera biopsia, respectivamente, con un valor predictivo negativo y positivo de 0,65 / 0,97 y 0,88 / 0,95 en la segunda y tercera biopsia, en ese orden. Conclusiones: Las CPCs utilizadas en conjunto con las pruebas de tamizaje actuales, APE y tacto rectal, pueden mejorar la efectividad del tamizaje, reduciendo la frecuencia de biopsias negativas, así como su número total y sus complicaciones. Además, el costo-beneficio para el sistema de salud público en términos de utilización de recursos es positivo

Introduction: The prostate-specific antigen (PSA) is the most frequently used serum marker for the detection of prostatic disease, and the only marker used for the detection of prostate cancer. While PSA is highly specific for prostatic tissue, a high PSA serum level is not specific for prostate cancer, since it can be high even in benign prostatic disease. There is a need for a simple exam to define the opportunity of a prostate biopsy in men with an altered PSA levels. Detection of malignant prostatic cells (mCPC) in blood may be a candidate for early detection of prostate cancer (PC). Patients and methods: a group of patients, who underwent an initial prostate biopsy -and also a second one during a follow up - due to suspicion of prostate cancer, were assessed prospectively. The results of the biopsy were compared with malignant circulating prostate cells (mCPC) levels, identified in blood samples drawn prior to the biopsy, using standard immunocytochemistry methods. The objective was to determine the diagnostic ability of mCPC before the first, the second and the third prostate biopsies. Results: In total, 423 consecutive patients participated in the study, with an average age of 65.3 ± 8.9 years and a PSA (median) of 5.28 ng/ml (interquartile range [IQR] 4.36-7.94 ng/ml). Of them, 138 (32.6%) had a prostate cancer detected in the initial biopsy. Tests for the detection of circulating prostatic cells in blood (CPCs) had a sensitivity of 0.89 (95% confidence interval [95% CI: 0.82-0.94) and a specificity of 0.89 (95% CI: 0.84 to 0.92). Of the 423 patients, 125 had a second biopsy, and 57 had a third biopsy. CPCs attained a sensitivity and specificity of 0.89/0.87 and 0.88/0.96 for the second and third biopsy, respectively, with a positive and negative predictive value of 0.65 / 0.97 and 0.88 / 0.95 in the second and third biopsy, in that order. Conclusions: CPCs used in combination with current screening tests -PSA and digital rectal exam- can improve screening effectiveness by reducing the frequency of negative biopsies, as well as the total number of biopsies and their complications. In addition, profitability for the public health system in terms of resource utilization, is positive

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INTRODUCTION: Radical prostatectomy (RP) is a potentially healing surgical procedure. OBJECTIVE: We evaluate and compare the surgical and oncologic outcomes between laparoscopic and retropubical radical prostatectomy in the Urology Department in DIPRECA Hospital. METHOD: We constructed a nonrandomised, prospective study between january 2003 and march 2007. A total of 115 patients, 56 operated laparoscopically and 59 by retropubical RP. Functional and oncologic results were compared according to standardized variables and their corresponding statistical analysis, for which we used SPSS 12.0 program. RESULTS: Mean operation time was 202,5 minutes for laparoscopic RP and 150,5 for retropubical RP (p<0.0001). Retropubical RP required more blood transfusions (p<0.0001), longer hospital stay (p=0,0073) and longer need for vesical catheter (p=0,0001) than laparoscopic RP. There were 23 complications, 15 attributable to laparoscopic RP. We found no significant differences in postsurgical sexual function and urinary continence. In respect to the oncologic variables, we found no statistically relevant differences in positive surgical margins nor biochemical relapse during follow up. CONCLUSION: We found no significant differences between retropubical and laparoscopic RP in the oncologic and functional variables analyzed. Nevertheless, our experience shows a distinct benefit in favour of the laparoscopic approach in relation to bleeding and recovery rate. Though retropubical RP has a shorter operating time, we believe this variable depends on the learning curve still developing for laparoscopic RP. According to our literary review, this is the first publication in Chile that compares both techniques.

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