We determined whether increasing the number of cores at first prostate biopsy would improve the cancer detection rate without increasing the detection of clinically insignificant tumors. From January 2009 to January 2010 patients scheduled for prostate biopsy were randomized to 12 or 18-core sampling. Study inclusion criteria were 1) age 45 to 75 years, 2) abnormal digital rectal examination and/or prostate specific antigen 4 to 20 ng/ml, and 3) no previous biopsy. The primary end point was the cancer detection rate. Secondary end points were clinically insignificant cancer detection and morbidity. A total of 150 patients were enrolled in the study. Preoperative variables were similar in the 2 groups of 75 patients each. Cancer was detected in 23 patients (30.7%) in group 1 and in 36 (48%) in group 2 (p = 0.02). More cases of insignificant cancer were detected in group 2 (p not significant). In men with prostate volume 65 cc or less the detection rate was 30.9% in group 1 and 52.8% in group 2 (p = 0.02). In men with prostate specific antigen 10 ng/ml or less the detection rate was 19.6% in group 1 and 38.4% in group 2 (p = 0.03). Two group 2 patients (5.5%) were diagnosed based on additional samples but the diagnosis corresponded to insignificant cancer. There was no statistically significant difference in morbidity. The 18-core protocol improves prostate cancer detection without increasing morbidity. Results suggest that the 12-core biopsy protocol is adequate for prostate cancer detection at first biopsy.

Objective. To estimate prostate cancer (PC) survival in Mexico and explore survival disparities according to the marginalization level of residence place. Materials and methods. A nationwide administrative claims database (4 110 men) whose PC treatment was financed by Seguro Popular between 2012-2016, was cross-linked to the National Mortality Registry up to December 2019. Patients were classified according to their oncological risk at diagnosis and the marginalization level of the residence municipality. Cox proportional hazards regression was used to estimate multivariable survival functions. Results. Five-years PC survival (69%; 95%CI: 68,71%) ranged from 72% to 54% at very low and very high marginalization, respectively (p for trend<0.001). The lowest PC survival was observed in men with high-risk PC (47%; 95%CI: 33,66%) residents in very high marginalization municipalities. Conclusions. Overall, PC survival was lower than that reported in other Latin American countries. The distribution of oncologic risk and survival differences across marginalization levels suggests limited early detection and cancer health disparities.

Objective: To evaluate the prognostic impact of early recurrence (within 12 months) after surgery on cancer-specific survival (CSS) of patients with localized clear-cell renal cell carcinoma (ccRCC). Methods: Patients with surgically treated localized ccRCC were studied. Using the Kaplan-Meier method, we calculated CSS; by univariate and multivariate models we analyzed the association of early recurrence with cancer-related mortality. Results: We identified 259 patients with pT1–4/NX/0M0 ccRCC treated between February 1981 and September 2009; of 66 (25.5%) with disease recurrence, 29 (43.9%) had early relapse. Overall, 43 patients (16.6%) died from ccRCC. The 5- and 10-year CSS for those without, late and early recurrence was 98.5 and 96.5%, 53 and 39.8%, and 23 and 23%, respectively (p < 0.0001). In the multivariate Cox model, pT stage (p = 0.01) and early recurrence (p < 0.0001) independently predicted CSS. Conclusions: Recurrent disease after localized ccRCC confers a poor prognosis, especially if detected within 12 months after surgery. Thus, this criterion should be included as an independent risk factor for cancer-related mortality.