He has just been appointed coordinator of the uro-oncology group of the Spanish Association of Urology. Who is part of it?
The group is made up of urologists who are dedicated to both the care work and the research of genitourinary tumors, mainly those of the prostate, kidney or bladder, which are the most common, although there are other less common tumors such as those of the testicles or penis. . Therefore, all Spanish urologists who focus their care and research activity on this type of tumors, both in localized disease and in the metastatic phase, belong to it.
How many people make it up?
I cannot give an exact figure because the group is part of the association, but the annual meetings are usually attended by around four hundred specialists. It is the strongest group because of everything it implies in terms of the prevalence of cancer and because of the repercussions that this has at the level of care, both in the surgical and medical part, since as surgical doctors we are also in charge of the treatment, diagnosis and follow-up of advanced disease.
What challenges do you face?
The group’s obligation is to promote continuous training because it is an area of continuous change and constant evolution, so one of our main tasks is to promote this training through courses, meetings and other initiatives that promote this training, the most up-to-date, because That ends up being reflected in better patient care. My goal for these four years is to expand the master’s degrees we have with the University of Salamanca and vindicate the role of the specialty because it is largely unknown to the general population.
What do you mean by urology being largely unknown?
At least it is in terms of our powers. There are areas in which we work collaboratively with other services such as radiotherapy or medical oncology, but all diagnoses start from urology. If a patient has blood in the urine and bladder cancer is detected, the diagnosis is made by the urologist and the first treatment and guidance, too, and the same with prostate cancer. It is important to claim the role of urology in coordination with other scientific societies and patient associations, whose work is very relevant.
Speaking of prostate cancer, whose World Day is commemorated this Tuesday. What would it affect in the fight against this type of tumor?
Precisely one of our projects is a campaign to prevent and diagnose these tumors early because when they are diagnosed early and localized, survival is very high. These campaigns are really very useful and we are increasingly moving towards these strategies, since logically when it is detected late, although we have treatments that in some cases in the medium term will allow us to make the disease chronic, survival rates drop by around 30 %, five years on average.
Any prevention factors that help avoid its development?
The literature in this regard is controversial and there is a lot of confusion, but it is clear that the classic factors for any type of cancer influence, although excluding smoking, where there is a direct association, it does not exist with the rest. Perhaps the prostate is not where it is clearest, but in the bladder, smoking is a brutal risk factor, it increases greatly among smokers. Therefore, the recommendations are those aimed at oncological and cardiological health in general: balanced diet, healthy lifestyle, and not consuming alcohol or tobacco.
Are they being screened for prostate cancer?
No. Work is being done by the European association and there are several projects to demonstrate the real impact and clinical benefit that these population screening policies have on prostate cancer. It is not about doing a continuous and annual PSA on all patients, but rather using these data from tests or MRIs to decide which patient should have intensified monitoring and which one can relax. Our opinion as a scientific society is that we should do these screenings between the ages of 50 and 70, individualizing the risk based on family history or mutations that predispose to greater risk.
Is its prevalence in the CHUS similar to that of the rest of Spain?
It is similar, with nuances. The older the population, the higher the incidence, and early diagnosis also influences because the more you monitor, the more you will find.
Where are you in terms of therapeutic options?
Much progress has been made. In the localized part, when it is curable, the entire prostate can be removed with very little aggression for the patient and with very few functional consequences, be it incontinence or erectile dysfunction. In Galicia, seven robots were incorporated into the main hospitals, and in the hands of a good surgeon they optimize the results, with undoubted benefits. The acquisition of new equipment in radiation oncology also allows for much more precise treatments with less toxicity in the advanced cancer phase. Added to this are therapies with a significant socioeconomic impact, but whose survival benefit is undoubted.
A promising horizon…
The advances make us optimistic, thinking about personalized medicine in which, with the genetic map of these patients, we can know their mutations and attack them directly.
“I am proud that Santiago is a pioneer in endourological surgery at the national level and an international reference”
What would you highlight at the research level about your unit at CHUS?
In the clinical part we have access to all the new technologies and treatments, and what we are looking for is that it does not take so long to be able to transfer a trial to the patient due to regulatory issues. We are doing basic research on genetic studies and to better understand the biology of the tumor, a field in which CHUS oncology is very notable, pioneers in everything related to liquid biopsy and other types of analysis. And in the Spanish association we want a public registry of trials to open it to patients from all hospitals.
His team was the first in Spain to perform percutaneous kidney surgery on a pregnant woman in December. Has there been any other intervention since then?
The truth is that at the moment we have not had any similar case again, among other things because it is very rare, but we are prepared to address this type of challenge, just as when pregnant women with a High complexity. The important thing is that the girl was born without sequelae, which was also our goal, in addition to leaving the mother’s kidney useful and free of stones.
A pioneering intervention, of which only fifteen others had been done around the world, in the public health system of Santiago.
Yes, it is one of the things that I am most proud of, that within endourological surgery we are pioneers at a national level and international leaders in public health. Logically, the system is not perfect, but great things are done, also in Santiago. I have performed surgeries and taught techniques in many countries on different continents, and I always carry a photo of my adopted city. I am from Ourense, but I have lived in Compostela since I was 18, and I like that it appears in all the presentations as a reference. We have even given the name of Santiago to a technique for operating on kidney stones, the SCQ-Score.