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1.
Proc Biol Sci ; 290(2001): 20230344, 2023 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-37357858

RESUMO

Ecological theory posits that temporal stability patterns in plant populations are associated with differences in species' ecological strategies. However, empirical evidence is lacking about which traits, or trade-offs, underlie species stability, especially across different biomes. We compiled a worldwide collection of long-term permanent vegetation records (greater than 7000 plots from 78 datasets) from a large range of habitats which we combined with existing trait databases. We tested whether the observed inter-annual variability in species abundance (coefficient of variation) was related to multiple individual traits. We found that populations with greater leaf dry matter content and seed mass were more stable over time. Despite the variability explained by these traits being low, their effect was consistent across different datasets. Other traits played a significant, albeit weaker, role in species stability, and the inclusion of multi-variate axes or phylogeny did not substantially modify nor improve predictions. These results provide empirical evidence and highlight the relevance of specific ecological trade-offs, i.e. in different resource-use and dispersal strategies, for plant populations stability across multiple biomes. Further research is, however, necessary to integrate and evaluate the role of other specific traits, often not available in databases, and intraspecific trait variability in modulating species stability.


Assuntos
Ecossistema , Plantas , Filogenia , Sementes , Fenótipo , Folhas de Planta
2.
Evol Appl ; 14(11): 2618-2634, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34815743

RESUMO

Iberian wild goats (Capra pyrenaica, also known as Iberian ibex, Spanish ibex, and Spanish wild goat) underwent strong genetic bottlenecks during the 19th and 20th centuries due to overhunting and habitat destruction. From the 1970s to 1990s, augmentation translocations were frequently carried out to restock Iberian wild goat populations (very often with hunting purposes), but they were not systematically planned or recorded. On the other hand, recent data suggest the occurrence of hybridization events between Iberian wild goats and domestic goats (Capra hircus). Augmentation translocations and interspecific hybridization might have contributed to increase the diversity of Iberian wild goats. With the aim of investigating this issue, we have genotyped 118 Iberian wild goats from Tortosa-Beceite, Sierra Nevada, Muela de Cortes, Gredos, Batuecas, and Ordesa and Monte Perdido by using the Goat SNP50 BeadChip (Illumina). The analysis of genotypic data indicated that Iberian wild goat populations are strongly differentiated and display low diversity. Only three Iberian wild goats out from 118 show genomic signatures of mixed ancestry, a result consistent with a scenario in which past augmentation translocations have had a limited impact on the diversity of Iberian wild goats. Besides, we have detected eight Iberian wild goats from Tortosa-Beceite with signs of domestic goat introgression. Although rare, hybridization with domestic goats could become a potential threat to the genetic integrity of Iberian wild goats; hence, measures should be taken to avoid the presence of uncontrolled herds of domestic or feral goats in mountainous areas inhabited by this iconic wild ungulate.

3.
Proc Natl Acad Sci U S A ; 117(39): 24345-24351, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32900958

RESUMO

The stability of ecological communities is critical for the stable provisioning of ecosystem services, such as food and forage production, carbon sequestration, and soil fertility. Greater biodiversity is expected to enhance stability across years by decreasing synchrony among species, but the drivers of stability in nature remain poorly resolved. Our analysis of time series from 79 datasets across the world showed that stability was associated more strongly with the degree of synchrony among dominant species than with species richness. The relatively weak influence of species richness is consistent with theory predicting that the effect of richness on stability weakens when synchrony is higher than expected under random fluctuations, which was the case in most communities. Land management, nutrient addition, and climate change treatments had relatively weak and varying effects on stability, modifying how species richness, synchrony, and stability interact. Our results demonstrate the prevalence of biotic drivers on ecosystem stability, with the potential for environmental drivers to alter the intricate relationship among richness, synchrony, and stability.


Assuntos
Plantas/classificação , Sequestro de Carbono , Mudança Climática , Ecossistema , Desenvolvimento Vegetal , Plantas/metabolismo , Solo/química
4.
Nat Commun ; 11(1): 3486, 2020 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-32661354

RESUMO

Local biodiversity trends over time are likely to be decoupled from global trends, as local processes may compensate or counteract global change. We analyze 161 long-term biological time series (15-91 years) collected across Europe, using a comprehensive dataset comprising ~6,200 marine, freshwater and terrestrial taxa. We test whether (i) local long-term biodiversity trends are consistent among biogeoregions, realms and taxonomic groups, and (ii) changes in biodiversity correlate with regional climate and local conditions. Our results reveal that local trends of abundance, richness and diversity differ among biogeoregions, realms and taxonomic groups, demonstrating that biodiversity changes at local scale are often complex and cannot be easily generalized. However, we find increases in richness and abundance with increasing temperature and naturalness as well as a clear spatial pattern in changes in community composition (i.e. temporal taxonomic turnover) in most biogeoregions of Northern and Eastern Europe.


Assuntos
Biodiversidade , Ecossistema , Mudança Climática , Europa (Continente)
5.
PLoS One ; 14(1): e0209972, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30608946

RESUMO

Many large carnivore populations are expanding into human-modified landscapes and the subsequent increase in coexistence between humans and large carnivores may intensify various types of conflicts. A proactive management approach is critical to successful mitigation of such conflicts. The Cantabrian Mountains in Northern Spain are home to the last remaining native brown bear (Ursus arctos) population of the Iberian Peninsula, which is also amongst the most severely threatened European populations, with an important core group residing in the province of Asturias. There are indications that this small population is demographically expanding its range. The identification of the potential areas of brown bear range expansion is crucial to facilitate proactive conservation and management strategies towards promoting a further recovery of this small and isolated population. Here, we used a presence-only based maximum entropy (MaxEnt) approach to model habitat suitability and identify the areas in the Asturian portion of the Cantabrian Mountains that are likely to be occupied in the future by this endangered brown bear population following its range expansion. We used different spatial scales to identify brown bear range suitability according to different environmental, topographic, climatic and human impact variables. Our models mainly show that: (1) 4977 km2 are still available as suitable areas for bear range expansion, which represents nearly half of the territory of Asturias; (2) most of the suitable areas in the western part of the province are already occupied (77% of identified areas, 2820 km2), 41.4% of them occurring inside protected areas, which leaves relatively limited good areas for further expansion in this part of the province, although there might be more suitable areas in surrounding provinces; and (3) in the eastern sector of the Asturian Cantabrian Mountains, 62% (2155 km2) of the land was classified as suitable, and this part of the province hosts 44.3% of the total area identified as suitable areas for range expansion. Our results further highlight the importance of increasing: (a) the connectivity between the currently occupied western part of Asturias and the areas of potential range expansion in the eastern parts of the province; and (b) the protection of the eastern sector of the Cantabrian Mountains, where most of the future population expansion may be expected.


Assuntos
Ecossistema , Animais , Humanos , Espanha , Ursidae
6.
Rev Esp Patol ; 51(4): 232-238, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30269774

RESUMO

INTRODUCTION: Currently, the diagnosis and treatment of prostate cancer requires the pathologist to adopt a fresh approach to the interpretation of biopsies in order to provide the data required for the new forms of therapy. DISCUSSION: The new evaluation criteria of the Gleason system are explained, with the redefinition of histological patterns and degree of malignancy, the incorporation of the so-called prognostic groups and the assessment of the tumour mass. CONCLUSIONS: Updating of histopathological information helps to improve patient management, especially in cases of tumour confined to the prostate, given the possibility of local therapy.


Assuntos
Adenocarcinoma/patologia , Biópsia por Agulha/métodos , Gradação de Tumores , Neoplasias da Próstata/patologia , Adenocarcinoma/cirurgia , Humanos , Masculino , Gradação de Tumores/tendências , Prostatectomia , Neoplasias da Próstata/cirurgia , Carga Tumoral , Ultrassonografia de Intervenção
7.
PLoS One ; 11(2): e0148632, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26849356

RESUMO

The Pyrenean rock ptarmigan (Lagopus muta pyrenaica) is the southernmost subspecies of the species in Europe and is considered threatened as a consequence of changes in landscape, human pressure, climate change, and low genetic diversity. Previous studies have shown a relationship between the date of snowmelt and reproductive success in the Pyrenean ptarmigan. It is well established that birds laying early in the breeding season have higher reproductive success, but the specific mechanism for this relationship is debated. We present an explicative model of the relationship between snowmelt date and breeding success mediated by food quality for grouse in alpine environments. From microhistological analyses of 121 faecal samples collected during three years in the Canigou Massif (Eastern Pyrenees), and the assessment of the chemical composition of the main dietary components, we estimated the potential quality of individual diets. Potential dietary quality was correlated with free-urate faecal N, a proxy of the digestible protein content ingested by ptarmigan, and both were correlated with phenological stage of consumed plants, which in turn depends on snowmelt date. Our findings suggest that the average snowmelt date is subject to a strong interannual variability influencing laying date. In years of early snowmelt, hens benefit from a longer period of high quality food resources potentially leading to a higher breeding success. On the contrary, in years of late snowmelt, hens begin their breeding period in poorer nutrient condition because the peaks of protein content of their main food items are delayed with respect to laying date, hence reducing breeding performance. We discuss the possible mismatch between breeding and snowmelt timing.


Assuntos
Ecossistema , Galliformes/fisiologia , Modelos Biológicos , Reprodução/fisiologia , Animais , Europa (Continente) , Feminino , Humanos , Masculino
8.
PLoS One ; 11(2): e0148614, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26863532

RESUMO

The Pyrenean rock ptarmigan (Lagopus muta pyrenaica) lives at one of the southernmost limits of the ptarmigan range. Their small population sizes and the impacts of global changes are limiting factors in the conservation of this threatened subspecies. An effective conservation policy requires precise basic knowledge of a species' food and habitat requirements, information that is practically non-existent for this Pyrenean population. Here, we describe the diet of a ptarmigan population in the Eastern Pyrenees, the environmental factors influencing its variability and the relationship between diet floristic composition and quality. Diet composition was determined by microhistological analysis of faeces and diet quality was estimated from free-urate faecal N content. Our results show that grouse diet is based mainly on arctic-alpine shrubs of the Ericaceae family, as well as dwarf willows (Salix spp.) and Dryas octopetala. The most frequently consumed plant species was Rhododendron ferrugineum, but its abundance in the diet was negatively related to the diet nitrogen content. Conversely, the abundance of Salix spp., grass leaves and arthropods increased the nitrogen content of the diet. Seasonality associated with snow-melting contributed the most to variability in the Pyrenean ptarmigan diet, differentiating winter from spring/summer diets. The latter was characterised by a high consumption of dwarf willows, flowers, arthropods and tender forb leaves. Geographic area and sex-age class influenced diet variability to a lesser extent. Current temperature increases in the Pyrenees due to global warming may reduce the persistence and surface area of snow-packs where preferred plants for rock ptarmigan usually grow, thus reducing food availability. The high consumption of Rh. ferrugineum characterised the diet of the Pyrenean population. Given the toxicity of this plant for most herbivores, its potential negative effect on Pyrenean ptarmigan populations should be evaluated.


Assuntos
Conservação dos Recursos Naturais , Comportamento Alimentar/fisiologia , Galliformes/fisiologia , Herbivoria/fisiologia , Altitude , Animais , Dieta , Ecossistema , Ericaceae/crescimento & desenvolvimento , Fezes/química , Feminino , França , Masculino , Rhododendron/crescimento & desenvolvimento , Rosaceae/crescimento & desenvolvimento , Salix/crescimento & desenvolvimento , Estações do Ano , Neve , Espanha
9.
Arch Esp Urol ; 69(10): 669-673, 2016 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-28042788

RESUMO

Desde que D. F. Gleason creara su sistema en 1966 (1 ) y que él mismo modificó en 1974 (2), su método ha sido universalmente aceptado y recomendado por la OMS (3)como factor pronóstico del carcinoma prostático (CaP). Pero, la generalización de la prueba del PSA a partir de 1979 (4), del desarrollo de la TRUS (5) y de la "biopty-gun" para la toma de biopsias en sextantes en los años 80 (6), y sus posteriores modificaciones, son hechos que han cambiado paulatinamente la postura ante el CaP y, con la experiencia adquirida, algunas de las reglas iniciales de Gleason han evolucionado. Aunque se publicaron varios estudios que proponían cambios en el sistema (7), solo los de la ISUP de 2005 (8), han tenido trascendencia real. En ellos se reconsideran algunos de los criterios para identificar aquellos tumores con un patrón histolgico de alto grado (patrón 4 o 5), redefiniendo estos patrones del sistema Gleason.


Assuntos
Neoplasias da Próstata/patologia , Carga Tumoral , Humanos , Masculino , Gradação de Tumores , Prognóstico
13.
Arch Esp Urol ; 59(4): 397-406, 2006 May.
Artigo em Espanhol | MEDLINE | ID: mdl-16800137

RESUMO

OBJECTIVES: Although transrectal ultrasound-guided (TRUS) prostatic biopsy is the procedure of choice for the diagnosis of prostate cancer (PC), neither the ideal number of cores nor the number of repeated biopsies, nor the required diagnostic yield have been established. After our experience of ten years with TRUS biopsy we perform a review of the technique and its indications. METHODS: PSA, ultrasound features, and pathologic data of 6000 patients undergoing modified sextant TRUS biopsy between 1994 to December 2002 were collected. 222 patients undergoing ten-core TRUS biopsy were included in an experimental group to study the role of the extended biopsy. The contribution of the extra cores to the diagnostic yield in the experimental group was studied to determine the effectiveness of the extended biopsy, using as a control group 552 patients undergoing sextant TRUS biopsy during 2002. Both groups were comparable for the study variables at the start of the study. RESULTS: The incidence of PC in the first biopsy in the group of 6000 patients was 39.1% (2345/6000). Patients with PSA between 4 and 10 ng/ml have an incidence of PC greater than 50% among prostates smaller than 20 cc, diminishing down to 8.9% in those greater than 50 cc. The percentage of PC among patients with negative digital rectal examination (DRE), normal TRUS, and PSA below 4 ng/ml was 16.7%. The diagnostic yield for PSA density lower than 0.11 ng/ml/cc was lower than 8%. The free/total PSA ratio shows a 13.7% incidence of PC with values higher than 0.24. Multivariate logistic regression analysis showed that the only non-significant parameter was free/total PSA. Sixty (27.15%) patients of the extended TRUS biopsy group had PC. Only 2.25% of the 221 patients benefited from the augmented number of biopsies. There were no significant differences in the figures of prostate cancer between groups. Only PSA and volume where significant in the multivariate logistic regression analysis; number of samples, PSA density and age lacked of influence in the detection of PC. CONCLUSIONS: The sextant biopsy model obtaining cores from the lateral horns of the prostate continues to be the reference for TRUS biopsy, and the extended biopsy is not applicable to all patients from the beginning do to the small increase in the diagnostic yield. Isolated PSA may not be the unique reference to indicate TRUS biopsy, being volume, in our experience, a definitive factor for the adjustment of high risk levels.


Assuntos
Biópsia por Agulha/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Reto , Fatores de Tempo , Ultrassonografia/métodos
14.
Arch Esp Urol ; 59(1): 15-24, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-16568689

RESUMO

OBJECTIVES: The number of biopsy samples for a proper prostate cancer diagnosis has not yet been established. We report our experience with the 10-sample extended biopsy. METHODS: We collected the results of a group of 222 patients undergoing extended ultrasound guided prostate biopsy with 10 samples. In addition to the sextant biopsies 2 extra samples were obtained from the dorsal-apex area on each lobe. Results of this group were compared with a control group of 552 patients undergoing sextant biopsy in 2002 with the same inclusion in criteria. RESULTS: 60 patients had cancer (27.15%). The extra samples gave the diagnosis in 5 out of 60 patients, 8.33% of the tumors and 2.25% of all patients. Control group showed cancer in 24.5%, not having the difference statistical significance. The incidence in prostates smaller than 20 cc was 69.2%, 11.6% in prostates bigger than 50 cc. 80% of the patients with prostate cancer only in the extra samples have a volume smaller than 35 cc. Multivariate logistic regression study for the probability of prostate cancer only showed association with serum PSA and prostate volume but not with the number of samples. CONCLUSIONS: The extended biopsy is not indicated as an initial diagnostic technique, being reserved for specific cases such as repeated biopsies in patients with high risk pathology reports. Neither it is indicated in the bigger volume prostates.


Assuntos
Neoplasias da Próstata/patologia , Adulto , Idoso , Biópsia/métodos , Biópsia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
15.
Arch Esp Urol ; 58(7): 623-34, 2005 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-16294784

RESUMO

OBJECTIVES: We review the results of 6000 patients with the clinical suspect of prostate cancer who underwent one or more prostate, biopsies, analyzing the role of PSA derived parameters in the probability of having prostate cancer in the TRUS biopsy. METHODS: We selected 6000 patients who under- went TRUS biopsy between 1994 and 2002. 861 of them underwent more than one is biopsy, adding up to a total of 7127 biopsies. For the study of PSA derived indexes we established ranges based on the 10th percentile for the first biopsy for all patients and also for those with PSA between 4 and 10 ng/ml. Several predictive models were determined by logistic regression of the variables related with presence/no presence of cancer. RESULTS: For first biopsies the ranges of PSAD established showed a diagnostic effectiveness below 8% with PSA densities lower than 0.11 ng/ml/cc. The free/total PSA ratio is less discriminant in the ranges obtained with a 13.7% incidence of prostate cancer for values above 0.24. In the case of second biopsies the group of patients with PSAD below 0.12 had only a 5.3% incidence, and only one patient with F/T PSA ratio higher than 0.24 had a prostate cancer (2.9%). All studied parameters but F/T PSA ratio showed statistical significance in the multivariant analysis. CONCLUSIONS: Although the establishment of a cut point for PSAD diminishes sensitivity, prostate biopsy habits should be modified assuming the loss of tumors in patients with low PSAD and increasing the number of biopsies in patients with total PSA values below 4 ng/ml with higher densities.


Assuntos
Neoplasias da Próstata/diagnóstico , Biópsia/métodos , Humanos , Masculino , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Reto , Ultrassonografia
17.
Arch Esp Urol ; 58(10): 989-1001, 2005 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-16482850

RESUMO

OBJECTIVES: The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles. METHODS: A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events. RESULTS: The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p < 0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p < 0.0002). The results of the visual analogical scale for pain were 2.46 +/- 1.67 and 4.5 +/- 2.11 for the anesthesia/without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission. CONCLUSIONS: The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain.


Assuntos
Anestésicos Locais/uso terapêutico , Biópsia/efeitos adversos , Biópsia/métodos , Lidocaína/uso terapêutico , Bloqueio Nervoso , Dor/prevenção & controle , Próstata/diagnóstico por imagem , Próstata/patologia , Biópsia/estatística & dados numéricos , Humanos , Masculino , Dor/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reto , Inquéritos e Questionários , Ultrassonografia
18.
Arch Esp Urol ; 58(10): 1003-29, 2005 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-16482851

RESUMO

OBJECTIVES: To perform a bibliographic review of the main features of cryotherapy as a therapeutic option in the monagemente of prostate cancer and to report our initial experience. METHODS: We employed the Endocare Fast-Trac system (Medipro) with 2.4 mm needles implanted in a single maneouvre without rack or transrectal U.S. transducer support. Two cycles of freezing thawing were employed, with apex backward movement when necessary. Freezing cycle duration was between 7-10 minutes or more. The Onik maneouvre--injection of saline into the Denonvillier's space-diminishes the risk of rectal injury and fistula allowing reaching posterior limits of the icaball beyond the prostatic capsule. RESULTS: We treated 20 patients. Follow-up was between 3036 months. 58% of the patients had unilateral prostate cancer, 42% bilateral. In accordance to the classic definition 9 patients were classified as low risk of extraprostatic disease, 6 medium risk and 5 high risk; using number of positive cores as the criterion for risk 5, 6 and 9 were low, medium and high risk respectively. Per protocol prostate biopsies were performed in 18 patients 6, 12 and 24 months after treatment. Two patients underwent a second treatment due to persistence of cancer cells in the 6-month biopsy (11%). 3-month PSA nadirs after a total of 21 cryo treatments administered were < 0,2 ng/cc in 15 cases (78.9%), < 0.5 ng/cc in 17 (89.4%) and < or = 1.0 ng/cc in 18 (94.7%); it was over 1 ng/cc in only 5.6%. 30 month PSA for the same cutoff values was 27.8%, 50.0%, 66.6% and 33.3%, respectively. Prostate cancer cells were detected in the 12-month biopsies of 5.5% cases. All 24-month biopsies were negative. COMPLICATIONS: We observed scrotal edema, hematoma, perineal pain and constipation which lasted 2-3 weeks. 1 patient suffered injury of the mucosa at the prostatic urethra, which did not result in rectal fistula and was treated with bladder catheter for 3 months. 4 patients had erectile dysfunction before treatment. All others presented erectile dysfunction after treatment; 3 of them (20%) recovered rigidity enough to have intercourse over the 30 month period. No urethral sloughing or acute urinary retention appeared and all patients are continent. CONCLUSIONS: Prostatic cryosurgery is an effective, minimally invasive procedure for the treatment of prostate cancer with very low surgical risk, low morbidity and almost null mortality.


Assuntos
Criocirurgia , Neoplasias da Próstata/cirurgia , Idoso , Criocirurgia/efeitos adversos , Árvores de Decisões , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Índice de Gravidade de Doença
19.
Arch Esp Urol ; 58(9): 873-97, 2005 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-16430036

RESUMO

OBJECTIVES: To perform a bibliographic review of the main features of cryotherapy as a therapeutic option in the managemente of prostate cancer and to report our initial experience. METHODS: We employed the Endocare Fast-Trac system (Medipro) with 2,4 mm needles implanted in a single maneouvre without rack or transrectal US transducer support. Two cycles of freezing--hawing were employed, with apex backward movement when necessary. Freezing cycle duration was between 7-10 minutes or more. The Onik maneouvre-injection of saline into the Denonvillier's space--diminishes the risk of rectal injury and fistula allowing reaching posterior limits of the ica-ball beyond the prostatic capsule. RESULTS: We treated 20 patients. Follow-up was between 30-36 months. 58% of the patients had unilateral prostate cancer, 42% bilateral. In accordance to the classic definition 9 patients were classified as low risk of extraprostatic disease, 6 medium risk and 5 high risk; using number of positive cores as the criterion for risk 5, 6 and 9 were low, medium and high risk respectively. Per protocol prostate biopsies were performed in 18 patients 6, 12 and 24 months after treatment. Two patients underwent a second treatment due to persistence of cancer cells in the 6-month biopsy (11%). 3-month PSA nadirs after a total of 21 cryo treatments administered were < 0,2 ng/cc in 15 cases (78,9%), < 0,5 ng/cc in 17 (89,4%) and < or = 1.0 ng/cc in 18 (94,7%); it was over 1 ng/cc in only 5,6%. 30 month PSA for the same cutoff values was 27.8%, 50.0%, 66.6% and 33.3%, respectively. Prostate cancer cells were detected in the 12-month biopsies of 5.5% cases. All 24-month biopsies were negative. COMPLICATIONS: We observed scrotal edema, hematoma, perineal pain and constipation which lasted 2-3 weeks. 1 patient suffered injury of the mucosa at the prostatic urethra, which did not result in rectal fistula and was treated with bladder catheter for 3 months. 4 patients had erectile dysfunction before treatment. All others presented erectile dysfunction after treatment; 3 of them (20%) recovered rigidity enough to have intercourse over the 30 month period. No urethral sloughing or acute urinary retention appeared and all patients are continent. CONCLUSIONS: Prostatic cryosurgery is an effective, minimally invasive procedure for the treatment of prostate cancer with very low surgical risk, low morbidity and almost null mortality.


Assuntos
Adenocarcinoma/cirurgia , Crioterapia , Neoplasias da Próstata/cirurgia , Adenocarcinoma/radioterapia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/radioterapia , Falha de Tratamento
20.
Arch Esp Urol ; 58(9): 903-13, 2005 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-16430038

RESUMO

OBJECTIVES: The limitations of PSA to identify patients with prostate cancer prompted the definition of different parameters trying to increase specificity without reducing sensitivity. This paper studies the relationship of volume and presence of prostate cancer in sextant biopsies. METHODS: We collected the results of prostate biopsies performed to 6000 patients between 1994 and 2002. 861 of them underwent more than one biopsy, adding up for a total of 7127 biopsies. Various predictive models to identify factors related to positive biopsy were constructed. RESULTS: Mean prostate volume is 14.6 +/- 66.2 cc for the first biopsy, increasing in successive biopsies to 85.17 cc. A high incidence of prostate cancer was observed in small prostates, reaching 67.2% of those with normal size (< 20 cc) and diminishing with the increase of volume down to only 19.7% in those larger than 50 cc (p < 0.0001). In second biopsies of patients with PSA between 4 and 10 ng/ml and gland volume higher than 50 cc percentage of biopsies positive for cancer was below 10%. Multivariant logistic regression showed that PSA, volume and PSA density were related with positive biopsies, but not free/total PSA ratio. CONCLUSIONS: Standard PSA cutoffs are not adequate for a proper diagnosis of prostate cancer by ultrasound guided transrectal biopsy Volume (BPH) has a significant influence in PSA values and results of the biopsy, so that it should be taken into consideration when indicating biopsies.


Assuntos
Antígeno Prostático Específico/sangue , Próstata/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Biópsia por Agulha/métodos , Humanos , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Ultrassonografia
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