Second brazilian consensus on the treatment of advanced prostate cancer: a SBOC-SBU-SBRT panel review

ABSTRACT Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

Second brazilian consensus on the treatment of advanced prostate cancer - a SBOC-SBU-SBRT panel review.

Prostate cancer is the second most common cancer and the fi fth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The fi rst Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

Do proliferating cell nuclear antigen and MIB-1/Ki-67 have prognostic value in penile squamous cell carcinoma?

OBJECTIVES: To evaluate the role of proliferating cell nuclear antigen (PCNA) and MIB-1/Ki-67 immunohistochemical expression in predicting lymph node metastasis and survival in primary penile squamous cell carcinoma. METHODS: We conducted a retrospective evaluation of 125 patients with penile squamous cell carcinoma submitted to primary tumor treatment, with information on lymph node status. Clinical and pathologic data for PCNA and MIB-1/Ki-67 expression in the primary tumor were analyzed. Correlations between these data and lymph node metastasis risk and survival were calculated. RESULTS: In univariate analysis, low MIB-1/Ki-67 expression, the presence of lymphovascular permeation, clinically positive lymph nodes, tumor thickness greater than 5 mm, and infiltration of cavernous bodies were correlated with lymph node metastasis. However, the independent factors for lymph node metastasis risk were PCNA and MIB-1/Ki-67 immunoreactivity, lymphovascular permeation, and N clinical stage. Independent variables for disease-free survival were urethra infiltration and the presence of lymph node metastasis. For death risk evaluation the independent variables were age, lymph node metastasis, and clinical stage. CONCLUSIONS: There was a correlation between PCNA and MIB1/Ki-67 immunohistochemical expression and the presence of lymph node metastasis. However, PCNA and MIB1/Ki-67 immunohistochemical expression did not have a relationship with survival and death risk.

Front pattern of invasion in squamous cell carcinoma of the penis: new prognostic factor for predicting risk of lymph node metastases.

OBJECTIVES: Treatment of penile carcinoma is based on excision of the primary tumor and regional lymphadenectomies. Lymph node metastasis is the most important prognostic factor, yet it cannot be reliably evaluated by imaging studies or clinical examinations; thus, new prognostic factors such as the pattern of invasion must be investigated. METHODS: The data of 112 patients with penile carcinoma who underwent amputation and lymphadenectomy were analyzed. The clinicopathologic variables were studied, in addition to the front pattern of invasion according to the standards established by the modified criteria of Anneroth and Bryne first used as a part of a prognostic score in squamous cell carcinoma of the oral cavity. The pattern of invasion expresses the tumor-host tissue relationship, demonstrating the infiltrative tumor characteristics. This pattern was defined as infiltrating (invasion in blocks of small solid strands of cell tumors that broadly infiltrated the organ's stroma) and pushing infiltration (tumor cells have invaded large cell blocks with well-defined tumor-host interfaces). RESULTS: The variables that were significantly associated with the presence of lymph node metastases on univariate analysis were clinical N stage (P = 0.011), lymphatic permeation (P <0.001), venous embolization (P = 0.025), and the pattern of invasion (P <0.001). In the multivariate model, the lymphatic permeation, clinical N stage, and invasion type were independent risk factors for lymph node metastases. The follow-up varied from 0.1 to 452.8 months (mean 76.9, median 27.3). CONCLUSIONS: Lymphatic permeation, clinical N stage, and standard infiltrating invasion were independent prognostic variables for the risk of lymph node metastasis.