RESUMO
The purpose of this study is to validate the Brazilian version of Functional Assessment of Cancer Therapy-Prostate FACT-P (version 4) in nonmetastatic prostate cancer (PC) patients. Patients with histopathological diagnosis of PC were submitted to health-related quality of life (HRQOL) questionnaires - SF-36 (Medical Outcomes Study 36 - Item Short-Form Health Survey) and FACT-P (version 4). After 7 to 15 days, FACT-P (version 4) was reapplied in the sample's percentage that participated the first evaluation. Cronbach alpha coefficient was used to determine internal consistency and intraclass correlation coefficient (ICC) certified stability. Correlations between FACT-P (version 4) and SF-36 tested convergent validity. Regarding known groups validity, the hypothesis tested was that FACT-P (version 4) is capable of discriminating HRQOL in patients with different PC risk classifications. A total of 112 patients with nonmetastatic PC were evaluated. Cronbach alpha coefficients (0.64-0.88) and ICC (0.75-0.93) obtained satisfactory results of reliability. Verified correlations (r 0.3-0.72) between FACT-P (version 4) and SF-36 suggest convergent validity. In the studied sample, FACT-P (version 4) was unable to discriminate HRQOL in nonmetastatic patients. The Brazilian version of FACT-P questionnaire (version 4) showed evidences of reliability and validity on evaluating HRQOL in Brazilian men with nonmetastatic PC.
Assuntos
Neoplasias da Próstata , Qualidade de Vida , Masculino , Humanos , Brasil , Reprodutibilidade dos Testes , Próstata , Inquéritos e Questionários , Neoplasias da Próstata/terapia , Psicometria/métodosRESUMO
INTRODUCTION: In view of the detailed histologic evaluation of prostate cancer (PC), it is usually advisable to provide a "second opinion" to confirm diagnosis. This study aimed to compare the Gleason score (GS) of initial diagnosis versus that of histopathologic review of patients with PC. The secondary objective was to compare initial GS versus histopathologic review versus post - surgical histopathology. MATERIAL AND METHODS: Retrospective study based on chart review of patients with PC that attended the Uro - oncology Department of Hospital das Clínicas - UNICAMP - Campinas, Brazil, from April, 2002, to April, 2012. Data were divided in groups: patients with biopsies performed elsewhere, biopsies after pathological review and histopathological results following retropubic radical prostatectomy (RRP). These were evaluated in relation to GS difference using Fleis's Kappa concordance coefficient. RESULTS: 402 PC patients, with a median age of 66 years, were evaluated. Reviewed GS showed worsening, with accuracy of 61.2%, and Kappa concordance value = 0.466. Among 143 patients submitted to surgery, GS varied widely, regarding initial evaluation, review and post - surgical RRP. Joint concordance of evaluations was weak (Kappa = 0.216), mainly due to almost no existence concordance between initial evaluation and following RRP (Kappa = 0.041). CONCLUSION: There is a great histopathological variation of initial GS versus reviewed GS. There is also a better correlation of reviewed GS and post - surgical GS than with initial GS. The second opinion by an uropathologist improves diagnosis and should be advised for better therapeutic decision.
Assuntos
Próstata/patologia , Neoplasias da Próstata/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Próstata/cirurgia , Prostatectomia , Neoplasias da Próstata/cirurgia , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
INTRODUCTION AND OBJECTIVES: Reactive Stroma (RStr) is observed in many human cancers and is related to carcinogenesis. The objectives of the present study were to stablish a relationship of the RStr microenvironment with prostate cancer (Pca) through a morphological and molecular characterization, and to identify a possible relationship between RStr with worse prognosis factors and occurrence of malignant prostatic stem cells. MATERIALS AND METHODS: Forty prostatic samples were selected from men with Pca diagnosis submitted to radical prostatectomy; they were divided in two groups: Group-1 (n=20): samples without reactive stroma; Group-2 (n=20): samples of PCa with intense stroma reaction. Prostatic samples were evaluated for RStr intensity by Masson Trichromic stain and posteriorly submitted to histopathological and immunohistochemistry analysis for antigens: a-actin, vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA, AR, Era and ERß. RESULTS: Reactive stroma with intense desmoplastic reactivity was significantly more frequent in intermediate (Gleason 7, 3+4) and high grade tumors (Gleason 7, 4+3). The group with intense stromal reactivity showed significant higher levels of Vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA and ERa. CONCLUSIONS: It can be concluded that RStr may be a predictive marker of Pca progression, since it was associated with increase of growth factors, imbalance of androgen and estrogen receptors and presence of malign prostatic stem cells.
Assuntos
Adenocarcinoma/patologia , Células Epiteliais/patologia , Células-Tronco Neoplásicas/patologia , Neoplasias da Próstata/patologia , Células Estromais/patologia , Actinas/análise , Adenocarcinoma/química , Idoso , Idoso de 80 Anos ou mais , Antígenos de Neoplasias/análise , Biomarcadores Tumorais/análise , Proteínas de Ligação a DNA/análise , Progressão da Doença , Células Epiteliais/química , Receptor alfa de Estrogênio/análise , Fator 2 de Crescimento de Fibroblastos/análise , Proteínas Ligadas por GPI/análise , Humanos , Imuno-Histoquímica , Fator de Crescimento Insulin-Like I/análise , Masculino , Metaloproteinase 2 da Matriz/análise , Pessoa de Meia-Idade , Gradação de Tumores , Proteínas de Neoplasias/análise , Células-Tronco Neoplásicas/química , Neoplasias da Próstata/química , Células Estromais/química , Fatores de Transcrição/análise , Microambiente Tumoral , Vimentina/análiseRESUMO
Non-obstructive azoospermia (NOA) is the most severe form of male factor infertility. It results form from either primary or secondary testicular failure. Here, we report cases of two patients with NOA due to maturation arrest and increased serum FSH, treated with GnRH agonist and gonadotrophins. The two NOA patients underwent a pharmacological treatment consisting of pituitary desensibilization using a GnRH agonist and testicular stimulation using menotropin. Testicular stimulation started one month after the beginning of GnRH agonist treatment. The female partner underwent controlled ovarian stimulation (COS) followed by intracytoplasmic sperm injection (ICSI). On the third day of the cycle, menotropin daily doses was administered. When at least one follicle ≥14 mm was visualized, pituitary blockage was performed using GnRH antagonist ganirelix. When three or more follicles attained a mean diameter of ≥17 mm, triptorelin acetate was administered to trigger final follicular maturation. Oocyte retrieval was performed 35 hours later. After treatment, male partner blood levels of the FSH, LH, decreased and total testosterone were increased. Spermatozoa was observed after semen collection in both cases. After COS, oocytes were retrieved and ICSI was performed. Embryos were biopsied for preimplantation genetic testing (PGT) and those considered euploidy were transferred resulting in positive implantation, ongoing pregnancy, and livebirth on both cases. In this report we present a successful strategy for hypergonadotropic hypogonadism AOA men, as an alternative approach to the surgical testicular sperm recovery. Nevertheless, prospective randomized trials are needed to confirm our findings.
Assuntos
Azoospermia , Hormônio Liberador de Gonadotropina , Hipogonadismo , Feminino , Humanos , Masculino , Gravidez , Azoospermia/tratamento farmacológico , Hormônio Liberador de Gonadotropina/agonistas , Gonadotropinas/uso terapêutico , Hipogonadismo/tratamento farmacológico , Nascido Vivo , Indução da Ovulação/métodos , Injeções de Esperma IntracitoplásmicasRESUMO
OBJECTIVE: Systematic review of literature and meta-analysis to evaluate the results of magnetic resonance image 1.5T with endorectal coil in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer, compared to the histopathological results of the radical prostatectomy specimen. MATERIALS AND METHODS: It was conducted a systematic review of literature and meta-analyses of all studies data published after 2008. In those studies, the patients with prostate cancer with indication to radical prostatectomy were submitted to magnetic resonance image (MRI) at pre-operatory period and the results were compared to those of histopathological studies after the surgery. The selected terms for research included prostate cancer, magnetic resonance, radical prostatectomy, and prostate cancer diagnosis, in the databases EMBASE, LILACS, PUBMED/MEDLINE and Cochrane Library. The data were collected using a specific qualitative instrument and the meta-analysis data were presented in the forest plot graphics, homogeneity test and sROC curves and funnel plot. RESULTS: A total of seven studies were included, with a total of 603 patients. Among these studies, six evaluated the value of MRI for the detection of prostate cancer, and the median sensitivity of meta-analysis was 0.6 and specificity 0.58, but with heterogeneity among the studies. Three studies evaluated extra-prostatic extension with a median sensitivity of 0.49, specificity 0.82 and heterogeneity only for sensitivity. Three studies evaluated invasion of seminal vesicles, with median sensitivity of 0.45 and specificity 0.96, with heterogeneity in both analysis. CONCLUSION: Magnetic resonance of 1.5T with endocoil showed low values of sensitivity and specificity for the diagnosis and staging of prostate cancer. The reviewed studies showed a significant heterogeneity among them. The best observed result was MRI specificity for invasion of seminal vesicles. More studies are necessary to evaluate new techniques and parameters before recommending the routine use of MRI in clinical practice.
Assuntos
Imageamento por Ressonância Magnética/métodos , Próstata/patologia , Neoplasias da Próstata/patologia , Glândulas Seminais/patologia , Humanos , Masculino , Prostatectomia , Neoplasias da Próstata/cirurgia , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Zoophilia has been known for a long time but, underreported in the medical literature, is likely a risk factor for human urological diseases. AIM: To investigate the behavioral characteristics of sex with animals (SWA) and its associations with penile cancer (PC) in a case-control study. METHODS: A questionnaire about personal and sexual habits was completed in interviews of 118 PC patients and 374 controls (healthy men) recruited between 2009 and 2010 from 16 urology and oncology centers. MAIN OUTCOME MEASURES: SWA rates, geographic distribution, duration, frequency, animals involved, and behavioral habits were investigated and used to estimate the odds of SWA as a PC risk factor. RESULTS: SWA was reported by 171 (34.8%) subjects, 44.9% of PC patients and 31.6% of controls (P < 0.008). The mean ages at first and last SWA episode were 13.5 years (standard deviation [SD] 4.4 years) and 17.1 years (SD 5.3 years), respectively. Subjects who reported SWA also reported more venereal diseases (P < 0.001) and sex with prostitutes (P < 0.001), and were more likely to have had more than 10 lifetime sexual partners (P < 0.001) than those who did not report SWA. SWA with a group of men was reported by 29.8% of subjects and SWA alone was reported by 70.2%. Several animals were used by 62% of subjects, and 38% always used the same animal. The frequency of SWA included single (14%), weekly or more (39.5%), and monthly episodes (15%). Univariate analysis identified phimosis, penile premalignancies, smoking, nonwhite race, sex with prostitutes, and SWA as PC risk factors. Phimosis, premalignant lesions, smoking, and SWA remained as risk factors in multivariate analysis. However, SWA did not impact the clinicopathological outcomes of PC. CONCLUSION: SWA is a risk factor for PC and may be associated with venereal diseases. New studies are required in other populations to test other possible nosological links with SWA.
Assuntos
Transtornos Parafílicos/complicações , Neoplasias Penianas/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Brasil , Estudos de Casos e Controles , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Profissionais do Sexo , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/complicações , Inquéritos e Questionários , Adulto JovemAssuntos
Neoplasias da Próstata/cirurgia , Medicina Baseada em Evidências , Seguimentos , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Antígeno Prostático Específico , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Medição de Risco , Carga Tumoral , Ultrassom Focalizado Transretal de Alta Intensidade/métodosRESUMO
OBJECTIVE: To evaluate psychological and demographic aspects of men who received DRE during the PCa screening in an outpatient clinical setting. METHODS: Patients (345) who underwent DRE for the first time from February 2006 to December 2007 were evaluated for their psychological reactions and feelings after the examination. RESULTS: The average age of the patients was 52.8 years (25 - 85 years); 40.94% had felt fear (examination fear 15.94%, and diagnosis fear 25%), 26.45% shame and 48.26% indicated they were not thinking about anything. There was no correlation between age, educational level and emotional reactions. Most patients (96.8%) would undergo a DRE again and 52.35% had considered it better than they had imagined. Of these patients, 41.81% were illiterate/incomplete elementary school. Only 4.12% described having a negative experience. The factors that persuaded the patients to book an appointment were: 50.1% made their own decision, 26.67% were recommended by a physician, 18.55% family/friends and 6.67% were influenced by the media. Wives booked 24.06% of the consultations. Although 85.47% of patients had some previous knowledge about the examination, 80.81% felt they had further clarification afterward. Lower educational level was related to lack of information about DRE, while 52.38% who made their own decision had previous knowledge of the importance of DRE. CONCLUSION: The majority of the patients found DRE less awkward than they had imagined it to be and would repeat the examination in the future. Fear and shame before the examination are present and are barriers to the DRE.
Assuntos
Exame Retal Digital , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Programas de Rastreamento/métodos , Neoplasias da Próstata/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Emoções , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Educação de Pacientes como Assunto , Neoplasias da Próstata/diagnóstico , Psicometria , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
TESE-ICSI (testicular sperm extraction associated with intracytoplasmic sperm injection) represents a technique to attain pregnancy in couples with non-obstructive azoospermia (NOA) and other unlikely situations. Because of the poor pregnancy outcomes obtained by this procedure, we need new sperm selection techniques to improve the livebirth rate of NOA patients. Here we describe a successful micro TESE-ICSI cycle performed with sperm selected through high magnification and polarized light microscopy in a couple with two previous ICSI failures.
Assuntos
Azoospermia , Injeções de Esperma Intracitoplásmicas , Azoospermia/diagnóstico , Azoospermia/terapia , Feminino , Humanos , Masculino , Gravidez , Estudos Retrospectivos , Recuperação Espermática , EspermatozoidesRESUMO
PURPOSE: The outcome of RCC has improved considerably in the last few years, and the treatment options have increased. LACOG-GU and LARCG held a consensus meeting to develop guidelines to support the clinical decisions of physicians and other health professionals involved in the care of RCC patients. METHODS: Eighty questions addressing relevant advanced RCC treatments were previously formulated by a panel of experts. The voting panel comprised 26 specialists from the LACOG-GU/LARCG. Consensus was determined as 75% agreement. For questions with less than 75% agreement, a new discussion was held, and consensus was determined by the majority of votes after the second voting session. RESULTS: The recommendations were based on the highest level of scientific evidence or by the opinion of the RCC experts when no relevant research data were available. CONCLUSION: This manuscript provides guidance for advanced RCC treatment according to the LACOG-GU/LARCG expert recommendations.
Assuntos
Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/terapia , Neoplasias Renais/diagnóstico , Neoplasias Renais/terapia , Tomada de Decisão Clínica , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Gerenciamento Clínico , Prova Pericial , Humanos , América Latina , Metastasectomia/métodos , Nefrectomia/métodos , Guias de Prática Clínica como Assunto , Padrão de CuidadoRESUMO
OBJECTIVES: Evidence-based medicine allows the best available external clinical evidence from systematic literature research to be graded in order to determine the strength of its recommendation. This guideline aims to assist physicians and health professionals in clinical decisions related to prostate cancer treatment, particularly in urology, clinical oncology and radiotherapy. METHODS: The publications used as information sources were obtained from structured data search in electronic databases, such as CENTRAL (Cochrane Central Register of Controlled Clinical Trials) and MEDLINE (online). Each item of this guideline derived from an original question which was distributed to the participants. Search strategies were prepared to select the studies presenting the best methodological quality, according to predefined levels of evidence. RESULTS: All the recommendations were followed by a level of evidence (LE) and a degree of recommendation (DR). We used a formal ranking system to help the reader to judge the strength of the evidence behind the results published in support of each recommendation. CONCLUSIONS: The existing parameters should be viewed as guidelines of conduct. The final trial on which the clinical procedure or treatment plan is most suitable for a particular patient should be done by a physician, who should discuss the available treatment options with the patient according to the diagnosis.
Assuntos
Neoplasias da Próstata , Medicina Baseada em Evidências , Humanos , Masculino , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia , Medição de RiscoRESUMO
BACKGROUND: Renal cell cancer (RCC) is one of the 10 most common cancers in the world, and its incidence is increasing, whereas mortality is declining only in developed countries. Therefore, two collaborative groups, The Latin American Oncology Cooperative Group-Genitourinary Section (LACOG-GU) and the Latin American Renal Cancer Group (LARCG), held a consensus meeting to develop this guideline. METHODS: Issues (134) related to the treatment of RCC were previously formulated by a panel of experts. The voting panel comprised 26 specialists (urologists and medical oncologists) from the LACOG-GU/LARCG. A consensus was reached if 75% agreement was achieved. If there was less concordance, a new discussion was undertaken, and a consensus was determined by the most votes after a second voting session. RESULTS: The expert meeting provided recommendations that were in line with the global literature; 75.0% of the recommendations made by the panel of experts were evidence-based level A, 22.5% of the recommendations were level B, and 2.5% of the recommendations were level D. CONCLUSIONS: This review suggests recommendations for the surgical treatment of RCC according to the LACOG-GU/LARCG experts.
RESUMO
Several biosimilar versions of enoxaparin are already approved and in use globally. Analytical characterization can establish good quality control in manufacturing, but they may not assure similarity in clinical outcomes between biosimilar and branded enoxaparin. This study evaluated the efficacy and safety of biosimilar Cristália versus branded Sanofi enoxaparin in venous thromboembolism (VTE) prevention in patients undergoing major abdominal surgery at risk for VTE. In this randomized, prospective single-blind study, we compared Cristália enoxaparin (Ce), a biosimilar version, versus branded Sanofi enoxaparin (Se; at a dose of 40 mg subcutaneously per day postoperatively from 7 to 10 days) in 243 patients submitted to major abdominal surgery at risk for VTE for VTE prevention. The primary efficacy outcome was occurrence of VTE or death related to VTE. The principal safety outcomes were a combination of major bleeding and clinically relevant non-major bleeding. Bilateral duplex scanning of the legs was performed from days 10 to 14, and follow-ups were performed up to 60 days after surgery. The incidence of VTE was 4.9% in the Cristália group and 1.1% in the Sanofi group (absolute risk difference = 3.80%, 95% confidence interval [CI]: -1.4%-9.0%) yielding noninferiority since the 95% CI does not reach the prespecified value Δ = 20%. Clinically significant bleeding occurred in 9.9% in the Cristália group and in 5.5% in the Sanofi group (n.s. ). In conclusion, this study suggests that 40 mg once daily of Ce, a biosimilar enoxaparin, is as effective and safe as the branded Sanofi enoxaparin in the prophylaxis of VTE in patients submitted to major abdominal surgery at risk for VTE.
Assuntos
Abdome/cirurgia , Medicamentos Biossimilares/administração & dosagem , Enoxaparina/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Medicamentos Biossimilares/efeitos adversos , Enoxaparina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tromboembolia Venosa/etiologiaRESUMO
INTRODUCTION AND OBJECTIVE: When feasible, the treatment for all-invasive bladder cancer is radical cystectomy. The aim of the present study was to analyze the prognostic difference, disease-specific survival rate, of muscle-invasive transitional cell cancer of the bladder (TCCB) for progressive invasive TCCB. PATIENTS AND METHODS: A retrospective multicentric analysis was performed studying a total of 242 patients who underwent radical cystectomy for invasive TCCB from 1993 to 2005. The patients were divided into two groups: group 1 included 57 patients with progressive invasive TCCB, and group 2 included 185 patients with primary invasive TCCB. Both groups were further divided according to the pathological findings in pT2/3 (muscle and/or perivesical fat invasion), pT4 (adjacent organs/structure invasion), N+ (positive lymphatic nodes) and M+ (distant organ metastasis). Several tests were employed for statistical analysis: chi2, Mann-Whitney, Kaplan-Meier method and Wilcoxon (Breslow) method were used to compare the possible survival curve differences of groups 1 and 2. Multivariated analysis determined by proportional risk regression excluded sex, age and disease stage interferences in the final results. RESULTS: The average time for a superficial TCCB to become muscle-invasive was 37.4 months, and the average number of transurethral resections performed in each patient was 3. The average and median global survival rates were, respectively, 96 and 88 months in group 1 and 98 and 90 months in group 2, without a statistically significant difference (p = 0.0734). The 1-year survival rate was 84.32% in group 1 and 76.54% in group 2. After 3 years of follow-up the survival rate fell to 74.50% in group 1 and to 59.05% in group 2. Finally, the 5-year survival rate was 57.94% in group 1 and 52.24% in group 2. CONCLUSION: In the present study, patients with primary invasive and progressive invasive TCCB showed a similar 5-year disease-specific survival rate. Pathological stage (pTN, N and M) and patient demography did not interfere with the results.
Assuntos
Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/cirurgia , Cistectomia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Brasil/epidemiologia , Carcinoma de Células de Transição/patologia , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologiaRESUMO
ABSTRACT Introduction: In view of the detailed histologic evaluation of prostate cancer (PC), it is usually advisable to provide a "second opinion" to confirm diagnosis. This study aimed to compare the Gleason score (GS) of initial diagnosis versus that of histopathologic review of patients with PC. The secondary objective was to compare initial GS versus histopathologic review versus post - surgical histopathology. Material and methods: Retrospective study based on chart review of patients with PC that attended the Uro - oncology Department of Hospital das Clínicas - UNICAMP - Campinas, Brazil, from April, 2002, to April, 2012. Data were divided in groups: patients with biopsies performed elsewhere, biopsies after pathological review and histopathological results following retropubic radical prostatectomy (RRP). These were evaluated in relation to GS difference using Fleis's Kappa concordance coefficient. Results: 402 PC patients, with a median age of 66 years, were evaluated. Reviewed GS showed worsening, with accuracy of 61.2%, and Kappa concordance value = 0.466. Among 143 patients submitted to surgery, GS varied widely, regarding initial evaluation, review and post - surgical RRP. Joint concordance of evaluations was weak (Kappa = 0.216), mainly due to almost no existence concordance between initial evaluation and following RRP (Kappa = 0.041). Conclusion: There is a great histopathological variation of initial GS versus reviewed GS. There is also a better correlation of reviewed GS and post - surgical GS than with initial GS. The second opinion by an uropathologist improves diagnosis and should be advised for better therapeutic decision.
Assuntos
Humanos , Masculino , Adulto , Idoso , Idoso de 80 Anos ou mais , Próstata/patologia , Neoplasias da Próstata/patologia , Próstata/cirurgia , Prostatectomia , Neoplasias da Próstata/cirurgia , Encaminhamento e Consulta , Estudos Retrospectivos , Gradação de Tumores , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: Since accurate tumor localization and quantification are essential requisites avoiding prostate cancer overtreatment, we analyzed the impact of core fragmentation and the relation between core biopsy taken and pathological information in regard to cancer extension and aggressiveness (Gleason score). METHODS: One hundred and ninety-nine men submitted to trans-rectal prostate biopsy by the same urologist between October 2006 and October 2008 were included, and the number of cores obtained by biopsy compared to the number of cores examined by the same pathologist. RESULTS: Total core number obtained by biopsy was 21.54 (± 3.56) compared to 24.08 (± 4.77) examined by the pathologist, P < 0.01. Dividing prostate gland by areas such as base, mid and apical right and left, all areas showed statistically different core number between biopsy and pathological examination report (P < 0.01). Mean ratio of positive core cancer length was 0.41 (± 0.12) and 0.32 (± 0.8) comparing individual and overall cores analysis, respectively (P < 0.01). The mean Gleason score in the individual and overall cores analysis were 6.6 (6-9) and 6.3 (6-9), respectively, P < 0.01. CONCLUSIONS: Considering the ongoing trend for earlier diagnosis of increasing numbers of younger men with low-risk prostate cancer, this study is original and demonstrates the possibility of core fragmentation, explaining in part over- and under-staging. One core per container and an overall Gleason score and percentage of adenocarcinoma for each container are encouraged.
Assuntos
Neoplasias da Próstata/patologia , Idoso , Biópsia por Agulha/métodos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
ABSTRACT Introduction and Objectives: Reactive Stroma (RStr) is observed in many human cancers and is related to carcinogenesis. The objectives of the present study were to stablish a relationship of the RStr microenvironment with prostate cancer (Pca) through a morphological and molecular characterization, and to identify a possible relationship between RStr with worse prognosis factors and occurrence of malignant prostatic stem cells. Materials and Methods: Forty prostatic samples were selected from men with Pca diagnosis submitted to radical prostatectomy; they were divided in two groups: Group-1 (n=20): samples without reactive stroma; Group-2 (n=20): samples of PCa with intense stroma reaction. Prostatic samples were evaluated for RStr intensity by Masson Trichromic stain and posteriorly submitted to histopathological and immunohistochemistry analysis for antigens: α-actin, vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA, AR, Erα and ERβ. Results: Reactive stroma with intense desmoplastic reactivity was significantly more frequent in intermediate (Gleason 7, 3+4) and high grade tumors (Gleason 7, 4+3). The group with intense stromal reactivity showed significant higher levels of Vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA and ERα. Conclusions: It can be concluded that RStr may be a predictive marker of Pca progression, since it was associated with increase of growth factors, imbalance of androgen and estrogen receptors and presence of malign prostatic stem cells.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/patologia , Células Epiteliais/patologia , Células-Tronco Neoplásicas/patologia , Neoplasias da Próstata/patologia , Células Estromais/patologia , Actinas/análise , Adenocarcinoma/química , Antígenos de Neoplasias/análise , Biomarcadores Tumorais/análise , Progressão da Doença , Proteínas de Ligação a DNA/análise , Células Epiteliais/química , Receptor alfa de Estrogênio/análise , /análise , Proteínas Ligadas por GPI/análise , Imuno-Histoquímica , Fator de Crescimento Insulin-Like I/análise , /análise , Gradação de Tumores , Proteínas de Neoplasias/análise , Células-Tronco Neoplásicas/química , Neoplasias da Próstata/química , Células Estromais/química , Microambiente Tumoral , Fatores de Transcrição/análise , Vimentina/análiseRESUMO
Objective Systematic review of literature and meta-analysis to evaluate the results of magnetic resonance image 1.5T with endorectal coil in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer, compared to the histopathological results of the radical prostatectomy specimen. Materials and Methods It was conducted a systematic review of literature and meta-analyses of all studies data published after 2008. In those studies, the patients with prostate cancer with indication to radical prostatectomy were submitted to magnetic resonance image (MRI) at pre-operatory period and the results were compared to those of histopathological studies after the surgery. The selected terms for research included prostate cancer, magnetic resonance, radical prostatectomy, and prostate cancer diagnosis, in the databases EMBASE, LILACS, PUBMED/MEDLINE and Cochrane Library. The data were collected using a specific qualitative instrument and the meta-analysis data were presented in the forest plot graphics, homogeneity test and sROC curves and funnel plot. Results A total of seven studies were included, with a total of 603 patients. Among these studies, six evaluated the value of MRI for the detection of prostate cancer, and the median sensitivity of meta-analysis was 0.6 and specificity 0.58, but with heterogeneity among the studies. Three studies evaluated extra-prostatic extension with a median sensitivity of 0.49, specificity 0.82 and heterogeneity only for sensitivity. Three studies evaluated invasion of seminal vesicles, with median sensitivity of 0.45 and specificity 0.96, with heterogeneity in both analysis. Conclusion Magnetic resonance of 1.5T with endocoil showed low values of sensitivity and specificity for the diagnosis and staging of prostate cancer. The reviewed studies showed a significant heterogeneity among them. The best observed result was MRI specificity for invasion of seminal ...
Assuntos
Humanos , Masculino , Imageamento por Ressonância Magnética/métodos , Próstata/patologia , Neoplasias da Próstata/patologia , Glândulas Seminais/patologia , Prostatectomia , Neoplasias da Próstata/cirurgia , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: Squamous cell carcinoma (SCC) of the penis with inguinal lymph node involvement aggravates prognosis and can cause femoral artery bleeding, hemorrhagic shock and even death. The objective of this study is to describe the use of extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis. CASUISTIC AND METHOD: Five patients with SCC and inguinal lymphatic metastasis involving the femoral vessels, who underwent extra-anatomical arterial bypass through obturator foramen between 1999 and 2007, were reviewed. The surgical technique and the postoperative outcome were described. RESULTS: After extra-anatomical transobturator bypass, all patients presented distal pulses. The mean time of surgery was 6 h. In four patients, a knitted Dacron tube was used; and in one, the contralateral devalvulated greater saphenous vein was used. Concomitantly, two patients underwent mass resection and one patient underwent node dissection 2 weeks after bypass. Two patients chose not to undergo inguinal resection, opting for palliative chemotherapy after the vascular procedure. The average follow-up period was 12 months and four patients have died-three due to pulmonary metastasis, and one due to acute myocardial infarct. No prosthetic complication was identified and no patient presented femoral bleeding. CONCLUSIONS: The use of the transobturator bypass can benefit patients presenting with penile SCC and inguinal lymph nodes metastasis involving the femoral vessels, allowing resection of extensive tumor lesions, as well as avoidance of local complications.
Assuntos
Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Artéria Femoral/cirurgia , Neoplasias Penianas/patologia , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia , Adulto , Idoso , Prótese Vascular , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Veia Safena/transplante , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
INTRODUCTION: Adrenal carcinomas are rare and are associated with a very poor prognosis. The incidence is estimated to be 1 in 1.7 million which represents 0.02% of all cancers and 0.2% of all cancer mortality. The 5-year survival rate is 38%. The purpose of this paper is to present a single-institution experience in excising right-sided giant adrenal carcinomas, discussing the difficulties and the usage of special surgical devices to facilitate the procedure. PATIENTS AND METHODS: During June 2001 to June 2003, 18 patients with right-sided adrenal tumors were treated at the State University of Campinas Hospital--UNICAMP. 4 out of the 18 patients presented lesions >15 cm, representing the study group. The mean age was 37 (range 26-65) years, 3 patients were younger than 35 years, and 2 patients were men. A right-sided extended subcostal incision was the surgical access in 1 patient (case 1) and a right-sided thoracoabdominal incision in the other 3 patients. RESULTS: Adrenal cortical carcinoma was the histological diagnosis according to the Weiss criteria; no positive surgical margin was detected, even in those patients with invasion of the hepatic capsule. The median follow-up period was 15 (range 6-30) months. CONCLUSIONS: A subcostal extended incision can accomplish broad exposure, if articulated costal retractors are available (used in liver transplantation), otherwise a thoracoabdominal incision is the best option. The most important feature of surgery is to accomplish an efficient hemostasis of the liver parenchyma. Suture and stitches are not suitable for minor vascular structures, and electrocauterization sometimes promotes hepatic lesions and does not provide bleeding control. Thus, the need for special hemostatic means is real, and they should be available in these situations.