Controversies in prostate cancer management: Consensus recommendations from experts in northern Spain.

In recent years, various aspects of prostate cancer (PC) management have undergone significant changes, including the implementation of therapeutic strategies such as the use of new hormonal agents like abiraterone, apalutamide, enzalutamide or darolutamide and the incorporation of next generation imaging techniques (NGI). However, the evidence regarding the role of NGI and the therapeutic decision-making based on their findings is not solid. Following the methodology of the Advanced Prostate Cancer Consensus Conference (APCCC), a multidisciplinary expert consensus was developed to address controversial questions concerning the use of NGI and clinical management in four priority scenarios: localized PC, PC after radical prostatectomy, PC after radiotherapy with curative intent, and metastatic hormone-sensitive PC. This consensus represents the opinions of medical oncology, radiation oncology and urology physicians and provides useful recommendations for clinical practice.

[Prostate cancer screening with Prostate-Specific Antigen (PSA) to men over 70 years old in an urban health zone, 2018-2020: A cross-sectional study]. / Uso del antígeno prostático específico (PSA) para el cribado de cáncer de próstata en la población de 70 años o más de una zona de salud urbana, 2018-2020. Un estudio transversal.

OBJECTIVES: To describe the epidemiology and estimate the cost of Prostate-Specific Antigen (PSA) screening tests to men ≥ 70 years old in an urban health zone. METHODS: A cross-sectional study was performed. We obtained every PSA test made in the health zone from 2018 to 2020, and classified them retrospectively as screening (PSAc) or not according to pre-established criteria, reviewing electronic health records. Testing rates were calculated by centres and clinical specialities. The standard population was provided by the city register of inhabitants (VM70). Cost estimation was made using our health system's price list. RESULTS: Two thousand and thirty six PSA, of 888 men ≥ 70 years old were obtained, and 350 met screening classification criteria. Six adenocarcinomas were diagnosed from those tests. We estimated 76.07 PSAc/1000 VM70-year from any centre, 1.45 tests for each screened individual, and 15.71% prevalence. The standard population was 1534 men (mean 2018-2020, SD 45.37). Patients who were screened (median age 75, SD 4.04) were younger than those not screened. We estimated a total screening test cost of 9,751 €. CONCLUSIONS: The epidemiology and cost of PSA screening tests to men ≥ 70 years old are reported, both in primary health care and in the hospital. PSA screening tests are common practice amongst professionals attending elderly men in our health zone, mostly in primary care. The screening testing rate of men without prostate cancer is similar to that reported in the literature.

Completeness of variables in Hospital-Based Cancer Registries for prostatic malignant neoplasm / Completitud de variables en Registros Hospitalarios de Cáncer para neoplasia maligna de próstata / Completude das variáveis dos Registros Hospitalares de Câncer de neoplasia maligna prostática

ABSTRACT Objectives: to analyze the completeness of variables from Hospital-Based Cancer Registries of cases of prostate neoplasm in the Oncology Care Network of a Brazilian state between 2000 and 2020. Methods: an ecological time series study, based on secondary data on prostate cancer Hospital-Based Cancer Registries prostate. Data incompleteness was classified as excellent (<5%), good (between 5%-10%), fair (10%-20%), poor (20%-50%) and very poor (>50%), according to the percentage of lack of information. Results: there were 13,519 cases of prostate cancer in the Hospital-Based Cancer Registries analyzed. The variables "family history of cancer" (p<0.001), "alcoholism" (p<0.001), "smoking" (p<0.001), "TNM staging" (p<0.001) had a decreasing trend, while "clinical start of treatment" (p<0.001), "origin" (p=0.008) and "occupation" (p<0.001) indicated an increasing trend. Conclusions: most Hospital-Based Cancer Registries variables showed excellent completeness, but important variables had high percentages of incompleteness, such as TNM and clinical staging, in addition to alcoholism and smoking.

RESUMEN Objetivos: analizar la completitud de las variables del Registro Hospitalario de Cáncer de casos de neoplasias de próstata en la Red de Atención Oncológica de un estado brasileño entre 2000 y 2020. Métodos: estudio de series de tiempo ecológicas, a partir de datos secundarios sobre el cáncer de próstata Registro Hospitalario de Cáncer próstata. La información incompleta se clasificó como excelente (<5%), buena (entre 5%-10%), regular (10%-20%), mala (20%-50%) y muy mala (>50%), según el porcentaje de falta de información. Resultados: hubo 13.519 casos de cáncer de próstata en los Registro Hospitalario de Cáncer analizados. Las variables "antecedentes familiares de cáncer" (p<0,001), "alcoholismo" (p<0,001), "tabaquismo" (p<0,001), "estadificación TNM" (p<0,001) tuvieron una tendencia decreciente, mientras que "inicio clínico" de tratamiento" (p<0,001), "origen" (p=0,008) y "ocupación" (p<0,001) indicaron una tendencia creciente. Conclusiones: la mayoría de las variables Registro Hospitalario de Cáncer mostraron una excelente completitud, pero variables importantes tuvieron altos porcentajes de incompletitud, como el TNM y el estadiaje clínico, además del alcoholismo y el tabaquismo.

RESUMO Objetivos: analisar a completude das variáveis dos Registros Hospitalares de Câncer dos casos de neoplasia prostática da Rede de Atenção Oncológica de um estado brasileiro entre 2000 e 2020. Métodos: estudo ecológico de séries temporais, baseados em dados secundários de câncer de próstata dos Registros Hospitalares de Câncer. A incompletude dos dados foi classificada como excelente (<5%), boa (entre 5%-10%), regular (10%-20%), ruim (20%-50%) e muito ruim (>50%), de acordo com o percentual de ausência de informação. Resultados: foram analisados 13.519 casos de câncer próstata. As variáveis "histórico familiar de câncer" (p<0,001), "alcoolismo" (p<0,001), "tabagismo" (p<0,001), "estadiamento TNM" (p<0,001) tiveram tendência de decréscimo, enquanto que "clínica do início do tratamento" (p<0,001), "procedência" (p=0,008) e "ocupação" (p<0,001) indicaram tendência crescente. Conclusões: a maioria das variáveis dos Registros Hospitalares de Câncer apresentou completude excelente, porém importantes variáveis tiveram altos percentuais de incompletude, como estadiamento TNM e clínico, além de alcoolismo e tabagismo.

The role of PET-PSMA in guiding prostate cancer radiation therapy: experience in a salvage and curative setting / Radioterapia guiada por PET-PSMA en cáncer de próstata: experiencia en el escenario curativo y en el salvamento

Introduction: The role of positron emission tomography (PET) prostate-specific membrane antigen (PSMA) in guiding radiation therapy treatment plans remains to be defined. Methods: We conducted a retrospective observational study of patients with prostate cancer referred for radiotherapy. Our objective was to establish the role of PET-PSMA in decision-making and changes in the radiotherapy treatment plan. Results: In the entire cohort, 26.8% had lymph node involvement outside the conventional field. The PET results upstaged and changed radiotherapy treatment plans for 75% in primary radiotherapy and 50% in salvage radiation. Conclusions: PET-PSMA changes decision-making and treatment planning for radiotherapy, including treatment volumes not traditionally delimited in contour atlases.

Introducción: El rol del PET-PSMA para guiar los planes de radioterapia aún debe definirse. Métodos: Realizamos un estudio observacional retrospectivo de pacientes con cáncer de próstata localizado remitidos para radioterapia. Nuestro objetivo fue establecer el rol del PET-PSMA en la toma de decisiones y cambios en el plan de tratamiento de radioterapia. Resultados: En toda la cohorte el 26,8% presentaba afectación ganglionar fuera del campo convencional. Los resultados del PET cambiaron los planes de tratamiento en el 75% para radioterapia primaria y en el 50% para salvamento. Conclusiones: El PET-PSMA cambia la toma de decisiones y planificación del tratamiento de radioterapia, incluyendo volúmenes de tratamiento no delimitados tradicionalmente en los atlas de contorneo.

Etapa al diagnóstico de cáncer de próstata en un hospital institucional. Revisión y comparación de datos nacionales e internacionales / Stage at diagnosis of prostate cancer in an institutional hospital. Review and comparison of national and international data

INTRODUCCIÓN: El cáncer prostático (CaP) es una patología de alta prevalencia e incidencia mundial. El tamizaje ha perseguido el diagnóstico precoz de esta enfermedad para otorgar tratamientos oportunos. Nosotros buscamos caracterizar los pacientes de un hospital local respecto al diagnóstico y etapificación, y comparar estos resultados con datos previamente reportados. MATERIAL Y MÉTODO: Análisis retrospectivo de pacientes diagnosticados con CaP en un hospital institucional. Se recolectaron variables clínicas al momento del diagnóstico, los métodos de etapificación, el estadío según TNM y grado histológico. RESULTADOS: Se incluyeron 129 pacientes en el análisis. La mediana de APE (ng/mL) al diagnóstico fue de 7,29. El grado histológico fue clasificado como ISUP 1 en 37,5%. Se realizó una resonancia magnética multiparamétrica de próstata (RMmp) en el 42,19% de los pacientes, siendo clasificados como PIRADS 4 en mayor proporción (21,09%). La etapificación con PET-CT PSMA se utilizó principalmente en el grupo de alto riesgo y ante dudas frente a etapificación con medios convencionales. Se prefirió la Tomografía computada (TC) contrastada y la cintigrafía ósea en los otros grupos. 6,25% fue catalogado N1 y 9,37% M1. CONCLUSIÓN: La etapa al diagnóstico de nuestra serie es algo mayor a lo reportado por países desarrollados, pero considerablemente menor a lo publicado por otros países de Latinoamérica e inclusive de otros hospitales de nuestro país. Pareciera ser de gran relevancia nacional contar con protocolos claros de tamizaje y acceso a APE con el fin de disminuir los casos diagnosticados en etapas avanzadas.

INTRODUCTION: Prostate cancer (PCa) is a disease with a high prevalence and incidence worldwide. Screening has pursued the early diagnosis of this disease to provide early treatment. We sought to characterize patients from a local hospital with respect to diagnosis and staging and to compare these results with previously reported data. METHODS: We conducted a retrospective analysis of patients diagnosed with PCa at an institutional hospital. Clinical variables were collected at the time of diagnosis, staging methods, TNM stage, and histological grade. RESULTS: 129 patients were included in the analysis. The median PSA (ng/mL) at diagnosis was 7.29. The histological grade was classified as ISUP 1 in 37.5%. An MRI was performed in 42.19% of the patients, being classified mostly as PIRADS 4 (21.09%). PET-CT PSMA staging was used mainly in the high-risk group, preferring contrast-enhanced CT and bone scintigraphy in the other groups. 6.25% were classified as N1 and 9.37% as M1. CONCLUSION: The stage at diagnosis in our series is somewhat higher than that reported by developed countries but considerably lower than that published by other Latin American countries and even from other hospitals in our country. It is of great national relevance to have clear protocols for screening and access to PSA to reduce the cases diagnosed in advanced stages.

Direct costs of treating men with prostate cancer with High Intensity Focused Ultrasound / Costos directos del tratamiento de hombres con cáncer de próstata con el uso de High Intensity Focused Ultrasound / Custos diretos do tratamento de homens com câncer de próstata via High Intensity Focused Ultrasound

ABSTRACT Objective: To analyze the direct costs of materials, medicines/solutions and healthcare professionals required to treat men with prostate cancer using High Intensity Focused Ultrasound. Method: Quantitative, exploratory-descriptive research, single case study type. Data were collected from electronic medical records/printed documentation from the Operating Room of a public teaching and research hospital. Health professionals estimated the respective time spent on activities in the following stages: "Before anesthetic induction", "Before performing thermal ablation", "During thermal ablation" and "After performing thermal ablation". Costs were calculated by multiplying the (estimated) time spent by the unit cost of direct labor, adding to the measured cost of materials, medicines/solutions. Results: The measured costs with materials corresponded to US$851.58 (SD = 2.17), with medicines/solutions to US$72.13 (SD = 25.84), and estimated personnel costs to US$196.03, totaling US$1119.74/procedure. Conclusion: The economic results obtained may support hospital managers in the decision-making process regarding the adoption of the High Intensity Focused Ultrasound for the treatment of prostate cancer.

RESUMEN Objetivo: Analizar los costos directos de materiales, medicamentos/soluciones y profesionales de la salud necesarios para tratar a hombres con cáncer de próstata a través de High Intensity Focused Ultrasound. Método: Investigación cuantitativa, exploratoria-descriptiva, tipo estudio de caso único. Los datos se obtuvieron de registros médicos electrónicos/documentación impresa del Centro Quirúrgico de un hospital público de enseñanza e investigación. Los profesionales de la salud estimaron el tiempo respectivo dedicado a las actividades en las siguientes etapas: "Antes de la inducción anestésica", "Antes de realizar la ablación térmica", "Durante la realización de la ablación térmica" y "Después de realizar la ablación térmica". Los costos se calcularon multiplicando el tiempo (estimado) invertido por el costo unitario de la mano de obra directa, sumándolo al costo medido de materiales, medicamentos/soluciones. Resultados: Los costos medidos con materiales correspondieron a US$851,58 (DE = 2,17), con medicamentos/soluciones a US$72,13 (DE = 25,84) y los costos de personal estimados a US$196,03, totalizando US$1119,74/procedimiento. Conclusión: Los resultados económicos obtenidos podrán apoyar a los gestores hospitalarios en el proceso de toma de decisiones respecto a la adopción del High Intensity Focused Ultrasound para el tratamiento del cáncer de próstata.

RESUMO Objetivo: Analisar os custos diretos com materiais, medicamentos/soluções e profissionais de saúde requeridos à realização do tratamento de homens com câncer de próstata via High Intensity Focused Ultrasound. Método: Pesquisa quantitativa, exploratória-descritiva, do tipo estudo de caso único. Coletaram-se os dados em prontuários eletrônicos/documentações impressas do Centro Cirúrgico de um hospital público de ensino e pesquisa. Profissionais de saúde estimaram os respectivos tempos despendidos em atividades constantes das etapas: "Antes da indução anestésica", "Antes da execução da termoablação", "Durante a execução da termoablação" e "Após a execução da termoablação". Calcularam-se os custos multiplicando-se o tempo (estimado) despendido pelo custo unitário da mão de obra direta, somando-se ao custo mensurado dos materiais, medicamentos/soluções. Resultados: Os custos mensurados com materiais corresponderam a US$851,58 (DP = 2,17), com medicamentos/soluções a US$72,13 (DP = 25,84) e os custos estimados com pessoal a US$196,03, totalizando US$1119,74/procedimento. Conclusão: Os resultados econômicos obtidos poderão subsidiar os gestores hospitalares no processo decisório quanto à adoção do High Intensity Focused Ultrasound para o tratamento do câncer de próstata.

Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group. / Diagnóstico y tratamiento del cáncer de prostata clínicamente localizado. Adherencia a las guías clínicas en un estudio poblacional nacional ­ GESCAP.

OBJECTIVE: To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain. PATIENTS AND METHODS: Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D'Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests. RESULTS: Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients' age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n=521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT. CONCLUSIONS: Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319).

Viabilidad y seguridad de la biopsia prostática transperineal en la era de fusión de imágenes por resonancia magnética cognitiva/ultrasonido en la detección del cáncer de próstata / Feasibility and safety of transperineal prostate biopsy in the era of cognitive magnetic resonance imaging/ultrasound fusion in prostate cancer detection

RESUMEN Objetivo : Describir los resultados de la biopsia prostática transperineal por fusión de la resonancia magnética cognitiva y ultrasonido en la detección del cáncer. Materiales y métodos : Estudio de serie de casos, retrospectivo, realizado en Clínica Delgado entre julio del 2019 y octubre del 2021. Se incluyó pacientes con examen digital de próstata y/o Antígeno Prostático Específico anormal e imágenes de Resonancia Magnética de próstata con lesiones categoría PI-RADS 4 o 5. Excluyendo a pacientes con trastorno de coagulación, lesiones rectales, imposibilidad para abducción, comorbilidades para anestesia. Registramos las características clínicas, demográficas, datos de antígeno prostático específico, volumen de la próstata, lesiones PI-RADS, tasas de cáncer, complicaciones. Resultados : Se evaluaron 18 pacientes, con edad media de 69,33 ± 7,67 años. La media del antígeno prostático específico de 14,94 ± 12,42 ng/mL. La media del volumen de próstata de 57,72 ± 28,68 cc. Al examen digital de la próstata 16/18 (88.88 %) pacientes tenían sospecha de cáncer. Se hicieron biopsias con 19 núcleos en pacientes cuya RMNmP tenían lesiones con categoría de PI-RADS 4 en 6/18 (33,33 %) de los cuales 3 resultaron positivas a Adenocarcinoma y otras 3 negativas a cáncer. Biopsia con 16 núcleos en PIRADS 5 en 12/18 (66,67 %) pacientes, resultando todas positivas a cáncer. Adenocarcinoma Acinar en 15/18 (83,33 %) con Gleason 6 en 2/18 (11,11 %) y Gleason ≥ 7 en 13/18 (72,22 %) pacientes. Complicaciones leves como hematuria 1/18 (5,6 %), disuria terminal 8/18 (44,4 %) y molestia perineal 7/18 (38,8 %) y ninguna infecciosa. Conclusiones : la biopsia prostática transperineal por fusión de imágenes de resonancia magnética cognitiva y ultrasonido es factible, segura, con tasas importantes de positividad y sin infecciones.

ABSTRACT Objective : To describe the results of transperineal prostate biopsy by fusion of cognitive magnetic resonance imaging and ultrasound in the detection of cancer. Materials and methods : A retrospective case series study conducted at the Delgado Clinic between July 2019 and October 2021. Patients with digital prostate examination and/or abnormal Prostatic Specific Antigen and prostate MRI images with category lesions were included PI-RADS 4 or 5. Excluding patients with coagulation disorders, rectal injuries, impossibility for abduction, comorbidities for anesthesia. We recorded clinical and demographic characteristics, prostate-specific antigen data, prostate volume, PI-RADS lesions, cancer rates, and complications. Results: 18 patients were evaluated, with a mean age of 69.33 ± 7.67 years. The mean prostate specific antigen was 14.94 ± 12.42 ng/mL. The mean prostate volume was 57.72 ± 28.68 cc. At the digital examination of the prostate, 16/18 (88.88%) patients had suspected cancer. Biopsies with 19 cores were performed in patients whose NMRmP had lesions with PI-RADS category 4 in 6/18 (33.33%), of which 3 were positive for Adenocarcinoma and another 3 were negative for cancer. Biopsy with 16 PIRADS 5 cores in 12/18 (66.67%) patients, all of which were positive for cancer. Acinar adenocarcinoma in 15/18 (83.33%) with Gleason 6 in 2/18 (11.11%) and Gleason ≥ 7 in 13/18 (72.22%) patients. Mild complications such as hematuria 1/18 (5.6%), terminal dysuria 8/18 (44.4%) and perineal discomfort 7/18 (38.8%) and none infectious. Conclusions : transperineal prostate biopsy by fusion of cognitive magnetic resonance imaging and ultrasound is feasible, safe, with significant positivity rates and without infections.

Percepción y disposición al tacto rectal en la prevención de cáncer de próstata / Perception and disposition to digital rectal examination in the prevention of prostate cancer

RESUMEN Introducción. El cáncer de próstata puede detectarse por el tacto rectal. Objetivo. Explorar la percepción y disposición al tacto rectal. Métodos. Se realizó un estudio cualitativo. La unidad de análisis fue el paciente que viene a consulta externa. Se utilizó entrevista a profundidad. Resultados. La percepción del tacto rectal tuvo como categorías apriorísticas el machismo, la homosexualidad, vergüenza, dolor e impotencia sexual. Se tuvo como categoría emergente la predisposición al tacto rectal del servicio de urología, predisposición por el beneficio de realizar el tacto rectal y predisposición de los pacientes que ya se realizaron el tacto rectal. Conclusiones. La percepción tiene categorías emergentes como son la predisposición al tacto rectal en pacientes del servicio de urología, predisposición de los pacientes que tuvieron una consulta anterior. La disposición al tacto rectal es aceptada por los pacientes ya que es una indicación médica realizada por un profesional capacitado.

ABSTRACT Introduction. Prostate cancer can be detected by digital rectal examination. Objectives. To explore the perception and disposition to digital rectal examination. Methods. A qualitative study was carried out. The unit of analysis was the patient who comes to the service's outpatient consultation. An in-depth interview was used. Results. The perception of digital rectal examination has as a priori categories that are machismo, homosexuality, shame, pain and sexual impotence. The emerging category was predisposition to digital rectal examination in the urology service, predisposition due to the benefit of performing digital rectal examination, and predisposition of patients who had already undergone digital rectal examination. Conclusions. The perception has emerging categories such as the predisposition to digital rectal examination in patients of the urology service, predisposition of patients who had a previous consultation. The willingness to digital rectal examination is accepted by patients as it is a medical indication performed by a trained professional.

Repercussões no contexto familiar do paciente com câncer de próstata

Objetivo Analisar as repercussões no contexto familiar do paciente com câncer de próstata. Método Foi realizada uma pesquisa descritiva com abordagem qualitativa, que teve como participantes 10 homens com diagnóstico de câncer de próstata, que tinham convívio familiar e que estavam cadastrados no Programa do Tratamento Fora do Domicílio (TFD) do município de Ipiaú, Bahia. A coleta de dados foi realizada através de uma entrevista, seguindo um roteiro semiestruturado, com visitas no domicílio dos participantes. Resultados A maior incidência de pacientes com câncer de próstata está na faixa etária maior que 70 anos, comparando com idades inferiores. O carcinoma acomete homens acima de 65 anos e sua incidência é ascendente em homens da raça negra, quando comparados ao da raça branca. A história familiar é um grande fator de risco para a ocorrência desta doença. A falta de informação faz com que a maioria dos homens resista ao exame, por preconceito ou mesmo medo do desconhecido, podendo afetar sua qualidade de vida. Conclusão O estudo evidenciou a importância da participação da família no processo de descoberta do câncer, bem como durante o seu diagnóstico e tratamento, o que leva os pacientes a superarem as diversas dificuldades vivenciadas. Outro ponto relevante é o cuidado como fator de grande importância no atendimento ao paciente, sendo considerado como facilidade durante o tratamento.

Objective To analyze the repercussions in the family context of patients with prostate cancer. Method A qualitative descriptive study was carried out with ten men diagnosed with prostate cancer and with a family relationship, who were enrolled in the Out of Home Treatment Program (PDT) of the city of Ipiaú, Bahia. The data was collected through interviews, using a semi-structured script, and visits were made to the participants' homes. Results The highest incidence of prostate cancer occurs in men aged over 70 years, compared to those in younger age groups. Prostate carcinoma primarily affects men over the age of 65, with a higher incidence rate in black men than in white men. A family history of prostate cancer is a major risk factor for developing the disease. Despite this, many men are reluctant to undergo screening exams due to misinformation, prejudice, or fear of the unknown. This reluctance can significantly impact their quality of life. Conclusion The study highlighted the importance of family involvement in the process of cancer diagnosis, treatment, and recovery, as it can help patients overcome the various challenges they face. Additionally, the study identified the significance of proper care during treatment, which can significantly improve the patient's overall experience.

Objetivo Analizar el impacto en el contexto familiar del paciente con cáncer de próstata. Método Se realizó un estudio descriptivo con enfoque cualitativo, en el que participaron 10 hombres diagnosticados con cáncer de próstata y con relaciones familiares, inscritos en el Programa de Tratamiento Fuera del Domicilio (TFD) del municipio de Ipiaú, Bahía. La recolección de datos se llevó a cabo mediante entrevistas, utilizando un guión semi-estructurado, y se visitaron los hogares de los participantes. Resultados La mayor incidencia de cáncer de próstata se presenta en hombres mayores de 70 años, en comparación con las edades más jóvenes. El carcinoma prostático afecta principalmente a los hombres mayores de 65 años, con una tasa de incidencia más alta en hombres de raza negra que en los de raza blanca. Tener antecedentes familiares de cáncer de próstata es un factor de riesgo importante para la aparición de esta enfermedad. A pesar de esto, muchos hombres se muestran reacios a someterse a exámenes de detección debido a la falta de información, prejuicios o miedo a lo desconocido, lo que puede afectar significativamente su calidad de vida. Conclusión El estudio demostró la importancia de la participación de la familia en el proceso de detección, diagnóstico y tratamiento del cáncer, pues ayuda a los pacientes a superar las diversas dificultades. Otro punto relevante es el cuidado, que se considera un factor muy importante en el cuidado del paciente y puede mejorar significativamente su experiencia durante el tratamiento.

Prevalencia de factores de riesgo y sintomatología prostática en indígenas de Tabasco / Prevalence of Prostate Cancer Risk Factors and Symptoms in Indigenous People in Tabasco, Mexico

Introducción: El cáncer de próstata, es un problema de salud pública, la neoplasia que se diagnostica con mayor frecuencia y segunda causa de muerte en los hombres. Poco se sabe de este problema en población indígena, por lo cual, los conocimientos actuales son demandantes en la prevención primaria. Objetivo: analizar la prevalencia de sintomatología prostática y factores de riesgo entre varones indígenas, Centro, Tabasco. Material y Métodos: estudio descriptivo correlacional, diseño transversal, muestra de 281 hombres de la etnia chontal de 40 y más años de las comunidades; Tamulté de las Sabanas, Aniceto y Tocoalt. Se utilizó el cuestionario de síntomas prostáticos y entrevista de factores de riesgo. Resultados: 52.7% sin escolaridad, 47.7% son campesinos, edad media 55 años, 16.7% con sintomatología prostática de moderada a severa. Factores de riesgo; 44.5% mediano y 55.5% alto riesgo. La prueba de Chi cuadrada de Pearson entre la variable edad y sintomatología prostática tuvo una asociación de p=.000. Un valor de p=.166 entre la edad y los factores de riesgo; hombres de menor edad presentaron más factores de riesgo. Ninguno se ha realizado los exámenes de detección integral. Discusión y conclusiones: coincide con otros estudios la prevalencia de síntomas prostáticos en adultos mayores, es preocupante la prevalencia de factores de riesgo en todos los participantes, mismos que se han observado en hombres con diagnóstico de cáncer de próstata, es importante crear estrategias de prevención con miras en los estilos de vida saludable.

Introduction: Prostate cancer is a public health problem being the most frequently diagnosed neoplasm and the second leading cause of cancer death in men. However, there is little information about this disease in indigenous people and therefore, current knowledge calls for urgent primary prevention. Objective: To analyze the prevalence of prostate cancer risk factors and symptoms in indigenous men in Centro, Tabasco. Materials and Methods: A cross-sectional descriptive correlational study was conducted with 281 Chontal men aged 40 years and older from the communities of Tamulté de las Sabanas, Aniceto and Tocoalt. The Prostate Symptom Score questionnaire and interviews for assessing risk factors were both implemented. Results: 52.7% had no formal schooling at all, 47.7% were peasants at an average age of 55 years, 16.7% had moderate to severe prostatic symptoms. As for risk factors, 44.5% were classified to be at medium risk and 55.5% at high risk. Pearson's chi-squared test between variables age and prostatic symptoms showed an association of p=.000 and a value of p=.166 between age and risk factors. Younger men showed to have more risk factors associated. None had undergone comprehensive screening. Discussion and Conclusions: Prevalence of prostatic symptoms found in older adults is consistent with other studies. Prevalence of risk factors in all participants is a matter of concern as these are the same risk factors observed in men diagnosed with prostate cancer. It is important to develop prevention strategies based on healthy lifestyles.

Introdução: O câncer de próstata é um problema de saúde pública, a neoplasia mais comumente diagnosticada e segunda causa de morte nos homens. Pouco se sabe sobre este problema na população indígena, portanto, os conhecimentos atuais são exigentes na prevenção primária. Objetivo: analisar a prevalência de sintomas de próstata e fatores de risco em varões indígenas, Centro, Tabasco. Material e Métodos: estudo descritivo correlacionado, desenho transversal, amostra de 281 homens da etnia chontal com 40 anos ou mais das comunidades; Tamulté de las Sabanas, Aniceto e Tocoalt. Foram utilizados o questionário de sintomas da próstata e a entrevista de fatores de risco. Resultados: 52.7% sem escolaridade, 47.7% são camponeses, idade média de 55 anos, 16.7% com sintomas de próstata moderados a graves. Fatores de risco; 44.5% médio y 55.5% alto risco. O teste qui-quadrado de Pearson entre a variável idade e sintomas de próstata teve uma associação de p=.000. Um valor de p=.166 entre idade e os fatores de risco; homens menores de idade apresentaram mais fatores de risco. Nenhum realizou os exames de detecção abrangente. Discussão e conclusões: coincide com outros estudos a prevalência de sintomas de próstata em idosos, é preocupante a prevalência de fatores de risco em todos os participantes, o mesmo que foi observado em homens com diagnóstico de câncer de próstata, é importante criar estratégias de prevenção com vistas a estilos de vida saudáveis.

Guía de práctica clínica para el tamizaje, diagnóstico y tratamiento inicial de cáncer de próstata localizado y localmente avanzado en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for screening, diagnosis and initial treatment of localized and locally advanced prostate cancer in the Peruvian Social Security (EsSalud)

Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje, diagnóstico, y tratamiento inicial del cáncer de próstata localizado y localmente avanzado en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el tamizaje, diagnóstico, y tratamiento inicial de adultos con cáncer de próstata localizado y localmente avanzado en EsSalud. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos, el cual formuló preguntas clínicas. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y ­cuando fue considerado pertinente­ estudios primarios en PubMed durante el 2020 y 2021. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. Se evaluó la certeza de evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones. La GPC fue revisada por expertos externos antes de su aprobación. Resultados: La GPC abordó 06 preguntas clínicas, divididas en 03 temas: tamizaje, diagnóstico, y tratamiento inicial. En base a dichas preguntas se formularon 08 recomendaciones (04 fuertes y 04 condicionales), 10 puntos de buena práctica clínica, y 04 flujogramas. Conclusión: Se emitieron recomendaciones basadas en evidencia para el manejo de pacientes con esta patología.

Background:This article summarizes the clinical practice guide (CPG) for the screening, diagnosis, and initial treatment of localized and locally advanced prostate cancer in the Social Security of Peru (EsSalud). To provide evidence-Objective:based clinical recommendations for the screening, diagnosis, and initial treatment of adults with localized and locally advanced prostate cancer in EsSalud. Methods: Aguideline developmentgroup(GDG)wasformed,whichincluded specialist physicians and methodologists, who formulated clinical questions. Systematic searches of systematic reviews were conducted and - when deemed relevant - primary studies in PubMed during 2020 and 2021. Evidence was selected to answer each of the proposed clinical questions. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic working meetings, the GEG used the GRADE methodology to review the evidence and formulate recommendations. The CPG was reviewed by external experts before its approval. The CPG Results: addressed 06 clinical questions, divided into 03 topics: screening, diagnosis, and initial treatment. Based on these questions, 08 recommendations were formulated (04 strong and 04 conditional), 10 points of good clinical practice, and 04 flow charts. Conclusion: Evidence-based recommendations were issued for the management of patients with this pathology

Incertidumbres en la radioterapia a pacientes con cáncer de próstata con tomografía computarizada de haz cónico día a día / Study of uncertainties in radiotherapy to prostate cancer patients with cone-beam computed tomography on a day-to day basis

RESUMEN Introducción: las radiaciones con fines terapéuticos han revolucionado la medicina y en especial, las tecnologías de radiación para el tratamiento del cáncer. Objetivo: determinar el margen de error de la configuración y el movimiento de órganos en la determinación de la posición del Clinical Target Volumen basadas en la tomografía computarizada de haz cónico de kilovoltaje en el tratamiento al cáncer de próstata, así como cuantificar el movimiento de los órganos durante la terapia conformal de la próstata obtenida un margen para la próstata. Métodos: investigación experimental; se asumió el método radioterápico de la adaptación día a día. Se seleccionaron los pacientes registrados de enero a abril del 2017 de Oncología Radioterápica del Hospital Universitario de la Universidad de Verona en Italia, con adenocarcinoma de próstata en estadios T1 a T4; fueron tratados mediante terapia de arco volumétrico modulado. Resultados: se utilizó la fórmula de Van Herk para encontrar el margen de la próstata, se observó que en la dirección cráneo caudal y lateral existen dispersiones pequeñas, y en la anteroposterior el grado de dispersión es más grande, lo que se relacionó con el llenado rectal, movimiento de la vejiga y peristalsis del paciente. Se encontró que los márgenes requeridos para la próstata entre CTV y PTV serían en la dirección cráneo caudal 3,3 mm, lateral 3,7 mm y anteroposterior 4,4mm. Conclusiones: la tomografía computarizada de haz cónico es una herramienta precisa para la guía de imágenes, proporciona un medio equivalente de corrección de la configuración para pacientes de próstata.

ABSTRACT Introduction: radiations with therapeutic aims have revolutionized medicine, particularly radiation technologies for the treatment of cancer. Objective: to determine the margin of errors of the configuration and the movement of organs in determining the position of Clinical Target Volume using kilovoltage cone-beam computed tomography in the treatment of prostate cancer, as well as to quantify the movement of organs during the planned therapy of prostate obtained by a margin for the prostate. Methods: an experimental research, the radio-therapeutic method on a day-to day basis was taken on. Patients registered from January to April 2017 on Cancer Radiotherapy from the University Hospital of Verona University in Italy, with prostate adenocarcinoma stages T1 to T4; and who were treated using volumetric modulated arch therapy. Results: making use of Van Herk's formula to position the margin of prostate, it was observed that in the craniocaudal and lateral direction there are small scatterings, and in the anteroposterior direction the degree of scattering is greater, being related to rectal filling, bladder movement and peristalsis of the patient. Finding the required margins for the prostate between CTV and PTV would be in the craniocaudal direction 3,3 mm, lateral 3,7 mm and anteroposterior 4,4 mm. Conclusions: cone-beam computed tomography is a precise tool to guide the images; it provides an equivalent approach of correction of the configuration for prostate cancer patients.

Prevalencia de factores de riesgo y sintomatología prostática en indígenas de Tabasco / Prevalence of Prostate Cancer Risk Factors and Symptoms in Indigenous People in Tabasco, Mexico / Prevalência de fatores de risco e sintomas de próstata em indígenas de Tabasco

Resumen Introducción El cáncer de próstata, es un problema de salud pública, la neoplasia que se diagnostica con mayor frecuencia y segunda causa de muerte en los hombres. Poco se sabe de este problema en población indígena, por lo cual, los conocimientos actuales son demandantes en la prevención primaria. Objetivo analizar la prevalencia de sintomatología prostática y factores de riesgo entre varones indígenas, Centro, Tabasco. Material y Métodos estudio descriptivo correlacional, diseño transversal, muestra de 281 hombres de la etnia chontal de 40 y más años de las comunidades; Tamulté de las Sabanas, Aniceto y Tocoalt. Se utilizó el cuestionario de síntomas prostáticos y entrevista de factores de riesgo. Resultados 52.7% sin escolaridad, 47.7% son campesinos, edad media 55 años, 16.7% con sintomatología prostática de moderada a severa. Factores de riesgo; 44.5% mediano y 55.5% alto riesgo. La prueba de Chi cuadrada de Pearson entre la variable edad y sintomatología prostática tuvo una asociación de p=.000. Un valor de p=.166 entre la edad y los factores de riesgo; hombres de menor edad presentaron más factores de riesgo. Ninguno se ha realizado los exámenes de detección integral. Discusión y conclusiones coincide con otros estudios la prevalencia de síntomas prostáticos en adultos mayores, es preocupante la prevalencia de factores de riesgo en todos los participantes, mismos que se han observado en hombres con diagnóstico de cáncer de próstata, es importante crear estrategias de prevención con miras en los estilos de vida saludable.

Abstract Introduction Prostate cancer is a public health problem being the most frequently diagnosed neoplasm and the second leading cause of cancer death in men. However, there is little information about this disease in indigenous people and therefore, current knowledge calls for urgent primary prevention. Objective To analyze the prevalence of prostate cancer risk factors and symptoms in indigenous men in Centro, Tabasco. Materials and Methods A cross-sectional descriptive correlational study was conducted with 281 Chontal men aged 40 years and older from the communities of Tamulté de las Sabanas, Aniceto and Tocoalt. The Prostate Symptom Score questionnaire and interviews for assessing risk factors were both implemented. Results 52.7% had no formal schooling at all, 47.7% were peasants at an average age of 55 years, 16.7% had moderate to severe prostatic symptoms. As for risk factors, 44.5% were classified to be at medium risk and 55.5% at high risk. Pearson's chi-squared test between variables age and prostatic symptoms showed an association of p=.000 and a value of p=.166 between age and risk factors. Younger men showed to have more risk factors associated. None had undergone comprehensive screening. Discussion and Conclusions Prevalence of prostatic symptoms found in older adults is consistent with other studies. Prevalence of risk factors in all participants is a matter of concern as these are the same risk factors observed in men diagnosed with prostate cancer. It is important to develop prevention strategies based on healthy lifestyles.

Resumo Introdução O câncer de próstata é um problema de saúde pública, a neoplasia mais comumente diagnosticada e segunda causa de morte nos homens. Pouco se sabe sobre este problema na população indígena, portanto, os conhecimentos atuais são exigentes na prevenção primária. Objetivo analisar a prevalência de sintomas de próstata e fatores de risco em varões indígenas, Centro, Tabasco. Material e Métodos estudo descritivo correlacionado, desenho transversal, amostra de 281 homens da etnia chontal com 40 anos ou mais das comunidades; Tamulté de las Sabanas, Aniceto e Tocoalt. Foram utilizados o questionário de sintomas da próstata e a entrevista de fatores de risco. Resultados 52.7% sem escolaridade, 47.7% são camponeses, idade média de 55 anos, 16.7% com sintomas de próstata moderados a graves. Fatores de risco; 44.5% médio y 55.5% alto risco. O teste qui-quadrado de Pearson entre a variável idade e sintomas de próstata teve uma associação de p=.000. Um valor de p=.166 entre idade e os fatores de risco; homens menores de idade apresentaram mais fatores de risco. Nenhum realizou os exames de detecção abrangente. Discussão e conclusões coincide com outros estudos a prevalência de sintomas de próstata em idosos, é preocupante a prevalência de fatores de risco em todos os participantes, o mesmo que foi observado em homens com diagnóstico de câncer de próstata, é importante criar estratégias de prevenção com vistas a estilos de vida saudáveis.

Análisis retrospectivo de las características y utilización de los recursos de salud en pacientes con cáncer de próstata resistente a la castración metastásico tratados con Enzalutamida o Acetato de Abiraterona en Colombia / Retrospective Analysis of the Characteristics and Utilization of Health Resources in Patients with Castration Resistant Prostate Cancer Treated with Enzalutamide or Abiraterone Acetate in Colombia

Objetivo Describir las características demográficas, clínicas, los recursos de salud utilizados y los costos directos del tratamiento del cáncer de próstata resistente a la castración metastásico (CPRCm), tratados con enzalutamida o acetato de abiraterona en Colombia. Métodos Mediante un estudio de corte transversal se analizaron datos de utilización de servicios de una EPS (entidad promotora de salud) colombiana. Para ello, se identificaron los pacientes que durante el 1 de julio de 2016 y 30 de junio de 2017 (fecha índice) presentaron registro de uso de enzalutamida o acetato de abiraterona y se confirmaron sus antecedentes de castración química o quirúrgica (6 meses previos a la fecha índice). Se establecieron las frecuencias de uso de servicios en dicha población y se extrajo el consumo reportado asociado a consultas (urgencias, consulta externa), procedimientos y medicamentos en el periodo de análisis. Los costos se organizaron por categorías y se reportaron en pesos colombianos (COP) 2016. Resultados se identificaron 161 pacientes con CPRCm con edad media de 77 años, se determinó que el departamento colombiano con más población de CPRCm en esta cohorte fue el Valle del Cauca, que 98,1% de los pacientes pertenecen al régimen contributivo y que 1,9% al subsidiado. El cálculo de la supervivencia con el índice de comorbilidad de Charlson mostró que esos pacientes tendrían una tasa de supervivencia de 0% a 10 años. Las comorbilidades más frecuentes encontradas fueron hipertensión, diabetes mellitus, insuficiencia renal y otras patologías tumorales relacionadas. El costo total de manejo de un paciente con CPRCm, que recibe de manera continua durante 12 meses abiraterona o enzalutamida es promedio $131.942.292 COP año. Esa cifra incluye tanto el uso de servicios como el consumo de medicamentos, y ese último representa cerca del 90% del costo. Conclusiones los pacientes con cáncer en estadio metastásico se caracterizan por presentar alta demanda de medicamentos, laboratorios, imágenes diagnósticas, visitas ambulatorias e ingresos hospitalarios. Debido a que es una muestra pequeña de pacientes, se requiere desarrollar una valoración posterior que permita corroborar los hallazgos encontrados en este estudio retrospectivo.

Objective describe the demographic, clinical characteristics, the health resources utilization and the direct costs of patients with metastatic castration-resistant prostate cancer (CPRCm) treated with Enzalutamide or Abiraterone Acetate in Colombia. Methods Through a descriptive retrospective analysis through the database of a Colombian health insurer, patients were identified who, during July 1st, 2016 and June 30th, 2017 (index date) were dispensed with enzalutamide or abiraterone acetate, medical history of chemical or surgical castration was confirmed (6 months prior to the index date). The frequencies of use of services in this population were established and the reported consumption associated with consultations (emergencies, outpatient consultation), procedures and medications in the period of analysis were extracted. The costs were organized by categories and were reported according to Colombian pesos (COP) 2016. Results In a cohort of 161 patients with CPRCm with an average age of 77 years, it was determined that Valle del Cauca is the Colombian department with the largest CPRCm population in this cohort. 98.1% of the patients belong to the contributory regimen and 1.9% to the subsidized. The calculation of the patient's survival with the Charlson Comorbidity Index (CCI) showed a 0% survival rate at 10 years and most frequent comorbidities were hypertension, diabetes mellitus, renal failure and other related tumor pathologies. The total cost of managing a patient with CPRCm, who receives continuous abiraterone or enzalutamide for 12 months on average is $ 131,942,292 COP per year, this figure includes both the use of services and the consumption of medications; the latter represents ∼90% of cost. onclusions These patients were characterized by being large demander of health services, namely, medicines, laboratories, images, outpatient visits and inpatient admission. Due to it is a small sample of patients, is necessary to develop a posterior evaluation to corroborate the findings found in this retrospective analysis.

Nivel de conocimientos en la prevención del cáncer de próstata en derechohabientes de una unidad de medicina familiar / Level of knowledge in prostate cancer prevention in beneficiaries from a family medicine unit

Introducción: el cáncer es una de las primeras causas de muerte mundial; en 2012 representó 8.2 millones de muertes. En México, a pesar de que la incidencia de cáncer de próstata es tres veces menor que lo observado en Estados Unidos, la mortalidad por esta causa es prácticamente igual (11.3 vs 9.8 muertes por cada 100,000 hombres) y representa la primera causa de cáncer y mortalidad por cáncer en hombres, por lo que es de vital importancia la prevención y para ello se debe promover el conocimiento de esta afección. Objetivo: identificar el nivel de conocimientos sobre la prevención del cáncer de próstata en hombres de 40 a 65 años de la Unidad de Medicina Familiar No. 51. Metodología: estudio descriptivo transversal. Se aplicó un cuestionario validado (alfa de Cronbach de 0.8) sobre las medidas preventivas del cáncer prostático a 204 derechohabientes masculinos de la unidad. Resultados: el grado de conocimientos sobre la prevención del cáncer de próstata es bajo en el 66% de los casos, me- dio en el 31% y alto en el 3%; el 78.9% de los participantes corresponde a casados, el 51.5% tiene grado de estudios de preparatoria o superior y el 47.1% es obrero. Conclusiones: el bajo grado de conocimientos en la prevención del cáncer prostático muestra un área de oportunidad de mejorar si se difunde a edades tempranas.

Introduction: Cancer is one of the leading causes of death worldwide; in 2012, 8.2 million deaths were attributed to it. In Mexico, despite the fact that the incidence of prostate cancer is three times lower than that observed in the United States, mortality from this cause is practically the same (11.3 vs. 9.8 deaths per 100 000 men) and represents the first cause of cancer and cancer mortality in men, which is why prevention is of vital importance, and for this, knowledge about the pathology must be promoted. Objective: To identify the level of knowledge about the pre- vention of prostate cancer in men between 40 and 65 years from the Family Medicine Unit No. 51. Methodology: Descriptive cross-sectional study. A validated questionnaire (Cronbach's alpha of 0.8) on preventive measures of prostate cancer was applied to 204 male beneficiaries from the aforementioned unit. Results: The level of knowledge about the prevention of prostate cancer is low in 66% of the cases, medium in 31% and high in 3%; 78.9% are married, 51.5% have a high school education level or higher and 47.1% are workers. Conclusions: The low level of knowledge of prostate cancer prevention shows an area of opportunity for improvement with a greater emphasis on early ages.

CRISP3 glycoprotein: a good biomarker for prostate cancer? / Glicoproteína CRISP3: um bom biomarcador para câncer de próstata?

ABSTRACT Introduction: Cysteine-rich secretory protein 3 (CRISP3) is expressed at low levels in normal human prostate but often overexpressed in prostate cancer (PCa). The relevance of this overexpression for the malignancy of PCa is still unclear. The prognostic value of the currently used prostate specific antigen (PSA) test can be misleading under certain circumstances, resulting in overtreatment of indolent tumors. New biomarkers are needed to reduce overtreatment and improve quality of life of men. Objective: Evaluate if CRISP3 expression could be a good biomarker for PCa. Methods: CRISP3 expression was determined by immunohistochemistry in tissue sections of prostate cancer from twenty-five patients subjected to radical prostatectomy. Gleason grading system was used as prognostic indicator and the staging of PCa was defined using the TNM system. Clinical parameters and PSA levels before and after surgery were determined. Results: CRISP3 expression was strong in 14 (56%), moderate in four (16%) and weak in seven (28%) specimens. There was no correlation between the intensity of CRISP3 expression and pre- and post-treatment PSA levels. Fifteen (60%) of PCa biopsies showed extension of the primary tumor pT2. Seven patients (28%) showed Gleason score higher than 7; thirteen (52%) equal to 7, and five (20%) lower than 7. There were no significant statistical differences between Gleason score and CRISP3 expression. Conclusion: CRISP3 is expressed in prostate cancer at different levels. Additional studies are required to better evaluate if CRISP3 could be used as a biomarker.

RESUMEN Introducción: La proteína rica en cisteína secretora 3 (CRISP3) se expresa en bajos niveles en la próstata humana normal, pero está mayormente expresada en el cáncer de próstata (CaP). Todavía, su relevancia en pacientes con CaP aún no está clara. La prueba de antígeno prostático específico (PSA) puede generar interpretaciones erróneas bajo ciertas circumstancias, acarreando sobretratamiento de tumores indolentes. Nuevos biomarcadores son fundamentales para evitar tratamientos innecesarios y mejorar la calidad de vida del paciente. Objetivo: Evaluar se la expresión de CRISP3 podría ser un buen biomarcador de CaP. Métodos: Se determinó la expresión de CRISP3 por inmunohistoquímica en cortes de tejido de CaP de 25 pacientes sometidos a prostatectomía radical. La clasificación Gleason fue utilizada como indicador pronóstico, y la estadificación fue determinada por el sistema TNM. Parámetros clínicos y niveles de PSA antes y después de la cirurgía fueron determinados. Resultados: La expresión de CRISP3 fue fuerte en 14 (56%) muestras; moderada en cuatro (16%) y débil en siete (28%). No hubo relación entre la expresión de CRISP3 y PSA pre y post-tratamiento. Quince (60%) biopsias de CaP tuvieron extensión del tumor primario pT2. Siete pacientes (28%) demostraron escala de Gleason mayor que 7; trece (52%), igual a 7; y cinco (20%), menor que 7. No hubo diferencias estadísticas significativas entre la escala de Gleason y la expresión de CRISP3. Conclusión: CRISP3 se expresa en CaP en diferentes niveles. Se necesitan estudios adicionales para evaluar se CRISP3 puede realmente ser usado como biomarcador.

RESUMO Introdução: A proteína CRISP3 é expressa em baixos níveis na próstata humana normal, mas superexpressa no câncer de próstata (CaP). Contudo, sua relevância em pacientes com CaP ainda não está clara. O teste de antígeno específico da próstata (PSA) pode proporcionar interpretações erradas em determinadas circunstâncias, resultando em excesso de tratamento para tumores indolentes. Novos biomarcadores são fundamentais para evitar tratamentos desnecessários e melhorar a qualidade de vida do paciente. Objetivo: Avaliar se a expressão de CRISP3 poderia ser um bom biomarcador para CaP. Métodos: A expressão de CRISP3 foi determinada por imuno-histoquímica em seções de tecido de CaP de 25 pacientes submetidos a prostatectomia radical. O sistema de classificação Gleason foi utilizado como indicador prognóstico, e o estadiamento foi determinado pelo sistema TNM. Parâmetros clínicos e níveis de PSA antes e pós-cirurgia foram determinados. Resultados: A expressão de CRISP3 foi forte em 14 (56%) amostras; moderada em quatro (16%) e fraca em sete (28%). Não houve correlação entre a expressão de CRISP3 e PSA pré e pós-tratamento. Quinze (60%) biópsias de CaP apresentaram extensão do tumor primário pT2. Sete pacientes (28%) mostraram escore de Gleason maior que 7; treze (52%), igual a 7; e cinco (20%), menor que 7. Não houve diferenças estatísticas significativas entre o escore de Gleason e a expressão de CRISP3. Conclusão: CRISP3 é expresso no CaP em diferentes níveis. Estudos adicionais são necessários para avaliar se CRISP3 realmente pode ser usado como biomarcador.

Prevalence and severity levels of post-radical prostatectomy incontinence: different assessment instruments / Prevalencia y niveles de severidad de la incontinencia urinaria pos-prostatectomía radical: diferentes instrumentos de evaluación / Prevalência e níveis de gravidade de incontinência urinária pós-prostatectomia radical: diferentes instrumentos de avaliação

ABSTRACT Objectives: to analyze urinary incontinence prevalence and severity in prostatectomized men assessed by three different instruments. Methods: a cross-sectional study was conducted with 152 men. The pad test, pad used, and International Consultation on Incontinence Questionnaire - Short Form (self-report) were considered. Data were analyzed using Spearman's correlation, Kappa index, considering a significance level of 0.05. Results: urinary incontinence prevalence was 41.4%, 46.7% and 80.3% according to pad used, pad test and self-report. Positive correlations and moderate to poor agreement were found between the instruments. As for severity, most participants had mild incontinence. The largest number of cases of mild and severe incontinence was identified by self-report. Conclusions: the self-report showed higher values for prevalence of mild and severe severity levels. Through the identified differences, we propose that the objective assessment (pad used and pad test) be associated with individuals' perception (self-report) to better estimate prevalence and severity.

RESUMEN Objetivos: analizar la prevalencia y la severidad de la incontinencia urinaria en hombres prostatectomizados a partir de tres instrumentos diferentes. Métodos: estudio transversal, realizado con 152 hombres. Los instrumentos considerados fueron el pad test, pad used y International Consultation on Incontinence Questionnaire - Short Form (autoinforme). Los datos fueron analizados mediante correlación de Spearman, índice Kappa, considerando un nivel de significancia de 0.05. Resultados: la prevalencia de incontinencia urinaria fue del 41,4%, 46,7% y 80,3% según pad used, pad test y autoinforme, respectivamente. Se encontraron correlaciones positivas y concordancia moderada a pobre entre los instrumentos. En cuanto a la gravedad, la mayoría de los participantes presentaba incontinencia leve. El mayor número de casos de incontinencia leve y grave se identificó mediante autoinforme. Conclusiones: el autoinforme mostró mayores valores de prevalencia y niveles de gravedad leve y grave. Mediante las diferencias identificadas, proponemos que la evaluación objetiva (pad used y pad test) se asocie con la percepción del individuo (autoinforme) para estimar mejor la prevalencia y severidade.

RESUMO Objetivos: analisar a prevalência e a gravidade da incontinência urinária em homens prostatectomizados a partir de três instrumentos diferentes. Métodos: estudo transversal, realizado com 152 homens. Foram considerados os instrumentos pad test, pad used e International Consultation on Incontinence Questionnaire - Short Form (autorrelato). Os dados foram analisados por correlação Spearman, Índice Kappa, considerando nível de significância 0,05. Resultados: a prevalência de incontinência urinária foi 41,4%, 46,7% e 80,3% segundo pad used, pad test e autorrelato, respectivamente. Constataram-se correlações positivas e concordâncias de moderada a pobre entre os instrumentos. Quanto à gravidade, a maioria dos participantes apresentou incontinência leve. O maior número de casos de incontinência leve e severa foi identificado pelo autorrelato. Conclusões: o autorrelato apontou valores superiores para prevalência e níveis de gravidade leve e severa. Mediante as diferenças identificadas, propomos que a avaliação objetiva (pad used e pad test) seja associada à percepção do indivíduo (autorrelato) para melhor estimativa da prevalência e gravidade.

Avaliação de tecnologia assistiva sobre câncer de próstata e mama para deficientes visuais em países lusófonos / Evaluation of assistive technology about prostate and breast cancer for visually impaired persons in portuguese-speaking countries / Evaluación de tecnología de asistencia en cáncer de próstata y mama para personas con discapacidad visual en países de habla portuguesa

Objetivo: Avaliar a acessibilidade de tecnologia assistiva sobre câncer de próstata e de mama por deficientes visuais de dois países lusófonos. Métodos: Estudo metodológico de avaliação de tecnologia assistiva em saúde. Dados coletados com instrumento validado, constituído por 17 itens distribuídos nos atributos objetivos, acesso, clareza, estruturação e apresentação, relevância e eficácia e interatividade. Na análise, aplicaram-se Teste Qui-quadrado de Pearson, Teste Exato de Fisher ou Razão de Verossimilhança de acordo com os pressupostos dos testes. Os aspectos éticos foram respeitados. Resultados: A amostra foi de 62 participantes. As variáveis que tiveram diferenças estatísticas significantes foram escolaridade (p=0,006), tipos de deficiência (p=0,010) e desenvolvimento da deficiência (p= 0,005). Todas os atributos e itens obtiveram boas avaliações com alguns tópicos que não houve diferença estatística em ambos os países. Conclusão: As tecnologias assistivas sobre câncer de mama e próstata foram bem avaliadas, independente do país, brasileiros e portugueses as consideraram adequadas. (AU)

Objective: To evaluate the accessibility of assistive technology about prostate and breast cancer by visually impaired persons in two Portuguese-speaking countries. Methods: Methodological study of an assess assistive health technology. Data were collected from a validated instrument, comprising of 17 items distributed in the attributes, objective, access, clarity, structure and presentation, relevance and effectiveness and interactivity. In the analysis, the Pearson's Chi-squared test and the Fisher's exact test or likelihood ratios were applied according to the assumptions of the tests. The ethical aspects involved in the research were respected. Results: The sample was of 62 participants. The variables that exhibited any statistical diferences ware: schooling (p = 0.006); types of disabilities (p = 0.010) and; disabilities development (p = 0.005). All attributes and items had good evaluations, with some topics that there was no statistical difference among the countries. Conclusion: Assistive technology about prostate and breast cancer were well evaluated, regardless of the country, were considered adequate by brazilians and portuguese. (AU)

Objetivo: Evaluar la accesibilidad de la tecnología de asistencia en el cáncer de próstata y mama por personas con daño visual de dos países de habla portuguesa. Métodos: Estudio metodológico para evaluar la tecnología asistencial sanitaria. Datos recolectados con un instrumento validado, compuesto por 17 ítems distribuidos en los atributos objetivos, acceso, claridad, estructuración y presentación, relevancia y efectividad e interactividad. En el análisis se aplicó la prueba de chi-cuadrado de Pearson, la prueba exacta de Fisher o razón de verosimilitud según los supuestos de las pruebas. Se respetaron los aspectos éticos. Resultados: La muestra estuvo formada por 62 participantes. Las variables que presentaron diferencias estadísticamente significativas fueron educación (p = 0,006), tipos de discapacidad (p = 0,010) y desarrollo de la discapacidad (p = 0,005). Todos los atributos e ítems obtuvieron buenas evaluaciones con algunos temas que no hubo diferencia estadística en ambos países. Conclusion: Las tecnologías de asistencia en cáncer de mama y próstata fueron bien evaluadas, independientemente del país, brasileños y portugueses las consideraron apropiadas. (AU)

Evidências de cuidado do enfermeiro aos homens com câncer de próstata: revisão integrativa / Evidencias del cuidado del enfermero a los hombres con cáncer de próstata: revisión integradora / Evidence of nurse care for men with prostate cancer: an integrative review

Objetivo: Avaliar evidências das necessidades de suporte de cuidados aos homens com câncer de próstata em seguimento e tratamento atendidos por enfermeiros. Método: Revisão integrativa da literatura nas bases de dados: PubMed e CINAHL, em inglês, português e espanhol, publicados entre 2009 a 2019, com o cruzamento dos descritores "Prostatic Neoplasms", "Masculinity", "Health Services Needs and Demand", "Needs assessment", "Nursing Care", "Comprehensive Health Care", "Oncology Nursing". Encontrados 2425 artigos e atenderam aos critérios de inclusão seis artigos. Para a extração e análise dos dados, utilizaram-se instrumentos validados. Resultados: As intervenções educativas, o planejamento individual coparticipativo e o acompanhamento longitudinal foram as principais ações desenvolvidas pelos enfermeiros, valorizados pelos cuidados oferecidos. Conclusão: A síntese do conhecimento direciona para a importância do enfermeiro no cuidado ao homem com câncer de próstata e para a elaboração de planos de cuidados inovadores e compartilhados, fundamentados nas necessidades e nas melhores evidências(AU)

Objective: To evaluate evidence of care support needs of men with prostate cancer under follow-up and treatment that were assisted by nurses. Method: Integrative literature review in the databases: PubMed and CINAHL in English, Portuguese and Spanish published between 2009 and 2019, using and crossing descriptors such as "Prostatic Neoplasms", "Masculinity", "Health Services Needs and Demand", "Needs assessment", "Nursing Care", "Comprehensive Health Care", "Oncology Nursing". A total of 2425 articles were found and six articles met the inclusion criteria. Validated instruments were used for data extraction and analysis. Results: Educational interventions, co-participatory individual planning and longitudinal follow-up were the main actions developed by nurses, valued for the care offered. Conclusion: The synthesis of knowledge directs to the importance of nurses in the care of men with prostate cancer and to the elaboration of innovative and shared care plans, based on the needs and the best evidence(AU)

Objetivo: Evaluar evidencias de las necesidades de soporte en cuidados a hombres con cáncer de próstata en seguimiento y tratamiento, atendidos por enfermeros. Método: Revisión integradora de literatura en las bases de datos: PubMed y CINAHL en inglés, portugués y español, publicada de 2009 a 2019, utilizando los descriptores: "Prostatic Neoplasms", "Masculinity", "Health Services Needs and Demand", "Needs Assessment", "Nursing Care", "Comprehensive Health Care" y "Oncology Nursing". Encontrados 2425 artículos, seis cumplieron los requisitos de inclusión. Para extracción y análisis de los datos se utilizaron instrumentos validados. Resultados: Intervenciones educativas, planificación individual coparticipativo y seguimiento longitudinal fueron las principales acciones desarrolladas por los enfermeros, valorizados por los cuidados ofrecidos. Conclusión: La síntesis del conocimiento direcciona hacia la importancia del enfermero en el cuidado del hombre con cáncer de próstata y hacia la elaboración de planes de cuidados innovadores y compartidos, basados en las necesidades y en las mejores evidencias(AU)