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1.
J Urol ; : 101097JU0000000000000692, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821099

RESUMO

PURPOSE: We aimed to compare cancer detection rates (CDR) in patients who underwent MRI cognitive guided micro-ultrasound biopsy (MB) versus Robotic ultrasound-magnetic resonance imaging fusion biopsies (RFB) for prostate cancer (PCa). MATERIALS AND METHODS: Out of 269 targeted biopsy procedures, 222 men underwent RFB and 47 MB. RFB was performed using the transperineal Artemis device (Eigen, Grass Valley, CA), while MB was performed transrectally through high resolution ExactVu™ system (Exact Imaging, Markham, Canada). Random biopsies were performed in addition to targeted biopsy in both modalities. PCa detection rates and concordance between random and target biopsies were also assessed. RESULTS: Groups were comparable regarding age, prostate-specific antigen, prostate volume and magnetic resonance PI-RADSv.2 score. MB group presented fewer biopsied cores in both random and target approaches. In targeted biopsies, MB patients presented higher detection of clinically significant disease (GS>6) than RFB group (38% vs. 23%, p=0.02). When considering PCa detection regardless of GS or PCa detection by random+target biopsies, no difference was found between the groups. However, on a per-core basis, overall PCa detection rates favoured MB patients in both random and targeted scenarios. In addition, the Prostate Risk Identification Using Micro-Ultrasound (PRI-MUS) score yielded by micro-ultrasound visualization was independently associated with improved CDR of clinically significant PCa (csPCa). CONCLUSIONS: In our initial experience, MB featured a higher csPCa detection rate in target cores than RFB, which was associated to target features in micro-ultrasound (PRI-MUS score). These findings reinforce the role of micro-ultrasound technology in targeted biopsies.

3.
World J Urol ; 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31595314

RESUMO

INTRODUCTION AND OBJECTIVE: This study aims to evaluate safety and efficacy of different endoscopic enucleation of the prostate (EEP) techniques, by comparing laser (L-EEP) and non-laser (NL-EEP) procedures; and EEP versus other endoscopic non-enucleation (ENE) surgeries for benign prostatic enlargement (BPE). METHODS: A systematic literature review was performed for randomized clinical trials (RCT) that compared different endoscopic treatments for BPE, between 1982 and 2018. Two analyses were performed: (1) EEP versus ENE; and (2) L-EEP versus NL-EEP. Efficacy was assessed using perioperative data (removed tissue volume, operation time (OT), catheterization time, length of hospital stay); and functional outcomes [IPSS, IIEF-5, maximum flow rate (Qmax), postvoid residual volume (PVR), quality of life (QoL)]. Safety was assessed through complications (Hb and sodium decrease, transfusion rate). Meta-analyses were performed using RevMan® 5.3. RESULTS: Out of 35 RCTs (4066 patients), 31 (3909 patients) evaluated EEP versus ENE, and 4 (327 patients) evaluated L-EEP versus NL-EEP. EEP presented greater Qmax. Also, EEP presented less catheterization time, length of hospital stay, Hb decrease, transfusion rate. OT and bladder injury were greater with EEP. There were no significant differences between other items. L-EEP removed more tissue volume, with a smaller drop in serum Hb. There were no significant differences in other perioperative data, functional outcomes, complications. CONCLUSIONS: EEP and ENE are effective and safe for treating BPE. Perioperative data favors EEP. Statistical differences, with questionable clinical significance in functional outcomes and complication rates were encountered. L-EEP provides greater tissue removal and smaller Hb decrease then NL-EEP, with similar functional profiles.

4.
Sex Med Rev ; 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31570315

RESUMO

INTRODUCTION: Peyronie's disease is characterized by abnormal healing of the tunica albuginea (TA), resulting in the production of a fibrotic plaque that leads to penile curvature and considerable psychological impact. Precise knowledge of various surgical techniques is of fundamental importance for proper management of the patient. AIM: To compare results (including surgical success on quality of life and sexual satisfaction and complications) between 2 different techniques: with TA incision vs without TA incision. METHODS: The search was performed according to PRISMA in PubMed and Embase through September 2018. Key words searched were ["Peyronie" or "Peyronie's disease" or "penile curvature" or "penile induration"] and ["technique" or "surgery" or "surgical"] and ["quality of life" or "sexual quality of life" or "sexual satisfaction" or "outcome" or "outcomes"]. MAIN OUTCOME MEASURE: Thirty-one articles were considered for this review. The main outcomes were reported descriptively. RESULTS: The most significant results included penile straightening (88.5% vs 70.9% favoring not opening TA), perception of a palpable nodule (13.2% vs 27.4% favoring not opening TA), and loss of sensibility (11% vs 20% favoring not opening TA). Neither a prospective randomized study nor a direct comparison study has been performed for these techniques. There is no consensus among the studies on how to measure results. Subjective criteria were primarily used for evaluation, and there is a paucity of objective tools to quantify the outcomes. CONCLUSION: There is no consensus on which technique achieves better results or fewer complications; therefore, the decision on which technique to use is a matter of surgeon preference. Studies comparing distinctive techniques and either opening or not opening the tunica albuginea should be performed to support surgical decision making. In addition, guidelines that could assist in the standardization of criteria should be investigated in future studies, with the aim of better evaluating outcomes. Barbosa, ARG, Takemura LS, Cha JD, et al. Surgical Treatment of Peyronie's Disease: Systematic Review of Techniques Involving or Not Tunica Albuginea Incision. Sex Med Rev 2019; XX:XXX-XXX.

5.
Arch Esp Urol ; 72(8): 825-830, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31579041

RESUMO

OBJECTIVE: High-intensity focused ultrasound (HIFU) Focal therapy appears to have encouraging oncologic outcomes and urinary and erectile function. The control of the treated area can be done using contrast enhanced ultrasound with sulfur hexafluoride (Sonovue®) at the end of the procedure. We report oncological and functional outcomes in HIFU focal therapy (FT) for prostate cancer (PCa) management using sonovue. METHODS: A total of 274 HIFU procedures were found in our registry in the period between June 2014 and July 2018. Prospective data of 59 consecutive patients after focal high-intensity focused ultrasound (HIFU) using Sonovue were collected. FT failure was defined as positive biopsy Gleason score (GS) ≥ 7 in- or out-field, local or systemic salvage treatment, PCa-metastasis or PCa-specific death. RESULTS: A total of 59 patients submitted to HIFU with median follow-up of 18 months were included in the analysis. Median age was 66.7 yr (IQR 59.1-74.3). Median preoperative prostate-specific antigen (PSA) was 7.6 ng/ml (IQR 5-10.2) and preoperative biopsies GS 6, 7(3+4), 7(4+3) were found in 26 (44%), 30 (50.8%) and 3 (5%), respectively. Failure was found in 16 (27.1%) patients. Failure-free survival (FFS) in 2 and 4yr was 83% and 74% respectively (Figure 1). No PCa-specific death was registered in the period of study. Median nadir PSA after FT was 2.67 ng/ml. Sexual potency was achieved in 75% of previous potent patients and urinary continence in 93.4% of patients at 3 months. Fourteen (23%) patients presented with complications. Four (6.7%) patients have presented complications grade 1 and 10 (16.9%) patients have presented complications grade 2. Six (10.1%) patients have presented acute urinary retention. CONCLUSIONS: Our study shows that the use of Sonovue after HIFU FT was safe. Patients present a significant proportion of failure after HIFU FT but with good functional outcomes and without incidence of severe complications.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade , Neoplasias da Próstata , Humanos , Masculino , Estudos Prospectivos , Antígeno Prostático Específico , Neoplasias da Próstata/terapia , Terapia de Salvação , Resultado do Tratamento
6.
J Urol ; : 101097JU0000000000000506, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31437121

RESUMO

PURPOSE: We report oncologic outcomes in patients treated with focal therapy of prostate cancer. MATERIALS AND METHODS: We retrospectively analyzed a single institution cohort of men with localized prostate cancer who received focal therapy using high intensity focused ultrasound or cryotherapy from 2009 to 2018. Focal therapy was offered for low or intermediate risk disease (prostate specific antigen less than 20 ng/ml, Gleason score 7 or less and clinical stage T2b or less). Patients with previous prostate cancer treatment or less than 6 months of followup were excluded from study. Failure was defined as local or systemic salvage treatment, a positive biopsy Gleason score of 7 or greater in field or out of field in nontreated patients, prostate cancer metastasis or prostate cancer specific death. Cox regression analysis was done to identify independent predictors of failure after focal therapy. RESULTS: Of the 309 patients included in study 190 and 119 were treated with high intensity focused ultrasound and cryotherapy, respectively. Median followup was 45 months. At 1, 3 and 5 years the failure-free survival rate was 95%, 67% and 54%, and the radical treatment free-survival rate was 99%, 79% and 67%, respectively. The 5-year metastasis-free survival rate was 98% and no prostate cancer specific death was registered in this cohort. Before focal therapy a biopsy Gleason score of 7 (3 + 4) or greater (HR 2.4, p <0.001) and nadir prostate specific antigen (HR 2.2, p <0.001) were independently associated with failed focal therapy. In the salvage focal therapy setting infield recurrence after primary focal therapy was associated with poorer failure-free survival (p=0.02). CONCLUSIONS: Almost half of the men were free of focal therapy failure 5 years after treatment. Still, a significant proportion experienced recurrence at the midterm followup. The preoperative biopsy Gleason score and nadir prostate specific antigen were significantly associated with treatment failure.

7.
Clin Nucl Med ; 44(7): e433-e434, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31058690

RESUMO

We report a case of a 43-year-old man who underwent a radical prostatectomy 3 years before the procedure (June 2015) for a locally advanced Gleason 7(4 + 3) prostate adenocarcinoma (pT3aN0), with negative surgical margins, followed by salvage radiotherapy. He also underwent antiandrogen therapy for biochemical relapse (bicalutamide) from October 2016 through May 2017, but prostate-specific antigen continued to rise (2.5 ng/mL [December 2017] and 3.3 ng/mL [February 2018]). At this point, he underwent a Ga-prostate-specific membrane antigen PET/CT, and after multidisciplinary discussion, the therapeutic option chosen was image-guided salvage cryoablation.


Assuntos
Criocirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/diagnóstico por imagem , Prostatectomia , Neoplasias da Próstata/diagnóstico por imagem , Adulto , Ácido Edético/análogos & derivados , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Oligopeptídeos , Complicações Pós-Operatórias/cirurgia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Compostos Radiofarmacêuticos
8.
Arch Esp Urol ; 72(2): 98-103, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855010

RESUMO

Prostate cancer (PCa) is the most common non-skin malignancy among men world-wide. PCa incidence is higher among African American (AA) menin comparison to the white population. Men with a previous history of PCa in first-line relatives carry also an increased risk for this disease. The incidence of PCa diminished in United States (US) since the publication in 2012 of US Preventive Service Task Force (USPSTF), in which PCa screening was bestowed with a grade D of recommendation. Nonetheless, locally advanced andmetastatic disease rates increased notably. In 2018, the USPSTF drop back in their statement against PCa screening and recommended this to be a shared-decision between men 55-69 years old and their physicians.A side-by-side evaluation methodology of the three trials included in USPSTF review was performed. The high intensity screening modality and the lower contamination rate in the control arm found in the ERSPC trial justify theearlier splitting in the cumulative mortality curves between the screening and control arm when contrasted with the CAP and PCLO trials presented. We aim to perform an objective and critical review of the current practice on prostate cancer screening, regarding its limitations and when the physician should offer a shared-decision process screening based on PSA.The controversy over PSA screening has not ended despite unequivocal evidence that it saves lives. Although the USPSTF's 2017 new draft is a step in the right direction, there is more progress to be made concerning the identification of patients harboring high-risk tumors and, consequently, die of PCa. PSA baseline may lead us to differentiate properly patients at high-risk from those under risk of overdiagnosis and overtreatment. It is well established that mpMRI has come to help us in the diagnosis of PCa and in the identification of clinically significanttumors. Finally, studies ongoing on biomarkers may assist us to improve our understanding about this frequent malignancy.


Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Idoso , Proteínas do Citoesqueleto , Detecção Precoce de Câncer , Humanos , Incidência , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Estados Unidos
9.
Arch. esp. urol. (Ed. impr.) ; 72(2): 98-103, mar. 2019.
Artigo em Inglês | IBECS | ID: ibc-FGT-1011

RESUMO

Prostate cancer (PCa) is the most common non-skin malignancy among men world-wide. PCa incidence is higher among African American (AA) men in comparison to the white population. Men with a previous history of PCa in first-line relatives carry also an increased risk for this disease. The incidence of PCa diminished in United States (US) since the publication in 2012 of US Preventive Service Task Force (USPSTF), in which PCa screening was bestowed with a grade D of recommendation. Nonetheless, locally advanced and metastatic disease rates increased notably. In 2018, the USPSTF drop back in their statement against PCa screening and recommended this to be a shared-decision between men 55-69 years old and their physicians. A side-by-side evaluation methodology of the three trials included in USPSTF review was performed. The high in tensity screening modality and the lower contamination rate in the control arm found in the ERSPC trial justify the earlier splitting in the cumulative mortality curves between the screening and control arm when contrasted with the CAP and PCLO trials presented. We aim to perform an objective and critical review of the current practice on prostate cancer screening, regarding its limitations and when the physician should offer a shared-decision process screening based on PSA. The controversy over PSA screening has not ended despite unequivocal evidence that it saves lives. Although the USPSTF’s 2017 new draft is a step in the right direction, there is more progress to be made concerning the identification of patients harboring high-risk tumors and, consequently, die of PCa. PSA baseline may lead us to differentiate properly patients at high-risk from those under risk of overdiagnosis and overtreatment. It is well established that mpMRI has come to help us in the diagnosis of PCa and in the identification of clinically significant tumors. Finally, studies ongoing on biomarkers may assist us to improve our understanding about this frequent malignancy


El cáncer de próstata (CaP) es el tumor maligno no cutáneo más frecuente entre los hombres en el mundo. La incidencia de CaP es mayor entre los afroamericanos (AA) en comparación con la población blanca. Los varones con antecedentes de CaP en familiares de primer grado también tienen un riesgo aumen CaP disminuyó en los Estados Unidos (EEUU) desde la publicación en 2012 del USPSTF (US Preventive Service Task Force), en la cual al cribado con PSA se le concedía un grado D de recomendación. No obstante, las tasas de enfermedad localmente avanzada y metastásica han aumentado notablemente. En 2018, la USPSTF dio marcha atrás en su declaración contra el cribado en CaP y recomendó que fuera una decisión compartida entre los varones de 55-69 años y sus médicos. Realizamos una evaluación conjunta de la metodología de los tres estudios incluidos en la revisión del USPSTF. La modalidad de cribado de alta intensidad y la baja tasa de contaminación en el grupo control del estudio ERSPC justifica la separación precoz de las curvas de mortalidad acumulada entre los brazos de cribado y control en comparación con la presentada en los estudios CAP y PLCO. El objetivo del artículo es realizar una revisión objetiva y crítica de las prácticas actuales en cribado de cáncer de próstata, en relación con sus limitaciones y cuándo debe un médico ofrecer el proceso de decisión compartida de cribado basado en PSA. La controversia sobre el cribado con PSA no ha terminado a pesar de la evidencia inequívoca de que salva vidas. Aunque el nuevo documento de la USPSTF 2017 es un paso en la dirección correcta, hay mas progresos por hacer en relación con los pacientes que tienen tumores de alto riesgo y, en consecuencia, mueren de CaP. El PSA basal puede llevarnos a diferenciar adecuadamente los pacientes con alto riesgo de sobrediagnóstico y sobretratamiento de los de bajo riesgo. Está bien establecido que la RMN multiparamétrica ha venido para ayudarnos en el diagnóstico del CaP y en la identificacion de los tumores clínicamente significativos. Finalmente, los estudios de marcadores en marcha pueden asistirnos para mejorar nuestro conocimiento sobre este frecuente tumor maligno


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Proteínas do Citoesqueleto , Detecção Precoce de Câncer , Programas de Rastreamento , Estados Unidos , Incidência
10.
Ther Adv Urol ; 11: 1756287218816595, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30671139

RESUMO

Background: Low-dose aspirin use has been correlated with an increased risk of bleeding and overall complications in surgical and invasive diagnostic procedures. In this review, our aim was to analyze the current literature on whether robot-assisted radical prostatectomy (RARP) is feasible and safe in patients taking low-dose aspirin perioperatively. Methods: A systematic review was performed identifying a total of 767 studies, published between January 2000 and September 2017, with five of these studies meeting the inclusion criteria for the meta-analysis, totalizing 1481 patients underwent RARP. Patients were divided into two groups: taking aspirin (group A) and those not taking aspirin (group B) perioperatively. Results: There were no significant differences between groups in the overall [group A 10.7% versus group B 15.7%, risk ratio (RR) 0.83; p = 0.45; I 2 = 0%] or major complication rates (group A 1% versus group B 3%, RR 0.98; p = 0.98; I² = 0%), rate of cardiovascular events (group A 1.4% and group B 0.5%, RR 2.06; p = 0.24; I 2 = 9%), blood loss (group A 278 ml versus group B 307 ml, SMD -0.12; p = 0.91; I 2 = 96%), or hospital length of stay [group A 4 days (3-5) and group B 4 days (3-4), SMD -0.09; p = 0.52; I² = 0%]. There was a slightly higher blood-transfusion rate in group A (2.6%) versus group B (1.6%) (RR, 5.05; p = 0.04; I 2 = 0%). Conclusion: Continued aspirin use in the perioperative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay. There was a slightly higher blood-transfusion rate in patients taking low-dose aspirin (group A) perioperatively.

11.
Int. braz. j. urol ; 44(6): 1106-1113, Nov.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-975665

RESUMO

ABSTRACT Purpose: Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. Materials and Methods: A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. Results: In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. −0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 - 6.28]; p=0.024). Conclusions: US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.

12.
Int Braz J Urol ; 44(6): 1106-1113, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30325600

RESUMO

PURPOSE: Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. MATERIALS AND METHODS: A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. RESULTS: In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. -0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 - 6.28]; p=0.024). CONCLUSIONS: US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.


Assuntos
Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética Intervencionista , Neoplasias da Próstata/diagnóstico por imagem , Ultrassonografia de Intervenção , Idoso , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Prostatectomia , Neoplasias da Próstata/patologia , Estudos Retrospectivos
13.
Front Oncol ; 8: 377, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30280090

RESUMO

Background: Prostate cancer (PCa) is a heterogeneous disease that lends itself toward numerous therapeutic options depending on its risk stratification. One of the greatest challenges in PCa urologic practice is to select patients who should be referred for biopsy and, for those patients who are diagnosed with cancer, to differentiate between patients with indolent disease from those with an unfavorable prognosis and, to determine ideal patient management and avoid unnecessary interventions. Accordingly, there is a growing body of literature reporting immunohistochemical studies with the objective of determining a prostate cancer prognosis. Among the most frequent biomarkers studied are Ki-67, p53, PTEN, MYC, and ERG. Based on these findings, we systematically reviewed articles that assessed the role of these main prognostic markers in prostate cancer. Methods: Consistent with PRISMA guidelines, we performed a systematic literature search throughout the Web of Science and PubMed Medline databases. We considered all types of studies evaluating the role of Ki-67, p53, PTEN, MYC, and ERG immunohistochemical analysis in prostate cancer until July 2017. Results: We identified 361 articles, 44 of which were summarized in this review. Diagnostically, no single immunohistochemical marker was able to define a tumor as benign or malignant. Prognostically, Ki-67, p53, and MYC were related to the tumor grade given by Gleason score and to the tumor stage (higher levels related to higher tumor grade). Furthermore, Ki-67 was also related to higher PSA levels, shorter disease-free intervals and shorter tumor-specific survival; the latter was also related to p53. The loss of PTEN protein expression showed a higher association with biochemical recurrence and with a worse prognosis, beyond that predicted by the Gleason score and tumor stage. ERG staining also showed a strong association with biochemical recurrence. Conclusion: There are several studies relating immunohistochemical markers with clinical-laboratorial outcomes in prostate cancer, the most frequent being Ki-67, p53, ERG, PTEN, and MYC. However, none of these markers have been validated by literary consensus to be routinely applied in medical practice.

14.
Tumour Biol ; 40(9): 1010428318799255, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30204063

RESUMO

Prostate cancer presents itself in a heterogeneous way with both aggressive and indolent forms. Despite the controversy surrounding its use, prostate-specific antigen screening ultimately leads to a greater number of diagnosed patients. One of the biggest challenges in clinical practice is to select the right patients for biopsy and, among diagnosed patients, to differentiate tumors with an indolent course from those with an unfavorable prognosis, in order to determine the best therapeutic decision for each case, avoiding unnecessary interventions. Currently, several types of biomarkers are available for clinical use in patients with prostate cancer, which include blood-based (prostate-specific antigen, Prostate Health Index®, 4K score®); urine sample-based (PCA3, SelectMDx®, ExoDx Prostate IntelliScore®); and biopsy, transurethral resection, or radical prostatectomy tissue-based (ConfirmMDx®, Oncotype®, Prolaris®, Decipher®). The aim of this review is to provide an overview of the current state of evidence and to highlight recent advances in the evaluation and diagnosis of prostate cancer, with emphasis on biomarkers related to diagnosis and to prognostic evaluation of localized prostate cancer.


Assuntos
Biomarcadores Tumorais/metabolismo , Próstata/metabolismo , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/metabolismo , Humanos , Masculino , Prognóstico , Antígeno Prostático Específico/metabolismo
15.
Can J Urol ; 25(4): 9401-9406, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30125519

RESUMO

INTRODUCTION: Hospital-related costs of renal cancer surgery have been described, but the societal costs of surgery-related lost productivity are poorly understood. We estimated the societal cost of renal cancer surgery by assessing surgery-related time off work (TOW) taken by patients and their caretakers. MATERIALS AND METHODS: A total of 413 subjects who underwent partial or radical nephrectomy enrolled in an IRB-approved prospective study received an occupational survey assessing employment status, work physicality, income, surgery-related TOW, and caretaker assistance. We excluded subjects with incomplete occupational information or metastatic disease. We estimated potential wages lost using individual income and TOW, and used logistic regression to evaluate for factors predictive of TOW > 30 days. RESULTS: Of the 219 subjects who responded, 138 were employed at time of surgery. Ninety-seven subjects returned to work, met the inclusion criteria, and were analyzed. Mean age was 54 and 56% of subjects had sedentary jobs. TOW ranged from 7 to 92 days; mean and median TOW was 35 and 33 days, respectively and 58% of subjects took > 30 days off. Mean potential wages lost for TOW was $10,152. Eighty-three percent of subjects had at least one caretaker take TOW (mean/median caretaker TOW: 11/7 days, respectively) to assist in recovery. Subjects with sedentary jobs were less likely to take > 30 days off (OR 0.30; 95% CI 0.09-0.99). CONCLUSIONS: Most renal cancer surgery patients take over 1 month off work. Recognizing the associated societal costs may allow better adjustment of patient expectations, and more comprehensive cost-effectiveness analyses in renal cancer care.


Assuntos
Cuidadores/estatística & dados numéricos , Efeitos Psicossociais da Doença , Neoplasias Renais/economia , Neoplasias Renais/cirurgia , Retorno ao Trabalho/estatística & dados numéricos , Absenteísmo , Adulto , Idoso , Eficiência , Emprego , Humanos , Renda , Pessoa de Meia-Idade , Nefrectomia , Salários e Benefícios/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo
16.
Acta Oncol ; 57(8): 1003-1010, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29882448

RESUMO

BACKGROUND: Hypofractionated (HRT) prostate radiation therapy has the potential to deliver a higher biologically effective dose over a shorter time compared with conventional fractionation (CRT). HRT, giving fewer fractions each with higher dose, might improve the therapeutic ratio, resource use and patient convenience but the toxicity is still controversial. Our objective was to compare the gastroinstestinal (GI) and genitourinary (GU) toxicity of HRT versus CRT. METHODS: Systematic review and meta-analysis of randomized clinical trials studies in PubMed, Cochrane and EMBASE databases published through December 2016 was done. Only randomized trials that evaluated patients with localized prostate cancer (PCa) undergoing CRT or HRT were included. In these studies, the daily dose was 1.8 Gy or 2 Gy per day for CRT and 2.4 to 3.4 Gy for HRT. RESULTS: 7317 patients in nine studies were analyzed. Six studies included acute GU toxicity data which showed similar rates for both HRT and CRT (32.6vs. 31.9%; RD 0.00; 95% CI; -0.03,0.03; p = .81; I2 = 0%). Similarly, seven studies showed no difference in late GU toxicity based on treatment schedule (28.7 vs. 28.0%; RD -0.01; 95% CI; -0.04,0.03; p = .67; I2 = 52%). GI toxicity at three months after radiotherapy was higher in patients treated with HRT in six studies (27.5 vs. 21.9%; RD 0.06; 95% CI; 0.02,0.10; p = .004; I2 = 39%); however, eight studies showed GI toxicity 12 months or more after radiotherapy that was statistically the same (12.9 HRT vs. 16.2% CRT; RD -0.01; 95% CI; -0.04,0.02; p = .41; I2 = 58%). CONCLUSION: In meta-analysis of the available randomized trials on moderate HRT versus CRT for prostate cancer, acute and late GU toxicity were similar for both treatment schemes. While HRT was associated with higher acute GI toxicity, late toxicity was similar.


Assuntos
Gastroenteropatias/etiologia , Doenças Urogenitais Masculinas/etiologia , Neoplasias da Próstata/radioterapia , Radioterapia/efeitos adversos , Humanos , Masculino , Hipofracionamento da Dose de Radiação , Radioterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Eur Urol ; 74(5): 537-539, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29724502

RESUMO

The literature on focal therapy is currently insufficient to recommend it as first-line treatment. We need information from both randomised controlled trials and prospective registries for every available energy. That said, important research is under way in this field, and the door should be kept open to an approach that has the potential to offer adequate cancer control with lower morbidity and better post-treatment quality of life in properly selected patients.


Assuntos
Técnicas de Ablação , Neoplasias da Próstata/cirurgia , Técnicas de Ablação/efeitos adversos , Tomada de Decisão Clínica , Humanos , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Fatores de Risco , Resultado do Tratamento
19.
Minerva Urol Nefrol ; 70(3): 252-263, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29664243

RESUMO

INTRODUCTION: The aim of this study was to review the oncological and functional outcomes of new and established primary focal treatments (FT) for localized prostate cancer (PCa). EVIDENCE ACQUISITION: We performed a systematic search of published studies on FT for localized PCa using electronic databases (Medline and Embase). These studies included reports on hemi-ablation, focal ablation and target-ablation. We excluded salvage focal therapy studies and limited the search to those with a minimum of 12 months of follow-up. EVIDENCE SYNTHESIS: We selected 20 studies with a total of 2523 patients who were treated in the primary setting. The energy sources used were cryotherapy (8), high-intensity focused ultrasound (9), irreversible electroporation (1), photodynamic therapy (1) and focused laser ablation (1), with 65% hemiablation, 25% focal ablation and 10% target-ablation. The median follow-ups ranged from 6 to 44.4 months. Mean age was 60.4-70 years and mean prostate-specific antigen was 4.4-<10 ng/dL; 26-100% had a Gleason Score of 6, and 0-65% had a Gleason Score of 7. Patient selection was carried out by TRUS biopsy in 9 studies, while transperineal template mapping biopsy and mp-MRI were employed in six and 13 studies, respectively. The overall post-treatment positive biopsy rate was 1.2-51% with 1.6-32% patients having a residual disease in the treated area. The post-treatment continence rates were 90-100%, and the rates of erectile dysfunction ranged from 0-53.2%. CONCLUSIONS: Reliable evidence for the partial-gland treatment of PCa is increasing, and encouraging mid-term oncologic outcomes with the preservation of sexual and urinary functions have been reported. Accurate patient selection at the outset of treatment and careful follow-up seem key attributes to achieve excellent functional results and encouraging oncological outcomes.


Assuntos
Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/terapia , Técnicas de Ablação , Crioterapia , Eletroporação , Medicina Baseada em Evidências , Humanos , Masculino , Fototerapia , Neoplasias da Próstata/tratamento farmacológico
20.
Eur J Radiol ; 100: 14-22, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29496072

RESUMO

OBJECTIVES: To describe the experience of our institution in image-guided renal nodules percutaneous cryoablation, evaluating demographic and technical aspects as well as efficacy, safety and follow up. MATERIALS AND METHODS: Retrospective study approved by our institutional review board. Seventy-one renal tumors evaluated in 60 patients treated with image guided percutaneous renal cryoablation from January 2009 to December 2015. No patient was excluded from study, even those who were lost on follow up. All the procedures were guided both by ultrasound and tomography. An argon and helium based cryoablation machine was used for all treatments. Hydrodissection was performed when the bowel or ureters were within 1 cm (iodinated contrast media in dextrose solution). Complications were assessed by the terminology criteria of the National Institutes of Health (NIH). Patients were monitored and evaluated by ultrasound, tomography, MRI and/or PET-CT. RESULTS: In most procedures (91.9%) only one nodule was treated. Nodules had a median size of 1.6 cm. Most nodules (61,9%) were exophytic. Hydrodissection and retrograde warm pyeloperfusion were performed in most procedures. Among all variables evaluated in univariate analysis, nearness of nodule to collecting system and anterior/posterior location were significantly associated with PRCA complications. No other factor evaluated was significantly associated with complications. CONCLUSION: PRCA is solid alternative to traditional surgical therapies for treatment of small renal tumors in wide subset of patients. Medium term evidence shows excellent long-term oncological results, similar to nephrectomy, with minimal risk of major complications.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/métodos , Neoplasias Renais/cirurgia , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Seguimentos , Humanos , Aumento da Imagem , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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