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1.
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.

2.
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.

3.
Int. braz. j. urol ; 44(6): 1129-1138, Nov.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-975650

RESUMO

ABSTRACT Background: Dynamic-contrast enhanced (DCE) sequence is used to increase detection of small lesions, based on increased vascularization. However, literature is controversy about the real incremental value of DCE in detection of clinically significant (CS) prostate cancer (PCa), since absence of enhancement does not exclude cancer, and enhancement alone is not definitive for tumor. Purpose: To test the hypothesis that DCE images do not increase CS PCa detection on MRI prior to biopsy, comparing exams without and with contrast sequences. Material and Materials and Methods: All men who come to our institution to perform MRI on a 3T scanner without a prior diagnosis of CS PCa were invited to participate in this study. Reference standard was transrectal prostate US with systematic biopsy and MRI/US fusion biopsy of suspicious areas. Radiologists read the MRI images prospectively and independently (first only sequences without contrast, and subsequently the entire exam) and graded them on 5-points scale of cancer suspicion. Results: 102 patients were included. Overall detection on biopsy showed CS cancer in 43 patients (42.2%), clinically non-significant cancer in 11 (10.8%) and negative results in 48 patients (47%). Positivities for CS PCa ranged from 8.9% to 9.8% for low suspicion and 75.0% to 88.9% for very high suspicion. There was no statistical difference regarding detection of CS PCa (no statistical difference was found when compared accuracies, sensitivities, specificities, PPV and NPV in both types of exams). Inter-reader agreement was 0.59. Conclusion: Exams with and without contrast-enhanced sequences were similar for detection of CS PCa on MRI.

4.
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.

5.
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.

6.
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
7.
Int Braz J Urol ; 44(6): 1129-1138, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30325611

RESUMO

BACKGROUND: Dynamic-contrast enhanced (DCE) sequence is used to increase detection of small lesions, based on increased vascularization. However, literature is controversy about the real incremental value of DCE in detection of clinically significant (CS) prostate cancer (PCa), since absence of enhancement does not exclude cancer, and enhancement alone is not definitive for tumor. PURPOSE: To test the hypothesis that DCE images do not increase CS PCa detection on MRI prior to biopsy, comparing exams without and with contrast sequences. Material and Materials and Methods: All men who come to our institution to perform MRI on a 3T scanner without a prior diagnosis of CS PCa were invited to participate in this study. Reference standard was transrectal prostate US with systematic biopsy and MRI/US fusion biopsy of suspicious areas. Radiologists read the MRI images prospectively and independently (first only sequences without contrast, and subsequently the entire exam) and graded them on 5-points scale of cancer suspicion. RESULTS: 102 patients were included. Overall detection on biopsy showed CS cancer in 43 patients (42.2%), clinically non-significant cancer in 11 (10.8%) and negative results in 48 patients (47%). Positivities for CS PCa ranged from 8.9% to 9.8% for low suspicion and 75.0% to 88.9% for very high suspicion. There was no statistical difference regarding detection of CS PCa (no statistical difference was found when compared accuracies, sensitivities, specificities, PPV and NPV in both types of exams). Inter-reader agreement was 0.59. CONCLUSION: Exams with and without contrast-enhanced sequences were similar for detection of CS PCa on MRI.


Assuntos
Meios de Contraste/administração & dosagem , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade
8.
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
10.
Int. braz. j. urol ; 43(4): 588-599, July-Aug. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-892879

RESUMO

ABSTRACT Context Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors. Objective To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa. Materials and Methods Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT). Results 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I2=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I2=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I2=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I2=67%) presented better outcomes. Conclusion LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.

12.
Clin Genitourin Cancer ; 15(3): e447-e454, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27856204

RESUMO

BACKGROUND: To compare the results of magnetic resonance imaging (MRI) with and without contrast-enhanced sequences for the detection of clinically significant prostate cancer. The value of contrast in the MRI protocol for the detection of prostate tumors has been discussed in previous studies. MATERIALS AND METHODS: We performed an institutional review board-approved, retrospective study of patients who had undergone prostate MRI followed by fusion biopsy during a 16-month period. The patients had undergone MRI on a 3-Tesla scanner with a phased-array coil using a routine multiparametric protocol: T2-weighted, diffusion, and dynamic postcontrast enhancement sequences. The examination films were read independently by 2 readers in 2 sessions: first without contrast-enhanced images and second with contrast-enhanced images. The images were graded according to the suspicion of clinically significant prostate cancer (scale, 1-5). The kappa coefficient was used to compare the readings with and without contrast. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for both readers were calculated using the biopsy findings as a reference standard. The level for statistical significance was set at P < .05. RESULTS: A total of 118 patients were included, and clinically significant prostate cancer was found in 48 patients (40.7%). The MRI findings on both contrast-enhanced and noncontrast-enhanced images had no statistically significant differences for either reader (P > .05 for all levels of suspicion). The sensitivity ranged from 68.3% to 80.7%, specificity from 57.1% to 77.1%, positive predictive value from 29.9% to 38.8%, negative predictive value from 88.0% to 91.3%, and accuracy from 60.6% to 73.0%. CONCLUSION: Our results show that contrast-enhanced sequences provide minimal or no increased value for the detection of clinically significant prostate cancer.


Assuntos
Imagem de Difusão por Ressonância Magnética/instrumentação , Imagem por Ressonância Magnética/instrumentação , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Meios de Contraste , Humanos , Masculino , Gradação de Tumores , Prostatectomia , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
13.
Int Braz J Urol ; 43(4): 588-599, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27802009

RESUMO

CONTEXT: Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors. OBJECTIVE: To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa. MATERIALS AND METHODS: Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT). RESULTS: 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I²=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I²=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I²=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I²=67%) presented better outcomes. CONCLUSION: LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.


Assuntos
Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/terapia , Intervalo Livre de Doença , Humanos , Masculino , Metástase Neoplásica , Neoplasias da Próstata/patologia
14.
Einstein (Sao Paulo) ; 14(3): 374-377, 2016.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27759826

RESUMO

Objective:: To describe the imaging findings of prostatic tumors nonadenocarcinoma on multiparametric magnetic resonance imaging. Methods:: A total of 200 patients underwented multiparametric magnetic resonance imaging of the prostate for screening for prostate cancer, from August 2013 to September 2014, followed by biopsy with ultrasound/magnetic resonance imaging fusion. Results:: We found three pathologic proved cases of prostatic pure leiomyomas (0.02%) in our series and described the multiparametric magnetic resonance imaging features of these prostatic leiomyomas. The imaging findings had similar features to lesions with moderate or high suspicion for significant cancer (Likert 4 or 5) when localized both in the transitional zone or in the peripheral zone of the gland. Conclusion:: Pure prostatic leiomyomas had imaging findings on multiparametric magnetic resonance imaging that mimicked usual adenocarcinomas on this test. Radiologists, urologists and pathologists must be aware of this entity and its imaging features. Objetivo:: Descrever os achados de imagem de tumores prostáticos não adenocarcinoma na ressonância magnética multiparamétrica. Métodos:: Realizaram ressonância magnética multiparamétrica da próstata para detecção de câncer de próstata 200 pacientes de agosto de 2013 a setembro de 2014, seguida por biópsia com fusão de imagens de ultrassonografia/ressonância magnética. Resultados:: Encontramos três casos confirmados histologicamente de leiomiomas prostáticos puros (0,02%) em nossa casuística e descrevemos os achados da ressonância magnética multiparamétrica destes casos de leiomiomas. Os achados de imagem foram semelhantes aos de lesões com moderada ou alta suspeição para neoplasia clinicamente significante (Likert 4 ou 5) quando localizados na zona de transição ou zona periférica da próstata. Conclusão:: Leiomiomas puros da próstata tiveram achados de imagem na ressonância magnética multiparamétrica que mimetizaram adenocarcinomas. Radiologistas, urologistas e patologistas devem estar cientes destas entidades e seus achados de imagem.


Assuntos
Leiomioma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Humanos , Biópsia Guiada por Imagem , Leiomioma/patologia , Imagem por Ressonância Magnética Intervencionista , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Ultrassonografia de Intervenção
15.
Int. braz. j. urol ; 42(5): 897-905, Sept.-Oct. 2016. tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-796878

RESUMO

ABSTRACT Objective: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) biopsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clinically significant tumors according to histological criteria. Materials and Methods: A total of 189 consecutive US/MRI fusion biopsies were performed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria. Results: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively. There was a statistically significant difference in terms of biopsy results between different levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different levels of suspicion on mpMRI (p-value <0.05 in both analyzes). Conclusion: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI.

16.
Einstein (Säo Paulo) ; 14(3): 374-377, July-Sept. 2016. graf
Artigo em Inglês | LILACS-Express | ID: lil-796959

RESUMO

ABSTRACT Objective: To describe the imaging findings of prostatic tumors nonadenocarcinoma on multiparametric magnetic resonance imaging. Methods: A total of 200 patients underwented multiparametric magnetic resonance imaging of the prostate for screening for prostate cancer, from August 2013 to September 2014, followed by biopsy with ultrasound/magnetic resonance imaging fusion. Results: We found three pathologic proved cases of prostatic pure leiomyomas (0.02%) in our series and described the multiparametric magnetic resonance imaging features of these prostatic leiomyomas. The imaging findings had similar features to lesions with moderate or high suspicion for significant cancer (Likert 4 or 5) when localized both in the transitional zone or in the peripheral zone of the gland. Conclusion: Pure prostatic leiomyomas had imaging findings on multiparametric magnetic resonance imaging that mimicked usual adenocarcinomas on this test. Radiologists, urologists and pathologists must be aware of this entity and its imaging features.


RESUMO Objetivo: Descrever os achados de imagem de tumores prostáticos não adenocarcinoma na ressonância magnética multiparamétrica. Métodos: Realizaram ressonância magnética multiparamétrica da próstata para detecção de câncer de próstata 200 pacientes de agosto de 2013 a setembro de 2014, seguida por biópsia com fusão de imagens de ultrassonografia/ressonância magnética. Resultados: Encontramos três casos confirmados histologicamente de leiomiomas prostáticos puros (0,02%) em nossa casuística e descrevemos os achados da ressonância magnética multiparamétrica destes casos de leiomiomas. Os achados de imagem foram semelhantes aos de lesões com moderada ou alta suspeição para neoplasia clinicamente significante (Likert 4 ou 5) quando localizados na zona de transição ou zona periférica da próstata. Conclusão: Leiomiomas puros da próstata tiveram achados de imagem na ressonância magnética multiparamétrica que mimetizaram adenocarcinomas. Radiologistas, urologistas e patologistas devem estar cientes destas entidades e seus achados de imagem.

17.
Int Braz J Urol ; 42(5): 897-905, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27532112

RESUMO

OBJECTIVE: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) bi¬opsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clini¬cally significant tumors according to histological criteria. MATERIALS AND METHODS: A total of 189 consecutive US/MRI fusion biopsies were per¬formed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria. RESULTS: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively. There was a statistically significant difference in terms of biopsy results between dif¬ferent levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different lev¬els of suspicion on mpMRI (p-value < 0.05 in both analyzes). CONCLUSION: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI.


Assuntos
Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Idoso , Humanos , Imagem por Ressonância Magnética/instrumentação , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Próstata/diagnóstico por imagem , Próstata/patologia , Antígeno Prostático Específico/sangue , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatísticas não Paramétricas , Ultrassonografia de Intervenção/métodos
18.
Einstein (Säo Paulo) ; 7(4)2009. ilus, tab
Artigo em Português | LILACS-Express | ID: lil-541636

RESUMO

Purpose: To report the initial experience on robot-assisted radical prostatectomy in Brazil. Methods: From March 2008 to March 2009, a hundred patients were treated with robot-assisted radical prostatectomy. Patients demographic data, as well as perioperative results of the procedures, are described in this study. Results: Patients mean age and mean PSA were 58 years and 7.58 ng/ml, respectively. All procedures were performed through transperitoneal approach, with a mean bleeding of 480 mL and surgical time of 298 minutes. A surgical margin affected by cancer was present in 16% of the cases. There were four complications: bleeding requiring transfusion (two cases), rectal perforation corrected on the spot and inadequate functioning of the robot. There was no conversion to another access or obit occurrences in this caseload. Conclusions: Robot-assisted prostatectomy is a reality in Brazil and the results herein presented demonstrate that this procedure can be safely performed. Long-term follow-up is still necessary to assess the oncological and functional outcomes.


Objetivo: Relatar a experiência inicial de prostatectomia radical robô-assistida realizada no Brasil. Métodos: No período de março de 2008 a março de 2009, cem pacientes foram tratados com a prostatectomia radical robô-assistida. Os dados demográficos dos pacientes, assim como os resultados perioperatórios dos procedimentos, são descritos neste estudo. Resultados: A média de idade e PSA dos pacientes foi de 58 anos e 7,58 ng/ml, respectivamente. Todos os procedimentos foram realizados por via transperitoneal, com sangramento médio foi de 480 ml e tempo cirúrgico de 298 minutos. A presença de margem cirúrgica comprometida por câncer ocorreu em 16% dos casos. Ocorreram quatro complicações: sangramento com necessidade de transfusão (dois casos), perfuração retal corrigida no ato e funcionamento inadequado do robô. Não houve conversão para outro acesso ou óbitos nesta casuística. Conclusões: A prostatectomia robótica é uma realidade no Brasil e os resultados apresentados demonstram que este procedimento pode ser realizado com segurança. Seguimento a longo prazo ainda é necessário para avaliar os resultados oncológicos e funcionais.

20.
São Paulo; Cultura Médica; 2008. 383 p. ilus.(Diagnóstico & Tratamento: Hospital Israelita Albert Einstein).
Monografia em Português | Sec. Munic. Saúde SP, AHM-Acervo, TATUAPE-Acervo | ID: sms-6730
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