Efectividad del entrenamiento muscular pélvico temprano en la fuerza de suelo pélvico, síntomas de incontinencia urinaria, función sexual y calidad de vida en pacientes posprostatectomía radical: revisión sistemática de ensayos clínicos aleatorizados / Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials

Este estudio tuvo como objetivo evaluar la efectividad del entrenamiento muscular pélvico temprano para reducir los síntomas de incontinencia urinaria, mejorar la calidad de vida, función sexual y aumentar la fuerza de suelo pélvico en pacientes posprostatectomía radical. Se realizó una búsqueda en 8 bases de datos hasta el 26 de octubre de 2022, se evaluó la calidad metodológica y el riesgo de sesgo de 14 estudios incluidos (n=1236), se calculó la evidencia y el metaanálisis. El entrenamiento redujo significativamente los síntomas de incontinencia urinaria en comparación con un grupo control (DME=−2,80; IC 95%=−5,21 a −0,39; p=0,02), con heterogeneidad significativa (I2=83%; p=<0,0001) y evidencia moderada. Además, presentó evidencia moderada para mejorar la calidad de vida, y muy baja para mejorar la función sexual y fuerza de suelo pélvico. Estos resultados deben ser observados con precaución debido a la heterogeneidad significativa de los estudios analizados. (AU)

This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=−2.80, 95% CI=−5.21 to −0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed. (AU)

[Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials]. / Efectividad del entrenamiento muscular pélvico temprano en la fuerza de suelo pélvico, síntomas de incontinencia urinaria, función sexual y calidad de vida en pacientes posprostatectomía radical: revisión sistemática de ensayos clínicos aleatorizados.

This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=-2.80, 95% CI=-5.21 to -0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed.

Behavior of total alkaline phosphatase after radium-233 therapy in metastatic castration-resistant prostate cancer: a single-center, real-world retrospective study / Estudo retrospectivo de vida-real, em centro único, para avaliação do comportamento da fosfatase alcalina total após terapia com rádio-223 no câncer de próstata resistente a castração

Abstract Objective: To describe the behavior of total alkaline phosphatase (tALP) in patients with metastatic castration-resistant prostate cancer receiving radium-223 therapy, in a real-world scenario, and to describe overall survival (OS) among such patients. Materials and Methods: This was a retrospective study involving 97 patients treated between February 2017 and September 2020. Patients were stratified by the baseline tALP (normal/elevated). A tALP response was defined as a ≥ 30% reduction from baseline at week 12. For patients with elevated baseline tALP, we also evaluated treatment response as a ≥ 10% reduction in tALP after the first cycle of treatment. We defined OS as the time from the first treatment cycle to the date of death. Results: There was a significant reduction in the median tALP after each cycle of treatment (p < 0.05 for all). Data for tALP at week 12 were available for 71 of the 97 patients. Of those 71 patients, 26 (36.6%) responded. Elevated baseline tALP was observed in 47 patients, of whom 19 (40.4%) showed a response. Longer OS was observed in the patients with normal baseline tALP, in those with elevated baseline tALP that showed a response to treatment (≥ 10% reduction), and in those who received 5-6 cycles of therapy. Conclusion: The tALP may be used to predict which patients will benefit from treatment with a greater number of cycles of radium-223 therapy and will have longer OS.

Resumo Objetivo: Descrever o comportamento da fosfatase alcalina total (tALP) em pacientes com carcinoma de próstata metastático resistente a castração, submetidos a terapia com rádio-223 em um cenário do mundo real, e a sobrevida global (SG) desses pacientes. Materiais e Métodos: Estudo retrospectivo envolvento 97 pacientes, no período de fevereiro/2017 a setembro/2020. Os pacientes foram estratificados de acordo com a tALP basal (normal/elevada). A resposta à tALP foi definida como uma redução em relação à linha de base de ≥ 30% na semana-12. Para pacientes com tALP basal elevada, também foi avaliada a resposta ao tratamento como uma redução de ≥ 10% de tALP após o primeiro ciclo. A SG foi definida como o tempo entre o primeiro ciclo e a data do óbito. Resultados: A redução da tALP média após cada ciclo foi significativa (p < 0,05). A tALP na semana 12 estava disponível para 71 dos 97 pacientes. Desses 71 pacientes, 26 (36,6%) responderam. Dezenove (40,4%) dos 47 pacientes com tALP elevada apresentaram resposta. Foi observada uma SG mais longa nos pacientes com tALP basal normal, nos pacientes com tALP basal elevada que apresentaram resposta ao tratamento (redução de ≥ 10%) e nos pacientes que receberam 5-6 ciclos. Conclusão: A tALP pode ser usada para prever parte dos pacientes que se beneficiarão do tratamento com um maior número de ciclos e uma SG mais longa.

Câncer de próstata e suicídio: qualidade de vida, ansiedade, depressão e o risco para o suicídio em um centro oncológico terciário / Prostate cancer and suicide: quality of life, anxiety, depression and the risk of suicide in an oncology center in the city of São Paulo

Nas últimas décadas, tem se verificado o aumento de diagnósticos de câncer. No Brasil, a estimativa é de 16.830 novos casos de câncer de próstata para este ano. São escassas as pesquisas sobre os riscos de suicídio após o diagnóstico de um câncer em nosso país. O objetivo deste estudo foi avaliar longitudinalmente o risco para suicídio, qualidade de vida, ansiedade e depressão em uma amostra de pacientes com câncer de próstata localizado. Trezentos e trinta e três pacientes foram entrevistados ao diagnóstico e novamente a partir do 18º mês após ter recebido o diagnóstico. Foram aplicados os questionários: a seção de risco de suicídio do questionário Mini International Neuropsychiatric Interview (MINI), a Escala Hospitalar de Ansiedade e Depressão (HADS), o questionário Cut down, Annoyed by criticism, Guilty and Eye opener (CAGE) sobre abuso ou dependência de álcool, o Teste de Fagerström para Dependência a Nicotina (FTND), o instrumento de qualidade de vida para pacientes com câncer de próstata UCLA Prostate Cancer Index (UCLA-PCI), três perguntas sobre a percepção da primeira fase da pesquisa, um questionário sociodemográfico e incluídas quatro perguntas sobre a pandemia da Covid-19. A prevalência de risco de suicídio entre os pacientes com câncer de próstata ao diagnóstico foi de 5,7% e de 3,7% no 18º mês após o diagnóstico. Ao diagnóstico, o risco de suicídio associou-se ao escore positivo de ansiedade (p<0,001) e não ter depressão (p<0,001), ao estado civil casado (p=0,031), não morar sozinho (p=0,025), risco intermediário pela classificação de recidiva D'Amico (p=0,009), indicação para cirurgia (p=0,03), não ter tratamento psiquiátrico prévio (p<0,001) e história familiar de comportamento suicida (p=0,025). Após o 18º mês do diagnóstico, apenas a HADs positiva para ansiedade foi associada ao risco de suicídio (p<0,001). Na análise comparativa para os pacientes que responderam ao UCLA-PCI, observou-se associação significativa da qualidade de vida com o risco de suicídio em relação às funções físicas (p=0,037), vitalidade (p=0,006), saúde mental (p=0,014), função social (p=0,011), saúde geral (p=0,019) e transição para a saúde (p=0,013) aos pacientes recém diagnosticados e em relação às funções físicas (p=0,003), limitações de função da saúde física (p<0,001) e de saúde emocional (p<0,001), vitalidade (p=0,008), saúde mental (p=0,007), função social (p<0,0001), dor corporal (p=0,033), saúde geral (p=0,014) e transição para a saúde (p=0,016) após o 18º mês do diagnóstico. Fatores como qualidade de vida, ansiedade e depressão devem ser monitorados ao diagnóstico e ao longo do tratamento e a oferta de orientação e assistência emocional ser oferecida aos pacientes.

In recent decades, there has been an increase in cancer diagnoses. In Brazil, the estimate is 16,830 new cases of prostate cancer for this year. There is little research on the risks of suicide after the diagnosis of cancer in our country. The aim of this study was to longitudinally evaluate the risk for suicide, quality of life, anxiety and depression in a sample of patients with localized prostate cancer. Three hundred and thirty-three patients were interviewed at diagnosis and again from the 18th month after diagnosis. The following questionnaires were applied: the suicide risk section of the Mini International Neuropsychiatric Interview (MINI) questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Cut down, Annoyed by criticism, Guilty and eye opener questionnaire (CAGE) on alcohol abuse or dependence, the Fagerström Test for Nicotine Dependence (FTND), the UCLA Prostate Cancer Index (UCLA-PCI) quality of life instrument for prostate cancer patients, three questions about the perception of the first phase of the survey, a sociodemographic questionnaire and included four questions about the Covid-19 pandemic. The prevalence of suicide risk among prostate cancer patients at diagnosis was 5.7% and 3.7% at 18 months after diagnosis. At diagnosis, the risk of suicide was associated with positive scores of anxiety (p<0.001) and not having depression (p<0.001), married marital status (p=0.031), not living alone (p=0.025), intermediate risk according to the D'Amico recurrence classification (p=0.009), indication for surgery (p=0.03), not having previous psychiatric treatment (p<0.001) and family history of completed suicide (p=0.025). After the 18th month of diagnosis, only anxiety positive HADs questionnaire was associated with suicide risk (p<0.001). In the comparative analysis for patients who answered to UCLA-PCI, a significant association was observed between quality of life and suicide risk in relation to physical functions (p=0.037), vitality (p=0.006), mental health (p=0.014), social function (p=0.011), general health (p=0.019) and transition to health (p=0.013) in newly diagnosed patients and in relation to physical functions (p=0.003), limitations of physical health function (p<0.001) and emotional health (p<0.001), vitality (p=0.008) mental health (p=0.007), social function (p<0.0001), body pain (p=0.033), general health (p=0.014) and transition to health (p=0.016) after the 18th month of diagnosis. Factors such as quality of life, anxiety and depression should be monitored at diagnosis and throughout treatment and the provision of guidance and emotional assistance should be offered to patients

Health-related quality of life and therapeutic adherence in breast and prostate cancer / Calidad de vida relacionada a la salud y adherencia terapéutica en los cánceres de mama y de próstata / Qualidade de vida relacionada à saúde e adesão terapêutica nos cânceres de mama e próstata

ABSTRACT Objective to correlate health-related quality of life and adherence to treatment of patients with breast and prostate cancer. Method an exploratory, descriptive and cross-sectional study, with a quantitative approach, conducted with 305 patients with breast and prostate cancer, in a state oncology hospital in Paraíba, Brazil, between June and November 2019. For data collection, a semi-structured instrument was used to obtain data regarding the sociodemographic and clinical profile, from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire "core" 30 items, from the specific module Quality of Life Questionnaire-Breast Cancer, and from the Adherence Determinants Questionnaire. Data analysis was performed using descriptive and inferential statistics. Results the correlation between health-related quality of life and adherence of patients with prostate cancer showed statistical significance (p≤0.05) between the Global health Scale and the Functional Scale, Intentions domain; emotional function and intentions; insomnia and subjective norms; financial difficulty and subjective norms. In women, there was statistical significance (p≤0.05) between role performance and subjective norms; fatigue and intentions; financial difficulty and total adherence; sexual desire, sexual satisfaction and perceived support/severity; breast symptoms and intentions. Conclusion health-related quality of life directly impacts on treatment adherence of patients with breast and prostate cancer.

RESUMEN Objetivo correlacionar la calidad de vida relacionada con la salud y la adherencia al tratamiento de pacientes con cáncer de mama y de próstata. Método estudio exploratorio, descriptivo y transversal, con enfoque cuantitativo, realizado con 305 pacientes con cáncer de mama y de próstata, en un hospital oncológico estatal de Paraíba, Brasil, entre junio y noviembre de 2019. En la recolección de datos, se utilizó un instrumento estructurado para la obtención de datos sobre el perfil sociodemográfico y clínico, el cuestionario del European Organization for Research and Treatment of Cancer Quality of Life Questionnaire "core" 30 itens, del módulo específico Quality of Life Questionnaire-Breast Cancer, y el Cuestionario de Determinantes de Adhesión. El análisis de datos se realizó por medio de estadística descriptiva e inferencial. Resultados la correlación entre la calidad de vida relacionada con la salud y la adherencia de los pacientes con cáncer de próstata mostró significancia estadística (p≤0.05) entre la Escala de Salud Global y la Escala Funcional, dominio Intenciones; función e intenciones emocionales; insomnio y normas subjetivas; dificultad financiera y normas subjetivas. En las mujeres, hubo significación estadística (p≤0.05) entre el desempeño de roles y las normas subjetivas; fatiga e intenciones; dificultad financiera y adhesión total; deseo sexual, satisfacción sexual y apoyo / severidad percibidos; síntomas de la mama e intenciones. Conclusión la calidad de vida relacionada con la salud tiene un impacto directo en la adherencia al tratamiento en pacientes con cáncer de mama y próstata.

RESUMO Objetivo correlacionar a qualidade de vida relacionada à saúde e a adesão ao tratamento de pacientes com câncer de mama e próstata. Método estudo exploratório, descritivo e transversal, com abordagem quantitativa, realizado com 305 pacientes com câncer de mama e de próstata, em hospital oncológico de referência estadual, na Paraíba, Brasil, entre junho e novembro de 2019. Para coleta de dados, utilizou-se de instrumento semiestruturado para obtenção de dados referentes ao perfil sociodemográfico e clínico, do questionário European Organization for Research and Treatment of Cancer Quality of Life Questionnaire "core" 30 itens, do módulo específico Quality of Life Questionnaire-Breast Cancer e Questionário de Determinantes de Adesão. A análise dos dados foi realizada por meio da estatística descritiva e inferencial. Resultados a correlação entre a qualidade de vida relacionada à saúde e a adesão de pacientes com câncer de próstata mostrou significância estatística (p≤0,05) entre a Escala de Saúde Global e a Escala Funcional, domínio Intenções; função emocional e intenções; insônia e normas subjetivas; dificuldade financeira e normas subjetivas. Nas mulheres, houve significância estatística (p≤0,05) entre desempenho de papéis e normas subjetivas; fadiga e intenções; dificuldade financeira e adesão total; desejo sexual, satisfação sexual e apoio/severidade percebida; sintomas da mama e intenções. Conclusão a qualidade de vida relacionada à saúde impacta diretamente a adesão ao tratamento de pacientes com câncer de mama e de próstata.

Caracterização sociodemográfica e clínica de homens com câncer de próstata: subsídios para cuidados de enfermagem / Caracterización sociodemográfica y clínica de hombres con cáncer de próstata: colaboraciones para cuidados de enfermería / Sociodemographic and clinical characterization of men with prostate cancer: subsidies for nursing care

RESUMO Objetivo: descrever as características sociodemográficas e clínicas de homens com câncer de próstata em atendimento oncológico. Método: estudo transversal, descritivo, de abordagem quantitativa. Os dados foram coletados de junho a dezembro de 2019 em entrevistas e por acesso aos prontuários, analisados por meio de estatística descritiva e apresentados em valores absolutos e relativos. Resultados: dos 55 participantes, predominaram homens na faixa etária de 70 a 79 anos (45,45%); brancos (45,45%); casados (63,64%); com ensino fundamental incompleto (54,55%); de crença católica (74,55%); residentes de zona urbana (87,27%); com esposa ou companheira (34,55%); com ótima relação com familiares (56,36%); aposentados (80%); com renda mensal de um a três salários mínimos (74,55%); que consideravam sua situação financeira regular (49,09%); negavam etilismo (56,36); eram ex-fumantes (47,27%); encaminhados ao serviço pelo Sistema Único de Saúde (85,45%); com tempo de diagnóstico há mais de 12 meses (69,09%); sem metástase (61,82%); que realizaram radioterapia (38,18%) e quimioterapia (61,82%). Conclusão: este estudo permitiu evidenciar que, no contexto do adoecimento por câncer de próstata dos homens entrevistados, há características que devem ser identificadas pelos profissionais de saúde que são essenciais para o planejamento do cuidado congruente às suas demandas.

RESUMEN Objetivo: describir las características sociodemográficas y clínicas de hombres con cáncer de próstata en atención oncológica. Método: estudio transversal, descriptivo, de abordaje cuantitativo. Los datos fueron recolectados de junio a diciembre de 2019 en entrevistas y por acceso a los registros médicos, analizados por medio de estadística descriptiva y presentados en valores absolutos y relativos. Resultados: de los 55 participantes, predominaron hombres en la franja etaria de 70 a 79 años (45,45%); blancos (45,45%); casados (63,64%); con enseñanza básica incompleta (54,55%); de creencia católica (74,55%); residentes de zona urbana (87,27%); con esposa o compañera (34,55%); con óptima relación con familiares (56,36%); jubilados (80%); con renta mensual de uno a tres salarios mínimos (74,55%); que consideraban su situación financiera regular (49,09%); negaban etilismo (56,36); eran ex fumadores (47,27%); encaminados al servicio por el Sistema Único de Salud (85,45%); con tiempo de diagnóstico hace más de 12 meses (69,09%); sin metástasis (61,82%); que realizaron radioterapia (38,18%) y quimioterapia (61,82%). Conclusión: este estudio permitió evidenciar que, en el contexto de la enfermedad por cáncer de próstata de los hombres entrevistados, hay características que deben ser identificadas por los profesionales de salud que son esenciales para la planificación del cuidado apropiado a sus demandas.

ABSTRACT Objective: to describe the sociodemographic and clinical characteristics of men with prostate cancer undergoing cancer care. Method: cross-sectional, descriptive, quantitative study. Data were collected from June to December 2019 through interviews and access to medical records, analyzed using descriptive statistics and presented in absolute and relative values. Results: of the 55 participants, there was predominance of men aged between 70 and 79 years (45.45%); white (45.45%); married (63.64%); with incomplete primary education (54.55%); Catholics (74.55%); residents in the urban area (87.27%); married or with a partner (34.55%); with a great relationship with family members (56.36%); retirees (80%); with monthly income from one to three minimum wages (74.55%); who classified their financial situation as regular (49.09%); denied alcohol consumption (56.36); were former smokers (47.27%); referred to the service by the National Health Service (Brazilian SUS) (85.45%); with diagnosis time of more than 12 months (69.09%); without metastasis (61.82%); who underwent radiotherapy (38.18%) and chemotherapy (61.82%). Conclusion: this study showed that, in the context of illness from prostate cancer among the men interviewed, there are essential characteristics for the planning of care congruent with their demands that must be identified by health professionals.

Expanding indication of padeliporfin (WST11) vascular-targeted photodynamic therapy: results of prostate cancer Latin-American multicenter study. / Extensión de la indicación de terapia fotodinámica dirigida vascular con padeliporfina (WST11): resultados de un estudio multicéntrico latinoamericano del cáncer de próstata.

OBJECTIVES: To explore the proportion of patients with higher risk localized prostate cancer (PCa) that would become safely biopsy negative 12 months after non-thermal focal therapy with padeliporfin vascular-targeted photodynamic therapy (VTP). METHODS: Multicenter study in a scenario of prostate-specific antigen (PSA) ≤20ng/ml and variable PCa target volumes Gleason pattern 3 or low-volume secondary Gleason pattern 4, all patients received VTP, consisting of intravenous 4mg/kg padeliporfin activated by light-diffusing fibers in the prostate. The prostate was biopsied at baseline, months 6 and 12, PSA, patient-reported functional outcomes and quality of life (QoL) questionnaires were recorded at baseline, months 3, 6, and 12 and adverse events (AE) throughout the study. RESULTS: In the intention-to-treat population (n=81), the proportion of patients with negative biopsies at month 12 was 74% (60/81 patients; 95% CI: 63.1%,83.2%). In the per-protocol population, the proportion was 79% (58/73 patients; 95% CI: 68.4%,88.0%). Questionnaire results indicated a slight improvement in urinary function and limited deterioration in sexual function. No difference in QoL was observed over time. A total of 42/81 (52%) patients reported mild or moderate and 4 of 81 (4.9%) experienced serious AE, all resolved without sequelae. No phototoxicity, cardiovascular event, fistula or prolonged urinary incontinence, secondary cancer or death was reported. CONCLUSIONS: Results support the efficacy, safety, and QoL associated with padeliporfin focal treatment for low/intermediate risk localized PCa.

Um novembro não tão azul: debatendo rastreamento de câncer de próstata e saúde do homem / A not-so-blue November: debating screening of prostate cancer and men's health / Un noviembre no tan azul: debate del rastreo del cáncer de próstata y salud del hombre

A campanha Novembro Azul, promovida no Brasil pelo Instituto Lado a Lado pela Vida em parceria com a Sociedade Brasileira de Urologia, busca alertar para o câncer de próstata e estimular o rastreamento da neoplasia. Pesquisas internacionais, entretanto, têm mostrado que esse rastreamento traz mais danos que benefícios. Comprometida com o conceito de prevenção quaternária, a Sociedade Brasileira de Medicina de Família e Comunidade questionou publicamente a campanha e sua proposta em 2015. Esta revisão narrativa discute esse posicionamento e sua repercussão, analisando criticamente os argumentos favoráveis e contrários ao rastreamento. A partir disso, discutimos alguns limites da prevenção, comentamos a relação entre mídia e saúde, e refletimos sobre ações mais adequadas para o cuidado dos homens, com base em estudos multicêntricos, revisões sistemáticas, documentos institucionais, reportagens e pesquisas qualitativas. Tal debate ajuda a promover um cuidado integral para a população masculina.(AU)

The Blue November campaign, promoted in Brazil by Lado a Lado pela Vida Institute in partnership with the Brazilian Society of Urology, looks for drawing attention to prostate cancer and encouraging screening for this neoplasm. International research, however, has shown that this screening may do more harm than good. Being committed to the concept of quaternary prevention, the Brazilian Society of Family and Community Medicine publicly questioned the campaign and its proposal in 2015. This narrative review discusses this positioning and its consequences, through critically analyzing arguments both in favor and contrary to screening. Based on this, we discuss about limits of prevention, commenting on the relationship between media and health and reflecting on more appropriate actions for the care of men, based on multicenter studies, systematic reviews, institutional documents, reports and qualitative research. The debate helps to promote comprehensive care for the male population.(AU)

La campaña Noviembre Azul, promovida en Brasil por el Instituto Lado a Lado por la Vida en alianza con la Sociedad Brasileña de Urología, busca alertar sobre el cáncer de próstata e incentivar el rastreo de la neoplasia. No obstante, las investigaciones internacionales han mostrado que tal rastreo causa más daños que beneficios. Comprometida con el concepto de prevención cuaternaria, la Sociedad Brasileña de Medicina de Familia y Comunidad cuestionó públicamente la campaña y su propuesta en 2015. Esta revisión narrativa discute este posicionamiento y su repercusión, analizando críticamente los argumentos favorables y contrarios al rastreo. A partir de ese punto, discutimos algunos límites de la prevención, comentamos la relación entre los medios y la salud y reflexionamos sobre acciones más adecuadas para el cuidado de los hombres, con base en: estudios multi-céntricos, revisiones sistemáticas, documentos institucionales, reportajes e investigaciones cualitativas. Tal debate ayuda a promover un cuidado integral para la población masculina.(AU)

A percepção de homens e companheiras acerca da disfunção erétil pós-prostatectomia radical / La percepción de hombres y compañeras acerca de la disfunción eréctil post-prostatectomía radical / The perception of men and wives about erectile dysfunction post radical prostatectomy

RESUMO Objetivo: analisar a percepção de pacientes prostatectomizados e de suas companheiras acerca dos desafios vivenciados após a cirurgia, relacionados à sexualidade do casal e aos efeitos da disfunção erétil. Método: estudo descritivo-exploratório, de abordagem qualitativa com coleta de dados a partir de um roteiro semiestruturado aplicado com nove casais. A análise dos dados ocorreu por meio do levantamento de unidades de sentidos e formação de categorias empíricas a partir do referencial da Teoria Social Cognitiva. Resultados: o tempo de realização da prostatectomia variou entre um ano e oito meses a três anos e dois meses. Dentre os homens, a média de idade foi de 65 anos e das mulheres 59 anos. O processo de análise dos dados permitiu a identificação de duas categorias empíricas e os resultados apontam que os desafios enfrentados pelos pacientes se referem à dificuldade de diálogo e ao distanciamento entre o casal e a consequente introspecção dos homens, a preocupação com o fator idade, o medo de abandono e a insegurança dos homens quanto ao uso de medidas terapêuticas para recuperação da capacidade de ereção. Entretanto, outros casais vivenciaram aspectos positivos baseados na compreensão e apoio psicológico, e até mesmo em mudanças na forma de pensarem e viverem após a cirurgia. Conclusão: a cirurgia de prostatectomia gera repercussões no cotidiano dos pacientes e de suas companheiras, sendo que a percepção do casal em relação às implicações da cirurgia é fator determinante no processo de recuperação e enfrentamento dos desafios advindos do tratamento.

RESUMEN Objetivo: analizar la percepción de pacientes después de una prostatectomía y de sus compañeras sobre los desafíos vividos en relación a la sexualidad de la pareja y a los efectos de la disfunción eréctil. Método: estudio descriptico exploratorio, de abordaje cualitativo con obtención de datos a partir de una guía semiestructurada con nueve parejas. El análisis de los datos se realizó por medio del análisis de unidades de sentidos y formación de categorías empíricas a partir de la referencia sobre la Teoría Social Cognitiva. Resultados: el tiempo de realización de la prostatectomía varió de un año y ocho meses a tres años y dos meses. Entre los hombres, el promedio de edad fue de 65 años y de 59 años para las mujeres. El proceso de análisis de los datos permitió la identificación de dos categorías empíricas y los resultados señalan que los desafíos enfrentados por los pacientes se refieren a la dificultad de diálogo, el distanciamiento entre la pareja y la consecuente introspección de los hombres. También, aparece la preocupación con el factor edad, el miedo del abandono y la inseguridad de los hombres sobre el uso de medidas terapéuticas para la recuperación de la capacidad de erección. Por otro lado, otras parejas vivenciaron aspectos positivos basados en la comprensión, el apoyo psicológico y, además, en los cambios en la forma de pensar y vivir después de la cirugía. Conclusión: la prostatectomía genera repercusiones en el cotidiano de los pacientes y sus compañeras, siendo que la percepción de la pareja en relación a las implicaciones de la cirugía es un factor determinante en el proceso de recuperación y enfrentamiento de los desafíos resultantes del tratamiento.

ABSTRACT Objective: analyzing the perception of patients prostatectomizados and her companions about the challenges experienced after the surgery, related to sexuality and to the effects of erectile dysfunction. Method: descriptive-exploratory study, qualitative approach to collecting data from semi-structured script with nine couples. Data analysis occurred through the withdrawal of senses and empirical categories from the benchmark of Social Cognitive Theory. Results: the time to perform the prostatectomy varied between one year and eight months to three years and two months. Among men, the average age was 65 years and women 59 years. The process of data analysis allowed the identification of two empirical categories and the results shows that the challenges faced by patients refer to difficulty of dialogue and the distance between the couple and the introspection of the men, the concern with the age factor, fear of abandonment and insecurity of men regarding the use of therapeutic measures for recovery of erectile capacity. However, other couples have experienced positive aspects based on understanding and psychological support, and even changes in the way of thinking and living after surgery. Conclusion: prostatectomy surgery generates an impact on daily life of patients and their companions, and the perception in relation to the implications of the surgery is the determining factor in the process of recovery and tackling the challenges arising from treatment.

Actualización sobre cáncer de próstata / Update on Prostate Cancer

El cáncer de próstata es una neoplasia hormono-dependiente de importante heterogeneidad. El comportamiento clínico, la respuesta a tratamientos y la supervivencia varían dependiendo de cada paciente. Más del 95% de los cánceres prostáticos son adenocarcinomas, las variantes que no lo son pueden dividirse en dos grupos con base en su origen celular: epitelial y no epitelial. Las variantes epiteliales son más diferenciadas y biológicamente menos agresivas, mientras que las no epiteliales tienen un comportamiento muy invasor. Su tratamiento está orientado al alivio de la sintomatología, al control de su expansión y a elevar las probabilidades de curación.

Prostate cancer is a hormone-dependent neoplasm of significant heterogeneity. Clinical behavior, response to treatments and survival vary depending on each patient. More than 95% of prostate cancers are adenocarcinomas, variants that cannot be, are divided into two groups based on their cellular origin: epithelial and non-epithelial. Epithelial variants are more differentiated and biologically less aggressive, whereas non-epithelial variants have a very invading behavior. Its treatment is oriented to the relief of the symptomatology, the control of its expansion and to increase the probabilities of cure.

Actualización sobre cáncer de próstata / Update on Prostate Cancer

El cáncer de próstata es una neoplasia hormono-dependiente de importante heterogeneidad. El comportamiento clínico, la respuesta a tratamientos y la supervivencia varían dependiendo de cada paciente. Más del 95 por ciento de los cánceres prostáticos son adenocarcinomas, las variantes que no lo son pueden dividirse en dos grupos con base en su origen celular: epitelial y no epitelial. Las variantes epiteliales son más diferenciadas y biológicamente menos agresivas, mientras que las no epiteliales tienen un comportamiento muy invasor. Su tratamiento está orientado al alivio de la sintomatología, al control de su expansión y a elevar las probabilidades de curación.(AU)

Prostate cancer is a hormone-dependent neoplasm of significant heterogeneity. Clinical behavior, response to treatments and survival vary depending on each patient. More than 95 percent of prostate cancers are adenocarcinomas, variants that cannot be, are divided into two groups based on their cellular origin: epithelial and non-epithelial.Epithelial variants are more differentiated and biologically less aggressive, whereas non-epithelial variants have a very invading behavior. Its treatment is oriented to the relief of the symptomatology, the control of its expansion and to increase the probabilities of cure.(AU)

ESTANDARIZACIÓN DEL PROTOCOLO PARA LA DETECCIÓN DE LAS FUSIONES TMPRSS2: ERG Y DE LA EXPRESIÓN DE LOS GENES EZH2, SPINK-1 y NKX3.1 EN CÁNCER DE PRÓSTATA (CaP) / Protocol Standardization for Detection of TMPRSS2 Fusions: ERG and Gene Expression of EZH2, SPINK-1 and NKX3.1 in Prostate Cancer (PCa)

En la actualidad no existe una herramienta que permita diferenciar pacientes con cáncer de próstata (CaP) de mal pronóstico de aquellos con enfermedad indolente que sólo requieren un seguimiento controlado de la enfermedad. Debido a la coexistencia de diferentes focos premalignos y malignos en el CaP, el entendimiento sobre el proceso de carcinogénesis requiere de un mejor conocimiento. Actualmente, la heterogeneidad morfológica en CaP es evaluada con la puntuación de Gleason, la cual está fuertemente relacionada con el pronóstico de la enfermedad, sin embargo, esto es insuficiente por lo que se trabaja actualmente en identificación de alteraciones moleculares que permitan identificar subtipos que puedan establecer de manera más precisa el pronóstico del paciente. Este estudio preliminar buscó la estandarización del método de cuantificación en muestras prostáticas de FFPE de la expresión de los transcritos de posibles biomarcadores, como los oncogenes SPINK-1 y EZH2, el supresor tumoral NKX3.1, en conjunto con la determinación de la presencia/ausencia del gen de fusión TMPRSS2:ERG, ya que estos transcritos se encuentran involucrados en aparentes eventos excluyentes de la evolución natural del CaP, que apoyan la posibilidad de una clasificación molecular para esta enfermedad.

At present doesn't exist tool to differentiate patients with prostate cancer (PCa) of poor prognosis of those with indolent disease that only require a controlled monitoring of the disease. Because of the coexistence of different premalignant and malignant foci in CaP, the understanding of the carcinogenesis process requires a better understanding. Currently, the morphological heterogeneity in PCa is evaluated with Gleason score, which is closely related to the prognosis of the disease, but this is insufficient so it is currently to work on identifying molecular alterations to identify subtypes that can establish more precisely the patient's prognosis. This preliminary study aimed to standardization of the method of quantification in prostatic samples of FFPE of expression of transcripts of possible biomarkers, such as the oncogenes, SPINK-1 y EZH2, the tumour suppressor, NKX3.1, together with the determination of the presence/absence of gene fusion, TMPRSS2:ERG, being that these transcripts are involved in apparent exclusive events of the natural evolution of PCa, that support the possibility of a molecular classification for this disease.

Número necessário a tratar (NNT) e custo por evento evitado (COPE) de enzalutamida e acetato de abiraterona para o tratamento de câncer de próstata resistente à castração que falharam a terapia de privação de androgênio / Number needed to treat (NNT) and cost of preventing an event (COPE) of enzalutamide vs. abiraterone acetate plus prednisone for the treatment of metastatic castration-resistant prostate cancer (mCRPC) patients who failed androgen deprivation therapy (ADT)

Objetivo: O objetivo deste estudo foi estimar o número necessário a tratar (NNT) e custo por evento evitado (COPE) de enzalutamida (ENZ) em comparação com abiraterona+prednisona (AA+P) em 12 e 24 meses sob perspectiva do sistema de saúde suplementar em pacientes com câncer de próstata resistente à castração metastático (CPRCM) sem quimioterapia prévia. Métodos: O NNT é calculado pelo inverso da diferença do risco absoluto de uma intervenção versus placebo; adicionalmente, o COPE representa o NNT multiplicado pelo custo de tratamento total de um período determinado. O risco absoluto de ENZ e AA+P e seus respectivos controles foram obtidos das curvas de sobrevida livre de progressão radiográfica (SLPr) e sobrevida global (SG) dos estudos PREVAIL e COU-AA-302, respectivamente. A duração de tratamento média no horizonte de 24 meses foi estimada utilizando a área sob a curva das respectivas curvas de SLPr. Os resultados foram a comparação entre ENZ e AA+P versus seus respectivos placebos em 12 e 24 meses para NNT e COPE. O custo total de tratamento consistiu em custos de medicamento, monitoramento, e manejo de eventos adversos (≥1%, eventos de interesses especiais). Resultados: A análise de 12 meses resultou em NNTSG/ENZ= 12,79; NNTSLPr/ENZ= 2,59; NNTSG/AA+P= 116,28; NNTSLPr/AA+P= 4,72 e COPESG/ENZ= BRL 1.626.583; COPESLPr/ENZ= BRL 329.701; COPESG/AA+P= BRL 15.144.886; COPESLPr/AA+P= BRL 614.368. Para a análise de 24 meses, os resultados foram: NNTSG/ENZ= 11,00; NNTSLPr/ENZ= 3,58; NNTSG/AA+P= 16,56; NNTSLPr/AA+P= 5,00 e COPESG/ENZ= BRL 1.965.454; COPESLPr/ENZ= BRL 639.327; COPESG/AA+P= BRL 2.833.580; COPESLPr/AA+P= BRL 855.741. Conclusão: Para ambos horizontes de tempo, os resultados foram favoráveis para ENZ vs. AA+P em pacientes com CPRCM.

Objective: The aim of this study was to estimate the NNT and COPE of enzalutamide (ENZ) in comparison with abiraterone acetate+prednisone (AA+P) over a 12-month and 24-month period from the Supplementary Health System perspective in metastatic castration-resistant prostate cancer patients who are chemotherapy naïve (MCRPC). Methods: The NNT is calculated by the inverse of the absolute risk reduction of an intervention vs. control; additionally, COPE represents the NNT multiplied by total cost of treatment in a pre-defined period. The absolute risk of ENZ and AA+P, and their respective control treatments, were obtained from the Kaplan Meier curves for the co-primary end points of radiographic progression free survival (rPFS) and overall survival (OS) from the clinical studies PREVAIL and COU-AA-302, respectively. Mean treatment duration was estimated utilizing the area under curve (AUC) technique from the respective intervention rPFS curves. The results analyzed ENZ or AA+P versus its respective placebo at 12 and 24 months for NNT and COPE. Total treatment cost consisted of drug cost, monitoring cost and adverse event (>=1% incidence and special interest adverse events) related cost. Results: The 12 month analysis resulted in NNTOS/ENZ= 12.79; NNTrPFS/ENZ= 2.59; NNTOS/AA+P= 116.28; NNTrPFS/AA+P= 4.72 and COPEOS/ENZ= BRL 1,626,583; COPErPFS/ENZ= BRL 329,701; COPEOS/AA+P= BRL 15,144,886; COPErPFS/AA+P= BRL 614,368. For the 24-month analysis, the results were: NNTOS/ENZ= 11.00; NNTrPFS/ENZ= 3.58; NNTOS/AA+P=16.56; NNTrPFS/AA+P= 5.00 and COPEOS/ENZ= BRL 1,965,454; COPErPFS/ENZ= BRL 639,327; COPEOS/ AA+P= BRL 2,833,580; COPErPFS/AA+P= BRL 855,741. Conclusion: Across the 12- and 24-month time horizons, the NNT and COPE was favorable for ENZ vs. AA+P in patients with MCRPC.

[Spanish version of the Satisfaction With Decision scale: cross-cultural adaptation, validity and reliability]. / Versión española de la Satisfaction With Decision scale: adaptación transcultural, validez y fiabilidad.

OBJECTIVE: The aim of this study is to develop a Spanish version of the Satisfaction With Decision scale (SWDs) and analyse the psychometric properties of validity and reliability. DESIGN: An observational, descriptive study and validation of a tool to measure satisfaction with the decision. SETTING: Urology, Radiation oncology, and Medical oncology Departments of the Hospital Universitari Germans Trias i Pujol, Institut Català d'Oncologia and the Institut Oncològic del Vallès - Hospital General de Catalunya. PARTICIPANTS: A total of 170 participants diagnosed with prostate cancer, and who could read and write in Spanish and gave their informed consent. MAIN MEASUREMENTS: A translation, back-translation and cross-cultural adaptation to Spanish was performed on the SWDs. The content validity, criterion validity, construct validity and reliability (internal consistency and stability) of the Spanish version were evaluated. RESULTS: The SWDs contains 6 items with 5-item Likert scales. A Spanish version (ESD) was obtained that was linguistically and conceptually equivalent to the original version. Criterion validity, the ESD correlated with "satisfaction with the decision" using a linear analogue scale, was significant (r=0.63, P<.01) for all items. The factorial analysis showed a unique dimension to explain 82.08% of the variance. The ESD showed excellent results in terms of internal consistency (Cronbach alpha=0.95) and good test-retest reliability with intraclass correlation coefficient of 0.711. CONCLUSIONS: The ESD is a validated Spanish scale to measure the satisfaction with the decisions taken in health, and demonstrates a correct validity and reliability.

Transrectal doppler ultrasound during prostate biopsy: clinical utility and limitations.

OBJECTIVE: To determine the clinical utility and limitations of guided prostate biopsy Power Doppler in patients with elevated serum PSA levels. MATERIALS AND METHOD: Prospective study. From April 2012 to May 2013, 111 men over 45 years of age with serum PSA level greater than 4.0ng/dl who underwent a transrectal prostate biopsy were included. The hypoechoic nodules in the peripheral region were considered positive on the gray scale. Subsequently, the study was conducted with the Power Doppler, where the vascularization of suspicious images was analyzed for sampling. In addition, samples were taken from the suspected areas when performing the digital rectal examination. We calculated sensitivity, specificity, positive predictive value and negative predictive value of the three tests (digital rectal examination, standard gray scale ultrasound and power Doppler). RESULTS: Prostate cancer was diagnosed in 48 of the 111 patients (43%). Fifty-nine cases (53%) were defined as positive with the Power Doppler. Of these, 39 (66%) corresponded to a diagnosis of prostate adenocarcinoma. The Power Doppler was positive in 39 cases of the 48 patients diagnosed with cancer and the gray scale ultrasound was positive in 31 cases. Overall sensitivity of the power Doppler was 81%, specificity 68%, PPV 66% and NPV 82%, which was higher compared to the other methods (P<.05). CONCLUSION: Currently, prostate biopsy using Power Doppler does not seem to identify prostate cancer with sufficient accuracy to omit the guided systematic biopsy gray scale, the combined use of these methods being preferable.

Are active surveillance criteria sufficient for predicting advanced stage prostate cancer patients?

OBJECTIVES: To examine the treatment outcomes of the prostate cancer (PCa) patients treated by radical prostatectomy (RP) who could be good candidates for active surveillance (AS) and test the confidence and reliability of the AS criterias for predicting advanced stage disease (RP Gleason score≥7 or Pathological stage T3). METHODS: Between 2005 and 2012 the records of the 401 patients who underwent RP with a diagnosis of PCa were examined. Of these patients, 173 were found to be candidates of AS. The inclusion criteria were as follows; clinical stage T2a or less, PSA<10ng/ml, 2 or fewer cores involved with cancer, no single core with 50% or greater maximum involvement of cancer, and no Gleason grade greater than 3 in the specimen. RESULTS: Univariate analyzes revealed that patients with advanced stage disease have higher prostate specific antigen density (PSAD), higher maximum percent (max%) in positive cores and higher RP tumor volumes. In multivariate analyzes PSAD, max% in positive cores and RP tumor volumes were statistically significant determinants for advanced stage disease. ROC analyzes revealed that the RP tumor volume is a good test on advanced stage disease. CONCLUSIONS: Decreasing the cutoff values for PSAD and max% in positive cores should be considered for AS inclusion criteria. If we could calculate the tumor volume before RP, we can minimize the treatment failures (over or undertreatment) of PCa. Perhaps new biopsy protocols, tissue biomarkers, and molecular imaging technology may refine AS criteria.