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2.
Nat Rev Clin Oncol ; 17(6): 372-381, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112055

RESUMO

Following detection of high levels of serum prostate-specific antigen, many men are advised to have transrectal ultrasound-guided biopsy in an attempt to locate a cancer. This nontargeted approach lacks accuracy and carries a small risk of potentially life-threatening sepsis. Worse still, it can detect clinically insignificant cancer cells, which are unlikely to be the origin of advanced-stage disease. The detection of these indolent cancer cells has led to overdiagnosis, one of the major problems of contemporary medicine, whereby many men with clinically insignificant disease are advised to undergo unnecessary radical surgery or radiotherapy. Advances in imaging and biomarker discovery have led to a revolution in prostate cancer diagnosis, and nontargeted prostate biopsies should become obsolete. In this Perspective article, we describe the current diagnostic pathway for prostate cancer, which relies on nontargeted biopsies, and the problems linked to this pathway. We then discuss the utility of prebiopsy multiparametric MRI and novel tumour markers. Finally, we comment on how the incorporation of these advances into a new diagnostic pathway will affect the current risk-stratification system and explore future challenges.


Assuntos
Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata/diagnóstico , Fatores Etários , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/urina , Biópsia com Agulha de Grande Calibre , Exame Retal Digital , Proteínas de Homeodomínio/genética , Humanos , Calicreínas/sangue , Masculino , Sobremedicalização , Diagnóstico Ausente , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , RNA Mensageiro/urina , Fatores de Transcrição/genética , Ultrassonografia
3.
Croat Med J ; 61(1): 49-54, 2020 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-32118378

RESUMO

AIM: To compare cognitive fusion targeted and systematic prostate biopsy in patients with repeated negative systematic biopsy but persistent clinical suspicion for prostate cancer. METHODS: The study enrolled 63 patients with at least one previously negative systematic biopsy who underwent targeted prostate biopsy using multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) in addition to standardized systematic biopsy from July 2016 to May 2018. Multiparametric MRI was performed with 3 Tesla device by uro-radiologists experienced in prostate cancer. Lesions with Prostate Imaging Reporting and Data System 3, 4, and 5 were considered suspicious. Targeted biopsies were performed with cognitive fusion of TRUS and mpMRI. RESULTS: Prostate cancer detection, using either targeted or systematic biopsy, was 60.32%. Targeted biopsies were positive in 52.38% and systematic biopsies in 47.62% of patients. The median highest percentage of cancer involvement per biopsy core was significantly higher in targeted cylinders. The biopsies obtained by using the two techniques did not significantly differ in Gleason score. CONCLUSION: Cognitive targeted prostate biopsy based on mpMRI presents a valuable addition to systematic biopsy in patients with repeated negative systematic biopsies but persistent clinical suspicion of prostate cancer.


Assuntos
Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata/diagnóstico por imagem , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Exame Retal Digital , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
5.
J Urol ; 203(6): 1117-1121, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31909690

RESUMO

PURPOSE: We studied the risk of metastatic prostate cancer development in men with Grade Group 2 disease managed with active surveillance at Memorial Sloan Kettering Cancer Center. MATERIALS AND METHODS: A total of 219 men with Grade Group 2 prostate cancer had disease managed with active surveillance between 2000 and 2017. Biopsy was performed every 2 to 3 years, or upon changes in magnetic resonance imaging, prostate specific antigen level or digital rectal examination. The primary outcome was development of distant metastasis. The Kaplan-Meier method was used to estimate treatment-free survival. RESULTS: Median age at diagnosis was 67 years (IQR 61-72), median prostate specific antigen was 5 ng/ml (IQR 4-7) and most patients (69%) had nonpalpable disease. During followup 64 men received treatment, including radical prostatectomy in 36 (56%), radiotherapy in 20 (31%), hormone therapy in 3 (5%) and focal therapy in 5 (8%). Of the 36 patients who underwent radical prostatectomy 32 (89%) had Grade Group 2 disease on pathology and 4 (11%) had Grade Group 3 disease. Treatment-free survival was 61% (95% CI 52-70) at 5 years and 49% (95% CI 37-60) at 10 years. Three men experienced biochemical recurrence, no men had distant metastasis and no men died of prostate cancer during the followup. Median followup was 3.1 years (IQR 1.9-4.9). CONCLUSIONS: Active surveillance appears to be a safe initial management strategy in the short term for carefully selected and closely monitored men with Grade Group 2 prostate cancer treated at a tertiary cancer center. Definitive conclusions await further followup.


Assuntos
Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Conduta Expectante/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Exame Retal Digital , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Avaliação de Resultados em Cuidados de Saúde , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/mortalidade , Estudos Retrospectivos , Risco , Centros de Atenção Terciária
6.
Gastroenterology ; 158(5): 1232-1249.e3, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31945360

RESUMO

With a worldwide prevalence of 15%, chronic constipation is one of the most frequent gastrointestinal diagnoses made in ambulatory medicine clinics, and is a common source cause for referrals to gastroenterologists and colorectal surgeons in the United States. Symptoms vary among patients; straining, incomplete evacuation, and a sense of anorectal blockage are just as important as decreased stool frequency. Chronic constipation is either a primary disorder (such as normal transit, slow transit, or defecatory disorders) or a secondary one (due to medications or, in rare cases, anatomic alterations). Colonic sensorimotor disturbances and pelvic floor dysfunction (such as defecatory disorders) are the most widely recognized pathogenic mechanisms. Guided by efficacy and cost, management of constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed, if necessary, by intestinal secretagogues and/or prokinetic agents. Peripherally acting µ-opiate antagonists are another option for opioid-induced constipation. Anorectal tests to evaluate for defecatory disorders should be performed in patients who do not respond to over-the-counter agents. Colonic transit, followed if necessary with assessment of colonic motility with manometry and/or a barostat, can identify colonic dysmotility. Defecatory disorders often respond to biofeedback therapy. For specific patients, slow-transit constipation may necessitate a colectomy. No studies have compared inexpensive laxatives with newer drugs with different mechanisms. We review the mechanisms, evaluation, and management of chronic constipation. We discuss the importance of meticulous analyses of patient history and physical examination, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients.


Assuntos
Constipação Intestinal/terapia , Defecação/fisiologia , Motilidade Gastrointestinal/fisiologia , Doença Crônica/epidemiologia , Doença Crônica/terapia , Colo/diagnóstico por imagem , Colo/inervação , Colo/metabolismo , Colo/fisiopatologia , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Defecografia , Fibras na Dieta/administração & dosagem , Suplementos Nutricionais , Exame Retal Digital , Eletromiografia , Motilidade Gastrointestinal/efeitos dos fármacos , Humanos , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/fisiopatologia , Laxantes/administração & dosagem , Imagem por Ressonância Magnética , Manometria , Diafragma da Pelve/inervação , Diafragma da Pelve/fisiopatologia , Prevalência , Receptores Opioides mu/antagonistas & inibidores , Receptores Opioides mu/metabolismo , Reto/diagnóstico por imagem , Reto/inervação , Reto/metabolismo , Reto/fisiopatologia , Secretagogos/administração & dosagem
7.
J Urol ; 203(6): 1122-1127, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31868556

RESUMO

PURPOSE: We report oncologic outcomes for men with Grade Group 1 prostate cancer managed with active surveillance at a tertiary cancer center. MATERIALS AND METHODS: A total of 2,907 patients were managed with active surveillance between 2000 and 2017, of whom 2,664 had Grade Group 1 disease. Patients were recommended confirmatory biopsy to verify eligibility and were followed semiannually with prostate specific antigen, digital rectal examination and review of symptoms. Magnetic resonance imaging was increasingly used in recent years. Biopsy was repeated every 2 to 3 years or after a sustained prostate specific antigen increase or changes in magnetic resonance imaging/digital rectal examination. The Kaplan-Meier method was used to estimate probabilities of treatment, progression and development of metastasis. RESULTS: Median patient age at diagnosis was 62 years. For men with Grade Group 1 prostate cancer the treatment-free probability at 5, 10 and 15 years was 76% (95% CI 74-78), 64% (95% CI 61-68) and 58% (95% CI 51-64), respectively. At 5, 10 and 15 years there were 1,146, 220 and 25 men at risk for metastasis, respectively. Median followup for those without metastasis was 4.3 years (95% CI 2.3-6.9). Distant metastasis developed in 5 men. Upon case note review only 2 of these men were deemed to have disease that could have been cured on immediate treatment. The risk of distant metastasis was 0.6% (95% CI 0.2-2.0) at 10 years. CONCLUSIONS: Active surveillance is a safe strategy over longer followup for appropriately selected patients with Grade Group 1 disease following a well-defined monitoring plan.


Assuntos
Neoplasias da Próstata/terapia , Conduta Expectante/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Exame Retal Digital , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Avaliação de Resultados em Cuidados de Saúde , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Risco , Centros de Atenção Terciária
8.
Int Braz J Urol ; 46(1): 34-41, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851456

RESUMO

PURPOSE: Prostate cancer screening in the elderly is controversial. The Brazilian government and the National Cancer Institute (INCA) do not recommend systematic screening. Our purpose was to assess prevalence and aggressiveness of prostate cancer in men aged 70 years and above, on the first Latin American database to date. MATERIALS AND METHODS: Cross-sectional study (n=17,571) from 231 municipalities, visited by Mobile Cancer Prevention Units of a prostate-specific antigen (PSA) based opportunistic screening program, between 2004 and 2007. The criteria for biopsy were: PSA>4.0ng/ml, or PSA 2.5-4.0ng/ml with free/total PSA ratio ≤15%, or suspicious digital rectal examination findings. The screened men were stratified in two age groups (45-69 years, and ≥70 years). These groups were compared regarding prostate cancer prevalence and aggressiveness criteria (PSA, Gleason score from biopsy and TNM staging). RESULTS: The prevalence of prostate cancer found was 3.7%. When compared to men aged 45-69 years, individuals aged 70 years and above presented cancer prevalence about three times higher (prevalence ratio 2.9, p<0.01), and greater likelihood to present PSA level above 10.0ng/ml at diagnosis (odds ratio 2.63, p<0.01). The group of elderly men also presented prevalence of histologically aggressive disease (Gleason 8-10) 3.6 times higher (p<0.01), and 5-fold greater prevalence of metastases (PR 4.95, p<0.05). CONCLUSIONS: Prostate cancer screening in men aged over 70 may be relevant in Brazil, considering the absence of systematic screening, higher prevalence and higher probability of high-risk disease found in this age range of the population studied.


Assuntos
Programas de Rastreamento/métodos , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biópsia , Brasil/epidemiologia , Estudos Transversais , Exame Retal Digital , Detecção Precoce de Câncer , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Prevalência , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Medição de Risco , Fatores de Risco
9.
In Vivo ; 34(1): 393-396, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882504

RESUMO

BACKGROUND/AIM: To evaluate the diagnostic accuracy of the urinary SelectMDx test in the diagnosis of clinically significant prostate cancer (csPCa) in men enrolled in an active surveillance (AS) protocol. PATIENTS AND METHODS: From July 2015 to July 2018, 125 men with very low-risk PCa were enrolled in the AS protocol; all patients underwent confirmatory transperineal saturation biopsy (SPBx). In the presence of PI-RADS score ≥3, a targeted MRI/TRUS fusion-guided biopsy was added to SPBx. Post-digital rectal examination urine was collected in 45/125 (36%) patients before SPBx; the genetic urine analysis was performed using a biomarker-based risk score model, the SelectMDx, that measured mRNA levels of distal-less homeobox 1 (DLX1) and homeobox C6 (HOXC6). RESULTS: A total of 9/45 (20%) patients were reclassified as csPCa (7 cases=Grade Group 2; 2 cases=Grade Group 3); sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of mpMRI vs. SelectMDx in the diagnosis of csPCa were equal to 66.6 vs. 55.6%, 87.7 vs. 65.8%, 54.5 vs. 27.8%, 92.3 vs. 87%, 84.9 vs. 70.3%, respectively. CONCLUSION: SPBx combined with MRI/TRUS fusion biopsy significantly outperformed the diagnostic accuracy of SelectMDx (70.3%) in the diagnosis of csPCa in men enrolled in AS.


Assuntos
Biomarcadores Tumorais/genética , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico , Urinálise/métodos , Conduta Expectante , Idoso , Biomarcadores Tumorais/urina , Exame Retal Digital , Seguimentos , Perfilação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Neoplasias da Próstata/genética , Neoplasias da Próstata/urina
10.
J BUON ; 24(5): 2107-2113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31786882

RESUMO

PURPOSE: To evaluate the potential of prostate cancer detection on the basis of prostate-specific antigen (PSA)-level and percent free PSA (% fPSA) according to the outcome of prostate needle biopsy. METHODS: This was a retrospective study of 1040 patients that underwent a prostate biopsy in the Urologic Clinic of the University Hospital of Ioannina, Greece. The patients underwent needle biopsy after abnormal finding in digital rectal examination (DRE). Tissue samples were extracted using a 12-core TRUS-GB. The patients were divided into four groups according to the biopsy outcome. Total serum and free PSA were measured. RESULTS: The mean PSA concentration of cancer versus noncancer groups was significantly higher (p<0.05). The positive predictive value (PPV) of PSA for serum concentration >10 ng/ml was 47% while the negative predictive value (NPV) in patients with PSA levels <4 ng/ml was 81%. The diagnostic accuracy of % fPSA for patients with PSA level between 4-10 ng/ml was 0.651 (95% CI, 0.549-0.754) (p<0.05). A statistically significant difference in mean PSA concentration was recorded between prostate cancers classified as grade 2 (3+4=7) and 3 (4+3=7) and grade 4 (8) and 5 (9-10) (p<0.05). CONCLUSIONS: Though informative and suggestive, PSA and % fPSA are not definitive for cancer or non-cancer determination. The differentiation of PSA level between tumours classified as grade 2 (3+4=7) and grade 3 (4+3=7) could support the determination of treatment by backing pathologist's interpretation of the histological diagnosis.


Assuntos
Biomarcadores Tumorais/metabolismo , Antígeno Prostático Específico/sangue , Próstata/metabolismo , Neoplasias da Próstata/metabolismo , Idoso , Biópsia , Exame Retal Digital , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Próstata/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Estudos Retrospectivos
11.
BMC Public Health ; 19(1): 1573, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775710

RESUMO

BACKGROUND: Digital rectal examination (DRE) is one of the most common strategies for prostate cancer early detection. However, the use for screening purposes has a controversial benefit and potential harms can occur due to false-positive results, overdiagnosis and overtreatment. The objective of this study is to calculate the prevalence and identify factors associated with the receipt of DRE in Brazilian men. METHODS: We selected men older than 40 from a nationwide population-based survey (13,625 individuals) excluding those with prostate cancer diagnosis. Information was extracted from the most recent database of the Brazilian National Health Survey (PNS 2013). Statistical analysis was carried out to calculate incidence rate ratios, with 95% confidence intervals and p values, through multivariate analysis with Poisson regression and robust variance. RESULTS: Men having private health insurance (63.3%; CI = 60.5-66.0) presented higher prevalence of DRE than those in the public health system (41.6%; CI = 39.8-43.4). The results show a positive association between DRE and men having private health insurance, aged 60-69, living with a spouse, never smokers, and living in urban areas. Among public health services users, this positive association was observed among men aged 70-79, living with a spouse, having bad/very bad health self-perception, abstainers, ex-smokers, with undergraduate studies, presenting four or more comorbidities, and residing in urban areas. CONCLUSIONS: Prostate cancer screening with DRE is quite frequent in Brazil, specially among men with private health plans and better access to health services, healthier lifestyle and at more advanced ages, characteristics which increase the risk of overdiagnosis and overtreatment.


Assuntos
Exame Retal Digital/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Neoplasias da Próstata/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade
12.
Arch Ital Urol Androl ; 91(3)2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577101

RESUMO

OBJECTIVES: Although cancer is believed to develop and progress with the involvement of inflammation, it is still unclear what the correlation between inflammation and prostate cancer is. This study based on results of transrectal ultrasound-guided prostate biopsies aimed to determine whether C-reactive protein (CRP) and sterile pyuria were clinically useful in the evaluation of patients with suspect of prostate cancer. MATERIALS AND METHODS: This study is a cross-sectional prospective study of patients without clinical prostatitis symptoms. Characteristics of the 200 consecutive patients recruited were 3-20 ng/mL value of serum prostate-specific antigen (PSA), normal digital rectal examination finding, and sterile urine culture result. All patients underwent 12-core prostatic biopsy. 163 of the 200 patients had benign prostatic hyperplasia confirmed through histology, while the residual 37 patients had prostate cancer. Patients with pre-treatment urinary leukocyte count ≤ 3/high power field were categorized as non-pyuria, whilst those with pre-treatment urinary leukocyte count > 3/high power field were categorized as pyuria. The serum CRP level was also used to differentiate patients before the biopsy. Subgroups were compared regarding a number of clinical variables. RESULTS: Histology revealed that 70% of pyuria patients and 38.5% of non-pyuria patients presented inflammation (p = 0.001). The pyuria group exhibited significantly higher total PSA compared to the non-pyuria group (p = 0.044). The two groups did not differ significantly regarding cancer detection rate (p = 0.752). CRP groups were similar regarding cancer detection and histologically-detected inflammation rates. CONCLUSION: In patients with no evidence of clinical prostatitis, sterile pyuria should be considered as a cause of increased PSA. Although sterile pyuria cannot predict non-palpable prostate cancer, it should be taken into account in urological evaluation in order to demonstrate minute prostatic inflammation due to its simplicity, convenience and non-invasiveness.


Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Piúria/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Exame Retal Digital , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Próstata/complicações , Piúria/complicações
13.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1173-1179, out.-dez. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022199

RESUMO

Objetivo: Descrever o conhecimento, o comportamento e as práticas em relação ao câncer de próstata em adultos. Métodos: Estudo quantitativo, realizado com 130 homens. A coleta de dados ocorreu no primeiro semestre de 2015, por meio do Modelo de Crenças em Saúde. Resultados: Embora relatem conhecimento sobre o câncer, 30% realizam a dosagem do Antígeno Prostático Específico e 17,6% o exame de toque retal anualmente. A maioria percebe a susceptibilidade e a severidade do câncer e acredita que é capaz de fazer algo por si mesmo, beneficiando-se com esses cuidados. Quanto às barreiras, 16,9% apresentaram comportamento não preventivo. Conclusão: O medo da dor, a vergonha e a falta de coragem para realizar o exame constituem barreiras a esses indivíduos. A equipe de saúde deve oportunizar abordagens considerando esses aspectos, utilizando estratégias que ampliem o acesso dos homens ao serviço de saúde e estimulem a prática do autocuidado


Objective: The study's purpose has benn to describe the knowledge, behavior and health practices regarding the prostate cancer in adults. Methods: It is a cross-sectional and descriptive study with a quantitative approach, which had 130 participating men. Data collection took place from March to April 2015, using the Health Belief Model. Results: Although they report having knowledge about cancer, only 30% had done the prostate-specific antigen dosage and 17.6% the rectal examination annually. Most comprehend the susceptibility and severity of this cancer, and believe that they are capable of doing something for themselves and benefiting from such care. Regarding the barriers, 16.9% had non-preventive behavior. Conclusion: Fear of pain, shame, and lack of courage to take the exam are barriers to these individuals. The health team should opportunistically approach these aspects by using strategies that increase men's access to health care and encourage self-care practices


Objetivo: Describir el conocimiento, el comportamiento y las prácticas en relación al cáncer de próstata en adultos. Métodos: Estudio cuantitativo, realizado con 130 hombres. La recolección de datos ocurrió entre marzo a abril de 2015, a través del Modelo de Creencias en Salud. Resultados: Aunque reportan conocimiento sobre el cáncer, el 30% realiza la dosificación del Antígeno Prostático y el 17,6% el examen de tacto anual. La mayoría percibe la susceptibilidad y la severidad del cáncer y cree que es capaz de hacer algo por sí mismo y beneficiarse con esos cuidados. En cuanto a las barreras, el 16,9% presentó comportamiento no preventivo. Conclusión: El miedo al dolor, la vergüenza y la falta de coraje para realizar el examen constituyen barreras a esos individuos. El equipo de salud debe oportunizar enfoques considerando estos aspectos, utilizando estrategias que amplíen el acceso al servicio de salud y estimulen la práctica del autocuidado


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias da Próstata , Autocuidado , Saúde do Homem , Comportamentos de Risco à Saúde , Brasil , Antígeno Prostático Específico/uso terapêutico , Pesquisa Comportamental , Exame Retal Digital/psicologia
14.
Urol Int ; 103(4): 415-422, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31466070

RESUMO

INTRODUCTION: To assess the association of prostate volume index (PVI), defined as the ratio of the central transition zone volume to the peripheral zone volume, and prostatic chronic inflammation (PCI) as predictors of prostate cancer (PCA) risk in patients presenting with normal digital rectal exam and prostate-specific antigen (PSA) ≤10 ng/mL at baseline random biopsies. METHODS: We evaluated patients with a negative digital rectal examination (DRE) and a PSA ≤10 ng/mL who underwent initial baseline prostate biopsy from 2010 to 2017. Parameters evaluated included age, PSA, total prostate volume (TPV), PSA density (PSAD), PVI and PCI. All patients underwent 14 core trans-perineal standard biopsies. The association of factors with the risk of PCA was evaluated by logistic regression analysis, utilizing 2 multivariate models: model I included age, TPV, PVI and PCI; model II included age, PSAD, PVI and PC. RESULTS: Overall, 564 Caucasian patients were included. PCA and PCI were detected in 242 (42.9%) and 129 (22.9%) cases respectively. In patients with PCA, the median PVI was 0.83 (interquartile range [IQR] 0.62-1.04). In patients with PCI, the median PVI was 1.12 (IQR 0.81-1.47). In model I, age (OR 1.080) TPV (OR 0.961), PVI (OR 0.517) and PCI (OR 0.249) were associated with PCA risk. In model II, the age (OR 1.074), PSAD (OR 3.080), PVI (OR 0.361) and PCI (OR 0.221) were associated with PCA risk. CONCLUSIONS: Higher PVI and PCI predicted decreased PCA risk in patients presenting with normal DRE, and a PSA ≤10ng/mL at baseline random biopsy. In this subset of patients, PVI is able to differentiate patients with PCI or PCA.


Assuntos
Calicreínas/sangue , Antígeno Prostático Específico/sangue , Próstata/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Prostatite/sangue , Prostatite/patologia , Idoso , Biópsia , Doença Crônica , Diagnóstico Diferencial , Exame Retal Digital , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos
15.
Revista Digital de Postgrado ; 8(2): e162, ago. 2019. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1006593

RESUMO

El cáncer de próstata es un problema de salud pública a nivel mundial, el cual clásicamente se sospecha por alteració en el antígeno prostático (PSA) y/o tacto rectal (TR) y se confirma con biopsia prostática. No obstante, existen otros marcadores como la densidad del PSA (DPSA) que se emplean para determinar la necesidad de una biopsia. Objetivo: Verificar la utilidad actual de la DPSA como herramienta diagnóstica para cáncer de próstata. Métodos: Es un estudio descriptivo, prospectivo, tipo transversal, la selección de la muestra se efectuó mediante muestreo no probabilístico intencional, quedando integrada por el número de pacientes con criterios de biopsia prostática que acudieron al Servicio de Urología del Hospital Universitario de Caracas durante los meses de junio -julio del 2014. El análisis estadístico se realizó con el programa SPSS/PC versión 25.0. Resultados: El estudio estuvo conformado por 100 pacientes con edad media de 65±7,7. La tasa de detección de cáncer de próstata fue del 38% tomando en cuenta los criterios convencionales (PSA y TR), sin embargo, cuando el criterio es la DPSA se redujo el número de pacientes a 33 de los cuales el 69,7% (n 23) presentaron cáncer de próstata. Conclusión: La DPSA es una herramienta útil para ser usada como criterio para la realización de biopsia prostática con una tasa de detección general del 60,52% lo cual supera por si sola a los métodos de despistaje convencionales como lo son el valor del PSA y el tacto rectal(AU)


Prostate cancer is a public health problem worldwide, which is classically suspected due to alteration in prostatic antigen (PSA) and / or rectal examination (RE) and confirmed by prostate biopsy. However, there are other markers such as PSA density (DPSA) that are used to determine the need for a biopsy. Objective: To verify the actual usefulness of PSA density as a diagnostic tool for prostate cancer. Methods: Prospective, descriptive, cross-sectional, the selection of the sample was performed by intentional nonprobabilistic sampling, being composed of the number of patients with prostate biopsy criteria who attended the department of urology at University Hospital in Caracas during the months of june -july 2014. Statistical analysis was performed using SPSS / PC Version 25.0 program. Descriptive statistics were used. Results: e study consisted of 100 patients with a mean age of 65 ± 7.7. e detection rate of prostate cancer was 38% taking into account the conventional criteria (PSA and RE), however when the criterion is the DPSA the number of patients was reduced to 33 of which 69.7% (n 23) prostate cancer. Conclusion: e DPSA is a useful tool to be used as a criterion for performing a prostate biopsy overall detection rate of 60.52% which exceeds by itself to conventional screening methods such as the value of PSA and DRE(AU)


Assuntos
Humanos , Masculino , Doenças Prostáticas/diagnóstico , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Antígeno Prostático Específico , Biópsia , Exame Retal Digital
16.
Expert Rev Anticancer Ther ; 19(8): 705-716, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31277551

RESUMO

Introduction: Prostate cancer (PCa) is the most common diagnosed malignancy among the male population in the United States. The incidence is increasing with an estimated amount of 175.000 cases in 2019. Areas covered: Primarily, PCa is generally detected by an elevated or rising serum prostate-specific antigen (PSA) and digital rectal examination (DRE) followed by pathological examination. Histopathology ultimately confirms the presence of PCa and determines a Gleason score. However, PSA and DRE have low specificity and sensitivity, respectively. Subsequently, accurate assessment of the aggressiveness of PCa is essential to prevent overdiagnosis and thus overtreatment of low-risk or indolent cancers. By visualizing PCa suspicious lesions and sampling them during the targeted biopsy, it is likely that the diagnostic accuracy of significant PCa improves. This article reviews the current imaging techniques used to secure biopsies in patients with a suspicion of PCa. The advantages and limitations of each technique are described. Expert opinion: Multiparametric magnetic resonance imaging (mpMRI) and subsequent-targeted biopsy have improved the diagnostic accuracy of PCa detection in men with an elevated or rising serum PSA. Prostate lesions visible on mpMRI are easily targeted during either in-bore MRI-guided biopsy, cognitive fusion biopsy or MRI-TRUS fusion biopsy.


Assuntos
Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico , Exame Retal Digital/métodos , Humanos , Masculino , Gradação de Tumores , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Sensibilidade e Especificidade
17.
Folia Med Cracov ; 59(1): 115-125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180080

RESUMO

BACKGROUND: The digital rectal examination (DRE) is a part of the standard physical examination and a useful diagnostic tool for detecting various lower gastrointestinal tract abnormalities. However nowadays it has been observed that medical students might not be properly prepared for performing and interpreting of DRE. The purpose of the study was to evaluate the knowledge and experience of Polish medical students about DRE. MATERIAL AND METHODS: A prospective study was carried out using a questionnaire accessible via internet platform. The survey consisted of 12 questions and considered experience as well as practical and theoretical knowledge about DRE. 976 responses from nine Polish medical universities were included in the study. RESULTS: 38.68% of students have never performed DRE with "lack of opportunity during courses" (71.09%) as the most common reason. Among responders who performed this examination only 12.72% had done it more than two times. Usefulness of DRE was mostly assessed as high and very high (55.63%). Students in the self-assessment part indicated low and very low (18.72% and 39.61%) technical abilities and also low (25.34%) interpretation skills. Conclusiosion: The knowledge of Polish medical students about DRE is insuffcient. Medical universities should pay particular attention to this field of examination to improve theoretical as well as practical skills of future doctors.


Assuntos
Competência Clínica , Exame Retal Digital , Educação de Graduação em Medicina , Estudantes de Medicina , Feminino , Humanos , Masculino , Manequins , Polônia , Estudos Prospectivos , Treinamento por Simulação , Inquéritos e Questionários
18.
Anticancer Res ; 39(6): 3101-3110, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177155

RESUMO

BACKGROUND/AIM: The aim of the study was to compare the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI), multiparametric ultrasound (mpUS) and US/MRI fusion imaging techniques in the detection of prostate cancer. PATIENTS AND METHODS: A total of 82 patients with persistently high prostate specific antigen (PSA) levels after medical therapy were prospectively evaluated. All patients underwent digital rectal examination, mpMRI, mpUS and prostate biopsy. RESULTS: Histological outcome was positive for prostate cancer (PCa) in 46/82 patients (56.1%). MpMRI detected 54/82 lesions; histological analysis confirmed PCa in 44 lesions (sensitivity 91.3% and specificity 66.7%). Ratio estimation with semiquantitative elastography, between lesions and the peripheral portion showed a higher sensitivity and specificity compared to strain ration (SR) evaluation between lesions and adenomas (sensitivity 84.8% vs. 78.3%; specificity 66.6% vs. 61.1%). Quantitative analysis of contrast-enhanced ultrasound (CEUS) showed 40.0% sensitivity and 97.2% specificity. A total of 54 lesions detected by mpMRI and MRI/TRUS fusion targeted biopsy had a high number of positive samples (81.5%). CONCLUSION: mpMRI is more accurate than mpUS which still remains a valuable technique used after MRI for prostate fusion-guided biopsy.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Exame Retal Digital , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Estudos Prospectivos , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes
19.
Medicina (Ribeiräo Preto) ; 52(2)abr.-jun., 2019.
Artigo em Inglês | LILACS | ID: biblio-1025051

RESUMO

Background: Prostate cancer is the second most incident of the male population in Brazil. The aim of this study is to analyze the frequency of risk factors associated to the evolution of the prostate cancer and the impact of conducting examinations in the age range (55-69 years old), in assisting health professionals to manage and prevent the disease. Methods: A case-control study was performed on patients from 2011 to 2016 in Criciúma ­ SC, Brazil. The sample was divided into two groups, one with biopsy for prostate adenocarcinoma (case; n = 124) and the other with a negative biopsy (control; n = 251). The following variables were compared between the two groups: age, family history of prostate cancer, prostate specific antigen, and altered digital rectal examination. Results: In the case group, ranging between 55-69 years old, there was a significant higher of altered digital rectal examination (p < 0.001, odds ratio 15.5 and positive predictive value 91.3%), prostate-specific antigen ≥ 4 ng/mL (p < 0.001, odds ratio 7.02 and positive predictive value 56.2%) and when both exams were altered (p < 0.001, odds ratio was 19.63 and the positive predictive value was 90.5%). Conclusion: This findings show that, mainly between 55-69 years old, there is a significant correlation between positive biopsy, altered digital rectal examination, and PSA ≥ 4 ng/mL (AU)


Objetivo: O câncer de próstata é o segundo mais incidente na população masculina no Brasil. O objetivo do estudo é analisar a frequência dos fatores de risco associados ao desenvolvimento do câncer de próstata e o impacto da realização de exames na faixa etária de rastreamento (55-69 anos), auxiliando os profissionais de saúde no manejo e prevenção da doença. Método: Foi realizado um estudo caso-controle no período de 2011 a 2016 em Criciúma ­ SC, Brasil. A amostra foi dividida em dois grupos, um com biópsia de adenocarcinoma de próstata (casos; n = 124) e outro com biópsia negativa (controles; n = 251). Entre ambos os grupos, foram comparadas as variáveis: idade, história familiar de câncer de próstata, antígeno prostático específico e toque retal alterado. Resultados:No grupo dos casos, na faixa etária entre 55-69 anos, ocorreu maior significância de toque retal alterado (p < 0,001; odds ratio 15.5 e valor preditivo positivo 91,3%), antígeno prostático específico ≥ 4 ng/mL (p < 0,001; odds ratio 7.02 e valor preditivo positivo 56,2%) e quando os dois exames estavam alterados (p < 0,001; odds ratio 19.63 e valor preditivo positivo 90,5%). Conclusão: Há evidências, principalmente entre 55-69 anos, de maior correlação de biópsia positiva, toque retal alterado e PSA ≥ 4 ng/mL (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias da Próstata , Fatores de Risco , Exame Retal Digital , Homólogo AlkB 3 da Dioxigenase Dependente de alfa-Cetoglutarato
20.
Pan Afr Med J ; 32: 15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31143320

RESUMO

There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria. A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of PCa and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations.


Assuntos
Exame Retal Digital/métodos , Sintomas do Trato Urinário Inferior/epidemiologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Neoplasias da Próstata/patologia
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