Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.057
Filtrar
1.
Nursing (Säo Paulo) ; 24(277): 5803-5818, jun.2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1253727

RESUMO

Objetivo: identificar os fatores associados à masculinidade no diagnóstico precoce do câncer de próstata. Método: trata-se de uma revisão narrativa realizada nas seguintes bases de dados: SCIELO, LILACS e PUBMED. Após a aplicação dos critérios de elegibilidade, a amostra do estudo foi composta por 14 artigos publicados entre 2000 e 2021. Resultados: os estudos abordam fortemente a influência dos aspectos socioeconômicos e culturais na busca preventiva dos homens pelo autocuidado. Os padrões estipulados pela sociedade dificultam a adesão masculina fazendo-os diminuir a procurar por serviços de saúde em relação às mulheres dificultando o diagnóstico precoce do câncer de próstata. O exame de toque retal encontra-se atrelado à transgressão de sua masculinidade repercutindo no medo de realizá-lo. Conclusão: concepções socioculturais acerca da masculinidade associam-se negativamente à saúde dos homens impondo dificuldades no diagnóstico precoce do câncer e, conseqüentemente, aumentando a mortalidade masculina.(AU)


Objective: to identify the factors associated with masculinity in the early diagnosis of prostate cancer. Method: this is a narrative review conducted in the following databases: SCIELO, LILACS and PUBMED. After applying the eligibility criteria, the study sample was composed of 14 articles published between 2000 and 2021. Results: the studies strongly address the influence of socioeconomic and cultural aspects on men's preventive search for self-care. The standards set by society hinder male adherence, making them less likely to seek health services than women, hindering the early diagnosis of prostate cancer. The rectal examination is linked to the transgression of their masculinity, resulting in the fear of performing it. Conclusion: sociocultural conceptions about masculinity are negatively associated with men's health, imposing difficulties in the early diagnosis of cancer and consequently increasing male mortality.(AU)


Objetivo: identificar los factores asociados a la masculinidad en el diagnóstico precoz del cáncer de próstata. Método: se trata de una revisión narrativa realizada en las siguientes bases de datos: SCIELO, LILACS y PUBMED. Tras aplicar los criterios de elegibilidad, la muestra del estudio estuvo compuesta por 14 artículos publicados entre 2000 y 2021. Resultados: los estudios abordan la influencia socioeconómica y cultural en la búsqueda preventiva del autocuidado por los hombres. Las normas estipuladas por la sociedad dificultan la adherencia masculina haciendo que reduzcan la búsqueda de servicios sanitarios en relación con las mujeres dificultando el diagnóstico precoz del cáncer de próstata. El tacto rectal está vinculado a la transgresión de su masculinidad, lo que provoca miedo a realizarlo. Conclusión: las concepciones socioculturales sobre la masculinidad se asocian negativamente con la salud del hombre imponiendo dificultades en el diagnóstico precoz del cáncer y, en consecuencia, aumentando la mortalidad masculina.(AU)


Assuntos
Humanos , Masculino , Neoplasias da Próstata , Detecção Precoce de Câncer , Masculinidade , Autocuidado , Exame Retal Digital , Saúde do Homem , Fatores Sociológicos
4.
Ann R Coll Surg Engl ; 103(2): e59-e64, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559550

RESUMO

Aggressive angiomyxoma is a rare mesenchymal tumour, primarily arising in the soft tissue of the pelvis and perineum in women of reproductive age. There is a paucity of evidence on optimal management because of the rarity of these tumours, but the consensus has been for surgical excision. We present the case of a 65-year-old woman who was admitted with left-sided buttock pain and initially diagnosed with a perianal abscess. She underwent examination under anaesthesia rectum with surgical excision of the lesion, subsequent histopathological and immunochemical analysis was suggestive of aggressive angiomyxoma. To complement our case report, we also present a literature review focusing on aggressive angiomyxoma in the ischioanal fossa (also known as the ischiorectal fossa) with only eight cases of primary aggressive angiomyxoma involving the ischioanal fossa documented to date. The primary aims of this case report and literature review are to familiarise clinicians with the clinical, histopathological and immunochemical features of these tumours, and to increase appreciation that despite the rarity of aggressive angiomyxoma, it might be considered in the differential diagnosis of ischioanal lesions.


Assuntos
Mixoma/diagnóstico , Períneo/patologia , Pós-Menopausa , Abscesso/diagnóstico , Idoso , Doenças do Ânus/diagnóstico , Erros de Diagnóstico , Exame Retal Digital , Feminino , Humanos , Imageamento por Ressonância Magnética , Mixoma/patologia , Mixoma/cirurgia , Neoplasia Residual , Períneo/diagnóstico por imagem , Períneo/cirurgia , Resultado do Tratamento
5.
Med Sci Monit ; 27: e929913, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33556045

RESUMO

BACKGROUND Two diagnostic models of prostate cancer (PCa) and clinically significant prostate cancer (CS-PCa) were established using clinical data of among patients whose prostate-specific antigen (PSA) levels are in the gray area (4.0-10.0 ng/ml). MATERIAL AND METHODS Data from 181 patients whose PSA levels were in the gray area were retrospectively analyzed, and the following data were collected: age, digital rectal examination, total PSA, PSA density (PSAD), free/total PSA (f/t PSA), transrectal ultrasound, multiparametric magnetic resonance imaging (mpMRI), and pathological reports. Patients were diagnosed with benign prostatic hyperplasia (BPH) and PCa by pathology reports, and PCa patients were separated into non-clinically significant PCa (NCS-PCa) and CS-PCa by Gleason score. Afterward, predictor models constructed by above parameters were researched to diagnose PCa and CS-PCa, respectively. RESULTS According to the analysis of included clinical data, there were 109 patients with BPH, 44 patients with NCS-PCa, and 28 patients with CS-PCa. Regression analysis showed PCa was correlated with f/t PSA, PSAD, and mpMRI (P<0.01), and CS-PCa was correlated with PSAD and mpMRI (P<0.01). The area under the receiver operating characteristic curves of 2 models for PCa (sensitivity=73.64%, specificity=64.23%) and for CS-PCa (sensitivity=71.41%, specificity=81.82%) were 0.79 and 0.87, respectively. CONCLUSIONS The prediction models had satisfactory diagnostic value for PCa and CS-PCa among patients with PSA in the gray area, and use of these models may help reduce overdiagnosis.


Assuntos
Calicreínas/sangue , Modelos Estatísticos , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/diagnóstico , Fatores Etários , Idoso , Biópsia/estatística & dados numéricos , Diagnóstico Diferencial , Exame Retal Digital/estatística & dados numéricos , Humanos , Masculino , Sobremedicalização/prevenção & controle , Imageamento por Ressonância Magnética Multiparamétrica/estatística & dados numéricos , Gradação de Tumores , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/sangue , Hiperplasia Prostática/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Curva ROC , Valores de Referência , Estudos Retrospectivos , Medição de Risco/métodos , Ultrassonografia/estatística & dados numéricos
6.
Cancer Radiother ; 25(3): 259-267, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33422417

RESUMO

PURPOSE: A proportion of 10 to 30% of patients treated by chemoradiotherapy followed by total mesorectal excision surgery for a locally advanced rectal cancer can achieve a complete pathological response. We aimed to identify predictive factors associated with complete pathological response or no response and to assess the impact of each response on survival rates. PATIENTS AND METHODS: Patients treated with long course chemoradiotherapy for locally advanced and/or node positive rectal cancer from 2010 to 2016 were retrospectively reviewed. Statistical analysis was carried out to determine predictors of tumor regression and treatment outcomes. RESULTS: Records were available on 70 patients. In the univariate analysis, clinical factors associated with complete tumor response were tumor mobility in digital rectal examination (P=0.047), a limited parietal invasion (P=0.001), clinically negative lymph node (P<0.001) and a circumferential extent greater than 50% (P=0.001). On the other hand, a T4 classification and an endoscopic tumor size greater than 6cm were associated with no response to treatment (P=0.049 and P=0.017 respectively). On multivariate analysis, T2 clinical classification and N0 statement before treatment were independent predictive factors of pathologic complete response (P<0.001 and P=0.001) and a delayed surgery after 12 weeks was associated with no response to treatment (P=0.001). CONCLUSION: The identification of predictive factors of histological response may help clinicians to predict the prognosis and to propose organ preservation for good responders.


Assuntos
Quimiorradioterapia Adjuvante , Terapia Neoadjuvante/métodos , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antimetabólitos Antineoplásicos/administração & dosagem , Capecitabina/administração & dosagem , Exame Retal Digital , Feminino , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/mortalidade , Reto/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Carga Tumoral
7.
Cancer Invest ; 39(2): 124-132, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33410359

RESUMO

BACKGROUND: Prostate cancer incidence and mortality in the United States in African Americans (AA) are higher than in Caucasians. Eastern Cuyahoga County in Ohio is majority AA and is considered an underserved population particularly vulnerable to healthcare disparities. There is a paucity of data about shared decision making among high-risk AA men with regard to prostate cancer screening. This study aims to examine shared versus informed decision making (SDM versus IDM) in a randomized, control trial among a large, high-risk AA population. METHODS: Patients were included in annual one-day outreach events, each held over 3 years (2017-2019), and were randomized at each event into IDM (control) and SDM (investigational) groups and then were offered screening via prostate specific antigen (PSA) and digital rectal exam (DRE). The primary endpoints were proportion of participants over 40 who did not demonstrate decisional conflict about prostate cancer screening measured by the SURE score, as well as change of knowledge score about prostate cancer screening. RESULTS: Overall, 175 patients were enrolled in the trial; 79 in the SDM arm and 96 in the IDM arm. The investigational (SDM) arm had 3/79 (3.9%) conflict versus 6/96 (6.4%) in the control (IDM) arm (p = 0.74). With regard to knowledge improvement, the SDM cohort demonstrated improvement following educational tools for 66/79 (81%) of participants versus 76/96 (79%) in the IDM cohort (p = 0.85). There was no difference in the proportion (63%) of participants in either group who found the information very helpful (using a Likert scale). CONCLUSIONS: Our education-based study showed no significant difference between SDM and IDM with regard to decisional conflict about prostate cancer screening. The study also demonstrated significant improvement in knowledge about prostate cancer screening in a high-risk AA population in both groups. Our results should be interpreted with caution due to several limitations; however, the study can serve as a benchmark for future studies in this very important topic.


Assuntos
Afro-Americanos/estatística & dados numéricos , Exame Retal Digital/métodos , Calicreínas/metabolismo , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/diagnóstico , Tomada de Decisões , Tomada de Decisão Compartilhada , Detecção Precoce de Câncer , Estudos de Viabilidade , Humanos , Masculino , Educação de Pacientes como Assunto , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/metabolismo , Sensibilidade e Especificidade , Estados Unidos/etnologia
8.
J Urol ; 205(3): 755-760, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33080149

RESUMO

PURPOSE: We investigated whether baseline acute or chronic prostate inflammation among men with initial negative biopsies for prostate cancer was associated with cancer grade in 2-year repeat biopsies. MATERIALS AND METHODS: Retrospective analyses were conducted of 889 men aged 50 to 75 years old with negative baseline prostate biopsy and 2-year repeat biopsy positive for prostate cancer in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study. Acute and chronic prostate inflammation and cancer grade were determined by central pathology during the REDUCE study. The association of inflammation in baseline and 2-year repeat biopsy and prostate cancer grade in 2-year repeat biopsy was evaluated with Student's t-test, chi-squared test and multivariable logistic regression. RESULTS: Chronic, acute inflammation and both were detected in 533 (60%), 12 (1%) and 85 (10%) baseline biopsies, respectively. Presence of acute and chronic inflammation were significantly associated with each other (p <0.001). Both types of inflammation were unrelated to race, body mass index, prostate specific antigen or digital rectal exam. At the 2-year biopsy, 621 (70%) tumors were low grade (Gleason scores 2-6) and 268 (30%) were high grade (Gleason scores 7-10). In univariable and multivariable analyses, men with baseline chronic inflammation had significantly fewer high grade tumors (univariable OR 0.64, 95% CI 0.47-0.87, p=0.004; multivariable OR=0.68, 95% CI0.50-0.93, p=0.016) than those without baseline chronic inflammation. Baseline acute inflammation was not associated with tumor grade (univariable OR 0.74, 95% CI 0.45-1.20, p=0.22; multivariable OR 0.78, 95% CI 0.48-1.29, p=0.34). CONCLUSIONS: Chronic inflammation in a negative biopsy was associated with lower prostate cancer grade among men with cancer on follow-up 2-year biopsy.


Assuntos
Neoplasias da Próstata/patologia , Prostatite/complicações , Idoso , Biomarcadores/sangue , Biópsia com Agulha de Grande Calibre , Exame Retal Digital , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Antígeno Prostático Específico/sangue , Estudos Retrospectivos
9.
J Urol ; 205(3): 732-739, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33080150

RESUMO

PURPOSE: The MyProstateScore test was validated for improved detection of clinically significant (grade group ≥2) prostate cancer relative to prostate specific antigen based risk calculators. We sought to validate an optimal MyProstateScore threshold for clinical use in ruling out grade group ≥2 cancer in men referred for biopsy. MATERIALS AND METHODS: Biopsy naïve men provided post-digital rectal examination urine prior to biopsy. MyProstateScore was calculated using the validated, locked multivariable model including only serum prostate specific antigen, urinary prostate cancer antigen 3 and urinary TMPRSS2:ERG. The MyProstateScore threshold approximating 95% sensitivity for grade group ≥2 cancer was identified in a training cohort, and performance was measured in 2 external validation cohorts. We assessed the 1) overall biopsy referral population and 2) population meeting guideline based testing criteria (ie, prostate specific antigen 3-10, or <3 with suspicious digital rectal examination). RESULTS: Validation cohorts were prospectively enrolled from academic (977 patients, median prostate specific antigen 4.5, IQR 3.1-6.0) and community (548, median prostate specific antigen 4.9, IQR 3.7-6.8) settings. In the overall validation population (1,525 patients), 338 men (22%) had grade group ≥2 cancer on biopsy. The MyProstateScore threshold of 10 provided 97% sensitivity and 98% negative predictive value for grade group ≥2 cancer. MyProstateScore testing would have prevented 387 unnecessary biopsies (33%), while missing only 10 grade group ≥2 cancers (3.0%). In 1,242 patients meeting guideline based criteria, MyProstateScore ≤10 provided 96% sensitivity and 97% negative predictive value, and would have prevented 32% of unnecessary biopsies, missing 3.7% of grade group ≥2 cancers. CONCLUSIONS: In a large, clinically pertinent biopsy referral population, MyProstateScore ≤10 provided exceptional sensitivity and negative predictive value for ruling out grade group ≥2 cancer. This straightforward secondary testing approach would reduce the use of more costly and invasive procedures after screening with prostate specific antigen.


Assuntos
Antígenos de Neoplasias/urina , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/urina , Serina Endopeptidases/urina , Idoso , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/urina , Biópsia , Exame Retal Digital , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Estudos Prospectivos , Neoplasias da Próstata/patologia , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco/métodos , Sensibilidade e Especificidade
10.
J Urol ; 205(3): 725-731, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33080153

RESUMO

PURPOSE: Prostate biopsy should be discussed with the patient in cases of negative magnetic resonance imaging and low clinical suspicion of prostate cancer.Our primary objective was to describe the risk of clinically significant prostate cancer in a negative magnetic resonance imaging biopsy naïve population at baseline and during long-term followup. The secondary objective was to evaluate clinical factors and prostate specific antigen as predictors of clinically significant prostate cancer at baseline. MATERIALS AND METHODS: All 503 consecutive patients who were biopsy naïve referred from 2007 to 2017 for biopsy with negative magnetic resonance imaging (PI-RADS™ 1-2) who had systematic 12-core biopsies at baseline were included. Clinical factors were digital rectal examination, prostate cancer family history and prostate specific antigen. In case of suspicious digital rectal examination or prostate specific antigen kinetics during followup, magnetic resonance imaging and biopsy were performed. Clinically significant prostate cancer was defined as either Gleason Grade 1 with cancer core length greater than 5 mm or 3 or more positive systematic 12-core biopsies in addition to Gleason Grade 2 or greater (clinically significant prostate cancer-1) or any Gleason Grade 2 or greater (clinically significant prostate cancer-2). Nonclinically significant prostate cancer was defined as either Gleason Grade 1 with cancer core length 5 mm or less and fewer than 3 positive systematic 12-core biopsies (nonclinically significant prostate cancer-1) or any Gleason Grade 1 (nonclinically significant prostate cancer-2). Definition of high risk clinically significant prostate cancer was Gleason Grade 3 or greater. Univariate and multivariate models were fitted to identify predictors of clinically significant prostate cancer risk. RESULTS: At baseline, biopsy showed clinically significant prostate cancer-1 in 9% (45), clinically significant prostate cancer-2 in 6% (29) and nonclinically significant prostate cancer in 22% (111). At median followup of 4 years (IQR 1.6-7.1), 31% (95% CI 27-36) of 415 untreated patients had a second magnetic resonance imaging and 24% (95% CI 20-28) a second biopsy that showed clinically significant prostate cancer-1 in 5% (21/415, 95% CI 3-7), clinically significant prostate cancer-2 in 2% (7/415, 95% CI 1-3) and nonclinically significant prostate cancer in 8%. Overall incidence was 13% (66/503, 95% CI 7-21) for clinically significant prostate cancer-1, 7% (36/503, 95% CI 5-9%) for clinically significant prostate cancer-2 and 2% (12/503, 95% CI 1.1-3.7) for high risk prostate cancer. Predictors of clinically significant prostate cancer risk were prostate specific antigen density 0.15 ng/ml/ml or greater (OR 2.43, 1.19-4.21), clinical stage T2a or greater (OR 3.32, 1.69-6.53) and prostate cancer family history (OR 2.38, 1.10-6.16). Performing biopsy in patients with negative magnetic resonance imaging and prostate specific antigen density 0.15 ng/ml/ml or greater or abnormal digital rectal examination or prostate cancer family history would have decreased from 9% to 2.4% the risk of missing clinically significant prostate cancer-1 at baseline while avoiding biopsy in 56% of cases. CONCLUSIONS: The risk of clinically significant prostate cancer in a negative magnetic resonance imaging biopsy naïve population was 6% to 9% at baseline and 7% to 13% at long-term followup depending on clinically significant prostate cancer definitions.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Biomarcadores Tumorais/sangue , Biópsia com Agulha de Grande Calibre , Exame Retal Digital , Predisposição Genética para Doença , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Ultrassonografia de Intervenção
11.
Med Clin North Am ; 105(1): 55-73, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246523

RESUMO

Primary care physicians frequently evaluate patients with constipation. The history is crucial in uncovering warning symptoms and signs that warrant colonoscopy. Particular elements in the history and rectal examination also can provide clues regarding the underlying etiology. Regardless of etiology, lifestyle modifications, fiber, and laxatives are first-line therapies. Patients who fail first-line therapies can be offered second-line treatments and/or referred for testing of defecatory function. In those with severely refractory symptoms, referrals to a gastroenterologist and a surgeon should be considered.


Assuntos
Constipação Intestinal/diagnóstico , Constipação Intestinal/tratamento farmacológico , Adulto , Colonoscopia , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Efeitos Psicossociais da Doença , Fibras na Dieta/uso terapêutico , Exame Retal Digital , Feminino , Humanos , Laxantes/uso terapêutico , Masculino , Manometria , Pessoa de Meia-Idade , Atenção Primária à Saúde , Qualidade de Vida , Fatores de Risco
12.
Theranostics ; 10(26): 11892-11907, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33204318

RESUMO

Background: There is an urgent need for the detection of aggressive prostate cancer. Glycoproteins play essential roles in cancer development, while urine is a noninvasive and easily obtainable biological fluid that contains secretory glycoproteins from the urogenital system. Therefore, here we aimed to identify urinary glycoproteins that are capable of differentiating aggressive from non-aggressive prostate cancer. Methods: Quantitative mass spectrometry data of glycopeptides from a discovery cohort comprised of 74 aggressive (Gleason score ≥8) and 68 non-aggressive (Gleason score = 6) prostate cancer urine specimens were acquired via a data independent acquisition approach. The glycopeptides showing distinct expression profiles in aggressive relative to non-aggressive prostate cancer were further evaluated for their performance in distinguishing the two groups either individually or in combination with others using repeated 5-fold cross validation with logistic regression to build predictive models. Predictive models showing good performance from the discovery cohort were further evaluated using a validation cohort. Results: Among the 20 candidate glycoproteins, urinary ACPP outperformed the other candidates. Urinary ACPP can also serve as an adjunct to serum PSA to further improve the discrimination power for aggressive prostate cancer (AUC= 0.82, 95% confidence interval 0.75 to 0.89). A three-signature panel including urinary ACPP, urinary CLU, and serum PSA displayed the ability to distinguish aggressive prostate cancer from non-aggressive prostate cancer with an AUC of 0.86 (95% confidence interval 0.8 to 0.92). Another three-signature panel containing urinary ACPP, urinary LOX, and serum PSA also demonstrated its ability in recognizing aggressive prostate cancer (AUC=0.82, 95% confidence interval 0.75 to 0.9). Moreover, consistent performance was observed from each panel when evaluated using a validation cohort. Conclusion: We have identified glycopeptides of urinary glycoproteins associated with aggressive prostate cancer using a quantitative mass spectrometry-based glycoproteomic approach and demonstrated their potential to serve as noninvasive urinary glycoprotein biomarkers worthy of further validation by a multi-center study.


Assuntos
Biomarcadores Tumorais/urina , Glicoproteínas/urina , Neoplasias da Próstata/diagnóstico , Adulto , Idoso , Biomarcadores Tumorais/sangue , Estudos de Coortes , Exame Retal Digital , Estudos de Viabilidade , Humanos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/urina , Curva ROC
13.
Sao Paulo Med J ; 138(6): 483-489, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146243

RESUMO

BACKGROUND: Population-wide screening for prostate cancer remains a controversial topic, given the need for an individualized approach to patients regarding the risks and benefits of prostate-specific antigen testing and digital rectal examination. OBJECTIVE: The aim of this study was to investigate the prevalence of, and factors associated with, prostate examination among men aged 45 or older. DESIGN AND SETTING: Cross-sectional population-based study developed in the city of Rio Grande (RS), Brazil. METHODS: The outcome of interest was a history of prostate examination (prostate-specific antigen testing or digital rectal examination). The following independent variables were analyzed: age group, skin color, marital status, schooling, economic level, leisure-time physical activity, smoking habits, excessive alcohol consumption, overweight, health insurance, visits to the doctor during the preceding year, hypertension and diabetes. After a two-stage sampling process, the final sample consisted of 281 male individuals. RESULTS: The prevalence of a history of prostate-specific antigen testing or digital rectal examination was 68.3% (95% confidence interval (CI): 62.2 to 74.5). The highest prevalence rates were observed among men aged 70 years or older (88%) and the lowest among smokers (36%). The following characteristics were found to be associated with the outcome: advanced age; marital status other than single; more schooling and higher economic status; practicing physical activity; non-smoking habits; overweight; having health insurance; and having visited a doctor during the preceding year. CONCLUSION: Approximately two thirds of the study population had been screened for prostate examination, mostly older individuals, with higher socioeconomic status and a healthier lifestyle.


Assuntos
Exame Retal Digital , Detecção Precoce de Câncer , Antígeno Prostático Específico , Idoso , Brasil , Cidades , Estudos Transversais , Exame Retal Digital/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Fatores Socioeconômicos
14.
BMC Gastroenterol ; 20(1): 338, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054847

RESUMO

BACKGROUND: A defecation disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. Three "low-cost" tools to evaluate DD-a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening. METHODS: This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET [standard and variable volume (VV)]. RESULTS: From 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. The sequential VVBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The sequential BET had an OR 8.942, p > 0.001, CI 3.18-25.14, revealing to be the most significant predictor for DD screening. CONCLUSION: The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.


Assuntos
Constipação Intestinal , Defecação , Constipação Intestinal/diagnóstico , Exame Retal Digital , Feminino , Humanos , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos
16.
Prostate ; 80(16): 1444-1449, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32970856

RESUMO

BACKGROUND: The early diagnosis of prostate cancer (PCa) is mainly based on prostate-specific antigen (PSA) blood levels and digital rectal examination. However, this approach may result in a high rate of negative biopsies and increased detection of clinically insignificant PCa (CS-PCa). An important prognostic biomarker, PSA density (PSA-D) demonstrated improved performance in PCa detection compared to PSA. The relationship between prostate volume and the prognostic accuracy of PSA-D remains mostly unclear. The aim of our study is to investigate the PSA-D predictive value of CS-PCa detection at different prostate volumes. METHODS: Using our local radical prostatectomy registry, patients were divided into three prostate size subgroups based on preoperative sonographic prostate volume assessment: less than 50, 50-75, and more than 75 cc. Patients' and PCa characteristics were recorded, including age, body mass index, PSA at diagnosis, prostate volume, PSA-D, D'Amico risk classification, Gleason grade group, and pathological staging following surgery. RESULTS: The study cohort included 364 patients who underwent Robotic Radical prostatectomy for biopsy-proven clinically localized PCa. 221 (61%) and 143 (39%) patients had PSA-D less than 0.15 and PSA-D more than 0.15, respectively. ISUP GG 1-2 PCa (CS-PCa) was observed in 220 patients (60%), while 144 (40%) had ISUP GG 3-5 PCa at final pathology. PSA-D correlated with CS-PCa only in small and medium-size prostates, but not in large glands (p = .03, p = .01, and p = .36, respectively). The highest sensitivity (72.7%) was observed in small prostates, compared to 3.2% in large prostates. The highest specificity (89.4%) was noted in large prostates. Positive predictive value in small and medium-size prostates was similar (~50%), compared to 20% in large glands. The negative predictive value was slightly better for small and medium-size prostates compared with large glands (68.9%, 73.7%, and 53.1%, respectively). An association between PSA-D and harboring CS-PCa was detected only in small and medium-size glands (72.7% and 43%, respectively). CONCLUSION: PSA-D is associated with CS-PCa detection in radical prostatectomy specimens in small and medium-size prostates. The level of PSA-D is directly associated with the ISUP PCa grade group. Therefore, PSA-D is a beneficial, available, and cost-effective tool during decision-making in patients with small and medium-size prostate when considering treatment for PCa.


Assuntos
Antígeno Prostático Específico/sangue , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Exame Retal Digital , Detecção Precoce de Câncer , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Tamanho do Órgão/fisiologia , Prognóstico , Prostatectomia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Sistema de Registros , Ultrassonografia
17.
J Med Internet Res ; 22(8): e18637, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32788146

RESUMO

BACKGROUND: Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients. OBJECTIVE: This paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers. METHODS: The system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system. RESULTS: The system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group. CONCLUSIONS: The proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal organs. The initial user study proved its applicability and usefulness.


Assuntos
Realidade Aumentada , Competência Clínica/normas , Exame Retal Digital/normas , Educação Médica/métodos , Humanos
18.
Dig Dis Sci ; 65(12): 3688-3695, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32666237

RESUMO

BACKGROUND: Outlet obstruction constipation accounts for about 30% of chronic constipation (CC) cases in a referral practice. AIMS: To assess the proportion of patients with CC diagnosed with descending perineum syndrome (DPS) by a single gastroenterologist and to compare clinical, radiological, and associated features in DPS compared to patients with constipation. METHODS: We conducted a review of records of 300 consecutive patients evaluated for constipation by a single gastroenterologist from 2007 to 2019, including medical, surgical, and obstetrics history, digital rectal examination, anorectal manometry, defecation proctography (available in 15/23 with DPS), treatment, and follow-up. DPS was defined as > 3 cm descent of anorectal junction on imaging or estimated perineal descent on rectal examination. Logistic regression with univariate and multivariate analysis compared factors associated with DPS to non-DPS patients. RESULTS: Twenty-three out of 300 (7.7%, all female) patients had DPS; these patients were older, had more births [including more vaginal deliveries (84.2% vs. 31.2% in non-DPS, p < 0.001)], more instrumental or traumatic vaginal deliveries, more hysterectomies, more rectoceles on proctography (86.7% vs. 28.6% non-DPS, p = 0.014), lower squeeze anal sphincter pressures (p < 0.001), and lower rectal sensation (p = 0.075) than non-DPS. On univariate logistic regression, history of vaginal delivery, hysterectomy, and Ehlers-Danlos syndrome increased the odds of developing DPS. Vaginal delivery was confirmed as a risk factor on multivariate analysis. CONCLUSIONS: DPS accounts for almost 10% of tertiary referral patients presenting with constipation. DPS is associated with age, female gender, and number of vaginal (especially traumatic) deliveries.


Assuntos
Constipação Intestinal , Complicações do Trabalho de Parto , Períneo , História Reprodutiva , Procedimentos Cirúrgicos Operatórios , Constipação Intestinal/diagnóstico , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Defecografia/estatística & dados numéricos , Exame Retal Digital/estatística & dados numéricos , Feminino , Gastroenterologia/métodos , Humanos , Masculino , Manometria/estatística & dados numéricos , Anamnese/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/fisiopatologia , Períneo/diagnóstico por imagem , Períneo/patologia , Períneo/fisiopatologia , Gravidez , Doenças Retais/complicações , Doenças Retais/diagnóstico , Doenças Retais/fisiopatologia , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
19.
Urologe A ; 59(10): 1237-1245, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32617622

RESUMO

BACKGROUND: Men die earlier than women in Germany. Men also have impaired access to cancer screening compared to women. OBJECTIVES: Our Movember campaign 2019 at University Hospital Frankfurt (UKF) aimed at improving health care awareness in the context of prostate cancer checkup. MATERIALS AND METHODS: In November 2019, every male employee of the UKF with a minimum age of 45 yrs (or 40 yrs with a first degree relative with prostate cancer) was offered a free prostate cancer checkup. This checkup contained digital rectal examination (DRE), transrectal ultrasound and PSA (prostata-specific antigen) testing. RESULTS: Overall, 121/840 employees (14.4%) participated in the Movember campaign. A first degree relative with prostate cancer was reported in overall by 14% of the participants (n = 17). At least one prior prostate cancer check up had 33%. A total of 2.5% (n = 3) had one prior negative prostate biopsy. Median age was 54 yrs (interquartile range 50-58). Median PSA level was 0.9 ng/ml and median free-PSA 0.3 ng/ml. A suspicious DRE was found in 5% (n = 6). After stratification according to age (≤ 50 yrs vs. > 50 yrs), participants over 50 yrs had a significantly higher PSA level (1.0 ng/ml vs. 0.7 ng/ml, p < 0.01) and had more frequently at least one prior prostate cancer checkup in the past (42.0 vs. 12.1%, p < 0.01). All suspicious DREs were in the cohort > 50 yrs. Overall, 32.2% (n = 39) had at least a suspicious checkup. A total of 3.3% (n = 4) had suspicious PSA levels. 17.4% (n = 21) of the participants had a suspicious PSA ratio (< 20%) only. During follow-up, 6 prostate biopsies were performed, with the detection of one case of intermediate-risk prostate cancer (Gleason 3 + 4, pT3a, pPn1, pNx, R0). CONCLUSION: Overall, 121 employees participated in our Movember Prostate cancer checkup campaign with measurement of the PSA level. Suspicious results were recorded in 32.2%. One employee was diagnosed and successfully treated with an intermediate-risk prostate cancer.


Assuntos
Detecção Precoce de Câncer , Neoplasias da Próstata , Exame Retal Digital , Alemanha , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...