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1.
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
2.
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
3.
Arq Gastroenterol ; 56(1): 79-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141075

RESUMO

BACKGROUND: Digital rectal examination (DRE) is part of the physical examination, is also essential for the colorectal surgeon evaluation. A good DRE offers precious information related to the patient's complaints, which will help in decision making. It is simple, quick and minimally invasive. In many centers around the world, the DRE is still the only method to evaluate the anal sphincter prior to patient's management. On the other hand, anorectal manometry (ARM) is the main method for objective functional evaluation of anal sphincter pressures. The discrepancy of DRE depending on the examiner to determine sphincter tonus in comparison to ARM motivated this study. OBJECTIVE: To compare the DRE performed by proficient and non-experienced examiners to sphincter pressure parameters obtained at ARM, depending on examiners expertise. METHODS: Thirty-six consecutive patients with complaints of fecal incontinence or chronic constipation, from the anorectal physiology clinic of the University of São Paulo School of Medicine, were prospectively included. Each patient underwent ARM and DRE performed by two senior colorectal surgeons and one junior colorectal surgeon prior to the ARM. Patient's history was blinded for the examiner's knowledge, also the impressions of each examiner were blinded from the others. For the DRE rest and squeeze pressures were classified by an objective scale (DRE scoring system) that was compared to the parameters of the ARM for the analysis. The results obtained at the ARM were compared to the DRE performed by the seniors and the junior colorectal surgeons. STATISTICAL ANALYSIS: Descriptive analysis was performed for all parameters. For the rest and squeeze pressures the Gamma index was used for the comparison between the DRE and ARM, which varied from 0 to 1. The closer to 1 the better was the agreement. RESULTS: The mean age was 48 years old and 55.5% of patients were female. The agreement of rest anal pressures between the ARM and the DRE performed by the senior proficient examiners was 0.7 (CI 95%; 0.32-1.0), while for the junior non-experienced examiner was 0.52 (CI 95%; 0.09-0.96). The agreement of squeeze pressures was 0.96 (CI 95%; 0.87-1.0) for the seniors and 0.52 (CI 95%; 0.16-0.89) for the junior examiner. CONCLUSION: More experienced colorectal surgeons used to DRE had a more significant agreement with the ARM, thereafter would have more appropriate therapeutic management to patients with sphincter functional problems. ARM, therefore, persists as an important exam to objectively evaluate the sphincter complex, justifying its utility in the clinical practice.


Assuntos
Canal Anal/fisiopatologia , Exame Retal Digital/métodos , Manometria/instrumentação , Adulto , Competência Clínica , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Incontinência Fecal/diagnóstico , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tono Muscular , Valor Preditivo dos Testes , Pressão , Estudos Prospectivos , Índice de Gravidade de Doença
4.
Arch Ital Urol Androl ; 91(1): 22-24, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932425

RESUMO

INTRODUCTION: The aim of this study was to report our experience in the management of hematospermia observed in 16 patients suffering from xanthogranulomatous prostatitis. METHODS: Recurrent episodes of hematospermia were the onset symptom in all patients, and in 25% of patients it was combined with fever. All patients reported PSA value elevation and the digital rectal examination (DRE) revealed an increase of the gland size and of its consistency in all cases. In all patients, the hematospermia was treated with the oral administration of two tablets of pollen extract in a single (1 g) dose daily for 30 days. RESULTS: Sixteen patients were observed between 2008 and 2016, referring hematospermia, progressive lower urinary tract symptoms (LUTS), and serum PSA level increase. To exclude the prostate cancer presence all patients were submitted to transperineal TRUS guided biopsy. In all the patients complete resolution of hematospermia was achieved treatment with pollen extract. All patients were subsequently treated for LUTS (alpha-adrenergic blockers), but none reported any significant improvement of symptoms. Basing on these pieces of evidence, after 90 days of alpha-blockers therapy, all patients underwent bipolar TURP. Histological examination of resected prostatic tissue revealed in all patients the diagnosis of xanthogranulomatous prostatitis. CONCLUSIONS: Patients with xanthogranulomatous prostatitis especially experience irritative symptoms, sometimes combined with fever or hematospermia. Hematospermia as the onset symptom has not been reported so far. The administration of the pollen extract for 30 days was associated with a complete resolution of hematospermia.


Assuntos
Hemospermia/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Pólen/química , Prostatite/terapia , Antagonistas Adrenérgicos alfa/administração & dosagem , Biópsia , Exame Retal Digital , Febre/etiologia , Hemospermia/diagnóstico , Hemospermia/etiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Antígeno Prostático Específico/sangue , Prostatite/complicações , Prostatite/diagnóstico , Ressecção Transuretral da Próstata/métodos
5.
In Vivo ; 33(3): 897-901, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31028214

RESUMO

BACKGROUND/AIM: The aim of the study was to determine the rate of clinically significant prostate cancer (csPCa) cases in men submitted to early second round mpMRI/TRUS (multiparametric magnetic resonance imaging/transrectal ultrasound) fusion biopsy (TPBx). MATERIALS AND METHODS: From January 2016 to December 2018, 256 men with a PI-RADS (Prostate Imaging-Reporting and Data System) score 3 (80 cases) or 4 (176 cases) and negative repeat transperineal saturation biopsy plus TPBx, underwent a new TPBx (four cores) for the persistent clinical suspicion of cancer. The accuracy of mpMRI ADC (apparent diffusion coefficient) values in the diagnosis of csPCa were evaluated. RESULTS: Overall detection rate of csPCa was equal to 10.1% (26/256 cases): 2.5% (2/80) versus 13.6% (24/176) had a PI-RADS score equal to 3 versus 4, respectively. The presence of csPCa was significantly correlated with an ADC value of 0.747×10-3 mm2/sec. CONCLUSION: A negative TBPx missed a csPCa in 13.6% of PI-RADS score 4 that was diagnosed by an early second round TBPx; the evaluation of ADC maps could select mpMRI lesions deserving a repeat TPBx.


Assuntos
Biópsia Guiada por Imagem , Neoplasias da Próstata/diagnóstico , Idoso , Biomarcadores Tumorais , Exame Retal Digital , Detecção Precoce de Câncer , Humanos , Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias da Próstata/metabolismo , Curva ROC
6.
Korean J Gastroenterol ; 73(2): 92-98, 2019 Feb 25.
Artigo em Coreano | MEDLINE | ID: mdl-30845385

RESUMO

Constipation is a common functional problem of the digestive system and may occur secondary to diet, drugs, endocrine diseases, metabolic diseases, neurological diseases, psychiatric disorders, or gastrointestinal obstruction. When there is no secondary cause, constipation is diagnosed as functional constipation. The first steps that should be taken to relieve symptoms are diet and lifestyle modifications, and if unsuccessful, laxative therapy should be initiated. If a patient does not respond to laxative therapy, diagnostic anorectal physiological tests are performed, though they are not routinely recommended. However, these tests may be considered earlier in patients strongly suspected to have a defecatory disorder. The revised guideline on the diagnosis and treatment of chronic constipation will undoubtedly aid the individualized management of chronic constipation in clinical practice.


Assuntos
Constipação Intestinal/patologia , Biorretroalimentação Psicológica , Doença Crônica , Constipação Intestinal/diagnóstico , Constipação Intestinal/tratamento farmacológico , Dieta , Exame Retal Digital , Humanos , Laxantes/uso terapêutico , Estilo de Vida , Agonistas do Receptor 5-HT4 de Serotonina/uso terapêutico
7.
Int Braz J Urol ; 45(2): 229-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30648826

RESUMO

PURPOSE: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ - confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. MATERIALS AND METHODS: Prostates were step - sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan - Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. RESULTS: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. CONCLUSIONS: Pathologic sub - staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.


Assuntos
Exame Retal Digital , Estadiamento de Neoplasias/normas , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Seguimentos , Humanos , Masculino , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias/métodos , Neoplasias/classificação , Prognóstico , Antígeno Prostático Específico , Neoplasias da Próstata/química , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
8.
Int Braz J Urol ; 45(2): 246-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30648827

RESUMO

OBJECTIVES: To evaluate the frequency of NIH category IV prostatitis, and the use of expressed prostatic secretions tests in an effort to improve the reliability of prostate specific antigen as an indicator, to avoid unnecessary prostate biopsy. MATERIALS AND METHODS: 178 expressed prostatic secretion positive patients with serum prostate specific antigen levels of ≥ 2.5 ng / mL were included in present prospective study. The diagnostic evaluation included detailed history and physical examination, digital rectal examination, urine analysis, urine culture, and expressed prostatic secretions tests. Transrectal ultrasonography was used both to measure prostate volume and conduct 12 core prostate biopsy. RESULTS: The prevalence of NIH category IV prostatitis was 36.9% (178 / 482) in our population of men. In our study patients (n: 178) prostate biopsy results were classified as; 66 prostatitis, 81 BPH, and 31 Pca. In asymptomatic prostatitis group, expressed prostatic secretion mean leucocyte ratio was higher compared to other two groups (p < 0.0001). The relation between number of expressed prostatic secretion leucocytes and prostatitis, benign prostate hyperplasia, and prostate cancer is analyzed. If 16 is taken as the cut of number for leucocyte presence, its sensitivity is 0.92 (AUC = 0.78 p = 0.01). CONCLUSIONS: The number of leucocytes in expressed prostatic secretion is higher in the chronic prostatitis group. If the leukocyte presence of 16 and above is taken as the cut off point, the sensitivity becomes 0.92 (AUC = 0.78). We firmly believe that our new cut off value may be used as to aid prostate specific antigen and derivates while giving biopsy decision.


Assuntos
Biópsia/normas , Antígeno Prostático Específico/sangue , Próstata/patologia , Hiperplasia Prostática/metabolismo , Neoplasias da Próstata/metabolismo , Prostatite/metabolismo , Idoso , Biomarcadores Tumorais/metabolismo , Doença Crônica , Diagnóstico Diferencial , Exame Retal Digital , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próstata/metabolismo , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/diagnóstico , Prostatite/classificação , Prostatite/patologia
9.
J Nippon Med Sch ; 85(4): 236-240, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30259894

RESUMO

A 73-year-old man presented with right lower back pain and dysuria. Right hydronephrosis and a large pelvic large mass were seen on computed tomography (CT). Although his prostate-specific antigen (PSA) was 0.5 ng/mL, an irregularly enlarged, stony, hard prostate was palpable on digital rectal examination. A prostate tumor was suspected, and a transrectal prostate biopsy and right transurethral ureteral stent placement were performed. Histological and immunohistochemical studies revealed diffuse large B-cell lymphoma. Positron emission tomography-computed tomography showed abnormal uptake in the stomach, cecum, right obturator lymph nodes, para-aortic lymph nodes, and dorsal left kidney. No abnormal findings were seen on bone marrow histology. Clinical stage IVA was confirmed according to Ann Arbor criteria. The patient achieved a complete response after 8 cycles of combination chemotherapy with rituximab, pirarubicin, cyclophosphamide, vincristine, and prednisolone.


Assuntos
Dor nas Costas/etiologia , Disuria/etiologia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/terapia , Linfoma/complicações , Linfoma/terapia , Neoplasias da Próstata/complicações , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/sangue , Exame Retal Digital , Humanos , Linfoma/diagnóstico , Linfoma/patologia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/patologia , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Zhonghua Nan Ke Xue ; 24(2): 142-146, 2018 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-30156074

RESUMO

Objective: The Prostate Cancer Prevention Trial risk calculator (PCPT-RC) is an online tool for assessing the risk of prostate cancer (PCa) based on age, race, serum PSA, biopsy history, family history, and other factors. This study aimed to investigate the value, sensitivity and specificity of the PCPT-RC 2.0 in assessing the risk of PCa in the Chinese high-risk population. METHODS: This study included 622 patients with the high risk of PCa characterized by high serum PSA (PSA >3 µg/L) or abnormality in digital rectal examination or imaging of the prostate. According to the results of prostate biopsy, we divided the patients into a PCa and a non-PCa group and used the PCPT-RC 2.0 for evaluation of all the cases followed by statistical analysis. RESULTS: PCa was detected in 264 (42.4%) of the 622 patients, including 126 cases of high-grade malignancy. Compared with the non-PCa group, the PCa patients showed a significantly older age (ï¼»68.40 ± 7.30ï¼½ vs ï¼»72.80 ± 7.20ï¼½ yr, P <0.001), higher serum PSA level (ï¼»11.20 ± 7.76ï¼½ vs ï¼»15.06 ± 10.65ï¼½, P <0.001), and higher PCPT risk score (ï¼»37.0 ± 10.8ï¼½% vs ï¼»44.4 ± 12.6ï¼½%, P <0.001). The PCPT risk score exhibited a greater area under the ROC curve than the level of serum PSA in evaluating the risk of PCa (0.67 vs 0.61, P <0.05), but no statistically significant difference between the two in predicting the risk of high-grade malignancy (0.67 vs 0.66, P >0.05). CONCLUSIONS: The PCPT risk score is valuable in predicting the risk of PCa in China, which may play a better role than the serum PSA level in screening PCa and avoid unnecessary prostate biopsy, though its advantage is not so obvious in identifying high-grade malignancy. A prediction tool needs to be established for evaluating the risk of PCa in the Chinese population.


Assuntos
Neoplasias da Próstata/prevenção & controle , Medição de Risco/métodos , Fatores Etários , Idoso , Grupo com Ancestrais do Continente Asiático , Biópsia , China , Grupos de Populações Continentais , Exame Retal Digital , Humanos , Masculino , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Curva ROC , Fatores de Risco
11.
Arq. bras. psicol. (Rio J. 2003) ; 70(2): 49-64, maio/ago. 2018.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-980011

RESUMO

Este trabalho buscou identificar as principais crenças de homens acerca do Exame do Toque Retal (ETR), comparando as respostas de homens que o fizeram (G1) e dos que ainda não o fizeram (G2). Utilizou-se um questionário sociodemográfico e clínico, além da técnica de evocação de palavras. No G1, as evocações relacionadas à suscetibilidade, gravidade e benefícios do exame foram mais enfatizadas. Já no G2, destacaram-se as crenças voltadas à suscetibilidade e aos benefícios de realizar o exame. Os dados encontrados sugerem que fazer o ETR pode reforçar alguns estereótipos em relação aos aspectos negativos do exame, porém não anula os aspectos positivos. Deve-se levar em consideração a relação paciente-profissional, bem como a condução do profissional durante a realização do ETR, já que barreiras podem estar sendo reforçadas nessa situação. Enfim, aponta-se para a necessidade de trabalhar a temática da busca pelo ETR não só com a população-alvo, mas também com os profissionais de saúde


This study aimed to identify the main male beliefs about the Digital Rectal Exam (DRE) comparing the responses of men who did the exam (G1) and those who did not (G2). We used a questionnaire containing sociodemographic and clinical variables, as well as free evocations. G1 showed evocations related to the susceptibility, severity, and beliefs associated with the benefits of the exam. Among G2, beliefs about susceptibility and benefits of screening were also highlighted. The results suggest that doing DRE may reinforce some stereotypes regarding negative aspects of the examination, but they do not cancel its positive aspects at all. It is necessary to take care of the patient-professional relationship and the professional's conduct during DRE, since barriers might be strengthened in that situation. Finally, we believe it is important to clarify the perception of searching for DRE not only with the target population, but also with health professionals


Este trabajo buscó identificar las principales creencias de hombres acerca del Examen del Toque Retal (ETR), comparando las respuestas de hombres que lo hicieron (G1) y de los que aún no lo hicieron (G2). Se utilizó un cuestionario sociodemográfico y clínico, además de la técnica de evocación de palabras. En el G1, las evocaciones relacionadas con la susceptibilidad, gravedad y beneficios del examen, fueron más enfatizadas. En el G2, se destacaron las creencias volcadas a la susceptibilidad y a los beneficios de realizar el examen. Los datos encontrados sugieren que hacer el ETR puede reforzar algunos estereotipos en relación a los aspectos negativos del examen, pero no anula los aspectos positivos. Se debe tener en cuenta la relación paciente-profesional, así como la conducción del profesional durante la realización del ETR, ya que las barreras pueden estar siendo reforzadas en esa situación. En fin, se apunta a la necesidad de trabajar la temática de la búsqueda por el ETR no solo con la población objetivo, sino también con los profesionales de salud


Assuntos
Humanos , Masculino , Neoplasias da Próstata/prevenção & controle , Exame Retal Digital
12.
Oncol. (Guayaquil) ; 28(2): 84-92, Ago. 30, 2018.
Artigo em Espanhol | LILACS | ID: biblio-1000153

RESUMO

Las alteraciones morfológicas de la próstata, por las que se realiza cribado son la hiperplasia prostática benigna (HPB) y el cáncer de próstata (CaP). La HPB es el tumor benigno más frecuente en varones mayores de 50 años, se caracteriza por el aumento del volumen de la glándula y usualmente acompañado de síntomas urinarios. El CaP es la segunda causa de muerte relacionada con cáncer en Estados Unidos y Europa en mayores de 70 años, su incidencia por debajo de los 50 es rara. El cribado o pruebas de detección, tiene como meta el hallar el cáncer antes de la aparición de síntomas, el cribado no se realiza en pacientes por sospechar que tienen cáncer, sino como un método de pesquisa. El objetivo de este artículo, es efectuar una revisión a los referentes teóricos, y proponer un nuevo algoritmo diagnóstico de alteraciones morfológicas de la próstata, basado en la evidencia.


Morphological alterations of the prostate, for which screening is performed include benign prostatic hyperplasia (BPH) and prostate cancer (PCa). BPH is the most common in men over 50 years benign tumor, is characterized by the increase in the volume of the gland and usually accompanied by urinary symptoms. PCa is the second leading cause of cancer-related death in the United States and Europe in over 70 years, the incidence below 50 is rare. Screening or testing, aims the finding cancer before the onset of symptoms, screening is not performed in patients with suspected cancer, but as a method of investigation. The purpose of this article is to review the theoretical framework and propose a new diagnostic algorithm of morphological alterations of the prostate, based on evidence.


Assuntos
Humanos , Hiperplasia Prostática , Neoplasias da Próstata , Antígeno Prostático Específico , Testes Obrigatórios , Exame Retal Digital
13.
Arch. esp. urol. (Ed. impr.) ; 71(6): 537-542, jul.-ago. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-178723

RESUMO

Objetivos: Primario: Evaluar el efecto del uso de simuladores en exploración prostática y sondaje vesical sobre la carga mental de trabajo soportada y la confianza adquirida en estudiantes de medicina. Secundario: Analizar el grado de satisfacción y habilidades adquiridas por parte de los estudiantes al usar simuladores como método docente. Métodos: Estudio prospectivo y aleatorizado sobre estudiantes de medicina. Hubo dos grupos de estudio: El grupo 1 (G1) recibió sólo explicación teórica y el grupo 2 (G2) explicación teórica + taller con simuladores. La valoración de la carga mental de trabajo se hizo a través del cuestionario validado NASA-TLX. El grado de confianza, de satisfacción y las habilidades adquiridas fueron también evaluadas. Resultados: Veintiocho estudiantes participaron en el taller de exploración prostática. Todos obtuvieron un mayor nivel de confianza tras la explicación teórica, siendo superior en el grupo que recibió también el taller con simuladores. En el taller de cateterismo vesical donde participaron 34 estudiantes todos aumentaron su confianza tras la actividad. El G2 mostró mejores puntuaciones en el examen de habilidades adquiridas que el G1. La mayoría consideró muy positiva la incorporación de simuladores en su aprendizaje. El uso de simuladores en ambos talleres produjo menos frustración según los resultados del NASA-TLX. Conclusiones: La formación de los alumnos mediante la implementación con simuladores podría lograr una mejora en el nivel de confianza, con un menor nivel de frustración al realizar estas exploraciones en el futuro y así una mejor calidad asistencial


Objectives: Primary: to assess the use of simulators in prostate digital rectal examination and bladder catheterization on mental workload and the level of confidence in medical students. Secondary: to analyze student satisfaction and skills acquired by students with simulators. Methods: We conducted a prospective, randomized study on medical students. Participants were divided into two groups: Group 1 (G1) (only the explanation) and group 2 (G2) (explanation + simulator workshop). For workload assessment, the validated NASA-TLX questionnaire was completed. The acceptability of the activity the degree of confidence and the skills acquired were also evaluated. Results: A total of 28 students participated in the practice of prostate examination. All participants reported a higher level of confidence after the theoretical explanation. 34 students participated in the bladder catheterization workshop and all of them increased their confidence after the activity. The G2 showed better scores on the acquired skills exam than the G1. Most students considered positive the incorporation of these models in their learning. According to the NASA-TLX results, less frustration is experienced with the use of simulators in both activities. Conclusion: The implementation of simulators in the training of students may improve their level of confidence, reducing frustration when performing these explorations in the future and improving care quality


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Exame Retal Digital , Treinamento por Simulação , Cateterismo Urinário , Urologia/educação , Carga de Trabalho , Competência Clínica , Satisfação no Emprego , Estudos Prospectivos
14.
Arch Esp Urol ; 71(6): 537-542, 2018 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-29991662

RESUMO

OBJECTIVES: Primary: to assess the use of simulators in prostate digital rectal examination and bladder catheterization on mental workload and the level of confidence in medical students. Secondary: to analyze student satisfaction and skills acquired by students with simulators. METHODS: We conducted a prospective, randomized study on medical students. Participants were divided into two groups: Group 1 (G1) (only the explanation) and group 2 (G2) (explanation + simulator workshop). For workload assessment, the validated NASA-TLX questionnaire was completed. The acceptability of the activity, the degree of confidence and the skills acquired were also evaluated. RESULTS: A total of 28 students participated in the practice of prostate examination. All participants reported a higher level of confidence after the theoretical explanation. 34 students participated in the bladder catheterization workshop and all of them increased their confidence after the activity. The G2 showed better scores on the acquired skills exam than the G1. Most students considered positive the incorporation of these models in their learning. According to the NASA-TLX results, less frustration is experienced with the use of simulators in both activities. CONCLUSIONS: The implementation of simulators in the training of students may improve their level of confidence, reducing frustration when performing these explorations in the future and improving care quality.


Assuntos
Exame Retal Digital , Treinamento por Simulação , Cateterismo Urinário , Urologia/educação , Carga de Trabalho , Competência Clínica , Feminino , Humanos , Satisfação no Emprego , Masculino , Estudos Prospectivos , Adulto Jovem
16.
Radiology ; 288(1): 158-163, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29664338

RESUMO

Purpose To assess the impact of clinical history on the maximum Prostate Imaging Recording and Data System (PI-RADS) version 2 (v2) score assigned to multiparametric magnetic resonance (MR) imaging of the prostate. Materials and Methods This retrospective cohort study included 120 consecutively selected multiparametric prostate MR imaging studies performed between November 1, 2016, and December 31, 2016. Sham clinical data in four domains (digital rectal examination, prostate-specific antigen level, plan for biopsy, prior prostate cancer history) were randomly assigned to each case by using a balanced orthogonal design. Six fellowship-trained abdominal radiologists independently reviewed the sham data, actual patient age, and each examination while they were blinded to interreader scoring, true clinical data, and histologic findings. Readers were told the constant sham histories were true, believed the study to be primarily investigating interrater agreement, and were asked to assign a maximum PI-RADS v2 score to each case. Linear regression was performed to assess the association between clinical variables and maximum PI-RADS v2 score designation. Intraclass correlation coefficients (ICCs) were obtained to compare interreader scoring. Results Clinical information had no significant effect on maximum PI-RADS v2 scoring for any of the six readers (P = .09-.99, 42 reader-variable pairs). Distributions of maximum PI-RADS v2 scores in the research context were similar to the distribution of the scores assigned clinically and had fair-to-excellent pairwise interrater agreement (ICC range: 0.53-0.76). Overall interrater agreement was good (ICC: 0.64; 95% confidence interval: 0.57, 0.71). Conclusion Clinical history does not appear to be a substantial bias in maximum PI-RADS v2 score assignment. This is potentially important for clinical nomograms that plan to incorporate PI-RADS v2 score and clinical data into their algorithms (ie, PI-RADS v2 scoring is not confounded by clinical data).


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Sistemas de Informação em Radiologia/estatística & dados numéricos , Idoso , Biópsia , Estudos de Coortes , Exame Retal Digital/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Estudos Retrospectivos
17.
J Coll Physicians Surg Pak ; 28(5): 409-411, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29690977

RESUMO

Prostate cancer (PCa) is one of the leading cancers in older males. The aim of this study was to evaluate the clinico-pathological characteristics of prostate cancer and rate of detection of prostate cancer by DRE (digital rectal exam) in patients presenting to a tertiary care private sector hospital in Islamabad, and determine the awareness about PCa in these patients. There were 226 patients who presented from December 2009 to December 2015 having mean age of 68.63 ±8.76 years and median Prostate Specific Antigen (PSA) value of 19.12 ng/mL (IQR=35.8). Median prostatic volume was 49 (IQR=22) gram/cc in the subjects. DRE was abnormal in 164 (72.56%) patients and normal in 62 (27.43%) patients only. Majority of patients presented relatively late, which may be due to lack of screening programme or public awareness.


Assuntos
Exame Retal Digital , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Idoso , Estudos Transversais , Hospitais Privados , Humanos , Masculino , Paquistão/epidemiologia , Setor Privado , Neoplasias da Próstata/sangue , Neoplasias da Próstata/epidemiologia , Reto , Centros de Atenção Terciária , Atenção Terciária à Saúde
18.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 37(2): 103-109, mar.-abr. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-171454

RESUMO

El cáncer de próstata (CaP) representa el tumor maligno más frecuente en los varones, pero según las directrices de la European Association of Urology (EAU) no deben realizarse cribados masivos para el diagnóstico de CaP debido a problemas relacionados con el sobrediagnóstico y sobretratamiento. El diagnóstico clínico precoz es posible, principalmente basado en el tacto rectal y la determinación del antígeno prostático específico (PSA). Sin embargo, el único test que puede determinar la presencia de un CaP es la biopsia guiada por ecografía, obteniendo múltiples muestras, la cual tiene un elevado valor pronóstico. En este contexto, la imagen diagnóstica juega un importante papel tal como lo confirmó la EAU, que en una actualización de 2016 de su guía clínica sobre CaP estableció la importancia de la tomografía por emisión de positrones (PET) con 11C- o 18F-colina combinada con la tomografía computarizada (TC) para individualizar la recidiva local, la afectación de ganglios linfáticos y la diseminación metastásica en todos los estadios. En consecuencia, en 2017, la European Association of Nuclear Medicine (EANM) junto con la Society of Nuclear Medicine and Molecular Imaging (SNMMI) compartieron nuevas directrices para la PET/TC con 68Ga-antígeno de membrana prostático específico (PSMA) para ayudar a los médicos en la recomendación, realización e interpretación de los estudios PET/TC en pacientes con CaP. De esta manera, el objetivo de este «artículo de evidencia» es definir el algoritmo diagnóstico actual en el CaP para incrementar el nivel de confianza global en el enfoque de un tema tan crucial (AU)


Prostate Cancer (PCa) represents the most common malignant tumor in men but according to the European Association of Urology (EAU) guidelines, a mass screening for PCa diagnosis should not be performed due to over-diagnosis and over-treatment related problems. An early clinical diagnosis is possible, mainly based on digital rectal examination and Prostatic Specific Agent (PSA) testing. However, the only mandatory test to define the presence of PCa is ultrasound guided-biopsy, obtained on multiple samples, which has also a high prognostic value. In this context, diagnostic imaging plays an important role as confirmed by EAU that in a 2016 update of their guidelines on PCa stated the importance of Positron Emission Tomography (PET) with 11C- or 18F-choline combined with computed tomography (CT) to identify local relapse, lymph node involvement and metastatic spread at all stages. Consequently, in 2017, the European Association of Nuclear Medicine (EANM) together with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published new guidelines for 68Ga-Prostate Specific Membrane Antigen (PSMA) PET/CT to help physicians in the recommendation, execution and interpretation of PET/CT scans in patients with PCa. Thus, the aim of this ‘evidence paper’ is to define the current diagnostic algorithm in PCa in order to increase the general level of confidence in approaching such a crucial topic (AU)


Assuntos
Humanos , Masculino , Neoplasias da Próstata/diagnóstico , Ensaio Radioligante/tendências , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Exame Retal Digital , Antígeno Prostático Específico/análise , Gadolínio/análise , Colina/análise , Fluordesoxiglucose F18/análise
19.
Ann Fam Med ; 16(2): 149-154, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29531107

RESUMO

PURPOSE: Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings. METHODS: We searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Six reviewers, in pairs, independently screened citations for eligibility and extracted data. Pooled estimates were calculated for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines to assess study risk of bias and quality. RESULTS: Our search yielded 8,217 studies, of which 7 studies with 9,241 patients were included after the screening process. All patients analyzed underwent both DRE and biopsy. Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36-0.67; I2 = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41-0.76; I2 = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31-0.52; I2 = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58-0.70; I2 = 95.0%). The quality of evidence as assessed with GRADE was very low. CONCLUSION: Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.


Assuntos
Exame Retal Digital/métodos , Detecção Precoce de Câncer/métodos , Neoplasias da Próstata/diagnóstico , Humanos , Masculino , Atenção Primária à Saúde/organização & administração
20.
Eur J Radiol ; 101: 17-23, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29571792

RESUMO

BACKGROUND: MRI plays a crucial role to identify men with a high likelihood of clinically significant prostate cancer who require immediate biopsy. The added value of DCE MRI in combination with T2-weighted imaging and DWI is controversial (risks related to gadolinium administration, duration of MR exam, financial burden, effects on diagnostic performance). A comparison of a biparametric and a standard multiparametric MR imaging protocol, taking into account the different experience of the readers, may help to choose the best MR approach regarding diagnostic performance. PURPOSE: To determine the added value of dynamic contrasted-enhanced imaging (DCE) over T2-weighted imaging (T2-WI) and diffusion weighted imaging (DWI) for the detection of clinically significant prostate cancer, and to evaluate how it affects the diagnostic performance of three readers with different grade of experience in prostate imaging. MATERIALS AND METHODS: Eighty-five patients underwent prostate MR examination at 1.5 T MR scanner performed because of elevated prostate-specific antigen level and/or suspicion of prostate cancer at digital rectal examination. Two MR images sets (Set 1 = biparametric, Set 2 = multiparametric) were retrospectively and independently scored by three radiologists with 7, 3 and 1 years of experience in prostate MR imaging respectively, according to PI-RADS v2. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated by dichotomizing reader scores. Receiver operating characteristic (ROC) analysis was performed and areas under the curve (AUCs) were calculated for each reader and image set. A comparison of ROC curves was performed to test the difference between the areas under the ROC curves among the three readers. RESULTS: There was no significant difference regarding the detection of clinically significant tumor among the three readers between the two image sets. The AUC for the bi-parametric and multi-parametric MR imaging protocol was respectively 0.68-0.72 (Reader 1), 0.72-0.70 (Reader 2) and 0.60-0.54 (Reader 3). ROC curve comparison revealed no statistically significant differences for each protocol among the most experienced (Reader 1) and the other readers (Readers 2-3). CONCLUSION: The diagnostic accuracy of a bi-parametric MR imaging protocol consisting of T2-weighted imaging and DWI is comparable with that of a standard multi-parametric imaging protocol for the detection of clinically significant prostate cancer. The experience of the reader does not significantly modify the diagnostic performance of both MR protocols.


Assuntos
Próstata/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Biópsia/métodos , Meios de Contraste , Imagem de Difusão por Ressonância Magnética/métodos , Exame Retal Digital/métodos , Métodos Epidemiológicos , Gadolínio , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem
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