Níveis séricos de antígeno prostático específico em pacientes de um hospital de Goiânia ­ GO / Serum levels of prostatic specific antigen in patients at a hospital in Goiânia ­ GO

O antígeno prostático específico (PSA) é o marcador mais importante para a detecção e monitoramento do câncer de próstata. Objetivo: O estudo objetivou analisar os dados laboratoriais e epidemiológicos do antígeno prostático específico de pacientes atendidos no Laboratório Clínico do Hospital do Policial Militar de Goiânia-GO (LC/HPM), considerando as medidas preventivas em relação ao câncer de próstata. Trata-se de um estudo retrospectivo baseado na análise de 1.249 prontuários de usuários do LC/HPM. O levantamento de dados laboratoriais e epidemiológicos, como idade, resultados do PSA total e PSA livre foi realizado por meio de um formulário padronizado pelos pesquisadores. Foram analisados 1.249 exames de PSA L/T, dos quais 58 (4,6%) apresentaram PSA total com resultados entre 4,0 e 10,0 ng/mL e 16 (1,3%) apresentaram concomitantemente valores de PSA total entre 4,0 e 10,0 ng/mL e relação PSA L/T < 25%. Os pacientes apresentaram faixa etária entre 34 e 93 anos, sendo a média 60 anos. Tornou-se evidente que tanto no ano de 2018 quanto em 2019, realizou-se um número maior de exames de PSA L/T, em comparação ao ano de 2020. O estudo revelou que 16 (1,3%) pacientes apresentaram risco aumentado para o desenvolvimento de neoplasia prostática, sendo observada uma diminuição do número de indivíduos que procuraram o LC/HPM para realização de exames de PSA livre e total no ano de 2020, quando comparado aos anos de 2019 e 2018, possivelmente em razão da pandemia de Covid-19, uma tendência global

Prostate-specific antigen (PSA) is the most important marker for the detection and monitoring of prostate cancer. This study aimed to analyse the epidemiological and laboratory data of prostate-specific antigen of patients treated at the Clinical Laboratory of the Military Police Hospital at Goiânia-GO (CL/MPH), considering preventive measures in relation to prostate cancer. Methods: This is a retrospective study with analysis of 1,249 medical records of CL/MPH users. The collection of epidemiological and laboratory data, such as age, total PSA and free PSA results, was performed using a form standardized by the researchers. We analyzed 1,249 PSA T/F tests, and of these, of which 58 (4.6%) total PSA sink with results between 4.0 and 10.0 ng/mL and 16 (1.3%) were concomitantly presenting total PSA values between 4.0 and 10.0 ng/mL and PSA T/F < 25%. The patients were aged between 34 and 93 years, with a mean age of 59 years. It became evident that both in 2018 and in 2019, there were a greater number of PSA T/F exams, compared to 2020. This study revealed that 16 (1.3%) patients were at increased risk for the development of prostate cancer, with a decrease in the number of individuals who sought the CL/MPH for free and total PSA tests in 2020, compared to 2019 and 2018, possibly due to Covid-19 pandemic, a global trend

Óbito neonatal em maternidade pública de referência: fatores associados / Transition of elderly men with prostate cancer: analysis of facilitating and difficulty conditions / Transición de ancianos con cáncer de próstata: análisis de condiciones facilitadoras y de dificultad

Objetivo: compreender a experiência de transição de homens idosos na experiência com o câncer de próstata. Método: estudo descritivo de abordagem qualitativa realizado em quatro serviços da rede de atenção à saúde de uma cidade da Bahia, Brasil. Os dados foram coletados por meio de entrevista semiestruturada com oitenta homens idosos, as quais foram organizados e analisados com base na Técnica do Discurso do Sujeito Coletivo e interpretados à luz da Teoria das Transições. Resultados: são facilitadores a influência de familiares, amigos, outros homens, enfermeiros e demais profissionais; e dificultadores a escassez do conhecimento e recursos financeiros do indivíduo, barreiras geográficas, limitações relacionadas à estrutura e burocracia dos serviços. Considerações finais: ao construir sentidos para o câncer de próstata e admitir a vulnerabilidade, os homens confrontam suas crenças, alcançam a consciencialização que permite superar limitações e assumir o protagonismo do cuidado de si na transição da saúde/doença.

Objective: to understand the transition experience of elderly men with prostate cancer. Method: descriptive study with a qualitative approach carried out in four services of the health care network in a city in Bahia, Brazil. Data were collected through semi-structured interviews with eighty elderly men, which were organized and analyzed based on the Collective Subject Discourse Technique and interpreted in light of the Theory of Transitions. Results: the influence of family members, friends, other men, nurses and other professionals are facilitators; and complicating factors are the scarcity of knowledge and financial resources of the individual, geographic barriers, limitations related to the structure and bureaucracy of services. Final considerations: when constructing meanings for prostate cancer and admitting vulnerability, men confront their beliefs, reach the awareness that allows them to overcome limitations and assume the leading role of self-care in the health/disease transition.

Objetivo: comprender la experiencia de transición de ancianos con cáncer de próstata. Método: estudio descriptivo con abordaje cualitativo realizado en cuatro servicios de la red de atención a la salud de un municipio de Bahía, Brasil. Los datos fueron recolectados a través de entrevistas semiestructuradas con ochenta ancianos, que fueron organizadas y analizadas a partir de la Técnica del Discurso del Sujeto Colectivo e interpretadas a la luz de la Teoría de las Transiciones. Resultados: la influencia de familiares, amigos, otros hombres, enfermeras y otros profesionales son facilitadores; y los factores que complican son la escasez de conocimientos y recursos financieros del individuo, las barreras geográficas, las limitaciones relacionadas con la estructura y la burocracia de los servicios. Consideraciones finales: al construir significados para el cáncer de próstata y admitir la vulnerabilidad, los hombres confrontan sus creencias, alcanzan la conciencia que les permite superar las limitaciones y asumir el papel protagónico del autocuidado en la transición salud/enfermedad.

Prevalence and Demographic Characteristics of Prostate Cancer Patients in Colombia: data from the National Health Registry from 2015 to 2019 / Prevalencia y características demográficas de pacientes con cáncer de próstata en Colombia: datos del Registro de Salud Nacional de 2015 a 2019

Background and Objective Prostate cancer is a multifactorial disease and is among the top five causes of death in men worldwide. The Colombian Ministry of Health has adopted the Integrated Information System on Social Protection (Sistema Integrado de Información de la Protección Social, SISPRO, by its Spanish acronym) registry to collect comprehensive information from the Colombian health system. The system provides close to universal coverage (around 95%). We aimed to establish the prevalence of prostate cancer in Colombia and to describe its demographics, based on data provided by SISPRO, openly available for scientific analysis. Methods Using the SISPRO data from 2015 through 2019, we analyzed the prevalence and demographic characteristics of patients diagnosed with prostate cancer. Results We identified a total of 43,862 patients with prostate cancer in the 5-year period and estimated a prevalence of 4.54 cases per 1,000 habitants, using as denominator males over 35 years old. We calculated a prevalence of early-onset prostate cancer (i.e., 35­54 years) of 0.14 per 1,000 habitants (791 cases in 5 years). The highest prevalence was observed in patients>80 years (33.45 per 1,000 habitants). The departments with the highest prevalence were Bogotá, Valle del Cauca, Risaralda, and Boyacá, and the region with the lowest prevalence was Amazonas.

Antecedentes y Objetivo El cáncer de próstata es una enfermedad multifactorial, y se encuentra entre las cinco principales causas de muerte en hombres a nivel mundial. El Ministerio de Salud de Colombia ha adoptado el Sistema Integrado de Información de la Protección Social (SISPRO) para la recopilación de la información integral del sistema de salud colombiano. El sistema proporciona una cobertura casi universal (alrededor del 95%). El objetivo de este estudio fue establecer la prevalencia del cáncer de próstata en Colombia y describir su demografía, con base en los datos proporcionados por el SISPRO, disponibles de forma abierta para el análisis científico. Métodos Utilizando los datos del SISPRO de 2015 a 2019, se analizaron la prevalencia y las características demográficas de los pacientes diagnosticados con cáncer de próstata. Resultados Se identificó un total de 43,862 pacientes con cáncer de próstata en el período de 5 años, con una prevalencia de 4,54 casos por cada mil habitantes, utilizando como denominador hombres mayores de 35 años. La prevalencia de cáncer de próstata de inicio temprano (es decir, paciente de 35 a 54 años) fue de 0.14 por mil habitantes (791 casos en 5 años). La mayor prevalencia se observó en pacientes > 80 años (33,45 por mil habitantes). Los departamentos con mayor prevalencia fueron Bogotá, Valle del Cauca, Risaralda, y Boyacá. Y la región con menor prevalencia fue Amazonas. Conclusión Describimos la prevalencia y la demografía del cáncer de próstata y el cáncer de próstata de inicio temprano en Colombia utilizando la base de datos del sistema nacional de salud. Observamos una distribución desigual de la prevalencia entre las regiones, que puede estar relacionada con factores raciales, ambientales, o de acceso, que justifican más estudios.

Avaliação de fatores de risco e antígeno prostático específico no rastreamento de câncer de próstata / Evaluation of risk factors and prostate-specific antigen in prostate cancerscreening

Introdução: no Brasil, o câncer de maior incidência nos homens é o câncer de próstata (CaP), com 6,9% de mortalidade. Atualmente, discute-se a aplicabilidade do antígeno prostático específico (PSA) em políticas de rastreamento para CaP e os riscos associados ao sobrediagnóstico. Objetivo: correlacionar a dosagem do PSA com fatores de risco, história clínica e a presença de neoplasia prostática. Metodologia: estudo descritivo transversal que analisou, comparativamente, dados clínico-epidemiológicos e níveis séricos de PSA de 200 pacientes. Valores de PSA foram estratificados em três categorias (<2,5, 2,5­10,0 e >10 ng/ml). Resultados: os fatores de risco analisados foram relacionados significativamente com o aumento do PSA e neoplasia prostática. A prevalência de CaP (11%) e hiperplasia prostática (61%) foi observada nos pacientes com maior dosagem de PSA, enquanto 1% dos pacientes apresentou CaP sem alteração do PSA e 4% tiveram CaP com 2,5­10,0 ng/ml de PSA. Maiores níveis séricos do biomarcador foram relacionados a diabetes (70%), hipertensão (77%), uso crônico de medicações (60%) e ausência de exames periódicos (58%). O grupo com PSA >10 ng/ml teve média de idade maior que o primeiro (p = 0,002) e o segundo grupos (p = 0,027). Conclusão: a prevalência de hiperplasia prostática benigna associada à alteração do PSA, e o elevado risco de exames falso-positivos evidenciam a preocupação com o sobrediagnóstico. No contexto dos dados clinico-epidemiológicos avaliados, a possibilidade de resultados falso-positivos e falso-negativos associados à dosagem do PSA deve ser considerada, ressaltando a importância de adoção de exames complementares para rastreio do CaP.

Introduction: in Brazil, the cancer with the highest incidence in men is prostate cancer (PCa), with 6.9% mortality. Currently, the applicability of prostate specific antigen (PSA) in screening policies for PCa and the risks associated with overdiagnosis are discussed. Objective: to correlate the PSA level with risk factors, clinical history and the presence of prostatic neoplasm. Methods: a cross-sectional descriptive study that analyzed, comparatively, clinical-epidemiological data and serum PSA levels of 200 patients. PSA values were stratified into three categories (<2.5, 2.5­10.0 and> 10 ng / ml). Results: the risk factors analyzed were significantly related to the increase in PSA and prostatic neoplasm. The prevalence of PCa (11%) and prostatic hyperplasia (61%) was observed in patients with higher levels of PSA, while 1% of patients had PCa without PSA changes and 4% had PCa with 2.5­10.0 ng/ml PSA. Increased serum levels of the biomarker were related to diabetes (70%), hypertension (77%), chronic use of medications (60%) and periodic exams (58%). The group with PSA> 10 ng/ml had a mean age greater than the first (p = 0.002) and the second group (p = 0.027). Conclusion: the prevalence of benign prostatic hyperplasia associated with PSA change and an increased risk of false-positive tests show a concern with overdiagnosis. In the context of clinical-epidemiological data, the possibility of false-positive and false-negative results associated with the PSA measurement have to be considered, highlighting the importance of complementary tests for PCa screening.

Epidemiological profile of prostate cancer mortality and access to hospital care in Brazilian regions - an ecological study / Perfil epidemiológico do acesso à atenção hospitalar e mortalidade por câncer de próstata nas regiões Brasileiras - um estudo ecológico

INTRODUCTION: Due to the high incidence and mortality rates that cancer has, the World Health Organization (WHO) defines it as a public health problem and points out that there are approximately 10 million people affected by cancer, the estimate for the year 2020 will be 16 million of sick individuals.One of the most frequent neoplasms in the world, Prostate Cancer (CaP) (1.1 million), occupies 4th place, being behind only lung cancer (1.8 million), breast (1.7 million), and intestine (1.4 million). In the year 2012, approximately 1,112,000 new global cases of CaP were registered, with about 307,000 deathsOBJECTIVE: To analyze the epidemiological profile of mortality from prostate cancer and the access of patients to health among Brazilian regionsMETHODS: Ecological study based on secondary data from between the years 2000 and 2015. Mortality, hospitalization, and population were collected at the DATASUS. The variables were related to the epidemiological profile of CaP among Brazilian regions, stratified by the number of hospitalizations, of deaths, admission fee, mortality rate, and age group (40 to 79 years). The study looks at a time trend and gains access to health and mortality using regression modelsRESULTS: The northern showed a greater decrease in cases from 40-59 years (β: -1,800; -0.46). Southeast, with a small reduction only between 40 and 44 years old (β: -0.345 and p: 0.665). Northeast, South, and Center-West regions did not express a drop in the hospitalization rate, with the greatest growth between 65 and 69 years old (β: 7,862; 11,346; and p> 0.05). The Midwest had the greatest increase between 55 and 59 years (β: 3,660, p: 0.098), followed by 65 to 69 years (β: 3,491, p: 0.314). Mortality rates indicated a reduction in the Southeast (β: - 0.440) and South (β: -0.361CONCLUSION: This study found an association with various environmental and economic cultures in each Brazilian region, being an important resource for the development of health services and their access to the population

INTRODUÇÃO: Devido às altas taxas de incidência e mortalidade que o câncer apresenta, a Organização Mundial da Saúde (OMS) define-o como um problema de saúde pública e aponta que existem aproximadamente 10 milhões de pessoas afetadas pelo câncer, a estimativa para o ano de 2020 será 16 milhões de doentes. Uma das neoplasias mais frequentes do mundo, o Câncer de Próstata (CaP) (1,1 milhão) ocupa a 4ª colocação, ficando atrás apenas do câncer de pulmão (1,8 milhão), mama (1,7 milhão) e intestino (1,4 milhões). No ano de 2012, foram registrados aproximadamente 1.112.000 novos casos globais de CaP, com cerca de 307.000 óbitosOBJETIVO: Analisar o perfil epidemiológico da mortalidade por câncer de próstata e o acesso de pacientes à saúde entre as regiões brasileirasMÉTODO: Estudo ecológico baseado em dados secundários entre os anos de 2000 e 2015. A mortalidade, hospitalização e população foram coletadas no DATASUS. As variáveis foram relacionadas ao perfil epidemiológico, entre as regiões brasileiras, estratificadas pelo número de internações; de mortes; taxa de admissão; taxa de mortalidade e faixa etária (40 a 79 anos). O estudo analisa uma tendência temporal e obtém acesso à saúde e mortalidade usando modelos de regressãoRESULTADOS: O Norte apresentou uma queda maior nos casos de 40 a 59 anos (β: -1,800; -0,46). Sudeste, com pequena redução apenas entre 40 e 44 anos (β: -0,345 e p: 0,665). As regiões Nordeste, Sul e Centro-Oeste não apresentaram queda na taxa de internação, com maior crescimento entre 65 e 69 anos (β: 7.862; 11.346; e p> 0,05). O Centro-Oeste teve o maior aumento entre 55 e 59 anos (β: 3.660, p: 0,098), seguido de 65 a 69 anos (β: 3.491, p: 0,314). As taxas de mortalidade indicaram redução no Sudeste (β: - 0,440) e Sul (β: -0,361CONCLUSÃO: Este estudo encontrou associação com várias culturas ambientais e econômicas em cada região brasileira, sendo um recurso importante para o desenvolvimento de serviços de saúde e seu acesso à população

Prostate Cancer Screening in Brazil: a single center experience in the public health system

ABSTRACT Purpose: Incidence and mortality of prostate cancer (PCa) are still increasing in developing countries. Limited access to the health system or more aggressive disease are potential reasons for this. Ethnic and social differences in developed countries seem to make inappropriate to extrapolate data from other centers. We aim to report the epidemiological profile of a PSA-screened population from a cancer center in Brazil. Materials and Methods: We retrospectively selected 9.692 men enrolled in a PCa prevention program, comprising total PSA level and digital rectal examination at the first appointment, associated with complementary tests when necessary. Men aged over 40 years-old were included after shared decision-making process. Prostate biopsy (TRUS) was performed when clinically suspected for PCa. After the diagnosis, patients underwent appropriate treatment. Results: TRUS was performed in 5.5% of men and PCa incidence was 2.6%. Overall ratio between number of patients who needed to be screened in order to diagnose one cancer was 38.9 patients, with 2.1 biopsies performed to diagnose a cancer. Positive predictive value (PPV) of TRUS biopsy in this strategy was 47.2%, varying from 38.5% (<50 years-old) to 60% (>80 years-old). We evidenced 70 patients (27.9%) classified as low risk tumors, 74 (29.5%) as intermediate risk, and 107 (42.6%) as high-risk disease. Conclusions: PSA-screening remains controversial in literature. In front of a huge miscegenated people and considering the big proportion of high-risk PCa, even in young men diagnosed with the disease, it is imperative to inform patients and health providers about these data particularities in Brazil.

Meningeal Carcinomatosis for Prostate Adenocarcinoma Mimicking Chronic SubduralHematoma: Case Report and Literature Review

Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). Meningeal infiltration by neoplasms that did not originate in the CNS is a rare fact that is present in 0.02% of the autopsies. Epidemiologically, the radiological presentation mimicking a subdural hematoma is even more uncommon. We report a case of meningeal carcinomatosis by an adenocarcinoma of the prostate mimicking a chronic subdural hematoma. Case Report A 60-year-old male patient was diagnosed with prostate cancer in 2011. He underwent radical resection of the prostate, as well as adjuvant hormonal therapy and chemotherapy. Five years later, the patient presented peripheral facial paralysis that evolved with vomiting and mental confusion. Tomography and magnetic resonance imaging scans confirmed the subdural collection. At surgery, the dura was infiltrated by friable material of difficult hemostasis. The anatomicopathological examination showed atypical epithelial cells. The immunohistochemistry was positive for prostate-specific antigen (PSA) and other keymarkers, and it was conclusive for meningeal carcinomatosis by a prostate adenocarcinoma.

Cuidados continuos y estado de salud en el adulto mayor con cáncer de próstata / Continuous Cares and Health Status in the Elderly with Prostate Cancer

Introducción: El proceso de envejecimiento trae consigo cambios fisiológicos en las esferas orgánica y mental, que predisponen eventos fisiopatológicos, entre ellos el cáncer, entidad con repercusión significativa en el estado de salud del adulto mayor. Objetivo: Destacar la necesidad de los cuidados continuos para potenciar el estado de salud en el adulto mayor con cáncer de próstata. Métodos: Se confeccionó una comunicación breve a partir de un estudio preliminar con enfoque descriptivo de corte transversal, desde junio 2019 hasta febrero 2020, en el Hospital de Oncología María Curie, Camagüey, Cuba, donde se aplicó una encuesta sobre el nivel información de los cuidados continuos en oncología y los componentes de las teorías de Sor Callista Roy y Kristen M. Swanson en 16 enfermeros(as) participantes en el proyecto. Se ejecutó valoración del estado de salud, utilizando los instrumentos (Índice de Katz y escala de Lawton) en 34 adultos mayores con cáncer de próstata. Resultados: Fueron descritos niveles de información, mínimo aceptable e inaceptable en el personal encuestado. La valoración integral al adulto mayor con cáncer de próstata permitió conocer expresiones de dependencia a las actividades de la vida diaria e instrumentada. Conclusión: El estudio favoreció la preparación integral del personal de enfermería en la atención continuada del paciente oncológico. Además facilitó pautas que fortalecen la utilidad de la valoración integral para el proceso de los cuidados continuos del adulto mayor con cáncer de próstata, que permitan preservar conductas generadoras de salud biopsicosocial y potenciar su estado de salud(AU)

Introduction: The aging process brings about physiological changes, both organically and mentally, that may be the cause for pathophysiological events, including cancer, an entity with significant repercussions on the health status of the elderlies. Objective: To highlight the need for continuous care to enhance the health status of the elderlies with prostate cancer. Methods: A brief communication was made from a preliminary study with a descriptive cross-sectional approach, from June 2019 to February 2020, at María Curie Oncology Hospital, in Camagüey, Cuba, where a survey about the information level of continuous care in oncology and the components of the theories of Sister Callista Roy and Kristen M. Swanson was applied in sixteen nurses who participated in the project. Health status assessment was carried out, using the Katz index and Lawton scale in 34 older adults with prostate cancer. Results: Minimum ally acceptable and unacceptable levels of information were described in the surveyed personnel. The comprehensive assessment of the elderlies with prostate cancer allowed us to know expressions of dependence on the activities of daily and instrumented life. Conclusion: The study favored the comprehensive training of the nursing staff regarding ongoing care of cancer patients. In addition, it provided guidelines that strengthen the usefulness of comprehensive assessment for the process of continuous care of the elderlies with prostate cancer, so that these guidelines allow preserving behaviors that generate biopsychosocial health and enhance their health status(AU)

Influencia de la modalidad de respuesta, edad y nivel de educación en el cuestionario internacional de síntomas prostáticos (IPSS) / Influence of the response modality, age and level of education in the international prostate symptoms questionnaire (IPSS)

OBJETIVOS: evaluar la influencia de la modalidad de respuesta (paciente vs. asistido por urólogo) en el cuestionario IPSS (International Prostate Symptom Score) y su relación con la edad y nivel de educación. MATERIALES Y MÉTODOS: Análisis prospectivo de 74 pacientes que acudieron a la consulta de urología por síntomas de Hiperplasia Prostática Benigna (HPB) con o sin tratamiento para su patología y que no hayan completado anteriormente el cuestionario internacional de síntomas prostáticos (IPSS). Los cuestionarios fueron completados en la misma consulta urológica, primero por el paciente y luego con ayuda del urólogo. Se categorizó por edad y nivel de educación. Se evaluó la diferencia entre los puntajes de IPSS obtenidos con la forma autocompletada y con asistencia del urólogo y si esta diferencia estaba relacionada con la edad y con el nivel de educación. Los datos fueron analizados utilizando test no paramétrico para datos apareados de Wilcoxon. RESULTADOS: no se encontró diferencia estadísticamente significativa entre el cuestionario completado por el paciente y el asistido por el urólogo. La media del score total fue de 13,66, y 13,67, respectivamente (p: 0.86). Al analizar los subgrupos, con respecto a la edad y al nivel de educación, tampoco se encontraron diferencias estadísticamente significativas. CONCLUSIÓN: en nuestra población de estudio, el cuestionario IPSS no fue influenciado por la modalidad de administración, tampoco por la edad ni por el nivel de educación.

OBJECTIVES: to evaluate the influence of the response modality (patient vs. urologist-assisted) in the IPSS questionnaire (international prostate symptom score) and its relationship with age and education level. MATERIALS AND METHODS: Prospective analysis of 74 patients who came to the urology clinic for symptoms of Benign Prostatic Hyperplasia (BPH) with or without treatment for their pathology and who have not previously completed the international prostate symptoms questionnaire (IPSS). The questionnaires were completed in the same urological consultation, first by the patient and then with the help of the urologist. It was categorized by age and education level. The difference between the IPSS scores obtained with the self-completed form and with the assistance of the urologist and whether this difference was related to age and level of education was evaluated. The data were analyzed using non-parametric test for paired Wilcoxon data. RESULTS: no statistically significant difference was found between the questionnaire completed by the patient and the one assisted by the urologist. The average of the total score was 13.66, and 13.67, respectively (p: 0.86). When analyzing the subgroups, regarding age and level of education, no statistically significant differences were found. CONCLUSION: In our study population, the IPSS questionnaire was not influenced by the modality of administration, neither by age nor by level of education.

Investigação do tempo entre primeira consulta e diagnóstico e do tempo entre diagnóstico e início de tratamento e fatores associados em pacientes com câncer de pulmão, mama e próstata, atendidos em um hospital público de referência em Porto Alegre, de 2012-2016 / Investigation of the time between first consultation and diagnosis and of time between diagnosis and initiation of treatment and factors associated in patients with lung, breast and prostate, treated at a public referral hospital in Porto Alegre, from 2012-2016

Introdução: em 2018 o câncer causou 9 milhões de mortes, das quais 70% em países de baixa e média renda. As desigualdades sociais associadas ao câncer potencializam o atraso no acesso ao diagnóstico e início do tratamento e consequente aumento de letalidade. Objetivo: investigar o tempo entre a primeira consulta e o diagnóstico e o tempo entre o diagnóstico e o início do tratamento e possíveis fatores associados. Métodos: emprego de registros da base de dados hospitalar de um hospital de referência no Sul do Brasil, período 2012-2016. Os fatores associados incluíram variáveis sociodemográficas e clínicas. Os tempos investigados foram categorizados a partir de legislação específica. Comparações foram realizadas por meio do teste de homogeneidade de proporções baseado na estatística de qui- quadrado de Pearson. Os fatores associados aos tempos foram investigados por modelo de regressão de Poisson com variação robusta. Resultados: a amostra de casos estudados totaliza 2.606 pessoas, sendo 1.023 (39,3%) casos com câncer de mama, 983 (37,7%) câncer de pulmão e 600 (23%) câncer de próstata. Nos casos de câncer de pulmão há predomínio de pessoas com idade de 50 a 79 anos (86,8%), sexo masculino (57,6%), branca (88,9%), ensino fundamental completo (76,3%), estadiamento 4 (60,3%) e 45,1% evoluiu para o óbito. As pessoas com estadiamento 0 apresentaram o maior RR do tempo superior a 30 dias entre a primeira consulta e o diagnóstico (4,33 vezes maior do que para pacientes com estadiamento 4 - referência); o maior RR (1,76) do tempo superior a 60 dias entre o diagnóstico e o início do tratamento foi no grupo de estadiamento 2. Nos casos de câncer de mama há predomínio de pessoas com idade de 50 e 69 anos (50,8%), branca (92,8%), ensino fundamental completo (55,4%), estadiamento 2 (46,4%) e 6,6% evoluiu para o óbito. No desfecho tempo entre a primeira consulta e o diagnóstico acima de 30 dias os pacientes, quando comparados aos pacientes com estadiamento 4 (referência), o estadiamento 0 apresentou o maior RR ( 8,81); n o desfecho tempo entre o diagnóstico e o início de tratamento acima de 60 dias, pacientes com estadiamento 1 apresentaram o maior RR (2,46). Nos casos de câncer de próstata há predomínio de pessoas com idade de 60 a 69 anos (43,4%), branca (89,8%), ensino fundamental completo (76,5%), estadiamento classificação 2 (59,5%) e 5,8% evoluiu para o óbito. No desfecho de tempo entre a primeira consulta e o diagnóstico acima de 30 dias o estadiamento 1 apresentou o maior RR (1,50); no desfecho de tempo entre a primeira consulta e o diagnóstico acima de 60 dias, os pacientes com estadiamento 1 apresentaram o maior RR (2,45). Conclusão: o desfecho de tempo entre a primeira consulta e o diagnóstico acima de 30 dias, para os casos de câncer de pulmão, permaneceram no modelo como variáveis explicativas do desfecho a faixa etária (p = 0,05) e o estadiamento (p < 0,001); para o desfecho de tempo entre o diagnóstico e o início do tratamento acima de 60 dias, permaneceram variáveis explicativas do desfecho a faixa etária (p = 0,024) e o estadiamento (p = 0,03) e apresentaram-se com RR de proteção as faixas etárias de 20 a 49 anos (RR = 0,29, IC95% = 0,20 ­ 0,55) e 60 a 69 anos (RR = 0,53, IC95% = 0,31 ­ 0,90). Os respectivos riscos relativos brutos e ajustados para o desfecho tempo entre a primeira consulta e o diagnóstico acima de 30 dias, para os casos de câncer de mama ajustado por faixa etária, raça/cor e escolaridade, mostraram que o RR de estadiamento diminuiu a medida que a classificação aumentou; para o desfecho tempo entre o diagnóstico e o início de tratamento acima de 60 dias, permaneceram no modelo explicativo final as variáveis faixa etária (p = 0,003) e estadiamento (p = 0,003). O desfecho de tempo entre a primeira consulta e o diagnóstico acima de 30 dias, para os casos de câncer de próstata, o estadiamento ficou a variável explicativa do tempo entre a primeira consulta e o diagnóstico, com significância estatística para as classificações 1 e 2 quando comparadas à classificação 4; para o desfecho de tempo entre o diagnóstico e o início do tratamento acima de 60 dias, permaneceu no modelo explicativo somente a variável estadiamento.

Introdution: in 2018, cancer caused 9 million deaths, of which 70% in low- and middle-in- come countries. The social inequalities associated with cancer enhance the delay in access to diagnosis and initiation of treatment and the consequent increase in lethality. Objective: to investigate the time between the first consultation and diagnosis and the time between diagnosis and the start of treatment and possible associated factors. Methods: use of hos- pital database records from a reference hospital in southern Brazil, period 2012-2016. Asso- ciated factors included sociodemographic and clinical variables. The investigated times were categorized based on specific legislation. Comparisons were performed using the ho- mogeneity of proportions test based on Pearson's chi-square statistics. Factors associated with times were investigated using a Poisson regression model with robust variation. Re- sults: the sample of cases studied totals 2,606 people, with 1,023 (39.3%) cases with breast cancer, 983 (37.7%) lung cancer and 600 (23%) prostate cancer. In cases of lung cancer, there is a predominance of people aged 50 to 79 years (86.8%), male (57.6%), white (88.9%), complete elementary school (76.3%) , stage 4 (60.3%) and 45.1% progressed to death. People with stage 0 had the highest RR for the time greater than 30 days between the first consultation and diagnosis (4.33 times higher than for patients with stage 4 - reference); the highest RR (1.76) for the time greater than 60 days between diagnosis and the start of treatment was in the stage 2 group. In cases of breast cancer there is a predominance of people aged 50 and 69 years (50.8 %), white (92.8%), completed elementary school (55.4%), stage 2 (46.4%) and 6.6% progressed to death. In the outcome time between the first consultation and the diagnosis above 30 days, patients, when compared to patients with stage 4 (reference), stage 0 had the highest RR (8.81); in the outcome time between diagnosis and start of treatment above 60 days, patients with stage 1 had the highest RR (2.46). In cases of prostate cancer, there is a predominance of people aged 60 to 69 years (43.4%), white (89.8%), complete elementary education (76.5%), stage 2 classification (59.5%) and 5.8% progressed to death. In the outcome of time between the first consultation and diagnosis over 30 days, stage 1 had the highest RR (1.50); in the outcome of time between the first consultation and the diagnosis above 60 days, patients with stage 1 had the highest RR (2.45). Conclusion: The time outcome between the first consultation and the diagnosis above 30 days, for cases of lung cancer, remained in the model as explanatory variables of the outcome age (p = 0.05) and staging (p < 0.001); for the outcome of time between diagnosis and beginning of treatment above 60 days, the explanatory variables of the outcome were age (p = 0.024) and staging (p = 0.03) and presented with RR of protection as age groups from 20 to 49 years (RR = 0.29, 95%CI = 0.20 - 0.55) and 60 to 69 years (RR = 0.53, 95%CI = 0.31 - 0.90). The respective crude and adjusted relative risks for the outcome time between the first visit and the diagnosis above 30 days, for cases of breast cancer adjusted for age group, race/color and education, showed that the RR for staging decreased the measure. that the rating has increased; for the outcome time between diagnosis and start of treatment above 60 days, the variables age group (p = 0.003) and stage (p = 0.003) remained in the final explanatory model. The outcome of time between the first visit and diagnosis over 30 days, for cases of prostate cancer, staging was the explanatory variable of the time between the first visit and diagnosis, with statistical significance for classifications 1 and 2 when compared to classification 4; for the outcome of time between diagnosis and start of treatment above 60 days, only the staging variable remained in the explanatory model.

Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center

ABSTRACT Background Focal therapy (FT) for localized prostate cancer (PCa) treatment is raising interest. New technological mpMRI-US guided FT devices have never been compared with the previous generation of ultrasound-only guided devices. Materials and Methods We retrospectively analyzed prospectively recorded data of men undergoing FT for localized low- or intermediate-risk PCa with US- (Ablatherm®-2009 to 2014) or mpMRI-US (Focal One®-from 2014) guided HIFU. Follow-up visits and data were collected using internationally validated questionnaires at 1, 2, 3, 6 and 12 months. Results We included n=88 US-guided FT HIFU and n=52 mpMRI-US guided FT HIFU respectively. No major baseline differences were present except higher rates of Gleason 3+4 for the mpMRI-US group. No major differences were present in hospital stay (p=0.1), catheterization time (p=0.5) and complications (p=0.2) although these tended to be lower in the mpMRI-US group (6.8% versus 13.2% US FT group). At 3 months mpMRI-US guided HIFU had significantly lower urine leak (5.1% vs. 15.9%, p=0.04) and a lower drop in IIEF scores (2 vs. 4.2, p=0.07). Of those undergoing 12-months control biopsy in the mpMRI-US-guided HIFU group, 26% had residual cancer in the treated lobe. Conclusion HIFU FT guided by MRI-US fusion may allow improved functional outcomes and fewer complications compared to US- guided HIFU FT alone. Further analysis is needed to confirm benefits of mpMRI implementation at a longer follow-up and on a larger cohort of patients.

Prostate examination among adult and elderly subjects in southern Brazil: a cross-sectional population-based study

ABSTRACT 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.

Tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior / Recommended postsurgical urinary catheterization time to avoid complications in endourological surgeries of the lower urinary tract

RESUMEN Objetivo: determinar el tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior. Materiales y métodos: se realizó una revisión bibliográfica actualizada sobre el tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior. Resultados: Se encontró asociación entre un mayor tiempo de sondaje y la ocurrencia de posteriores complicaciones relacionadas cirugías endourológicas del tracto urinario inferior, siendo el período menor a 72h el óptimo para la permanencia de la sonda ve-sical postquirúrgica en este tipo de intervenciones. No se identificaron factores de riesgo asociados a la prolongación del tiempo de sondaje postquirúrgico. Recomendaciones: El tipo de abordaje endoscópico se ha convertido en la actualidad en el tratamiento estándar de oro para la mayoría de las patologías del tracto urinario inferior; sin embargo, se requiere realizar más estudios sobre las complicaciones y factores de riesgo relacionados al tiempo de sondaje postquirúrgico para evitar complicaciones en cirugías endourológicas del tracto urinario inferior

ABSTRACT Objective: to determine the recommended post-surgical probing time to avoid complications in endourological surgeries of the lower urinary tract. Materials and methods: an updated bibliographic review was carried out on the recommended post-surgical catheterization time to avoid complications in endou-rological surgeries of the lower urinary tract. Results: An association was found between a longer catheterization time and the occurrence of subsequent complications related to endourological surgeries of the lower urinary tract, with the period of less than 72h being the optimal period for the permanence of the postsurgical urinary catheter in this type of intervention. No risk factors associated with prolonged postoperative probing time were identified. Recom-mendations: The type of endoscopic approach has now become the gold standard treatment for most lower urinary tract pathologies; However, more studies are required on the complications and risk factors related to the time of postoperative catheterization to avoid complications in endourological surgeries of the lower urinary tract

Acute prostatitis after prostate biopsy under ciprofloxacin prophylaxis with or without ornidazole and pre-biopsy enema: analysis of 3. 479 prostate biopsy cases

ABSTRACT Objectives: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. Materials and Methods: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. Results: Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). Conclusions: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.

Bone scan positivity in non-metastatic, castrate-resistant prostate cancer: external validation study

ABSTRACT Introduction: Tables predicting the probability of a positive bone scan in men with non-metastatic, castrate-resistant prostate cancer have recently been reported. We performed an external validation study of these bone scan positivity tables. Materials and Methods: We performed a retrospective cohort study of patients seen at a tertiary care medical center (1996-2012) to select patients with non-metastatic, castrate-resistant prostate cancer. Abstracted data included demographic, anthropometric, and disease-specific data such as patient race, BMI, PSA kinetics, and primary treatment. Primary outcome was metastasis on bone scan. Multivariable logistic regression was performed using generalized estimating equations to adjust for repeated measures. Risk table performance was assessed using ROC curves. Results: We identified 6.509 patients with prostate cancer who had received hormonal therapy with a post-hormonal therapy PSA ≥2ng/mL, 363 of whom had non-metastatic, castrate-resistant prostate cancer. Of these, 187 patients (356 bone scans) had calculable PSA kinetics and ≥1 bone scan. Median follow-up after castrate-resistant prostate cancer diagnosis was 32 months (IQR: 19-48). There were 227 (64%) negative and 129 (36%) positive bone scans. On multivariable analysis, higher PSA at castrate-resistant prostate cancer (4.67 vs. 4.4ng/mL, OR=0.57, P=0.02), shorter time from castrate-resistant prostate cancer to scan (7.9 vs. 14.6 months, OR=0.97, P=0.006) and higher PSA at scan (OR=2.91, P <0.0001) were significantly predictive of bone scan positivity. The AUC of the previously published risk tables for predicting scan positivity was 0.72. Conclusion: Previously published risk tables predicted bone scan positivity in men with non-metastatic, castrate-resistant prostate cancer with reasonable accuracy.

Trends in prostate cancer mortality in the state of São Paulo, 2000 to 2015 / Tendências na mortalidade por câncer de próstata no estado de São Paulo, 2000 a 2015

ABSTRACT OBJECTIVE To estimate the magnitude and identify patterns of change in prostate cancer mortality in the state of São Paulo and in the 17 regional health care networks, according to age groups from 50 years onwards, in the period between 2000 to 2015. METHODS Age-adjusted mortality rates (per 100,000 men) were calculated by the direct method using the Segi world population as standard. Joinpoint regression was used to calculate the average annual percent change (AAPC), with a confidence interval of 95% (95%CI), by regional network and age group (50-59, 60-69, 70-79 and 80 years or more). RESULTS For the state of São Paulo, age-adjusted mortality rates were 15.2, 13.3 and 11.9 per 100,000 men, respectively, in the periods between 2000 to 2005, 2006 to 2010 and 2011 to 2015, with a significant decrease trend (AAPC = -2.10%; 95%CI -2.42 - -1.79) each year. Among the 17 networks, 11 presented significant mean annual reductions, ranging from -1.72% to -3.05%. From the age of 50 onwards, there was a sharper reduction in the groups from 50 to 59 (AAPC = -2.33%; 95%CI -3.04 - -1.62) and 60 to 69 years (AAPC = -2.84%; 95%CI - 3.25 - -2.43). CONCLUSION Although reductions in mortality are still slight, they indicate progress in prostate cancer control actions. Screening actions and changes in therapeutic behaviors in recent decades may be modifying incidence and survival, resulting in changes in the mortality profile. More detailed studies will be useful in understanding the factors that lead to the interregional variations found.

RESUMO OBJETIVO Estimar a magnitude e identificar padrões de mudança na mortalidade por câncer de próstata no estado de São Paulo e nas 17 redes regionais de atenção à saúde, segundo grupos etários a partir dos 50 anos, no período de 2000 a 2015. MÉTODOS As taxas de mortalidade ajustadas por idade (por 100 mil homens) foram calculadas pelo método direto usando a população mundial de Segi como padrão. A análise de regressão Joinpoint foi utilizada para calcular as variações percentuais anuais médias (AAPC), com intervalo de confiança de 95% (IC95%), por rede regional e grupo etário (50-59, 60-69, 70-79 e 80 anos ou mais). RESULTADOS Para o estado de São Paulo, as taxas ajustadas de mortalidade foram de 15,2, 13,3 e 11,9/100 mil homens, respectivamente, nos períodos de 2000 a 2005, 2006 a 2010 e 2011 a 2015, com tendência de decréscimo significativo (AAPC = -2,10%; IC95% -2,42 - -1,79) a cada ano. Das 17 redes, 11 apresentaram reduções médias anuais significativas, que variaram entre -1,72% e -3,05%. A partir dos 50 anos, verificou-se redução mais acentuada nos grupos de 50 a 59 (AAPC = -2,33%; IC95% -3,04 - -1,62) e 60 a 69 anos (AAPC = -2,84%; IC95% -3,25 - -2,43). CONCLUSÕES Embora as reduções na mortalidade ainda sejam discretas, indicam progresso nas ações de controle do câncer de próstata. Ações de rastreamento e mudanças nas condutas terapêuticas nas últimas décadas podem estar modificando a incidência e a sobrevida, resultando em mudanças no perfil de mortalidade. Estudos mais detalhados serão úteis na compreensão dos fatores que levam às variações inter-regionais encontradas.

The relation between the storage symptoms before and after transurethral resection of the prostate, analysis of the risk factors and the prevention of the symptoms with solifenacin

ABSTRACT Objective and Hypothesis We aimed to investigate the reasons of storage symptoms ( SS) after transurethral resection of the prostate (TURP). The hypothesis was that a positive correlation would be identified between preoperative and postoperative SS in patients with undergoing TURP and starting early solifenacin treatment in patients with high preoperative SS would be reasonable. In addition, we aimed to analyze multiple other risk factors for post-TURP SS. Materials and Methods A total of 160 patients undergoing TURP were prospectively evaluated and divided into two groups according to their OABS. Those with a score of ≥10 points were Group 1 (G1), and those with <10 points Group 2 (G2). In addition, patients in each group were randomly further divided into two subgroups: those who were started on 5 mg solifenacin succinate in the early postoperative period (G1/G2 A) and those who were not (G1/G2 B). In additions to SS Preop, perop and at the 3rd-month of postoperatively 14 variable were evaluated. The effects of these factors, surgery and the efficacy of an early medical treatment on the postoperative SS were investigated. LUTS were assessed by International Prostate Symptom Score (IPSS) and SS were assessed by sum of IPSS 2, 4 and 7 questionnaires (Storage, S- IPSS). Results Preoperative IPSS and S-IPSS were significantly higher in G1 (p<0.001); there was a significant improvement at IPSS, S-IPSS, QoL score, Qmax, and PVR for all groups after surgery. Only preoperative S-IPSS was found to have significant effect on postoperative SS (p<0.001). There was a significant difference between G1A and G1B but no significant difference between G2A and G2B in terms of SS at postoperatively. In addition to this, prostatic volume was found smaller than non-symptomatic patients in de novo SS patients. Conclusion TURP provides significant improvement in both storage and voiding symptoms. The predictive value of the preoperative S-IPSS on postop SS is significant. These results suggest that 5 mg solifenacin succinate treatment in the early postoperative period may be beneficial for patients with high preoperative SS and may not be beneficial in others. Small prostatic volume may bode ill for postoperative SS in the patients with de novo SS.

Perfil de força de preensão manual em pacientes idosos com câncer de próstata / Profile of hand grip strength in elderly patients with prostate cancer

Objetivo: analisar o perfil de Força de Preensão Manual em pacientes idosos com câncer de próstata, atendidos em instituição hospitalar filantrópica do Recife. Métodos: estudo transversal com análise de dados secundários, coletados no Ambulatório de Oncogeriatria do Instituto de Medicina Integral Professor Fernando Figueira, utilizando uma amostra por conveniência com uma amostragem de 72 idosos. A análise estatística foi realizada utilizando o programa estatístico STATA 12. O teste de Kolmogorov-Smirnov foi aplicado a variáveis numéricas para se determinar a normalidade da amostra. Em caso de não normalidade, foi utilizado o teste de Mann-Whitney. Adotou-se o nível de significância de 0,05%. Resultados: observou-se uma Força de Preensão Manual reduzida nos pacientes com estadiamento de uma doença mais avançada quando comparado a outros estágios mais localizados ou clinicamente melhores (estadiamento I: 27,78 vs. estadiamento IV: 27,20 no braço dominante (p=0, 340)/ estadiamento I: 27,33 vs. estadiamento IV: 24,13 no braço não dominante) sendo esse resultado melhor reproduzido na mão não dominante (p=0,090). Por meio da análise das comorbidades (hipertensão, diabetes, cardiomiopatia e osteoartrite) em relação à mão dominante e não dominante, não foram verificadas diferenças significativas na Força de Preensão Manual na presença ou ausência das comorbidades analisadas tanto na mão dominante quanto da não dominante (p=0,189 vs.p=0,437). Conclusões: o estudo trouxe subsídios relevantes sobre a importância da Força de Preensão Manual como um importante parâmetro geral para força e um indicativo de saúde, principalmente quando analisados em idosos com câncer, onde afeta significativamente sua função física e neuromuscular, incluindo atrofia muscular, diminuição da força muscular e diminuição do desempenho funcional em atividades diárias, comprometendo significativamente a qualidade de vida e seu prognóstico.

Aims: to analyze the profile of Handgrip Strength in elderly prostate cancer patients treated at a philanthropic hospital in Recife. Methods: cross-sectional study with analysis of secondary data collected at the Oncogeriatric Outpatient Clinic of the Professor Fernando Figueira Institute of Integral Medicine, using a convenience sample with a sample of 72 elderly. Statistical analysis was performed using the STATA 12 statistical program. The Kolmogorov-Smirnov test was applied to numerical variables to determine sample normality. In case of non-normality, the Mann-Whitney test was used. The significance level of 0.05% was adopted. Results: reduced Handgrip Strength was observed in patients with staging of a more advanced disease when compared to other more localized or clinically better stages(staging I: 27.78 vs. staging IV: 27.20 in the dominant arm (p = 0.349) / staging I: 27.33 vs. staging IV: 24.13 in the non-dominant arm), this result being better reproduced in the non-dominant hand(p=0,090). By analyzing the comorbidities (hypertension, diabetes, cardiomyopathy and osteoarthritis) in relation to the dominant and non-dominant hand, no significant differences were found in the Handgrip Strength in the presence or absence of the comorbidities analyzed in both the dominant and non-dominant hands (p=0,189 vs.p=0,437). Conclusions: The study provided relevant insights into the importance of Handgrip Strength as an important general parameter for muscle strength and a health code, especially when analyzed in older adults with cancer, where it significantly affects their physical and neuromuscular function, including muscle atrophy, decreased strength. muscle function and decreased functional performance in daily activities, significantly compromising quality of life and its prognosis.

Seminal citrate is superior to PSA for detecting clinically significant prostate cancer

ABSTRACT Purpose: To establish whether the citrate concentration in the seminal fluid ([CITRATE]) measured by means of high-resolution nuclear magnetic resonance spectroscopy (1HNMRS) is superior to the serum prostate-specific antigen (PSA) concentration in detecting of clinically significant prostate cancer (csPCa) in men with persistently elevated PSA. Materials and Methods: The group of patients consisted of 31 consecutively seen men with histological diagnosis of clinically localized csPCa. The control group consisted of 28 men under long-term follow-up (mean of 8.7 ± 3.0 years) for benign prostate hyperplasia (BPH), with persistently elevated PSA (above 4 ng/mL) and several prostate biopsies negative for cancer (mean of 2.7 ± 1.3 biopsies per control). Samples of blood and seminal fluid (by masturbation) for measurement of PSA and citrate concentration, respectively, were collected from patients and controls. Citrate concentration in the seminal fluid ([CITRATE]) was determined by means of 1HNMRS. The capacities of PSA and [CITRATE] to predict csPCa were compared by means of univariate analysis and receiver operating characteristic (ROC) curves. Results: Median [CITRATE] was significantly lower among patients with csPCa compared to controls (3.93 mM/l vs. 15.53 mM/l). There was no significant difference in mean PSA between patients and controls (9.42 ng/mL vs. 8.57 ng/mL). The accuracy of [CITRATE] for detecting csPCa was significantly superior compared to PSA (74.8% vs. 54.8%). Conclusion: Measurement of [CITRATE] by means of 1HNMRS is superior to PSA for early detection of csPCa in men with elevated PSA.

Conhecimento, comportamento e práticas em saúde do homem em relação ao câncer de próstata / Knowledge, behaviour and health practices of men concerning the prostate cancer / Conocimiento, comportamiento y práctica en salud del hombre en relación con cáncer de próstata

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