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Introducción: El desarrollo de la tecnología con el ultrasonido transrectal ha permitido obtener imágenes diagnósticas de la glándula prostática; su interés deriva de la inmensa frecuencia de problemas clínicos, tanto benignos como malignos. El medio diagnóstico del cáncer de próstata se basa en una biopsia dirigida por ultrasonido transrectal en la mayoría de los casos. Objetivo: Determinar los hallazgos ultrasonográficos y su relación con estudios histopatológico en el diagnóstico de la neoplasia prostática, de los pacientes con sospecha, atendidos en la consulta de urooncología. Métodos: Se realizó un estudio descriptivo transversal en pacientes con sospecha clínica de cáncer prostático, procedentes del servicio de urología en el Hospital Celia Sánchez Manduley en el período comprendido entre julio de 2019 a julio de 2021; que acudieron a consulta con indicación de ultrasonido transrectal. El universo estuvo constituido por 105 pacientes. Se utilizaron criterios de inclusión y exclusión para la selección del universo, previo consentimiento informado de los pacientes. Las variables estudiadas fueron: edad, color de la piel, síntomas clínicos, hallazgos del ultrasonido transrectal, relación ecosonográfica- anatomopatológico. Resultados: Predominó el grupo de edad de 60 a 79 años, de la raza negra, con síntomas urinarios obstructivos bajos, con presencia del nódulo hipoecoico. Predominó la localización ultrasonográfica periférica, así como el adenocarcinoma prostático como hallazgos anatomopatológico encontrado a través de la biopsia. Conclusiones: Se demostró correlación ecográfica-histológica y anatomopatológica(AU)

Introduction: The development of transrectal ultrasound technology has made it possible to obtain diagnostic images of the prostate gland; its interest derives from the massive frequency of clinical problems, both benign and malignant. The diagnosis of prostate cancer is based on a transrectal ultrasound-guided biopsy in most cases. Objective: To determine the ultrasonographic findings and the how they relate with histopathological studies in the diagnosis of prostatic neoplasia in suspected patients treated in the uro-oncology clinic. Methods: A cross-sectional descriptive study was carried out in patients with clinical suspicion of prostate cancer, in the urology service at Celia Sánchez Manduley Hospital from July 2019 to July 2021; they attended the consultation with an indication for transrectal ultrasound. The universe consisted of 105 patients. Inclusion and exclusion criteria were used for the selection of the universe, with the prior informed consent of the patients. The variables studied were age, skin color, clinical symptoms, transrectal ultrasound findings, echosonographic-pathological relationship. Results: Predominance was observed of subjects from the age group of 60 to 79 years, black race, with lower obstructive urinary symptoms, and presence of hypoechoic nodule. Peripheral ultrasonographic location prevailed, as well as prostatic adenocarcinoma as pathological findings found through biopsy. Conclusions: Ultrasound-histological and pathological correlation was demonstrated(AU)

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RESUMEN Introducción. El cáncer de próstata puede detectarse por el tacto rectal. Objetivo. Explorar la percepción y disposición al tacto rectal. Métodos. Se realizó un estudio cualitativo. La unidad de análisis fue el paciente que viene a consulta externa. Se utilizó entrevista a profundidad. Resultados. La percepción del tacto rectal tuvo como categorías apriorísticas el machismo, la homosexualidad, vergüenza, dolor e impotencia sexual. Se tuvo como categoría emergente la predisposición al tacto rectal del servicio de urología, predisposición por el beneficio de realizar el tacto rectal y predisposición de los pacientes que ya se realizaron el tacto rectal. Conclusiones. La percepción tiene categorías emergentes como son la predisposición al tacto rectal en pacientes del servicio de urología, predisposición de los pacientes que tuvieron una consulta anterior. La disposición al tacto rectal es aceptada por los pacientes ya que es una indicación médica realizada por un profesional capacitado.

ABSTRACT Introduction. Prostate cancer can be detected by digital rectal examination. Objectives. To explore the perception and disposition to digital rectal examination. Methods. A qualitative study was carried out. The unit of analysis was the patient who comes to the service's outpatient consultation. An in-depth interview was used. Results. The perception of digital rectal examination has as a priori categories that are machismo, homosexuality, shame, pain and sexual impotence. The emerging category was predisposition to digital rectal examination in the urology service, predisposition due to the benefit of performing digital rectal examination, and predisposition of patients who had already undergone digital rectal examination. Conclusions. The perception has emerging categories such as the predisposition to digital rectal examination in patients of the urology service, predisposition of patients who had a previous consultation. The willingness to digital rectal examination is accepted by patients as it is a medical indication performed by a trained professional.

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Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.

El trauma de recto es poco frecuente, pero generalmente se asocia a lesiones de órganos adyacentes en la región pélvica y abdominal. Estudios recientes han cambiado los paradigmas del manejo tradicional derivados del trauma militar, mostrando mejores resultados en la morbilidad y mortalidad. Sin embargo, las técnicas de control de daños en el trauma rectal aún son controvertidas. El objetivo de este articulo es proponer el algoritmo de manejo del paciente con trauma rectal e inestabilidad hemodinámica, según los principios de la cirugía de control de daños. Se propone que las lesiones del recto en su porción intraperitoneal sean manejadas de la misma manera que las lesiones del colon. Mientras que el manejo de las lesiones extraperitoneales del recto dependerá del compromiso de la circunferencia rectal. Si es mayor del 25% se recomienda realizar una colostomía. Si es menor, se propone optar por el manejo conservador o el reparo primario. Saber que hacer o que no hacer en el trauma de recto marca la diferencia.

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

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

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

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Abstract Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.

Resumen El trauma de recto es poco frecuente, pero generalmente se asocia a lesiones de órganos adyacentes en la región pélvica y abdominal. Estudios recientes han cambiado los paradigmas del manejo tradicional derivados del trauma militar, mostrando mejores resultados en la morbilidad y mortalidad. Sin embargo, las técnicas de control de daños en el trauma rectal aún son controvertidas. El objetivo de este articulo es proponer el algoritmo de manejo del paciente con trauma rectal e inestabilidad hemodinámica, según los principios de la cirugía de control de daños. Se propone que las lesiones del recto en su porción intraperitoneal sean manejadas de la misma manera que las lesiones del colon. Mientras que el manejo de las lesiones extraperitoneales del recto dependerá del compromiso de la circunferencia rectal. Si es mayor del 25% se recomienda realizar una colostomía. Si es menor, se propone optar por el manejo conservador o el reparo primario. Saber que hacer o que no hacer en el trauma de recto marca la diferencia.

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AIM: This study aims to assess primary care physicians (PCPs) knowledge and skills regarding prostate cancer early detection (PCa-ED). MATERIALS AND METHODS: A survey about knowledge and skills of PCa-ED was delivered to PCP. Logistic regression analysis was conducted for the propensity of PCP to test prostatic specific antigen (PSA) on asymptomatic men. RESULTS: The survey was completed by 170 PCP. Score on risk factors knowledge was 51.5 ± 15.7% a better score was not associated with conducting PCa-ED (p = 0.674). The 40.6% answered having an institutional program on PCa-ED and 86% having access to PSA testing. Testing PSA on asymptomatic men was found in 40%. Moreover, 61.2% do not performed any digital rectal examination for PCa-ED, and this was not associated with preventing factors such as lack of space, time, and assistance (p > 0.05). Fewer years in practice and being a family medicine resident were associated with a less likelihood of testing PSA in asymptomatic men. The only associated factor in the multivariable model was having access to PSA testing (odds ratio: 3.36 confidence interval 95% 1.54-7.30) p = 0.002). CONCLUSIONS: A low rate of PCP performs PCa-ED and using concepts outside evidence-based recommendations. A national program on PCa-ED and continuing medical education for PCP are a promising strategy to improve PCa-ED.

OBJETIVO: Evaluar el conocimiento y las habilidades de los médicos de primer contacto en la detección oportuna del cáncer de próstata (DO-CaP). MÉTODO: Se aplicó una encuesta a médicos de primer contacto. Se realizó un análisis de regresión logística evaluando la propensión de los médicos a medir el antígeno prostático específico (APE) en sujetos asintomáticos. RESULTADOS: Contestaron 170 médicos y la calificación del conocimiento sobre factores de riesgo fue de 51.5 ± 15.7%, pero una mejor calificación no se asoció con realizar DO-CaP (p = 0.674). El 40.6% respondió contar con un programa institucional en DO-CaP y un 86% con acceso a la prueba de APE. El 40% medían el APE en sujetos asintomáticos. El 61.2% no ­realizaba ningún examen digital rectal para DO-CaP, y esto no se asoció con factores limitantes como falta de tiempo, espacio o asistencia (p > 0.05). Menos años en práctica y ser residente de medicina familiar disminuyeron la probabilidad de determinar el APE en asintomáticos. El único factor asociado en el análisis multivariado fue el acceso a la prueba de APE (odds ratio: 3.36; intervalo de confianza del 95%: 1.54-7.30; p = 0.002). CONCLUSIÓN: Una baja proporción de médicos de primer contacto realizan DO-CaP y utilizan conceptos alejados de la evidencia científica. Un programa nacional en DO-CaP y de educación continua para médicos de primer contacto es una estrategia prometedora para mejorar la DO-CaP.

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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.

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The aim of this study was to identify and analyze meanings attributed to practices related to prostate cancer prevention among men. A qualitative methodology was employed, with semi-structured interviews being conducted with 21 men in the city of Vitoria da Conquista, Bahia, between July and August of 2017. Data analysis was based on a dialectical hermeneutic approach. We found that practices related to prostate cancer prevention were based on scarce information and permeated by a sense of fear of the disease, which was thought of as a death sentence. Additionally, these feelings were compounded by the repercussions of rectal examination, perceived as a violation of one's masculinity. We were able to observe that practices devised to prevent prostate cancer reflect the repercussions of conceptions of masculinity regarding men's health care, where manliness and toughness can be susceptible by the touch.

El objetivo del estudio fue identificar y analizar los sentidos atribuidos por hombres a las prácticas relacionadas con la prevención del cáncer de próstata. Se realizó un estudio cualitativo, con entrevistas semiestructuradas, en el que participaron 21 hombres del municipio de Vitória da Conquista, Bahía. El período de recopilación de información fue entre julio y agosto de 2017. El análisis de los datos se basó en los principios de la hermenéutica-dialéctica. Se percibió que las prácticas relacionadas con la prevención del cáncer de próstata se elaboran con escasa información y permeadas por sentidos que remiten al miedo a la enfermedad, asumida como una sentencia a la vida, y a las repercusiones del tacto rectal, asimilado como una violación de la condición masculina. Se constató que las prácticas elaboradas para prevenir el cáncer de próstata reflejan las implicancias de la masculinidad en el cuidado de la salud de los hombres y, sobre todo, que la dureza masculina puede sentirse interpelada a partir de un tacto.

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RESUMEN El objetivo del estudio fue identificar y analizar los sentidos atribuidos por hombres a las prácticas relacionadas con la prevención del cáncer de próstata. Se realizó un estudio cualitativo, con entrevistas semiestructuradas, en el que participaron 21 hombres del municipio de Vitória da Conquista, Bahía. El período de recopilación de información fue entre julio y agosto de 2017. El análisis de los datos se basó en los principios de la hermenéutica-dialéctica. Se percibió que las prácticas relacionadas con la prevención del cáncer de próstata se elaboran con escasa información y permeadas por sentidos que remiten al miedo a la enfermedad, asumida como una sentencia a la vida, y a las repercusiones del tacto rectal, asimilado como una violación de la condición masculina. Se constató que las prácticas elaboradas para prevenir el cáncer de próstata reflejan las implicancias de la masculinidad en el cuidado de la salud de los hombres y, sobre todo, que la dureza masculina puede sentirse interpelada a partir de un tacto.

ABSTRACT The aim of this study was to identify and analyze meanings attributed to practices related to prostate cancer prevention among men. A qualitative methodology was employed, with semi-structured interviews being conducted with 21 men in the city of Vitoria da Conquista, Bahia, between July and August of 2017. Data analysis was based on a dialectical hermeneutic approach. We found that practices related to prostate cancer prevention were based on scarce information and permeated by a sense of fear of the disease, which was thought of as a death sentence. Additionally, these feelings were compounded by the repercussions of rectal examination, perceived as a violation of one's masculinity. We were able to observe that practices devised to prevent prostate cancer reflect the repercussions of conceptions of masculinity regarding men's health care, where manliness and toughness can be susceptible by the touch.

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

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Resumen La próstata es un órgano fibromuscular y glandular, produce una secreción líquida que forma parte del semen, contiene sustancias que proporcionan nutrientes y un medio adecuado para la supervivencia de los espermatozoides. Su patología es uno de los motivos de consulta más frecuentes en medicina familiar y urología; por ello, es importante reconocer los principales datos clínicos que ayuden a realizar diagnósticos diferenciales entre hiperplasia prostática, cáncer de próstata y prostatitis. La hiperplasia prostática (HP) es la proliferación no maligna de las células epiteliales y del estroma de la glándula prostática, relacionada con el proceso de envejecimiento del hombre. La prevalencia de HP aumenta con la edad, el 50% de los hombres de 51 a 60 años la padece. El mecanismo por el cual la HP puede producir una obstrucción vesical, comprende 2 componentes: uno estático y otro dinámico. Existen síntomas obstructivos e irritativos del tracto urinario inferior que afectan la calidad de vida del paciente, al interferir con sus actividades diarias y patrones de sueño. La anamnesis permite precisar y evaluar la magnitud de estos síntomas, constituyendo así una etapa fundamental del diagnóstico, de ahí la utilidad de utilizar el International Prostate Symptom Score (IPSS). El tacto rectal proporciona datos principales como volumen y consistencia. Los bloqueadores α-adrenérgicos y los inhibidores de la 5α-reductasa son las 2 clases de fármacos utilizados. La prostatitis bacteriana aguda se asocia a infección del aparato urinario inferior. La clasificación de los pacientes con prostatitis depende del estudio bacteriológico de la vía urinaria inferior; los síndromes de prostatitis se pueden clasificar en 5 grupos principales: prostatitis bacteriana aguda, prostatitis bacteriana crónica, síndrome de prostatitis crónica (PC)/síndrome doloroso pélvico crónico (SDPC), prostatitis inflamatoria asintomática y prostatitis granulomatosa. Representa el diagnóstico urológico más frecuente en varones jóvenes. La prevalencia es del 2-16% y representa el 8% de las consultas urológicas. El cáncer de próstata (CP) es el tumor maligno más frecuente en hombres a partir de los 50 años, y su pico máximo es después de los 65 años. Su incidencia ha aumentado en los últimos años debido en parte a la mejora en las técnicas diagnósticas, el aumento de la esperanza de vida y otros factores no tan conocidos como la exposición ambiental, dieta, estilo de vida y genética. La American Cancer Society recomienda la realización de APE con o sin examen digital rectal, comenzando a los 50 años. La American Urology Association recomienda realizarlo a partir de los 40 años y se sugiere realizar biopsia en pacientes con APE igual o superior a 4 ng/mL. La selección del tratamiento depende de la estadificación tumoral y categoría de riesgo, edad del paciente, esperanza de vida, presencia o ausencia de síntomas y efecto de las opciones de tratamiento sobre la calidad de vida.

Abstract The prostate is a fibromuscular and glandular organ that produces a liquid secretion that is part of the semen, it contains substances that provide nutrients and an adequate medium for the survival of the sperm. This pathology is one of the most frequent reasons for consultation in family medicine and urology, so it is important to recognize the main clinical data to be able to make differential diagnoses between prostatic hyperplasia, prostate cancer and prostatitis. Prostatic hyperplasia (HP) is the non-malignant proliferation of epithelial cells and the stroma of the prostate gland related to the aging process of men. The prevalence of HP increases with age; 50% of men aged between 51 and 60 have it. The mechanism by which HP can produce a bladder obstruction comprises two components: a static and a dynamic one. There are obstructive and irritative symptoms of the lower urinary tract that affect the quality of life of the patient, interfering with their daily activities and sleep patterns. The anamnesis allows the clinicians to determine and evaluate the magnitude of these symptoms, constituting a fundamental stage of the diagnosis, hence the usefulness of using the IPSS (International Prostate Symptom Score). The rectal examination provides major data such as volume and consistency. α-Adrenergic blockers and 5α-reductase inhibitors are the two types of drugs used. Prostate cancer (PC) is the most frequent malignant tumor in men of 50 years old and its maximum peak is after 65 years. Its incidence has increased in recent years due, in part, to the improvement in diagnostic techniques, the increase in life expectancy and other factors not so well known as environ mental exposure, diet, lifestyle and genetics. The American Cancer Society recommends an APE with or without a digital rectal exam starting at the age 50. The American Urology Association recommends it starting at the age of 40 and a biopsy in patients with PSA equal to or greater than 4 ng / ml is also suggested. The selection of the treatment depends on the tumor staging and category of the risk, the age of the patient, life expectancy, presence or absence of symptoms and the effects of the treatment options on the quality of life. Acute bacterial prostatitis is associated with lower urinary tract infection. The classification of patients with prostatitis depends on the bacteriological study of the lower urinary tract; prostatitis syndromes can be classified into four main groups: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS), asymptomatic inflammatory prostatitis and granulomatous prostatitis. It represents the most frequent urological diagnosis in young males. The prevalence is 2-16% and represents 8% of urological consultations.

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

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

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ABSTRACT 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.

RESUMO CONTEXTO: Exame anorretal digital (EAD) faz parte do exame físico, também é essencial para a avaliação do cirurgião colorretal. Um bom EAD oferece informações preciosas relacionadas às queixas do paciente, que auxiliam na tomada de decisões. Sua realização é simples, rápida e minimamente invasiva. Em diversos centros ao redor do mundo, o toque retal ainda é o único método para avaliar o esfíncter anal antes do tratamento. Por outro lado, a manometria anorretal (MAR) é o principal método para avaliação funcional objetiva das pressões esfincterianas. A discrepância entre o EAD, dependendo do examinador para determinar o tônus esfincteriano em comparação à MAR motivou este estudo. OBJETIVO: Comparar o EAD com os parâmetros de pressão esfincteriana obtidos na MAR, dependendo da experiência dos examinadores. MÉTODOS: Trinta e seis pacientes consecutivos com queixas de incontinência fecal ou constipação crônica, do ambulatório de Fisiologia Anorretal da Faculdade de Medicina da Universidade de São Paulo, foram prospectivamente incluídos. Cada paciente foi submetido a MAR e EAD realizados por dois cirurgiões colorretais seniores e um júnior antes da MAR. A história dos pacientes propositalmente omitida dos examinadores, e os resultados de cada examinador foram cegos dos demais. Para o EAD, as pressões de repouso e contração foram classificadas por uma escala objetiva (EAD Scoring System), realizada pelos examinadores seniores e pelo júnior em todos os pacientes, que foi comparada com os parâmetros da MAR para a análise. ANÁLISE ESTATÍSTICA: A análise descritiva foi feita para todos os parâmetros. Para as pressões de repouso e contração, o índice Gamma foi utilizado para a comparação entre o EAD e a MAR, que variou de 0 a 1. Quanto mais próximo de 1 melhor a concordância entre os dois métodos de avaliação. RESULTADOS: A idade média foi de 48 anos e 55,5% dos pacientes eram do sexo feminino. A concordância das pressões anais de repouso entre a MAR e o EAD realizadas pelos examinadores seniores, proficientes, foi de 0,7 (IC 95%; 0,32-1,0), enquanto para o examinador júnior, menos experiente, foi de 0,52 (IC95%; 0,09-0,96). A concordância das pressões de contração foi de 0,96 (IC 95%; 0,87-1,0) para os examinadores seniores e de 0,52 (IC 95%; 0,16-0,89) para o júnior. CONCLUSÃO: Cirurgiões colorretais mais experientes, o EAD teve concordância mais significativa com a MAR, o que poderia levar a um manejo terapêutico mais adequado aos pacientes portadores de doença anorretais funcionais. A manometria anorretal permanece, portanto, como método de avaliação objetiva da função esfincteriana.

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O câncer de próstata e de mama se constituem em desafios para a saúde pública mundial, e o seu rastreamento para a detecção precoce possui vantagens e desvantagens. No sentido de garantir benefícios superiores ao possíveis danos e malefícios atrelados ao rastreamento, suas práticas, tanto no serviço púbico quanto no setor privado de saúde, devem estar orientadas pela evidência científica. O presente estudo tem como objetivo identificar a prevalência e os fatores associados à realização do exame digital retal (EDR) em homens brasileiros com idade superior a 40 anos, e à realização de mamografias na população feminina de 18-39 anos. Foi utilizado a base de dados da Pesquisa Nacional de Saúde (PNS), Brasil, 2013. Para tabulação e análise estatística foi usado o software Stata® 14 verificando as Razões de Prevalência com respectivos Intervalos de Confiança de 95% e valores de p, através de análise multivariada com regressão de Poisson. Os usuários de planos de saúde privado (63,3%; IC=60,5-66,0) apresentaram maior prevalência na realização do EDR do que os do sistema público de saúde (41,6%; IC=39,8- 43,4). Os resultados apresentaram associação positiva para o EDR em homens com planos privados com idade entre 60-69 anos, que vivem com cônjuges, que nunca fumaram, e domiciliados em zonas urbanas. Para os homens usuários do serviço de saúde público essa associação positiva com o EDR se deu para a faixa etária de 70-79 anos, que vivem com cônjuges, que possuem autopercepção de saúde ruim/ muito ruim, que não bebem, ex-fumantes, com nível universitário, que apresentam 4 ou mais comorbidades, e domiciliados em zonas urbanas. Ainda para esse grupo houve associação negativa da realização do EDR para homens que moram na região Norte do país. Os resultados para a realização de mamografia na população feminina mostraram que a prevalência do exame foi de 11.6% (IC 95%-10.7-12.5), com maior realização para a faixa etária de 30-39 (18.6%). Após análise multivariada, observou-se associação positiva estatisticamente significativa para mulheres com planos de saúde privado, das regiões Sul e Sudeste (regiões com melhor nível socioeconômico), de maior escolaridade, e ainda com a realização do exame citopatológico do colo de útero. Mulheres com idade entre 18-39 anos, baixo risco de câncer de mama, estão realizando mamografias e há uma associação disso com o maior e melhor acesso aos cuidados médicos e aos serviços. Os achados apontam para diferença nos modos de atuação da prática médica vigente nos dois tipos de serviço de saúde no país, e ainda diferenças estruturais que condicionam o acesso a estes exames de diagnósticos (AU).

Screening for the early detection of cancer, a challenge to global public health, has advantages and disadvantages in its realization, and its practices, both in the public service and in the private health sector, should be guided by scientific evidence in an attempt to ensure advantages over possible damage and harnesses. The present study aims to identify the prevalence and factors associated with digital rectal examination (DRE) in Brazilian men over 40 years old, and mammographies in the female population aged 18-39 years. We used the National Health Survey (NHS) database, Brazil, 2013. For statistical tabulation and analysis, Stata® 14 software was used to verify the Prevalence Ratios with their 95% Confidence Intervals and p values through multivariate analysis with Poisson regression. The users of private health plans (63.3%, CI = 60.5-66.0) had a higher prevalence in the implementation of EDR than in the public health system (41.6%, CI = 39.8% 43.4). The results showed a positive association for DRE in men with private plans aged 60-69 who live with spouses, who never smoked, and domiciled in urban areas. For men who use the public health service, this positive association with DRE occurred in the age group of 70-79 years, living with spouses who have poor / very poor selfperception, who do not drink, former smokers, with university level, who have 4 or more comorbidities, and domiciled in urban areas. Also for this group there was a negative association of the RDS for men living in the northern region of the country. The results for mammography in the female population showed that the prevalence of the test was 11.6% (95% CI -10.7-12.5), with a higher prevalence for the 30-39 age group (18.6%). After multivariate analysis, a statistically significant positive association was observed for women with private health plans, from the South and Southeast regions, with higher schooling, and with the cervical cytopathology exam. Women aged 18-39 years, at low risk of breast cancer, are undergoing mammograms and there is an association with increased access to medical care and services.The findings point to differences in the modes of action of the current medical practice in the two types of health service in the country, and structural differences that condition access to these diagnostic exams (AU).

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Black men are known to have a higher risk for prostate cancer (PC). Carotenoids and retinol, linked to PC, have not been compared in different black populations at risk. We examined serum carotenoid and retinol levels between PC-free African-Caribbean (AC) Tobagonian men with a high PC risk (high-grade prostatic intraepithelial neoplasia, atypical foci or repeated abnormal PC screenings) and African-American (AA) men with elevated serum prostate-specific antigen (PSA) levels (≥4 ng/ml). AC men who participated in the 2003 lycopene clinical trial and AA men who participated in the 2001-2006 National Health and Nutrition Examination Survey were compared. Serum specimens were analysed for carotenoid (ß-carotene, α-carotene, ß-cryptoxanthin, lutein/zeaxanthin and lycopene) and retinol levels by isocratic HPLC. Quantile regression was used to examine the association between serum carotenoid and retinol levels and black ethnicity, overall and among men with elevated serum PSA. There were sixty-nine AC men and sixty-five AA men, aged 41-79 years, included. AC men were associated with lower serum lycopene and retinol levels, and higher serum α- and ß-carotenes and lutein/zeaxanthin levels compared with AA men, after adjusting for age, BMI, ever smoked cigarettes, education and hypertension (P≤0·03). Among men with elevated PSA, serum retinol was no longer statistically significant with ethnicity (P=0·06). Possible differences may be attributed to dietary intake, genetics and/or factors that influence bioavailability of these micronutrients. Prospective studies are warranted that investigate whether these differences in micronutrients between AC Tobagonian and AA men influence PC risk.

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ABSTRACT Background Anal sphincter tone is routinely assessed by digital rectal examination in patients with fecal incontinence, although its accuracy in detecting sphincter defects or separating competent from incompetent muscles has not been established. Objective In this setting, we aimed to evaluate the accuracy of digital rectal examination in grading anal defects in order to separate small from extensive cases as depicted on 3D endoanal ultrasound, using a scoring sphincter defect and correlate anal tone to anal pressures. Methods Women with fecal incontinence were divided into two groups: small or extensive defects according to the ultrasound scoring system. Sensitivity, specificity, positive and negative predictive values of digital rectal examination in grading global and external sphincter defects were calculated. Anal tone at digital rectal examination was compared to resting and incremental pressures. Results A cohort of 76 consecutive incontinent women were enrolled. The median Wexner score was 9. Sixty-eight showed sphincter defects on 3D endoanal ultrasound. Anal tone at digital rectal examination was considered abnormal in 62 cases. Abnormal digital rectal examination showed a sensitivity of 90%, specificity of 27.78% in distinguishing small from extensive defects of both sphincters. Five out of eight women with no sphincter defects had only abnormal squeeze tone at digital rectal examination. Abnormal squeeze tone at digital rectal examination had a sensitivity of 65.31% in distinguishing small from extensive external anal sphincter defects. Digital rectal examination sensitivity increased linearly from small to extensive external anal sphincter defects (P=0.001). Women with abnormal resting tone had lower resting pressures than women with normal tone at digital rectal examination (P=0.0001). Women with abnormal squeeze tone had lower incremental pressures than women with normal tone at digital rectal examination (P=0.017). Conclusion Digital rectal examination had good sensitivity and poor specificity in discerning small from severe global anal sphincter defects. Moreover, digital rectal examination had fair sensitivity and poor specificity in grading external anal sphincter defects, and its best accuracy was on complete external anal sphincter lesions. Anal resting and squeeze tone were correlated to anal pressures.

RESUMO Contexto O toque retal é exame clínico rotineiro na avaliação coloproctológica, especialmente em pacientes com incontinência fecal. Entretanto, sua acurácia é variável na predição de defeito esfincteriano ou de alterações nas pressões anais. Objetivo Avaliar a sensibilidade, especificidade, valores preditivo positivo e negativo da avaliação do tônus esfincteriano ao toque retal, em diferenciar defeitos leves de defeitos graves em mulheres com incontinência fecal e correlacionar tônus com pressões anais. Métodos Mulheres portadoras de incontinência fecal e estratificadas de acordo com o grau de defeito ao ultrassom endoanal tridimensional (USEA 3D) foram avaliadas com toque retal e manometria anorretal. O tônus esfincteriano ao toque retal foi comparado com o grau de defeito e com as pressões anais no repouso e na contração. Resultados Das 76 mulheres com sintomas de incontinência fecal, 68 tinham defeito esfincteriano ao USEA 3D. Quarenta pacientes com defeitos graves. Escore de Wexner mediano de 9. O tônus esfincteriano ao toque retal foi considerado alterado em 62 casos. Um toque retal alterado teve alta sensibilidade e baixa especificidade em distinguir defeitos esfincterianos leves de extensos. Das oito pacientes sem defeito muscular, cinco tinham tônus ao toque retal alterado sendo todas no tônus na contração. O toque retal na contração teve moderada sensibilidade e baixa especificidade em distinguir defeitos leves de esfíncter externo do ânus de defeitos extensos. A sensibilidade do toque retal na contração foi melhor quanto mais extensos eram os defeitos de esfíncter externo do ânus (P=0,001). Mulheres com tônus de repouso alterado tinham menores pressões de repouso que aquelas com tônus normal (P=0,0001). Mulheres com tônus de contração alterado tinham menor incremento pressórico que aquelas com tônus normal (P=0,017). Conclusão O toque retal possui boa sensibilidade e baixa especificidade em diferenciar defeitos leves de extensos da musculatura esfincteriana e moderada sensibilidade em diferenciar defeitos de esfíncter externo do ânus, com melhora da sensibilidade quanto mais extensos eram os defeitos de esfíncter externo do ânus. Houve correlação entre tônus e pressões anais no repouso e na contração.

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OBJECTIVE: To describe the beliefs, knowledge and opinions that influence the practice of digital rectal examination in a group of urological patients. METHODOLOGY: A descriptive study was conducted using convenience sampling and an anonymous questionnaire with 15 questions. The questionnaire was divided in three blocks: socio-demographic variables; delay in going to the urology clinic and taking the rectal examination; evaluation of patients’ perception of pain and discomfort during digital rectal examination and the impact of discomfort on potential future screening compliance. Percentages were used for the descriptive analysis. RESULTS: Eighty-five surveys were conducted at the Institute of Oncology and Radiobiology of Cuba. The results showed that 70.24% of participants to some extent had information about prostate cancer and 64.29% about prostate specific antigen. Only 27% thought that the digital rectal examination would be helpful, while 66.66% delayed their visit to the urologist in order to avoid the digital rectal examination and 79.76%, to elude the biopsy. It was observed that 52.39% and 36.90% of men complained of moderate and severe pain, respectively. Digital rectal examination was deemed traumatic by 61.9% of the surveyed men. A high number of patients responded they would repeat prostate exam the following year (88.09%) and 94.05% would encourage a friend to have the prostate exam. CONCLUSIONS: More than half of the sample claimed to know about prostate cancer and prostate specific antigen; however, they did not consider helpful to undergo digital rectal examination. The main reasons for not assisting to the urologist was to avoid biopsy and the digital rectal examination. Nonetheless, in most patients traumatic digital rectal examination was performed and responders said they would repeat it in the future.

OBJETIVO: Describir las creencias, los conocimientos y opiniones sobre el examen dígito rectal en un grupo de pacientes urológicos. MÉTODOS: Se desarrolló un estudio descriptivo transversal donde se evaluó un cuestionario anónimo con 15 preguntas, dividido en tres bloques: 1) variables socio-demográficas; 2) retraso en ir a la consulta de urología y su inconformidad con la práctica del examen dígito rectal; 3) percepción de dolor y malestar durante el examen dígito rectal. El cuestionario fue aplicado a una muestra de conveniencia. RESULTADOS: Se analizaron 84 encuestas aplicadas en el Instituto de Oncología y Radiobiología de Cuba. Los resultados mostraron que 70,24% de los participantes conocían en cierta medida sobre el cáncer de próstata y 64,29%, sobre el uso del antígeno prostático específico. Sólo 27% encontró útil realizarse el examen digito rectal. Los mayores impedimentos para asistir a la consulta del urólogo fueron: no someterse a una biopsia (79,76%) y evadir la práctica del examen dígito rectal (66,66%). Además, se observó que 52,39% y 36,90% de los hombres se quejaron de dolor moderado y severo respectivamente, siendo traumático el examen dígito rectal en 61,9%. Sin embargo, 88,09% de los pacientes respondió que repetirían el examen al siguiente año y el 94,05% animaría a un amigo para someterse al él. CONCLUSIONES: En la muestra de individuos estudiados, más de la mitad afirmó conocer sobre el cáncer de próstata y el antígeno prostático específico, sin embargo, no consideró provechoso someterse a un examen dígito rectal. Evitar someterse a una biopsia o al examen dígito rectal fueron los principales impedimentos para su asistencia al urólogo. A pesar de que en la mayoría de los pacientes, realizarse el examen dígito rectal fue traumático, estos consintieron en repetírselo en el futuro.

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INTRODUCTION: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. MATERIALS AND METHODS: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level( >4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume , biopsy results and PSA levels were recorded. RESULTS: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. CONCLUSION: Nodule is the most important finding in DRE for cancer detection. Only na asymmetric prostate itself does not mean malignity.

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ABSTRACT Introduction: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. Materials and Methods: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level(>4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume, biopsy results and PSA levels were recorded. Results: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. Conclusion: Nodule is the most important finding in DRE for cancer detection. Only an asymmetric prostate itself does not mean malignity.

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Introducción. El examen de la próstata es una de las herramientas de detección temprana con las que se cuenta para prevenir el cáncer de próstata, patología que constituye la primera causa de morbilidad y la segunda de mortalidad de los hombres en Colombia. Objetivo. Identificar el conocimiento, la percepción y la disposición sobre el examen de la próstata en hombres mayores de 40 años residentes en Bogotá, D.C. Materiales y métodos. Estudio descriptivo transversal realizado a través de una encuesta a los participantes del estudio. Resultados. Se encontró relación entre el nivel académico y el conocimiento que tienen los hombres sobre el examen de la próstata (X²=80.00; p=0.0000), entre el nivel académico y la práctica del examen (X²=25.63; p=0.0000) y entre el nivel académico y la disposición para la realización del examen (X²=37.49; p=0.0002). Conclusiones. Existen factores condicionantes para que los hombres bogotanos mayores de 40 años no se realicen el examen de la próstata; tales factores están relacionados con el nivel educativo, las creencias de tipo personal y la falta de promoción de la práctica por parte de las instituciones de salud.

Background. The examination of the prostate is one of the early detection ways available to prevent prostatic cancer, a pathology that ranks as the first cause of morbidity and the second of mortality in men in Colombia. Ojective. To identify the knowledge, perception and disposition on prostate examination of men older than 40 years old residing in Bogotá. Materials and Methods. A descriptive cross-sectional study was carried out through a survey applied to the participants of this research. Results. Relationships between academic level and knowledge that men have on prostate examination (X²=80.00; p=0.0000), educational level and taking the examination (X²=25.63; p=0.000), and between the academic level and the disposition to do the examination (X²=37.49; p=0.0002) were found. Conclusions. There are determining factors causing that men older than 40 years old residing in Bogotá don't take the examination of their prostates. Such factors are related to educational level, individual beliefs and the lack of prostate examination promotion by health institutions.