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Purpose To identify metabolites in humans that can be associated with the presence of malignant disturbances of the prostate. Methods In the present study, we selected male patients aged between 46 and 82 years who were considered at risk of prostate cancer due to elevated levels of prostate-specific antigen (PSA) or abnormal results on the digital rectal examination. All selected patients came from two university hospitals (Hospital Universitario del Valle and Clínica Rafael Uribe Uribe) and were divided into 2 groups: cancer (12 patients) and non-cancer (20 patients). Cancer was confirmed by histology, and none of the patients underwent any previous treatment. Standard protocols were applied to all the collected blood samples. The resulting plasma samples were kept at -80°C, and a profile of each one was acquired by nuclear magnetic resonance (NMR) using established experiments. Multivariate analyses were applied to this dataset, first to establish the quality of the data and identify outliers, and then, to model the data. Results We included 12 patients with cancer and 20 without it. Two patients were excluded due to contamination with ethanol. The remaining ones were used to build an Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) model (including 15 non-cancer and 10 cancer patients), with acceptable discrimination (Q2 = 0.33). This model highlighted the role of lactate and lipids, with a positive association of these two metabolites and prostate cancer. Conclusions The primary discriminative metabolites between patients with and without prostate cancer were lactate and lipids. These might be the most reliable biomarkers to trace the development of cancer in the prostate.

Objetivo Identificar metabolitos en humanos que pueden estar asociados con la presencia de alteraciones malignas de la próstata. Métodos Se incluyeron muestras de pacientes masculinos entre 46 y 82 años y que se consideraron en riesgo de cáncer de próstata debido a la elevación del antígeno prostático específico (PSA) o el examen rectal anormal. Todos los pacientes seleccionados procedían de dos hospitales universitarios (Hospital Universitario del Valle y Clínica Rafael Uribe Uribe) y se dividieron en dos grupos: Oncológicos (12) vs no oncológicos (20). El cáncer fue confirmado por histología, y ninguno de ellos recibió tratamiento previo. Se aplicaron protocolos estándar a todas las muestras de sangre recolectadas. Las muestras de plasma resultantes se mantuvieron a −80°C y se adquirió un perfil de cada muestra mediante RMN. Se aplicaron análisis multivariantes a este conjunto de datos, primero para establecer la calidad de los datos e identificar valores atípicos, y para modelar los datos. Resultados Se incluyeron 12 pacientes con cáncer y 20 pacientes sin cáncer. Dos pacientes fueron excluidos por contaminación con etanol. Los restantes se utilizaron para construir un modelo OPLS-DA (15 pacientes no oncológicos y diez oncológicos), con una discriminación aceptable (Q2 = 0,33). Este modelo destacó el papel del lactato y los lípidos, encontrando una asociación positiva entre estos dos metabolitos y el cáncer de próstata. Conclusiones Los principales metabolitos discriminativos entre pacientes con cáncer de próstata versus no cáncer fueron el lactato y los lípidos. Estos podrían ser los biomarcadores más confiables para rastrear el desarrollo del cáncer en la próstata.

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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)

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RESUMO O uso de agrotóxicos na agricultura brasileira é um problema de saúde pública, dadas as contaminações no ambiente, em alimentos e as intoxicações resultantes do uso dessas substâncias. O objetivo deste artigo é investigar a distribuição espacial das áreas plantadas de lavouras e as taxas de mortalidade de alguns tipos de câncer: mama, colo do útero e próstata. Escolheram-se quatro estados brasileiros que possuem grande produção de commodities agrícolas a serem estudadas. Trata-se de um estudo ecológico de análise espacial conduzido com dados e informações do Sistema de Informação sobre Mortalidade (SIM) do Ministério da Saúde, por meio do qual elaboraram-se taxas de mortalidade para os referidos tipos de câncer, cujos óbitos tenham ocorrido entre 1996 e 2016. Há indícios de que existe correspondência entre as áreas de maior estimativa de uso de agrotóxicos Disruptores Endócrinos e o aumento das taxas de mortalidade pelos diferentes tipos de câncer.

ABSTRACT The use of agrochemicals in Brazilian agriculture is a public health problem, given the contamination of the environment, food and the poisoning resulting from the use of these substances. The objective of this article is to investigate the spatial distribution of planted crops area and mortality rates of some types of cancer: breast, cervix and prostate. Four Brazilian states were chosen that have large production of agricultural commodities to be studied. This is an ecological study of spatial analysis conducted with data and information from the Mortality Information System (SIM) of the Ministry of Health, and mortality rates were calculated for those types of cancer whose deaths occurred between 1996 and 2016. There are indications that there is a correspondence between the areas of higher estimation of the use of agrochemical Endocrine Disruptors and the increase of mortality rates by different types of cancer.

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ABSTRACT Purpose To evaluate the usefulness of natural killer cell activity (NKA) in diagnosing prostate cancer (PC). Materials and Methods The medical records of patients who underwent transrectal prostate biopsy (TRBx) at Korea University Ansan Hospital between May 2017 and December 2017 were retrospectively reviewed. NKA levels were measured using NK Vue® Tubes (ATgen, Sungnam, Korea). All blood samples were obtained at 8 AM on the day of biopsy. Patients with other malignancies, chronic inflammatory conditions, high prostate-specific antigen (PSA) level (>20ng/mL), or history of taking 5-alpha-reductase inhibitor or testosterone replacement therapy were excluded. Results A total of 102 patients who underwent TRBx for PC diagnosis were enrolled. Among them, 50 were diagnosed with PC. Significant differences in age and NKA level were observed between the PC and no-PC groups. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off of NKA level for the prediction of PC was 500pg/dL, with a sensitivity of 68.0% and a specificity of 73.1%. In addition, NKA level (0.630) had the greatest area under the ROC curve compared to those for the ratio of total PSA to free PSA (0.597) and PSA density (0.578). Conclusions The results of this pilot study revealed that low NKA and high PSA levels were likely to be associated with a positive TRBx outcome. NKA detection was easy and improved the diagnostic accuracy of PC.

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PURPOSE: To evaluate the usefulness of natural killer cell activity (NKA) in diagnosing prostate cancer (PC). MATERIALS AND METHODS: The medical records of patients who underwent transrectal prostate biopsy (TRBx) at Korea University Ansan Hospital between May 2017 and December 2017 were retrospectively reviewed. NKA levels were measured using NK VueR Tubes (ATgen, Sungnam, Korea). All blood samples were obtained at 8 AM on the day of biopsy. Patients with other malignancies, chronic inflammatory conditions, high prostate-specifi c antigen (PSA) level (>20ng/mL), or history of taking 5-alphareductase inhibitor or testosterone replacement therapy were excluded. RESULTS: A total of 102 patients who underwent TRBx for PC diagnosis were enrolled. Among them, 50 were diagnosed with PC. Significant differences in age and NKA level were observed between the PC and no-PC groups. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off of NKA level for the prediction of PC was 500pg/dL, with a sensitivity of 68.0% and a specifi city of 73.1%. In addition, NKA level (0.630) had the greatest area under the ROC curve compared to those for the ratio of total PSA to free PSA (0.597) and PSA density (0.578). CONCLUSIONS: The results of this pilot study revealed that low NKA and high PSA levels were likely to be associated with a positive TRBx outcome. NKA detection was easy and improved the diagnostic accuracy of PC.

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Resumen: La resonancia magnética multiparamétrica (RMmp) de próstata ha tenido un desarrollo importante en los últimos años dado la alta prevalencia del cáncer de próstata y la necesidad de tener información imagenológica concreta para el correcto manejo de los pacientes urológicos. Otras técnicas de imágenes aportan información parcial sobre la morfología de la próstata, pero es la RMmp de próstata la técnica imagenológica que nos entrega mayor información, a través de secuencias morfológicas y funcionales, para detectar lesiones clínicamente significativas y disminuir el número de biopsias, predecir riesgo de agresividad de los tumores, estadificación local y ayudar al urólogo a realizar biopsias dirigidas cognitivas o por fusión RM/US. En este artículo se pretende mostrar casos representativos de errores frecuentes al momento de informar una resonancia magnética de próstata. Damos algunas recomendaciones para evitar estos errores y mejorar los informes radiológicos. Es común al comenzar a realizar informes de RMmp de próstata tener dudas sobre la correcta interpretación de los hallazgos. Ofrecemos a través de este articulo imágenes representativas de los principales errores en la búsqueda de patología neoplásica y algunas sugerencias para evitarlos. Desde el punto de vista académico se pueden dividir en pitfalls de condiciones anatómicas y patologías benignas que pueden simular un tumor. En el caso de pitfalls anatómicos mostramos casos referentes al estroma fibromuscular anterior hipertrófico, cápsula quirúrgica engrosada, plexo venoso peri-prostático, complejo neurovascular y pseudolesión posterior en zona periférica. Dentro de las condiciones benignas se encuentra la hiperplasia prostática benigna, procesos inflamatorios/infecciosos y otras condiciones que pueden simular tumor. Respecto a pitfalls relacionados con la hiperplasia prostática benigna podemos señalar hiperplasia de la zona de transición / central ("moustache-sign"), proliferación estromal en la zona de transición y nódulos adenomatosos ectópicos u extruidos en la zona periférica (ZP). Pitfalls inflamatorios/infecciosos corresponden a casos de prostatitis focal, prostatitis aguda, prostatitis con abscesos y prostatitis granulomatosa. Otros errores frecuentes de dificultad en la interpretación corresponden a casos de calcificaciones y hemorragia.

Abstract: Multiparameter magnetic resonance imaging (RMmp) of the prostate has had an important development in recent years given the high prevalence of prostate cancer and the need to have specific imaging information for the correct management of urological patients. Other imaging techniques provide partial information about the morphology of the prostate, but it is the mp-MRI of the prostate that gives us more information, through morphological and functional sequences, to detect clinically significant lesions and reduce the number of biopsies, predict risk of aggressiveness of the tumors, local staging and help the urologist to perform cognitive biopsies or by MR / US fusion. This article aims to show representative cases of frequent errors when reporting an MRI of the prostate. We give some recommendations to avoid these errors and improve radiological reports. It is common to start making mp-MRI of the prostate reports having doubts about the correct interpretation of the findings. We offer through this article representative images of the main errors in the search for neoplastic pathology and some suggestions to avoid them. From the academic point of view they can be divided into pitfalls of anatomical conditions and benign pathologies that can simulate a tumor. In the case of anatomical pitfalls, we show cases related to the hypertrophic anterior fibromuscular stroma, thickened surgical capsule, peri-prostatic venous plexus, neurovascular complex and posterior pseudo-injury in the peripheral area. Among the benign conditions is benign prostatic hyperplasia, inflammatory / infectious processes and other conditions that can simulate tumor. Regarding pitfalls related to benign prostatic hyperplasia, we can indicate hyperplasia of the transition / central zone ("mustache-sign"), stromal proliferation in the transition zone and ectopic or extruded adenomatous nodules in the peripheral zone. Inflammatory / infectious pitfalls correspond to cases of focal prostatitis, acute prostatitis, prostatitis with abscesses and granulomatous prostatitis. Other frequent errors of difficulty in interpretation correspond to cases of calcifications and hemorrhage.

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Objective To describe the frequency of mutations in DNA-repair genes in a southwestern Colombian population. Methods We have designed an observational study, including 162 people from all ages from southwest Colombia. We have extracted and collected their DNA in filters. We have immersed the DNA in a phosphate buffer along with DNeasy package (Thermo Fisher Scientific, Waltham, MA, USA). The preparation process was with the TruSeq Exome Library Prep (Illumina, Inc. San Diego, CA, USA), then the obtained libraries were normalized with TruSeq Rapid Exome (Illumina, Inc. San Diego, CA, USA). We sequenced the full exome and identified the variants associated with 12 genes (ataxia telangiectasia mutated [ATM], BRCA1 DNA repair associated [BRCA1], BRCA2 DNA repair associated [BRCA2], checkpoint kinase 2 [CHEK2], epithelial cell adhesion molecule [EPCAM], homeobox protein Hox-B13 [HOXB13], mutS homolog 1, 2 and 6 [MLH1, MSH2, MSH6], nibrin [NBN], PMS1 homolog 2, mismatch repair system component [PMS2], and tumor protein p53 [TP53]). Descriptive statistics were performed with the R software (The R Foundation for Statistical Computing, Vienna, Austria). Results A total of 7,315,466 pieces of data were sequenced in this population. The most frequently mutated genes were ATM (1,221 pieces of data; 13.2%), BRCA1 (1,178 pieces of data; 12.8%), BRCA2 (1,484 pieces of data; 16.12%), and NBN (965 pieces of data; 10.42%). The most common single nucleotide polymorphisms (SNPs) in these 12 genes were the following: BRCA2 (rs169547, rs206075, rs206076); ATM (rs659243, rs228589); TP53 (rs1625895, rs1042522, rs1642785); PMS2 (rs2228006, rs1805319); NBN (rs709816); and MSH6 (rs3136367) Conclusion The BRCA2, ATM, BRCA1 and NBN DNA-repair genes were the most frequently mutated in this southwestern Colombian Population

Objetivo Describir la frecuencia de las mutaciones en los genes de reparación del ADN en una población del suroccidente de Colombia. Métodos Diseñamos un estudio observacional que incluyó a 162 personas del suroccidente de Colombia de todas las edades. Hemos extraído y recogido el ADN en filtros. Los sumergimos en tampón fosfato junto con el paquete DNeasy (Thermo Fisher Scientific, Waltham, MA, EEUU). El proceso de preparación fue realizado con TruSeq Exome Library Prep (Illumina, Inc. San Diego, CA, EEUU); luego, las bibliotecas obtenidas se normalizaron con TruSeq Rapid Exome (Illumina, Inc. San Diego, CA, USA). Secuenciamos el exoma completo e identificamos las variantes asociadas a doce genes (ataxia telangiectasia mutated [ATM], BRCA1 DNA repair associated [BRCA1], BRCA2 DNA repair associated [BRCA2], checkpoint kinase 2 [CHEK2], epithelial cell adhesion molecule [EPCAM], homeobox protein Hox-B13 [HOXB13], mutS homolog 1, 2 and 6 [MLH1, MSH2, MSH6], nibrin [NBN], PMS1 homolog 2, mismatch repair system component [PMS2], y tumor protein p53 [TP53]). La estadística descriptiva se realizó en el programa R (The R Foundation for Statistical Computing, Viena, Austria). Resultados Un total de 7.315.466 datos fueron secuenciados en esta población. Los genes más frecuentemente mutados fueron el ATM, con 1.221 datos (13,2%), el BRCA1, con 1.178 datos (12,8%), el BRCA2, con 1.484 datos (16,12%) y el NBN, con 965 datos (10,42%). Los polimorfismos de un solo nucleótido (PSN) más comunes en estos 12 genes fueron los siguientes: BRCA2 (rs169547, rs206075, rs206076); ATM (rs659243, rs228589); TP53 (rs1625895, rs1042522, rs1642785); PMS2 (rs2228006, rs1805319); NBN (rs709816) y MSH6 (rs3136367) Conclusión Los genes de reparación de ADN BRCA2, ATM, BRCA1 NBN fueron los más frecuentemente mutados en esta población del suroccidente de Colombia.

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INTRODUCTION: To determine the effectiveness and safety of extended pelvic lymphadenectomy compared with standard lymphadenectomy in the overall, cancer-specific survival and biochemical recurrence-free survival of patients with localized prostate cancer who underwent radical prostatectomy. MATERIAL AND METHODS: Clinical trials and cohort studies were included without language restrictions with the following participants: men older than 40 years of age diagnosed with localized prostate cancer who received radical prostatectomy plus pelvic lymphadenectomy. Standard vs. extended pelvic lymphadenectomy were compared. The primary outcomes were overall and cancer-specific survival. A search strategy in MEDLINE, EMBASE, CENTRAL, LILACS, and other databases was conducted to obtain published and unpublished literature. The risk of bias was evaluated with the Cochrane Collaboration tool. The statistical analysis was performed in STATA 14. RESULTS: Six studies were included, of which only one was experimental; the other studies were cohort studies. The surgical technique was robot-assisted in three studies. Two studies only had information concerning the adverse effects. It was not possible to include one clinical trial that met the criteria because an erratum was published in which falsification of the experimental data was proven. There was a biochemical recurrence-free survival hazard ratio (HR) = 0.62 and a 95% confidence interval (CI) (0.36 to 0.87). CONCLUSIONS: According to current literature, a mild difference was evident favoring the extended lymphadenectomy in biochemical recurrence-free survival. Additionally, there was no evidence to draw a conclusion regarding the overall survival since we did not find any studies concerning this outcome.

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Abstract Objective: to evaluate the prevalence of symptoms of depression among men diagnosed with prostate cancer and their association with quality of life and treatment-related factors. Methods: a cross-sectional study of 85 men with a mean age of 66±8 years who were diagnosed with prostate cancer was performed. The survey was based on a questionnaire with previously validated instruments which investigated social, demographic and economic characteristics, the history of the disease, quality of life (European Organization for Research and Treatment of Cancer Questionnaire C30 - EORTC QLQ-C30 / QLQ-PR25) and symptoms of depression (Beck Depression Inventory). The presence of symptoms of depression was considered an outcome, and statistical analyzes were performed using the Chi-square test, Fisher's exact test, Mann Whitney U test and Poisson regression (p<0.05). Results: significant results were found for quality of life in relation to symptoms of depression in the functional, global and symptomatic health scale (p<0.001). This demonstrates that the presence of symptoms of depression is related to a negative quality of life. Conclusions: for a greater understanding of prostate cancer and its consequences on the quality of life of patients it is important to consider possible disorders in psychological aspects caused by the illness, as symptoms of depression are frequent in patients undergoing treatment for prostate cancer. AU

Resumo Objetivo: Avaliar a prevalência de sintomas depressivos em homens com diagnostico de câncer de próstata e a associação com escores de qualidade de vida e fatores relacionados ao tratamento Métodos: Estudo transversal composto por 85 homens, com média de idade de 66±8 anos, diagnosticados com câncer de próstata; utilizou-se um questionário com instrumentos previamente validados onde investigaram-se as características sociais, demográficas, econômica, história da doença, qualidade de vida (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 - EORTC QLQ-C30/ QLQ-PR25) e sintomas depressivos (Inventário de Depressão de Beck). Foi considerado como desfecho a presença de sintomas depressivos, sendo realizadas análises estatísticas por meio do teste qui-quadrado, teste Exato de Fisher, teste U de Mann Whitney e Regressão de Poisson (p<0,05). Resultados: Foram encontrados resultados significativos para a qualidade de vida na escala funcional, saúde global e sintomática (p<0,001), em relação aos sintomas depressivos. Demonstrando que a presença de sintomas depressivos está relacionada à qualidade de vida mais negativa. Conclusões: Para a melhor compreensão sobre o câncer prostático e suas consequências na qualidade de vida dos pacientes faz-se necessário levar em consideração as possíveis alterações nos aspectos psicológicos ocorridos diante da realidade dessa doença, uma vez que os sintomas depressivos têm sido frequentes em pacientes no tratamento do câncer de próstata. AU

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El Virus Papiloma Humano (HPV por sus siglas en inglés) es una de las infecciones de transmisión sexual más frecuentes del mundo y se encuentra presente en la mayoría de los cánceres de cuello uterino. Se ha descrito su presencia en otros tipos de cáncer no ginecológicos como lo son esófago y próstata. Sin embargo, las frecuencias de HPV descritas hasta el momento para estos tipos de cáncer son muy variables, y no hay artículos donde se muestren la presencia de HPV en estas neoplasias en Chile. El objetivo de este estudio fue determinar la frecuencia de HPV en muestras de biopsias de tumores no ginecológicos y tejido inflamatorio de pacientes de la región de La Araucanía. Se extrajo DNA desde un total de 47 biopsias de pacientes con esofagitis, 25 con carcinoma escamoso esofágico, 20 con hiperplasia nodular de la próstata y 39 con adenocarcinoma prostático. Estas fueron analizadas por PCR de la región L1 del virus y posterior genotipificación por reverse line blot. Se detectó HPV en el 53,2% de las muestras de esofagitis, 48% en muestras de carcinoma escamoso esofágico, 15% en hiperplasia nodular de la próstata y un 15,4% en los casos de adenocarcinoma prostático. Siendo los más frecuentes los genotipos de HPV 16 y 18, ya sea en infecciones simples o junto con otros genotipos, en lesiones preneoplásicas y neoplásicas de los tejidos estudiados. Existe una alta frecuencia de infección por HPV en biopsias de esofagitis y tejido inflamatorio esofágico de pacientes de la región de la Araucanía. En los casos de adenocarcinoma prostático e hiperplasia nodular de la próstata se observa una baja frecuencia de HPV.

Human Papilloma Virus (HPV) is the most common sexually transmitted disease in the world and it is present in practically all cervical cancers. Its presence was described in other types of non-gynecologic cancer such as esophageal and prostate. However, HPV frequency described for these cancers is highly variable, and there are no articles describing the presence of HPV in these tumors in Chile. To determine HPV frequency in samples from biopsies of non-gynecological tumors and inflammatory tissue from patients in the Araucanía region, DNA was extracted from a total of 47 biopsies from patients with esophagitis, 25 with esophageal squamous cell carcinoma, 20 with prostate nodular hyperplasia and 39 with prostate adenocarcinoma. These were analyzed by PCR of HPV L1 region and subsequent genotyping by reverse line blot. HPV was detected in 53.2% of esophagitis samples, 48% in esophageal squamous cell carcinoma, 15% in prostatitis and 15.4% in cases of prostatic adenocarcinoma. The most frequent HPV genotypes were 16 and 18, either single or in combination with other genotype infections, in inflammatory tissue and neoplastic lesions. In patients of the Araucanía region, there is a high rate of HPV infection in biopsies obtained in esophagitis and esophageal inflammatory tissue. In cases of prostatic adenocarcinoma and prostate nodular hyperplasia a low rate of HPV was observed.

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INTRODUÇÃO: O câncer de próstata é responsável por 15% dos casos novos de câncer que acometem os homens e pela 5ª causa de morte. As técnicas minimamente invasivas, sobretudo a cirurgia robótica tornou-se a técnica comumente empregada nos Estados Unidos. Muitos artigos tentam demonstrar a curva de aprendizado necessária para a estabilização dos resultados, mas a implementação de novas tecnologias passa por diversos desafios, além da avaliação de seus resultados e dos custos, o que em países em desenvolvimento pode ter um importante impacto no sistema de saúde. OBJETIVO: Avaliar a curva de aprendizado da prostatectomia radical laparoscópica robótica assistida (PRRA) para o tratamento do câncer de próstata, de acordo com a continência urinária, a potência sexual, o tempo cirúrgico e o controle oncológico. MÉTODOS: Duzentos pacientes com neoplasia de próstata localizada submetidos à PRRA por um único cirurgião foram divididos em quatro grupos de acordo com a sequência das cirurgias. Foram avaliados os dados intra-operatórios, como: tempo cirúrgico, perda sanguínea estimada e as margens cirúrgicas. Também durante o pósoperatório foram avaliadas a potência (IIEF) e a continência (ICIQ). RESULTADOS: Os pacientes apresentaram idade média de 60,6 anos (59,72-61,61), volume prostático ao toque retal de 40 gramas e valor do PSA 6,95 ng/ml (5,79-8,10) semelhantes em todos os grupos (p > 0,05). A biópsia prostática pré-operatória mostrou diferença no escore de Gleason e no tamanho da próstata, sendo que o escore 6 foi menos frequente no grupo 4, representado por 23 pacientes (46%) e no grupo 1, com 39 pacientes (78%) (p < 0,01). Já o tamanho prostático avaliado pelo USTR foi de 39,6 gramas (29,75-48,7) no grupo 4 e 30,5 gramas (23,0-38,15) no grupo 2. A curva de aprendizado estabelecida demonstrou uma diminuição no tempo cirúrgico de 157 minutos (145-170) no grupo 1, para 132 minutos (119-140) no grupo 2 (p < 0,01). A perda sanguínea estimada também se reduziu...

BACKGROUND: Prostate cancer is responsible for 15% of new cases of male cancer and is the fifth leading cause of death. Minimally invasive and mainly, robotic surgery technique became the technique most widely utilized in the United States. Many articles have tried to demonstrate the required learning curve to achieve the plateau. Although, new techniques implementation go through many challenges besides the evaluation of its results, costs also became an issue, which may impact in developing countries health system. OBJECTIVE: We aim to evaluate the learning curve of robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer, according to continence, potency, surgical time and oncologic control. METHODS: Two hundred patients with localized prostate cancer that underwent RARP by a single surgeon were divided into four groups according to its surgical sequence. Intraoperative data, such as surgical time, estimated blood loss and margins were recorded. Also postoperative functional parameters as continence and potency were gathered using validated questionnaires (ICIQ and IIEF). RESULTS: Patients mean age were 60.6 years (59.72- 61.61), mean prostate volume at digital rectal examination was 40 grams and PSA value 6.95 ng/ml (5.79-8.10) were similar in all groups (p > 0.05). Pre-operative prostate biopsy showed difference in Gleason score and prostate size. Gleason score 6 was less frequent in group 4, 23 patients (46%), than group 1, 39 patients (78%)(p <0.01) and prostate size at TRUS was 39.6 grams (29.75- 48.7) in group 4 and 30.5 grams (23.0- 38.15) in group 2. The established learning curve showed a reduction on surgical time from 157 minutes (145-170) in group 1 to 132 minutes (119-140 min) in group 2 (p < 0.01). The estimated blood loss also decreased almost to half, from 395 ml (250-500) in group 1 to 200 ml (150-250) in group 3 (p < 0.01). Positive margins decreased from 16% to only 8 %, but were statistically similar (p=0.236)....

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INTRODUCTION AND OBJECTIVE: To analyze the immuno-histochemical expression of MIB-1 marker as a prognostic factor in patients with localized prostate neoplasia. METHODS: Analysis of 100 cases of patients with localized prostate neoplasia who underwent curative surgery from January 2000 to December 2006. The customary histological preparation was carried out, followed by immunohistochemical reaction to detect MIB-1 protein accumulation and statistical analysis. RESULTS: There was a larger proportion of negative expression for MIB-1 marker (63.0 percent, p < 0.0001). Patients with positive expression (MIB-1 positive) had higher PSA (PSA > 10 ng/dl) (p = 0.010), higher Gleason score (> 7) (p = 0.0003) and pathological stage pT2c (p = 0.001). In the comparison of variables, it was noticed that patients with positive expression had a higher mean PSA (p = 0.031), higher Gleason score (p < 0.0001), longer follow-up (p = 0.037), larger area of vascular proliferation (p < 0.0001) and higher proportion of tumor in relation to normal area (p = 0.012). CONCLUSION: MIB-1 proved to be a prognostic factor comparable to PSA, Gleason and staging.

INTRODUÇÃO E OBJETIVO: Analisar a expressão imuno-histoquímica do marcador MIB-1 como fator prognóstico em pacientes com neoplasia de próstata localizada. MÉTODOS: Análise de cem casos de pacientes portadores de neoplasia prostática localizada submetida a cirurgia curativa no período de janeiro de 2000 a dezembro de 2006. Realizou-se o preparo histológico habitual seguido de reação imuno-histoquímica para a detecção do acúmulo da proteína MIB-1 e análise estatística. RESULTADOS: Obteve-se maior proporção de expressão negativa ao marcador MIB-1(63 por cento, p < 0,0001). Os pacientes com expressão positiva (MIB1 positivo) apresentaram antígeno prostático específico (PSA) mais elevado (PSA > 10 ng/dl) (p = 0,01), escore de Gleason mais alto (> 7) (p = 0,0003) e estádio patológico pT2c (p = 0,001). Na comparação das variáveis observou-se que os pacientes com expressão positiva apresentaram PSA médio mais elevado (p = 0,031), escore de Gleason mais alto (p < 0,0001), maior tempo de seguimento (p = 0,037), maior área de proliferação vascular (p < 0,0001) e maior proporção de tumor em relação à área normal (p = 0,012). CONCLUSÃO: O MIB-1 mostrou-se um fator prognóstico comparável a PSA, Gleason e estádio.

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PURPOSE: Preexisting bone loss in men with prostate cancer is an important issue due to the accelerated bone loss during androgen deprivation therapy (ADT). In addition, a high prostate-specific antigen (PSA) level has been reported to be related to bone metabolism. This study assessed the factors associated with osteoporosis in Korean men with non-metastatic prostate cancer before undergoing ADT. MATERIAL AND METHODS: The study enrolled patients admitted for a prostate biopsy because of a high PSA or palpable nodule on a digital rectal examination. We divided the patients (n = 172) according to the results of the biopsy: group I, non-metastatic prostate cancer (n = 42) and group II, benign prostatic hypertrophy (BPH; n = 130). The lumbar bone mineral density (BMD) was evaluated using quantitative computed tomography. The demographic, health status, lifestyle, body mass index (BMI), serum testosterone concentration, and disease variables in prostate cancer (Gleason score, clinical stage, and PSA) were analyzed prospectively to determine their effect on the BMD. RESULTS: The estimated mean T-score was higher in group I than in group II (-1.96 ± 3.35 vs. -2.66 ± 3.20), but without statistic significance (p = 0.235). The significant factors correlated with BMD in group I were a high serum PSA (ß = -0.346, p = 0.010) and low BMI (ß = 0.345, p = 0.014) in the multiple linear regression model. Also old age (r = -0.481, p = 0.001), a high serum PSA (r = -0.571, p < 0.001), low BMI (r = 0.598, p < 0.001), and a high Gleason’s score (r = -0.319, p = 0.040) were the factors related to BMD in the correlation. The significant factors correlated with BMD in group II were old age (ß = -0.324, p = 0.001) and BMI (ß = 0.143, p = 0.014) in the multiple linear regression model. CONCLUSIONS: The risk factors for osteoporosis in men with prostate cancer include a low BMI, and elevated serum PSA. Monitoring BMD from the outset of ADT is a logical first...

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