Second brazilian consensus on the treatment of advanced prostate cancer: a SBOC-SBU-SBRT panel review

ABSTRACT Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

Serum tissue factor as a biomarker for renal clear cell carcinoma

ABSTRACT Purpose to determine the usefulness of serum TF as a potential marker for patients with clear cell RCC. Materials and Methods prospective study of 30 patients with clear cell RCC submitted to nephrectomy and 16 controls without clear cell RCC treated surgically for other conditions. TF is a endothelium marker that was correlated with worse prognosis in a variety of solid tumors including RCC. Serum TF was collected before surgery at the operating room and in the postoperative setting after at least four weeks. Serum samples were analyzed with a commercial ELISA kit for human TF (R&D Systems®). Results Mean preoperative serum TF levels in clear cell RCC patients and in controls were 66.8 pg/dL and 28.4 pg/dL, respectively (p<0.001). Mean postoperative serum TF levels in clear cell RCC patients were 26.3 pg/dL. In all patients with clear cell RCC postoperative serum levels of TF were lower, with a mean reduction of 41.6 pg/dL in the postoperative setting (p<0.001). Linear regression revealed that tumor size was correlated with the postoperative reduction of serum TF levels (p=0.037). Conclusions We have shown a 3-fold reduction in the median preoperative serum levels of TF in patients with clear cell RCC after surgery. We have also shown a difference of the same magnitude in the serum levels of TF compared with those of a control group of patients with benign diseases. TF appears to be a useful serum marker for the presence of clear cell RCC. Further studies are needed to validate these findings.

Association between Literacy, Compliance with Prostate Cancer Screening, and Cancer Aggressiveness: Results from a Brazilian Screening Study

Purpose Little is known about the effects of literacy levels on prostate cancer screening. This study evaluates the association between literacy, compliance with screening, and biopsy findings in a large Brazilian screening study. Materials and Methods We analyzed 17,571 men screened for PCa with digital rectal examination (DRE) and total and free prostate-specific antigen (PSA) from January 2004 to December 2007. Of those, 17,558 men had information regarding literate status. Full urological evaluation in a specialized cancer center was recommended in the case of: a) suspicious DRE, b) PSA > 4.0 ng/mL, or c) PSA 2.5-3.9 ng/mL and free/total PSA (f/tPSA) ratio < 15%. Transrectal ultrasound guided prostate biopsy (14 cores) was performed upon confirmation of these findings after the patient's consent. Patients' compliance with screening recommendations and biopsy results were evaluated according to literacy levels. Results an abnormal PSA, a suspicious DRE, or both were present in 73.2%, 19.7%, and 7.1% of those men who underwent biopsy, respectively. PCa was diagnosed in 652 men (3.7%). Previous PSAs or DREs were less common among illiterate men (p < 0.0001). Additionally, illiterate men were less prone to attend to further evaluations due to an abnormal PSA or DRE (p < 0.0001). PSA levels > 10 mg/mL (p = 0.03), clinical stage > T2a (p = 0.005), and biopsy Gleason > 7 (p = 0.02) were more common among illiterate men. Conclusions In a screened population, literacy levels were associated with prior PCa evaluations and with compliance with screening protocols. Illiterate men were at higher risk of being diagnosed with more advanced and aggressive PCa. .

Púrpura trombocitopênica trombótica decorrente de infecção urinária complicada / Thrombotic thrombocytopenic purpura due to a complicated urinary tract infection

Os autores relatam um caso infreqüente de púrpura trombocitopênica trombótica associada à infecção urinária por Escherichia coli e apresentam uma revisão bibliográfica sobre o assunto. A púrpura trombocitopênica trombótica é uma complicação incomum da infecção urinária por Escherichia coli. Caracteriza-se por anemia hemolítica microangiopática, trombocitopenia, sintomas neurológicos, insuficiência renal e febre. Entretanto, somente 40% dos casos apresentam todos esses sinais/sintomas. Sua evolução pode ser fatal se não for diagnosticada e tratada precocemente. No caso descrito, somente o tratamento agressivo do quadro séptico, com antibióticos, medidas de suporte e remoção do foco infeccioso (nefrectomia), e o manejo da púrpura trombocitopênica, com imunoglobulina, corticoterapia e plasmaférese associada à reposição de plasma fresco possibilitaram a recuperação da paciente (AU)

The authors report a rare case of a patient with thrombotic thrombocytopenic purpura associated with Escherichia coli urinary tract infection and present a review about this subject. Thrombotic thrombocytopenic purpura is an uncommon complication of Escherichia coli urinary tract infection. It is characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurologic abnormalities, renal failure and fever. However, only 40% of cases do present all of these signs and symptoms. The disease can be fatal if not diagnosed and treated early. In our report, only the aggressive management of the urinary sepsis, with general measures, antibiotics and the removal of the septic focus (with nephrectomy), and the treatment of the thrombotic thrombocytopenic purpura with immunoglobulins, corticosteroids and plasmapheresis with administration of fresh plasma have allowed the patient to recover (AU)

O professor universitário e a medicina: aspectos do contexto contemporâneo / Medical school teaching: aspects of contemporary context

O padräo de ensino-aprendizado vigente na maior parte das instituiçöes de ensino médico em nosso país deriva fundamentalmente do modelo americano proposto por Flexner no início deste século. Entretanto, a transposiçäo deste modelo para nosso tempo e realidade padece de distorçöes importantes, que devem ser analisadas e resolvidas caso queiramos promover o aprimoramento de nossas faculdades de medicina e de seus formandos. Este artigo objetiva revisar sucintamente os principais problemas vivenciados pelos profissionais do ensino médico em nosso país, na esperança de que a reflexäo sobre os mesmos nos ajude a encontrar soluçöes viáveis