ABSTRACT
Objectives: This paper aims to study biochemical control, hormonal therapy-free survival, and prognostic factors related tosalvage radiation for prostate cancer patients submitted to radical prostatectomy (RP) without hormonal therapy (HT) before orduring radiation. Materials and Methods: from August 2002 to July 2004, 39 prostate cancer patients submitted to RPpresented biochemical failure after achieving PSA nadir (<0.2ng/ml). All patients were submitted to three-dimensional conformalexternal beam radiation therapy (3DC-EBRT) and no patients had received HT. Median age was 62 years, median preoperativePSA was 9.4ng/ml, median Gleason Score was 7. We defined PSA rise above 0.2 as biochemical failure after surgery. Median3DC-EBRT dose was 70Gy, and biochemical failure after EBRT was defined as three consecutive rises in PSA or a single risesufficient to trigger HT. Results: Biochemical non-evidence of disease (BNED) in 3 years was 72%. PSA doubling time (PSADT)lower than 4 months (p=0.04), and delay to salvage EBRT (p=0.05) were associated to worse chance of successful salvagetherapy. Late morbidity was acceptable. Conclusion: Expressive PSA control (72% BNED / 3years) could be achieved withsalvage radiotherapy in well-selected patients. The importance of PSADT was confirmed, and radiotherapy should be started asearly as possible. Follow-up is somewhat short, but it is possible to conclude that it is possible to achieve a long interval freefrom hormonal therapy with low rate of toxicity, avoiding or at least delaying morbidity related to hormonal treatment.radiotherapy
Subject(s)
Humans , Male , Middle Aged , Prostatectomy , Prostatic Neoplasms , Radiotherapy , Prostatic Neoplasms/surgeryABSTRACT
Obstrução da junção ureteropélvica é a mais freqüente causa de hidronefrose detectada através da ultra-sonografia fetal. Antes da década de 80 a grande maioria dos casos era diagnosticada em crianças maiores geralmente sintomáticas, com dor abdominal e infecção urinária. Atualmente, a maioria dos casos de aparente obstrução da junção ureteropélvica é detectada na investigação de hidronefrose fetal em lactentes quase sempre assintomáticos. O objetivo dessa revisão é avaliar os aspectos relacionados a etiopatogênese e ao tratamento da obstrução da junção ureteropélvica. Foram revistos os principais estudos clínicos que compararam a abordagem conservadora com a cirúrgica. Essa compilação mostrou que a abordagem conservadora é segura para a maioria dos neonatos assintomáticos com obstrução de junção pieloureteral unilateral e a abordagem cirúrgica deve ser reservada para os casos que apresentem dano ao parênquima renal.
Ureteropelvic junction obstruction is the most frequent cause of prenatally detected fetal hydronephrosis. Before the eighties, most cases were detected in children with symptoms such as abdominal pain and urinary tract infection. Today, most cases of apparent ureteropelvic junction obstruction are identified by investigation of fetal hydronephrosis in asymptomatic infants. The aim of this review is to evaluate the aspects related with the pathogenesis and the approach of the ureteropelvic junction obstruction. The main clinical studies that compared conservative and surgical treatments were compiled. The review shows that the conservative approach is safe for asymptomatic neonates and the surgical procedure should be reserved for cases with damaged renal parenchvma.