A case series on the impact of abiraterone acetate with prednisone in metastatic prostate adenocarcinoma: The real world experience

OBJECTIVE@#To evaluate the clinical benefit of Abiraterone acetate plus prednisone (AA + P) withandrogen deprivation therapy in patients with metastatic prostate cancer as a local experience in thePhilippines.@*MATERIALS AND METHODS@#The authors evaluated retrospectively a case series of seven patients receivingandrogen deprivation therapy with high-risk metastatic castration-sensitive prostate cancer (mCSPC)and metastatic castration-resistant prostate cancer (mCRPC) treated with AA + P in a tertiary hospitalfrom April 2019 to October 2020. Disease characteristics, biochemical trend, quality of life evaluationusing the European Organization for Research and Treatment of Cancer Questionnaire (EORTCQLQ-C30 v.3), and adverse events reporting using Common Terminology Criteria for Adverse Events(CTCAE) Version 5.0 were all retrieved from the medical records as outcome measures.@*RESULTS@#Analysis of 18 months period using chart review was done. Five patients showed clinicalimprovement on positive PSA response. Patients also presented with Grade 1-2 adverse events scorebased on CTCAE including hypertension, hepatotoxicity, gastrointestinal symptoms, and electrolyteimbalances. Using the EORTC QLQ-C30 v.3 showed that AA + P provided significant improvementon the overall quality of life, functioning in terms of role, emotional, cognitive and social aspectswith reasonable safety profile and minimal adverse events limited to worsening of gastrointestinalsymptoms from baseline.@*CONCLUSION@#The addition of AA + P to androgen deprivation therapy is a suitable option for bothhigh-risk mCSPC and mCRPC exhibiting a significant biochemical, functional and quality of lifeimprovement with reasonable safety profile and limited adverse events in the ‘real-world’ setting, whichis comparable with the findings in other similar studies.

Clinicopathological Features and Expression of P504s,E-cadherin,Erythroblast Transformation-specific Related Gene and Estrogen Receptor in Prostate Adenocarcinoma in Tibet / 中国医学科学院学报

Objective To investigate the clinicopathological features and immunohistochemical expression of P504s,E-cadherin,erythroblast transformation-specific related gene(ERG)and estrogen receptor(ER)in prostate adenocarcinoma in Tibet.Methods The clinical data of 15 patients with prostate adenocarcinoma diagnosed by the Department of Pathology of Tibet Autonomous Region People's Hospital from September 2013 to September 2020 were analyzed retrospectively.All patients were assigned to prognostic grade groups based on Gleason score according to the WHO 2016 criteria.Immunostaining of P504s,E-cadherin,ERG,and ER was performed.Results The age of all 15 patients ranged from 61 to 86 years.The serum prostate specific antigen(PSA)concentration was ≥20 ng/ml in 12 patients and<20 ng/ml in 3 patients.Among the 15 patients,11 underwent needle biopsy,1 transurethral resection of the prostate,and 3 radical prostatectomy.Prognostic grouping results revealed 5 cases in grade groups 1-3,4 cases in grade group 4,and 6 cases in grade group 5.Immunohistochemistrically,15 cases(100%)were positive for P504s,E-cadherin and PSA;one case(7%)was positive for ERG;all cases were negative for P63,ER and CK34βE12.Thirteen cases were followed up for 2-48 months,with 2 cases treated with total prostatectomy and 11 cases with non-surgical treatment.Two cases were lost to follow-up. Conclusions Prostate adenocarcinoma is rare relatively in Tibet.The accuracy of diagnosis can be improved by using multiple immunohistochemical markers.The cases of grades 4 and 5 by pathological confirmed are relatively common in Tibet.P504s and E-cadherin are highly expressed in prostate adenocarcinoma patients in Tibet,while ERG presents low expression,ER is unexpressed.

Diagnostic utility of immunohistochemical marker prostein for evaluation of primary and metastatic prostatic carcinomas

Context: The diagnosis of prostatic adenocarcinoma on histopathology depends on architectural and cytomorphological features supported by immunohistochemistry (IHC). Though all the prostate markers show excellent specificity, the sensitivity and percentage positivity vary. Aims: In this study, we aim to study the expression of prostein in normal, benign, and malignant (primary and metastatic) lesions with particular emphasis on its utility in the differential diagnosis of poorly differentiated and metastatic prostatic adenocarcinoma along with a standard panel of IHC markers. Settings and Design: This was both a prospective and retrospective as well as descriptive and observational study. Subjects and Methods: All samples from patients with clinically suspected carcinoma prostate from both primary and metastatic sites from June 2015 to May 2016 were included in the study. Samples with difficulty in diagnosis on hematoxylin and eosin staining were subjected to a panel of IHC markers along with prostein. Statistical Analysis Used: Receiver operating curve analysis and Chi-square test. Results: Prostein showed a 100% sensitivity and specificity to identify normal prostatic epithelium, benign and premalignant lesions, and prostatic adenocarcinoma. Prostein showed a specificity of 100% in differentiating prostatic carcinoma from poorly differentiated urothelial carcinoma and in differentiating metastatic prostatic carcinoma from adenocarcinoma of nonprostatic origin. Conclusions: Prostein is a new and promising prostate-specific marker that showed slightly more sensitivity and specificity than prostate-specific antigen. Thus, adding prostein to the IHC panel will greatly improve the detection of poorly differentiated primary and metastatic lesions of the prostate.

Identification and functional analysis of pathogenic genes and key transcription factors in prostate adenocarcinoma / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To investigate the pathogenesis of prostate cancer by analyzing the associated hub gene modules of prostate cancer and identifying key transcription factors and genes that affect these modules. Methods: WGCNA (weighted gene co-expressed network analysis) was used to identify hub gene modules associated with important clinicopathological features of prostate cancer, such as pathological staging, Gleason grading etc. The OPOSSUM online tool was used to analyze the transcription factors enriching and regulating those genes. Pathway enrichment analysis and protein-protein interaction network analysis were used to identify key genes in prostate cancer. Finally, the effects of these genes on clinical features and disease-free survival (DFS) of prostate cancer patients were analyzed. Results: Three hub modules were identified, and they were highly associated with pathologic T stage, pathologic N stage and Gleason grading of prostate cancer, respectively. Further screening revealed 13 key dysregulated transcription factors that participated in the regulation of these three hub modules. The differentially expressed genes regulated by the 13 key transcription factors were significantly enriched in Calcium signaling pathway, cGMP-PKG signaling pathway and cAMP signaling pathway. 14 key genes (PRKG1, PRKG2, CYSLTR2, GRPR, CHRM3, ADCY5, ADRA1D, EDNRA, EDNRB, CYSLTR2, AGTR1, GRPR, GRIA1 and OXT) were at important nodes in the gene network. Among them, the high expression of ADRA1A, PRKG2, CHRM3, ADRA1D and EDN3 significantly extended the DFS of patients with prostate cancer (all P<0.01). Conclusion: ADRA1A, PRKG2, CHRM3, ADRA1D and EDN3 are regulated by key dysregulated transcription factors and highly associated with clinical features of prostate cancer. Their high expressions will significantly prolong the DFS of prostate cancer patients, which may shed light to the discovery of mechanism in prostate adenocarcinoma.

Histomorphological study of prostatic adenocarcinoma and its mimics

Context: Prostate adenocarcinoma (PC) is one of the common cancers in India and world over. Numerous prostatic, nonprostatic lesions, and normal structures can be very similar to adenocarcinoma. A pathologist's awareness of the benign mimics is important for the diagnosis of PC. Aim: The aim of this study was to determine the prevalence, clinical, and histopathological features of PC, and its common mimics, and to study the criteria for their distinction from PC. Materials and Methods: A prospective study of histopathological features of radical prostatectomy and transurethral resection of the prostate specimens, sent to the department of pathology in a medical college, for a period of 2 years was done. A brief clinical history followed by a clinical examination, including per-rectal findings and serum prostate-specific antigen (PSA) levels, was noted. Results: After excluding all the cases of benign hyperplasia of prostate without any associated findings, 50 cases of operated surgical specimens of prostate were studied. PC was the most frequent diagnosis in 28 patients of 50 cases (56.0%). Basal cell hyperplasia formed the predominant mimic (26.0%), followed by prostatic intraepithelial neoplasia (8%), prostate atrophy (4%), clear-cell cribriform hyperplasia(4%),, and one case of atypical adenomatous hyperplasia (2%). Serum PSA was >4 ng/mL in all the cases of PC. In three of the mimics, PSA was >4 ng/mL and in the rest it was <4 ng/mL. Immunohistochemistry (IHC) was not applied in our study. Conclusion: Biopsy still remains a gold standard for diagnosis of PC and its mimics. All the lesions in the above study were diagnosed on routine hematoxylin and eosin staining. IHC is useful especially for lesions in the grey zone but not in routine histopathological study and should not be used as a screening test but should be applied in specific selected cases only.

Spectrum of prostate gland lesions: a clinico-pathologic study in south-western Bihar, India

Background: Prostate gland is an endocrine dependent organ in males and age-related lesions involve it. Inflammation, benign nodular hyperplasia and tumours are the commonest to involve it worldwide. Occasionally some other pathological changes can also involve it. The study was carried out for the first time to know the spectrum and prevalence of prostate lesions which will be of help to the clinicians in this location.Methods: Retrospective study was carried out for a period of four years and out of surgical cases of males which underwent operative procedure, prostate cases were retrieved and in the department of pathology, haematoxylin and eosin stained slides were evaluated and diagnosed.Results: A total of 138 cases were included and five cases were excluded from this series. Benign nodular hyperplasia (73.9%) was the commonest finding followed by chronic prostatitis associated with hyperplasia (15.2%), atypical glandular hyperplasia (2.9%) and prostatic intraepithelial neoplasia (2.1%). Malignant tumours were 5.8% constituting adenocarcinoma prostate as the most common (62.5%). A case of hemangiopericytoma was also diagnosed.Conclusions: Benign nodular hyperplasia of prostate is the most common affliction among males starting at age 45 years. Early consultation and screening will be of immense value. Adenocarcinoma prostate may involve at age around 58 years.

Adenocarcinoma of the Prostate Presenting as a Soft Tissue Metastasis: A Case Report and Review of Literature

Metastasis is the most frequent cause of mortality in cancer patients and symptoms related to a secondary deposit are a common form of presentation in malignancies. Cancers of the prostate commonly present with metastasis to the vertebrae, and less commonly to the lungs and liver. Metastasis to soft tissue is extremely rare and a highly unlikely form of presentation. However, with rising cancer rates in the developing world, secondary tumors should be excluded when soft tissue masses are encountered

Gleason scores in prostate needle biopsy and prostatectomy specimens in prostatic adenocarcinoma: A correlation study

@#Introduction: Gleason scoring (GS) categorised prostatic adenocarcinoma into five prognostic grade groups (PGGs); associated with different prognosis and treatment. This study aims to correlate between Gleason scores of needle biopsies with the corresponding total prostatectomy specimens, and to assess the relationship between the percentage of Gleason 4 tumour pattern (GP4) within Gleason score 7 (GS7) needle biopsy groups with the pathological staging. Materials and Methods: Seventy-eight specimens of needle prostate biopsy and its subsequent radical prostatectomy were retrospectively studied. The GSs of the needle biopsy were compared with the corresponding prostatectomy specimens. The percentage of GP4 in GS7 needle biopsy groups was calculated and correlated with the pathological staging. Results: More than half (60%) of GS 6 needle biopsy cases (PGG 1) were upgraded in the prostatectomy specimen, while the majority (80%) of the GS7 needle biopsy groups (PGG 2 and 3) remain unchanged. Cohen’s Kappa shows fair agreement in the Gleason scoring between needle biopsies and prostatectomy specimens, K = 0.324 (95% CI, 6.94 to 7.29), p <0.0005 and in the percentage of GP4 in GS7 needle biopsy groups and their corresponding radical prostatectomy specimens, K = 0.399 (95% CI 34.2 – 49.2), p<0.0005. A significant relationship was seen between the percentage of GP4 in GS7 needle biopsy with the pT and pN stage of its radical prostatectomy (p = 0.008 and p=0.001 respectively). Conclusion: A higher percentage of GP4 in GS7 tumour is associated with worse tumour behaviour, therefore it is crucial for clinicians to realise this in deciding the optimal treatment.

Coexisting prostate adenocarcinoma with multiple myeloma: A rare case report

We report a rare case of an 83-year-old male with synchronous occurrence of prostate adenocarcinoma and multiple myeloma. He presented with lower back pain and incontinence of urine for the past 6 months. Routine hematological and biochemical investigations were performed which pointed toward prostate adenocarcinoma. Transrectal ultrasonography and magnetic resonance imaging showed prostatomegaly along with osteolytic lesions in the skull and vertebrae. Prostate biopsy was performed and adenocarcinoma was confirmed. To rule out metastatic deposits in the bone and to rule out bone marrow infiltration, bone marrow aspiration and biopsy of the patient was done, and unexpectedly, it showed multiple myeloma. The association between these two disorders is poorly understood, but some studies show that bone marrow microenvironment plays an important role.

Robotic radical prostatectomy experience of a single practitioner at and beyond the learning curve

OBJECTIVE@#To determine the proficiency of a single Urological Oncologist in performing RoboticRadical Prostatectomy (RRP) for localized prostate adenocarcinoma based on the following surgicaland functional outcomes: 1) operative time, 2) estimated blood loss, 3) positive surgical margin rate,4) postoperative complication rate, 5) open conversion rate, and 6) urinary continence rate.@*MATERIALS AND METHODS@#The authors reviewed the records of a single Urological Oncologist fromJanuary 2010 to September 2017 for patients who underwent RRP for prostate adenocarcinoma.Patients were divided into 3 groups: Group 1 consisted of the first 30 cases done by the surgeon,Group 2 consisted of the next set of 30 cases, and Group 3 consisted of his cases done thereafter. Themean operative time, mean estimated blood loss, positive surgical margin rate, site of positive surgicalmargins (apex, midgland, or base), postoperative complication rate, open conversion rate, and urinarycontinence rate at 4, 8, and 12 weeks post-op were compared among the 3 groups.@*RESULTS@#A total of 30 patients were included in Group 1, another 30 were included in Group 2, and 45patients were included in Group 3 for a total of 105. There is significant difference in the meanoperative times among the 3 groups with a Group 1 having a mean operative time of 302.1 minutes,170.3 minutes for Group 2, and 146.7 minutes for Group 3 (p<0.0001.) There is a statisticallysignificant difference in mean estimated blood loss among the 3 groups (706.9 mL, 528.2 mL and386.3 mL, respectively; p<0.0001.) No open conversion was performed in all 105 patients and only3 complications were noted in this study. There was no statistical significance with regards to positivesurgical margin rates among the 3 groups (5.7%, 11.4% and 15.2%, respectively.) with the apex beingthe most common site of positive margin in this study. There is a statistically significant difference in8-week urinary continence rate among the 3 groups (12.4%, 20% and 36.2%, respectively; p=0.005).@*CONCLUSION@#Robotic Radical Prostatectomy is quickly becoming a feasible and safe option in themanagement of localized and locally-advanced prostate cancer in the local setting. The learningcurve of 30 cases, based on the experiences of the Urological Oncologist, is sufficient in establishingproficiency in performing the said procedure.

Yes-Associated Protein Expression Is Correlated to the Differentiation of Prostate Adenocarcinoma

BACKGROUND: Yes-associated protein (YAP) in the Hippo signaling pathway is a growth control pathway that regulates cell proliferation and stem cell functions. Abnormal regulation of YAP was reported in human cancers including liver, lung, breast, skin, colon, and ovarian cancer. However, the function of YAP is not known in prostate adenocarcinoma. The purpose of this study was to investigate the role of YAP in tumorigenesis, differentiation, and prognosis of prostate adenocarcinoma. METHODS: The nuclear and cytoplasmic expression of YAP was examined in 188 cases of prostate adenocarcinoma using immunohistochemistry. YAP expression levels were evaluated in the nucleus and cytoplasm of the prostate adenocarcinoma and the adjacent normal prostate tissue. The presence of immunopositive tumor cells was evaluated and interpreted in comparison with the patients’ clinicopathologic data. RESULTS: YAP expression levels were not significantly different between normal epithelial cells and prostate adenocarcinoma. However, YAP expression level was significantly higher in carcinomas with a high Gleason grades (8–10) than in carcinomas with a low Gleason grades (6–7) (p < .01). There was no statistical correlation between YAP expression and stage, age, prostate-specific antigen level, and tumor volume. Biochemical recurrence (BCR)–free survival was significantly lower in patients with high YAP expressing cancers (p = .02). However high YAP expression was not an independent prognostic factor for BCR in the Cox proportional hazards model. CONCLUSIONS: The results suggested that YAP is not associated with prostate adenocarcinoma development, but it may be associated with the differentiation of the adenocarcinoma. YAP was not associated with BCR.

Prostate adenocarcinoma mandibular metastasis associated with numb chin syndrome: a case report

The purpose of this study is to report a rare case of mandibular adenocarcinoma that was diagnosed due to metastasis from the prostate. Numb chin syndrome (NCS), which was associated with this case, is also discussed. Computed tomography (CT) and an intraoral incisional biopsy of the left mandibular area were performed. Urology consultation, hormone therapy, chemotherapy and follow-up radiographic images were administered. Histological examination of the incised specimen revealed moderately differentiated adenocarcinoma. The Gleason score was 8 (primary 4/secondary 4). Immunohistochemical features and radiographic results confirmed the diagnosis of metastasis from prostate adenocarcinoma, moderately differentiated. The patient's prostate-specific antigen (PSA) level was very high. After hormone treatment, the patient's PSA levels dropped gradually. Seventeen months later, in May 2015, the PSA level was elevated. The 18-month follow-up CT image indicated that the patient's condition was aggravated. Docetaxel chemotherapy was started in June 2015 (18 months later), and the sixth cycle of the therapy is in progress. Oral metastases that originate from prostate adenocarcinoma are rare and can induce various periosteal reactions. Hormone therapy, chemotherapy and close follow-up could be additional, appropriate treatment, and were applied in this case. Finally, NCS is a valuable indicator of metastatic disease in the mandible.

Assessment of risk factors for prostatic tumor invasion in patients undergoing radical cystectomy / 中华泌尿外科杂志

Objective To identify the risk factors for prostate-sparing cystectomy by evaluating the risk of prostatic invasion or incidental prostatic adenocarcinoma (PCa) in bladder cancer (BCa) patients undergoing radical cystectomy.Methods The patients undergoing radical cystectomy from 2009 to 2014 in Fujian Medical University Union Hospital were enrolled to analyze the risk factors of prostatic tumor invasion.These factors included age,tumor size,location,quantity,histologic grade and pathologic stage.Results In the 123 male patients,the mean age was 60 years (range,31-78 years);23 (18.7％) patients had BCa or PCa in the prostate;14 (11.4％) had prostatic Bca;11 (8.9％) had PCa.The risk factors of prostatic BCa included multifocal bladder tumors (OR =26.70,P =0.032),tumor in the bladder neck and trigone(OR =17.13,P =0.013),pathological stage (OR =26.70,P ＜ 0.001).Among the 11 patients with PCa,3(27.3％) patients had Gleason score of ≥7,8(72.7％) patients ≤6 and 2(18.2％) patients had extracapsular extension.Three patients had clinically significant PCa.The factor of advanced age was associated with incidental PCa (P =0.003).Conclusion The risk factors of prostatic tumor invasion in patients undergoing radical cystectomy included advanced age,bladder tumor in bladder neck and trigone,muhifocal bladder tumors,and advanced pathological stage.

Triple cancer: chronic lymphocytic leukemia with bladder and prostate carcinoma

B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a common lymphoproliferative disorder with an increased risk of developing subsequent neoplasms of epithelial and mesenchymal origin. The decreased immunity and B-cell dysfunction in CLL probably accounts for this emergence of second malignancies. We report a case of synchronous bladder transitional cell carcinoma (TCC) and prostatic carcinoma with CLL. A 74-year-old male who underwent transurethral resection of the prostate (TURP) for benign prostatic hyperplasia 2 years before, presented with recurrent urinary tract infection. Peripheral blood smear revealed leukocytosis with absolute lymphocytosis (absolute lymphocyte count: 37870 cells/mm3). Flow cytometric immunophenotyping revealed 75% abnormal lymphoid cells which were positive for CD 19, CD5, CD23, CD22, CD200, CD20 (moderate) with lambda light chain restriction and negative for CD3, CD10, FMC7, CD38, CD138, IgM, CD103, CD123. 18 F Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) showed increased metabolic activity of the left lateral wall of the urinary bladder extending to the left UV junction, adjacent part of trigone and bladder neck region along with multiple heterogeneous enhancing areas with increased FDG avidity within the prostate. Transurethral resection of the bladder tumour by cystoscopy was performed. Histopathology showed high grade, muscle invasive urothelial carcinoma. Due to presence of uptake in the prostate, transurethral resection of the prostate was done and histopathology revealed adenocarcinoma of prostate (prostate specific antigen- positive), Gleason grade III+III and Gleason score 6. A high index of suspicion is required to detect synchronous and metachronous malignancies. Ancillary studies such as immunohistochemistry, flow cytometry and PET/CT are often essential for detection and an accurate diagnosis.

Five-year follow up of prostate adenocarcinoma patients treated with interstitial high dose rate brachytherapy monotherapy, a single-center experience

OBJECTIVE: Prostate cancer is the most common cancer in men and localized prostate adenocarcinoma has multiple treatment options. In this study, the objective was to review the outcome of patients that were treated with HDR brachytherapy as monotherapy in all prostate adenocarcinoma patients at the St Luke's Medical Center. MATERIALS AND METHODS: Thirty three (33) patients who underwent HDR prostate brachytherapy as monotherapy for prostate adenocarcinoma in a single institution for the past 5 years received 38 Gy in 4 fractions. The charts of these patients were reviewed to determine biochemical control using the Phoenix criteria and ASTRO definition, and toxicity. RESULTS: Patients showed good biochemical control, with 92.16% meeting the target PSA value of 2 ng/mL or less and a 96.51% without consecutive rise of PSA post brachytherapy. There was also minimal toxicity, with no report of gastrointestinal toxicity and 9.1% rate of temporary genitourinary toxicity. CONCLUSION: Good biochemical control of prostate adenocarcinoma was achieved with the use of HDR brachytherapy as monotherapy, with a minimal toxicity profile.

Realidad actual del screening para cáncer de próstata: ¿se llevan a cabo las recomendaciones? / Current reality of the screening for prostate cancer: are we carrying out the recommendations?

INTRODUCCIÓN: El cáncer de próstata es la segunda causa de muerte por cáncer en hombres, al igual que en países desarrollados. A pesar de la alta prevalencia y mortalidad, no existen programas de amplia cobertura para detección precoz en la población masculina. OBJETIVO: Determinar la prevalencia del tamizaje para cáncer de próstata en hombres de diversos centros de salud de Santiago de Chile. METODOLOGÍA: Encuesta dirigida a hombres mayores o igual de 40 años que consultaron a centros de salud por causas no urológicas. Se preguntó respecto a edad, realización de exámenes de detección de cáncer de próstata e inicio de controles para pesquisa. RESULTADOS: Respondieron a la encuesta 517 hombres, con una edad promedio de 59 años. Un 50,3 por ciento de los encuestados refirieron haber tenido control para detección de cáncer de próstata alguna vez en su vida. Se observó una mayor proporción de pacientes controlados en un centro de alto nivel socioeconómico de la ciudad, y de un Hospital, en comparación a otros 3 centros. La mayor parte de los controlados tenían más de 60 años, y sólo un tercio inició los controles antes de los 50 años. Finalmente, sólo un 50 por ciento de los controlados se habían realizado tanto medición de antígeno prostático específico como el examen digital rectal. CONCLUSIÓN: La cobertura del screening para cáncer de próstata es baja en la población masculina de Santiago de Chile. Además, la mayor parte de los pacientes inician los controles a edades tardías.

BACKGROUND: In Chile, prostate cancer is the second leading cause of cancer death in men, similar to developed countries. Despite the high prevalence and mortality, there are no established screening programs for early detection. AIM: To evaluate the prevalence of the prostate cancer screening method in different centers of Santiago. MATERIALS AND METHODS: A questionnaire was applied to men 40 years or older to determine age, performing some prostate screening, age at first screening, and which type of screening has been performed. RESULTS: The questionnaire was answered by 517 men, mean age 59 years. 50,3 percent reported had control for detection of prostate cancer at least one time in their life. A higher proportion of patient controlled was observed in a high socioeconomic center of the city and a hospital, compared to other 3 centers. Most of the controlled were over 60 years, and only one third of the controlled started before 50 age. Finally, only 50 percent had done prostate specific antigen plus digital rectal examination. CONCLUSION: The screening for prostate cancer is low in the male population of Santiago de Chile. Furthermore, most patients stars controls at later ages.

Comparação do escore de Gleason da biópsia prostática com o da peça cirúrgica em pacientes com câncer de próstata / Comparison of Gleason score of prostatic biopsy with surgical specimen in patients with prostate cancer

JUSTIFICATIVA E OBJETIVOS: O escore de Gleason da biópsia prostática transretal representa um dos métodos prognósticos mais importantes na avaliação dos cânceres de próstata, permitindo a indicação terapêutica mais adequada. O objetivo deste estudo foi comparar os valores do escore de Gleason obtidos na biópsia com os valores da peça cirúrgica a fim de obter valores a respeito do grau de concordância entre os dois métodos diagnósticos. MÉTODO: Foram estudados retrospectivamente os prontuários de 70 pacientes com diagnóstico anatomopatológico de adenocarcinoma prostático que foram submetidos à prostatectomia, atendidos em clínica de Oncologia na cidade de Salvador-BA, no período de 1998 a 2009. Os dados foram analisados pelo software SPSS 19.0. Foi utilizado o teste Kappa para avaliar a concordância entre os escores de Gleason da biópsia prostática transretal e aqueles da peça cirúrgica. RESULTADOS: A idade média dos pacientes foi 61,61 anos ± 7,25. O antígeno prostático específico (PSA) total pré-operatório teve média de 7,32 ng/mL ± 4,57. O escore de Gleason mais frequente foi 6, tendo 49 pacientes apresentado este valor à biópsia e 44 pacientes no espécime cirúrgico, 70% e 62,86%, respectivamente. Trinta e nove pacientes (55,71%) tinham Gleason 6(3+3) à biópsia e mantiveram o escore na peça cirúrgica. Houve concordância em 72,86% dos casos, subgradação em 21,43% e supergradação em 5,71%. O teste Kappa foi igual a +0,505 e o valor de p foi < 0,01. CONCLUSÃO: Ao comparar os resultados histológicos da biópsia prostática com os da peça cirúrgica, obteve-se concordância de 72,86%, com Kappa igual a +0,505; p < 0,01.

BACKGROUND AND OBJECTIVES: Gleason score of transrectal prostate biopsy is one of the most important prognostic methods in the evaluation of prostate cancers, allowing the most appropriate therapeutic indication. Our aim is to compare Gleason score values in biopsies with surgical specimens in order to obtain values about the degree of agreement between the two diagnostic methods. METHOD: We studied retrospectively 70 patients with anatomopathological diagnosis of prostatic adenocarcinoma who underwent prostatectomy in an Oncology clinic in the city of Salvador, in the state of Bahia, within 1998 to 2009. Data were analyzed by SPSS 19.0 software. Kappa was used to evaluate the agreement between Gleason scores of transrectal prostate biopsy and those of the surgical specimen. RESULTS: The average age of patients was 61.61 years ± 7.25. The preoperative prostatic specific antigen (PSA) had an average of 7.32 ng/mL ± 4.57. The most common Gleason score was 6. Forty-nine patients presented this score at the time of biopsy and 44 patients in surgical specimens (70% and 62.86% respectively). Thirty-nine patients (55.71%) had Gleason 6 (3+3) at the time of biopsy and the value remained the same in the surgical specimen. There was agreement in 72.86% of cases. We found underestimation in 21.43% and overestimation in 5.71%. Kappa was equal to +0.505 and the p value was < 0.01. CONCLUSION: When comparing the histological results of prostate biopsy with the surgical specimen we found agreement of 72.86%, with Kappa equal to +0,505, p < 0.01.

Bilateral Candida albicans Endophthalmitis after Robot-Assisted Laparoscopic Radical Prostatectomy in a Patient with Prostate Adenocarcinoma

PURPOSE: To report a case of bilateral Candida albicans endophthalmitis after robot-assisted laparoscopic radical prostatectomy (RALP) in a patient with prostate adenocarcinoma. CASE SUMMARY: A 61-year-old male patient had RALP for prostate adenocarcinoma. Four days after the surgery, the patient had a fever and pancytopenia. Two weeks after the surgery, the patient complained of decreased visual acuity in both eyes. Best-corrected visual acuity (BCVA) was counting fingers at 60 cm in the right eye and 20/63 in the left eye. The fundus examination showed vitreous opacity and yellow circumscribed chorioretinal lesions in both eyes. The blood and urine cultures were negative. An intravitreal voriconazole injection (100 microg/0.1 ml) was given in both eyes. However, the vitritis worsened, and BCVA decreased to counting fingers at 30 cm in the right eye and 60 cm in the left eye. Thus, combined phacoemulsification and 23-gauge microincisional vitrectomy surgery with a silicone oil injection was performed in both eyes at 1-week intervals. The vitrectomy sample culture was positive for Candida albicans in both eyes. Four months after the vitrectomy, BCVA was 20/100 in both eyes without subretinal lesions. CONCLUSIONS: Clinicians should be aware that bilateral Candida albicans endophthalmitis could be complicated by RALP in a patient with prostate adenocarcinoma or with other risk factors.

Initial Clinical Experience of Simultaneous Robot-Assisted Bilateral Partial Nephrectomy and Radical Prostatectomy

A 62-year-old male patient with prostate cancer and bilateral renal cell carcinoma underwent a simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. We describe our initial experience of combined operation with a port strategy allowing reuse of ports and surgical considerations because of prolonged pneumoperitoneum.

A Case of Bullous Pemphigoid Associated with Prostate Adenocarcinoma / 대한피부과학회지

The presence of various cutaneous disorders may reflect the occult internal malignancy. Bullous pemphigoid (BP), a common autoimmune skin disease, is characterized by the presence of subepidermal blisters. The association of bullous pemphigoid with internal malignant neoplasm has occasionally been reported. However, the relationship of bullous pemphigoid and malignancy is still controversial; the evidence for this association is increasing. Here, we report a rare case of a bullous pemphigoid associated with prostate adenocarcinoma.