Vigilancia activa en cáncer de próstata en un grupo de pacientes asistidos en el Centro Docente Asociado de Oncología Médica Rivera: Cooperativa Médica de Rivera (COMERI) / Active surveillance in prostate cancer in a group of patients assisted at the Rivera Associated Teaching Center for Medical Oncology: Rivera Medical Cooperative (COMERI) / Vigilância ativa do câncer de próstata em um grupo de pacientes atendidos no Rivera Associated Teaching Center for Medical Oncology: Rivera Medical Cooperative (COMERI)

Introducción: En Uruguay el cáncer de próstata ocupa el primer lugar en incidencia y el tercer lugar en mortalidad en el hombre. La mayoría de estos cánceres se diagnostican en estadios precoces. Hoy en día, para pacientes con adenocarcinoma de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, la vigilancia activa es una opción adecuada. Objetivos: Describir una población de pacientes con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, en vigilancia activa en COMERI. Material y métodos: Estudio descriptivo, observacional, retrospectivo. Se incluyeron pacientes con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, tratados entre 2010 y 2018 en COMERI. Se recopilaron datos en el sistema de registro clínico electrónico. Resultados: Se incluyeron 33 pacientes, la mediana de edad al diagnóstico fue de 74 años. Todos los pacientes fueron sometidos a controles clínicos y determinación de PSA cada 3 meses. El tacto rectal se realizó en forma anual. El tiempo mediano de vigilancia activa fue de 33 meses. Durante el seguimiento, se observaron pocas variaciones en los valores de PSA. El 21% de los pacientes fue sometido a una nueva biopsia durante el seguimiento activo, y en todos los casos, el Gleason se mantuvo incambiado. Ningún paciente abandonó la modalidad de vigilancia activa. Conclusión: En nuestro entorno, la vigilancia activa se considera una opción terapéutica válida para pacientes altamente seleccionados con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, y es bien aceptada por ellos.

Introduction: In Uruguay, prostate cancer ranks first in incidence and third in mortality among men. The majority of these cancers are diagnosed at early stages. Nowadays, active surveillance is an appropriate option for patients with adenocarcinoma of very low risk, low risk, or favorable intermediate risk. Objectives: To describe a population of patients with prostate cancer of very low risk, low risk, or favorable intermediate risk under active surveillance at COMERI. Materials and Methods: Descriptive, observational, retrospective study. Patients with prostate cancer of very low risk, low risk, or favorable intermediate risk treated between 2010 and 2018 at COMERI were included. Data were collected from the electronic clinical registry system. Results: Thirty-three patients were included, with a median age at diagnosis of 74 years. All patients underwent clinical monitoring and PSA determination every 3 months. Digital rectal examination was performed annually. The median time of active surveillance was 33 months. During follow-up, there were few variations in PSA values. 21% of patients underwent a repeat biopsy during active surveillance, and in all cases, the Gleason score remained unchanged. No patient discontinued active surveillance. Conclusion: In our setting, active surveillance is considered a valid therapeutic option for highly selected patients with prostate cancer of very low risk, low risk, or favorable intermediate risk, and it is well accepted by them.

Introdução: No Uruguai, o câncer de próstata ocupa o primeiro lugar em incidência e o terceiro lugar em mortalidade entre os homens. A maioria desses cânceres é diagnosticada em estágios precoces. Atualmente, para pacientes com adenocarcinoma de risco muito baixo, baixo risco ou risco intermediário favorável, a vigilância ativa é uma opção adequada. Objetivos: Descrever uma população de pacientes com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável sob vigilância ativa em COMERI. Material e métodos: Estudo descritivo, observacional, retrospectivo. Foram incluídos pacientes com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável, tratados entre 2010 e 2018 em COMERI. Os dados foram coletados no sistema de registro clínico eletrônico. Resultados: Foram incluídos 33 pacientes, com mediana de idade no diagnóstico de 74 anos. Todos os pacientes foram submetidos a controles clínicos e determinação de PSA a cada 3 meses. O toque retal foi realizado anualmente. O tempo médio de vigilância ativa foi de 33 meses. Durante o acompanhamento, houve poucas variações nos valores de PSA. 21% dos pacientes foram submetidos a uma nova biópsia durante a vigilância ativa, e em todos os casos, o Gleason permaneceu inalterado. Nenhum paciente abandonou a modalidade de vigilância ativa. Conclusão: Em nosso ambiente, a vigilância ativa é considerada uma opção terapêutica válida para pacientes altamente selecionados com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável, e é bem aceita por eles.

Relation between Delay Time to Surgical Treatment of Prostate Cancer and Disease Recurrence Risk / Relação entre Tempo de Atraso no Tratamento Cirúrgico do Câncer de Próstata e Risco de Recorrência da Doença

De acordo com a literatura, não há consenso sobre um tempo de atraso razoável desde o diagnóstico até a operação da prostatectomia radical (PR) sem piora do prognóstico. Objetivo: Avaliar a influência desse tempo no risco de recorrência da doença em pacientes com adenocarcinoma acinar da próstata tratados com PR. Método: Quatrocentos e doze pacientes submetidos à PR foram avaliados retrospectivamente. Destes, 172 foram excluídos por dados incompletos e outros 28, por estadiamento pré- -operatório como câncer de próstata de alto risco (PSA > 10 ng/mL ou escore de Gleason na biópsia > 7). Os estadiamentos pré e pós-operatórios foram comparados, e a análise de sobrevida feita pelo método de Kaplan-Meier para examinar a influência do tempo na discordância entre os estadiamentos pré e pós-operatórios. Resultados: Para os 212 pacientes da amostra, o tempo médio desde o diagnóstico até a PR foi de 176,1 ± 120,2 dias (mediana de 145,5 dias), variando de 29 a um máximo de 798 dias. A curva de Kaplan-Meier indicou que o câncer piorava quanto maior o atraso entre o diagnóstico e a operação. Pacientes submetidos à cirurgia dentro de 60 dias tiveram cerca de 95% de probabilidade de não aumentarem o risco inicial de recorrência. Esse número caiu para 80%, 70% e 50% nos pacientes operados em até 100, 120 e 180 dias, respectivamente. Conclusão: O atraso na realização da PR representa risco contínuo de recorrência da neoplasia. O tempo ideal para PR é de até 60 dias a partir da biópsia da próstata, uma vez que a probabilidade de upstaging é inferior a 5% nesse período.

There is no consensus in the literature on a reasonable delay time from diagnosis to radical prostatectomy (RP) surgery, without worsening the prognosis. Objective: To evaluate the influence of the delay on the risk of disease recurrence in patients with acinar adenocarcinoma of the prostate treated with RP. Method: Four hundred and twelve patients undergoing RP were retrospectively evaluated. Of these, 172 were excluded due to incomplete data and another 28 due to preoperative staging as high-risk prostate cancer (PSA > 10 ng/mL or Gleason score on biopsy > 7). Pre-and postoperative stagings were compared and survival analysis was performed using the Kaplan-Meier method to investigate the influence of time on discordance between pre- and postoperative stagings. Results:For the 212 patients of the sample, the average time from diagnosis to RP was 176.1 ± 120.2 days (median 145.5 days), ranging from 29 to a maximum of 798 days. The Kaplan-Meier curve indicated that the cancer worsened the longer the delay between diagnosis and surgery. Patients undergoing surgery within 60 days had an approximately 95% probability of not increasing the initial risk of recurrence. This number fell to 80%, 70% and 50% in patients operated on up to 100, 120 and 180 days, respectively. Conclusion:Delay in performing RP represents a continuous risk of relapse. The ideal time for RP is up to 60 days from prostate biopsy, as the probability of upstaging is less than 5% in this period

Según la literatura, no existe consenso sobre un tiempo razonable de retraso desde el diagnóstico hasta la cirugía de prostatectomía radical (PR), sin empeorar el pronóstico. Objetivo: Evaluar la influencia de este tiempo sobre el riesgo de recurrencia de la enfermedad en pacientes con adenocarcinoma acinar de próstata tratados con PR. Método: Se evaluaron retrospectivamente 412 pacientes sometidos a PR. De ellos, 172 fueron excluidos por datos incompletos y otros 28 por estadificación preoperatoria como cáncer de próstata de alto riesgo (PSA > 10 ng/mL o puntuación de Gleason en la biopsia > 7). Se compararon las estadificaciones pre y posoperatorias y se realizó un análisis de supervivencia utilizando el método de Kaplan-Meier para examinar la influencia del tiempo en la discordancia entre las estadificaciones pre y posoperatorias. Resultados: Para los 212 pacientes de la muestra, el tiempo promedio desde el diagnóstico hasta la PR fue de 176,1 ± 120,2 días (mediana 145,5 días), oscilando entre 29 y 798 días. La curva de Kaplan-Meier indicó que el cáncer empeoraba cuanto mayor era el retraso entre el diagnóstico y la cirugía. Los pacientes sometidos a cirugía dentro de los 60 días tenían aproximadamente un 95% de probabilidad de no aumentar el riesgo inicial de recurrencia. Esta cifra cayó al 80%, 70% y 50% en los pacientes operados hasta 100, 120 y 180 días, respectivamente. Conclusión: El retraso en la realización de la PR representa un riesgo continuo de restablecimiento de la neoplasia. El momento ideal para la PR es hasta los 60 días desde la biopsia de próstata, ya que la probabilidad de upstaging es inferior al 5% en este periodo.

Intervención educativa sobre el examen y autoexamen de próstata en pacientes mayores de 45 años / Educational Intervention on Prostate Examination and Self-Examination in Patients older than 45

Introducción: El examen físico mediante el tacto rectal es una manera de encontrar temprano el cáncer de próstata. Aunque este resulta de suma importancia en las pesquisas, tiene poca aceptación debido a los tabúes arraigados en la sociedad. Por tanto, es necesario educar a la población masculina. Objetivo: Elevar el nivel de conocimientos sobre el examen y autoexamen de próstata en pacientes mayores de 45 años. Métodos: Se realizó un estudio cuasiexperimental de intervención educativa en un universo constituido por 62 pacientes mayores de 45 años pertenecientes al Policlínico Docente Área Este, de la ciudad de Camagüey. La muestra quedó conformada por 55 pacientes que cumplieron con los criterios de selección del estudio. Se analizaron las variables grupo de edades, nivel educacional; así como los conocimientos sobre las características generales del cáncer de próstata, prevención y control de los factores de riesgo, examen y autoexamen de próstata, antes y después de aplicada la intervención educativa. Resultados: En la muestra analizada predominaron los pacientes de entre 45-49 años (30,9 por ciento) y el nivel educacional técnico medio (43,6 por ciento), mientras se logró elevar el conocimiento en relación a las características generales del cáncer de próstata (40,0/94,6 por ciento), prevención y control de los factores de riesgo (20,0/92,7 por ciento), y de 7,3/87,3 por ciento en lo concerniente al examen y autoexamen de próstata. Conclusiones: Se alcanzaron valores estadísticamente significativos, de manera que se logró elevar el nivel de conocimientos en la muestra estudiada(AU)

Introduction: Examination by digital rectal examination is a way to early find prostate cancer. Although this examination is utmost important in the investigations, it has little acceptance due to the taboos rooted in society. In this sense, it is necessary to educate the male population. Objective: To raise the level of knowledge about prostate examination and self-examination in patients older than 45 years of age. Methods: A quasi-experimental study of educational intervention was carried out in a universe consisting of 62 patients older than 45 years of age from Área Este Teaching Polyclinic, in the city of Camagüey. The sample was made up of 55 patients who met the study selection criteria. The variables were analyzed age group, educational level; as well as knowledge about the general characteristics of prostate cancer, prevention and control of risk factors, prostate examination and self-examination before and after the educational intervention is applied. Results: In the studied sample, patients between 45-49 years of age (30.9percent) and the average technical educational level (43.6percent) predominated, while knowledge was raised in relation to the general characteristics of prostate cancer (40.0/94.6percent), prevention and control of risk factors (20.0/92.7percent), and 7.3/87.3percent regarding prostate examination and self-examination. Conclusions: Statistically significant values were reached, so that the level of knowledge was raised in the sample studied(AU)

Humoral and Cellular Immunology in Human Prostate Cancer: Plasma Cells and T and B Lymphocytes / Inmunología Humoral y Celular en el Cáncer de Próstata Humano: Células Plasmáticas y Linfocitos T y B

SUMMARY: In solid and malignant tumors, innate and adaptive immunity are combined in antitumor responses. This study aimed to analyze the activation of plasma cells and the correlation between the infiltration of B and T lymphocytes with the degree of malignancy or Gleason grade in human prostate biopsies diagnosed with cancer. Prostate cancer biopsies were obtained from the Clinical Hospital of Universidad de Chile (n=70), according to the bioethical norms of the institution. Histological sections of 5µm thickness were processed for immunohistochemistry with primary antibodies against BL and total TL (HRP/DAB). Recognition and quantification were performed under a Leica DM750 optical microscope. Microsoft Excel and GraphPad software were used for the statistical study. Correlation coefficient (Pearson) and mean comparison tests (Kruskal-Wallis and Dunn) and p≤ 0.05 were developed. B and T lymphocyte populations were inversely interregulated in prostate cancer (Gleason) (r= -0.46). Their relationship with Gleason grade is variable according to lymphocyte type (LB vs. Gleason r= -0.0.47 and LT vs. Gleason r= -0.21). Histological diagnosis of prostate cancer correlates with a predominance of LT. The malignancy of the pathology correlates with a predominance of LTs, according to the Gleason grade. The increased knowledge of B and T lymphocyte infiltration and plasma cell activation could be used to better target clinical trials on treatments based on immune system responses. Immunotherapy could be a new paradigm to apply better antitumor therapy strategies.

En tumores sólidos y malignos, la inmunidad innata y adaptativa se combinan en respuestas antitumorales. Este estudio tuvo como objetivo analizar la activación de células plasmáticas y la correlación entre la infiltración de linfocitos B y T con el grado de malignidad o grado de Gleason en biopsias de próstata humana diagnosticadas con cáncer. Las biopsias de cáncer de próstata se obtuvieron del Hospital Clínico de la Universidad de Chile (n=70), de acuerdo con las normas bioéticas de la institución. Secciones histológicas de 5 µm de espesor fueron procesadas para inmunohistoquímica con anticuerpos primarios contra LB y LT total (HRP/DAB). El reconocimiento y las cuantificaciones se realizaron bajo un microscopio óptico Leica DM750. Para el estudio estadístico se utilizaron los programas Microsoft Excel y GraphPad. Se desarrollaron pruebas de coeficiente de correlación (Pearson) y comparación de medias (Kruskal-Wallis y Dunn) y p≤ 0.05. Los resultados muestran que las poblaciones de linfocitos B y T están inversamente interreguladas en el cáncer de próstata (r= -0,4578). Su relación con el grado de Gleason es variable según el tipo de linfocito (LB vs Gleason r= -0,47* y LT vs Gleason r= -0,21). Se concluye que la malignidad del cáncer de próstata se correlaciona con un predominio de LT, versus el grado de Gleason. El mayor conocimiento de la infiltración de linfocitos B y T y la activación de células plasmáticas podría aprovecharse para una mejor orientación de ensayos clínicos en tratamientos basados en las respuestas del sistema inmunitario. La inmunoterapia podría ser un nuevo paradigma para aplicar mejores estrategias de terapias antitumorales.

Evolução da mortalidade por neoplasias entre os anos de 2010 a 2020 no Brasil segundo sexo e localização primária do tumor / Evolution of mortality from neoplasms between the years 2010 to 2020 in Brazil according to gender and primary location of the tumour

Introdução: o câncer é um grave problema de saúde pública, considerado a segunda causa de óbitos no Brasil. Devido à sua relevância, é indispensável um controle eficiente dos casos através do acompanhamento da taxa de mortalidade. Dessa forma, o trabalho analisou a evolução da mortalidade por câncer para as localizações primárias mais frequentes, segundo sexo, durante o período de 2010 a 2020. Metodologia: trata-se de um estudo observacional descritivo, no qual os dados foram obtidos através do Atlas On-line de Mortalidade por Câncer. Os dados colhidos correspondem ao número de óbitos estratificados por tipo de câncer mais frequente, por ano estudado e por sexo, além das taxas de mortalidade específica bruta e a taxa de mortalidade ajustada por idade para o sexo masculino e feminino, para cada tipo de câncer em estudo, considerando a população padrão mundial, sendo avaliado por regressão linear a significância da tendência temporal. Resultados: no Brasil, no período de 2010 a 2020, as neoplasias mais frequentes em mulheres foram câncer de mama, câncer nos brônquios e pulmões, câncer no colo do útero, câncer no cólon e no pâncreas e em homens foram brônquios e pulmões, câncer de próstata, câncer de estômago, de esôfago e no fígado e vias biliares, sendo observado uma tendência crescente na taxa de mortalidade em mulheres e decrescente na taxa de mortalidade em homens. Conclusão: os resultados demonstram um possível comprometimento com a notificação durante o período de pandemia por Covid-19 e um possível rastreamento ainda deficiente de câncer na população masculina.

Introduction: cancer is a severe public health problem, considered the second cause of death in Brazil. Due to its relevance, efficient control of cases by monitoring the mortality rate is essential. Thus, the work analysed the evolution of cancer mortality for the most frequent primary locations, according to sex, from 2010 to 2020. Methodology: this is a descriptive observational study in which data were obtained through the Atlas Online Cancer Mortality Report. The data collected correspond to the number of deaths stratified by the most frequent type of cancer, by year studied and by sex, in addition to the crude specific mortality rates and the age-adjusted mortality rate for males and females, for each type of cancer. Understudy, considering the standard world population, the significance of the temporal trend is evaluated by linear regression. Results: in Brazil, from 2010 to 2020, the most frequent neoplasms in women were breast cancer, bronchial and lung cancer, cervical cancer, colon and pancreas cancer and in men, they were bronchial and lung cancer, cancer prostate, stomach, oesophagal and liver and biliary tract cancer, with an increasing trend in the mortality rate in women and a decreasing trend in the mortality rate in men. Conclusion: the results demonstrate a possible compromise with notification during the Covid-19 pandemic and a possible still poor screening of cancer in the male population.

Assistência ginecológica aos transgênero / Gynecological care for transgenders

Transgênero (trans) é um termo que alberga toda a diversidade de gênero. A incongruência de gênero faz parte desse espectro e refere-se à pessoa cuja identidade de gênero é oposta ao sexo que lhe foi atribuído no nascimento. A terapia hormonal de afirmação de gênero, bem como a cirurgia de afirmação de gênero, é necessária para adequar o corpo ao gênero ao qual a pessoa se identifica. Os homens trans necessitam da terapia com testosterona, que visa reduzir as concentrações de estradiol e incrementar a testosterona circulante para níveis fisiológicos masculinos, resultando em masculinização. A mulher trans receberá o estradiol, associado ou não a um antiandrogênico, visando reduzir a testosterona e incrementar o estrogênio para níveis femininos, resultando em feminização. A cirurgia de afirmação de gênero é, frequentemente, requerida para completar as modificações fenotípicas para o homem e a mulher trans. O ginecologista e obstetra tem um papel crucial no provimento de cuidados a essa população. O presente artigo visa sistematizar algumas ações que o ginecologista e obstetra pode oferecer e que têm potencial para melhorar a qualidade de vida dos homens e mulheres trans. (AU)

Transgenero (trans) is an umbrella term that encompasses all gender diversity. Gender Incongruity is part of this spectrum and refers to the person whose gender identity is opposed to the sex assigned to them at birth. Gender-affirming hormone therapy as well as gender-affirming surgery are necessary to adapt the body to the gender to which the person identifies. Trans men require testosterone therapy to reduce estradiol concentrations and increase circulating testosterone to male physiological levels resulting in masculinization. Trans women will receive estradiol associated or not with an antiandrogenic to reduce testosterone and increase estrogen to female levels resulting in feminization. gender-affirming surgery is often required to complete phenotypic modifications for trans men and women. The gynecologist and obstetrician plays a crucial role in to provide care to this population. This article aims to systematize some actions that the gynecologist and obstetrician can offer to improve the quality of life of trans men and women. (AU)

Atenção plena como opção terapêutica para as disfunções sexuais / Mindfulness as a therapeutic option for sexual dysfunctions

A prevalência das disfunções sexuais é alta na população geral. A capacidade de regular as experiências emocionais facilita o relacionamento mais adaptado aos estados internos e às condições ambientais. A prática da atenção plena promove atenção à experiência do momento presente ­ com curiosidade, abertura, aceitação, não reatividade e não julgamento ­ e tem se mostrado eficaz para melhorar muitas condições biopsicossociais, sendo utilizada em ambientes de saúde, escolas e locais de trabalho. O objetivo é apresentar atualizações na abordagem das dificuldades sexuais por meio do desenvolvimento da atenção plena. Entre outras recomendações, o treinamento para descentralizar a atenção, o desenvolvimento de habilidades para perceber pensamentos e sentimentos como estados mentais, não necessariamente reais, além de promover aceitação, compaixão e melhor gestão de pensamentos intrusivos e ruminativos são alguns pontos positivos da prática da atenção plena como única abordagem ou associada a outras. É apresentado um protocolo com grupo terapêutico para desenvolvimento da atenção plena para casais, em que o parceiro é sobrevivente do câncer de próstata. Segue uma proposta terapêutica com oito módulos desenvolvida em formato presencial e adaptada para a plataforma virtual. Os módulos são: definições e causas da disfunção sexual; conscientização crescente das sensações físicas; exploração do corpo e julgamentos sobre ele; consciência de pensamentos e crenças sexuais; trabalho com aversão e autotoque; consciência das sensações sexuais; foco sensorial com o parceiro; manutenção (e aumento) dos ganhos. Essa prática desenvolvida online abriu um campo importante para beneficiar portadores de disfunção sexual com dificuldade para buscar outras modalidades de intervenção.

Direct costs of treating men with prostate cancer with High Intensity Focused Ultrasound / Costos directos del tratamiento de hombres con cáncer de próstata con el uso de High Intensity Focused Ultrasound / Custos diretos do tratamento de homens com câncer de próstata via High Intensity Focused Ultrasound

ABSTRACT Objective: To analyze the direct costs of materials, medicines/solutions and healthcare professionals required to treat men with prostate cancer using High Intensity Focused Ultrasound. Method: Quantitative, exploratory-descriptive research, single case study type. Data were collected from electronic medical records/printed documentation from the Operating Room of a public teaching and research hospital. Health professionals estimated the respective time spent on activities in the following stages: "Before anesthetic induction", "Before performing thermal ablation", "During thermal ablation" and "After performing thermal ablation". Costs were calculated by multiplying the (estimated) time spent by the unit cost of direct labor, adding to the measured cost of materials, medicines/solutions. Results: The measured costs with materials corresponded to US$851.58 (SD = 2.17), with medicines/solutions to US$72.13 (SD = 25.84), and estimated personnel costs to US$196.03, totaling US$1119.74/procedure. Conclusion: The economic results obtained may support hospital managers in the decision-making process regarding the adoption of the High Intensity Focused Ultrasound for the treatment of prostate cancer.

RESUMEN Objetivo: Analizar los costos directos de materiales, medicamentos/soluciones y profesionales de la salud necesarios para tratar a hombres con cáncer de próstata a través de High Intensity Focused Ultrasound. Método: Investigación cuantitativa, exploratoria-descriptiva, tipo estudio de caso único. Los datos se obtuvieron de registros médicos electrónicos/documentación impresa del Centro Quirúrgico de un hospital público de enseñanza e investigación. Los profesionales de la salud estimaron el tiempo respectivo dedicado a las actividades en las siguientes etapas: "Antes de la inducción anestésica", "Antes de realizar la ablación térmica", "Durante la realización de la ablación térmica" y "Después de realizar la ablación térmica". Los costos se calcularon multiplicando el tiempo (estimado) invertido por el costo unitario de la mano de obra directa, sumándolo al costo medido de materiales, medicamentos/soluciones. Resultados: Los costos medidos con materiales correspondieron a US$851,58 (DE = 2,17), con medicamentos/soluciones a US$72,13 (DE = 25,84) y los costos de personal estimados a US$196,03, totalizando US$1119,74/procedimiento. Conclusión: Los resultados económicos obtenidos podrán apoyar a los gestores hospitalarios en el proceso de toma de decisiones respecto a la adopción del High Intensity Focused Ultrasound para el tratamiento del cáncer de próstata.

RESUMO Objetivo: Analisar os custos diretos com materiais, medicamentos/soluções e profissionais de saúde requeridos à realização do tratamento de homens com câncer de próstata via High Intensity Focused Ultrasound. Método: Pesquisa quantitativa, exploratória-descritiva, do tipo estudo de caso único. Coletaram-se os dados em prontuários eletrônicos/documentações impressas do Centro Cirúrgico de um hospital público de ensino e pesquisa. Profissionais de saúde estimaram os respectivos tempos despendidos em atividades constantes das etapas: "Antes da indução anestésica", "Antes da execução da termoablação", "Durante a execução da termoablação" e "Após a execução da termoablação". Calcularam-se os custos multiplicando-se o tempo (estimado) despendido pelo custo unitário da mão de obra direta, somando-se ao custo mensurado dos materiais, medicamentos/soluções. Resultados: Os custos mensurados com materiais corresponderam a US$851,58 (DP = 2,17), com medicamentos/soluções a US$72,13 (DP = 25,84) e os custos estimados com pessoal a US$196,03, totalizando US$1119,74/procedimento. Conclusão: Os resultados econômicos obtidos poderão subsidiar os gestores hospitalares no processo decisório quanto à adoção do High Intensity Focused Ultrasound para o tratamento do câncer de próstata.

Use of nanoparticles in animal models for prostate cancer treatment: a systematic review

Purpose: To conduct a systematic review of nanoparticles' use in the treatment of prostate cancer in animals. Methods: A systematic review was conducted in the databases PubMed, Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, and EMBASE, and the descriptors were chosen based on terms indexed in Health Sciences Descriptors (DeCS)/Medical Subject Headings (MESH), which are: nanoparticles, nanomedicine, and prostate cancer. The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42021271008. Results: A total of 3,897 articles was chosen; after reading the inclusion and exclusion criteria, six scientific articles with themes involving nanoparticles carrying medications were reached. Among the nanoparticles found, there were carboxymethylcellulose polymer, micellar casein nanoparticles, liquid crystal nanoparticles, serum albumin nanoparticles, and poly(ethylene glycol)-block-polylactide (mPEG-PLA) conjugated nanoparticles encapsulating cabazitaxel, docetaxel, and flutamide, which were nanoparticles used to treat prostate cancer in animals. Conclusions: Through using nanoparticles to encapsulate medications for treating prostate cancer in animals, studies show a decrease in weight and tumor reduction, with nanoparticles resulting in greater survival time than free medications. The improved permeability and retention effect of nanoparticles in the bloodstream contribute to their effectiveness.

Câncer de próstata e suicídio: qualidade de vida, ansiedade, depressão e o risco para o suicídio em um centro oncológico terciário / Prostate cancer and suicide: quality of life, anxiety, depression and the risk of suicide in an oncology center in the city of São Paulo

Nas últimas décadas, tem se verificado o aumento de diagnósticos de câncer. No Brasil, a estimativa é de 16.830 novos casos de câncer de próstata para este ano. São escassas as pesquisas sobre os riscos de suicídio após o diagnóstico de um câncer em nosso país. O objetivo deste estudo foi avaliar longitudinalmente o risco para suicídio, qualidade de vida, ansiedade e depressão em uma amostra de pacientes com câncer de próstata localizado. Trezentos e trinta e três pacientes foram entrevistados ao diagnóstico e novamente a partir do 18º mês após ter recebido o diagnóstico. Foram aplicados os questionários: a seção de risco de suicídio do questionário Mini International Neuropsychiatric Interview (MINI), a Escala Hospitalar de Ansiedade e Depressão (HADS), o questionário Cut down, Annoyed by criticism, Guilty and Eye opener (CAGE) sobre abuso ou dependência de álcool, o Teste de Fagerström para Dependência a Nicotina (FTND), o instrumento de qualidade de vida para pacientes com câncer de próstata UCLA Prostate Cancer Index (UCLA-PCI), três perguntas sobre a percepção da primeira fase da pesquisa, um questionário sociodemográfico e incluídas quatro perguntas sobre a pandemia da Covid-19. A prevalência de risco de suicídio entre os pacientes com câncer de próstata ao diagnóstico foi de 5,7% e de 3,7% no 18º mês após o diagnóstico. Ao diagnóstico, o risco de suicídio associou-se ao escore positivo de ansiedade (p<0,001) e não ter depressão (p<0,001), ao estado civil casado (p=0,031), não morar sozinho (p=0,025), risco intermediário pela classificação de recidiva D'Amico (p=0,009), indicação para cirurgia (p=0,03), não ter tratamento psiquiátrico prévio (p<0,001) e história familiar de comportamento suicida (p=0,025). Após o 18º mês do diagnóstico, apenas a HADs positiva para ansiedade foi associada ao risco de suicídio (p<0,001). Na análise comparativa para os pacientes que responderam ao UCLA-PCI, observou-se associação significativa da qualidade de vida com o risco de suicídio em relação às funções físicas (p=0,037), vitalidade (p=0,006), saúde mental (p=0,014), função social (p=0,011), saúde geral (p=0,019) e transição para a saúde (p=0,013) aos pacientes recém diagnosticados e em relação às funções físicas (p=0,003), limitações de função da saúde física (p<0,001) e de saúde emocional (p<0,001), vitalidade (p=0,008), saúde mental (p=0,007), função social (p<0,0001), dor corporal (p=0,033), saúde geral (p=0,014) e transição para a saúde (p=0,016) após o 18º mês do diagnóstico. Fatores como qualidade de vida, ansiedade e depressão devem ser monitorados ao diagnóstico e ao longo do tratamento e a oferta de orientação e assistência emocional ser oferecida aos pacientes.

In recent decades, there has been an increase in cancer diagnoses. In Brazil, the estimate is 16,830 new cases of prostate cancer for this year. There is little research on the risks of suicide after the diagnosis of cancer in our country. The aim of this study was to longitudinally evaluate the risk for suicide, quality of life, anxiety and depression in a sample of patients with localized prostate cancer. Three hundred and thirty-three patients were interviewed at diagnosis and again from the 18th month after diagnosis. The following questionnaires were applied: the suicide risk section of the Mini International Neuropsychiatric Interview (MINI) questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Cut down, Annoyed by criticism, Guilty and eye opener questionnaire (CAGE) on alcohol abuse or dependence, the Fagerström Test for Nicotine Dependence (FTND), the UCLA Prostate Cancer Index (UCLA-PCI) quality of life instrument for prostate cancer patients, three questions about the perception of the first phase of the survey, a sociodemographic questionnaire and included four questions about the Covid-19 pandemic. The prevalence of suicide risk among prostate cancer patients at diagnosis was 5.7% and 3.7% at 18 months after diagnosis. At diagnosis, the risk of suicide was associated with positive scores of anxiety (p<0.001) and not having depression (p<0.001), married marital status (p=0.031), not living alone (p=0.025), intermediate risk according to the D'Amico recurrence classification (p=0.009), indication for surgery (p=0.03), not having previous psychiatric treatment (p<0.001) and family history of completed suicide (p=0.025). After the 18th month of diagnosis, only anxiety positive HADs questionnaire was associated with suicide risk (p<0.001). In the comparative analysis for patients who answered to UCLA-PCI, a significant association was observed between quality of life and suicide risk in relation to physical functions (p=0.037), vitality (p=0.006), mental health (p=0.014), social function (p=0.011), general health (p=0.019) and transition to health (p=0.013) in newly diagnosed patients and in relation to physical functions (p=0.003), limitations of physical health function (p<0.001) and emotional health (p<0.001), vitality (p=0.008) mental health (p=0.007), social function (p<0.0001), body pain (p=0.033), general health (p=0.014) and transition to health (p=0.016) after the 18th month of diagnosis. Factors such as quality of life, anxiety and depression should be monitored at diagnosis and throughout treatment and the provision of guidance and emotional assistance should be offered to patients

Qualidade de vida e perfil sociodemográfico e clínico de pacientes com câncer de mama e próstata / Quality of life and sociodemographic and clinical profile of breast and prostate cancer patients

RESUMO Objetivo avaliar a associação entre a qualidade de vida relacionada à saúde e as características sociodemográficas e clínicas de pacientes com câncer de mama e próstata. Métodos estudo transversal com 305 pacientes. Foram utilizados o European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, Quality of Life Questionnaire Breast Cancer e um instrumento estruturado. Realizaram-se análises estatísticas, descritiva e inferencial. Resultados observou-se prevalência de faixa etária entre 50 e 69 anos, casados, 13 anos ou mais de estudo, aposentados, com renda de até dois salários mínimos, com câncer de mama em radioterapia. Houve associação significante entre Escala de Saúde Global e sexo e conjugalidade; Escala Funcional e faixa etária e renda familiar; Escala de Sintomas e sexo, faixa etária, tipo de câncer, tratamento atual; Escala de Saúde Global e tipo de câncer, tratamento atual, tempo de tratamento, falta de acompanhante e número de comorbidades. Conclusão a qualidade de vida relacionada à saúde é influenciada negativamente pelas características sociodemográficas e clínicas de pacientes com câncer de mama e próstata. Contribuições para a prática os dados fornecem subsídios para concepção de um plano individualizado de cuidados de enfermagem.

ABSTRACT Objective to assess the association between health-related quality of life and sociodemographic and clinical characteristics of breast and prostate cancer patients. Methods a cross-sectional study of 305 patients was performed. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the Quality of Life Questionnaire Breast Cancer, and a structured instrument were used. Descriptive and inferential statistical analyses were performed. Results the study revealed a prevalence of patients aged 50-69 years, married, with 13 or more years of education, retired, with an income of up to two minimum wages, and receiving radiotherapy for breast cancer. Significant associations were observed between the Global Health Scale and gender and marital status, the Functional Scale and age group and family income, the Symptom Scale and gender, age group, cancer type, and current treatment, and between the Global Health Scale and cancer type, current treatment, treatment duration, lack of companion, and number of comorbidities. Conclusions health-related quality of life in breast and prostate cancer patients is negatively influenced by sociodemographic and clinical characteristics. Contributions to practice the data provide insights for designing individualized care plans.

Les urgences urologiques dans deux hôpitaux universitaires de Douala: une étude rétrospective (2016-2020) / Urological emergencies in two university hospitals in Douala: a retrospective study (2016-2020)

Introduction: les urgences en urologie sont des situations urologiques critiques qui nécessitent une intervention rapide par un professionnel de santé qualifié en urologie. Cette étude a été menée dans le but de ressortir le profil des urgences urologiques reçues dans deux hôpitaux universitaires de la ville de Douala en appréciant leurs prises en charge en urgence. Méthodes: il s´agit d´une étude rétrospective portant sur les urgences urologiques dans deux hôpitaux de références de la ville de Douala que sont les hôpitaux Laquintinie et Général de Douala. Les dossiers ont été colligés durant une période de 5 ans (1er janvier 2016 au 31 décembre 2020). Nous avons inclus toutes les consultations effectuées en urgence et reçues par le service des urgences ainsi que toutes les données cliniques et thérapeutiques venant du registre de garde durant la période d´étude. Nous avons exclu de notre étude toutes les urgences (consultations reçues pendant la période d´étude, non relevées dans le registre des urgences) Résultats: nous avons étudié 364 patients, l´âge moyen des patients était de 43 ± 8,34 ans. Quatre vingt-douze virgule cinquante huit pourcent (92,58%) (n=337) des patients étaient des hommes. Les principales urgences urologiques reçues étaient la rétention d´urine vésicale (45,05%, n=164), la colique néphrétique (15,33%, n=56) et l´hématurie (13,18%, n=48). Les principales étiologies des rétentions d´urine vésicale étaient les tumeurs prostatiques, la colique néphrétique était principalement d´origine lithiasique (96,45%, n=159) et l´hématurie était d´origine tumorale chez 68,75%(n=33) des patients. Sur le plan thérapeutique, les gestes effectués en urgence étaient le sondage vésical (39,01%, n=142), le traitement médical était associé à une surveillance (27,47%, n=100) et la cystostomie sus pubienne (10,71%, n=39). Conclusion: les rétentions aigues d´urines vésicales sur tumeurs prostatiques constituent l´urgence urologique la plus fréquente dans les hôpitaux universitaires de la ville de Douala. Cela implique une prise en charge précoce et optimale des tumeurs prostatiques.

Safe duration of silicon catheter replacement in urological patients

Objectives: This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks). Design: A cross-sectional study with stratified simple random sampling Setting: Urology Unit, Korle Bu Teaching Hospital Participants: One hundred and thirty-seven male patients with long-term urinary catheters Interventions: Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacementsPrimary outcomes measures: Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed. Results: Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065. Conclusions: In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.

Exploring prostate cancer screening among men in Accra using the health belief model

Objective: To explore the prevalence of prostate cancer screening among Ghanaian men and interrogate why some individuals screen for the disease and others do not. Design: A cross-sectional questionnaire survey based on the Health Belief Model was used to collect data from 356 men aged 40 years and above. Data were collected between February and March 2021. Setting: The study was conducted in the Accra metropolitan area of the Greater Accra region of Ghana. Participants: Convenience sampling was used to recruit participants for the study. Results: Although 86% of the respondents had heard about prostate cancer, only 23% had ever screened for it. Logistic regression analysis suggested that knowledge of the disease (OR = 1.19, CI 95% = 1.03 -1.38) and barriers to screening (OR = .87, CI 95% = .83 -.91) were statistically significant predictors of screening behaviour. Conclusion: HBM has limited predictive power as far as our study is concerned. We suggest increasing public education on prostate cancer and its screening methods. The cost of screening should also be made more affordable so as not to become a barrier.

Marsdenia tenacissima injection induces the apoptosis of prostate cancer by regulating the AKT/GSK3β/STAT3 signaling axis / 中国天然药物

Marsdenia tenacissima injection, a standard Marsdenia tenacissima extract (MTE), has been approved as an adjuvant therapeutic agent for various cancers. Our previous study showed that MTE inhibited the proliferation and metastasis of prostate cancer (PCa) cells. However, the underlying mechanisms and active ingredients of MTE against PCa were not completely understood. This study revealed that MTE induced significant decreases in cell viability and clonal growth in PCa cells. In addition, MTE induced the apoptosis of DU145 cells by reducing the mitochondrial membrane potential and increasing the expression of Cleaved Caspase 3/7, Cyt c, and Bax. In vivo, DU145 xenografted NOD-SCID mice treated with MTE showed significantly decreased tumor size. TUNEL staining and Western blot confirmed the pro-apoptotic effects of MTE. Network pharmacology analysis collected 196 ingredients of MTE linked to 655 potential targets, and 709 PCa-associated targets were retrieved, from which 149 overlapped targets were screened out. Pathway enrichment analysis showed that the HIF-1, PI3K-AKT, and ErbB signaling pathways were closely related to tumor apoptosis. Western blot results confirmed that MTE increased the expression of p-AKTSer473 and p-GSK3βSer9, and decreased the expression of p-STAT3Tyr705in vitro and in vivo. A total of 13 compounds in MTE were identified by HPLC-CAD-QTOF-MS/MS and UPLC-QTOF-MS/MS. Molecular docking analysis indicated that six compounds may interact with AKT, GSK3β, and STAT3. In conclusion, MTE induces the endogenous mitochondrial apoptosis of PCa by regulating the AKT/GSK3β/STAT3 signaling axis, resulting in inhibition of PCa growth in vitro and in vivo.

Advances in cancer vaccines for immunotherapy of prostate cancer / 中南大学学报(医学版)

Prostate cancer is currently one of the most common malignancies that endanger the lives and health of elderly men. In recent years, immunotherapy, which exploits the activation of anti-cancer host immune cells to accomplish tumor-killing effects, has emerged as a new study avenue in the treatment of prostate cancer. As an important component of immunotherapy, cancer vaccines have a unique position in the precision treatment of malignant tumors. Monocyte cell vaccines, dendritic cell vaccines, viral vaccines, peptide vaccines, and DNA/mRNA vaccines are the most often used prostate cancer vaccines. Among them, Sipuleucel-T, as a monocyte cell-based cancer vaccine, is the only FDA-approved therapeutic vaccine for prostate cancer, and has a unique position and role in advancing the development of immunotherapy for prostate cancer. However, due to its own limitations, Sipuleucel-T has not been widely adopted. Meanwhile, owing to the complexity of immunotherapy and the specificity of prostate cancer, the remaining prostate cancer vaccines have not shown good clinical benefit in large randomized phase II and phase III trials, and further in-depth studies are still needed.

Clinicopathological Features of Primary Small Cell Neuroendocrine Carcinoma of the Bladder / 中国医学科学院学报

Objective To investigate the clinicopathological features,immunohistochemical features,diagnosis,and relationship with sporadic prostate cancer in primary small cell neuroendocrine carcinoma of the bladder. Methods We retrospectively analyzed the clinical characteristics of 12 patients with primary small cell neuroendocrine carcinoma of the bladder diagnosed at Beijing Chao-Yang Hospital affiliated to Capital Medical University from January 2013 to September 2022.The histological features of primary small cell neuroendocrine carcinoma of the bladder were re-evaluated by two pathologists according to the 2022 revision of the World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs.Electronic medical records were retrieved,and telephone follow-up was conducted from the time of histopathological diagnosis to the death or the end of the last follow-up until January 31,2023. Results The 12 patients include 7 patients in pT3 stage and 1 patient in pT4 stage.Eight patients were complicated with other types of tumors,such as high-grade urothelial carcinoma of the bladder and squamous cell carcinoma.Five patients had sporadic prostate cancer.Immunohistochemical staining showed that 12 (100.0%),10 (83.3%),and 8 (66.7%) patients were tested positive for CD56,Syn,and CgA,respectively.The Ki67 proliferation index ranged from 80% to 90%.Five patients with urothelial carcinoma were tested positive for CK20,GATA3,and CK7.P504S was positive in all the 5 patients with prostate cancer,while P63 and 34βE12 were negative.The follow-up of the 12 patients lasted for 3-60 months.Eight of these patients died during follow-up,with the median survival of 15.5 months.Four patients survived. Conclusions Primary small cell neuroendocrine carcinoma of the bladder is a rare urological tumor with high aggressiveness and poor prognosis.In male patients with bladder prostatectomy,all prostate tissue should be sampled.If prostate cancer is detected,the prostate-specific antigen level should be monitored.

Comparison of the treatment outcomes: percent change in the sum of longest diameters (RECIST) and percent change of the lesion with the highest SUL (PERCIST) between standard therapy plus Lu-177 PSMA ligand therapy and standard therapy alone among patients with prostatic cancer status-post castration using Ga-18 PET-CT as an outcome indicator

Introduction@#Prostate cancer is the third most common cancer among Filipino males. Ga-68 PSMA PET-CT and Lu-177 PRLT have been introduced in the Philippines for the diagnostics and therapy of prostate cancer. @*Objective@#The aim of this study is to compare treatment outcomes of standard therapy plus Lu-177 PSMA radioligand therapy and standard therapy alone among patients with prostatic cancer status-post castration using Ga-68 PET-CT as an outcome indicator. @*Methodology@#This is an ambispective cohort study on Ga-68 PSMA PET-CT scans performed between January 1, 2018 and July 31, 2021. Serum PSA data taken within one month of the PET-CT scans were also collected when available. The PET-CT images were reviewed by a radiologist for RECIST response, and by a nuclear medicine physician for PERCIST response . @*Results@#A total of 11 participants were included in the study. Six participants (55.5%) received standard therapy, while five participants (45.5%) received Lu-177 PSMA radioligand therapy plus standard therapy. There was no significant difference in the baseline and follow-up CT as shown by all p values > 0.05. A trend towards higher number of participants with non-complete/non-progressive RECIST response was noted in the control group than the treatment group, as well as higher number of participants with progressive or stable disease using the PERCIST response. @*Conclusion@#There were no significant differences noted in the clinical outcomes of participants who received Lu-177 PRLT and those with standard therapy alone. A trend towards decreasing serum PSA, CT and PET measurements were noted among patients given Lu-177 PRLT than those with standard therapy.

Propensity-matched analysis comparing the peri- and post-operative outcomes of side-docking versus standard lithotomy docking for robot-assisted radical prostatectomy

Introduction@#Limited access to the perineum and limited operating room space are just some of the limitations of the standard lithotomy docking for robot-assisted radical prostatectomy (RARP-LD). The side-docking technique (RARP-SD) may address these problems.@*Methods@#Thirty cases of robot-assisted radical prostatectomy were matched to 120 cases of RARP-LD cases by propensity scoring using age, body mass index (BMI), clinical T stage, biopsy Gleason score, and ultrasound prostate volume. Operative and docking time, complications were used to compare peri-operative and safety outcomes.@*Results@#Evaluation of 30 RARP-LD and 30 RARP-SD cases was done after propensity matching. Patient age, BMI, clinical T stage, biopsy Gleason score, and prostate volume were similar between the two groups (p>0.050). The mean docking time of RARP-SD is shorter than that of RARP-LD cases (7.56 vs. 4.12, p <0.001), but this did not translate to a shorter operative time. There were less peri-operative complications in the RARP-SD cases.@*Conclusions@#RARP-SD has a docking time and produces less complication than RARP-LD.

Efficacy and safety of LY01005 versus goserelin implant in Chinese patients with prostate cancer: A multicenter, randomized, open-label, phase III, non-inferiority trial / 中华医学杂志(英文版)

BACKGROUND@#LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer.@*METHODS@#We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels.@*RESULTS@#On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]).@*CONCLUSION@#LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT04563936.