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)

Free PSA performs better than total PSA in predicting prostate volume in Chinese men with PSA levels of 2.5-9.9 ng ml-1 / 亚洲男科学杂志(英文版)

This study investigated whether free prostate-specific antigen (fPSA) performs better than total PSA (tPSA) in predicting prostate volume (PV) in Chinese men with different PSA levels. A total of 5463 men with PSA levels of <10 ng ml-1 and without prostate cancer diagnosis were included in this study. Patients were classified into four groups: PSA <2.5 ng ml-1, 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1. Pearson/Spearman's correlation coefficient (r) and receiver operating characteristic (ROC) curves were used to evaluate the ability of tPSA and fPSA to predict PV. The correlation coefficient between tPSA and PV in the PSA <2.5 ng ml-1 cohort (r = 0.422; P < 0.001) was markedly higher than those of the cohorts with PSA levels of 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1 (r = 0.114, 0.167, and 0.264, respectively; all P ≤ 0.001), while fPSA levels did not differ significantly among different PSA groups. Area under ROC curve (AUC) analyses revealed that the performance of fPSA in predicting PV ≥40 ml (AUC: 0.694, 0.714, and 0.727) was better than that of tPSA (AUC = 0.545, 0.561, and 0.611) in men with PSA levels of 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1, respectively, but not at PSA levels of <2.5 ng ml-1 (AUC: 0.713 vs 0.720). These findings suggest that the relationship between tPSA and PV may vary with PSA level and that fPSA is more powerful at predicting PV only in the ''gray zone'' (PSA levels of 2.5-9.9 ng ml-1), but its performance was similar to that of tPSA at PSA levels of <2.5 ng ml-1.

Correlación entre las pruebas de antígeno prostático específico rápida y sérica / Correlation between rapid and serum prostate-specific antigen tests

Introducción: Al día de hoy no se ha alcanzado un consenso sobre el mejor enfoque para realizar el tamizaje y la detección precoz del Cáncer de Próstata (CaP), en la población. No obstante, hay programas que recomiendan la utilización de la prueba de antígeno prostático específico rápida para la detección de CaP sin un análisis de correlación frente a la prueba sérica. Objetivo: Identificar la correlación entre las pruebas de antígeno prostático específico rápida y sérica, en la población mexicana. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo, bajo un muestreo no probabilístico por conveniencia. En el período comprendido entre el 25 de mayo al 13 de julio de 2017. Se calcularon los coeficientes de correlación punto biserial (r pb ) y phi (r phi ). Resultados: Se incluyeron 1 635 registros, principalmente de la Ciudad de México y del Estado de México (n= 1 398; 85,5 por ciento, IC95 por ciento 81-89,9). La edad promedio fue de 51 años (DE= 7,68). El valor promedio de antígeno prostático sérico fue de 1,49 ng/mL (DE= 1,91). La proporción de hombres con una prueba rápida positiva (n=60; 3,7 por ciento; IC95 por ciento 2,9-4,6) fue menor (p= 0,0415) en comparación con la proporción de pacientes con una prueba sérica ≥ 4 ng/mL (n=85; 5,2 por ciento; IC95 por ciento 4,1-6,3). El número de casos dobles negativos fue de 1 530 (93,6 por ciento; IC95 por ciento 92,3-94,6) y de dobles positivos fue de 40 (2,4 por ciento; IC95 por ciento1,7-3,2). Los coeficientes de correlación punto biserial y phi mostraron una correlación baja entre la prueba rápida y la prueba sérica de antígeno prostático (rpb= 0,469; p < 0,001; r2= 0,2199 y r ph i= 0,540; p < 0,001; r2= 0,2916). Conclusiones: La prueba de antígeno prostático específico rápida es una herramienta conveniente para los programas de detección de alteración prostática en unidades médicas del primer nivel de atención, donde la prueba sérica no se puede realizar, al ser una prueba con una baja sensibilidad y con un bajo coeficiente de correlación respecto de la prueba de antígeno prostático específico sérica, esto es un punto importante que debe considerarse al diseñar programas de detección oportuna de cáncer de próstata(AU)

Introduction: To date, no consensus has been reached on the best approach for screening and early detection of Prostate Cancer (PCa) in the population. However, there are programs recommending the use of the rapid prostate-specific antigen test for the detection of PCa without a correlation analysis versus the serum test. Objective: To identify the correlation between rapid and serum prostate specific antigen tests in the Mexican population. Methods: A descriptive, cross-sectional and retrospective study was carried out, under a non-probabilistic convenience sampling from May 25 to July 13, 2017. The correlation coefficients of point biserial (rpb) and phi (rphi) were calculated. Results: One thousand six hundred thirty five (1,635) records were included, mainly from Mexico City and the State of Mexico (n= 1,398; 85.5 percent, 95 percent CI 81-89.9). The average age was 51 years (SD= 7.68). The mean value of serum prostate antigen was 1.49 ng/ml (SD= 1.91). The proportion of men with positive rapid test (n=60; 3.7 percent; 95 percent CI 2.9-4.6) was lower (p= 0.0415) compared to the proportion of patients with a serum test ≥ 4 ng/ml (n= 85; 5.2 percent; 95 percent CI 4.1-6.3). The number of double negative cases was 1,530 (93.6 percent; CI95 percent 92.3-94.6) and of double positives was 40 (2.4 percent; CI95 percent 1.7-3.2). The point biserial and phi correlation coefficients showed low correlation between the rapid test and the serum prostate antigen test (rpb= 0.469; p < 0.001; r2= 0.2199 and rphi= 0.540; p < 0.001; r2= 0. 2916). Conclusions: The rapid prostate-specific antigen test is a convenient tool for prostatic alteration detection programs in primary care medical units, where the serum test cannot be performed, however, as it is a test with low sensitivity and with low correlation coefficient with respect to serum prostate-specific antigen testing, this is an important point to consider when designing prostate cancer early detection programs(AU)

Níveis séricos de antígeno prostático específico em pacientes de um hospital de Goiânia ­ GO / Serum levels of prostatic specific antigen in patients at a hospital in Goiânia ­ GO

O antígeno prostático específico (PSA) é o marcador mais importante para a detecção e monitoramento do câncer de próstata. Objetivo: O estudo objetivou analisar os dados laboratoriais e epidemiológicos do antígeno prostático específico de pacientes atendidos no Laboratório Clínico do Hospital do Policial Militar de Goiânia-GO (LC/HPM), considerando as medidas preventivas em relação ao câncer de próstata. Trata-se de um estudo retrospectivo baseado na análise de 1.249 prontuários de usuários do LC/HPM. O levantamento de dados laboratoriais e epidemiológicos, como idade, resultados do PSA total e PSA livre foi realizado por meio de um formulário padronizado pelos pesquisadores. Foram analisados 1.249 exames de PSA L/T, dos quais 58 (4,6%) apresentaram PSA total com resultados entre 4,0 e 10,0 ng/mL e 16 (1,3%) apresentaram concomitantemente valores de PSA total entre 4,0 e 10,0 ng/mL e relação PSA L/T < 25%. Os pacientes apresentaram faixa etária entre 34 e 93 anos, sendo a média 60 anos. Tornou-se evidente que tanto no ano de 2018 quanto em 2019, realizou-se um número maior de exames de PSA L/T, em comparação ao ano de 2020. O estudo revelou que 16 (1,3%) pacientes apresentaram risco aumentado para o desenvolvimento de neoplasia prostática, sendo observada uma diminuição do número de indivíduos que procuraram o LC/HPM para realização de exames de PSA livre e total no ano de 2020, quando comparado aos anos de 2019 e 2018, possivelmente em razão da pandemia de Covid-19, uma tendência global

Prostate-specific antigen (PSA) is the most important marker for the detection and monitoring of prostate cancer. This study aimed to analyse the epidemiological and laboratory data of prostate-specific antigen of patients treated at the Clinical Laboratory of the Military Police Hospital at Goiânia-GO (CL/MPH), considering preventive measures in relation to prostate cancer. Methods: This is a retrospective study with analysis of 1,249 medical records of CL/MPH users. The collection of epidemiological and laboratory data, such as age, total PSA and free PSA results, was performed using a form standardized by the researchers. We analyzed 1,249 PSA T/F tests, and of these, of which 58 (4.6%) total PSA sink with results between 4.0 and 10.0 ng/mL and 16 (1.3%) were concomitantly presenting total PSA values between 4.0 and 10.0 ng/mL and PSA T/F < 25%. The patients were aged between 34 and 93 years, with a mean age of 59 years. It became evident that both in 2018 and in 2019, there were a greater number of PSA T/F exams, compared to 2020. This study revealed that 16 (1.3%) patients were at increased risk for the development of prostate cancer, with a decrease in the number of individuals who sought the CL/MPH for free and total PSA tests in 2020, compared to 2019 and 2018, possibly due to Covid-19 pandemic, a global trend

Prostate Cancer Screening in Brazil: a single center experience in the public health system

ABSTRACT Purpose: Incidence and mortality of prostate cancer (PCa) are still increasing in developing countries. Limited access to the health system or more aggressive disease are potential reasons for this. Ethnic and social differences in developed countries seem to make inappropriate to extrapolate data from other centers. We aim to report the epidemiological profile of a PSA-screened population from a cancer center in Brazil. Materials and Methods: We retrospectively selected 9.692 men enrolled in a PCa prevention program, comprising total PSA level and digital rectal examination at the first appointment, associated with complementary tests when necessary. Men aged over 40 years-old were included after shared decision-making process. Prostate biopsy (TRUS) was performed when clinically suspected for PCa. After the diagnosis, patients underwent appropriate treatment. Results: TRUS was performed in 5.5% of men and PCa incidence was 2.6%. Overall ratio between number of patients who needed to be screened in order to diagnose one cancer was 38.9 patients, with 2.1 biopsies performed to diagnose a cancer. Positive predictive value (PPV) of TRUS biopsy in this strategy was 47.2%, varying from 38.5% (<50 years-old) to 60% (>80 years-old). We evidenced 70 patients (27.9%) classified as low risk tumors, 74 (29.5%) as intermediate risk, and 107 (42.6%) as high-risk disease. Conclusions: PSA-screening remains controversial in literature. In front of a huge miscegenated people and considering the big proportion of high-risk PCa, even in young men diagnosed with the disease, it is imperative to inform patients and health providers about these data particularities in Brazil.

Adenopatia cervical: uma apresentação rara de câncer da próstata / Cervical lymphadenopathy ­ a rare presentation of prostate cancer

A metastização ganglionar cervical por neoplasia da próstata é rara, sendo ainda menos frequente como manifestação inicial da doença. O presente estudo é um relato de um caso clínico de uma pessoa do sexo masculino, com 72 anos, que apresentava massa cervical esquerda, indolor, com 2 meses de evolução e dores ósseas lombar e torácica. A citologia aspirativa por agulha fina com estudo imuno-histoquímico revelou positividade para o antígeno prostático específico, concluindo se tratar de metástase ganglionar de carcinoma da próstata. Analiticamente, constatou-se que o valor do antígeno prostático específico foi maior que 1.000ng/mL, além da elevação da fosfatase alcalina. A cintilografia óssea de corpo inteiro revelou envolvimento ósseo secundário. Após o diagnóstico, o paciente iniciou hormonoterapia e recusou radioterapia com intuito paliativo. Oito meses após o diagnóstico, constatou-se a recorrência da doença, com elevação do valor do antígeno prostático específico novamente. Dessa forma, relata-se um caso de neoplasia da próstata com metastização óssea e ganglionar cervical esquerda em um indivíduo assintomático do ponto de vista urológico. Salienta-se que, no diagnóstico diferencial de adenopatias cervicais, deve-se considerar a neoplasia da próstata em pessoas do sexo masculino. (AU)

Cervical lymph nodes involvement is rare in prostate cancer and uncommon as an initial manifestation. This study is a clinical case report of a 72-year-old man who presented with a left cervical painless mass of 2-month progression, and bone pain on the lumbar and thoracic regions. Fine-needle aspiration cytology with immunohistochemistry staining was performed and revealed positivity for prostate-specific antigen consistent with prostate adenocarcinoma metastasis. Blood tests revealed a prostate-specific antigen of more than 1,000ng/mL, as well as high alkaline phosphatase. Whole-body bone scan showed secondary bone involvement. Following diagnosis, the patient started hormonal therapy and refused palliative radiotherapy. Eight months after diagnosis, recurrence was observed, with prostate-specific antigen elevation again. Thus, a clinical case of prostate cancer with bone and cervical lymph node metastasis in a patient with no urologic symptoms is reported. It should be noted that prostate cancer shall always be considered in the differential diagnosis of cervical lymphadenopathies in male patients. (AU)

Decreased levels of cathepsin Z mRNA expressed by immune blood cells: diagnostic and prognostic implications in prostate cancer

Cathepsin Z (CTSZ) is a cysteine protease responsible for the adhesion and migration of both immune and tumor cells. Due to its dual role, we hypothesized that the site of CTSZ expression could be determinant of the pro- or anti-tumorigenic effects of this enzyme. To test this hypothesis, we analyzed CTSZ expression data in healthy and tumor tissues by bioinformatics and evaluated the expression levels of CTSZ mRNA in the blood cells of prostate cancer (PCa) patients by qRT-PCR compared with healthy subjects, evaluating its diagnostic and prognostic implications for this type of cancer. Immune cells present in the blood of healthy patients overexpress CTSZ. In PCa, we found decreased CTSZ mRNA levels in blood cells, 75% lower than in healthy subjects, that diminished even more during biochemical relapse. CTSZ mRNA in the blood cells had an area under the curve for PCa diagnosis of 0.832, with a 93.3% specificity, and a positive likelihood ratio of 9.4. The site of CTSZ mRNA expression is fundamental to determine its final role as a protective determinant in PCa, such as CTSZ mRNA in the blood cells, or a malignant determinant, such as found for CTSZ expressed in high levels by different types of primary and metastatic tumors. Low CTSZ mRNA expression in the total blood is a possible PCa marker complementary to prostate-specific antigen (PSA) for biopsy decisions, with the potential to eliminate unnecessary biopsies.

Prostate health index for the diagnosis of prostate cancer in Asians in Macau with a PSA level of 4－10 μg/L / 中华男科学杂志

Objective@#To evaluate the prostate health index (PHI) as a tool for the diagnosis of PCa with a PSA level of 4－10 μg/L and determine the best cut-off value of PHI.@*METHODS@#Fifty-eight patients with a PSA level of 4－10 μg/L underwent transrectal ultrasound-guided prostatic biopsy in our hospital between April 2017 and June 2019. We constructed receiver operating characteristic (ROC) curves for the relationship of the biopsy results with the level of PSA, the ratio of ［－2］ proPSA to fPSA and PHI, and calculated the area under the ROC curves (AUC).@*RESULTS@#Prostatic biopsy revealed 18 cases of PCa in the 58 patients (31.0%). Statistically significant differences were observed between the PCa and non-PCa groups in ［－2］ proPSA, %［－2］ proPSA and PHI, but not in tPSA, % fPSA and PSA-density. The AUCs of PSA, % fPSA, PSA-density, ［－2］ proPSA, %［－2］ proPSA and PHI were 0.556, 0.407, 0.533, 0.746, 0.751 and 0.774, respectively. The specificity of PHI was 27.50% (95% CI: 14.6%－43.9%), the highest among the above predictors at 90% sensitivity. By applying PHI to this cohort, 13 cases (22.4%) of unnecessary biopsy could be avoided.@*CONCLUSIONS@#The application of PHI can increase the accuracy of PCa prediction and reduce unnecessary prostatic biopsy.、.

Research status and prospect of artificial intelligence technology in the diagnosis of urinary system tumors / 生物医学工程学杂志

With the rapid development of artificial intelligence technology, researchers have applied it to the diagnosis of various tumors in the urinary system in recent years, and have obtained many valuable research results. The article sorted the research status of artificial intelligence technology in the fields of renal tumors, bladder tumors and prostate tumors from three aspects: the number of papers, image data, and clinical tasks. The purpose is to summarize and analyze the research status and find new valuable research ideas in the future. The results show that the artificial intelligence model based on medical data such as digital imaging and pathological images is effective in completing basic diagnosis of urinary system tumors, image segmentation of tumor infiltration areas or specific organs, gene mutation prediction and prognostic effect prediction, but most of the models for the requirement of clinical application still need to be improved. On the one hand, it is necessary to further improve the detection, classification, segmentation and other performance of the core algorithm. On the other hand, it is necessary to integrate more standardized medical databases to effectively improve the diagnostic accuracy of artificial intelligence models and make it play greater clinical value.

Expert consensus on clinical diagnosis and treatment of bone metastases and bone-related diseases of prostate cancer (2021 edition) / 中华肿瘤杂志

The morbidity and mortality of prostate cancer ascend yearly, which seriously threatens the health of the male population. Bone is the main metastasis site of prostate cancer, with bone metastases and skeletal-related events (SREs) occuring in more than 70% of patients with advanced prostate cancer. Bone metastases and the resulting SREs, such as spinal cord compression and pathological fracture, seriously affect the life quality of the patients. Although the active treatments of the primary disease is important, the application of bone-modifying agents to prevent SREs cannot be overlooked. However, there is no standard treatment procedure for the bone metastasis of prostate cancer at present. According to the clinical status, the Genitourinary Oncology Committee of Chinese Anti-cancer Association formulated this consensus, which integrated clinical evidence and real world clinical practices in China and abroad, to help clinicians make more accurate diagnosis and treatment for the bone metastases of prostate cancer with multidisciplinary strategies.

Prostate cancer awareness in the city of São Paulo / Conhecimento da população da cidade de São Paulo a respeito do câncer de próstata

ABSTRACT Objective: To evaluate awareness of prostate cancer in the population of the city of São Paulo. Methods: A total of 392 adults were randomly interviewed on public spaces in the city of São Paulo, and answered a questionnaire that addressed demographic questions and specific knowledge about the prostate cancer. A score was used to assess awareness of cancer in general, and of prostate cancer, considering satisfactory knowledge a score of 6 points. Results: The mean age was 36.9 years (standard deviation of ±12.6) and 58.2% of participants were male. No previous contact with information related to prostate cancer was reported by 45.5% of participants. For these cases, a greater proportion was observed among men aged over 50 years. As to the score, the mean was 3.7 (standard deviation of ±1.3), with a positive correlation among higher scores, higher income and education level. Less than 5% of participants believed they should only search for prostate cancer screening when symptomatic. Finally, among the less frequent responses to risk factors for prostate cancer, is "ethnic origin" (2.8%). Conclusion: Even though most participants did not have a satisfactory score, the level of awareness demonstrated in this study seems superior to that of other populational series. Hence it suggested the assessed population understood some essential concepts in prostate cancer, such as the importance of screening and the follow-up. The efforts made by the Sociedade Brasileira de Urologia on educational campaigns partially explain this. However, working in some concepts, like identifying risk factors for prostate cancer, might optimize screening outcomes.

RESUMO Objetivo: Avaliar o conhecimento da população da cidade de São Paulo em relação ao câncer de próstata. Métodos: Foram entrevistados randomicamente 392 adultos em espaços públicos da cidade de São Paulo, os quais responderam a um questionário que abordava questões demográficas e de conhecimentos específicos sobre o câncer de próstata. Um escore foi utilizado para avaliar o conhecimento de câncer em geral e do câncer de próstata, considerando um conhecimento satisfatório com escore de 6 pontos. Resultados: A média de idade foi de 36,9 anos (desvio-padrão de ±12,6), e 58,2% dos participantes eram do sexo masculino. Ausência de contato anterior com informações relacionadas ao câncer de próstata foi relatada por 45,5% dos participantes. Nesses casos, maior proporção foi observada entre os homens com mais de 50 anos. Quanto ao escore, a média foi 3,7 (desvio-padrão de ±1,3), com correlação positiva entre maiores escores e maiores renda e escolaridade. Menos de 5% dos participantes acreditavam que só deveriam procurar o rastreamento do câncer de próstata quando sintomáticos. Por fim, entre as respostas menos frequentes aos fatores de risco para câncer de próstata, encontrou-se "etnia" (2,8%). Conclusão: Embora a maioria dos participantes não tenha apresentado escore satisfatório, o nível de conhecimento revelado neste estudo parece superior ao de outros estudos populacionais. Assim, sugere-se que a população avaliada tenha compreendido alguns conceitos essenciais do câncer de próstata, como a importância do rastreamento e do acompanhamento. Os esforços da Sociedade Brasileira de Urologia nas campanhas educacionais explicam parcialmente isso. No entanto, trabalhar em alguns conceitos, como identificar fatores de risco para câncer de próstata, pode otimizar os resultados do rastreamento.

Prostate examination among adult and elderly subjects in southern Brazil: a cross-sectional population-based study

ABSTRACT BACKGROUND: Population-wide screening for prostate cancer remains a controversial topic, given the need for an individualized approach to patients regarding the risks and benefits of prostate-specific antigen testing and digital rectal examination. OBJECTIVE: The aim of this study was to investigate the prevalence of, and factors associated with, prostate examination among men aged 45 or older. DESIGN AND SETTING: Cross-sectional population-based study developed in the city of Rio Grande (RS), Brazil. METHODS: The outcome of interest was a history of prostate examination (prostate-specific antigen testing or digital rectal examination). The following independent variables were analyzed: age group, skin color, marital status, schooling, economic level, leisure-time physical activity, smoking habits, excessive alcohol consumption, overweight, health insurance, visits to the doctor during the preceding year, hypertension and diabetes. After a two-stage sampling process, the final sample consisted of 281 male individuals. RESULTS: The prevalence of a history of prostate-specific antigen testing or digital rectal examination was 68.3% (95% confidence interval (CI): 62.2 to 74.5). The highest prevalence rates were observed among men aged 70 years or older (88%) and the lowest among smokers (36%). The following characteristics were found to be associated with the outcome: advanced age; marital status other than single; more schooling and higher economic status; practicing physical activity; non-smoking habits; overweight; having health insurance; and having visited a doctor during the preceding year. CONCLUSION: Approximately two thirds of the study population had been screened for prostate examination, mostly older individuals, with higher socioeconomic status and a healthier lifestyle.

Diagnosis accuracy of PCA3 level in patients with prostate cancer: a systematic review with meta-analysis

ABSTRACT Background: The diagnostic value and suitability of prostate cancer antigen 3 (PCA3) for the detection of prostate cancer (PCa) have been inconsistent in previous studies. Thus, the aim of the present meta-analysis was performed to systematically evaluate the diagnostic value of PCA3 for PCa. Materials and Methods: A meta-analysis was performed to search relevant studies using online databases EMBASE, PubMed and Web of Science published until February 1st, 2019. Ultimately, 65 studies met the inclusion criteria for this meta-analysis with 8.139 cases and 14.116 controls. The sensitivity, specificity, positive likelihood ratios (LR+), negative likelihood ratios (LR−), and other measures of PCA3 were pooled and determined to evaluate the diagnostic rate of PCa by the random-effect model. Results: With PCA3, the pooled overall diagnostic sensitivity, specificity, LR+, LR−, and 95% confidence intervals (CIs) for predicting significant PCa were 0.68 (0.64-0.72), 0.72 (0.68-0.75), 2.41 (2.16-2.69), 0.44 (0.40-0.49), respectively. Besides, the summary diagnostic odds ratio (DOR) and 95% CIs for PCA3 was 5.44 (4.53-6.53). In addition, the area under summary receiver operating characteristic (sROC) curves and 95% CIs was 0.76 (0.72-0.79). The major design deficiencies of included studies were differential verification bias, and a lack of clear inclusion and exclusion criteria. Conclusions: The results of this meta-analysis suggested that PCA3 was a non-invasive method with the acceptable sensitivity and specificity in the diagnosis of PCa, to distinguish between patients and healthy individuals. To validate the potential applicability of PCA3 in the diagnosis of PCa, more rigorous studies were needed to confirm these conclusions.

Morphological changes of the cellularity in the prostatic gland from patients with confirmed cancer: Gleason level and presence of eosinophils and mast cells: cellular bioindicators / Cambios morfológicos de la celularidad en la glándula prostática de pacientes con cáncer confirmado: nivel de gleason y presencia de eosinófilos y mastocitos: bioindicadores celulares

The different pathologies of the prostate, involve the presence of a new microenvironment where inflammatory cells are actively recruited. This research explores the presence of mast cells and eosinophils associated with age and the evaluation of prostate cancer progress (Gleason Index). Forty two biopsies of anonymized patients, with confirmed prostate cancer, were used for histological analysis for eosinophils and mast cells and subsequent determination of Gleason index according to age. The results of the histological analyzes show the presence of eosinophils and mast cells in prostate biopsies with confirmed cancer. In the multiple correlation studies, a high correlation was observed between the presence of lymphocytes and the age of the patient diagnosed with prostate cancer, same correlation was observed between the patient's age and higher Gleason Index (Pearson and Spearman p< 0.05). It is concluded that in prostate biopsies from Chilean patients with confirmed cancer, eosinophilia and tissue mastocytosis were observed. Correlation analyzes show a direct correlation between older patients, higher Gleason index and presence of mast cell. Regarding eosinophilia, only a correlation between age and Gleason index was observed Further studies are suggested to determine that the presence of eosinophils and mast cells can be used as early bioindicators of prostate cancer.

Las diferentes patologías de próstata, involucran la presencia de un nuevo microambiente donde las células inflamatorias son activamente reclutadas. La presente investigación explora la presencia de mastocitos y eosinófilos asociadas a la edad y la evaluación del progreso del cáncer de próstata según índice de Gleason. Cuarenta y dos biopsias de pacientes anonimizados, con cáncer prostático confirmados, fueron utilizadas para su análisis histológico para eosinófilos y mastocitos y posterior determinación del índice de Gleason según edad. Los resultados de los análisis histológicos, muestran la presencia de eosinófilos y mastocitos en biopsias de próstata con cáncer confirmado. En los estudios de correlación múltiple, se observó una alta correlación entre la presencia de linfocitos, mastocitos y la edad del paciente diagnosticado con cáncer prostático, igual correlación se observó entre la edad del paciente y mayor índice de Gleason (Pearson y Spearman p<0,05). Se concluyó que en las biopsias de próstata de pacientes chilenos con cáncer confirmado, se observó eosinofilia y mastocitosis tisular. Los análisis de correlación muestran una correlación directa entre pacientes de mayor edad, índice de Gleason más alto y la presencia de mastocitos. Con respecto a la eosinofilia, solo se observó una correlación entre la edad y el índice de Gleason. Se sugieren estudios adicionales para determinar que la presencia de eosinófilos y mastocitos puede usarse como bioindicadores tempranos del cáncer de próstata.

Detecção precoce do câncer de próstata: atuação de equipe de saúde da família / Detección precoz del cáncer de próstata: actuación del equipo de salud de la familia / Early detection of prostate cancer: family health team operation

Resumo O objetivo desta investigação foi compreender a atuação de Equipes de Saúde da Família sobre a detecção precoce do câncer de próstata. É uma investigação pesquisa de abordagem qualitativa realizada com 10 profissionais de saúde, entre eles médicos, enfermeiros, técnicos de enfermagem e agentes comunitários de saúde, de duas Unidades de Saúde da Família de Jaguaquara, Bahia, Brasil. Para a coleta de dados foi aplicado a entrevista semiestruturada norteada por um roteiro contendo cinco questões inerentes a temática. As informações produzidas foram submetidas à técnica de análise do conteúdo de Bardin, que originaram três categorías temáticas. Ressalta-se que o projeto foi aprovado pelo Comitê de Ética em Pesquisa, sob parecer nº. 1.644.785. Entre os resultados foram obtidos: Ações para promoção da detecção precoce do câncer de próstata; Importância do Diagnóstico Precoce; Fatores que dificultam a detecção precoce do Câncer de próstata. Conclui-se que diante da problemática existente acerca da procura dos serviços de saúde pelo público masculino, é preciso que os profissionais estejam preparados e capacitados de forma que os programas de saúde possam cumprir seus objetivos de promoção e prevenção eficaz.

Abstract The aim of this research was to understand the performance of Family Health Teams on early detection of prostate cancer. It is a qualitative research conducted with 10 health professionals, including doctors, nurses, nursing technicians and community health agents, from two Family Health Units of Jaguaquara, Bahia, Brazil. For data collection we apply a semi-structured interview guided by a script containing five questions inherent to the theme. The information produced was submitted to Bardin's content analysis technique, which originated three thematic categories. It is noteworthy that the project was approved by the Research Ethics Committee, under opinion no. 1,644,785. Between the results we obtained: actions to promote early detection of prostate cancer; importance of early diagnosis; factors that hinder early detection of prostate cancer. It is concluded that given the existing problem regarding the demand for health services by the male public, professionals need to be prepared and trained so that health programs can meet their objectives of effective promotion and prevention.

Resumen El objetivo de esta investigación fue comprender el desempeño de los equipos de salud familiar en la detección temprana del cáncer de próstata. Es una investigación cualitativa realizada con 10 profesionales de la salud, incluidos médicos, enfermeras, técnicos de enfermería y agentes de salud comunitaria, de dos Unidades de Salud Familiar de Jaguaquara, Bahía, Brasil. Para la recopilación de datos, utilizamos una entrevista semiestructurada con una guía que contiene cinco preguntas inherentes al tema. Se aplicó la técnica de análisis de contenido de Bardin, que originó tres categorías temáticas. Es de destacar que el proyecto fue aprobado por el Comité de Ética de Investigación, en virtud del dictamen no. 1,644,785. Entre los resultados se obtuvo: las acciones para promover la detección temprana del cáncer de próstata; importancia del diagnóstico precoz; factores que dificultan la detección temprana del cáncer de próstata. Se concluye que debido al problema existente con respecto a la demanda de servicios de salud por parte del público masculino, los profesionales deben estar preparados y capacitados para que los programas de salud puedan cumplir sus objetivos de promoción y prevención efectivas.

Can natural killer cell activity help screen patients requiring a biopsy for the diagnosis of prostate cancer?

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

Prostate cancer screening among elderly men in Brazil: should we diagnose or not?

ABSTRACT Purpose: Prostate cancer screening in the elderly is controversial. The Brazilian government and the National Cancer Institute (INCA) do not recommend systematic screening. Our purpose was to assess prevalence and aggressiveness of prostate cancer in men aged 70 years and above, on the first Latin American database to date. Materials and Methods: Cross-sectional study (n=17,571) from 231 municipalities, visited by Mobile Cancer Prevention Units of a prostate-specific antigen (PSA) based opportunistic screening program, between 2004 and 2007. The criteria for biopsy were: PSA>4.0ng/ml, or PSA 2.5-4.0ng/ml with free/total PSA ratio ≤15%, or suspicious digital rectal examination findings. The screened men were stratified in two age groups (45-69 years, and ≥70 years). These groups were compared regarding prostate cancer prevalence and aggressiveness criteria (PSA, Gleason score from biopsy and TNM staging). Results: The prevalence of prostate cancer found was 3.7%. When compared to men aged 45-69 years, individuals aged 70 years and above presented cancer prevalence about three times higher (prevalence ratio 2.9, p<0.01), and greater likelihood to present PSA level above 10.0ng/ml at diagnosis (odds ratio 2.63, p<0.01). The group of elderly men also presented prevalence of histologically aggressive disease (Gleason 8-10) 3.6 times higher (p<0.01), and 5-fold greater prevalence of metastases (PR 4.95, p<0.05). Conclusions: Prostate cancer screening in men aged over 70 may be relevant in Brazil, considering the absence of systematic screening, higher prevalence and higher probability of high-risk disease found in this age range of the population studied.

Accuracy of digital rectal examination to diagnose prostate cancer confirmed by needle biopsy reports: A 3­year hospital-based study

Background: Digital rectal examination (DRE) is an indispensable tool for provisional diagnosis of prostate diseases. When abnormal prostate examination findings are elicited, a diagnosis of prostate cancer (Pca) is usually entertained and further tests to confirm or rule out the presence of Pca demands histological examination of biopsied tissue. A combination of DRE findings and serum PSA increases the predictive value for Pca diagnosis. In this study, we evaluated the degree of accuracy of DRE to diagnose Pca confirmed by histology reports of biopsy specimens.Materials and Methods: Two hundred and six (206) patients were studied over a period of three years. Information retrieved from their case notes were entered into a well-structured protocol for management of prostatic diseases. Analysis of variables collated was performed with the statistical package for the social sciences (SPSS) version 20.0. Frequency table was used to analyze categorical variables while descriptive statistics was used for continuous variables. Level of significance was set at P<.05.Results: 206 patients were studied with mean age of 68.23±8.71 years ranging from 48 to 91 years. Men in the Pca group were older than those in the BPH group. Abnormal DRE was associated with high grade tumours, and high level of aggressive tumour characteristics by WHO grade group standard.Conclusion: DRE has a high level of accuracy in predicting a diagnosis of Pca which was confirmed by histology reports especially in prostates with abnormal findings