Cáncer de próstata: análisis de tasa de mortalidad, periodo 2017-2021 en Chile / Prostatic Cancer: analysis of the mortality rate in Chile between 2017-2021

Introducción: El cáncer de próstata (CP) es una neoplasia dependiente de hormonas de la próstata. Presenta una mortalidad mundial en descenso, disminuyendo de 39 a 19 por cada 100.000 personas; En Chile no existen datos recientes. Objetivos: Describir la tasa de mortalidad (TM) por cáncer de próstata en el periodo 2017-2021 en Chile. Materiales y métodos: Estudio ecológico sobre defunciones por CP en el periodo 2017-2021 en Chile (n=10.783), según grupo etario y región. Utilizando datos obtenidos por el Departamento de Estadística e Información de Salud para realizar la estadística descriptiva y cálculo de TM. No se requirió comité de ética. Resultados: Se evidenció una TM del período de 34,84/100.000 hombres, presentando una disminución de 7,90% entre los años 2017 y 2021. El grupo etario de 65 a 79 años presentó la mayor cantidad de defunciones con 139,95% (4308). La región metropolitana presentó la mayor cantidad de defunciones con 32,96% (3.555). Conclusión: La disminución de la TM durante la pandemia por COVID-19 puede deberse a que posiblemente pacientes fueron mal clasificados como defunciones por COVID-19. Respecto al grupo etario con mayor cantidad de defunciones, se condice con la literatura. La región con mayor cantidad de defunciones fue la región más poblada de Chile, la cual puede presentar mayor cantidad de pacientes con CP. En conclusión, el CP presenta altas TM en grupos de avanzada edad, es importante realizar los diagnósticos de manera oportuna, ya que es una patología detectable que acarrea gastos en salud.

Introduction: Prostate cancer (PC) is a hormone-dependent neoplasm of the prostate. It presents a global mortality in decline, decreasing from 39 to 19 per 100,000 people; In Chile, there is no recent data. Objective: To describe the mortality rate (MR) of prostate cancer in the years between 2017-2021 in Chile. Materials and methods: An ecological study on deaths from PC in the period 2017-2021 in Chile (n=10,783), according to age group and region. Using data obtained by the Departamento de Estadística e Información de Salud, to perform descriptive statistics and calculate MR. No ethics committee was required. Results: A MR of 34.84/100,000 men in the period studied was evidenced, presenting a decrease of 7.90%. The age group of 65 to 79 years old presented a greater number of deaths with 139.95% (4308). The metropolitan region presented the largest number of deaths with 32.96% (3,555). Conclusion: The decrease in MR during the COVID-19 pandemic may be due to the fact that patients were possibly misclassified as COVID-19 deaths. Regarding the age group with the highest number of deaths, it is consistent with the literature. The region with the highest number of deaths was the most populated region of Chile, which may have the highest number of patients with PC. In conclusion, PC presents high MR in older age groups; it is important to make diagnoses in a timely manner, as it is a detectable pathology that entails health costs.

Prostate Cancer Survival and Mortality according to a 13-year retrospective cohort study in Brazil: Competing-Risk Analysis / Sobrevida e mortalidade por câncer da próstata no Brasil por 13 anos em um estudo de coorte retrospectivo: Análise de riscos competitivos

ABSTRACT: Objective: To analyze cancer-specific mortality (CSM) and other-cause mortality (OCM) among patients with prostate cancer that initiated treatment in the Brazilian Unified Health System (SUS), between 2002 and 2010, in Brazil. Methods: Retrospective observational study that used the National Oncological Database, which was developed by record-linkage techniques used to integrate data from SUS Information Systems, namely: Outpatient (SIA-SUS), Hospital (SIH-SUS), and Mortality (SIM-SUS). Cancer-specific and other-cause survival probabilities were estimated by the time elapsed between the date of the first treatment until the patients' deaths or the end of the study, from 2002 until 2015. The Fine-Gray model for competing risk was used to estimate factors associated with patients' risk of death. Results: Of the 112,856 studied patients, the average age was 70.5 years, 21% died due to prostate cancer, and 25% due to other causes. Specific survival in 160 months was 75%, and other-cause survival was 67%. For CSM, the main factors associated with patients' risk of death were: stage IV (AHR = 2.91; 95%CI 2.73 - 3.11), systemic treatment (AHR = 2.10; 95%CI 2.00 - 2.22), and combined surgery (AHR = 2.30, 95%CI 2.18 - 2.42). As for OCM, the main factors associated with patients' risk of death were age and comorbidities. Conclusion: The analyzed patients with prostate cancer were older and died mainly from other causes, probably due to the presence of comorbidities associated with the tumor.

RESUMO: Objetivo: Analisar a mortalidade câncer-específica (MCE) e a mortalidade por outras causas (MOC) em pacientes diagnosticados com câncer da próstata que iniciaram tratamento no Sistema Único de Saúde (SUS) entre 2002 e 2010, no Brasil. Métodos: Estudo observacional retrospectivo utilizando a "Base Nacional em Oncologia", desenvolvida por meio de pareamento determinístico-probabilístico dos sistemas de informação do SUS: Ambulatorial (SIA), Hospitalar (SIH) e de Mortalidade (SIM). Probabilidades de sobrevivência específicas do câncer e por outras causas foram estimadas pelo tempo decorrido entre a data do primeiro tratamento até a morte do paciente ou o final do estudo, de 2002 a 2015. O modelo de riscos competitivos de Fine & Gray foi utilizado para estimar os fatores associados ao risco de morte do paciente. Resultados: Dos 112.856 pacientes estudados, a idade média foi de 70,5 anos, 21% foi a óbito devido ao câncer de próstata e 25% por outras causas. A probabilidade de sobrevida específica em160 meses foi de 75% e a por outras causas de 67%. Na CSM, os principais fatores associados ao risco de óbito dos pacientes foram: estágio IV (AHR = 2,91; IC95% 2,73 - 311), tratamento sistêmico (AHR = 2,10; IC95% 2,00 - 2,22) e cirurgia combinada (AHR = 2,30; IC95% 2,18 - 2,42). Na MOC, os principais fatores associados ao risco de óbito do paciente foram idade e comorbidades. Conclusão: Os pacientes com câncer da próstata analisados mostraram-se mais velhos e faleceram principalmente por outras causas, provavelmente devido às comorbidades associadas ao tumor.

Lugar de residencia y grado de marginación como factores pronóstico de supervivencia al cáncer de próstata en Veracruz, México / Place of residence and social marginalization as prognostic factors for prostate cancer survival in Veracruz, Mexico

Resumen Objetivos: Determinar si el lugar de residencia y el grado de marginación se encuentran asociados a la supervivencia al cáncer de próstata. Materiales y métodos: Se incluyeron a todos los pacientes diagnosticados con cáncer de próstata (CP) en el periodo 2013-2017 en un hospital de tercer nivel de atención de Veracruz, México. Los casos expuestos fueron los pacientes que habitualmente residían en zonas rurales, los no expuestos fueron los de zonas urbanas. Se recolectaron variables según características clínico epidemiológicas e histopatológicas. Para medir la supervivencia se utilizó el método de Kaplan Meier y la prueba de Log Rank. Los factores pronósticos fueron determinados calculando hazard ratio ajustado (HRa) en un análisis multivariado mediante el método de riesgos proporcionales de Cox. Resultados: Se analizaron 186 casos de CP. La supervivencia global a 5 años fue de 48,3%. Los hombres que residían en zonas urbanas tuvieron una probabilidad de supervivencia mayor que quienes residían en zonas rurales (HRa 1,67; IC 95%: 1,16-2,41). Asimismo, las personas que vivían en lugares catalogados como zonas de baja marginación tuvieron una mayor probabilidad de supervivencia que quienes vivían en zonas de alta marginación (HRa 2,32; IC 95%: 1,47-3,66). Conclusiones: El lugar de residencia rural se identificó como un factor de mal pronóstico para la supervivencia de pacientes con CP independientemente de otras variables sociodemográficas y clínicas; los pacientes que vivían en lugares con grados de marginación más elevados tuvieron un pronóstico desfavorable de supervivencia.

ABSTRACT Objectives: To determine if the place of residence and the level of social marginalization are associated with prostate cancer survival. Materials and methods: All patients diagnosed with prostate cancer (PC) in the period from 2013 to 2017 in a tertiary healthcare hospital in Veracruz, Mexico were included. Patients resided in rural and urban areas. Variables were collected according to clinical-epidemiological and histopathological characteristics. The Kaplan Meier method and the Log Rank test were used to measure survival. Prognostic factors were determined by calculating the adjusted hazard ratio (HRa) in a multivariate analysis using the Cox proportional risk method. Results: A total of 186 PC cases were analyzed. Overall, after 5 years, 48.3% of the patients survived. Men living in urban areas had a higher probability of survival than those living in rural areas (HRa 1.67, 95% CI 1.16-2.41). Similarly, people living in areas classified as low- marginalization zones had a higher probability of survival than those living in areas with a high level of social marginalization (HRa 2.32, 95% CI 1.47-3.66). Conclusions: To reside in a rural place was identified as a negative prognostic factor for the survival of patients with PC regardless of other sociodemographic and clinical variables; patients living in high-marginalization places had an unfavorable survival prognosis.

Morbimortalidade de câncer de próstata / Morbimortality of prostate cancer

Objetivo: Analisar o perfil epidemiológico da mortalidade por câncer da próstata, identificando fatores de risco para a pato- gênese. Métodos: Estudo retrospectivo, populacional. Os dados analisados foram coletados do Sistema de Informação sobre Mor- talidade e Informações de Saúde. O desfecho foi definido como C-61, como descrito na CID-10. Foram incluídos pacientes do sexo masculino acima de 40 anos. As variáveis para o desfecho estudado foram: zona de residência, faixa etária, cor, escolaridade e local de óbito. Na análise e na associação entre as variáveis e o desfecho, foi usado o teste qui-quadrado (p<0,05) com o método de Mantel-Haenszel (intervalo de confiança de 95%). Resultados: Foram identificados 1.254 casos de óbito por neoplasias malignas, sendo 15% de neoplasia maligna prostática e demais 85% por outras neoplasias. As variáveis que influenciaram no desfecho foram: faixa etária 60 ou mais anos (97,3%) comparada com 40 a 59 anos (2,7%), com razão de chance de 18,1, intervalo de con- fiança de 95% 0,7-0,8 e p<0,05; escolaridade com zero a 3 anos de estudo (75%) como influenciadora e 4 anos ou mais de estudo (25%), com razão de chance de 2,5, intervalo de confiança de 95% 1,6-3,0 e p<0,05; local de óbito, com significância estatística mos- trada na comparação entre hospital, com números de mortes de 76,6% e domicílio e via pública de 23,4%, com razão de chance de 0,5, intervalo de confiança de 95% 0,4-0,8 e p<0,05. Conclusão: Nas mortes por neoplasia maligna da próstata, mostraram-se associados ao desfecho idade acima de 60 anos, ambientes intra ou extra-hospitalares e escolaridade até 3 anos de estudo.

Objective: To analyze the epidemiological profile of mortality due to prostate neoplasia, identifying the risk factors for its pathoge- nesis. Methods: This is a retrospective, population-based study. The data analyzed were collected from the information system of mortality and health information. The outcome was defined as described in the International Classification of Diseases 10th revision, C-61. The subjects included were male patients over 40 years of age. The variables for the outcome studied were: residen- ce area; age group; color; schooling; place of death. In the analy- sis and association among the variables and the outcome, the chi-square test (p<0.05) was used with the Mantel-Haenszel me- thod (95% Confidence Interval). Results: A total of 1,254 cases of death was identified from malignant neoplasms, with 15% of pros- tate malignant neoplasia, and 85% of other neoplasms. The varia- bles influencing the outcome were; mean age of 60 years or more (97.3%), compared to 40 to 59 years (2.7%), (Odds Ratio=18.1), 95% confidence interval (0.7-0.8), (p<0.05); level of education of 0-3 years (75%) of study as an influencer, and 4 years or more years of study (25%) (Odds Ratio= 2.5), 95% confidence interval (1.6-3.0), (p<0.05); place of death, with statistical significance shown in the comparison between hospital, with number of deaths of 76.6%, and at home and in the streets(23,4%), (Odds Ratio=0.5), 95% confidence interval (0.4-0.8), (p <0.05). Conclusion: In the deaths from malignant neoplasia of the prostate, age over 60 years, place of death inside or outside hospitals, and level of education of up to 3 years of study were associated with the outcome.

Trends in prostate cancer mortality in the state of São Paulo, 2000 to 2015 / Tendências na mortalidade por câncer de próstata no estado de São Paulo, 2000 a 2015

ABSTRACT OBJECTIVE To estimate the magnitude and identify patterns of change in prostate cancer mortality in the state of São Paulo and in the 17 regional health care networks, according to age groups from 50 years onwards, in the period between 2000 to 2015. METHODS Age-adjusted mortality rates (per 100,000 men) were calculated by the direct method using the Segi world population as standard. Joinpoint regression was used to calculate the average annual percent change (AAPC), with a confidence interval of 95% (95%CI), by regional network and age group (50-59, 60-69, 70-79 and 80 years or more). RESULTS For the state of São Paulo, age-adjusted mortality rates were 15.2, 13.3 and 11.9 per 100,000 men, respectively, in the periods between 2000 to 2005, 2006 to 2010 and 2011 to 2015, with a significant decrease trend (AAPC = -2.10%; 95%CI -2.42 - -1.79) each year. Among the 17 networks, 11 presented significant mean annual reductions, ranging from -1.72% to -3.05%. From the age of 50 onwards, there was a sharper reduction in the groups from 50 to 59 (AAPC = -2.33%; 95%CI -3.04 - -1.62) and 60 to 69 years (AAPC = -2.84%; 95%CI - 3.25 - -2.43). CONCLUSION Although reductions in mortality are still slight, they indicate progress in prostate cancer control actions. Screening actions and changes in therapeutic behaviors in recent decades may be modifying incidence and survival, resulting in changes in the mortality profile. More detailed studies will be useful in understanding the factors that lead to the interregional variations found.

RESUMO OBJETIVO Estimar a magnitude e identificar padrões de mudança na mortalidade por câncer de próstata no estado de São Paulo e nas 17 redes regionais de atenção à saúde, segundo grupos etários a partir dos 50 anos, no período de 2000 a 2015. MÉTODOS As taxas de mortalidade ajustadas por idade (por 100 mil homens) foram calculadas pelo método direto usando a população mundial de Segi como padrão. A análise de regressão Joinpoint foi utilizada para calcular as variações percentuais anuais médias (AAPC), com intervalo de confiança de 95% (IC95%), por rede regional e grupo etário (50-59, 60-69, 70-79 e 80 anos ou mais). RESULTADOS Para o estado de São Paulo, as taxas ajustadas de mortalidade foram de 15,2, 13,3 e 11,9/100 mil homens, respectivamente, nos períodos de 2000 a 2005, 2006 a 2010 e 2011 a 2015, com tendência de decréscimo significativo (AAPC = -2,10%; IC95% -2,42 - -1,79) a cada ano. Das 17 redes, 11 apresentaram reduções médias anuais significativas, que variaram entre -1,72% e -3,05%. A partir dos 50 anos, verificou-se redução mais acentuada nos grupos de 50 a 59 (AAPC = -2,33%; IC95% -3,04 - -1,62) e 60 a 69 anos (AAPC = -2,84%; IC95% -3,25 - -2,43). CONCLUSÕES Embora as reduções na mortalidade ainda sejam discretas, indicam progresso nas ações de controle do câncer de próstata. Ações de rastreamento e mudanças nas condutas terapêuticas nas últimas décadas podem estar modificando a incidência e a sobrevida, resultando em mudanças no perfil de mortalidade. Estudos mais detalhados serão úteis na compreensão dos fatores que levam às variações inter-regionais encontradas.

High D-dimer levels are associated with prostate cancer

RESUMO OBJETIVO O câncer de próstata é uma das neoplasias mais comuns em homens. Os principais fatores de risco para a ativação da coagulação e trombose são malignidade e idade mais avançada. O risco de trombose pode estar associado ao aumento do nível dos marcadores de coagulação, tais como o fibrinogênio e D-dímero. O objetivo deste estudo é avaliar a relação entre os marcadores de coagulação e o câncer de próstata. METODOLOGIA Este estudo prospectivo incluiu os pacientes que foram submetidos à biópsia de próstata transretal guiada por ultrassonografia e que passaram por cirurgia da próstata entre janeiro de 2015 e janeiro de 2016. Os níveis no plasma de antígeno prostático específico (PSA), PSA livre (fPSA), porcentagem de fPSA, D-dímero e fibrinogênio foram medidos antes dos procedimentos. Os pacientes foram divididos em dois grupos de acordo com os resultados de patologia. Os pacientes com hiperplasia benigna da próstata foram colocados no grupo 1 e os pacientes com câncer de próstata no grupo 2. RESULTADOS No total, 76 pacientes foram incluídos neste estudo. Houve um total de 53 pacientes no grupo 1 e 23 pacientes no grupo 2. A idade média dos pacientes e os níveis de PSA, fPSA, fibrinogênio e D-dímero foram, respectivamente, 65.33 ± 7.47 anos, 8.21 ± 4.59, 1.41 ± 0.74 ng/ml, 309.75 ± 80.46 mg/dl e 0.42 ± 0.39 µg/ml no grupo 1. No grupo 2, a idade média dos pacientes e os níveis de PSA, fPSA, fibrinogênio e D-dímero foram, respectivamente, 66.08 ± 6.7 anos, 145.69 ± 509.35, 7.32 ± 15 ng/ml, 312.16 ± 69.48 mg/dl, 1.09 ± 2.11 µg/ml. Biópsia da próstata e cirurgia transuretal foram realizadas em 64 (%84,21) e 12 (%15,79) pacientes, respectivamente. CONCLUSÃO O presente estudo demonstrou que os níveis de D-dímero no plasma foram maiores em pacientes com câncer de próstata. Novos estudos com um maior número de pacientes são necessários para definir a relação entre câncer de próstata e distúrbios de coagulação.

Intensity modulated radiotherapy (IMRT) or conformational radiotherapy (3D-CRT) with conventional fractionation for prostate cancer: Is there any clinical difference?

ABSTRACT Purpose: To compare the treatment outcomes of a cohort of prostate cancer patients treated with conventional schedule using IMRT or 3DRT technique. Materials and Methods: Between 2010-2017, 485 men with localized prostate cancer were treated with conventional radiotherapy schedule with a total dose ≥74Gy using IMRT (231) or 3DCRT (254). Late gastrointestinal (GI) and genitourinary (GU) toxicity were retrospectively evaluated according to modified RTOG criteria. The biochemical control was defined by the Phoenix criteria (nadir + 2ng/mL). The comparison between the groups included biochemical recurrence free survival (bRFS), overall survival (OS) and late toxicity. Results: With a median follow-up of 51 months (IMRT=49 and 3DRT=51 months), the maximal late GU for >=grade- 2 during the entire period of follow-up was 13.1% in the IMRT and 15.4% in the 3DRT (p=0.85). The maximal late GI ≥ grade- 2 in the IMRT was 10% and in the 3DRT 24% (p=0.0001). The 5-year bRFS for all risk groups with IMRT and 3D-CRT was 87.5% vs. 87.2% (p=0.415). Considering the risk-groups no significant difference for low-, intermediate- and high-risk groups between IMRT (low-95.3%, intermediate-86.2% and high-73%) and 3D-CRT (low-96.4%, intermediate-88.2% and high-76.6%, p=0.448) was observed. No significant differences for OS and DMFS were observed comparing treatment groups. Conclusion: IMRT reduces significantly the risk of late GI severe complication compared with 3D-CRT using conventional fractionation with a total dose ≥74Gy without any differences for bRFS and OS.

Prostate brachytherapy with iodine-125 seeds: analysis of a single institutional cohort

ABSTRACT Objectives: Brachytherapy (BT) with iodine-125 seeds placement is a consolidated treatment for prostate cancer. The objective of this study was to assess the clinical outcomes in patients with prostate cancer who underwent low-dose-rate (LDR) -BT alone in a single Brazilian institution. Materials and Methods: Patients treated with iodine-125 BT were retrospectively assessed after at least 5 years of follow-up. Patients who received combination therapy (External beam radiation therapy-EBRT and BT) and salvage BT were not included. Results: 406 men were included in the study (65.5% low-risk, 30% intermediate-risk, and 4.5% high-risk patients). After a median follow-up of 87.5 months, 61 (15.0%) patients developed biochemical recurrence. The actuarial biochemical failure-free survival (BFFS) at 5 and 10 years were 90.6% and 82.2%, respectively. A PSA nadir ≥ 1 ng / mL was associated with a higher risk of biochemical failure (HR = 5.81; 95% CI: 3.39 to 9.94; p ≤ 0.001). The actuarial metastasis-free survival (MFS) at 5 and 10 years were 98.3% and 94%, respectively. The actuarial overall survival (OS) at 5 and 10 years were 96.2% and 85.1%, respectively. Acute and late grade 2 and 3 gastrointestinal toxicities were observed in 5.6%, 0.5%, 4.6% and 0.5% of cases, respectively. For genitourinary the observed acute and late grade 2 and 3 toxicities rates were 57.3%, 3.6%, 28% and 3.1%, respectively. No grade 4 and 5 were observed. Conclusions: BT was effective as a definitive treatment modality for prostate cancer, and its endpoints and toxicities were comparable to those of the main series in the literature.

Mortalidade em homens com câncer de próstata e sua associação com variáveis sociodemográficas e clínicas / Mortality among men bearing prostate cancer and its association with sociodemographic and clinical variables / Mortalidad en hombres con cáncer de próstata y su asociación con variables sociodemográficas y clínicas

Objective: The study's purpose has been to evaluate the association of socio-demographic and clinical variables with the general and specific mortality from prostate cancer. Methods: This is a retrospective study that was carried out through the analyses of medical records from 1,290 men diagnosed with prostate cancer over the period from 2000 to 2006. Results: Considering the 1,290 men, 758 were alive, 308 had died from prostate cancer, and 224 had died from other causes. Those that were associated with death from prostate cancer include: Gleason score > 9, Prostate Specific Antigen (PSA) > 20 and the presence of metastasis. Furthermore, there were those associated with death due to other causes, as follows: widowers, admission to the hospital without diagnosis and without treatment, and also PSA > 50. Conclusion: Clinical variables predominated with regards to prostate cancer-specific mortality. On the other hand, socio-demographic variables prevailed towards deaths originated from other causes

Objetivo: Avaliar a associação de variáveis sociodemográficas e clínicas com a mortalidade geral e específica por câncer de próstata. Método: Estudo retrospectivo de 1290 homens diagnosticados com câncer de próstata entre 2000 e 2006. Consultou-se prontuários, Sistema de Registro Hospitalar e Sistema de Informações sobre Mortalidade. Resultados: Dos 1290 homens, 758 estavam vivos, 308 morreram por câncer de próstata e 224 por outras causas. Associaram-se ao óbito por câncer de próstata: escore de Gleason > 9, PSA > 20 (entre 2,82 e 5,55 vezes) e presença de metástase. Associaram-se ao óbito por outras causas: estado civil viúvo, ingresso no hospital sem diagnóstico e sem tratamento e PSA > 50. Conclusão: Variáveis clínicas predominaram sobre a mortalidade específica por câncer de próstata, já variáveis sociodemográficas em óbitos por outras causas

Objetivo: Evaluar la asociación de las variables sociodemográficas y clínicas con la mortalidad general y específica por cáncer de próstata. Métodos:Estudio retrospectivo de 1.290 hombres con cáncer de próstata en el período del 1 de enero de 2000 al 31 de diciembre de 2006. Resultados: De los 1.290 hombres, 758 estaban vivos, 308 murieron por cáncer de próstata y 224 por otras causas. Se asociaron con la muerte por cáncer de próstata: Gleason puntuación >9, PSA>20 (entre 2,82 y 5,55 veces) y metástasis. Ellos se asociaron con muerte por otras causas: el estado civil viuda, la admisión al hospital diagnosticar y sin tratar y el PSA>50. Conclusión: Las variables clínicas predominaron sobre la mortalidad específica por cáncer de próstata, ya variables sociodemográficas en muertes por otras causas

Prognosis of patients with prostate cancer and middle range prostate - specific antigen levels of 20 - 100 ng / mL

ABSTRACT Introduction: Prostate - specific antigen (PSA) is a useful biomarker for detection of prostate cancer (PCa) and for risk classification in addition to TNM classification and Gleason score (GS). We reported the role of PSA in patients with low (< 20 ng / mL) and extremely high (≥ 100 ng / mL) PSA levels. However, it is unclear whether a correlation exists between middle range PSA levels (20 - 100 ng / mL) at diagnosis and prognosis. Materials and Methods: Between January 2000 and December 2014, 1873 patients underwent prostate biopsy at Kanazawa University Hospital. Of 802 patients who were diagnosed with PCa, 148 patients with middle range PSA levels (20 - 100 ng / mL) were retrospectively analyzed. Results: The percentage of patients with T3 - 4 consistently increased as PSA levels increased from 20 to 100 ng / mL. Although the percentage of patients with GS ≥ 8 or metastases increased as PSA levels increased up to approximately 70 ng / mL, there was no significant increase between 70 and 100 ng / mL. PCa - specific and castration - resistant PCa - free survivals were adversely associated with PSA levels up to 70 ng / mL, but not between 70 and 100 ng / mL. Conclusion: PSA is a useful biomarker for predicting prognosis at levels between 20 and 70 ng / mL. However, PSA cannot be used as a prognostic factor in patients with PCa and PSA levels ≥ 70 ng / mL. When the PSA level reaches approximately 70 ng / mL, prognosis might bottom and reach a plateau.

Evaluation of incidence and histolopathological findings of soft tissue sarcomas in genitourinary tract: Uludag university experience

ABSTRACT Purpose: In this study we aimed to review urological soft tissue sarcomas of genitourinary tract that were diagnosed in our institution and their prognostic factors for survival. Materials and Methods: The clinical and pathological records of 31 patients who had diagnosis of soft tissue sarcomas primarily originating from the genitourinary tract between 2005-2011 were reviewed. Results: The most common site was kidney (17 cases, 54.8%), and most common diagnosis was leiomyosarcoma (11 cases, 35.4%). A total of 24 patients (77.4%) had surgical excision. The surgical margins were positive in 7 patients who presented with local recurrence after primary resection. Twelve patients developed metastatic disease. During follow-up (range 9-70 month), 26 of the 31 patients (88.9%) were alive. Significant survival differences were found according to histological type (p: 0.001), with lower survival rates for malignant fibrous histiocytoma. The tumor size, the presence of metastasis at the time of diagnosis and tumor localization were not statistically significant for overall survival. Conclusions: In our series, prostate sarcomas, paratesticular rhabdomyosarcoma and malignant fibrous histiocytoma had poor prognosis, especially in patients presenting with metastatic disease.

Cost-effectiveness analysis of abiraterone, docetaxel or placebo plus androgen deprivation therapy for hormone-sensitive advanced prostate cancer / Análise de custo-efetividade da adição de abiraterona ou quimioterapia ao tratamento do câncer de próstata metastático hormônio-sensível

ABSTRACT Objective To evaluate the cost-effectiveness of the addition of chemotherapy or abiraterone to androgen deprivation. Methods We developed an analytical model to determine the cost-effectiveness of the addition of docetaxel or abiraterone versus androgen deprivation therapy alone. Direct and indirect costs were included in the model. The effects were expressed in Quality-Adjusted Life Years adjusted for side effects. Results Compared to androgen deprivation therapy alone, the addition of chemotherapy and of abiraterone generated 0.492 and 0.999, respectively, in Quality-Adjusted Life Years. Abiraterone led to a Quality-Adjusted Life Years gain of 0.506 compared to docetaxel. The incremental costs per Quality-Adjusted Life Years were R$ 133.649,22 for docetaxel, R$ 330.828,70 for abiraterone and R$ 571.379,42 for abiraterone compared to docetaxel, respectively. Conclusion The addition of chemotherapy to androgen deprivation therapy is more cost-effective than the addition of abiraterone to androgen deprivation therapy. However, discounts on abiraterone cost might improve cost-effectiveness.

RESUMO Objetivo Avaliar a relação custo-efetividade da adição de quimioterapia ou abiraterona à terapia de privação hormonal. Métodos Um modelo analítico foi desenvolvido para determinar a relação custo-efetividade da adição de docetaxel ou abiraterona comparada à terapia de privação hormonal isolada. Custos diretos e indiretos foram incluídos no modelo. Os efeitos foram expressos em Anos de Vida Ajustados para Qualidade corrigidos pelos efeitos colaterais de cada terapia. Resultados A adição de quimioterapia e de abiraterona à terapia de privação hormonal aumentou os Anos de Vida Ajustados para Qualidade em 0,492 e 0,999, respectivamente, em comparação à terapia de privação hormonal isolada. A abiraterona promoveu ganho de Anos de Vida Ajustados para Qualidade de 0,506 em relação ao docetaxel. O custo incremental por Anos de Vida Ajustados para Qualidade foi R$ 133.649,22 para o docetaxel, R$ 330.828,70 para a abiraterona e R$ 571.379,42 para a abiraterona comparada ao docetaxel. Conclusão A adição de quimioterapia à terapia de privação hormonal é mais custo-efetiva que a adição de abiraterona à terapia de privação hormonal. Contudo, descontos no custo da abiraterona poderiam tornar esse tratamento mais custo-efetivo.

Prostate Cancer Screening in Men of African Descent: 15-year Results of the Tobago Prostate Cancer Survey / Tamización del cáncer de próstata en hombres de ascendencia africana: resultados de 15 años de la Encuesta de Cáncer de Próstata de Tobago

ABSTRACT Objective: To compare all-cause-mortality in screening-detected prostate cancer cases versus non-cases after a median 12.2-year follow-up. Methods: In this prospective, population-based study of 3089 Afro-Caribbean men aged 40-79 years in Tobago, Trinidad and Tobago, West Indies, all men were screened for prostate cancer (serum prostate specific antigen and/or digital rectal exam) one to three times between 1997 and 2007 and followed for mortality to 2012. Among 502 men diagnosed with prostate cancer, 81 younger men underwent radical retropubic prostatectomy. Minimal treatment was available for older men. Survival curves compared all-cause-mortality in cases versus non-cases within 10-year age groups at first screening. Results: There were 350 all-cause-deaths over 34 089 person-years of follow-up. All-cause-survival curves in men aged 60 years or above at first screening did not diverge between cases and non-cases until after 10-12 years of follow-up (p > 0.36). In contrast, among men first screened at age 50-59 years, survival was lower in cases, with survival curves diverging at seven years (p = 0.003). Survival in men aged 50-59 years who underwent prostatectomy was similar to survival in non-cases (p = 0.63). Conclusion: Among men aged 60 years or above, the absence of excess all-cause-mortality among screening-detected prostate cancer cases provides argument against the utility of routine prostate cancer screening in this older population of African descent. However, the significantly poorer survival in men aged 50-59 years with screening-detected prostate cancer, compared with screened men without prostate cancer, along with the potential for prostate cancer treatment to improve survival, supports the continuation of prostate cancer screening in this age group, pending further research to assess the risks and benefits.

RESUMEN Objetivo: Comparar la mortalidad por todas las causas en casos de cáncer de próstata frente a no casos tras un seguimiento medio de 12.2 años. Métodos: En este estudio prospectivo poblacional de 3089 hombres afrocaribeños de 40-79 años en Tobago, Trinidad y Tobago, West Indies, todos los hombres fueron expuestos a tamizaje de cáncer de próstata (antígeno prostático específico en suero y/o examen rectal digital) de una a tres veces entre 1997 y 2007, y a un seguimiento de la mortalidad hasta 2012. De entre los 502 hombres diagnosticados con cáncer de próstata, a 81 hombres de los más jóvenes se les practicó una prostatectomía retropúbica radical. El tratamiento mínimo estuvo disponible para los hombres mayores. Las curvas de supervivencia compararon la mortalidad por todas las causas en los casos frente a los no casos dentro de los grupos de edades de 10 años en la primera tamización. Resultados: Hubo 350 muertes por todas las causas con más de 34 089 persona-años de seguimiento. Las curvas de supervivencia por todas las causas en hombres de 60 años o más en el primer tamizaje, no divergieron entre casos y no casos hasta después de 10 a 12 años de seguimiento (p > 0.36). En cambio, entre los hombres tamizados por primera vez a la edad 50-59 años, la supervivencia fue menor en los casos, con curvas de supervivencia divergentes a los siete años (p = 0.003). La supervivencia en los hombres de 50-59 años que tuvieron prostatectomía fue similar a la supervivencia en los no casos (p = 0.63). Conclusión: Entre los hombres de 60 años o más, la ausencia de exceso de mortalidad por todas las causas entre los casos de cáncer de próstata detectados por tamizaje proporciona argumentos contra la utilidad de la tamización rutinaria del cáncer de próstata en esta población mayor de ascendencia africana. Sin embargo, la supervivencia significativamente más pobre en hombres de 50 a 59 años con cáncer de próstata detectado mediante tamizaje - en comparación con los hombres tamizados sin cáncer de próstata, además de las posibilidades de tratamiento del cáncer de próstata para mejorar la supervivencia - respalda la continuación del tamizaje del cáncer de próstata en este grupo etario, quedando pendiente una investigación ulterior a fin de evaluar sus riesgos y beneficios.

Analysis of survival in patients with brain metastases treated surgically: Impact of age, gender, oncologic status, chemotherapy, radiotherapy, number and localization of lesions, and primary cancer site

SUMMARY OBJECTIVE To evaluate the survival of patients with brain metastases treated surgically according to the potentially involved factors. METHODS 71 patients treated surgically were analyzed with the diagnosis of brain metastases during the period from January 2011 to November 2014, totaling 47 months of follow-up. The Kaplan-Meier curve method was used for survival analysis. Results We evaluated 71 patients with brain metastases treated surgically, 44 female and 27 male, mean age of 60.1 years. According to the Karnofsky scale, 44 patients were classified with Karnofsky greater than or equal to 70 and 27 patients with Karnofsky inferior to 70. Lung was the primary site most commonly found. Death occurred in twenty patients (28%), and lung tumors were responsible for the most deaths. Twelve patients had supra and infratentorial metastases, fifty-nine only had supratentorial lesions, and lesions were multiple in twenty-eight patients and single in forty-three. Thirty patients were also treated with chemotherapy, eighteen with chemotherapy and radiation therapy, while only three received just radiotherapy. Survival analysis by Kaplan-Meier curve showed no statistical significance regarding age, histological type, location, Karnofsky, chemotherapy, and radiotherapy. There was statistical significance regarding gender. CONCLUSION The factors analyzed did not change survival rates, except for gender. This fact may probably be explained due to the systemic and diffuse behavior of cancer.

RESUMO OBJETIVO Avaliar a sobrevivência de pacientes com metástases cerebrais tratados cirurgicamente de acordo com os fatores potencialmente envolvidos. Métodos 71 pacientes tratados cirurgicamente foram analisados com o diagnóstico de metástases cerebrais durante o período de janeiro de 2011 a novembro de 2014, totalizando 47 meses de seguimento. A curva de Kaplan-Meier foi utilizada para análise de sobrevivência. Resultados Avaliamos 71 pacientes com metástases cerebrais atendidas cirurgicamente, 44 do sexo feminino e 27 do sexo masculino, idade média de 60,1 anos. De acordo com a escala de Karnofsky, 44 pacientes foram classificados com Karnofsky maior ou igual a 70 e 27 pacientes com Karnofsky com menos de 70. O pulmão era o local mais comum. A morte ocorreu em 20 pacientes (28%) e os tumores pulmonares são responsáveis pela maioria das mortes. Doze pacientes apresentavam metástases supra e infratentoriais, 59 apresentavam apenas lesões supratentoriais, e as lesões eram múltiplas em 28 pacientes e isoladas em 43. Trinta pacientes também foram tratados com quimioterapia, 18 foram tratados com quimioterapia e radioterapia, enquanto que apenas três receberam apenas radioterapia. A análise de sobrevivência pela curva de Kaplan-Meier não mostrou significância estatística de acordo com a idade, tipo histológico, localização, Karnofsky, quimioterapia e radioterapia. Houve significância estatística em relação ao gênero. Conclusão Os fatores analisados não alteraram a sobrevivência, exceto o gênero. Este fato provavelmente pode ser explicado devido ao comportamento sistêmico e difuso do câncer.

Prostate cancer incidentally discovered at the time of radical cystoprostatectomy does not decrease overall survival: Results from a large Chinese medical center

ABSTRACT Purpose To investigate the incidence and pathologic characteristics of prostate cancer (PCa) incidentally discovered at the time of radical cystectomy and its impact on overall survival. Materials and Methods A single center retrospective study of 762 male patients who underwent radical cystoprostatectomy from Jan 1994 to Dec 2012. Results Of all included patients, 132 (17.3%) were found to have PCa. Patients with incidental PCa had a significantly higher mean age (69.2 vs. 62.2 years, P=0.015). Among the 132 patients with PCa, prostate specific antigen (PSA) analysis was available in 76 patients (57.6%), with a median value of 1.06ng/mL, and 61 (80.3%) patients had a PSA value below 4ng/mL. Four hundred and thirty-six patients (57.1%) were successfully followed, with a median duration of 46.5 months. The overall 5-year survival rate was 62.1%, and the 5-year cancer-specific survival rate was 72%. PCa recurrence was defined by two consecutive PSA values of >0.2 ng/mL and rising, and no PCa recurrence occurred. According to a univariate analyses, incidental PCa was not associated with cancer-specific survival (P=0.192) or overall survival (P=0.493). According to univariate analyses, the overall survival of patients with PCa was not associated with prostate cancer staging, PSA value, or Gleason score (All P values>0.05). Conclusions Prostate cancer incidentally discovered at the time of radical cystectomy does not decrease overall survival. Patients with incidental PCa were older than those without. The PSA value before operation is not helpful for predicting incidental prostate cancers.

Cancer incidence estimates and mortality for the top five cancer in Colombia, 2007-2011 / Estimaciones de incidencia y mortalidad para los principales cinco tipos de cáncer en Colombia, 2007-2011

Abstract Objectives: To describe the incidence and mortality for the five main types of cancer in Colombia, from 2007-2011. Methods: We estimated cases and cancer incidence rates standardised by age, based on incidence/mortality ratios; and we calculated the observed deaths and mortality rates standardised by age in Colombia, both differentiated by province, type of cancer and sex. Incidence estimates were generated based on information from four cancer population registries (Cali, Pasto, Bucaramanga and Manizales), published in Cancer Incidence in Five Continents, volume X, and the official mortality and population information of the National Administrative Province of Statistics (DANE, for its initials in Spanish). Results: The annual number of expected cases (all cancers) was 62,818 in men and women; and there were 32,653 recorded deaths. The main incidental cancers were prostate (46.5 per 100,000 person-years) in men, and breast (33.8 per 100,000 person-years) in women. The highest mortality figures were for stomach cancer in men (14.2); and breast cancer in women (9.9). Conclusions: The highest incidence and mortality estimates in Colombia were for breast and prostate cancers, as well as a proportion of infection-related cancers, such as stomach and cervical cancer. These four neoplasms were responsible for more than 50% of the burden of the disease. Only through good quality, long-duration cancer registries, can information be obtained about the changes in incidence trends.

Resumen Objetivos: Describir la incidencia y mortalidad para los cinco principales tipos de cáncer en Colombia, de 2007-2011. Métodos: Se estimaron casos y tasas de incidencia de cáncer ajustadas por edad a partir de razones incidencia/mortalidad y se calcularon las muertes observadas y tasas de mortalidad ajustadas por edad en Colombia, ambas diferenciadas por departamentos, tipo de cáncer y sexo. Las estimaciones de incidencia se generaron con base en la información de cuatro registros poblacionales de cáncer (Cali, Pasto, Bucaramanga y Manizales), publicada en Cancer Incidence in Five Continents, volumen X, y la información oficial de mortalidad y población del Departamento Administrativo Nacional de Estadística (DANE). Resultados: El número anual de casos esperados (todos los cánceres) fue 62,818 en hombres y en mujeres y se registraron 32,653 muertes. Los principales cánceres incidentes fueron próstata (46.5 por 100,000 años-persona) en hombres y mama (33.8 por 100,000 años-persona) en mujeres. La mortalidad más alta en hombres se presentó en estómago (14.2) y mama en mujeres (9.9). Conclusiones: Las estimaciones de incidencia y mortalidad más altas en Colombia fueron para los cánceres de mama y próstata, además de una proporción de cánceres relacionados con la infección como son el cáncer de estómago y de cuello uterino. Estas cuatro neoplasias fueron responsables de más del 50% de la carga de la enfermedad. Solamente a través de los registros de cáncer de buena calidad y de larga trayectoria podrá tenerse información sobre el cambio en las tendencias de incidencia.

Análisis estadístico implicativo para la identificación de factores pronósticos de la mortalidad por cáncer de próstata / Statistical analysis involving mortality prediction factors for the identification of prostate cancer

Se efectuó una investigación observacional y analítica, desde septiembre de 2013 hasta igual mes de 2014, con el fin de evaluar la utilidad de una nueva técnica de análisis estadístico implicativo para la identificación de los factores pronósticos de la mortalidad por cáncer de próstata en la provincia de Santiago de Cuba. Según la regresión logística, los factores que empeoraron el pronóstico en los pacientes con cáncer de próstata fueron la afectación ganglionar y el grado III de la diferenciación histológica, y según el análisis estadístico implicativo, lo hicieron la afectación ganglionar, las metástasis y las complicaciones. El análisis estadístico implicativo complementó a la regresión logística en la identificación de los factores pronósticos, con lo cual se logró una mejor comprensión de la causalidad y se elevó la calidad de este tipo de estudio

An observational and analytic investigation was carried out, from September, 2013 to the same month in 2014, with the purpose of evaluating the usefulness of a new technique of involving statistical analysis for the identification of mortality prediction factors for prostate cancer in Santiago de Cuba. According to the logistical regression, the factors that worsened the prediction in the patients with prostate cancer were the ganglionic disorder and the grade III of the histological differentiation, and according to the involving statistical analysis, the ganglionar disorder, the metastasis and complications. The involving statistical analysis supplemented the logistical regression in the identification of the prediction factors, with which a better understanding of the causation was achieved and there was an increase in the quality of this type of study

miR-483-5p promotes prostate cancer cell proliferation and invasion by targeting RBM5

ABSTRACT Objective: miR-483-5p has been identified as a miRNA oncogene in certain cancers. However, its role in prostate cancer has not been sufficiently investigated. In this study, we investigated the role of miR-483-5p in prostate cancer and examined RBM5 regulation by miR-483-5p. Material and methods: Expression levels of miR-483-5p were determined by quantitative real-time PCR. The effect of miR-483-5p on proliferation was evaluated by MTT assay, cell invasion was evaluated by trans-well invasion assays, and target protein expression was determined by western blotting in LNCaP, DU-145, and PC-3 cells. Luciferase reporter plasmids were constructed to confirm the action of miR-483-5p on downstream target gene RBM5 in HEK-293T cells. Results: we observed that miR-483-5p was upregulated in prostate cancer cell lines and tissues. A miR-483-5p inhibitor inhibited prostate cancer cell growth and invasion in DU-145 and PC-3 cells. miR-483-5p directly bound to the 3' untranslated region (3'UTR) of RBM5 in HEK-293T cells. RBM5 overexpression inhibited prostate cancer cell growth and invasion in LNCaP cells. Enforced RBM5 expression alleviated miR-483-5p promotion of prostate cancer cell growth and invasion in LNCaP cells. Conclusion: The present study describes a potential mechanism underlying a miR-483-5p/RBM5 link that contributes to prostate cancer development.