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Int. braz. j. urol ; 48(2): 263-274, March-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364963


ABSTRACT Purpose: Prostate cancer (PCa) is the second most common oncologic disease among men. Radical treatment with curative intent provides good oncological results for PCa survivors, although definitive therapy is associated with significant number of serious side-effects. In modern-era of medicine tissue-sparing techniques, such as focal HIFU, have been proposed for PCa patients in order to provide cancer control equivalent to the standard-of-care procedures while reducing morbidities and complications. The aim of this systematic review was to summarise the available evidence about focal HIFU therapy as a primary treatment for localized PCa. Material and methods: We conducted a comprehensive literature review of focal HIFU therapy in the MEDLINE database (PROSPERO: CRD42021235581). Articles published in the English language between 2010 and 2020 with more than 50 patients were included. Results: Clinically significant in-field recurrence and out-of-field progression were detected to 22% and 29% PCa patients, respectively. Higher ISUP grade group, more positive cores at biopsy and bilateral disease were identified as the main risk factors for disease recurrence. The most common strategy for recurrence management was definitive therapy. Six months after focal HIFU therapy 98% of patients were totally continent and 80% of patients retained sufficient erections for sexual intercourse. The majority of complications presented in the early postoperative period and were classified as low-grade. Conclusions: This review highlights that focal HIFU therapy appears to be a safe procedure, while short-term cancer control rate is encouraging. Though, second-line treatment or active surveillance seems to be necessary in a significant number of patients.

Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Ultrasound, High-Intensity Focused, Transrectal/methods , Treatment Outcome , Salvage Therapy/methods , Neoplasm Recurrence, Local/surgery
Int. braz. j. urol ; 48(2): 244-262, March-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364955


ABSTRACT Objective: This review aimed to analyze interventions raised within primary and tertiary prevention concerning the disease's incidence, progression, and recurrence of Prostate Cancer (PCa). Priority was given to the multidisciplinary approach of PCa patients with an emphasis on modifiable risk factors. Materials and Methods: We conducted a comprehensive literature review in the following databases: Embase, Central, and Medline. We included the most recent evidence assessing cohort studies, case-control studies, clinical trials, and systematic reviews published in the last five years. We only included studies in adults and in vitro or cell culture studies. The review was limited to English and Spanish articles. Results: Preventive interventions at all levels are the cornerstone of adherence to disease treatment and progression avoidance. The relationship in terms of healthy lifestyles is related to greater survival. The risk of developing cancer is associated to different eating habits, determined by geographic variations, possibly related to different genetic susceptibilities. Discussion: PCa is the second most common cancer in men, representing a leading cause of death among men in Latin America. Prevention strategies and healthy lifestyles are associated with higher survival rates in PCa patients. Also, screening for anxiety and the presence of symptoms related to mood disorders is essential in the patient's follow-up concerning their perception of the condition.

Humans , Male , Adult , Prostatic Neoplasms , Mass Screening , Incidence , Risk Factors , Life Style
Int. braz. j. urol ; 48(2): 212-219, March-Apr. 2022. graf
Article in English | LILACS | ID: biblio-1364948


ABSTRACT Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.

Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Robotic Surgical Procedures/methods , Erectile Dysfunction/etiology , Erectile Dysfunction/prevention & control , Prostate/surgery , Prostatectomy/adverse effects , Prostatectomy/methods , Treatment Outcome
Int. braz. j. urol ; 48(2): 369-370, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364947


ABSTRACT Introduction: Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been proposed by several authors (1). However, even with the robotic surgery advantages, functional outcomes following RARP, especially erection recovery, still challenge surgeons and patients (2, 3). In this scenario, we have described different ways and grades of neurovascular bundle preservation (NVB) using the prostatic artery as a landmark until our most recent technique with lateral prostatic fascia preservation and modified apical dissection (4-6). In this video compilation, we have illustrated the anatomical and technical details of different grades of NVB preservation. Surgical technique: After the anterior and posterior bladder neck dissection, we lift the prostate by the seminal vesicles to access the posterior aspect of the prostate. Then, we incise the Denonvilliers layers and work between an avascular plane to release the posterior NVB from 5 to 1 and 7 to 11 o'clock positions on the right and left sides, respectively6. In sequence, we access the prostate anteriorly by incising the endopelvic fascia bilaterally (close to the prostate) until communicating the anterior and posterior planes. Finally, we control the prostatic pedicles with Hem-o-lok clips and then proceed for the apical dissection preserving the maximum amount of urethra length and periurethral tissues. Considerations: Potency recovery following radical prostatectomy remains a challenge due to its multifactorial etiology. However, basic concepts for nerve-sparing are crucial to achieving optimal outcomes, such as minimizing the amount of traction used on dissection, avoiding excessive cautery, and neural preservation based on anatomical landmarks (arteries and planes of dissection).

Humans , Male , Prostatic Neoplasms/surgery , Robotic Surgical Procedures , Prostate/surgery , Prostatectomy/methods , Penile Erection
Semina cienc. biol. saude ; 43(1): 153-166, jan./jun. 2022. ilus
Article in Portuguese | LILACS | ID: biblio-1354474


Desde o início dos anos 2000 é crescente o número de estudos que avaliam a exposição a agrotóxicos e suas consequências para a saúde do trabalhador. Contudo, não há sistematização da produção relacionada ao câncer de próstata em trabalhadores rurais. Assim, objetivou-se mapear a literatura que trata da associação entre a exposição aos agrotóxicos e a ocorrência de câncer de próstata em trabalhadores rurais. Foi realizada uma revisão de escopo nas bases de dados Web of Science (WoS), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL) e Biblioteca Virtual em Saúde (BVS), empregando os descritores "Agrochemicals", "Farmers" e "Prostatic Neoplasms". Dezenove artigos fizeram parte desta revisão. Em dezessete, verificou-se associações entre a ocorrência de câncer de próstata em trabalhadores rurais e a exposição a agrotóxicos. Os fatores de risco relacionados foram: histórico familiar, tabagismo, raça/cor, idade avançada, alterações genéticas, toneladas de soja produzidas e o uso de agrotóxicos específicos. A literatura aponta a existência de consistência e plausibilidade biológica para a ocorrência de câncer de próstata em indivíduos expostos a agrotóxicos que exercem atividades agrícolas.

Since the early 2000s there has been an increasing number of studies evaluating pesticide exposure and its consequences for worker health. However, they are not systematized in relation to prostate cancer in rural workers. We aimed to map the literature dealing with the association between exposure to pesticides and the occurrence of prostate cancer in rural workers. A scoping review was conducted in the Web of Science (WoS), Scopus, Cumulative Index to Nursing and Allied Health Abstract Literature (CINHAL) and Virtual Health Library (VHL) databases. The descriptors "Agrochemicals", "Farmers" and "Prostatic Neoplasms" were employed. Nineteen articles were part of this review. In seventeen articles, associations were found between the occurrence of prostate cancer in rural workers and exposure to agrochemicals. The related risk factors were: family history, smoking, race/color, advanced age, genetic alterations, tons of soybeans produced, and the use of specific pesticides. The literature points to the existence of consistency and biological plausibility for the occurrence of prostate cancer in individuals exposed to pesticides who perform agricultural activities.

Humans , Male , Prostatic Neoplasms , Tobacco Use Disorder , Rural Workers , Occupational Health , Agrochemicals , Smoking , Health
Int. braz. j. urol ; 48(1): 54-66, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356296


ABSTRACT Introduction: The therapeutic role of pelvic lymph node dissection (PLND) in prostate cancer (PCa) is unknown due to absence of randomized trials. Objective: to present a critical review on the therapeutic benefits of PLND in high risk localized PCa patients. Materials and Methods: A search of the literature on PLND was performed using PubMed, Cochrane, and Medline database. Articles obtained regarding diagnostic imaging and sentinel lymph node dissection, PLND extension, impact of PLND on survival, PLND in node positive "only" disease and PLND surgical risks were critically reviewed. Results: High-risk PCa commonly develops metastases. In these patients, the possibility of presenting lymph node disease is high. Thus, extended PLND during radical prostatectomy may be recommended in selected patients with localized high-risk PCa for both accurate staging and therapeutic intent. Although recent advances in detecting patients with lymph node involvement (LNI) with novel imaging and sentinel node dissection, extended PLND continues to be the most accurate method to stage lymph node disease, which may be related to the number of nodes removed. However, extended PLND increases surgical time, with potential impact on perioperative complications, hospital length of stay, rehospitalization and healthcare costs. Controversy persists on its therapeutic benefit, particularly in patients with high node burden. Conclusion: The impact of PLND on biochemical recurrence and PCa survival is unclear yet. Selection of patients may benefit from extended PLND but the challenge remains to identify them accurately. Only prospective randomized study would answer the precise role of PLND in high-risk pelvis confined PCa patients.

Humans , Male , Prostatic Neoplasms/surgery , Lymph Node Excision , Pelvis , Prostatectomy , Prospective Studies , Lymph Nodes/surgery
Int. braz. j. urol ; 48(1): 122-130, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356274


ABSTRACT Purpose: To analyze the association between obesity and urinary incontinence rate in men submitted to robot-assisted radical prostatectomy (RARP) in a high-volume cancer center. Materials and Methods: We reported 1.077 men who underwent RARP as the primary treatment for localized prostate cancer from 2013 to 2017. Patients were classified as non-obese (normal BMI or overweight) or obese men (BMI ≥30kg/m2). They were grouped according to the age, PSA level, D'Amico risk group, Gleason score, ASA classification, pathological stage, prostate volume, salvage/adjuvant radiotherapy, perioperative complications, and follow-up time. Urinary continence was defined as the use of no pads. For the analysis of long-term urinary continence recovery, we conducted a 1:1 propensity-score matching to control confounders. Results: Among the obese patients, mean BMI was 32.8kg/m2, ranging 30 - 45.7kg/m2. Only 2% was morbidly obese. Obese presented more comorbidities and larger prostates. Median follow-up time was 15 months for the obese. Complications classified as Clavien ≥3 were reported in 5.6% of the obese and in 4.4% of the non-obese men (p=0.423). Median time for continence recovery was 4 months in both groups. In this analysis, HR was 0.989 for urinary continence recovery in obese (95%CI=0.789 - 1.240; p=0.927). Conclusions: Obese can safely undergo RARP with similar continence outcomes comparing to the non-obese men when performed by surgeons with a standardized operative technique. Future studies should perform a subgroup analysis regarding the association of obesity with other comorbidities, intending to optimize patient counseling.

Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Obesity, Morbid , Robotic Surgical Procedures/adverse effects , Prostate/surgery , Prostatectomy/adverse effects , Treatment Outcome , Recovery of Function , Propensity Score
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1370822


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

Humans , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Prostatic Neoplasms/prevention & control , Prostate-Specific Antigen , Biomarkers, Tumor , Medical Records/statistics & numerical data , Retrospective Studies , Monitoring , Hospitals, Military
Enferm. foco (Brasília) ; 12(5): 1040-1046, dez. 2021. ilus, tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1367498


Objetivo: Avaliar a acessibilidade de tecnologia assistiva sobre câncer de próstata e de mama por deficientes visuais de dois países lusófonos. Métodos: Estudo metodológico de avaliação de tecnologia assistiva em saúde. Dados coletados com instrumento validado, constituído por 17 itens distribuídos nos atributos objetivos, acesso, clareza, estruturação e apresentação, relevância e eficácia e interatividade. Na análise, aplicaram-se Teste Qui-quadrado de Pearson, Teste Exato de Fisher ou Razão de Verossimilhança de acordo com os pressupostos dos testes. Os aspectos éticos foram respeitados. Resultados: A amostra foi de 62 participantes. As variáveis que tiveram diferenças estatísticas significantes foram escolaridade (p=0,006), tipos de deficiência (p=0,010) e desenvolvimento da deficiência (p= 0,005). Todas os atributos e itens obtiveram boas avaliações com alguns tópicos que não houve diferença estatística em ambos os países. Conclusão: As tecnologias assistivas sobre câncer de mama e próstata foram bem avaliadas, independente do país, brasileiros e portugueses as consideraram adequadas. (AU)

Objective: To evaluate the accessibility of assistive technology about prostate and breast cancer by visually impaired persons in two Portuguese-speaking countries. Methods: Methodological study of an assess assistive health technology. Data were collected from a validated instrument, comprising of 17 items distributed in the attributes, objective, access, clarity, structure and presentation, relevance and effectiveness and interactivity. In the analysis, the Pearson's Chi-squared test and the Fisher's exact test or likelihood ratios were applied according to the assumptions of the tests. The ethical aspects involved in the research were respected. Results: The sample was of 62 participants. The variables that exhibited any statistical diferences ware: schooling (p = 0.006); types of disabilities (p = 0.010) and; disabilities development (p = 0.005). All attributes and items had good evaluations, with some topics that there was no statistical difference among the countries. Conclusion: Assistive technology about prostate and breast cancer were well evaluated, regardless of the country, were considered adequate by brazilians and portuguese. (AU)

Objetivo: Evaluar la accesibilidad de la tecnología de asistencia en el cáncer de próstata y mama por personas con daño visual de dos países de habla portuguesa. Métodos: Estudio metodológico para evaluar la tecnología asistencial sanitaria. Datos recolectados con un instrumento validado, compuesto por 17 ítems distribuidos en los atributos objetivos, acceso, claridad, estructuración y presentación, relevancia y efectividad e interactividad. En el análisis se aplicó la prueba de chi-cuadrado de Pearson, la prueba exacta de Fisher o razón de verosimilitud según los supuestos de las pruebas. Se respetaron los aspectos éticos. Resultados: La muestra estuvo formada por 62 participantes. Las variables que presentaron diferencias estadísticamente significativas fueron educación (p = 0,006), tipos de discapacidad (p = 0,010) y desarrollo de la discapacidad (p = 0,005). Todos los atributos e ítems obtuvieron buenas evaluaciones con algunos temas que no hubo diferencia estadística en ambos países. Conclusion: Las tecnologías de asistencia en cáncer de mama y próstata fueron bien evaluadas, independientemente del país, brasileños y portugueses las consideraron apropiadas. (AU)

Technology , Prostatic Neoplasms , Technology Assessment, Biomedical , Breast Neoplasms , Visually Impaired Persons
Rev. colomb. anestesiol ; 49(4): e201, Oct.-Dec. 2021. tab
Article in English | LILACS, COLNAL | ID: biblio-1341237


Abstract Introduction Prostatectomy is the standard treatment for patients with clinically localized prostate cancer. Currently, robot-assisted radical prostatectomy (RARP) is widely used for its advantages, as it provides better visualization, precision, and reduced tissue manipulation. However, RARP requires a multidisciplinary approach in which anesthesia and analgesia management are especially important. Objective This study aims to describe our experience delivering anesthesia for the first cases of patients undergoing RARP in a teaching hospital in Bogotá, Colombia. Methodology An observational study was conducted. We included all patients undergoing RARP from September 2015 to December 2019 at Fundación Santa Fe de Bogotá. All patients with incomplete data were excluded. Patient demographics were recorded, and significant perioperative events were reviewed. Results A total of 301 patients were included. At our institution, the mean age for patients undergoing RARP was 61.4 ± 6.7 years. The mean operative time was 205 ± 43 min and mean blood loss was 300 [200400] mL. Only 6 (2%) patients required transfusion. Age and BMI were not associated with clinical outcomes. Conclusions An adequate perioperative approach in RARP is important to minimize complications, which in this study and in this institution were infrequent.

Resumen Introducción La prostatectomía es el tratamiento estándar para pacientes con cáncer de próstata localizado. Actualmente, la prostatectomía radical asistida por robot es ampliamente utilizada por sus ventajas en visualización, precisión y manipulación de los tejidos. Sin embargo, este abordaje requiere un manejo multidisciplinario, pues el enfoque analgésico y anestésico es fundamental para optimizar los desenlaces. Objetivo Describir los primeros casos de prostatectomía radical asistida por robot realizadas en un hospital universitario de cuarto nivel en Bogotá, Colombia. Metodología Estudio observacional en el cual se incluyeron todos los pacientes sometidos a prostatectomía radical asistida por robot (PRAR) en el hospital Fundación Santa Fe de Bogotá entre septiembre de 2015 y diciembre de 2019. Se excluyeron los pacientes con historia clínica incompleta. Se registraron los datos demográficos y se revisaron los eventos perioperatorios importantes. Resultados Se analizaron 301 pacientes. La edad media de pacientes sometidos a PRAR fue 61,4 ± 6,7 años. El tiempo quirúrgico promedio fue 205 ± 43 minutos y la pérdida sanguínea media fue 300 [200-400] mL. Solo 6 pacientes (2 %) requirieron transfusión. La edad y el IMC no mostraron una asociación relevante con los desenlaces clínicos. Conclusiones El adecuado abordaje perioperatorio en PRAR es importante para minimizar las complicaciones, las cuales en este estudio y en esta institución fueron infrecuentes.

Humans , Male , Middle Aged , Prostatectomy , Natural Orifice Endoscopic Surgery , Robotic Surgical Procedures , Anesthesia, General , Prostatic Neoplasms , Observational Studies as Topic , Analgesia
Rev. baiana saúde pública ; 45(3,supl.n.esp): 141-150, 28 dec. 2021.
Article in Portuguese | LILACS | ID: biblio-1352346


Este relato aborda o caso de um homem de 52 anos, portador de neoplasia prostática (Gleason 3 + 3), que deu entrada no pronto-socorro com quadro de lesão renal aguda, anemia normocrômica e normocítica e relato de fratura patológica. Encaminhado para o hospital geral, foi iniciada a investigação do quadro. Alguns achados em exames laboratoriais, como inversão da relação albumina-globulina e lesões líticas em exame de imagem, fizeram os médicos levantarem um importante diagnóstico diferencial no contexto de metástase óssea e neoplasias: o mieloma múltiplo. Diante disso, foi indicado aspirado de medula óssea e imunofetipagem, que, surpreendentemente, teve como resultado principal a presença de 12% de células plasmocitárias com caraterísticas anômalas. O tratamento inicial foi estabelecido com dexametasona, ciclofosfamida e pamidronato com melhora progressiva dos parâmetros laboratoriais e clínicos, sendo encaminhado para acompanhamento ambulatorial em cidade de origem com onco-hematologista e urologista.

This study describes the case of a 52-year-old male patient with prostate cancer (Gleason 3+3) admitted to the emergency room with acute kidney injury, normochromic and normocytic anemia, and a pathological fracture report. The patient was referred to the General Hospital to investigate the condition. Laboratory tests indicated inversion of the albumin-globulin ratio and imaging exams evinced lytic lesions, leading physicians to raise an important differential diagnosis in the context of bone metastases and neoplasms: multiple myeloma. Bone marrow aspirate and immunophetyping indicated the presence of 12% plasma cells with anomalous characteristics. After initial treatment with dexamethasone, cyclophosphamide, and pamidronate, the patient showed progressive improvement in laboratory and clinical parameters, being referred for outpatient follow-up in the city of origin with an onco-hematologist and urologist.

Este es un reporte de caso de un varón de 52 años de edad, con cáncer de próstata (Gleason 3 +3) ingresado en urgencias por lesión renal aguda, anemia normocrómica y normocítica y reporte de fractura patológica. Derivado al Hospital General, se inició una investigación de la condición. Algunos hallazgos en las pruebas de laboratorio, como la inversión del cociente albúmina globulina y las lesiones líticas en los exámenes de imagen, llevaron a los médicos a plantear un importante diagnóstico diferencial, en el contexto de las metástasis óseas y las neoplasias: el mieloma múltiple. Por tanto, se indicó el aspirado de médula ósea y la inmunofenotipificación, que sorprendentemente tuvo como principal resultado la presencia de un 12% de células plasmáticas con características anómalas. Se estableció el tratamiento inicial con dexametasona, ciclofosfamida y pamidronato, con mejoría progresiva de los parámetros analíticos y clínicos, siendo remitido para seguimiento ambulatorio en su ciudad de origen con un oncohematólogo y un urólogo.

Prostatic Neoplasms , Immunophenotyping , Diagnosis, Differential , Urologists , Multiple Myeloma
Int. braz. j. urol ; 47(6): 1279-1280, Nov.-Dec. 2021.
Article in English | LILACS | ID: biblio-1340031


ABSTRACT Introduction: Salvage Radical Prostatectomy after radiation therapy is challenging and associated with high rates of serious complications (1, 2). The novel Retzius-Sparing RARP (RS-RARP) approach has shown excellent continence outcomes (3, 4). Purpose: To describe step-by-step our Salvage Retzius-Sparing RARP (sRS-RARP) operative technique and report feasibility, safety and the preliminary oncological and continence outcomes in the post-radiation scenario. Materials and Methods: Twelve males presenting local prostate cancer recurrence after radiotherapy that underwent sRS-RARP were included. All patients performed preoperative multiparametric MRI and PSMA-PET. Surgical technique: 7cm peritoneum opening at Douglas pouch, Recto-prostatic space development, Seminal vesicles and vas deferens isolation and section, Extra-fascial dissection through peri-prostatic fat, Neurovascular bundle control, Bladder neck total preservation and opening, Anterior dissection at Santorini plexus plane, Apex dissection with urethra preservation and section, Prostate release, Vesicouretral modified Van Velthoveen anastomosis, Rocco Stitch, Oncological and continence outcomes reported with minimum 1-year follow-up. Results: Ten patients had previously received external beam radiation (EBR) whereas two received previous brachytherapy plus EBR. At 1, 3 and 12 months after surgery, 25%, 75% and 91.6% of the men used one safety pad or less, respectively. No major complications or blood transfusions were reported. Final pathology reported pT2b 41.6%, pT2c 33.3% and pT3a 25%, positive surgical margins 25%, positive lymph nodes were not found, biochemical recurrence 16.6%. Conclusion: Salvage Retzius-Sparing Robotic Assisted Radical Prostatectomy approach appears to be technically feasible and oncologically safe with potential to provide better continence outcomes.

Humans , Male , Prostatic Neoplasms/surgery , Robotic Surgical Procedures , Prostate , Prostatectomy , Brazil , Treatment Outcome , Organ Sparing Treatments
Int. braz. j. urol ; 47(6): 1120-1130, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1340017


ABSTRACT Background: Periodontal disease is reportedly associated with the risk of various systemic diseases, including pancreatic and lung cancers. However, its association with prostate cancer remains inconclusive. Herein, we explored the association of periodontal disease with the risk of prostate cancer through a meta-analysis. Materials and Methods: MEDLINE, Embase, Web of Sciences and Cochrane Library databases were searched for eligible publications up to April 2020. Multivariate adjusted risk estimates with corresponding 95% confidence intervals (CIs) were extracted and calculated using random- or fixed-effect models. Results: Nine cohort studies involving 3.353 prostate cancer cases with 440.911 participants were identified and included in the meta-analysis. We found that periodontal disease significantly increased the risk of prostate cancer by 1.40-fold (hazard ratio [HR]=1.40, 95% CI: 1.16-1.70; P=0.001; I2=76.1%) compared with normal condition. Interestingly, the risk of developing prostate cancer was not significant in patients treated with periodontal therapy (HR=1.22, 95% CI: 0.86-1.73; P=0.272; I2=65.2%). The results of subgroup analyses were also consistent and significant when stratified by study design and follow-up period, whereas conflicting results were observed in periodontal disease ascertainment stratification. These findings were robust as indicated by sensitivity analyses. Conclusions: Periodontal disease was associated with the increased risk of prostate cancer, whereas no significant association was observed in patients treated with periodontal therapy. Hence, the awareness and importance for maintaining oral health should be improved, and the underlying mechanisms linking periodontal disease and prostate cancer should be fully explored in future research.

Humans , Male , Periodontal Diseases/complications , Periodontal Diseases/epidemiology , Prostatic Neoplasms/epidemiology , Lung Neoplasms , Proportional Hazards Models , Cohort Studies
J. Hum. Growth Dev. (Impr.) ; 31(2): 310-317, May-Aug. 2021.
Article in English | LILACS, INDEXPSI | ID: biblio-1340090


INTRODUCTION: Due to the high incidence and mortality rates that cancer has, the World Health Organization (WHO) defines it as a public health problem and points out that there are approximately 10 million people affected by cancer, the estimate for the year 2020 will be 16 million of sick individuals.One of the most frequent neoplasms in the world, Prostate Cancer (CaP) (1.1 million), occupies 4th place, being behind only lung cancer (1.8 million), breast (1.7 million), and intestine (1.4 million). In the year 2012, approximately 1,112,000 new global cases of CaP were registered, with about 307,000 deathsOBJECTIVE: To analyze the epidemiological profile of mortality from prostate cancer and the access of patients to health among Brazilian regionsMETHODS: Ecological study based on secondary data from between the years 2000 and 2015. Mortality, hospitalization, and population were collected at the DATASUS. The variables were related to the epidemiological profile of CaP among Brazilian regions, stratified by the number of hospitalizations, of deaths, admission fee, mortality rate, and age group (40 to 79 years). The study looks at a time trend and gains access to health and mortality using regression modelsRESULTS: The northern showed a greater decrease in cases from 40-59 years (β: -1,800; -0.46). Southeast, with a small reduction only between 40 and 44 years old (β: -0.345 and p: 0.665). Northeast, South, and Center-West regions did not express a drop in the hospitalization rate, with the greatest growth between 65 and 69 years old (β: 7,862; 11,346; and p> 0.05). The Midwest had the greatest increase between 55 and 59 years (β: 3,660, p: 0.098), followed by 65 to 69 years (β: 3,491, p: 0.314). Mortality rates indicated a reduction in the Southeast (β: - 0.440) and South (β: -0.361CONCLUSION: This study found an association with various environmental and economic cultures in each Brazilian region, being an important resource for the development of health services and their access to the population

INTRODUÇÃO: Devido às altas taxas de incidência e mortalidade que o câncer apresenta, a Organização Mundial da Saúde (OMS) define-o como um problema de saúde pública e aponta que existem aproximadamente 10 milhões de pessoas afetadas pelo câncer, a estimativa para o ano de 2020 será 16 milhões de doentes. Uma das neoplasias mais frequentes do mundo, o Câncer de Próstata (CaP) (1,1 milhão) ocupa a 4ª colocação, ficando atrás apenas do câncer de pulmão (1,8 milhão), mama (1,7 milhão) e intestino (1,4 milhões). No ano de 2012, foram registrados aproximadamente 1.112.000 novos casos globais de CaP, com cerca de 307.000 óbitosOBJETIVO: Analisar o perfil epidemiológico da mortalidade por câncer de próstata e o acesso de pacientes à saúde entre as regiões brasileirasMÉTODO: Estudo ecológico baseado em dados secundários entre os anos de 2000 e 2015. A mortalidade, hospitalização e população foram coletadas no DATASUS. As variáveis foram relacionadas ao perfil epidemiológico, entre as regiões brasileiras, estratificadas pelo número de internações; de mortes; taxa de admissão; taxa de mortalidade e faixa etária (40 a 79 anos). O estudo analisa uma tendência temporal e obtém acesso à saúde e mortalidade usando modelos de regressãoRESULTADOS: O Norte apresentou uma queda maior nos casos de 40 a 59 anos (β: -1,800; -0,46). Sudeste, com pequena redução apenas entre 40 e 44 anos (β: -0,345 e p: 0,665). As regiões Nordeste, Sul e Centro-Oeste não apresentaram queda na taxa de internação, com maior crescimento entre 65 e 69 anos (β: 7.862; 11.346; e p> 0,05). O Centro-Oeste teve o maior aumento entre 55 e 59 anos (β: 3.660, p: 0,098), seguido de 65 a 69 anos (β: 3.491, p: 0,314). As taxas de mortalidade indicaram redução no Sudeste (β: - 0,440) e Sul (β: -0,361CONCLUSÃO: Este estudo encontrou associação com várias culturas ambientais e econômicas em cada região brasileira, sendo um recurso importante para o desenvolvimento de serviços de saúde e seu acesso à população

Humans , Male , Female , Prostatic Neoplasms , Health Profile , Mortality , Universal Access to Health Care Services , Hospital Care , Hospitalization , Ecological Studies
Int. braz. j. urol ; 47(4): 705-729, Jul.-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1286767


ABSTRACT Introduction: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. 68Ga-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive 68Ga-PSMA PET and the accuracy of this technique. Materials and methods: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was α=0.05. Results: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. Conclusion: 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.

Humans , Male , Prostatic Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography , Tomography, X-Ray Computed , Cross-Sectional Studies , Prospective Studies , Retrospective Studies , Radiopharmaceuticals , Positron-Emission Tomography