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1.
Int. braz. j. urol ; 48(2): 263-274, March-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364963

ABSTRACT

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.


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Ultrasound, High-Intensity Focused, Transrectal/methods , Treatment Outcome , Salvage Therapy/methods , Neoplasm Recurrence, Local/surgery
2.
Revista Digital de Postgrado ; 8(2): e161, ago. 2019. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1008415

ABSTRACT

En vista de la alta prevalencia del cáncer de próstata en la población venezolana y la ausencia de un patrón genético conocido en relación a la expresión de las enzimas Glutatión S-transferasas, se estudió la relación entre la expresión de un polimorfismo nulo de estas enzimas y la presencia de cáncer de adenocarcinoma prostática Métodos: Se incluyen 100 individuos para el muestreo no probabilístico, 50 pacientes con diagnóstico de adenocarcinoma de próstata comprobado mediante biopsia y 50 controles con hiperplasia prostática benigna demostrada mediante tacto y corroborada por ultrasonido transrectal, provenientes de los principales hospitales del país, se procedió a tomar muestra de sangre y mediante reacción de cadena de polimerasa, se determinó la presencia o ausencia de los genes para las enzimas Glutatión S-transferasa Mu 1 (GST M) y glutatión S-transferasa theta 1 (GST T1). Resultados: se logró evidenciar que el genotipo nulo se encontró en 40 y 24% de los pacientes mientras que para los controles fue de 38% y 22% respectivamente, demostrando que en la población venezolana estudiada no existen diferencias significativas entre casos y controles. Conclusiones: No se pudo demostrar una diferencia significativa entre los dos grupos estudiados. Recomendaciones: A pesar de nuestros hallazgos, se necesitan estudios futuros con muestras de mayor tamaño para dilucidar la posible asociación entre este patrón enzimático con el riesgo de presentar cáncer de próstata(AU)


Prostate cancer presents with a high incidence in the Venezuelan population. there is no known genetic pattern related to the expression of drug metabolizing enzymes Glutathione S-transferases. Methods: We proceeded to study the possible correlation between null polymorphism for these enzymes and prostate adenocarcinoma. the sample included 100 patients recruited from the Urology Department of three University Hospitals in Caracas, Venezuela, 50 cancer patients and 50 cancer free controls. Blood samples were drawn from each patient and polymorphisms for Glutathione S-transferase Mu 1 (GST M1) and Glutathione-sS-transferase theta 1(GST T1) were determined by polymerase chain reaction from lymphocytes. Results: Null genotype was found in 40% and 24% of cancer patients whereas the percentage in controls was 38 and 22% respectively, showing no statistically significant differences between the two groups. Conclusions: It was not possible to show a significant difference between the two groups. Recommendations: Due to the small size of the sample, it would be necessary to explore further in a larger population sample to determine whether there is an association between the expression of these enzymes and prostate cancer(AU)


Subject(s)
Humans , Male , Prostatic Hyperplasia/diagnosis , Prostatic Neoplasms/enzymology , Prostatic Neoplasms/pathology , Prostate-Specific Antigen , Ultrasound, High-Intensity Focused, Transrectal/methods , Glutathione Transferase
3.
Ann. afr. med ; 18(3): 132-137, 2019.
Article in English | AIM | ID: biblio-1258908

ABSTRACT

Background: It is established that antibiotic prophylaxis prevents infection following transrectal ultrasound-guided prostate biopsy. This study compares the infective complications in transrectal prostate biopsy (TRPB) in empirical versus targeted prophylactic antibiotics. Patients and Methods: Urine and rectal swabs were obtained prior to TRPB. They were randomized into targeted antibiotic (TA) and empirical antibiotic (EA) groups. TA had prophylactic antibiotics according to rectal swab culture, whereas EA had the standard parenteral ciprofloxacin. They were followed up weekly for 4 weeks. Chi-square or Fisher's exact tests were used to compare categorical variables, Student's "t"-test was used to compare means of numerical variables, and P < 0.05 was considered statistically significant. Results: One hundred patients were studied, fifty in each group. The mean age was 66 years, with men aged 60­69 years accounting for 50% of the study population. Providencia stuartii, Escherichia coli, and Citrobacter freundii were the most predominant bacteria identified in the prebiopsy rectal swab culture, with resistance to ciprofloxacin (57%) being much more common than that to levofloxacin (21%). Postbiopsy infection occurred in one (2%) patient in the TA group and five (10%) patients in the EA group. Difference in the infection rate between the two groups was statistically significant (P = 0.042). Three of the patients with postbiopsy infection in the EA group had urosepsis and required hospitalization. Fluoroquinolone-resistant bacteria were responsible for infection in all the six patients. TA reduced the risk of postbiopsy infection by 5.6 folds. Conclusion: TA was associated with a decreased risk of infection in TRPB


Subject(s)
Antibiotic Prophylaxis , Biopsy , Lakes , Nigeria , Patients , Prostate , Ultrasound, High-Intensity Focused, Transrectal
4.
São Paulo; s.n; 2019. 53 p. ilust, tabelas, quadros.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1179929

ABSTRACT

O câncer de próstata é o 2º tumor mais prevalente em homens no Brasil. Existem hoje vários métodos de tratamentos que podem ser curativos e de prolongamento da vida tais como a cirurgia de prostatectomia radical (PR), radioterapia externa (RDT) e o ultrassom focalizado de alta intensidade (HIFU) que aumentam a sobrevida dos indivíduos, mas alteram a qualidade de vida em razão das alterações funcionais como incontinência urinária, disfunção sexual e incômodo intestinal. Estudos descrevem que avaliar a qualidade de vida do indivíduo portador de câncer de próstata antes e após o tratamento pode ajudar a definir estratégias e intervenções que reduzam complicações no tratamento e na reabilitação. Objetivo: comparar a Qualidade de Vida Relacionada á Saúde (HRQoL) entre os pacientes submetidos a PR, RDT e HIFU utilizando o questionário Prostate Cancer Index (UCLA-PCI). Metodologia: Trata-se de um estudo prospectivo com corte transversal em que foram analisados 232 indivíduos divididos em 4 grupos: Grupo 1: controle ­ 80 indivíduos sadios; Grupo 2: PR - 78 indivíduos; Grupo 3: RDT ­ 53 indivíduos; Grupo 4: HIFU ­ 21 indivíduos. Resultados: Quando comparamos a QV do grupo controle com os grupos PR, RDT e HIFU observou-se maiores diferenças estatísticas no grupo da PR para as variáveis dor corporal (p 0,015), transição de Saúde e incômodo Urinário (p 0,003) . Quando comparada a QV entre os grupos PR e RDT, foram observadas diferenças estatísticas no domínio função sexuais (p<0,001) e função urinária (p<0,002). Quando comparado os grupos PR e HIFU observamos uma diferença no domínio de transição de saúde (p=0,040); e nos grupos de HIFU e RDT observaram-se alterações na função física (p= 0,018). Para a comparação da QV antes e 1 ano após o tratamento entre os grupos, observamos no grupo de RDT diferenças nos domínios dor corporais (p<0,027) e transição de saúde (p< 0,001). No grupo de PR, dor corporal (p<0,001), transição de saúde (p<0,001), função urinária (p<0,001), função sexual (p<0,001) e incômodo sexual (p<0,001). No grupo HIFU, observamos alterações na função Física (p<0,048), limitações de função devido a problemas de saúde física (p<0,013), limitações de funções devido a problemas emocionais (p<0,033) e dor corporal (p<0,007). Conclusão: A qualidade de vida dos pacientes tratados por câncer de próstata submetido à PR, RDT e HIFU foi semelhante aos encontrados na literatura, porém no nosso estudo os pacientes submetidos à PR foram os que apresentaram maiores alterações na QV


Introduction: Prostate cancer is the second most prevalent tumor in men in Brazil. There are now several medicinal and life-prolonging treatment methods such as radical prostatectomy (PR), external beam radiotherapy (RDT), and high intensity focused ultrasound (HIFU) that increase survival rates of individuals. But alter the quality of life due to functional changes such as involuntary urination, sexual dysfunction and intestinal nuisance. Studies describe that assessing the quality of life of individuals with prostate cancer before and after treatment may help to define strategies and remedies that reduce complications in treatment and rehabilitation. Objective: To compare the Health-Related Quality of Life (HRQoL) among patients submitted to PR, RDT and HIFU using the Prostate Cancer Index (UCLA-PCI) questionnaire. Methods: This is a prospective cross-sectional study in which 232 individuals were divided in 4 groups: Group 1: Control (80 healthy individuals); Group 2: PR (78 individuals); Group 3: RDT (53 individuals); Group 4: HIFU (21 individuals). Results: When comparing the QoL of the Control Group with the PR, RDT and HIFU groups, we observed statistically significant differences in the PR group for the variables body pain (p 0.015), health transition and urinary discomfort (p 0.003). Statistical differences in the sexual function (p <0.001) and urinary function (p <0.002) were observed when comparing the QoL between PR and RDT groups. When comparing the PR and HIFU groups, we observed a difference in the health transition domain (p = 0.040); and in the HIFU and RDT groups, changes in physical function were observed (p = 0.018). For the comparison of QoL before and 1 year after treatment between groups, we observed differences in the body pain (p <0.027) and health transition in the RDT group (p <0.001).In the PR group, we also witnessed body pain (p <0.001), health transition (p <0.001), urinary function (p <0.001), sexual function (p <0.001) and sexual discomfort (p <0.001). In the HIFU group, we observed changes in physical function (p <0.048), functional limitations due to physical health problems (p <0.013), limitations of functions due to emotional problems (p <0.033) and body pain (p <0.007). Conclusion: The quality of life of patients diagnosed with prostate cancer and submitted to PR, RDT and HIFU was similar to those found in the literature. However based on our study, patients submitted to PR presented significant changes in QoL


Subject(s)
Humans , Male , Female , Middle Aged , Prostatectomy , Prostatic Neoplasms , Quality of Life , Radiotherapy , Surveys and Questionnaires , Ultrasound, High-Intensity Focused, Transrectal , Case-Control Studies
5.
Int. braz. j. urol ; 44(2): 248-257, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-892986

ABSTRACT

ABSTRACT Background Some men with localized radio-recurrent prostate cancer may benefit from salvage high-intensity focused ultrasound (HIFU). Herein, we describe oncologic outcomes and predictors of disease response after salvage whole gland HIFU from our prospective cohort. Materials and Methods Patients with localized radio-recurrent prostate cancer were prospectively enrolled from January 2005 to December 2014. Participants had to meet both biochemical and histological definitions of recurrence. Exclusion criteria included the receipt of prior salvage therapy, presence of metastatic disease, and administration of ADT in the 6-months prior to enrollment. Participants were treated with a single session of whole-gland HIFU ablation with the AblathermTM device (EDAP, France). The primary endpoint was recurrence-free survival (RFS), defined as a composite endpoint of PSA progression (Phoenix criteria), receipt of any further salvage therapy, receipt of ADT, clinical progression, or death. Kaplan-Meier survival analysis was used to determine the primary end-point and stratifications were used to determine the significance of 6 pre-specified predictors of improved RFS (TRUS biopsy grade, number of study entry TRUS biopsy cores positive, palpable disease at study enrollment, pre-HIFU PSA, an undetectable post-HIFU PSA nadir, and receipt of prior hormone therapy). Survival analysis was performed on participants with a minimum of 1-year follow-up. Results Twenty-four participants were eligible for study inclusion with a median follow-up of 31.0 months. Median PSA at study entry was 4.02ng/ml. Median time to PSA nadir was 3 months after treatment and median post-HIFU PSA nadir was 0.04ng/ml. Median 2-year and 5-year RFS was 66.3% and 51.6% respectively. Of our 6 prespecified predictors, an undetectable PSA nadir was the only significant predictor of improved RFS (HR 0.07, 95% CI 0.02-0.29, log-rank P<0.001). One participant underwent an intervention for a urethral stricture. No participants developed osteitis pubis or rectourethral fistulae. Conclusions Salvage HIFU allows for disease control in selected patients with localized radio-recurrent prostate cancer. An undetectable PSA nadir serves as an early predictor of disease response.


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Salvage Therapy/methods , Ultrasound, High-Intensity Focused, Transrectal , Neoplasm Recurrence, Local/surgery , Prostatic Neoplasms/pathology , Prostatic Neoplasms/blood , Prospective Studies , Treatment Outcome , Prostate-Specific Antigen/blood , Disease-Free Survival , Disease Progression , Kaplan-Meier Estimate , Middle Aged , Neoplasm Recurrence, Local/blood
6.
Egyptian Journal of Hospital Medicine [The]. 2018; 71 (2): 2490-2497
in English | IMEMR | ID: emr-192488

ABSTRACT

Objective: of this study is to evaluate the relationship between ADC map values of MR imaging and local aggressiveness of the prostate Cancer via comparing the ADC values and Gleason score in prostate Cancer


Methodology: this study carried out in Radiology Department of Ain Shams University Hospitals. 21 patients with pathologically proven prostate cancer underwent pelvic MRI examination including diffusion weighted imaging [DWI] and apparent diffusion coefficient [ADC]


Result: The mean ADC value is inversely related to Gleason Score


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Diffusion Magnetic Resonance Imaging , Neoplasm Grading , Ultrasound, High-Intensity Focused, Transrectal , Neoplasm Invasiveness
7.
Rev. fac. cienc. méd. (Impr.) ; 15(1): 26-35, 2018. ilus
Article in Spanish | LILACS | ID: biblio-947013

ABSTRACT

El cérvix es la porción del útero que se encarga de mantener el embarazo hasta el momento del término. El acortamiento es un factor de riesgo de parto pretérmino, de hecho se considera que el riesgo de parto pretérmino es inversamente proporcional a la longitud cervical, siendo mayor el riesgo con un cérvix menor de 15mm. Objetivo: identificar los rangos de longitud cervical, con riesgo de parto pretérmino acorde a la edad gestacional. Material y Métodos: la información se obtuvo a través de una búsqueda por medio de Google Académico, PubMed y el programa HINARI, seleccionando 21 artículos. Conclusión: el acortamiento del cérvix se asocia a parto pretérmino inminente, sobre todo cuando la longitud cervical es menor de 15mm antes de las 20 semanas de gestación. La ecografía transvaginal es la mejor herramienta para determinar longitud cervical.


Subject(s)
Humans , Female , Pregnancy , Cervix Uteri/abnormalities , Databases, Bibliographic , Obstetric Labor, Premature/diagnosis , Ultrasound, High-Intensity Focused, Transrectal/methods
8.
Korean Journal of Urology ; : 346-350, 2015.
Article in English | WPRIM | ID: wpr-76184

ABSTRACT

Infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-Bx) appear to be increasing, which reflects the high prevalence of antibiotic-resistant strains of Enterobacteriaceae. Identifying patients at high risk for antibiotic resistance with history taking is an important initial step. Targeted prophylaxis with a prebiopsy rectal swab culture or augmented antibiotic prophylaxis can be considered for patients at high risk of antibiotic resistance. If infectious complications are suspected, the presence of urosepsis should be evaluated and adequate antibiotic treatment should be started immediately.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis , Biopsy/adverse effects , Drug Resistance, Bacterial , Escherichia coli Infections/drug therapy , Humans , Male , Prostate/pathology , Ultrasound, High-Intensity Focused, Transrectal , Urinary Tract Infections/drug therapy
9.
Korean Journal of Urology ; : 386-392, 2015.
Article in English | WPRIM | ID: wpr-76178

ABSTRACT

PURPOSE: There is no reported evidence for an anthropometric index that might link obesity to men's sexual health. We evaluated the ability of an anthropometric index and the symptom scores of five widely used questionnaires to detect men's health problems. We determined the predictive abilities of two obesity indexes and other clinical parameters for screening for lower urinary tract symptoms and sexual dysfunction in middle-aged men. MATERIALS AND METHODS: A total of 1,910 middle-aged men were included in the study. Participants underwent a detailed clinical evaluation that included recording the symptom scores of five widely used questionnaires. The participants' body mass index and waist-to-hip ratio were determined. Serum prostate-specific antigen, urinalysis, testosterone, estimated glomerular filtration rate, evaluation of metabolic syndrome, and transrectal ultrasonography were assessed. RESULTS: By use of logistic regression analysis, age and total prostate volume were independent predictors of lower urinary tract symptoms. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis symptoms. Age and metabolic syndrome were independent predictive factors for erectile dysfunction. Waist-to-hip ratio had a statistically significant value for predicting erectile dysfunction. CONCLUSIONS: Our data showed that total prostate volume is a significant predictor of lower urinary tract symptoms, and central obesity has predictive ability for erectile dysfunction. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis-like symptoms. The management of correctable factors such as waist-to-hip ratio and metabolic syndrome may be considered preventive modalities against the development of men's health problems.


Subject(s)
Aging , Body Mass Index , Erectile Dysfunction/diagnosis , Humans , Logistic Models , Lower Urinary Tract Symptoms/diagnosis , Male , Men's Health , Metabolic Syndrome/physiopathology , Middle Aged , Obesity , Organ Size , Prognosis , Prostate/diagnostic imaging , Prostate-Specific Antigen/blood , Prostatitis/diagnosis , Testosterone/blood , Ultrasound, High-Intensity Focused, Transrectal , Waist-Hip Ratio
10.
Int. braz. j. urol ; 40(5): 605-612, 12/2014. tab
Article in English | LILACS | ID: lil-731121

ABSTRACT

Objective To compare cancer detection rates according to the number of biopsy cores in patients on whom a repeat prostate biopsy was performed for atypical small acinar proliferation (ASAP). Materials and Methods The data of 4950 consecutive patients on whom prostate biopsies were performed were assessed retrospectively. A total of 107 patients were identified as having ASAP following an initial prostate biopsy, and they were included in the study. A six-core prostate biopsy (PBx) was performed on 15 of the 107 patients, 12 PBx on 32 patients, and 20 PBx on 60 patients. Cancer detection rates were compared according to the number of biopsy cores. The localization of the cancer foci was also evaluated. Results The cancer detection rates in patients on whom 6 PBx, 12 PBx, and 20 PBx were performed were 20% (3/15), 31% (10/32), and 58% (35/60), respectively, and a statistically significant difference was found (p = 0.005). When cancer detection rates in patients with total prostate specific antigen (PSA) < 10ng/mL, PSA density ≥ 0.15, normal digital rectal examination, and prostate volume ≥ 55mL were compared according to the number of biopsy cores, a significant difference was identified (p = 0.02, 0.03, 0.006, and 0.04, respectively). Seventy-five percent of the foci where cancer was detected were at the same and/or adjacent sites as the ASAP foci in the initial biopsy, and 54% were identified in contralateral biopsies in which ASAP foci were present. Conclusion As the biopsy core number increases, the cancer detection rate increases significantly in patients on whom a repeat biopsy is performed due to ASAP. The highest cancer rate is found in 20-core repeat biopsies performed equally from all foci. .


Subject(s)
Aged , Humans , Male , Middle Aged , Biopsy, Large-Core Needle/methods , Prostate/pathology , Prostatic Intraepithelial Neoplasia/pathology , Prostatic Neoplasms/pathology , Analysis of Variance , Cell Proliferation , Digital Rectal Examination/methods , Neoplasm Grading , Predictive Value of Tests , Prostate-Specific Antigen/blood , Retreatment , Retrospective Studies , Time Factors , Ultrasound, High-Intensity Focused, Transrectal/methods
11.
Article in English | WPRIM | ID: wpr-95309

ABSTRACT

Early prostate cancers are best detected with transrectal ultrasound (TRUS)-guided core biopsy of the prostate. Due to increased longevity and improved prostate cancer screening, more men are now subjected to TRUS-guided biopsy. To improve the detection rate of early prostate cancer, the current trend is to increase the number of cores obtained. The significant pain associated with the biopsy procedure is usually neglected in clinical practice. Although it is currently underutilized, the periprostatic nerve block is an effective technique to mitigate pain associated with prostate biopsy. This article reviews contemporary issues pertaining to pain during prostate biopsy and discusses the practical aspects of periprostatic nerve block.


Subject(s)
Biopsy, Needle , Humans , Lidocaine , Male , Nerve Block , Pain Measurement , Prostate/anatomy & histology , Prostatic Neoplasms/pathology , Ultrasound, High-Intensity Focused, Transrectal
13.
Article in English | WPRIM | ID: wpr-102165

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of the Holmium: yttrium-aluminium-garnet (YAG) laser for the treatment of urethral/bladder neck strictures after high-intensity focused ultrasound for prostate cancer. METHODS: Between February 2007 and July 2010, Holmium: YAG laser urethrotomies were performed in eleven patients for bladder neck strictures or prostatic urethral strictures. The laser was used with a 550-microm fiber at 2 J and frequency 30 to 50 Hz. The medical records were retrospectively reviewed for medical history, perioperative and postoperative data, uroflowmetry, International Prostate Symptoms Score/quality of life, and stricture recurrence. RESULTS: At a median follow-up of 12.0 months (range, 4 to 35 months), the mean postoperative maximal flow rate and residual volume were improved significantly (P<0.05). The mean postoperative total, voiding and quality of life of international prostate symptom score were improved significantly (P<0.05). Of the 11 patients, 7 patients required one treatment, 4 patients two treatment, and 1 patients three treatment. 2 patients who had a documented urinary incontinence prior to the laser treatment subsequently required artificial urinary sphincter implantation and reported satisfaction without developing any recurrent strictures or artificial urinary sphincter erosion. All patients exhibited well-healed strictures and could void without difficulty. CONCLUSIONS: Holmium: YAG laser therapy represents a safe, effective and minimally invasive treatment for urethral/bladder neck strictures occurring secondary to high-intensity focused ultrasound for prostate cancer.


Subject(s)
Constriction, Pathologic , Follow-Up Studies , Holmium , Humans , Lasers, Solid-State , Medical Records , Neck , Prostate , Prostatic Neoplasms , Quality of Life , Residual Volume , Retrospective Studies , Ultrasound, High-Intensity Focused, Transrectal , Urethral Stricture , Urinary Bladder , Urinary Bladder Neck Obstruction , Urinary Incontinence , Urinary Sphincter, Artificial
14.
Chinese Journal of Surgery ; (12): 691-694, 2012.
Article in Chinese | WPRIM | ID: wpr-245806

ABSTRACT

<p><b>OBJECTIVE</b>To study on the efficacy, prognosis and security of high-intensity focused ultrasound (HIFU) combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Totally 72 HCC patients treated by HIFU from December 2009 to January 2011 were divided into two groups according to treatment methods: 40 cases in HIFU group, 32 cases in TACE + HIFU treatment group (combined group). Then set up a control group include 40 cases treated by only TACE in the same period (TACE group). The improvement of clinical symptoms, AFP, reduce rate of tumor volume, survival rate of 1 year after operation and postoperative complications in front and behind the treatment were analyzed.</p><p><b>RESULTS</b>There was no significant statistical difference on the improvement of clinical symptoms in all these three groups (P > 0.05) after treatment for HCC. There is no significant statistical difference also on reduce rate of tumor volume and decrease rate of AFP in both HIFU group (35.0%, 41.4%) and TACE group (37.5%, 41.9%) (χ² = 0.054, P = 0.816; χ² = 0.002, P = 0.965). Both reduce rate of tumor volume (62.5%) and decrease rate of AFP (72.0%) in combined group were better than HIFU group (χ² = 5.394, P = 0.020; χ² = 5.098, P = 0.024) and TACE group (37.5%, 41.9%) (χ² = 4.448, P = 0.035; χ² = 5.062, P = 0.024). Kaplan-Meier survival curve showed that there was no significant statistical difference on short-term survival rate in the 3 groups. But the long-term survival rate of combined group was better than TACE group and HIFU group.</p><p><b>CONCLUSION</b>TACE combined with HIFU is a effective, safe and noninvasive treatment method to HCC.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Carcinoma, Hepatocellular , Therapeutics , Chemoembolization, Therapeutic , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Liver Neoplasms , Therapeutics , Male , Middle Aged , Prognosis , Treatment Outcome , Ultrasound, High-Intensity Focused, Transrectal
15.
Int. braz. j. urol ; 37(2): 213-222, Mar.-Apr. 2011. graf, tab
Article in English | LILACS | ID: lil-588994

ABSTRACT

PURPOSE: To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA < 10 ng/mL, < 3 positive biopsies with only 1 lobe involved, clinical stage < T2a, Gleason score < 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm(R) device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy. RESULTS: Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91 percent) patients. Overall survival was 83 percent (10/12) and cancer specific survival was 100 percent at 10 years. Two patients died from other causes. Recurrence free survival was 90 percent (95 percent CI; 0.71-1) at 5 years, and 38 percent (95 percent CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention. CONCLUSIONS: Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate long-term cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.


Subject(s)
Aged , Aged, 80 and over , Humans , Male , Prostatic Neoplasms/therapy , Ultrasound, High-Intensity Focused, Transrectal , Feasibility Studies , Follow-Up Studies , Neoplasm Recurrence, Local , Prostate-Specific Antigen/blood , Retrospective Studies , Treatment Outcome
16.
Medical Principles and Practice. 2011; 20 (1): 34-38
in English | IMEMR | ID: emr-110994

ABSTRACT

To determine the detection rate and clinical pattern of prostate cancer in Kuwait. One hundred and fifty-three males suspected of having prostate cancer based on elevation of prostate-specific antigen [PSA] of more than 4 ng/ml underwent transrectal-ultrasound [TRUS]-guided needle biopsy of the prostate between January 2003 and January 2008; these formed the study group. Analysis of prostate cancer was based on age, prostate volume, PSA level and on finding any abnormality based on a combination of the diagnostic tools. A diagnosis of prostate cancer was histologically confirmed in 42 [27.4%] patients. In those aged <55, 56-65, 66-75 and >76 years, the detection rates were 16.7, 17.6, 33.3 and 40.7%, respectively. In those with prostate volumes of >71, 51-70, 31-50 and <30 g, the detection rates were 18.2, 23.8, 30.8 and 42.9%, respectively. When the PSA levels were divided into groups of 4-10, 10-20, 20-100 and >100 ng/ml, the cancer detection rate was 11.8, 20.5, 47.1 and 83.3%, respectively. When 1, 2 and 3 of the 3 diagnostic tools [digital rectal examination, PSA, TRUS] were abnormal, the detection rate was 15.6, 27.9 and 80%, respectively. Our data showed that the prostate cancer rate differs according to the region and that the rate was low in our center. Higher PSA and higher number of diagnostic tools with abnormal findings were associated with a higher incidence of prostate cancer


Subject(s)
Humans , Male , Prostate-Specific Antigen , Ultrasound, High-Intensity Focused, Transrectal , Biopsy, Needle , Ultrasonography , Analysis of Variance , Age Distribution , Digital Rectal Examination/standards
18.
Int. braz. j. urol ; 36(3): 308-316, May-June 2010. graf
Article in English | LILACS | ID: lil-555190

ABSTRACT

PURPOSE: To determine whether the peri-procedural administration of low-dose aspirin increases the risk of bleeding complications for patients undergoing extended prostate biopsies. MATERIALS AND METHODS: From February 2007 to September 2008, 530 men undergoing extended needle biopsies were divided in two groups; those receiving aspirin and those not receiving aspirin. The morbidity of the procedure, with emphasis on hemorrhagic complications, was assessed prospectively using two standardized questionnaires. RESULTS: There were no significant differences between the two groups regarding the mean number of biopsy cores (12.9 ± 1.6 vs. 13.1 ± 1.2 cores, p = 0.09). No major biopsy-related complications were noted. Statistical analysis did not demonstrate significant differences in the rate of hematuria (64.5 percent vs. 60.6 percent, p = 0.46), rectal bleeding (33.6 percent vs. 25.9 percent, p = 0.09) or hemospermia (90.1 percent vs. 86.9 percent, p = 0.45). The mean duration of hematuria and rectal bleeding was significantly greater in the aspirin group compared to the control group (4.45 ± 2.7 vs. 2.4 ± 2.6, p = < 0.001 and 3.3 ± 1.3 vs. 1.9 ± 0.7, p < 0.001). Multivariate logistic regression analysis revealed that only younger patients (mean age 60.1 ± 5.8 years) with a lower body mass index (< 25 kg/m2) receiving aspirin were at a higher risk (odds ratio = 3.46, p = 0.047) for developing hematuria and rectal bleeding after the procedure. CONCLUSIONS: The continuing use of low-dose aspirin in patients undergoing extended prostatic biopsy is a relatively safe option since it does not increase the morbidity of the procedure.


Subject(s)
Aged , Humans , Male , Middle Aged , Aspirin/administration & dosage , Biopsy, Needle/methods , Platelet Aggregation Inhibitors/administration & dosage , Prostate/pathology , Prostatic Neoplasms/pathology , Ultrasound, High-Intensity Focused, Transrectal/methods , Aspirin/adverse effects , Biopsy, Needle/adverse effects , Hemospermia/etiology , Logistic Models , Platelet Aggregation Inhibitors/adverse effects , Postoperative Hemorrhage/etiology , Risk Factors
19.
Article in English | WPRIM | ID: wpr-101656

ABSTRACT

OBJECTIVE: To improve the diagnostic efficacy of transrectal ultrasound (TRUS)-guided targeted prostatic biopsies, we have suggested the use of a new scoring system for the prediction of malignancies regarding the characteristics of focal suspicious lesions as depicted on TRUS. MATERIALS AND METHODS: A total of 350 consecutive patients with or without prostate cancer who underwent targeted biopsies for 358 lesions were included in the study. The data obtained from participants were randomized into two groups; the training set (n = 240) and the test set (n = 118). The characteristics of focal suspicious lesions were evaluated for the training set and the correlation between TRUS findings and the presence of a malignancy was analyzed. Multiple logistic regression analysis was used to identify variables capable of predicting prostatic cancer. A scoring system that used a 5-point scale for better malignancy prediction was determined from the training set. Positive predictive values for malignancy prediction and the diagnostic accuracy of the scored components with the use of receiver operating characteristic curve analysis were evaluated by test set analyses. RESULTS: Subsequent multiple logistic regression analysis determined that shape, margin irregularity, and vascularity were factors significantly and independently associated with the presence of a malignancy. Based on the use of the scoring system for malignancy prediction derived from the significant TRUS findings and the interactions of characteristics, a positive predictive value of 80% was achieved for a score of 4 when applied to the test set. The area under the receiver operating characteristic curve (AUC) for the overall lesion score was 0.81. CONCLUSION: We have demonstrated that a scoring system for malignancy prediction developed for the characteristics of focal suspicious lesions as depicted on TRUS can help predict the outcome of TRUS-guided biopsies.


Subject(s)
Aged , Aged, 80 and over , Area Under Curve , Biopsy/methods , Humans , Male , Middle Aged , Predictive Value of Tests , Prostate/diagnostic imaging , Prostatic Neoplasms/classification , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Ultrasound, High-Intensity Focused, Transrectal/methods
20.
Cir. & cir ; 76(4): 349-353, jul.-ago. 2008. tab, ilus
Article in Spanish | LILACS | ID: lil-568074

ABSTRACT

BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.


Subject(s)
Humans , Male , Female , Pregnancy , Young Adult , Middle Aged , Cysts/complications , Prostatic Diseases/complications , Ejaculatory Ducts/surgery , Hemospermia/etiology , Infertility, Male/etiology , Oligospermia/etiology , Cysts/congenital , Cysts/surgery , Cysts , Prostatic Diseases/congenital , Prostatic Diseases/surgery , Prostatic Diseases , Ejaculatory Ducts , Heart Valve Prosthesis Implantation , Kidney Transplantation , Postoperative Complications , Transurethral Resection of Prostate , Ultrasound, High-Intensity Focused, Transrectal
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