Consensus on diagnosis and management of non-metastatic castration resistant prostate cancer in Brazil: focus on patient, selection, treatment efficacy, side effects and physician's perception according to patient comorbidities

ABSTRACT Background: Non-metastatic castration resistant prostate cancer (M0 CRPC) has seen important developments in drugs and diagnostic tools in the last two years. New hormonal agents have demonstrated improvement in metastasis free survival in M0 CRPC patients and have been approved by regulatory agencies in Brazil. Additionally, newer and more sensitive imaging tools are able to detect metastasis earlier than before, which will impact the percentage of patients staged as M0 CRPC. Based on the available international guidelines, a group of Brazilian urology and medical oncology experts developed and completed a survey on the diagnosis and treatment of M0 CRPC in Brazil. These results are reviewed and summarized and associated recommendations are provided. Objective: To present survey results on management of M0 CRPC in Brazil. Design, setting, and participants: A panel of six Brazilian prostate cancer experts determined 64 questions concerning the main areas of interest: 1) staging tools, 2) treatments, 3) side effects of systemic treatment/s, and 4) osteoclast-targeted therapy. A larger panel of 28 Brazilian prostate cancer experts answered these questions in order to create country-specific recommendations discussed in this manuscript. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on the predefined questions. These answers are the panelists' opinions, not a literature review or meta-analysis. Therapies not yet approved in Brazil were excluded from answer options. Each question had five to seven relevant answers including two non-answers. Results were tabulated in real time. Conclusions: The results and recommendations presented can be used by Brazilian physicians to support the management of M0 CRPC patients. Individual clinical decision making should be supported by available data, however, for Brazil, guidelines for diagnosis and management of M0 CRPC patients have not been developed. This document will serve as a point of reference when confronting this disease stage.

Preservação da fertilidade em homens jovens com câncer: conceitos atuais e o futuro / Fertility preservation in young men with cancer: current concepts and future

Nos últimos 40 anos, o perfil mundial do câncer vem mudando. Encarado inicialmente como uma doença dos países ricos, nota-se atualmente que a maior parte de seu ônus global provêm de países de poucos recursos ou em desenvolvimento. Nas últimas décadas o câncer se tornou um problema de saúde pública mundial, com estimativas alarmantes para as décadas subseqüentes. No Brasil, as estimativas para o ano de 2012 serão válidastambém para o ano de 2013 e revelam a ocorrência de aproximadamente 518.510 casos novos de câncer,incluindo os casos de pele não melanoma. São esperados um total de 257.870 casos novos para o sexo masculino. A grande questão é que cerca de 10% destes casos serão na faixa etária inferior a 45 anos e 1% abaixo de 20 anos de idade. Embora o tratamento atual do câncer tenha aumentado consideravelmente as taxas de sobrevida em 5 anos de pacientes jovens, ele quase que invariavelmenteestará associado a enorme risco de infertilidade, levando a impacto negativo importante na vida destes jovens homens. Este artigo de revisão aborda os mais atuais conceitos empreservação de fertilidade em homens jovens tratados de câncer, o crescimento deste campo dentro da oncologia e da urologia e o futuro deste tema tão relevante para nossapopulação. Até hoje existe uma importante desconexão entre os guidelines mundiais e a prática médica, quando o assunto é preservação da fertilidade em homens com câncer em idade reprodutiva...

Over the past 40 years, the global profile of cancer is changing. Initially regarded as a disease of the richcountries, it is noted that currently most of its global burden comes from poor or developing countries. In recent decades cancer has become a public health problem worldwide, withalarming estimates for subsequent decades. In Brazil, the estimates for the year 2012 will be valid for the year 2013 and reveals the occurrence of approximately 518,510 new cases of cancer, including cases of non-melanoma skin. Are expected a total of 257,870 new cases for males. The greatthing is that about 10% of these cases are in the age group below 45 years and 1% below 20 years of age. Although the current treatment of cancer has increased considerablysurvival rates at 5 years young patients, it is almost invariably associated with great risk of infertility, leading to significant negative impact in the lives of these young men. This review article discusses the most current concepts in preserving fertility in young men treated for cancer, thegrowth of this field within the oncology and urology and the future of this topic so relevant to our population. Eventoday there is a important disconnect between the world and medical practice guidelines, when it comes to fertility preservation in men with cancer of reproductive age...

Verrucous carcinoma of the bladder with koilocytosis unassociated with vesical schistosomiasis

CONTEXTO: O carcinoma verrucoso de bexiga é uma neoplasia maligna muito rara, histologicamente semelhante ao condiloma acuminado. Normalmente apresenta-se associado à esquistossomose vesical (bilharzíase). Apenas 13 casos não relacionados à bilharzíase foram descritos até o momento, sendo que em nenhum deles foi relatada presença de coilocitose, um achado característico da infecção pelo papiloma vírus humano. RELATO DE CASO: Apresentamos um caso de carcinoma verrucoso de bexiga não relacionado à bilharzíase com presença de coilocitose e ausência de papiloma vírus humano. A literatura relacionada ao assunto é discutida.