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.

Coleta de uma história espiritual: fundamentos para uma prática profissional culturalmente sensível / Collecting a spiritual history: foundations for a culturally sensitive professional practice

Realizar a coleta de uma história espiritual é fundamental para se adotar, cotidianamente, práticas profissionais culturalmente sensíveis. Algumas razões para se considerar essa abordagem: religião e espiritualidade (R/E) são importantes para muitas pessoas, principalmente na realidade religiosa brasileira; R/E influencia desfechos de saúde, comumente por meio de associações positivas; a coleta de dados sobre a espiritualidade pode fornecer uma compreensão mais ampla da natureza e da relação entre a R/E e a sintomatologia do paciente. Já existem roteiros desenvolvidos para facilitar a obtenção de uma história espiritual pela equipe de saúde, mas também é possível ampliá-los e adaptá-los às características próprias de cada serviço de saúde. Essa identificação adequada das necessidades espirituais é central para que os profissionais possam tomar atitudes que facilitem aos pacientes a prática de suas crenças, particularmente diante de um momento de extrema vulnerabilidade, que é o adoecer

Collecting a spiritual history is fundamental to adopting culturally sensitive professional practices. Some reasons to consider this approach: religion and spirituality (R/S) are important to many people, especially in the Brazilian religious context; R/S influences health outcomes, commonly through positive associations; collecting spirituality data can provide a broader understanding of the nature and relationship between R/S and patient symptomatology. There are already scripts developed to facilitate the obtaining of a spiritual history by the health team, but it is also possible to expand them and adapt them to the characteristics of each health service. This proper identification of spiritual needs is central for professionals to take actions that facilitate patients to practice their beliefs, particularly in the face of a moment of extreme vulnerability, which is getting sick

Evaluation of antiphospholipid antibodies testing for the diagnosis of antiphospholipid syndrome / Avaliação da pesquisa de anticorpos antifosfolipídios para o diagnóstico da síndrome antifosfolípide

OBJETIVO: Determinar a prevalência de anticoagulante lúpico (LAC) e dos isótipos de anticardiolipina (ACL) e suas eventuais associações clínicas. PACIENTES E MÉTODOS: Estudo retrospectivo que avaliou manifestações clínicas e laboratoriais em indivíduos que apresentaram positividade para anticorpos antifosfolipídios no Hospital Edmundo Vasconcelos entre março de 2005 e junho de 2006. RESULTADOS: Cento e seis indivíduos (média de idade 42,2 ± 14,1 anos, 84 por cento do sexo feminino) foram incluídos no estudo. A prevalência de trombose foi de 17,9 por cento (19/106) e de morbidade gestacional foi de 12,3 por cento (13/106). O diagnóstico de Síndrome Antifosfolípide (SAF) foi feito em 23,6 por cento (25/106), sendo primária em 68 por cento (17/25) e secundária em 32 por cento (8/25). A prevalência de ACL foi de 97,1 por cento (103/106) e de LAC foi de 11,4 por cento (5/44 dos exames realizados). ACL isótipos IgM, IgG e IgA foram encontrados em 100 por cento, 23,3 por cento e 4,9 por cento dos 103 soros ACL positivos, respectivamente. Para o diagnóstico de SAF, a ACL IgM apresentou sensibilidade de 92 por cento e especificidade de 1,2 por cento, enquanto a ACL IgG teve sensibilidade de 40 por cento e especificidade de 82,5 por cento. A ausência de ACL IgG teve alto valor preditivo negativo (81,4 por cento) para SAF. O LAC apresentou sensibilidade de 18,7 por cento e especificidade de 92,8 por cento. A curva Receiver Operating Characteristic (ROC) demonstrou maior área abaixo da curva para ACL IgG e LAC. CONCLUSÃO: Em amostra aleatória de indivíduos com anticorpos antifosfolipídios positivos, ACL IgG e LAC apresentaram maior especificidade para o diagnóstico de SAF, que se caracterizou pela maior prevalência de trombose.

OBJECTIVE: To evaluate the prevalence of lupus anticoagulant (LAC) and isotypes of anticardiolipin (ACL) antibodies and its possible clinical associations. PATIENTS AND METHODS: A retrospective study analyzed clinical and laboratorial manifestations in individuals who showed positive antiphospholipid antibodies followed-up at Hospital Edmundo Vasconcelos from March 2005 to June 2006. RESULTS: 106 participants (mean age of 42.2 ± 14.1 years at inclusion and female gender in 84 percent of patients) were included in the study. The prevalence of thrombosis was 17.9 percent (19/106 patients) and pregnancy morbidity was 12.3 percent (13/106 patients). The antiphospholipid syndrome (APS) was confirmed in 23.6 percent (25/106 patients), and it was primary in 68 percent (17/25 patients) and secondary in 32 percent (8/25 patients). The ACL antibodies were found in 97.1 percent (103/106) and LAC in 11.4 percent (5/44 of the serum samples tested). IgM, IgG and IgA ACL isotypes were respectively found in 100 percent, 23.3 percent and in 4.9 percent of these ACL positive sera. For APS diagnosis the sensitivity of IgM ACL was 92 percent and its specificity was 1.2 percent, while IgG ACL had a sensitivity of 40 percent and specificity of 82.5 percent. The absence of IgG ACL had a high negative predictive value for APS diagnosis (81.4 percent).The analysis of the Receiver Operating Characteristic (ROC) curve showed larger area under the curve for ACL IgG and LAC. CONCLUSION: In a random sample of individuals with positive antiphospholipid antibodies, IgG ACL and LAC showed a larger specificity for APS diagnosis which had been characterized by a higher prevalence of thrombosis.