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.

Second brazilian consensus on the treatment of advanced prostate cancer: a SBOC-SBU-SBRT panel review

ABSTRACT Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

Comparação do escore de Gleason da biópsia prostática com o da peça cirúrgica em pacientes com câncer de próstata / Comparison of Gleason score of prostatic biopsy with surgical specimen in patients with prostate cancer

JUSTIFICATIVA E OBJETIVOS: O escore de Gleason da biópsia prostática transretal representa um dos métodos prognósticos mais importantes na avaliação dos cânceres de próstata, permitindo a indicação terapêutica mais adequada. O objetivo deste estudo foi comparar os valores do escore de Gleason obtidos na biópsia com os valores da peça cirúrgica a fim de obter valores a respeito do grau de concordância entre os dois métodos diagnósticos. MÉTODO: Foram estudados retrospectivamente os prontuários de 70 pacientes com diagnóstico anatomopatológico de adenocarcinoma prostático que foram submetidos à prostatectomia, atendidos em clínica de Oncologia na cidade de Salvador-BA, no período de 1998 a 2009. Os dados foram analisados pelo software SPSS 19.0. Foi utilizado o teste Kappa para avaliar a concordância entre os escores de Gleason da biópsia prostática transretal e aqueles da peça cirúrgica. RESULTADOS: A idade média dos pacientes foi 61,61 anos ± 7,25. O antígeno prostático específico (PSA) total pré-operatório teve média de 7,32 ng/mL ± 4,57. O escore de Gleason mais frequente foi 6, tendo 49 pacientes apresentado este valor à biópsia e 44 pacientes no espécime cirúrgico, 70% e 62,86%, respectivamente. Trinta e nove pacientes (55,71%) tinham Gleason 6(3+3) à biópsia e mantiveram o escore na peça cirúrgica. Houve concordância em 72,86% dos casos, subgradação em 21,43% e supergradação em 5,71%. O teste Kappa foi igual a +0,505 e o valor de p foi < 0,01. CONCLUSÃO: Ao comparar os resultados histológicos da biópsia prostática com os da peça cirúrgica, obteve-se concordância de 72,86%, com Kappa igual a +0,505; p < 0,01.

BACKGROUND AND OBJECTIVES: Gleason score of transrectal prostate biopsy is one of the most important prognostic methods in the evaluation of prostate cancers, allowing the most appropriate therapeutic indication. Our aim is to compare Gleason score values in biopsies with surgical specimens in order to obtain values about the degree of agreement between the two diagnostic methods. METHOD: We studied retrospectively 70 patients with anatomopathological diagnosis of prostatic adenocarcinoma who underwent prostatectomy in an Oncology clinic in the city of Salvador, in the state of Bahia, within 1998 to 2009. Data were analyzed by SPSS 19.0 software. Kappa was used to evaluate the agreement between Gleason scores of transrectal prostate biopsy and those of the surgical specimen. RESULTS: The average age of patients was 61.61 years ± 7.25. The preoperative prostatic specific antigen (PSA) had an average of 7.32 ng/mL ± 4.57. The most common Gleason score was 6. Forty-nine patients presented this score at the time of biopsy and 44 patients in surgical specimens (70% and 62.86% respectively). Thirty-nine patients (55.71%) had Gleason 6 (3+3) at the time of biopsy and the value remained the same in the surgical specimen. There was agreement in 72.86% of cases. We found underestimation in 21.43% and overestimation in 5.71%. Kappa was equal to +0.505 and the p value was < 0.01. CONCLUSION: When comparing the histological results of prostate biopsy with the surgical specimen we found agreement of 72.86%, with Kappa equal to +0,505, p < 0.01.