Circadian rhythm in prostate cancer: time to take notice of the clock / 亚洲男科学杂志(英文版)

The circadian clock is an evolutionary molecular product that is associated with better adaptation to changes in the external environment. Disruption of the circadian rhythm plays a critical role in tumorigenesis of many kinds of cancers, including prostate cancer (PCa). Integrating circadian rhythm into PCa research not only brings a closer understanding of the mechanisms of PCa but also provides new and effective options for the precise treatment of patients with PCa. This review begins with patterns of the circadian clock, highlights the role of the disruption of circadian rhythms in PCa at the epidemiological and molecular levels, and discusses possible new approaches to PCa therapy that target the circadian clock.

Relación de las cinéticas del PSA en la detección de la recurrencia del cáncer de próstata post prostatectomía radical con la 18f-colina tomografía por emisión de positrones/tomografía computada [PET/TC colina (PETC)] / Kinetic Relation Between PSA and 18F-choline PET/ CT in the Detection of Recurrent Prostatic Cancer After Radical Prostatectomy

Resumen Objetivo: El objetivo de este estudio es evaluar la relación de las cinéticas del antígeno prostático específico (PSA por su sigla en inglés) con la positividad de la tomografía por emisión de positrones/tomografía computada [PET/TC colina (PETC)]en pacientes con una recaída de cáncer de próstata (RCP). Materiales y métodos: Se realizó un trabajo retrospectivo de 48 pacientes con RCP post prostatectomía radical (PR) evaluados con PETC. Resultados: La PETC negativa tuvo una mediana de 16,3 meses y la PETC positiva de 5,5 meses (p = < 0,001) para el tiempo de doblaje de PSA (PSADT por su sigla en inglés); la PETC fue positiva en el 96% de los pacientes con un PSADT< 12 meses. La PETC negativa tuvo una mediana de 0,03 ng/ml/año y la PETC positiva de 4,1 ng/ml/año (p = < 0,001) para la velocidad del PSA (PSAVpor su sigla en inglés); la PETC fue positiva en el 92% de los pacientes con un PSAV > 0,75 ng/ml/año. Las áreas bajo la curva ROC para PSAV fue de 0,984 con un punto de corte de mayor discriminación de 0.785 ng/ml/año, mostrando razones de verosimilitud (LR por su sigla en inglés) LR + = 25 y LR- = 0,1. Para PSADT el ROC fue de 0,992 con un punto de corte de mayor discriminación de 11 meses, mostrando LR + = 11 y LR- = 0. Discusión: El PSA es un indicador inespecífico de PETC positiva. Un estudio inicial demostró que los pacientes con una RCP con una PETC positiva tenían un menor PSADT y una mayor PSAV que los pacientes con una PETC negativa. Conclusión: La positividad de la PETC se vio influenciada por las cinéticas del PSA, observándose que a menor PSADT y que a mayor PSAV mayor fue la probabilidad de la positividad de la PETC.

Abstract Purpose: The aim of this study is to evaluate the relationship between Prostate-Specific Antigen (PSA) kinetics and the detection of Prostate Cancer Relapse (PCR) with Positron-Emission Tomography (PETC). Material and methods: A retrospective study of 48 patients with a PCR after a radical prostatectomy evaluated with PETC was performed. Results: PSA Doubling Time (PSADT), with negative PETC, had a median of 16.3 months and the positive PETC a median of 5.5 months (p = < 0.001); 96% of patients with a PSADT <12 months had positive PETC. PSA Velocity (PSAV), negative PETC, had a median of 0.03 ng/ml/year and positive PETC a median of 4.1 ng/ml/year (p = < 0.001); 92% of patients who had a PSAV > 0.75 ng/ml/year had positive PETC. The ROC for PSAV was 0.984 with a cut-off value of 0.785 ng/ml/year, Showing Likelihood Ratios (LR) LR + = 25 and LR- = 0.1. The ROC for PSADT was 0.992 with a cut off value of 11 months, showing LR + = 11 and LR- = 0. Discussion: PSA is a nonspecific indicator of positive PETC. An initial study demon-strated that patients with a PCR and positive PETC had lower PSADT and higher PSAV than patients with a negative PETC. Conclusion: The rate of detection of PCR with PETC was influenced by the kinetics of PSA, and it was observed that the lower the PSADT and the higher the PSAV, the greater the probability of the positivity of the PETC.

Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

Cáncer de próstata: actualización / Câncer de próstata: atualização / Prostate cancer: update

Introducción: en Cuba el cáncer de próstata es la primera causa de muerte por cáncer en hombres. Objetivo: sistematizar las bases teóricas esenciales que sustenten la autopreparación del estudiante de medicina y al médico general para su participación en la prevención, diagnóstico precoz y manejo del paciente con cáncer de próstata. Método: en la Facultad de Medicina de Guantánamo, entre septiembre y diciembre de 2018; se hizo una búsqueda en las bases de datos electrónicas a través del metabuscador Google Scholar. Resultados: se elaboró una monografía sobre las consideraciones actuales sobre el cáncer d próstata al nivel de los estudiantes de medicina y del médico general que contuvo los siguientes núcleos de conocimientos: definición, fisiopatología, etiología, diagnóstico y tratamiento. Conclusiones: la expresión clínica de este cáncer es diversa y aún no se cuenta con biomarcadores precisos para su diagnóstico, lo que hace ineludible la habilitación de los médicos generales para contribuir con eficiencia en su prevención y diagnóstico clínico precoz en función de asegurar al paciente una mayor posibilidad de cura y supervivencia(AU)

Introduction: in Cuba, prostate cancer is the leading cause of cancer death in men. Objective: systematize the essential theoretical bases that sustain the self-preparation of the medical student and the general practitioner for their participation in the prevention, early diagnosis and management of the patient with prostate cancer. Method: in the Faculty of Medicine of Guantánamo, between September and December 2018; a search was made in the electronic databases through the Google Scholar metasearch engine. Results: a monograph was prepared on the current considerations on prostate cancer at the level of medical students and general practitioner that contained the following nuclei of knowledge: definition, pathophysiology, etiology, diagnosis and treatment. Conclusions: the clinical expression of this cancer is diverse and precise biomarkers are not yet available for its diagnosis, which makes it essential for general practitioners to be able to contribute efficiently to its prevention and early clinical diagnosis in order to ensure the patient a greater chance of cure and survival(AU)

Introdução: em Cuba, o câncer de próstata é a principal causa de morte por câncer em homens. Objetivo: sistematizar as bases teóricas essenciais que sustentam a autopreparação do estudante de medicina e do clínico geral para sua participação na prevenção, diagnóstico precoce e manejo do paciente com câncer de próstata. Método: na Faculdade de Medicina de Guantánamo, entre setembro e dezembro de 2018; foi realizada uma busca nas bases de dados eletrônicas por meio do mecanismo de metabusca do Google Acadêmico. Resultados: elaborouse uma monografia sobre as atuais considerações sobre o câncer de próstata em nível de estudantes de medicina e clínico geral que continha os seguintes núcleos de conhecimento: definição, fisiopatologia, etiologia, diagnóstico e tratamento. Conclusões: A expressão clínica desse tipo de câncer é diversa e ainda não tem biomarcadores precisos para o diagnóstico, o que torna inevitável permitindo que clínicos gerais para contribuir de forma eficaz na prevenção e no diagnóstico clínico precoce em termos de assegurar ao paciente um maior chance de cura e sobrevivência(AU)

Síndrome de bazex: acroqueratosis paraneoplásica secundaria a cáncer de próstata / Bazex syndrome: paraneoplasic acroqueratosis secondary to prostatic cancer

La piel puede ofrecer el primer síntoma guía en el 1% de los pacientes con neoplasias internas. Las manifestaciones cutáneas de malignidades internas se pueden producir por invasión directa de la piel por el tumor y por diseminación metastásica, pero existen mecanismos indirectos que inducen la aparición de signos y síntomas cutáneos no relacionados con el tumor primitivo. El Síndrome de Bazex es una rara dermatosis descrita por Bazex y colaboradores en 1965. Se caracteriza por la presencia de placas eritematosas, psoriasiformes, que típicamente afectan a las manos, los pies, la nariz y los pabellones auriculares. La inexperiencia puede motivar retrasos en el diagnóstico, haciendo que la neoplasia asociada se encuentre en estadios avanzados en el momento del diagnóstico. Se discute un caso clínico de un paciente masculino de 53 años de edad, hipertenso, quien acude por presentar lesiones cutáneas tipo placas hipertróficas, hiperpigmentadas, descamativas y dolorosas con fondo eritematoso acompañados de secreción hialina amarillenta en regiones acrales y cuero cabelludo. La biopsia cutánea reportó granulocitosis y aumento del espesor de la capa córnea; en los cultivos bacteriano y micológico de tejido dérmico creció flora habitual. La biopsia prostática diagnosticó adenocarcinoma prostático Gleason 4/5, Se inició hormonoterapia y se realizó prostatectomía total, con mejoría clínica significativa posterior al inicio del tratamiento. La acroqueratosis de Bazex es un proceso muy infrecuente, con pocos casos descritos en la literatura. Su reconocimiento temprano podría permitir el diagnóstico de la neoplasia asociada en estadios más precoces y conducentes a un tratamiento más temprano(AU)

The skin can show the first symptom in 1% of patients with internal neoplasias. Cutaneous manifestations of internal malignancies can be caused by direct invasion of the skin by the tumor and by metastatic dissemination, but there are indirect mechanisms that induce the appearance of cutaneous signs and symptoms unrelated to the primitive tumor. Bazex Syndrome is a rare dermatosis described by Bazex et al. in 1965. It is characterized by the presence of erythematous, psoriasiform plaques, which typically affect the hands, feet, nose, and ear-lobes. The lack of experience may carry diagnostic delays and the associated neoplasia could be at advanced stages when diagnosed. We describe here the case of a 53-year-old male patient, who consulted for cutaneous lesions.These were hypertrophic, hyperpigmented, scaly and painful plaques with an erythematous background accompanied by a yellowish hyaline secretion in the hands, feet and scalp. A skin biopsy was done that reported granulocytosis and increased thickness of the corneal layer; in addition, bacterial and mycological culture of dermal tissue were negative. The prostate biopsy diagnosed a prostate adenocarcinoma, Gleason 4/5. Hormone therapy was started and total prostatectomy was performed, with significant clinical improvement .Bazex acroqueratosis is a very rare process, with few cases described in the literature. Its early recognition could allow the diagnosis of the associated neoplasia in earlier stages, leading to earlier treatment(AU)

Preparation and physicochemical characterization of prazosin conjugated PLGA nanoparticles for drug delivery of flutamide

In the current work, a sustained drug delivery system of flutamide (FLT) was developed using Poly(D,L-lactide-co-glycolide) (PLGA) decorated bypoly(ethylene glycol) (PEG) grafted prazosin (PLGA-PEG-Praz) as a targeting moiety. In a multi-step reaction, PLGA was linked to PEG and prazosin. The structure of the synthesized polymers was confirmed by FTIR and 1H-NMR. Flutamide-loaded nanoparticles were prepared by quasi-emulsion solvent diffusion technique. The nanoparticles were evaluated for size, zeta potential, polydispersity index, drug crystallinity, loading efficiency, and release properties. Also, the physicochemical properties of the nanoparticles were analyzed using Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry, and Powder X-Ray Diffractometry (XRD). The particle size of nanoparticles was ranged between 191 and 249 nm. Loading efficiency of nanoparticles was about 43%-69%. Results showed a steady release rate for nanoparticles compared to that of a pure drug powder. SEM characterization confirmed that particles were in nanosize range. DSC and XRPD results verified a decrease in drug crystallinity in the prepared formulations. In conclusion, the results of this study showed that PLGA-PEG-Praz nanoparticles could be a good choice to improve the physicochemical properties of the drug and these formulations can increase Flutamide efficacy.

Evaluación de la calidad de vida en pacientes con cáncer de próstata tratados mediante prostatectomía radical: estudio prospectivo y resultados a seis meses de seguimiento / Assessment of quality of life in patients with prostate cancer treated with radical prostatectomy: prospective study and results at six months of follow-up

El cáncer de próstata representa un grave problema de salud en el mundo occidental. Actualmente disponemos de diferentes alternativas terapéuticas para el cáncer localizado, por lo que cobra gran importancia la calidad de vida (CDV) de los pacientes al momento de ofrecerles las diferentes modalidades de tratamiento. Nuestro objetivo consistió en evaluar la calidad de vida de los pacientes con cáncer de próstata localizado antes y después de ser tratados mediante prostatectomía radical, analizando su evolución a través del tiempo.Estudio de cohorte abierta prospectivo con una duración de dos años (estudio aún no concluido). Se incluyeron un total de cuarenta pacientes sometidos a prostatectomía radical por cáncer de próstata localizado en el servicio de Urología de dos instituciones de salud. Se evaluaron parámetros de CDV (potencia sexual, continencia urinaria y defecatoria) mediante la aplicación del cuestionario UCLA-PCI previo al tratamiento, y luego de la cirugía a los 3 y 6 meses. Se utilizó T-student para la comparación de medias, estableciendo como significativo un p < 0,05. Mediante análisis multivariado se estudiaron factores protectores de recuperación precoz de las diferentes funciones. Fueron reclutados un total de cuarenta pacientes, todos con un seguimiento mínimo de seis meses. La media de edad fue de 64.9 años (rango 44-78; DE: 8.5). En la evaluación de los 3 meses, se obtuvo una caída significativa en la función urinaria (74.7 v/s 58.4; p=0.046) y sexual (55.9 v/s 25.98; p=0.001) con respecto al basal. El ámbito evaluado que presentó el mayor deterioro a los tres meses, fue la función sexual, observándose una caída promedio de un 78.2 por ciento con respecto a la evaluación inicial. De los tres ámbitos evaluados, la función urinaria (74.7 v/s 73.1; p=0.83) y defecatoria (80.1 v/s 85.8; p=0.86) muestran una recuperación significativa a los seis meses, con respecto a la medición inicial, no así, la función sexual (25.98 v/s 30,5; p=0.89)...

Prostate cancer is asignificant health problem in Western countries. Use of PSA has increased significantly the number of tumors diagnosed in early stages. Men undergo different therapeutics methods can generallyexpect excellent long-term survival, thus consideration of health related quality of life (HRQOL) after treatment is of great importance. Our objective was to evaluate HRQOL after radical prostatectomy in men with localized prostate cáncer. Prospective open cohort study with duration of two years (study ongoing). A total of 40 patients undergoing radical prostatectomy were prospectively enrolled at two institutions (Clinica Las Condes and Hospital San Borja) between august 2011 and december 2011. HRQOL parameters were evaluated (sexual potency, urinary continence and bowel function) by applying the UCLA-PCI questionnaire before treatment and after surgery at 3 and 6 months. T-student was used to compare means. A p value <0.05 was considered statistically significantRESULTS: A total of forty patients were recruited with a minimum follow up of six months. The mean age was 64.9 years (range 44-78, SD: 8.5). The evaluation conducted at three months showed a significant decline in urinary function (74.7 v / s 58.4, P = 0.046) and sexual (55.9 v / s 19.2; p = 0,001) compared to baseline...

Contribuição da densidade do PSA para predizer o câncer da próstata em pacientes com valores de PSA entre 2, 6 e 10, 0 ng/ml / Contribution of PSA density in the prediction of prostate cancer in patients with PSA values between 2.6 and 10.0 ng/ml

OBJETIVO: Estudar o perfil dos pacientes submetidos a biópsia prostática, determinando possíveis padrões que, associados aos níveis de PSA entre 2,6 e 10,0 ng/ml, possam levar a uma diminuição de biópsias desnecessárias. MATERIAIS E MÉTODOS: De 2007 a 2009, foi realizado um estudo transversal com 1.282 indivíduos submetidos a biópsia prostática e que apresentavam níveis de PSA entre 2,6 e 10,0 ng/ml. RESULTADOS: A prevalência de câncer foi de 28,6 por cento. Pacientes com câncer eram, em média, mais idosos, com valores de PSA e densidade de PSA mais altos e menor volume da próstata. Na análise da densidade de PSA, os pacientes com câncer tiveram média de 0,31 ng/ml/cc, enquanto nos pacientes com resultado negativo a média foi de 0,10 ng/ml/cc. Utilizando como critério de positividade para câncer o ponto de corte de densidade de PSA de 0,15 ng/ml/cc, obtivemos especificidade de 74 por cento e sensibilidade de 70 por cento. Para aumentar a sensibilidade é preciso reduzir o ponto de corte. Com o valor 0,09 ng/ml/cc, obtivemos sensibilidade de 84 por cento (IC 95 por cento: 80-87 por cento) e especificidade de 75 por cento (IC 95 por cento: 72-78 por cento). CONCLUSÃO: O uso sistemático da densidade de PSA na indicação de prosseguimento da investigação do paciente com biópsia poderia reduzir a quantidade de procedimentos desnecessários.

OBJECTIVE: To study the profile of patients with PSA level between 2.6 and 10.0 ng/ml and submitted to prostate biopsy, determining possible patterns that might lead to a reduction of unnecessary biopsies. MATERIALS AND METHODS: In the period from 2007 to 2009, a cross-sectional study was developed with 1,282 patients with PSA levels between 2.6 and 10.0 ng/ml, and submitted to prostate biopsy. RESULTS: Cancer prevalence was 28.6 percent. On average, the patients with positive biopsies were older, with higher PSA levels and density, and smaller prostate volume as compared with the patients with negative biopsies. In the analysis of PSA density, the cancer patients averaged 0.31 ng/ml/cc, while patients with negative results averaged 0.10 ng/ml/cc. Utilizing a cutoff value of 0.15 ng/ml/cc for PSA density as a cancer positiveness criterion, the authors obtained sensitivity of 74 percent and specificity of 70 percent. The cutoff value should be reduced to increase the sensitivity. With a cutoff value of 0.09 ng/ml/cc, sensitivity reached 84 percent (CI 95 percent: 80-87 percent), and specificity, 75 percent (CI 95 percent: 72-78 percent). CONCLUSION: The systematic use of PSA density as an indicator to proceed with the investigation of a patient with biopsy could substantially reduce the amount of unnecessary procedures.

From two-dimensional to three-dimensional conformal radiotherapy in prostate cancer: An Indian experience.

Background: Sparse data from India are available regarding the outcome of prostate cancer treatment. We report our experience in treating prostate cancer with radiotherapy (RT). Materials and Methods: This study included 159 men with locally advanced cancer treated with RT with or without hormone therapy between 1984 and 2004. The median RT dose was 70 Gy over 35 fractions. Eighty-five patients received whole pelvic RT and prostate boost, and 74 patients were treated with 3-dimensional conformal radiotherapy (3DCRT) to prostate and seminal vesicles alone. Results: The median follow-up was 25 months and the freedom from biochemical failure for all the patients at 5 years was 76%, disease-free survival (DFS) 59.1%, and overall survival (OAS) was 70.1%. The risk stratification (91% vs 52%, P < 0.03) and RT dose (72.8% for dose > 66 Gy vs 43.5% for dose < 66 Gy; P = 0.01) affected the DFS. DFS at 5 years was better in the group receiving 3DCRT to prostate and seminal vesicles (78% vs 51.5%; P = 0.001) and was reflected in OAS as well (P = 0.01). Conclusion: CRT technique with dose escalation results in significant benefit in DFS and OAS in locally advanced prostate cancer.

Rastreamento e diagnóstico de câncer de próstata / Screening and diagnosis of prostate cancer

Não existem até o momento provas contundentes que a população coberta pelo plano de saúde UNIMED-POA deva ser submetida ao rastreamento sistemático do câncer de próstata com o intuito de reduzir a mortalidade decorrente deste tipo de câncer, uma vez que não existem estudos desenhados no Estado do Rio Grande do Sul que contemplem este aspecto. Recentemente, dois grandes estudos randomizados que visavam a esclarecer se o rastreamento populacional poderia reduzir a mortalidade por câncer de próstata concluíram: em estudo realizado nos Estados Unidos (prostate, lung, colorectal and ovary trial), não houve diferença na mortalidade da população rastreada ou não; no estudo europeu (European randomized of screening for prostate cancer), houve uma redução de 20 por cento da mortalidade da população rastreada em relação à não rastreada. Cabe ressaltar que ambos os estudos apresentaram, entre outros problemas, viés de seleção dos pacientes, onde mais de 50 por cento do grupo teoricamente não rastreado efetivamente realizou exames antes ou durante o estudo. Sendo assim, permanece recomendada realização de rastreamento nas diretrizes da Associação Americana de Urologia, Associação Europeia de Urologia e Sociedade Brasileira de Urologia.

So far, there is no compelling evidence that the local population covered by the health plan UNIMED-POA should be submitted to systematic screening for prostate cancer in order to reduce mortality resulting from this type of cancer, as no studies in Rio Grande do Sul have been performed to address this particular issue. In other countries, two large randomized studies aimed at clarifying whether such screening could reduce mortality from prostate cancer were conducted recently: the prostate, lung, colorectal and ovary trial in the United States, and the European randomized screening for prostate cancer. In the former, there was no difference in mortality between screened and non-screened groups; in the latter there was a 20 percent reduction in mortality in the screened as compared to the non-screened group. It should be highlighted that both studies had many design problems including biased selection of patients, as more than 50 percent of the supposedly non-screened group was in fact submitted to medical tests either before or during the trial. Therefore, screening still should be performed according to the guidelines of the American Association of Urology, European Association of Urology and the Brazilian Society of Urology.

Orquiectomia bilateral sob anestesia local no tratamento do câncer de próstata avançado / Bilateral orquiectomy under local anesthesia in treatment of advanced prostate cancer

O câncer de próstada (CAP) é a neoplasia mais freqüente no homem. Os autores descrevem a técnica operativa da orquiectomia bilateral subepidimária e analisam os parâmetros clínicos e os valores de PSA pré e pós-operatórios em portadores de CAP. Trinta e sete pacientes com CAP avançado foram submetidos à orquiectomia bileteral subepidimária sob anestesia funicular com lidocaìna. A idade média dos doentes foi de 71 anos. Setenta por cento deles apresentaram escore de Gleason igual ou superior a sete. A média dos níveis de PSA decresceu de 161,36np/ml para 12ng/ml no 30º PO; 95 por cento dos pacientes eram T3/T4; a média do PSA foi inferior naqueles com cintilografia óssea negativa e naqueles que receberam hormonioterapia prévia; nenhum paciente referiu dor intensa; ocorreu um caso de hematoma, um de deiscência d FO e fois óbitos durante o estudo. Os autores concluem que a orquiectomia bilateral sob anestesia local é factível...

The European Organization for Research and Treatment of Cancer prostate-specific quality of life module (PR-25) in Hindi and Marathi: translation and pilot testing process.

BACKGROUND: The side effects of various treatments for prostate cancer have a measurable impact on the general as well as disease-related quality of life, which is of pivotal concern as an outcome measure. AIM: Translation and pilot testing of the European Organization for Research and Treatment of Cancer (EORTC) prostate cancer-specific module (PR-25) into Hindi and Marathi. MATERIALS AND METHODS: The translation procedure described by the EORTC was adopted; this comprised two forward translations of the original English questionnaire into Hindi and Marathi each with formation of first intermediary questionnaires and two back translations of the first intermediary questionnaires into English. The first intermediary questionnaires were adapted as the second intermediary questionnaires and pilot tested in ten prostate cancer patients as no modifications were suggested by the back translators. RESULTS: Each patient, after completing the questionnaire, was interviewed by the local project coordinator who questioned them about each item in the second intermediary questionnaire. The patients were asked whether there was any difficulty in answering, confusion while answering, or difficulty in understanding the questions; whether the questions were upsetting; and if the patients themselves would have framed the question in a different way. Based on the suggestions or interpretations of this pilot testing, the necessary changes were incorporated and the final Hindi and Marathi questionnaires were formed. CONCLUSION: Both the translations were submitted to the EORTC for review and have been subsequently approved for clinical studies.

The Functional Assessment of Cancer Therapy-Prostate (FACT-P) Scales in Men with Prostate Cancer: Reliability and Validity of the Korean Version

The Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire is a relevant, worldwide tool used for assessing the health-related quality of life in men with prostate cancer. The purpose of this study was to translate the FACT-P into Korean, to assess its reliability and validity, and to test its discriminative ability between the cancer patients and normal controls. The Korean version was developed via the FACT multilingual translation project. The translated questionnaire was self-administered to 70 prostate cancer patients and 70 age-matched controls. In evaluating its psychometric properties for cancer patients, internal consistency and test-retest reliability were used. Validity was estimated by using inter-subscale correlations and discriminant validity between cancer patients and controls. Cronbach's alpha coefficient for the individual subscales were 0.7 or greater (range 0.73 to 0.89), except for emotional well-being (0.61). The test-retest reliability showed high correlations (intraclass coefficients ranged from 0.72 to 0.93). Inter-subscale correlations demonstrated each subscale was unrelated, but moderate correlation was observed between social/family well-being and functional well-being subscales (r=0.56). The FACT-P scale could discriminate reliably between the cancer patients and controls in most subscales. In conclusion, the Korean version of the FACT-P is a reliable and valid questionnaire in patients with prostate cancer.

Massa retroperitoneal / Retroperitoneal mass

Os autores relatam um caso de volumosa massa retroperitoneal com edema de membro inferior por compressão de linfáticos, além de massa cervical. A investigação diagnóstica mostrou um adenocarcinoma de próstata, Gleason 9, com metástases para linfonodos retroperitoneais e de região cervical. A castração cirúrgica resultou em diminuição importante da massa de retroperitônio e do linfedema, com grande redução dos níveis séricos de PSA

Which patients with prostate cancer are actually candidates for hormone therapy?

In this article, we will try to address the following aspects: which factors are responsible of the introduction of new candidates for hormone therapy in prostate cancer, who are actually candidates for hormone therapy, classifying them on the basis of the stage of the disease, and which treatment modalities can be proposed for each candidate. Since the introduction of hormone therapy for the treatment of prostate cancer, there has been a debate about the optimal timing of hormone therapy. A modification in the timing of hormone therapy produced new candidates for hormone manipulation. In particular, the use of hormone treatment for younger patients, longer periods and early prostate cancer, absolutely requires a whole re-evaluation of which therapy is indicated and it may produce new problems such as higher risk of over-treatment, need of a better evaluation of quality of life in younger patients and the research for better tolerated therapies. Therapies that resist for longer periods without the production of a hormone-refractory disease are also required.

Avaliação da resposta bioquímica no câncer inicial de próstata: experiência uninstitucional comparando teleterapia exclusiva ou associada à braquiterapia de alta taxa de dose / Evaluation of biochemical response on early prostate cancer: comparison between treatment with external beam radiation alone and in combination with high-dose rate conformal brachytherapy boost

OBJETIVO: Análise comparativa da resposta bioquímica em pacientes submetidos à teleterapia exclusiva ou associada à braquiterapia de alta taxa de dose para tumores localizados da próstata. MATERIAIS E MÉTODOS: De novembro de 1997 a janeiro de 2000, 74 pacientes foram submetidos à teleterapia com 45 Gy e reforço com braquiterapia de alta taxa de dose com irídio-192 e dose de 16 Gy em quatro inserções (BT). Estes foram comparados a 29 pacientes submetidos à teleterapia com 45 Gy e reforço com arcoterapia e dose mediana de 24 Gy (RT) entre outubro de 1996 e fevereiro de 2000. Nos dois grupos houve associação ocasional de hormonioterapia neoadjuvante. Sobrevida atuarial livre de doença em três anos (SB3) e fatores prognósticos pré-tratamento da resposta bioquímica, como o antígeno prostático-específico inicial (PSAi), escore de Gleason da biópsia de próstata (EG) e estádio clínico (EC), foram analisados. RESULTADOS: O seguimento mediano foi de 25 meses para o grupo RT e 37 meses para o BT. Na análise atuarial, a SB3 foi de 51 por cento e 73 por cento (p = 0,032) para RT e BT, respectivamente. Na análise estratificada pelo PSAi, a SB3 para RT e BT foi de 85,7 por cento e 79,1 por cento (p = 0,76) para PSAi < 10 ng/mL e de 38 por cento e 68 por cento (p = 0,023) para PSAi > 10 ng/mL, respectivamente. Quando estratificado pelo EG, a SB3 para RT e BT foi de 37 por cento e 80 por cento (p = 0,001) para EG < 6 e 78 por cento e 55 por cento para EG > 6 (p = 0,58); estratificando-se pelo EC, a SB3 para RT e BT foi de 36 por cento e 74 por cento (p = 0,018) para EC < T2a e 73 por cento e 69 por cento para EC > T2a (p = 0,692), respectivamente. O risco relativo bruto de recidiva bioquímica foi de 2,3 (95 por cento IC: 1,0-5,1) para os pacientes tratados com RT, em relação à BT; quando ajustado pelo PSAi e EG, o risco relativo de recidiva bioquímica foi de 2,4 (95 por cento IC: 1,0-5,7)...

OBJECTIVE: To compare the biochemical response in patients with locally advanced prostate cancer treated with external beam radiation therapy alone or in combination with conformal brachytherapy boost. MATERIALS AND METHODS: From November 1997 to January 2000, 74 patients received 45 Gy of pelvic external irradiation and four were treated with high dose rate iridium-192 conformal boost implants of 4 Gy each (BT). These were compared with 29 other patients treated with 45 Gy of pelvic external irradiation followed by a 24 Gy of bilateral ARC boost (RT) from October 1996 to February 2000. Some patients received neoadjuvant androgen deprivation therapy. Three-year actuarial biochemical control rates (BC3) and pretreatment biochemical response predictors such as prostate-specific antigen pretreatment (PSAi), Gleason score (GS) and clinical stage (CS), were evaluated. RESULTS: Median follow-up was of 25 months for the RT group and 37 months for the BT group. BC3 was 51% versus 73% (p = 0.032) for RT and BT, respectively. Comparisons of biochemical control by treatment group stratified by PSAi showed that BC3 for RT versus BT was 85.7% versus 79.1% (p = 0.76) for PSAi < 10 ng/mL and 38% versus 68% (p = 0.023) for PSAi > 10 ng/mL, respectively. For patients with GS < 6, BC3 was 37% versus 80% (p = 0.001) for RT versus BT and, for patients with GS > 6, BC3 was 78% versus 55% (p = 0.58) for RT versus BT, respectively. For patients with CS < T2a, BC3 was 36% versus 74% (p = 0.018) for RT versus BT and, for patients with CS > T2a, BC3 was 73% versus 69% (p = 0.692) for RT versus BT, respectively. The relative risk of biochemical relapse was 2.3 (95% IC: 1.0–5.1) for patients in RT group compared to the BT group. When adjusted for PSAi and GS, the relative risk of biochemical relapse was 2.4 (95% IC: 1.0–5.7)...

El papel del selenio y la vitamina E en la prevención y tratamiento del cáncer de próstata / The paper of the selenium and the vitamin E in the prevention and treatment of the prostate cancer

Un consumo de alimentos ricos en micronutrientes antioxidantes, complementado con una dosis diaria de selenio y vitamina E, junto con un diagnóstico precoz, parecieran ser factores muy importantes para lograr disminuir la incidencia y la mortalidad por cáncer de próstata en Costa Rica. El cáncer de próstata ocupa en Costa Rica el segundo lugar en incidencia del cáncer en hombres, después del estómago, reportándose en el año 1997 un total de 398 casos nuevos (1). Existe gran preocupación por el aumento en la mortalidad masculina por esta causa. En 1999 la tasa de mortalidad alcanzó un 13,53 por 100 mil habitantes, cifra más elevada a la que se reportó en 1996, de 12,81. Los factores de riesgo para cáncer de próstata son: edad (superior a los 45 años), la raza (más común fue raza negra), la herencia (representa una alerta para aquellos hombres cuyo padre padece o padeció de este mal, pues tienen más posibilidades de sufrirla), el estilo de vida (lo que implica una inadecuada alimentación, con dieta mal balanceada y poco variada, que incluya muy pocas frutas y vegetales, mucha carne y mucha grasa saturada), el fumado y el sobrepeso. Recientes estudios científicos basados en la suplementación con selenio y vitamina E a pacientes con cancer de próstata o factores de riesgo alto, han dado resultados positivos y prometedores para la prevención y cura de este tipo de cáncer. Aunque el selenio, pareciera ser un mineral milagroso, no se pueden consumir indiscriminadamente o sin recomendación médica, porque en grandes dosis, resulta tóxico.

Cuidados paliativos en cáncer avanzado. Experiencia de siete años en el hospital civil de Guadalajara, Jalisco, México, Dr. Juan I. Menchaca / Palliative care in advanced cancer. A 7-year experience at the Dr. Juan I.Menchaca Civil Hospital of Guadalajara, Jalisco, Mexico

We describe 7 years of experience in terminal cancer care provided by a multi-professional palliative care team. A total of 995 persons requested our services during this period. We included 649 patients for whom we had sufficient information for this study. Average age was 58 years; 60.2 patients were female, whereas 39.7 were male. Underlying disease was cervical cancer followed by breast cancer and prostate, etc. The most frequent symptom on admission was pain followed by weakness, loss of weight, anorexia, and emesis (nausea and vomiting). Average stay in the program of patients who died (406) was 67 days with a range of 1-707 days. We compare symptom incidence and model of care with other palliative care and hospice programs in the world. Cost-Benefit and future implementation of similar programs in Mexico is discussed.

Hallazgos citogenéticos en cáncer de próstata / Discoveries cytogenetic in prostate cancer

Los estudios citogenéticos han sido buenos instrumentos en la caracterización de múltiples tipos de cáncer especialmente en el monitoreo y diagnóstico de malignidades hernatológicas, sin embargo en el campo de los tumores sólidos, el campo de la citogenética no ha avanzado mucho, puesto que el cultivo de muchos tumores epiteliales continúa siendo bastante difícil y laborioso (Brothman, 1999). El cáncer de próstata se ha convertido en una de las malignidades más comunes en hombres mayores de 50 años. este cáncer causa obstrucción del tracto urinario y generalmente hace metástasis en pulmón y hueso. No parece que existan grandes diferencias étnicas en este tipo de tumor, tal vez si existe variaciones étnicas en factores endógenos tales como el metabolismo de andrógenos, así como existe la hipótesis de la existencia de una susceptibilidad heredada en este tipo de neoplasia. Siendo la próstata no visible o fácilmente asequible a un propio examen, hace difícil el que detectada a tiempo la presencia de un tumor de próstata. Además, obstáculos como ineficientes modelos de cultivo celular para cáncer de próstata, un crecimiento bastante lento de estos tumores in vitro, bajo índice mitótico, etc., han retrasado los estudios de citogenética convencional en esta tumorogenésis. No obstante, existen estudios citogenéticos que reportan cambios citogenéticos en tumores primarios de próstata, y el modelo de los cambios cromosómicos que surgen a lo largo de esta enfermedad está empezando a delinearse, así como la de ciertos genes involucrados en la etiología de la misma tales como aquellos que regulan el anormal crecimiento celular, muerte celular así como activación de protoencogenes (Brothman, 1999). Técnicas de citogenética molecular especialmente hibridación in situ con fluorescencia (FISH), hidridación comparativa de genomas (CGH), han sido referidos en varios reportes que señalan aberraciones específicas en esta neoplasia y parecen ser al igual que SKY (spectral karyotype imagining) herramientas poderosas en el análisis de cariotipos complejos en malignidades como esta...