Heterogeneous methodology of racial/ethnic classification may be responsible for the different risk assessments for prostate cancer between Black and White men in Brazil.

OBJECTIVES: To evaluate if the different results of prostate cancer risk between black and white Brazilian men may be associated with the varying methodology used to define participants as either Blacks or Whites. PATIENTS AND METHODS: We evaluated median PSA values, rate of PSA level ≥ 4.0 ng/ mL, indications for prostate biopsy, prostate cancer detection rate, biopsy/cancer rate, cancer/biopsy rate, and the relative risk of cancer between blacks versus whites, blacks versus non-blacks (browns and whites), non-whites (browns and blacks) versus whites, African versus non-African descendants, and African descendants or blacks versus non-African descendants and non-blacks. RESULTS: From 1544 participants, there were 51.4% whites, 37.2% browns, 11.4% blacks, and 5.4% African descendants. Median PSA level was 0.9 ng/mL in whites, browns, and non-African descendants, compared to 1.2 ng/mL in blacks, and African descendants or blacks, and 1.3 ng/mL in African descendants. Indications for prostate biopsy were present in 16.9% for African descendants, 15.9% of black, 12.3% of white, 11.4% for non-African descendants, and 9.9% of brown participants. Prostate cancer was diagnosed in 30.3% of performed biopsies: 6.2% of African descendants, 5.1% of blacks, 3.3% of whites, 3.0% of non-African descendants, and 2.6% of browns. CONCLUSIONS: Median PSA values were higher for Blacks versus Whites in all classification systems, except for non-white versus white men. The rate of prostate biopsy, prostate cancer detection rate, and relative risk for cancer was increased in African descendants, and African descendants or blacks, compared to non-African descendants, and non-African descendants and non-blacks, respectively.

Heterogeneous methodology of racial/ethnic classification may be responsible for the different risk assessments for prostate cancer between Black and White men in Brazil

Objectives To evaluate if the different results of prostate cancer risk between black and white Brazilian men may be associated with the varying methodology used to define participants as either Blacks or Whites. Patients and Methods We evaluated median PSA values, rate of PSA level ≥4.0 ng/mL, indications for prostate biopsy, prostate cancer detection rate, biopsy/cancer rate, cancer/biopsy rate, and the relative risk of cancer between blacks versus whites, blacks versus non-blacks (browns and whites), non-whites (browns and blacks) versus whites, African versus non-African descendants, and African descendants or blacks versus non-African descendants and non-blacks. Results From 1544 participants, there were 51.4% whites, 37.2% browns, 11.4% blacks, and 5.4% African descendants. Median PSA level was 0.9 ng/mL in whites, browns, and non-African descendants, compared to 1.2 ng/mL in blacks, and African descendants or blacks, and 1.3 ng/mL in African descendants. Indications for prostate biopsy were present in 16.9% for African descendants, 15.9% of black, 12.3% of white, 11.4% for non-African descendants, and 9.9% of brown participants. Prostate cancer was diagnosed in 30.3% of performed biopsies: 6.2% of African descendants, 5.1% of blacks, 3.3% of whites, 3.0% of non-African descendants, and 2.6% of browns. Conclusions Median PSA values were higher for Blacks versus Whites in all classification systems, except for non-white versus white men. The rate of prostate biopsy, prostate cancer detection rate, and relative risk for cancer was increased in African descendants, and African descendants or blacks, compared to non-African descendants, and non-African descendants and non-blacks, respectively. .

Prevalence and risk factors for penile lesions/anomalies in a cohort of Brazilian men ≥ 40 years of age.

PURPOSE: To report the prevalence and risk factors of penile lesions/anomalies in a Metropolitan Brazilian city. MATERIALS AND METHODS: All participants undergoing prostate cancer screening in the city of Curitiba were systematically examined to identify penile lesions including cutaneous mycosis, sexually transmitted diseases, penile cancer, meatal stenosis, hypospadias, and Peyronie's disease. Outcomes of interest included the prevalence and the relative risk and 95% confidence intervals of the lesions/anomalies according to age, school level, race, personal history of diabetes, arterial hypertension, nonspecific urethritis, and vasectomy. RESULTS: Balanoposthitis occurred in 11.8% of all participants, with an increased risk in those with diabetes (RR = 1.73), or past history of nonspecific urethritis (RR = 1.58); tinea of the penis was present in 0.2% ; condyloma acuminata in 0.5% ; herpes virus infection in 0.4% ; urethral discharge in 0.2% ; genital vitiligo in 0.7%, with an increased prevalence in non-white men (RR = 4.43), and in subjects with lower school level (RR = 7.24); phimosis in 0.5%, with a nearly 7-fold increased risk in diabetics; lichen sclerosus in 0.3%; stenosis of the external urethral meatus in 0.7%, with a higher prevalence in subjects with lichen sclerosus (RR = 214.9), and in those older than 60 years of age (RR = 3.57); hypospadia in 0.6%; fibrosis suggestive of Peyronie's disease in 0.9%, especially in men older than 60 years (RR = 4.59) and with diabetes (RR = 3.91); and penile cancer in 0.06%. CONCLUSION: We estimated the prevalence and risk factors of commonly seen penile diseases in an adult cohort of Brazilian men.

Prevalence and risk factors for penile lesions/anomalies in a cohort of Brazilian men ≥ 40 years of age

Purpose To report the prevalence and risk factors of penile lesions/anomalies in a Metropolitan Brazilian city. Materials and Methods All participants undergoing prostate cancer screening in the city of Curitiba were systematically examined to identify penile lesions including cutaneous mycosis, sexually transmitted diseases, penile cancer, meatal stenosis, hypospadias, and Peyronie's disease. Outcomes of interest included the prevalence and the relative risk and 95% confidence intervals of the lesions/anomalies according to age, school level, race, personal history of diabetes, arterial hypertension, nonspecific urethritis, and vasectomy. Results Balanoposthitis occurred in 11.8% of all participants, with an increased risk in those with diabetes (RR = 1.73), or past history of nonspecific urethritis (RR = 1.58); tinea of the penis was present in 0.2%; condyloma acuminata in 0.5%; herpes virus infection in 0.4%; urethral discharge in 0.2%; genital vitiligo in 0.7%, with an increased prevalence in non-white men (RR = 4.43), and in subjects with lower school level (RR = 7.24); phimosis in 0.5%, with a nearly 7-fold increased risk in diabetics; lichen sclerosus in 0.3%; stenosis of the external urethral meatus in 0.7%, with a higher prevalence in subjects with lichen sclerosus (RR = 214.9), and in those older than 60 years of age (RR = 3.57); hypospadia in 0.6%; fibrosis suggestive of Peyronie's disease in 0.9%, especially in men older than 60 years (RR = 4.59) and with diabetes (RR = 3.91); and penile cancer in 0.06%. Conclusion We estimated the prevalence and risk factors of commonly seen penile diseases in an adult cohort of Brazilian men. .

The significance of biological, environmental, and social risk factors for prostate cancer in a cohort study in Brazil

To evaluate the significance of several risk factors for prostate cancer in a cohort of Brazilian men.

Subjects and methods: Men ≥ 40 years-old participating in a prostate cancer screening program between December 2006 and April 2011 in the city of Curitiba, Brazil, were evaluated to determine the prevalence, relative risk (RR) and 95% CI of prostate cancer according to age, race, ethnicity, family history of prostate cancer, educational level, and history of vasectomy, increased blood pressure, diabetes mellitus, and urethritis.

In 2121 men included in this study, prostate cancer prevalence was 0.6% for men between 40-49 years versus 2.0% (adjusted RR = 2.58), 7.7% (adjusted RR = 5.76), and 8.4% (adjusted RR = 4.88) for men 50-59 years, 60-69 years, and ≥ 70 years, respectively (p < 0.05 to all). The prevalence of cancer was 5.1% in blacks versus 3.3% in whites (adjusted RR = 1.56, p > 0.05); 6.1% in African descendants, in comparison to 3.0% in non-African descendants (adjusted RR = 3.17, p < 0.05); 5.1% in men with a positive family history, compared to 2.5% in those with no family history (adjusted RR = 1.55, p > 0.05); and 4.8% in participants with incomplete elementary school level or lower, compared to 2.2% in men with complete elementary school level or higher education (adjusted RR = 1.85, p > 0.05). Men with/without history of vasectomy, increased blood pressure, diabetes, and urethritis had a prostate cancer prevalence of 0.8%/3.0% (adjusted RR = 0.23, p > 0.05), 3.8%/2.2% (adjusted RR = 1.16, p > 0.05), 3.7%/2.6% (adjusted RR = 1.39, p > 0.05), and 2.6%/2.6% (adjusted RR = 0.99, p > 0.05), respectively.

Risk factors associated with an increased prevalence of prostate cancer in this cohort ...

The prevalence of prostate cancer in Brazil is higher in Black men than in White men: systematic review and meta-analysis.

BACKGROUND: Black men have a higher incidence of prostate cancer compared with White men in several countries. In Brazil, most studies reported a similar prevalence of prostate cancer between Blacks and Whites as a result of the high race mixture of the population. OBJECTIVE: To perform a systematic review with meta-analysis of the prevalence of prostate cancer in Black versus White, Brown versus White, and Black versus Brown Brazilian men. DESIGN, SETTING, AND PARTICIPANTS: This systematic review included cohort, cross sectional and case-control studies comparing the prevalence of prostate cancer between races in Brazil. It was performed using an electronic search of references in bibliographic databases, and dissertations and theses databases from several Brazilian hospitals, universities, and schools of medicine. Meta-analysis was conducted using the RevMan software from the Cochrane Collaboration. To control for potential confounding variables, sensitivity analyses excluding case-control and cross sectional studies were performed. MEASUREMENTS: The outcomes of interest included the number of participants, prevalence of prostate cancer, and odds ratio of cancer between Black and White men, Brown and White men, and Black and Brown men. RESULTS AND LIMITATIONS: Twelve studies approaching the prevalence of prostate cancer in Black or Brown vs. White men in Brazil were identified, totalizing 41388 participants. The prevalence of prostate cancer was 9.6% in Black vs. 5.6% in White men (OR 1.58), 10.1% in Black vs. 6.7% in Brown men (OR 1.43), and 6.7% in Brown vs. 6.6% in White men (OR 1.14). Limitations of this review reflect the complexity and ambiguity in the definition of who is Black and who is not in such an heterogeneous population like the Brazilian people. CONCLUSIONS: This systematic review with meta-analysis demonstrates a higher prevalence of prostate cancer in Black men compared to White or Brown Brazilian men. The prevalence of prostate cancer is similar in Brown versus White men.

The prevalence of prostate cancer in Brazil is higher in Black men than in White men: systematic review and meta-analysis

BACKGROUND: Black men have a higher incidence of prostate cancer compared with White men in several countries. In Brazil, most studies reported a similar prevalence of prostate cancer between Blacks and Whites as a result of the high race mixture of the population. OBJECTIVE: To perform a systematic review with meta-analysis of the prevalence of prostate cancer in Black versus White, Brown versus White, and Black versus Brown Brazilian men. DESIGN, SETTING, AND PARTICIPANTS: This systematic review included cohort, cross sectional and case-control studies comparing the prevalence of prostate cancer between races in Brazil. It was performed using an electronic search of references in bibliographic databases, and dissertations and theses databases from several Brazilian hospitals, universities, and schools of medicine. Meta-analysis was conducted using the RevMan software from the Cochrane Collaboration. To control for potential confounding variables, sensitivity analyses excluding case-control and cross sectional studies were performed. MEASUREMENTS: The outcomes of interest included the number of participants, prevalence of prostate cancer, and odds ratio of cancer between Black and White men, Brown and White men, and Black and Brown men. Results and Limitations: Twelve studies approaching the prevalence of prostate cancer in Black or Brown vs. White men in Brazil were identified, totalizing 41388 participants. The prevalence of prostate cancer was 9.6% in Black vs. 5.6% in White men (OR 1.58), 10.1% in Black vs. 6.7% in Brown men (OR 1.43), and 6.7% in Brown vs. 6.6% in White men (OR 1.14). Limitations of this review reflect the complexity and ambiguity in the definition of who is Black and who is not in such an heterogeneous population like the Brazilian people. CONCLUSIONS: This systematic review with meta-analysis demonstrates a higher prevalence of prostate cancer in Black men compared to White or Brown Brazilian men. The prevalence of prostate cancer is similar in Brown versus White men.

The significance of biological, environmental, and social risk factors for prostate cancer in a cohort study in Brazil.

PURPOSE: To evaluate the significance of several risk factors for prostate cancer in a cohort of Brazilian men. SUBJECTS AND METHODS: Men ≥ 40 years-old participating in a prostate cancer screening program between December 2006 and April 2011 in the city of Curitiba, Brazil, were evaluated to determine the prevalence, relative risk (RR) and 95 % CI of prostate cancer according to age, race, ethnicity, family history of prostate cancer, educational level, and history of vasectomy, increased blood pressure, diabetes mellitus, and urethritis. RESULTS: In 2121 men included in this study, prostate cancer prevalence was 0.6 % for men between 40-49 years versus 2.0 % (adjusted RR = 2.58), 7.7 % (adjusted RR = 5.76), and 8.4 % (adjusted RR = 4.88) for men 50-59 years, 60-69 years, and ≥ 70 years, respectively (p < 0.05 to all). The prevalence of cancer was 5.1% in blacks versus 3.3 % in whites (adjusted RR = 1.56, p > 0.05); 6.1 % in African descendants, in comparison to 3.0 % in non-African descendants (adjusted RR = 3.17, p < 0.05); 5.1% in men with a positive family history, compared to 2.5 % in those with no family history (adjusted RR = 1.55, p > 0.05); and 4.8 % in participants with incomplete elementary school level or lower, compared to 2.2 % in men with complete elementary school level or higher education (adjusted RR = 1.85, p > 0.05). Men with/without history of vasectomy, increased blood pressure, diabetes, and urethritis had a prostate cancer prevalence of 0.8 %/3.0 % (adjusted RR = 0.23, p > 0.05), 3.8 %/2.2 % (adjusted RR = 1.16, p > 0.05), 3.7 %/2.6 % (adjusted RR = 1.39, p > 0.05), and 2.6 %/2.6 % (adjusted RR = 0.99, p > 0.05), respectively. CONCLUSIONS: Risk factors associated with an increased prevalence of prostate cancer in this cohort included increasing age and African ethnicity.

Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results.

PURPOSE: To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly. MATERIALS AND METHODS: Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening. RESULTS: The preferred position was modified lithotomy position reported by 63.4% of Urologists, and left lateral position reported by 42.7% of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions. CONCLUSIONS: Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.

Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results

PURPOSE: To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly. MATERIALS AND METHODS: Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening. RESULTS: The preferred position was modified lithotomy position reported by 63.4 percent of Urologists, and left lateral position reported by 42.7 percent of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions. CONCLUSIONS: Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.

[Combined risk factors leading to well-leg compartment syndrome after laparoscopic radical prostatectomy]. / Factores de riesgo combinados para síndrome compartimental de la pierna después de una prostatectomía radical laparoscópica.

Well leg compartment syndrome is rare after laparoscopic radical prostatectomy. We report a 68-year-old man that developed compartment syndrome after laparoscopic radical prostatectomy for prostate cancer. There are several circumstantial risk factors associated with LRP that, when combined, may potentially predispose to the development of compartment syndrome, including: obesity, evidence of peripheral vascular disease (advanced age, hypertension, hyperlipidemia, and diabetes mellitus), thromboembolism prophylaxis with compressive leg wraps together with intermittent pneumatic devices, combined general-spinal anesthesia, prolonged operative time in Trendelenburg position, and systemic hypotension due to intraoperative bleeding. The pathogenesis of this serious complication is discussed and preventive measures are highlighted.

Factores de riesgo combinados para síndrome compartimental de la pierna después de una prostatectomía radical laparoscópica / Combined risk factors leading to well-leg compartment syndrome after laparoscopic radical prostatectomy

El síndrome compartimental de la pierna es una complicación rara después de la prostatectomía radical laparoscópica. Varios factores de riesgo circunstanciales combinados entre sí pueden predisponer al síndrome compartimental, entre ellos la obesidad, criterios de enfermedad vascular periférica (edad avanzada, hipertensión, hiperlipemia y diabetes mellitus), la profilaxis de la tromboembolia venosa con compresión mecánica junto con compresión neumática intermitente, la anestesia general-espinal combinada, un tiempo operatorio prolongado en posición de Trendelenburg y la hipotensión sistémica por sangrado intraoperatorio. Se expone el caso de un varón de 68 años de edad que sufrió síndrome compartimental de la pierna después de una prostatectomía radical laparoscópica por cáncer de próstata, se trata de la patogenia de esta complicación grave y se destacan las medidas preventivas (AU)

Well leg compartment syndrome is rare after laparoscopic radical prostatectomy. We report a 68-year-old man that developed compartment syndrome after laparoscopic radical prostatectomy for prostate cancer. There are several circumstantial risk factors associated with LRP that, when combined, may potentially predispose to the development of compartment syndrome, including: obesity, evidence of peripheral vascular disease (advanced age, hypertension, hyperlipidemia, and diabetes mellitus), thromboembolism prophylaxis with compressive leg wraps together with intermittent pneumatic devices, combined general-spinal anesthesia, prolonged operative time in Trendelenburg position, and systemic hypotension due to intraoperative bleeding. The pathogenesis of this serious complication is discussed and preventive measures are highlighted (AU)

Paratesticular sarcomas in Brazil.

PURPOSE: Paratesticular sarcomas are rare and frequently reported as isolated case reports. Studies evaluating the relative frequency of the paratesticular sarcomas are limited, and to the best of our knowledge, this is the first study of paratesticular sarcomas in the Brazilian population. PATIENTS AND METHODS: Medical records of all patients undergoing treatment for paratesticular sarcomas between 1993 and 2006 were retrieved from the archives of our institution. RESULTS: Complete data from 12 patients (39 +/- 23 years, range 13-78) with paratesticular sarcomas were available, which represented 6.7% of all orchiectomies performed for testicular malignancies in the same period. At the time of diagnosis, 3 patients had retroperitoneal spread of the disease, all of which had elevated serum lactic dehydrogenase levels. The remaining 9 patients had normal serum markers. There were 6 rhabdomyosarcomas, 4 leiomyosarcomas, 1 liposarcoma and 1 undifferentiated sarcoma. Median follow-up was 31.4 months. Primary surgical excision by inguinal approach was performed in all cases (radical orchiectomy in 10 and preservation of the testis in 2). Retroperitoneal lymph node dissection was performed in 3 patients and excision of the hemiscrotum in 1. Eight patients received adjuvant chemotherapy. Mean overall survival time was 27.8 +/- 6.2 months after orchiectomy. CONCLUSION: Patients with paratesticular sarcomas are at high risk of disease progression, and systemic relapse remains a significant problem, determining poor prognosis. The high risk of local recurrence demands long-term follow-up, and intraoperative frozen section analysis might be of benefit. Elevated lactic dehydrogenase might also be a marker of retroperitoneal disease and poor prognosis. Improvement in survival requires effective systemic adjuvant therapy.

Renal subcapular saline injection during percutanoues renal cryoablation to prevent bowel injury.

INTRODUCTION: To evaluate the feasibility of percutaneous injection of saline in the renal subcapsular space to prevent bowel injury and histopathologic effects of bowel cryolesion during renal cryoablation in a porcine model. MATERIAL AND METHOD: Six pigs underwent percutaneous renal cryoablation with two freeze cycles in the lower pole of both kidneys. Six kidneys were injected with 10 ml saline into the renal subcapular space before cryoablation. The bowel was brought into contact with the edge of the ice ball with laparoscopic assistance during renal cryoablation, on the side with saline injection as well as on the control side. One of these animals was kept for survival follow-up and laparotomy for 7 days post cryoablation. The bowel cryolesion sites were observed and compared based on the presence or absence of renal subcapsular saline injection. RESULTS: The mean diameter of acute bowel injury with and without saline renal subcapsular injection was 7.25 +/- 1.26 and 14.5 +/- 0.58 mm, respectively. The influence of injecting a saline buffer was a significant decrease in the bowel cryolesion compared to controls (p = 0.0003). In addition, a pig kept for follow-up confirmed no bowel perforation after 7 days at a site that was cryolesioned on the side with renal subcapsular saline injection, but sustained bowel perforation in another segment lesioned by contact with a kidney without a saline injection. Gross and microscopic pathological examination was consistent with these interpretations. CONCLUSION: Preliminary results in a porcine model show that percutaneous renal subcapsular saline injection is a feasible and promising technique for preventing bowel complications of percutaneous image-guided renal cryoablation.