Prostate Cancer and Spirituality: A Systematic Review.

The diagnosis, treatment, and sequels of cancer are relevant sources of stress, conflicts, and suffering, but spirituality may be a positive coping element. However, studies involving the correlation between prostate cancer patients and spirituality are few and heterogeneous. MEDLINE (PUBMED), SCOPUS, and EMBASE were the databases used for this review with the keywords "spirituality," "religion," and "prostate cancer." The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. About 250 articles were found, and 30 were eligible. Most studies (N = 26; 86.6%) reported the relationship between spirituality and better health findings such as 80% being positively associated with more screening for prostate cancer and better patients' quality of life. More interventional, randomized, and multicentric trials are needed to clarify this relationship.

Resultados peri-operatórios da nefrectomia parcial aberta, vídeolaparoscópica e robótica no tratamento do tumor renal em um centro de referência no tratamento do câncer / Perioperative outcomes in open, laparoscopic and robot-assisted partial nephrectomy for renal tumor treatment from a Cancer Center

Introdução: A nefrectomia parcial (NP) é considerada atualmente o padrão ouro no tratamento das pequenas massas renais (PMR) estádio clínico T1a. Poucos são os estudos disponíveis que comparam os resultados peri-operatórios das nefrectomias parciais aberta (NPA), vídeo-laparoscópica (NPVL) e robô-assistida (NPR) no tratamento das PMR. Objetivo: Avaliamos e comparamos os resultados peri-operatórios da NP realizada por três diferentes vias: NPA, NPVL e NPR no tratamento das PMR. Material e Método: Os dados peri-operatórios dos pacientes com tumor renal e submetidos à NP no período de maio de 2013 a maio de 2016 no Núcleo de Urologia do A.C.Camargo Cancer Center foram, retrospectivamente, coletados e avaliados. Os dados cirúrgicos foram comparados segundo a técnica cirúrgica empregada. Resultados: Trezentos e noventa NP foram revistas: 59 NPA, 251 NPVL e 80 NPR. Seguem resultados (média) comparativos entre NPA, NPVL e NPR, respectivamente: tamanho do tumor (3.73, 2.68 e 3.99cm), p=0.011; tempo de cirurgia (209, 189 e 159 min), p=0.012; tempo de isquemia (14.87, 15,83 e 9.98 min), p= 0.001; transfusão sanguínea (33.9, 29.1 e 40%), p=0.184; volume de transfusão sanguínea (3.3, 1.02 e 0.95 concentrado de hemácias), p= 0.018; taxa de conversão para cirurgia aberta (0, 4.8 e 1.25%), p=0.038; margem cirúrgica positiva (5.2, 6.5 e 2.5%), p=0.407; complicações precoces e tardias (13.56 e 10.17, 7.17 e 9.56 e 16.25% e 8.75%), p=0.038 e p=0.959; gravidade das complicações >III ­ Clavien-Dindo (0, 7.2 e 3.8%), p=0.003; Hb pré e pós operatório (13.63 e 11.44; 14.25 e 13.13 e 14.39 g/dl e 13.80 g/dl), p= 0.066 e p= 0.083; creatinina pré e pós-operatório (1.37 e 0.97, 1.02 e 1.04 e 0.95 mg/dl e 1.09 mg/dl), p=0.281 e p=0.198; dias de internação (9.29, 3.45 e 3.79 dias), p= 0.000. Conclusão: A escolha do tipo de abordagem cirúrgica no tratamento do tumor renal T1a-T2a afetou os resultados peri-operatórios dos pacientes: a NPR foi a técnica utilizada na abordagem dos tumores de maior tamanho, apresentou menores tempos de cirurgia e isquemia, em relação à NPA e NPVL, e apresentou menor taxa de conversão para cirurgia aberta, em relação à NPVL; a NPVL apresentou complicações de maior gravidade, segundo classificação de Clavien-Dindo, e menor taxa de complicações precoces em relação à NPA e NPR e a NPA apresentou maior necessidade de concentrado de hemácias nas transfusões sanguíneas realizadas e maior tempo de internação hospitalar em relação à NPVL e NPR

Introduction: Partial nephrectomy (PN) is the gold standard treatment for slow renal masses (SRM), clinical T1a renal tumors. Comparison of PN perioperative outcomes in the treatment of SRM are limited. Purpose: We evaluated and compared the A.C.Camargo Cancer Center surgical perioperative outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN) and robotic partial nephrectomy (RPN) in the treatment of SRM. Material and method: The data of patients undergoing PN at A.C.Camargo Cancer Center Urology Service were retrospectively collected and analyzed. Were compared the surgical outcomes as the three different approaches: OPN, LPN and RPN. Results: Three hundred and ninety procedures were reviewed: 59 OPN, 251 LPN and 80 RPN. The comparative results (median) as OPN, LPN and RPN were, respectively: tumor size (3.73, 2.68 and 3.99 cm), p=0.011; operative time (209, 189 and 159 min), p=0.012; ischemia time (14.87, 15,83 and 9.98 min), p= 0.001; blood transfusion (33.9, 29.1 and 40%), p=0.184; blood transfusion volume (3.3, 1.02 and 0.95 red cells concentrate unit), p= 0.018; conversion to open surgery (0, 4.8 and 1.25%), p=0.038; positive surgical margin (5.2, 6.5 and 2.5%), p=0.407; postoperative complications: early and late (13.56 and 10.17, 7.17 and 9.56 and 16.25% and 8.75%), p=0.038 and p=0.959; Clavien Grade complications ≥ III (0, 7.2 and 3.8%), p=0.003; Hemoglobin before and after surgery (13.63 and 11.44; 14.25 and 13.13 and 14.39 g/dl and 13.80 g/dl), p= 0.066 and p= 0.083; Creatinine before and after surgery ( 1.37 and 0.97, 1.02 and 1.04 and 0.95 mg/dl and 1.09 mg/dl), p=0.281 and p=0.198; hospital stay (9.29, 3.45 and 3.79 days), p= 0.000. Conclusion: The surgical approach for clinical T1a-T2a renal tumors treatments affected the perioperative outcomes: RPN was the approach used for bigger tumors, had shorter operative and ischemia times as compared to LPN and OPN; RPN had lower risk of conversion to open surgery as compared to LPN. Clavien Grade ≥ III and less early postoperative complications were found in the LPN group as compared to OPN and RPN. Longer hospital stay and more blood volume need in the transfusions were found in the OPN group

Sex with animals (SWA): behavioral characteristics and possible association with penile cancer. A multicenter study.

INTRODUCTION: Zoophilia has been known for a long time but, underreported in the medical literature, is likely a risk factor for human urological diseases. AIM: To investigate the behavioral characteristics of sex with animals (SWA) and its associations with penile cancer (PC) in a case-control study. METHODS: A questionnaire about personal and sexual habits was completed in interviews of 118 PC patients and 374 controls (healthy men) recruited between 2009 and 2010 from 16 urology and oncology centers. MAIN OUTCOME MEASURES: SWA rates, geographic distribution, duration, frequency, animals involved, and behavioral habits were investigated and used to estimate the odds of SWA as a PC risk factor. RESULTS: SWA was reported by 171 (34.8%) subjects, 44.9% of PC patients and 31.6% of controls (P < 0.008). The mean ages at first and last SWA episode were 13.5 years (standard deviation [SD] 4.4 years) and 17.1 years (SD 5.3 years), respectively. Subjects who reported SWA also reported more venereal diseases (P < 0.001) and sex with prostitutes (P < 0.001), and were more likely to have had more than 10 lifetime sexual partners (P < 0.001) than those who did not report SWA. SWA with a group of men was reported by 29.8% of subjects and SWA alone was reported by 70.2%. Several animals were used by 62% of subjects, and 38% always used the same animal. The frequency of SWA included single (14%), weekly or more (39.5%), and monthly episodes (15%). Univariate analysis identified phimosis, penile premalignancies, smoking, nonwhite race, sex with prostitutes, and SWA as PC risk factors. Phimosis, premalignant lesions, smoking, and SWA remained as risk factors in multivariate analysis. However, SWA did not impact the clinicopathological outcomes of PC. CONCLUSION: SWA is a risk factor for PC and may be associated with venereal diseases. New studies are required in other populations to test other possible nosological links with SWA.

Avaliação do comprometimento linfonodal através de análise Imuno-histoquímica e sua importância como fator prognóstico em pacientes com câncer invasivo de bexiga / Evaluation of lymph node involvement by immunohistochemical analysis and its importance as a prognostic factor in patients with invasive bladder cancer

Introdução: A progressão sistêmica é a principal forma de recorrência do câncer invasivo de bexiga (CB) após a cistectomia radical (CR). O diagnóstico de células tumorais ocultas em linfonodos (LN) normais histologicamente pode ter valor prognóstico. Os autores avaliaram a possibilidade do marcador AE1AE3, através de exame imuno-histoquímico, diagnosticar a presença de células tumorais ocultas em 832 LN de 61 pacientes com CB submetidos à CR e os impactos prognósticos na sobrevida câncer específica (SCE) em 5 anos. Casuísticas e métodos: Estudaram-se 61 pacientes admitidos no Departamento de Cirurgia Pélvica do Hospital do Câncer A.C. Camargo com CB, sem tratamento prévio e que foram submetidos à CR. A coleta de dados foi realizada nos prontuários, sendo registrados dados sociodemográficos, clínicos, histopatológicos e terapêuticos. Os cortes histológicos dos LN foram revistos e analisados por imuno-histoquímica (IHQ) com anticorpos AE1AE3 em corte histológico único.Resultados: Após avaliação imuno-histoquímica com o marcador AE1AE3 2/61 pacientes (3,27%) apresentaram micrometástase linfonodal. Não foi possível a avaliação de sobrevida câncer específica nos 2 pacientes diagnosticados com micrometástases uma vez que os dois morreram por complicacações da CR. Conclusão: Os autores concluíram que o uso do anticorpo monoclonal anticitoqueratina AE1AE3 em pacientes com câncer de bexiga estádios pN0 submetidos a CR evidenciou a presença de micrometáses em 3,27% da amostra analisada. Não foi possível avaliar o impacto da presença de micrometástase como fator prognóstico devido à sua baixa positividade na população estudada.

Introduction: Systemic progression is the main form of recurrence of muscle invasive bladder cancer (BC) after radical cystectomy (RC). The diagnosis of occult tumor cells in lymph nodes (LN) histologically normal may have prognostic value. The authors evaluated the ability of the marker AE1AE3 through immunohistochemical examination, diagnose the presence of occult tumor cells in 61LN of 832 patients with BC who underwent CR and its impacts prognosis in cancer specific survival (SCE) in 5 years. Material and Methods: We studied 61 patients with BC admitted to the Department of Pelvic Surgery of the Cancer Hospital AC Camargo, without prior treatment and who underwent RC. Data collection was performed on records, and recorded demographic data, clinical, histopathological and therapeutic. Histological sections of LN were reviewed and analyzed by immunohistochemistry (IHC) with AE1AE3 antibody single histological sections. Results: After immunohistochemical analysis with the marker AE1AE3 2/61 patients (3.27%) had lymph node micrometastases. Conclusions: The authors concluded that the use of monoclonal cytokeratin AE1AE3 in patients with bladder cancer stage pN0 undergoing radical cystectomy revealed the presence of micrometastasis in 3,27% of the sample analised. It was not possible to assess the impact of the presence of micrometastases as a prognostic factor because of its low positivity in this population.

Carcinoma of the renal pelvis and ureter

OBJECTIVE: To assess the occurrence of upper urinary tract urothelial tumors (UUTT) in Brazil. MATERIALS AND METHODS: We performed a clinical and histopathologic study of 33 patients who were diagnosed with a malignant neoplasm in the renal pelvis or ureter in the period of 1994 to 2004, in a single institution. RESULTS: Among the patients with upper urinary tract carcinoma, 70 percent were males and 30 percent females, with mean age of 65 ± 16 years (ranging from 31 to 91 years). Nineteen patients presented renal pelvis tumor (58 percent), 9 ureteral tumor (27 percent) and 5 synchronic pelvic and ureteral tumors (15 percent). Renal pelvis tumors represented 2.8 percent of all the urothelial neoplasms, and 11.4 percent of all renal neoplasms treated in the same period. Ureteral tumors represented 1.6 percent of all the urothelial malignancies surgically managed in these 11 years. Tobacco smoking was the most common risk factor, and analgesic abuse was not reported by those patients. Most carcinomas were high-grade and muscle-invasive. Mean time to diagnosis was 7 months, being hematuria the most common symptom. CONCLUSIONS: A high association was also found between UUTT and bladder urothelial carcinoma. UUTT were mostly seen in men in their seventies and related to a high overall and cancer-related mortality rate. The overall disease-specific survival was 40 percent, much lower than found in most of the reported series.

Carcinoma of the renal pelvis and ureter.

OBJECTIVE: To assess the occurrence of upper urinary tract urothelial tumors (UUTT) in Brazil. MATERIALS AND METHODS: We performed a clinical and histopathologic study of 33 patients who were diagnosed with a malignant neoplasm in the renal pelvis or ureter in the period of 1994 to 2004, in a single institution. RESULTS: Among the patients with upper urinary tract carcinoma, 70% were males and 30% females, with mean age of 65 +/- 16 years (ranging from 31 to 91 years). Nineteen patients presented renal pelvis tumor (58%), 9 ureteral tumor (27%) and 5 synchronic pelvic and ureteral tumors (15%). Renal pelvis tumors represented 2.8% of all the urothelial neoplasms, and 11.4% of all renal neoplasms treated in the same period. Ureteral tumors represented 1.6% of all the urothelial malignancies surgically managed in these 11 years. Tobacco smoking was the most common risk factor, and analgesic abuse was not reported by those patients. Most carcinomas were high-grade and muscle-invasive. Mean time to diagnosis was 7 months, being hematuria the most common symptom. CONCLUSIONS: A high association was also found between UUTT and bladder urothelial carcinoma. UUTT were mostly seen in men in their seventies and related to a high overall and cancer-related mortality rate. The overall disease-specific survival was 40%, much lower than found in most of the reported series.