Contribution of PSA density in predicting prostate cancer in patients with PSA values between 2,6 and 10,0 ng/ml

Objective: To study the profile of patients with PSA values between 2.6 and 10.0 ng/ml who underwent prostate biopsy at São Paulo Hospital, a university Hospital from the Federal University of São Paulo, determining possible patterns that might lead to a reduction of unnecessary biopsies. Methods: We performed a cross-sectional study with patients with PSA values between 2.6 and 10.0 ng/mL who were refered to the Interventional Radiology Service for prostate biopsies between 2007 and 2009. One thowsand two hundred and eighty two were included in this study. Results: Of the 1282 patients undergoing prostate biopsy, the prevalence of cancer was 28.6% (336 patients). Patients with positive biopsies were older, with values of PSA and PSA density higher than patients com negative biopsies. Neoplasia tends to be more common in the peripheral region of the gland compared to the transition zone. There was no difference between the tumor distribution and the Gleasson scale. Regarding PSA density (PSAD), patients with cancer had an average of 0.31 ng/ml/cc compared with 0.10 ng/ml / cc in patients with negative results (p<0,001). Recent data propose a PSAD cutoff value of 0.15 ng/ml/cc. Using this cutoff, we found a specificity of 74% and sensitivity of 70%. When we used a cutoff value of 0.09 ng/ml/cc, we obtained a sensitivity of 84% (95% CI: 80-87%) and specificity of 75% (95% CI: 72-78%) and area under the ROC curve of 0.794 .The likelihood ratio for the two cutoffs chosen. We find the criterion for 0.15 ng/ml/cc value for RV + and RV - = 2.72 = 0.41. As for the criterion 0.09 ng/ml/cc, we find a value of RV + and RV - = 3.36 = 0.21. Conclusion: In this study we showed that the systematic use of PSA density in patients with PSA values between 2.6 and 10.0 ng/mL patients can substantially reduce the amount of unnecessary procedures.Objetivo: Estudar o perfil dos pacientes com valores de PSA entre 2,6 e 10,0 ng/ml submetidos a biópsia prostática no Hospital São Paulo, determinando possíveis padrões que possam levar a uma diminuição de biópsias desnecessárias. Métodos: De 2007 a 2009, foi realizado um estudo transversal com indivíduos com valores de PSA entre 2,6 e 10,0 ng/ml submetidos a biópsias prostáticas. Foram estudados 1282 pacientes encaminhados ao Serviço de Ultrassonografia Intervencionista do Hospital São Paulo /Universidade Federal de São Paulo. Resultados: Dos 1282 pacientes submetidos à biópsia prostática, a prevalência de câncer foi de 28,6% (336 pacientes). Pacientes com biópsias positivas eram, em média, mais idosos, com valores de PSA e densidade de PSA mais altos e menor volume da próstata. Notamos uma distribuição preferencial da neoplasia pelas regiões periféricas da glândula em relação à zona de transição. Não houve diferenças significativas entre o local de manifestação da neoplasia e seu grau de malignidade. Na análise da PSAD, os pacientes com positividade para câncer prostático tiveram uma média de 0,31 ng/ml/cc, enquanto nos pacientes com resultado negativo, a média foi de 0,10 ng/ml/cc. Utilizando-se como critério de positividade para câncer o ponto de corte de PSAD sugerido pela literatura: 0,15 ng/ml/cc – a área sob a curva ROC, foi de 0,720. Para esse critério obtivemos uma especificidade de 74% e sensibilidade de 70%. Para aumentar a sensibilidade é preciso reduzir o ponto de corte. Com o valor 0,09 ng/ml/cc obtivemos uma sensibilidade de 84% (IC 95%: 80 – 87%) e especificidade de 75% (IC 95%: 72 – 78%) e área sob a curva ROC de 0,794. Calculamos também a razão de verossimilhança para os dois pontos de corte escolhidos. Encontramos para o critério 0,15 ng/ml/cc um valor para RV+ = 2,72 e RV-= 0,41. Já para o critério 0,09 ng/ml/cc, encontramos um valor de RV+=3,36 e RV-=0,21. Conclusão: No grupo de pacientes estudados, o uso sistemático da densidade de PSA na indicação de prosseguimento da investigação do paciente com biópsia, quando possível, reduziria substancialmente a quantidade de procedimentos desnecessários.TEDEBV UNIFESP: Teses e dissertaçõe

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others