Higher Prostate Weight Is Inversely Associated With Gleason Score Upgrading In Radical Prostatectomy Specimens

Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1 g of prostate weight increment, while it increased by 10.2% for every 1 ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage (P = 0.019), higher tumor extent (P = 0.009), extraprostatic extension (P = 0.04), positive surgical margins (P < 0.001), seminal vesicle invasion (P = 0.003), less "insignificant" tumors (P < 0.001), and also worse DFS, χ 2 = 4.28, df = 1, P = 0.039. However, when setting the final Gleason score (BGS ≤ 6 to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, χ 2 = 0.40, df = 1, P = 0.530. Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation. © 2013 Leonardo Oliveira Reis et al.Pinthus, J.H., Witkos, M., Fleshner, N.E., Sweet, J., Evans, A., Jewett, M.A., Krahn, M., Trachtenberg, J., Prostate Cancers Scored as Gleason 6 on Prostate Biopsy are Frequently Gleason 7 Tumors at Radical Prostatectomy: Implication on Outcome (2006) Journal of Urology, 176 (3), pp. 979-984. , DOI 10.1016/j.juro.2006.04.102, PII S0022534706011645King, C.R., McNeal, J.E., Gill, H., Presti Jr., J.C., Extended prostate biopsy scheme improves reliability of Gleason grading: Implications for radiotherapy patients (2004) International Journal of Radiation Oncology Biology Physics, 59 (2), pp. 386-391. , DOI 10.1016/j.ijrobp.2003.10.014, PII S0360301603021187Chun, F.K., Steuber, T., Erbersdobler, A., Currlin, E., Walz, J., Schlomm, T., Haese, A., Karakiewicz, P.I., Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology (2006) European Urology, 49 (5), pp. 820-826. , 2-s2.0-33645760008 10.1016/j.eururo.2005.11.007Gonzalgo, M.L., Bastian, P.J., Mangold, L.A., Trock, B.J., Epstein, J.I., Walsh, P.C., Partin, A.W., Relationship between primary Gleason pattern on needle biopsy and clinicopathologic outcomes among men with Gleason score 7 adenocarcinoma of the prostate (2006) Urology, 67 (1), pp. 115-119. , DOI 10.1016/j.urology.2005.07.037, PII S0090429505011337Kvåle, R., Møller, B., Wahlqvist, R., Fosså, S.D., Berner, A., Busch, C., Kyrdalen, A.E., Halvorsen, O.J., Concordance between Gleason scores of needle biopsies and radical prostatectomy specimens: A population-based study (2009) BJU International, 103 (12), pp. 1647-1654. , 2-s2.0-67149126604 10.1111/j.1464-410X.2008.08255.xBillis, A., Magna, L.A., Ferreira, U., Correlation between tumor extent in radical prostatectomies and preoperative PSA, histological grade, surgical margins, and extraprostatic extension: Application of a new practical method for tumor extent evaluation (2003) International Braz J Urol, 29 (2), pp. 113-120Epstein, J.I., Allsbrook Jr., W.C., Amin, M.B., Egevad, L.L., Bastacky, S., Lopez Beltran, A., Berner, A., Young, R.H., The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma (2005) American Journal of Surgical Pathology, 29 (9), pp. 1228-1242. , DOI 10.1097/01.pas.0000173646.99337.b1Cookson, M.S., Aus, G., Burnett, A.L., Canby-Hagino, E.D., D'Amico, A.V., Dmochowski, R.R., Eton, D.T., Thompson, I., Variation in the Definition of Biochemical Recurrence in Patients Treated for Localized Prostate Cancer: The American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel Report and Recommendations for a Standard in the Reporting of Surgical Outcomes (2007) Journal of Urology, 177 (2), pp. 540-545. , DOI 10.1016/j.juro.2006.10.097, PII S0022534706028576Colleselli, D., Pelzer, A.E., Steiner, E., Ongarello, S., Schaefer, G., Bartsch, G., Schwentner, C., Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range (2010) Prostate Cancer and Prostatic Diseases, 13 (2), pp. 182-185. , 2-s2.0-77952543434 10.1038/pcan.2009.54Montironi, R., Mazzucchelli, R., Scarpelli, M., Lopez-Beltran, A., Mikuz, G., Algaba, F., Boccon-Gibod, L., Prostate carcinoma II: Prognostic factors in prostate needle biopsies (2006) BJU International, 97 (3), pp. 492-497. , 2-s2.0-33645000123 10.1111/j.1464-410X.2006.05973.xFitzsimons, N.J., Presti Jr., J.C., Kane, C.J., Terris, M.K., Aronson, W.J., Amling, C.L., Freedland, S.J., Is Biopsy Gleason Score Independently Associated With Biochemical Progression Following Radical Prostatectomy After Adjusting for Pathological Gleason Score? (2006) Journal of Urology, 176 (6), pp. 2453-2458. , DOI 10.1016/j.juro.2006.08.014, PII S0022534706019665Müntener, M., Epstein, J.I., Hernandez, D.J., Gonzalgo, M.L., Mangold, L., Humphreys, E., Walsh, P.C., Nielsen, M.E., Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy (2008) European Urology, 53 (4), pp. 767-776. , 2-s2.0-39549100371 10.1016/j.eururo.2007.11.016Serkin, F.B., Soderdahl, D.W., Cullen, J., Chen, Y., Hernandez, J., Patient risk stratification using Gleason score concordance and upgrading among men with prostate biopsy Gleason score 6 or 7 (2010) Urologic Oncology, 28 (3), pp. 302-307. , 2-s2.0-77951607370 10.1016/j.urolonc.2008.09.030Freedland, S.J., Kane, C.J., Amling, C.L., Aronson, W.J., Terris, M.K., Presti Jr., J.C., Upgrading and Downgrading of Prostate Needle Biopsy Specimens: Risk Factors and Clinical Implications (2007) Urology, 69 (3), pp. 495-499. , DOI 10.1016/j.urology.2006.10.036, PII S0090429506024502Sved, P.D., Gomez, P., Manoharan, M., Kim, S.S., Soloway, M.S., Limitations of biopsy Gleason grade: Implications for counseling patients with biopsy Gleason score 6 prostate cancer (2004) Journal of Urology, 172 (1), pp. 98-102. , DOI 10.1097/01.ju.0000132135.18093.d6Ozden, C., Oztekin, C.V., Ugurlu, O., Gokkaya, S., Yaris, M., Memis, A., Correlation between upgrading of prostate biopsy and biochemical failure and unfavorable pathology after radical prostatectomy (2009) Urologia Internationalis, 83 (2), pp. 146-150. , 2-s2.0-70349276002 10.1159/000230014Hong, S.K., Han, B.K., Lee, S.T., Kim, S.S., Min, K.E., Jeong, S.J., Jeong, H., Lee, S.E., Prediction of Gleason score upgrading in low-risk prostate cancers diagnosed via multi (≥12)-core prostate biopsy (2009) World Journal of Urology, 27 (2), pp. 271-276. , 2-s2.0-63649106008 10.1007/s00345-008-0343-3Dong, F., Jones, J.S., Stephenson, A.J., Magi-Galluzzi, C., Reuther, A.M., Klein, E.A., Prostate cancer volume at biopsy predicts clinically significant upgrading (2008) Journal of Urology, 179 (3), pp. 896-900. , 2-s2.0-39149109597 10.1016/j.juro.2007.10.060Liu, J.J., Brooks, J.D., Ferrari, M., Nolley, R., Presti Jr., J.C., Small prostate size and high grade disease-biology or artifact? (2011) Journal of Urology, 185 (6), pp. 2108-2111. , 2-s2.0-79955796559 10.1016/j.juro.2011.02.053Ngo, T.C., Conti, S.L., Shinghal, R., Presti Jr., J.C., Prostate size does not predict high grade cancer (2012) Journal of Urology, 187 (2), pp. 477-480. , 2-s2.0-84855603087 10.1016/j.juro.2011.10.042Rahmouni, A., Yang, A., Tempany, C.M., Frenkel, T., Epstein, J., Walsh, P., Leichner, P.K., Zerhouni, E., Accuracy of in-vivo assessment of prostatic volume by MRI and transrectal ultrasonography (1992) Journal of Computer Assisted Tomography, 16 (6), pp. 935-940. , 2-s2.0-0026481087Varma, M., Morgan, J.M., The weight of the prostate gland is an excellent surrogate for gland volume (2010) Histopathology, 57 (1), pp. 55-58. , 2-s2.0-77954546284 10.1111/j.1365-2559.2010.03591.

Antibiotic Prophylaxis For Transrectal Prostate Biopsy.

Transrectal prostate biopsy (TRPB) is a well established procedure used to obtain tissue for the histological diagnosis of carcinoma of the prostate. Despite the fact that TRPB is generally considered a safe procedure, it may be accompanied by traumatic and infective complications, including asymptomatic bacteriuria (bacteria in the urine), urinary tract infection (UTI), transitory bacteremia (bacteria in the blood), fever episodes, and sepsis (pathogenic microorganisms or their toxins in the blood). Although infective complications after TRPB are well known, there is uncertainty about the necessity and effectiveness of routine prophylactic antibiotics and their adverse effects, as well as a clear lack of standardization. To evaluate the effectiveness and adverse effects of prophylactic antibiotic treatment in TRPB. The search covered the principal electronic databases: MEDLINE, EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL). Experts were consulted and references from the relevant articles were scanned. All randomized, controlled trials (RCTs) of men who underwent TRPB and received prophylactic antibiotics or placebo/no treatment, were selected, and all RCTs looking at one type of antibiotic versus another, including comparable dosages, routes of administration, frequency of administration, and duration of antibiotic treatment. Two reviewers (ELZ, OACC) independently selected included trials and extracted study data. Any disagreements were resolved by a third party (NRNJ). Overall, more than 3500 references were considered and 19 original reports with a total of 3599 patients were included.There were 9 trials analysing antibiotics versus placebo/no treatment, with all outcomes significantly favouring antibiotic use (P < 0.05) (I(2) = 0%), including bacteriuria (risk ratio (RR) 0.25 (95% confidence interval (CI) 0.15 to 0.42), bacteremia (RR 0.67, 95% CI 0.49 to 0.92), fever (RR 0.39, 95% CI 0.23 to 0.64), urinary tract infection (RR 0.37, 95% CI 0.22 to 0.62), and hospitalization (RR 0.13, 95% CI 0.03 to 0.55). Several classes of antibiotics were effective prophylactically for TRPB, while the quinolones, with the highest number of studies (5) and patients (1188), were the best analysed. For 'antibiotics versus enema', we analysed four studies with a limited number of patients. The differences between groups for all outcomes were not significant. For 'antibiotic versus antibiotic + enema', only the risk of bacteremia (RR 0.25, 95% CI 0.08 to 0.75) was diminished in the 'antibiotic + enema group'. Seven trials reported the effects of short-course (1 day) versus long-course (3 days) antibiotics. Long course was significantly better than short-course treatment only for bacteriuria (RR 2.09, 95% CI 1.17 to 3.73). For 'single versus multiple dose', there was significantly greater risk of bacteriuria for single-dose treatment (RR 1.98, 95% CI 1.18 to 3.33). Comparing oral versus systemic administration - intramuscular injection (IM), or intravenous (IV) - of antibiotics, there were no significant differences in the groups for bacteriuria, fever, UTI and hospitalization. Antibiotic prophylaxis is effective in preventing infectious complications following TRPB. There is no definitive data to confirm that antibiotics for long-course (3 days) are superior to short-course treatments (1 day), or that multiple-dose treatment is superior to single-dose.

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on 10^3 pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype

Commentary

[No abstract available]42129130Lane, B.R., Aydin, H., Danforth, T.L., Zhou, M., Remer, E.M., Novick, A.C., Clinical correlates of renal angiomyolipoma subtypes in 209 patients: Classic, fat poor, tuberous sclerosis associated and epithelioid (2008) J. Urol., 180, pp. 836-843Kim, J.K., Park, S.Y., Shon, J.H., Cho, K.S., Angiomyolipoma with minimal fat: Differentiation from renal cell carcinoma at biphasic helical CT (2004) Radiology, 230, pp. 677-684Jinzaki, M., Tanimoto, A., Narimatsu, Y., Ohkuma, K., Kurata, T., Shinmoto, H., Angiomyolipoma: Imaging findings in lesions with minimal fat (1997) Radiology, 205, pp. 497-502Bosniak, M.A., Megibow, A.J., Hulnick, D.H., Horii, S., Raghavendra, B.N., CT diagnosis of renal angiomyolipoma: The importance of detecting small amounts of fat (1988) AJR Am. J. Roentgenol., 151, pp. 497-501Milner, J., McNeil, B., Alioto, J., Proud, K., Rubinas, T., Picken, M., Fat poor renal angiomyolipoma: Patient, computerized tomography and histological findings (2006) J. Urol., 176, pp. 905-909Dixon, B.P., Hulbert, J.C., Bissler, J.J., Tuberous sclerosis complex renal disease (2011) Nephron. Exp. Nephrol., 118, pp. e15-e20Israel, G.M., Hindman, N., Hecht, E., Krinsky, G., The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas (2005) AJR Am. J. Roentgenol., 184, pp. 1868-1872Lin, W.Y., Chuang, C.K., Ng, K.F., Liao, S.K., Renal angiomyolipoma with lymph node involvement: A case report and literature review (2003) Chang. Gung. Med. J., 26, pp. 607-61

Psa-nadir At 1 Year As A Sound Contemporary Prognostic Factor For Low-dose-rate Iodine-125 Seeds Brachytherapy

Objectives: To identify predictors of outcomes in patients with localized prostate cancer treated with iodine-125 brachytherapy in a longitudinal uncontrolled study. Methods: Between 2000 and 2011, 560 histologically confirmed patients were treated with brachytherapy of whom 305 with ≥24-month follow-up and localized tumor were evaluated after exclusion of those locally advanced and under androgen ablation. Results: Patients' mean age was 63.93 years (44-88), mean pretreatment prostate-specific antigen (PSA) was 6.34 ng/mL (0.67-33.09), overall median follow-up was 75.35 months (24-158.37), biochemical recurrence occurred in 17 patients (5.57 %), cancer-specific survival was 100 %, and overall survival was 98.03 %. At multivariate analyses, only PSA-nadir at 1 year and age were related to disease-free survival: To each unit of PSA-nadir, the risk increases 87.3 %-OR 1.87 (p 70)-OR 4.69 (p = 0.04; 95 % CI 1.39-18.47). Best cutoff for PSA-nadir at one year was 0.285 (AUC = 0.78; p < 0.001; 95 % CI 0.68-0.89). Kaplan-Meier analysis confirmed PSA-nadir (p < 0.001) as prognostic, while D'Amico's classification failed (p = 0.24). No grade 3 or 4 complication was reported, and only 31.4 % of patients had grade 2 urinary or rectal toxicity. PSA bounce ≥0.4 ng/mL occurred in 18.4 % with no impact on biochemical recurrence. Conclusions: Half (50.49 %) of patients in the scenario of localized prostate cancer treated with iodine-125 brachytherapy reach PSA-nadir at 1 year <0.285, recognized as a key independent prognostic factor. Graphical Abstract: [Receiver Operating Characteristic curve analysis for PSA-nadir at 1 year] [Figure not available: see fulltext.] © 2013 Springer-Verlag Berlin Heidelberg.323753759Merrick, G.S., Butler, W.M., Dorsey, A.T., Galbreath, R.W., Blatt, H., Lief, J.H., Rectal function following prostate brachytherapy (2000) Int J Radiat Oncol Biol Phys, 48 (3), pp. 667-674Sylvester, J.E., Grimm, P.D., Wong, J., Galbreath, R.W., Merrick, G., Blasko, J.C., Fifteen-year biochemical relapse-free survival, cause-specific survival, and overall survival following I (125) prostate brachytherapy in clinically localized prostate cancer: Seattle experience (2011) Int J Radiat Oncol Biol Phys, 81 (2), pp. 376-381Vigneri, P., Herati, A.S., Potters, L., The second decade of prostate brachytherapy: evidence and cost based outcomes (2010) Urol Oncol, 28 (1), pp. 86-90Roach III, M., Hanks, G., Thames Jr., H., Schellhammer, P., Shipley, W.U., Sokol, G.H., Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO phoenix consensus conference (2006) Int J Radiat Oncol Biol Phys, 65 (4), pp. 965-974Rivard, M.J., Butler, W.M., Devlin, P.M., Hayes Jr., J.K., Hearn, R.A., Lief, E.P., Meigooni, A.S., Williamson, J.F., American Brachytherapy Society recommends no change for prostate permanent implant dose prescriptions using iodine-125 or palladium-103 (2007) Brachytherapy, 6 (1), pp. 34-37Potters, L., Morgenstern, C., Calugaru, E., Fearn, P., Jassal, A., Presser, J., 12-year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer (2008) J Urol, 179 (5 SUPPL.), pp. S20-S24Stock, R.G., Cesaretti, J.A., Stone, N.N., Disease-specific survival following the brachytherapy management of prostate cancer (2006) Int J Radiat Oncol Biol Phys, 64 (3), pp. 810-816Stock, R.G., Cesaretti, J.A., Unger, P., Stone, N.N., Distant and local recurrence in patients with biochemical failure after prostate brachytherapy (2008) Brachytherapy, 7 (3), pp. 217-222Ko, E.C., Stone, N.N., Stock, R.G., PSA-nadir of <0.5 ng/mL following brachytherapy for early-stage prostate adenocarcinoma is associated with freedom from prostate-specific antigen failure (2012) Int J Radiat Oncol Biol Phys, 83 (2), pp. 600-607Taira, A.V., Merrick, G.S., Galbreath, R.W., Wallner, K.E., Butler, W.M., Natural history of clinically staged low- and intermediate-risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy (2010) Int J Radiat Oncol Biol Phys, 76 (2), pp. 349-354Taira, A.V., Merrick, G.S., Butler, W.M., Galbreath, R.W., Lief, J., Adamovich, E., Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy (2011) Int J Radiat Oncol Biol Phys, 79 (5), pp. 1336-1342Stone, N.N., Stock, R.G., Unger, P., Intermediate term biochemical-free progression and local control following 125 iodine brachytherapy for prostate cancer (2005) J Urol, 173 (3), pp. 803-807Zelefsky, M.J., Kuban, D.A., Levy, L.B., Potters, L., Beyer, D.C., Blasko, J.C., Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation (2007) Int J Radiat Oncol Biol Phys, 67 (2), pp. 327-333Bowes, D., Crook, J.M., Wallace, K., Evans, A., Toi, A., Finelli, A., Jewett, M.A., Catton, C., Results of a surgically derived nomogram to predict Gleason score upgrading applied to a cohort of patients with "favorable-risk" prostate cancer treated with permanent seed brachytherapy (2012) Urology, 80 (3), pp. 649-655Stokes, S.H., Real, J.D., Adams, P.W., Clements, J.C., Wuertzer, S., Kan, W., Transperineal ultrasound-guided radioactive seed implantation for organ-confined carcinoma of the prostate (1997) Int J Radiat Oncol Biol Phys, 37 (2), pp. 337-341Guarneri, A., Botticella, A., Ragona, R., Filippi, A.R., Munoz, F., Casetta, G., Gontero, P., Ricardi, U., Prostate-specific antigen kinetics after I 125-brachytherapy for prostate adenocarcinoma (2013) World J Urol, 31 (2), pp. 411-415Storey, M.R., Landgren, R.C., Cottone, J.L., Stallings, J.W., Logan, C.W., Fraiser, L.P., Transperineal 125 iodine implantation for treatment of clinically localized prostate cancer: 5-year tumor control and morbidity (1999) Int J Radiat Oncol Biol Phys, 43 (3), pp. 565-567Shapiro, E.Y., Rais-Bahrami, S., Morgenstern, C., Napolitano, B., Richstone, L., Potters, L., Long-term outcomes in younger men following permanent prostate brachytherapy (2009) J Urol., 181 (4), pp. 1665-1671. , Discussion 71Burri, R.J., Ho, A.Y., Forsythe, K., Cesaretti, J.A., Stone, N.N., Stock, R.G., Young men have equivalent biochemical outcomes compared with older men after treatment with brachytherapy for prostate cancer (2010) Int J Radiat Oncol Biol Phys, 77 (5), pp. 1315-1321Merrick, G.S., Wallner, K.E., Galbreath, R.W., Butler, W.M., Brammer, S.G., Allen, Z.A., Biochemical and functional outcomes following brachytherapy with or without supplemental therapies in men < or =50 years of age with clinically organ-confined prostate cancer (2008) Am J Clin Oncol, 31 (6), pp. 539-544Abdel-Wahab, M., Reis, I.M., Hamilton, K., Second primary cancer after radiotherapy for prostate cancer-a SEER analysis of brachytherapy versus external beam radiotherapy (2008) Int J Radiat Oncol Biol Phys, 72 (1), pp. 58-6

Psychotherapy: a missing piece in the puzzle of post radical prostatectomy erectile dysfunction rehabilitation

To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy. From 132 patients surgically treated for prostate cancer, thirty sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20mg and underwent psychotherapy sessions, both weekly for three months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale. The average age was 62.5 (46 to 77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7 to 13.3, p=0.0006), with increased satisfaction with life in general (2.1 to 2.7, P=.028) and sexual life (3.1 to 3.7, P=.028), added to facilitation of expressing feelings/emotions (1.8 to 3.0, P=.0008). Satisfaction with relationship and intimacy with partner did not present significant improve (P=.12 and P=.61, respectively). A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario.sem informação386385390sem informaçãosem informaçã

Psychotherapy: A Missing Piece In The Puzzle Of Post Radical Prostatectomy Erectile Dysfunction Rehabilitation [psicoterapia: Una Pieza Que Falta En El Puzle De La Rehabilitación De La Disfunción Eréctil Tras Prostatectomía Radical]

Objectives To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy. Methods From 132 patients surgically treated for prostate cancer, thirty sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20 mg and underwent psychotherapy sessions, both weekly for three months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale. Results The average age was 62.5 (46 to 77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7 to 13.3, p = 0.0006), with increased satisfaction with life in general (2.1 to 2.7, P =.028) and sexual life (3.1 to 3.7, P =.028), added to facilitation of expressing feelings/emotions (1.8 to 3.0, P =.0008). Satisfaction with relationship and intimacy with partner did not present significant improve (P =.12 and P =.61, respectively). Conclusions A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario. © 2013 AEU. Published by Elsevier España, S.L. 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Does The Criterion For Prostate Biopsy Indication Impact Its Accuracy? A Prospective Population-based Outpatient Clinical Setting Study [¿impacta El Criterio Para Indicar La Biopsia Prostática Sobre Su Exactitud? Estudio Prospectivo Llevado A Cabo Sobre Una Población De Pacientes Ambulantes]

Introduction: Prostate specific antigen (PSA) and digital rectal examination (DRE) are the main tests for initial prostate investigation; there is no consensus about the best criterion for prostate biopsies. We aim to check the accuracy of different criteria in this context including PSA derivatives to detect prostate cancer. Material and methods: Four different criteria for indication of prostate biopsy were compared: (A) PSA-density (>15 ng/ ml/ cc); (B) PSA > 2,5ng/ml; (C) PSA-velocity (> 0.7 ng/ ml/ year); (D) free/total PSA ratio ( 0.05). Associating positive DRE with changed PSA, the PPV increased to 50%, 50%, 43.9% and 68.2% for criteria A, B, C and D, respectively (p > 0.05). In univariate analysis, DRE (positive versus negative), PSA level (>10 ng/ ml versus 15%) and age were associated with PC. In multivariate analysis only positive DRE was associated with prostate cancer. Conclusions: All the criteria of PSA derivatives are complementary and useful predictors of cancer risk. However, a positive DRE increased the PPV of PSA derivatives. New tools are needed to improve the accuracy of prostate cancer detection. © 2010 AEU. Publicado por Elsevier España, S.L. Todos los derechos reservados.3511014Catalona, W.J., Richie, J.P., Ahmann, F.R., Hudson, M.A., Scardino, P.T., Flanigan, R.C., Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: Results of a multicenter clinical trial of 6,630 men (1994) J Urol., 151, pp. 1283-1290Catalona, W.J., Smith, D.S., Ratliff, T.L., Basler, J.W., Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening (1993) JAMA, 270, pp. 948-954Richie, J.P., Catalona, W.J., Ahmann, F.R., Hudson, M.A., Scardino, P.T., Flanigan, R.C., Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination (1993) Urology., 42, pp. 365-374Carter, H.B., A PSA threshold of 4.0 ng/mL for early detection of prostate cancer: The only rational approach for men 50 years old and older (2000) Urology., 55, pp. 796-799Catalona, W.J., Ramos, C.G., Carvalhal, G.F., Yan, Y., Lowering PSA cutoffs to enhance detection of curable prostate cancer (2000) Urology., 55, pp. 791-795Gann, P.H., Hennekens, C.H., Stampfer, M.J., A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer (1995) JAMA, 273, pp. 289-294Heidenreich, A., Aus, G., Bolla, M., Joniau, S., Matveev, V.B., Schmid, H.P., EAU guidelines on prostate cancer (2009) Actas Urol Esp., 33, pp. 113-126Partin, A.W., Brawer, M.K., Subong, E.N., Kelley, C.A., Cox, J.L., Bruzek, D.J., Prospective evaluation of percent free-PSA and complexed-PSA for early detection of prostate cancer (1998) Prostate Cancer Prostatic Dis., 1, pp. 197-203Catalona, W.J., Partin, A.W., Slawin, K.M., Brawer, M.K., Flanigan, R.C., Patel, A., Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: A prospective multicenter clinical trial (1998) JAMA, 279, pp. 1542-1547Kobori, Y., Kitagawa, Y., Mizokami, A., Komatsu, K., Namiki, M., Free-to-total prostate-specific antigen (PSA) ratio contributes to an increased rate of prostate cancer detection in a Japanese population screened using a PSA level of 2.1-10.0 ng/mL as a criterion (2008) Int J Clin Oncol., 13, pp. 229-232Roehl, K.A., Antenor, J.A., Catalona, W.J., Robustness of free prostate specific antigen measurements to reduce unnecessary biopsies in the 2.6 to 4.0 ng/mL range (2002) J Urol., 168, pp. 922-925Lujan, M., Paez, A., Llanes, L., Miravalles, E., Berenguer, A., Prostate specific antigen density. Is there a role for this parameter when screening for prostate cancer? (2001) Prostate Cancer Prostatic Dis., 4, pp. 146-149Catalona, W.J., Richie, J.P., Dekernion, J.B., Ahmann, F.R., Ratliff, T.L., Dalkin, B.L., Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: Receiver operating characteristic curves (1994) J Urol., 152 (6 PART 1), pp. 2031-2036Stephan, C., Stroebel, G., Heinau, M., Lenz, A., Roemer, A., Lein, M., The ratio of prostate-specific antigen (PSA) to prostate volume (PSA density) as a parameter to improve the detection of prostate carcinoma in PSA values in the range of < 4 ng/mL (2005) Cancer., 104, pp. 993-1003Catalona, W.J., Southwick, P.C., Slawin, K.M., Partin, A.W., Brawer, M.K., Flanigan, R.C., Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging (2000) Urology., 56, pp. 255-260Carter, H.B., Ferrucci, L., Kettermann, A., Landis, P., Wright, E.J., Epstein, J.I., Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability (2006) J Natl Cancer Inst., 98, pp. 1521-1527Loeb, S., Roehl, K.A., Nadler, R.B., Yu, X., Catalona, W.J., Prostate specific antigen velocity in men with total prostate specific antigen less than 4 ng/mL (2007) J Urol., 178, pp. 2348-2352Stopiglia, R.M., Ferreira, U., Silva Jr., M.M., Matheus, W.E., Denardi, F., Reis, L.O., Prostate specific antigen decrease and prostate cancer diagnosis: Antibiotic versus placebo prospective randomized clinical trial (2010) J Urol., 183, pp. 940-944Vickers, A.J., Savage, C., O'Brien, M.F., Lilja, H., Systematic review of pretreatment prostate-specific antigen velocity and doubling time as predictors for prostate cancer (2009) J Clin Oncol., 27, pp. 398-403Sun, L., Moul, J.W., Hotaling, J.M., Rampersaud, E., Dahm, P., Robertson, C., (2007) Prostate-specific Antigen (PSA) and PSA Velocity for Prostate Cancer Detection in Men Aged <50 Years. BJU Int., 99, pp. 753-757Loeb, S., Catalona, W.J., What to do with an abnormal PSA test (2008) Oncologist., 13, pp. 299-305Schroder, F.H., Roobol, M.J., Defining the optimal prostate-specific antigen threshold for the diagnosis of prostate cancer (2009) Curr Opin Urol., 19, pp. 227-231Stamey, T.A., Caldwell, M., McNeal, J.E., Nolley, R., Hemenez, M., Downs, J., The prostate specific antigen era in the United States is over for prostate cancer: What happened in the last 20 years? (2004) J Urol., 172, pp. 1297-1301Andriole, G.L., Crawford, E.D., Grubb III, R.L., Buys, S.S., Chia, D., Church, T.R., Mortality results from a randomized prostate-cancer screening trial (2009) N Engl J Med., 360, pp. 1310-1319Schröder, F.H., Hugosson, J., Roobol, M.J., Tammela, T.L., Ciatto, S., Nelen, V., Screening and prostate-cancer mortality in a randomized European study (2009) N Engl J Med., 360, pp. 1320-132

Efeito do miriadenolídeo isolado de Alomia myriadenia (Asteraceae) sobre o tumor de Erlich ascítico no camundongo Effect of myriadenolide isolated from Alomia myriadenia (Asteraceae) on Ehrlich tumor in its ascitic form

Estudou-se atividade antineoplásica de um produto natural isolado de Alomia myriadenia (miriadenolídeo) no modelo do tumor de Ehrlich em camundongos. Dezoito fêmeas de camundongo Swiss foram inoculadas com 2x10(7) células viáveis de tumor de Ehrlich via intraperitoneal (0,3ml) e posteriormente distribuídas aleatoriamente em três grupos que receberam: grupo I (controle) - 0,3ml de solução de Hanks; grupo II - 31&micro;g/kg de miriadenolídeo; e grupo III - 139&micro;g/kg de miriadenolídeo. No oitavo dia de experimento, foram realizados exames hematológicos e perfil protéico sérico eletroforético. Coletou-se todo o líquido ascítico para avaliação do volume, aparência, pH, contagem de células viáveis e inviáveis, realização de esfregaços para contagem de células claras e escuras, leucócitos e avaliação das regiões organizadoras de nucléolos argentafins (AgNORs). Foram realizados exames macro e microscópicos do baço, fígado e rins e aspirado o conteúdo da medula óssea dos fêmures direito e esquerdo de cada animal para avaliação da relação mielóide:eritróide. Não houve diferença significativa no volume, pH, contagem de células viáveis e inviáveis entre os três grupos estudados, observando-se valores de 17,6 x 10(4) células tumorais viáveis no grupo III, 27,7 x 10(4) no grupo II e 21,1 x 10(4) no grupo I. As AgNORs apresentaram-se pequenas, com distribuição difusa e incontáveis no grupo I, e em menor quantidade no grupo III. Os animais do grupo III apresentaram a menor concentração protéica total sérica (4,7g/dl) (P<0,05) quando comparados com os do grupo II (5,3g/dl) e do grupo I (5,1g/dl). Os valores de albumina foram semelhantes nos três grupos (2,6g/dl), e as globulinas totais foram maiores (P<0,05) no grupo II (2,71g/dl) quando comparadas com os valores médios do grupo III (2,11g/dl) e semelhantes ao grupo I (2,43g/dl). Não houve diferença entre alfa e beta globulinas entre os três grupos estudados, porém as gamaglobulinas foram maiores (P<0,05) no grupo II (1,72g/dl) quando comparadas com as do grupo III (1,13g/dl). Com relação ao eritrograma e leucograma, não houve diferença significativa entre os grupos tratados. A relação mielóide:eritróide foi maior (P<0,05) no grupo III (1,40) quando comparada com a relação nos grupos I (0,92) e II (0,61). A contagem de reticulócitos também foi maior (P<0,05) (11,2) no grupo III, quando comparada com as dos grupos I (4,3) e II (3,6). Em todos os grupos, observou-se degeneração hepática.<br>Antitumoral activity of a natural product of Alomia myriadenia (myriadenolide) in Ehrlich tumor in mice was studied. Eighteen Swiss female mice were intra-peritoneal inoculated 2x10(7) viable cells of Ehrlich Tumor (0.3ml) and randomly distributed in three groups receiving via intra-peritoneal on the 3rd and 5th day post-inoculation the following treatments: group I (control) - 0.3ml Hanks solution; group II: 31&micro;g/kg myriadenolide; and group III: 139&micro;g/kg myriadenolide. On the eighth day of the experiment blood profile and protein serum electrophoresis were performed. All ascitic liquid was collected to evaluate the volume and pH; to observe the aspect; to count viable and no viable cells, dark and clear cells, leukocytes and nucleolar organizer regions (NORs). Macro and microscopic exams were performed and bone marrow was aspirated from right and left femurs of each animal to evaluate myeloid:erythroid ratio. It was not observed difference in volume, pH, counts viable and no viable cells in the groups, although group III showed smaller number of viable tumoral cells (17.6 x 10(4)) when compared to the group II (27.7 x 10(4)) and group I (21.1 x 10(4)). The investigation of NORs to evaluate the proliferative capacity of tumoral cells after myriadenolide treatment showed that cells were smaller, uncountable and with diffuse distribution in group I. They were in lower quantity in group III. These results suggest that myriadenolide in dose 139&micro;g/kg (group III) delay the tumoral growing and, probably, cell proliferation. The animals of group III showed lower value of total protein (4.7g/dl) (P<0.05) when compared to animals from group II (5.3g/dl) and group I (5.1g/dl). The values of albumin were similar in all groups (2.6g/dl) and total globulin was higher (P<0.05) in group II (2.71g/dl) when compared to mean values of group III (2.11g/dl) and similar to group I (2.43g/dl). The decrease of total protein in group III occurred by globulin reduction. There was no difference in alpha and beta globulin in the three studied groups, although the immunoglobulins were higher (P<0.05) in group II (1.72g/dl) when compared to group III (1.13g/dl). These results suggest the viable number of tumoral cells in group II could cause the increase response of IgM reflecting on the final value of immunoglobulins. In relation to erythrogram and leukogram there was no statistical difference. The myeloid:erythroid ratio was higher (P<0.05) in group III (1.40) when compared to groups I (0.92) and II (0.61). Reticulocytes count were higher (P<0.05) (11.2) in group III, when compared to groups I (4.3) and II (3.6). In all groups, hepatic degeneration was observed