Antonio W. Romero

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.

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.

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.

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 Peyronies 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 Peyronies 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 prostate exam

Objective: To help students, residents, and general practitioners to improve the technique, skills, and reproducibility of their prostate examination. Methods: We developed a comprehensive guideline outlining prostate anatomy, indications, patient preparation, positioning, technique, findings, and limitations of this ancient art of urological evaluation. Results: The prostate exam was the first diagnostic test used for prostate cancer screening and other urological conditions. Although several alternative procedures have been developed in the past century, the prostate exam is still an important part of genital–pelvic evaluation because of its simplicity, cost and time effectiveness, and relatively minimal patient discomfort experienced. Conclusion: With an aging population and increasing incidence of prostate diseases, it is imperative that healthcare professionals possess the knowledge, skills, and attitudes to make the prostate exam a routine part of a complete physical examination.