Wagner Eduardo Matheus

Prostate Specific Antigen Decrease and Prostate Cancer Diagnosis: Antibiotic Versus Placebo Prospective Randomized Clinical Trial

PURPOSE Prostate inflammation can lead to an increase in serum prostate specific antigen concentration and confound the use of prostate specific antigen kinetics. Repeat prostate specific antigen measurements after a period of observation or a course of empirical antibiotics are controversial in terms of the optimal approach to reduce the confounding impact on prostate cancer screening. This issue was analyzed in patients with a diagnosis of type IV or asymptomatic prostatitis (National Institutes of Health classification) and high prostate specific antigen. MATERIALS AND METHODS We studied 200 men between 50 and 75 years old with a high prostate specific antigen (between 2.5 and 10 ng/dl). Of these patients 98 (49%) had a diagnosis of type IV prostatitis. In a prospective, double-blind trial they were randomized to receive placebo (49 patients, group 1) or 500 mg ciprofloxacin (49 patients, group 2) twice a day for 4 weeks. Prostate specific antigen was determined after treatment and all patients underwent transrectal ultrasound guided biopsy of the prostate. RESULTS In group 1, 29 (59.18%) patients presented with a decrease in prostate specific antigen and 9 (31%) had cancer on biopsy, while in group 2 there were 26 (53.06%) patients with a decrease in prostate specific antigen and 7 (26.9%) with prostate cancer. There was no statistical difference in either group in relation to prostate specific antigen decrease after treatment or the presence of tumor. CONCLUSIONS A considerable number of patients (49%) were diagnosed with type IV prostatitis and high prostate specific antigen in agreement with the current literature. Of the patients 26.9% to 31% presented with a decrease in prostate specific antigen after the use of antibiotic or placebo and harbor cancer as demonstrated on prostate biopsy. Prostate specific antigen decreases do not indicate the absence of prostate cancer.

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.

Primary Invasive versus Progressive Invasive Transitional Cell Bladder Cancer: Multicentric Study of Overall Survival Rate

Introduction and Objective: When feasible, the treatment for all-invasive bladder cancer is radical cystectomy. The aim of the present study was to analyze the prognostic difference, disease-specific survival rate, of muscle-invasive transitional cell cancer of the bladder (TCCB) for progressive invasive TCCB. Patients and Methods: A retrospective multicentric analysis was performed studying a total of 242 patients who underwent radical cystectomy for invasive TCCB from 1993 to 2005. The patients were divided into two groups: group 1 included 57 patients with progressive invasive TCCB, and group 2 included 185 patients with primary invasive TCCB. Both groups were further divided according to the pathological findings in pT2/3 (muscle and/or perivesical fat invasion), pT4 (adjacent organs/structure invasion), N+ (positive lymphatic nodes) and M+ (distant organ metastasis). Several tests were employed for statistical analysis: χ2, Mann-Whitney, Kaplan-Meier method and Wilcoxon (Breslow) method were used to compare the possible survival curve differences of groups 1 and 2. Multivariated analysis determined by proportional risk regression excluded sex, age and disease stage interferences in the final results. Results: The average time for a superficial TCCB to become muscle-invasive was 37.4 months, and the average number of transurethral resections performed in each patient was 3. The average and median global survival rates were, respectively, 96 and 88 months in group 1 and 98 and 90 months in group 2, without a statistically significant difference (p = 0.0734). The 1-year survival rate was 84.32% in group 1 and 76.54% in group 2. After 3 years of follow-up the survival rate fell to 74.50% in group 1 and to 59.05% in group 2. Finally, the 5-year survival rate was 57.94% in group 1 and 52.24% in group 2. Conclusion: In the present study, patients with primary invasive and progressive invasive TCCB showed a similar 5-year disease-specific survival rate. Pathological stage (pTN, N and M) and patient demography did not interfere with the results.

Intraprostatic Injection of Alcohol Gel for the Treatment of Benign Prostatic Hyperplasia: Preliminary Clinical Results

Benign prostatic hyperplasia (BPH) is one of the most common diseases ailing older men. Office-based procedures offer the advantage of being more effective than medications, while limiting the adverse effects, cost, and recovery of surgery. This study presents preliminary data on a new procedure that utilizes intraprostatic alcohol gel injection to ablate prostatic tissue. The purpose of this study is to evaluate the feasibility of using this gel as a treatment for BPH. A total of 65 patients with lower urinary tract symptoms (LUTS) due to BPH were treated with intraprostatic injections of alcohol gel. The gel is composed of 97% denatured alcohol and a patented polymer to cause viscosity. Three different methods of injection were utilized: transrectal (TR) injections (8), transurethral (TU) injections (36), and transperineal (TP) injections guided by biplaned ultrasound (21). Each method provided easy access to the center of the prostate, where a volume of gel, approximately 20–30% of the prostatic volume, was injected. Follow-up was based on changes in peak urinary flow (Qmax), IPSS scores, quality of life scores (QoL), adverse effects, and failures. Data are available at 3 and 12 months. The procedure was well tolerated with only local or no anesthesia in the TR and TP groups; the TU group received spinal anesthesia. All groups showed statistically significant (p < 0.0001) improvements in Qmax, IPSS, and QoL. The mean amount of gel injected was 8.05 ml, representing 21.56% of the prostatic volume. Qmax increased from a baseline mean of 8.50 to 12.01 ml/s at 3 months, and to 11.29 ml/s at 12 months. IPSS scores improved from a baseline mean of 21.12 to 10.00 at 3 months, and to 11.84 at 12 months. QoL scores were only available for 55 patients. QoL scores improved from a baseline of 3.93 to 1.98 at 3 months, and to 2.18 at 12 months. No extraprostatic injury or adverse effects were reported due to treatment. This preliminary study presents significant results showing that intraprostatic injection of alcohol gel could be an option for the treatment of BPH and LUTS. The viscosity of the gel allows for accurate imaging under ultrasound, no run back along the needle allowing for multiple methods of delivery, and the gel does not spread to extraprostatic tissue. This new technique could provide a simple and possibly less expensive clinic procedure for treating BPH, and warrants further study.

Extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients

ObjectivesSquamous cell carcinoma (SCC) of the penis with inguinal lymph node involvement aggravates prognosis and can cause femoral artery bleeding, hemorrhagic shock and even death. The objective of this study is to describe the use of extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis.Casuistic and methodFive patients with SCC and inguinal lymphatic metastasis involving the femoral vessels, who underwent extra-anatomical arterial bypass through obturator foramen between 1999 and 2007, were reviewed. The surgical technique and the postoperative outcome were described.ResultsAfter extra-anatomical transobturator bypass, all patients presented distal pulses. The mean time of surgery was 6 h. In four patients, a knitted Dacron tube was used; and in one, the contralateral devalvulated greater saphenous vein was used. Concomitantly, two patients underwent mass resection and one patient underwent node dissection 2 weeks after bypass. Two patients chose not to undergo inguinal resection, opting for palliative chemotherapy after the vascular procedure. The average follow-up period was 12 months and four patients have died—three due to pulmonary metastasis, and one due to acute myocardial infarct. No prosthetic complication was identified and no patient presented femoral bleeding.ConclusionsThe use of the transobturator bypass can benefit patients presenting with penile SCC and inguinal lymph nodes metastasis involving the femoral vessels, allowing resection of extensive tumor lesions, as well as avoidance of local complications.

Análisis de satisfacción en varones que presentaban cáncer de próstata localizado tratados con prostatectomía radical o radioterapia: Aspectos Psicológicos y Sociales

Resumen Analisis de satisfaccion en varones que presentaban cancer de prostata localizado tratados con prostatectomia radical o radioterapia: Aspectos psicologicos y sociales Objetivos Analizar la satisfaccion y el impacto del tratamiento en pacientes con cancer de prostata localizado Metodos 180 pacientes con una edad media de 60 anos que fueron divididos en 3 grupos: grupo I – 100 pacientes que se habian sometido a prostatectomia radical retropubica (PRR), grupo II– 40 pacientes sometidos a radioterapia (RT), y grupo III – 40 hombres sanos. Se aplico un cuestionario a los grupos para valorar los cambios fisicos y psicologicos a los 18 meses tras el tratamiento. La herramienta de investigacion se baso en dos cuestionarios; primero: SF-36 (Short Form Health Survey), segundo: FACT-P (Functional Assessment Cancer Therapy) Resultados En el grupo I, el 70% nunca uso compresas, el 5% tuvo incontinencia urinaria total, y el 10% perdidas ocasionales de heces. En el grupo II, 85% no utilizo compresas y el 5% informo haber utilizado dos compresas al dia; 15% reportaron incontinencia fecal. La disfuncion sexual fue similar en ambos grupos: 75% del grupo de cirugia y el 72,5% del de radioterapia informaron de disfuncion erectil. En el grupo de control, 40% informaron de disfuncion erectil; 10% perdidas ocasionales de heces y ninguno tuvo cambios por lo que respecta a la satisfaccion global con el tratamiento. Setenta y ocho por ciento del grupo de PRR y el 77,5% del de RT informaron sentirse felices y satisfechos del tratamiento aceptado o elegido y afirmaron que lo elegirian de nuevo Conclusiones La valoracion de la satisfaccion relacionada con el tratamiento determina la tolerancia al mismo. Los resultados de este estudio no muestran cambios importantes en este aspecto entre ambas modalidades de tratamiento (p>0,05)

Cáncer de próstata: práctica clínica basada en la evidencia

Objectives: Evidence-based medicine allows the best available external clinical evidence from systematic literature rese arch to be graded in order to determine the strength of its recommendation. This guideline aims to assist physicians and healthprofessionalsinclinicaldecisionsrelatedtoprostatecancertreatment,particularlyinurology,clinicaloncologyand radiotherapy. Methods: The publications used as information sources were obtained from structured data search in electronic databa ses, such as CENTRAL (Cochrane Central Register of Controlled Clinical Trials) and MEDLINE (online). Each item of this guideline derived from an original question which was distributed to the participants. Search strategies were prepared to select the studies presenting the best methodological quality, according to predefined levels of evidence. Results: All the recommendations were followed by a level of evidence (LE) and a degree of recommendation (DR). We used a formal ranking system to help the reader to judge the strength of the evidence behind the results published in support of each recommendation. Conclusions: The existing parameters should be viewed as guidelines of conduct. The final trial on which the clinical procedure or treatment plan is most suitable for a particular patient should be done by a physician, who should discuss the available treatment options with the patient according to the diagnosis.

Sentinel lymph node biopsy in penile cancer: a comparative study using modified inguinal dissection.

INTRODUCTION In the case of clinically negative inguinal regions in penile cancer, the treatments proposed might vary from careful observation to radical dissection for all patients. We evaluated the effectiveness of the sentinel lymph node biopsy using lymphoscintigraphy in patients with penile cancer and at least one negative inguinal region. MATERIALS AND METHODS In 18 patients, biopsy of the sentinel lymph node from the 32 negative inguinal regions and modified radical lymphadenectomy in these regions regardless of the biopsy results was performed. Clinical staging, pathological results of the sentinel and the other lymph nodes removed during lymphadenectomy, tumor behavior, local and inguinal recurrence and specific disease mortality were accessed. RESULTS The mean age of the study sample was 57.7 years (44 - 81 years) and the sentinel lymph node presented 0% false negative 66% sensitivity, and 79.3% specificity when compared with the modified inguinal lymphadenectomy as the gold standard treatment. CONCLUSION Sentinel lymph node biopsy is a feasible method of assessing the presence of regional metastasis in patients with penile cancer and clinically negative inguinal regions. However, the optimal lymphoscintigraphy technique is still in evolution and requires further optimization at high volume centers.

Magnetic Resonance Image in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer: a systematic review of literature and meta-analysis

OBJECTIVE Systematic review of literature and meta-analysis to evaluate the results of magnetic resonance image 1.5T with endorectal coil in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer, compared to the histopathological results of the radical prostatectomy specimen. MATERIALS AND METHODS It was conducted a systematic review of literature and meta-analyses of all studies data published after 2008. In those studies, the patients with prostate cancer with indication to radical prostatectomy were submitted to magnetic resonance image (MRI) at pre-operatory period and the results were compared to those of histopathological studies after the surgery. The selected terms for research included prostate cancer, magnetic resonance, radical prostatectomy, and prostate cancer diagnosis, in the databases EMBASE, LILACS, PUBMED/MEDLINE and Cochrane Library. The data were collected using a specific qualitative instrument and the meta-analysis data were presented in the forest plot graphics, homogeneity test and sROC curves and funnel plot. RESULTS A total of seven studies were included, with a total of 603 patients. Among these studies, six evaluated the value of MRI for the detection of prostate cancer, and the median sensitivity of meta-analysis was 0.6 and specificity 0.58, but with heterogeneity among the studies. Three studies evaluated extra-prostatic extension with a median sensitivity of 0.49, specificity 0.82 and heterogeneity only for sensitivity. Three studies evaluated invasion of seminal vesicles, with median sensitivity of 0.45 and specificity 0.96, with heterogeneity in both analysis. CONCLUSION Magnetic resonance of 1.5T with endocoil showed low values of sensitivity and specificity for the diagnosis and staging of prostate cancer. The reviewed studies showed a significant heterogeneity among them. The best observed result was MRI specificity for invasion of seminal vesicles. More studies are necessary to evaluate new techniques and parameters before recommending the routine use of MRI in clinical practice.

Barriers to prostate cancer screening: psychological aspects and descriptive variables – is there a correlation?

Objective. To evaluate psychological and demographic aspects of men who received DRE during the PCa screening in an outpatient clinical setting. Methods. Patients (345) who underwent DRE for the first time from February 2006 to December 2007 were evaluated for their psychological reactions and feelings after the examination. Results. The average age of the patients was 52.8 years (25 - 85 years); 40.94% had felt fear (examination fear 15.94%, and diagnosis fear 25%), 26.45% shame and 48.26% indicated they were not thinking about anything. There was no correlation between age, educational level and emotional reactions. Most patients (96.8%) would undergo a DRE again and 52.35% had considered it better than they had imagined. Of these patients, 41.81% were illiterate/incomplete elementary school. Only 4.12% described having a negative experience. The factors that persuaded the patients to book an appointment were: 50.1% made their own decision, 26.67% were recommended by a physician, 18.55% family/friends and 6.67% were influenced by the media. Wives booked 24.06% of the consultations. Although 85.47% of patients had some previous knowledge about the examination, 80.81% felt they had further clarification afterward. Lower educational level was related to lack of information about DRE, while 52.38% who made their own decision had previous knowledge of the importance of DRE. Conclusion. The majority of the patients found DRE less awkward than they had imagined it to be and would repeat the examination in the future. Fear and shame before the examination are present and are barriers to the DRE.