The use of PSA in the screening, detection and prognosis of prostate cancer (PCa) has revolutionized the diagnosis and treatment of this disorder with an increase in detection rates and PCa organ-confined. Despite these benefits and ease of implementation, tracking PCa remains a matter of great controversy. We conducted a literature review and demographic and epidemiological data in Brazil feeling to assess the current state of screening and whether there is justification for population programs. the diferences are valued between developed and underdeveloped countries as the incidence, mortality, screening and access to health. an analysis of the advantages and disadvantages of screening is made as well as a critical analysis of existing studies on screening and some recommendations on a rational screening.
Vol. 42 (6): 1081-1090, November – December, 2016
Rafael Rocha Tourinho-Barbosa 1, Antonio Carlos Lima Pompeo 1, Sidney Glina 1
1 Departamento Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
Introduction: Prostate cancer is one of the tumors with higher incidence and mortality among men in the World. Epidemiological data are influenced by life expectancy of population, available diagnostic methods, correct collection of data and quality of health services. Screening of the disease is not standardized around the World. Up till now there is no consensus about the risks versus benefits of early detection. There are still missing data about this pathology in Latin America.
Objective: to revise current epidemiologic situation and early diagnosis policies of prostate cancer in Brazil and Latin America.
Materials and Methods: Medline, Cochrane Library and SciELO databases were reviewed on the subject of epidemiology and screening of prostate cancer. Screening research was performed in websites on national public health organizations and Latin America. Screening recommendations were obtained from those governmental organizations and from Latin American urological societies and compared to the most prominent regulatory agencies and societies of specialists and generalists from around the World.
Results: Brazil and Latin America have a special position in relation to incidence and mortality of prostate cancer. In Brazil, it occupies the first position regarding incidence of cancer in men and the second cause of mortality. Central America has the highest rate of mortality of the continent with lower...
Vol. 42 (6): 1091-1098, November – December, 2016
Dharam Kaushik 1,2, Stephen A. Boorjian 1, R. Houston Thompson 1, Manuel S. Eisenberg 1, Rachel E. Carlson 3, Eric J. Bergstralh 3, Igor Frank 1, Matthew T. Gettman 1, Matthew K. Tollefson 1, R. Jeffrey Karnes 1
1 Department of Urology, Mayo Clinic, Rochester, Minnesota, USA; 2 Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA; 3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
Objectives: Radical prostatectomy (RP) for locally advanced prostate cancer may reduce the risk of metastasis and cancer-specific death. Herein, we evaluated the outcomes for patients with pT4 disease treated with RP.
Materials and methods: Among 19,800 men treated with RP at Mayo Clinic from 1987 to 2010, 87 were found to have pT4 tumors. Biochemical recurrence (BCR)-free survival, systemic progression (SP) free survival and overall survival (OS) were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to assess the association of clinic-pathological features with outcome.
Results: Median follow-up was 9.8 years (IQR 3.6, 13.4). Of the 87 patients, 50 (57.5%) were diagnosed with BCR, 30 (34.5%) developed SP, and 38 (43.7%) died, with 11 (12.6%) dying of prostate cancer. Adjuvant androgen deprivation therapy was administered to 77 men, while 32 received adjuvant external beam radiation therapy. Tenyear BCR-free survival, SP-free survival, and OS was 37%, 64%, and 70% respectively. On...
Vol. 42 (6): 1099-1108, November – December, 2016
Laparoscopic Radical Cystectomy in the Elderly – Results of a Single Center LRC only Series
Tom J. N. Hermans 1, Laurent M. C. L. Fossion 1, Rob Verhoeven 2, Simon Horenblas 3
1 Department of Urology, Maxima Medical Center Veldhoven, Veldhoven, The Netherlands; 2 Eindhoven Cancer Registry/Comprehensive Cancer Centre South, Eindhoven, Netherlands; 3 Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Objective: To compare outcome of laparoscopic radical cystectomy (LRC) with ileal conduit in 22 elderly (≥75 years.) versus 51 younger (<75 years.) patients.
Materials and Methods: Analysis of prospectively gathered data of a single institution LRC only series was performed. Selection bias for LRC versus non-surgical treatments was assessed with data retrieved from the Netherlands Cancer Registry.
Results: Median age difference between LRC groups was 9.0 years. (77.0 versus 68.0 years.). Both groups had similar surgical indications, body mass index and gender distribution. Charlson Comorbidity Index score was 3 versus 4 in ≥50% of younger and elderly patients. Median operative time (340 versus 341 min) and estimated blood loss (<500 versus >500mL) did not differ between groups. Median total hospital stay was 12.0 versus 14.0 days for younger and elderly patients. Grade I-II 90-d complication rate was higher for elderly patients (68 versus 43%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (23 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (14 versus 4%, p=0.157). Median...