Posts made in July, 2017

The Middle Term

Vol. 43 (4): 577-578, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2017.04.01

EDITORIAL in this Issue

Stênio de Cássio Zequi
Editor Associado, International Braz J Urol
Divisão de Urologia do A.C. Camargo Cancer Center
Fundação A. Prudente, São Paulo, Brasil

As it is been daily debated, the dilemmas on to treat or not to treat patients with localized prostate cancer are under the scope of the “Difference of opinion section”: Between two extremes: the radical whole gland treatments versus the active surveillance protocols, the “middle term”, probably will be arise from judicious and individualized patient selection. Using biomolecular markers, nomograms, modern magnetic resonance evaluations and the individual patient preferences and payment capacities, the urologists will be able to decide a personalized approach’s, varying from traditional whole gland therapies, passing by the emerging focal treatments until exclusive surveillance. Concomitantly, in the future, less patients will be overdiagnosed and overtreated. Our readers will be able the get their self “middle term decisions”, after reading the favorable arguments (Dell´Oglio and Sanchez Salas, from Paris) and contrary to treatment (Schulman and Polascyck, from North Carolina)…

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Most of patients with localized prostate cancer will be treated in the future? | Opinion: Yes

Vol. 43 (4): 579-583, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2017.04.02


Paolo Dell’Oglio 1,2, Rafael Sanchez-Salas 1
1 Department of Urology, Institut Mutualiste Montsouris, Paris, France; 2 Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy

Keywords: Prostatic Neoplasms; Patients; Epidemiology


Localized prostate cancer (LPCa) is an heterogeneous disease extending from individuals who harbor indolent cancer, that are highly unlikely to develop metastases, to individuals with more aggressive disease, that have higher risk of metastatic burden. This would translates into different oncologic outcomes and have implications for disease management.

Once the diagnosis of LPCa is established, remains challenging to identify those patients who may benefit from delayed or immediate treatment. Several options exist, from active surveillance (AS) to the whole-gland treatments (1). However, the optimal one is still unclear. To date, the percentage distribution of treatment for LPCa is around 8.4% for observation, 13.1% for ablative therapies, 28.1% for external beam radiotherapy (RT), 1.6% for brachytherapy, 45% for radical prostatectomy (RP) and 3.7% for primary androgen deprivation therapy (2)…

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Most of patients with localized prostate cancer will be treated in the future? | Opinion: No

Vol. 43 (4): 584-587, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2017.04.03


Ariel A. Schulman 1, Thomas J. Polascik 1
1 Division of Urology, Duke University Medical Center, Durham, NC, USA

Keywords: Prostatic Neoplasms; Patients; Epidemiology


We are in the midst of a major shift in the diagnosis and management of localized prostate cancer. The prevailing approach of the 1980’s and 1990’s focused on widespread population-based prostate specific antigen (PSA) testing and curative-intent treatment for any detected cancer. The philosophical approach in the most recent decade is now defined by risk-adapted PSA screening, and integration of novel imaging techniques and biomarkers to increase the detection of clinically significant cancer. Concomitantly, we are witnessing the expanding utilization of active surveillance and partial ablation trategies to avoid overtreatment. We believe that continued development in each of these areas will continue to decrease the number of patients with localized disease treated with traditional whole gland surgery or radiation in the future…

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Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

Vol. 43 (4): 588-599, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0483


Arie Carneiro 1,2, Willy Baccaglini 2, Felipe P.A. Glina 3, Paulo P. Kayano 1, Victor M. Nunes 4, Oren Smaletz 5, Wanderley Marques Bernardo 4, Icaro Thiago de Carvalho 6, Gustavo Caserta Lemos 1
1 Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil; 2 Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasil; 3 Faculdade de Ciências Médicas, Universidade Metropolitana de Santos, SP, Brasil; 4 Centro Universitário Lusiada, Faculdade de Ciências Médicas de Santos, SP, Brasil; 5 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil; 6 Departamento de Radioterapia, Hospital Israelita Albert Einstein, São Paulo, Brasil

Context: Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors.

Objective: To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa.

Materials and Methods: Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT).

Results: 34.338 patients were analyzed in six included papers,...

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High cancer detection rate using cognitive fusion – targeted transperineal prostate biopsies

Vol. 43 (4): 600-606, July – August, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0511


Snir Dekalo 1, Haim Matzkin 1, Nicola J Mabjeesh 1
1 Department of Urology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel



Objective MRI of the prostate improves diagnostic accuracy of prostate cancer. Dif­ferent fusion approaches with transrectal ultrasound images are employed. Objective: To determine detection rate of prostate cancer in men undergoing transperineal MRI-based cognitive fusion biopsy.

Materials and Methods: One hundred and sixty-four consecutive men underwent a multiple-core prostate transperineal biopsy. Univariable and multivariable logistic re­gression analyses were used to address the relationship between clinical parameters and prostate cancer detection rate.

Results: One hundred and fourteen patients underwent mpMRI prior to the transperi­neal biopsy, 52 (45%) were diagnosed with prostate cancer, of them, 36 had Gleason score ≥7 (69%). Among these 114 patients, 82 had suspicious lesions on MRI, and 43 of them were diagnosed with cancer (52%). On multivariate analysis, the most significant independent predictive factors were PSA density (P<0.001) and suspicious MRI lesion (P=0.006). Men with a PSA density of more than 0.22 and a suspicious lesion on MRI had a detection rate of 78%. Detection rate among 50 patients with no MRI study prior to this biopsy was 26%.

Conclusions: This study showed that among a group of mostly multi-biopsied patients, the presence of mpMRI lesions and high PSA density values helped to detect clinically significant prostate cancer using cognitive MRI/TRUS fusion...

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