Difference of opinion

Radical prostatectomy for high-risk prostate cancer | Opinion: NO

Vol. 45 (3): 428-434, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2019.03.03


DIFFERENCE OF OPINION

Saum Ghodoussipour 1, Giovanni Enrico Cacciamani 1, Andre Luis de Castro Abreu 1
1 USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.

Keywords: Prostatic Neoplasms; Prostatectomy; Radiotherapy


BACKGROUND

Prostate cancer (PC) is the most common solid malignancy in men. In 2019, there are expected to be 174,000 new diagnoses in the United States with 31,000 patients ultimately succumbing to their disease (1). Those with more aggressive disease are at a greater risk of local treatment failure and death (2), thus emphasis on the appropriate management for the subset of patients with high risk PC (HRPC) is paramount.

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Radical prostatectomy for high-risk prostate cancer | Opinion: YES

Vol. 45 (3): 424-427, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2019.03.02


DIFFERENCE OF OPINION

Leonardo O. Reis 1, 2, Rodrigo Montenegro 3, Quoc-Dien Trinh 3
1 UroScience, Pontificia Universidade de Campinas – PUC, Campinas, SP, Brasil; 2 Departamento de Urologia, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 3 Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Keywords: Prostatic Neoplasms; Prostatectomy; Radiotherapy


INTRODUCTION

Prostate cancer is the commonest non-skin malignancy in men. In most cases, prostate cancer has an indolent course however approximately 30,000 still die from the disease every year. Indeed, a subset of men will present with potentially lethal high-risk prostate cancer at diagnosis. We believe that this proportion will increase as fewer men are screened for prostate cancer, amidst ongoing concerns about overdiagnosis and overtreatment.

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Super active surveillance for low-risk prostate cancer | Opinion: Yes

Vol. 45 (2): 210-214, March – April, 2019

doi: 10.1590/S1677-5538.IBJU.2019.02.02


DIFFERENCE OF  OPINION

Leonardo O. Reis 1, 2, Danilo L. Andrade 1, Fernando J. Bianco Jr. 3
1 UroScience, Pontifícia Universidade de Campinas – PUC Campinas, Campinas, SP, Brasil; 2 Departa­mento de Urologia, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 3 – Urological Research Network, Miami, FL, USA

Keywords: Prostatic Neoplasms; Risk Reduction Behavior; Watchful Waiting; Therapeutics


Prostate cancer is the most common solid tumor in men in western countries. Notwithstanding, its high incidence, most patients survive their prostate cancer diagnosis and die from other causes (1). This low cancer death event rate poses remarkable challenges for both patients and their treating physicians. Fundamentally the “overs”, meaning overdiagnosis and overtreatment (2).
Both particularly important as significant issues for patients arise as consequences of treatment.
Distastefully, urinary incontinence and erectile dysfunction, among other, both exerting substantial impact in quality of life (3).

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Super active surveillance for low-risk prostate cancer | Opinion: No

Vol. 45 (2): 215-219, March – April, 2019

doi: 10.1590/S1677-5538.IBJU.2019.02.03


DIFFERENCE OF  OPINION

Saum Ghodoussipour 1, Amir Lebastchi 2, Peter Pinto 2, Andre Berger 1
1 Department of Urology, University of Southern California, Los Angeles, California, USA; 2 National Cancer Institute – NCI, Bethesda, Maryland, USA

Keywords: Prostatic Neoplasms; Risk Reduction Behavior; Watchful Waiting; Therapeutics


Prostate cancer (PC) is diagnosed in over 170,000 men in the United States each year. While this makes PC one of the most common solid malignancies in men, a significant majority will not die from PC but from other unrelated causes (1). In fact, almost half of men with screening detected and localized PC are considered candidates for deferred treatment (2). In an effort to decrease the morbidity associated with overtreatment, guideline panels now recommend active surveillance (AS) for those with low risk (LR) disease (3-5).

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Microdissection is the best way to perform sperm retrieval in men with non-obstructive azoospermy? | Opinion: Yes

Vol. 44 (6): 1063-1066, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.06.02


DIFFERENCE OF OPINION

Renato Fraietta 1
1 Setor Integrado de Reprodução Humana, Universidade Federal de São Paulo, São Paulo, SP, Brasil

 Keywords: Azoospermia; Microdissection; Sperm Retrieval; Fertility


Non-obstructive azoospermia (NOA) is the diagnosis of one percent of all men and 10% of men complaining about infertility (1, 2). All NOA patients should be evaluated with complete history and physical examination, with genetic testing (karyotype analysis and Y chromosome microdeletion testing) being offered and performed, which will identify the causes of NOA in up to 17% of men (3, 4). Hormonal profile is also important as up to 47% of men that have impaired spermatogenesis with NOA were found to have hypogonadism (4,5).

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Microdissection is the best way to perform sperm retrieval in men with non-obstructive azoospermy? | Opinion: No, there are other options

Vol. 44 (6): 1067-1070, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.06.03


DIFFERENCE OF OPINION

Marcelo Vieira 1, 2
1 Membro Titular da Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil; 2 Urologista do Projeto ALFA, Sao Paulo, SP, Brasil

Keywords: Azoospermia; Microdissection; Sperm Retrieval; Fertility


In the last 23 years, Intracitoplasmic Sperm Injection (ICSI) has given non-obstructive azoospermic man the opportunity to become biological fathers, if sperm could be found in their testicles. These men present the biggest challenge in the routine of infertility clinics around the World, since there are no positive, clinical or laboratory, prognostic factors for sperm recovery.

Once testicular sperm has been regularly used for ICSI, discussion about which technique for testicular sperm retrieval has been done. Sperm can be harvest from testicular parenchyma by: open biopsy (Testicular Sperm Extraction-TESE), percutaneous aspiration (Testicular Sperm Aspiration), open guided biopsy by previous cytology (Testicular fine-needle Aspiration) and open biopsy using microsurgery technique (Testicular Microdissection). The proposed techniques have the same objective, to find sperm with minimal testicular damage and in a reproducible way (1).

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