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Mariotti GC, Schmid BP, Gilberto GM, Garcia RG, Carneiro A. Letter: Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial. J Urol 2024; 211:707. [PMID: 38353240 DOI: 10.1097/ju.0000000000003883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 04/10/2024]
Affiliation(s)
| | - Bruno Pagnin Schmid
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Arie Carneiro
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Andrade GM, Manente FG, Barroso PJDD, Teles SB, Partezani AD, Baccaglini W, Sanchez-Salas R, Olivares R, Nahar B, Lemos GC, Bianco B, Carneiro A. Outcomes of ablative therapy and radical treatment for prostate cancer: a systematic review and meta-analysis. Int Braz J Urol 2024; 50:IBJU20230628. [PMID: 38446906 DOI: 10.1590/s1677-5538.ibju.2023.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
PURPOSE To compare biochemical recurrence, sexual potency and urinary continence outcomes of ablative therapy and radical treatment (radical prostatectomy or radiotherapy with androgen deprivation therapy). MATERIAL AND METHODS A systematic review and meta-analysis followed the PRISMA guidelines were performed. We searched MEDLINE/PubMed. Biochemical recurrence at three and five years; incontinence rate (patients who used one pad or more) and erectile dysfunction rate at 12 and 36 months (patients who did not have sufficient erection to achieve sexual intercourse) were evaluated. The Mantel-Haenszel method was applied to estimate the pooled risk difference (RD) in the individual studies for categorical variables. All results were presented as 95% confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998). RESULTS Eight studies comprising 2,677 men with prostate cancer were included. There was no difference in biochemical recurrence between ablative and radical treatments. We observed the same biochemical recurrence between ablative therapy and radical treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD -0.13; 95%CI, -0.27, 0.01; I2=89%; P=0.32). When focal treatment was analyzed alone, two studies with 582 patients found higher erectile function at 12 months in the ablative therapy group than in the radical treatment (88.9% vs. 30.8%, respectively; RD -0.45; 95%CI -0.84, -0.05; I2=93%; P=0.03). CONCLUSION Biochemical recurrence and urinary continence outcomes of ablative therapy and radical treatment were similar. Ablative therapy appears to have a high rate of sexual potency.
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Affiliation(s)
- Guilherme Miranda Andrade
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Faculdade de Medicina do ABC - Centro Universitário (FMABC), Santo André, SP, Brasil
| | | | | | | | | | - Willy Baccaglini
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Ruben Olivares
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine, Miami, USA
| | | | - Bianca Bianco
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Faculdade de Medicina do ABC - Centro Universitário (FMABC), Santo André, SP, Brasil
| | - Arie Carneiro
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Badan SC, Baccaglini W, Carneiro A, Lemos GC. Robot-assisted retroperitoneal lymph node dissection as primary treatment for stage II seminoma germ cell tumor. Int Braz J Urol 2024; 50:225-226. [PMID: 38386793 PMCID: PMC10953600 DOI: 10.1590/s1677-5538.ibju.2023.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Historically, therapeutic avenues for patients with clinical stage II seminoma germ cell tumors (SGCT) were confined to radiotherapy and chemotherapy. While survival rates with these modalities are commendable, both entail substantial long-term morbidities. Furthermore, this youthful patient cohort exhibits elevated rates of secondary malignancies, surfacing decades post-successful primary cancer treatment (1). Recently, retroperitoneal lymph node dissection (RPLND) has emerged as a primary treatment consideration for individuals with low-volume metastatic seminoma (2-4). However, there is a dearth of video documentation illustrating the robotic assisted (RA) bilateral approach (5- 7). METHODS We present the case of a 24-year-old male who underwent prior left orchiectomy for seminoma (pT1b). Despite negative serum tumor markers, a 1.7 x 1.4cm lymph node enlargement was identified in the aortic bifurcation after 4 months, classifying the patient as stage IIA per the IGCCCG risk classification. Subsequently, a RA bilateral template RPLND was performed due to the patient's refusal of chemotherapy, citing concerns about offspring. RESULTS The surgery was performed, incorporating nerve sparing techniques, lasting 4h13minutes, an estimated bleeding rate of 400ml, without intraoperative complications. The patient was discharged within 24 hours of the procedure, following a prescribed low-fat diet. CONCLUSION The patient experienced postoperative well-being, painlessness, and resumed work three weeks post-procedure. Preserved ejaculation was noted, and adjuvant therapy was performed with 2 cycles of EP due to the anatomopathological result. The feasibility of robotic primary RPLND for SGCT was demonstrated, showing reduced postoperative pain and early hospital discharge. Further studies are necessary to validate our findings regarding oncological, safety, and functional outcomes.
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Affiliation(s)
- Stefano Cogo Badan
- Albert Einstein Instituto Israelita de Ensino e PesquisaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Albert Einstein Instituto Israelita de Ensino e Pesquisa, São Paulo, SP, Brasil;
| | - Willy Baccaglini
- Faculdade de Medicina do ABCDisciplina de UrologiaSanto AndréSPBrasilDisciplina de Urologia, Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil;
| | - Arie Carneiro
- Albert Einstein Instituto Israelita de Ensino e PesquisaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Albert Einstein Instituto Israelita de Ensino e Pesquisa, São Paulo, SP, Brasil;
| | - Gustavo Caserta Lemos
- Hospital Israelita Albert EinsteinSão PauloSPBrasilServiço de Urologia, Hospital Israelita Albert Einstein, , São Paulo, SP, Brasil
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Lourenço DB, Santos HOD, Hirakawa EY, Rios LAS, Lemos GC, Bianco B, Carneiro A. Does vaginal surgery for correction of pelvic organ prolapse improve urinary function? A prospective cohort study. Int Urogynecol J 2024; 35:149-156. [PMID: 37999760 DOI: 10.1007/s00192-023-05683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction. METHODS A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery. RESULTS Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001). CONCLUSIONS Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms.
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Affiliation(s)
- Danilo B Lourenço
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Hugo O D Santos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Elizabeth Y Hirakawa
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Luis Augusto S Rios
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Gustavo C Lemos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Bianca Bianco
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil.
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
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Costa PHP, Papa ACD, Carneiro A. Editorial Comment: Association between self-reported mobile phone use and the semen quality of young men. Int Braz J Urol 2024; 50:105-107. [PMID: 38166228 PMCID: PMC10947643 DOI: 10.1590/s1677-5538.ibju.2024.9904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 01/04/2024] Open
Affiliation(s)
- Pedro Henrique Peixoto Costa
- Hospital Israelita Albert EinsteinDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil;
| | - Arthur Cardoso Del Papa
- Centro Universitário -FMABCDepartamento de UrologiaSanto AndréSPBrasilDepartamento de Urologia, Centro Universitário -FMABC, Santo André, SP, Brasil
| | - Arie Carneiro
- Hospital Israelita Albert EinsteinDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil;
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Carneiro A, Andrade GM. Technology description, initial experience and first impression of HUGO™ RAS robot platform in urologic procedures in Brazil. Int Braz J Urol 2023; 49:763-774. [PMID: 37903010 PMCID: PMC10947622 DOI: 10.1590/s1677-5538.ibju.2023.9910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 11/01/2023] Open
Affiliation(s)
- Arie Carneiro
- Hospital Israelita Albert EinsteinDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP. Brasil;
| | - Guilherme Miranda Andrade
- Hospital Israelita Albert EinsteinDepartamento de Uro-oncologia e Cirurgia RobóticaSão PauloSPBrasilDepartamento de Uro-oncologia e Cirurgia Robótica, Hospital Israelita Albert Einstein, São Paulo, SP. Brasil;
- FMABCFaculdade de Medicina do ABCDisciplina de UrologiaSanto AndréSPBrasilDisciplina de Urologia da Faculdade de Medicina do ABC – FMABC, Santo André, SP. Brasil
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Jardim DL, Gonçalves E Silva A, Pompeo ASFL, Sarkis AS, Cardoso APG, Sasse AD, Fay AP, Soares A, Pompeo ACL, Carneiro A, Kann AG, Fogassa C, De Freitas CH, Chade DC, Herchenhorn D, De Almeida DVP, Da Rosa DAR, Wiermann EG, Schutz FAB, Kater FR, De Moura F, Korkes F, Meyer F, De Oliveira FNG, Sabino F, Almeida GL, Avanço G, Guimaraes GC, Lemos GC, Carvalhal GF, Kim H, Morbeck IP, Campagnari JC, Rinck JA, Da Ponte JRT, Da Trindade KM, Atem L, Borges L, Nogueira LM, Batista LTEA, Maia MC, Sadi MV, Rocha MAA, Luz MDA, Smaletz O, Lages PSM, Matuda RMK, Reis RBD, Indio RF, Fernandes RDC, Cavallero SR, Souza VC, Busato W, Alfer W, Maluf F. "Non-metastatic, Castration-resistant Prostate Cancer: Diagnostic and Treatment Recommendations by an Expert Panel from Brazil". Clin Genitourin Cancer 2023; 21:e58-e69. [PMID: 36266221 DOI: 10.1016/j.clgc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Non-metastatic, castration-resistant prostate cancer (nmCRPC) is an important clinical stage of prostate cancer, prior to morbidity and mortality from clinical metastases. In particular, the introduction of novel androgen-receptor signaling inhibitors (ARSi) has changed the therapeutic landscape in nmCRPC. Given recent developments in this field, we update our recommendations for the management of nmCRPC. METHODS A panel of 51 invited medical oncologists and urologists convened in May of 2021 with the aim of discussing and providing recommendations regarding the most relevant issues concerning staging methods, antineoplastic therapy, osteoclast-targeted therapy, and patient follow-up in nmCRPC. Panel members considered the available evidence and their practical experience to address the 73 multiple-choice questions presented. RESULTS Key recommendations and findings include the reliance on prostate-specific antigen doubling time for treatment decisions, the absence of a clear preference between conventional and novel (i.e., positron-emission tomography-based) imaging techniques, the increasing role of ARSis in various settings, the general view that ARSis have similar efficacy. Panelists highlighted the slight preference for darolutamide, when safety is of greater concern, and a continued need to develop high-level evidence to guide the intensity of follow-up in this subset of prostate cancer. DISCUSSION Despite the limitations associated with a consensus panel, the topics addressed are relevant in current practice, and the recommendations can help practicing clinicians to provide state-of-the-art treatment to patients with nmCRPC in Brazil and other countries with similar healthcare settings.
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Affiliation(s)
- Denis L Jardim
- Hospital Sírio Libanês, Sociedade Beneficente de Senhoras, São Paulo, SP, Brasil
| | | | - Alexandre Saad Fere Lima Pompeo
- Hospital Beneficência Portuguesa, Departamento de Uro-Oncologia, São Paulo, SP, Brasil; Grupo de Uro-Oncologia do Hcor, São Paulo, SP, Brasil
| | - Alvaro Sadek Sarkis
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | | | - Andrey Soares
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil; Grupo Oncoclínicas, São Paulo, SP, Brasil; Latin American Cooperative Oncology Group (LACOG), Genitourinary Group
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | - Camilla Fogassa
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | - Daher Cezar Chade
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da USP, São Paulo, SP, Brasil
| | - Daniel Herchenhorn
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Rede D'Or, Rio de Janeiro, RJ, Brasil
| | | | | | | | | | - Fabio Roberto Kater
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Fernando De Moura
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Fernando Korkes
- Grupo de uro-oncologia da Faculdade de Medicina do ABC, Santo André, SP, Brasil; Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Fernando Meyer
- Sociedade Brasileira de Urologia, Curitiba, PR, Brasil; Hospital Universitário Cajuru, Curitiba, PR, Brasil; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
| | - Fernando Nunes Galvao De Oliveira
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Clínica de Oncologia do Grupo CAM (CLION), Salvador, BA, Brasil
| | - Fernando Sabino
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Hospital Santa Lúcia, Brasília, DF, Brasil; Hospital Universitário de Brasília, Brasília, DF, Brasil
| | | | | | | | | | - Gustavo Franco Carvalhal
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil; Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | - Hanna Kim
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Igor Protzner Morbeck
- Hospital Sírio Libanês, Sociedade Beneficente de Senhoras, São Paulo, SP, Brasil; Universidade Católica de Brasília, Brasília, DF, Brasil
| | - Joao Carlos Campagnari
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Clínica de Urologia e Nefrologia, São Paulo, SP, Brasil
| | | | | | - Karine Martins Da Trindade
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Rede D'Or, Fortaleza, CE, Brasil
| | | | - Leonardo Borges
- Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Lucas Mendes Nogueira
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | | | - Manuel Caitano Maia
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Hospital Porto Dias, Department of Medical Oncology, Belém, Pará, Brasil
| | | | | | - Murilo De Almeida Luz
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Hospital Erasto Gaertner, Curitiba, PR, Brasil
| | - Oren Smaletz
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | | | | | | | - Roni De Carvalho Fernandes
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil; Irmandade da Santa Casa de Misericórdia de São Paulo - Hospital Central, São Paulo, SP, Brasil
| | - Sandro Roberto Cavallero
- Centro de Tratamento Oncológico (CTO), Belém, PA, Brasil; Hospital Adventista de Belém (HAB), Belém, PA, Brasil
| | - Vinicius Carrera Souza
- Instituto D'Or de Ensino e Pesquisa, Salvador, BA, Brasil; Rede D'Or, Salvador, BA, Brasil
| | - Wilson Busato
- Universidade do Vale do Itajai (UNIVALI), Itajai, SC, Brasil
| | - Wladimir Alfer
- Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Fernando Maluf
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil.
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Andrade GM, Sesconetto L, da Silva RBR, Dos Santos GGR, Kayano PP, Baccaglini W, Bezerra MB, Bianco B, Lemos GC, Carneiro A. Impact of COVID-19 pandemic on prostate cancer outcomes at an uro-oncology referral center. Int Braz J Urol 2023; 49:233-242. [PMID: 36826377 DOI: 10.1590/s1677-5538.ibju.2022.0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/09/2022] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION To evaluate the possible effects of the coronavirus disease 2019 (COVID-19) pandemic on the oncologic results of patients with prostate cancer regarding clinical staging, presence of adverse pathological outcomes, and perioperative complications. MATERIALS AND METHODS This retrospective study included patients who underwent radical prostatectomy. The time between biopsy and surgery, staging tests, final histopathological evaluation after surgery, lymphadenectomy rate, postoperative complications, and prostatic specific antigen (PSA) levels (initial and 30 days after surgery) were analyzed and compared in a group of patients before and during the pandemic period. RESULTS We included 226 patients: 88 in the pre-pandemic period and 138 during the pandemic period. There was no statistically significant difference in mean age, body mass index, ASA, pathological locally advanced disease, the proportion of patients who underwent lymphadenectomy, and ISUP grade in the biopsy between the groups. Positive surgical margins, prostatic extracapsular extension, and PSA levels at 30 days were also similar between the groups. The mean time between medical consultation and surgery was longer in the pandemic period than in the pre-pandemic (124 vs. 107 days, p<0.001), and the mean time between biopsy and medical consultation (69.5 days vs. 114 days, p<0.001) and between biopsy and surgery (198.5 days vs. 228 days, p=0.013) was shorter during the pandemic. The incidence of severe early and late perioperative complications was similar between the periods. CONCLUSIONS There was no delay between diagnosis and treatment at our institution during the COVID-19 pandemic period. No worsening of the prostate cancer features was observed.
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Affiliation(s)
| | - Lucas Sesconetto
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | | | | | - Paulo Priante Kayano
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | - Willy Baccaglini
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | | | - Bianca Bianco
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | - Gustavo Caserta Lemos
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | - Arie Carneiro
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
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Teles SB, Sanchez-Salas R, Carneiro A. Editorial Comment: Radical prostatectomy without prior biopsy following multiparametric magnetic resonance imaging and prostate-specific membrane antigen positron emission tomography. Int Braz J Urol 2023; 49:155-157. [PMID: 36512465 PMCID: PMC9881807 DOI: 10.1590/s1677-5538.ibju.2023.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Saulo Borborema Teles
- Hospital Israelita Albert EinsteinDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Rafael Sanchez-Salas
- McGill UniversityDivision of UrologyDepartment of SurgeryMontrealQuebecCanadaDepartment of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada
| | - Arie Carneiro
- Hospital Israelita Albert EinsteinDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil,Arie Carneiro, MD, Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil. E-mail:
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Lourenço DB, Duarte-Santos HO, Partezani AD, Teles SB, Bianco B, Rios LAS, Lemos GC, Carneiro A. Urodynamic profile of voiding in patients with pelvic organ prolapse after surgery: a systematic review with meta-analysis. Int Urogynecol J 2023; 34:53-65. [PMID: 35460345 DOI: 10.1007/s00192-022-05086-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/03/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is a defect of the female pelvic floor. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), and obstructive symptoms may occur in these patients. The objective of surgical treatment is to restore the anatomy and function of the pelvic floor; however, it may prompt urinary symptoms not present previously. We performed a systematic review and meta-analysis to determine urodynamic changes in patients undergoing surgical correction for POP. METHODS PubMed and Cochrane databases were searched for studies that contained data from urodynamic evaluation before and after vaginal surgery for POP. The main urodynamic data collected were free uroflowmetry (maximum flow [Qmax], voided volume, and post-void residual volume [PVR]), cystometry (bladder capacity, presence of detrusor overactivity [DO], SUI or UUI, and Valsalva leak point pressure), and pressure × flow study (detrusor pressure at maximum flow [PdetQmax], Qmax, and PVR). RESULTS A total of 22 studies were included (1,549 women). Patients had a significantly higher prevalence of DO before surgery (OR = 1.56; 95% CI = 1.06-2.29), and surgeries without sling placement demonstrated a tendency to ameliorate DO. Patients who did not receive a sling were more incontinent after surgery. Bladder-emptying parameters improved after surgery, with higher PdetQmax before surgery (IV = 3.23; 95% CI = 0.45-1.18). Patients who did not receive MUS presented a lower Qmax (IV = -3.19; 95%CI = -4.09 to -2.30) and a higher PVR (IV = 27.89; 95%CI = 15.68-40.1) before surgery. CONCLUSION Correction surgery for POP yields better urodynamic emptying parameters, with a reduction in the prevalence of DO. In contrast, sling placement enhances obstructive parameters.
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Affiliation(s)
- Danilo Budib Lourenço
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Hugo Octaviano Duarte-Santos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Alexandre Dib Partezani
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Saulo Borborema Teles
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Bianca Bianco
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Luis Augusto Seabra Rios
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Gustavo Caserta Lemos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil.
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11
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Takemura LS, Barbosa ÁRG, Amaral BS, Bosco AAD, Lourenço DB, Apezzato M, Barbosa JABA, Faria EF, Bianco B, Lemos GC, Carneiro A. Radical prostatectomies for treatment of prostate cancer: trends in a ten-year period in public health services in the city of São Paulo, Brazil. Einstein (Sao Paulo) 2022; 20:eAO0049. [PMID: 36477523 DOI: 10.31744/einstein_journal/2022ao0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the characteristics of public health services related to radical prostatectomy, according to hospital volume of surgeries and stratified as academic and non-academic centers. METHODS An ecological study was conducted using a database available in TabNet platform of the Unified Health System Department of Informatics. Number of surgeries, length of hospital stay, length of stay in intensive care unit, in-hospital mortality rate, and cost of hospitalization were evaluated. The hospitals were divided into three subgroups according to surgery volume (tercile), and results were compared. The same comparisons were made among academic and non-academic centers. We considered academic centers those providing Urology residency program. RESULTS A total of 11,259 radical prostatectomies were performed in the city of São Paulo between 2008 and 2018. We observed a significant trend of increase in radical prostatectomies for treating prostate cancer over the years (p=0.007). The length of stay in intensive care unit, and number of deaths were not statistically different among centers with diverse surgery volume, nor between academic and non-academic centers. However, length of hospital stay was significantly shorter in academic centers (p=0.043), while cost of hospitalization was significantly higher in high-volume center compared to low- (p<0.001) and intermediate-volume centers (p<0.001). CONCLUSION Length of hospital stay for radical prostatectomies performed in public services in the city of São Paulo was shorter in academic centers, whereas hospitals with a high volume of surgeries showed greater cost of hospitalization.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bianca Bianco
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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12
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Carneiro A, Claros OR, Cha JD, Kayano PP, Apezzato M, Wagner AA, Lemos GC. Can remote assistance for robotic surgery improve surgical performance in simulation training? A prospective clinical trial of urology residents using a simulator in south america. Int Braz J Urol 2022; 48:952-960. [PMID: 36173407 PMCID: PMC9747033 DOI: 10.1590/s1677-5538.ibju.2022.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the role of remote proctoring during the initial training phases of a robotics curriculum using surgical robot skills simulator exercises. MATERIALS AND METHODS Prospective randomized study comprising 36 urology residents and junior staff urologists without previous robotic training. Group 1 (G1) performed exercises without any assistance or support, group 2 (G2) received support from in-person proctor, and group 3 (G3) from a remote proctor through a telementoring system. Qualitative and quantitative analyses were conducted for each exercise and group. RESULTS The overall score approval rates (OSA) for the different skill exercises were Ring Walk 2 (RW2) 83%, Energy Dissection 2 (ED2) 81%, and Ring Walk 3 (RW3) 14%. RW2 OSA was higher on attempt 3 than on attempt 1 (83.3% vs. 63.9%, p=0.032). ED2 OSA rate was higher in attempt 3 than in attempt 1 (80.6% vs. 52.8%, p=0.002). RW2 OSA was similar among the groups. In ED2, both remote and live assistance were significantly related to upper OSA (G1=47.2%, G2=75.0%, G3=83.3%, p=0.002). RW3 had similar OSA among the groups, which can be explained by the high level of difficulty and low OSA in all the groups. However, in a sensitive quantitative analysis, the mean overall score of the participants in RW3 was higher in both proctored groups (G1=24, G2=57.5, G3=51.5, p=0.042). CONCLUSION Robotic performance increased significantly over three attempts for simulation exercises of low, medium, but not high-complexity. Proctoring, either in-person or remotely, has a positive impact on approval performance, particularly in intermediate tasks.
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Baccaglini W, Rodrigues AF, Teles SB, Christofe NM, Glina FPA, Lemos GC, Sanchez-Salas R, Olivares R, Carneiro A. The current role of local treatment in metastatic prostate cancer: systematic review and meta-analysis. Acta Oncol 2022; 61:1386-1393. [PMID: 36258673 DOI: 10.1080/0284186x.2022.2132113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the current role of local treatment in prostate cancer with a low metastatic burden (or oligometastatic) in relation to survival and safety. METHODS We performed a meta-analysis of studies published in the MEDLINE, EMBASE, and Cochrane databases until December 2021. Studies comparing local and nonlocal treatment in patients with metastatic prostate cancer were included. The risk of bias within studies was assessed using the Newcastle-Ottawa and Cochrane risk of bias tool. Oligo-metastasis was defined as low-volume metastasis with up to five lesions. The local treatment used was radical prostatectomy or external beam radiation therapy associated with systemic therapy (i.e., androgen deprivation therapy ± abiraterone, docetaxel, enzalutamide, or apalutamide). The endpoints evaluated were overall survival, cancer-specific survival, failure-free survival, and complication rates. RESULTS Thirteen studies including 46,541 patients were included. The 5-year overall survival (16.0% vs. 6.5%, respectively; odds ratio (OR) 2.74; 95% confidence interval (CI), 2.18, 3.44; I2 = 0%; p < .00001) and 3-year cancer-specific survival (48.2% vs. 26.3%, respectively; OR 1.87; 95% CI: 1.44, 2.44; I2 = 0%; p < .00001) were higher in the local treatment group than that of the nonlocal treatment group. In addition, failure-free survival at 3 years was higher in the local treatment group than that of the nonlocal treatment group (40.5% vs. 28.4%, respectively; OR 1.72; 95% CI, 1.38, 2.14; I2 = 0%; p < .00001). The low complication rate of Clavien-Dindo grade ≥3 indicated that local treatment is feasible and safe in this setting. CONCLUSION Recent data have shown that local treatment combined with systematic therapy, might improve the overall, cancer-specific, and failure-free survivals of patients diagnosed with metastatic prostate cancer. Furthermore, local treatment is both feasible and safe. Further studies evaluating the quality of life of these patients are needed.
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Affiliation(s)
- Willy Baccaglini
- Department of Urology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Department of Urology, Centro Universitário FMABC, Santo André, Brazil
| | - Antonio F Rodrigues
- Department of Uro-oncology and Robotic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Saulo B Teles
- Department of Uro-oncology and Robotic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Nicolle M Christofe
- Department of Urology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Felipe P A Glina
- Department of Urology, Centro Universitário FMABC, Santo André, Brazil
| | - Gustavo C Lemos
- Department of Urology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Rubén Olivares
- Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Case Western University, Cleveland, OH, USA
| | - Arie Carneiro
- Department of Urology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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14
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Andrade GM, Gil AO, Barbosa ARG, Teles SB, Amaral BS, Monteiro J, Apezzato M, Bianco B, Lemos GC, Carneiro A. Analysis of adrenalectomy for the treatment of adrenal diseases performed by the Public Health Service in São Paulo between 2008 and 2019. Rev Col Bras Cir 2022; 49:e20223320. [PMID: 35946638 PMCID: PMC10578801 DOI: 10.1590/0100-6991e-20223320-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION treating benign (hormonally active or nonfunctional) and malignant adrenal cancer includes adrenalectomy. The expertise of surgeons and surgery performed by high-volume surgeons were associated with fewer complications and lower cost. We aimed to describe and compare the number of surgeries, mortality rate, and length of hospital stay for adrenalectomies performed between 2008 and 2019 in the public health system of São Paulo. METHODS this was an ecological study. The data were collected using the TabNet Platform of the Unified Health System Department of Informatics. Outcomes analyzed included the number of surgeries performed, mortality rate during hospital stay, and length of hospital stay. Public hospitals in Sao Paulo were divided into three subgroups according to the surgical volume of adrenalectomies performed as well as hospitals with and without a residency program in Urology, and the results were compared among them. RESULTS a total of 943 adrenalectomies were performed in Sao Paulo between 2008 and 2019. Mortality rates during hospital stay according to hospital surgical volume were no reported deaths in low-volume, 0.015% in intermediate-volume, and 0.004% in high-volume hospitals. The average length of the ICU stay was 1.03 days in low-volume, 2.8 in intermediate-volume, and 1.12 in high-volume hospitals (analysis between intermediate and high volume centers with statistical significance, p=0.016). CONCLUSIONS despite no statistically significant differences among the groups analyzed, mortality rates were very low in all groups. ICU stay was shorter in high-volume centers than in intermediate-volume centers.
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Affiliation(s)
| | - Antonio Oterol Gil
- - Hospital Israelita Albert Einstein, Urologia - São Paulo - SP - Brasil
| | | | | | | | - Jose Monteiro
- - Hospital Israelita Albert Einstein, Urologia - São Paulo - SP - Brasil
| | - Marcelo Apezzato
- - Hospital Israelita Albert Einstein, Urologia - São Paulo - SP - Brasil
| | - Bianca Bianco
- - Hospital Israelita Albert Einstein, Urologia - São Paulo - SP - Brasil
| | | | - Arie Carneiro
- - Hospital Israelita Albert Einstein, Urologia - São Paulo - SP - Brasil
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15
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Partezani AD, Duarte-Santos HO, Amaral BS, Gomes Barbosa AR, Apezzato M, Brunhara J, Bianco B, Lemos GC, Carneiro A. Outcomes of nephrectomy for renal cell carcinoma: An ecologic retrospective study in a middle-income country. Arch Ital Urol Androl 2022; 94:129-133. [PMID: 35775333 DOI: 10.4081/aiua.2022.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe and compare the outcomes and indirect costs of oncological radical (RN) and partial nephrectomies (PN) in hospitals from the São Paulo public health system, Brazil. MATERIALS AND METHODS An ecologic retrospective study was performed from 2008 to 2019, using the TabNet Platform of the Brazilian Unified Health System Department of Informatics. Hospitals were classified according to volume of surgeries (low and high-volume, and also into four quartiles according to volume of surgeries), and with or without medical residency program in urology. The results were compared between groups. RESULTS In the period analyzed were performed 2.606 RN in 16 hospitals. Data available for PN ranged only from 2013-2019 and included 1.223 surgeries comprising 15 hospitals. Overall mortality rates were 0.41% for PN and 2.87% for RN. The length of hospital stay was significantly higher in low-volume hospitals for both RN and PN (8.97 vs. 5.62 days, p = 0.001, and 7.75 vs. 4.37 days, p = 0.001, respectively), and also for the RN in hospitals without residency program in Urology (9.37 vs. 6.54 days, p = 0.03). When the volume of surgeries was divided into four quartiles, the length of hospital stay and ICU hospitalization days were significantly higher in the first quartile hospitals for RN (p = 0.016) and PN (p = 0.009), respectively. The mortality rates and indirect costs were not different considering PN and RN in the different types of hospitals. CONCLUSIONS The length of hospital stay was significantly lower for both PN and RN in high-volume hospitals, and also for RN in hospitals with residency program in Urology.
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Affiliation(s)
| | | | | | | | - Marcelo Apezzato
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | - João Brunhara
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | - Bianca Bianco
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | | | - Arie Carneiro
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
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16
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Wroclawski ML, Amaral BS, Kayano PP, Busato WFS, Westphal SJ, Montagna E, Bianco B, Soares A, Maluf FC, Lemos GC, Carneiro A. Knowledge, attitudes, and practices of active surveillance in prostate cancer among urologists: a real-life survey from Brazil. BMC Urol 2022; 22:86. [PMID: 35706024 PMCID: PMC9199143 DOI: 10.1186/s12894-022-01036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Active surveillance (AS) is the preferred treatment for patients with very low-and low-risk prostate cancer (PCa), but it is underperformed worldwide. This study aimed to report knowledge, attitudes, and practices (KAP) of AS for PCa among urologists in Brazil. Methods This cross-sectional study used a questionnaire with 50 questions divided into participant characteristics, knowledge regarding inclusion criteria for AS, follow-up, intervention triggers, acceptance, and practice for an index patient. Data analysis comprises absolute and relative frequencies of the variables. After that, a logistic regression was performed in order to verify possible patterns of answers provided by the respondents in the index patient questionnaire. Results Questionnaires were sent through the SurveyMonkey® platform to 5,015 urologists using email addresses and through social media. A total of 600 (12%) questionnaires returned and 413 (8.2%) were completed and included in the analysis. Only 53% of urologists adopt AS for low- and very-low-risk PCa. Inclusion criteria were patients with age > 50 years (32.2%), prostate specific antigen (PSA) < 10 ng/mL (87.2%), T1 clinical stage (80.4%), Biopsy Gleason score ≤ 6, positive cores ≤ 2 (44.3%), positive core involvement < 50% (45.3%), and magnetic resonance imaging findings (38.7%). The PSA doubling time was still used by 60.3%. Confirmatory biopsy (55.9%), PSA level (36.6%), and digital rectal examination (34.4%) were considered by most urologists for follow-ups. Patient preference (85.7%), upgrade of Gleason score (73.4%), and increased number of positive cores (66.8%) were associated with conversion to definitive treatment. In an index patient, non-acceptance and active treatment request were the most cited reasons for not performing AS. Conclusion There is significant variability in the KAP of AS in Brazil, which indicates the need to reinforce AS, its inclusion and follow-up criteria, and the benefits for physicians and the general population. Trial registration: Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01036-1.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil. .,BP - A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil. .,Faculdade de Medicina do ABC, Santo Andre, SP, Brazil.
| | - Breno Santos Amaral
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil
| | - Paulo Priante Kayano
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil
| | | | | | - Erik Montagna
- Faculdade de Medicina do ABC, Santo Andre, SP, Brazil
| | - Bianca Bianco
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil.,Faculdade de Medicina do ABC, Santo Andre, SP, Brazil
| | - Andrey Soares
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil.,Centro Paulista de Oncologia - Oncoclínicas, São Paulo, SP, Brazil.,Latin American Cooperative Oncology Group - Genitourinary, Porto Alegre, RS, Brazil
| | - Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil.,BP - A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Gustavo Caserta Lemos
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43, São Paulo, SP, CEP: 04530-050, Brazil
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17
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Barbosa ÁRG, Takemura LS, Amaral BS, Wroclawski ML, Alfer W, Gil AO, Monteiro J, Lourenço DB, Cha JD, Apezzato M, Barbosa JABA, Bianco B, Lemos GC, Carneiro A. Benign prostatic hyperplasia surgical treatment trends in the Public Health System in São Paulo, Brazil. einstein (São Paulo) 2022; 20:eAO6880. [PMID: 35730806 PMCID: PMC9239570 DOI: 10.31744/einstein_journal/2022ao6880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022] Open
Abstract
Objective To describe and compare the number of surgeries, mortality rate, length of hospital stay, and costs of transurethral resection of the prostate and open prostatectomy for the treatment of benign prostatic hyperplasia, between 2008 and 2018, in the Public Health System in São Paulo, Brazil. Methods Ecological and retrospective study using data from the informatics department of the Brazilian Public Health System database. Procedure codes were “open prostatectomy” and “transurethral resection of the prostate.” The outcomes analyzed were compared between transurethral resection of the prostate and open prostatectomy according to the hospital surgical volume and presence or absence of a residency program. Results A total of 18,874 surgeries were analyzed (77% transurethral resection of the prostate) and overall mortality was not statistically different between procedures. Intermediate and high-volume centers had shorter length of hospital stay than low-volume centers for transurethral resection of the prostate (3.28, 3.02, and 6.58 days, respectively, p=0.01 and p=0.004). Length of hospital stay was also shorter for open prostatectomy in high-volume compared to low-volume centers (4.86 versus 10.76 days, p=0.036). Intrahospital mortality was inversely associated with surgical volume for transurethral resection of the prostate. Centers with residency program had shorter length of hospital stay considering open prostatectomy and less mortality regarding transurethral resection of the prostate. Open prostatectomy was 64% more expensive than transurethral resection of the prostate. Conclusion The findings suggest the importance of investing in specialized centers, which could be potential referral centers for surgical cases.
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18
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Barbosa ÁRG, Amaral BS, Lourenço DB, Bianco B, Gushiken FA, Apezzato M, Silva JF, Cunha MLD, Filippi RZ, Baroni RH, Lemos GC, Carneiro A. Accuracy of 68Ga-PSMA PET-CT and PET-MRI in lymph node staging for localized prostate cancer. einstein (São Paulo) 2022; 20:eAO6599. [PMID: 35584444 PMCID: PMC9094607 DOI: 10.31744/einstein_journal/2022ao6599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the predictive value of positron emission computed tomography or magnetic resonance (PET-CT and PET-MRI) using gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA) in lymph node involvement in prostate cancer. Methods A retrospective study comprising 91 patients diagnosed with prostate cancer between 2016 to 2020, who underwent 68Ga-PSMA PET-CT or PET-MRI for staging before prostatectomy. The patients were divided into Group 1, with 65 patients with satisfactory pathological lymph node analysis, and Group 2, with 91 patients representing the sum of patients with pathological lymph node analysis and those with postoperative prostate-specific antigen within 60 days after surgery. Receiver Operating Characteristic curves were used to assess accuracy of predictive capacity of imaging exams for lymph node involvement. Results Regarding local clinical staging, the groups showed similar results, and 50% were classified as staging T2a. The accuracy of 68Ga-PSMA PET-CT for prostate cancer lymph node staging was 86.5% (95%CI 0.74-0.94; p=0.06), with a sensitivity of 58.3% and specificity of 95%. The accuracy of 68Ga-PSMA PET-MRI was 84.6% (95%CI 0.69-0.94; p=0.09), with a sensitivity of 40% and specificity of 100%. Considering both 68Ga-PSMA PET-CT and PET-MRI, the accuracy was 85.7% (95%CI 0.76-0.92; p=0.015), with sensitivity of 50% and specificity of 97%. Conclusion The imaging tests 68Ga-PSMA PET-CT and PET-MRI were highly accurate to detect preoperative lymph node involvement, and could be useful tools to indicate the need for extended lymph node dissection during radical prostatectomy.
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Partezani A, Kayano P, Mariotti G, Garcia R, Baroni R, Lemos G, Carneiro A. Focal treatment of prostate cancer with High-Intensity Focused Ultrasound (HIFU): Oncological, functional and morbidity outcomes of a prospective and unicentric series. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Adrian G, Brus A, Konradsson E, Eriksson S, Andresen T, Petersson K, Carneiro A, Hansen A, Ceberg C. FLASH Mechanisms Track (Oral Presentations) FLASH SPARING OF MELANOMA CELLS IN VITRO AND IN VIVO. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Carneiro A. The management of muscle-invasive bladder Cancer is still a significant challenge in the clinical practice. Int Braz J Urol 2021; 48:99-100. [PMID: 34735085 PMCID: PMC8691231 DOI: 10.1590/s1677-5538.ibju.2021.0329.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Arie Carneiro
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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22
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Ferreira J, Carneiro A, Vila I, Cunha C, Silva C, Longatto-Filho A, Mesquita A, Cotter J, Mansilha A, Correia-Neves M, Cunha P. Association of skeletal muscle and cardiovascular risk factors in patients with lower extremity arterial disease. Ann Vasc Surg 2021; 80:223-234. [PMID: 34688875 DOI: 10.1016/j.avsg.2021.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/31/2021] [Accepted: 08/05/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sarcopenia is defined as low muscle mass, with low muscle strength or low physical performance. The skeletal muscle mass (or density) and strength are inversely associated with cardiovascular risk factors. We aim to determine the relationship between skeletal muscle characteristics (strength, mass, area), and cardiovascular risk factors in a population with lower extremity artery disease (LEAD) METHODS: : An observational, prospective study including patients with LEAD was conducted from January 2018 to December 2020. The cardiovascular risk factors and anthropometric measurements were prospectively registered. The skeletal muscle characteristics (area, density/mass and strength) were analysed. The skeletal muscle area and density were quantified with a CT scan. The strength was determined with a Jamar® hydraulic hand dynamometer. RESULTS 96 patients with LEAD with 67.70± 10.11 years-old were enrolled in the study. The most prevalent cardiovascular risk factor was hypertension, followed by dyslipidemia and diabetes. Patients with diabetes had a lower handgrip strength and skeletal muscle density, when compared with patients without diabetes (strength: 19.67± 9.98 kgf versus 26.79 ± 11.80 kgf, p=0.002 and skeletal muscle density: 10.58 ± 17.61 HU versus 18.17 ± 15.33 HU, p=0.032). There was a trend for the association between the presence of cardiovascular risk factors (hypertension and dyslipidemia) and a decrease in skeletal muscle density and strength (density: hypertension: 13.46 ± 16.74 HU versus 20.38 ± 11.63 HU p=0.055; dyslipidemia: 13.57 ± 17.16 HU versus 17.74 ± 13.00 HU p=0.315; strength- hypertension: 22.55 ± 10.08 kgf versus 27.58 ± 15.11 p= 0.073; dyslipidemia: 22.80 ± 10.52 kgf versus 25.28 ± 13.14 kgf p=0.315). Interestingly, we found that smokers had a favorable skeletal muscle characteristic, which could be explained by the higher prevalence of diabetes in non-smokers. CONCLUSIONS The indicators of skeletal muscle dysfunction (strength and density) are associated to the presence of diabetes in patients with LEAD. Therapeutic strategies to improve the skeletal muscle characteristics could have a role in improving LEAD risk factors, particularly diabetes.
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Affiliation(s)
- J Ferreira
- Vascular Surgery Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - A Carneiro
- Radiology Department- ULSAM, Viana do Castelo, Portugal
| | - I Vila
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - C Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - C Silva
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - A Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - A Mesquita
- Vascular Surgery Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - J Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - A Mansilha
- Faculty of Medicine, University of Porto, Porto, Portugal; Vascular Surgery Department Hospital de São João, Porto, Portugal
| | - M Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - P Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
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Luz MDA, Guimarães GC, Nardi AC, Pompeo ASFL, Sarkis ÁS, Nowier A, Lima Pompeo AC, Nardozza A, Adamy A, Carneiro A, Salvajoli BP, Benigno BS, Freitas CHD, Chade CADC, Palhares DMF, Otero DAC, Neto DCVDS, Carvalhal EF, Gil E, Freire de Arruda F, Korkes F, Caserta Lemos G, Carvalhal GF, de Carvalho ÍT, Gimpel IFP, Chambô JL, Pontes J, Filho LAR, Nogueira LM, Wroclawski ML, Freitas MRP, Arap MA, Sadi MV, Bulbul M, Coelho RF, Gadia R, Khauli RB, Dos Reis RB, Rojas RAL, Guimarães RG, Aldousari S, Ferrigno R. Consensus on Prostate Cancer Treatment of Localized Disease With Very Low, Low, and Intermediate Risk: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC). JCO Glob Oncol 2021; 7:523-529. [PMID: 33856894 PMCID: PMC8162508 DOI: 10.1200/go.20.00515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE A group of international urology and medical oncology experts developed and completed a survey on prostate cancer (PCa) in developing countries. The results are reviewed and summarized, and recommendations on consensus statements for very low-, low-, and intermediate-risk PCa focused on developing countries were developed. METHODS A panel of experts developed more than 300 survey questions of which 66 questions concern the principal areas of interest of this paper: very low, low, and intermediate risk of PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up for very low-, low-, and intermediate-risk PCa in areas of limited resources discussed in this manuscript. RESULTS The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION The voting results and recommendations presented in this document can be used by physicians to support management for very low, low, and intermediate risk of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment for very low, low, and intermediate risk of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.
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Affiliation(s)
| | | | | | | | - Álvaro Sadek Sarkis
- A Beneficiência Portuguesa de São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | - Ari Adamy
- Hospital Santa Cruz, Curitiba, Brazil
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Erlon Gil
- A Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | - José Pontes
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Marcelo Langer Wroclawski
- A Beneficiência Portuguesa de São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Marcus Vinícius Sadi
- A Beneficiência Portuguesa de São Paulo, São Paulo, Brazil.,Universidade Federal de São Paulo, São Paulo, Brazil
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24
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Carneiro A, Racy D, Bacchi CE, Leite KRM, Filippi RZ, Martins IAF, Salvajoli JV, Hanriot RDM, Baroni RH, Sarkis AS, Pompeo ACL, Benigno BS, Guimarães GC, Aldousari S, Nardi AC, Pompeo ASFL, Nowier A, Nardozza A, Adamy A, Freitas CHD, Chade DC, Otero DAC, Neto DCVDS, Carvalhal EF, Korkes F, Ferrigno R. Consensus on Screening, Diagnosis, and Staging Tools for Prostate Cancer in Developing Countries: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC). JCO Glob Oncol 2021; 7:516-522. [PMID: 33856895 PMCID: PMC8162957 DOI: 10.1200/go.20.00527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To generate and present the survey results on critical issues relevant to screening, diagnosis, and staging tools for prostate cancer (PCa) focused on developing countries. METHODS A total of 36 of 300 questions concern the main areas of interest of this paper: (1) screening, (2) diagnosis, and (3) staging for various risk levels of PCa in developing countries. A panel of 99 international multidisciplinary cancer experts voted on these questions to create recommendations for screening, diagnosing, and staging tools for PCa in areas of limited resources discussed in this manuscript. RESULTS The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION The voting results and recommendations presented in this document can be used by physicians to support the screening, diagnosis, and staging of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for screening, diagnosis, and staging of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.
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Affiliation(s)
- Arie Carneiro
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Douglas Racy
- Hospital Beneficiencia Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ari Adamy
- Hospital Santa Cruz, Santa Cruz do Sul, Brazil
| | | | | | | | | | | | | | - Robson Ferrigno
- Hospital Beneficiencia Portuguesa de São Paulo, São Paulo, Brazil
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Santos H, Lourenço D, Partezani A, Teles S, Takemura L, Andrade G, Gushiken F, Bianco B, Rios L, Carneiro A, Lemos G. Urodynamic profile of voiding in prolapse pelvic organ patients after surgery: A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00762-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Sivaraman A, Marra G, Stabile A, Mombet A, Macek P, Lanz C, Cathala N, Moschini M, Carneiro A, Sanchez-Salas R, Cathelineau X. Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center. Int Braz J Urol 2021; 46:984-992. [PMID: 32822127 PMCID: PMC7527093 DOI: 10.1590/s1677-5538.ibju.2019.0682] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Focal therapy (FT) for localized prostate cancer (PCa) treatment is raising interest. New technological mpMRI-US guided FT devices have never been compared with the previous generation of ultrasound-only guided devices. Materials and Methods We retrospectively analyzed prospectively recorded data of men undergoing FT for localized low- or intermediate-risk PCa with US- (Ablatherm®-2009 to 2014) or mpMRI-US (Focal One®-from 2014) guided HIFU. Follow-up visits and data were collected using internationally validated questionnaires at 1, 2, 3, 6 and 12 months. Results We included n=88 US-guided FT HIFU and n=52 mpMRI-US guided FT HIFU respectively. No major baseline differences were present except higher rates of Gleason 3+4 for the mpMRI-US group. No major differences were present in hospital stay (p=0.1), catheterization time (p=0.5) and complications (p=0.2) although these tended to be lower in the mpMRI-US group (6.8% versus 13.2% US FT group). At 3 months mpMRI-US guided HIFU had significantly lower urine leak (5.1% vs. 15.9%, p=0.04) and a lower drop in IIEF scores (2 vs. 4.2, p=0.07). Of those undergoing 12-months control biopsy in the mpMRI-US-guided HIFU group, 26% had residual cancer in the treated lobe. Conclusion HIFU FT guided by MRI-US fusion may allow improved functional outcomes and fewer complications compared to US- guided HIFU FT alone. Further analysis is needed to confirm benefits of mpMRI implementation at a longer follow-up and on a larger cohort of patients.
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Affiliation(s)
- Arjun Sivaraman
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.,Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Armando Stabile
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Petr Macek
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Nathalie Cathala
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Arie Carneiro
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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Maluf F, Soares A, Avanço G, Hada AL, Cardoso APG, Carneiro A, Herchenhorn D, Jardim DLF, Schutz FA, Kater FR, Pereira FMT, Monteiro FSM, Morbeck IAP, Reolon JFN, da Trindade KM, Andrade LMQDS, Nogueira LM, Furoni R, Natel RA, Dos Reis RB, Fogace RN, Souza VC. Consensus on diagnosis and management of non-metastatic castration resistant prostate cancer in Brazil: focus on patient, selection, treatment efficacy, side effects and physician's perception according to patient comorbidities. Int Braz J Urol 2020; 47:359-373. [PMID: 33284538 PMCID: PMC7857750 DOI: 10.1590/s1677-5538.ibju.2020.0249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Non-metastatic castration resistant prostate cancer (M0 CRPC) has seen important developments in drugs and diagnostic tools in the last two years. New hormonal agents have demonstrated improvement in metastasis free survival in M0 CRPC patients and have been approved by regulatory agencies in Brazil. Additionally, newer and more sensitive imaging tools are able to detect metastasis earlier than before, which will impact the percentage of patients staged as M0 CRPC. Based on the available international guidelines, a group of Brazilian urology and medical oncology experts developed and completed a survey on the diagnosis and treatment of M0 CRPC in Brazil. These results are reviewed and summarized and associated recommendations are provided. OBJECTIVE To present survey results on management of M0 CRPC in Brazil. DESIGN, SETTING, AND PARTICIPANTS A panel of six Brazilian prostate cancer experts determined 64 questions concerning the main areas of interest: 1) staging tools, 2) treatments, 3) side effects of systemic treatment/s, and 4) osteoclast-targeted therapy. A larger panel of 28 Brazilian prostate cancer experts answered these questions in order to create country-specific recommendations discussed in this manuscript. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on the predefined questions. These answers are the panelists' opinions, not a literature review or meta-analysis. Therapies not yet approved in Brazil were excluded from answer options. Each question had five to seven relevant answers including two non-answers. Results were tabulated in real time. CONCLUSIONS The results and recommendations presented can be used by Brazilian physicians to support the management of M0 CRPC patients. Individual clinical decision making should be supported by available data, however, for Brazil, guidelines for diagnosis and management of M0 CRPC patients have not been developed. This document will serve as a point of reference when confronting this disease stage.
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Affiliation(s)
- Fernando Maluf
- Departamento de Oncologia, Hospital Beneficência Portuguesa de São Paulo, SP, Brasil.,Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Guilherme Avanço
- Departamento de Oncologia, Hospital Beneficência Portuguesa de São Paulo, SP, Brasil
| | - Aline Lury Hada
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Arie Carneiro
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Daniel Herchenhorn
- Grupo Latino - Americano de Oncologia Cooperativa, Porto Alegre, RS, Brasil
| | | | - Fabio Augusto Schutz
- Departamento de Oncologia, Hospital Beneficência Portuguesa de São Paulo, SP, Brasil
| | - Fabio Roberto Kater
- Departamento de Oncologia, Hospital Beneficência Portuguesa de São Paulo, SP, Brasil
| | | | - Fernando Sabino Marques Monteiro
- Unidade de Oncologia, Hospital Universitário de Brasília, Brasília, DF, Brasil.,Centro de Oncologia e Hematologia, Hospital Santa Lucia, Brasília, DF, Brasil
| | | | | | | | | | - Lucas Mendes Nogueira
- Divisão de Urologia e Departamento de Cirurgia, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte, Minas Gerais, Brasil
| | - Renato Furoni
- Departamento de Oncologia, Hospital Beneficência Portuguesa de São Paulo, SP, Brasil
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Lourenço DB, Amaral BS, Alfer-Junior W, Vasconcellos A, Russo F, Sanchez-Salas R, Bianco B, Wagner AA, Chang P, Moschovas MC, Lemos GC, Carneiro A. Portuguese version of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP): psychometric validation and prospective application for early functional outcomes at a single institution. BMC Urol 2020; 20:163. [PMID: 33081748 PMCID: PMC7574474 DOI: 10.1186/s12894-020-00734-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background The Expanded Prostate Index Composite for Clinical Practice (EPIC-CP) is a short version of the original EPIC, developed to facilitate the instrument’s use in routine care. This study aimed to validate the EPIC-CP Portuguese version, and evaluate its role in presenting early functional outcomes of surgically treated prostate cancer patients at a Latin American referral center.
Methods The EPIC-CP was self-administered prospectively and individually by all localized prostate cancer patients, before and after robotic-assisted radical prostatectomy, from March 2017 to June 2018 at a single institution. For validation, we used the Cronbach’s alpha coefficient to evaluate internal consistency. The EPIC-CP domains were compared before surgery, and 6 months and 12 months after surgery. Statistical analyses were performed using the student’s t test, and Wilcoxon and Friedman tests, with p values < 0.05 considered significant. Results One hundred and fifty two patients answered the EPIC-CP. The patients had a median age of 62.7 (± 8.5) years and prostate specific antigen level of 6.3 (± 4.6) ng/ml. The Cronbach’s alpha varied from 0.75 to 0.77 for all domains with good internal consistency, except for the “vitality/hormonal” domain, which had a score of 0.35. The domain evolution for the preoperative and 6-month postoperative groups revealed that the domains related to urinary continence and bowel worsened, and were increased during the first 6 months; however, this variation had no obvious clinical implications, and the irritative symptoms improved. Regarding the sexual domain, the scores worsened, and also increased over the first 6 months. The results of the confirmatory factor analysis were robust, with an explained variance of 0.951 and covariance of 0.929. Conclusions The Portuguese version of the EPIC-CP is a reliable and valid questionnaire for postoperative patients, and very useful to improve the knowledge of the early functional outcomes of men treated for prostate cancer.
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Affiliation(s)
- Danilo B Lourenço
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Breno Santos Amaral
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Wladimir Alfer-Junior
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Ana Vasconcellos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Fernanda Russo
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | | | - Bianca Bianco
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil.
| | - Andrew A Wagner
- Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Chang
- Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marcio Covas Moschovas
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Gustavo Caserta Lemos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
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Wroclawski ML, Kayano PP, Amaral BS, Mariotti GC, Yamauchi FI, Cha JD, Carneiro A, Korkes F, Vitalli AS, Mussi TC, Lemos GC, Baroni RH. Can multiparametric magnetic resonance of the prostate avoid biopsies in patients with elevated PSA and surgical indication for benign prostatic enlargement? Abdom Radiol (NY) 2020; 45:3278-3282. [PMID: 31974659 DOI: 10.1007/s00261-020-02411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION To evaluate the clinical dilemma of men with surgical indication due to benign prostatic enlargement (BPE) and concomitant elevated PSA, we analysed if multiparametric magnetic resonance imaging (mpMRI) could safely prescind the prostate biopsy. METHODS Forty men with surgical indication due to BPE and concomitantly elevated PSA levels were prospectively enrolled and retrospectively analysed. All patients underwent 1.5 Tesla mpMRI prior to TRUS-guided biopsies. In cases where mpMRI was PIRADS 3 with focal lesions, PIRADS 4 or PIRADS 5, additional fragments were obtained with the fusion guided technique. Biopsy histopathological results were used as the standard of reference. Two scenarios were evaluated: scenario 1, considering mpMRI PIRADS 1 and 2 as negative; and scenario 2, considering PIRADS 1, 2 and 3 as negative. Clinically significant prostate cancer (CsPCa) was defined as ISUP ≥ 2. RESULTS Median age was 68 years, median PSA was 9.41 (6.40-19.54) and median prostatic volume was 116.5 cc (IQR 86.5-155). Scenario 1 mpMRI sensitivity, specificity, PPV, NPV and accuracy for any prostate cancer on prostate biopsy was 76.9%, 63%, 50%, 85% and 67.5%. For csPCa, they were 87.5%, 59.4%, 35%, 95% and 65%, respectively, for the same measures. Scenario 2 the sensitivity, specificity, PPV, NPV and accuracy of mpMRI for any prostate cancer on prostate biopsy was 53.8%, 96.3%, 87.5%, 81.3% and 82.5%. For csPCa, they were 75%, 93.8%, 75%, 93.8% and 90%, respectively, for the same measures. CONCLUSION Prostate mpMRI may prevent unnecessary biopsies in patients with elevated PSA and surgical indications due to BPE, given its high negative predictive value.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil.
| | - Paulo Priante Kayano
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Breno Santos Amaral
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Guilherme Cayres Mariotti
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Fernando Ide Yamauchi
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Jonathan Doyun Cha
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Fernando Korkes
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Alessandra Sousa Vitalli
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Thais Caldara Mussi
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Gustavo Caserta Lemos
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
| | - Ronaldo Hueb Baroni
- Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil
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30
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Heldwein FL, Loeb S, Wroclawski ML, Sridhar AN, Carneiro A, Lima FS, Teoh JYC. A Systematic Review on Guidelines and Recommendations for Urology Standard of Care During the COVID-19 Pandemic. Eur Urol Focus 2020; 6:1070-1085. [PMID: 32532703 PMCID: PMC7274599 DOI: 10.1016/j.euf.2020.05.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/29/2020] [Indexed: 01/01/2023]
Abstract
CONTEXT The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. OBJECTIVE To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic. EVIDENCE ACQUISITION Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria. EVIDENCE SYNTHESIS Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence). CONCLUSIONS To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal. PATIENT SUMMARY We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.
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Affiliation(s)
- Flavio Lobo Heldwein
- Federal University of Santa Catarina and Baiasul Medical Hospital, Florianopolis, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
| | - Stacy Loeb
- New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Hospital Beneficiencia Portuguesa, Sao Paulo, Brazil
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Carneiro A, Amaral T, Brandao M, Scheffler M, Bol K, Ferrara R, Jalving M, Lo Russo G, Marquez-Rodas I, Matikas A, Mezquita L, Morgan G, Onesti C, Pilotto S, Saloustros E, Trapani D. LBA66_PR Disparities in access to oncology clinical trials in Europe in the period 2009-2019. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fernandez AA, O'Day S, Merino LDLC, Petrella T, Jamal R, Ny L, Carneiro A, Berrocal A, Márquez-Rodas I, Spreafico A, Victoria Atkinson V, Costa Svedman F, Smith A, Chen K, Diede S, Krepler C, Long G. LBA44 Lenvatinib (len) plus pembrolizumab (pembro) for advanced melanoma (MEL) that progressed on a PD-1 or PD-L1 inhibitor: Initial results of LEAP-004. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Castilho TML, Lemos GC, Cha JD, Colombo JR, Claros OR, Lemos MB, Carneiro A. Transition from open partial nephrectomy directly to robotic surgery: experience of a single surgeon to achieve "TRIFECTA". Int Braz J Urol 2020; 46:814-821. [PMID: 32648421 PMCID: PMC7822359 DOI: 10.1590/s1677-5538.ibju.2019.0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recent data suggest that robotic platform has become the most accessible minimal invasive surgery even for surgeons without previous training in laparoscopy. Laparoscopic partial nephrectomy (LPN) is a well-stablished procedure, however, with high level of complexity and long learning curve that limit its use. OBJECTIVE To describe safety, efficiency and learning curve of a single surgeon without previous experience in LPN to reach "TRIFECTA" at robot-assisted partial nephrectomy (RAPN). PATIENTS AND METHODS This is a retrospective study, with prospective data collection of 101 patients submitted to RAPN by a single surgeon. In order to analyze the learning curve, sample was chronologically divided in two phases: first phase: P1: 50 first patients, second phase: P2: 51 subsequent patients. TRIFECTA was defined as: ischemia time lower than 25 minutes, negative surgical margin and absence of severe complications (Clavien >2). RESULTS Mean age of patients was 54 years (SD=11.85), median tumor size was 32mm (SD=17) and surgery was performed with zero ischemia time in 33.6% of patients (29.8% at P1 and 40.9% at P2). Demographic data of patients were similar between both groups, except tumor size (P1=27.5mm vs. P2=35.3mm; p=0.02) and body mass index (BMI) (P1=26.6kg/m2 vs. P2=29kg/m2; p=0.03). Rate of bleeding, surgical time, presence of positive margin and peri-operatory surgical complications were similar in both phases. TRIFECTA was higher in P2 in relation to P1 (P1: 58% vs. P2: 87.8%; p=0.002) and median time of hot ischemia was significantly lower at P2 (P1: 17.3 vs. P2: 11.7; p=0.02). At multivariate analysis independent factors related to TRIFECTA included: chronological phase (OR 10.74; 95% IC: 1.63-70.53; p=0.013) and tumor size (OR 0.95; 95% IC: 0.91-0.99; p=0.024). CONCLUSION RAPN seems to be safe and efficient with good functional and oncological results (TRIFECTA) since the beginning. Experience improvement was related to treatment of larger tumors, higher proportion of patients with zero ischemia and higher rate of TRIFECTA.
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Affiliation(s)
| | | | | | | | | | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Carneiro A, Wroclawski ML, Nahar B, Soares A, Cardoso AP, Kim NJ, Carvalho FT. Impact of the COVID-19 Pandemic on the Urologist's clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period. Int Braz J Urol 2020; 46:501-510. [PMID: 32271512 PMCID: PMC7239291 DOI: 10.1590/s1677-5538.ibju.2020.04.03] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 01/09/2023] Open
Abstract
This letter to the Editor aims to provide suggestions and recommendations for the management of urological conditions in times of COVID-19 crisis in Brazil and other low- and middle-income countries. It is important to highlight that one of the main characteristics of this pandemic is the oversaturation of the health system capacity, mostly due to a high demand for personal protective equipment (PPE), Hospital/ICU beds, as well as ventilators. In places with limited resources and where the health care systems are already saturated, such consideration is even more worrisome. Therefore, most worldwide authorities are recommending to avoid, as much as possible, patient's elective visits to hospitals, as well as a judicious use of the operating room in order to mitigate the strain put on the health system. While efforts should be directed to the care of COVID-19 patients, other conditions (especially urgencies and oncological cases) must continue to be assisted. Thus, through a panel of experts, we have prepared a practical guide for Thus, through a panel of experts, we have prepared a practical guide for urologists based on the recommendations from the main Urologic Associations, as well as data from the literature to support the suggested management. We will try to follow the standard guideline recommendations from the American Urological Association (AUA) and European Association of Urology (EAU), with the aim of pursuing the best outcomes possible. However, some recommendations were based on the consensus of the panel, taking into consideration the reality of developing countries and the unprecedented situation caused by the COVID-19 crisis. Most importantly, all recommendations on this manuscript are based on the expectancy of a maximum 3-month duration of the crisis. If this period shall extended, these recommendations will be revised and updated.
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Affiliation(s)
- Arie Carneiro
- Departamento de UrologiaHospital Albert EinsteinSão PauloSPBrasil Departamento de Urologia , Hospital Albert Einstein , São Paulo , SP , Brasil ;
- Grupo Internacional de Urologia AvançadaSão PauloSPBrasil Diretor Científico e Executivo - Grupo Internacional de Urologia Avançada , São Paulo , SP , Brasil ;
| | - Marcelo Langer Wroclawski
- Departamento de UrologiaHospital Albert EinsteinSão PauloSPBrasil Departamento de Urologia , Hospital Albert Einstein , São Paulo , SP , Brasil ;
- Departamento de UrologiaBeneficiência Portuguesa de São PauloSão PauloSPBrasil Departamento de Urologia - Beneficiência Portuguesa de São Paulo , São Paulo , SP , Brasil ;
| | - Bruno Nahar
- Department of UrologyUniversity of Miami MillerSchool of MedicineFLUSA Department of Urology , University of Miami Miller School of Medicine , FL , USA ;
| | - Andrey Soares
- Departamento de Oncologia MédicaHospital Albert EinsteinSão PauloSPBrasil Departamento de Oncologia Médica , Hospital Albert Einstein , São Paulo , SP , Brasil ;
- Departamento de Oncologia MédicaCentro Paulista de OncologiaSão PauloSPBrasil Departamento de Oncologia Médica , Centro Paulista de Oncologia – Oncoclínicas, São Paulo , SP , Brasil ;
- Grupo Latino-Americano de Oncologia CooperativaSão PauloSPBrasil Diretor científico - Grupo Latino-Americano de Oncologia Cooperativa , São Paulo , SP , Brasil ;
| | - Ana Paula Cardoso
- Departamento de Oncologia MédicaHospital Albert EinsteinSão PauloSPBrasil Departamento de Oncologia Médica , Hospital Albert Einstein , São Paulo , SP , Brasil ;
| | - Nam Jin Kim
- Programa de Cirurgia e Cirurgia RobóticaHospital Albert EinsteinSão PauloSPBrasil Chefe do Programa de Cirurgia e Cirurgia Robótica , Hospital Albert Einstein , São Paulo , SP , Brasil ;
| | - Fabricio Torres Carvalho
- Departamento de Doenças InfecciosasHospital Albert EinsteinSão PauloSPBrasil Departamento de Doenças Infecciosas , Hospital Albert Einstein , São Paulo , SP , Brasil ;
- Departamento de Medicina IntensivaUnidade de Terapia IntensivaAC Camargo Cancer CenterSão PauloSPBrasil Departamento de Medicina Intensiva e Unidade de Terapia Intensiva - AC Camargo Cancer Center , São Paulo , SP , Brasil
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Amaral B, Carneiro A, Budib Lourenço D, Langer Wroclawski M, Camargo Tiseo B, Alfer JW, Roberto Colombo J, Vasconcelos A, Russo F, Jim Kim N, Eduardo Alonso Araujo S, Cendoroglo Neto M, Caserta Lemos G. Ten years of experience in robot-assisted laparoscopic radical prostatectomy in brazil: Indirect evaluation of the perioperative costs and oncologic patients’ profiles. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Wroclawski ML, Teles SB, Carneiro A. Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!). Andrologia 2020; 52:e13707. [PMID: 32559344 DOI: 10.1111/and.13707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
Most cases of lower urinary tract symptoms due to benign prostatic hyperplasia are initially managed through medical therapy. In cases that surgery is indicated, the anatomical endoscopic enucleation of the prostate (aEEP), first described in 1983, allegedly presents the same safety profile as the best endoscopic non-enucleating procedures and the same long-term functional outcomes as simple prostatectomy. Thus, why aEEP has not yet been consolidated as the gold-standard BPH surgical treatment? The main reasons are as follows: (a) Multiple energy sources and techniques; (b) High costs; (c) Steep learning curve; (d) Rare in-residency training; (e) Reimbursement issues; (f) Outcomes and (g) Complications. We do believe aEEP is an important advance and a "practice-changing" procedure that will play an important role in the BPH surgical options arsenal, especially for larger prostates. However, there is a need to start an in-residency training program, with a mentor guidance, and, over time, the cost will likely be reduced due to greater competition between companies and greater support from health insurers. Considering these points, in the future, EEP may be considered the gold-standard treatment for BPH… but not yet.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP - a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Barbosa AR, Takemura LS, Cha JD, Carneiro A, Lemos GC, Glina S, Korkes F. Surgical Treatment of Peyronie’s Disease: Systematic Review of Techniques Involving or Not Tunica Albuginea Incision. Sex Med Rev 2020; 8:324-332. [DOI: 10.1016/j.sxmr.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023]
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Carneiro A, Wroclawski ML, Peixoto GA, Cha JD, Moran NKS, Chen FK, Satkunas HN, Campos JRA, Garcia AMMR, Monga M, Lemos GC. Same sized three-way indwelling urinary catheters from various manufacturers present different irrigation and drainage properties. Ther Adv Urol 2020; 12:1756287219889496. [PMID: 31949476 PMCID: PMC6952853 DOI: 10.1177/1756287219889496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 10/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background: The three-way indwelling urinary catheter (IUC) is used for continuous
bladder irrigation and is considered the cornerstone for clinical treatment
of patients with macroscopic hematuria. Although there seems to be a logical
relationship between catheter size and efficacy of irrigation and drainage,
we often observe relevant variations in these parameters between different
brands of catheters available on the market. The aim of this study was to
compare the mechanical properties of different models of latex and silicone
three-way catheters in an in vitro setting that resembles
clinical use. Methods: Three different three-way catheters were evaluated: Gold Silicone-Coated
Rusch® (Model A), 100% Silicone Rusch® (Model B)
and X-Flow Coloplast® (Model C). Irrigation channel, drainage
channel, and overall cross-sectional areas were all digitally measured.
Irrigation and drainage channel flow rates were measured and correlated with
their corresponding catheter cross-sectional area values. Results: Different catheter models of the same caliber have different internal
irrigation port diameters, internal drainage port diameters and internal
cuff port diameters. The Model C IUC internal irrigation port diameter is
significantly larger than models A and B. When flows were evaluated, we
found that in the same model, the increase in caliber of the IUC was related
to an increased drainage flow, but not to an increased irrigation flow. Conclusion: Precise measurements of the internal architecture of the three-way catheter,
rather than relying on the caliber itself, could assist surgeons in choosing
the best product for each specific patient, while minimizing
complications.
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Affiliation(s)
- Arie Carneiro
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP - 06455-010, Brazil; Faculdade de Medicina do ABC, São André, Brazil
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade de Medicina do ABC, São André, Brazil
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Wroclawski ML, Teles SB, Amaral BS, Kayano PP, Cha JD, Carneiro A, Alfer W, Monteiro J, Gil AO, Lemos GC. A systematic review and meta-analysis of the safety and efficacy of endoscopic enucleation and non-enucleation procedures for benign prostatic enlargement. World J Urol 2019; 38:1663-1684. [DOI: 10.1007/s00345-019-02968-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/20/2019] [Indexed: 12/31/2022] Open
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Makdisse M, Ramos P, Malheiro D, Cypriano A, Soares J, Carneiro A, Felix M, Neto M, Klajner S. PNS42 A SURVEY OF PRACTICING PHYSICIANS ON VALUE-BASED HEALTH CARE IN A PRIVATE HEALTH SYSTEM IN BRAZIL. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Claros OR, Tourinho-Barbosa RR, Carneiro A, Collura-Merlier S, Macek P, Lanz C, Cathala N, Prapotnich D, Mombet A, Sanchez-Salas R, Cathelineau X. HIFU focal therapy for prostate cancer using intraoperatory contrast enhanced ultrasound. ARCH ESP UROL 2019; 72:825-830. [PMID: 31579041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE High-intensity focused ultrasound (HIFU) Focal therapy appears to have encouraging oncologic outcomes and urinary and erectile function. The control of the treated area can be done using contrast enhanced ultrasound with sulfur hexafluoride (Sonovue®) at the end of the procedure. We report oncological and functional outcomes in HIFU focal therapy (FT) for prostate cancer (PCa) management using sonovue. METHODS A total of 274 HIFU procedures were found in our registry in the period between June 2014 and July 2018. Prospective data of 59 consecutive patients after focal high-intensity focused ultrasound (HIFU) using Sonovue were collected. FT failure was defined as positive biopsy Gleason score (GS) ≥ 7 in- or out-field, local or systemic salvage treatment, PCa-metastasis or PCa-specific death. RESULTS A total of 59 patients submitted to HIFU with median follow-up of 18 months were included in the analysis. Median age was 66.7 yr (IQR 59.1-74.3). Median preoperative prostate-specific antigen (PSA) was 7.6 ng/ml (IQR 5-10.2) and preoperative biopsies GS 6, 7(3+4), 7(4+3) were found in 26 (44%), 30 (50.8%) and 3 (5%), respectively. Failure was found in 16 (27.1%) patients. Failure-free survival (FFS) in 2 and 4yr was 83% and 74% respectively (Figure 1). No PCa-specific death was registered in the period of study. Median nadir PSA after FT was 2.67 ng/ml. Sexual potency was achieved in 75% of previous potent patients and urinary continence in 93.4% of patients at 3 months. Fourteen (23%) patients presented with complications. Four (6.7%) patients have presented complications grade 1 and 10 (16.9%) patients have presented complications grade 2. Six (10.1%) patients have presented acute urinary retention. CONCLUSIONS Our study shows that the use of Sonovue after HIFU FT was safe. Patients present a significant proportion of failure after HIFU FT but with good functional outcomes and without incidence of severe complications.
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Affiliation(s)
- Oliver Rojas Claros
- Institut Mutualiste Montsouris. Paris. France. Hospital Israelita Albert Einstein. São Paulo. Brazil
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein. São Paulo. Brazil
| | | | - Petr Macek
- Institut Mutualiste Montsouris. Paris. France
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Jespersen H, Olofsson Bagge R, Ullenhag G, Carneiro A, Helgadottir H, Ljuslinder I, Levin M, All-Eriksson C, Andersson B, Stierner U, Nilsson L, Nilsson J, Ny L. Phase II multicenter open label study of pembrolizumab and entinostat in adult patients with metastatic uveal melanoma (PEMDAC study). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martins J, Carneiro A, Souza L, Almeida-Cortez J. How pollinator visits are affected by flower damage and ants presence in Ipomoea carnea subs. fistulosa (Martius and Choise) (Convolvulaceae)? BRAZ J BIOL 2019; 80:47-56. [PMID: 31066764 DOI: 10.1590/1519-6984.189025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/03/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the effects of florivory and of the patrolling ants associated to EFNs-extrafloral nectaries, on the frequency of floral visitors, using the specie Ipomoea carnea subs. fistulosa (Martius and Choise) in Caatinga area. The floral attributes of the species were characterized. The effect of florivoria on the frequency of visitors and the influence of the presence of ants associated with the NEFs on the pollinator visit rate were evaluated. The rate of natural florivoria was recorded and collected floral visitors and ants over eight months. The damage on floral structure and the presence of ants foraging in the flowers causes a decrease in the number of total visits. The results may be justified by the fact that the floral damage consisted in the loss of important floral attributes. These effects for Ipomoea carnea subs. fistulosa can affect reproductive success, since it is a self-incompatible species and depends on the activity of the pollinators for their fertilization to occur.
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Affiliation(s)
- J Martins
- Departamento de Botânica, Universidade Federal de Pernambuco - UFPE, Av. Professor Morais Rego, 1235, Cidade Universitária, CEP 50670-901, Recife, PE, Brasil
| | - A Carneiro
- Departamento de Ciências Biológicas, Universidade Federal de Campina Grande - UFCG, Campus Patos, CEP 58700-970, Patos, PB, Brasil
| | - L Souza
- Departamento de Ciências Biológicas, Universidade Federal de Campina Grande - UFCG, Campus Patos, CEP 58700-970, Patos, PB, Brasil
| | - J Almeida-Cortez
- Departamento de Botânica, Universidade Federal de Pernambuco - UFPE, Av. Professor Morais Rego, 1235, Cidade Universitária, CEP 50670-901, Recife, PE, Brasil
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Baccaglini W, Cathelineau X, Araújo Glina FP, Medina LG, Sotelo R, Carneiro A, Sanchez-Salas R. Screening: Actual trends on PSA marker. When, who, how? ARCH ESP UROL 2019; 72:98-103. [PMID: 30855010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prostate cancer (PCa) is the most common non-skin malignancy among men world-wide. PCa incidence is higher among African American (AA) menin comparison to the white population. Men with a previous history of PCa in first-line relatives carry also an increased risk for this disease. The incidence of PCa diminished in United States (US) since the publication in 2012 of US Preventive Service Task Force (USPSTF), in which PCa screening was bestowed with a grade D of recommendation. Nonetheless, locally advanced andmetastatic disease rates increased notably. In 2018, the USPSTF drop back in their statement against PCa screening and recommended this to be a shared-decision between men 55-69 years old and their physicians.A side-by-side evaluation methodology of the three trials included in USPSTF review was performed. The high intensity screening modality and the lower contamination rate in the control arm found in the ERSPC trial justify theearlier splitting in the cumulative mortality curves between the screening and control arm when contrasted with the CAP and PCLO trials presented. We aim to perform an objective and critical review of the current practice on prostate cancer screening, regarding its limitations and when the physician should offer a shared-decision process screening based on PSA.The controversy over PSA screening has not ended despite unequivocal evidence that it saves lives. Although the USPSTF's 2017 new draft is a step in the right direction, there is more progress to be made concerning the identification of patients harboring high-risk tumors and, consequently, die of PCa. PSA baseline may lead us to differentiate properly patients at high-risk from those under risk of overdiagnosis and overtreatment. It is well established that mpMRI has come to help us in the diagnosis of PCa and in the identification of clinically significanttumors. Finally, studies ongoing on biomarkers may assist us to improve our understanding about this frequent malignancy.
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Affiliation(s)
- Willy Baccaglini
- Department of Urology. L'Institut Mutualiste Montsouris. Université Paris Descartes. Paris. France. Discipline of Urology. ABC Medical School. Santo Andre. SP. Brazil. University of Southern California. Keck School of Medicine. Institute of Urology. Los Angeles. CA. US
| | - Xavier Cathelineau
- Department of Urology. L'Institut Mutualiste Montsouris. Université Paris Descartes. Paris. France
| | | | - Luis G Medina
- University of Southern California. Keck School of Medicine. Institute of Urology. Los Angeles. CA. US
| | - Rene Sotelo
- University of Southern California. Keck School of Medicine. Institute of Urology. Los Angeles. CA. US
| | - Arie Carneiro
- Department of Urology. Israelita Albert Einstein Hospital. Sao Paulo. SP. Brazil
| | - Rafael Sanchez-Salas
- Department of Urology. L'Institut Mutualiste Montsouris. Université Paris Descartes. Paris. France
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Kayano PP, Carneiro A, Castilho TML, Sivaraman A, Claros OR, Baroni RH, Garcia RG, Mariotti GC, Smaletz O, Filippi RZ, Lemos GC. Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer. Int Braz J Urol 2019; 44:1106-1113. [PMID: 30325600 PMCID: PMC6442175 DOI: 10.1590/s1677-5538.ibju.2017.0552] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 08/05/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. MATERIALS AND METHODS A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. RESULTS In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. -0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 - 6.28]; p=0.024). CONCLUSIONS US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.
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Affiliation(s)
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Arjun Sivaraman
- Memorial Sloan Kettering Cancer Center - USA, New York, NY, EUA
| | | | | | | | | | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Carneiro A, Cha JD, Baccaglini W, Husain FZ, Wroclawski ML, Nunes-Silva I, Sanchez-Salas R, Ingels A, Kayano PP, Claros OR, Saviano Moran NK, Sotelo R, Lemos GC. Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis. Ther Adv Urol 2019; 11:1756287218816595. [PMID: 30671139 PMCID: PMC6329037 DOI: 10.1177/1756287218816595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/06/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Low-dose aspirin use has been correlated with an increased risk of bleeding and overall complications in surgical and invasive diagnostic procedures. In this review, our aim was to analyze the current literature on whether robot-assisted radical prostatectomy (RARP) is feasible and safe in patients taking low-dose aspirin perioperatively. Methods: A systematic review was performed identifying a total of 767 studies, published between January 2000 and September 2017, with five of these studies meeting the inclusion criteria for the meta-analysis, totalizing 1481 patients underwent RARP. Patients were divided into two groups: taking aspirin (group A) and those not taking aspirin (group B) perioperatively. Results: There were no significant differences between groups in the overall [group A 10.7% versus group B 15.7%, risk ratio (RR) 0.83; p = 0.45; I2 = 0%] or major complication rates (group A 1% versus group B 3%, RR 0.98; p = 0.98; I² = 0%), rate of cardiovascular events (group A 1.4% and group B 0.5%, RR 2.06; p = 0.24; I2 = 9%), blood loss (group A 278 ml versus group B 307 ml, SMD −0.12; p = 0.91; I2 = 96%), or hospital length of stay [group A 4 days (3–5) and group B 4 days (3–4), SMD −0.09; p = 0.52; I² = 0%]. There was a slightly higher blood-transfusion rate in group A (2.6%) versus group B (1.6%) (RR, 5.05; p = 0.04; I2 = 0%). Conclusion: Continued aspirin use in the perioperative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay. There was a slightly higher blood-transfusion rate in patients taking low-dose aspirin (group A) perioperatively.
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Affiliation(s)
- Arie Carneiro
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Jonathan Doyun Cha
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Willy Baccaglini
- Discipline of Urology - ABC Medical School, Av. Lauro Gomes, 2000 - Anexo II, Vila Sacadura Cabral - Santo André/SP, CEP: 09060-870, Brazil
| | - Fatima Z Husain
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Marcelo Langer Wroclawski
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Igor Nunes-Silva
- Arnaldo Vieira de Carvalho Cancer Institute - IAVC, São Paulo, Brazil
| | | | - Alexandre Ingels
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - René Sotelo
- Institute of Urology, University of Southern California, Los Angeles, California, USA
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Sanchez-Salas R, de la Rosette J, Polascik TJ, Carneiro A, Sivaraman A, Cathelineau X, Walz J. Focal Therapy for Prostate Cancer: A More Vehement View of the Approach Could Translate into Real Benefits for Our Patients. Eur Urol 2018; 74:537-539. [DOI: 10.1016/j.eururo.2018.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/16/2018] [Indexed: 01/20/2023]
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Carneiro A, Barbosa ÁRG, Takemura LS, Kayano PP, Moran NKS, Chen CK, Wroclawski ML, Lemos GC, da Cunha IW, Obara MT, Tobias-Machado M, Sowalsky AG, Bianco B. The Role of Immunohistochemical Analysis as a Tool for the Diagnosis, Prognostic Evaluation and Treatment of Prostate Cancer: A Systematic Review of the Literature. Front Oncol 2018; 8:377. [PMID: 30280090 PMCID: PMC6153326 DOI: 10.3389/fonc.2018.00377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/23/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Prostate cancer (PCa) is a heterogeneous disease that lends itself toward numerous therapeutic options depending on its risk stratification. One of the greatest challenges in PCa urologic practice is to select patients who should be referred for biopsy and, for those patients who are diagnosed with cancer, to differentiate between patients with indolent disease from those with an unfavorable prognosis and, to determine ideal patient management and avoid unnecessary interventions. Accordingly, there is a growing body of literature reporting immunohistochemical studies with the objective of determining a prostate cancer prognosis. Among the most frequent biomarkers studied are Ki-67, p53, PTEN, MYC, and ERG. Based on these findings, we systematically reviewed articles that assessed the role of these main prognostic markers in prostate cancer. Methods: Consistent with PRISMA guidelines, we performed a systematic literature search throughout the Web of Science and PubMed Medline databases. We considered all types of studies evaluating the role of Ki-67, p53, PTEN, MYC, and ERG immunohistochemical analysis in prostate cancer until July 2017. Results: We identified 361 articles, 44 of which were summarized in this review. Diagnostically, no single immunohistochemical marker was able to define a tumor as benign or malignant. Prognostically, Ki-67, p53, and MYC were related to the tumor grade given by Gleason score and to the tumor stage (higher levels related to higher tumor grade). Furthermore, Ki-67 was also related to higher PSA levels, shorter disease-free intervals and shorter tumor-specific survival; the latter was also related to p53. The loss of PTEN protein expression showed a higher association with biochemical recurrence and with a worse prognosis, beyond that predicted by the Gleason score and tumor stage. ERG staining also showed a strong association with biochemical recurrence. Conclusion: There are several studies relating immunohistochemical markers with clinical-laboratorial outcomes in prostate cancer, the most frequent being Ki-67, p53, ERG, PTEN, and MYC. However, none of these markers have been validated by literary consensus to be routinely applied in medical practice.
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Affiliation(s)
- Arie Carneiro
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | - Carolina Ko Chen
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Langer Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Marcos Takeo Obara
- Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Adam G Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Bianca Bianco
- Human Reproduction and Genetics Center, Faculdade de Medicina do ABC, Santo André, Brazil
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Carneiro A, Priante Kayano P, Gomes Barbosa ÁR, Langer Wroclawski M, Ko Chen C, Cavlini GC, Reche GJ, Sanchez-Salas R, Tobias-Machado M, Sowalsky AG, Bianco B. Are localized prostate cancer biomarkers useful in the clinical practice? Tumour Biol 2018; 40:1010428318799255. [PMID: 30204063 PMCID: PMC6602068 DOI: 10.1177/1010428318799255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer presents itself in a heterogeneous way with both aggressive and indolent forms. Despite the controversy
surrounding its use, prostate-specific antigen screening ultimately leads to a greater number of diagnosed patients. One of the
biggest challenges in clinical practice is to select the right patients for biopsy and, among diagnosed patients, to differentiate
tumors with an indolent course from those with an unfavorable prognosis, in order to determine the best therapeutic decision for
each case, avoiding unnecessary interventions. Currently, several types of biomarkers are available for clinical use in patients
with prostate cancer, which include blood-based (prostate-specific antigen, Prostate Health Index®, 4K score®);
urine sample-based (PCA3, SelectMDx®, ExoDx Prostate IntelliScore®); and biopsy, transurethral resection, or radical
prostatectomy tissue-based (ConfirmMDx®, Oncotype®, Prolaris®, Decipher®). The aim of this review is
to provide an overview of the current state of evidence and to highlight recent advances in the evaluation and diagnosis of
prostate cancer, with emphasis on biomarkers related to diagnosis and to prognostic evaluation of localized prostate cancer.
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Affiliation(s)
- Arie Carneiro
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil.,2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paulo Priante Kayano
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Álan Roger Gomes Barbosa
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Langer Wroclawski
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil.,2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carolina Ko Chen
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Giulio Costa Cavlini
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Guilherme Jose Reche
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | | | - Marcos Tobias-Machado
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Adam G Sowalsky
- 4 Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bianca Bianco
- 5 Center for Human Reproduction and Genetics, Department of Collective Health, Faculdade de Medicina do ABC, São Paulo, Brazil
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Carneiro A, Sanchez-Salas R. Re: Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018; 74:234. [DOI: 10.1016/j.eururo.2018.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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