OBJECTIVES: The risks of identifying prostate cancer (PCa) in patients with serum total PSA (tPSA) between 4 and 10 ng/dl are between 25 and 35%. There are no data in Brazil showing the incidence of disease when all variables for PSA assessment are considered altogether, specifically tPSA, free fraction, PSA velocity and PSA stratified by age. The objective in this work was to define the incidence of disease in a population of men with abnormal values of PSA variables and normal digital rectal examination. MATERIALS AND METHODS: Between 1998 and 2003, 273 prostate biopsies were performed by the same radiologist and analyzed by the same pathologist. All patients had a normal digital rectal examination and biopsy had been indicated due to tPSA above 4 ng/dl or free-to-total PSA ratio (F/T PSA) below 15% or PSA velocity higher than 25% per year or a PSA level regarded as high for the age range. The relationship between these parameters and the positivity for prostate caner was determined. RESULTS: Patients' mean age was 63.8 years, and PCa was identified in 135 cases (49.5%). The incidence of PCa, related to unitary variations in tPSA, ranged from the limits of 33 to 80%, respectively, in tPSA < 3 and PSA between 15.1 to 20. When the other PSA parameters were assessed (free PSA, PSA according to age, rise velocity) PCa was detected in more than 25.3% of cases. CONCLUSION: When patients with normal digital rectal examination are selected for prostate biopsy due to tPSA levels above 4 or F/T PSA ratio lower than 15% or PSA velocity higher than 25% per year or high PSA for the age range, the incidence of PCa is quite higher than that observed in a population selected exclusively with basis on total PSA value.

OBJECTIVES: To analyze the behavior of the prostate specific antigen velocity (PSAV) in localized prostate adenocarcinoma. MATERIALS AND METHODS: We conducted a retrospective study of 500 men who had localized prostate adenocarcinoma, who underwent radical retropubic prostatectomy between January 1986 and December 1999. The PSAV was calculated for each patient and subsequently, the values were correlated with 5 groups: age, initial PSA value, clinical stage, tumor volume and Gleason score. RESULTS: The behavior of PSAV presented statistic significance with an increment between 1.3 ng/mL and 9.6 ng/mL, ranging from 38.6% and 59.8% when compared with the initial PSA value (p < 0.0001), clinical stage (p = 0.0002), tumor volume (p < 0.0001) and Gleason score (p = 0.0009). CONCLUSION: PSAV up to 2.5 ng/mL/year is associated with factors of good prognosis, such as initial PSA below 10 mg/mL, clinical stage T1, tumor volume below 20% and Gleason score lower than 7.

OBJETIVOS: Pacientes com carcinoma de células renais (CCR) quando diagnosticados precocemente têm maior possibilidade de cura com o tratamento cirúrgico. Este estudo tem como objetivo analisar as características anatomopatológicas dos espécimes cirúrgicos que justificam a diferença da história natural dos pacientes com CCR incidental e sintomático. MÉTODOS: Foram estudados retrospectivamente 115 pacientes submetidos a nefrectomia por CCR esporádico, divididos em Grupo 1: 59 pacientes assintomáticos com diagnóstico incidental e Grupo 2: 56 pacientes sintomáticos. A média de idade dos pacientes foi de 59 anos, com 86 homens e 29 mulheres. Cirurgia radical foi realizada em 96 pacientes e cirurgia conservadora em 19 casos. Foram analisadas as características anatomopatológicas, incluindo grau nuclear, estadio patológico, tamanho do tumor e presença de invasão microvascular intratumoral, sendo estes parâmetros comparados com a sobrevida dos pacientes. RESULTADOS: Ao compararmos os dois grupos, confirmou-se que os tumores incidentais têm menor grau nuclear (p=0,003), menor tamanho (p=0,001), menor incidência de invasão microvascular (p<0,001) e mais baixo estadio (p<0,001). A probabilidade de sobrevida do grupo incidental foi significativamente maior quando comparada ao grupo sintomático (p<0,001). CONCLUSÃO: Os CCR descobertos incidentalmente têm características anatomopatológicas mais favoráveis e estes pacientes têm maiores chances de sobrevida livre de doença quando comparados com os CCR sintomáticos.

BACKGROUND: Patients with early diagnosis of renal cell carcinoma (CCR) have higher chance of cure following surgical treatment. This study was set to compare the pathological characteristics between the surgical specimens and the survival of the patients with incidental and symptomatic CCR. METHODS: One hundred and fifteen patients with sporadic CCR were studied retrospectively following nephrectomy and divided into two groups. Group 1; 59 patients with incidental diagnosis and Group 2; 56 symptomatic patients. The mean age of the patients was 59 years, with 86 men and 29 women. Radical nephrectomy was performed in 96 patients and the conservative surgery was performed in the remaining 19. Comparison parameters included pathological outcome, specifically nuclear grade, pathological stage, size of the tumor and presence of microvascular invasion intratumoral and patients survival. RESULTS: Comparison between the two groups confirmed that the incidental tumors have smaller nuclear grade (p=0,003), smaller size (p=0,001) smaller incidence of micro vascular invasion (p< 0,001) and lower stage (p<0,001). Disease specific survival and recurrence free survival of the incidental group were statistically higher than the symptomatic group (p<0,001). CONCLUSION: Incidentally discovered CCR have more favorable pathological characteristics; the patients have disease free survival when compared to symptomatic CCR.

OBJETIVOS: O comportamento do carcinoma de células renais estádio PT1 não está completamente esclarecido. Nós estudamos a presença de fatores prognósticos e tamanho tumoral na recorrência e sobrevida do carcinoma de rim esporádico após tratamento cirúrgico. MÉTODOS: Foram revisados retrospectivamente 120 pacientes, 93 PT1, nove PT2, 11 PT3, sete PT4, seguidos após nefrectomia. Foram analisadas sobrevida e recorrência da doença dentro de três grupos de tumores: grupo 1: < 4cm, grupo 2: 4-7 cm e grupo 3: >7 cm e os fatores prognósticos preditivos avaliados foram grau nuclear, invasão microvascular, presença de gânglios comprometidos e degeneração sarcomatosa RESULTADOS: A freqüência de fatores prognósticos adversos aumenta à medida que aumenta o tamanho do tumor. No grupo 1 tivemos apenas quatro tumores de alto grau e somente um apresentou invasão microvascular não havendo gânglios comprometidos ou degeneração sarcomatosa. No grupo 2 havia 16 tumores de alto grau, quatro sarcomatosos, dois com invasão microvascular positiva e dois com gânglios positivos. No grupo 3, encontraram-se 18 tumores de alto grau, 15 com invasão microvascular e sete com gânglios positivos e cinco sarcomatosos. Houve significância estatística na sobrevida câncer específica (p=0,002) e livre de doença (p=0,0002) entre os três grupos. CONCLUSÃO: A evolução dos tumores PT1 é distinta para tumores menores de 4 cm e de 4-7 cm cabendo a subdivisão destes dois grupos em T1a e T1b.

OBJECTIVE: The behavior of the renal cells carcinoma stage PT1 is not completely clarified. We studied the presence of factors after prognostics and tumoral size in the recurrence of survival of the sporadic kidney carcinoma after surgical treatment. METHODS: 120 patients followed after nephrectomy had been revised retrospectively 93 PT1, 9 PT2, 11 PT3, 7 PT4, It was analyzed survival and recurrence of the disease inside of three groups of tumors: Group 1: < 4cm, group 2: 4-7cm and group 3: > 7cm, and the prognostics factors above-mentioned evaluated were nuclear degree, microvascular invasion, presence of committed ganglia and sarcomatous degeneration. RESULTS: The frequency of adverse prognostics factors increase as the tumor size increase. In the group 1, we had only four tumors of high degree and only one shown microvascular invasion that does not committed ganglia or sarcomatous degeneration. In group 2 there was 16 tumors of high degree, 4 sarcomatoses, two with positive microvascular invasion and two with positive ganglia. In group 3, was found 18 tumors of high degree, 15 with microvascular invasion and 7 with positive ganglia and 5 sarcomatoses. There was statistical significance in the specific cancer survival (p=0.002) and free of illness (p=0.0002) between the three groups. CONCLUSION: The evolution of tumors PT1 is distinct for lesser tumors of 4 cm and 4-7 cm fitting the subdivision of these two groups in T1a and T1b.