ABSTRACT Purpose: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ - confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. Materials and Methods: Prostates were step - sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan - Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. Conclusions: Pathologic sub - staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.

ABSTRACT Introduction: In view of the detailed histologic evaluation of prostate cancer (PC), it is usually advisable to provide a “second opinion” to confirm diagnosis. This study aimed to compare the Gleason score (GS) of initial diagnosis versus that of histopathologic review of patients with PC. The secondary objective was to compare initial GS versus histopathologic review versus post - surgical histopathology. Material and methods: Retrospective study based on chart review of patients with PC that attended the Uro - oncology Department of Hospital das Clínicas - UNICAMP - Campinas, Brazil, from April, 2002, to April, 2012. Data were divided in groups: patients with biopsies performed elsewhere, biopsies after pathological review and histopathological results following retropubic radical prostatectomy (RRP). These were evaluated in relation to GS difference using Fleis's Kappa concordance coefficient. Results: 402 PC patients, with a median age of 66 years, were evaluated. Reviewed GS showed worsening, with accuracy of 61.2%, and Kappa concordance value = 0.466. Among 143 patients submitted to surgery, GS varied widely, regarding initial evaluation, review and post - surgical RRP. Joint concordance of evaluations was weak (Kappa = 0.216), mainly due to almost no existence concordance between initial evaluation and following RRP (Kappa = 0.041). Conclusion: There is a great histopathological variation of initial GS versus reviewed GS. There is also a better correlation of reviewed GS and post - surgical GS than with initial GS. The second opinion by an uropathologist improves diagnosis and should be advised for better therapeutic decision.

ABSTRACT Introduction and Objectives: Reactive Stroma (RStr) is observed in many human cancers and is related to carcinogenesis. The objectives of the present study were to stablish a relationship of the RStr microenvironment with prostate cancer (Pca) through a morphological and molecular characterization, and to identify a possible relationship between RStr with worse prognosis factors and occurrence of malignant prostatic stem cells. Materials and Methods: Forty prostatic samples were selected from men with Pca diagnosis submitted to radical prostatectomy; they were divided in two groups: Group-1 (n=20): samples without reactive stroma; Group-2 (n=20): samples of PCa with intense stroma reaction. Prostatic samples were evaluated for RStr intensity by Masson Trichromic stain and posteriorly submitted to histopathological and immunohistochemistry analysis for antigens: α-actin, vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA, AR, Erα and ERβ. Results: Reactive stroma with intense desmoplastic reactivity was significantly more frequent in intermediate (Gleason 7, 3+4) and high grade tumors (Gleason 7, 4+3). The group with intense stromal reactivity showed significant higher levels of Vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA and ERα. Conclusions: It can be concluded that RStr may be a predictive marker of Pca progression, since it was associated with increase of growth factors, imbalance of androgen and estrogen receptors and presence of malign prostatic stem cells.

Objectives At present there are several drugs for the treatment of advanced renal cell carcinoma (ARCC). The main objective of this work was to perform a systematic review (SR) and meta-analysis (MA) of clinical randomized studies that compared target cell therapies (TCT). Materials and Methods SR identified clinical randomized trials that compared TCT versus interferon-alpha in the treatment of patients with ARCC. In order to analyze efficiency, it was evaluated free-survival progression (FSP), total survival (TS) and response rate (RR). Results In relation to first line treatment, seven studies of TCT were identified using sunitinib, sorafenib, bevacizumab and temsirolimus; and two studies with sorafenib and everolimus for second line treatment. Relative risk (RRi) of MA for FSP of first line therapies was: 0.83, CI = 0.78-0.87, I2 = 94% and p < 0.00001. Best results of RR of specific FSP among studies were: 0.38, sunitinib, CI = 0.25-0.58, bevacizumab, 0.62, CI = 0.47-0.83; and temsirolimus, 0.78, CI = 0.70-0.87. MA didn't show any benefit regarding TS of first line treatment of all analyzed drugs. As for RR significant results were: sunitinib, 3.83 CI = 2.86-5.12; bevacizumab, 2.52 CI = 1.78-3.57 and bevacizumab, 1.97 CI = 1.43-2.71. Conclusions: For first line treatment, sunitinib was the most effective TCT in relation to FPS; there was no alteration of TS and RR was small but significant for sunitinib and bevacizumab. Available studies could not conclude any results for second line treatments.

Objective Systematic review of literature and meta-analysis to evaluate the results of magnetic resonance image 1.5T with endorectal coil in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer, compared to the histopathological results of the radical prostatectomy specimen. Materials and Methods It was conducted a systematic review of literature and meta-analyses of all studies data published after 2008. In those studies, the patients with prostate cancer with indication to radical prostatectomy were submitted to magnetic resonance image (MRI) at pre-operatory period and the results were compared to those of histopathological studies after the surgery. The selected terms for research included prostate cancer, magnetic resonance, radical prostatectomy, and prostate cancer diagnosis, in the databases EMBASE, LILACS, PUBMED/MEDLINE and Cochrane Library. The data were collected using a specific qualitative instrument and the meta-analysis data were presented in the forest plot graphics, homogeneity test and sROC curves and funnel plot. Results A total of seven studies were included, with a total of 603 patients. Among these studies, six evaluated the value of MRI for the detection of prostate cancer, and the median sensitivity of meta-analysis was 0.6 and specificity 0.58, but with heterogeneity among the studies. Three studies evaluated extra-prostatic extension with a median sensitivity of 0.49, specificity 0.82 and heterogeneity only for sensitivity. Three studies evaluated invasion of seminal vesicles, with median sensitivity of 0.45 and specificity 0.96, with heterogeneity in both analysis. Conclusion Magnetic resonance of 1.5T with endocoil showed low values of sensitivity and specificity for the diagnosis and staging of prostate cancer. The reviewed studies showed a significant heterogeneity among them. The best observed result was MRI specificity for invasion of seminal vesicles. More studies are necessary to evaluate new techniques and parameters before recommending the routine use of MRI in clinical practice.

Objectives: Evidence-based medicine allows the best available external clinical evidence from systematic literature research to be graded in order to determine the strength of its recommendation. This guideline aims to assist physicians and health professionals in clinical decisions related to prostate cancer treatment, particularly in urology, clinical oncology and radiotherapy. Methods: The publications used as information sources were obtained from structured data search in electronic databases, such as CENTRAL (Cochrane Central Register of Controlled Clinical Trials) and MEDLINE (online). Each item of this guideline derived from an original question which was distributed to the participants. Search strategies were prepared to select the studies presenting the best methodological quality, according to predefined levels of evidence. Results: All the recommendations were followed by a level of evidence (LE) and a degree of recommendation (DR). We used a formal ranking system to help the reader to judge the strength of the evidence behind the results published in support of each recommendation. Conclusions: The existing parameters should be viewed as guidelines of conduct. The final trial on which the clinical procedure or treatment plan is most suitable for a particular patient should be done by a physician, who should discuss the available treatment options with the patient according to the diagnosis.

Objetivo: La medicina basada en la evidencia permite la mejor evidencia clínica externa de la que se dispone respecto a las búsquedas sistemáticas en la literatura para determinar la amplitud de su recomendación. Esta guía clínica tiene la intención de asistir a médicos y profesionales de la salud en decisiones clínicas en relación con el tratamiento del cáncer de próstata, particularmente en urología, oncología clínica y radioterapia. Métodos: Las publicaciones usadas como fuentes de información fueron obtenidas de búsquedas en bases electrónicas como CENTRAL (Cochrane Central Register of Controlled Clinical Trials) y MEDLINE (online). Cada punto de esta guía clínica deriva de una pregunta original distribuida entre los participantes. Las estrategias de búsqueda fueron preparadas para elegir estudios presentando la mejor calidad metodológica, de acuerdo a los niveles de evidencia predefinidos. Resultados: Todas las recomendaciones fueron seguidas por un nivel de evidencia (NE) y un grado de recomendación (GR). Hemos usado un sistema de ranking formal para ayudar al lector a juzgar la amplitud de la evidencia. Conclusiones: Los parámetros existentes deberían ser vistos como guías clínicas de conducta. El ensayo final en el cual el proceso clínico o plan de tratamiento es más conveniente para un paciente debe ser hecho por un médico, quien discutiría las opciones de tratamiento disponibles con el paciente de acuerdo con el diagnóstico.

INTRODUCTION: In the case of clinically negative inguinal regions in penile cancer, the treatments proposed might vary from careful observation to radical dissection for all patients. We evaluated the effectiveness of the sentinel lymph node biopsy using lymphoscintigraphy in patients with penile cancer and at least one negative inguinal region. MATERIALS AND METHODS: In 18 patients, biopsy of the sentinel lymph node from the 32 negative inguinal regions and modified radical lymphadenectomy in these regions regardless of the biopsy results was performed. Clinical staging, pathological results of the sentinel and the other lymph nodes removed during lymphadenectomy, tumor behavior, local and inguinal recurrence and specific disease mortality were accessed. RESULTS: The mean age of the study sample was 57.7 years (44 - 81 years) and the sentinel lymph node presented 0% false negative 66% sensitivity, and 79.3% specificity when compared with the modified inguinal lymphadenectomy as the gold standard treatment. CONCLUSION: Sentinel lymph node biopsy is a feasible method of assessing the presence of regional metastasis in patients with penile cancer and clinically negative inguinal regions. However, the optimal lymphoscintigraphy technique is still in evolution and requires further optimization at high volume centers.

Objetive: To analyze the importance of the starting time for pelvic floor physiotherapy in patients with post radical prostatectomy urinary incontinence. Methods: Between May 2003 and February 2004 18 patients with the diagnosis of post radical prostatectomy urinary incontinence underwent physiotherapy of the pelvic floor. Each patient received 12 sessions using kinesitherapy and electric stimulation on a weekly basis. Patients were divided into two groups: Group 1 included eight patients that started therapy within the first six months after surgery; Group 2 included 10 patients starting therapy after the sixth post operative month. All patients were evaluated by the pad test and number of incontinence pads per day. Results: Evaluating pad tests before and after treatment, six patients in group 1 had a reduction of the amount of urine leak in comparison to seven patients in group 2. The statistical analysis showed signi.cant differences before and after treatment for both groups (group 1: p= 0.028; group 2: p = 0.018). The evaluation of the number of pads showed: Group 1: all eight patients using pads had a reduction in the number of pads. Group 2: 5 of the eight patients using pads had a reduction and the other three continued using the same number. Statistical analysis comparing the number of pads per day before and after treatment showed a significant difference in group1 (p = 0.004). There was no statistically significant difference in the number of pads per day before and after physiotherapy in group 2, although half of the patients showed a diminishment in the number of pads required after treatment. Conclusions: Results demonstrate that early indication of physiotherapy for the treatment of post radical prostatectomy urinary incontinence is better than delayed treatment. New works may be developed in the future to confirm our results.

Objetivo: El objetivo de este trabajo es analizar la importancia del tiempo de inicio de la fisioterapia del suelo pélvico, en pacientes con incontinencia urinaria post-prostatectomía radical. Métodos: En el período de mayo de 2003 a febrero de 2004, dieciocho pacientes con diagnóstico de incontinencia urinaria post-prostatectomía radical fueron sometidos a tratamiento de fisioterapia del suelo pélvico. Cada paciente realizó doce sesiones de fisioterapia, utilizando cinesioterapia y electroestimulación, de forma semanal. Los pacientes fueron divididos en dos grupos: el Grupo 1 compuesto de ocho pacientes que iniciaron la fisioterapia en los primeros seis meses de post-operatorio; y el Grupo 2 compuesto de diez pacientes que iniciaron el tratamiento fisioterapéutico después del sexto mes de la intervención quirúrgica. Posteriormente, todos los pacientes fueron evaluados por medio del pad test y contando el número de pañales. Resultados: A partir del análisis del pad test pre y post-tratamiento, del Grupo 1; seis pacientes tuvieron reducción de la cantidad de pérdida urinaria, sin embargo recibido: 8 de febrero 2006 en el Grupo 2; siete pacientes tuvieron reducción en la cantidad de pérdida urinaria. El resultado del análisis estadístico con relación a la media del pad test del Grupo 1, pre y post-tratamiento fisioterapéutico, demostró mejorías estadísticamente significantes, con p = 0,028 y del Grupo 2, también fue observada una mejoría estadísticamente significante, con p = 0,018. En la evaluación del número de pañales, fue observado que en el Grupo 1: de los 8 pacientes que usaban pañales, todos presentaron reducción del número de pañales. Sin embargo en el Grupo 2, del total de 10 pacientes: fueron analizados estadísticamente los ocho pacientes que usaban pañales; y cinco pacientes presentaron reducción de ese número, sin embargo tres continuaron utilizando el mismo número de pañales. Con relación al análisis estadístico del número de pañales del Grupo 1, pre y post-tratamiento .fisioterapéutico, fue demostrada una diferencia estadísticamente significante, con p=0,004. En el Grupo 2, a pesar de no haber sido demostrada diferencia estadísticamente significante, con relación al número de pañales, pre y posttratamiento de fisioterapia, la mitad de los pacientes de ese grupo presentaron disminución de la cantidad de pañales utilizados después del tratamiento. Conclusión: Los resultados presentados demostraron que la indicación precoz de tratamiento fisioterápico de la incontinencia urinaria pos-prostatectomia radical es mejor que el inicio tardío. En el futuro, nuevos trabajos podrán ser desarrollados para la confirmación de estos datos.