Background: New prognostic grade groupings were recently proposed for prostate cancer. They are based on Gleason grading of either biopsy or prostatectomy specimen. Former Gleason 6 corresponds to group 1, Gleason 7=3+4 corresponds to group 2, Gleason 7=4+3 corresponds to group 3, Gleason 8 corresponds to group 4, and Gleason 9-10 correspond to group 5. Objective: To assess the prognostic value of Gleason grade groups in men with prostate cancer from a nationwide population‑based cohort. Design, Setting and Participants: From the National Prostate Cancer Register of Sweden, we identified 5,880 men diagnosed with prostate cancer from 2005 to 2007, including 4,325 who had radical prostatectomy and 1,555 treated by radiotherapy.  Outcome Measurements and Statistical Analysis: Kaplan-Meier survival analysis was used to calculate the cumulative 4-year biochemical recurrence-free survival. Cox proportional hazards regression models were used to examine the relationship between prognostic Gleason grade groups and biochemical recurrence after radical prostatectomy and radiotherapy. The 4-year biochemical progression-free survival was compared for groups based on biopsy and prostatectomy Gleason grade groups. Results and Limitations: Among men undergoing surgery, the 4‑year biochemical progression-free survival was 89%, 82%, 74%, 77%, and 49% for prognostic Gleason grade groups 1-5 on biopsy. The corresponding 4-year biochemical progression-free survival based on prostatectomy prognostic Gleason grade groups was 92%, 85%, 73%, 63%, and 51% for prognostic Gleason grade groups 1-5. For men undergoing radiotherapy, biopsy prognostic Gleason grade groups 1-5 had 4-year biochemical progression-free survival of 95%, 91%, 85%, 78%, and 70%. After adjusting for preoperative serum prostate specific antigen and clinical stage, biopsy prognostic Gleason grade groups were significant independent predictors of biochemical progression after radical prostatectomy and radiotherapy. There was no central review of pathology. Conclusions: These results confirm the prognostic value of the newly proposed prognostic Gleason grade groups in men undergoing radical prostatectomy and radiotherapy in a population-based setting.

No description available.

Background: We evaluated the validity of a set of 11 quality indicators for prostate cancer radiotherapy and radical prostatectomy by examining their association with outcomes. The selected indicators were: hospital volume, pre-treatment risk assessment, patient consultation with a radiation oncologist, appropriate follow-up care, leg immobilization during radiotherapy, bladder filling during radiotherapy, portal film target localization, use of nerve sparing surgery, operative blood loss, margin status and pelvic lymph node dissection. The selected outcomes were: cause-specific survival, disease-free survival, late morbidity (urinary incontinence, gastrointestinal and genitourinary morbidity), change in node stage from clinical N0 to pathologic N1, and margin status. Methods: Our study sample consisted of 1570 prostate cancer patients who were diagnosed in Ontario between January 1, 1990 and December 31, 1998 who received radical prostatectomy within 6 months of diagnosis (n=646), or curative radiotherapy within 9 months of diagnosis (n=924). Quality of care, outcomes, and potential confounders were measured using patient chart and administrative data. Regression techniques were used to evaluate the associations between quality indicators and relevant outcomes. Results: For patients treated surgically, hospital volume met our test of validity. Patients treated in the lowest volume hospital (0-1 RP/month) were at greater risk of prostate cancer death than patients treated in the highest volume hospitals (7+ RP/month) (HR=5.37 95% CI=1.23-23.46). For patients treated with radiotherapy, leg immobilization and bladder filling during radiotherapy met our test of validity. Patients treated without leg immobilization were more likely to experience urinary incontinence (RR=2.18, 95% CI=1.23-3.87) and genitourinary late morbidities (RR=1.72, 95% CI=1.16-2.56) than patients who received leg immobilization. Patients who were treated with an empty bladder were more likely to experience GU late morbidities (RR=1.98, 95% CI=1.08-3.63) than those treated with a full bladder. The remaining indicators did not meet our test of validity. Conclusion: Our results support the validity of one surgical quality indicator and two radiotherapy quality indicators. Explanations for our non-significant findings, including limited study power, data quality, our definition and measurement of indicators, and a true failure to predict outcome(s) are discussed, and recommendations for further research are presented. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-09-07 20:26:34.461

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--Florida State University, 2006. / Advisor: James Whyte IV, Florida State University, School of Nursing. Title and description from dissertation home page (viewed June 13, 2006). Document formatted into pages; contains vii, 90 pages. Includes bibliographical references.

Objetivo: Analisar a casuística de prostatovesiculectomias radicais com linfadenectomia ilíaca avaliando a validade das Tabelas de Partin versão 2001. Estudar variáveis que possam interferir no confinamento ou não da neoplasia como retardo cirúrgico, peso prostático, resultados referentes à biópsia e ano da cirurgia. Material e Métodos: Avaliação retrospectiva de 568 prontuários de pacientes submetidos à cirurgia para câncer de próstata clinicamente localizado entre 1995 até agosto de 2005 no Hospital de Clínicas de Porto Alegre. Foram excluidos quem tivesse feito hormonioterapia neoadjuvante ou com diagnóstico feito por ressecção endoscópica da próstata e aqueles com insuficiência dos dados no prontuário. Estágio clínico pelo toque retal , valores de PSA e dados da biópsia que diagnosticou a neoplasia, assim como dos dados da peça da prostatectomia radical foram coletados. Os valores preditivos das Tabelas de Partin, versão 2001 foram comparados com os do espécime cirúrgico e analisados através de Curvas R.OC. Foram também avaliados tempo de espera para cirurgia, peso da próstata, ano da cirurgia, uni ou bilateralidade tumoral na biópsia e qual a biópsia que diagnosticou (primeira ou ulterior) e analisados como fatores preditivos para confinamento ou não da neoplasia. Resultados: A idade média do pacientes foi 63 (42-77). A percentagem de estágio T1c foi de 63 %. Pacientes com escore de Gleason 2-4 na biópsia constituiram 20,2 %, notadamente antes de 2000. O percentual de pacientes com níveis de PSA menores de 4,0 ng/ml foi de 8,3 % e acima de 10,0 ng/ml foi de 35 %. Os percentuais de doença confinada ao órgão, extensão extra-prostática, invasão de vesículas seminais e metástases linfonodais foram 48,2 %, 35,3%, 13,9% e 2,6% , respectivamente. A área sob a curva calculada para doença confinada ao órgão foi de 0,65 , enquanto as áreas sob as curvas para extensão extra-prostática, invasão de vesículas seminais e metástases linfonodais foi respectivamente 0,54; 063 e 0,77. Pacientes que tiveram o diagnóstico já na primeira biópsia, ou com biópsias bilateralmente comprometidas e aqueles operados antes de 2000 tinham tendência ao não confinamento. Biópsias realizadas a partir de 2000 que já foram positivas na primeira tentativa tiveram maior tendência ao confinamento do que até 1999. Conclusão: As Tabelas de Partin tiveram valor preditivo marginal para as características patológicas finais como doença confinada ao órgão e invasão de vesículas seminais e valor preditivo importante para metástases linfonodais. Não mostraram valor preditivo para extensão extra-prostática. Bilateralidade tumoral na biópsia, diagnóstico na primeira biópsia (especialmente até 1999) e cirurgia antes de 2000 configuraram situações com tendência a tumores não confinados. / Objective: The predictive value of current Partin tables (2001) has been not validated in most of the countries as well Brazil. Therefore, we evaluated the validity of 2001 Partin tables for the ability to predict the pathological stage in specimens of radical prostatectomy. Also, we analysed how biopsies can predict results for organ confinement or not and as well what the year of the surgery can make in organ confinement issue . Materials and methods: The clinical and pathological findings of 568 patients who have had radical prostatectomy and iliac lymphadenectomy from 1995 to 2005 at Hospital de Clínicas de Porto Alegre were assessed. Those with missing information, patients who had neoadjuvant endocrine treatment and those who had the diagnosis by transurethral ressection of prostate were excluded. Serum PSA, clinical stage, biopsy characteristics and the pathological features of the specimens were collected. The predictive value of Partin tables and pathological findings of prostatectomy specimens were compared and analyzed according to Receiver Operating Characteristics curves. The delay of the surgery, prostate weight, year of the surgery, bilaterality of the biopsies and if the diagnostic biopsy was the first or not were important for the organ confined disease were also tested. Results: Median age of the patients was 63(42-77). The percentage of patients with clinical stage T1c was 63%. Gleason score 2-4 in biopsy constituted 20,2 %, at mainly before 2000. The ratio of patients with serum PSA above 4,0 ng/ml was 8,3% and higher than 10,0 ng/ml was 35%.Organ confined disease, extra-prostatic extension, seminal vesicle involvement and lymph node metastasis were 48,2%; 35,3%; 13,9 % and 2,6% respectively. Area under curve (AUC) values for organ confined disease, extra-prostatic extension, seminal vesicle invasion and lymph node involvement were 0,65 ; 0,54; 0,63 and 0,77. Tumor bilaterallity at biopsy and positive biopsy at the first procedure (at least until 1999) as well radical prostatectomy before 2000 were predictors for non organ confined prostate cancer. Conclusion: Partin tables have a marginally predictive value for the pathological features like organ confined disease and seminal vesicle involvement and a good predictive value for lymph node metastasis prediction. They don’t have predictive value for extra-prostatic extension. Positive first biopsy, bilateral tumor at biopsy and radical prostatectomy before 2000 were predictive for non organ confined disease.

Orientador: João Luiz Amaro / Banca: Monica Oliveira Oersi Gameiro / Banca: Hamilto Akihissa Yamamoto / Banca: Carlos Alberto Riceto Sacomani / Banca: Eliney Ferreira Faria / Resumo: Objetivos: Avaliar o impacto da eletroestimulação retal na recuperação da continência urinária em pacientes submetidos à prostatectomia radical. Método: Ensaio clínico, randomizado e controlado, no qual foram incluídos pacientes no período pré operatório de prostatectomia radical. Foram avaliados a qualidade de vida (pelo questionário específico ICIQ-SF), os sintomas urinários (pelo escore IPSS), a função erétil (pelo instrumento específico IIEF-5), a perda urinária (por Pad Test de 01 hora) e a força muscular do assoalho pélvico (por perineometria), em quatro momentos: pré operatório, 01º, 03º e 06º meses pós operatórios. Os pacientes foram randomizados em três grupos (controle, orientação e eletroestimulação + exercícios perineais). O grupo orientação recebeu instruções de uma fisioterapeuta para realização de exercícios de fortalecimento do assoalho pélvico, após a retirada da sonda vesical. O grupo eletroestimulação realizou 14 sessões de eletroestimulação do assoalho pélvico, com frequência de 35Hz, duas vezes por semana e tambpem recebeu orientações para exercícios perineais. Resultados: No período de outubro de 2010 à setembro de 2013, 123 pacientes submetidos a Prostatectomia Radical, com Incontinência Urinária Leve (Pad Test ≥ 3 gramas), Moderada ou Grave foram randomizados para o grupo controle (n:40), orientação (n:41) e eletroestimulação + exercícios perineais (n:42). Não houve diferença estatisticamente significativa entre os grupos em relação às variáveis clínicas e patológicas. Nas medidas de qualidade de vida, sintomas urinários e função erétil, a realização de eletroestimulação não demonstrou impacto na população estudada. O valor de perda urinária (medido pelo Pad Test), ao final do seguimento, foi similar e não houve diferença estatística: 1,0 (0,0-23,0) vs (1,0 (0,0-78,0) vs 1,0 (0,0-18,0), respectivamente. Em relação à perineometria,... / Abstract: Objective: To evaluate impact of rectal electrical stimulation in urinary continence and sexual function rehabilitation in patients undergone to radical prostatectomy. Methods: This randomized controlled clinical trial included patients in preoperative workup for radical prostatectomy. Were evaluated quality of life (ICIQ-SF), erectile function (IIEF-5), urinary symptoms (IPSS score), urinary loss (Pad Test 1 hour), and pelvic floor muscular strenght (Perineometry), in four moments: preoperative, postoperative follow-up of 1, 3 and 6 months. Patients were randomized in three groups (control, verbal guidance and electrical stimulation). The verbal guidance group were instructed by a physiotherapist to practice exercises to empowering pelvic floor after catheter removal. The electrical stimulation group undergone to 14 sesions of pelvic floor electrical stimulation, with 35Hz frequency, twice a week. Results: Between October 2010 and September 2013, were included 123 patients undergone to radical prostatectomy with mild, moderate or high urinary incontinence (Pad Test ≥ 3 gr). These patients were randomized: control group (n:40), verbal guidance (n:41) and electrical stimulation (n:42). Demographics and pathological variables were similar between the groups. The analysis of the variables QoL, urinary symptoms, erectile function and perineometry did not demonstrate differences between the groups analysed. The Pad Test values in 6 months follow-up had no statistical significance between the groups (median were: 1,0gr (0-23,0); 1,0gr (0-78,0) and 1,0gr (0-18,0), respectively. Conclusion: QoL, urinary symptoms, erectile function and muscular strength do not show a better rehabilitation in electrical stimulation group in our study population. Pelvic floor electrical stimulation did not show impact in urinary continence after radical prostatectomy / Doutor

Made available in DSpace on 2015-10-06T13:02:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-12-16. Added 1 bitstream(s) on 2015-10-06T13:19:37Z : No. of bitstreams: 1 000847165_20181216.pdf: 835697 bytes, checksum: 98c12c0b2d34cb955e1e461bfa5c5093 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivos: Avaliar o impacto da eletroestimulação retal na recuperação da continência urinária em pacientes submetidos à prostatectomia radical. Método: Ensaio clínico, randomizado e controlado, no qual foram incluídos pacientes no período pré operatório de prostatectomia radical. Foram avaliados a qualidade de vida (pelo questionário específico ICIQ-SF), os sintomas urinários (pelo escore IPSS), a função erétil (pelo instrumento específico IIEF-5), a perda urinária (por Pad Test de 01 hora) e a força muscular do assoalho pélvico (por perineometria), em quatro momentos: pré operatório, 01º, 03º e 06º meses pós operatórios. Os pacientes foram randomizados em três grupos (controle, orientação e eletroestimulação + exercícios perineais). O grupo orientação recebeu instruções de uma fisioterapeuta para realização de exercícios de fortalecimento do assoalho pélvico, após a retirada da sonda vesical. O grupo eletroestimulação realizou 14 sessões de eletroestimulação do assoalho pélvico, com frequência de 35Hz, duas vezes por semana e tambpem recebeu orientações para exercícios perineais. Resultados: No período de outubro de 2010 à setembro de 2013, 123 pacientes submetidos a Prostatectomia Radical, com Incontinência Urinária Leve (Pad Test ≥ 3 gramas), Moderada ou Grave foram randomizados para o grupo controle (n:40), orientação (n:41) e eletroestimulação + exercícios perineais (n:42). Não houve diferença estatisticamente significativa entre os grupos em relação às variáveis clínicas e patológicas. Nas medidas de qualidade de vida, sintomas urinários e função erétil, a realização de eletroestimulação não demonstrou impacto na população estudada. O valor de perda urinária (medido pelo Pad Test), ao final do seguimento, foi similar e não houve diferença estatística: 1,0 (0,0-23,0) vs (1,0 (0,0-78,0) vs 1,0 (0,0-18,0), respectivamente. Em relação à perineometria,... / Objective: To evaluate impact of rectal electrical stimulation in urinary continence and sexual function rehabilitation in patients undergone to radical prostatectomy. Methods: This randomized controlled clinical trial included patients in preoperative workup for radical prostatectomy. Were evaluated quality of life (ICIQ-SF), erectile function (IIEF-5), urinary symptoms (IPSS score), urinary loss (Pad Test 1 hour), and pelvic floor muscular strenght (Perineometry), in four moments: preoperative, postoperative follow-up of 1, 3 and 6 months. Patients were randomized in three groups (control, verbal guidance and electrical stimulation). The verbal guidance group were instructed by a physiotherapist to practice exercises to empowering pelvic floor after catheter removal. The electrical stimulation group undergone to 14 sesions of pelvic floor electrical stimulation, with 35Hz frequency, twice a week. Results: Between October 2010 and September 2013, were included 123 patients undergone to radical prostatectomy with mild, moderate or high urinary incontinence (Pad Test ≥ 3 gr). These patients were randomized: control group (n:40), verbal guidance (n:41) and electrical stimulation (n:42). Demographics and pathological variables were similar between the groups. The analysis of the variables QoL, urinary symptoms, erectile function and perineometry did not demonstrate differences between the groups analysed. The Pad Test values in 6 months follow-up had no statistical significance between the groups (median were: 1,0gr (0-23,0); 1,0gr (0-78,0) and 1,0gr (0-18,0), respectively. Conclusion: QoL, urinary symptoms, erectile function and muscular strength do not show a better rehabilitation in electrical stimulation group in our study population. Pelvic floor electrical stimulation did not show impact in urinary continence after radical prostatectomy / FAPESP: 2011/12154-7

Objetivo: Analisar a casuística de prostatovesiculectomias radicais com linfadenectomia ilíaca avaliando a validade das Tabelas de Partin versão 2001. Estudar variáveis que possam interferir no confinamento ou não da neoplasia como retardo cirúrgico, peso prostático, resultados referentes à biópsia e ano da cirurgia. Material e Métodos: Avaliação retrospectiva de 568 prontuários de pacientes submetidos à cirurgia para câncer de próstata clinicamente localizado entre 1995 até agosto de 2005 no Hospital de Clínicas de Porto Alegre. Foram excluidos quem tivesse feito hormonioterapia neoadjuvante ou com diagnóstico feito por ressecção endoscópica da próstata e aqueles com insuficiência dos dados no prontuário. Estágio clínico pelo toque retal , valores de PSA e dados da biópsia que diagnosticou a neoplasia, assim como dos dados da peça da prostatectomia radical foram coletados. Os valores preditivos das Tabelas de Partin, versão 2001 foram comparados com os do espécime cirúrgico e analisados através de Curvas R.OC. Foram também avaliados tempo de espera para cirurgia, peso da próstata, ano da cirurgia, uni ou bilateralidade tumoral na biópsia e qual a biópsia que diagnosticou (primeira ou ulterior) e analisados como fatores preditivos para confinamento ou não da neoplasia. Resultados: A idade média do pacientes foi 63 (42-77). A percentagem de estágio T1c foi de 63 %. Pacientes com escore de Gleason 2-4 na biópsia constituiram 20,2 %, notadamente antes de 2000. O percentual de pacientes com níveis de PSA menores de 4,0 ng/ml foi de 8,3 % e acima de 10,0 ng/ml foi de 35 %. Os percentuais de doença confinada ao órgão, extensão extra-prostática, invasão de vesículas seminais e metástases linfonodais foram 48,2 %, 35,3%, 13,9% e 2,6% , respectivamente. A área sob a curva calculada para doença confinada ao órgão foi de 0,65 , enquanto as áreas sob as curvas para extensão extra-prostática, invasão de vesículas seminais e metástases linfonodais foi respectivamente 0,54; 063 e 0,77. Pacientes que tiveram o diagnóstico já na primeira biópsia, ou com biópsias bilateralmente comprometidas e aqueles operados antes de 2000 tinham tendência ao não confinamento. Biópsias realizadas a partir de 2000 que já foram positivas na primeira tentativa tiveram maior tendência ao confinamento do que até 1999. Conclusão: As Tabelas de Partin tiveram valor preditivo marginal para as características patológicas finais como doença confinada ao órgão e invasão de vesículas seminais e valor preditivo importante para metástases linfonodais. Não mostraram valor preditivo para extensão extra-prostática. Bilateralidade tumoral na biópsia, diagnóstico na primeira biópsia (especialmente até 1999) e cirurgia antes de 2000 configuraram situações com tendência a tumores não confinados. / Objective: The predictive value of current Partin tables (2001) has been not validated in most of the countries as well Brazil. Therefore, we evaluated the validity of 2001 Partin tables for the ability to predict the pathological stage in specimens of radical prostatectomy. Also, we analysed how biopsies can predict results for organ confinement or not and as well what the year of the surgery can make in organ confinement issue . Materials and methods: The clinical and pathological findings of 568 patients who have had radical prostatectomy and iliac lymphadenectomy from 1995 to 2005 at Hospital de Clínicas de Porto Alegre were assessed. Those with missing information, patients who had neoadjuvant endocrine treatment and those who had the diagnosis by transurethral ressection of prostate were excluded. Serum PSA, clinical stage, biopsy characteristics and the pathological features of the specimens were collected. The predictive value of Partin tables and pathological findings of prostatectomy specimens were compared and analyzed according to Receiver Operating Characteristics curves. The delay of the surgery, prostate weight, year of the surgery, bilaterality of the biopsies and if the diagnostic biopsy was the first or not were important for the organ confined disease were also tested. Results: Median age of the patients was 63(42-77). The percentage of patients with clinical stage T1c was 63%. Gleason score 2-4 in biopsy constituted 20,2 %, at mainly before 2000. The ratio of patients with serum PSA above 4,0 ng/ml was 8,3% and higher than 10,0 ng/ml was 35%.Organ confined disease, extra-prostatic extension, seminal vesicle involvement and lymph node metastasis were 48,2%; 35,3%; 13,9 % and 2,6% respectively. Area under curve (AUC) values for organ confined disease, extra-prostatic extension, seminal vesicle invasion and lymph node involvement were 0,65 ; 0,54; 0,63 and 0,77. Tumor bilaterallity at biopsy and positive biopsy at the first procedure (at least until 1999) as well radical prostatectomy before 2000 were predictors for non organ confined prostate cancer. Conclusion: Partin tables have a marginally predictive value for the pathological features like organ confined disease and seminal vesicle involvement and a good predictive value for lymph node metastasis prediction. They don’t have predictive value for extra-prostatic extension. Positive first biopsy, bilateral tumor at biopsy and radical prostatectomy before 2000 were predictive for non organ confined disease.