OBJETIVO: Avaliar a relação entre mensurações de gordura (subcutânea e periprostática) realizadas em ressonância magnética, com o prognóstico do paciente portador de câncer de próstata. MATERIAIS E MÉTODOS: A mensuração da gordura periprostática e subcutânea com exame de ressonância magnética com ênfase na próstata foram realizadas em 58 pacientes com o diagnóstico histopatológico de câncer de próstata. Dados demográficos, clínicos e patológicos dos pacientes foram coletados e a correlação com o prognóstico, realizada. RESULTADOS: Na análise univariada, as gorduras periprostática e a subcutânea indicaram serem preditores de evolução desfavorável com significância estatística para o observador 1, no caso da gordura periprostática e para o observador 2 no caso da gordura subcutânea. Na análise multivariada, não houve associação com significância estatística. CONCLUSÃO: A associação entre obesidade e o câncer de próstata é complexa. Os dados obtidos neste estudo indicam que a medida da gordura periprostática, pelas imagens em T2, na RM, podem ser um preditor independente, da evolução desfavorável de pacientes com neoplasia de próstata / PURPOSE: Evaluate the relationship between fat measurements (subcutaneous and periprostatic) performed on MRI, with the prognosis of the patient with prostate cancer. MATERIALS AND METHODS: Measurements of periprostatic and subcutaneous fat with magnetic resonance imaging with emphasis on the prostate were performed in 58 patients with the histopathological diagnosis of prostate cancer. Demographic, clinical and pathological data of the patients were collected and the correlation with the prognosis was performed. RESULTS: In the univariate analysis, the periprostatic and subcutaneous fat were predictors of unfavorable evolution with statistical significance for the observer 1, in the case of the periprostatic fat and for the observer 2 in the case of the subcutaneous fat. In the multivariate analysis, there was no association with statistical significance. CONCLUSION: The association between obesity and prostate cancer is complex. The data obtained in this study indicate that the measurement of periprostatic fat by T2-weighted images in MRI may be an independent predictor of the unfavorable evolution of patients with prostate neoplasia

Background: Transrectal ultrasound is commonly performed in the clinical evaluation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypoechoic, e.g. hyperechoic or irregular lesions in relation to CaP is not clear. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Material and Methods: 265 patients who were referred for prostatic evaluation because of an elevated PSA serum level or a positive digital rectal examination were enrolled in a prospective study. All patients had a systematic ultrasound-guided sextant biopsy of the prostate and a 4-core biopsy of the transition zone. All biopsy cores taken were guided by transrectal ultrasound. In case of a sonographically suspicious lesion, biopsy was always directed into this area. The predominant ultrasound appearance was separately recorded for each core. Results: Carcinoma of the prostate was detected in 87 (32.8%) of the 265 patients. Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic and anechoic lesions were 34.5, 26.9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of the prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of the prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesions of mixed or irregular echogenicity were found to contain cancer in significant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable. / Hintergrund: Der transrektale Ultraschall ist die häufigste bildgebende Untersuchung zur klinischen Beurteilung der Prostata. Zur Diagnostik des Prostatakarzinoms (PCa) hat sich die ultraschallgesteuerte Sextanten-Biopsie als Standardverfahren etabliert. Eine gezielte Biopsie irregulärer Ultraschallbezirke ist hier nicht vorgesehen. Es ist jedoch bekannt, daß sonographisch echoarm erscheinende Areale suspekt für die Präsenz eines PCa sind. Die Wertigkeit nicht einheitlicher oder echoreicher Ultraschallmuster ist jedoch bisher nicht zweifelsfrei geklärt. Ziel der vorliegenden Arbeit war es, mit einem Ultraschallgerät der neuesten Generation die Bedeutung der verschiedenen Ultraschallmuster bezüglich des Vorhandenseins von Prostatakarzinomen zu klären. Material und Methoden: 265 Patienten mit erhöhten PSA-Serumwerten oder suspekten Tastbefunden der Prostata wurden in die prospektive Untersuchung eingeschlossen. Bei allen Patienten wurden systematische, ultraschallgesteuerte Prostatabiopsien, wie in der Sextantenbiopsie vorgesehen, und 4 Zylinder aus der Transitionalzone entnommen. Bei der Biopsie wurde jedoch gezielt die Punktion in Bereichen von – falls vorhanden – irregulärem Ultraschallmuster vorgenommen und das entsprechende Ultraschallbild dokumentiert. Ergebnisse: Bei 87 der 265 Patienten (32,8%) wurden Prostatakarzinome nachgewiesen. Biopsiezylinder aus isodensen Bereichen wiesen in 7,6% ein Prostatakarzinom auf. Die Karzinomhäufigkeit bei Biopsie von echoarmen und echoreichen Arealen sowie von Arealen mit unterschiedlichen Echomustern und von zystischen Arealen wurde mit 34,5, 26,9, 21,1 bzw. 0% ermittelt. Echoarme Befunde wurden seltener in der Transitionalzone nachgewiesen, waren jedoch dort in etwa gleicher Häufigkeit mit einem Karzinom verbunden wie in der peripheren Zone. Schlußfolgerungen: Das transrektale Ultraschallmuster in der Prostata liefert wichtige Hinweise auf das Vorhandensein eines Prostatakarzinoms. Insbesondere echoarme Läsionen deuten auf ein PCa hin. Echoreiche Läsionen und solche mit unterschiedlichen Echomustern enthielten jedoch Karzinome in so bedeutender Anzahl, daß diese Läsionen ebenfalls als karzinomverdächtig eingestuft werden müssen und auch eine gezielte Biopsie dieser Areale im Rahmen der Sextantenbiopsie empfehlenswert erscheint. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-03-27T14:09:53Z No. of bitstreams: 2 Tese - Mariana Batista Rodrigues Faleiro - 2014.pdf: 5818224 bytes, checksum: a60fa8936047debb466ca6014a330b87 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-03-27T15:47:36Z (GMT) No. of bitstreams: 2 Tese - Mariana Batista Rodrigues Faleiro - 2014.pdf: 5818224 bytes, checksum: a60fa8936047debb466ca6014a330b87 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-03-27T15:47:36Z (GMT). No. of bitstreams: 2 Tese - Mariana Batista Rodrigues Faleiro - 2014.pdf: 5818224 bytes, checksum: a60fa8936047debb466ca6014a330b87 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-11-14 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Somedysplastic lesionsof prostate, such as proliferativeinflammatoryatrophy (PIA) and prostatic intraepithelial neoplastic(PIN) are proliferative,consideredpremalignant andcan progress toprostatic carcinoma (PC). Others, such asbenign prostatichyperplasia(BPH) are proliferative, butare not related tomalignancy.The humanPC is the one ofcancers that more kill,and dog`sthe onlyanimal species thatpresentsadiseasewith similarcharacteristics, thishas been usedas a modelfor studyof prostatecancer. Thus, in order tobetter understandthe molecular mechanisms involvedin repairand cell cycleevolution ofproliferative lesionsincanine prostate, this study aimed to evaluatethe gene expression ofErbB1, ErbB2, CDKN1A, CDKN1BandTP53andimmunostaining ofEGFR(Her1), Her2(c-erbB-2), p21, p27and p53 inprostateswithPIAandPC. Also was evaluatedtheimmunostaining ofp21, p27, p53, c-myc andcyclinD1inprostateswith BPH, PIA, PINandPC. For this purpose,wereobtained from atissue microarray (TMA)block, 106samplesofcanineprostate tissue, which 15 normal, 16with BPH, 30 withPIA, 20 with PIN, and 25with CP. The RT-PCR andRT-qPCR techniques wereused to evaluategene expression, as well as immunohistochemistrywas used to determinetheimmunophenotypeofprostatic lesions. As forEGFRand Her2has beenobserved that thesereceptorsactin canine lesions withPIA and with PCan importantaction ofHer2, suggesting that theyare involvedin carcinogenesisandtumor development in canineprostate. Regarding to cellcycleinhibitor concludethat whenoverexpressedin canine prostateswithPIAandPC, p21andp27control cellproliferation, acting as a protective factorin the evolution of PIA to PC, and in the PC development, even in the presence of altereted p53. In assessing ofimmunostaining ofcell cycle regulators(p21, p27, p53, cyclinD1andc-myc) in canineprostateswithproliferative lesionswas observedthatcarcinomas probably have lowgrowth potentialwhenoverexpressed of p21andp27, reduced expression of cyclinD1and unalteredexpression ofc-myc, even in the presence ofmutant p53type.Further,considering thesimilarimmunophenotypein canine glands with PIA, PINandPC considered the regulatorsofcell cycle progression, it is reinforce the pre-malignant potential of PIA andPINin the canineprostate. / Algumas lesões displásicas da próstata, como a atrofia inflamatória proliferativa (PIA) e a neoplasia intraepitelial prostática (PIN), são proliferativas, consideradas pré-malignas e podem evoluir para carcinoma prostático (PC). Outras, como a hiperplasia prostática benigna (HPB), apesar de proliferativas, não possuem relação com malignidade. Sendo o PC humano uma das neoplasias que mais matam, e o cão aúnica espécie animal que apresenta a enfermidade com características semelhantes, esta tem sido utilizada como modelo para o estudo do câncer de próstata. Assim, com o intuito de melhor compreender os mecanismos moleculares envolvidos na regulação do ciclo celular e evolução das lesões proliferativas na próstata canina, este estudo teve por objetivo avaliar a expressão gênica de ErbB1, ErbB2, CDKN1A, CDKN1B e TP53,e imunomarcação deEGFR (Her1), Her2 (c-erbB-2), p21, p27 e p53 em próstatas com PIA e PC. Também foi avaliada a imunomarcação de p21, p27, p53, cmyc e cyclin D1 em próstatas com HPB, PIA, PIN e PC. Para tal, foram obtidas de um bloco de microarranjo tecidual (TMA) 106 amostras de tecido prostático canino, sendo 15 normais, 16com HBP, 30com PIA, 20com PIN, e25com PC. As técnicas de RT-PCR e RT-qPCR foram empregadas na avaliação da expressão gênica, assim como a técnica de imunoistoquímica foi utilizada para verificar o imunofenótipo das lesões prostáticas. Quanto aos receptores EGFReHer2 foi observado que esses atuam naslesões de PIAePCcanino, com ação importante do receptor Her2, sugerindoqueessesestão envolvidosna carcinogênese e no desenvolvimentotumoral da prostata canina.Em relação aos inibidores do ciclo celular councluiu-se que quando superexpressos em próstatas com PIA e PC, p21 e p27 controlam a proliferação celular, atuando comofator protetivo na evolução da PIA para PC, e no desenvolviemento do PC, mesmo quando da alteração de p53. Na avaliação da imunoexpressão dos reguladores do ciclo celular (p21, p27, p53, ciclina D1 e c-myc) em próstatas caninas com lesões proliferativas foi constatado que os carcinomas possivelmente apresentam baixo potencial de crescimento quando da superexpressãop21 ep27, menor subexpressão de ciclina D1e expressão inalterada de c-myc, mesmo na presença de p53 tipo mutante. Ainda, considerando o imunofenótipo semelhante nas glândulas com PIA, PIN e PC no que se refere aos reguladores daprogressão do ciclo celular, reforça o potencial prémaligno da PIA e PIN na próstata canina.

Background: Transrectal ultrasound is commonly performed in the clinical evaluation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypoechoic, e.g. hyperechoic or irregular lesions in relation to CaP is not clear. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Material and Methods: 265 patients who were referred for prostatic evaluation because of an elevated PSA serum level or a positive digital rectal examination were enrolled in a prospective study. All patients had a systematic ultrasound-guided sextant biopsy of the prostate and a 4-core biopsy of the transition zone. All biopsy cores taken were guided by transrectal ultrasound. In case of a sonographically suspicious lesion, biopsy was always directed into this area. The predominant ultrasound appearance was separately recorded for each core. Results: Carcinoma of the prostate was detected in 87 (32.8%) of the 265 patients. Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic and anechoic lesions were 34.5, 26.9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of the prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of the prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesions of mixed or irregular echogenicity were found to contain cancer in significant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable. / Hintergrund: Der transrektale Ultraschall ist die häufigste bildgebende Untersuchung zur klinischen Beurteilung der Prostata. Zur Diagnostik des Prostatakarzinoms (PCa) hat sich die ultraschallgesteuerte Sextanten-Biopsie als Standardverfahren etabliert. Eine gezielte Biopsie irregulärer Ultraschallbezirke ist hier nicht vorgesehen. Es ist jedoch bekannt, daß sonographisch echoarm erscheinende Areale suspekt für die Präsenz eines PCa sind. Die Wertigkeit nicht einheitlicher oder echoreicher Ultraschallmuster ist jedoch bisher nicht zweifelsfrei geklärt. Ziel der vorliegenden Arbeit war es, mit einem Ultraschallgerät der neuesten Generation die Bedeutung der verschiedenen Ultraschallmuster bezüglich des Vorhandenseins von Prostatakarzinomen zu klären. Material und Methoden: 265 Patienten mit erhöhten PSA-Serumwerten oder suspekten Tastbefunden der Prostata wurden in die prospektive Untersuchung eingeschlossen. Bei allen Patienten wurden systematische, ultraschallgesteuerte Prostatabiopsien, wie in der Sextantenbiopsie vorgesehen, und 4 Zylinder aus der Transitionalzone entnommen. Bei der Biopsie wurde jedoch gezielt die Punktion in Bereichen von – falls vorhanden – irregulärem Ultraschallmuster vorgenommen und das entsprechende Ultraschallbild dokumentiert. Ergebnisse: Bei 87 der 265 Patienten (32,8%) wurden Prostatakarzinome nachgewiesen. Biopsiezylinder aus isodensen Bereichen wiesen in 7,6% ein Prostatakarzinom auf. Die Karzinomhäufigkeit bei Biopsie von echoarmen und echoreichen Arealen sowie von Arealen mit unterschiedlichen Echomustern und von zystischen Arealen wurde mit 34,5, 26,9, 21,1 bzw. 0% ermittelt. Echoarme Befunde wurden seltener in der Transitionalzone nachgewiesen, waren jedoch dort in etwa gleicher Häufigkeit mit einem Karzinom verbunden wie in der peripheren Zone. Schlußfolgerungen: Das transrektale Ultraschallmuster in der Prostata liefert wichtige Hinweise auf das Vorhandensein eines Prostatakarzinoms. Insbesondere echoarme Läsionen deuten auf ein PCa hin. Echoreiche Läsionen und solche mit unterschiedlichen Echomustern enthielten jedoch Karzinome in so bedeutender Anzahl, daß diese Läsionen ebenfalls als karzinomverdächtig eingestuft werden müssen und auch eine gezielte Biopsie dieser Areale im Rahmen der Sextantenbiopsie empfehlenswert erscheint. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Made available in DSpace on 2014-07-29T15:07:55Z (GMT). No. of bitstreams: 1 dissertacao mariana faleiro part 1.pdf: 60728 bytes, checksum: 82e5bf30cd60c4752f1de660f88797ed (MD5) Previous issue date: 2010-03-02 / Humans and dogs show dysplastic lesions in the prostate, such as prostatic intraepithelial neoplasms (PIN) and proliferative inflammatory atrophy (PIA), which are studied due to their malignance potential. The matrix metalloproteinases (MMP) are a family of proteolytic enzymes thought to play an important role in tumor invasion and metastasis in face of their ability to degrade the extracellular matrix (ECM) and basement membrane. The plasminogen activator (PA) system has been suggested to play a central role in cell adhesion, migration, wound healing, angiogenesis, inflammation, regulation of growth factors and tumor invasion. The receptor of plasminogen activator type activator (uPAR) is a component of the PA, with a range of expression in tumor cell and stromal cells. So, this study was aimed to evaluated the expression and correlation between MMP-2 (gelatinase A) and MMP-9 (gelatinase B) as well as the expression of uPAR in normal canine prostate tissue and also in tissue with proliferative disorders, including benign prostatic hyperplasia (HPB), PIA, PIN and carcinoma. And therefore establish relation among the role of these enzymes in the remodeling of the extracellular matrix (ECM) and in the process of tumor invasion and metastasis. For this, it was performed immunohistochemical staining in tissue microarray of 149 paraffin-embedded fragments of prostate tissue selected from 57 prostates of non-castrated adult dogs with or without prostatic diseases. A total of 298 cores were analyzed and it was made 363 diagnoses: 36 (9.9%) normal, 49 (13.5%) BPH, 132 (36.3%) PIA, 75 (20.7%) PIN and 71 (19.6%) carcinomas. It was observed differences in cytoplasmatic immunohistochemical staining by MMP-2 and MMP-9 antibodies in relation to the cell number and intensity of labeling of the acinar epithelial and stromal perilobular cells between normal tissue and in those with proliferative disorders. A correlation between MMP-2 and MMP-9 antibodies occurred just in canine prostates with PIA in relation to the number of labeled cells in acinar epithelium and perilobular stroma, as well as, the staining intensity in the perilobular stromal cells. In relation to uPAR, it was observed differences of immunohistochemical staining of uPAR antibodies in canine prostate. Likewise, there was over expression in dysplastic and neoplasic specimens, but not in normal and benign prostate tissue. A number of epithelial cells labeled for uPAR showed variation among the diagnoses, except between PIN and carcinoma. Less intensity of labeling was observed in acinar epithelial cells of normal prostates compared with PIA, PIN and carcinoma. However, in the normal cells and in those with PIA, there was a difference in the number of cells, as well as in the intensity of stromal labeling. The intensity of labeling of stromal perilobular cells was higher in the PIA. PIA-A (accentuated) and PIA-M (moderated) cells showed greater intensity staining stroma and stromal cells labeled for uPAR, respectively. Thus, this study concludes that there was variation in gelatinases and uPAR expression in canine prostate according to the lesion. Also, there was Less labeling in normal and BPH and higher in PIA, PIN and carcinoma prostate tissues. The correlation between MMP-2 and MMP-9 in canine prostates with PIA indicates that the inflammation likely influenced the activity of these enzymes with simultaneous increase in their expression. The uPAR high expression in inflammatory and neoplasic tissues suggests high ECM proteolytic activity in these situations / Nas espécies humana e canina lesões displásicas da próstata, como a neoplasia intra-epitelial prostática (PIN) e a atrofia inflamatória proliferativa (PIA), são estudadas quanto ao potencial de malignidade. As metaloproteinases (MMP) são enzimas proteolíticas envolvidas no processo de invasão tumoral e metástase, causando destruição de barreiras biológicas como a matriz extracelular (MEC) e a membrana basal (MB). O sistema ativador de plasminogênio (PA) compreende proteínas com ação na adesão celular, regulação da migração, cicatrização, angiogênese, inflamação, regulação de fatores de crescimento e invasão tumoral. O receptor de ativador de plasminogênio tipo uroquinase (uPAR) é um dos componentes do PA, com variação de expressão em células neoplásicas e estromais. Este trabalho teve por objetivo verificar a expressão e a correlação entre MMP-2 e MMP-9, assim como a expressão do uPAR no tecido prostático canino normal e com alterações proliferativas, incluindo a hiperplasia prostática benigna (HPB), a PIA, a PIN e o carcinoma, buscando avaliar o papel dessas proteínas no remodelamento da MEC e no processo de invasão tumoral e metástase. Para isso, foi realizada a imunoistoquímica em lâminas de microarranjo tecidual (TMA), com 149 cores selecionadas de 57 próstatas de cães adultos, não castrados, com ou sem histórico de afecções prostáticas. Foram analisados, para cada anticorpo, 298 cores, perfazendo 363 diagnósticos, sendo 36 (9,9%) normais, 49 (13,5%) HPB, 132 (36,3%) PIA, 75 (20,7%) PIN e 71 (19,6%) carcinomas. Foi possível observar diferença de imunomarcação citoplasmática de MMP-2 e MMP-9 em relação ao número de células e intensidade de imunomarcação nas células epiteliais acinares e estromais periacinares em relação aos diagnósticos. A correlação entre os anticorpos MMP-2 e MMP-9 ocorreu em próstatas caninas com PIA quanto ao número de células imunomarcadas no epitélio acinar e no estroma periacinar, bem como quanto à intensidade de imunomarcação nas células estromais periacinares. Quanto ao uPAR, houve diferença na imunomarcação em relação ao diagnóstico, com maior expressão nas displásicas e neoplásicas em relação ás normais e com HPB. O número de células epiteliais imunomarcadas para uPAR variou entre os diagnósticos, exceto entre PIN e carcinoma. Menor intensidade de imunomarcação epitelial foi constatada nas próstatas normais em relação às com PIA, PIN e carcinoma. Entre as normais e com PIA houve diferença no número de células e intensidade de imunomarcação estromal. A intensidade de imunomarcação estromal foi maior nas com PIA. As PIA-M (inflamação moderada) e PIA-A (inflamação acentuada) apresentaram maior intensidade de imunomarcação estromal e células estromais imunomarcadas para uPAR, respectivamente. Concluiu-se que há variação na expressão das gelatinases e do uPAR na próstata canina, de acordo com a lesão, com menor expressão nas normais e com HPB e maior naquelas com PIA, PIN e carcinoma. A correlação entre MMP-2 e MMP-9 em próstatas caninas com PIA indica que a inflamação influencia a atividade dessas enzimas, com aumento simultâneo na expressão de ambas no microambiente inflamatório. Ainda, o aumento na expressão do uPAR nos microambientes inflamatório e neoplásico sugere maior atividade proteolítica na MEC nesses casos