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Made available in DSpace on 2016-08-10T10:54:22Z (GMT). No. of bitstreams: 1 LEANDRO FERRO DE MORES BEZERRA.pdf: 1240257 bytes, checksum: a30f985e8e1e6335c0962e3a513026fc (MD5) Previous issue date: 2014-03-14 / Introduction: Prostate cancer is one of he most frequent cancer types among men around the world and its global incidence has dramatically arrised on last decade. The prognostic factors already known are: Seric Prostatic Specific Antigen (PSA), Gleason Score and Clinical Stage. The prostate gland volume may be associated with these factors. Objecives: Evaluate a possible association between protate gland volume and the presence of high Gleason Score (7 or higher) on individuals with prostate cancer. Methods: We analyzed data from 139 files of patients who underwent radical prostatectomy for prostate cancer between march 2009 and november 2012. Prostate weight measured at prostatectomy was compared to other clinical variables (age, prostate specific antigen, PSA density) and pathological outcomes (final Gleason score, pathological stage). Patients were divided in 3 groups due to its prostate size (under 50grams, between 50-80grams and over 80grams). Multivariate logistic regression was used to assess prostate size as a predictor of high grade prostate cancer. RESULTS: The study population included 139 patients during march 2009 to november 2012, of whom 64 (46,04%) had Gleason Score 7 or higher. No association between low prostate weight and hight grade gleason score was found. This event were more frequent on intermediate group (prostate weight between 50 and 80 grams). We also did not find any association between prostate weight and any of the others paramters analysed between the 3 groups. Conclusions: No association between prostate size and hight grade Gleason score was found. Association between prostate size and any of the others paramters analysed between the 3 groups was not found either. / Introdução: O câncer de próstata é um dos cânceres mais frequentes entre homens no mundo e sua incidência global tem aumentado dramaticamente na última década. Os fatores prognósticos já conhecidos são: valores séricos do antígeno prostático específico (PSA), grau de diferenciação histológica (Score de Gleason) e estádio clínico. O peso da glândula prostática pode estar associado a estes fatores. Objetivo: Avaliar a possível associação entre volume da glândula prostática e a presença de perfil histológico desfavorável (Score de Gleason 7 ou acima) em sujeitos portadores de câncer de próstata. Material e Métodos: Foram analisados dados de 139 prontuários de indivíduos portadores de câncer de próstata submetidos a prostatectomia radical entre março de 2009 e dezembro de 2012. O tamanho prostático foi medido através da aferição de peso do espécime cirúrgico e foi comparado às outras variáveis clínicas (idade, PSA, densidade de PSA) e dados anátomo-patológicos (Score de Gleason e estádio patológico). Os casos foram separados em 3 grupos, relacionados ao peso prostático (abaixo de 50 gramas, entre 50 e 80 gramas e acima de 80 gramas). Análise multivariada foi usada para avaliar a associação entre o peso prostático e o tumor prostático de alto grau. Resultados: A população estudada incluiu 139 sujeitos submetidos a prostatectomia radical entre março de 2009 e novembro de 2012. Destes, 64 (46,04%) apresentavam Score de Gleason maior ou igual a 7. Não houve associação significativa entre baixo peso prostático (abaixo de 50 gramas) a presença de Score de Gleason de alto grau. Tal evento foi mais frequente no grupo com próstatas com peso entre 50 e 80 gramas. Também não foi evidenciado associação entre baixo volume prostático e demais fatores avaliados. Conclusão: Não foi encontrado associação entre baixo volume prostático e presença de Score de Gleason de alto grau assim como com os demais parâmetros avaliados.

Le cancer de la prostate est la pathologie tumorale la plus fréquente aux Antilles. Notre étude a pour but d’étudier certains facteurs de risque de survenue et de récidive. Pour mener à bien cette étude, nous avons utilisé les patients inclus dans l’étude cas-témoins Karuprostate, et une cohorte de patients après prostatectomie radicale.Les principaux résultats et conclusions de ma thèse portent sur :a) L’étude des facteurs génétiques en lien avec le métabolisme des xénobiotiques dans le risque de survenue du cancer de la prostate en Guadeloupe. Le nombre exact de copies (CNV) des gènes codant pour les Glutathion S transférases GSTM1 et GSTT1 ont été déterminés chez 629 cas incidents de cancer de la prostate et 622 témoins. Les hommes présentant 2, 3 ou plus de copies de GSTT1 présentent un risque significativement augmenté de cancer de la prostate. De même les hommes avec 3, 4, 5 ou plus de copies combinant GSTM1 et GSTT1 présentent un risqué augmenté de survenue de la maladie.b) L’étude des facteurs génétiques en lien avec le métabolisme des œstrogènes dans le risque de survenue du cancer de la prostate en Guadeloupe. Cinq polymorphismes (3 SNP concernant CYP17, CYP1B1 et COMT, ainsi que de polymorphismes de taille concernant CYP19 et UGT1A1) ont été étudiés et comparés chez 498 cas incidents et 565 témoins. Les sujets présentant le génotype AA de COMT présentent un risque significativement diminué de survenue du cancer la prostate. Aucune association significative n’a été retrouvée avec les autres polymorphismes étudiés. Une étude portant sur 150 cas incidents de cancer de la prostate et 150 témoins issus d’une population du Congo-Zaïre a fait l’objet de ces mêmes génotypages avec les mêmes résultats.c) L’influence des expositions environnementales à des polluants persistants présentant des propriétés hormonales sur la récidive biologique de cancer de la prostate après prostatectomie radicale. Les concentrations plasmatiques en chlordécone, DDE (principal métabolite du DDT) et en PCBs ont été mesurés chez 340 sujets porteurs d’un cancer de la prostate ayant subi une prostatectomie radicale. L’exposition (préopératoire) au chlordécone a été retrouvée associé à une augmentation significative du risque de récidive biologique. A l’inverse, les concentrations croissantes en DDE ont été retrouvées associées à une diminution significative du risque de récidive biologique. Aucune association n’a été retrouvée entre l’exposition au PCB153 et la récidive de la maladie.d) Les facteurs de risque de récidive de cancer de la prostate clinique et histologique ont été étudiés sur 964 patients qui ont bénéficié d’une prostatectomie radicale avec un suivi média de 4,8 ans. Le diabète, le PSA, le stade clinique avancé, le score de Gleason élevé, un pourcentage de biopsie de prostate élevé, le stade pathologique avancé, la présence de marge positive sont des facteurs prédictifs de récidive biologique après prostatectomie radicale. Nos résultats montrent que la survenue et la récidive du cancer de la prostate sont sous l’influence des facteurs génétiques et environnementaux. Le contexte génétique et environnemental spécifique à la Guadeloupe expliquerait en partie la forte incidence du cancer de la prostate.Par ailleurs, d’autres travaux intégreront d’autres gènes dans le futur. Le projet ambitieux à venir est la création d’une cohorte prospective de tous les patients atteints d’un cancer de la prostate tout stade confondu. / Prostate cancer is the most common tumor pathology in West Indies. Our study aims to study risk factors of occurrence and recurrence.To carry out this study, we used the patients included in the case-control study called Karuprostate and a cohort of patients after radical prostatectomy.The main results and conclusions of my work are:a) The study of genetic factors related to the metabolism of xenobiotics and the risk of prostate cancer occurrence in Guadeloupe. The exact number (CNV) gene encoding the glutathione S transferases GSTT1 and GSTM1 were determined in 629 incident cases of prostate cancer and 622 controls. Men having 2, 3 or more copies of GSTT1 have a significantly increased risk of prostate cancer. Similarly men with 3, 4, 5 or more copies of GSTM1 and GSTT1 combined have an increased risk of disease occurrence.b) The study of genetic factors related to estrogen metabolism and the risk of prostate cancer occurrence in Guadeloupe. Five polymorphisms (SNP 3 on CYP17, CYP1B1 and COMT as well as size and UGT1A1 polymorphisms on CYP19) were studied and compared in 498 incident cases and 565 controls. Individuals with the AA genotype COMT have a significantly decreased risk of prostate cancer occurrence. No significant association was found with other studied polymorphisms. A study of 150 incident cases of prostate cancer and 150 controls from a population of Congo-Zaire was the subject of these same genotyping, with the same results.c) The influence of environmental exposure to persistent pollutants with hormonal properties of biochemical recurrence of prostate cancer after radical prostatectomy. The plasma concentrations of chlordecone, DDE (the main metabolite of DDT) and PCBs were measured in 340 subjects with prostate cancer who underwent radical prostatectomy. The exhibition (preoperative) to chlordecone was found associated with a significant increased risk of biochemical recurrence. Conversely, the increasing concentrations of DDE were found associated with a significantly decreased risk of biochemical recurrence. No association was found between exposure to PCB153 and recurrence of the disease.d) The clinical and histological risk factors of recurrence of prostate cancer were studied in 964 patients who underwent radical prostatectomy with a médian follow-up of 4.8 years. Diabetes, PSA, advanced clinical stage, high Gleason score, a high percentage of prostate biopsy, advanced pathological stage, the presence of positive margins are predictors of biochemical recurrence after radical prostatectomy.Our results show that the occurrence and recurrence of prostate cancer are Under influence of genetic and environmental factors. The specific genetic and environmental context in Guadeloupe may partly explain the high incidence of prostate cancer.In addition, further work will incorporate other genes in the future. The next ambitious project is the creation of a prospective cohort of all patients with all prostate cancer stages.

<p><strong>Bakgrund- </strong>Prostatacancer är en av de vanligaste cancerformerna i Sverige och nästan 34 % av alla fall av cancer hos män är prostatacancer. Radikal prostatektomi är en behandling som innebär att hela prostatan och intilliggande körtlar tas bort. Prostatektomi kan ha negativ påverkan på livskvaliteten p.g.a. ingreppets komplikationer.</p><p><strong>Syfte- </strong>att belysa hur män upplever sin livskvalitet efter att ha genomgått en prostatektomi.</p><p><strong>Metod- </strong>En systematisk litteraturstudie. Artiklar har sökts fram i elektroniska databaser. Tio artiklar har granskats enligt kriterier för kvalitetsgranskning där nio kvalificerats och används i resultatet. Inspireras av kvalitativ analys och identifierat olika teman i texten. Vi kom fram till fyra kategorier som vi redovisar resultaten ifrån: fysiska, psykiska, sociala och omvårdnadsaspekter.</p><p><strong>Resultat- </strong>Sexualitet, relationer, männens upplevelse av självkänsla och kontroll över sin kropp samt informationsbrist var de viktigaste områdena där livskvaliteten påverkades negativt.</p><p><strong>Slutsats</strong>- Radikal prostatektomi innebar en stor förändrig för männens livskvalitet och deras liv. Vi tror att mer forskning behövs inom ämnesområdet för att få en djupare förståelse för hur männen upplever sin livskvalitet efter operationen.</p>

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Adjuvant hormonal therapy has been demonstrated to be able to delay disease progression in nonmetastatic prostate cancer. To date, however, a favorable impact on survival has only been demonstrated in lymph-node-positive disease and in external-beam radiotherapy series with locally advanced and probably mainly micrometastatic tumors. The Bicalutamide Early Prostate Cancer Program is the largest study under way to define the role of adjuvant treatment in early prostate cancer and identify subgroups of patients likely to benefit from immediate hormonal therapy. At the time of the most recently published analysis, the risk of objective clinical progression was significantly reduced in the bicalutamide arm (hazards ratio 0.58, 95% confidence interval 0.51–0.66, p < 0.0001). However, further maturation of data is needed to see whether this difference will lead to a survival advantage. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The treatment of clinically locally advanced prostate carcinoma (stage cT3) remains controversial. One of the main reasons for this controversy results from the substantial staging error attached to the clinical diagnosis cT3 with overstaged T2 tumors and understaged node-positive cases. Treatment options in this situation include radical prostatectomy, external beam radiotherapy, immediate or delayed androgen deprivation treatment and the so-called ‘watchful waiting’. Acceptable and often surprisingly good tumor-specific survival rates have been reported for radical prostatectomy in pT3 series – based on good clinical case selection – approaching those of pT2 series. In lymph node-positive pT3 cases, adjuvant hormone deprivation seems to prolong survival which it does not in lymph node-negative pT3 disease. A benefit of adjuvant external beam radiotherapy after radical prostatectomy for pT3 cases in prolonging overall survival has not been shown, despite the fact that it can prevent or delay biochemical and local recurrence. External beam radiotherapy as the only treatment for cT3 disease results in unfavorable tumor-specific survival rates, which can be significantly improved with adjuvant hormonal treatment with LHRH agonists. If, in case of advanced age and/or significant comorbidity, primary hormonal treatment is chosen, early hormonal deprivation therapy seems to offer marginal benefits in survival compared to delayed treatment. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Objectives: To investigate the prevalence and distribution of comorbidity and its association with perioperative complications in patients undergoing radical prostatectomy (RPE). Methods: In 431 unselected RPE patients, the American Society of Anesthesiologists Physical Status classification (ASA-PS), the New York Heart Association classification of cardiac insufficiency (NYHA), the classification of angina pectoris of the Canadian Cardiovascular Society (CCS), height, weight, the body mass index (BMI), and the number of concomitant diseases (NCD) were assessed and related to perioperative cardiovascular complications. Results: In RPE patients less than 70 years old, comorbidity rose nearly continuously with increasing age. However, after reaching an age of 70 years, the proportion of NYHA-0 patients increased (60–64 years, 86%; 65–69 years, 85%; ≥70 years, 87%). Furthermore, the severe comorbidities decreased in patients selected for RPE aged 70 or more years. There was a nonsignificant trend towards higher comorbidity in patients with perioperative cardiovascular complications. Conclusions: These data suggest that documentation of the distribution of ASA-PS, CCS, NYHA and of concomitant diseases might be helpful to characterize the general health status and the degree of selection of prostate cancer treatment populations especially in series with a high portion of patients aged 70 or more years. Concerning perioperative complications, the individual predictive value of comorbidity seems to be poor in the radical prostatectomy setting. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Made available in DSpace on 2016-06-02T19:48:26Z (GMT). No. of bitstreams: 1 6434.pdf: 658741 bytes, checksum: f84a8719966c44b2f043024741f1472e (MD5) Previous issue date: 2014-09-02 / Prostate cancer is the second most common cancer between men, and, despite the high incidence rate, has a good prognosis if diagnosed and treated early. Radical prostatectomy is considered the gold standard treatment, but it can cause complications, such as urinary incontinence, erectile dysfunction, urethral stenosis and injury of the rectum. It might also lead to psychological effects, due to the prostate cancer diagnosis itself and also surgical complications, which can cause symptoms of anxiety and depression, as well as loss of self-esteem. Therefore, this study aimed to evaluate self-esteem, anxiety and depression among men who went through radical prostatectomy. This was a cross sectional study with a quantitative approach. The sample consisted of 40 men who had been submitted to radical prostatectomy from 3 months to 5 years prior to this analysis, and which were treated in two different outpatient services. Two instruments were used for data collection, an instrument of socio-demographic, clinical and economic analysis, the Rosenberg self-esteem scale, in order to evaluate self-esteem, and the Hospital Anxiety and Depression Scale (HADS), to evaluate anxiety and depression. The average age of the men who volunteered to this study was 65.42 years (±6.66), with average post-prostatectomy time of 21.85 months (±12.91). They presented high self-esteem rate (24.37 ± 3.92) and low anxiety (4.96 ± 3.14) and depression (3.70 ± 3.03) scores. The group with men who were between 50 and 59 years old showed lower self-esteem rates (20.86, p = 0,014). The individuals who had been diagnosed with depression had higher average age (74.00, p = 0.037) and lower self-esteem (13.00, p = 0.005). It was also observed negative correlation, of moderate magnitude, and with statistical significance, between self-esteem and the following factors: time after prostatectomy (r = -0.326), anxiety (r = -0.385) and depression. There was also a positive correlation, of moderate magnitude, between anxiety and depression (r = 0.529), with statistically significant. It is possible to conclude that these men achieved good self-esteem, anxiety and depression, and also that these variables are correlated. Only self-esteem, however, presented correlation with the post prostatectomy time. / Prostate cancer is the second most common cancer between men, and, despite the high incidence rate, has a good prognosis if diagnosed and treated early. Radical prostatectomy is considered the gold standard treatment, but it can cause complications, such as urinary incontinence, erectile dysfunction, urethral stenosis and injury of the rectum. It might also lead to psychological effects, due to the prostate cancer diagnosis itself and also surgical complications, which can cause symptoms of anxiety and depression, as well as loss of self-esteem. Therefore, this study aimed to evaluate self-esteem, anxiety and depression among men who went through radical prostatectomy. This was a cross sectional study with a quantitative approach. The sample consisted of 40 men who had been submitted to radical prostatectomy from 3 months to 5 years prior to this analysis, and which were treated in two different outpatient services. Two instruments were used for data collection, an instrument of socio-demographic, clinical and economic analysis, the Rosenberg self-esteem scale, in order to evaluate self-esteem, and the Hospital Anxiety and Depression Scale (HADS), to evaluate anxiety and depression. The average age of the men who volunteered to this study was 65.42 years (±6.66), with average post-prostatectomy time of 21.85 months (±12.91). They presented high self-esteem rate (24.37 ± 3.92) and low anxiety (4.96 ± 3.14) and depression (3.70 ± 3.03) scores. The group with men who were between 50 and 59 years old showed lower self-esteem rates (20.86, p = 0,014). The individuals who had been diagnosed with depression had higher average age (74.00, p = 0.037) and lower self-esteem (13.00, p = 0.005). It was also observed negative correlation, of moderate magnitude, and with statistical significance, between self-esteem and the following factors: time after prostatectomy (r = -0.326), anxiety (r = -0.385) and depression. There was also a positive correlation, of moderate magnitude, between anxiety and depression (r = 0.529), with statistically significant. It is possible to conclude that these men achieved good self-esteem, anxiety and depression, and also that these variables are correlated. Only self-esteem, however, presented correlation with the post prostatectomy time. / Prostate cancer is the second most common cancer between men, and, despite the high incidence rate, has a good prognosis if diagnosed and treated early. Radical prostatectomy is considered the gold standard treatment, but it can cause complications, such as urinary incontinence, erectile dysfunction, urethral stenosis and injury of the rectum. It might also lead to psychological effects, due to the prostate cancer diagnosis itself and also surgical complications, which can cause symptoms of anxiety and depression, as well as loss of self-esteem. Therefore, this study aimed to evaluate self-esteem, anxiety and depression among men who went through radical prostatectomy. This was a cross sectional study with a quantitative approach. The sample consisted of 40 men who had been submitted to radical prostatectomy from 3 months to 5 years prior to this analysis, and which were treated in two different outpatient services. Two instruments were used for data collection, an instrument of socio-demographic, clinical and economic analysis, the Rosenberg self-esteem scale, in order to evaluate self-esteem, and the Hospital Anxiety and Depression Scale (HADS), to evaluate anxiety and depression. The average age of the men who volunteered to this study was 65.42 years (±6.66), with average post-prostatectomy time of 21.85 months (±12.91). They presented high self-esteem rate (24.37 ± 3.92) and low anxiety (4.96 ± 3.14) and depression (3.70 ± 3.03) scores. The group with men who were between 50 and 59 years old showed lower self-esteem rates (20.86, p = 0,014). The individuals who had been diagnosed with depression had higher average age (74.00, p = 0.037) and lower self-esteem (13.00, p = 0.005). It was also observed negative correlation, of moderate magnitude, and with statistical significance, between self-esteem and the following factors: time after prostatectomy (r = -0.326), anxiety (r = -0.385) and depression. There was also a positive correlation, of moderate magnitude, between anxiety and depression (r = 0.529), with statistically significant. It is possible to conclude that these men achieved good self-esteem, anxiety and depression, and also that these variables are correlated. Only self-esteem, however, presented correlation with the post prostatectomy time. / O câncer de próstata é o segundo tipo de câncer mais comum entre os homens, e apesar da alta incidência, possui bom prognóstico se diagnosticado e tratado precocemente. A prostatectomia radical é considerada o tratamento padrão ouro, porém pode acarretar complicações como incontinência urinária, disfunção erétil, estenose de uretra e lesão de reto. Pode haver também acometimento psicológico decorrente do diagnóstico do câncer de próstata e das complicações cirúrgicas, possibilitando o aparecimento de sintomas de ansiedade e depressão além do comprometimento da autoestima. Assim, este estudo teve como objetivo avaliar a autoestima, ansiedade e depressão em homens submetidos à prostatectomia radical. Tratou-se de um estudo transversal com abordagem quantitativa. A amostra foi composta de 40 homens entre 3 e 50 meses após prostatectomia radical, que se encontravam em acompanhamento em dois serviços ambulatoriais. Para a coleta dos dados, foi utilizado um instrumento de caracterização sociodemográfica, econômica e clínica, a Escala de autoestima de Rosenberg para avaliação da autoestima, e a Hospital Anxiety and Depression Scale (HADS) para avaliação da ansiedade e da depressão. Os homens possuíam média de idade de 65,42 anos (±6,66) com média de tempo pós prostatectomia de 21,85 meses (±12,91). Apresentaram altos níveis de autoestima (24,37 ± 3,92) e baixos escores de ansiedade (4,96 ± 3,14) e depressão (3,70 ± 3,03). A faixa etária entre 50 e 59 anos apresentou menor autoestima (20,86; p=0,014). Os homens categorizados como casos para depressão apresentaram maior média de idade (74,00; p=0,037) e menor autoestima (13,00; p=0,005). Observou-se correlação negativa, de moderada magnitude, com significância estatística, entre a autoestima e o tempo pós prostatectomia (r= -0,326), a ansiedade (r= -0,385) e a depressão (r= -0,532). Houve também correlação positiva, de moderada magnitude, entre a ansiedade e a depressão (r=0,529) com significância estatística. Conclui-se que os homens apresentaram bons escores relacionados à autoestima, ansiedade e depressão e que estas variáveis possuem correlação entre si. Apenas a autoestima obteve correlação com o tempo pós prostatectomia. / O câncer de próstata é o segundo tipo de câncer mais comum entre os homens, e apesar da alta incidência, possui bom prognóstico se diagnosticado e tratado precocemente. A prostatectomia radical é considerada o tratamento padrão ouro, porém pode acarretar complicações como incontinência urinária, disfunção erétil, estenose de uretra e lesão de reto. Pode haver também acometimento psicológico decorrente do diagnóstico do câncer de próstata e das complicações cirúrgicas, possibilitando o aparecimento de sintomas de ansiedade e depressão além do comprometimento da autoestima. Assim, este estudo teve como objetivo avaliar a autoestima, ansiedade e depressão em homens submetidos à prostatectomia radical. Tratou-se de um estudo transversal com abordagem quantitativa. A amostra foi composta de 40 homens entre 3 e 50 meses após prostatectomia radical, que se encontravam em acompanhamento em dois serviços ambulatoriais. Para a coleta dos dados, foi utilizado um instrumento de caracterização sociodemográfica, econômica e clínica, a Escala de autoestima de Rosenberg para avaliação da autoestima, e a Hospital Anxiety and Depression Scale (HADS) para avaliação da ansiedade e da depressão. Os homens possuíam média de idade de 65,42 anos (±6,66) com média de tempo pós prostatectomia de 21,85 meses (±12,91). Apresentaram altos níveis de autoestima (24,37 ± 3,92) e baixos escores de ansiedade (4,96 ± 3,14) e depressão (3,70 ± 3,03). A faixa etária entre 50 e 59 anos apresentou menor autoestima (20,86; p=0,014). Os homens categorizados como casos para depressão apresentaram maior média de idade (74,00; p=0,037) e menor autoestima (13,00; p=0,005). Observou-se correlação negativa, de moderada magnitude, com significância estatística, entre a autoestima e o tempo pós prostatectomia (r= -0,326), a ansiedade (r= -0,385) e a depressão (r= -0,532). Houve também correlação positiva, de moderada magnitude, entre a ansiedade e a depressão (r=0,529) com significância estatística. Conclui-se que os homens apresentaram bons escores relacionados à autoestima, ansiedade e depressão e que estas variáveis possuem correlação entre si. Apenas a autoestima obteve correlação com o tempo pós prostatectomia. / O câncer de próstata é o segundo tipo de câncer mais comum entre os homens, e apesar da alta incidência, possui bom prognóstico se diagnosticado e tratado precocemente. A prostatectomia radical é considerada o tratamento padrão ouro, porém pode acarretar complicações como incontinência urinária, disfunção erétil, estenose de uretra e lesão de reto. Pode haver também acometimento psicológico decorrente do diagnóstico do câncer de próstata e das complicações cirúrgicas, possibilitando o aparecimento de sintomas de ansiedade e depressão além do comprometimento da autoestima. Assim, este estudo teve como objetivo avaliar a autoestima, ansiedade e depressão em homens submetidos à prostatectomia radical. Tratou-se de um estudo transversal com abordagem quantitativa. A amostra foi composta de 40 homens entre 3 e 50 meses após prostatectomia radical, que se encontravam em acompanhamento em dois serviços ambulatoriais. Para a coleta dos dados, foi utilizado um instrumento de caracterização sociodemográfica, econômica e clínica, a Escala de autoestima de Rosenberg para avaliação da autoestima, e a Hospital Anxiety and Depression Scale (HADS) para avaliação da ansiedade e da depressão. Os homens possuíam média de idade de 65,42 anos (±6,66) com média de tempo pós prostatectomia de 21,85 meses (±12,91). Apresentaram altos níveis de autoestima (24,37 ± 3,92) e baixos escores de ansiedade (4,96 ± 3,14) e depressão (3,70 ± 3,03). A faixa etária entre 50 e 59 anos apresentou menor autoestima (20,86; p=0,014). Os homens categorizados como casos para depressão apresentaram maior média de idade (74,00; p=0,037) e menor autoestima (13,00; p=0,005). Observou-se correlação negativa, de moderada magnitude, com significância estatística, entre a autoestima e o tempo pós prostatectomia (r= -0,326), a ansiedade (r= -0,385) e a depressão (r= -0,532). Houve também correlação positiva, de moderada magnitude, entre a ansiedade e a depressão (r=0,529) com significância estatística. Conclui-se que os homens apresentaram bons escores relacionados à autoestima, ansiedade e depressão e que estas variáveis possuem correlação entre si. Apenas a autoestima obteve correlação com o tempo pós prostatectomia.

Adjuvant hormonal therapy has been demonstrated to be able to delay disease progression in nonmetastatic prostate cancer. To date, however, a favorable impact on survival has only been demonstrated in lymph-node-positive disease and in external-beam radiotherapy series with locally advanced and probably mainly micrometastatic tumors. The Bicalutamide Early Prostate Cancer Program is the largest study under way to define the role of adjuvant treatment in early prostate cancer and identify subgroups of patients likely to benefit from immediate hormonal therapy. At the time of the most recently published analysis, the risk of objective clinical progression was significantly reduced in the bicalutamide arm (hazards ratio 0.58, 95% confidence interval 0.51–0.66, p < 0.0001). However, further maturation of data is needed to see whether this difference will lead to a survival advantage. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.