La prédiction d'un événement clinique à l'aide d'outils pronostiques est une question centrale en oncologie. L'émergence des biomarqueurs mesurés au cours du temps permet de proposer des outils incorporant les données répétées de ces biomarqueurs pour mieux guider le clinicien dans la prise en charge des patients. L'objectif de ce travail est de développer et valider des outils pronostiques dynamiques de rechute de cancer de la prostate, chez des patients traités initialement par radiothérapie externe, en prenant en compte les données répétées du PSA, l'antigène spécifique de la prostate, en plus des facteurs pronostiques standard. Ces outils sont dynamiques car ils peuvent être mis à jour à chaque nouvelle mesure disponible du biomarqueur. Ils sont construits à partir de modèles conjoints pour données longitudinales et de temps d'événement. Le principe de la modélisation conjointe est de décrire l'évolution du biomarqueur à travers un modèle linéaire mixte, décrire le risque d'événement à travers un modèle de survie et lier ces deux processus à travers une structure latente. Deux approches existent, les modèles conjoints à effets aléatoires partagés et les modèles conjoints à classes latentes. Dans un premier travail, nous avons tout d'abord comparé, en terme de qualité d'ajustement et de pouvoir prédictif, des modèles conjoints à effets aléatoires partagés différant par leur forme de dépendance entre le PSA et le risque de rechute clinique. Puis nous avons évalué et comparé ces deux approches de modélisation conjointe. Dans un deuxième travail, nous avons proposé un outil pronostique dynamique différentiel permettant d'évaluer le risque de rechute clinique suivant l'initiation ou non d'un second traitement (un traitement hormonal) au cours du suivi. Dans ces travaux, la validation de l'outil pronostique a été basée sur deux mesures de pouvoir prédictif: le score de Brier et l'entropie croisée pronostique. Dans un troisième travail, nous avons enfin décrit la dynamique des PSA après un second traitement de type hormonal chez des patients traités initialement par une radiothérapie seule. / The prediction of a clinical event with prognostic tools is a central issue in oncology. The emergence of biomarkers measured over time can provide tools incorporating repeated data of these biomarkers to better guide the clinician in the management of patients. The objective of this work is to develop and validate dynamic prognostic tools of recurrence of prostate cancer in patients initially treated by external beam radiation therapy, taking into account the repeated data of PSA, the Prostate-Specific Antigen, in addition to standard prognostic factors. These tools are dynamic because they can be updated at each available new measurement of the biomarker. They are built from joint models for longitudinal and time-to-event data. The principle of joint modelling is to describe the evolution of the biomarker through a linear mixed model, describe the risk of event through a survival model and link these two processes through a latent structure. Two approaches exist, shared random-effect models and joint latent class models. In a first study, we first compared in terms of goodness-of-fit and predictive accuracy shared random-effect models differing in the form of dependency between the PSA and the risk of clinical recurrence. Then we have evaluated and compared these two approaches of joint modelling. In a second study, we proposed a differential dynamic prognostic tool to evaluate the risk of clinical recurrence according to the initiation or not of a second treatment (an hormonal treatment) during the follow-up. In these works, validation of the prognostic tool was based on two measures of predictive accuracy: the Brier score and the prognostic cross-entropy. In a third study, we have described the PSA dynamics after a second treatment (hormonal) in patients initially treated by a radiation therapy alone.

Ce travail de thèse porte sur la quantification et la prise en compte des variations anatomiques en cours de radiothérapie guidée par l'image pour le cancer de la prostate. Nous proposons tout d'abord une approche basée population pour quantifier et analyser les incertitudes géométriques, notamment à travers des matrices de probabilité de présence de la cible en cours de traitement. Nous proposons ensuite une méthode d'optimisation des marges suivant des critères de couverture géométrique de la cible tumorale. Cette méthode permet d'obtenir des marges objectives associées aux différents types d'incertitudes géométriques et aux différentes modalités de repositionnement du patient. Dans un second temps, nous proposons une méthode d'estimation de la dose cumulée reçue localement par les tissus pendant un traitement de radiothérapie de la prostate. Cette méthode repose notamment sur une étape de recalage d'images de façon à estimer les déformations des organes entre les séances de traitement et la planification. Différentes méthodes de recalage sont proposées, suivant les informations disponibles (délinéations ou points homologues) pour contraindre la déformation estimée. De façon à évaluer les méthodes proposées au regard de l'objectif de cumul de dose, nous proposons ensuite la génération et l'utilisation d'un fantôme numérique reposant sur un modèle biomécanique des organes considérés. Les résultats de l'approche sont présentés sur ce fantôme numérique et sur données réelles. Nous montrons ainsi que l'apport de contraintes géométriques permet d'améliorer significativement la précision du cumul et que la méthode reposant sur la sélection de contraintes ponctuelles présente un bon compromis entre niveau d'interaction et précision du résultat. Enfin, nous abordons la question de l'analyse de données de populations de patients dans le but de mieux comprendre les relations entre dose délivrée localement et effets cliniques. Grâce au recalage déformable d'une population de patients sur une référence anatomique, les régions dont la dose est significativement liée aux événements de récidive sont identifiées. Il s'agit d'une étude exploratoire visant à terme à mieux exploiter l'information portée par l'intégralité de la distribution de dose, et ce en fonction du profil du cancer. / This work deals with the quantification and the compensation of anatomical deformations during image-guided radiotherapy of prostate cancer. Firstly, we propose a population-based approach to quantify the geometrical uncertainties by means of coverage probability matrices of the target tumor during the treatment. We then propose a margins optimization method based on geometrical coverage criteria of the tumor target. This method provides rationnal margins models associated to the different geometrical uncertainties and patient repositioning protocols. Secondly, we propose a method to estimate the locally accumulated dose during the treatment. This method relies on a deformable image registration process in order to estimate the organ deformations between each treatment fraction and the planning. Different registration methods are proposed, using different level of user interactions (landmarks specification or delineations) to constrain the deformation estimation. In order to evaluate the performance of the proposed methods, we then describe the generation of a numerical phantom based on a biomechanical model. The results are presented for the numerical phantom and real clinical cases. We show that the benefit brought by the manual placement of some landmarks to constrain the registration represents a good compromise between the required interaction level and the dose estimation accuracy. Finally, we address the issue of the analysis of population data in order to better understand the relationship between the locally delivered dose and clinical effects. With deformable image registration of a population of patients on an anatomical template, regions whose dose is significantly associated with recurrence events are identified. This last part is an exploratory study aiming to better use the information carried by the entire distribution dose, and according to the cancer profile.

Le cancer de la prostate représente la deuxième cause de décès liée au cancer. Des stratégies thérapeutiques ciblant des mécanismes moléculaires conduisant à la résistance doivent donc être développées. Une stratégie visant à améliorer les traitements du cancer de la prostate consiste à cibler les gènes qui sont activés lors de la disparition des androgènes, soit pour retarder ou empêcher l'émergence du phénotype de résistance à la castration. Le but de cette thèse est d'identifier et de développer des petites molécules inhibitrices ciblant des interactions protéine-protéine impliquées dans le cancer de la prostate. Cette thèse porte sur l'étude de deux protéines cruciales liées au cancer de la prostate, à savoir, la protéine de choc thermique de bas poids moléculaire (Hsp27) et la protéine TCTP. Nous avons validé deux composés ciblant TCTP en utilisant une chimiothèque dédiée à l'inhibition d'interaction protéine-protéine. Des tests fonctionnels sont actuellement mis au point pour évaluer la capacité de ces molécules à être proposées comme composés potentiels contre le cancer de la prostate. / Prostate Cancer (PCa) is one of most common malignancies, being the second leading cause among cancer-related death. Additional therapeutic strategies targeting molecular mechanisms mediating resistance must be developed because of the defects of docetaxel-based treatments. One strategy to improve therapies in advanced PCa involves targeting genes that are activated by androgen withdrawal, either to delay or prevent the emergence of the CR phenotype. The purpose of my thesis is to identify & develop small molecules inhibitors targeting PPIs involved in prostate cancer. we focuses on 2 crucial prostate cancer related proteins, namely, the small molecular weight Heat shock protein 27 (Hsp27) and the Translationally Controlled Tumor Protein (TCTP). We have validated 2 compounds targeting TCTP by using a "PPI Inhibitor-like" dedicated chemical library. Functional tests are now being developed to evaluate the capacity of such molecules to be proposed as potential compounds against prostate cancer.

Cette thèse concerne le développement et l'évaluation des nanoparticules pour le traitement du cancer et plus particulièrement pour le cancer de la prostate.Le manuscrit comprend une revue de la littérature sur l'application de la nano médecine pour le traitement du cancer de la prostate. Dans la première partie expérimentale, des nanoparticules d'or fonctionnalisées ont été caractérisées et chargées avec le docétaxel par adsorption non covalente.Ces nanoparticules d'or ont montré un effet cytotoxique in vitro prolongé contre les cellules cancéreuses de la prostate. La deuxième partie expérimentale de cette thèse décrit une étude de synthèse et une nano-précipitation de polyesters pour la co-délivrance de deux médicaments chimio-thérapeutiques, le docétaxel (DOC) et la mitoxantrone (MIT). Les polycaprolactone, poly(acide lactique) et poly(lactide-co-glycolide) ont été synthétisés par polymérisation par ouverture de cycle avec des poids moléculaires différents de polyéthylène glycol. Des nanoparticules monodisperses d’un diamètre d’environ 80 nm ont été obtenues et se sont avérées être efficaces contre les cellules cancéreuses de la prostate quand cela est chargé en MIT et DOC. De plus, un effet synergique a été observé en utilisant des combinaisons de ces nanoparticules. Par conséquent, ces nanoparticules, à base de polyester, ont de potentielles applications cliniques. / This thesis concerns the development and evaluation of nanoparticles for cancer treatment, and in particular to prostate cancer. The manuscript includes a literature review on the application of nanomedicine to the treatment of prostate cancer. In the first experimental part, functionalized gold nanoparticles were characterized and loaded with docetaxel by non covalent adsorption. These gold nanoparticles showed a sustained cytotoxic effect in vitro against prostate cancer cells. The second experimental part of this thesis describes a study of synthesis and nanoprecipitation of polyesters for the co-delivery of two chemotherapeutic drugs, docetaxel (DOC) and mitoxantrone (MIT). Polycaprolactone, poly(lactic acid) and poly (lactide-co-glycolide) were synthesized by ring-opening polymerization with different molecular weights of polyethylene glycol. Monodisperse nanoparticles with diameters of less than 80 nm were produced and were shown to be effective against prostate cancer cells when loaded with MIT and DOC. Moreover, a synergistic effect was observed using combinations of these nanoparticles. Therefore, these polyester based nanoparticles have potential clinical applications.

A Organização Mundial da Saúde (OMS) relata o câncer como uma das principais causas de morte no mundo. O câncer de próstata é o segundo tipo de câncer mais prevalente em homens. Uma modalidade de tratamento que vem sendo bastante utilizada é a braquiterapia, que consiste na introdução de sementes com material radioativo no interior do orgão. Sementes de Iodo-125 podem ser inseridas soltas ou em cordas poliméricas bioabsorvíveis. As sementes em cordas poliméricas apresentam algumas vantagens, pois reduzem a taxa de migração das sementes, evento que poderia afetar a dosimetria da região e causar danos desnecessários a tecidos ou órgãos sadios. Para as sementes de Iodo-125 em cordas poliméricas, utiliza-se a poliglactina 910, (poli(ácido lático-co-ácido glicólico)) (PLGA), com cobertura de poliglactina 370 (Vicryl®). Foi proposto neste trabalho, o estudo e desenvolvimento da metodologia de síntese do biopolímero PLGA, via polimerização por abertura de anéis, assim como sua caracterização, com o propósito de utilizar o material sintetizado para fabricar um material similar ao RAPID-Strand®. Os resultados obtidos demonstram que, através da metodologia utilizada, foi possível determinar os melhores parâmetros de reação (tempo e temperatura) para o PLGA na proporção 80/20 (lactídeo/glicolídeo). Com uma temperatura de 110ºC e tempo de reação de 24h, foi possível obter 86% de rendimento, e com o aumento o tempo de reação para 72h, o rendimento é superior a 90%. Os valores de massas moleculares obtidas entre os testes, ainda são muito baixos quando comparados com os valores obtidos por outros autores na literatura (cerca de 20%). Falhas na selagem das ampolas, deixando-os vulneráveis à umidade e oxigênio, ou a falta de uma sistema eficiente de agitação podem ser possíveis explicações para estes resultados. Um reator químico adequado poderia solucionar o problema. Em relação à caracterização, as técnicas utilizadas confirmaram a estrutura esperada do polímero, e a maior proporção das unidades provenientes do dímero lactídeo, em relação ao glicolídeo. / According to World Health Organization (WHO), cancer is a leading cause of death worldwide. Prostate cancer is the second most common cancer in men. A method of radiotherapy which has been extensively used is brachytherapy, where radioactive seeds are placed inside the area requiring treatment. Iodine-125 seeds can be placed loose or stranded in bioabsorbable polymers. Stranded seeds show some advantages, since they reduce the rate of seed migration, an event that could affect the dosimetry of the prostate and cause unnecessary damage to healthy tissues or organs. For Iodine-125 stranded seeds, polyglactin 910 (poly(lactic-co-glycolic acid)) (PLGA), with a coverage of polyglactin 370 (Vicryl ®) is used. It was purposed in this dissertation, the study and development of the synthesis methodology for PLGA via ring-opening polymerization, as well as its characterization, with the objective of using the synthesized material to manufacture a material similar to RAPID Strand®. The results obtained show that it was possible to determine the optimal reaction parameters (time and temperature) for PLGA in 80/20 (lactide/glycolide) ratio. Using a temperature of 110 ° C and reaction time of 24h, a yield of 86% was obtained, and increasing the reaction time to 72 hours, the yield was higher than 90%. The molecular mass values obtained from the samples are still very low compared to those obtained by other authors in the literature (about 20%). Failures in the sealing of vials, leaving them vulnerable to moisture and oxygen, or lack of an efficient stirring system might be possible explanations for these results. A suitable chemical reactor could solve the problem. Regarding polymer characterization, all techniques used not only confirmed the expected structure of the polymer, but also showed the highest proportion of lactide units compared to to glycolide units.

O câncer de próstata (CaP) é a segunda causa mais comum de câncer em homens. De acordo com o INCA, no Brasil, em 2016, estimam-se aproximadamente 61.200 novos casos de câncer de próstata. Objetivo: Identificar as características demográficas e epidemiológicas, bem como dados do estadiamento tumoral dos pacientes com CaP atendidos na Unidade de Oncologia do Hospital Marcio Cunha na cidade de Ipatinga-MG nos anos de 2012, 2013 e 2014. Metodologia: Trata-se de um estudo retrospectivo e descritivo onde foram analisados 668 prontuários de pacientes, com registro do diagnóstico anatomopatológico, atendidos nos anos de 2012, 2013 e 2014, conforme lista fornecida pela instituição, com diagnóstico de CaP cadastrados com CID-10 - C 61. As variáveis analisadas foram: procedência, ano do diagnóstico, faixa etária, raça autodeclarada, fatores de risco como tabagismo, etilismo, história familiar de CaP, PSA total ao diagnóstico, tipo histológico da biópsia, score de Gleason da biópsia, tipo histológico da peça cirúrgica, score de Gleason da peça cirúrgica. Os dados foram analisados empregando-se estatística descritiva e inferencial, utilizando o software SPSS, versão 19.0. Resultados: A maior incidência de casos de CaP foram provenientes das cidades mais populosas da microrregião de saúde analisada e faixa etária mais prevalente foi entre 61 e 80 anos com prevalência em pardos e brancos e com histórico familiar de 17,2% de parentes de primeiro grau; com o pai em 37,3%, o irmão em 60,8% e filho em 1,9%. Apenas 165 (25,9 %) eram fumantes e 20,8% etilistas. Os níveis de PSA ficaram entre 4,1ng/ e 10ng/ml (49,5%) e quanto maior a faixa etária maiores os valores do PSA. Pacientes pardos apresentaram PSA total mais elevado. Ao avaliarmos se existia relação entre os níveis de PSA total com fatores de risco como tabagismo, etilismo e histórico familiar, somente houve relação estatisticamente significativa com o etilismo. Houve concordância do score de Gleason entre biópsia e peça cirúrgica em 70%, subgraduação em 18,7% e supergraduação em 11,3%. Comparando a idade dos pacientes com Score de Gleason, quanto maior a idade do paciente maior foi o Score de Gleason do material obtido pela biópsia via transretal Pacientes tabagistas e etilistas apresentaram Score de Gleason da peça cirúrgica mais elevados. Conclusão: A concordância entre o Score de Gleason da biópsia e o Score de Gleason da peça cirúrgica foi de 70%; etilistas apresentaram PSA mais elevados; quanto maior foi a faixa etária, mais indiferenciado foi o tumor ( biópsia); pacientes tabagistas e etilistas apresentaram tumores mais indiferenciados na peça cirúrgica; este é o primeiro estudo epidemiológico de CaP desenvolvido na região do Vale do Aço, a caracterização sócio demográfica e as associações aqui encontradas podem contribuir com programas para desenvolver ações de controle do CaP nesta região. / Prostate cancer (PCa) is the second most common cause of cancer in men. According to INCA, in Brazil, in 2016, approximately 61,200 new cases of prostate cancer are estimated. Objective: To identify the demographic and epidemiological characteristics, as well as data on the tumor staging of patients with PCa treated at the Oncology Unit of Hospital Marcio Cunha in the city of Ipatinga-MG in the years of 2012, 2013 and 2014. Methodology: This is a retrospective and descriptive study where 668 patients\' records, with a diagnosis of pathological diagnosis, were analyzed in the years 2012, 2013 and 2014, according to the list provided by the institution, with a diagnosis of PCa registered with ICD-10-C 61. The analyzed variables were: origin, year of diagnosis, age group, self-reported race, risk factors such as smoking, alcoholism, family history of PCa, total PSA at diagnosis, histological type of biopsy, Gleason score of biopsy, histological type of the surgical specimen, Gleason score of the surgical specimen. Data were analyzed using descriptive and inferential statistics, using SPSS software, version 19.0. Results: The highest incidence of PCa cases came from the most populated cities of the analyzed health micro-region and the most prevalent age group was between 61 and 80 years old, with prevalence in brown and whites and with a family history of 17.2% of first-degree relatives degree; With father in 37.3%, brother in 60.8% and son in 1.9%. Only 165 (25.9%) were smokers and 20.8% were alcoholics. PSA levels ranged from 4.1ng / e to 10ng / ml (49.5%) and the higher the age group the higher the PSA values. Brown patients had higher total PSA. When we evaluated whether there was a relationship between total PSA levels and risk factors such as smoking, alcohol consumption and family history, there was only a statistically significant relationship with alcohol consumption. There was concordance of the Gleason score between biopsy and surgical specimen in 70%, subgrade in 18.7% and overdose in 11.3%. Comparing the age of patients with Gleason score, the greater the patient\'s age, the greater the Gleason score of the material obtained by the transrectal biopsy. Smokers and alcoholists presented the highest Gleason score of the surgical specimen. Conclusion: The agreement between the Gleason score of the biopsy and the Gleason score of the surgical specimen was 70%; Higher PSA levels; The longer the age group, the more undifferentiated was the tumor (biopsy); Smokers and alcoholics presented more undifferentiated tumors in the surgical specimen; This is the first epidemiological study of PCa developed in the Vale do Aço region, the socio-demographic characterization and the associations found here can contribute with programs to develop actions of control of PCa in this region.

The development and advancement of prostate cancer is supported by a plethora of genetic and proteomic abnormalities, including events of post-translational modifications. The protein arginine methyltransferase 5 (PRMT5) enzyme regulates epigenetic events of histone modifications and protein post-translational modifications within protein signaling pathways. PRMT5 functions by catalyzing the symmetric dimethylation of terminal arginine residues on target protein substrates. Under abnormal conditions of overexpression and upregulation, PRMT5 methyltransferase activity constitutively drives the growth and proliferation of dysregulated cells. Overexpression or upregulation of PRMT5 correlates with disease progression as observed among numerous cancer types, including breast, colorectal, leukemia, lung, melanoma and prostate cancers. We demonstrated previously that PRMT5 knockdowns attenuated both growth and proliferation of lung and prostatic tumors, in vitro and in vivo. Plants naturally produce chemical toxins as mechanisms of defense against microbial and other biological threats. Human exploitation, consumption and application of agents isolated from plants for therapeutic intervention dates back throughout the millennia. In this study, we extracted, purified and evaluated natural, small, chemical compounds from plant products that antagonize PRMT5 activity in prostate cancer cells. We found that crude and purified extracts of Dendrobium aurantiacum var. denneanum (D. denneanum) plants attenuated prostate tumor growth and proliferation by selective inhibition of PRMT5 methyltransferase activity. These findings establish the first set of natural PRMT5-specific inhibitors reported.

Prostatacancer är en av världens vanligaste cancerformer. Varje år diagnostiseras ungefär 1,3 miljoner män världen över med prostatacancer och trots det vet man inte de bakomliggande orsakerna. Det finns flera studier som visar att det finns en koppling mellan infektion och olika typer av cancer och Cutibacterium acnes återfinns i hög utsträckning i prostatacancervävnad. Det har därför föreslagits att det finns ett samband mellan infektion av C. acnes och prostatacancer. Närvaro av tumörassocierade makrofager har visats sig vara gynnande för olika typer av cancer och från dessa makrofager frisätts kemokiner, bland annat CCL22. CCL22 kan vara inblandad i en lokal hämning av immunförsvaret som ofta förknippas med tillväxt av cancer. I detta arbete odlas makrofager från blodgivare med C. acnes för att ta reda på om makrofagerna ökar sitt uttryck av CCL22 mRNA. Genom att analysera resultaten från en kvantitativ realtids-PCR indikeras det att makrofager som behandlats med C. acnes signifikant ökar sitt uttryck av CCL22 mRNA. Sammanfattningsvis bedöms resultaten från detta arbete styrka uppfattningen att det kan finnas en koppling mellan C. acnes och orsakerna bakom prostatacancer men mer arbete återstår för att kunna klargöra dess relevans. / Prostate cancer is one of world´s most common forms of cancer. Every year about 1.3 million men around the world are diagnosed with prostate cancer and even so we cannot fully explain the etiology. There have been several studies indicating that there is a correlation between infection and different forms of cancer. Cutibacterium acnes (C.acnes) can be found to a large extent in prostate cancer tissue and a correlation between infection of C. acnes and prostate cancer has therefore been suggested. The presence of tumor-associated macrophages has been shown to favor various types of cancer. Several chemokines including CCL22 are released from these macrophages. CCL22 may be involved in a local inhibition of the immune system that is often associated with cancer growth. In this work, macrophages from a blood donor are grown with C. acnes to find out if the macrophages increase their expression of CCL22 mRNA after this exposure. By analyzing the results of a quantitative real-time PCR for CCL22 mRNA, it was demonstrated that macrophages treated with C. acnes significantly increase their expression of CCL22 mRNA. In conclusion, the results of this work indicate that there could be a link between C. acnes and the causes of prostate cancer, but more work remains to be able to clarify its relevance.

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.

O câncer de próstata é o quinto tipo mais comum de câncer no mundo e o mais comum em homens. Fatores clínicos e anatomopatológicos atualmente usados na clínica não são capazes de distinguir entre a doença indolente e a agressiva. Existe uma grande necessidade de novos marcadores de prognóstico, a fim de melhorar o gerenciamento clínico de pacientes de câncer de próstata. Além das anormalidades em genes codificadores de proteínas, alterações em RNAs não codificadores (ncRNAs) contribuem para a patogênese do câncer e, portanto, representam outra fonte potencial de biomarcadores de câncer de próstata. Entretanto, até o momento, poucos estudos de perfis de expressão de ncRNAs foram publicados. Este projeto teve como principal objetivo identificar perfis de expressão de genes codificadores e não codificadores de proteína correlacionados com recorrência de tumor de próstata, a fim de gerar um perfil prognóstico com potencial uso como biomarcadores e elucidar o possível papel de ncRNAs no desenvolvimento do câncer. Para isso, foram analisados os perfis de expressão de genes codificadores e não codificadores de proteína de um conjunto de 42 amostras de tecido tumoral de câncer de próstata de pacientes de amostras de pacientes submetidos à prostatectomia radical, com longo acompanhamento clínico (cinco anos) e conhecida evolução da doença Nós utilizamos microarranjos por nós desenhados e fabricados pela Agilent sob encomenda, interrogando aproximadamente 18.709 transcritos não codificadores longos (>500 nt), sem evidência de splicing, que mapeiam em regiões intrônicas dentro de 5.660 loci genômicos. Os dados de expressão foram extraídos de cada arranjo, normalizados entre todas as 42 amostras de pacientes. Usando uma estratégia de múltipla amostragem, foi identificado um perfil de expressão de mau prognóstico, contendo 51 transcritos intrônicos não codificadores de proteína. O perfil prognóstico de ncRNAs foi aplicado a um conjunto teste independente de 22 pacientes, classificando corretamente 82% das amostras. Uma análise de Kaplan-Meier dos pacientes do conjunto teste indicou que as curvas de sobrevida dos grupos de alto e baixo risco foram significativamente distintas (Log-rank test p = 0,0009; Hazard ratio = 23,4, 95% CI = 3,62 a 151,2), confirmando assim que este classificador é útil para identificar pacientes com alto risco de recorrência. Além disso, estas descobertas indicam um potencial papel destes RNAs intrônicos não codificadores na progressão do tumor de próstata e apontam para os RNAs intrônicos como potenciais novos marcadores de câncer / Prostate cancer is the fifth most common type of cancer in the world, and the most common in men. Clinical and anatomo-pathological factors currently used in clinic are not able to distinguish between the indolent and the aggressive disease. There is a major need of new prognostic makers in order to improve the clinical management of prostate cancer patients. Apart from abnormalities in protein-coding genes, changes in non-coding RNAs (ncRNAs) contribute to the pathogenesis of cancer and thus represent another potential source of prostate cancer biomarkers. However, few studies of expression profiles of ncRNAs have been published. This project aimed to identify expression profiles of protein-coding and non-coding genes correlated to prostate cancer biochemical recurrence. For this, we analyzed the expression profile of 42 prostate cancer samples from patients undergoing radical prostatectomy, with long follow-up (five years), and know disease outcome. We used a custom microarray designed by us and printed by Agilent, that probes 18,709 long (>500 nt) ncRNAs mapping to intronic regions within 5,660 genomic loci. The expression data were extracted from each array and normalized across all 42 samples. Using a multiple random sampling validation strategy, we identified an expression profile of poor prognosis, comprising 51 ncRNAs. The prognostic profile of ncRNAs was applied to an independent test set of 22 patients, correctly classifying 82% of the samples. A Kaplan-Meier analysis of the test set of patients indicated that the survival curves of high and low risk groups were significantly different (Log-rank test p = 0.0009, Hazard ratio = 23.4, 95% CI = 3.62 to 151.2) thus confirming that this classifier is useful for identifying patients at high risk of recurrence. Furthermore, these findings indicate a potential role of these intronic non-coding RNAs in the progression of prostate tumors and points to the intronic ncRNAs as potential new markers of cancer.