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.

Robotic surgery is at the forefront of surgical innovation and presents novel challenges for both postgraduate learners and seasoned specialists. Robotic teaching is underway, often without formalized robotic curricula. Research into robotic surgical steps and surgical decision-making that should be imparted to learners has been neglected. As such, I aimed to determine the knowledge gap of urology residents for a robotic prostatectomy. Further, I also aimed to determine the patterns and cognitive rules used by experienced surgeons to complete a robotic prostatectomy. This master’s thesis included a knowledge gap survey, completed by urology residents, and compared to urologic oncologists, of a robotic prostatectomy and contained both open-ended and rating scale questions. A cognitive task analysis (CTA) was then performed as a series of semi-structured interviews in which incident-probing questions were used to make urologic oncologists explain visual cues and decision-making processes. 42 surveys were administered to urology residents and urologists at The Ottawa Hospital over 10 weeks. There was disagreement between urology resident and urologist responses from the rating scale responses, from the following procedural steps: vesicourethral anastomosis, apical dissection, and seminal vesicle dissection. The open-ended responses found discrepancies between the residents’ and urologists’; understanding of anatomy and surgical decision-making, and of cause-and-consequence cognitive awareness. Subsequently, 16 CTA interviews of four urologic oncologists were completed. After data coding and thematic analysis was performed, CTA grids for each surgeon described a map of a robotic prostatectomy including the steps and goals of the procedure, procedural landmarks, key visual cues for each step, complications and/or error prevention, and management. Specific content not yet described in the literature also includes how the lack of haptic feedback is compensated by robotic surgeons. Additional findings included a gap in urology resident knowledge and understanding of a robotic prostatectomy. The CTA of a robotic prostatectomy documented the surgical decision-making rules, patterns and visual cues urologic oncologists use to avoid errors, and to manage intraoperative surgical complications. This information is key to expanding the understanding of robotic prostatectomy surgical decision-making and training and can be used to produce robust robotic educational curricula.

Quality-of-life and functional outcomes are important in the choice of treatment for men with localized prostate cancer. These issues were investigated in the present thesis. All living 400 men randomized to radical prostatectomy or watchful waiting from 1989 to 1999 in the Scandinavian Prostate Cancer Group Number 4 (SPCG-4) were included. An additional 281 men compromised an age-matched control group. Physical symptoms, symptom-induced stress, sense of well-being and self-assessed quality of life were evaluated by a study-specific questionnaire. Results showed that prostate cancer men, regardless if they were allocated to radical prostatectomy or watchful waiting were suffering of long term adverse effects, mainly erectile dysfunction, urinary leakage and voiding symptoms. In the prostatectomy group, erectile dysfunction and urinary leakage were often consequences of surgery; in the watchful waiting group the side-effects could be caused by tumor progression. The quality of life deteriorated over time. High self-assessed quality of life was reported by 35 % in the radical, 34 % in watchful-waiting, and 43 % in the control groups after a median follow-up time of 12.2 years. The SPCG-4 men significantly more often reported anxiety than did controls. Erectile dysfunction was associated with the most negative influence on quality of life in both SPCG-4 groups. Men in the prostatectomy group were more distressed by erectile dysfunction than watchful waiting. Androgen deprivation therapy had negative effects on all psychological parameters, including quality of life, for the watchful waiting but not for the prostatectomy group. Information about the prostate-cancer disease was significantly higher in the radical-prostatectomy group than in watchful waiting. Check-ups were associated with worry, especially for those on androgen deprivation therapy. Open radical prostatectomy led to an increased rate of inguinal hernia compared with robot-assisted technique. In conclusion, the data of this thesis emphasize that it takes more than a decade to understand the patterns of adverse effects and time dimension of their occurrence for each treatment. Consideration of quality of life has a high priority to aid the ageing man through the shifting scenarios of localized prostate cancer.

Background: To explore cross‐sectional and longitudinal differences in general health‐related and prostate cancer‐specific quality of life (QoL) after robotic‐assisted (RARP) and laparoscopic (LRP) radical prostatectomy and to analyze predictive variables for QoL outcomes. Methods: In this multicenter, randomized controlled trial, prostate cancer patients were randomly assigned 3:1 to undergo either RARP or LRP. Patient‐reported outcomes were prospectively collected before and 1, 3, 6, 12 months after radical prostatectomy and included QoL as a secondary outcome. Validated questionnaires were used to assess general health‐related (EORTC QLQ‐C30) and prostate cancerspecific (QLQ‐PR25) QoL. Cross‐sectional and longitudinal contrasts were analyzed through linear mixed models. Predictive variables for QoL outcomes were identified by general linear modeling. Results: Of 782 randomized patients, QoL was evaluable in 681 patients. In terms of general QoL, the cross‐sectional analysis showed only small differences between study arms, whereas longitudinal comparison indicated an advantage of RARP on recovery: RARP patients reported an earlier return to baseline in global health status (3 vs. 6 months) and social functioning (6 vs. 12 months). In role functioning, only the RARP arm regained baseline scores. Regarding prostate‐specific QoL, LRP patients experienced more urinary symptoms and reported 3.2 points (95% confidence interval 0.4–6, p = 0.024) higher mean scores at 1‐month follow‐up and in mean 2.9 points (0.1–5, p = 0.042) higher urinary symptoms scores at 3‐month follow‐up than RARP patients. There were no other significant differences between treatment groups. Urinary symptoms, sexual activity, and sexual function remained significantly worse compared with baseline at all time points in both arms. Conclusions: Compared with LRP, the robotic approach led to an earlier return to baseline in several domains of general health‐related QoL and better short‐term recovery of urinary symptoms. Predictive variables such as the scale‐specific baseline status and bilateral nerve‐sparing were confirmed.:1 Abkürzungsverzeichnis 3 2 Einführung 4 2.1 Das Prostatakarzinom 4 2.1.1 Vorsorge und Diagnostik 4 2.1.2 Grundsätze der Therapie 5 2.1.3 Die radikale Prostatektomie 6 2.2 Lebensqualität 8 2.2.1 Gesundheitsbezogene Lebensqualität 8 2.2.2 Lebensqualität von Prostatakarzinompatienten 9 2.2.3 Prädiktoren der Lebensqualität nach radikaler Prostatektomie 12 2.3 Die LAP-01 Studie 13 2.3.1 Studiendesign 13 2.3.2 Lebensqualität im Rahmen der LAP-01 Studie 15 2.4 Zielsetzung und Fragestellung 16 3 Publikationsmanuskript 17 4 Zusammenfassung der Arbeit 28 5 Literaturverzeichnis 33 6 Anlagen 39 6.1 EORTC QLQ-C30 39 6.2 EORTC QLQ-PR25 42 7 Darstellung des eigenen Beitrags 44 8 Selbstständigkeitserklärung 45 9 Lebenslauf 46 10 Danksagung 48

BAKGRUND: Prostatacancer (PCa) är den vanligaste cancerformen bland män i Sverige. Efter kirurgisk behandling, radikal prostatektomi (RP), drabbas många av urininkontinens och sexuella besvär. Studier på kvinnor visar att urininkontinens påverkar sexuell lust men det finns få liknande studier bland män. SYFTE: Syftet med studien är att jämföra självskattad sexuell lust bland män med och utan inkontinens, ett år efter RP. METOD: Denna kvantitativa tvärsnittstudie utgår från enkätmaterial insamlat i en pågående prospektiv studie. Data insamlat bland 1751 män, ett år efter RP, har analyserats och jämförts mellan två grupper (fall-kontrollstudie). RESULTAT: Resultatet visar att män med urininkontinens skattar lägre sexuell lust, ett år efter RP, än män utan urininkontinens samt att de i högre grad beskriver tanken på ett fortsatt liv med sina sexualproblem med negativa begrepp. KONKLUSION: Män som genomgått RP, och i synnerhet de som har urininkontinens, har nedsättningar i sexuallivet. Sjuksköterskan bör uppmärksamma och ge tid till samtal om påverkan på sexuallivet efter RP, med både patient och partner. Ökad kunskap inom området bidrar till ökad förståelse, och behövs för att sjuksköterskor ska kunna hjälpa dessa patienter. Nedsatt sexuell lust hos män är ett outforskat område och vidare forskning behövs. / BACKGROUND: Prostate cancer (PCa) is the most common form of cancer among Swedish men. Urinary incontinence and sexual dysfunction are two side effects that many men experience after surgery, radical prostatectomy (RP). Previous studies show that urinary incontinence has negative effects on women’s sexual desire. Few similar studies concern men. AIM: The aim of the study is to compare self-reported sexual desire among men with and without urinary incontinence, one year post-surgical treatment (RP). METHOD: This quantitative, cross-sectional study is based on a self-reported survey from an ongoing prospective study. Data collected from 1751 men, one year post-treatment, have been analyzed and compared between two groups (case-control study). RESULT: The result shows that men with urinary incontinence after RP have less sexual desire than men without urinary incontinence. These men are also less satisfied with the idea of spending the rest of their lives with their sexual problems. CONCLUSION: Men that have undergone RP, especially the ones who have urinary incontinence, experience sexual dysfunction. Nurses need to acknowledge and initiate dialogues with patients and their partners about effects on sexual life after RP. Research concerning men’s sexual desire will help nurses’ knowledge and ability to discuss sexual problems. More studies about men’s reduced sexual desire are necessary.

Background Screening for prostate cancer is debated, there is conflicting data on the net benefit of screening. Men who consider screening need to be informed on the pros and cons. Rehospitalization after surgery can be used as an indicator of general quality of care. For radical prostatectomy, little is known on the readmission rate after surgery. Men diagnosed with low- and intermediate-risk prostate cancer have low prostate-cancer specific mortality. However, adverse effects after curative treatment can be severe and decrease quality of life. Curative treatments for prostate cancer differ mainly in the pattern of adverse effects but detailed analysis of long-term adverse effects is lacking. The aim of this thesis was to assess the perioperative quality of radical prostatectomy and the risk of adverse effects after curative treatment for prostate cancer. Material and Methods In this thesis, data from the National Prostate Cancer Register (NPCR) and other nationwide Swedish registers were used. By use of the Swedish personal identity number, NPCR was cross-linked to other registers creating Prostate Cancer data Base Sweden (PCBaSe), a large dataset for research. Results The proportion of men who had received information on the pros and cons of screening for prostate cancer with PSA testing was low (14%) indicating that the majority of men who were screened did not make an informed decision. The risk of rehospitalization within 90 days after radical prostatectomy was approximately 10% and similar after retropubic and robot-assisted radical prostatectomy. Compared to controls, there was an increased risk of adverse effects after both radiotherapy and radical prostatectomy up to twelve years after treatment and the overall risk was quite similar after retropubic and robot-assisted radical prostatectomy. Conclusion Improved information to men on the pros and cons of PSA screening is warranted. The risk of adverse effects was elevated up to 12 years after curative treatment for prostate cancer. The pattern of adverse effects was different after radiotherapy and radical prostatectomy but quite similar after retropubic and robot-assisted radical prostatectomy.

Bakgrund: Prostatacancer är den vanligaste cancerformen i Sverige där det finns olika behandlingsalternativ. Behandlingarna medför olika biverkningar och effekter för männen. Under behandlingen är det oftast en sjuksköterska männen träffar innan, under och efter behandlingen. Syfte: Syftet var att beskriva mäns upplevelser av livskvalitet under behandling av prostatacancer. Metod: En litteraturöversikt av aktuell forskning med kvalitativ och kvantitativ ansats där 12 artiklar har analyserats. Resultat: Många män upplevde en förändrad livsrytm och att det var viktigt att försöka leva så normalt och hälsosamt som möjligt. Männen upplevde förändringar av kroppen vilket ledde till att en del män kände skam och upplevde sig mindre manliga. Männen upplevde en förändrad syn på livet. Flera av männen upplevde att relationen till deras partner kunde bli påverkad både positivt och negativt. För att kunna hantera sjukdomen upplevde männen att det var viktigt med stöd och information från sjukvården för att behålla sin livskvalitet. Konklusion: Studien visar att män under behandling av prostatacancer upplever flera olika förändringar som påverkar deras livskvalitet. Män upplever en förändrad livsrytm, en förändring av kroppen, en förändrad syn på livet, ett förändrat samliv och ett behov av information och stöd från sjukvården. Som sjuksköterska är det därför viktigt att ha kunskap om förändringarna för att kunna vara ett stöd för patienten och därmed minska lidande.

Mäns upplevelser efter genomförd prostatektomi till följd av prostatacancer  En litteraturstudie  Abstrakt  Bakgrund: Prostatacancer är den vanligaste cancerformen hos män i Sverige som oftast behandlas med prostatektomi, vilket innebär att prostatakörteln avlägsnas. Prevalensen väntas öka vilket innebär att fler män kommer att komma i kontakt med sjukvården. Studier har visat att det finns stora brister i omvårdnaden och anledningen till detta är bristen på adekvat information.  Syfte: Syftet med litteraturstudien var att belysa mäns upplevelser efter genomförd prostatektomi till följd av prostatacancer.  Metod: Syftet besvarades med en litteraturstudie där nio artiklar med kvalitativ ansats användes. Artiklarna kvalitetsgranskades, analyserades och sammanställdes till ett resultat. Artikelsökningarna utfördes i CINAHL och PubMed.  Resultat: Komplikationer, bristande information och otillfredsställande uppföljning var brister som männen upplevde orsakade både ett kroppsligt och själsligt lidande samt en minskad tillit till vårdpersonalen. Trots bristerna upplevde männen tacksamhet över att ha överlevt och att stödet som de fått var betydelsefullt. Relaterat till bristerna uttryckte männen även en önskan om att hjälpa andra.  Konklusion: Utifrån bristerna som männen upplevde kan vårdpersonal ses som en orsak till lidande, men också som ett hopp i den rådande situationen. Relaterat till detta kan en ökad förståelse leda till en förbättrad omvårdnad. / Men’s experiences after completed prostatectomy due to prostate cancer A literature study Abstract Background: Prostate cancer is the most common cancer among men in Sweden and is often treated with prostatectomy. The prevalence is expected to increase, which means that more men will be forced to seek healthcare. Studies have shown that major shortcomings exist in the care and the reason is the lack of adequate information. Aim: To illustrate men´s experiences after completed prostatectomy due to prostate cancer. Method: A literature study based on nine articles with a qualitative approach. The articles quality was reviewed, analyzed and compiled into a result.The article searches were conducted in CINAHL and PubMed. Results: Complications, lack of information and inadequate follow-ups caused men both physical and mental suffering, and reduced reliance on caregivers. Despite the shortcomings, men experienced gratitude for having survived and that the support they received was important. Related to the shortcomings men expressed their desire to help others. Conclusion: Based on the shortcomings that the men experienced, health professionals can be seen as a cause of suffering, but also as a hope in the current situation. Related to this, better understanding can lead to improved care.

INTRODUÇÃO: Disfunção erétil (DE) e incontinência urinária são complicações comuns em pacientes submetidos à prostatectomia radical (PR). Sabe-se que a reabilitação do assoalho pélvico com biofeedback pode antecipar o retorno da continência urinária; porém, os efeitos sobre a função erétil não são conhecidos. Neste trabalho estudou-se o efeito da reabilitação precoce do assoalho pélvico com biofeedback sobre a função erétil, após 12 meses da PR. MÉTODOS: Realizou-se um estudo prospectivo, controlado e randomizado. Foram convidados a participar do estudo 56 pacientes sem disfunção erétil que escolheram a PR para tratamento do câncer de próstata localizado, e que poderiam cumprir a agenda de seguimento ambulatorial. A função erétil foi avaliada pelo índice internacional de função erétil (IIEF5). Foram considerados potentes os pacientes com escore IIEF 5 >= 20. Os pacientes foram randomizados para um grupo de tratamento (n=26), recebendo reabilitação do assoalho pélvico com biofeedback uma vez por semana e orientação para exercícios domiciliares ou para um grupo controle (n=26), no qual os pacientes receberam as instruções habituais do urologista. Durante o estudo, nenhum paciente recebeu tratamento com medicamentos para DE. Foram considerados continentes os pacientes que usavam no máximo um absorvente por dia. A associação entre recuperação da continência e recuperação da potência foi avaliada. RESULTADOS: Nove pacientes do grupo de tratamento e dez do grupo controle foram precocemente excluídos do estudo, antes da avaliação inicial do primeiro mês. As causas de exclusão foram: por abandono do programa (8 pacientes), complicações pós-operatórias (9), necessidade de radioterapia adjuvante (2). Não houve diferença entre os grupos em relação à idade, índice de massa corpórea, presença de diabetes, bem como quanto à função erétil pré-operatória. Nos dois grupos observou-se significativa redução da função erétil. Após 12 meses da cirurgia 8 (47,1%) pacientes do grupo de tratamento recuperaram ereção, contra 2 (12,5%) pacientes no grupo controle (p=0,032). A redução do risco absoluto foi de 34,6% (3.8-64%)IC95%. O número necessário para tratar foi de 3 (1.5-17.2; IC95%). Foi observada forte associação entre recuperação da potência e da continência, de tal forma que a probabilidade de estar potente nos pacientes continentes foi 2,6 vezes maior do que nos pacientes incontinentes (p=0,017; [1,45-4,69] IC 95%). CONCLUSÃO: A reabilitação precoce do assoalho pélvico com biofeedback parece ajudar na recuperação da função erétil após a PR. A continência urinária foi um bom indicador da recuperação da função erétil, conferindo uma chance maior de sua recuperação. / INTRODUCTION: Erectile dysfunction (ED) and urinary incontinence are common complications in the early postoperative follow-up of patients undergoing radical prostatectomy (RP). Previous studies indicate that the preservation of potency is not associated with the recovery of urinary continence after RP. Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. METHODS: Fifty-two patients who elected PR for treatment of clinically localized prostate cancer and who could comply with the ambulatory treatment schedule were invited to participate in this prospective study. Patients were randomized for a treatment group (n=26) receiving PFBT once a week for 3 months and home exercises or a control group (n=26), in which patients received the usual instructions to contract the pelvic floor. Patients were not allowed to receive drug treatment for ED throughout the study duration. Erectile function was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and one, three, six and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score of >= 20. Additionally, the continence status was assessed and patients were considered continent when the use of pads was <= 1/day. The association of continence and recovery of potency was evaluated. RESULTS: Nine patients in the treatment group and 10 in the control group were excluded due to failure to return for the evaluation (8 pts), postoperative complications (9 pts), need for adjuvant radiotherapy (2 pts). Preoperative assessment did not show differences in age, body mass index, and diabetes between the groups. There was a significant reduction in IIEF 5 scores after surgery in both groups. In the treatment group 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (p=0.032). The absolute risk reduction was 34.6% (95% CI: 3.8-64%). The number needed to treat was 3 (95% CI: 1.5-17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 2.6 higher chance of being potent than incontinent patients (p=0.017; 95% CI: 1.45-4.69). CONCLUSIONS: Early PFBT appears to have a significant impact on the recovery of erectile function after PR. Urinary continence status was a good indicator of erectile function recovery, with continent patients having higher chance of being potent than incontinent patients.

Introdução: Biopsia de próstata com único fragmento comprometido geralmente associa-se a um câncer de próstata (CaP) pequeno e de baixo risco. O objetivo é avaliar e comparar os achados patológicos dos pacientes com único versus múltiplos fragmentos comprometidos à biopsia que foram submetidos a prostatectomia radical (PR) e correlacioná-los com CaP de baixo risco. Material e Métodos: Foram avaliados 249 pacientes com único fragmento comprometido à biopsia (grupo 1) e 250 pacientes com múltiplos fragmentos (grupo 2) que foram submetidos a PR. Os grupos foram pareados de acordo com idade, peso da próstata, níveis de antígeno prostático específico (PSA) e estadio clínico. Foram avaliadas a concordância do escore de Gleason (EG), margem cirúrgica positiva (MCP), extensão extraprostática (EEP) e invasão de vesículas seminais (IVS). Também foram avaliadas a influência do número de fragmentos biopsiados e do peso prostático. Resultados: EG da biopsia foi idêntico ao EG pós-PR em 55% no grupo 1 e 45% no grupo 2 (p = 0,028). Biopsias com 12 ou mais fragmentos mostraram maior concordância em ambos os grupos quando comparadas aos com menos de 12 fragmentos (p = 0,01 no grupo 1). Subgraduação foi a discrepância mais comum no EG (35% no grupo 1 e 50% no grupo 2), com uma proporção maior no grupo 1 quando menos de 12 fragmentos foram biopsiados (p = 0,007). O grupo 1 apresentou menores taxas de MCP (20,9% vs 37,6%, p < 0,001), de EEP (10% vs 26%, p < 0,001) e IVS (6% vs 13,2%, p = 0,006). As taxas de MCP, EEP e IVS aumentaram com o aumento de EG em ambos os grupos. No grupo 1, biopsias com menos de 12 fragmentos obtiveram maiores taxas de MCP em relação as com 12 ou mais fragmentos (37% vs. 16%, p < 0,001), e esta diferença não ocorreu no grupo 2 (p = 0,69). No grupo 1, pacientes com EG >= 8 tiveram 3,5 vezes mais chance de estar associado com MCP quando comparados àqueles com EG <= 6 (p = 0,03). No grupo 1, EEP e IVS não tiveram diferenças de acordo com o EG (p = 0,273 e p = 0,95, respectivamente). Entretanto, o grupo 2 teve maior proporção de EEP com EG=7 quando comparado ao EG <= 6 (OR = 3,1, p < 0,001) e maior proporção de IVS no EG=7 quando comparado ao EG <= 6 (OR = 3,1, p < 0,004). No grupo 1, 67,3% dos tumores não palpáveis tornaram-se tumores de maior risco (pT2c-pT3). Analisando apenas tumores não palpáveis no grupo 1 com EG <= 6 à biopsia (156 pacientes), notamos que 106 (67,9% de cT1) progrediram para pT2c-pT3. Conclusão: Pacientes com CaP com um fragmento comprometido à biopsia, embora apresentem achados patológicos favoráveis em relação ao grupo com múltiplos fragmentos positivos, ainda têm taxas consideráveis de supergraduação do EG, pT2c-pT3, MCP, EEP e IVS. Estes achados são mais evidentes em biopsias com alto EG e menos de 12 fragmentos. Os resultados sugerem que pacientes com único fragmento comprometido à biopsia não devam, categoricamente, serem classificados sempre como portadores de CaP de baixo risco / Introduction: Single positive core at prostate biopsy is usually associated with small and low risk prostate cancer (PCa). The aim is to evaluate and compare the pathological findings in single versus multiple positive cores patients who underwent radical prostatectomy (RP) and correlates them with low risk PCa. Material and Methods: We evaluated 249 single core patients (Group 1) and 250 with multiple cores (Group 2) who underwent RP. The groups were matched according to age, prostate weight, PSA and clinical stage. We evaluated the Gleason score (GS) concordance, positive surgical margin (PSM), extraprostatic extension (EPE) and seminal vesicle invasion (SVI) between the groups. We also evaluated the influence of the number of fragments sampled and the prostate weight. Results: GS biopsy was identical to RP GS in 55% in group 1 and 45% in group 2 (p = 0,028). Biopsies with 12 or more cores showed higher concordance in both groups than less than 12 cores (p = 0,01 in group 1). Undergrading was the most common GS discrepancy (35% in group 1 and 50% in group 2), with a higher proportion in group 1 when less than 12 fragments were sampled (p = 0,007). Group 1 had lower PSM rate (20,9% vs 37,6%, p < 0,001), less EPE (10% vs 26%, p < 0,001) and SVI (6% vs 13,2%, p = 0,006). PSM, EPE and SVI rates increased with increasing GS in both groups. In group 1, biopsies with less than 12 cores have higher PSM rates than 12 or more cores (37% vs 16%, p < 0,001), and we found no difference in group 2 (p = 0,69). In group 1, a patient with GS >= 8 was 3,5 times more likely associated with PSM than GS <= 6 (p = 0,03). In Group 1, EPE and SVI did not have any difference according the GS (p = 0,273 and p = 0,95, respectively). However, group 2 have higher rate of EPE in GS 7 than among GS <= 6 (OR = 3,1, p < 0,001) and higher rate of SVI in GS 7 than among GS <= 6 (OR = 3,1, p < 0,004). In group 1, a total of 67,3% with nonpalpable tumors became greater risk tumors (pT2c-pT3). Analyzing only nonpalpable tumors in group 1 with a GS <= 6 at biopsy (156 patients), we noted that 106 (67,9% of cT1) progressed to pT2c-pT3. Conclusion: Single core PCa, although they have favorable pathological features than the multiple positive cores PCa, still have considerable rates of overgraduated GS, pT2c-pT3, PSM, EPE and SVI. These findings are even more evident in biopsies with high GS and less than 12 fragments. The results suggest that single core patients should not categorically be classified always as having a low risk PCa