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Abstrak :
Tujuan : Biopsi prostat transrektal telah menjadi baku emas untuk diagnosis kanker prostat. Beberapa penelitian melaporkan keluhan nyeri dan ketidaknyamanan pasien akibat tindakan tersebut. Penelitian ini dimaksudkan untuk evaluasi toleransi pasien terhadap nyeri dengan visual analog scale (VAS) yang dilakukan biopsi prostat. Metode : Dilakukan studi prospektif keluhan nyeri menggunakan VAS pada pasien yang dilakukan biopsi prostat sejak bulan Juli 2002 hingga Januari 2003 dan dievaluasi faktor-faktor yang mungkin berpengaruh yaitu : usia, retensi urin, lekosituri, echostruktur dan pelebaran vena periprostat. Analisa statistik menggunakan SPSS ver 11.5. Hasil : Terdapat 40 pasien yang dilakukan biopsi prostat sextant dengan usia rata-rata 65,85 ± 8,00 tahun. Nilai median prostate spesific antigen (PSA) 14.0 ng/ml (antara 6.4 - 448 nglml). Dengan transrektal ultrasonografi diperoleh volume prostat rata-rata 54.30 cc (antara 22 - 137 cc). Pada evaluasi keluhan nyeri yang dirasakan penderita dengan menggunakan skor VAS saat dilakukan biopsi sebanyak 31 orang (77.5%) menyampaikan keluhan nyeri sedang sampai berat dengan nilai median VAS lima.. Terdapat hubungan antara usia penderita dengan keluhan nyeri yang dirasakan (p<0.05) dimana pasien yang berusia lebih Bari 66 tahun merasakan keluhan nyeri yang lebih berat. Dari studi ini juga didapatkan hubungan yang bermakna antara keluhan nyeri yang dirasakan dengan adanya pelebaran vena periprostat. (p= 0,019). KesimpuIan : Walaupun 77.5% pasien mengeluh nyeri tetapi pada keseluruhan pasien dilakukan biopsi secara lengkap (enam kali). Faktor usia dan pelebaran vena periprostat mempunyai hubungan yang bermakna dengan keluhan nyeri yang dievaluasi dengan VAS.

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Purpose : Transrectal ultrasound guided prostate biopsy has become the gold standard for diagnosing prostate cancer however there are several studies reporting pain and discomfort of the patient who underwent prostate biopsy. This study was conducted to evaluate the tolerance to pain with visual analog scale (VAS) in patients who underwent prostate biopsy. Material and Methods : From July 2002 to January 2003 all patient who underwent sextant prostate biopsy were evaluated and the degree of pain using visual analog scale were recorded. We evaluated characteristic of the patients such as age, urine retention, leukosituria, echostructur of the prostate and dilatation periprostatic vein. Statistical analysis were performed using SPSS ver 11.5. Result : Forty patients with mean age 65,85 ± 8,00 years underwent sextant prostate biopsy. The median prostate spesific antigen (PSA) was 14.00 ng/ml (range 6.4 - 448 nglml), and mean prostate volume was 54.30 cc (range 22 - 137 cc). Most of patients have moderate to severe pain (77.5%) with median visual analog scale (VAS) was five when underwent prostate biopsy. There was correlation between degree of pain for patients with age more than 66 years old (p< 0.05), and the prescense of periprostatic vein dilatation (p < 0.05). Conclution : Although 77.5% of the patient have moderate to severe pain, but the procedure was done completely. Existence periprostatic vein dilatation of prostate have positive correlation with degree of pain using VAS. Older patient have less tolerance to pain cause by biopsy of the prostate.

Abstrak :
Tujuan: Mengevaluasi secara prospektif keamanan dan efektifitas penyuntikan lidokain 1% periprostat pada biopsi prostat transrektal dengan bimbingan USG transrektal. Materi dan Metoda: sari 60 pasien yang dibiopsi prostat, dipilih secara random masing-masing 30 orang disuntikan lidokain 1% atau plasebo secara double-blind. Disuntikan 5 cc lidokain 1% atau Na CI 0,9% menggunakan jarum 22 dengan bantuan probe USG transrektal ke kumpulan syaraf dikedua sisi prostat. Nyeri yang dirasakan waktu biopsi dinilai dengan menggunakan skala nyeri "Visual Analogue Scale" (VAS) dan komplikasi yang terjadi setelah biopsi pada kedua grup. Skala nyeri dianalisa statistik menggunakan Student -T Test. Hasil: Skala nyeri waktu biopsi antara yang disuntikan lidokain 1% dibandingkan NaCl 0,9% berbeda secara bermakna dengan VAS (2,1 ± 1,3 dan 5,7 ± 1,7 p<0,05). Komplikasi setelah biopsi seperti nyeri, hematuri, hematochezia dan demam pada kedua perlakuan tidak memberikan perbedaan yang bermakna. Kesimpulan: Penyuntikan lidokain 1% periprostat merupakan metode mudah, aman dan efektif untuk mengurangi nyeri pada biopsi prostat.

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Purpose : We prospectively evaluated the safety and efficacy of periprostatic 1 % lidocaine injection during transrectal prostate biopsy with transrectal ultrasound guided. Materials and Methods: A total of 60 consecutive patients undergoing prostate biopsy were randomized into 1% lidocaine and placebo groups using 0,9% sodium chloride of 30 each in double-blind fashion. A 2,5 ml dose of 1% lidocaine or 0,9% sodium chloride was injected via 22 gauge needle inserted through and guided by the transrectal ultrasound probe at the prostatic neurovasculer bundle on each side. Pain during biopsy was assessed using a 0 to 10 point linear visual analog pain scale and other complications (pain after biopsy, hematuria, hematochezia and fever) were recorded to determine whether there was a difference between those two groups. Statistical analysis of pain score was performed by using Student T-Test. Results : Pain scores were significantly lower in the periprostatic 1% lidocaine injection group compared to the placebo group (2.1 ± 1.3 versus 5.7 ±1.7 , p < 0.05 ). There was no significant difference in pain after biopsy, hematuria, hematochezia and fever rate among these two groups. Conclusions : Per iprostatic 1% lidocaine injection is a simple, safe and efficacious method of providing satisfactory anesthesia to reduce pain in men undergoing transrectal prostate biopsy.

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ABSTRAK
Pemeriksaan Urinary Bladder Cancer Antigen (UBC) merupakan salah satupemeriksaan non invasive terbaru dalam mendeteksi karsinoma buli dengan mengidentifikasi ekspresisito keratin 8 dan 18 di dalam urin. Tujuan dari penelitian ini adalah uji diagnostic dari pemeriksaan Rapid UBC pada populasi Indonesia dengan kecurigaan klinis tumor buli.Penelitian ini mengevaluasi 21 pasien secara prospektif di rumah sakit pusat rujukan nasional Indonesia padatahun 2011-2012. Kriteria inklusi pada penelitian ini adalah pasien usia diatas 18 tahun dengan gross hematuria dan hasil pemeriksaan imajing menunjukkan adanya tumor buli, atau pasien KST buli dengan riwayat reseksi tumor buli habis yang menjalani follow up sistoskopi rutin. Kriteria eksklusi meliputi pasien dengan infeksi saluran kemih atau dengan hasil pemeriksaan bakteri tahan asam di urin positif. Pemeriksaan Rapid UBC dilakukan sebelum sistoskopi dilakukan. Hasil pemeriksaan selanjutnya dibandingkan dengan hasil sistoskopi dan histopatologi. Analisa statistic dilakukan dengan perbandingan bivariat menggunakan SPSS v.17.0. Mayoritas subjek penelitian adalah laki-laki (71.4%). Nilai rerata usia adalah 56.1± 15.4 tahun. Lima belas pasien (71.4%) memiliki hasil UBC positif, dan 6 pasien (28.6%) memilikihasil UBC negatif. Diantara pasien-pasien dengan hasil positif tersebut, 93.3% memiliki penemuan sistoskopi positif tumor buli dengan hasil histopatologi menunjukkan positif karsinoma sel transisional buli, dan 1 pasien memiliki hasil sistoskopi dan histopatologi negatif. Diantara pasien-pasien denganhasil UBC negatif, 83.3% memiliki hasil sistoskopi positif menunjukkan adanya tumor buli dan hasilhistopatologi karsinoma sel transisional buli, dan 1 pasien memiliki hasil sistoskopi dan histopatologi negatif. Nilai positif predictive value pemeriksaan rapid UBC dalam mendeteksi KST buli adalah 93.3% dan nilai negative predictive value adalah 16.7%. Sensitivitas rapid UBC dalam penelitian ini sebesar 73.7%, spesifisitas 50%, p=0.5 Pemeriksaan rapid UBC memberikan nilai PPV yang cukup tinggi terkait temuan sistoskopi tumor buli dan hasil histopatologi karsinoma sel transisional buli. Pada penelitian awal ini, pemeriksaan Rapid UBC dapat menjadi pemeriksaan penunjang yang menjanjikan dan berguna untuk evaluasi cepat pada kasus-kasus dengan dugaan tumor buli. Dibutuhkan studi lanjutan dengan jumlah sampel yang lebih besar untuk mengevaluasi nilai diagnostik pemeriksaan Rapid UBC.

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ABSTRAK
Urinary Bladder Cancer Antigen (UBC) test is a novel non-invasive detection method of bladder cancer, which identifies the expression of cytokeratin 8 and 18 in the urine. This study objective is to evaluate the diagnostic performance of the Rapid UBC urine test in Indonesian population with clinical bladder tumor. We prospectively evaluated 21 subjects in the national referral hospital of Indonesia from year 2011-2012. The inclusion criteria were patients older than 18 years old with gross hematuria and imaging result suggestive of bladder cancer, or patients with history of complete transurethral resection of bladder tumor who underwent routine follow-up cystoscopy. The exclusion criteria were: active urinary tract infection or positive acid fast bacilli urine test. Rapid UBC urine tests were conducted prior to cystoscopy. The result was compared with cystoscopy and histopatology findings. Statistics were analyzed by chi-square comparison, using SPSS v17.0. Majority of the subjects were males (71.4%). The mean age was 56.1 ± 15.4 years old. Fifteen patients (71.4%) had positive UBC result, and 6 patients (28.6%) had negative UBC result. Among those with positive UBC result, 93.3% had positive cystoscopy finding of bladder mass and histopatology report of bladder TCC, while one subject had negative cystoscopy and histopatology findings. Among patients with negative UBC result, 83.3% had positive cystoscopy finding of bladder mass and positive histopatology report of bladder TCC, whereas one subject had negative cystoscopy and histopatology findings. The positive predictive value of rapid UBC test in detection of bladder TCC was 93.3%, and the negative predictive value was 16.7%. The rapid UBC test sensitivity was 73.7% and, the specificity was 50%, overall p = 0.5.Rapid UBC urine test were giving high positive predictive value associated with positive cystoscopic and histopathologic findings of bladder cancer in our initial evaluation. The UBC rapid test may be a promising additional test that might be useful for quick clinical evaluation of suspected bladder cancer. Further studies with larger samples are required to evaluate the diagnostic value of rapid UBC urine test

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ABSTRAK
Penelitian ini membandingkan kuesioner Visual Prostate Symptom Score VPSS yang jarang digunakan dengan kuesioner International Prostate Symptom Score IPSS dan parameter uroflowmetri di Indonesia pada pasien laki-laki yang berobat di Rumah Sakit Umum Nasional Cipto Mangunkusumo. Evaluasi menggunakan IPSS dalam bahasa Indonesia, VPSS, uroflowmetri dan ultrasonografi transabdominal dikerjakan pada pasien pria berusia lebih dari 45 tahun yang berobat ke Rumah Sakit Umum Nasional Cipto Mangunkusumo antara Februari 2014 dan Agustus 2015. Dari seluruh subyek, 24,2 dan 11,1 membutuhkan bantuan ketika menjawab kuesioner IPSS dan VPSS. Usia rata-rata, skor total IPSS, skor total VPSS, Q-max, volume berkemih, dan volume residu pasca berkemih masing-masing adalah 67,4 8,9 tahun, 13,4 7,8, 10,8 2,7, 13,6 8,6 mL / detik, 248 136 ml, dan 54,9 68,3 ml. Skor total, IPSS kualitas hidup QoL , IPSS pertanyaan Q 2, IPSS Q7, dan IPSS Q5, secara signifikan berkorelasi dengan skor total VPSS, VPSS QoL, VPSS Q1, VPSS Q2, dan VPSS Q3 koefisien korelasi r , nilai P masing-masing: 0,57,

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ABSTRACT
This study aims to compare and correlate the novel Visual Prostate Symptom Score VPSS with International Prostate Symptom Score IPSS questionnaire and uroflowmetry parameters in Indonesian men who visited Dr. Cipto Mangunkusumo National General Hospital. Male patients older than 45 years who visited Dr. Cipto Mangunkusumo National General Hospital between February 2014 and August 2015 with LUTS were evaluated with Indonesian version of the IPSS, VPSS, uroflowmetry and transabdominal ultrasound. Appropriate statistical analysis was employed. Of all subjects, 24.2 and 11.1 require assistance when answering IPSS and VPSS questionnaires respectfully. The mean age, IPSS total score, VPSS total score, Q max, voided volume, and post void residual volume were 67.4 8.9 years, 13.4 7.8, 10.8 2.7, 13.6 8.6 mL sec, 248 136 ml, and 54.9 68.3 ml respectively. Total IPSS, IPSS quality of life QoL , IPSS question Q 2, IPSS Q7, and IPSS Q5, were significantly correlated with total VPSS, VPSS QoL, VPSS Q1, VPSS Q2, and VPSS Q3 correlation coefficient r P value 0.57,

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Tujuan : untuk mengetahui karakteristik dan faktor-faktor prediktif tumor testis dewasa di Jakarta Bahan dan Cara : Data dikumpulkan dari status khusus di departemen urologi RSCM dan RS kanker Dharmais. Data yang dikumpulkan adalah : usia, tumor marker yaitu AFP, LDH, 13 HCG, jenis operasi, jenis tumor, jenis terapi, dan stadium. Dilakukan analisa terhadap usia dengan stadium, UDT dengan stadium, tumor marker dengan stadium pad a semua kasus, dan hubungan AFP dengan jenis nonseminoma dengan stadium menggunakan ANOVA pad a SPSS 11,5 . Hasil : Selama 10 tahun terdapat 149 kasus tumor testis, 129 kasus diantaranya adalah dewasa. Rentang usia yaitu 18-72 tahun, dengan usia rata-rata 33,03 tahun. Jenis tumor diantaranya seminoma 67 ( 51,9 % ) pasien, non-seminoma 50 ( 38,8 % ) pasien, non germinal 6 ( 4,7 % ) pasien, tidak diketahui jenis tumornya 6 ( 4,7 % ) pasien. Delapan puluh tujuh pasien ( 67,4 % ) dilakukan orkhidektomi ligasi tinggi, 23 ( 17,8 % ) pasien dilakukan orkhidektomi transscrotal. Insidens UDT terdapat pada 13 ( 10,1 % ) pasien. Seminoma paling banyak ditemukan pad a stadium 2c ( 36,9 % ), dan non -seminoma pada stadium 3c ( 48,9 % ). Kemoterapi dilakukan terhadap 51 ( 39,5 % ) pasien, radioterapi pada 24 ( 18,6 % ) pasien, dan 27 ( 20,9 % ) pasien menol&k dilakukan tindakan, dan 18 ( 14,0 % ) pasien meninggal karena keadaan umum yang buruk. Pada penelitian ini tidak ditemukan hubungan bermakna antara usia dengan stadium. Tujuh puluh tujuh persen pasien dengan UDT ditemukan pada stadium lanjut, dibandingkan dengan 66,7 % pada pasien non-UDT, tetapi secara statistik tidak bermakna. Angka rata-rata LDH 1785,35 dan nilai LDH meningkat sesuai dengan stadium, tetapi tidak bermakna untuk memprediksi stadium. Angka rata-rata AFP pada pasien non-seminoma adalah 6421,13 dan mempunyai hubungan yang bermakna dengan stadium ( p : 0,009 ). Kesimpulan : Jenis tumor yang paling banyak ditemukan di Jakarta adalah seminoma. Pada penelitian ini usia dan LDH tidak dapat memprediksi stadium tumor, tetapi AFP mempunyai hubungan yang bermakna dengan stadium pada penderita kanker testis non-seminoma.

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Tujuan: Mengevaluasi tren tatalaksana kanker prostat stage T3 berdasarkan faktor faktor yang mempengaruhi. Material dan Metode: Studi retrospektif tatalaksana kanker prostat stage T3 di Rumah Sakit Cipto Mangunkusumo dan Rumah Sakit Kanker Dharmais periode 1995 2013. Data tren pemilihan terapi antara radioterapi atau terapi hormonal dianalisis berdasarkan kelompok tahun terapi kadar PSA grade tumor dan kelompok usia. Hasil: Dari 50 subjek 25 50 23 46 and 2 4 subjek mendapatkan tatalaksana radioterapi terapi hormonal dan prostatektomi radikal secara berturutan. Perubahan tren pemilihan terapi berdasarkan tahun terapi secara statistik signifikan p 0 012 dengan mengeksklusikan kelompok periode terapi 1995 1999. Terapi hormonal lebih menjadi pilihan untuk kelompok tumor high grade 53 8 dan lebih sering dipilih seiring bertambahnya usia pasien Kadar PSA tidak mempengaruhi tren pemilihan terapi. Kesimpulan: Terdapat perubahan yang bermakna dalam pemilihan terapi kanker prostat stage T3 berdasarkan tahun terapi Terapi hormonal lebih menjadi pilihan pada kasus dengan tumor high grade dan kelompok usia yang semakin tua. ......Objective: To evaluate treatment trend of stage T3 prostate cancer based on several factors. Materials and Methods: A retrospective study was done on stage T3 prostate cancer patients from year 1995 2013 at two national referral hospitals in Indonesia. Treatment trends between hormonal therapy and radiotherapy based on year of treatment PSA level tumor grade and age groups were evaluated. Results: On 50 patients subjects 25 50 23 46 and 2 4 subjects were treated by radiotherapy hormonal therapy and radical prostatectomy respectively. Year of treatment were significantly associated with treatment selection p 0 012 after excluding year of treatment 1995 1999 group. Hormonal therapy was preferred on high grade tumor group 53 8 and more applied for older patients. Treatment trend was not affected by PSA level. Conclusion: Year of treatment were significantly associated with treatment selection of stage T3 prostate cancer Hormonal therapy was preferred on high grade tumor group and older age groups.

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Tujuan: Untuk mengetahui bagaimana upaya diagnosis kanker prostat yang dilakukan oleh spesialis urologidi Indonesia. Metode: Dilakukan pembagian kuesioner yang dirancang sendiri kepada Spesialis Urologi di Indonesia. Kuesioner berisi 11 pertanyaan tentang jenis dan indikasi pemeriksaan yang dilakukan, serta fasilitas yang tersedia di tempat responden dalam penegakan diagnosis kanker prostat. Hasil: Sebanyak 65 (36%) dari 182 (saat penelitian ini dilakukan) spesialis urologi di Indonesia mengembalikan formulir kuesioner. Dari jenis RS primer tempat bekerja terbanyak berasal dari RS swasta (35%), disusul RS pendidikan utama Fakultas Kedokteran (32%). Seluruh responden menjadikan lower urinary tract symptoms (LUTS) sebagai indikasi untuk melakukan pemeriksaan colok dubur. Selain itu 83% responden juga menjawab, peningkatan PSA sebagai salah satu indikasi pemeriksaan colok dubur. Pemeriksaan PSA dilakukan oleh 72% responden pada penderita dengan kecurigaan kanker prostat tanpa melihat usia. Sebanyak 66% responden mengerjakan sendiri pemeriksaan transrectal ultrasonografi (TRUS) dan biopsi, 18% merujuk pada sejawat lain di propinsi yang sama dan 15% tidak memiliki fasilitas TRUS dan biopsi di propinsi tempat bekerja. Sebanyak 75% responden memiliki fasilitas bone scan di Rumah Sakit primer, atau tersedia di RS pada propinsi yang sama. Indikasi tersering melakukan biopsi prostat adalah pada PSA lebih dari 10 ng/ml tanpa melihat usia. Sebanyak 86% responden melakukan biopsi pada kecurigaan kanker prostat melalui colok dubur tanpa melihat usia. Sembilan puluh persen responden menggunakan antibiotik profilaksis golongan Kuinolon untuk biopsi prostat. Sebanyak 46% menggunakan analgesia oral atau suppositoria atau kombinasi keduanya sebagai analgesia dalam biopsi prostat. Kesimpulan: Dalam mendiagnosis kanker prostat, spesialis urologi di Indonesia melakukan pemeriksaan colok dubur, PSA dan TRUS biopsi prostat, namun masih terdapat perbedaan pendapat tentang indikasi dan waktu dilakukannya masing-masing pemeriksaan. Ketersediaan fasilitas diagnostik juga berpengaruh dalam diagnostik kanker prostat di Indonesia. Belum tersedianya guideline Nasional pada saat penelitian ini dilakukandiduga menyebabkan perbedaan pendapat tersebut. ......Purpose: To get information on diagnosis of prostate cancer conducted by urologist in Indonesia. Method: A self-constructed questionnare of 11 questions about the type and indication of the tests, as well as the available facilities at the place of the respondents to diagnose prostate cancer distributed to Indonesian Urologist. Result: As much as 65 (36%) from 182 (when the survey was conducted) Indonesian Urologist returned the questionnare. Most of them worked in Private Hospital (35%), followed by Medical School Hospital (32%). All respondents performed DRE in patients with Lower Urinary Tract Symptoms (LUTS). Elevated PSA was also indication for conducting DRE in 83% respondents. PSA level was tested by 72% respondents in patients with suspicion of prostate cancer regardless of age. As much as 66% respondents did Trans Rectal Ultrasound (TRUS) and prostate biopsy by themselves, 18% referred to other urologists in the same province and 15% didn?t have TRUS and prostate biopsy facilities in their province. Bone scan was available in the Primary Hospital or another hospital in the province of 75% respondents. Main indication to perform prostate biopsy was elevated PSA level above 10ng/ml regardless of the age. Meanwhile, 86% respondents did prostate biopsy in suspiciousness of prostate cancer by DRE regardless of age. Most respondents (90%) chose Quinolon as prophylaxis antibiotic in prostate biopsy and 46% respondents used oral analgesia or suppository or both in prostate biopsy. Conclusions: In diagnosing prostate cancer, Indonesian Urologists performed DRE, PSA serum analysis and TRUS biopsy of the prostate. But the Indonesian Urologists still had different opinions about the indications and timing of the procedure. The availability of diagnostic equipment and unavailability of National Guideline of Prostate Cancer when this study was conducted played a role of how the prostate cancer diagnosed in Indonesia.

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Pendahuluan: Saat ini belum ada publikasi tentang hasil radioterapi eksterna (RT) pada kanker prostat lokal atau lokal-lanjut di Indonesia. Metode: Studi retrospektif ini meneliti 96 pasien dengan kanker prostat lokal atau lokal-lanjut yang mendapat terapi radiasi dari tahun 1995-2009, di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dan Rumah Sakit Kanker Dharmais, Indonesia. Jenis / dosis kumulatif radiasi prostat dan pelvis pada 84,4% pasien sebesar <70Gy dengan RT konvensional, dan pada 15,6% pasien diberikan dosis ≥70Gy dengan three dimensional-conformal RT atau intensity modulated RT. Sintasan Overall survival (OS) dan biochemical progression-free survival (BFS) diestimasi dengan Kaplan-Meier. Faktor-faktor prediksi dari OS dan biochemical recurrence dianalisis dengan Multivariate Cox regressions. Hasil: Median durasi follow-up adalah 61 bulan (rentang, 24-169 bulan). Diantara seluruh kasus kanker prostat, terdapat 3,1% risiko rendah, 26% risiko sedang, dan 70,8% risiko tinggi. Lebih dari separuh pasien (52,1%) memiliki nilai Prostatespecific antigen (PSA) sebelum terapi >20 ng/ml. Angka sintasan 5 tahun pada pasien-pasien dengan risiko rendah, sedang, dan tinggi, secara berurutan adalah: OS, 100%, 94,7%, 67,9% (P=0,297); dan BFS, 100%, 94,1%, 57,1% (P=0,016). Pada kelompok risiko tinggi, didapatkan OS 5 tahun 88,3% pada pasien yang mendapatkan terapi adjuvan hormonal androgen deprivation therapy (HT), dibandingkan dengan 53% pada pasien yang mendapat terapi radiasi saja, P =0,08. Faktor prediksi yang signifikan pada OS meliputi kelompok risiko tinggi (hazard ratio [HR], 9,35; confidence interval [CI] 95%, 1,52-57,6; P=0,016), terapi adjuvan (HR, 0,175; 95% CI, 0,05-0,58; P=0,005), deteksi dengan transurethral resection of the prostate (TUR-P) (HR, 6,81; 95% CI, 2,28-20,33; P=0,001), dan nilai PSA sebelum terapi (HR, 1,003; 95% CI, 1,00-1,005; P=0,039). Satu-satunya faktor prediksi biochemical failure adalah PSA sebelum terapi (P=0,04), dengan odds ratio 4,52 (95% CI, 1,61-12,65) untuk PSA > 20 ng/ml. Kesimpulan: RT merupakan modalitas yang efektif untuk terapi kanker prostat lokal atau lokal-lanjut di Indonesia, dengan hasil dan faktor prediksi yang konsisten dengan publikasi di tempat lain. Faktor prediksi dari hasil yang lebih buruk meliputi kelompok risiko tinggi, PSA sebelum terapi yang lebih tinggi, temuan insidental pada TUR-P, dan tidak diberikannya terapi adjuvan HT. Terapi adjuvan hormonal secara signifikan meningkatkan sintasan pada pasien dengan risiko tingggi. ......Introduction: Presently there is no published data on the outcomes of localized or locally-advanced prostate cancer (PCa) treated by external-beam radiotherapy (RT) in Indonesia. Methods: This study retrospectively analyzed 96 patients with localized or locally-advanced PCa treated by RT from year 1995 to 2009, at the national referral hospital and the national cancer hospital of Indonesia. Cumulative prostate and pelvic radiation dose/ type was <70 Gy conventional RT in 84.4% patients, and ≥70 Gy Three dimensional-conformal or intensity modulated RT in 15.6% patients. Overall survival (OS) and biochemical progression-free survival (BFS) were estimated by Kaplan-Meier. Predictors of OS and biochemical recurrence were analyzed by multivariate Cox regressions. Results: The median follow-up was 61 months (range, 24 to 169 months). There were 3.1% low-risk, 26% intermediate-risk, and 70.8% high-risk cases. More than half of the patients (52.1%) had pretreatment prostate specific antigen (PSA) >20 ng/mL. The 5-year survival outcome of low-risk, intermediate-risk, and high-risk patients were: OS, 100%, 94.7%, and 67.9% (P=0.297); and BFS, 100%, 94.1%, and 57.1% (P=0.016), respectively. In the high-risk group, the 5-year OS was 88.3% in patients who received adjuvant hormonal androgen deprivation therapy (HT), compared to 53% in RT only, P=0.08. Significant predictors of OS include high-risk group (hazard Ratio [HR], 9.35; 95% confidence interval [CI], 1.52 to 57.6; P=0.016), adjuvant therapy (HR, 0.175; 95% CI, 0.05 to 0.58; P=0.005), detection by transurethral resection of the prostate (TUR-P) (HR, 6.81; 95% CI, 2.28 to 20.33; P=0.001), and pretreatment PSA (HR, 1.003; 95% CI, 1.00 to 1.005; P=0.039). The sole predictor of biochemical failure was pretreatment PSA (P=0.04), with odds ratio of 4.52 (95% CI, 1.61 to 12.65) for PSA >20 ng/mL. Conclusions: RT is an effective treatment modality for localized or locally advanced PCa in Indonesian patients, with outcomes and predictors consistent to that reported elsewhere. Predictors of poorer outcomes include high-risk group, higher pretreatment PSA, incidental detection by TUR-P, and lack of adjuvant HT. Adjuvant hormonal therapy significantly improve the survival of high risk patients.

Abstrak :
[ABSTRAK
Tujuan: Insiden kanker prostat secara global terus meningkat. Meskipun dapat dilakukan deteksi dini kanker prostat, perlu dipahami bahwa progresivitas penyakit ? menjadi metastasis ? berbeda untuk setiap pasien. Penelitian ini bertujuan untuk mengamati aspek-aspek yang mungkin berperan sebagai faktor prediktif metastasis pada kanker prostat tidak terpalpasi. Material dan Metode: Data dikumpulkan dari Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dan Rumah Sakit Pusat Kanker Nasional Dharmais sejak tahun 1995-2013. Pasien dengan kanker prostat tidak terpalpasi kemudian dibagi menjadi dua kelompok: dengan metastasis dan tanpa metastasis. Usia, volume prostat, nilai prostate-spesific antigen (PSA), Gleason score sum group, stadium tumor, Karnofsky performance score (KPS), kadar hemoglobin, dan kadar kreatinin serum merupakan faktor yang dianalisis dalam penelitian ini. Data dianalisis menggunakan analisis bivariat dan uji regresi logistik. Hanya pasien dengan data lengkap yang dimasukkan dalam penelitian ini. Hasil: Didapatkan 91 pasien dengan data lengkap, 59 pasien (64,83%) tanpa metastasis dan 32 pasien (35,16%) dengan metastasis. Terdapat perbedaan statistik yang signifikan antara kelompok tanpa metastasis dan kelompok dengan metastasis, yakni untuk PSA (13.7ng / mL vs 71.5ng / mL; p = 0,001), kadar hemoglobin (13,60 g / dL vs 12,25 g / dL; p = 0,002), dan KPS (90 vs 90 ; p = 0,004). Perbedaan yang signifikan secara statistik juga didapatkan pada kelompok GSS (35 dan 24 pada kelompok tanpa metastasis vs 12 dan 20 pada kelompok dengan metastasis; p = 0,047). Usia, volume prostat, stadium tumor, dan kadar kreatinin antara kedua kelompok tidak memiliki perbedaan signifikan secara statistik (p> 0,05). Nilai pretreatment PSA adalah satu-satunya faktor prediktif untuk metastasis dengan odds ratio 1.014 (95% CI, 1,005-1,022; p = 0,002). Kesimpulan: Sebagian besar pasien kanker prostat tidak terpalpasi terdeteksi pertama kali tanpa metastasis. Nilai pretreatment PSA yang diperoleh pada kunjungan awal pasien dapat digunakan sebagai faktor prediktif metastasis di masa depan.

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ABSTRACT
Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.;Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future., Objective: Prostate cancer incident is globally increasing. Despite early detection of prostate cancer, the progressivity of the disease itself toward metastatic disease remains different for each patient. The purpose of this study is to observe aspects that may have roles as predictive factors for metastasis in nonpalpable prostate cancer. Materials and Methods: Data was collected from National Hospital Cipto Mangunkusumo and Dharmais National Cancer Center Hospital from 1995-2013. Patients with nonpalpable prostate cancer then divided into two groups: metastasis-free group and metastasis group. Age, prostate volume, pretreatment Prostate-specific antigen (PSA) value, Gleason score sum group, tumor stadium, Karnofsky performance score (KPS), hemoglobin level, and serum creatinine level were factors that were analyzed in the study. The data was analyzed using bivariate analysis and logistic regression test. Only patients with complete data are included in the study. Results: There are 91 patients with complete data, 59 patients (64.83%) were patients without metastasis and 32 patients (35.16%) were with metastasis. There was significant statistical difference between no metastasis group with metastasis group for PSA (13.7ng/mL vs71.5ng/mL; p = 0.001), hemoglobin level (13.60 g/dL vs 12.25 g/dL; p = 0.002), and KPS (90vs90; p = 0.004). There was also significant statistical difference in GSS groups (35 and 24 in metastasis-free group vs 12 and 20 in metastasis group; p = 0.047). Age, prostate volume, tumor stadium, and creatinine level had no statistical difference between the two groups (p > 0.05). Pretreatment PSA value was the only predictive factor for metastasis with odds ratio 1.014 (95% CI, 1.005 to 1.022; p = 0.002). Conclusion: Most nonpalpable prostate cancer patients are first detected without metastasis. Pretreatment PSA value that was obtained at their initial visit might be used as predictive factor for metastasis for them in the future.]

Abstrak :
[Tujuan: Mengidentifikasi korelasi dan insiden metastasis tulang pada pasien kanker prostat dengan Gleason Score (GS) dan Prostate Specific Antigen (PSA) yang rendah. Material dan Metode: Studi deskriptif retrospektif pada pasien kanker prostat di Rumah Sakit Cipto Mangunkusumo periode 2006-2011. Ada 478 pasien dengan kanker prostat. Pasien kanker prostat dengan PSA rendah, telah menjalani pemeriksaan histopatologi, dan bone scan diikutsertakan dalam studi, sehingga didapatkan 358 pasien sebagai subjek penelitian. Nilai PSA diukur dengan sandwich electrochemiluminescent immunoassay. Pemeriksaan histopatologi diklasifikasikan menurut sistem grading Gleason dan dibagi menjadi 3 kategori: diferensiasi baik (GS ≤6), diferensiasi sedang (GS 7), dan diferensiasi buruk (GS 8-10). Bone scan dikerjakan dengan dengan agen radiofarmaka (Tc99m methylenendiphosphonate) dan kemudian gambar ditangkap dengan kamera gamma. Hasil: Rerata usia 67.52±7.8 tahun, rerata GS 7.7±1.3, dan median PSA adalah 56.9 (rentang: 0,48-17000 ng/mL). Ada 11 orang pasien (3,0%) dengan bone scan positif dengan PSA <20 ng/mL dan GS<8. Lebih lanjut, ada 2 pasien (0,6%) dengan GS≤6 dan PSA<10 ng/mL memperlihatkan metastasis ke tulang. Kesimpulan: Pada studi ini, ada sebagian kecil pasien mengalami metastasis tulang dengan PSA (PSA<10 mg/mL) dan GS (GS≤6) rendah., Objective This study was aimed to identify correlation and incidence of bone metastases in prostate cancer patient with low Gleason Score GS and Prostate Specific Antigen PSA Materials and Methods A descriptive restrospective study to patients with prostate cancer in Cipto Mangunkusumo Hospital in 2006 2011 There were 478 patient with prostate cancer Patients with prostate cancer who had PSA value histological examination and bone scan were included in the study resulting in 358 eligible patients for the study PSA value was measured using the sandwich electrochemiluminescent immunoassay Histological examination was graded according to Gleason rsquo s grading system and divided into 3 category well differentiated GS le 6 moderately differentiated GS 7 and poorly differentiated GS 8 10 Bone scan was done using radiopharmaceuticals agent Tc 99m methylenen diphosphonate and then the image was captured using gamma camera Results The mean age was 67 52 7 8 mean GS was 7 7 1 3 and median PSA was 56 9 range 0 48 17000 ng mL There were 11 patients 3 0 with positive bone scan with PSA]