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Id: biblio-989781
Autor: Aguiar Jr, Pedro Nazareth; Tan, Pui San; Simko, Sarah; Barreto, Carmelia Maria Noia; Gutierres, Bárbara de Souza; Giglio, Auro del; Lopes Jr, Gilberto de Lima.
Título: Cost-effectiveness analysis of abiraterone, docetaxel or placebo plus androgen deprivation therapy for hormone-sensitive advanced prostate cancer / Análise de custo-efetividade da adição de abiraterona ou quimioterapia ao tratamento do câncer de próstata metastático hormônio-sensível
Fonte: Einstein (Säo Paulo);17(2):eGS4414, 2019. tab, graf.
Idioma: en.
Resumo: ABSTRACT Objective To evaluate the cost-effectiveness of the addition of chemotherapy or abiraterone to androgen deprivation. Methods We developed an analytical model to determine the cost-effectiveness of the addition of docetaxel or abiraterone versus androgen deprivation therapy alone. Direct and indirect costs were included in the model. The effects were expressed in Quality-Adjusted Life Years adjusted for side effects. Results Compared to androgen deprivation therapy alone, the addition of chemotherapy and of abiraterone generated 0.492 and 0.999, respectively, in Quality-Adjusted Life Years. Abiraterone led to a Quality-Adjusted Life Years gain of 0.506 compared to docetaxel. The incremental costs per Quality-Adjusted Life Years were R$ 133.649,22 for docetaxel, R$ 330.828,70 for abiraterone and R$ 571.379,42 for abiraterone compared to docetaxel, respectively. Conclusion The addition of chemotherapy to androgen deprivation therapy is more cost-effective than the addition of abiraterone to androgen deprivation therapy. However, discounts on abiraterone cost might improve cost-effectiveness.

RESUMO Objetivo Avaliar a relação custo-efetividade da adição de quimioterapia ou abiraterona à terapia de privação hormonal. Métodos Um modelo analítico foi desenvolvido para determinar a relação custo-efetividade da adição de docetaxel ou abiraterona comparada à terapia de privação hormonal isolada. Custos diretos e indiretos foram incluídos no modelo. Os efeitos foram expressos em Anos de Vida Ajustados para Qualidade corrigidos pelos efeitos colaterais de cada terapia. Resultados A adição de quimioterapia e de abiraterona à terapia de privação hormonal aumentou os Anos de Vida Ajustados para Qualidade em 0,492 e 0,999, respectivamente, em comparação à terapia de privação hormonal isolada. A abiraterona promoveu ganho de Anos de Vida Ajustados para Qualidade de 0,506 em relação ao docetaxel. O custo incremental por Anos de Vida Ajustados para Qualidade foi R$ 133.649,22 para o docetaxel, R$ 330.828,70 para a abiraterona e R$ 571.379,42 para a abiraterona comparada ao docetaxel. Conclusão A adição de quimioterapia à terapia de privação hormonal é mais custo-efetiva que a adição de abiraterona à terapia de privação hormonal. Contudo, descontos no custo da abiraterona poderiam tornar esse tratamento mais custo-efetivo.
Descritores: Neoplasias da Próstata/economia
Neoplasias da Próstata/tratamento farmacológico
Análise Custo-Benefício/métodos
Antineoplásicos Hormonais/economia
Docetaxel/economia
Antagonistas de Androgênios/economia
Androstenos/economia
-Placebos/economia
Placebos/uso terapêutico
Neoplasias da Próstata/mortalidade
Valores de Referência
Fatores de Tempo
Brasil
Protocolos de Quimioterapia Combinada Antineoplásica/economia
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Reprodutibilidade dos Testes
Resultado do Tratamento
Anos de Vida Ajustados por Qualidade de Vida
Antineoplásicos Hormonais/uso terapêutico
Docetaxel/uso terapêutico
Intervalo Livre de Progressão
Antagonistas de Androgênios/uso terapêutico
Androstenos/uso terapêutico
Limites: Humanos
Masculino
Responsável: BR1.1 - BIREME


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Id: biblio-890760
Autor: Cunha, Flávia Siqueira; Domenice, Sorahia; Sircili, Maria Helena Palma; Mendonca, Berenice Bilharinho de; Costa, Elaine Maria Frade.
Título: Low estrogen doses normalize testosterone and estradiol levels to the female range in transgender women
Fonte: Clinics;73:e86, 2018. tab.
Idioma: en.
Projeto: CNPq; . CNPq.
Resumo: OBJECTIVE: The ideal dosage of cross-sex hormones remains unknown. The aim of this study was to evaluate the luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin levels after low-dose estrogen therapy with or without cyproterone acetate in transgender women. METHODS: The serum hormone and biochemical profiles of 51 transgender women were evaluated before gonadectomy. Hormone therapy consisted of conjugated equine estrogen alone or combined with cyproterone acetate. The daily dose of conjugated equine estrogen was 0.625 mg in 41 subjects and 1.25 mg in 10 subjects, and the daily dose of cyproterone acetate was 50 mg in 42 subjects and 100 mg in one subject. RESULTS: Estrogen-only therapy reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 731.5 to 18 ng/dL, 6.3 to 1.1 U/L and 9.6 to 1.5 U/L, respectively. Estrogen plus cyproterone acetate reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 750 to 21 ng/dL, 6.8 to 0.6 U/L and 10 to 1.0 U/L, respectively. The serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin in the patients treated with estrogen alone and estrogen plus cyproterone acetate were not significantly different. The group receiving estrogen plus cyproterone acetate had significantly higher levels of gamma-glutamyltransferase than the group receiving estrogen alone. No significant differences in the other biochemical parameters were evident between the patients receiving estrogen alone and estrogen plus cyproterone acetate. CONCLUSION: In our sample of transgender women, lower estrogen doses than those usually prescribed for these subjects were able to adjust the testosterone and estradiol levels to the physiological female range, thus avoiding high estrogen doses and their multiple associated side effects.
Descritores: Testosterona/sangue
Acetato de Ciproterona/administração & dosagem
Estradiol/sangue
Estrogênios/administração & dosagem
Pessoas Transgênero
Antagonistas de Androgênios/administração & dosagem
-Prolactina/sangue
Hormônio Luteinizante/sangue
Estudos Retrospectivos
Relação Dose-Resposta a Droga
Interações Medicamentosas
Estrogênios/sangue
Hormônio Foliculoestimulante/sangue
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Adulto Jovem
Tipo de Publ: Research Support, Non-U.S. Gov't
Ensaio Clínico
Responsável: BR1.1 - BIREME


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Id: biblio-1253780
Autor: Abdala, Rubén; Nagelberg, Alberto; Brance, M. Lorena.
Título: Salud ósea en personas transgénero / Bone health in transgender subjects
Fonte: Actual. osteol;16(3):176-186, 2020. ilus.
Idioma: es.
Resumo: Una persona transgénero es aquella en la cual el género autopercibido difiere del asignado al nacer, mientras que el término cisgénero es utilizado en aquellos individuos no trans. El tratamiento hormonal cruzado (THC) constituye una opción para lograr caracteres sexuales secundarios deseados. Es conocido que los esteroides sexuales desempeñan un rol fundamental en la adquisición de la densidad mineral ósea (DMO) durante la pubertad. Por lo tanto, el impacto del THC sobre la masa ósea se ha convertido en materia de estudio. En estadios puberales tempranos, los análogos de la hormona liberadora de gonadotrofinas (GnRH) son utilizados con un efecto reversible. Si bien la DMO parece mantenerse estable, cuando se compara con una población de referencia del mismo sexo biológico y edad, el Z-score se encuentra por debajo de lo esperado. En adultos, durante el THC no se informaron disminuciones en la DMO. Está reportado que las mujeres trans antes del inicio del TH presentan características densitométricas diferentes de los hombres cisgénero. Hasta el momento, la carga de datos para los calculadores del riesgo de fractura y el software del equipo DXA se basan en el sexo biológico y no en identidad de género. Recientemente, la International Society for Clinical Densitometry (ISCD) emitió sus recomendaciones para la evaluación de la masa ósea en personas transgénero y en aquellos individuos no conformes con el género. Si bien la ISCD sugiere realizar la evaluación únicamente en aquellos pacientes con factores de riesgo, es de importancia realizar DXA basal, sobre todo en mujeres transgénero, para determinar el riesgo inicial de dicha población. En este artículo se revisa la evidencia disponible sobre el impacto del THC en la salud ósea de personas transgénero. (AU)

Cross sex hormone therapy (CSHT) in transgender women (TW) it is an option to achieve desired secondary sexual characteristics. It is known that sex steroids play a fundamental role in the acquisition of bone mineral density during puberty, in addition to determining a different characteristic bone pattern between both biological sexes. So the impact of affirming HT on bone is it has become in subject of study. In early pubertal stages, GnRH analogs are used with a reversible effect. Although bone mineral density (BMD) seems to remain stable, when compared with a reference population of the same biological sex and age, the Z-score is lower than expected. In adults, during CSHT no decreases in BMD were reported. However, it was reported that TW prior to starting CSHT present different densitometric characteristics than cisgender men. So far, the data load for the fracture risk calculators and DXA software is based on biological sex and not gender identity. Recently the ISCD issued its recommendations for the evaluation of bone mass in transgender subjects and in those non-conforming to gender. Although the ISCD suggests performing the evaluation only in those patients with risk factors, our group recognizes that baseline DXA, especially in TW, constitutes a useful tool to determine the initial risk of this population. Our proposal arises from our own experience and from that compiled in the international literature, where it is observed that even without starting CSHT, transgender women have lower BMD. DXA. This article reviews the available evidence regarding the effect of CSHT on health bone in transgender people. (AU)
Descritores: Densidade Óssea/efeitos dos fármacos
Pessoas Cisgênero
-Hormônios Esteroides Gonadais/uso terapêutico
Testosterona/uso terapêutico
Fatores Sexuais
Fatores de Risco
Hormônio Liberador de Gonadotropina/análogos & derivados
Puberdade
Caracteres Sexuais
Densitometria
Estrogênios/uso terapêutico
Procedimentos de Readequação Sexual
Pessoas Transgênero
Antagonistas de Androgênios/uso terapêutico
Limites: Humanos
Masculino
Feminino
Tipo de Publ: Revisão
Responsável: AR2.1 - Biblioteca Central


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Id: biblio-989971
Autor: Yoshimura, Koji; Nakashima, Yoshiharu; Sugiyama, Kyohei; Kohei, Naoki; Takizawa, Akitoshi.
Título: Supposed pituitary-production of human chorionic Gonadotropin induced by androgen deprivation therapy
Fonte: Int. braz. j. urol;45(1):38-44, Jan.-Feb. 2019. tab, graf.
Idioma: en.
Resumo: ABSTRACT Introduction: The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays. Materials and Methods: We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCG-β subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after. Results: On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951-1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-β was not detectable at any times in any patients. Conclusions: Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.
Descritores: Neoplasias da Próstata/sangue
Testosterona/sangue
Hormônio Luteinizante/sangue
Hormônio Foliculoestimulante/sangue
Gonadotropina Coriônica/biossíntese
Gonadotropina Coriônica/sangue
-Neoplasias da Próstata/tratamento farmacológico
Curva ROC
Sensibilidade e Especificidade
Gonadotropina Coriônica Humana Subunidade beta/urina
Gonadotropina Coriônica Humana Subunidade beta/sangue
Antagonistas de Androgênios/administração & dosagem
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Adulto
Idoso
Idoso de 80 Anos ou mais
Tipo de Publ: Estudo Comparativo
Responsável: BR1.1 - BIREME


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Id: biblio-1012312
Autor: Leitsmann, Conrad; Thelen, Paul; Schmid, Marianne; Meller, Johannes; Sahlmann, Carsten-Oliver; Meller, Birgit; Trojan, Lutz; Strauss, Arne.
Título: Enhancing PSMA-uptake with androgen deprivation therapy - a new way to detect prostate cancer metastases?
Fonte: Int. braz. j. urol;45(3):459-467, May-June 2019. tab, graf.
Idioma: en.
Resumo: ABSTRACT Purpose: 68Ga-PSMA PET/CT imaging is a promising modality for the staging of recurrent prostate cancer (PCa). Current evidence suggests limited diagnostic value of the 68Ga-PSMA PET/CT in PSA-levels ≤0.3ng/mL. Experimental data have demonstrated an increase in PSMA-expression in PCa metastases by androgen deprivation in vitro. The aim of the current study was to investigate a possible enhancing effect of PSMA with low-dose androgen deprivation in patients with BCR and low PSA-levels. Materials and Methods: Five patients with PCa and BCR, following radical prostatectomy, underwent 68Ga-PSMA PET/CT. A consecutive 68Ga-PSMA PET/CT was performed 6 to 11 days after injection of 80mg of Degarelix (Firmagon®). We recorded PSA and testosterone serum-levels and changes of PSMA-uptake in 68Ga-PSMA PET/CT images. Results: Median PSA prior 68Ga-PSMA PET/CT was 0.27ng/mL. All patients had a decrease in testosterone serum levels from median 2.95μg/l to 0.16μg/l following Degarelix injection. We observed an increase in the standardized uptake value (SUV) in PSMA-positive lymphogenous and osseous lesions in two patients following androgen deprivation. In another two patients, no PSMA positive signals were detected in either the first or the second scan. Conclusion: Our preliminary results of this feasibility assessment indicate a possible enhancing effect of PSMA-imaging induced by low-dose ADT. Despite several limitations and the small number of patients, this could be a new approach to improve staging by 68Ga-PSMA PET/CT in PCa patients with BCR after primary therapy. Further prospective studies with larger number of patients are needed to validate our findings.
Descritores: Compostos Organometálicos
Neoplasias da Próstata/patologia
Glicoproteínas de Membrana
Compostos Radiofarmacêuticos
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos
Antagonistas de Androgênios/uso terapêutico
Metástase Neoplásica/diagnóstico por imagem
-Oligopeptídeos/uso terapêutico
Valores de Referência
Fatores de Tempo
Reprodutibilidade dos Testes
Antígeno Prostático Específico/sangue
Gradação de Tumores
Pessoa de Meia-Idade
Recidiva Local de Neoplasia/patologia
Limites: Humanos
Masculino
Idoso
Tipo de Publ: Estudo de Avaliação
Responsável: BR1.1 - BIREME


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Id: biblio-1090602
Autor: Freitas, Carla S. M. de; Soares, Aleida N.
Título: Efficacy of Leuprorelide acetate (Eligard®) in daily practice in Brazil: a retrospective study with depot formulations in patients with prostate cancer
Fonte: Int. braz. j. urol;46(3):383-389, May-June 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Introduction: Androgen deprivation therapy (ADT) is the mainstay of therapy for advanced prostate cancer. Studies addressing the efficacy of different depot formulations of long acting luteinizing hormone releasing hormone agonists in the Brazilian population are lacking. We aimed to compare the efficacy of three schedules of leuprolide acetate in lowering PSA in a real world population. Materials and Methods: We reviewed the medical records of patients with prostate cancer seen at our institution between January 2007 and July 2018. We analyzed patients treated with long-acting leuprolide acetate and grouped these patients into three strata according to the administration of ADT every 1, 3 or 6 months. The primary outcome was the serum prostate specific antigen (PSA) levels at 6 and 12 months after treatment initiation. We used Friedman test to compare the distribution of PSA levels at baseline and at 6 and 12 months within each treatment stratum. We considered two-sided P values <0.05 as statistically significant. We analyzed toxicity descriptively. Results: We analyzed a total of 932 patients, with a median age of 72 years and a median time since diagnosis of prostate cancer of 8.5 months. ADT was administered monthly in 115 patients, quarterly in 637, and semiannually in 180. Nearly half of the patients had locally advanced disease. In comparison with baseline, median serum PSA levels were reduced at 12 months by at least 99.7% in the three strata (P <0.001 in all cases). Sexual impotence and hot flashes were the most frequently reported toxicities. Conclusion: To our knowledge, this is the largest assessment of real-world data on alternative schedules of leuprolide in a Brazilian population. Our study suggests that PSA levels can be effectively be reduced in most patients treated with monthly, quarterly, or semiannual injections of long-acting leuprolide acetate.
Descritores: Neoplasias da Próstata
Leuprolida/uso terapêutico
Antígeno Prostático Específico/metabolismo
Antineoplásicos Hormonais/uso terapêutico
-Brasil/epidemiologia
Estudos Retrospectivos
Antagonistas de Androgênios
Acetatos
Limites: Humanos
Masculino
Idoso
Responsável: BR1.1 - BIREME


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Id: biblio-1090615
Autor: Sharma, Ashish; Sinha, Rahul Janak; Garg, Gaurav; Agarwal, Samarth; Akhtar, Asif; Singh, Vishwajeet.
Título: Special emphasis on bone health management in prostate cancer patients: a prospective longitudinal study
Fonte: Int. braz. j. urol;46(3):363-373, May-June 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Introduction: Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018. Materials and Method: Baseline bone health was assessed using Tc-99 MDP Bone scan/ DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were receiving ADT. Baseline and follow-up (at 12-months) BMD using DEXA scan at various sites (spine, femur total, femur neck and radius) and subjective improvement in bony pain using Numeric Pain Rating Score after administration of ZA were compared. Results: A total of 96-patients of locally advanced and metastatic prostate cancer receiving ADT with or without BDT were included in the study cohort. Mean age of presentation was 68.4±15.61 years. Median serum PSA was 32.2±13.1ng/mL. There was significant improvement in mean BMD (T-score) in 64-patients post ZA therapy at 12-months (at femoral total, femoral neck and spine; 0.95, 0.79 and 0.68, respectively) (p <0.05) while there was significant deterioration in mean BMD at 12-months (at spine, femoral neck and femoral total; −0.77, −0.55 and −0.66, respectively) in 32 patients who did not receive ZA and were on ADT (p <0.05). Pain scores significantly decreased in patients after 12-months of ZA use (−2.92±2.16, p <0.01). Conclusion: Bone-directed therapy (Zoledronic acid) leads to both subjective and objective improvement in bone health of prostate cancer patients on ADT.
Descritores: Neoplasias da Próstata
Densidade Óssea
Antagonistas de Androgênios
-Tomografia Computadorizada por Raios X
Estudos Prospectivos
Estudos Longitudinais
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Idoso
Idoso de 80 Anos ou mais
Responsável: BR1.1 - BIREME


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Id: biblio-1090626
Autor: Favorito, Luciano A.
Título: Pediatric urology highlighted
Fonte: Int. braz. j. urol;46(3):311-313, May-June 2020.
Idioma: en.
Descritores: Urologia
-Neoplasias da Próstata
Qualidade de Vida
Neoplasias Testiculares
Estudos Retrospectivos
Antagonistas de Androgênios
Limites: Humanos
Masculino
Criança
Tipo de Publ: Editorial
Responsável: BR1.1 - BIREME


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Id: biblio-1134281
Autor: Sanchez, Lara Rodriguez; Cathelineau, Xavier; Pinto, Alexis M. Alva; Borque-Fernando, Ángel; Gil, Maria Jesús; Yee, Chi-Hang; Sanchez-Salas, Rafael.
Título: Clinical and surgical assistance in prostate cancer during the COVID-19 Pandemic: implementation of assistance protocols
Fonte: Int. braz. j. urol;46(supl.1):50-61, July 2020. tab.
Idioma: en.
Resumo: ABSTRACT Purpose: Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. Material and Methods: We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. Results: Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. Conclusions: Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged.
Descritores: Pneumonia Viral/epidemiologia
Neoplasias da Próstata/cirurgia
Neoplasias da Próstata/terapia
Urologia/métodos
Infecções por Coronavirus/epidemiologia
-Pandemias
Betacoronavirus
SARS-CoV-2
COVID-19
Antagonistas de Androgênios/uso terapêutico
Limites: Humanos
Masculino
Tipo de Publ: Revisão
Responsável: BR1.1 - BIREME


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Id: biblio-1134334
Autor: Lott, Felipe.
Título: Editorial comment: Abiraterone in high- and low-risk metastatic hormone-sensitive prostate cancer
Fonte: Int. braz. j. urol;47(1):200-201, Jan.-Feb. 2021.
Idioma: en.
Descritores: Neoplasias da Próstata/tratamento farmacológico
Androstenos
-Hormônios
Antagonistas de Androgênios/uso terapêutico
Limites: Humanos
Masculino
Tipo de Publ: Comentário
Editorial
Responsável: BR1.1 - BIREME



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