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"Latar belakang: Clinically significant prostate cancer (csPCa) merupakan kanker prostat yang mempunyai kemungkinan progresi lokal, metastasis, rekurensi, dan kematian yang sedang hingga tinggi, serta tata laksana yang lebih agresif. Penelitian ini bertujuan untuk membantu diagnosis antara csPCa dan bukan csPCa menggunakan rasio apparent diffusion coefficient (rADC) lesi prostat dengan urine. Metode: Penelitian dilakukan pada lesi prostat kategori 3-5 prostate imaging-reporting and data system yang telah dibiopsi prostat transperineal tertarget magnetic resonance imaging (MRI) dengan ultrasound/MRI fusion software di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo pada Juni 2019 hingga Maret 2021. rADC lesi prostat dengan urine merupakan perbandingan rerata nilai apparent diffusion coefficient (ADC) lesi prostat dan urine di vesica urinaria pada MRI prostat peta ADC potongan aksial multi-institusi. rADC lesi prostat dengan urine antara csPCa (adenokarsinoma asinar prostat dengan skor Gleason ≥7) dan bukan csPCa (jaringan prostat nonneoplastik atau adenokarsinoma asinar prostat dengan skor Gleason 6) dibandingkan dan ditentukan nilai titik potongnya menggunakan receiver operating curve. Hasil: Terdapat perbedaan rADC lesi prostat dengan urine yang bermakna antara 19 lesi prostat yang merupakan csPCa dan 35 lesi prostat yang bukan merupakan csPCa, dengan nilai tengah rADC lesi prostat dengan urine pada csPCa 0,21 (0,11-0,33), nilai tengah rADC lesi prostat dengan urine pada bukan csPCa 0,43 (0,30-0,61), dan nilai p <0,001. Nilai titik potong rADC lesi prostat dengan urine dalam membedakan csPCa dan bukan csPCa adalah 0,30 dengan sensitivitas 94,73% dan spesifisitas 100%, area under curve 0,998 (IK95% 0,994-1,000), serta nilai p <0,001. Kesimpulan: rADC lesi prostat dengan urine dapat membantu diagnosis csPCa dan bukan csPCa pada lesi prostat sebelum biopsi prostat yang tidak invasif, mudah dikerjakan, serta tidak membutuhkan persiapan dan pemeriksaan tambahan.

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Background: Clinically significant prostate cancer (csPCa) is prostate cancer with moderate to high probability of local progression, metastasis, recurrence, and death, as well as more aggressive management. This study aims to aid diagnose between csPCa and non-csPCa using apparent diffusion coefficient ratio (rADC) of prostate-lesion-to-urine. Methods: This study analyze prostate lesions with prostate imaging-reporting and data system category 3-5 that underwent magnetic resonance imaging (MRI)-targeted transperineal prostate biopsy using ultrasound/MRI fusion software at Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo from June 2019 to March 2021. rADC of prostate-lesion-to-urine is defined as comparison between mean apparent diffusion coefficient (ADC) value of prostate lesion and urine in urinary bladder from axial section of ADC map of multi-institutional prostate MRI. rADC of prostate-lesion-to-urine between csPCa (acinar adenocarcinoma of the prostate with Gleason score ≥7) and non-csPCa (non-neoplastic prostate tissue or acinar adenocarcinoma of the prostate with Gleason score 6) is compared and the cutoff point is determined using receiver operating curve. Results: There is significance rADC of prostate-lesion-to-urine difference between 19 prostate lesions with csPCa and 35 prostate lesions with non-csPCa, with mean rADC of prostate-lesion-to-urine in csPCa is 0.21 (0.11-0.33), mean rADC of prostate-lesion-to-urine in non-csPCa is 0.43 (0.30-0.61), and p value is <0.001. The cut-off value of rADC of prostate-lesion-to-urine to differentiate between csPCa and non-csPCa is 0.30, with 94.73% sensitivity and 100% specificity, area under curve is 0.998 (CI95% 0.994-1.000), and p value is <0.001. Conclusion: rADC of prostate-lesion-to-urine may help diagnose between csPCa and non-csPCa in prostate lesions before prostate biopsy, which is non-invasive, easy to perform, does not require additional preparation and examination."

"Telah diketahui bahwa estrogen dan reseptor estrogen sangat berpengaruh pada sistem reproduksi, perkembangan payudara dan pembentukan kanker pada wanita. Namun efek estrogen pada sistem reproduksi pria serta mekanisme estrogen pada terjadinya kanker pada pria, khususnya kanker prosat masih belum jelas. Dari sekumpulan penelitian didapatkan kemungkinan estrogen dan reseptor estrogen berperan pada terjadinya kanker pada pria, terutama kanker prosat Reseptor estrogen dapat ditemukan pada stroma dan sel epitel prostat.

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It is known that estrogen and estrogen receptors have a great influence on the reproductive system, breast development and the formation of cancer in women. However, the effect of estrogen on the male reproductive system and the mechanism of estrogen in the occurrence of cancer in men, especially prostate cancer, is still unclear. From a set of studies, it is possible that estrogen and estrogen receptors play a role in the occurrence of cancer in men, especially prostate cancer Estrogen receptors can be found in the stroma and epithelial cells of the prostate."

"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.

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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."

"Latar Belakang: Pemeriksaan dan diagnosis kanker prostat (PCa) diperlukan untuk memberikan manajemen optimal pada tahap awal. Meskipun telah dibahas dalam banyak pedoman, implementasi pemeriksaan dan diagnosis PCa di Indonesia masih belum diketahui. Studi ini bertujuan untuk mengevaluasi pola pemeriksaan dan diagnosis PCa di antara urolog Indonesia serta kepatuhan mereka terhadap pedoman.Metode: Studi potong lintang ini dilakukan antara Februari dan Juli 2019. Responden adalah urolog Indonesia yang terdaftar sebagai anggota Perhimpunan Urologi Indonesia (IUA) dan telah berpraktik selama setidaknya enam bulan. Data dikumpulkan menggunakan kuesioner yang dibagikan dalam simposium urologi nasional dan secara elektronik melalui Google Form. Data disajikan secara deskriptif, dan semua data diproses menggunakan SPSS versi 23.Hasil: Dari 458 urolog, 195 (42,6%) memberikan respons lengkap. Sebagian besar responden, 181 (92,8%) urolog, menggunakan pedoman IUA. Di antara 103 (52,8%) responden yang melakukan pemeriksaan, hampir separuh (42,7%) setuju untuk memeriksa pasien yang berusia ≥ 50 tahun atau ≥ 45 tahun dengan riwayat keluarga PCa. Selain itu, 76,8% akan mengulang pemeriksaan setiap tahun, dan 35,6% akan menghentikannya ketika pasien berusia 70 tahun. Pemeriksaan rektal digital (DRE) sering dilakukan untuk pemeriksaan (74,5%), sementara tes antigen spesifik prostat (PSA) hanya dilakukan dalam 52,3% kasus. Tes PSA tersedia di 74,8% rumah sakit. Reseksi transuretral prostat (TURP) masih digunakan oleh 67,2% responden untuk diagnosis. Hanya 52,3% peserta yang menggunakan biopsi prostat transrektal untuk diagnosis, menggunakan anestesi (78,1%) selama prosedur, dan peningkatan kadar PSA (98%) sebagai indikasi. Namun, USG Transrektal (TRUS) hanya tersedia di 49% rumah sakit. Studi ini menemukan bahwa tingkat kepatuhan urolog Indonesia terhadap pedoman adalah 63,3% (9-100%).Kesimpulan: Pemeriksaan dan diagnosis PCa masih bervariasi di antara urolog Indonesia, yang mungkin disebabkan oleh ketersediaan modalitas diagnostik yang berbeda.

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Background: Prostate cancer (PCa) screening and diagnosis are mandatory to deliver optimal management in the early phase. Even though it has been discussed in many guidelines, the implementation of PCa screening and diagnosis in Indonesia remains unknown. This study aims to evaluate the pattern of PCa screening and diagnosis among Indonesian urologists and their adherence to guidelines.

Methods: This cross-sectional study was conducted between February and July 2019. Respondents were Indonesian urologists registered as members of the Indonesian Urological Association (IUA) and had already practiced for at least six months. Data were collected using questionnaires, which were distributed at a national urology symposium and electronically via Google Form. Data were presented descriptively, and all data were processed using SPSS version 23.

Result: Of 458 urologists, 195 (42.6%) gave full responses. Most of the respondents, 181 (92.8%) urologists, used the IUA guidelines. Among the 103 (52.8%) respondents who performed screening, nearly half (42.7%) agreed to screen patients aged ≥ 50 years or ≥ 45 years with a family history of PCa. Moreover, 76.8% would repeat screening annually, and 35.6% would stop when the patient's age reached 70 years old. Digital rectal examination (DRE) was frequently performed for screening (74.5%), while prostate-specific antigen (PSA) tests were only performed in 52.3% of cases. The PSA test was available in 74.8% of hospitals. Transurethral resection of the prostate (TURP) was still used by 67.2% of respondents for diagnosis. Only 52.3 % of participants used transrectal prostate biopsy for diagnosis, using anesthesia (78.1%) during the procedure, and increased PSA level (98%) as its indication. However, Transrectal Ultrasound (TRUS) was only available in 49% of hospitals. This study found that Indonesian urologist adherence level toward guidelines was 63.3% (9-100%).

Conclusion: PCa screening and diagnosis are still varied among Indonesian urologists, which might arise due to the different availability of diagnostic modalities."

"Kanker prostat diketahui berhubungan dengan pekerjaan yang melibatkan kerja shift. Pada tahun 2007, International Agency for Research on Cancer (IARC) menyatakan bahwa kerja shift dengan disrupsi sirkadian menyebabkan kemungkinan kanker pada manusia. Pajanan terhadap LAN (Light at Night) menekan sekresei melatonin pineal dan menstimulasi peningkatan hormon sex yang pada gilirannya dapat meningkatkan kerentanan terhadap kanker yang bergantung pada hormon. Kasus disini akan menilai bagaimana hubungan antara pekerja shift suatu manufaktur yang telah bekerja 30 tahun dengan peningkatan risiko kanker prostat melalui beberapa telaah jurnal kritis untuk menilai validitas dan aplikabilitasnya. Dari ketiga jurnal yang ditelaah adalah valid dan aplikatif. Sebuah systematic review dan meta-analysis oleh Mancio J.dkk tahun 2018 adanya peningkatan yang signifikan antara kanker prostat dengan rotasi kerja gilir. Begitu pula dengan Behrens T.dkk tahun 2017. Namun, studi kohort Torbjrn A.dkk tahun 2017 menilai tidak ada hubungan kanker prostat dengan durasi kerja malam. Perbedaan ini mungkin karena kurangnya pengukuran pajanan, dan perbedaan dalam jenis kovariat yang disesuaikan untuk kelompok pekerjaan heterogen yang terlibat.

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Prostate cancer has been associated with jobs that involve some degree of work at night. In 2007, the International Agency for Research on Cancer (IARC) concluded that shift work involving circadian disruption was probably carcinogenic in humans. Exposure to artificial LAN (Light at Night) suppresses pineal melatonin secretion and subsequently leads to an increase of sex hormones, which in turn could increase the susceptibility to hormone-dependent cancers. In this case, the authors assessed the relationship between workers in a manufacture company who had worked shift work for 30 years and an increased risk of prostate cancer. This case takes evidence base from several journals that support this hypothesis while doing a critical appraisal to determine its validity and applicability. The three journals appraised were valid and applicable. From A systematic review and meta-analysis by Mancio J. et al. in 2018, there was a significantly increased risk of prostate cancer with rotating shift work. Behrens T. et al. (2017) observed a twofold increased HR among shift workers and night workers working in industries. However, cohort studies by Torbjrn A. et al (2017) with no association with duration of night work was seen, this discrepancy may be due to a lack of a common exposure measurement, differences in the type of covariates adjusted for or heterogeneous occupational group involved, and selection into and out of night work occurs continously."

"[ABSTRAKTujuan: 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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ABSTRACTObjective: 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.]"

"Kanker prostat merupakan kanker yang terdiagnosis kedua terbanyak dan mendudukiperingkat keenam dari penyebab kematian pada pria di seluruh dunia. Diperkirakan914.000 kasus ditemukan dan berperan dalam 6% (258.400) dari total angka kematiandi tahun 2008. Telah diciptakan Indonesian Prostate Cancer Risk Calculator (IPCRC)yang diperoleh dari penelitian multisenter sebelumnya, namun masih perlu dilakukanvalidasi eksternal untuk menguji validitas dari kalkulator tersebut. Kami inklusikanseluruh pasien pembesaran prostat jinak (BPH) dan kanker prostat (PCa) yangmenjalani biopsi prostat ataupun prostatektomi di RS Adam Malik Medan pada periode11 Agustus sampai 31 Desember 2014. Dilakukan analisis untuk membandingkanvariabel-variabel yang terkait resiko kanker prostat, termasuk: usia, kadar PSA, volumprostat, dan temuan pemeriksaan colok dubur (DRE). Kemudian resiko kanker prostatpada masing-masing pasien dihitung menggunakan IPCRC dan dianalisis hasilnyamenggunakan kurva receiver operating characteristic (ROC). Kami jugamembandingkan hasilnya dengan luas area di bawah kurva (AUC) untuk PSA. Padastudi ini dijumpai 21 pasien PCa dan 24 pasien BPH. Rata-rata umur, PSA, dan volumprostat secara berturut-turut adalah 66.8±7.3 tahun, 27.3±32.2 ng/ml, dan 64.9±38.1 ml.Temuan DRE abnormal dijumpai pada 6 pasien PCa dan 1 pasien BPH. Seluruhvariabel antara PCa dan BPH tidak berbeda signifikan (p>0.05). AUC dari IPCRCadalah 79.8% (95% IK= 66.2%-93.3%; p=0.001) dalam memprediksi kanker prostat.Analisis ROC IPCRC memiliki sensitivitas 85.7% dan spesifisitas 70.8%. AUC IPCRCini lebih tinggi daripada AUC PSA dengan selisih sebesar 11.4%. Indonesian ProstateCancer Risk Calculator (IPCRC) lebih baik daripada PSA tunggal dalam memprediksikejadian kanker prostat. Validasi dan studi prospective lebih lanjut dengan sampel yanglebih besar perlu dilakukan.

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Prostate cancer is the second most frequently diagnosed cancer and the sixth leadingcause of cancer death in men worldwide. It was estimated 914.000 new cases werefound and responsible for 6% (258.400) of total cancer deaths in men in 2008.Indonesian Prostate Cancer Risk Calculator (IPCRC) was developed from a multicentricstudy to predict the risk of prostate cancer in suspected patient. An externalvalidation is needed to c onfirm the validity of the calculator. We included all benignprostatic hyperplasia (BPH) and prostate cancer (PCa) patients who underwent prostatebiopsy and prostatectomy in Adam Malik Hospital between August 11th and December31st 2014. The relationship between variables affecting the percentage of prostatecancer risk were evaluated, including: age, PSA level, prostate volume, and digitalrectal examination (DRE) findings. We calculated the risk of prostate cancer for eachpatient using IPCRC and analyse the results using the receiver operating characteristic(ROC) curve. We also compared them with the area under curve (AUC) of PSA results.There were 21 PCa and 24 BPH patients in our study. The mean ages, PSA, and prostatevolume were 66.8±7.3 years old; 27.3±32.2 ng/ml and 64.9±38.1 ml, repectively.Abnormal DRE was found in 6 PCa and 1 BPH. Each variable didnt show significantdifference between PCa and BPH groups (p > 0.05). The AUC of IPCRC was 79.8%(CI 95%: 66.2%-93.3%; p=0.001) in predicting prostate cancer. The ROC analysis ofIPCRC had sensitivity of 85.7% and specificity of 70.8%. This AUC of IPCRC washigher than of PSA, with 11.4% difference. The Indonesian Prostate Cancer RiskCaluclator is better than PSA alone in predicting prostate cancer in this population.Further validation and future prospective study in larger population is needed."

"Model prediksi kesintasan kanker prostat metastasis tulang sudah pernah dilakukan sebelumnya. Namun, model prediksi kesintasan kanker prostat metastasis tulang pra-terapi belum pernah dialukan sebelumnya. Tujuan penelitian ini adalah untuk menganalisis faktor-faktor klinis yang mempengaruhi ketahanan hidup (survival) pada kanker prostat dengan metastasis tulang serta mengembangkan nomogram prognostik ketahanan hidup pada pasien dengan kondisi tersebut. Terdapat 392 subyek dengan kanker prostat dengan metastasis tulang yang mendapat terapi Androgen Deprivation Therapy (ADT) dalam penelitian ini. Parameter pra-perawatan dianalisis menggunakan model cox-proportional untuk mengidentifikasi prediktor ketahanan hidup secara keseluruhan. Kovariat yang menunjukkan nilai signifikansi secara statistik pada analisis multivariat akan dipakai untuk membentuk nomogram. Model prediktor linier digunakan untuk mengembangkan nomogram. Nilai median ketahanan hidup keseluruhan adalah 40,3 bulan (95% CI: 32.2 - 48.5). Analisis univariat menunjukkan bahwa T-stage, Gleason Score, nilai antigen spesifik prostat inisial, dan jumlah lesi metastasis merupakan faktor-faktor prognostik independen terhadap angka ketahanan hidup keseluruhan. Semua prediktor ini tetap menunjukkan hasil yang signifikan secara statistik sebagai faktor prognostik independen pada analisis model multivariat cox-regression. Nomogram yang terbentuk dari faktor-faktor prediktor tersebut menunjukkan diskriminasi yan baik dalam memprediksi ketahanan hidup dalam 5 tahun dengan area under the curve (AUC) sebesar 0.69. Kesepakatan yang diterima dari probabilitas yang diamati dan diprediksi telah dinilai dalam plot kalibrasi. Nilai median ketahanan hidup keseluruhan adalah 40,3 bulan. Prediksi nomogram ini dapat berguna sebagai alat untuk memprediksi angka ketahanan hidup keseluruhan pada sebelum terapi kanker prostat metastasis, secara spesifik pada populasi Indonesia. Penelitian lebih lanjut dibutuhkan untuk memberikan validasi eksternal untuk mendukung penggunaan nomogram ini.

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A survival prognostic model of prostate cancer with bone metastasis had been done before. However, a prognostic model of pre-treatment prostate cancer with bone metastasis had not yet done. This study aims to analyze the clinical factors among bone-metastatic prostate cancer and their relationships with survival as well as to develop a prognostic nomogram for overall survival in patients with this condition. This study included 392 patients with bone metastatic prostate caner treated with androgen deprivation therapy. Pre-treatment parameters were analyzed using cox-proportional hazard model to identify the predictors of overall survival. Covariates, which showed statistical significance on multivariate analysis, were used to develop a nomogram. Linear predictor model was utilized to develop the nomogram. Median overall survival was 40.3 months (95% CI: 32.2 to 48.5). Univariate analysis showed that clinical T-stage, Gleason Score, initial prostate specific antigen value, and number of metastatic lesion were independent prognostic factors for OS. These predictors still remained significant as independent prognostic factors for overall survival following analysis using multivariate cox-regression model. The nomogram constructed from those prognostic factors showed good discriminaton for predicting the 5-year OS with an Area Under the Curve of 0.69. Acceptable agreement of the observed and predicted probabilites was observed in the calibration plot. The median overall survival of patient with bone metastatic prostate cancer was 40.3 months. The prediction nomogram might be a useful tool for predicting overall survival in pre-treatment bone metastatic prostate cancer, specifically among Indonesian patients. Further studies are needed to provide external validation to support the utilization of this nomogram."

"Era revolusi industri 4.0 memberikan peluang bagi data science untuk membantu kepentingan masyarakat tidak hanya di bidang teknologi dan industri, tetapi juga di bidang kesehatan. Salah satu masalah di bidang kesehatan yaitu ketika mendiagnosis suatu penyakit dari hasil biopsi, CT-scan, maupun MRI-scan para tenaga medis akan kewalahan jika memeriksanya satu per satu. Oleh karena itu, penelitian ini menggunakan machine learning untuk membantu dunia kesehatan menyelesaikan masalah overload data saat mendiagnosis pasien. Penyakit yang digunakan dalam penelitian ini adalah kanker prostat, yaitu salah satu penyebab kematian tertinggi pada pria di negara Barat. Kanker prostat adalah tumor ganas yang tumbuh secara perlahan di dalam kelenjar prostat. Pada umumnya, kanker prostat stadium awal timbul tanpa adanya gejala dan berkembang dengan perlahan. Maka, sangat penting bagi pasien untuk mendeteksi dini penyakit kanker prostat, dengan melakukan pemeriksaan kadar Prostate Specific Antigen (PSA). Kadar PSA dalam darah diukur dalam satuan nanogram per milimeter (ng / mL) yang normalnya berada pada angka 4 – 7 ng/mL. Jika lebih dari itu, disarankan untuk melakukan tes lebih lanjut atau langsung melakukan biopsi (Kementerian Kesehatan Republik Indonesia, 2017). Tingkat keganasan kanker prostat dapat diukur dengan sistem pengelompokan gleason score dari hasil tes biopsi pasien. Penelitian ini bertujuan untuk memprediksi pasien mengidap kanker prostat atau tidak dengan menggunakan citra hasil biopsi pasien yang telah diperbesar yang diambil dari Prostate cANcer graDe Assessment (PANDA) Challenge 2020. Ekstraksi fitur dengan metode Gray Level Co-occurence Matrix (GLCM) akan membantu untuk mengubah data citra menjadi data numerik. Metode yang dipilih pada penelitian ini adalah Fuzzy Robust Kernel C-Means dengan akurasi 87,5 %.

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The era of the industrial revolution 4.0 provides opportunities for data science to help the interests of society not only in technology and industry, but also in the health sector. One of the problems in the health sector is that when diagnosing a disease from the results of a biopsy, CT-scan, or MRI-scan, medical personnel will be overwhelmed if they check one by one. Therefore, this study uses machine learning to help the healthcare world solve the problem of data overload when diagnosing patients. The disease used in this study is prostate cancer, which is one of the leading causes of death in men in Western countries. Prostate cancer is a malignant tumor that grows slowly in the prostate gland. In general, early stage prostate cancer appears without symptoms and develops slowly. So, it is very important for patients to detect prostate cancer early, by checking the levels of the Prostate Specific Antigen (PSA). PSA levels in the blood are measured in units of nanograms per millimeter (ng / mL), which is normally 4 - 7 ng / mL. If it is more than that, it is advisable to carry out further tests or to immediately perform a biopsy (Ministry of Health of the Republic of Indonesia, 2017). The level of malignancy of prostate cancer can be measured by a system of grouping the gleason score from the results of the patient's biopsy test. This study aims to predict whether or not a patient has prostate cancer using enlarged biopsy images of patients taken from the Prostate Cancer GraDe Assessment (PANDA) Challenge 2020. Feature extraction using the Gray Level Co-occurrence Matrix (GLCM) method will help to change image data becomes numeric data. The method chosen in this study is Fuzzy Robust Kernel C-Means with an accuracy of 87.5%."