This letter to the Editor aims to provide suggestions and recommendations for the management of urological conditions in times of COVID-19 crisis in Brazil and other low-and middle-income countries.

We report a case of verrucous carcinoma of the bladder that was unrelated to bilharziasis, with koilocytosis and absence of human papillomavirus. The literature relating to the topic is discussed.

PURPOSE To present a summary of the recommendations for the treatment and follow-up for metastatic castration-resistant prostate cancer (mCRPC) as acquired through a questionnaire administered to 99 physicians working in the field of prostate cancer in developing countries who attended the Prostate Cancer Consensus Conference for Developing Countries. METHODS A total of 106 questions out of more than 300 questions addressed the use of imaging in staging mCRPC, treatment recommendations across availability and response to prior drug treatments, appropriate drug treatments, and follow-up, and those same scenarios when limited resources needed to be considered. Responses were compiled and the percentages were presented by clinicians to support each response. Most questions had five to seven relevant options for response including abstain and/or unqualified to answer, or in the case of yes or no questions, the option to abstain was offered. RESULTS Most of the recommendations from this panel were in line with prior consensus, including the preference of a new antiandrogen for first-line therapy of mCRPC. Important aspects highlighted in the scenario of limited resources included the option of docetaxel as treatment preference as first-line treatment in several scenarios, docetaxel retreatment, consideration for reduced doses of abiraterone, and alternative schedules of an osteoclast-targeted therapy. CONCLUSION There was wide-ranging consensus in the treatment for men with mCRPC in both optimal and limited resource settings.

Background: Non-metastatic castration resistant prostate cancer (M0 CRPC) has seen important developments in drugs and diagnostic tools in the last two years. New hormonal agents have demonstrated improvement in metastasis free survival in M0 CRPC patients and have been approved by regulatory agencies in Brazil. Additionally, newer and more sensitive imaging tools are able to detect metastasis earlier than before, which will impact the percentage of patients staged as M0 CRPC. Based on the available international guidelines, a group of Brazilian urology and medical oncology experts developed and completed a survey on the diagnosis and treatment of M0 CRPC in Brazil. These results are reviewed and summarized and associated recommendations are provided. Objective: To present survey results on management of M0 CRPC in Brazil. Design, setting, and participants: A panel of six Brazilian prostate cancer experts determined 64 questions concerning the main areas of interest: 1) staging tools, 2) treatments, 3) side effects of systemic treatment/s, and 4) osteoclast-targeted therapy. A larger panel of 28 Brazilian prostate cancer experts answered these questions in order to create countryspecific recommendations discussed in this manuscript.

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Purpose: Complete androgen blockade (CAB) does not prolong overall survival (OS) in patients with castration refractory prostate cancer (CRPC). Although there is variable clinical benefit with second-line hormone manipulation, we do not know which patients might benefit the most. Objectives: To identify clinical predictors of benefit of complete androgen blockade. Materials and Methods:We reviewed the records for 54 patients who received treatment with CAB in the setting of disease progression despite castration. We evaluated progression-free survival (PFS) and OS according to PSA at diagnosis, Gleason scores, age, testosterone level, and duration of prior disease control during castration in first line treatment. Results: Among 54 patients who received CAB, the median PFS was 9 months (CI 4.3-13.7) and OS was 36 months (CI 24-48). We did not find an effect of PSA at diagnosis (p = 0.32), Gleason score (p = 0.91), age (p = 0.69) or disease control during castration (p = 0.87) on PFS or OS. Thirty-four patients subsequently received chemotherapy, with a mean OS of 21 months (CI 16.4-25.5, median not reached). Conclusion: Age, Gleason score, PSA at diagnosis and length of disease control with castration did not affect PFS or OS. In the absence of predictors of benefit, CAB should still be considered in CRPC.

We also evaluated small and large shift scenarios of 7.8% and 20.2%, respectively. We calculated the incremental QALYs, costs, and cost-effectiveness ratio (ICER) in each scenario. RESULTS: The assay strategy was dominant in all scenarios evaluated. In the 5-year and lifetime horizon analyses, the assay resulted in 0.02 and 0.04 more QALYs and $780 and $730 less in costs, respectively. The small and large shift scenarios resulted 0.02 and 0.05 more QALYs, and $5 and $1,300 less in costs over a lifetime horizon, respectively. The ICER was most sensitive to the assay cost, the AS health state utility, and the proportion of low-risk patients receiving AS in usual care. CONCLUSIONS: Our results suggest that the 8-protein prognostic assay is potentially cost-effective vs. usual care in patients with Gleason 3+3 & 3+4 prostate cancer. Future studies will evaluate the impact of the assay on patient/physician treatment choices in real-world settings. PCN92Cost effeCtiveNess ANAlysis of PANitumumAb + folfox As 1st liNe of treAtmeNt of mCrC rAs-Wt

RESUMO: Nos últimos 40 anos, o perfil mundial do câncer vem mudando. Encarado inicialmente como uma doença dos países ricos, nota-se atualmente que a maior parte de seu ônus global provêm de países de poucos recursos ou em desenvolvimento. Nas últimas décadas o câncer se tornou um problema de saúde pública mundial, com estimativas alarmantes para as décadas subseqüentes. No Brasil, as estimativas para o ano de 2012 serão válidas também para o ano de 2013 e revelam a ocorrência de aproximadamente 518.510 casos novos de câncer, incluindo os casos de pele não melanoma. São esperados um total de 257.870 casos novos para o sexo masculino. A grande questão é que cerca de 10% destes casos serão na faixa etária inferior a 45 anos e 1% abaixo de 20 anos de idade. Embora o tratamento atual do câncer tenha aumentado consideravelmente as taxas de sobrevida em 5 anos de pacientes jovens, ele quase que invariavelmente estará associado a enorme risco de infertilidade, levando a impacto negativo importante na vida destes jovens homens. Este artigo de revisão aborda os mais atuais conceitos em preservação de fertilidade em homens jovens tratados de câncer, o crescimento deste campo dentro da oncologia e da urologia e o futuro deste tema tão relevante para nossa população. Até hoje existe uma importante desconexão entre os guidelines mundiais e a prática médica, quando o assunto é preservação da fertilidade em homens com câncer em idade reprodutiva.