Author details

To summarize, in recent years, many new promising PCa biomarkers have been identified (Table 1) (Figure 3), and found to be associated with tumor aggressiveness. Multiplied studies showed the utility of the PHI, the 4Kscore™ and the PCA3 score to reduce the number of unnecessary prostate biopsies in PSA tested men. Actually, these biomarkers have been recommended for different guidelines. Still, large prospective studies, avoiding bias due to selection of patients according to PSA serum levels, are necessary to compare the value of these biomarkers. Also, new efforts are necessary to standardize the methodology for the measurement of exosomal and non-exosomal miRNAs, in order to analyze accurately their usefulness in the management of patients with early PCa. Finally, the combined role of these biomarkers

Adapted from: Filella and Foj [69]. (\*Recommended by the National Comprehensive Cancer

PCa treatment is variable, and it is chosen according to the staging of the cancer and, mainly, according to the patient's own preference. Since this type of cancer has slow growth, the presence of low-risk groups, where tumor is diagnosed still in situ, is indicative of an active surveillance treatment in which the patient only accompanies the tumor through regular PSA testing, and digital touch every 3–6 months [90]. During this follow-up period, if the existence of a tumor progression is observed, radiotherapy or surgery is indicated by total removal of

Radical prostatectomy may be the first choice of the patient who opts for complete removal of the gland, by caution of future metastasis. It is an effective procedure, however, just like any surgical procedure, there may be complications and compromise the patient's quality of life. For this procedure, the most common complications are the urinary incontinence, erectile dysfunction, and inguinal hernia; anyhow, the prognosis tends to be positive and long-lasting [91]. Nonetheless, some tumors may recur over time even after radical prostatectomy. In such cases, it is important to evaluate whether the recurrence was local or occurred at a distance

Hormone therapy is usually used in patients with lymph node involvement or distant metastasis. It consists of reducing androgen concentrations to the level of castration. This can be done by surgical method through bilateral orchiectomy, or through drugs that act on the androgen receptor (AR) pathways; the latter being more commonly used nowadays. At first, hormone deprivation therapy has great effects on the control of advanced PCa. However, it is known that part of the cases evolves to the state of CRPC. The mechanisms responsible for progression of tumor growth, despite hormonal blockade, have not been fully elucidated yet. Current studies have shown that molecular changes in the androgen receptor (AR) are related to such progression. Among these changes, it is relevant to mention the overexpression of AR, mutations in the

together with magnetic resonance imaging data should be elucidated [89].

Network).

6. Treatment modalities for PCa

194 Pathophysiology - Altered Physiological States

the prostate gland (radical prostatectomy).

(lymph nodes or other organs, such as liver, bone, or lung).

Gustavo Ferreira Simoes1,2, Paula Sakuramoto3 , Caroline Brito dos Santos<sup>3</sup> , Nilva Karla Cervigne Furlan<sup>4</sup> and Taize Machado Augusto<sup>4</sup> \*

\*Address all correspondence to: taizea@gmail.com

1 Research Associate at Department of Structural and Functional Biology, Biology Institute, UNICAMP, Campinas-SP, Brazil

2 Faculty of Medicine of Santa Casa de Sao Paulo, Department of Morphology, FCMSCSP, Sao Paulo-SP, Brazil

3 Undergraduated Medical Student at Faculty of Medicine of Jundiai, Jundiai-SP, Brazil

4 Department of Morphology and Basic Pathology, Faculty of Medicine of Jundiai, Jundiai-SP, Brazil

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**Chapter 11**

**Provisional chapter**

**Polycystic Ovary Syndrome, Pathophysiology, and**

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. The clinical picture characterized by both endocrine disorders (hyperandrogenism, menstrual cycle disorders, obesity) and metabolic alteration with implications for women's health and reproductive and metabolic consequences. Leventhal described for the first time a syndrome characterized by polycystic ovaries associated with menstrual cycle disorders, hirsutism, and obesity. The pathophysiology and other metabolic disorders that make the PCOS more complex than originally described are the most common cause of infertility linked to chronic anovulation. In fact, this is a multifactorial disorder that involves the hypothalamus, pituitary, ovary, adrenal, and peripheral adipose tissues, which are simultaneously involved in the pathogenesis

**Keywords:** infertility, polycystic ovary (PCO), polycystic ovarian syndrome (PCOS), menstrual irregularities, acne, hirsutism, anovulation, obesity, hyperandrogenism,

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of repro-

The PCOS Consensus Workshop Group has proposed a review of diagnostic criteria, defining

ductiveage. It was described for the first time by Stein and Leventhal in 1935 [1].

PCOS as the presence of at least two of the following criteria together [2]:

**Polycystic Ovary Syndrome, Pathophysiology, and** 

DOI: 10.5772/intechopen.70848

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

**Reproductive Health Implications**

**Reproductive Health Implications**

Additional information is available at the end of the chapter

insulin resistance and hyperinsulinemia, metformin

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.70848

Bassim Alsadi

**Abstract**

of the syndrome.

**1. Introduction**

Bassim Alsadi


**Provisional chapter**
