Prevention of Prostate Cancer in Primary Care: an Integrative Review RevIew

Laryssa Lins de Araújo1, Thiago Lívio Barbosa Pereira2, Marilena Maria de Souza3, Renata Lívia Silva Fonseca Moreira de Medeiros4, Janaina Ferreira Moreira5, Paula Frassinetti Oliveira Cezário1, Arielle Wignna Brasil Abrantes6, Gabrielle Morais Arruda Costa2, Jesana Sá Damasceno Moraes7, Erinalda Araújo Ramos8, Kátia Alves Soares9, Francisca Cristiane Pessoa Lima10, Francisca Karla Esmeraldo Neves11, Janaíne Chiara Oliveira Moraes12, Renata Maia de Medeiros13 1 Specialist in Family Health, Federal University of Paraiba. João Pessoal*. 2 Bachelor of Nursing, Federal University of Campina Grande. Cajazeiras*. 3 Doctor in Medicine and Health, Federal University of Bahia. Salvador**. 4 Master of the Nursing Postgraduation Program, Federal University of Paraiba. João Pessoa*. 5 Specialist in Intensive Therapy, Federal University of Paraiba. João Pessoal*. 6 Specialist in Nursing Intensive Care, Federal University of Campina Grande. Cajazeiras*. 7 Specialist in Health Management, State University of Paraiba. Cajazeiras*. 8 Nursing Student, College Santa Maria. Cajazeiras*. 9 Bachelor of Nursing, College Santa Maria. Cajazeiras*. 10 Specialist in Urgency and Emergency, Occupational Health and Occupational Health Nursing, Cajazeiras*. 11 Specialist, Regional Hospital of Cajazeiras. Cajazeiras*. 12 Academic Unit of Nursing, Teacher Training Center, Federal University of Campina Grande. Cajazeiras*. 13 Nursing Student, Federal University of Paraiba. João Pessoa*. * Paraíba, Brazil. ** Bahia, Brazil.


Introduction
The National integral Attention to Men's Health Policy (NiAMHP) was established in August 2009 under the Ordinance 1944 and established by the Unified Health System (UHS).This policy has the purpose to demystify the idea of invulnerability on male health, provide health professionals a greater understanding about the disease process of these individuals, and develop actions and strategies that encourage men to attend health facilities of primary care [1].
Most men do not seek primary care services for the prevention and treatment of pathological processes in the early stages, preferring to use the specialized care services of urgent moments or when the disease is installed, thus causing the increase in morbidity and mortality rates in this population and the increased costs to the public purse.Therefore, the objective of NiAMHP strengthen and qualify the primary care so that health care is not just restricted to recovery, ensuring, above all, health promotion and prevention to preventable diseases [1].
Among the diseases that most affect the male population, prostate cancer deserves attention because it is considered the sixth most common type of cancer worldwide and the second most prevalent in men, accounting for about 10% of all malignancies.in 2014, we calculated the emergence of 68.800 new cases, representing an estimated risk of 70.42 new cases per 100.000men [2].
This cancer can be detected early and simply in a Family Health Strategy (FHS), through the evaluation of the prostate with the digital rectal exams and the serum levels of Prostate Specific Antigen (PSA) [3].
From the studies conducted on human health, the experience in health facilities and the itinerant design of the Cajazeiras Regional Hospital, it was noted the demand of this population for actions that address the prevention of diseases, especially prostate cancer.Therefore, we opted for this study because of the need of passing on information that may contribute to a better assistance to the male population in the FHS.
Thus, the objective of this study is to assessing the prevention of prostate cancer in primary care from the analysis of scientific productions.

Method
We opted for the realization of an integrative literature review, because it addresses, in a satisfactory manner, the established objective, in addition to performing as a broad method, which allows the incorporation of several studies, thus resulting in a more comprehensive knowledge about the subject studied [4].
The integrative review process includes six distinct stages, similar to the stages of performing a standard search: 1 st ) Issue identification and selection of the research question.This step begins with the definition of the problem and formulates a research hypothesis, which must have relevance to the health of individuals.in this sense, the guiding question of the study was: How is taking place prevention of prostate cancer in primary care?
2 nd ) Criteria for the selection of the sample.on the 1st of October 2015 there was conducted to treatment of patients with cancer.in addition, it is necessary that these actions advance and become routine in institutions, not restricted to the campaigns of "Blue November", but forming part of the daily planning of the Family Health Strategy.
search the publications by searching in the databases of the Virtual Health Library (VHL): ScieLO (Scientific electronic Library Online), LiLACS (Latin American and Caribbean Health Sciences) and international database PubMeD (Medical Publishedserve of the US National Library of Medicine).They used the descriptors: human health, prostate cancer, primary care, men's health, prostate cancer and Family Health.inclusion criteria articles were: scientific works published in Portuguese and english, with abstracts and full text available free of charge in full in the period between 2008 and September 2015. in the first search performed using the above descriptors, found 763 articles, and 316 in Portuguese and 447 in english.
3 rd ) Identification of pre-selected and selected studies.First held up reading the summaries of each article, being selected 21 publications in PubMeD, 15 and 6 in the ScieLO and LiLACS.Subsequently, the complete reading of the pre-selected articles and verified their compliance with the inclusion criteria and the guiding question of the survey was conducted, which resulted in the selection of 13 articles, which were 9 and 4 of the ScieLO and Li-LACS.
4 th ) Categorization of studies.This step is considered similar to the collection of conventional data, for which we used a tool [5] that allows the researcher to evaluate, individually, selected studies, analyzing them methodologically and in relation to synthesis of the findings.Thus, studies were listed through a careful reading and inclusion criteria chosen.
5 th ) Analysis and interpretation of results.For analysis and subsequent synthesis of the articles there was prepared a framework containing the following aspects relevant to the selected theme: author names, article title, journal and publication year.Then, the results were discussed according to the relevant literature.
6 th ) Presentation of synthesis of knowledge.The knowledge gained by conducting this review was presented as a document, which forms the explicit content in this scientific work.

Selected publications-specifications
Table 1 presents the authors, titles, periodicals and years relating to each publication analyzed.Journals that published more articles were: Brazilian Journal Table 1.Characterization of publications according to the authors, title, journal and year of publication, in the period from 2008 to 2015.

Discussion
The FHS was developed as a plan to guide the organization of the health system and respond to the population's needs, requiring an understanding of health as a social right and favors the facing of social determinants to promote it.Thus, the proper organization of the services available in the FHS contribute to the assistance provided under primary care, with positive impacts on health population [18].According to Ordinance 648 from March 28th, 2006 [19], all FHS's team member professionals have as common assignments health promotion, disease prevention, treatment and monitoring of diseases, and activities permanent health education.From this, the creation of the FHS provided a focused attention on the family, understood and perceived by their physical and social environment, thus enabling the FHS team to work together with these persons a broader understanding of the health/disease process and the need to interventions that transcend healing practices [9,15,20].
Thus, arises the need to address human health and all the complexities involving the care of these individuals.To do this, there was set up to NiAMHP, which directed the focus of attention of professionals to the most common disorders in the male population, especially in relation to prostate cancer.This disease is the sixth most common malignancy in the world in number of new cases, the third most common cancer in the male population and more neoplasia presented by european men, American and some parts of Africa [3,6,8,10].
in recent years there have seen a significant increase in incidence rates of this cancer in Brazil, which can be explained by the increase in population life expectancy, the constant campaigns to identify the disease, the development of diagnostic methods and quality systems Brazilian information, in addition to environmental and dietary influences, such as high energy consumption, intake of red meat, fats and milk [14,[21][22].
The study of prostate cancer is of great importance to public health, due to its high incidence and high clinical cure rates in these patients when the disease is detected in early stages [22][23].The tests most commonly used to screen cancer are the digital rectal examination and serum PSA.The first has limitations when the prostate has a not palpable lesion, common in early stages, and when changed, the differentiation between malignant and benign lesion is quite complex.The second examination, serum PSA in clinical use since 1986, is the tumor marker most often used for screening for prostate cancer and plays an important role in the early diagnosis and prevention of complications of the disease, direct impact in reducing of morbidity and mortality [6,[12][13]24].
The prevention of prostate cancer should be performed primarily in primary care services such as FHS, and the role of professionals receiving the male population in a universal manner, comprehensive and equitable, given the advocated by UHS principles and guidelines, and promoting increased access to the right information on health, especially on prostate cancer, contributing thus to face the risk factors [11,13,15].Moreover, it should also be encouraged by the FHS professionals, adopting healthy eating habits and physical activity as a means of prevention against prostate cancer and other common injuries to this population [16][17].
in Brazil, about 60% to 70% of cases are diagnosed when the disease is already widespread, given that, in most cases, this type of cancer has a very slow growth period, taking years to the individual presents any symptom [7,17].We observe, then, the great need to target the male population about the issues surrounding prostate cancer and its prevention and early detection in primary care [16].
Through this context notes the importance of the FHS for the prevention of prostate cancer and other diseases prevalent in the male population and society in general, working efficiently and resolute manner, and reducing morbidity and mortality from preventable causes [9,15].
The FHS brings in its conception a redesign of care model that emphasizes the link with care lines of logic in which every citizen has the right to be ca-red for by a team of full and resolute manner, with therapeutic projects caregivers solidarity with the demands and/or the suffering of users, also being co-responsibilities of producers and autonomy or self-government on the part of those involved in this process [25].

Conclusion
By analyzing the studies included in the research, it was observed that the strategies used for the prevention of prostate cancer in the context of primary health care, are the examination of digital rectal examination and serum PSA. in addition, some also mention encouraging the adoption of lifestyles and healthy food, contributing to the prevention of numerous injuries to men's health.
Searching for information in the scientific literature and pass on knowledge to the people is an extremely important action for public health, allowing the exchange of knowledge and experiences between professionals and users, thus contributing to the formation and/or strengthening of the bond.So, through health education and the commitment of the FHS teams, strategies can be developed to encourage men to seek more frequently the primary care services for health promotion and prevention of diseases, not limited only to monitoring and treatment health problems.
it is hoped that this study will encourage practitioners to start on changes that result in better acceptance of men to action and best efficiency ratios in the collection and treatment of patients with cancer.it is hoped, too, that these actions advance and become routine in health institutions as part of the daily planning of the FHS.
International Archives of Medicine is an open access journal publishing articles encompassing all aspects of medical science and clinical practice.IAM is considered a megajournal with independent sections on all areas of medicine.IAM is a really international journal with authors and board members from all around the world.The journal is widely indexed and classified Q1 in category Medicine.