Avaliação da resposta ao tratamento radioterápico no seguimento de 5 anos após recidiva bioquímica em pacientes com câncer de próstata
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Data
2021-11-26
Autores
Romano, Guilherme Gomes
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
As neoplasias são a segunda causa de morte no Brasil, e as malignas dos órgãos genitais masculinos estão inseridas no quarto grupo que mais leva ao óbito. A neoplasia maligna da próstata é a mais frequente e responsável por aproximadamente 95% desses óbitos. O desencadeamento do câncer de próstata ocorre devido a algumas alterações genômicas que dão início à progressão da doença. O exame de antígenos prostático específico (PSA) auxilia no diagnóstico, permitir acompanhar a evolução e indica o tratamento mais adequado, que pode ser por meio de vigilância ativa, prostatectomia radial ou radioterapia. Mesmo com o tratamento, o câncer pode recidivar e a constatação pode ser identificada pela alteração de biomarcadores, recidiva bioquímica, esta situação deve ser constatada por meio da monitoração bioquímica a fim de propor estratégia terapêutica adequada e precisa. Objetivo: Avaliar a resposta ao tratamento radioterápico no seguimento de 5 anos após recidiva bioquímica em pacientes com câncer de próstata que realizaram prostatectomia. Métodos: Esta pesquisa documental foi conduzida de maneira retrospectiva por meio de prontuários dos últimos cinco anos de pacientes submetidos à recidiva bioquímica no Hospital Amaral Carvalho (HAC) na cidade de Jaú/SP. Foram coletados dados sociodemográficos, antropométricos, valores de PSA pré e pós-cirurgia e de 1 a 5 anos pós-radioterapia e a ocorrência de óbito. As variáveis contínuas foram apresentadas em média e desvio padrão, ou mediana e percentil 25-75, de acordo com a distribuição de normalidade dos dados. As variáveis categóricas foram apresentadas como frequência absoluta e relativa. Para comparação entre os momentos foi aplicado o Teste de Friedman (p<0,05). Resultados: Foram coletados dados de 38 homens com média de idade de 70,18 ± 6,60 anos, peso de 79,77 ± 18,01 Kg, altura de 1,70 ± 0,06 m, e índice de massa corporal de 27,78 ± 5,48 kg/m2. Os valores de PSA diminuíram significativamente após a cirurgia de prostatectomia. No primeiro ano após a recidiva bioquímica e realização da radioterapia, os valores de PSA foram menores se comparado ao pós-cirúrgico. Houve diferença entre PSA pré-cirúrgico [169,5 (43,7 – 1308,3)] e PSA 1ano [0,13 (0,004 – 23,330)], com p = 0,012, e entre PSA pré-cirúrgico [169,5 (43,7 –1308,3)] e PSA 2anos [0,095 (0,012 – 341,10)] com p = 0,039. Conclusão: Não há modificação do PSA após 5 anos de recidiva bioquímica devido prostatectomia, sendo o o tratamento radioterápico considerado eficaz.
Neoplasms are the second leading cause of death in Brazil, with malignant neoplasms of the male genital organs being the fourth group that most causes death, and specifically a malignant prostate neoplasm the most frequent and responsible for approximately 95% of deaths. The onset of prostate cancer occurs due to some genomic changes that initiate the progress of the disease. Digital rectal exams and PSA analysis can assist in the diagnosis and indicate the most appropriate treatment, which can be through active surveillance, radical prostatectomy, or radiotherapy. Even with treatment, cancer can recur and can be seen by altering some biomarkers, this method of assessment is called biochemical recurrence. Objective: To evaluate the response to radiotherapy treatment in the 5-year post-biochemical recurrence segment in patients with prostate cancer who underwent prostatectomy. Methods: This documentary research was conducted in an observational manner in medical records of the last five years of patients that occurred in a biochemical recurrence at the Amaral Carvalho Hospital (HAC) in the city of Jaú / SP. Demographic data, anthropometric characteristics, prostatectomy procedure, PSA values before and after surgery, and 1 to 5 years after radiotherapy were collected. For the analysis statistics, the continuous variables were evaluated as mean and standard deviation, or median and 25th and 75th percentile, according to the normality of the data. The categorical variables were assigned as a percentage. To analyze the PSA values, the Friedman Test was performed, which is a non-parametric test for the evaluation of repeated measures (p<0,05). Partial results: To date, data were collected from 38 men with a mean age of 70.18 ± 6.60 years, weight of 79.77 ± 18.01 kg, height of 1.70 ± 0.06 m, and body mass index of 27.78 ± 5.48 kg / m2 . PSA values decreased despite prostatectomy surgery. In the first year after biochemical recurrence and radiotherapy, PSA values are lower than in the post-surgical period. Over the 5 years of follow-up after biochemical recurrence, the values will increase, however, lower than the pre-surgical values. The multiple comparisons test showed statistically significant differences between pre-surgical PSA (169.5 (43.7 – 1308.3)) and 1-year PSA (0.13 (0.004 – 23.330)), with p = 0.012, and between PSA pre-surgical (169.5 (43.7 – 1308.3)) and PSA 2 years (0.095 (0.012 - 341.10)) with p = 0.039. Conclusion: For patients undergoing this study, radiotherapy treatment without segment 5 years after biochemical recurrence in patients with prostate cancer who underwent prostatectomy was effective.
Neoplasms are the second leading cause of death in Brazil, with malignant neoplasms of the male genital organs being the fourth group that most causes death, and specifically a malignant prostate neoplasm the most frequent and responsible for approximately 95% of deaths. The onset of prostate cancer occurs due to some genomic changes that initiate the progress of the disease. Digital rectal exams and PSA analysis can assist in the diagnosis and indicate the most appropriate treatment, which can be through active surveillance, radical prostatectomy, or radiotherapy. Even with treatment, cancer can recur and can be seen by altering some biomarkers, this method of assessment is called biochemical recurrence. Objective: To evaluate the response to radiotherapy treatment in the 5-year post-biochemical recurrence segment in patients with prostate cancer who underwent prostatectomy. Methods: This documentary research was conducted in an observational manner in medical records of the last five years of patients that occurred in a biochemical recurrence at the Amaral Carvalho Hospital (HAC) in the city of Jaú / SP. Demographic data, anthropometric characteristics, prostatectomy procedure, PSA values before and after surgery, and 1 to 5 years after radiotherapy were collected. For the analysis statistics, the continuous variables were evaluated as mean and standard deviation, or median and 25th and 75th percentile, according to the normality of the data. The categorical variables were assigned as a percentage. To analyze the PSA values, the Friedman Test was performed, which is a non-parametric test for the evaluation of repeated measures (p<0,05). Partial results: To date, data were collected from 38 men with a mean age of 70.18 ± 6.60 years, weight of 79.77 ± 18.01 kg, height of 1.70 ± 0.06 m, and body mass index of 27.78 ± 5.48 kg / m2 . PSA values decreased despite prostatectomy surgery. In the first year after biochemical recurrence and radiotherapy, PSA values are lower than in the post-surgical period. Over the 5 years of follow-up after biochemical recurrence, the values will increase, however, lower than the pre-surgical values. The multiple comparisons test showed statistically significant differences between pre-surgical PSA (169.5 (43.7 – 1308.3)) and 1-year PSA (0.13 (0.004 – 23.330)), with p = 0.012, and between PSA pre-surgical (169.5 (43.7 – 1308.3)) and PSA 2 years (0.095 (0.012 - 341.10)) with p = 0.039. Conclusion: For patients undergoing this study, radiotherapy treatment without segment 5 years after biochemical recurrence in patients with prostate cancer who underwent prostatectomy was effective.
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Palavras-chave
Câncer de próstata, PSA, Recidiva bioquímica, Tratamento radioterápico, Prostate cancer, Biochemical recurrence, Radiotherapy