Características principais de pacientes com PSA menor ou igual a 4,0 ng/ml, submetidos à biópsia de próstata guiada pelo ultrassom transretal
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Data
2010-07-30
Autores
Biazzi, Fernando [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O surgimento do antígeno prostático específico (PSA) revolucionou o diagnóstico, tratamento e seguimento dos pacientes portadores do câncer de próstata (CaP). O limite da normalidade do PSA esta sendo modificado em virtude de um quarto dos CaP serem diagnosticados com PSA menor ou igual a 4,0 ng/ml melhorando o tratamento em virtude do diagnóstico precoce. Estudo retrospectivo com 300 pacientes que foram submetidos ao exame digital da próstata (EDP), PSA e biópsia prostática dirigida pelo ultrassom transretal, com a retirada mínima de 6 fragmentos, em três níveis de PSA, menor ou igual a 4,0 ng/ml, que foram subdivididos conforme os níveis séricos do PSA: menor ou igual a 4,0 ng/ml, entre 4,01 e 10,0 ng/ml e acima de 10,0 ng/ml que compunham respectivamente os grupos 1, 2 e 3.O número e porcentagem de pacientes submetidos a biópsia prostática nos grupos 1, 2, 3 foram 58 (19,3%), 150 (50%) e 92 (30,7%). A taxa de detecção para CaP foi de 32% (96). A taxa de detecção nos G1, G2 e G3 foi 27,6%, 25,3% e 45,6% respectivamente, evidenciando maior positividade no grupo 3 (p=0,003). A idade média nos grupos foi 61±6,5, 64±8,0, 69±9,0 anos com G1,G2<G3 (p < 0,001). O EDP foi normal em 48,7% dos pacientes e em 48,3% (G1), 58% (G2) e (G3) 33,7%, apresentando diferença estatística entre os grupos (p < 0,001). A proporção de fragmentos positivos foi superior no G1 em relação ao G2 (34,5 a 22,7%) mas inferior ao G3 (53,1%). O volume prostático foi menor no G1 (28 cm3) em relação aos demais grupos. Quanto ao escore de Gleason na biópsia, no espécime e no estádio patológico os grupos 1 e 2 foram semelhantes. As principais indicações de biópsia para o G1 foram: EDP alterado: (n= 33) 57%; PSA em elevação isolado (n=19) 32,8%; PSA em elevação e EDP alterado (n= 5) 8,6%; PSA em elevação e relação PSA livre por PSA total menor que 15% (n= 4)...
Prostatic Specific Antigen (PSA) changes the diagnoses, treatment, prognoses and follow-up of prostate cancer (PC). PSA cut-off has been changed due to many patients with PSA lower than 4,0 ng/ml will present a probability of 25% chance to have PC. In these cases, the treatment is favorable because of the early diagnosis. Characterize the main pathological and clinical aspects of patients with PSA lower than 4,0 ng/ml submitted to transrectal prostate biopsy guided by ultrasound. In an observational retrospective study, 300 patients were submitted to digital rectal exam (DRE), PSA serum dosage and transrectal prostate biopsy guided by ultrasound. At least six cores in three PSA levels were performed: lower than 4,0 ng/ml, 4,01 to 10,0 ng/ml, higher than 10,01ng/ml which were groups 1, 2 and 3, respectively. The patients number and percentage submitted to prostatic biopsy in groups 1, 2 and 3 were 58 (19,3%), 150 (50%) e 92 (30,7%). Detection PC rate was 32% (96). Detection PC rate in G1, G2 and G3 was 27,6%, 25,3% and 45,6%, respectively. The age average was 61±6,5, 64±8,0, 69±9,0 years-old with G1,G2<G3 (p < 0,001). The positive cores were higher in G1 than in G2. DRE was normal in 48.7% of all the patients and in 48,3% (G1), 58% (G2) e (G3) 33,7% (p< 0,001). G1 prostate volume was smaller than the others. Prostate biopsy, specimen Gleason Score and the pathological stage were similar between G1 and G2. The main indications for prostate biopsy in G1 were: abnormal DRE (33) 57%; velocity PSA (19) 32,8%; velocity PSA and abnormal DRE (5) 8,6%; velocity PSA and relation of free PSA by total PSA (fPSA/tPSA) less than 15% (4) 6,8%; fPSA/tPSA alone (1) 1,7%; Abnormal DRE and fPSA/tPSA less than 15% (1) 1,7%; Atypical small acinar proliferation (ASAP) (1) 1,7%.The main indication for malignancy positivity were abnormal DRE ... (Complete abstract click electronic access below)
Prostatic Specific Antigen (PSA) changes the diagnoses, treatment, prognoses and follow-up of prostate cancer (PC). PSA cut-off has been changed due to many patients with PSA lower than 4,0 ng/ml will present a probability of 25% chance to have PC. In these cases, the treatment is favorable because of the early diagnosis. Characterize the main pathological and clinical aspects of patients with PSA lower than 4,0 ng/ml submitted to transrectal prostate biopsy guided by ultrasound. In an observational retrospective study, 300 patients were submitted to digital rectal exam (DRE), PSA serum dosage and transrectal prostate biopsy guided by ultrasound. At least six cores in three PSA levels were performed: lower than 4,0 ng/ml, 4,01 to 10,0 ng/ml, higher than 10,01ng/ml which were groups 1, 2 and 3, respectively. The patients number and percentage submitted to prostatic biopsy in groups 1, 2 and 3 were 58 (19,3%), 150 (50%) e 92 (30,7%). Detection PC rate was 32% (96). Detection PC rate in G1, G2 and G3 was 27,6%, 25,3% and 45,6%, respectively. The age average was 61±6,5, 64±8,0, 69±9,0 years-old with G1,G2<G3 (p < 0,001). The positive cores were higher in G1 than in G2. DRE was normal in 48.7% of all the patients and in 48,3% (G1), 58% (G2) e (G3) 33,7% (p< 0,001). G1 prostate volume was smaller than the others. Prostate biopsy, specimen Gleason Score and the pathological stage were similar between G1 and G2. The main indications for prostate biopsy in G1 were: abnormal DRE (33) 57%; velocity PSA (19) 32,8%; velocity PSA and abnormal DRE (5) 8,6%; velocity PSA and relation of free PSA by total PSA (fPSA/tPSA) less than 15% (4) 6,8%; fPSA/tPSA alone (1) 1,7%; Abnormal DRE and fPSA/tPSA less than 15% (1) 1,7%; Atypical small acinar proliferation (ASAP) (1) 1,7%.The main indication for malignancy positivity were abnormal DRE ... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Próstata - Biópsia por agulhas, Próstata - Câncer, Ultrassonografia, Needle biopsy
Como citar
BIAZZI, Fernando. Características principais de pacientes com PSA menor ou igual a 4,0 ng/ml, submetidos à biópsia de próstata guiada pelo ultrassom transretal. 2010. 56 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.