Biópsia de próstata inicial : 12 versus 20 fragmentos : estudo prospectivo
Arquivos
Data
2017-10-10
Autores
Solha, Raphael Sandes 
Orientadores
Ajzen, Sergio Aron
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Resumo Objetivo: Comparar a taxa de detecção de dois protocolos de biópsia com número de fragmentos diferentes, como forma de abordagem inicial nos pacientes com suspeita de câncer de próstata. Método: Foram incluídos no estudo 196 pacientes encaminhados ao Setor de Intervenção do Departamento de Diagnóstico por Imagem da Universidade Federal de São Paulo para a realização da primeira biópsia de próstata, com PSA menor ou igual a 20 ng/ml. Os pacientes foram randomizados em dois grupos, um com um protocolo de biópsia de 12 fragmentos e outro com um protocolo de 20 fragmentos. A análise estatística comparou a taxa de detecção geral de cânceres, bem como a taxa de detecção de cânceres clinicamente insignificantes e o grau de agressividade dos cânceres detectados entre os dois grupos, correlacionando-os com o volume prostático, o PSA e a idade dos pacientes. Uma revisão sistemática com meta-análise foi realizada a fim de confrontar os nossos achados com a literatura disponível. Resultados: Dos 105 pacientes incluídos no grupo de 12 fragmentos, 46 (43,81%) tiveram a biópsia positiva e dos 91 pacientes do grupo de 20 fragmentos 40 (44,25%) foram detectados com câncer de próstata. A mediana do escore de Gleason foi igual a 7 nos dois grupos. Não houve diferença significativa na taxa de detecção de cânceres insignificantes (6,66 vs 5,49%; p = 0,415). Não encontramos subgrupos baseados no PSA, no volume prostático ou na idade que se beneficiassem do protocolo de 20 fragmentos. A análise consolidada da revisão sistemática corrobora os nossos achados. Conclusão: Não foi observada uma diferença significativa na taxa de detecção de câncer de próstata entre o protocolo de biópsia com 12 fragmentos e o com 20 fragmentos.
Objective: Compare detection rate of two prostate biopsy protocols with a different number of cores, as the initial approach of patients with suspicion of prostate cancer. Methods: One hundred-ninety-six patients referred to the Department of Interventional Radiology of Sao Paulo Federal University to perform first prostate biopsy were included in this study. Patients were randomized in two groups, one of a 12-core biopsy protocol and another one of a 20-core biopsy protocol. Statistical analysis compared overall cancer detection rate, insignificant cancer detection rate and aggressiveness of detected cancers between groups, correlating them with prostate volume, PSA level, and patient age. A systematic review with meta-analysis was performed in order to compare our findings with the currently available literature. Results: Of the 105 patients included in the 12-core group, 46 (43.81%) had a positive biopsy and 40 (44.25%) of the 91 patients included in the 20-core group were detected with prostate cancer. There was no significant difference of insignificant cancer detection rate (6.66 vs 4.49%, p = 0.415). We did not find patients subgroups that could benefit from 20-core protocol, based on PSA levels, prostate volume and patient age. The summary of systematic review analysis corroborates with our findings. Conclusion: There was no significant difference in prostate cancer detection rate between the 12-core protocol and the 20-core protocol.
Objective: Compare detection rate of two prostate biopsy protocols with a different number of cores, as the initial approach of patients with suspicion of prostate cancer. Methods: One hundred-ninety-six patients referred to the Department of Interventional Radiology of Sao Paulo Federal University to perform first prostate biopsy were included in this study. Patients were randomized in two groups, one of a 12-core biopsy protocol and another one of a 20-core biopsy protocol. Statistical analysis compared overall cancer detection rate, insignificant cancer detection rate and aggressiveness of detected cancers between groups, correlating them with prostate volume, PSA level, and patient age. A systematic review with meta-analysis was performed in order to compare our findings with the currently available literature. Results: Of the 105 patients included in the 12-core group, 46 (43.81%) had a positive biopsy and 40 (44.25%) of the 91 patients included in the 20-core group were detected with prostate cancer. There was no significant difference of insignificant cancer detection rate (6.66 vs 4.49%, p = 0.415). We did not find patients subgroups that could benefit from 20-core protocol, based on PSA levels, prostate volume and patient age. The summary of systematic review analysis corroborates with our findings. Conclusion: There was no significant difference in prostate cancer detection rate between the 12-core protocol and the 20-core protocol.
Descrição
Citação
SOLHA, Raphael Sandes. Biópsia de próstata inicial : 12 versus 20 fragmentos : estudo prospectivo. 2017. São Paulo, [43] p. Tese (Doutorado em Medicina: radiologia clínica) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2017.