Frequência de Adenocarcinoma Prostático em biópsias de 12 ou 18 fragmentos de pacientes com valores de PSA total entre 2,5 e 10 ng/ml, relação PSAlivre / PSAtotal ≤ 19% e densidade do PSA ≥ 15ng/ml/cc

Abstract

Introduction: PSA (Prostate-Specific Antigen) is the main tool for screening for prostate cancer, and studies now seek to improve the diagnosis by creating combinations of PSA with its variables, free/total PSA, PSA density, PSA velocity, and an association with the patient's age, ethnicity and heredity for prostate cancer.The diagnosis of prostate cancer is achieved by the analysis of prostatic tissue obtained by prostate biopsy guided by ultrasound, and it is considered the standard procedure. The objective of this study was to evaluate prostate cancer frequency in men undergoing prostate biopsy of 18 fragments and to compare that with positivity, when only the first 12 fragments were analyzed. Materials and methods: from May 2008 to October 2013, 216 medical records of patients undergoing prostate biopsy that had total PSA between 2.5 and 10 ng/ml, free/total PSA ≤ 19%, PSA density ≥ 0.15 ng/ml/cc3 with normal digital rectal exam and absence of prostate nodules of trans rectal ultrasonography were analyzed. The trans rectal ultrasound guided biopsies involving using needles were distributed as follows:3 right base fragments, 3 left base fragments, 3 1/3 right mid fragments, 3 1/3 left mid fragments, 3 right apex and 3 left apex fragments. These fragments were numbered from 1 to 18 and separated into 2 groups: Group 1 - 1 to 12, with two fragments of each prostatic region - and Group 2 - 13 to 18, with one fragment from each prostatic region (each fragment being analyzed separately).Positive comparison was made between the 18 fragments and only the first 12.Patients diagnosed with cancer in the first 12 fragments were compared with those for which all 18 fragments were analyzed regarding the values of PSA and prostate volume. Results: 216 men with mean age of 64 + - 8.0 years, with extremes 34-90 years were evaluated. The prevalence of patients with prostate cancer in 12 fragments was 42/216 (19.44%), and in 18 fragments it was 58/216 (26.85%); with an increase of 38% in the detection capacity, which shows 7.45% more tumors. When comparing the patients who had positive biopsy in the first 12 fragments (42 patients) with those with positivity only in the evaluation of all 18 fragments (16 patients), it was found that patients with positivity only in the 18 fragments showed higher PSA value and larger prostates. This leads to consider that patients with larger prostates and higher PSA values would benefit from a greater number of fragments. Conclusions: the analysis of 18 prostate biopsy samples compared to 12 fragments showed a positive increase in prostate cancer detection. Also, the patients who were benefited from the increase in the number of fragments had higher PSA and larger prostate volume.