Biopsia de próstata en pacientes con diagnóstico clínico de hiperplasia prostática benigna y relación con el antígeno prostático específico

Abstract

BackgroundBenign prostatic hyperplasia (BPH) is the most frequent benign tumor in men above 50 years of age. Initial suspicion of prostate cancer is based on a digital rectal examination with abnormal findings or elevated serum levels of prostate-specific antigen (PSA) (≥ 4ng/mL); these patients must be evaluated in order to rule out prostate cancer. AimsThe aim of the present study was to determine the association of ultrasound-guided prostate biopsy with prostate cancer diagnosis in patients presenting with clinical BPH diagnosis. Material and methodsA descriptive analytic study was conducted within the time frame of January to July 2012. Patients diagnosed with BPH that underwent ultrasound-guided prostate biopsy were included. Data were analyzed through descriptive statistics, categorical variables were compared using the chi-square test, and odds ratio was used to determine association. ResultsThe mean age of the BPH patients was 68.5 ± 9.9 years (39-93) and the mean PSA (standard deviation, SD) was 5.9 ± 6.4ng/mL. Of these patients, 166 (47.8%) had normal PSA and in 181 (52.2%) it was abnormal. The patients with BPH had an odds ratio (OR) of 1.8 (95% CI = 1.5- 2.6); ultrasound-guided prostate biopsy was performed if they had an abnormal PSA, regardless of digital rectal examination findings and age. ConclusionsIn our study, the patients clinically diagnosed with BPH underwent ultrasoundguided prostate biopsy based on PSA levels in the majority of the cases, to rule out prostate cancer. The patients that underwent the biopsy presented with significantly higher PSA levels (10.9 ± 6.6 vs. 4.6 ± 5.4ng/mL, p=0.0001), but only 28 (32%) of them had a digital rectal examination, and free PSA and PSA density or velocity were not determined. The ultrasound-guided prostate biopsy requested by the urologists in the majority of the cases was not based on the recommendations of the clinical practice guidelines (CPG).