Variação de dados clínicos e histológicos com o Grau de Gleason na Biópsia Prostática

Abstract

Introduction: In Europe, prostate cancer is the most common solid neoplasm in males. In most cases the diagnosis is made by prostate biopsy following changes in PSA or digital rectal exam (DRE). The Gleason score is a key element in addressing prostate carcinoma, with particular importance in treatment decisions and long-term prognosis.Objective: This study aims to assess the interrelationship between Gleason and DRE, age, PSA, ultrasound study and histological results in patients undergoing transrectal prostate biopsy.Materials and methods: Retrospective study of 290 transrectal ultrasound-guided prostate biopsies performed between January 2012 and December 2013. 10 cases were excluded due to lack of relevant information in the clinical file or repeated biopsy.Results: Of the 280 prostatic biopsies evaluated, 156 (55.7%) showed acinar adenocarcinoma of the prostate. The mean age of patients with carcinoma was statistically higher than those without histological evidence of adenocarcinoma (p = 0.001). The PSA ranged between 0.4 and 541ng/ml: in the subset of negative biopsy the average was 8.88 (± 4.49) ng/ml compared with 37.51 (± 73.79) ng/ml for the sub-group of Prostate Adenocarcinoma (p < 0.001). PSA also changed significantly within Gleason score: the mean PSA in patients with poorly differentiated carcinomas was superior to those with well or moderately differentiated carcinomas (p < 0.001). The DRE is described in 265 patients and suspicious in 115 (43.4%): the positive and negative predictive value was 82.6% and 64.7%, respectively, showing a higher sensitivity for diagnosis of high-grade tumors (Gleason ≥ 4+3).This study also revealed a statistically significant relationship between the degree of tumor differentiation and ultrasound study, presence of perineural invasion, number of positive fragments and maximum involvement exceeding 50% per fragment.Discussion / Conclusion: This study aims to demonstrate the differences between age, PSA, DRE, existence of hypoechoic nodules and histological data of prostate biopsy in well or moderately differentiated adenocarcinoma of the prostate (Gleason ≤ 3 +4) versus poorly differentiated (Gleason ≥ 4+3).© 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.