Son los criterios de vigilancia activa suficientes para predecir el cáncer de próstata de estadio avanzado

Resumen Objetivos Examinar los resultados del tratamiento en pacientes con cancer de prostata (CP) tratados con prostatectomia radical (PR) que podrian ser buenos candidatos para vigilancia activa (VA) y evaluar la confianza y fiabilidad de los criterios de VA para predecir la enfermedad en estadios avanzados (puntuacion de Gleason en PR ≥ 7 o estadio patologico T3). Metodos Entre 2005 y 2012 se examinaron los registros de 401 pacientes sometidos a PR con un diagnostico de CP. De estos pacientes 173 resultaron ser candidatos para VA. Los criterios de inclusion fueron los siguientes: estadio clinico T2a o inferior, PSA  Resultados Los analisis univariantes revelaron que los pacientes con un estadio mas avanzado de la enfermedad tenian una densidad del antigeno prostatico especifico (PSAD) mas elevada, un mayor porcentaje maximo (%max) de nucleos positivos y un mayor volumen tumoral en PR. En los analisis multivariantes la PSAD, el %max de nucleos positivos y el volumen tumoral en PR eran factores estadisticamente significativos de enfermedad en estadios avanzados. Los analisis ROC revelaron que el volumen tumoral en PR es un buen test de la enfermedad en estadio avanzado. Conclusiones Se deberia considerar reducir los valores umbral de PSAD y %max en nucleos positivos como criterios de inclusion para VA. Si se pudiera calcular el volumen tumoral antes de la PR podriamos minimizar los fracasos del tratamiento (exceso o falta de tratamiento) de CP. Quizas los nuevos protocolos de biopsias, los biomarcadores de tejidos y la tecnologia de imagenes moleculares puedan perfeccionar los criterios para VA.

[1]  J. Machan,et al.  Diffusion-weighted MRI of peripheral zone prostate cancer: comparison of tumor apparent diffusion coefficient with Gleason score and percentage of tumor on core biopsy. , 2010, AJR. American journal of roentgenology.

[2]  M. Kattan,et al.  The utility of magnetic resonance imaging and spectroscopy for predicting insignificant prostate cancer: an initial analysis , 2007, BJU international.

[3]  A Semjonow,et al.  Implementation of a map in radical prostatectomy specimen allows visual estimation of tumor volume. , 2007, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[4]  Baris Turkbey,et al.  Correlation of magnetic resonance imaging tumor volume with histopathology. , 2012, The Journal of urology.

[5]  James A Eastham,et al.  Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance. , 2008, The Journal of urology.

[6]  H. J. G. Gundersen,et al.  The new stereological tools: Disector, fractionator, nucleator and point sampled intercepts and their use in pathological research and diagnosis , 1988, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[7]  S. Srivastava,et al.  PCA3 score before radical prostatectomy predicts extracapsular extension and tumor volume. , 2008, The Journal of urology.

[8]  A. Shalhav,et al.  Robotic laparoscopic radical prostatectomy for biopsy Gleason 8 to 10: prediction of favorable pathologic outcome with preoperative parameters. , 2008, Journal of endourology.

[9]  J. Epstein,et al.  Characterization of minute adenocarcinomas of prostate at radical prostatectomy. , 2004, Urology.

[10]  Thomas Wheeler,et al.  An analysis of men with clinically localized prostate cancer who deferred definitive therapy. , 2004, The Journal of urology.

[11]  T. Tammela,et al.  Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly. , 2009, European urology.

[12]  L. Egevad,et al.  The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma , 2005, The American journal of surgical pathology.

[13]  A. Jemal,et al.  Cancer Statistics, 2007 , 2007, CA: a cancer journal for clinicians.

[14]  G. Bartsch,et al.  Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range , 2008, Prostate Cancer and Prostatic Diseases.

[15]  Lars Egevad,et al.  International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume , 2011, Modern Pathology.

[16]  W. Catalona,et al.  Prostate specific antigen density correlates with features of prostate cancer aggressiveness. , 2007, The Journal of urology.

[17]  A. Partin,et al.  Multiparametric magnetic resonance imaging findings in men with low‐risk prostate cancer followed using active surveillance , 2013, BJU international.

[18]  E. Metter,et al.  Expectant management of prostate cancer with curative intent: an update of the Johns Hopkins experience. , 2007, The Journal of urology.

[19]  Alan Horwich,et al.  Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance. , 2008, European urology.

[20]  P. Carroll,et al.  Pathological outcomes of candidates for active surveillance of prostate cancer. , 2009, The Journal of urology.

[21]  K. Wallner,et al.  Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting , 2009, Prostate Cancer and Prostatic Diseases.

[22]  S. Phillips,et al.  Tumor volume as a predictor of adverse pathologic features and biochemical recurrence (BCR) in radical prostatectomy specimens: A tale of two methods , 2010, World Journal of Urology.

[23]  Alan W Partin,et al.  Characteristics of insignificant clinical T1c prostate tumors , 2004, Cancer.

[24]  M. Soloway,et al.  Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. , 2010, European urology.

[25]  M. Cooperberg,et al.  Active surveillance for the management of prostate cancer in a contemporary cohort , 2008, Cancer.

[26]  P. Troncoso,et al.  PCA3 molecular urine assay correlates with prostate cancer tumor volume: implication in selecting candidates for active surveillance. , 2008, The Journal of urology.