Abstract
Background: In the last decade, the introduction of multiparametric magnetic resonance imaging (mpMRI) and fusion ultrasound-targeted mpMRI (TBx) has generated great expectations about the diagnostic pathway for prostate cancer. This method also has better sensitivity for locating and detecting clinically significant tumors, and is used to target biopsies specifically to suspicious areas.
Aim: Through an observational study, evaluate the experience of a private clinic in performing TBx-guided prostate biopsies. Method: This is an observational, retrospective study, which used information from medical records already archived at the Instituto de Urologia Bragança, located in the city of Bragança Paulista – SP, Brazil, of patients treated from September 2021 to March 2023, and which performed TBx-guided prostate biopsies.
Results: In the present study, it was observed that the average age of the patients was approximately 66 years old, with an average PSA of 7.70 ng/mL. Among the patients evaluated, approximately one third had an increased risk of prostate cancer based on the values of the relationship between free PSA and total PSA. The most prevalent PIRADS classification in the studied sample was 4, and among patients with PIRADS classification 3, who would not naturally be indicated for biopsy, PSAd greater than 0.15 was identified in just over a third of them, suggesting that the they should also be subjected to examination. The majority of patients evaluated in our sample presented a negative result based on the Gleason scale. Among the positives, the most prevalent was 3+4.
Conclusion: This study evaluated our Service's experience in performing fusion ultrasound, describing the epidemiological profile of patients and identifying those who actually required prostate biopsy for cancer research. As the main result, it was possible to identify the superiority of fusion biopsy when compared to randomized biopsy. It is suggested that similar surveys be carried out in various regions of Brazil with a view to verifying whether the phenomenon observed in our region could be repeated on a national scale.
References
BRASIL. Ministério da Saúde. Câncer de próstata. Disponível em: <https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/c/cancer-de-prostata/cancer-de-prostata>. Acesso em: 17 nov. 2023.
DEMUNER, B. B.; CARRIJO-CARVALHO, L. C. Avaliação de fatores de risco e antígeno prostático específico no rastreamento de câncer de próstata. Revista de Ciências Médicas e Biológicas, v. 20, n. 2, p. 235–239, 29 set. 2021.
DROST, F.-J. H. et al. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. The Cochrane Database of Systematic Reviews, v. 4, n. 4, p. CD012663, 25 abr. 2019.
FINE, S. Classification/Stratification Systems for Prostate Cancer. Medscape, , 2022. Disponível em: <http://decisionpoint.medscape.com/viewarticle/974563>. Acesso em: 17 nov. 2023
FOREMAN, K. J. et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet (London, England), v. 392, n. 10159, p. 2052–2090, 10 nov. 2018.
FULCO, A. et al. Multiparametric Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Prostate Biopsy: Diagnostic Accuracy from a Single Center Retrospective Study. Cancers, v. 13, n. 19, p. 4833, 28 set. 2021.
GBD 2017 Disease and injury incidence and prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England), v. 392, n. 10159, p. 1789–1858, 10 nov. 2018.
HASSANZADEH, E. et al. Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2): A pictorial review. Abdominal radiology (New York), v. 42, n. 1, p. 278–289, jan. 2017.
HOOGENDAM, A.; BUNTINX, F.; DE VET, H. C. The diagnostic value of digital rectal examination in primary care screening for prostate cancer: a meta-analysis. Family Practice, v. 16, n. 6, p. 621–626, dez. 1999.
JAIN, M. A.; LESLIE, S. W.; SAPRA, A. Prostate Cancer Screening. Em: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023.
LEE, S. H.; SHEN, M. M. Cell types of origin for prostate cancer. Current Opinion in Cell Biology, v. 37, p. 35–41, dez. 2015.
LEIN, M. et al. Relation of Free PSA/Total PSA in Serum for Differentiating Between Patients with Prostatic Cancer and Benign Hyperplasia of the Prostate: Which Cutoff Should Be Used? Cancer Investigation, v. 16, n. 1, p. 45–49, 1 jan. 1998.
LILJA, H.; ULMERT, D.; VICKERS, A. J. Prostate-specific antigen and prostate cancer: prediction, detection and monitoring. Nature Reviews. Cancer, v. 8, n. 4, p. 268–278, abr. 2008.
LOY, L. M. et al. A systematic review and meta-analysis of magnetic resonance imaging and ultrasound guided fusion biopsy of prostate for cancer detection-Comparing transrectal with transperineal approaches. Urologic Oncology, v. 38, n. 8, p. 650–660, ago. 2020.
MAGALHÃES PINA, J. et al. Biópsia prostática dirigida por fusão cognitiva após ressonância magnética multiparamétrica. Comparação com a técnica habitual de biópsia aleatória. Acta Urológica Portuguesa, v. 32, n. 3, p. 101–107, 1 set. 2015.
MARRA, G. et al. Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach? World Journal of Urology, v. 37, n. 2, p. 277–287, fev. 2019.
MARRA, G. et al. Transperineal Free-hand mpMRI Fusion-targeted Biopsies Under Local Anesthesia: Technique and Feasibility From a Single-center Prospective Study. Urology, v. 140, p. 122–131, jun. 2020.
MARRA, G. et al. Transperineal freehand multiparametric MRI fusion targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicentre prospective study of 1014 cases. BJU international, v. 127, n. 1, p. 122–130, jan. 2021.
MOTTET, N. et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. European Urology, v. 71, n. 4, p. 618–629, abr. 2017.
MUNJAL, A.; LESLIE, S. W. Gleason Score. Em: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023.
NGUYEN-NIELSEN, M.; BORRE, M. Diagnostic and Therapeutic Strategies for Prostate Cancer. Seminars in Nuclear Medicine, v. 46, n. 6, p. 484–490, nov. 2016.
PARK, J. W. et al. Prostate epithelial cell of origin determines cancer differentiation state in an organoid transformation assay. Proceedings of the National Academy of Sciences of the United States of America, v. 113, n. 16, p. 4482–4487, 19 abr. 2016.
REBELLO, R. J. et al. Prostate cancer. Nature Reviews. Disease Primers, v. 7, n. 1, p. 9, 4 fev. 2021.
SANDHU, S. et al. Prostate cancer. The Lancet, v. 398, n. 10305, p. 1075–1090, 18 set. 2021.
SBU. Sociedade Brasileira de Urologia. Câncer de Próstata. , 2023. Disponível em: <https://sbu-sp.org.br/publico/cancer-de-prostata-3/>. Acesso em: 17 nov. 2023
SFANOS, K. S. et al. The inflammatory microenvironment and microbiome in prostate cancer development. Nature Reviews. Urology, v. 15, n. 1, p. 11–24, jan. 2018.
SPEKTOR, M.; MATHUR, M.; WEINREB, J. C. Standards for MRI reporting—the evolution to PI-RADS v 2.0. Translational Andrology and Urology, v. 6, n. 3, p. 355–367, jun. 2017.
ULMERT, D. et al. Long-term prediction of prostate cancer: prostate-specific antigen (PSA) velocity is predictive but does not improve the predictive accuracy of a single PSA measurement 15 years or more before cancer diagnosis in a large, representative, unscreened population. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, v. 26, n. 6, p. 835–841, 20 fev. 2008.
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