Deteccion del cáncer de próstata en el rango de psa entre 3 y 3,9 ng/ml
J.M. Gómez De Vicente1, M. Luján Galán, A. Páez Borda, I. Romero Cagigal, A. Moreno Santurino, D. Santos Arrontes, A. Berenguer Sánchez
Servicio de Urología. Hospital Universitario de Getafe. Madrid
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Alonso Gracia, J.A. Lorente Garin, G. Conde Santos, E. De León Morales, D. Cañís Sánchez, A. Gelabert-Más" "autores" => array:6 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Alonso Gracia" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Lorente Garin" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Conde Santos" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "De León Morales" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Cañís Sánchez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Gelabert-Más" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021048060272771X?idApp=UINPBA00004N" "url" => "/02104806/0000002600000004/v1_201304251653/S021048060272771X/v1_201304251653/es/main.assets" ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Deteccion del cáncer de próstata en el rango de psa entre 3 y 3,9 ng/ml" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "274" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Gómez De Vicente, M. Luján Galán, A. Páez Borda, I. Romero Cagigal, A. Moreno Santurino, D. Santos Arrontes, A. Berenguer Sánchez" "autores" => array:7 [ 0 => array:3 [ "nombre" => "J.M." "apellidos" => "Gómez De Vicente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Luján Galán" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Páez Borda" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Romero Cagigal" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Moreno Santurino" ] 5 => array:2 [ "nombre" => "D." "apellidos" => "Santos Arrontes" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Berenguer Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología. Hospital Universitario de Getafe. Madrid" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Dr. J.M. Gómez de Vicente Servicio de Urología Hospital Universitario de Getafe Ctra. Toledo km. 12,500, N. 401 28905 Getafe (Madrid)" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2002-02-07" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras Clave" "identificador" => "xpalclavsec86608" "palabras" => array:3 [ 0 => "Cáncer de próstata" 1 => "Antígeno Específico Prostático" 2 => "Screening" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec86607" "palabras" => array:3 [ 0 => "Prostate Cancer" 1 => "Prostate Specific Antigen" 2 => "Screening" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En este estudio se analiza el beneficio de reducir el valor de PSA para el cual se indica una biopsia prostática de 4 a 3 ng/ml.</p> <span class="elsevierStyleSectionTitle">Material Y Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Partimos de 4.278 pacientes procedentes de un programa de screening de cáncer de próstata. Consideramos 1.217 actuaciones en las que se realizó determinación sérica de PSA, indicando la biopsia prostática cuando el PSA era =3 ng/ml. En ningún caso el TR (TR) fue la indicación para realizar la misma. Todas las biopsias fueron sextantes y ecodirigidas por vía transrectal. Comparamos el rendimiento de la biopsia al emplear como puntos de corte 4 y 3 ng/ml.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De Las 1.217 actuaciones realizadas, 947 presentaron valores de PSA inferiores a 3 ng/ml, 80 entre 3 y 3,9 ng/ml y 190 por encima de 4 ng/ml. De los 270 pacientes que componen estos dos últimos grupos, 189 (70%) se sometieron a una biopsia prostática. Con el nivel de corte establecido de forma habitual (4 ng/ml) se indicaron 134 biopsias y se detectaron 28 cánceres (valor predictivo positivo 20,9%). Sin embargo al reducir el punto de corte a 3 ng/ml el número de biopsias indicadas ascendió a 189, detectando 34 cánceres (valor predictivo positivo 17,9%). El descenso en el rendimento de la biopsia no fue significativo (OR=0,89). De los 6 tumores detectados al reducir el punto de corte, ninguno era palpable o visible (T1c), todos presentaron un score de Gleason menor de 7 y la mitad cumplían criterios de tumor clinicamente relevante.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La Reducción del valor de PSA a 3 ng/ml como punto de corte para indicar una biopsia prostática ha supuesto un incremento en la tasa de detección del cáncer de próstata de un 21,4%, sin reducir significativamente el rendimiento de la biopsia. Por tanto, creemos que la inclusión del grupo de pacientes con PSA entre 3 y 3,9 ng/ml como candidatos a biopsiar es importante en un programa de screening precoz de cáncer de próstata.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objetive</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In our study, we analize the benefit of lowering the PSA cutoff point for which a prostate biopsy is indicated from 4 to 3 ng/ml.</p> <span class="elsevierStyleSectionTitle">Materials And Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We have considered 4.278 individuals coming from a prostate cancer screening program. We studied 1.217 interventions in wich PSA was deteminated, indicating the prostate biopsy with PSA =3 ng/ml. Digital rectal examination was never the indication for the biopsy. All biopsies were sextant and assisted by transrectal ultrasound. We compared the performance of the biopsy using 4 and 3 ng/ml as cut points.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 1.217 interventions performed, 947 had PSA values lower than 3 ng/ml, 80 between 3 and 3.9 ng/ml and 190 over 4 ng/ml. A total of 189 patients (70% of these two last groups) underwent a prostate biopsy. With 4 ng/ml as the cut point, 134 biopsies were indicated, detecting 28 cancers (positive predictive value 20.9%). However 189 biopsies were indicated and 34 cancers detected by lowering the cut point to 3 ng/ml (positive predictive value 17,9%). The reduction in the biopsy performance was not statistically significant (OR=0,89). None of the 6 additional cancers detected was palpable or ecographically visible (T1c), all of them had a Gleason score under 7 and half of them could be considered clinically relevant.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Lowering PSA cutoff point from 4 to 3 ng/ml improved the detection rate in 21.4% not jeopardizing the biopsy performance. Therefore, we think that the group of patients with PSA between 3 and 3.9 ng/ml as candidates for prostate biopsy, should be included in screening programs.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.T. 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