Ricardo García González

Rentabilidad de la biopsia ampliada con 10 muestras prostáticas: Estudio prospectivo sobre 222 pacientes

Resumen es: Objetivo: Actualmente no esta establecido ni el numero de muestras ni de biopsias para el correcto diagnostico del cancer prostatico. Presentamos nuestra...

TOLERANCIA Y COMPLICACIONES DE LA BIOPSIA TRANSRECTAL ECODIRIGIDA PROSTÁTICA AMPLIADA A DIEZ CILINDROS. PAPEL DEL BLOQUEO DE HACES NEUROVASCULARES CON LIDOCAÍNA

OBJECTIVES The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles. METHODS A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events. RESULTS The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p < 0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p < 0.0002). The results of the visual analogical scale for pain were 2.46 +/- 1.67 and 4.5 +/- 2.11 for the anesthesia/without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission. CONCLUSIONS The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain.Resumen es: OBJETIVO: El creciente interes por ampliar el numero de muestras obtenidas durante la biopsia transrectal ecodirigida prostatica nos ha hecho evaluar la ...

Results of a series of transrectal ultrasound guided biopsy of the prostate in 6000 patients: Part II: PSA derived parameters

Resumen es: OBJETIVO: En esta serie se revisan los resultados de 6000 pacientes biopsiados en una o mas ocasiones por sospecha de CP, analizando el papel que puedan ...

Criocirugía (Tercera Parte): Revisión de la literatura y nuestra experiencia (II)

Resumen es: OBJETIVOS: La criocirugia es una tecnica verdaderamente mini-invasiva, eficaz para tratar el adenocarcinoma de prostata con riesgo quirurgico escaso, nul...

Biopsia transrectal ecodirigida de próstata: aportación de una unidad urológica de diagnóstico ecográfico tras 10 años de experiencia

OBJECTIVES: Although transrectal ultrasound-guided (TRUS) prostatic biopsy is the procedure of choice for the diagnosis of prostate cancer (PC), neither the ideal number of cores nor the number of repeated biopsies, nor the required diagnostic yield have been established. After our experience of ten years with TRUS biopsy we perform a review of the technique and its indications. METHODS: PSA, ultrasound features, and pathologic data of 6000 patients undergoing modified sextant TRUS biopsy between 1994 to December 2002 were collected. 222 patients undergoing ten-core TRUS biopsy were included in an experimental group to study the role of the extended biopsy. The contribution of the extra cores to the diagnostic yield in the experimental group was studied to determine the effectiveness of the extended biopsy, using as a control group 552 patients undergoing sextant TRUS biopsy during 2002. Both groups were comparable for the study variables at the start of the study. RESULTS: The incidence of PC in the first biopsy in the group of 6000 patients was 39.1% (2345/6000). Patients with PSA between 4 and 10 ng/ml have an incidence of PC greater than 50% among prostates smaller than 20 cc, diminishing down to 8.9% in those greater than 50 cc. The percentage of PC among patients with negative digital rectal examination (DRE), normal TRUS, and PSA below 4 ng/ml was 16.7%. The diagnostic yield for PSA density lower than 0.11 ng/ml/cc was lower than 8%. The free/total PSA ratio shows a 13.7% incidence of PC with values higher than 0.24. Multivariate logistic regression analysis showed that the only non-significant parameter was free/total PSA. Sixty (27.15%) patients of the extended TRUS biopsy group had PC. Only 2.25% of the 221 patients benefited from the augmented number of biopsies. There were no significant differences in the figures of prostate cancer between groups. Only PSA and volume where significant in the multivariate logistic regression analysis; number of samples, PSA density and age lacked of influence in the detection of PC. CONCLUSIONS: The sextant biopsy model obtaining cores from the lateral horns of the prostate continues to be the reference for TRUS biopsy, and the extended biopsy is not applicable to all patients from the beginning do to the small increase in the diagnostic yield. Isolated PSA may not be the unique reference to indicate TRUS biopsy, being volume, in our experience, a definitive factor for the adjustment of high risk levels.

Papel del volumen prostático en la biopsia transrectal ecodirigida de próstata: ¿es un marcador tan importante como el PSA?

Resumen es: Resumen.- OBJETIVO: La limitacion del PSA para identificar a los pacientes con cancer prostatico ha hecho que se definan diferentes parametros que aument...