Correlação entre PSA e o Escore de Gleason pré e pós-operatório de pacientes com câncer de próstata no hospital Evangélico Mackenzie do Paraná
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TCC
Data de publicação
2024-11-21
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Citações (Scopus)
Autores
Santos, João Arthur Motta dos
Carvalho, Pedro Henrique Duarte
Carvalho, Pedro Henrique Duarte
Orientador
Jawosrki, Paulo Eduardo Dietrich
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Introdução: O câncer de próstata (CP) é a neoplasia mais prevalente na população masculina mundialmente, excluindo o câncer de pele não melanoma. O tumor possui como biomarcador o antígeno prostático específico (PSA) que também pode estar elevado em manifestações não neoplásicas. Dessa forma, a biópsia permitindo análise histopatológica, além de estipular o escore de Gleason (GS), é de suma importância para a compreensão da história da doença e estratificação de risco do paciente. Além disso, o entendimento das relações entre o PSA, GS e o índice de massa corporal (IMC) é extremamente relevante para o manejo terapêutico adequado dos homens acometidos. Objetivos: Avaliar a correlação entre o PSA e o GS, comparar o GS obtido pela biópsia e o posterior realizado na prostatectomia radical (PR), bem como a associar o IMC com o GS. Metodologia: Trata-se de estudo epidemiológico, transversal e retrospectivo realizado a partir da coleta dos dados de prontuários de pacientes diagnosticados com CP atendidos em hospital terciário de Curitiba/PR, do período de novembro de 2019 e abril 2023, catalogando dados clínicos, exames laboratoriais e anatomopatológicos. Após seleção pelos critérios de elegibilidade, a amostra foi composta por 109 homens. Para análise estática foram aplicados testes de Qui-quadrado e Kruskal-Wallis e correlação de Pearson. Resultados: A média de idade dos pacientes foi de 67 anos, e o tipo histológico predominante o adenocarcinoma acinar prostático. O GS mais observado foi o 7 (70,64%), sendo 40,36% correspondente à soma 3+4 e 30,27% a 4+3. Ao cruzar as variáveis de idade com o GS, não houve diferença significativa entre os grupos por faixa etária. Ao comparar o GS da biópsia com o da peça cirúrgica, constatou-se diferença significativa entre os valores, sendo que 13,76% dos pacientes foram subestadiados e 30,27% foram superestadiados na biópsia prévia. Além disso, não houve significância estatística na comparação entre os valores de PSA e o GS da prostatectomia. Ademais, relacionando os elementos da estratificação de peso com o GS da peça cirúrgica, verificou-se tendência à significância estatística, indicando que o IMC baixo ou adequado está relacionado a GS mais elevados, contrastando como fator de risco estabelecido para o CP, com resultados contrários ao esperado. Conclusão: Os dados encontrados na amostra para idade e GS estão de acordo com os encontrados na literatura para população brasileira. Além disso, a análise do IMC com o GS não veio de encontro à literatura, sendo necessários estudos nacionais com maior amostragem para melhor compreender essa característica epidemiológica. Por fim, vale destacar que foi possível observar discrepâncias entre o resultado do GS da biópsia e da peça cirúrgica, demonstrando dificuldade no estadiamento dos pacientes, o que pode impactar na escolha de um tratamento não otimizado e no prognóstico dos homens com câncer de próstata.
Introduction: Prostate cancer (CP) is the most prevalent neoplasm in the male population worldwide, excluding non-melanoma skin cancer. The tumor has prostate-specific antigen (PSA) as a biomarker, which can also be elevated in non-neoplastic manifestations. Therefore, biopsy allowing histopathological analysis, in addition to determining the Gleason score (GS), is of paramount importance for understanding the history of the disease and risk stratification of the patient. Furthermore, understanding the relationships between PSA, GS, and body mass index (IMC) is extremely relevant for the appropriate therapeutic management of affected men. Objectives: To evaluate the correlation between PSA and GS, to compare the GS obtained by biopsy and the subsequent one performed in radical prostatectomy (PR), as well as to associate BMI with GS. Methodology: This is an epidemiological, cross-sectional, and retrospective study conducted from the collection of data from medical records of patients diagnosed with CP treated at a tertiary hospital in Curitiba/PR, from November 2019 to April 2023, cataloging clinical data, laboratory tests, and anatomopathological data. After selection by eligibility criteria, the sample consisted of 109 men. For statistical analysis, Chi-square and Kruskal-Wallis and Pearson correlation tests were applied. Results: The average age of the patients was 67 years, and the predominant histological type was prostatic acinar adenocarcinoma. The most observed GS was 7 (70.64%), with 40.36% corresponding to the sum 3+4 and 30.27% to 4+3. When crossing the variables of age with GS, there was no significant difference between the groups by age group. When comparing the GS of the biopsy with that of the surgical specimen, a significant difference was found between the values, with 13.76% of patients being understaged and 30.27% being overstaged in the previous biopsy. Furthermore, there was no statistical significance in the comparison between PSA values and the GS of prostatectomy. Additionally, relating the elements of weight stratification with the GS of the surgical specimen, a trend towards statistical significance was observed, indicating that low or adequate BMI is related to higher GS, contrasting as an established risk factor for CP, with results contrary to expectations. Conclusion: The data found in the sample for age and GS are in accordance with those found in the literature for the Brazilian population. Furthermore, the analysis of IMC with GS did not meet the literature, requiring national studies with larger samples to better understand this epidemiological characteristic. Finally, it is worth noting that discrepancies were observed between the GS results of the biopsy and the surgical specimen, demonstrating difficulty in staging patients, which can impact the choice of non-optimized treatment and the prognosis of men with prostate cancer.
Introduction: Prostate cancer (CP) is the most prevalent neoplasm in the male population worldwide, excluding non-melanoma skin cancer. The tumor has prostate-specific antigen (PSA) as a biomarker, which can also be elevated in non-neoplastic manifestations. Therefore, biopsy allowing histopathological analysis, in addition to determining the Gleason score (GS), is of paramount importance for understanding the history of the disease and risk stratification of the patient. Furthermore, understanding the relationships between PSA, GS, and body mass index (IMC) is extremely relevant for the appropriate therapeutic management of affected men. Objectives: To evaluate the correlation between PSA and GS, to compare the GS obtained by biopsy and the subsequent one performed in radical prostatectomy (PR), as well as to associate BMI with GS. Methodology: This is an epidemiological, cross-sectional, and retrospective study conducted from the collection of data from medical records of patients diagnosed with CP treated at a tertiary hospital in Curitiba/PR, from November 2019 to April 2023, cataloging clinical data, laboratory tests, and anatomopathological data. After selection by eligibility criteria, the sample consisted of 109 men. For statistical analysis, Chi-square and Kruskal-Wallis and Pearson correlation tests were applied. Results: The average age of the patients was 67 years, and the predominant histological type was prostatic acinar adenocarcinoma. The most observed GS was 7 (70.64%), with 40.36% corresponding to the sum 3+4 and 30.27% to 4+3. When crossing the variables of age with GS, there was no significant difference between the groups by age group. When comparing the GS of the biopsy with that of the surgical specimen, a significant difference was found between the values, with 13.76% of patients being understaged and 30.27% being overstaged in the previous biopsy. Furthermore, there was no statistical significance in the comparison between PSA values and the GS of prostatectomy. Additionally, relating the elements of weight stratification with the GS of the surgical specimen, a trend towards statistical significance was observed, indicating that low or adequate BMI is related to higher GS, contrasting as an established risk factor for CP, with results contrary to expectations. Conclusion: The data found in the sample for age and GS are in accordance with those found in the literature for the Brazilian population. Furthermore, the analysis of IMC with GS did not meet the literature, requiring national studies with larger samples to better understand this epidemiological characteristic. Finally, it is worth noting that discrepancies were observed between the GS results of the biopsy and the surgical specimen, demonstrating difficulty in staging patients, which can impact the choice of non-optimized treatment and the prognosis of men with prostate cancer.
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Palavras-chave
antígeno prostático específico , gradação de tumores , câncer de próstata , prostate-specific antigen , neoplasm grading , prostatic neoplasms