Porcentaje de subgraduación del puntaje de Gleason en la biopsia transrectal de pacientes candidatos a vigilancia activa

La vigilancia activa (VA) constituye una alternativa de manejo valida para pacientes con cancer de prostata que cumplen con ciertos criterios que incluyen las caracteristicas anatomopatologicas de la biopsia preoperatoria transrectal. La subgraduacion del puntaje de Gleason en la biopsia preoperatoria respecto de la biopsia definitiva se reporta en un 24-39 por ciento de los casos, lo que constituye un problema al momento de querer incluir a un paciente en un protocolo de vigilancia. El objetivo principal de este estudio consistio en determinar el porcentaje de subgraduacion del score de Gleason en biopsias preoperatorias de pacientes que cumplian criterios para VA pero que fueron sometidos a prostatectomia radical y la relacion con el numero de punciones realizadas y el porcentaje de subgraduacion. Se incluyo restrospectivamente a 167 pacientes sometidos a prostatectomia radical, que por sus caracteristicas preoperatorias cumplian criterios para ingresar a un protocolo de VA. Se evaluo la concordancia entre las biopsias preoperatorias y definitivas y ademas la relacion entre el numero de punciones realizadas y el nivel de subgraduacion. 52 pacientes (31,1 por ciento) tuvieron un puntaje de Gleason mayor a 6 (GS 7 n=49; GS 8 n=3) en la biopsia definitiva. El menor porcentaje de subgraduacion (23.4 por ciento) se observo en el grupo de pacientes que se sometio a biopsias preoperatorias que incluyeron 15 o mas punciones. La biopsia prostatica preoperatoria presenta un significativo porcentaje de subgraduacion respecto a la biopsia definitiva, que tiende a disminuir al aumentar el numero de punciones realizadas. Estos factores deben ser considerados al momento de ofrecer al paciente su ingreso a un protocolo de VA. (AU) Active surveillance (AS) is a validated alternative for the management of patients with prostate cancer that meet certain criteria including the histopathological characteristics of preoperative transrectal biopsy. The down-grading of preoperative Gleason score compared to postoperative biopsy is reported in 24-39 percent of cases, which represents a significative problem to include a patient in a AS protocol. The main objective of this study was to determine the percentage of down-grading Gleason score compared to postoperative biopsy is reported in 24-39 percent of cases, which represents a significative problem to include a patient in a AS protocol. The main objective of this study was to determine the percentage of down-grading of the preoperative Gleason score compared to the definitive score in biopsy specimens from patients that met criteria for AS but that were subjected to a radical prostatectomy, and the relation between the number of punctures and the percentage of downgrading. 167 patients subjected to radical prostatectomy were retrospectively included, all of them having preoperative characteristics that fulfilled the criteria for entry into an AS protocol. We evaluated the correlation between preoperative and postoperative biopsies. We also evaluated the relationship between the number of punctures and the percentage of down-grading in the preoperative biopsy. RESULTS: 52 patients (31.1 percent) were found to have a Gleason score higher than 6 (GS 7 n=49; GS 8 n=3) in the definitive biopsy. The lowest percentage of downgrading (23.4 percent) was observed in the group of patients with preoperative biopsies that included 15 or more punctures. The preoperative prostatic biopsy has a significant percentage of downgrading compared to the definitive biopsy, which tends to decrease with increasing the number of punctures. These factors must be considered when offering AS to a patient. (AU)