Adenocarcinoma bem diferenciado de próstata na biópsia pode estar associado a doença extraprostática
Palavras-chave:
Próstata, Câncer de próstata, Neoplasias prostáticas, Patologia, Patologia cirúrgicaResumo
CONTEXTO E OBJETIVO: A determinação acurada do escore de Gleason nas biópsias prostáticas é fundamental para seleção do tratamento adequado para o câncer de próstata, especialmente em relação aos tumores bem diferenciados (Gleason 2 a 4), para os quais a abordagem terapêutica pode ser mais conservadora. O objetivo deste trabalho foi avaliar a correlação entre o escore de Gleason 2 a 4 na biópsia de próstata com o estádio patológico final após a prostatectomia radical. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. MÉTODOS: Foram revisados os prontuários médicos de 120 pacientes submetidos a prostatectomia radical retropúbica para tratamento de câncer de próstata localizado em nossa instituição entre dezembro de 2001 e julho de 2006. Trinta e dois destes pacientes apresentavam diagnóstico de câncer de próstata bem-diferenciado na biópsia prostática com agulha e foram incluídos no estudo. Os resultados das biópsias de próstata com agulha foram comparados com o estadiamento patológico final dos espécimes cirúrgicos obtidos com a prostatectomia radical. RESULTADOS: 16 de 32 pacientes (50%) apresentaram câncer de próstata moderadamente diferenciado (escore de Gleason 5 a 7) na avaliação do espécime cirúrgico. 18 de 32 pacientes (56%) apresentavam acometimento da cápsula prostática pelo tumor, sendo que 10 (31%) destes pacientes apresentavam, em associação, envolvimento de órgãos adjacentes. Avaliando os 16 pacientes que mantiveram escore de Gleason 2 a 4 no estadiamento patológico da peça cirúrgica, 11 (68,7%) destes pacientes apresentavam invasão focal da cápsula prostática e 5 (31,25%) pacientes apresentavam doença confinada à próstata. CONCLUSÃO: Tumores bem diferenciados da próstata na biópsia com agulha (escore de Gleason 2 a 4) não são preditivos de doença órgão-confinada.
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