La biopsia de próstata y sus carencias en el diagnóstico de cáncer de próstata.

 

La biopsia transrectal de próstata es la técnica diagnóstica más utilizada hasta el momento actual para detectar la presencia de un cáncer de próstata. Se suelen coger entre 8 y 12 muestras, de forma aleatoria, de ambos lóbulos de la próstata. A pesar de su uso, esta forma de realizar la biopsia de próstata tiene muchas limitaciones puesto que detecta cánceres de bajo grado (no van a afectar a la calidad y vida del paciente, y muchas veces no logra detectar los cánceres de importancia); además, las complicaciones infecciosas pueden ser significativas.

En los EEUU, se realizan más de 1 millón de biopsias de próstata al año. El análisis del Programa de Vigilancia epidemiológica de este país, informó que la probabilidad de hospitalización por infección en los 30 días posteriores a una biopsia transrectal de próstata fue de 2,26 veces mayor. Una de las principales razones de este aumento de complicaciones en los últimos años es la mayor resistencia bacteriana a los antibióticos profilácticos que aconsejamos previamente a la biopsia.

También, con este tipo de biopsia existe la probabilidad de que algunos cánceres se quedan sin diagnosticar. Como he escrito en múltiples ocasiones, la biopsia transrectal realiza unas punciones a “ciegas” en varias zonas de la próstata. Si tras una o varias biopsias de próstata con resultado negativo, el PSA se sigue incrementando, una opción es hacer una biopsia por saturación. Esta biopsia se realiza en quirófano y el número de muestras que se pueden recoger varía entre 18 y hasta 24. Esta técnica aumenta la tasa de complicaciones del procedimiento como pueden ser el sangrado, el dolor y la infección.

Para mejorar las importantes limitaciones y los riesgos de la biopsia transrectal de próstata, se han incorporado marcadores específicos en sangre como pueden ser el 4K, en orina como el PCA3 y pruebas radiológicas específicas como la Resonancia Multiparamétrica de próstata. El objetivo final es reducir el gran número de biopsias de próstata innecesarias y las complicaciones de las mismas.

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