Beneficios y perjuicios del PSA.

Hay mucha variación por países en la realización del Antígeno Prostático Específico (PSA), el marcador prostático en sangre . En el Reino Unido, el 39% de los hombres de 45-69 años se han hecho un PSA en los últimos 10 años frente a un 23% de los hombres suecos. En los EEUU, hasta la mitad de los varones se han realizado este análisis.

Un artículo publicado por el British Medical Journal hace una revisión sobre los beneficios y perjuicios de realizar PSA en la población, tomando como referencia 5 ensayos clínicos con 721.718 hombres.

La realización de PSA incrementa la detección del cáncer de próstata en 7 por cada 1000 hombres a los 10 años, particularmente el cáncer de próstata localizado, pero la determinación generalizada del PSA no incide en la mortalidad por cáncer de próstata. Por tanto, la realización del test de PSA, probablemente tiene una pequeña o ninguna consecuencia sobre la mortalidad por este cáncer. El PSA incrementa el diagnóstico del cáncer de próstata, pero no significa que detecte cánceres de próstata avanzados.

Casi dos tercios de los hombres que se realizan una biopsia de próstata por PSA elevado, no tendrán cáncer de próstata en el resultado de la biopsia.

Los detractores de hacer PSA de forma rutinaria exponen que alrededor de un 15% de los hombres con un PSA normal serán diagnosticados de un cáncer, y un 2% de los hombres con un PSA normal tendrán, además, un cáncer de próstata avanzado.
Cada biopsia de próstata tiene el riesgo de importantes efectos secundarios y serias complicaciones que incluyen sangre en el semen (93%), sangre en la orina (66%), dolor (44%), fiebre (18%) e ingresos hospitalarios por sepsis (1-2%). Por ello, las nuevas técnicas como la biopsia guiada por resonancia, los marcadores genéticos y las herramientas de estratificación de riesgo, serán decisivos en los próximos años.

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