Cancer de próstata: Nuevas técnicas diagnósticas. Estado actual de la biopsia de próstata

Abstract

OBJETIVES: Ultrasound guided prostate biopsy is the only method to obtain the confirmation diagnosis of prostate cancer. Since its introduction at the end of the '80s multiple modifications of the technique have been implemented to improve cancer detection rates and to diminish the rate of false negative results, with maximum patient comfort and less complications. METHODS: Bibliographic review and critical analysis of the literature on prostate biopsy. RESULTS/CONCLUSIONS: Published studies suggest extensive biopsy schemes increase detection rates in comparison to sextant biopsies, both first and successive biopsies, being necessary to sample the most lateral areas of the gland and the dorsal apex where the diagnostic yield is greater. The indications for repeated biopsies after a negative one include high grade PIN and/or Atypical Small Acinar Proliferation (ASAP), persistent PSA elevation and/or total PSA doubling time increase. There is no consensus about the time for repeating biopsies, although it seems that cancer detection rates descend after the third biopsy. The introduction of periprostatic anesthetic blockage techniques has enabled pain control, mainly in more extensive biopsies.