{"id":1623,"date":"2020-08-10T10:07:06","date_gmt":"2020-08-10T10:07:06","guid":{"rendered":"https:\/\/bxta-staging.website\/prostate-biopsy-a-change-of-approach\/"},"modified":"2021-09-14T21:33:15","modified_gmt":"2021-09-14T21:33:15","slug":"prostate-biopsy-a-change-of-approach","status":"publish","type":"post","link":"https:\/\/bxta.com\/es\/prostate-biopsy-a-change-of-approach\/","title":{"rendered":"Biopsia de pr\u00f3stata: un cambio de planteamiento"},"content":{"rendered":"
\n
A PESAR de los avances significativos que se han dado estos \u00faltimos a\u00f1os en la utilizaci\u00f3n de im\u00e1genes para el diagn\u00f3stico del c\u00e1ncer de pr\u00f3stata, sobre todo en las de resonancia magn\u00e9tica (IRM) y la molecular, las biopsias siguen siendo la base del diagn\u00f3stico de c\u00e1ncer de pr\u00f3stata. Se realizan sobre 2 millones de biopsias de pr\u00f3stata al a\u00f1o en todo el mundo, y se llevan a cabo v\u00eda transrectal o transperineal.<\/div>\n
Las biopsias de pr\u00f3stata guiadas por ultrasonido transrectal tradicionales (TRUSB) implican realizar una prueba de ultrasonido junto con la introducci\u00f3n de la aguja de biopsia en el recto. La aguja pasa a trav\u00e9s del recto hasta llegar a la pr\u00f3stata, por lo que la intervenci\u00f3n deja de ser en condiciones de esterilidad. Por tanto, la TRUSB precisa utilizar una amplio espectro de antibi\u00f3ticos para reducir el riesgo de sepsis, lo cual puede poner en peligro la vida. De hecho, la tasa de sepsis relacionadas con TRUSB ha ido en aumento. Nam y colaboradores observaron un aumento en la tasa de hospitalizaciones por sepsis relacionadas con TRUSB, desde un 0,6% en 1996 hasta el 3,5% en 2005, en un estudio retrospectivo de pacientes sometidos a TRUSB en Canad\u00e1. Las tasas de sepsis por TRUSB suelen variar entre el 1% y el 5%, aunque pueden llegar al 17,5%.<\/div>\n
Otro de los problemas del TRUSB es que se necesita una profilaxis de un amplio espectro de antibi\u00f3ticos, fomentando el desarrollo de organismos resistentes a estos (aqu\u00ed, y aqu\u00ed). Se suelen utilizar fluoroquinolonas, pero hay una preocupaci\u00f3n por la relaci\u00f3n entre las fluoroquinolonas y los posibles efectos adversos serios, tales como diarrea, v\u00f3mitos, tendinopat\u00edas, miopat\u00edas, problemas del sistema nervioso central, desprendimiento de retina y aneurisma a\u00f3rtica. De hecho, la Asociaci\u00f3n Europea de Urolog\u00eda advirti\u00f3 recientemente que no se deber\u00eda seguir usando como profilaxis para las pruebas TRUSB.<\/div>\n
El problema no es solo la fluoroquinolona, sino un espectro de antibi\u00f3ticos m\u00e1s amplio (es decir, las carbapenemas) que se utilizan en su lugar, aumentando la prevalencia de bacterias beta-lactamasa de amplio espectro y otras bacterias resistentes. En realidad, es cuesti\u00f3n de tiempo que surjan cepas resistentes a estos antibi\u00f3ticos.<\/div>\n
Afortunadamente, existe una alternativa a la biopsia transrectal.<\/div>\n
Las biopsias transperineales de pr\u00f3stata (TPB) tambi\u00e9n implican insertar una sonda de ultrasonidos en el recto para visualizar la pr\u00f3stata, pero la aguja, pasa a trav\u00e9s de la piel del perineo hasta llegar a la pr\u00f3stata. Se puede limpiar la piel perineal con alg\u00fan agente t\u00f3pico, siguiendo un procedimiento est\u00e9ril. El TBP tiene unas tasas m\u00e1s reducidas de infecci\u00f3n y sepsis, incluso cuando no se utiliza la profilaxis por antibi\u00f3ticos. Vyas y colaboradores y Pepe y colaboradores observaron una tasa s\u00e9ptica del 0% en sus series de TPB de 634 y 3000 pacientes, respectivamente. Otros estudios, como el de Baba y colaboradores, han demostrado una tasa s\u00e9ptica muy baja, del 0,82% en una serie retrospectiva de 495 pacientes sometidos a TPB.<\/div>\n
Adem\u00e1s de ofrecer una menor tasa de infecci\u00f3n demostrada, est\u00e1 demostrado que la TPB da mejores tasas de detecci\u00f3n de tumores en la pr\u00f3stata anterior, frente al TRUSB (aqu\u00ed, aqu\u00ed y aqu\u00ed). Por tanto, es a\u00fan m\u00e1s necesario moverse hacia la TPB.<\/div>\n
Lamentablemente, ha costado cambiar al TPB. En 2017, TRUSB sigui\u00f3 siendo el m\u00e9todo m\u00e1s utilizado en las biopsias de pr\u00f3stata en Australia y Nueva Zelanda, con el 50% de las biopsias realizadas v\u00eda rectal. El principal escollo ha sido que la TPB se realizaba tradicionalmente bajo anestesia general (GA), ya que hay que introducir varias agujas a trav\u00e9s del perineo. Por tanto, conlleva el riesgo de utilizar la AG, con el aumento de riesgo y necesita la utilizaci\u00f3n del quir\u00f3fano. Sin embargo, estos \u00faltimos a\u00f1os ha emergido una prometedora tendencia: ha descendido la proporci\u00f3n del TRUSB hasta un 13% y ha aumentado la proporci\u00f3n de TPBs realizadas.<\/div>\n
Esta tendencia ha sido impulsada, en parte, por el desarrollo de sistemas de abordaje transperineal (TAS), tales como PrecisionPoint (Perineol\u00f3gico, Cumberland, EEUU), que permiten al TPB manos libres realizar dos punciones en la piel con anestesia local (AL) en centros ambulatorios. Diversos estudios han demostrado la viabilidad y el buen resultado de la toma de muestras con AL y su potencial reducci\u00f3n de costes. La capacidad de realizar TPB con AL, utilizada como promesa TAS ser\u00e1 el catalizador del \u00abTRexit\u00bb- el proceso de cambiar del TRUSB al TPB.<\/div>\n
Nuestro departamento del Hospital Fiona Stanley, en Perth, al Oeste de Australia ha realizado con \u00e9xito el \u00abTRexit\u00bb, por lo que ha dejado de realizar biopsias transrectales. Es m\u00e1s, la mayor parte de nuestros TPB se desarrollan con AL en ambulatorios. Solo se les realiza una interevenci\u00f3n TPB AG a pacientes obesos y a aquellos que rechacen la AL. El \u00abTRexit\u00bb sigui\u00f3 un proceso de implementaci\u00f3n por pasos en nuestro hospital.<\/div>\n
El Dr. Matthew Brown visit\u00f3 el Hospital Guy\u2019s en el Reino Unido durante un periodo de 2 semanas para realizar una formaci\u00f3n con el Dr. Rick Popert, un ur\u00f3logo l\u00edder en su sector y autor de uno de los estudios m\u00e1s afamados sobre la eficacia de TPB AL mediante TAS PrecisionPoint. El Dr. Brown trat\u00f3 los primeros nueve casos con anestesia epidural o AG, y someti\u00f3 a los 14 siguientes a la intervenci\u00f3n con sedaci\u00f3n para familiarizarse con la t\u00e9cnica y el protocolo de administraci\u00f3n de AL. En los siguientes casos se utiliz\u00f3 AL. Despu\u00e9s, se form\u00f3 a otros facultativos de nuestro departamento para realizar TPB con AL. En la actualidad, estamos evaluando nuestros resultados y estamos informando a los pacientes.<\/div>\n
Bajo nuestro punto de vista, los pr\u00f3ximos pasos a dar para el diagn\u00f3stico de c\u00e1ncer en Australia ser\u00eda mejorar el acceso al TPB. Se deber\u00eda formar a m\u00e1s ur\u00f3logos en TPB con AL en ambulatorios, para completar la transici\u00f3n y dejar de realizar TRUSB. Es m\u00e1s, tambi\u00e9n podr\u00edan formarse enfermeras para que realizaran la intervenci\u00f3n y mejorar el acceso al servicio. Las enfermeras practicantes han realizado TPBs en centros del Reino Unido durante a\u00f1os, y los estudios confirman que estas enfermeras pueden realizarlas de manera segura y efectiva.<\/div>\n
Esperamos que haya mejoras en la realizaci\u00f3n del TPB y se descarten las TRUSB en los pr\u00f3ximos a\u00f1os. Los hombres se merecen un enfoque del diagn\u00f3stico del c\u00e1ncer de pr\u00f3stata est\u00e9ril y m\u00e1s seguro.<\/div>\n
El Dr. Matt Brown es cirujano ur\u00f3logo y Jefe de Cirug\u00eda Rob\u00f3tica en el Hospital Fiona Stanley, y socio fundador de la Cl\u00ednica Urol\u00f3gica de Perth, el mayor centro privado de urolog\u00eda de la zona Oeste de Australia.<\/div>\n
El Dr. Pravin Visambaram es registrador urol\u00f3gico en el Hospital Fiona Stanley, en Perth, y est\u00e1 asociado a la University of Western Australia\u2019s School of Medicine y al ANZUP.<\/div>\n
Las afirmaciones u opiniones expresadas en este art\u00edculo reflejan los puntos de vista de sus autores y no representan la opini\u00f3n oficial del AMA, del MJA o InSight+ a menos que se indique.<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"

DESPITE significant advances in prostate imaging in recent years, notably the emergence of multiparametric magnetic resonance imaging (MRI) and molecular imaging, biopsy remains central to prostate cancer diagnosis. Over 2 million prostate biopsies are performed annually worldwide, and these are performed via the transrectal or transperineal route. Traditional transrectal ultrasound-guided prostate biopsies (TRUSB) involve an ultrasound probe attached to a biopsy needle being inserted into the<\/p>","protected":false},"author":10,"featured_media":1744,"comment_status":"open","ping_status":"open","sticky":false,"template":"template-old-blog.php","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[7],"tags":[],"class_list":["post-1623","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-resources"],"acf":[],"yoast_head":"\nProstate biopsy: a change of approach - BXTA<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/bxta.com\/es\/fr\/prostate-biopsy-a-change-of-approach\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Prostate biopsy: a change of approach - BXTA\" \/>\n<meta property=\"og:description\" content=\"DESPITE significant advances in prostate imaging in recent years, notably the emergence of multiparametric magnetic resonance imaging (MRI) and molecular imaging, biopsy remains central to prostate cancer diagnosis. Over 2 million prostate biopsies are performed annually worldwide, and these are performed via the transrectal or transperineal route. 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