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Organo Oficial de la Sociedad Mexicana de Urología

2008, Número 4

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Rev Mex Urol 2008; 68 (4)


Cáncer de próstata

Álvarez-Blanco MA, Escudero-de los Ríos PM, Hernández-Toríz N

Idioma: Español
Referencias bibliográficas: 87
Paginas: 245-254
Archivo PDF: 431.87 Kb.


RESUMEN

El adenocarcinoma prostático es la neoplasia maligna más frecuente en hombres, superando al cáncer pulmonar y de colon. En los últimos cinco años, la supervivencia para la enfermedad localizada fue de 100% y para metastásica 33%. Aproximadamente, 70% de los cánceres de próstata se diagnostican en varones mayores de 65 años de edad. De éstos, alrededor de 90% son descubiertos en etapa local y/o regional. La supervivencia a cinco años es cerca de 100% y la sobrevida general calculada a 10 y 15 años es de 92 y 61%, respectivamente. A diferencia de otros países, en México, la mortalidad por cáncer de próstata se ha incrementado en las últimas dos décadas y actualmente constituye la principalcausa de muerte por cáncer en el hombre adulto. Desde el punto de vista etiológico, se considera que éste es una enfermedad multifactorial. Los lineamientos actuales para el diagnóstico temprano del cáncer de próstata son: determinación del antígeno prostático específico (PSA, por sus siglas en inglés) y el examen rectal digital anual, a partir de los 50 años de edad. En pacientes con PSA elevado, se sugiere toma de biopsia transrectal. La mayor parte de los carcinomas prostáticos se originan en la zona periférica de la glándula. El grado histológico se correlaciona estrechamente con el curso clínico y con el comportamiento biológico del adenocarcinoma de la próstata. El tratamiento y pronóstico de los pacientes con cáncer de próstata se encuentran en función directa de la etapa en el momento del diagnóstico. En la actualidad, los mejores candidatos para prostatectomía radical son pacientes con una expectativa de vida de 10 años o más, con tumor no palpable, de grado bajo o intermedio en la escala de Gleason, confinado a la próstata. Para pacientes con enfermedad temprana, de bajo riesgo, los resultados con radioterapia externa, radioterapia conformacional tridimensional, braquiterapia o prostatectomía radical han sido similares en la mayoría de la series, con seguimiento hasta de 15 años o mayor. Actualmente, la castración quirúrgica o médica con análogos de la hormona liberadora de la hormona luteinizante, combinados con antiandrógenos no esteroideos como la flutamida y bicalutamida, es el tratamiento de elección para pacientes que debutan con enfermedad metastásica.


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