Câncer de próstata final
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Transcript of Câncer de próstata final
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Acadêmica: Marcella Reis Goulart
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CÂNCER DE PRÓSTATA
Alta prevalência Incidência crescenteCurável na fase inicialMúltiplas formas de tratamento
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CÂNCER DE PRÓSTATA
Interpretação do PSAComo diagnosticarEscolha particularizada da forma de
tratamento
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CÂNCER DE PRÓSTATA
Aumento da incidência
Envelhecimento da população
Aumento do diagnóstico
PSACampanhas
Biópsia transretal
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Campanhas
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HISTÓRIA FAMILIAR = MAIOR RISCO!!!
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INFLUÊNCIA RACIAL
NEGRA > BRANCA > AMARELA
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FATORES DE RISCO Dieta Hormônio
Obs: Vale ressaltar que se sabe muito pouco sobre a maioria desses fatores
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PESO : 15 a 20g
Localização: Abaixo da bexiga atravessada pelo canal uretral
Função:Reprodutiva
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COMPORTAMENTO BIOLÓGICO
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COMPORTAMENTO BIOLÓGICO
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COMPORTAMENTO BIOLÓGICO Estudos de autópsias Mortes não relacionadas à câncer de próstata
30% de doença oculta aos 50 anos 70% de doença oculta aos 80 anos
Scand J urol Nephrol 1980; 14 (1): 29-35
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HISTÓRIA NATURAL E QUADRO CLÍNICO Formas de apresentação:
Doença localizadaDoença localmente avançadaDoença metastática
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Doença local izada Geralmente assintomática!!!Sintomas miccionais irritativos ocasionaisPossibilidade de cura
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EXAME PREVENTIVO História familiar = 45 anos Restantes = 50 anos Dosagem do PSA Toque retal
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EXAME DIGITAL DA PRÓSTATA OBRIGATÓRIO!!!
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Doença localmente avançada Sintomas irritativos e obstrutivos Hemospermia Hematúria Obstrução uretral
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Doença Metastát ica Dor óssea Compressão medular Fraturas Astenia , emagrecimento
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RESUMO
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DIAGNÓSTICOPSAGlicoproteína produzida na próstata
Marcador específico do parênquima prostát ico Pode estar alterado: Câncer, HPB, prostatite, manipulação
prostáticaValor normal = “4ng /ml”
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DIAGNÓSTICO
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PSA Livre
Ligado a proteínas
Normal (varia de autor)>20%> 25%
Ex: PSA livre 1,5
PSA ligado a prot: 3,0
Total : 4,5
1,5 / 3,0 = 0,5 = 50%
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INTERPRETAÇÃO DO PSA
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DIAGNÓSTICO
Toque suspeito Fazer biópsia ouAlteração do PSA
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Tipo histológico = Adenocarcinoma
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GLEASON
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ESTADIAMENTO USG transretal + guiar biópsia
Lesão hipoecogênica
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ESTADIAMENTO Ressonância Estadiamento local
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ESTADIAMENTO Tomografia Linfonodos > 2 cm PSA > 30
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ESTADIAMENTOCintilografia
PSA> 10
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ESTADIAMENTO Linfadenectomia obturatória PSA > 30
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TRATAMENTO
DEPENDE DO ESTADIAMENTO E CONDIÇÃO DO PACIENTE!!!
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TRATAMENTO DOENÇA LOCALIZADA
Paciente hígido ( expectativa de vida > 10 anos) = tratamento curativo
Co-morbidades = observação vigilante ou hormonioterapia
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DOENÇA LOCALIZADA – HÍGIDO
Prostatectomia radicalRadioterapiaCrioterapia
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ESPÉCIMES
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ROBÓTICA
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PROSTATECTOMIA RADICAL Complicações
Disfunção erétil Incontinência urináriaSangramento
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Braquioterapia com sementes
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PROSTATECTOMIA RADICAL Expectativa de vida > 10 anos Ausência de contra-indicação clínica Participação do paciente na decisão
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RADIOTERAPIA Conformacional Risco para tratamento cirúrgico Ausência de doença coloretal Boa expectativa de vida Participação do paciente na desição
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CONDUTA EXPECTANTE Histologia favorável = bem diferenciado ,Gleason até 6 Idosos Co-morbidades Participação do paciente na decisão
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DOENÇA AVANÇADA
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Doença avançadaHormonioterapiaQMT em doenças hormônio resistentes
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TRATAMENTO Orquiectomia Anti-androgênicos Análogos do LHRH Estrógeno
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CA PRÓSTATA METASTÁTICO Resposta ao tratamento hormonal