Autor: Izabella Danezi Felin | Publicado: 2017-06-26T10:59:00-03:00

Grupo de 
monitores 2017/ 1 da disciplina de Patologia Geral Médica e do Projeto 
PATONLINE estuda, revisa e compartilha conhecimentos relativos aos 
avanços na área da Pato-Onco- Genética:&nbsp;

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RECOMENDAÇÕES
PARA ENCAMINHAMENTO MACROSCÓPICO E REBIÓPSIAS PROSTÁTICAS EM PACIENTE COM
ANTÍGENO PROSTÁTICO ESPECÍFICO (PSA) ELEVADO E BIÓPSIAS ANTERIORES NEGATIVAS



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<![endif]-->O diagnóstico definitivo do câncer de próstata
(CaP) é estabelecido pela biópsia seguida de exame anatomopatológico, realizada
preferencialmente por via transretal guiada por ultrassom. Esse é um procedimento
invasivo e por oferecer alguns riscos, a sua realização deve ser limitada a
pacientes com suspeita de CaP seja por alteração do antígeno prostático
específico (PSA) e/ou exame digital retal da próstata. A Sociedade Brasileira de Urologia (SBU) recomenda
que os fragmentos de biópsia sejam enviados em, no mínimo, seis frascos separados
e rotulados de acordo com o sextante biopsiado e referidos como: basal, mediano
e apical, cada um, direito e/ou esquerdo. &nbsp;Essa recomendação é de extrema importância,
pois se não for seguida, informações fundamentais para planejar o acompanhamento
mais adequado do paciente poderão ser perdidas. Em
muitos pacientes com concentração elevada de PSA sérico, uma biópsia inicial pode não detectar o câncer.
Sabendo-se disso, em homens com elevação persistente do PSA e biópsia negativa,
a repetição da biópsia pode revelar
câncer em 19 a 23% dos pacientes, dependendo da série. As indicações atuais
para rebiópsia incluem: a presença de neoplasia intraepitelial prostática (PIN)
de alto-grau, focos microscópicos suspeitos, mas não diagnósticos de
malignidade, elevação do PSA sérico, anormalidade no exame digital do reto e ou
no ultra-som.