Efectividad de la orquiectomia simple y subcapsular en los niveles del PSA de pacientes con cáncer prostatico
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2022
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Antecedentes: La castración quirúrgica en cáncer de próstata metastásico (CaPM), es
una opción válida aún, por coste y posibilidad de realizarse mediante cirugía ambulatoria,
siempre acompañada de tratamiento con bloqueadores o agonistas de la GNRH. Existen
controversias en los resultados obtenidos con la orquiectomía subcapsular bilateral
(OSCB) y la simple bilateral (OSB).
Objetivos: Comparar la efectividad de la OSB frente a la OSCB para el manejo del CaPM
tomando como referencia la respuesta bioquímica mediante la medición de PSA.
Metodología: Se realizó un estudio observacional, analítico, retrospectivo en el que se
incluyeron de manera no aleatoria 33 casos de CaPM intervenidos por orquiectomía en el
hospital Teodoro Maldonado Carbo entre 01-05-2016 y 30-11-2020, 17 casos con OSCB
bilateral y 16 controles indicados para OSB. Para el análisis estadístico se utilizaron la
prueba del chi-cuadrado de homogeneidad y la prueba t de student Fisher para muestras
relacionadas e independientes y el Odds ratio. Se consideran significativos valores de p
< 0.05.
Resultados: Existieron diferencias significativas a favor de la OSC con relación a valores
de PSA (30.7 ± 23.3 ng/ml vs 96.6 ± 41.7 ng/ml; P < 0.000), eventos adversos (43,8 vs 88.2;
P < 0.01) eventos adversos de grado 3 o superior (12.5% vs 70.6%; P < 0.01) y muerte
(18.8% vs 64.7% P < 0.01); esta diferencia se mantuvo con la corrección por valor de
PSA en eventos adversos (P 0.015), eventos adversos de grado 3 (P 0.003) y muerte (P
0.038
Conclusión: OSB es superior a la OSCB para el tratamiento del CaPM
Background: Surgical castration in metastatic prostate cancer (MCaP), is still a valid option, due to cost and possibility of being performed by ambulatory surgery, always accompanied by treatment with GNRH blockers or agonists. There are controversies in the results obtained with bilateral subcapsular orchiectomy (BSCO) and simple bilateral orchiectomy (BSO). Objectives: To compare the effectiveness between BSO and BSCO for the management of MCaP taking as a reference the biochemical response by PSA measurement. Methodology: An observational, analytical, retrospective study was carried out in which 33 cases of MCaP operated by orchiectomy at the Teodoro Maldonado Carbo hospital between 05-01-2016 and 11-30-2020 were included without randomization, 17 cases with bilateral BSCO and 16 controls indicated for BSO. For statistical analysis, the chi-square test for homogeneity and the Fisher Student's t-test for related and independent samples and the Odds ratio were used. Values of p < 0.05 were considered significant. Results: There were significant differences in favor of CSO in relation to PSA values (30.7 ± 23.3 ng/ml vs 96.6 ± 41.7 ng/ml; P < 0.000), adverse events (43.8 vs 88.2; P < 0.01) grade 3 or higher adverse events (12. 5% vs 70.6%; P < 0.01) and death (18.8% vs 64.7% P < 0.01); this difference was maintained with correction for PSA value in adverse events (P 0.015), grade 3 adverse events (P 0.003) and death (P 0.038). Conclusion: BSO is superior to BSCO for the treatment of MCaP
Background: Surgical castration in metastatic prostate cancer (MCaP), is still a valid option, due to cost and possibility of being performed by ambulatory surgery, always accompanied by treatment with GNRH blockers or agonists. There are controversies in the results obtained with bilateral subcapsular orchiectomy (BSCO) and simple bilateral orchiectomy (BSO). Objectives: To compare the effectiveness between BSO and BSCO for the management of MCaP taking as a reference the biochemical response by PSA measurement. Methodology: An observational, analytical, retrospective study was carried out in which 33 cases of MCaP operated by orchiectomy at the Teodoro Maldonado Carbo hospital between 05-01-2016 and 11-30-2020 were included without randomization, 17 cases with bilateral BSCO and 16 controls indicated for BSO. For statistical analysis, the chi-square test for homogeneity and the Fisher Student's t-test for related and independent samples and the Odds ratio were used. Values of p < 0.05 were considered significant. Results: There were significant differences in favor of CSO in relation to PSA values (30.7 ± 23.3 ng/ml vs 96.6 ± 41.7 ng/ml; P < 0.000), adverse events (43.8 vs 88.2; P < 0.01) grade 3 or higher adverse events (12. 5% vs 70.6%; P < 0.01) and death (18.8% vs 64.7% P < 0.01); this difference was maintained with correction for PSA value in adverse events (P 0.015), grade 3 adverse events (P 0.003) and death (P 0.038). Conclusion: BSO is superior to BSCO for the treatment of MCaP
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NEOPLASIAS DE LA PROSTATA, ORQUECTOMIA, TRATAMIENTO, ESTUDIO RETROSPECTIVOS, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR