Antecedentes
En general, aproximadamente 2 hombres hispanos y 1 de cada 3 mujeres hispanas serán diagnosticados con cáncer en algún momento de su vida y la probabilidad de fallecer por ésta enfermedad es de 1 en 5 entre los hombres hispanos y 1 en 6 entre las mujeres hispanas (fuente: 2012 Sociedad Americana Contra el Cáncer).
El Problema
El cáncer más común en la población masculina es el cáncer de próstata y los métodos convencionales de diagnóstico preventivo tienen limitantes importantes:
- TACTO RECTAL. Este método diagnóstico busca identificar nódulos en la glándula prostática así como la consistencia de ésta ya que son “signos” de un posible problema. Suele ser realizada por su médico introduciendo el dedo por el recto para explorar la próstata.
Sin embargo, este método no es infalible pues en ocasiones, el tumor puede estar albergado de manera profunda en la glándula (lejos del alcance del médico) o ser aún muy pequeño para poder ser identificado por este método (fuente: Mark Litwin, MD, Urology, answered on behalf of UCLA Health – http://www.sharecare.com/user/dr-mark-litwin).
- ANTÍGENO PROSTÁTICO ESPECÍFICO (PSA). Junto con el “Tacto Rectal”, una de las herramientas diagnósticas más comunes para monitorear el estado de salud de la próstata es la prueba laboratorial PSA[1].
EL PSA es una substancia generada por las células (normales o cancerígenas) de la próstata. Una persona sana, normalmente tiene niveles inferiores 4 nanogramos por mililitro (ng/mL) de sangre.
Sin embargo, tener un nivel inferior a 4 ng/mL no garantiza estar libre de desarrollar cáncer en la próstata. Por debajo de este valor, la probabilidad es de un 15% , entre 4-10 ng/mL la probabilidad aumenta a 25% y por arriba de 10 ng/mL la probabilidad llega hasta el 50% (fuente: American Cancer Society).
Desafortunadamente, el monitoreo adecuado de la salud de la próstata es más complejo que solo vigilar el valor del PSA, pues existen muchos factores como obesidad, crecimiento de la próstata, infección prostática, otros rasgos personales, antecedentes familiares, el uso de medicamentos, etc. que pueden afectar los valores obtenidos con esta prueba.
Por otro lado, es posible tener niveles de PSA elevados sin tener cáncer o niveles de PSA bajos teniendo cáncer. Algunos tipos de cáncer de próstata, especialmente aquellos que crecen rápido, no elevan mucho el PSA (fuente: Mayo Clinic).
Debido a la complejidad de esta enfermedad, resulta riesgoso basar su prevención solo en el Tacto Rectal o en la prueba laboratorial PSA. Por ello, es recomendable la exploración celular del tejido prostático así como de sus zonas aledañas mediante la tecnología más apropiada para ello.
- MÉTODOS DIAGNÓTICOS CONVENCIONALES POR IMAGEN. Aquí se encuentran el ultrasonido transrectal o resonancia magnética de 1.5 Tesla los cuales requieren el uso de un elemento invasivo que suele desalentar al paciente.
Si bien el ultrasonido puede identificar lesiones en el tejido prostático, no puede hacerlo adecuadamente cuando estas se encuentran en etapa (temprana) celular.
Por su parte, la resonancia magnética de 1.5 Tesla permite una más completa exploración que el ultrasonido transrectal pero la resolución de sus imágenes queda muy por debajo a lo que es posible obtener con resonadores mucho más potentes como son los de 3.0 Tesla y sin el uso de la incómoda antena endocavitaria.
Por qué es importante vigilar proactivamente la gestación del cáncer de próstata?
Identificar de manera temprana la aparición de esta enfermedad es fundamental, pues facilita su tratamiento y aumenta significativamente el pronóstico de recuperación. Por el contrario, cuando se detecta posterior a la aparición de síntomas, el pronóstico disminuye ya que es posible que dicho cáncer haya comenzado a diseminarse a otras partes del cuerpo.
¿A partir de qué edad debo revisarme la próstata?
La Sociedad Americana del Cáncer recomienda que los hombres consideren discutir con su médico el hacerse pruebas para detectar la posible formación de cáncer de próstata en los siguientes casos:
- a los 50 años de edad, para los hombres sin antecedentes familiares con ésta enfermedad
- a los 45 años de edad, para hombres con mayor riesgo de desarrollar el cáncer, incluyendo hombres con un familiar inmediato con diagnóstico de cáncer de la próstata antes de cumplir 65 años
- antes de los 40 años de edad, para hombres con aún mayor riesgo por tener más de un familiar inmediato diagnosticado con cáncer de la próstata.
¿Cuál es la NUEVA HERRAMIENTA para examinar la próstata, cuáles son sus alcances y beneficios?
Hoy día, ya existe una novedosa herramienta diagnóstica para el diagnóstico oportuno del cáncer de próstata, la Resonancia Magnética (RM) 3.0 Tesla Multiparamétrica de Próstata.
Este estudio es particularmente útil en la localización y estadificación del cáncer, permite una mayor resolución espacial y temporal de la zona de exploración con lo que se puede seleccionar con mayor precisión a pacientes candidatos y el sitio más apropiado para realizar una biopsia prostática transrectal (en caso de ser necesaria) al combinar su resultado con el de la prueba laboratorial PSA.
Adicionalmente a estas grandes ventajas para médicos y pacientes, la RM 3.0T Multiparamétrica de Próstata con tecnología 3.0 Tesla DIGITAL permite la exploración de la próstata SIN NECESIDAD DE USAR ANTENA ENDOCAVITARIA y con una resolución inigualable por equipos de menor o igual teslaje; lo que se traduce en una valoración y diagnóstico más preciso.
Características de la RM 3.0T DIGITAL Multiparamétrica de Próstata.
La Resonancia Magnética Multiparamétrica recibe este nombre por la múltiple información que se obtiene al evaluar diferentes parámetros mediante técnicas llamadas T1, T2, Difusión, Perfusión y Permeabilidad.
Las secuencias T1 y T2 se utilizan en la valoración anatómica, en la detección de hemorragia secundaria a biopsias, en la estadificación o infiltración regional y del paquete neurovascular.
Las secuencias de Difusión permiten valorar el movimiento de las moléculas de agua en el espacio intracelular, el cual se reduce considerablemente en las neoplasias (cáncer) debido al aumento de la cantidad de células de las neoplasias malignas.
Al incrementarse la vascularidad de una lesión en próstata se altera la microvasculatura especialmente en lesiones como cáncer en comparación con otras entidades como la hiperplasia prostática, situación que puede ser valorada con la Perfusión y la Permeabilidad.
PREGUNTAS FRECUENTES
- Qué utilidad tiene la RM 3.0T DIGITAL Multiparamétrica de Próstata en pacientes con valores elevados de PSA pero con resultados negativo de biopsia?
Es importante recordar que la presencia de cáncer en la glándula prostática puede estar localizado solo en alguna(s) zona(s) de ésta y, por tanto, la ubicación precisa de estas zonas es fundamental para la realización de una biopsia. La RM 3.0T DIGITAL Multiparamétrica de Próstata permite identificar con precisión las zonas indicadas para la realización de la biopsia, aún cuando la enfermedad se encuentra en etapa de actividad a nivel celular.
- Puede la RM 3.0T DIGITAL Multiparamétrica de Próstata sustituir a la biopsia?
NO, es un método diagnóstico recomendable previo a la realización de la biopsia para informar las zonas donde deberán tomarse las muestras para su análisis histopatológico.
- He escuchado de la Resonancia Magnética BIparamétrica de Próstata. Qué diferencias tiene con la Multiparamétrica?
La RM BIparamétrica de Próstata solo valora dos parámetros: la anatomía mediante las secuencias T1 y T2 y el parámetro del movimiento de las moléculas de agua en el espacio intracelular mediante las secuencias de Difusión.
Al no utilizar material de contraste para realizar las secuencias de Perfusión y Permeabilidad, como en el caso de la Multiparamétrica, su costo disminuye pero la información obtenida pudiera no ser concluyente en caso de existir una lesión.
- Entonces, cómo saber cuál de los dos estudios (BIparamétrica o Multiparamétrica) es el más recomendable para mi?
Al día de hoy no hay estudios científicos que respondan con precisión a esta pregunta. Nuestra recomendación sería la realización del estudio Multiparamétrico.
Sin embargo, la RM 3.0T DIGITAL BIparamétrica de Próstata podría ser una buena opción para:
- personas menores a 50 años sin antecedentes familiares con ésta enfermedad y
- sin síntomas de algún problema con la glándula prostática (i.e. molestias al orinar, disfunción, sangre en la orina, valores anormales del PSA, etc.).
Para personas mayores de 50 años sin antecedentes familiares con esta enfermedad o menores a 50 años pero con antecedentes familiares con esta enfermedad sugeriríamos la versión Multiparamétrica.
Independientemente de estas recomendaciones, sugerimos consultarlo previamente con su médico.
[1] Este antígeno o químico es producido normalmente por la próstata en pequeñas cantidades. La cantidad del antígeno en la sangre aumenta cuando hay cáncer, pero también cuando la próstata aumenta de tamaño por causas no malignas.
Los niveles del PSA varían ampliamente y la capacidad diagnóstica (sensibilidad y especificidad) es poca en niveles por debajo de 10 ng/mL, sin embargo, un PSA superior a 4 ng/mL es anormal. En hasta un 70-80% de pacientes con una elevación moderada del PSA encuentran el origen en una entidad benigna como una hiperplasia prostática o bien una prostatitis.
Entre un 15-44% de paciente con cáncer prostático comprobado mediante biopsia tienen niveles de PSA normales por debajo de 4 ng/mL. El nivel de PSA libre menor al 10% se asocia con un riesgo del 30% de tener cáncer de próstata, sin embargo clínicamente la decisión de una biopsia se sustenta con un PSA libre menor del 25%.
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