Características clínicas e histopatológicas dos pacientes com carcinoma de próstata metastático tratados em uma unidade de referência do Sistema Único de Saúde em Salvador - Bahia

Abstract

Introduction: Prostate carcinoma (PC) is the most common malignancy in men in Brazil and in the world. Some studies indicate that african descent are affected by PC at a younger age and they presents with high histological grades and advanced stages. While some authors attribute this adverse profile to the difficulty to access the healthy system, other indicate that this may be related to genetic background. Considering the large population of african descent and the absence of systematic screening for PSA decided to identify histopathologic profile of the advanced CP in our region. Methods: We identified the patients undergoing palliative treatment by orchiectomy offered by the National Health System for advanced CP. All cases occurred consecutively between 2009 and 2010 at the Hospital Aristides Maltez, (HAM), reference for oncological treatment for public Health System. Clinical and pathological data were obtained from pathologic reports filed in the HAM. Patients with negative transurethral resection (RTU) for CP or histological grade lower than 7, the previous reports of sextant biopsies were accessed. Results: 2144 patients were registered for treatment of prostate cancer in HAM this period. Of these, 166 (7.7%) underwent bilateral orchiectomy, corresponding to advanced cases. 6 cases were excluded due to inaccessibility of data. In 160 patients, the mean age was 71 years, ranging from 45 to 93 at the time of orchiectomy. Most patients (85.6%) were between 61 and 80 years old. Over half of the patients were below 72 years old. The RTU was positive in 133 patients (83%) and negative 27 (17%). Gleason histological grades ranged between 6 and 10, and 109 patients (68%) exhibited high tumor grade, 38 had moderate histologic grade and 13 had low histological grade. Almost all patients (12/13) with low histological grade were negative for carcinoma at the RTU. Conclusions: The frequency of CPM in our population is higher than described in American and Brazilian series. A large positivity in the RTU tissue (83%) in our study, higher than observed in the literature, indicates that our patients exhibit more advanced stages of the disease. Thus, further studies are needed to investigate whether this advanced profile is associated with delayed diagnosis or related to genetic factors