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PSA ELEVADO Y BX NEGATIVA

PSA ELEVADO Y BX NEGATIVA. Prof.Dr Daniel Lopez Laur Catedra Urologia FCM UNCUYO 2009. TR + PSA+ECOTR :LIMITACIONES, BAJO VALOR PREDICTIVO + Y ESPECIFICIDAD 10-54% LOS TU. EN 1RA BX PASAN DESPERCIBIDOS EN 2DA,3RA Y 4TA BX HAY UN 10-31% DETECCION. PARA EPSTEIN 24% Y 18.7%

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PSA ELEVADO Y BX NEGATIVA

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  1. PSA ELEVADO Y BX NEGATIVA Prof.Dr Daniel Lopez Laur Catedra Urologia FCM UNCUYO 2009

  2. TR + PSA+ECOTR :LIMITACIONES, BAJO VALOR PREDICTIVO + Y ESPECIFICIDAD • 10-54% LOS TU. EN 1RA BX PASAN DESPERCIBIDOS • EN 2DA,3RA Y 4TA BX HAY UN 10-31% DETECCION. PARA EPSTEIN 24% Y 18.7% • PERSISTE LA SOSPECHA C/PIN O ASAP O SIGUE EL PSA ELEVADO

  3. TIPO TUMORAL DE LA 1RA BX ES EL QUE TIENE LA AGRESIVIDAD DETERMINADA Y DE 2DA A 4TA BX TIENEN UN < GLEASON (< AGRESIVIDAD BIOLOGICA) • RIESGO CAP • 1RA BX PIN ASAP 27.2% 35.7% 24.1% 40% (Epstein)

  4. A QUIEN RE-BX • PERSITE ELEVADO PSA • PSAV > 0.75 ng/ml • PIN O ASAP

  5. RE BX • LA POSIBILIDAD DE DIAGNOSTICO DE ENFERMEDAD CLINICA NO SIGNIFICATIVA: 9-50% • 3RA,4TA Y 5TA BX: SOBREDIAGNOSTICO : 28,57% • TOMANDO: 6 CILINDROS 14% 10-12 32% REBIOPSIA 14.6%

  6. EN 1RA Y 2DA BX TUMOR TIENE IGUAL AGRESIVIDAD • EN 3RA Y 4TA BX TIENE BAJO GRADO, ESTADIO Y VOLUMEN • 2DA BX 10 % CAP • 3RA BX 5% • 4TA BX 4% MARBERGER,SCHULMAN Y COL. J.Urol 2001

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