PET-RM MULTITRAZADOR EN LA ESTADIFICACIÓN Y DETECCION DE RECIDIVA EN CANCER DE PROSTATA

Autores/as

  • Antonio Maldonado Suarez
  • Manuel Recio Rodriguez
  • Javier Carrascoso Arranz
  • Felipe Couñago Lorenzo
  • Silvia Fuertes Cabero
  • Vicente Martinez De Vega

Palabras clave:

cancer próstata, PET-RM, poster, seram, estadificación

Resumen

Describir la utilidad de la PET-RM tanto en la estadificación del cáncer de próstata de elevado riesgo como en la detección de recidiva bioquímica y en la planificación de radioterapia. Exponer el rendimiento de los radiofármacos PET más utilizados en la práctica diaria, especialmente la Fluorocolina

INTRODUCCIÓN

En Estados Unidos, el carcinoma de próstata (CP) es el tumor más frecuente y la segunda causa de muerte por cáncer tras el carcinoma de pulmón en varones [1].
En la actualidad, el CP se estudia y clasifica acorde a la estadificación TNM, el score Gleason y el nivel sérico del antígeno prostático específico (PSA). Tanto la detección de los niveles séricos de PSA como los programas de cribado del CP han contribuido a una disminución de la mortalidad. Sin embargo, ante unos valores elevados de PSA existe un riesgo potencial de sobrediagnóstico y, consecuentemente, de sobretratamiento. De hecho, se ha estimado que hasta un 50% los pacientes con enfermedad silente que no presentarán síntomas durante su vida [2]. La incidencia de CP cuando los niveles de PSA son inferiores a 4 ng/ml es del 15.2% [3].
El diagnóstico del CP se realiza por biopsia prostática por sextantes guiada por ecografía transrectal. El CP es el único tumor que se diagnostica por biopsia a ciegas, y dada la heterogeneidad y multifocalidad del tumor, se tiende a subestimar el grado histológico. Además, más del 28% de los cánceres clínicamente significativos no son diagnosticados en la biopsia por sextantes [4].
La estadificación de la enfermedad se basa en la combinación de diferentes técnicas de diagnóstico por la imagen, entre las que se encuentran la Tomografía Computarizada (TC), la Resonancia Magnética (RM) y la gammagrafía ósea [5;6].
Sin embargo, la sensibilidad de las técnicas de imagen anatómicas (TC y RM) para la detección de adenopatías infiltradas no es muy elevada, ya que dependen básicamente de que exista un aumento de tamaño de los ganglios linfáticos. La estrategia terapéutica (con finalidad paliativa o radical) dependerá de la agresividad tumoral local (escala de Gleason) y de la extensión (TNM y PSA).
Cuando se sospecha recurrencia tras el tratamiento radical del CP, bien sea por la sintomatología clínica o por la elevación del PSA, se realizan diferentes técnicas de imagen convencionales [7;8].

Sin embargo, la ecografía transrrectal tiene dificultades en la detección de recurrencias en un 30% de los casos [9], la TC presenta problemas sobre todo en el diagnóstico de recurrencia local y metástasis ganglionares y la RM en la detección de metástasis a distancia. En muchos pacientes, y a pesar de practicarse todos los procedimientos diagnósticos habituales disponibles, la enfermedad no puede localizarse y por tanto no puede definirse su extensión real.
La PET con 18F-FDG ha sido utilizada en el estudio de diferentes tumores con muy buenos resultados. Sin embargo, en el CP presenta limitaciones [10;11] (Figura 1), por lo que se han aplicado otros radiofármacos, entre los que se encuentran el carbono de colina (11C-Colina) y el Cloruro de fluorocolina (18F-Fluorocolina o 18F-FCH) [12-16] (Figura 2)
La 18 F-Fluorocolina (18F-fluoroetilcolina o FEC y 18F-fluorometil-dimetil-2-hidroxietilamonio o FCH) fue introducida por Coleman et al. [17] como un radiotrazador prometedor en la evaluación del CP, y ha demostrado una mayor captación que la 18 flúordeoxiglucosa marcada con 18 Flúor (18F-FDG), tanto en el tumor primitivo como en el metastásico [18].

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Citas

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Publicado

2018-11-22

Cómo citar

Maldonado Suarez, A., Recio Rodriguez, M., Carrascoso Arranz, J., Couñago Lorenzo F., Fuertes Cabero, S., & Martinez De Vega, V. (2018). PET-RM MULTITRAZADOR EN LA ESTADIFICACIÓN Y DETECCION DE RECIDIVA EN CANCER DE PROSTATA. Seram. Recuperado a partir de https://piper.espacio-seram.com/index.php/seram/article/view/106

Número

Sección

Abdominal

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