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Ιατρείο Δρ. Πούλιας Ηρακλής

Το ιατρείο του Χειρουργού – Ουρολόγου Δρ. Πούλια Ηρακλή βρίσκεται στην Αθήνα. Συγκεκριμένα είναι έναντι του Ξενοδοχείου President. 

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Εξέταση ανιχνεύει τους «κρυμμένους» καρκίνους του προστάτη

Εξέταση ανιχνεύει τους «κρυμμένους» καρκίνους του προστάτη

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  • Εξέταση ανιχνεύει τους «κρυμμένους» καρκίνους του προστάτη

Μια πειραματική εξέταση που συνδυάζει υπερήχους με μαγνητική τομογραφία και έναν νέο τρόπο λήψης βιοψίας μπορεί να ανιχνεύει τους καλά κρυμμένους καρκίνους του προστάτη, σύμφωνα με νέα ευρήματα.

Η συνδυασμένη αυτή εξέταση επιτρέπει τη δημιουργία μιας τρισδιάστατης εικόνας του προστατικού αδένα, καθώς η εικόνα από το υπερηχογράφημα προβάλλεται πάνω σε εκείνες της μαγνητικής. Με τον τρόπο αυτόν απεικονίζονται πολύ πιο καθαρά το ανώτερο και το πρόσθιο τμήμα του προστάτη, που συνήθως δεν φαίνονται καλά στο κλασικό διορθικό υπερηχογράφημα, ούτε στην απλή δισδιάστατη μαγνητική, αλλά εκεί κρύβονται οι δύο στους δέκα καρκίνους του προστάτη.
Στη συνέχεια ο γιατρός τοποθετεί πάνω από την εικόνα του προστάτη ένα «πλέγμα», για να τον χωρίσει σε περιοχές και να πάρει στοχευμένα βιοψίες μόνο από τις ύποπτες.

Η καλύτερη απεικόνιση και η στοχευμένη βιοψία επιτρέπουν την ανίχνευση καλά κρυμμένων όγκων, ενώ ταυτόχρονα μειώνεται ο αριθμός των βιοψιών που πρέπει να ληφθούν.

Ανάλογα με το μέγεθος και την επιθετικότητα των όγκων αποφασίζεται εάν ο ασθενής θα κάνει θεραπεία για τον καρκίνο ή θα υποβληθεί σε ενεργό παρακολούθηση, δηλαδή συχνές εξετάσεις για να παρακολουθεί την εξέλιξη του καρκίνου του.

Η πειραματική εξέταση αποκαλείται BiopSee και ουσιαστικά είναι μια στοχευμένη, στερεοτακτική μέθοδος βιοψίας του προστάτη. Οι σχετικές μελέτες με αυτήν πραγματοποιούνται σε πολλά κέντρα της Ευρώπης, όπως στο Νοσοκομείο Nuffield και στο Νοσοκομείο Addenbrooke’s του Κέμπριτζ, καθώς και στο Πανεπιστημιακό Νοσοκομείο Χαϊδελβέργης της Γερμανίας.

ΕΠΙΜΟΝΗ ΑΥΞΗΣΗ ΤΟΥ PSA

Όπως εξηγεί ο Ηρακλής Πούλιας, διευθυντής της Ουρολογικής Κλινικής του Κοργιαλένειου- Μπενάκειου Νοσοκομείου, η μέθοδος δοκιμάζεται προς το παρόν σε ασθενείς με επίμονη σταδιακή αύξηση της τιμής του ειδικού προστατικού αντιγόνου (PSA), στους οποίους δεν μπορεί να αποκλειστεί η ύπαρξη καρκίνου, παρότι έχουν επανειλημμένες αρνητικές κλασικές βιοψίες προστάτη.
Τα πρώτα αποτελέσματα με τη νέα τεχνική δείχνουν ότι «διαθέτει διαγνωστική υπεροχή» έναντι της κλασικής βιοψίας, αλλά «απαιτούνται πολλές ακόμα μελέτες έως ότου επιβεβαιωθεί αυτό» επισημαίνει ο κ. Πούλιας.

Μελέτη του Νοσοκομείου της Χαϊδελβέργης που θα δημοσιευθεί σε επερχόμενο τεύχος της επιστημονικής επιθεώρησης «Journal of Urology» δείχνει ότι η πειραματική βιοψία ανιχνεύει με μεγαλύτερη ακρίβεια τους καρκινικούς όγκους.
«Το ‘κλειδί’ είναι η ‘ένωση’ της μαγνητικής με τον υπέρηχο, η οποία αυξάνει τη διαγνωστική ακρίβεια όταν λαμβάνεται η βιοψία, διότι αυτή γίνεται στοχευμένα στα σημεία όπου είναι πιθανό να υπάρχει ένας καρκινικός όγκος», εξηγεί στην εφημερίδα «Daily Mail» ο δρ Μπεν Έντι, ουρολόγος στο Νοσοκομείο Ανατολικού Κεντ.
Μάλιστα, η βιοψία δεν γίνεται από το ορθό έντερο όπως στην κλασική μορφή της, αλλά από το περίνεο (είναι η επιφάνεια που εκτείνεται από τα έξω γεννητικά όργανα μέχρι τον πρωκτό), γεγονός που μπορεί να μειώσει τον κίνδυνο μόλυνσης. Και αυτό, διότι με την κλασική, διορθική βιοψία, ο γιατρός πρέπει να τρυπήσει το έντερο για να αποκτήσει πρόσβαση στον προστάτη, με συνέπεια μικρό ποσοστό των ανδρών (κάτω από 3%) να αναπτύσσει σοβαρές λοιμώξεις.

ΓΕΝΙΚΗ ΑΝΑΙΣΘΗΣΙΑ

Με τη νέα βιοψία όμως ο κίνδυνος αυτός μειώνεται κατακόρυφα, κατά τον δρα Κριστόφ Κάστνερ, χειρουργό-ουρολόγο του Addenbrooke, ο οποίος μελετά την πειραματική βιοψία.

«Τον τελευταίο χρόνο έχουμε κάνει 140 τέτοιου είδους βιοψίες και κανένας από τους ασθενείς μας δεν παρουσίασε λοίμωξη», είπε. «Εξάλλου, ενώ κάποιοι ασθενείς αισθάνονται ενοχλήσεις και πόνο έπειτα από την κλασική βιοψία προστάτη, η νέα τεχνική είναι σχεδόν ανώδυνη».

Ωστόσο, η νέα τεχνική εφαρμόζεται υπό γενική αναισθησία, ενώ η κλασική βιοψία γίνεται με τοπική – αυτό είναι ένα από τα μειονεκτήματα της πειραματικής μεθόδου.
«Ελπίζουμε ότι η νέα μέθοδος θα μας βοηθήσει να εντοπίζουμε νωρίτερα καρκίνους που δεν φαίνονται στον κλασικό υπέρηχο ή στη δισδιάστατη μαγνητική, ούτως ώστε να μπορούμε να τους αντιμετωπίσουμε εγκαίρως σε περίπτωση που είναι επιθετικοί» υπογραμμίζει ο δρ Κάστνερ.
«Η τεχνική αυτή είναι πολλά υποσχόμενη» παραδέχεται ο κ. Πούλιας. «Προκειμένου όμως να επικρατήσει ως η καλύτερη, πρέπει να πιστοποιηθεί η διαγνωστική υπεροχή της μέσα από τυχαιοποιημένες μελέτες, σε μεγάλο αριθμό ασθενών και σε βάθος χρόνου».

Σημειώνεται πως παρεμφερείς μέθοδοι δοκιμάζονται και σε άλλα μεγάλα ερευνητικά κέντρα, όπως το Νοσοκομείο του King’s College και το Νοσοκομείο Guy’s του Λονδίνου. Όλες αυτές οι τεχνικές έχουν κοινό χαρακτηριστικό ότι βασίζονται σε προηγμένα υπερηχογραφήματα, πολυπαραμετρική μαγνητική τομογραφία ή συνδυασμό των δύο εξετάσεων για να ανιχνεύουν με μεγαλύτερη ακρίβεια τους προστατικούς καρκίνους.

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