Medicinski vjesnik, Vol. 41 No. (1-2), 2009.
Stručni rad
Directions in diagnosis and therapy of prostate cancer: controversies in uro-oncology
Carlos D. M Winkler
Sažetak
At the present time, it is recommended that the prostate cancer must be detected by digital rectal palpation (DRE) and PSA elevation. TRUS coupled with ultrasonically guided biopsies might become the most appealing staging technique for early diagnosed prostate cancer. To promote earlier diagnosis, better PSA thresholds need to be defined, with a clear free-PSA threshold. This could be complemented by the use of nomograms and, in suspected cases, repeated biopsies, TRUS, bone scans and new imaging techniques. Deferred therapy, by means of an active observation and alertness to start therapy when signs of rapid progression occur, may therefore be an alternative to active therapy in patients with a low risk localized prostate cancer with a life expectance of 10 years or less. Radical prostatectomy was more effective than watchful waiting in terms of cancer-specific survival benefit, when compared in a prospective randomized trial. Neoadjuvant hormonal therapy (NHT) has a non-significant impact on overall, and progression free survival. In Europe the focus is on biochemical recurrence after a curative treatment (nerve sparing radical prostatectomy and/or radiotherapy in low, intermediate and high-risk patients with 72-78 Gy. In metastatic disease adjuvant androgen deprivation ADT Monotherapy is the treatment of choice. These are patients who cannot be cured and some data suggest that intermittent hormone therapy can lead to a better life quality than a continuous one. The substantial reduction in pain and therapy related morbidity often makes chemotherapy with Docetaxel for hormone refractive prostatic cancer a better choice to a simple pain-and-complication treatment. The article presents the summary of the essential features of each condition as well as its management.
Ključne riječi
Prostatic neoplasms - diagnosis, surgery, therapy; Treatment outcome; Neoplasms, hormone-dependent - drug therapy; Androgen antagonist - therapeutic use; Antineoplastic agents, hormonal - therapeutic use; Drug therapy. Radiotherapy
Hrčak ID:
191643
URI
Datum izdavanja:
1.12.2009.
Posjeta: 880 *