Acta clinica Croatica
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Acta clinica Croatica · Nov 2019
ReviewPROSTATE CANCER DIAGNOSIS IN 2019 - CHANGES IN EUROPEAN GUIDELINES AND IMPACT ON DAILY PRACTICE.
Changes in the diagnostic pathway for prostate cancer advised in the most recent Guidelines of the European Association of Urology bring many endeavors for everyday practice. Availability, costs and radiological expertise are still representing a challenge for the adoption of these guidelines in everyday clinical practice. In this article we discuss the current situation regarding these issues and future options.
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Prostate cancer is one of the most important men's health issues in developed countries. For patients with prostate cancer a preoperative staging of the disease must be made. Involvement of lymph nodes could be assessed using imaging methods (CT or/and MRI), however, newer methods also exist (PET/CT, PSMA PET/CT). ⋯ In 1-20% of patients, the lymph node invasion is present. Pelvic lymphadenectomy is primarily a diagnostic and staging method, and in minority of patients with positive lymph nodes it can be a curative method, too. In other patients with positive lymph nodes adjuvant therapy (radiotherapy and androgen deprivation therapy) can be beneficial.
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Acta clinica Croatica · Nov 2019
ReviewSURGICAL TREATMENT OF HIGH-RISK PROSTATIC CARCINOMA AND OLIGOMETASTATIC DISEASE.
Prostate cancer is responsible for the largest number of cancer-related deaths in male population in many countries of the world. Aggressive forms of the disease are associated with an increased risk of local recurrence and death. Treatment of high-risk local prostate cancer most commonly involves radical prostatectomy (RP) or external beam radiation therapy (EBRT) combined with androgen deprivation therapy (ADT) with or without the addition of brachytherapy (BT). ⋯ Radical prostatectomy in oligometastatic prostate cancer can significantly decrease the risk of local complications but only multimodal approach in selected group of patients may offer opportunities to eradicate tumor or delay its progression. Surgery for oligometastatic disease most commonly targets lymphatic disease with salvage pelvic lymph node dissection, whereas it rarely targets distant metastases. Further prospective, randomized studies are necessary to define the role and value of therapies in oligometastatic prostate cancer.
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Acta clinica Croatica · Nov 2019
ReviewRADIOTHERAPY OF PROSTATE CANCER: PRIMARY RADIOTHERAPY AND RADIOTHERAPY IN DISEASE RELAPSE.
Radiotherapy presents one of the essential modes of treatment in patients with prostate cancer at almost any stage of the disease. It can be delivered as external beam radiotherapy, as brachytherapy or two methods combined. ⋯ Stereotactic body radiotherapy (SBRT) with doses from 3.4 to 7.25 Gy per fraction presents valuable option in certain subgroups of patients. In case of local regional disease relapse, radiotherapy is used in curative setting.