Szwedzkie standardy i zalecenia dot. raka prostaty różnią się w niektórych aspektach od standardów i zaleceń EAU.
Poniżej część 1. i 2. Guidelines 2022.
This is part 1 of a summary of the Swedish prostate cancer guidelines that were published in June 2022.
It covers the early detection, diagnostics, staging, patient support and management of the non-metastatic disease.
The 2022 Swedish guidelines include several new recommendations:
=> rectal iodine-povidone to reduce post-biopsy infections,
=> external beam radiation with focal boost to the tumour,
=> use of a pre-rectal spacer to reduce rectal side effects after external beam radiotherapy in some expert centres,
=> 6 months’ concomitant and adjuvant rather than neoadjuvant and concomitant hormonal treatment together with radiotherapy for unfavourable intermediate and high-risk disease,
=> adjuvant abiraterone plus prednisolone together with a GnRH agonist for a subgroup of men with very high-risk disease.
The Swedish guidelines differ from the European by
=> having more restrictive recommendations regarding genetic testing and pelvic lymph node dissection,
=> the risk group classification,
=> recommending ultra-hypofractionated (7 fractions) external radiotherapy for intermediate and selected high-risk cancers,
=> not recommending any hormonal treatment together with radiotherapy for favourable intermediate-risk disease,
=> recommending bicalutamide monotherapy instead of a GnRH agonist for some patient groups.
This is part 2 of a summary of the Swedish prostate cancer guidelines that were published in June 2022.
This part covers recurrence after local treatment and management of metastatic and castration resistant disease.
The 2022 Swedish guidelines include several new recommendations.
Among these is a recommendation of
=> a period of observation with repeated PSA tests for patients with approximately 10 years’ life expectancy who experience a BCR more than 2–5 years after radical prostatectomy, to allow for estimating the PSA doubling time before deciding whether to give salvage radiotherapy or not.
Recent results from the PEACE-1 trial led to the
=> recommendation of triple-treatment with a GnRH agonist, abiraterone plus prednisolone and 6 cycles of docetaxel for patients with high-volume metastatic disease who are fit for chemotherapy.
The Swedish guidelines differ from the European ones by having more restrictive recommendations about
=> genetic testing
=> high-dose zoledronic acid or denosumab treatment for men with metastatic prostate cancer,
and by
=> recommending considering bicalutamide monotherapy for selected patients with low-volume metastatic disease.