Prostate Cancer (PCa) Guidelines EAU 2017

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Prostate Cancer (PCa) Guidelines EAU 2017

Nieprzeczytany postautor: zosia bluszcz » 10 maja 2017, 06:32

Prostate Cancer (PCa) Guidelines EAU 2017
https://uroweb.org/guideline/prostate-cancer/



3.2.3 Summary of evidence and guidelines for epidemiology and aetiology


Summary of evidence

=> Prostate cancer is a major health issue in men, the incidence mainly dependent on age.
=> Genetic factors are associated with risk of (aggressive) PCa but ongoing trials will need to define the clinical applicability of screening for genetic susceptibility of PCa.
=> A variety of exogenous/environmental factors may have an impact on the risk of progression.
=> 5-ARIs are not EMA-approved for PCa prevention.
=> Selenium or vitamin-E supplements have no beneficial effect in preventing PCa.
=> In hypogonadal men, testosterone supplementation does not increase the risk of PCa.


Recommendation


=> No definitive recommendation can be provided for specific preventive or dietary measures to reduce the risk of developing prostate cancer.

Table 4.2.2:
EAU risk groups for biochemical recurrence of localised and locally advanced prostate cancer

Definition
Low-risk (Localised)
PSA < 10 ng/mL
and GS < 7 (ISUP Grade 1)
and cT1-2a

Intermediate-risk (Localised)
PSA 10-20 ng/mL
or GS 7 (ISUP Grade 2/3)
or cT2b

High-risk (Localised)

PSA > 20 ng/mL
or GS > 7 (ISUP Grade 4/5)
or cT2c


High-risk (Advanced)

any PSA
any GS cT3-4
or cN+
Any ISUP Grade
____________

GS=Gleason score; ISUP=International Society for Urologcal Pathology; PSA=prostate-specific antigen.



6.1.5 Guidelines for active surveillance and watchful waiting


Recommendations - active surveillance

=> Perform multiparametric magnetic resonance imaging before a confirmatory biopsy.
LE 2b
GR B
=> During confirmatory biopsy include systematic and targeted biopsies.
LE 2a
GR B

6.2.7.5 Guidelines for eLND in prostate cancer and pN+ patients

Recommendation

=> Do not perform a frozen section of nodes during radical prostatectomy to decide whether to proceed with, or abandon, the procedure.
LE 2a
GR A


6.2.10 Guidelines for radical prostatectomy


Recommendations

=> Offer both radical prostatectomy and radiotherapy in patients with low- and intermediate-risk disease and a life expectancy > 10 years.
LE 1b
GRA
=> Offer active surveillance as an alternative to surgery in patients with low-risk disease and a life expectancy of > 10 years.
LE 1b
GR A


6.3.8 Summary of evidence and guidelines for definitive radiotherapy


Summary of evidence

=> The optimum duration of androgen deprivation therapy (ADT) with external beam radiation therapy (EBRT) is well established in the literature. There is no evidence that these durations should change when using brachytherapy boost with EBRT.
LE 1b
=> Limited data, from experienced centres only, are available for the use of fractionated high-dose-rate brachytherapy as monotherapy in patients with low and intermediate-risk PCa.
LE 2a

Recommendations

=> Moderate hypofractionation (HFX) with IMRT including image-guided radiation therapy (IGRT) to the prostate only can be offered to carefully selected patients with localised disease (as discussed in the text).
LE 1a
GR A
=> Moderate HFX should adhere to radiotherapy-protocols from trials with equivalent outcome and toxicity, i.e. 60 Gy/20 fractions in four weeks or 70 Gy/28 fractions in six weeks.
LE 1a
GR A


6.9.4.6 Guidelines for imaging in patients with biochemical recurrence


Prostate-specific antigen (PSA) recurrence after radical prostatectomy

=> PSA > 1 ng/mL: positon emission tomography (PET)/computed tomography (CT) imaging is recommended using choline or prostate-specific membrane antigen (PMSA).
LE 2b
GR A


8.3.1.1Guidelines for long term quality of life in men with localised disease


Recommendations

=> Advise eligible patients for active surveillance, that global quality of life is equivalent for up to five years compared to radical prostatectomy or radiotherapy.
LE 1b
GR A
=> Discuss the negative impact of surgery on urinary and sexual function, as well as the negative impact of radiotherapy on bowel function with patients.
LE 1b
GR A
=> Advise patients treated with brachytherapy of the negative impact on irritative urinary symptomatology at one year but not after five years.
LE 1b
GR C


8.3.2.1 Guidelines on improving quality of life in men who have been diagnosed with prostate cancer


Recommendations

=> Offer men on androgen deprivation therapy, twelve weeks of supervised (by trained exercise specialists) combined aerobic and resistance exercise.
LE 1a
GR A
=> Offer men with T1-T3 disease specialist nurse led, multi-disciplinary rehabilitation based on the patients’ personal goals addressing incontinence, sexuality, depression and fear of recurrence, social support and positive lifestyle changes after any radical treatment.
LE 1b
GR A
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