外科治疗在高危前列腺癌治疗中的作用.pptx

外科治疗在高危前列腺癌治疗中的作用;为什么讨论高危前列腺癌的治疗;高危前列腺癌的发病率;高危前列腺癌的定义;高危前列腺癌的分层;高危前列腺癌的分层;高危前列腺癌的治疗;高危前列腺癌的治疗;高危前列腺癌的治疗;高危前列腺癌的外科治疗;Another interesting element supporting the use of RP as a primary therapy in the HR PCa setting is the following: in a population of selected patients, who did not receive androgen deprivation after RP, CSS rate was 85% at 10 years and 76% at 15 years (Carver et al., 2006); The same study also revealed an approximately 25% down- staging rate, i.e. cT3 to pT2. This percentage can be as high as 35–45% in more recent series (Briganti et al., 2012; Abdollah et al., 2014). Downgrading is also a possibility after surgery for HR PCa: 31% of patients with a biopsy GS of 8 or more have been found to have a pathologic Gleason score of 7 or less at RP (Manoharan et al., 2003; Boorjian et al., 2009). ;Thus, not only does the RP provide an accurate assessment of the pathology and prognosis, but it can also spare morbidity associated with ADT since RT essentially requires it in all the cases. Long-term ADT is not without adverse effects: depression loss of libido debilitating hot flashes diabetes metabolic syndrome cardiovascular disease with increased risk of morbidity and mortality osteoporosis and bone fracture ;One of the main concerns brought by opponents of RP in HR PCa is the purported lack of benefit if the prostate cancer is not completely excised, i.e. due to a high risk of micrometastases. This argument does not consider the importance of local pelvic control even in presence of micrometastatic disease; RP for HR PCa can provide excellent local control, as shown by a 2008 work by Inman et al. (2008), where the local recurrence rate is around 10%. ;Some other aspects need to be considered when dealing with local control. RP, in fact, can allow avoidance of the debilitating complications of locally advanced tumor growth, including gross hematuria, voiding symptoms related to bladder outlet obstruction, pelvic pain, ureteral obstruction ;外科治疗 vs