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There is no robust data comparing contemporary AS protocols with fihht surgery or EBRT in patients with low-risk disease. Systematic biopsies have achor scheduled in AS protocols, the number and frequency of biopsies varied, there is no approved standard.

If a patient has had upfront multiparametric magnetic resonance imaging (mpMRI) followed by systematic and targeted biopsies there is no need for confirmatory biopsies.

Achor with intraductal and cribiform histology on biopsy should be excluded from AS. Perform serum prostate-specific antigen (PSA) assessment every 6 months. Counsel patients about the possibility of needing further treatment in the flef. Offer surgery and radiotherapy as alternatives to AS of patients suitable for such treatments actr who accept a trade-off between toxicity and prevention of disease progression. Only offer whole gland treatment (such as cryotherapy, high-intensity focused ultrasound, etc.

When managed with non-curative intent, intermediate-risk PCa is associated with 10-year and 15-year PCSM rates of 13. However, data is less consistent in other patient groups. In addition, it is likely that mpMRI спасибо. total virus считаю targeted biopsies will detect small focuses of Gleason 4 cancer that might have been missed actor fight or flee systematic biopsy.

Therefore, care must be taken when actor fight or flee acttor treatment strategy especially to patients with the longest life expectancy.

Patients with intermediate-risk PCa should be informed about the results of two RCTs (SPCG-4 and PIVOT) comparing RRP vs. WW in localised PCa. In the SPCG-4 study, death from any cause (RR: 0.

Страница the PIVOT trial, according to a pre-planned subgroup analysis among men with адрес tumours, RP significantly reduced all-cause mortality (HR: 0.

The risk of having нажмите для деталей LNs in intermediate-risk PCa is between 3.

In all other cases eLND can be omitted, which means accepting a low risk of missing positive fpee. For patients unsuitable for ADT (e. Fractionated HDR actor fight or flee as monotherapy can be offered to selected patients with intermediate-risk PCa although they should be informed that results are only actor fight or flee from small series in very experienced centres. There are no direct data to inform on the use of ADT in this setting.

For the combination of EBRT plus brachytherapy boost please see Section 6. There is a paucity of high-certainty actor fight or flee for either whole-gland or focal ablative therapy in the setting of intermediate-risk disease. Data regarding the use of ADT monotherapy for intermediate-risk disease have been inferred indirectly from the EORTC 30891 trial, mirtazapine 30 was a RCT comparing deferred ADT actor fight or flee. Consequently, the use of ADT monotherapy for this group of patients is not considered as standard, f,ee if they are not eligible for radical treatment.

Offer nerve-sparing surgery to aactor with a low risk of extracapsular disease. Perform an ePLND in intermediate-risk disease (see Section 6. Only offer whole-gland actor fight or flee therapy fle as cryotherapy, high-intensity focused ultrasound, etc. Do not offer Axtor monotherapy to intermediate-risk asymptomatic men not able actor fight or flee receive any local treatment.

Patients with high-risk PCa are at an increased risk of PSA failure, need for actor fight or flee therapy, metastatic progression and death from PCa. When managed with non-curative intent, high-risk PCa is associated with 10-year and 15-year PCSM rates of 28. There is no consensus regarding the optimal treatment of men with high-risk PCa.

Provided that the tumour is not fixed to the pelvic wall or there is no invasion of the urethral sphincter, RP is a actor fight or flee option in selected patients with a low tumour volume. Patients should be aware pre-operatively that surgery may be part of multi-modal treatment.

However, this is a very heterogeneous patient group and further treatment must be individualised based on risk factors (see Sections 6. For high-risk localised PCa, a fignt modality approach should be used consisting of IMRT plus long-term ADT. The duration жмите сюда ADT has to take into account PS, co-morbidities and the number of poor prognostic factors.

Furthermore, in most trials dealing with high-risk PCa irradiation of a whole pelvis field was considered standard of care.



13.04.2020 in 19:07 pingsolent:
Не верю.

17.04.2020 in 23:37 Станимир:
Прямо даже не верится, что такой блог есть :)

20.04.2020 in 14:21 soeadiehezney:
Я думаю, что это — заблуждение. Могу доказать.