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The selected commercially available tests significantly improved the prognostic accuracy of clinical multivariable models for identifying men who would benefit of AS and those with csPCa requiring curative treatment, as well as for guidance of patient management after RP.

In addition, a few studies showed that tissue biomarker tests and MRI findings independently improved the detection of clinically significant cancer in an AS setting, but it remains unclear which men would benefit of both tests. Since the long-term impact of the use of these commercially available tests on oncological outcome remains unproven and prospective trials are largely lacking, the Panel concluded chemistry pharmaceutical journal these tests should not be offered routinely but only in subsets of patients where the test result provides clinically actionable information, such as for instance in men with favourable intermediate-risk PCa who might opt for AS or страница with unfavourable intermediate-risk PCa scheduled for RT to decide on treatment intensification with hormonal therapy (HT).

Histopathological examination of RP specimens describes the pathological stage, histopathological type, grade chemistry pharmaceutical journal surgical margins of PCa.

It is recommended that RP specimens are totally embedded to enable assessment of cancer location, multifocality and heterogeneity. The most widely accepted method includes complete embedding of the posterior prostate and a single mid-anterior left and right section. The entire RP specimen should be inked upon receipt in the laboratory to demonstrate the surgical margins. Specimens are fixed by immersion in buffered formalin for at least 24 hours, preferably before slicing.

The resultant tissue slices can be embedded and processed as whole-mounts or after quadrant sectioning. Whole-mounts provide better topographic visualisation, faster histopathological examination and better correlation with pre-operative, although they are more time-consuming and require specialist handling.

For routine sectioning, the advantages of whole mounts do not outweigh their disadvantages. Ensure total embedding, by conventional приведу ссылку or whole-mount sectioning. Ink the entire surface before cutting, to evaluate the surgical margin.

Examine the apex and base separately, using the cone method with sagittal or chemistry pharmaceutical journal sectioning. The pathology report provides essential information on the prognostic characteristics relevant for clinical decision-making (Table 5. As a result of the complex information to be provided for each RP specimen, the use of synoptic(-like) or checklist reporting is recommended (Table 5. Grading according to ISUP перейти (or not applicable if therapy-related changes).

Chemistry pharmaceutical journal (sub)staging источник статьи surgical margin status: location and extent of EPE, presence of bladder chemistry pharmaceutical journal invasion, laterality of EPE or SV invasion, location and extent of positive surgical margins.

The ISUP grade is based on the sum of the most and second-most dominant chemistry pharmaceutical journal terms of volume) Gleason grade. ISUP grade 1 is Нажмите для деталей 6. ISUP grade 4 is largely composed of Gleason grade 4 and ISUP grade 5 of a combination of Gleason grade 4 and 5 chemistry pharmaceutical journal only Gleason grade 5.

A global ISUP grade is given for multiple tumours, but a separate tumour focus with a higher ISUP grade should also be mentioned. Extraprostatic extension is defined as carcinoma mixed with peri-prostatic adipose tissue, or tissue that extends beyond the prostate gland boundaries (e. Microscopic bladder neck invasion is considered EPE. There are no internationally accepted definitions of focal or chemistry pharmaceutical journal, vs. At the apex of the prostate, tumour mixed with skeletal muscle does not constitute EPE.

In the bladder neck, chemistry pharmaceutical journal invasion of smooth muscle fibres is not equated to bladder wall invasion, i. Nevertheless, a cut-off of 0. Improvement in prostatic radio-imaging allows more accurate pre-operative measurement of cancer ссылка. Surgical margin на этой странице an independent risk factor for BCR.

Margin status is positive if tumour cells are in contact with the ink on the specimen surface. The cT category used in the risk table only refers to the Chemistry pharmaceutical journal finding.

T2-weighted imaging remains the most useful method for local staging on MRI. Pooled data from a meta-analysis showed a sensitivity and specificity of 0. Magnetic resonance imaging cannot detect microscopic EPE. Its sensitivity increases with the radius of chemistry pharmaceutical journal within peri-prostatic fat. However, all these studies were based on cohorts chemistry pharmaceutical journal men diagnosed with systematic biopsy and their generalisability in the targeted biopsy setting is questionable.

However, MRI can still be useful for treatment planning. Abdominal CT and T1-T2-weighted MRI indirectly assess nodal invasion by using LN diameter and morphology. However, the size of non-metastatic LNs varies widely and may overlap the size of LN metastases. Decreasing these thresholds improves sensitivity but decreases specificity.

Among 4,264 patients, 654 (15. In a multi-centre database of 1,091 patients who underwent pelvic LN dissection, CT sensitivity and specificity were 8. Although these nomograms are associated with good performance, they have been developed using systematic biopsy findings and may therefore not be sensitive chemistry pharmaceutical journal patients diagnosed with MRI-TBx and systematic biopsy.

One model tested on an external cohort of 187 patients treated by RP chemistry pharmaceutical journal по этому адресу LN dissection showed a prevalence of LN invasion of 13. The C-index was 0. The AUC was 0. Chemistry pharmaceutical journal present there are no conclusive data about comparison of such tracers, with additional new radiotracers being developed. In 103 chemistry pharmaceutical journal patients at increased risk for metastatic LNs prior to surgery, 97 extended chemistry pharmaceutical journal lymph-node dissections (ePLND) were performed, resulting in the ampi of 85 LN metastases in 41 patients (42.

Positron-emission tomography was positive in 17 patients, resulting in a per-patient-based sensitivity and specificity перейти 41. A treatment change occurred in 12. The посмотреть больше uptake is also influenced by the ISUP grade and the Chemistry pharmaceutical journal The pooled sensitivity and specificity of 68Ga-PSMA PET were 0.

The mean bone scan positivity rate in 23 different series was 2.



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