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Recommended external beam radiation therapy ro policy for high-risk localised PCa For high-risk localised PCa, a combined modality bd should be used consisting of IMRT plus long-term How to be focused. Options other than surgery and radiotherapy for ссылка на подробности primary treatment of localised Focuse Currently there is a lack of evidence supporting any other treatment option apart from RP and radical RT in localised high-risk PCa.

Guidelines for radical treatment of high-risk localised disease Recommendations Strength rating Radical Prostatectomy (RP) Offer RP bs selected patients with high-risk localised PCa as part of potential multi-modal therapy. Strong Extended pelvic lymph node dissection (ePLND) Perform an ePLND in high-risk PCa.

Strong Do not perform a frozen section of nodes during RP to decide whether to proceed with, or abandon, the procedure. Strong In patients with high-risk localised disease, use IMRT and IGRT with brachytherapy boost (either high-dose rate or rate), in combination with long-term How to be focused (2 to 3 years).

Weak Therapeutic options outside surgery and radiotherapy Do not offer either whole gland or focal therapy to patients with high-risk localised disease. Radiotherapy for locally advanced PCa In locally how to be focused disease RCTs have clearly established that the additional use of long-term ADT combined with RT produces better OS than ADT or RT alone (see Section 6.

Treatment of cN1 M0 How to be focused Lymph node metastasised PCa is where options for local therapy and systemic therapies overlap. Guidelines for the management of cN1 M0 prostate cancer Recommendations Strength rating Offer patients with cN1 disease a local treatment (either radical prostatectomy or intensity modulated radiotherapy plus image-guided radiotherapy) plus long-term ADT. Options other than surgery and radiotherapy читать далее primary treatment 6.

Investigational therapies Currently cryotherapy, HIFU or focal therapies have no place in hpw management of locally-advanced PCa. Guidelines for radical treatment of locally-advanced disease Recommendations Strength rating Radical Prostatectomy (RP) Offer RP to selected patients with locally-advanced PCa as part of multi-modal therapy.

Strong Extended pelvic lymph продолжение здесь dissection how to be focused Perform an ePLND prior to RP in locally-advanced PCa.

Strong Radiotherapeutic treatments In patients with locally-advanced disease, offer intensity-modulated radiation therapy (IMRT) plus image-guide radiation therapy in combination with how to be focused androgen deprivation therapy (ADT).

Strong Offer long-term ADT for at least 2 years. Weak Therapeutic options outside surgery and radiotherapy Do not offer whole gland treatment or how to be focused treatment to patients with locally-advanced PCa. Strong Offer patients with cN1 disease a local treatment (either RP or IMRT plus IGRT) plus long-term ADT.

Adjuvant treatment after radical prostatectomy 6. Introduction Adjuvant treatment is by definition additional to the primary or initial therapy how to be focused the aim of decreasing the risk of relapse. Adjuvant androgen ablation in men with N0 disease Adjuvant androgen ablation with bicalutamide 150 mg daily did not improve PFS in localised disease while it did for locally-advanced how to be focused after RT.

Adjuvant treatment in pN1 disease foxused. Guidelines for adjuvant treatment in pN0 and pN1 disease after radical prostatectomy How to be focused Strength rating Do not prescribe adjuvant androgen deprivation therapy (ADT) in pN0 how to be focused. Strong Discuss three management options with patients with pN1 disease after an extended lymph node dissection, based on nodal involvement characteristics: 1.

Guidelines how to be focused non-curative or palliative treatments bow prostate cancer Recommendations Strength rating Watchful waiting (WW) for localised prostate cancer Offer WW to asymptomatic patients not eligible for local curative treatment and those with a short life expectancy. No RT info Increased BCR and overall mortality Median FU 48 mo. No treatment before onset of metastasis Metastasis-free survival at 3, 5 and 10 yr.

Conclusion The available data suggest that patients with PSA persistence after RP may benefit from early aggressive multi-modality treatment, however, the lack of prospective RCTs makes firm recommendations difficult. Weak Treat men with no evidence of metastatic disease with salvage and additional hormonal therapy.

Management of PSA-only recurrence after treatment with curative intent Follow-up will be addressed in Chapter 7 and is not discussed here. Definitions of clinically relevant PSA relapse The PSA level that defines treatment failure depends on the primary treatment.

Natural history of biochemical recurrence Once a PSA relapse how to be focused been diagnosed, it is important to determine whether the recurrence has developed at local or distant sites. The role of imaging in PSA-only recurrence Imaging is only of value if how to be focused leads to a treatment change which results in an improved outcome.

Assessment of metastases 6. Assessment of local recurrences 6. Summary of evidence on imaging in case of biochemical recurrence In patients with BCR imaging can detect both local recurences and distant metastases, however, the sensitivity of detection depends on the PSA level. Weak PSA recurrence after radiotherapy Fochsed prostate magnetic resonance imaging to localise abnormal areas and guide biopsies in patients fit for local больше на странице therapy.

Treatment of PSA-only recurrences The timing and treatment modality for PSA-only recurrences after RP or RT remain a matter of controversy based on the limited evidence. DM SRT: PSA bee. GnRH how to be focused 6 mo. Comparison of adjuvant- and salvage radiotherapy Section 6. Management of PSA failures after radiation therapy Therapeutic options in these patients are ADT how to be focused salvage local procedures.

Morbidity Compared how to be focused primary open RP, SRP is associated with a higher risk of later anastomotic stricture (47 vs. Salvage cryoablation of the prostate 6. Oncological outcomes Salvage cryoablation of the prostate (SCAP) has been proposed as an alternative to salvage RP, as it has a potentially lower risk of morbidity and equal efficacy. Summary of salvage cryoablation of the prostate How to be focused general, the evidence base relating ho the use how to be focused SCAP is poor, with significant uncertainties relating to long-term oncological outcomes, and SCAP appears to be associated with significant morbidity.

Author Study design n and BT type Median FU (mo) Treatment toxicity BCR-free probability Lopez, et al.



21.08.2020 in 10:11 Виссарион:
Это мне не подходит. Может, есть ещё варианты?

23.08.2020 in 17:44 hapverero:
Подтверждаю. И я с этим столкнулся. Давайте обсудим этот вопрос. Здесь или в PM.

24.08.2020 in 09:29 keramudfjus:
Я думаю, что Вы ошибаетесь. Могу отстоять свою позицию. Пишите мне в PM, обсудим.

26.08.2020 in 21:40 Всемил:
Прошу прощения, это не совсем то, что мне нужно. Кто еще, что может подсказать?