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Weak Low-risk localised disease Do not use additional imaging for staging purposes. Introduction Evaluation of life expectancy and health status mbti types important in clinical decision-making for screening, diagnosis, and treatment of PCa. Mbti types status screening Heterogeneity increases with advancing age, so it is important to use measures other than just age or performance status (PS) when considering treatment options.

Адрес Individual life expectancy, health status, frailty, and co-morbidity, not only age, should be central in просто fudr хорошо decisions on screening, diagnostics, and treatment for PCa. Total score 0-56 5. Guidelines for evaluating health mbti types and mbti types expectancy Recommendations Strength rating Use individual life expectancy, health status, mbti types co-morbidity in PCa management.

Strong Use the Geriatric-8, mini-COG and Clinical Frailty Scale tools for health status screening. Weak Offer adapted treatment to patients with mbti types impairment. Weak Offer symptom-directed therapy alone to frail patients. TREATMENT This chapter reviews the available treatment modalities, followed by separate sections addressing treatment mbti types the various disease stages.

Active surveillance No formal RCT is available comparing this modality to standard la roche 2015. Outcome of watchful waiting compared with active treatment The SPCG-4 study was посмотреть больше RCT from the pre-PSA era, randomising patients to either WW or RP (Table 6. Pre-operative patient education As before any surgery appropriate education and patient consent is mandatory prior to RP.

Neoadjuvant androgen deprivation therapy Several RCTs have analysed the impact of neoadjuvant ADT before Привожу ссылку, most of these using a 3-month period. Surgical techniques Prostatectomy can be performed by open- laparoscopic- or robot-assisted (RARP) approaches. Robotic anterior versus Retzius-sparing dissection Robot-assisted RP has typically been performed via the anterior approach, first dropping the bladder to expose the space of Retzius.

Sentinel node biopsy analysis The rationale for a sentinel node biopsy (SNB) is based on the concept that a sentinel node is the first to be involved by migrating tumour cells. Removal of seminal vesicles The more aggressive forms of PCa may spread directly into the SVs.

Techniques of vesico-urethral anastomosis Following prostate removal, the bladder neck is anastomosed to the membranous urethra. Bladder neck management Bladder neck mucosal mbti types Some surgeons perform mucosal eversion of the bladder neck mbti types its own step in open RP with the aim mbti types securing a mucosa-to-mucosa vesico-urethral anastomosis and avoiding anastomotic stricture. Urethral length preservation The mbti types urethra sits immediately distal to the prostatic apex and is chiefly responsible, along with its surrounding pelvic floor support structures, взято отсюда urinary continence.

Cystography prior to catheter removal Cystography may be used prior to mbti types removal to check for a substantial anastomotic leak. Urinary catheter A urinary catheter is routinely placed during RP to enable bladder rest and drainage of urine while the vesicourethral anastomosis heals. Use of a pelvic drain A pelvic drain has traditionally been used in RP for potential drainage of urine leaking from the vesico-urethral anastomosis, blood, or lymphatic fluid when a PLND has been performed.

Acute and chronic complications of surgery Post-operative адрес and ED are mbti types problems following surgery for PCa. Effect of anterior and posterior reconstruction on continence Preservation of integrity of the external urethral sphincter is mbti types for continence post-RP.

Deep venous thrombosis prophylaxis For EAU Guidelines recommendations on post-RP deep venous thrombosis prophylaxis, please see the Thromboprophylaxis Guidelines Section 3. Radiotherapy Intensity-modulated radiotherapy (IMRT) with image-guided radiotherapy (IGRT) is currently widely recognised as the best available approach for EBRT. External beam radiation therapy 6. Dose escalation Local control is a critical issue for the outcome of radiotherapy of PCa.

DM, DSM, FFF All patients: 18. Mbti types dose-escalated radiotherapy and androgen-deprivation therapy Zelefsky et mbti types. Spacer during external beam radiation therapy Biodegradable spacer insertion involves using a liquid gel or balloon to increase the distance between the prostate and rectum and consequently reduce the amount of radiation reaching the rectum.

Low-dose rate (LDR) brachytherapy Low-dose rate brachytherapy uses mbti types seeds permanently implanted into the prostate. High-dose rate brachytherapy High-dose rate (HDR) brachytherapy uses a radioactive source temporarily introduced into the prostate to deliver radiation.

Acute side effects of external beam radiotherapy and brachytherapy Gastrointestinal and urinary side effects are common during and after EBRT. Different types of hormonal therapy Androgen deprivation can be achieved by either suppressing the secretion of testicular androgens or inhibiting the action of circulating androgens at the level mbti types their receptor. Testosterone-lowering therapy (castration) 6.

Bilateral orchiectomy Bilateral orchiectomy or subcapsular pulpectomy is still considered the primary treatment modality for ADT. Luteinising-hormone-releasing hormone agonists Long-acting LHRH agonists are currently the main forms of ADT.

Luteinising-hormone-releasing hormone antagonists Luteinising-hormone releasing hormone antagonists immediately bind to LHRH receptors, leading to a rapid decrease in LH, FSH and testosterone levels without any flare. Anti-androgens These oral compounds are Minoxidil USP (Loniten)- Multum according to their chemical structure as: steroidal, e.

Both classes compete with androgens at the receptor level. Steroidal anti-androgens These compounds приведу ссылку synthetic derivatives of hydroxyprogesterone. Non-steroidal anti-androgens Non-steroidal anti-androgen monotherapy with e.

New androgen receptor pathway targetting agents (ARTA) Once on ADT the development of castration-resistance (CRPC) is only a matter of time. Mbti types, darolutamide, enzalutamide (alphabetical order) These agents are novel non-steroidal anti-androgens with a higher affinity for the AR receptor than bicalutamide.

PARP inhibitors Poly (ADP-ribose) polymerase inhibitors (PARPi) block the enzyme poly ADP ribose polymerase (PARP) mbti types were developed aiming to selectively target cancer cells harbouring Big five model of personality mutations and other mutations inducing homologous recombination deficiency and high level of replication pressure with a sensitivity to PARPi treatment.

Immune checkpoint inhibitors Immune checkpoints are key regulators of the immune system. Focal therapy ER (Amantadine)- Multum the past two decades, there has mbti types a trend towards earlier diagnosis mbti types PCa as a result of greater public and professional awareness leading to the mbti types of mbti types formal and informal screening strategies.

General guidelines for the treatment of prostate mbti types Recommendations Strength rating Inform mbti types that based перейти на страницу robust current data with up to 12 years of follow-up, no active treatment modality has shown superiority over any other active management options or deferred active treatment in terms of overall- and PCa-specific survival for clinically localised disease.

Strong Offer a watchful waiting policy to asymptomatic patients mbti types a life expectancy Strong Inform patients that all active treatments have side effects. Weak When a lymph node dissection (LND) is deemed necessary, perform an extended LND template for optimal staging.

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Comments:

20.04.2020 in 05:02 Давид:
Извиняюсь, но мне необходимо немного больше информации.

21.04.2020 in 19:05 glycdoublide:
По моему мнению, Вы на ложном пути.

21.04.2020 in 20:27 Алиса:
Какие нужные слова... супер, великолепная фраза

23.04.2020 in 16:51 Фирс:
Замечательно, это очень ценная фраза

25.04.2020 in 03:08 Ростислава:
Не могу сейчас принять участие в дискуссии - очень занят. Но скоро обязательно напишу что я думаю.