Title Ciljane biopsije prostate Title (english) Targeted prostate biopsies Author Stjepan Frkanec Mentor Tomislav Kuliš (mentor)Committee member Tvrtko Hudolin (predsjednik povjerenstva)Committee member Tomislav Meštrović (član povjerenstva)Committee member Tomislav Kuliš (član povjerenstva)Granter University of Zagreb Defense date and country 2022-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Karcinom prostate najčešći je karcinom starijih muškaraca u razvijenim zemljama i Republici Hrvatskoj danas. Čimbenici rizika nisu jasno definirani, ali najznačajniji su dob, rasa i nasljedni čimbenici. Klinička slika karcinoma prostate je nespecifična ili oskudna s malim brojem kliničkih simptoma i znakova. Zlatni standard dijagnostike karcinoma prostate je biopsija prostate. Tradicionalne shematske biopsije (SB) prostate koje se najčešće izvode pod kontrolom transrektalnog ultrazvuka (TRUS) dugo godina su bile opće prihvaćene kao najbolja tehnika biopsija. Razvitkom tehnologije i njezinim implementiranjem u medicinu, ciljane biopsije navođene multiparametrijskom magnetskom rezonancom (mpMR-CB) postale su nova metoda izbora. Prednosti koje pružaju su veća stopa detekcije klinički značajnih karcinoma prostate i smanjena stopa detekcije indolentnih karcinoma čime se smanjuje nepotrebno liječenje. Rezultati Centra za prostatu, Klinike za urologiju, KBC-a Zagreb u periodu 2018.-2021. su za SB 38.6% pozitivnih, N=1494, a za mpMR-CB 55.7% pozitivnih, N=534. Nadalje, maksimalna stopa detekcije karcinoma vjerojatno se postiže kombinacijom mpMR-CB i SB što je metoda izbora u pacijenata s prijašnjom negativnom biopsijom, a visoko suspektnim karcinomom. Također, preporučuje se transperinealni pristup (TP) jer smanjuje mogućnost infekcije i posljedično sepse. Trenutno u literaturi nema jasnih podataka koja metoda mpMR-CB (kognitivna, fuzijska, „in bore“) je najbolja. CB navođene mikroultrazvukom pokazuju obećavajuće rezultate, no potrebna su daljnja istraživanja. mpMR-CB je optimalan pristup biopsijama prostate i prema aktualnim smjernicama EAU metoda izbora, no mnoga pitanja još nisu odgovorena poput toga koja je najbolja tehnika CB, koliko cilindara bioptirati, treba li bioptirati ako je mpMR nalaz negativan i druga. Daljnje inovacije u medicini, razvitak tehnologije i nova istraživanja dat će kvalitetnije odgovore i možda promijeniti trenutna mišljenja te poboljšati pristup biopsijama prostate.
Abstract (english) Prostate cancer is the most common cancer of older men in developed countries and in the Republic of Croatia today. Risk factors are not clearly defined, but the most important are age, race and hereditary factors. The symptoms of prostate cancer are nonspecific or sparse. The gold standard for diagnosing prostate cancer is a prostate biopsy. For many years traditional systematic biopsies (SB), which are most commonly guided by transrectal ultrasound (TRUS), have been widely accepted as the best biopsy technique. With the development of technology and its implementation in medicine, targeted biopsies guided by multiparametric magnetic resonance imaging (MRI-TB) have become a new method of choice. The advantages they provide are a higher detection rate of clinically significant prostate cancer and a reduced detection rate of indolent cancers thus reducing overdiagnosis and overtreatment. Results of the Department of urology, University Hospital Center Zagreb in the period 2018-2021 are: SB 38.6% positive, N=1494, and for MRI-TB 55.7% positive, N=534. Furthermore, the maximum detection rate is likely to be achieved by a combination of MRI-TB and SB. In patients with previous negative biopsy but cancer suspected, TB are the method of choice. Also, a transperineal approach (TP) is recommended because it reduces the possibility of infection and consequently sepsis. Currently, there is no clear data in the literature as to which MRI-TB method (cognitive, fusion, "in bore") provides best detection rates. Micro-ultrasound guided TB show promising results, but further research is needed. According to current EAU guidelines, MRI-TBs are the optimal technique. Many questions have not yet been answered such as what is the best TB method, how many cores should be used, whether to biopsy if MRI is negative and others. Further innovations in technology and new researches will provide better answers, and perhaps change current opinions and approaches to prostate biopsies.
Keywords
biopsija prostate
ciljane biopsije prostate
karcinom prostate
Keywords (english)
prostate biopsies
prostate cancer
targeted prostate biopsies
Language croatian URN:NBN urn:nbn:hr:105:407742 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-01-09 08:17:40
