Operativno liječenje raka prostate

master's thesis

• Title (english): Surgical treatment of prostate cancer
• Author: Marina Juričić
• Mentor: Željko Kaštelan (mentor)
• Committee member: Davor Tomas (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Željko Kaštelan (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Urology); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Urology

Abstract

Karcinom prostate je najčešća maligna bolest i drugi uzročnik smrti muškaraca u razvijenim zemljama. Jedan je od vodećih zdrastvenih problema muškaraca starije životne dobi. U Hrvatskoj je, kao i u Europskoj uniji, drugi po učestalosti sa 16% udjela i drugi uzročnik smrtnosti muške populacije oboljele od malignoma. Nažalost, u Hrvatskoj je samo polovica tumora lokalizirano u trenutku postavljanja dijagnoze (HZJZ, bilten 2013). Pacijenti u najvećem broju slučajeva niti ne znaju da imaju karcinom jer je on uglavnom asimptomatski. Brojni bolesnici umiru s karcinomom, a ne od njega. No, sve se više karcinoma otkriva zahvaljujući dijagnostičkim postupcima: serumski prostata specifičan antigen (PSA), digitorektalni pregled (DRP) i transrektalnim ultrazvukom vođena biopsija prostate (TRUZ). Biopsija je najbolja dijagnostička metoda jer otkriva diferenciranost karcinoma i stupanj proširenosti bolesti. Pacijenta se upućuje na biopsiju prostate nakon suspektnog digitorektalnog nalaza ili povišenih vrijednosti PSA. Liječenje lokaliziranog karcinoma uključuje konzervativne metode i operativno liječenje – radikalnu prostatektomiju. Konzervativne metode su aktivni nadzor pacijenata, hormonska terapija i radioterapija. Iako su ovo dobre metode liječenja, radikalna prostatektomija (RP) je zlatni standard liječenja karcinoma prostate. Ovom operacijom se uklanjaju prostata, sjemeni mjehurići i limfni čvorovi. Iako pruža najbolju kontrolu bolesti, inkontinencija i impotencija su česte komplikacije (Wallis i sur, 2015). Zato se razvila radikalna prostatektomija uz očuvanje neurovaskularnog snopa – operativna tehnika koja uklanja tumor i ne oštećuje neurovaskularni snop. Laparoskopska i robotska radikalna prostatektomija su minimalno invazivni zahvati kojima se smanjuje gubitak krvi, omogućuje bolja vizualizacija operacijskog polja, smanjuje postoperativni ožiljak i bol. Postotak komplikacija je najveći kod laparoskopske RP, a najmanji kod robotske laparoskopske RP (Beryhill i sur. 2008). Laparoskopska tehnika ima dulju krivulju učenja, ali je bolja za pacijente, a funkcionalni i onkološki rezultati su slični onima kod otvorene RP.

Abstract (english)

Prostate cancer is most common malignant disease and second leading cause of death among men in developed countries. It is one of the leading health problems in elderly men. Sadly, in Croatia only half of the tumors are localized by the time they are diagnosed (HZJZ, bilten 2013). Most of patients don't even know that they have the cancer because it is mostly asymptomatic. Majority of men die with the cancer and not of it. More and more cancers are diagnosed because of the diagnostic methods: serum prostate specific antigen (PSA), digital rectal examination (DRE) and prostate biopsy under transrectal ultrasound control (TRUS). The most reliable diagnostic method is the biopsy because it detects the degree of cancer differentiation and the degree of the disease spread. The decision whether to perform biopsy or not is made upon results of PSA test or suspicious DRE. Treatment of localized prostate cancer includes conservative and surgical treatment – radical prostatectomy. Conservative methods are watchful waiting, hormonal therapy and radiotherapy. Despite these effective treatment methods, radical prostatectomy (RP) is gold standard for prostate cancer treatment. This surgery removes the prostate, seminal vesicles and lymph nodes. Even though it provides the best control of the disease, incontinence and impotence are frequent complications (Wallis i sur. 2015). Therefore, radical prostatectomy with preservation of neurovascular bundle was developed – a technique that removes the tumor and preserves the neurovascular bundle. Laparoscopic and robotic radical prostatectomy are minimally invasive operations which reduce the blood loss, provides better visualization of the operative field, reduces postoperative pain and scaring. The percentage of complications is the highest in laparoscopic RP and lowest in robotic RP (Berryhill i sur. 2008). Laparoscopic technique has longer learning curve, but is better for the patients and functional and oncological results are similar to those of open RP.

• Keywords: karcinom prostate; radikalna prostatektomija; radikalna prostatektomija uz očuvanje neurovaskularnog snopa; laparoskopska radikalna prostatektomija; robotska laparoskopska radikalna prostatektomija
• Keywords (english): prostate cancer; radical prostatectomy; radical prostatectomy with preservation of neurovascular bundle; laparoscopic radical prostatectomy; robotic laparoscopic radical prostatectomy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:937822
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-08-09 10:50:53