Fokalna terapija raka prostate

master's thesis

• Title (english): Focal therapy of prostate cancer
• Author: Ivan Raguž
• 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; School of Medicine; Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Urology

Abstract

Karcinom prostate je najčešći dijagnosticirani maligni tumor muškaraca u više od polovine svjetskih zemalja, uključujući i Republiku Hrvatsku. Najčešće se otkriva u muškaraca starijih od 70 godina. Najvažniji rizični faktori za nastanak bolesti su dob pacijenta, obiteljska anamneza i stil života. Klinička slika karcinoma prostate je nespecifična i podudara se sa simptomatologijom drugih stanja poput benigne hiperplazije prostate i prostatitisa. Fizikalni pregled je ograničen i nije dovoljno specifičan niti osjetljiv za postavljanje dijagnoze. Krajem prošlog stoljeća u kliničku praksu se uvodi određivanje prostata specifičnog antigena (PSA) koji i danas ima značajnu ulogu u probiru pacijenata sa sumnjom na bolest. Preoperativna lokalizacija karcinoma prostate je od vitalne važnosti u svrhu određivanja terapijskog pristupa. Danas se za tu namjenu koriste radiološke metode i biopsija prostate. Trenutno, multiparametrijska magnetska rezonancija (mpMR) ima najveću osjetljivost i specifičnost od svih radioloških metoda u detekciji karcinoma prostate, dok se aktivno traga za novim ultrazvučnim tehnologijama kako bi se prebrodili nedostaci cijene i pristupačnosti magnetske rezonancije. Biopsija prostate je još uvijek zlatni standard u definitivnom postavljanju dijagnoze maligne bolesti. Krajnji ciljevi terapije karcinoma su osiguranje kontrole ili potpunog izlječenja bolesti, pri čemu se procjenjuje korist terapije naspram rizika progresije bolesti. Ideja fokalne terapije raka prostate proizašla je iz definiranja indeks lezije, budući da radikalne kirurške resekcije u većini slučajeva za sobom ostavljaju velike posljedice. Najvažniji cilj fokalne terapije prostate je smanjenje ukupne stope mortaliteta povezane s karcinomom prostate, a zatim i smanjenja morbiditeta uzrokovanog bilo samom bolešću ili onog povezanog s liječenjem, kao i unaprjeđenje ukupne kvalitete života oboljelih pacijenata. Tipovi fokalne terapije koji se koriste u kliničkoj praksi su : krioterapija, fokusirani ultrazvuk visokog inteziteta (HIFU), fotodinamska terapija (PDT), fokalna laserska ablacija (FLA) i ireverzibilna elektroporacija (IRE). Svaka od navedenih tehnika ima svoje prednosti i mane a poseban naglasak se stavlja na potrebu za provođenjem multicentričnih istraživanja čijim bi se rezultatima stručnjaci koristili u svrhu pisanja smjernica za pravilan odabir pacijenata i terapijskih metoda kako bi onkološki i funkcionalni ishodi bili što bolji.

Abstract (english)

Prostate cancer is the most commonly diagnosed malignant tumor in men in more than half of the world's countries, including the Republic of Croatia. It is most often detected in men older than 70 years. The most important risk factors for the onset of the disease are the patient's age, family history and lifestyle. The clinical picture of prostate cancer is non-specific and coincides with the symptoms of other conditions such as benign prostatic hyperplasia and prostatitis. Physical examination is limited and not specific or sensitive enough to make a diagnosis. At the end of the last century, the determination of prostate specific antigen (PSA) was introduced into clinical practice, which still plays a significant role in the screening of patients with suspected disease. Preoperative localization of prostate cancer is of vital importance in order to determine the therapeutic approach. Today, radiological methods and prostate biopsy are used for this purpose. At the moment, multiparametric magnetic resonance (mpMR) has the highest sensitivity and specificity of all radiological methods in the detection of prostate cancer, while new ultrasound technologies are actively sought to overcome it's disadvantages of cost and accessibility. Prostate biopsies still remain the gold standard for definitive diagnosis of prostate cancer. The ultimate goals of cancer therapy are to ensure control or complete cure of the disease, weighing the benefit of therapy against the risk of disease progression. The idea of focal therapy came from defining the index lesion, since radical surgical resections in most cases leave behind major consequences. The most important goal of focal therapy is to reduce the overall mortality rate associated with prostate cancer, and to reduce the morbidity caused either by the disease itself or that associated with treatment, as well as improving the overall quality of life of affected patients. Types of focal therapy used in clinical practice are: cryotherapy, high intensity focused ultrasound (HIFU), photodynamic therapy (PDT), focal laser ablation (FLA) and irreversible electroporation (IRE). Each of the mentioned techniques has its advantages and disadvantages, while special emphasis is placed on the need to conduct multicenter researches, the results of which would be used by experts for the purpose of writing guidelines for the proper selection of patients and therapeutic methods in order to improve oncological and functional outcomes.

• Keywords: fokalna terapija; karcinom prostate; indeks lezija
• Keywords (english): focal therapy; prostate cancer; index lesion
• Language: croatian
• URN:NBN: urn:nbn:hr:105:627296
• 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: 2024-06-19 17:31:12